Heart Failure Deadly At Earlier Age in Poorer Countries

MedicalResearch.com Interview with:

Hisham Dokainish, M.D., FRCPC, FASE, FACC Associate Professor of Medicine, McMaster University Principal Investigator, Population Health Research Insitute Director of Heart Failure Services, Director of Medical Diagnostic Units & Echocardiography, Hamilton Health Sciences Hamilton, ON, Canada

Dr. Dokainish

Hisham Dokainish, M.D., FRCPC, FASE, FACC
Associate Professor of Medicine, McMaster University
Principal Investigator, Population Health Research Insitute
Director of Heart Failure Services,
Director of Medical Diagnostic Units & Echocardiography, Hamilton Health Sciences
Hamilton, ON, Canada

MedicalResearch.com: What is the background for this study?

Response: Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions of the world, particularly from low and middle income countries.

MedicalResearch.com: What are the main findings?

Response: We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). These large regional differences in mortality persisted after multivariable adjustment for demographic, clinical, medication and socioeconomic variables. About half of the mortality risk was explained by multivariable modeling with these variables; however, the remainder was unexplained.

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Most Newly Arrived Refugees Have Overseas Vaccination Documentation

MedicalResearch.com Interview with:
Deborah Lee, MPH

Division of Global Migration and Quarantine
Centers for Disease Control and Prevention, Atlanta, GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to assess whether documentation for vaccines provided to refugees overseas was received by clinicians in the US and if doses of measles-mumps-rubella (MMR) vaccine were integrated into the vaccine schedule as recommended for adults and children by the US Advisory Committee on Immunization Practices.

CDC recommends that US-bound refugees receive vaccinations prior to arrival in the United States. Vaccinations are documented on the Vaccination Documentation Worksheet (DS-3025), which refugees bring with them to the United States, and made available to state and local refugee health programs through CDC’s Electronic Disease Notification (EDN) system. Thirty to 90 days after arrival, most refugees have a post-arrival health assessment performed by clinicians affiliated with the state and local refugee health programs.

Our assessment indicated that most refugees had overseas vaccination documentation available at the post-arrival health assessments (87%), and that MMR vaccine was given when needed (83%). Furthermore, many refugees (90%) in our assessment did not require an additional MMR dose because they had received vaccination before entering the United States.

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Pediatric Death Fall Worldwide, But Still Disproportionately Affect Poorer Countries

MedicalResearch.com Interview with:
Dr. Nicholas Kassebaum, MD Assistant Professor

Institute for Health Metrics and Evaluation
University of Washington

MedicalResearch.com: What is the background for this study?

Response: Reducing deaths of young children has been an international priority over the past few decades, and much progress has been made in this regard. Comprehensive and timely measurement of death and disease burden among children and adolescents is essential for improving the health of young people. Analyzing the latest estimates from the Global Burden of Disease (GBD), the current study quantifies and describes levels and trends of mortality and disease burden among children and adolescents under the age of 19 from 1990 to 2015.

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Promising New Drug Can Stop Malaria After Mosquito Bite

MedicalResearch.com Interview with:

Dr Mihály Sulyok MD Eberhard Karls University Institute of Tropical Medicine, Tübingen, Germany

Dr Mihály Sulyok

Dr Mihály Sulyok MD
Eberhard Karls University
Institute of Tropical Medicine,
Tübingen, Germany

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: New antimalarials are desperately needed, not just for treatment, but also for prophylaxis. DSM265, a novel antimalarial compound that selectively inhibits the plasmodial dihydroorotate dehydrogenase has a promising pharmacokinetic profile characterized by a long elimination half-life.

We performed a study at the Institute of Tropical Medicine, Eberhard Karls University (Tübingen, Germany) to investigate safety, tolerability and efficacy of DSM265 using controlled human malaria infection. In the first cohort, 400mg of DSM265 was administered orally to five healthy, malaria naive individuals one day before direct venous inoculation of an established infective dose of P. falciparum sporozoites (PfSPZ Challenge). Placebo was administered to two volunteers. The study was randomized and double blinded. In this cohort all placebo participants developed malaria, whereas all DSM265 participants were protected.

In a second cohort, 400mg DSM265 was administered 7 days before the sporozoite inoculation for six participants, two participants recieved placebo. In this cohort, the two placebo and three of six DSM265 volunteers developed thick blood smear positive malaria. The remaining three DSM265 volunteers developed transient submicroscopic parasitemia without symptoms or thick blood smear positivity. The only possible DSM265-related adverse event was a slight transient elevation in serum bilirubin in one volunteer.

The study was funded by the Global Health Innovative Technology Fund, Wellcome Trust, Bill & Melinda Gates Foundation through Medicines for Malaria Venture, and the German Center for Infection Research.

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No Increased Health Consequences After Chinese Famine Except Schizophrenia

MedicalResearch.com Interview with:

L. H. Lumey, MD, PhD Professor of Epidemiology Mailman School of Public Health Columbia University

Dr. Lumey

L. H. Lumey, MD, PhD
Professor of Epidemiology
Mailman School of Public Health
Columbia University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Chinese Great Leap Forward Famine in 1959-1961 is the largest famine in human history. Earlier studies have reported that overweight, type 2 diabetes, hyperglycemia, the metabolic syndrome and schizophrenia were more common among adults who were exposed to the famine. Our re-analysis of all previous studies shows no increases in diabetes, high blood pressure and other chronic conditions among famine births except for schizophrenia.

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Skin Diseases A Major Cause of Disability Worldwide

MedicalResearch.com Interview with:

Chante Karimkhani, MD University Hospitals Case Western Medical Center, Cleveland, Ohio now with Department of Dermatology University of Colorado, Denver

Dr. Karimkhani

Chante Karimkhani, MD
University Hospitals Case Western Medical Center, Cleveland, Ohio
now with Department of Dermatology
University of Colorado, Denver

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Ranging from benign inflammatory to infectious, autoimmune, and malignant conditions, skin diseases cause significant disfigurement, pain, and psychological morbidity. The Global Burden of Disease (GBD) Study 2013 is a large-scale epidemiological assessment of burden from 306 diseases in 195 countries, both sexes, and 14 age groups. Disease burden is measured by combining morbidity and mortality into a single metric of disability-adjusted life years (DALYs), where one DALY is equivalent to one year of healthy life lost. Skin diseases contributed 1.79% of the total global burden from all diseases.

The skin diseases arranged in order of decreasing global DALYs are: dermatitis (atopic, contact, seborrheic), acne vulgaris, urticaria, psoriasis, viral skin diseases, fungal skin diseases, fungal skin diseases, scabies, melanoma, pyoderma, cellulitis, keratinocyte carcinoma (basal and squamous cell carcinomas), decubitus ulcer, and alopecia areata. Younger populations had the greatest burden from infectious skin conditions, while acne caused the greatest burden in the second and third decades of life. Elderly populations had the greatest DALY rates from melanoma and keratinocyte carcinoma. Skin conditions also exhibit distinct geographical patterns of disease burden.

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Western US Smog Increasingly Due To Asian Emissions

MedicalResearch.com Interview with:

Dr. Meiyun Lin PhD Research Scholar NOAA and Princeton University’s Cooperative Institute for Climate Science

Dr. Meiyun Lin

Dr. Meiyun Lin PhD
Research  Scholar
NOAA and Princeton University’s Cooperative Institute for Climate Science

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Ground-level ozone, also known as smog, has climbed in the rural West over the past 25 years, even in such seemingly pristine places as Yellowstone National Park. We have found out why – and why cutting our own output of smog-forming chemicals such as nitrogen oxides by 50% hasn’t helped. This study found that increased pollution from Asia, which has tripled its nitrogen oxide emissions since 1990, contribute to the persistence of smog in the West.

While ozone in the eastern U.S. has decreased overall, the levels can spike during heat waves, characterized by large-scale air stagnation, warm temperatures, and plentiful radiation needed for ozone formation locally. As heat waves appears to be on the rise due to global climate change, progress in reducing smog in the eastern US is likely to be slower in the coming decades.

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Educating Religious Leaders Improves Uptake of Male Circumcision in Tanzania

MedicalResearch.com Interview with:

Jennifer A. Downs, M.D., Ph.D. Assistant Professor of Medicine and Microbiology & Immunology Department of Medicine Weill Cornell Medicine Center for Global Health New York, NY 10065

Dr. Jennifer Downs

Jennifer A. Downs, M.D., Ph.D.
Assistant Professor of Medicine and Microbiology & Immunology
Department of Medicine
Weill Cornell Medicine
Center for Global Health
New York, NY 10065

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Between 2002 and 2006, three large randomized controlled trials in sub-Saharan Africa demonstrated that male circumcision reduces new HIV infections in men by approximately 60%. Based on these findings, the World Health Organization recommended male circumcision as an HIV prevention strategy in countries with high levels of HIV and a low prevalence of male circumcision. This led to prioritization of 14 countries in Eastern and Southern Africa for massive scale-up of male circumcision beginning in 2011.

In many of these countries, the uptake of male circumcision was lower than expected. In northwest Tanzania, where we work, there are a number of barriers to male circumcision. Some of these barriers are cultural, tribal, economic, and religious. We conducted focus group interviews in 2012 that showed that many Christian church leaders and church attenders in our region in Tanzania had major concerns about whether male circumcision was compatible with their religious beliefs. This led us to hypothesize that the uptake of male circumcision could be increased when religious leaders were taught about male circumcision, with the goal that they would then be equipped to discuss this issue with their congregations.
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Air Pollution Linked To Millions of Preterm Births

MedicalResearch.com Interview with:

Chris Malley PhD The Stockholm Environment Institute University of York

Dr. Chris Malley

Chris Malley PhD
The Stockholm Environment Institute
University of York

MedicalResearch.com: What is the background for this study?

Response: When a baby is born preterm (at less than 37 weeks of gestation, an indicator of premature birth), there is an increased risk of infant death, or long-term physical and neurological disabilities. For example, 965,000 infant deaths in 2013 (35% of all neonatal deaths) have been estimated to be due to preterm birth complications. In 2010, an estimated 14.9 million births were preterm – about 4–5% of the total in some European countries, but up to 15–18% in some African and South Asian countries. The human and economic costs are enormous.

There are many risk factors for preterm birth – from the mother’s age, to illness, to poverty and other social factors. Recent research has suggested that exposure to air pollution could also be a risk factor. Our study quantifies for the first time the global impact of pregnant women’s exposure to outdoor fine particulate matter (PM2.5) by combining data about air pollution in different countries with knowledge about how exposure to different levels of air pollution is associated with preterm birth rates.

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Physical Activity Not Enough To Ward Off Weight Gain

MedicalResearch.com Interview with:

Lara Dugas, PhD, MPH, FTOS Public Health Sciences Loyola University Chica

Dr. Lara Dugas

Lara Dugas, PhD, MPH, FTOS
Public Health Sciences
Loyola University Chicago

MedicalResearch.com: What is the background for this study?

Response: Our NIH-funded study is led by Dr. Amy Luke, Public Health Sciences, Loyola University Chicago, and is titled “Modeling the Epidemiologic Transition study” or METS. It was initiated in 2010, and 2,500 young African-origin adults were recruited from 5 countries, spanning the Human Development Index (HDI), a WHO index used to rank countries according to 4 tiers of development. The 5 countries include the US, Seychelles, Jamaica, South Africa, and Ghana. Within each country 500 young adults, 25-45 yrs., and 50% male, were recruited and followed prospectively for 3 years. Each year, contactable participants completed a health screening, body composition, wore an activity monitor for 7 days, and told researchers everything they had eaten in the preceding 24hrs. Our main research questions we were trying to answer were to understand the impact of diet and physical activity on the development of obesity, and cardiovascular disease in young adults. It was important to have countries spanning the HDI, with differences in both country-level dietary intake and physical activity levels.

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Effects of Delayed Vs Early Umbilical Cord Clamping on Infant Anemia

Ola Andersson, MD, PhD Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden

MedicalResearch.com Interview with:
Dr. Ola Andersson MD, PhD
Uppsala University,
Uppsala, Sweden

MedicalResearch.com: What is the background for this study?

Response: Anemia affects over 40% of all children under 5 years of age in the world. Anemia can impinge mental and physical performance, and is associated with long-term deterioration in growth and development. Iron deficiency is the reason for anemia in approximately 50% of the children.is. When clamping of the umbilical cord is delayed, ie after 3 minutes, iron deficiency up to 6 months of age can be prevented, but it has not been shown to prevent iron deficiency or anemia in older infants.

At birth, approximately 1/3 of the child’s blood is in the placenta. If clamping of the umbilical cord is done immediately (early cord clamping), the blood will remain in the placenta and go to waste (or can be stored in stem cell banks). If instead clamping is postponed for 3 minutes, most of the blood can flow back to the child as an extra blood transfusion, consisting of about one deciliter (1/2 cup) of blood, equivalent to about 2 liters (half a US gallon) of an adult. A blood donor leaves 0.4-0.5 liters of blood.

Blood contains red blood cells that contain hemoglobin. Hemoglobin carries oxygen to the tissues of the body. Hemoglobin contains a lot of iron, and the extra deciliter of blood may contain iron that corresponds to 3-4 months of the need for an infant.

The World Health Organization (WHO) recommends umbilical cord clamping at 1 minute or later, American College of Obstetricians and Gynecologists (ACOG) recommends umbilical cord clamping at 30-60 seconds or later.

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Hypertension Is Global Risk For Disability and Premature Death

MedicalResearch.com Interview with:

Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington

Dr. Gregory Roth

Dr. Gregory Roth MD
Assistant Professor of Medicine
Institute for Health Metrics and Evaluation and
Division of Cardiology at the University of Washington

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time.

In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased.

Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).

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