MedicalResearch.com Interview with:Richard Saitz, MD MPH
Professor of Medicine and Epidemiology
Boston University Schools of Medicine and Public Health
Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts
MedicalResearch.com: What are the main findings of the study?Dr. Saitz: Chronic care management in primary care did not improve health outcomes (abstinence from cocaine, opioids or heavy drinking; or any other clinical outcomes, like addiction consequences, emergency or hospital use, health-related quality of life, addiction severity) for people with alcohol or other drug dependence.
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MedicalResearch.com Interview with:Rodolfo Savica, MD, MSc
Department of Neurology, College of Medicine
Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota
MedicalResearch.com: What are the main findings of this study?Dr. Savica:This study is the first in North America to explore the incidence of DLB and PDD in a population based sample. We found that the overall incidence of dementia with Lewy bodies (DLB), considered the second leading cause of neurodegenerative dementia after Alzheimer`s disease, is lower than that of Parkinson`s disease (PD), increases steeply with age, and is markedly higher in men than in women.
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MedicalResearch.com Interview with:Faisal G. Bakaeen, MD FACS
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas
MedicalResearch.com: What are the main findings of the study?Dr. Bakaeen: The relative use of off-pump CABG peaked at 24% in 2003, followed by a slow decline after that to about 19%. In addition, the conversion rate from off- to on-pump decreased with time and has stayed below 3.5% in recent years. Perioperative mortality rates decreased over time for both on- and off-pump CABG and have stayed below 2% since 2006. The mortality associated with converted cases was high regardless of the surgery year.
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MedicalResearch.com Interview with:Mine Tezal, DDS, PhD
Oral Biology
University at Buffalo
NYS Center of Excellence in Bioinformatics and Life Sciences
MedicalResearch.com: What are the main findings of the study? Dr. Tezal: We observed an inverse association between dental caries and head and neck cancer (HNSCC), which persisted among never smokers and never drinkers. Besides untreated caries, two other objective measures of long-standing caries history (endodontic treatments and crowns) were also inversely associated with HNSCC with similar effect sizes, supporting the validity of the association. Missing teeth was associated with increased risk of HNSCC in univariate analyses, but after adjustment for potential confounders, its effect was attenuated and was no longer statistically significant.
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MedicalResearch.com Interview with:
Laura A. Petersen, MD, MPH
MEDVAMC Associate Chief of Staff, Research
Director, VA HSR&D Center of Excellence (152)
Houston TX 77030
Professor of Medicine
Chief, Section of Health Services Research
Baylor College of Medicine
HSR&D Center of Excellence
Michael E. DeBakey Veterans Affairs Medical Center
Houston, Texas 77030
MedicalResearch.com: What are the main findings of the study?Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension. The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups. Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year. The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant. None of the incentives resulted in increased incidence of hypotension compared with controls. While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group. The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000.
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MedicalResearch.com Interview with:Dr. Elsie Taveras
Massachusetts General Hospital for Children
Division of General Pediatrics, Department of Pediatrics
100 Cambridge St, 15th Floor
Boston, MA 02114
MedicalResearch.com: What are the main findings of the study?Dr. Taveras: The main findings of the study were that, overall, the body mass index of children in the intervention group dropped an average of 0.18, while it rose 0.21 in the control group. Children in the intervention group were sleeping about 45 minutes longer than children in the control group. Time spent watching television on weekends dropped about an hour per day in the intervention group, leading to a significant difference from the control group, which increased weekend TV viewing. Both groups had a small reduction in weekday TV viewing, with a greater decrease in the intervention group, as well.
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MedicalResearch.com Interview with: Thanh N. Huynh, MD, MSHS
Clinical Instructor
UCLA Division of Pulmonary Critical Care
MedicalResearch.com: What are the main findings of the study?Dr. Huynh: Our study shows that it is common for ICU doctors to recognize that futile treatment is provided to patients who cannot benefit from it. In our study, 11% of ICU patients were perceived as receiving futile treatment. The outcomes of these 123 patients were uniformly poor, with 85% dying within 6 months. Advances in critical care medicine has allowed us to save lives, but it has also allowed us provide aggressive life-sustaining treatments that may not benefit all patients. When aggressive treatment is poorly matched with a patient’s prognosis, doctors will consider such treatment as futile and our study shows that this is not an uncommon occurrence in our health system.
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MedicalResearch.com Interview with:Ricardo E. Carrión, PhD
Division of Psychiatry Research
The Zucker Hillside Hospital, North Shore–Long Island Jewish Health System, Glen Oaks, New YorkCenter for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, New York
MedicalResearch.com: What are the main findings of your study:Answer: Reduced neurocognition, poor functioning, and other behavioral symptoms at baseline were associated with an increased risk of long-term social difficulties and school/work problems in adolescents and young adults at high clinical risk for psychosis.
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MedicalResearch.com Interview with:Dr. Amy Sanderson MD
Department of Anesthesiology
Perioperative & Pain Medicine
Boston Children’s Hospital
Boston, Massachusetts
MedicalResearch.com: What are the main findings of the study?Dr. Sanderson: There is substantial variability in the interpretation of a DNR order. 66.9% of clinicians believed that a DNR order indicates limitation of resuscitative measures only on cardiopulmonary arrest, whereas 33.1% considered a DNR order to be the threshold for the limitation of treatments not specifically related to resuscitation. 68.7% of clinicians reported that the care of a patient changes once a DNR order is written. Of those reporting changes in care, 11.2% reported that this happens only if a cardiopulmonary arrest occurs, while 36.7% believed that there is an increased attention to comfort. Finally, 52.1% reported that care changes beyond both resuscitative measures and focusing on comfort, including limitation or withdrawal of diagnostic and therapeutic interventions. Most clinicians reported that resuscitation status discussions happen later in the illness course than is ideal.
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MedicalResearch.com Interview with:Shanshan Li, MD, MSc, ScD
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
On behalf of Drs. Chuive, Flint, Pai, Forman, Hu, Willett, Mukamal and Rimm.
MedicalResearch.com: What are the main findings of the study?Answer: In our prospective study of diet quality among MI survivors, we found that a higher diet quality post-MI, measured by Alternative Healthy Eating Index 2010, was associated with 24% lower death rate and 26% lower death rate from cardiovascular disease. Greater improvement of diet quality from pre- to post-MI was associated with 30% lower death rate and 40% lower cardiovascular disease death rate. In addition to reducing the bad fats intake, for example, saturated and transfat intake, MI patients also tended to reduce the good healthy polyunsaturated fats.
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MedicalResearch.com Interview with: Gearoid M. McMahon, MB, BCh
Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Massachusetts Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, Massachusetts
MedicalResearch.com: What are the main findings of the study?Answer: This study examined the incidence, causes and outcomes of rhabdomyolysis in two large University Teaching hospitals. Rhabdomyolysis is a characterized by an increase in serum creatine phosphokinase (CPK) and results from muscle damage from a variety of causes. The most important complication of rhabdomyolysis is acute kidney injury which can result in a need for dialysis. Using a series of laboratory and clinical variables that are readily available on admission, we constructed a risk score that can predict with some accuracy the likelihood that a patient with rhabdomyolysis might die or need dialysis during an admission. The final variables included in the model were age, gender, the cause of rhabdomyolysis and the admission CPK, creatinine, phosphate, bicarbonate and calcium. One of the advantages of this study was, because we had access to data from two institutions, we were able to derive the risk score in one hospital and confirm its accuracy in the second institution.
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MedicalResearch.com Interview with: Seth A. Seabury, PhD
Department of Emergency Medicine, University of Southern California, Los Angeles Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
MedicalResearch.com: What are the main findings of the study?Dr. Seabury: We studied the trends in the earnings of male and female physicians in the US from 1987-2010 using nationally representative data from the Current Population Survey (CPS). We found that, while the number of female physicians grew significantly, male physicians continue to have significantly higher earnings than female physicians. The difference in the median earnings of male physicians compared to female physicians actually increased from $33,840 in 1987-1990 to $56,019 in 2006-2010, though the difference across years was not statistically significant. Our approach controlled for differences in hours worked, so earnings gap was not driven by differences in work hours, though it could be explained by other factors we did not observe in our data (e.g., specialty choice).
Looking at other occupations in the US health care industry, the male-female earnings gap was smaller for pharmacists and registered nurses and decreased over time, but was large and increased for physicians assistants. On the other hand, our numbers indicate that outside of the health care industry, the male-female earnings gap fell by more than 45%. Even though significant gender inequality persists across the US, female physicians do not appear to have benefited from the relative gains that female workers outside the health care industry have.
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MedicalResearch.com Interview with:
Arif Khan, MD
Medical Director, Northwest Clinical Research Center
Adjunct Professor of Psychiatry
Duke University Medical Center
and
Christine Khan, Psychiatric Nurse1951 – 152nd Place NE
Northwest Clinical Research Center
Bellevue, WA 98007
MedicalResearch.com: What are the main findings of your study?
The original idea set in early 20th century that psychiatric patients discharged from mental hospitals had a shortened life span or faced early death was supported by this analysis of psychiatric patients participating in research trials for new medications. There was no increased risk of early death or shortened life span for participating in these research clinical trials.
Life span shortening or increased risk of early death is highest among patients with schizophrenia, followed by patients with major mood disorders such as Bipolar Mood Disorder and Major Depression.
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MedicalResearch.com Interview with:Ekaterina Rogaeva, PhD
Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine, University of Toronto, Toronto, Ontario, CanadaCambridge Institute for Medical Research and Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
MedicalResearch.com: What are the main findings of the study?Answer: We tested the hypothesis that late-onset Alzheimer disease (AD) might be in part explained by the homozygosity of unknown loci. In a genome-wide study of a Caribbean Hispanic population with noticeable inbreeding and high risk of AD we assessed the presence of long runs of homozygosity (ROHs) – regions where the alleles inherited from both parents are identical. Our results suggest the existence of recessive AD loci, since the mean length of the ROH per person was significantly longer in AD cases versus controls, and this association was stronger in familial AD.
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MedicalResearch.com Interview with:Dr. Marc Jaffe, MD
Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program
Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group
Associate Clinical Professor of Medicine, UCSF
Endocrinology and Internal Medicine
Kaiser South San Francisco Medical Center
1200 El Camino Real
South San Francisco, California 94080
MedicalResearch.com: What are the main findings of the study?Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates.
If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period.
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MedicalResearch.com Interview with:
Ann M. Sheehy, M.D., M.S.
Associate Professor
Division Head, Hospital Medicine
University of Wisconsin Department of Medicine
MedicalResearch.com: What are the main...
MedicalResearch.com Interview with:
Lu Qi, MD, PhD, FAHA
Assistant Professor of Medicine
Harvard Medical School
Assistant Professor of Nutrition
Harvard School of Public Health
MedicalResearch.com: What are the main findings of the study?Answer: The main findings include, we for the first time identified a genetic variant predisposing to high risk of coronary heart disease in patients with type 2 diabetes, using genome-wide association (GWA) approach. More interesting, we demonstrated that the variant may affect expression of a gene involved in metabolism of amino acid glutamic acid, which has been related to insulin secretion and heart health in previous studies.
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MedicalResearch.com Interview with:Dr Pamela N Peterson MD
Denver Health Medical Center, CO
MedicalResearch.com: What are the main findings of the study?Answer:We assessed the outcomes of mortality, rehospitalization, and procedural complications among 24,169 patients in the NCDR-ICD Registry with left ventricular systolic dysfunction receiving a cardiac resynchronization device in addition to an implantable defibrillator for the primary prevention of sudden cardiac death between 2006 and 2009. After stratification by the QRS complex morphology and duration on the ECG and adjustment for measured differences in other characteristics, patients with left bundle branch block (LBBB) and QRS durations of at least 150 msec had significantly lower rates of mortality and rehospitalization at 3 years compared with patients with non-LBBB QRS morphology and/or QRS duration of 120-149 msec. Rates of mortality and readmission were generally highest in patients with non-LBBB and QRS duration of 120-149 msec. Rates of procedural complications at 30- and 90-days were similar across strata of QRS morphology and duration.
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MedicalResearch.com Interview with: Bjarke Feenstra, Ph.D.
Senior Research Scientist
Statens Serum Institut
Artillerivej 5, 2300 Copenhagen S
Denmark
MedicalResearch.com: What are the main findings of the study?Dr. Feenstra: We discovered a new genome-wide significant locus for infantile hypertrophic pyloric stenosis (IHPS) in a region on chromosome 11 harboring the apolipoprotein (APOA1/C3/A4/A5) gene cluster and also confirmed three previously reported loci. Characteristics of the new locus led us to propose the hypothesis that low levels of circulating lipids in infants are associated with increased risk of IHPS. We addressed this hypothesis by measuring plasma lipid levels in prospectively collected umbilical cord blood from a set of 46 IHPS cases and 189 matched controls. We found that levels were on average somewhat lower in the children who went on to develop the condition.
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MedicalResearch.com Interview with: Matthew Parkes
Research Statistician
Research in Osteoarthritis Manchester (ROAM)
Arthritis Research UK Epidemiology Unit
Centre for Musculoskeletal Research
Institute of Inflammation and Repair
The University of Manchester
Manchester Academic Health Science Centre
Manchester M13 9PT
MedicalResearch.com: What are the main findings of the study?Answer: Looking at all trials of lateral wedge insoles, they seem to reduce pain slightly.
However, looking at trials which compare lateral wedges to flat wedges, they don’t appear to differ in terms of pain reduction.
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MedicalResearch.com: Interview with: Therese Koops Grønborg PhD student/ph.d.-studerende, MSc
Section of Biostatistics/Sektion for Biostatistisk
Department of Public Health/Institut for Folkesundhed
Aarhus University
Bartholins Allé 2, DK-8000 Aarhus C, Denmark
MedicalResearch.com: What are the main findings of the study?Answer: There are three important findings in our study.
We estimated a population-based Autism Spectrum Disorder (ASD) sibling recurrence risk relative to the background population and found an almost seven-fold increase. While this indeed is an increased risk, it is also lower than what other recent studies have suggested.
We also compared the relative recurrence risk for full and maternal/paternal half siblings and found a lower relative recurrence risk in half siblings than in full siblings, which supports the genetic pathway to ASD. The recurrence risk for maternal half siblings is still higher than for the background population suggesting that factors unique to the mother, such as the intrauterine environment and perinatal history, may contribute to ASD.
Last, but not least, we estimated the time trends in the relative recurrence risk. While the ASD prevalence has been increasing for several years, we found no time trends in the relative recurrence risk, suggesting that the factors contributing to the risk for ASDs recurrence in siblings (perhaps a combination of genes and environment) have not changed over time.
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MedicalResearch.com Interview with:Leora I. Horwitz, MD, MHSSection of General Internal Medicine, Department of Medicine,
Yale School of Medicine,
Center for Outcomes Research and Evaluation,
Yale–New Haven Hospital, New Haven, Connecticut
MedicalResearch.com: What are the main findings of the study?Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:
40% of patients could not understand or explain the reason they were in the hospital in the first place;
A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand;
Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist;
Only 44% accurately recalled details of their appointments.
In other words, we didn't do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home.
We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients - that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients - we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn't even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn't find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies.
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MedicalResearch.com Interview with: Michiyo Yamakawa MHSc
Department of Epidemiology
Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences,
Okayama, Japan
MedicalResearch.com: What are the main findings of the study?Answer: We found that breastfeeding was associated with decreased risk of overweight and obesity at the age of 7 and 8 years compared with formula feeding. Moreover, the protective associations for obesity were greater than those for overweight.
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MedicalResearch.com Interview with: Miles D. Witham, PhD
Aging and Health, University of Dundee, Dundee, United Kingdom
MedicalResearch.com: What are the main findings of the study?Answer: We gave high dose vitamin D3 (100,000 units) or placebo every 3 months to people aged 70 or over, who all had isolated systolic hypertension (ISH). The main focus of the trial was to test whether vitamin D supplementation could reduce blood pressure in this group of patients – this pattern of blood pressure, whether the systolic (top number) is high, and the diastolic (bottom number) is normal, is very common in older people. Previous studies have suggested a link between low vitamin D levels and higher blood pressure, but no trial has yet tested this idea in older patients with ISH.
Despite the treatment causing a significant increase in circulating vitamin D levels, we saw no significant reduction in blood pressure with vitamin D supplementation, despite the trial running for a year. We tested whether certain groups might still benefit – e.g. those with very high blood pressure or very low vitamin D levels, but even these groups did not show a reduction in blood pressure.
We also tested whether vitamin D supplementation reduced the health and stiffness of arteries – both important predictors of future heart attack or stroke. Unfortunately, vitamin D did not affect these measures either, and didn’t reduce cholesterol or glucose levels.
On the more positive side, vitamin D supplements did appear safe, and the number of falls in the vitamin D group was slightly lower than in those people who received placebo. This is reassuring, as an earlier study (Sanders et al) had suggested that very high doses of vitamin D might make falls more likely, in contrast to previous low dose studies that show a protective effect of vitamin D against falls.
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MedicalResearch.com: Interview with Peter Nordström Ph.D
Umeå University in Sweden
MedicalResearch.com: What are the main findings of the study?Answer: I would say that the main finding of our study is the nine independent risk factors identified for Young-Onset Dementia.
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MedicalResearch.com Interview with Edna B. Foa, PhDDepartment of Psychiatry, University of Pennsylvania, Philadelphia
MedicalResearch.com: What are the main findings of the study?Dr. Foa:Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder during active treatment. Six months after treatment discontinuation, participants who received prolonged exposure therapy for PTSD drank less than those who did not receive prolonged exposure. Participants who received a combined treatment of prolonged exposure and naltrexone had the lowest drinking level after six-month treatment discontinuation. The main message of the study is that simultaneous treatment of alcohol dependence and PTSD yield superior outcome than each treatment alone. Importantly, the findings indicated that prolonged exposure therapy was not associated with increased drinking or alcohol craving, a concern that has been voiced by some investigators. In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts that common view that trauma-focuses therapy is contraindicated for individuals with alcohol dependence and PTSD, because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use. (more…)
MedicalResearch.com: Interview with: Samir Gupta, MD, MSCS
San Diego Veterans Affairs Healthcare System
Associate Professor of Clinical Medicine
Division of Gastroenterology, Department of Internal Medicine
Moores Cancer Center
University of California San Diego
MedicalResearch.com: What are the main findings?Dr. Gupta: In a randomized, comparative effectiveness study among uninsured individuals not up to date with screening, we found that mailed outreach invitations to complete colonoscopy outreach, and mailed outreach to complete a non-invasive fecal immunochemical test (FIT) tripled screening rates compared to usual care. Additionally, we found that outreach was almost twice as effective with offers for FIT versus colonoscopy screening.
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MedicalResearch.com Interview with: Jelle Vehof PhD
Department of Twin Research & Genetic Epidemiology
King’s College London, St Thomas’ Hospital, Waterloo, London, England
Department of Ophthalmology & Epidemiology
University Medical Center Groningen, Groningen, the Netherlands
MedicalResearch.com: What are the main findings of the study?Dr. Vehof: The current study provides the first empirical evidence that individuals with dry eye disease show altered pain sensitivity. Specifically, this study demonstrates that subjects with DED pain and discomfort complaints have lower pain threshold and pain tolerance of heat-based stimulus compared to those without.
These findings support the hypothesis that a subset of persons with DED is more sensitive to pain.
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MedicalResearch.com Interview with:Carol S. North, MD, MPE
The Nancy and Ray L. Hunt Chair in Crisis Psychiatry
Director, Program in Trauma and Disaster,
VA North Texas Health Care System
4500 S. Lancaster Rd., Dallas, TX 75216
Professor of Psychiatry and Surgery/Division of Emergency Medicine
UT Southwestern Medical Center
6363 Forest Park Rd. Dallas, TX 75390-8828
MedicalResearch.com: What are the main findings of the study?Answer: In post-disaster settings, a systematic framework of case identification, triage, and mental health interventions can guide overall mental health response and should be integrated into emergency medicine and trauma care responses.
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MedicalResearch.com Interview with Dr. Pietro Manuel Ferraro
Division of Nephrology–Renal Program, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli Hospital, Rome, Italy
MedicalResearch.com: What are the main findings of the study?Dr. Ferraro: We analyzed three large cohorts over time to see if those with prevalent or incident kidney stones might have a higher risk of developing coronary heart disease (fatal or non fatal myocardial infarction or the need for coronary revascularization). The cohorts consisted of over 200,000 participants without any prior history of coronary heart disease. After a median follow-up of over 8 years, we observed that women affected with stones seem to have a greater risk of developing coronary heart disease independent of a number of other known cardiovascular risk factors such as diabetes or high blood pressure. We did not observe a significant association among men. (more…)
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