Author Interviews, Gastrointestinal Disease, JAMA, Nutrition, Sugar / 23.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47100" align="alignleft" width="133"]Miriam Vos, MD, MSPH Assistant professor of Pediatrics Emory University School of Medicine Physician on staff, Children’s Healthcare of Atlanta Dr. Vos[/caption] Miriam Vos, MD, MSPH Associate Professor of Pediatrics and Director Pediatric Fatty Liver Program Emory and Children’s Healthcare of Atlanta MedicalResearch.com: What is the background for this study? What are the main findings? Response: Fatty liver disease has quickly become a common problem in children and adolescents, affecting an estimated 7 million children in the U.S.  This study resulted from our previous research demonstrating that fructose increases cardiometabolic risk factors in children with NAFLD in addition to other research that had demonstrated associations between NAFLD and sugar.   
Author Interviews, End of Life Care, JAMA, Kidney Disease / 22.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47065" align="alignleft" width="174"]Susan P. Y. Wong, MD MS Assistant Professor Division of Nephrology University of Washington VA Puget Sound Health Care System  Dr. Wong[/caption] Susan P. Y. Wong, MD MS Assistant Professor Division of Nephrology University of Washington VA Puget Sound Health Care System  MedicalResearch.com: What is the background for this study? Response: Patients who reach the advanced stages of kidney disease  must often face the difficult decision of whether to undergo maintenance dialysis. While maintenance dialysis is a remarkable therapy that has extended the lives of many patients, its benefits do not necessarily accrue in older patients with significant comorbidity and functional impairment. It is also a very demanding form of therapy that comes with its own burdens and complications. Based on our prior research in the national VA health system, 1 in 7 patients with very advanced kidney disease (or their decision makers) do not pursue dialysis. We wanted to understand how these decisions to forgo initiation of maintenance dialysis unfold.
Author Interviews, Diabetes, Infections, JAMA, Pediatrics, Vaccine Studies / 22.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47077" align="alignleft" width="200"]Dr Kirsten Perrett MBBS FRACP PhD Team Leader / Clinician-Scientist Fellow, Population Allergy, Murdoch Children's Research Institute Consultant Paediatrician, Department of Allergy and Immunology and General Medicine The Royal Children's Hospital Fellow, School of Population and Global Health, The University of Melbourne Murdoch Children's Research Institute Parkville, Victoria  Australia Dr. Kirsten Perrett[/caption] Dr Kirsten Perrett MBBS FRACP PhD Team Leader / Clinician-Scientist Fellow, Population Allergy, Murdoch Children's Research Institute Consultant Paediatrician, Department of Allergy and Immunology and General Medicine The Royal Children's Hospital Fellow, School of Population and Global Health The University of Melbourne Parkville, Victoria  Australia MedicalResearch.com: What is the background for this study? Response: Before rotavirus vaccines were available, rotavirus infection was the most common cause of severe gastroenteritis in infants and young children. Because it is so contagious, infection in childhood is thought to be universal in unvaccinated children. Previous studies indicated that rotavirus infection of infants might be an environmental promoter of type 1 diabetes. Therefore, we anticipated that the introduction of the rotavirus vaccine might alter the disease incidence in young children. 
Author Interviews, Breast Cancer, Cancer Research, JAMA, Leukemia / 21.01.2019

MedicalResearch.com Interview with: medicalresearch.comDr. Marie Joelle Jabagi, PharmD, MPH University of Paris Sud, Paris-Saclay University, Paris Health Product Epidemiology Department French National Agency for Medicines and Health Products Safety Saint-Denis, France MedicalResearch.com: What is the background for this study? Response: Secondary hematologic malignant neoplasms that develop months or years after the diagnosis of breast cancer may be a consequence of genetic predisposition, environmental factors, previous cancer treatments or a combination of all those factors. These secondary malignant neoplasms are increasingly becoming a concern given that the population of breast cancer survivors is growing substantially. However, their frequency in real life has been poorly investigated to date. The aims of our research were to estimate the frequency of various types of hematologic malignant neoplasm following a diagnosis of primary breast cancer among women aged 20 to 85 years in France during the past decade, and to compare it to the corresponding frequency in women of the French general population.
Author Interviews, Genetic Research, Hearing Loss, JAMA, Karolinski Institute / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46982" align="alignleft" width="200"]Christopher R. Cederroth | Ph.D. Docent Associate Professor Experimental Audiology | Department of Physiology and Pharmacology Karolinska Institutet  Sweden Dr. Cederroth[/caption] Christopher R. Cederroth | Ph.D. Docent Associate Professor Experimental Audiology | Department of Physiology and Pharmacology Karolinska Institutet Sweden MedicalResearch.com: What is the background for this study? Response: Tinnitus is experienced is experienced by a large proportion of the population and affects more than 15% of the population worldwide (estimated 70 million people in Europe). However, for near 3% of the population, tinnitus becomes a chronic bothersome and incapacitating symptom. Severe tinnitus interferes with sleep, mood, and concentration and thus impacts life quality, ultimately leading to sick leave and disability pension. A high cost to society has been reported, and since the prevalence of tinnitus has been predicted to double in Europe by 2050, there is an important need for an effective treatment. And today there are none, with the exception of cognitive behavioral therapy, which helps coping with it but does not remove the tinnitus. There has been a number of innovative treatment approaches, but they are overall not successful and it is now agreed that it is likely because tinnitus is a heterogeneous condition – meaning that we cannot consider tinnitus a single entity but an ensemble of different forms or subtypes, which need to be defined. Tinnitus has always been considered a condition influenced by environmental factors, but our initial studies suggested the opposite. Adoption studies are excellent in showing the influence of shared-environment effects and establish a genetic basis for a disease or a trait. It allows to test the transmission of a trait between the adoptee and their biological or their adoptive parent. Transmission via the biological parent is expected to be due to a heritable genetic effect, while transmission via the adoptive parent is associated with home-environment, the so-called shared-environmental effect. We used medical registry data to identify tinnitus patients and adoptees.
Author Interviews, Depression, Dermatology, JAMA, Mental Health Research / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47053" align="alignleft" width="200"]Isabelle Vallerand, PhD Epidemiologist, MD Student Department of Community Health Sciences Cumming School of Medicine University of Calgary Dr. Vallerand[/caption] Isabelle Vallerand, PhD Epidemiologist, MD Student Department of Community Health Sciences Cumming School of Medicine University of Calgary MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that patients with alopecia areata, a form of autoimmune hair loss, are at a higher risk of suffering from depression than the general population. But in practice, we often hear patients tell us that they believe their hair loss developed as a result of stress or problems with mental health – certainly the phrase “so stressed your hair is falling out” is something most people have heard of. Despite this, there has actually been very little research investigating the role that mental health may have on development of alopecia areata. Interestingly, depression has recently been associated with increased systemic inflammatory markers, so there is biologic plausibility that depression could increase the risk of alopecia areata. Our group was interested in addressing this question, and used a large population-level health records database with up to 26 years of follow-up to study it. We ultimately found that not only does depression increase one’s risk of alopecia areata, but that it increases their risk by nearly 90% compared to people who have never had depression. We also found that using antidepressants can significantly decrease the risk of developing alopecia areata in patients with depression. So there appears to be an important link between mental health and development of hair loss from alopecia areata.
Author Interviews, Global Health, JAMA, Mental Health Research, Pediatrics, UCLA, Zika / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47036" align="alignleft" width="200"]Karin Nielsen-Saines, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases  David Geffen School of Medicine at UCLA Dr. Nielsen[/caption] Karin Nielsen-Saines, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases David Geffen School of Medicine at UCLA MedicalResearch.com: What is the background for this study? Response: Our study used a very simple evaluation called GMA (General Movement Assessment tool) which checks baby movements at approximately 3 to 5 months of age. We examined 111 babies exposed to maternal illness during the Zika epidemic in Brazil and 333 control babies without this exposure by GMA at 3 months  and then tested them through standard neurodevelopmental tests at the age of 12 months. We found that this simple evaluation, which consists of filming a baby lying down on their back for one minute and studying their movements worked extremely well in predicting which babies would or would not have future problems in their neurodevelopment. The study advances knowledge in the area because a simple one minute video of a baby can predict neurodevelopment, something that is extremely hard to determine in young babies.  This is true even in places where sophisticated brain scans are available. By identifying which babies are at risk of developmental problems early on, professionals can rapidly refer these babies to  stimulation programs when they are very young, which increases their chances of having better outcomes. Because the brains of young children respond much better  to stimulation, the timing of interventions to improve their development is very important, that is why they need to be identified early.
Author Interviews, Health Care Systems, JAMA / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47027" align="alignleft" width="160"]David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania Dr. Shulkin[/caption] David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings?  Response: I came to VA in 2015 as Under Secretary for Health, as a result of the 2014 wait time crisis.  At that time, it was determined that in some locations, veterans had been waiting for care for too long and there were allegations that this had resulted in harm to a number of veterans.  I was in the private sector at the time, but was asked by President Obama to come and help improve the situation. Upon my arrival we created systems to determine which veterans were waiting for urgent healthcare and which ones for routine care.  From here, we established same day services for all veterans waiting for urgent care through primary care and behavioral health access points.  This goal was achieved nationwide at the end of 2016.  When I became Secretary in 2017,  we began publishing our wait time data for all to see, so that veterans had accurate information on which to base their choices on and to provide transparency into where we were improving and where we needed to focus our efforts.  In addition, through programmatic and legislative efforts, we expanded our utilization of private sector options so that veterans with clinical needs would be able to get better access to care. This study was meant to determine whether our efforts from 2014 had resulted in improvements to access and in addition how access to care in the VA compared to access in the private sector.   Despite limitations in the data available from the private sector (since others do not publish their actual wait time data similar to VA) we used a data set that we felt had some applicability for these comparisons. We found that for the most part, VA wait times are often shorter than in the private sector,  and that VA wait times had improved since 2014 while the private sectors access had stayed the same. 
Allergies, Author Interviews, JAMA / 18.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47008" align="alignleft" width="150"]ESS= Erica S. Shenoy, MD, PhD Harvard Medical School Dr. Shenoy[/caption] ESS= Erica S. Shenoy, MD, PhD Harvard Medical School Division of Infectious Diseases, Department of Medicine Massachusetts General Hospital, Boston [caption id="attachment_47011" align="alignleft" width="150"]Kimberly G. Blumenthal MD, MSc Division of Rheumatology, Allergy and Immunology Department of Medicine, Massachusetts General Hospital, Boston Dr. Blumenthal[/caption] KGB= Kimberly G. Blumenthal MD, MSc Division of Rheumatology, Allergy and Immunology Department of Medicine, Massachusetts General Hospital,Boston   [caption id="attachment_47012" align="alignleft" width="100"]EMM= Eric M. Macy MD, MS Department of Allergy Southern California Permanente Medical Group San Diego Medical Center Dr. Macy[/caption] EMM= Eric M. Macy MD, MS Department of Allergy Southern California Permanente Medical Group San Diego Medical Center [caption id="attachment_47013" align="alignleft" width="150"]TR= Theresa Rowe, DO, MS General Internal Medicine and Geriatrics Feinberg School of Medicine Northwestern University, Chicago, Illinois Dr. Rowe[/caption] TR= Theresa Rowe, DO, MS General Internal Medicine and Geriatrics Feinberg School of Medicine Northwestern University, Chicago, Illinois MedicalResearch.com: What is the background for this review? ESS: A key component of reducing antimicrobial resistance is improving how antimicrobials are prescribed—both reducing inappropriate use (i.e., not prescribing when not needed) and favoring the use of narrow-spectrum agents that are less likely to contribute to the development of antimicrobial resistance. KGB: Because unverified penicillin allergy labels are so prevalent with greater than 32 million Americans affected, and these labels lead to the use of alternative antibiotics that are often more broad-spectrum, we now know that penicillin allergy evaluations are an emerging important component of antibiotic stewardship.  When patients with a reported penicillin allergy are tested, more than 95% of them are not allergic, and thus could (and should) receive penicillins, and often related drugs, when appropriate.
Author Interviews, Cost of Health Care, Heart Disease, Inflammation, JAMA, Stanford / 17.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46992" align="alignleft" width="150"]Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte Dr. Sehested[/caption] Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte [caption id="attachment_46991" align="alignleft" width="150"]Jenny Bjerre, MD Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen, Denmark Department of Health Research and Policy Stanford University School of Medicine Stanford, California Dr. Bjerre[/caption]   Jenny Bjerre, MD Department of Cardiology Copenhagen University Department of Health Research and Policy Stanford University School of Medicine Stanford, California   MedicalResearch.com: What is the background for this study? Response: n 2017, the results from the much-awaited Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial were published, confirming the inflammatory hypothesis, i.e. that targeting inflammation can reduce cardiovascular disease. The trial tested the monoclonal antibody canakinumab in a population of post-myocardial infarction patients with elevated inflammation markers (hs-CRP). Canakinumab is currently used for rare diseases and carries an orphan drug price: the 150mg dose used in CANTOS costs approximately $73,000 per year. Due to the high prevalence of cardiovascular disease, millions of patients could potentially be eligible for treatment with this high-priced anti-inflammatory drug. Therefore, we wanted to investigate the cost-effectiveness for canakinumab for secondary prevention of cardiovascular disease, using the reported results from CANTOS.
Author Interviews, Gastrointestinal Disease, JAMA, Microbiome / 16.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46964" align="alignleft" width="200"]Samuel P. Costello MBBS Inflammatory Bowel Disease Service, Department of Gastroenterology, The Queen Elizabeth Hospital Australia Dr. Costello[/caption] Samuel P. Costello MBBS Inflammatory Bowel Disease Service, Department of Gastroenterology The Queen Elizabeth Hospital Australia MedicalResearch.com: What is the background for this study? Response: Ulcerative colitis (UC) is an inflammatory bowel disease that has high rates of persistent or relapsing symptoms despite available therapies. Many of these therapies also have the potential for unacceptable side effects including allergy, intolerance, serious infection and malignancy due to long-term immunosuppression. It is for these reasons that new therapies for Ulcerative colitis are required; particularly therapies that target novel pathways and are not immune suppressing.
Author Interviews, Dermatology, Diabetes, JAMA / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46959" align="alignleft" width="259"]Example of Bullous Pemphigoid Derm NZ image Example of Bullous Pemphigoid
Derm NZ image[/caption] Dong Hyun Kim M.D. Associate professor Department of Dermatology CHA Bundang Medical Center CHA University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: As a dermatologist, we see many patients with newly diagnosed with bullous pemphigoid (BP), many of whom have diabetes. The use of DPP-4 inhibitors is a common treatment for diabetes, we have noted previous case reports that DPP-4 inhibitors may be the cause of BP. For this reason, we started this study. The most important thing in my article is DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of bullous pemphigoid in male patients with diabetes. We have confirmed these points based on the nationwide, population-based study. It is very meaningful because there have been few studies using large sample sizes so far.
Author Interviews, JAMA, Pediatrics, Transplantation, Vaccine Studies / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46956" align="alignleft" width="152"]Amy G. Feldman, MD, MSCS Assistant Professor, Pediatrics-Gastroenterology, Hepatology and Nutrition Program Director, Liver Transplant Fellowship Children's Hospital Colorado  University of Colorado Medicine Dr. Feldman[/caption] Amy G. Feldman, MD, MSCS Assistant Professor, Pediatrics-Gastroenterology, Hepatology and Nutrition Program Director, Liver Transplant Fellowship Children's Hospital Colorado University of Colorado Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pediatric solid organ transplant recipients are at increased risk for vaccine preventable infections due to life-long immunosuppressive medications.  The objectives of this study were to 1) evaluate in pediatric    solid organ transplant recipients the number of hospitalizations for vaccine-preventable infections in the first five years post-transplantation and 2) determine the associated morbidity, mortality and costs. In this multicenter cohort study of 6980 children who underwent solid organ transplantation from January 1, 2004, to December 31, 2011, at a center participating in Pediatric Health Information System (PHIS), 15% of individuals had at least 1 hospitalization for a vaccine-preventable infection in the first 5 years after transplant.  Children who received transplants when they were younger than 2 years and recipients of lung, intestine, heart, and multi-visceral organs were at increased risk for hospitalization with a vaccine-preventable infection.  Transplant hospitalizations complicated by a vaccine-preventable infection were $120,498 more expensive (median cost) and were on average 39 days longer than transplant hospitalizations not complicated by vaccine-preventable infections
Author Interviews, CDC, Infections, JAMA, Pediatrics / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46953" align="alignleft" width="200"]Dr. Nanduri Srinivas Acharya, MBBS, MD, MPH Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Roybal Campus Atlanta, GA 30333 Dr. Nanduri[/caption] Dr. Srinivas Acharya Nanduri, MBBS, MD, MPH Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Roybal Campus Atlanta, GA 3033 MedicalResearch.com: What is the background for this study? Response: Group B Streptococcus (GBS) is a leading cause of serious illness such as meningitis and sepsis in infants. Among infants, there are two main types of GBS disease. Early-onset GBS disease occurs during the first week of life and late-onset GBS disease occurs from the first week through three months of life. Rates of early-onset disease in the United States have decreased significantly since the 1990s through widespread implementation of intrapartum antibiotic prophylaxis (IAP) guidelines. However, IAP does not prevent late-onset disease. Maternal immunization represents a nonantibiotic strategy to prevent both early and late-onset disease. Multivalent polysaccharide-protein conjugate vaccines are under development against GBS capsular types, with candidate vaccines in phase I and II trials. Active Bacterial Core surveillance (ABCs) conducts active surveillance for early and late-onset GBS disease among infants in select counties of 10 states, covering about 10% of live births across the United States. We analyzed data from early and late-onset GBS cases identified from ABCs between 2006 and 2015 to describe their epidemiology, incidence trends, and associated strain characteristics.
Addiction, Author Interviews, JAMA, UCLA / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46947" align="alignleft" width="200"]Dr-John W. Ayers Dr. Ayers[/caption] John W. Ayers, PhD MA Division of Infectious Diseases and Global Public Health Department of Medicine, University of California San Diego, La Jolla MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The Substance Abuse and Mental Health Services Administration national helpline (1-800-662-HELP) is the only free, federally managed and endorsed US drug treatment referral service, helping callers find the best local services that match their needs. Are millions suffering simply because they are not aware that lifesaving help is a phone call away? In our new study, published in JAMA Internal Medicine, Mark Dredze, Alicia Nobles and I delved into Americans’ engagement with 1-800-662-HELP following singer Demi Lovato’s July 24, 2018 hospitalization for a reported overdose that on-the-scene investigators originally linked to heroin. Lovato has since recovered.
Author Interviews, Depression, JAMA, Surgical Research, Urology / 14.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46921" align="alignleft" width="114"]Blayne Welk MD, MSc, FRCSC Associate Professor of Surgery St. Joseph's Hospital Western University Dr. Welk[/caption] Blayne Welk MD, MSc, FRCSC Associate Professor of Surgery St. Joseph's Hospital Western University MedicalResearch.com: What is the background for this study? What are the main findings? Response: I found that when I was referred women with midurethral sling complications, they were often quite emotional and described a significant period of time when they struggled with the complications before they were referred to someone to assess them. The study looked at the rate of depression and self-harm behavior of women who had surgery for midurethral sling complications compared to women who did not have midurethral sling complications. I found that there was an increased risk of both of these outcomes among women who had surgery for complications, however this risk was primarily present in younger women.
Author Interviews, Diabetes, JAMA, Ophthalmology / 13.01.2019

MedicalResearch.com Interview with: [caption id="attachment_38910" align="alignleft" width="300"]Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. Illustration depicting diabetic retinopathy Illustration depicting diabetic retinopathy[/caption] Eugene Yu-Chuan Kang, MD. House Staff, Department of Ophthalmology Chang Gung Memorial Hospital Chang Gung University, School of Medicine MedicalResearch.com: What is the background for this study?   Response: More and more patients suffered from diabetes mellitus (DM) around the world, as well diabetic complications such as diabetic retinopathy (DR). DR is one of the major causes of blindness in working-age adults. In addition to the cost of treatment for patients with advanced DR, loss of visual function also yields a great burden to the family and society. For advanced DR, surgical interventions such as retinal laser, intravitreal injection, and vitrectomy are needed. However, those surgical interventions for severe DR can only retard or stop disease progression. If DR can be prevented or slowed by medical treatments, the burden of medical costs for treating severe DR may be decreased. Statin, an HMG-CoA reductase inhibitor, was discussed frequently in the recent years. Multiple functions of statins besides their lipid lowering effect were discovered. Previous investigations have reported that statin therapy could reduce mortality rate and decrease risk of cardiovascular diseases. In our study, we wanted to figure out if statin therapy may have any association between diabetic retinopathy. 
Author Interviews, JAMA, Smoking, Social Issues, Tobacco Research, UCSD / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46797" align="alignleft" width="128"]Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego Dr. Leas[/caption] Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent research has demonstrated the importance that neighborhood context has on life opportunity, health and well-being that can perpetuate across generations. A strongly defining factor that leads to differences in health outcomes across neighborhoods, such as differences in chronic disease, is the concurrent-uneven distribution of modifiable risk factors for chronic disease. The main goal of our study was to characterize inequities in smoking, the leading risk factor for chronic disease, between neighborhoods in America's 500 largest cities. To accomplish this aim we used first-of-its-kind data generated from the 500 Cities Project—a collaboration between Robert Wood Johnson Foundation and the US Centers for Disease Control and Prevention—representing the largest effort to provide small-area estimates of modifiable risk factors for chronic disease. We found that inequities in smoking prevalence are greater within cities than between cities, are highest in the nation’s capital, and are linked to inequities in chronic disease outcomes. We also found that inequities in smoking were associated to inequities in neighborhood characteristics, including race, median household income and the number of tobacco retailers. 
Author Interviews, JAMA, Primary Care / 10.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46878" align="alignleft" width="142"]Ying Xue, DNSc, RN Associate Professor University of Rochester School of Nursing Rochester NY 14642 Dr. Ying Xue[/caption] Ying Xue, DNSc, RN Associate Professor University of Rochester School of Nursing Rochester NY 14642 MedicalResearch.com: What is the background for this study? Response: Shortages of primary care physicians have been a national concern, and forecasts project worsening trends in the future.1 The shortfall of primary care physicians is particularly severe in rural and other underserved communities, and some evidence indicates that the shortage of primary care physicians is due to maldistribution rather than insufficient supply.2 Nurse practitioners (NPs) constitute the largest and fastest growing group of non-physician primary care providers. The Health Resources and Services Administration (HRSA) estimated that the number of primary care NPs will grow 93% from 2013 to 2025, and a projected shortage of 23,640 full-time equivalent primary care physicians in 2025 could be effectively mitigated with better utilization of NPs and physician assistants.1 As the primary care physician shortage persists, examination of trends in the distribution of primary care NP supply, particularly in relation to populations most in need, will inform strategies to strengthen primary care capacity. However, such evidence is limited, particularly in combination with physician workforce trends. We thus characterized the temporal trends in the distribution of primary care NPs in low-income and rural areas compared with the distribution of primary care physicians.
Author Interviews, Cost of Health Care, Dartmouth, JAMA, Pharmaceutical Companies / 09.01.2019

MedicalResearch.com Interview with: Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth InstituteSteven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth Institute MedicalResearch.com: What is the background for this study? What are the main findings? What influence does medical marketing have on medical care and drug prices? Response: There are published studies looking at promotional spending mostly for drugs (DTC and professional).  This paper is unique because it is such a broad look including not just drugs but also marketing of disease (in "awareness campaigns"), health services and laboratory tests. What is new here is the size and scope of marketing.  For context, $29.9 billion spent on promoting prescription drugs, disease awareness campaigns, health services, and laboratory tests corresponds approximately to $1000 per American.    For context, FDA's total budget is around $5 billion – and NIH's total budget is about $30 billion. This figure is up from $17.7 billion in 1997, with the most rapid increase in DTC promotion of prescription drugs and health services.   Pharmaceutical marketing to professionals (detailing visits and samples) accounted for most spending and remained high despite policies to limit industry influence. $30 billion is of an underestimate (egg, we did not include monies spent on professional marketing (detailing) of laboratory tests, health services or devices, the value of drug coupons/discounts/rebates, company marketing budgets, lobbying or campaign contributions). Further it is just the tip of the iceberg – marketing works so promotional spending is an important driver of why medical care is so expensive:  it leads to more – and more expensive - tests and treatments.
Alcohol, Author Interviews, Depression, JAMA / 09.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46863" align="alignleft" width="200"]Dr. Ingunn Olea Lund, PhD The Norwegian Institute of Public Health Oslo, Norway Dr. Ingunn Olea Lund[/caption] Dr. Ingunn Olea Lund, PhD The Norwegian Institute of Public Health Oslo, Norway MedicalResearch.com: What is the background for this study? Response: There are significant amounts of research on children of parents with alcohol use disorders – where the children are shown to be at risk of several adverse outcomes, including mental disorders, substance use disorders, suicide, impaired school performance, and employment problems. There is very little previous research on how other, more normal levels of parental drinking may influence child outcomes, such as mental health. This is a grave oversight, as there are vastly more parents with normal drinking patterns than there are parents who suffer from an alcohol use disorder. This means that there are potentially a lot more cases of adverse effect for children, and the number of children at risk may be higher than previously assumed. In addition to parents' alcohol use, several other risk factors in the family that may affect child mental health outcomes, such as parents' mental health and socio-economic status. Researchers have tended to look at these risk factors separately, but as these risks tend to co-occur, it may be more informative to consider them together. To our knowledge, this is the first study that examines possible harm from normal levels of parental drinking, alone or in combination with other parental risk factors, on children’s anxiety and depression. The sample consists of more than 8700 triads: children and both their parents. We combined information from three health registries with survey data where both adolescents and their parents provided information about health and social conditions. The health registers include information about the children 's actual contact with the health care system; we used information about whether children received diagnoses and/or treatment for anxiety and/or depression.
Author Interviews, JAMA, Orthopedics, Pain Research, University of Pittsburgh / 09.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46849" align="alignleft" width="200"]Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences  University of Pittsburgh Dr. Schneider[/caption] Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Lumbar spinal stenosis (LSS) is one of the fastest growing problems in the country due to its aging population. One third of Medicare users have the condition, and it is the number one reason for spine surgery in this population. Existing research evaluates the benefits of nonsurgical treatment options compared to surgery, but there was no existing research that compared the available nonsurgical options to each other to determine the best course of treatment for each patient. We studied three nonsurgical treatments for LSS: medical management with medications and/or epidural injections, individualized care with a physical therapist or chiropractor, and group exercise. We assessed each of these treatment methods with a questionnaire, a walking distance test, and a physical activity monitor. 
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46845" align="alignleft" width="200"]Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland Dr. Kiu Tay-Teo[/caption] Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland MedicalResearch.com: What are the main findings? Response: High costs and high risks of R&D for drugs have been presented to justify high drug prices, especially for cancer drugs. However, it is unclear whether prices are in fact justifiable compared to the overall return on R&D investment. In this paper, we systematically compared incomes from the sales of cancer drugs with the R&D costs. We quantified the incomes generated from the sales of 99 cancer drugs approved by FDA from 1989–2017. This was based on sales figures reported in the originator companies’ annual financial reports, and where necessary, estimates deduced from the reported figures. The sales incomes were net of rebates and discounts, but without accounting for expenses and taxes. For the R&D costs of bringing one new cancer drug to the market, the literature reported a typical costs of between $219 million and $2.9 billion, after accounting for the costs of failed products that were investigated but not marketed and the opportunity costs. For the main analysis, we used a median cost of $794 million, as reported in the literature. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs.
Author Interviews, Columbia, Depression, Hearing Loss, JAMA / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46841" align="alignleft" width="147"]Justin S. Golub, MD, MS Assistant Professor Otology, Neurotology, and Skull Base Surgery Department of Otolaryngology-Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons NewYork-Presbyterian/Columbia University Irving Medical Center Dr. Golub[/caption] Justin S. Golub, MD, MS Assistant Professor Otology, Neurotology, and Skull Base Surgery Department of Otolaryngology-Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons NewYork-Presbyterian/Columbia University Irving Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Age-related hearing loss is extremely common, yet few people do anything about it. We studied a population of over 5,000 individuals and found that hearing loss was related to feelings of depression. The worse the hearing loss, the worse the symptoms of depression. Even people with just mild hearing loss had nearly two times the odds of depressive symptoms compared to normal hearing people. Among people with moderate hearing loss, the odds of depressive symptoms were four times as high. These statistics take into account various factors that can cause both hearing loss and depression, such as age and demographic background. 
ALS, Author Interviews, Brigham & Women's - Harvard, Cognitive Issues, JAMA, Multiple Sclerosis / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46832" align="alignleft" width="200"]Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine, St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto  PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University Dr. Fralick[/caption] Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This medication is a pill that combines two ingredients: dextromethorphan (the active ingredient in cough syrup) and quinidine (used to increase the concentration of dextromethorphan). The medication was primarily studied and evaluated in patients with amyotrophic lateral sclerosis (ALS)   or (multiple sclerosis) MS, but anecdotal evidence suggested it was being prescribed to patients with dementia. We used data from two nationwide healthcare databases to understand how the medication was being used in routine care.
Author Interviews, JAMA, Pediatrics, Smoking, Tobacco, Tobacco Research / 07.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46793" align="alignleft" width="165"]Dr. Hongying Dai, PhD Associate Professor at the College of Public Health University of Nebraska Medical Center. Dr. Dai[/caption] Dr. Hongying Dai, PhD Associate Professor at the College of Public Health University of Nebraska Medical Center. MedicalResearch.com: What is the background for this study? Response: The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) banned cigarettes with characterizing flavors (e.g., candy, fruit, clove) except menthol. However, there are no restrictions on the marketing and sales of flavored non-cigarette tobacco products. This has led to a proliferation of flavored tobacco products in the marketplace. Flavoring has become one of the leading reasons for current tobacco use among youth. It is reported that 81% of e-cigarette users, 79% of hookah users, 74% of cigar users, 69% of smokeless tobacco users, and 67% of snus users attributed the availability of appealing flavors for their tobacco use in 2013–2014 among teenagers aged 12 to 17 years. In November 2018, the FDA proposed new restrictions on flavored tobacco products.
Accidents & Violence, Author Interviews, JAMA, Social Issues / 06.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46819" align="alignleft" width="125"]Rebecca R. Thompson, Ph.D. Postdoctoral Scholar Department of Psychological Science University of California, Irvine Dr. Thompson[/caption] Rebecca R. Thompson, Ph.D. Postdoctoral Scholar Department of Psychological Science University of California, Irvine MedicalResearch.com: What is the background for this study? Response: Our research team has been interested in how people respond to the repeated threat of disaster exposure for many years. We recently published a review of the literature on evacuation from natural disasters, and one of our main findings was that there have been no studies that include assessments of individuals’ intentions, perceptions, and psychological states assessed prior to an approaching storm’s landfall – all prior research has been retrospective, and recall is undoubtedly biased and unreliable.  Our goal in undertaking this study was to fill this hole in the literature. We sought to assess individuals' responses to Hurricane Irma in the days leading up to and immediately after its landfall in the State of Florida.
Author Interviews, JAMA, Johns Hopkins, Social Issues / 06.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46800" align="alignleft" width="120"]Megan Wallace, DrPH Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland Dr. Wallace[/caption] Megan Wallace, DrPH Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Local health departments are often evaluated on a nationwide or statewide basis, however, given diversity among counties that exists even at the state level, we felt there might be a better way to group health departments for evaluation. In this study, we created county-level clusters using local characteristics most associated with the outcomes of interest, which were smoking, motor vehicle crash deaths, and obesity. We then compared county-level percentile rankings for the outcomes within sociodemographic peer clusters vs nationwide rankings. We identified 8 groups of counties with similar local characteristics. Percentile ranks for the outcomes of interest often differed when counties were compared within their peer groups in comparison with a nationwide scale. 
Author Interviews, Autism, Cognitive Issues, JAMA / 04.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46784" align="alignleft" width="158"]Tjasa Velikonja, PhD Department of Psychiatry The Seaver Autism Center for Research and Treatment Icahn School of Medicine at Mount Sinai New York, New York Dr. Velikonja[/caption] Tjasa Velikonja, PhD Department of Psychiatry The Seaver Autism Center for Research and Treatment Icahn School of Medicine at Mount Sinai New York, New York MedicalResearch.com: What is the background for this study? What are the main findings? Response: Autism is a lifelong condition, and challenges associated with autism persist from childhood into adulthood. Despite this, research and treatment have been largely dedicated to children. Because of that, we had very little understanding of what areas – what cognitive domains - are most severely impacted in adults with autism. Importantly, the lack of such information also limits treatment development in this area. What is known already is that adults with autism display deficits in social cognition (which refers to the role that cognitive processes play in our social interactions). Although our meta-analysis supported these theories, it also highlighted several other challenges in cognitive processing, such as deficits in processing speed and verbal learning and memory. And these impairments were observed in adults with autism without an overall intellectual disability.