Does Exercise Slow Dementia? Interview with:

Prof. Sarah E Lamb,  MSc, MA, MCSP, Grad Dip Statistics, DPhil Centre for Rehabilitation Research and Centre for Statistics in Medicine Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences Botnar Research Centre, University of Oxford, Oxford

Prof. Lamb

Prof. Sarah E Lamb,  MSc, MA, MCSP, Grad Dip Statistics, DPhil
Centre for Rehabilitation Research and Centre for Statistics in Medicine
Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences
Botnar Research Centre, University of Oxford, Oxford What is the background for this study? What are the main findings?

Response: Scientists and clinicians have considered the possibility that higher intensity aerobic and muscle strength training might have a beneficial effect in preventing dementia or slowing the progression of cognitive impairment in those who have dementia.

The hypothesis has come mostly from animal research.

The main findings of our research which used a large sample and high quality methods was that higher intensity exercise, whilst possible, did not slow cognitive impairment. Neither did it have an impact on the functional and behavioural outcomes for people with dementia. It was a substantial commitment for people to participate in the programmes, although many enjoyed the experience and their physical fitness improved.

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Men Receive Triple Amount of Cancer Research Funding Interview with:
“Faecal Coliforms analysis” by SuSanA Secretariat is licensed under CC BY 2.0Dr. Mahiben Maruthappu

Public Health Registrar What is the background for this study? What are the main findings?

Response: Gender disparities in the fields of science and technology have been documented, and  it becomes increasingly apparent at higher levels of seniority. In this analysis, we found a quantifiable difference in cancer research funding awarded to female principle investigators compared to male principle investigators (PIs).

Across all cancer research funding grants that we identified, male PIs received 3.6 times the total investment value, and 1.6 times the average award value compared with their female counterparts.  Continue reading

How Many Diseases Should Newborns Be Screened For? Interview with:
“Newborn” by Brad Carroll is licensed under CC BY 2.0Dr Sian Taylor-Phillips MPhys, PhD
Associate Professor Screening and Test Evaluation /
NIHR Career Development Fellow
Division of Health Sciences
Warwick Medical School
University of Warwick Coventry What is the background for this study? What are the main findings?

Response: In newborn blood spot screening a small amount of blood is taken from newborn babies heels, and this is tested for a range of rare diseases. The idea is to detect each disease earlier when it is more treatable. However, it would be better not to test for some diseases, for example if the test is inaccurate so worries parents that their baby may have a serious illness when they do not. Some countries test for as few as 5 diseases and others as many as 50. In this study we investigated how different countries choose which diseases to test for.

We found that many national recommendations on whether to screen newborn babies for rare diseases do not assess the evidence on the key benefits and harms of screening. Evidence about the accuracy of the test was not considered in 42% of recommendations, evidence about whether early detection at screening has health benefits was not consulted in 30% of recommendations, and evidence around the potential harm of overdiagnosis where babies have variants of the disease that would never have caused any symptoms or ill effects was not considered in 76% of recommendations.

We also found through meta-analysis that when a systematic review was used to bring together the evidence then countries were less likely to recommend screening for the disease.

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How Much US Life is Lost to Police Violence? Interview with:
“police” by istolethetv is licensed under CC BY 2.0Anthony L. Bui, MPH

M.D. Candidate, David Geffen School of Medicine at UCLA
Matthew M. Coates, MPH
Associate, Harvard Medical School, Department of Global Health and Social Medicine
Ellicott C. Matthay, MPH
Ph.D. Candidate, Division of Epidemiology, University of California, Berkeley School of Public Health What is the background for this study? What are the main findings?

Response: Protests after recent deaths from encounters with law enforcement, the Black Lives Matter movement, and activism over social media platforms have raised the profile of the problem of police violence. Several studies have suggested that the public health community has a duty to address these deaths as a public health problem. These studies have also pointed out that although there is a lack of officially reported statistics on police violence, other journalistic and crowd-sourced efforts such as “The Counted” from The Guardian,, U.S. Police Shootings Database,, and Mapping Police Violence have relatively complete documentation of deaths from police violence.

To help frame the issue as a public health problem, we calculated years of life lost (YLLs) attributed to deaths from encounters with law enforcement. YLLs are, a metric that measures premature deaths, by age, gender, and race/ethnicity. To do this, we followed established methods, subtracting the age of each death from a corresponding standard life expectancy. For example, if an individual who died at age 25 had a life expectancy of 75, their YLL would be 50.  Continue reading

Artificial Pancreas Reduces Hypoglycemia in Type 1 Diabetes Interview with:

Dr-Apostolos Tsapas

Dr. Tsapas

Apostolos Tsapas, MD PhD MSc(Oxon)
Associate Professor of Medicine
Director of the Second Medical Department | Aristotle University Thessalonik
Cruddas Link Fellow
Harris Manchester College
University of Oxford What is the background for this study?

Response: Artificial pancreas treatment, also referred to as closed loop glucose control, is an emerging treatment option combining a pump and continuous glucose monitoring with a control algorithm to deliver insulin (and potentially glucagon) in a glucose responsive manner. Compared with insulin pumps or sensor augmented pumps, artificial pancreas use can reduce the burden for patients by automatically adjusting the amount of insulin entering the body on the basis of sensor glucose levels. The US Food and Drug Administration has recently approved the first artificial pancreas system for use by people with type 1 diabetes over 14 years of age, based on a safety outpatient study.

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Severely Malnourished Children May Benefit From Vitamin D Supplement Interview with:
Dr Javeria Saleem PhD

Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London, United Kingdom What is the background for this study? What are the main findings?

Response: Severe acute malnutrition is the most extreme and visible form of undernutrition. Affected children have very low weight for their height and severe muscle wasting; they may also have swollen feet, face and limbs. Around 20 million children suffer from severe acute malnutrition worldwide of whom an estimated 1.4 million live in Pakistan. The condition is a major cause of death in children under 5 in Asia and Africa. The standard treatment is to give a high-energy, micronutrient enhanced paste called ready-to-use therapeutic food (RUTF).

Vitamin D deficiency has been reported to be a risk factor for severe wasting in children with severe acute malnutrition Ready-to-use therapeutic food contains relatively modest amounts of vitamin D. However, the effects of adding high-dose vitamin D to this standard treatment have not previously been evaluated.

We therefore did a clinical trial to assess whether high-dose vitamin D hastened recovery in 185 children aged 6-58 months who were receiving standard treatment for severe acute malnutrition in Southern Punjab, Pakistan. The 93 children in the active arm of the study received two doses of 5 mg vitamin D by mouth, while the 92 children in the control arm received placebo (a dummy medicine containing no vitamin D).

Our findings were very striking: after 2 months of treatment, the children who received high-dose vitamin D in addition to standard therapy had significantly better weight gain, and significantly better motor and language development, than those who received standard treatment alone.

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For Your Surgeon, Do You Want Younger Hands or More Experience? Interview with:
“Untitled” by Marcin Wichary is licensed under CC BY 2.0
Yusuke Tsugawa, MD, MPH, PhD
Assistant professor
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine at UCL
Los Angeles, CA What is the background for this study? What are the main findings?

Response: We studied whether patients’ mortality rate differ based on age and sex of surgeons who performed surgical procedures. Using a nationally representative data of Medicare beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries, we found that patients treated by older surgeons have lower mortality than those cared for by younger surgeons, whereas there was no difference in patient mortality between male and female surgeons. When we studied age and sex together, we found that female surgeons at their 50s had the lowest patient mortality across all groups.

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Some Depression and Overactive Bladder Drugs Linked to Dementia Interview with:

Professor Phyo Kyaw Myint Chair in Old Age Medicine University of Aberdeen

Prof. Myint

Professor Phyo Kyaw Myint
Chair in Old Age Medicine
University of Aberdeen What is the background for this study?

Response: We have previously studied the potential harmful effects of a group of medications called anticholinergics. They can have side effects on central as well peripheral systems. The link between use of these drugs and dementia is less well understood due to limitations of previous studies.

We used large GP practices data from the UK with long term follow up and examined this association using robust statistical methods. What are the main findings?

Response: Key findings are:

  • Drugs with anticholinergic properties which are used to treat depression, urological conditions (e.g. for overactive bladder) and Parkinsonism are linked to development of dementia.
  • Drugs with similar properties which are used to treat gut disorders and heart conditions are not found to be linked to dementia
  • Drugs with low level of anticholinergic effect are not linked to dementia What should readers take away from your report?

Response: Clinicians should use the drugs with high level of anticholinergic burden cautiously. Also attempts should be made whenever appropriate to reduce or replace with similar drugs but without such properties. What recommendations do you have for future research as a result of this study?

Response: We need to ensure confounding effects are minimised by conducting carefully designed prospective studies. Further clinical trial evidence of benefit of deprescribing of these medications (when possible) in at risk populations is also urgently warranted. Is there anything else you would like to add? Any disclosures?

Response: In the absence of trial evidence, this study provides best available evidence using robust statistical methods in the largest study of its kind and will help clinicians in making treatment choices for the benefit of the patients.


Anticholinergic drugs and risk of dementia: case-control study

BMJ 2018; 361 doi: (Published 25 April 2018)Cite this as: BMJ 2018;361:k1315

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.




Migraine Linked To Increased Risk of Heart Disease and Stroke Interview with:

Islam Elgendy MD Division of Cardiovascular Medicine University of Florida  

Dr. Elgendy

Islam Elgendy MD
Division of Cardiovascular Medicine
University of Florida What is the background for this study? What are the main findings? 

Response: Migraine headache is a prevalent medical condition, often being chronic and debilitating to many. Previous studies have shown that migraine, particularly migraine with aura, is associated with an increased risk of cardiovascular events. Recently, a number of these studies have reported long-term follow up data. To better understand the long-term morbidity that is associated with migraines, we performed a systematic evaluation to study the link between migraine and risk of cardiovascular and cerebrovascular events.

This study demonstrated that migraine is associated with an increased risk of major adverse cardiovascular and cerebrovascular events, which was driven by an increased long-term risk of myocardial infarction and stroke. This effect was predominantly observed in migraineurs who have aura.  Continue reading

Tai Chi At Least As Beneficial As Standard Therapy For Fibromyalgia Interview with:
“tai chi 11.4.09” by Luigi Scorcia is licensed under CC BY 2.0Chenchen Wang MD, MSc
Professor of Medicine
Tufts University School of Medicine
Director, Center For Complementary And Integrative Medicine
Division of Rheumatology
Tufts Medical Center Boston, MA 02111 What is the background for this study?

Response: Patients with chronic widespread pain often try many different types of pain medications, anti-depressants, physical therapy, and other approaches, and commonly find that none of these therapies work for them. Finding safe, effective approaches for pain management is an urgent priority. Previous evidence suggested that Tai Chi, a multi-dimensional mind-body practice that integrates physical, psychosocial, and behavioral elements, may be especially suited to address both chronic pain and associated psychological and somatic symptoms. In our most recent study published in the BMJ, we directly compared the effectiveness of Tai Chi versus aerobic exercise, which is a standard care non-drug treatment for fibromyalgia. Continue reading