Artificial Sweeteners May Be Bad For Your Waistline and Your Heart

MedicalResearch.com Interview with:

Dr. Azad

Dr. Azad

Meghan Azad PhD
Assistant Professor, Department of Pediatrics & Child Health and Community Health Sciences, University of Manitoba; Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study
Research Scientist, Children’s Hospital Research Institute of Manitoba; co-Lead, Population Health Pillar, Developmental Origins of Chronic Diseases in Children Network

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

Response: Consumption of artificial sweeteners, such as aspartame, sucralose and stevia, is widespread and increasing.  Emerging data indicate that artificial, or non-nutritive, sweeteners may have negative effects on metabolism, gut bacteria and appetite, although the evidence is conflicting.

MedicalResearch.com: What are the main findings?

Response: We conducted a systematic review of 37 studies that collectively followed over 400,000 people for an average of 10 years.

Only 7 of these studies were randomized clinical trials (the gold standard in clinical research), involving 1003 people followed for 6 months on average. The trials did not show a consistent effect of artificial sweeteners on weight loss, and the longer observational studies showed a link between consumption of artificial sweeteners and relatively higher risks of weight gain and obesity, high blood pressure, diabetes, heart disease and other health issues.

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Perinatal and Maternal Adverse Events After Attempted Operative Vaginal Delivery at MidPelvic Station

MedicalResearch.com Interview with:

Giulia Muraca, MPH, PhD(c) Vanier Canada Graduate Scholar School of Population and Public Health Child & Family Research Institute Faculty of Medicine University of British Columbia

Dr. Muraca

Giulia Muraca, MPH, PhD(c)
Vanier Canada Graduate Scholar
School of Population and Public Health
Child & Family Research Institute
Faculty of Medicine
University of British Columbia 

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

Response: The rate of cesarean delivery has increased dramatically over the last 30 years. And in an effort to curb the rising trend in caesarean delivery, The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have recently advocated for increased use of operative vaginal delivery (forceps/vacuum delivery) as a strategy to reduce the cesarean delivery rate. The evaluation of approaches to achieve this end are underway and the current discourse surrounding operative vaginal delivery centers on methods to promote these important skills. But, the truth is, we don’t yet fully understand the balance of risks and benefits to mothers and their babies following operative vaginal delivery compared with caesarean delivery.

The preferred choice given these two options relies heavily on how far the baby’s head has descended in the birth canal. If the baby’s head has descended far enough that it is visible and on the perineum, then the use of an instrument has clear advantage. However, when the fetal head is engaged in the maternal pelvis, but has not descended so far down the birth canal, the decision between these modes of delivery becomes much less clear. These deliveries are called midpelvic deliveries. And it’s an increase in these midpelvic deliveries that would have the most potential as a strategy to reduce the cesarean delivery rate, and as a result, it is these deliveries that we were interested in studying.

Operative vaginal deliveries are carried out in approximately 14% of all term births in Canada and those that occur when the baby is at midpelvic station account for over 20% of all operative vaginal deliveries. This translates to about 2-3% of all term, singleton deliveries in Canada or about 10,000 deliveries per year overall.

The literature on perinatal and maternal outcomes contrasting midpelvic operative vaginal delivery and caesarean delivery is based on studies undertaken 25 to 30 years ago that are no longer reflective of the current obstetric practice.  This was the impetus for our study. We reasoned that before we decide to encourage increased OVD we should first get a sense of the safety of such procedures compared to cesarean delivery as provided by contemporary maternity care providers.

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Pregnant Women Exposed To Cold Temperatures May Have Lower Risk of Gestational Diabetes

MedicalResearch.com Interview with:

Dr. Gillian Booth PhD Researcher at St. Michael's and the Institute for Clinical Evaluative Sciences (ICES)

Dr.Gillian Booth

Dr. Gillian Booth PhD
Researcher at St. Michael’s and the
Institute for Clinical Evaluative Sciences (ICES)

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

Response: The impact of climate change on health is becoming increasingly relevant given the rise in global air temperature, and there is growing evidence supporting a link between air temperature, metabolic function, and energy expenditure. We know from animal models and small studies in humans that cold exposure and activate a type of fat known as brown fat and it appears that this process can improve sensitivity to insulin. However no studies have yet looked at air temperature and the development of diabetes. So we decided to examine the relationship between outdoor air temperature and gestational diabetes – a temporary form of diabetes that arises in the second trimester of pregnancy.

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Fetal Reduction in Multifetal Pregnancies Results in Fewer Preterm Births and Deaths

MedicalResearch.com Interview with:

Neda Razaz, PhD, MPH Postdoctoral Fellow Reproductive Epidemiology Unit Karolinska Institutet

Dr. Razaz

Neda Razaz, PhD, MPH
Postdoctoral Fellow
Reproductive Epidemiology Unit
Karolinska Institutet

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

Response: Multiple births of twins and triplets – and the associated health risks – have increased in many high-income countries, with a respective two-fold and three-fold increase in recent decades.

In Canada, triplet births or higher have increased from 52.2 per 100 000 live births to 83.5 between 1991 and 2009, mainly because of an increase in fertility treatments for older women of child-bearing age. In this study we found that among twin and triplet pregnancies that were reduced to singleton or twin pregnancies, there was a substantial reduction in complications such as preterm birth and very preterm birth. Although rates of death and serious illness were not lower among all multifetal pregnancies that were reduced, pregnancies that resulted from fertility treatments did show a significant reduction in rates of death or serious illness following fetal reduction.

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Some Antibiotics Linked To Increased Risk of Miscarriage

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

Dr. Anick Bérard

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

MedicalResearch.com: The Danish study you cite reported a connection between antibiotics and miscarriage – why was further research of this topic necessary?

Response: Given that a single study will assess an association, repetition of findings are essential in order to assess causality. For example, we were able to conclude that smoking was causing lung cancer after 10 years of observational research on the topic showing concordant associations.

In addition, antibiotic prescription patterns vary from country to country, hence the importance of studying the research question in various patient populations.

Finally, our cohort has validated exposure status, gestational age (first day of pregnancy) and miscarriage cases – our study was also able to look at types of antibiotics.

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Failed Fertility Therapy Linked To Increased Risk of Heart Disease

MedicalResearch.com Interview with:

Jacob A. Udell MD MPH FRCPC Cardiovascular Division Women's College Hospital Toronto General Hospital University of Toronto

Dr. Jacob Udell

Jacob A. Udell MD MPH FRCPC
Cardiovascular Division
Women’s College Hospital
Toronto General Hospital
University of Toronto 

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

Response: We’ve noticed for a long time that fertility drug treatment can cause short-term complications such as high blood pressure or diabetes in pregnancy. We recently started wondering whether there may be long term consequences for these women years after a baby was or was not born.  To do this, we looked at all women who were treated with fertility therapy in Ontario for the last 20 years, from what we could determine this amounted to more than 28,000 women. We then followed up years later to examine every woman’s cardiovascular health.

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Lifestyle Modifications May Improve Health and Prognosis in Breast Cancer Patients

MedicalResearch.com Interview with:
Ellen Warner, MD, FRCPC, FACP, M.Sc.
Affiliate scientist
Sunnybrook Health Sciences Centre
Toronto, ON

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

Response: As a medical oncologist who has treated breast cancer patients for over 30 years, I have found that most of the women in my practice are desperately looking for things they can do beyond standard surgery, radiation, chemotherapy, etc. to increase their chance of cure.  Unfortunately, many fall prey to false claims they read over the Internet or hear from well-meaning friends and relatives.  As a result they turn to absurdly restrictive diets (eg. No meat, dairy or sugar) or to ‘supplements’ with unproven effectiveness or even safety. So I thought it would be helpful to review the literature to determine what evidence-based lifestyle changes these women could make that would at least improve their overall health and, ideally, reduce their risk of dying of recurrent breast cancer.  For this review I thought it would be great to team up with Julia Hamer, a pre-med student with a degree in nutrition who just happens to also be an Olympic level athlete!
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Association Between Statin Use and Ischemic Stroke or Hemorrhage in Patients Taking Dabigatran for A Fib

MedicalResearch.com Interview with:

Dr-Tony-Antoniou.jpg

Dr. Tony Antoniou

Dr. Tony Antoniou, PhD Research Scholar
Department of Family and Community Medicine and a Scientist
Keenan Research Centre of the Li Ka Shing Knowledge Institute
St. Michael’s Hospital
Assistant Professor in the Department of Family and Community Medicine and
Leslie Dan Faculty of Pharmacy
University of Toronto, Toronto, Ontario

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

Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate.

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Benefits and Harms of Duloxetine For Treatment of Stress Urinary Incontinence

MedicalResearch.com Interview with:
Emma Maund, MSc PhD
Nordic Cochrane Centre

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

Response: Duloxetine has been approved in Europe for the treatment of stress urinary incontinence in women. It is not approved for this indication in the US and Canada. Currently, reasons why marketing authorization applications are withdrawn or denied are not published by either the Canadian or the US drug agency. However, the FDA has said that a higher-than-expected rate of suicide attempts – 2.6 timer higher – was observed in the open-label extensions of controlled trials of duloxetine for stress urinary incontinence. Given the FDA’s statement about the rate of suicide attempts, we wanted to determine whether duloxetine increased the risk of suicidality, violence or their possible precursors (drug induced akathisia, an extreme type of restlessness; activation, which consists of stimulating effects such as insomnia, anxiety and agitation; emotional disturbance, such as depersonalization and derealization; or psychotic events, such as delusions and hallucinations) in the randomized phases of the trials.

We therefore assessed the benefits and harms of duloxetine in stress urinary incontinence using clinical study reports, including individual patient data, of the 4 main trials submitted by Eli Lilly to the European Medicines Agency.
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Immunity to the Acellular Whooping Cough Vaccine Wanes With Time

MedicalResearch.com Interview with:
Dr. Kevin Schwartz, MD MSc
Infection Prevention and Control Physician
Infection Prevention and Control
Public Health Ontario | Santé publique Ontario

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

Response: There has been a resurgence of pertussis, or ‘whooping cough’, in several countries and regions since the introduction of the new “acellular” pertussis vaccine in the 1990s to replace the older “whole cell” vaccine. In Ontario, we have not seen large increases but observed a small outbreak in 2012 that affected both unvaccinated people, as well as in those who have been vaccinated against pertussis. Our objective was to evaluate the effectiveness of the current acellular vaccine used in Ontario. We wanted to find out whether immunity wanes with time in the same way as had been previously observed during a large outbreak in California. We also wanted to study the impact of receiving the older ‘whole cell’ vaccine, which we used in Ontario until 1997.

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