Keyhole vs Open Surgery For Ruptured Abdominal Aortic Aneurysm

MedicalResearch.com Interview with:

ruptured Abdominal Aortic Aneurysm as seen on CT- Wikipedia James Heilman, MD

A ruptured abdominal aortic aneurysm  as seen on CT

 

 

Professor JT Powell PhD, MD, FRCPath
Faculty of Medicine,
Department of Surgery & CancerImperial College London

 

 

 

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

Response: The mortality from ruptured abdominal aortic aneurysm (AAA) remains very high causing about 6000 deaths each year in the UK.  The only hope for survival is an emergency operation to repair the burst aorta.  Even so the mortality may be as high as 45% within a month of repair using open surgery.

It has been suggested that minimally invasive repair using keyhole or endovascular techniques would lower the mortality to about 25% within a month of repair.  However not all shapes of aorta are suitable for endovascular repair (also called EVAR).

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Risk of Gastric Cancer Increased With Long-Term Proton Pump Inhibitors

MedicalResearch.com Interview with:
Dr. Wai Keung Leung
Professor, Division of Gastroenterology & Hepatology
Department of Medicine
Assistant Dean, LKS Faculty of Medicine
University of Hong Kong
Hong Kong

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

Response: It remains controversial whether proton pump inhibitors will increase the risk of gastric cancer. Although previous studies have shown a possible increase in risk in patients taking long-term proton pump inhibitors (PPI), these studies are confounded by the presence of H. pylori infection. In this population-based study from Hong Kong, we have determined the risk of gastric cancer development in more than 63,000 H. pylori-infected subjects who had the bacterium eradicated by a course of  clarithromycin-based triple therapy and continued to take PPI or H2-receptor antagonist (H2RA).

After adjusting for various baseline differences among those PPI and non-PPI users, we found that the risk of gastric cancer was increased by 2.4-fold in those who used long-term PPI. The risk was in tandem with the frequency and duration of PPIs treatment. The risk increased from 5-fold to 8-fold for more than 1-year and 3-year use of PPI, respectively. Similar increase in risk was not observed among those who took H2RA, a weaker acid suppressive agent.

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Focusing on Physical Activity Can Help Avoid Unnecessary Later Life Social Care Expenses

MedicalResearch.com Interview with:
Dr. Scarlett McNally

Consultant Orthopaedic Surgeo
Eastbourne D.G.H.

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

Response: There are vast differences between older people in their abilities and their number of medical conditions. Many people confuse ageing with loss of fitness. Ageing has specific effects (reduction in hearing and skin elasticity for example) but the loss of fitness is not inevitable. Genetics contributes only 20% to diseases. There is abundant evidence that adults who take up physical activity improve their fitness up to the level of someone a decade younger, with improvements in ‘up and go’ times. Physical activity can reduce the severity of most conditions, such as heart disease or the risk of onset or recurrence of many cancers. Inactivity is one of the top four risk factors for most long-term conditions. There is a dose-effect curve. Dementia, disability and frailty can be prevented, reduced or delayed.

The need for social care is based on an individual’s abilities; for example, being unable to get to the toilet in time may increase the need for care from twice daily care givers to needing residential care or live-in care, which increases costs five-fold.

Hospitals contribute to people reducing their mobility, with the ‘deconditioning syndrome’ of bed rest, with 60% of in-patients reducing their mobility.

The total cost of social care in the UK is up to £100 billion, so even modest changes would reduce the cost of social care by several billion pounds a year.

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Multivitamins in Pregnancy May Be Associated With Lower Autism Risk

MedicalResearch.com Interview with:
Elizabeth DeVilbiss, PhD MPH
Dornsife School of Public Health
Drexel University

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

Response: Unfortunately, not much is known about how diet during pregnancy affects autism risk.  There have been studies in recent years about varied aspects of diet during pregnancy and autism risk involving multivitamins, iron, folic acid, vitamin D, and more, but the evidence is still inconclusive.

After adjusting for several potentially influencing factors in both mothers and children, we found that multivitamin use, with or without additional iron and/or folic acid, was associated with a lower likelihood of child autism spectrum disorder with intellectual disability relative to mothers who did not use folic acid, iron, and multivitamins.

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NHS: Delayed Hospital Discharges May Be Linked To Increase in Mortality

MedicalResearch.com Interview with:
Dr Mark A Green 
BA (Hons), MSc, PhD, AFHEA
Lecturer in Health Geography
University of Liverpool

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

Response: Between Dec 2013 and Dec 2015 there was an increase of 41% in the number of acute patients delayed being discharged from hospital. If we compare the previous year of data –Dec 2012- Dec 2014 – there was only a 10% increase. 2015 saw one of the largest annual spikes in mortality rates for almost 50 years – we wanted to explore if there was any correlation between these two trends.

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Vitamin D May Have a Role In Reducing Risk of Severe Asthma Attacks

MedicalResearch.com Interview with:

David Jolliffe, PhD Centre for Primary Care and Public Health Blizard Institute Barts and the London School of Medicine and Dentistry London

Dr. Jolliffe

David Jolliffe, PhD
Centre for Primary Care and Public Health
Blizard Institute
Barts and the London School of Medicine and Dentistry
London

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

Response: Asthma affects more than 300 million people worldwide and is estimated to cause almost 400,000 deaths annually. Asthma deaths arise primarily during episodes of acute worsening of symptoms, known as attacks or ‘exacerbations’, which are commonly triggered by viral upper respiratory infections. Vitamin D is thought to protect against such attacks by boosting immune responses to respiratory viruses and dampening down harmful airway inflammation.

Several clinical trials have tested whether vitamin D supplementation might protect against asthma attacks, but individually their results are inconclusive. In the current study, we pooled raw data from 955 asthma patients who took part in 7 separate trials, which allowed us to answer two questions:

1, Does vitamin D protects against asthma attacks overall, when data from all trials are pooled?

2, Do people who have lower vitamin D levels to start with particularly benefit from supplementation?

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Women Tend To Manage Their Cardiac Risk Factors Less Well Than Men

MedicalResearch.com Interview with:
Min Zhao PhD student

Julius Center for Health Sciences and Primary Care, Clinical Epidemiology
University Medical Center Utrech

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

Response: Heart disease is still one of leading causes of deaths and disability worldwide. Management of modifiable risk factors, including both medical treatment target and healthy lifestyle, reduce the chance of new heart attack among those who survived a previous heart attack (so-called secondary prevention). Previous studies have demonstrated that the secondary prevention of heart disease is poorer among women than men. However, most studies were performed in Western populations.

We aimed to assess whether sex differences exist on risk factor management and to investigate geographic variations of any such sex differences. Our study is a large-scale international clinical audit performed during routine clinic visit. We recruited over 10,000 patients who had survived a previous heart attack from 11 countries in Europe, Asia, and the Middle East.

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Nerf Guns Can Cause Serious Eye Bleeding

Helgi Halldórsson from Reykjavík, Iceland Wikipedia image

A man aiming an N-Strike Stampede ECS
Wikipedia image

MedicalResearch.com Interview with:
Dr. Mukhtar Bizrah
Accident & Emergency Department,
Moorfields Eye Hospita
NHS Foundation Trust
London, UK

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

Response: We noticed a number of patients presenting to the accident and emergency department at our hospital following ‘Nerf gun’ injuries. We decided to perform this study because an online literature search revealed that currently there was no published work on this topic. It was worth doing because it is a public health issue. A number of doctors in A&E commented that they have seen a number of patients present with Nerf gun injuries. I personally saw a patient which an inflamed eye and damage to the iris following a ‘Nerf gun’ injury.

We decided to write about three patients with bleeding in the eye (hyphema) because most journals have a cap on the number of patients in a case series. Also, bleeding in the eye following trauma is known to be associated with serious ocular injury and long term repercussions.

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Longer Breastfeeding Linked To Lower Risk of Endometriosis

MedicalResearch.com Interview with:

Leslie V. Farland, ScD Assistant Director of Epidemiologic Research Center for Infertility and Reproductive Surgery Brigham and Women's Hospital | Harvard Medical School  Instructor | Harvard T.H. Chan School of Public Health

Dr. Farland

Leslie V. Farland, ScD
Assistant Director of Epidemiologic Research
Center for Infertility and Reproductive Surgery
Brigham and Women’s Hospital | Harvard Medical School
Instructor | Harvard T.H. Chan School of Public Health

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

Response: Endometriosis is chronic gynecologic condition that affects approximately ten percent of women. Women with endometriosis can experience painful menstrual periods, general chronic pelvic pain, and pain associated with intercourse. Currently we know very few modifiable risk factors for endometriosis.

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Study Evaluates Pediatric Outcomes of Antidepressant Use During Pregnancy

MedicalResearch.com Interview with:

Xiaoqin Liu, PhD Department of Economics and Business Economics Aarhus University

Dr. Xiaoqin Liu

Xiaoqin Liu, PhD
Department of Economics and Business Economics
Aarhus University 

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

Response: Previous research on the long-term neurodevelopmental outcomes of serotonin-reuptake inhibitor (SSRI) use during pregnancy has primarily focused on offspring risk of autism spectrum disorder. Given SSRIs cross the placental barrier and affect the fetal brain, in-utero SSRI exposure may increase risks of other psychiatric disorders as well as autism spectrum disorder.

We conducted a population-based study to look at a range of diagnostic groups of psychiatric disorders in children whose mothers used antidepressants during pregnancy. This was possible because of the nature of information available in Danish population registers, allowing us to follow children for many years. We found increased risks of various diagnostic groups of psychiatric disorders in children whose mothers continued antidepressant treatment during pregnancy, in comparison to children whose mothers stopped antidepressant treatment before pregnancy.

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IED Injuries Even Worse Than Landmines

MedicalResearch.com Interview with:

Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS Professor - Department of Surgery London Health Sciences Centre University Hospital London, Ontario, Canada

Dr. McAlister

Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS
Professor – Department of Surgery
London Health Sciences Centre
University Hospital
London, Ontario, Canada

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

Response: This study was performed by medical and nursing officers who were all deployed to the war zone. We were deeply concerned about the type of injuries we were seeing. They were more awful than any we had seen before. We were familiar with reviews of antipersonnel landmine injuries that were reported by Red Cross surgeons in the 1990s. The injuries that we were dealing with were from antipersonnel IEDs more than landmines. We decided to do a formal prospective study for two reasons: first was to carefully describe the pattern of injury so we could develop new medical strategies, if possible, to help victims. The second reason was to catalogue these injuries so we could impartially and scientifically report what we were witnessing.

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Preterm Babies Still At Risk of Developmental Delays

MedicalResearch.com Interview with:
Dr. Andrei Morgan and Dr.Veronique Pierrat

Obstetrical, Perinatal, and Pediatric Epidemiology Team,
Epidemiology and Biostatistics Sorbonne
Cité Research Center INSERM, Paris France
Descartes University, Paris, France
Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France. 

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

Response: The risk of neurodevelopmental and behavioural disabilities remains high in children and adults born preterm. In the 2000s, outcomes of neonates born extremely preterm was described in several settings, but the outcome of neonates born very and moderately preterm was rarely reported. However, in absolute numbers, these infants represent a larger proportion of preterm births and account for more children with long-term deficits and learning disabilities.

EPIPAGE-2 is a national study which aims to study short and long term outcomes of children born at 22-26 weeks’gestation, 27-31 weeks’gestation and 32-34 weeks’gestation in France in 2011. We also compared results from this study with the first EPIPAGE study, carried out in 1997. At two years of age, neuro motor and sensory impairment, as well as overall development, were investigated by sending questionnaires to the attending physician and the parents.

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Oral Glucosamine Found No More Effective Than Placebo For Osteoarthritis Pain

MedicalResearch.com Interview with:

Jos Runhaar, PhD Erasmus MC Department of General Practice Rotterdam The Netherlands

Dr. Runhaar

Jos Runhaar, PhD
Erasmus MC
Department of General Practice
Rotterdam
The Netherlands 

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

Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages.

For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding.

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More Babies Experiencing Neonatal Drug Withdrawal After Exposure To Opioids and Psychotropic Meds

MedicalResearch.com Interview with:

Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120

Dr. Krista Huybrechts

Krista F. Huybrechts, MS PhD
Assistant Professor of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120

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

Response: Neonatal drug withdrawal is common; in the U.S. about 1 infant is born every 25 minutes with signs of drug withdrawal. Neonatal drug withdrawal is a well-recognized complication of intrauterine exposure to illicit or prescription opioids, but other psychotropic medications can also cause signs of withdrawal. Psychotropic medications are frequently co-prescribed with opioids in pregnancy, and the use of both has increased significantly, raising concerns about an increase in the incidence and severity of neonatal drug withdrawal due to potential drug-drug interactions, but these risks are not well understood.

In this study, we found a 30-60% increase in the risk of neonatal drug withdrawal associated with co-exposure to antidepressants, benzodiazepines and gabapentin, compared to opioids alone; no significant increase in risk was observed for atypical antipsychotics and Z-drugs. Exposure to psychotropic polypharmacy along with opioids was associated with a two-fold increased risk of withdrawal.

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Dieting and Physical Activity During Pregnancy Linked To Lower C-Section Rate

MedicalResearch.com Interview with:

Shakila Thangaratinam Professor of Maternal and Perinatal Health Joint Director of BARC (Barts Research Centre for Women's Health) Women's Health Research Unit | Multidisciplinary Evidence Synthesis Hub (MESH) Barts and the London School of Medicine and Dentistry  R & D Director for Women's Health Queen Mary University of London 

Prof. Thangaratinam

Shakila Thangaratinam
Professor of Maternal and Perinatal Health
Joint Director of BARC
(Barts Research Centre for Women’s Health)
Women’s Health Research Unit | Multidisciplinary Evidence Synthesis Hub (MESH)
Barts and the London School of Medicine and Dentistry
R & D Director for Women’s Health
Queen Mary University of London 

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

Response: Pregnant women who are overweight or obese, or who gain excess weight gain in pregnancy are at high risk of complications. We wanted to find

  1. If healthy diet and physical activity in pregnancy reduced weight gain, and improved outcomes for the mother and baby
  2. If the effects of the interventions differed according to the characteristics of the mother such as body mass index, parity, ethnicity, and underlying medical condition

We established a network (International Weight Management in Pregnancy i-WIP) of researchers from 16 countries, and 41 institutions to answer the above.

We found that women who followed a healthy diet and moderate physical activity gained less weight in pregnancy than other women; this beneficial effect was observed irrespective of mother’s body mass index, parity, ethnicity, and underlying medical condition.

Diet and physical activity in pregnancy has a beneficial effect on weight gain in pregnancy, and lowers the odds of caesarean section, and gestational diabetes.

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Proton Pump Inhibitors Linked To Increased Risk of Adverse Effects and and Death

MedicalResearch.com Interview with:

Ziyad Al-Aly MD FASN Assistant Professor of Medicine Co-director for Clinical Epidemiology Center Department of Medicine, Washington University School of Medicine Saint Louis, Missouri

Dr. Ziyad Al-Aly

Ziyad Al-Aly MD FASN
Assistant Professor of Medicine
Co-director for Clinical Epidemiology Center
Department of Medicine, Washington University School of Medicine
Saint Louis, Missouri
Associate Chief of Staff for Research and Education
Veterans Affairs Saint Louis Health Care System

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

Response: Proton Pump Inhibitors (PPI) are commonly used, and they are associated with adverse events including kidney disease, dementia, fractures, cardiovascular disease, and pneumonia. We asked the question of whether this translates to increased risk of death.

We conducted this large cohort study to specifically examine the association between PPI use and risk of death. The results consistently showed an association between use of PPI and increased mortality risk. Moreover, there was a graded relationship between duration of PPI use and risk of death in that longer duration of use was associated with incrementally higher risk of death.

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When Interpreting Skin Biopsies, Pathologists Often Disagree

MedicalResearch.com Interview with:

Joann G. Elmore M.D., M.P.H. Professor of Medicine,  Adjunct Professor of Epidemiology, University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104-2499

Dr. Elmore

Joann G. Elmore M.D., M.P.H.
Professor of Medicine,
Adjunct Professor of Epidemiology,
University of Washington School of Medicine
Harborview Medical Center
Seattle, WA 98104-2499

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

JE: Previous studies on diagnostic accuracy in interpreting melanocytic lesions exist but have small sample size, inclusion of experts only, or small numbers of specimens. We sought to examine accuracy and reproducibility in melanocytic skin lesions by improving upon the methodological limitations of previous studies. Specifically, we recruited a large national sample of practicing community and academic pathologists with a wide range of experience, and we utilized a large sample of biopsy cases that were carefully selected. Given that diagnostic errors can lead to patient deaths and invasive melanoma kills more than 9,000 Americans each year, we wanted to study the issue of diagnostic accuracy in interpreting melanocytic skin lesions in a very robust fashion.

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Maternal Obesity Linked To Increased Risk of Congenital Malformations in Offspring

MedicalResearch.com Interview with:
Dr. Martina Persson

Clinical Epidemiology Unit
Department of Medicine Solna
Karolinska University Hospita

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

Response: It is well known that obesity increases risks of several maternal, fetal and neonatal complications including congenital malformations. However, it has not been clear if risks of malformations are increased also in offspring of normal weight mothers or if risks increase with degree of maternal obesity.

In this study, we found progressively increasing risks of major congenital malformations in the offspring with a mother’s overweight and obesity severity.

MedicalResearch.com: What should readers take away from your report?

Response: The most sensitive period of fetal organ development is the first eight weeks of gestation and it is during this time a mother´s BMI may influence risks of malformations. Thus, it is important to try to obtain a normal bodyweight before conception.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our results should be confirmed in other populations and mechanisms behind the increased risks of malformations associated with maternal obesity should be further explored.

MedicalResearch.com: Is there anything else you would like to add?

Response: Obesity is a major health problem in many countries in the world. Preventive measures to halt the obesity epidemic should be implemented at all levels of society.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

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

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Patients With Paroxysmal Atrial Fibrillation Less Likely To Receive Anticoagulants

MedicalResearch.com Interview with:

Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD Institute of Applied Health Research Research Fellow University of Birmingham

Dr. Adderley

Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD
Institute of Applied Health Research
Research Fellow
University of Birmingham

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

Response: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major global public health problem. It is associated with a five-fold increase in risk of stroke.

There are three types of AF – paroxysmal, persistent or permanent. In paroxysmal AF, episodes come and go, and usually stop without any treatment. With persistent AF episodes can last for periods of more than seven days and are treated with medication or a medical procedure called cardioversion. In permanent AF, the irregular heartbeat is present all the time and cardioversion has failed to restore a normal heart rhythm.

All patients with AF, including paroxysmal AF, are at an increased risk of stroke. UK guidelines recommend anticoagulant treatment, such as the blood-thinning drug warfarin, for patients with all types of AF in order to reduce the risk of stroke.

Our study aimed to determine whether patients with paroxysmal AF are less likely to be treated with anticoagulants than patients with persistent or permanent AF and to investigate trends in treatment between 2000 and 2015.

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Regular Adolescent Cannabis Users More Likely To Have Later Problems with Drugs, Alcohol and Tobacco

MedicalResearch.com Interview with:
Dr Michelle Taylor PhD
Senior Research Associate in Epidemiology
MRC Integrative Epidemiology Unit (IEU)
School of Social and Community Medicine
University of Bristol
Bristol UK

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

Response: Many previous studies have looked at adolescent cannabis use, however most of these look at use at a single time point, for example whether an individual has ever used cannabis at age 16 years, or how regularly a person uses cannabis at age 18. However, as young people do not initiate use at the same time or follow the same pattern of use, using measures at a single time point does not always tell the whole story.
We used a form of statistical modelling using data taken over the course of adolescence to try and characterise underlying patterns of cannabis use across adolescence. We used data from the Avon Longitudinal Study of Parents and Children which had information on cannabis use at six time points between the ages of 13 and 18 years.

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Pharmaceutical Grade Chondroitin Sulfate As First-Line Treatment of Osteoarthritis

MedicalResearch.com Interview with:

Jean-Yves Reginster M.D.,PH.D. Professor of Epidemiology, Public Health and Health Economics Head of the Bone and Cartilage Metabolism Unit University of Liège

Dr. Reginster

Jean-Yves Reginster M.D.,PH.D.
Professor of Epidemiology, Public Health and Health Economics
Head of the Bone and Cartilage Metabolism Unit
University of Liège

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

Response: Whereas several recommendations, issued by scientific societies, recommend to use Symptom-Modifying Slow Acting Drugs (SYSADOAs) for the symptomatic and structural management of osteoarthritis, no medication is currently registered, in this particular indication, by the European Medicines Agency (EMA) or by the Food and Drug Administration (FDA).

This study is the first study, conducted, with a SYSADOA which fully complies with the requirements of the EMA for the assessment of drugs to be used in the treatment of osteoarthritis, i.e. a six-month duration, two co-primary endpoints (pain and function) and a three-arm design, with a placebo and an active comparator. The main findings are that pharmaceutical grade chondroitin sulfate provides an improvement in pain and function, which is greater than placebo and not distinguishable from celecoxib, a non-steroidal anti-inflammatory drug currently licensed for the symptomatic management of osteoarthritis.

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Whose Patients Have Lower 30-Day Mortality? Younger or Older Doctors?

MedicalResearch.com Interview with:

Yusuke Tsugawa, MD, MPH, PhD</strong> Harvard T. H. Chan School of Public Health Department of Health Policy and Management Cambridge, MA 02138

Dr. Tsugawa

Yusuke Tsugawa, MD, MPH, PhD
Harvard T. H. Chan School of Public Health
Department of Health Policy and Management
Cambridge, MA 02138

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

Response: Although evidence has suggested that older physicians may experience a
decline in medical knowledge and are less likely to adhere to standard care, patients in general had a perception that older doctors are more
experienced and therefore provide superior care.

Using a nationally representative sample of Medicare beneficiaries who were hospitalized
for medical conditions in 2011-2014, we found that patients treated by
younger doctors have lower 30-day mortality compared to those cared
for by older doctors, after adjusting for patient, physician, and
hospital characteristics.

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All NSAIDS Raise Risk of Heart Attack, Even When Taken For Short Period of Time

MedicalResearch.com Interview with:
Michèle Bally, BPharm, MSc, PhD

Epidemiologist, Department of Pharmacy, CHUM
Researcher, Health Innovation and Evaluation Hub, CRCHUM

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

Response: The objective of this study was to better understand the risk of heart attack associated with using oral prescription non-steroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, celecoxib, and naproxen) the way people usually do to treat pain and inflammation in real life circumstances.

In clinical trials, NSAIDs were typically taken on a continuous basis in high standardized doses, as assigned by the trial protocol. However, the dosages and the treatment durations studied in trials may not represent the reality of many patients who use NSAIDs in low or varying doses, use these drugs on and off, or switch between NSAID medications.

We were particularly interested in determining the onset of the risk, that is how soon does the risk of heart attack start increasing? Also, we wanted to investigate the effect of dose and duration of treatment. To do this, we studied the use of a low or high dose level of NSAIDs over certain set periods of time, including taking these medications only for 1 to 7 days.

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Over 50? Exercise Linked To Improved Cognitive Function

MedicalResearch.com Interview with:
Dr. Joseph Michael Northey
UC Research Institute for Sport and Exercise (UCRISE),
Discipline of Sport and Exercise Science, Faculty of Health
University of Canberra, Canberra, Australia

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

Response: Physical exercise has an important role to play in maintaining cognitive function across the lifecycle. However, the benefits of implementing a physical exercise intervention were not clear. To address these issues which prevented evidence-based prescription of exercise for cognitive function, a systematic review of all the available literature up to November of 2016 in adults older than 50 was conducted.

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Submission and Publication Bias Against Studies With Negative Results Declining

MedicalResearch.com Interview with:
Gary Evoniuk, PhD

Director of Publication Practices, Medical Communications Quality & Practices
GlaxoSmithKline Research and Development, Research Triangle Park, NC 27709

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

Response: In recent years, industry, and to a lesser extent academia, have been criticised for failing to submit clinical trial data for publication, especially when the data are perceived to be “negative”, (i.e. unfavourable to the drug under study) leading to publication bias. We felt it was important to determine whether this criticism is based on perception or reality and so we conducted what is, to our knowledge the only study to systematically address the issue of submission and publication bias based on study outcome.

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Childhood Adversities Linked To Increased Suicide Risk in Adolescents and Young Adults

MedicalResearch.com Interview with:
Charlotte Björkenstam PhD

Dept of Clinical Neuroscience
Karolinska Institutet
Division of Insurance Medicine
Stockholm

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

Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.

We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.

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Inhaling Poppers Associated With Visual Toxicity

MedicalResearch.com Interview with:
Dr. Rebecca Rewbury
Sussex Eye Hospital
Brighton and Sussex University Hospitals Trust
Brighton, UK

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

Response: ‘Poppers’ are recreational drugs which are illegal to sell for human ingestion, but are sold under the guise of household cleaning products. Inhalation leads to a brief sense of euphoria, enhanced sexual arousal and smooth muscle relaxation. The Psychoactive Substances Act 2016 was due to outlaw poppers, but they were excluded on the basis that they do not act directly on the central nervous system.

The main constituent of poppers, isopropyl nitrite, replaced isobutyl nitrite when the latter was classified as a carcinogen in 2006. Since then, there have been several case reports of ‘poppers maculopathy.’

We noted an increase in patients presenting with central visual disturbances after using poppers and describe 12 such cases. They all demonstrated similar disruption of the photoreceptor layer on retinal imaging. Onset of symptoms was frequently linked to specific brands of poppers, with 3 people having used poppers for many years and only developing side effects on changing brand. Chemical analysis showed that these products contained isopropyl nitrite. One brand of poppers, used without side effects by one patient, contained amyl nitrite, 2-methyl butyl nitrite and isobutyl alcohol, but no isopropyl nitrite.

The outcome of poppers maculopathy varied, but following abstention, visual disturbances and retinal damage tended to improve over months, if not fully resolve. Although in some cases, symptoms and/or imaging findings were prolonged. Ongoing use of implicated brands led to persistent, but not worsening maculopathy, whereas one patient that switched back to another brand showed full recovery.

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Consequences of Interpersonal Violence Against Child Athletes Persist into Adulthood

MedicalResearch.com Interview with:

Tine Vertommen, Criminologist Faculty of Medicine and Health Sciences Universiteitsplein 1 Antwerp, Belgium

Tine Vertommen

Tine Vertommen, Criminologist
Faculty of Medicine and Health Sciences
Universiteitsplein 1
Antwerp, Belgium

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

Response: A recent prevalence study into interpersonal violence against child athletes in the Netherlands and Belgium showed that 6% experienced severe sexual violence, 8% experienced severe physical violence, and 9% of respondents experienced severe psychological violence in sport (Vertommen et al., 2016). While general literature has repeatedly shown that exposure to interpersonal violence during childhood is associated with mental health problems in adulthood, this relationship has not yet been demonstrated in (former) athletes. Thus, the objective of the current study is to assess the long-term consequences of these experiences on adult mental health and quality of life.

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Knee Replacement Would Be More Cost Effective If Limited To Those With Severe Symptoms

MedicalResearch.com Interview with:

Bart S Ferket, MD, PhD Assistant Professor, Population Health Science and Policy Icahn School of Medicine at Mount Sinai

Dr. Bart Ferket

Bart S Ferket, MD, PhD
Assistant Professor, Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

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

Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms.   Continue reading

Combination Opioids and Benzodiazepines Raises Risk of Overdose

MedicalResearch.com Interview with:

Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA

Dr. Eric Sun

Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA

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

Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.

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Environmental Pyrethroids May Be Associated With Behavioral Problems in Children

MedicalResearch.com Interview with:
Professor Jean-Francois Viel
Department of Epidemiology and Public Health
University Hospital
Rennes, France

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

Response: The use of pyrethroid insecticides has increased substantially throughout the world over the past several decades, replacing organophosphate and carbamate insecticides, because of their chemical potency against many pests, their relatively low mammalian toxicity and their favorable environmental profiles. However, despite the neurotoxicity of these insecticides at high doses, the potential impact of environmental exposure to pyrethroid insecticides on child neurodevelopment has only just started to receive attention.

Using a longitudinal design (PELAGIE mother-child cohort), we were able to assess pyrethroid exposure (trough urine concentrations) both prenatally and during childhood (at 6 years of age). We showed that increased prenatal concentrations of one pyrethroid metabolite (cis-DCCA, a metabolite of permethrin, cypermethrin and cyfluthrin) were associated with internalising difficulties (children showing behaviours that are inhibited and over-controlled).

Moreover, for childhood 3-PBA (a common metabolite of up to 20 synthetic pyrethroid insecticides) concentrations, a positive association was observed with externalising difficulties (children showing behaviours that are under-controlled and having generally a more challenging temperament).

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11 Cancer Types Have Strong Connection to Obesity

MedicalResearch.com Interview with:

Dr Maria Kyrgiou MSc, PhD, MRCOG Clinical Senior Lecturer & Consultant in Gynaecologic Oncology IRDB - Department of Surgery and Cancer, Imperial College London West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust

Dr. Kyrgiou

Dr Maria Kyrgiou MSc, PhD, MRCOG
Clinical Senior Lecturer & Consultant in Gynaecologic Oncology
IRDB – Department of Surgery and Cancer, Imperial College London
West London Gynaecological Cancer Centre, Queen Charlotte’s & Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity has become a major public health challenge and it’s prevalence worldwide has more than doubled amongst women n the last four decadesExcess body weight has been associated with an increased risk of developing and dying from numerous cancers. Although the reported associations may be potentially causal, some of the associations may be flawed due to inherent study biases such as residual confounding and selective reporting of positive results.

We included 204 meta-analyses investigating associations between adiposity and the development or death from 36 primary cancers and their sub-types. Adiposity was associated with a higher risk of developing esophageal adenocarcinoma, gastric cardia, colon and rectal cancer in men, biliary tract system, pancreatic, postmenopausal breast among HRT non-users, endometrial, ovarian, and kidney cancer and multiple myeloma.

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Flu Treatment With Neuraminidase Inhibitors During Pregnancy Not Linked To Birth Defects

MedicalResearch.com Interview with:

Dr. Sophie Graner Department of Women's and Childrens Health Karolinska Institute, Stockholm, Sweden

Dr. Graner

Dr. Sophie Graner
Department of Women’s and Childrens Health
Karolinska Institute, Stockholm, Sweden

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

Response: Pregnant women are at increased risks of severe disease and death due to influensa infection, as well as hospitalization. Also influenza and fever increase the risk of adverse pregnancy outcomes for their infants such as intrauterine death and preterm birth. Due to this, the regulatory agencies in Europe and the US recommended post exposure prophylaxis and treatment for pregnant women with neuraminidase inhibitors during the last influenza pandemic 2009-10. Despite the recommendations, the knowledge on the effect of neuraminidase inhibitors on the infant has been limited. Previously published studies have not shown any increased risk, but they have had limited power to assess specific neonatal outcomes such as stillbirth, neonatal mortality, preterm birth, low Agar score, neonatal morbidity and congenital malformations.
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Is the Benefit of Arthroscopic Meniscus Surgery a Placebo Effect?

MedicalResearch.com Interview with:

Jonas Bloch Thorlund Associate Professor (MSc, PhD) Department of Sports Science and Clinical Biomechanics Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark

Dr. Jonas Thorlund

Jonas Bloch Thorlund
Associate Professor (MSc, PhD)
Department of Sports Science and Clinical Biomechanics
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark

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

Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse.

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NSAIDS Have Minimal Effect On Back Pain and Risk GI Side Effects

MedicalResearch.com Interview with:

Dr. Gustavo Machado BPhty (Hons) Cert.MDT The George Institute for Global Health Sydney Medical School, University of Sydney Sydney, New South Wales, Australia

Dr. Gustavo Machado

Dr. Gustavo Machado BPhty (Hons) Cert.MDT
The George Institute for Global Health
Sydney Medical School, University of Sydney
Sydney, New South Wales, Australia

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

Response: People with back pain are usually told by their health care practitioners to take analgesic medications to relieve their pain. But our previous research published in the BMJ showed that paracetamol does not have a measurable impact on patient’s symptoms. This resulted in recent changes in guidelines’ recommendations. The 2017 National Institute for Health and Care Excellence (NICE) guidelines/UK no longer recommend paracetamol as a stand-alone intervention for back pain.

So now non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as the analgesic of first choice. However, our results show that compared to placebo, commonly used NSAIDs, such as Ibuprofen (e.g. Nurofen) and Diclofenac (e.g. Voltaren), provide only small benefits for people with back pain while increasing the risk of gastrointestinal adverse effects by 2.5 times.

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Study Validates Good Quality Care Provided By Foreign-Trained Doctors

MedicalResearch.com Interview with:

Yusuke Tsugawa, MD, MPH, PhD Research Associate at Department of Health Policy and Management Harvard T.H. Chan School of Public Health

Dr. Yusuke Tsugawa

Yusuke Tsugawa, MD, MPH, PhD
Research Associate at Department of Health Policy and Management
Harvard T.H. Chan School of Public Health  

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

Response: Prior evidence has been mixed as to whether or not patient outcomes
differ between U.S. and foreign medical graduates.

However, previous studies used small sample sizes or data from a small number of states.
Therefore, it was largely unknown how international medical graduates
perform compared with US medical graduates.

To answer this question, we analyzed a nationally representative
sample of Medicare beneficiaries admitted to hospitals with a medical
condition in 2011-2014. Our sample included approximately 1.2 million
hospitalizations treated by 40,000 physicians. After adjusting for
severity of illness of patients and hospitals (we compared physicians
within the same hospital), we found that patient treated by
international medical graduates had lower mortality than patients
cared for by US medical graduates (adjusted 30-day mortality rate
11.2% vs 11.6%, p<0.001). We observed no difference in readmissions,
whereas costs of care was slightly higher for international medical
graduates.

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Approval of Medical Disability Claims Vary By the Examiner

MedicalResearch.com Interview with:

Prof. Dr. Regina Kunz Professorin für Versicherungsmedizin Evidence-based Insurance Medicine I Departement Klinische Forschung Universitätsspital Basel Basel Switzerland

Prof. Regina Kunz

Prof. Dr. Regina Kunz
Professorin für Versicherungsmedizin
Evidence-based Insurance Medicine I Departement Klinische Forschung
Universitätsspital Basel
Basel Switzerland

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

Response: Many workers seek wage replacement benefits due to a disabling illness or injury. Public and private insurance systems provide wage replacement benefits for such employees, as long as eligibility criteria are met. Insurers often arrange for evaluation of eligibility by medical professionals, but there are concerns regarding low quality evaluations and poor reliability between medical experts assessing the same claimant. In order to better understand this situation, we performed a systematic review of reproducibility studies on the inter-rater agreement in evaluation of disability.

We carried out a systematic review of 23 studies, conducted between 1992-2016, from 12 countries in Europe, North America, Australia, the Middle East, and Northeast Asia. The studies include those carried out in an insurance setting, with medical experts assessing claimants for work disability benefits, and in a research setting, where evaluation of patients took place outside of actual assessments, for example, for rehabilitation.

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Thyroid Hormone Treatment In Pregnant Women With Subclinical Hypothyroidism

MedicalResearch.com Interview with:

Dr. Spyridoula Maraka Assistant professor of medicine Division of Endocrinology and Metabolism Center for Osteoporosis and Metabolic Bone Diseases University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System Little Rock Arkansas

Dr. Spyridoula Maraka

Dr. Spyridoula Maraka
Assistant professor of medicine
Division of Endocrinology and Metabolism
Center for Osteoporosis and Metabolic Bone Diseases
University of Arkansas for Medical Sciences and
Central Arkansas Veterans Health Care System
Little Rock Arkansas

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

Response: Subclinical hypothyroidism, a mild thyroid dysfunction, has been associated in pregnancy with multiple adverse outcomes. Our aim was to estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.

Using a large national US dataset, we identified 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated.

Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to experience a preterm delivery, gestational diabetes or preeclampsia. Moreover, the benefit of thyroid hormone treatment on pregnancy loss was seen only among women with higher TSH levels (4.1 to 10 mIU/L) before treatment. We also found that for women with lower levels of TSH (2.5–4.0 mIU/L), the risk of gestational hypertension was significantly higher for treated women than for untreated women.

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Non-Dialysis Chronic Kidney Disease Expenses On Par With Cancer and Stroke

MedicalResearch.com Interview with:

Talar W. Markossian PhD MPH Assistant Professor of Health Policy Loyola University Chicago 2160 S. First Ave, CTRE 554 Maywood, IL 60153

Dr. Talar Markossian

Talar W. Markossian PhD MPH
Assistant Professor of Health Policy
Loyola University Chicago
2160 S. First Ave, CTRE 554
Maywood, IL 60153

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

Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses.

We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent chronic kidney disease and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke. Continue reading

Reasons for Drug Policy Reform: Millions of People are Left with Untreated Pain

MedicalResearch.com Interview with:
Dr. Katherine Irene Pettus, PhD, OSB

Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs
Secretary NGO Committee on Ageing, Geneva

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

Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries.

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Women From Disadvantaged Backgrounds More Likely To Have Heart Disease

MedicalResearch.com Interview with:
Sanne Peters, PhD

Research Fellow in Epidemiology
The George Institute for Global Health
University of Oxford
Oxford United Kingdom

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

Response: People from disadvantaged backgrounds are, on average, at greater risk of cardiovascular diseases than people with more affluent backgrounds. Some studies have suggested that these socioeconomic inequalities in cardiovascular disease are more consistent and stronger in women than in men. However, the literature is inconsistent.

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Link Between Antidepressants During Pregnancy and Birth Defects

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE

Research chair FRQ-S on Medications and Pregnancy and
Director, Réseau Québécois de recherche sur le médicament (RQRM)
and Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy University of Montreal and
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine 

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

Response: We have over 20 years of research showing that antidepressant use during the first trimester of pregnancy increases the risk of major congenital malformations. However, it still remains that controversies exist because we are not sure which of this increased risk is due to maternal depression. Therefore, we have only studied depressed pregnant women – some of them did not take antidepressant during pregnancy.

We were able to show that among depressed pregnant women, those who took antidepressants were at increased risk of having children with malformations – especially those taking citalopram. We were also able to show that many SSRIs, SNRI and tricyclic antidepressants put women at increased risk of having children with various malformations due to their similar mechanism of action (serotonin inhibition in utero).

MedicalResearch.com: What should readers take away from your report?

Response: Depression is a serious condition that requires medical attention during pregnancy. However, given that up to 85% of depressed pregnant women have mild to moderate depression – other treatment (other than antidepressants) options need to be considered. If a woman finds out she is pregnant and is taking antidepressants however, no abrupt discontinuation is suggested and a discussion with a health care provider is advised.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Very few data on the benefits of antidepressant use during pregnancy is available within depressed pregnant women with mild to moderate depression. Our study results taken together with all the body of literature on this topic should lead to other research on the benefits and risks of other forms of treatment for depression such as psychotherapy.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Anick Bérard, Jinping Zhao and Odile Sheehy. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: An updated analysis of the Quebec Pregnancy Cohort. BMJ Open, January 2017 DOI: 10.1136/bmjopen-2016-01337

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

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Financial Ties of Principal Investigators Associated With Positive Outcomes

MedicalResearch.com Interview with:
Salomeh Keyhani MD
Associate professor of general internal medicine
San Francisco VA Medical Center and University of California
San Francisco, CA 94121, USA

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

Response: Randomized controlled trials are the foundation of the evidence base. We examined the prevalence of financial ties in randomized controlled trials and also examined the relationship of financial ties of principal investigators (PI) with trial outcome. We defined a financial tie as the direct compensation (e.g., consulting fees) of a PI by the drug manufacturer of interest. Although there have been past studies that have examined this relationship, many did not separate financial ties from funding source for the trial and many were focused on one specialty, journal, or type of drug.

This study identified a random sample of RCTs published in 2013 that were focused on assessing drug efficacy. Both the disclosure section of the paper and several online databases (Medline, Google, Propublica’s Dollars for Doctors, and the US Patent Office) were searched for evidence of financial ties. Principal investigators financial ties with industry were independently associated with positive study outcomes.

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Does HAART Treatment for HIV Contribute To Rapid Rise in Syphilis Infections?

MedicalResearch.com Interview with:

Michael Rekart, MD, DTM&H Clinical Professor, Medicine and Global Health The University of British Columbia .... On behalf of my co-authors

Dr. Michael Rekart

Michael Rekart, MD, DTM&H
Clinical Professor, Medicine and Global Health
The University of British Columbia
…. On behalf of my co-authors

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

Response: The background for this study is the observation that new syphilis cases over the last decade in British Columbia, Canada, have been escalating more rapidly than anyone could have predicted and that syphilis incidence has outpaced the incidence of other sexually transmitted diseases (STDs), including gonorrhea and chlamydia. This unexpected increase in syphilis has been almost wholly concentrated in men who have sex with men (MSM). Most of these MSM are HIV-1 infected and many are taking highly active antiretroviral therapy (HAART). In fact, the expansion in HAART coverage in MSM parallels the growth in syphilis in the same population. In addition, my co-authors and I had serious doubts as to whether ‘treatment optimism’, the generally accepted explanation for this phenomenon, was robust enough to account for such a dramatic increase in new syphilis cases. Treatment optimism posits that HAART availability and effectiveness have led to the perception in both HIV-1-infected and HIV-1-uninfected individuals that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhea, chlamydia and syphilis.

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Migraine Increases Risk of Perioperative Stroke and Hospital Readmission

MedicalResearch.com Interview with:

Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia, Harvard Medical School Clinical Director, Critical Care Division

Dr. Matthias Eikermann

Dr. Matthias Eikermann, MD, PhD
Associate Professor of Anaesthesia
Harvard Medical School
Clinical Director, Critical Care Division 

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

Response: Up to one fifth of the general population have migraine, a primary, chronic-intermittent headache disorder affecting the neuronal and vascular systems and characterized by severe headache accompanied by nausea and/or sensory hypersensitivities such as photophobia and phonophobia. In approximately 20-30% of patients, the headache phase is preceded or accompanied by transient focal neurological disturbances presenting as visual symptoms but also sensory, aphasic, or motor symptoms known as migraine aura.

Stroke is responsible for approximately 6.2 million deaths a year and is a leading global cause of long term disability. Considering that more than 50 million patients in hospital and 53 million ambulatory patients undergo surgical procedures in the United States every year.

We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge.

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Shock-Absorbing Insoles Probably Don’t Prevent Injuries

MedicalResearch.com Interview with:
Daniel Bonanno

Lecturer & 3rd Year Podiatry Co-ordinator
Discipline of Podiatry, College of Science, Health, and Engineering
La Trobe University
Victoria Australia

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

Response: Foot orthoses and shock-absorbing insoles are commonly used for the prevention of many musculoskeletal disorders of the lower extremity, so this review summarized the findings of existing clinical trials that evaluated their effectiveness for preventing such injuries.

The main findings of our review were that foot orthoses were found to be effective for preventing overall injuries and stress fractures, but not soft-tissue injuries.

Regarding shock-absorbing insoles, there is no evidence to date to support their use for the prevention of injury.

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Cured Meat Linked To Worsening of Asthma Symptoms

MedicalResearch.com Interview with:
Zhen LI, MD, MPH, PhD Candidate

INSERM UMR-S 1168 (ex-Equipe 5 du CESP)
(VIMA : Aging and chronic diseases. Epidemiological and public health approaches.), Hôpital Paul Brousse
France

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

Response: -Cured meat, which is rich in nitrite, has been known as a probable carcinogen. However, although some studies have suggested a potential deleterious role of cured meat intake in lung health, its role in asthma remained unknown.

This study was conducted using data from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA). Using data from 971 participants with seven years’ follow-up, we found that participants who ate frequently cured meat, including ham, sausages, and dried sausages, had a high likelihood of having worsening asthma symptoms. The highest likelihood (76% more) was observed among participants who ate cured meats four or more servings per week, compared with those who ate less than one serving per week. Moreover, as previous studies suggested that obesity is linked to worsening asthma, we used a newly developed method to estimate if this effect was mediated by Body Mass Index (BMI), and we found that overweight/obesity only partly explained the association (14%).

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Children Can Choke to Death on Grapes

MedicalResearch.com Interview with:
Dr Jamie G Cooper

Consultant in Emergency Medicine
Aberdeen Royal Infirmary
Aberdeen UK

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

MedicalResearch.com Interview with: Jamie Cooper Consultant in Emergency Medicine Aberdeen Royal Infirmary Aberdeen MedicalResearch.com: What is the background for this study? Response: Choking in children can be fatal and regularly grapes can be the cause. We believe that public awareness of the choking hazard posed by grapes (and other similarly shaped foods, such as cherry tomatoes) is not wide spread. By publishing this article we aimed to highlight the problem to health professionals who look after children and also to the public at large in an attempt to reduce the number of future episodes. MedicalResearch.com: What are the main findings? Response: With parental consent we published the cases of three small children who suffered choking episodes as a result of whole grapes, two of whom died as a result. In each case it was not possible to dislodge the grape using first aid techniques. MedicalResearch.com: What should readers take away from your report? Response: Small children are at risk from choking because they have smaller airways, reduced ability to chew foods, underdeveloped swallowing coordination and can be easily distracted when eating. Grapes are a healthy and popular snack but are ideally suited to cause airway obstruction, particularly if inhaled whole. Small children (up to 5 years) should always be supervised by adults while eating; and grapes should be halved, or ideally quartered, before consumption. We hope that by drawing attention to this issue that consideration will be given at a political level to wider dissemination of this information so as to prevent further occurrences. MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: BMJ The choking hazard of grapes: a plea for awareness Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Grapes
Wikipedia image

Response: Choking in children can be fatal and regularly grapes can be the cause.  We believe that public awareness of the choking hazard posed by grapes (and other similarly shaped foods, such as cherry tomatoes) is not wide spread.  By publishing this article we aimed to highlight the problem to health professionals who look after children and also to the public at large in an attempt to reduce the number of future episodes.

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Centrally-Acting Obesity Medications May Have Significant Side Effects

MedicalResearch.com Interview with:

Igho Onakpoya MD MSc University of Oxford Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health Sciences Oxford UK

Dr. Igho Onakpoya

Igho Onakpoya MD MSc
University of Oxford
Centre for Evidence-Based Medicine
Nuffield Department of Primary Care Health Sciences
Oxford UK

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

Response: Several medicines used to treat obesity have been withdrawn from the market over the last few years. However, the reasons for, and time trends about their withdrawals have not been systematically researched.

We identified 25 anti-obesity medicines withdrawn from the market over the last 50 years. 23 of these analogues of amphetamine or fenfluramine, i.e., neurotransmitters.

The reasons for withdrawal in the overwhelming majority of instances were cardiovascular or psychiatric adverse reactions, and drug abuse and dependence.

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Young Smokers Have Drastic Increase in Heart Attack Risk

MedicalResearch.com Interview with:

Dr. Kevin Campbell MD FACC Wake Heart and Vascular Assistant Professor of Medicine,  UNC School of Medicine Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson North Carolina.

Dr. Kevin Campbell

Dr. Kevin Campbell MD FACC
Wake Heart and Vascular
Assistant Professor of Medicine,  UNC School of Medicine
Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson
North Carolina 

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

Response: In this study, data was analyzed from nearly 1800 patients who had ST elevation MI.  Findings were published in Heart.  They found that younger  smokers (age under the age of 50)  had an 8-fold increased risk of acute STEMI , when compared to ex- and never smokers.

In addition, researchers found that current smokers of all ages were 3.26 times more likely to have STEMI than ex- and never-smokers—suggesting that if you stop smoking, you can reduce your risk for heart attack.

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