JAMA
04 Nov Atrial Fibrillation: More Bleeding With Dabigatran Than Warfarin
MedicalResearch.com Interview with:
Yuting Zhang, Ph.D.
Associate Professor and Director
Pharmaceutical Economics Research Group
University of Pittsburgh Graduate School of Public Health
Department of Health Policy and Management.
Medical Research: What are the main findings of the study?
Dr. Zhang: Patients with atrial fibrillation who take the blood thinner dabigatran are at greater risk for major bleeding and gastrointestinal bleeding than those who take warfarin, indicating that greater caution is needed when prescribing dabigatran to certain high-risk patients. High-risk groups include those who are 75 and older; African Americans; those with chronic kidney disease; and those with seven or more co-existing medical problems.
03 Nov Rise In Autism Rates Largely Due to Changes in Diagnostic Criteria
MedicalResearch.com Interview with:
Stefan Nygaard Hansen PhD Student, MSc Stat
Section for Biostatistics
Department of Public Health
Aarhus University Denmark
Medical Research: What are the main findings of the study?
Response: The main finding of our study is that 60% of the observed increase in autism prevalence among children born 1980-1991 in Denmark can be explained by changes in the way diagnoses are established and changes in the subsequent registration to national health registries.
In 1994, the diagnostic criteria used by clinicians to establish psychiatric diagnoses was changed. This meant the recognition of autism as a spectrum of disorders but it also meant changes in the specific symptoms that form the basis of the autism diagnosis. In 1995, the national health registries in Denmark, which are often used in Danish health research, began to also include diagnoses given in connection with outpatient consultations whereas before 1995 only diagnoses given in connection with hospitalization was reported to the registries. This could mean that we after 1995 see more of the mild autism diagnoses since they may not require hospitalization.
03 Nov Family Support Mitigates Negative Impact of Cyberbullying
MedicalResearch.com Interview with:
Frank J. Elgar, PhD
Associate Professor of Psychiatry
Canada Research Chair in Social Inequalities in Child Health
Institute for Health and Social Policy, McGill University
Montreal, Quebec, Canada
Medical Research: What are the main findings of the study?
Dr. Elgar: Our study addressed two questions. The first was whether cyberbullying has unique links to adolescent mental health, or is an extension of traditional (face-to-face) bullying. We measured various forms of bullying and found that cyberbullying does indeed have a unique impact on mental health.
Our second question about protective factors in the home environment. We examined the frequency of family dinners as potential a moderating factor - understanding, of course, that dinners are a proxy of various family characteristics that benefit adolescents, such as communication, support, and parental monitoring. We found that teens who were targeted by cyberbullying but had ate dinner with their families more often had significantly better mental health outcomes as a result.
29 Oct “Bad Cholesterol” LDL-C Linked to Aortic Valve Disease
MedicalResearch.com Interview with: George Thanassoulis, MD MSc FRCP(C) Director, Preventive and Genomic Cardiology FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien Assistant Professor of Medicine, McGill University McGill University Health Center Montreal, QC Medical Research: What is the background for this study? What are the main findings? Dr. Thanassoulis: Although LDL-C (i.e. bad cholesterol) has been linked with aortic valve disease in several prior reports, randomized trials to lower cholesterol in aortic valve disease were not effective suggesting that cholesterol may not be important in valve disease. To address this, we performed a Mendelian randomization study, that showed that a genetic predisposition to LDL-C, was associated with both calcium deposits on the aortic valve and aortic stenosis (I.e. Valve narrowing). These results can be viewed as the effect of a life-long increase in LDL-C on the incidence of aortic valve disease and suggest that increases in LDL-C cause aortic stenosis.28 Oct Age-Related Macular Degeneration: If One Eye Has It, The Other Eye More Likely To Develop It As Well
MedicalResearch.com Interview with:
Ronald Klein, MD, MPH, Professor
Department of Ophthalmology and Visual Sciences
University of Wisconsin School of Medicine and Public Health
Madison WI
Medical Research: What are the main findings of the study?
Dr. Klein: We found that more severe age-related macular degeneration (AMD) in 1 eye was associated with increased incidence of age-related macular degeneration [levels 1-2: hazard ratio [HR], 4.90 [95%CI, 4.26-5.63] and accelerated progression [levels 2-3: HR, 2.09 [95%CI, 1.42-3.06]; levels 3-4: HR, 2.38 [95%CI, 1.74-3.25] and incidence of late age-related macular degeneration [levels 4-5: HR, 2.46 [95%CI, 1.65-3.66] in its fellow eye. Less severe AMD in 1 eye was associated with less progression of AMD in its fellow eye. We estimated that 51% of participants who develop any age-related macular degeneration maintained age-related macular degeneration severity states within 1 step of each other between eyes and 90% of participants stay within 2 steps.
27 Oct Traumatic Brain Injury Raises Dementia Risk in Elderly
MedicalResearch.com Interview with:
Raquel C. Gardner, MD, Research Fellow
San Francisco VA Medical Center
Clinical Instructor
Memory and Aging Center, Department of Neurology
University of California, San Francisco
Medical Research: What are the main findings of the study?
Dr. Gardner: We found that people who experience a traumatic brain injury (TBI )when they are 55 or older have a 26% higher chance of getting dementia over the next 5 to 7 years compared to people who experience bodily trauma.
27 Oct Agave Offers Placebo Effect For Cough In Young Children
MedicalResearch.com Interview with: Ian M. Paul, M.D., M.Sc. Professor of Pediatrics and Public Health Sciences Chief, Division of Academic General Pediatrics Associate Vice Chair for Research, Department of Pediatrics Penn State College of Medicine Hershey, PA 17033-0850 Medical Research: What are the main findings of the study? Dr. Paul: This study highlights that a significant placebo effect exists in the treatment of young children with cough due to colds because agave nectar and placebo both resulted in improvement of child symptoms by parents compared with no treatment.23 Oct Pathology Reveals Overlap Between Schizophrenia and Bipolar Disorder
MedicalResearch.com Interview with:
Glenn T. Konopaske, MD
McLean Hospital, Belmont, Massachusetts
Department of Psychiatry, Harvard Medical School
Boston, Massachusetts
Medical Research: What are the main findings of the study?
Dr. Konopaske: Using postmortem human brain tissue this study did reconstructions of basilar dendrites localized to pyramidal cells in the deep layer III of the dorsolateral prefrontal cortex. Tissue from individuals with schizophrenia, bipolar disorder or controls was examined. Dendritic spine density (number of spines per μm dendrite) was significantly reduced in bipolar disorder and also reduced in schizophrenia at a trend level. The number of dendritic spines per dendrite and dendrite length were significantly reduced in subjects with schizophrenia and bipolar disorder.
23 Oct Faster Weight Gain in Infancy Predicts Adult Obesity
MedicalResearch.com Interview Invitation
Dr Ken Ong, Programme Leader & Paediatric Endocrinologist
MRC Epidemiology Unit, University of Cambridge
Box 285 Institute of Metabolic Science
Cambridge Biomedical Campus, Cambridge
Medical Research: What are the main findings of this report?
Dr. Ong: We found that genetic factors that predict adult obesity were associated with faster weight gain and growth during infancy – the findings indicate that the biological mechanisms that predispose to later obesity are already active from birth.
23 Oct Analgesics May Enhance Depression Treatment
MedicalResearch.com Interview with:
Karl Ole Köhler, Research assistant
Department of Clinical Medicine
The Department of General Psychiatry
Aarhus University
Medical Research: What are the main findings of the study?
Response: We found that anti-inflammatory drugs and ordinary analgesics, which mainly are used against physical disorders, may have treatment effects against depression when used in combination with antidepressants. Thereby, our results furthermore support the hypothesis regarding a comorbidity between inflammatory diseases and depression, i.e. a connection between somatic and mental disorders.
22 Oct Shared Savings May Promote Lower Costs With Equally Effective Health Care
MedicalResearch.com Interview with
Dr. Harald Schmidt, MA, PhD
Assistant Professor, Department of Medical Ethics and Health Policy , Research Associate, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine
University of Pennsylvania Philadelphia, PA 19104-3308
Medical Research: What are the main findings of the study?
Dr. Schmidt: We reviewed currently available policies for aligning cost and quality of care. We focused on interventions are similar in their clinical effectiveness, have modest differences in convenience, but pose substantial cost differences to the healthcare system and patients. To control health care costs while ensuring patient convenience and physician burden, reference pricing would be the most desirable policy. But it is currently politically unfeasible. Alternatives therefore need to be explored. We propose the novel concept of Inclusive Shared Savings, in which physicians, the healthcare system, and, crucially, patients, benefit financially in moving more patients to lower cost but guideline concordant and therapeutically equivalent interventions.
21 Oct Opioid Dependence: Buprenorphine Maintenance May Be Better Than Taper for Treatment Retention
MedicalResearch.com Interview with
David A. Fiellin, M.D.
Professor of Medicine, Investigative Medicine and Public Health
Yale University School of Medicine
Medical Research: What are the main findings of the study?
Dr. Fiellin: The main finding of our randomized clinical trial, conducted in primary care, was that among prescription opioid dependent patients, ongoing buprenorphine therapy resulted in better treatment retention and reduced illicit opioid use when compared to buprenorphine taper (detoxification).
20 Oct Alopecia Areata: Humira May Improve, or Worsen, Hair Loss
MedicalResearch.com Interview with
Marie C. Leger, MD, PhD
Ronald O. Perelman Department of Dermatology
New York University School of Medicine, New York
Medical Research: What are the main findings of the study?
What was most surprising about the results?
Dr. Leger: Alopecia areata is a T-cell mediated autoimmune disease. As such, there was initially hope that inhibiting the helper T cell cytokine TNF-α could effectively treat this condition. This has not been shown to be the case—in fact, one open-label study of etanercept in 17 patients with moderate to severe alopecia showed no hair regrowth and even worsening of alopecia in several subjects. There have been many other case reports in the dermatologic literature of TNF-α inhibitors causing alopecia areata. In contrast, our case report presents a patient who very clearly grew hair on adalimumab—its strength lies in the fact that her hair loss and regrowth were replicated on withdrawal and rechallenge with the medication.
Our patient’s paradoxical response to adalimumab complements other literature suggesting that there are genetic variations in the way a patient’s immune system responds to TNF-α inhibitors. In different individuals, these medications can either treat or cause conditions such as psoriasis or lupus. It seems that this is also the case with alopecia areata.
16 Oct Role of Steroids Post Tonsillectomy Explored
MedicalResearch.com Interview with: Sayaka Suzuki, MD Department of Clinical Epidemiology and Health Economics, School of Public Health, Faculty of Medicine, Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo, Japan Medical Research: What are the main findings of the study? Dr. Suzuki: We found a slight increase in the risk of severe bleeding requiring surgery for hemostasis in children who were administrated intravenous steroid on the day of tonsillectomy. Physicians should carefully make a decision to use steroids, taking into account patients' choice under being well informed on the risks and benefits of steroid use.16 Oct Losing Ability To Smell Raises Risk of Household Hazardous Events
MedicalResearch.com Interview with:
Richard M. Costanzo, PhD.
Professor of Physiology and Biophysics and
Special Assistant to the Vice President for Research
Virginia Commonwealth University
Medical Research: What are the main findings of the study?
Dr. Costanzo: In this study we found that individuals with varying degrees olfactory impairment have an increased risk of experiencing a hazardous event. Those with complete loss (anosmia) were three times more likely to experience an event than those with normal olfactory function. Factors such as age,sex, and race were found to affect an individual’s risk.
15 Oct Smoking Continues To Be Major Source Of Preventable Disease In US
MedicalResearch.com Interview with:
Dr. Brian Rostron PhD, MPH
Center for Tobacco Products
US Food and Drug Administration
Silver Spring, Maryland
Medical Research: What are the main findings of the study?
Dr. Rostron: We estimated that Americans in 2009 had had 14 million major medical conditions such as heart attack, stroke, lung cancer, and COPD that were attributable to smoking. COPD was the leading cause of smoking-attributable morbidity, with over 7.5 million cases of COPD attributable to smoking.
15 Oct Vancomycin Still Highly Effective Against Staphylococcus Aureus Bloodstream Infections
MedicalResearch.com Interview with:
Andre Kalil, M.D., M.P.H.
Professor of Medicine
Director, Transplant ID Program
University of Nebraska Nebraska Medical Center
Omaha, NE 68198-5400
Medical Research: What are the main findings of the study?
Dr. Kalil: In recent years, physicians treating staph infections with vancomycin have seen an increase in the minimum inhibitory concentration (MIC), the lowest concentration of an antimicrobial agent that inhibits the growth of a microorganism. This condition is referred to as vancomycin “MIC creep.” It is an indicator that the bacteria might be developing a reduced susceptibility to vancomycin. There also have been reports suggesting that elevations in vancomycin MIC values may be associated with increased treatment failure and death.
To determine the effectiveness of vancomycin and other newer antibiotics used to treat Staphylococcus aureus, the UNMC team analyzed nearly 8,300 episodes of Staphylococcus aureus bloodstream infections from patients around the U.S. and in several other countries. The adjusted absolute risk of mortality among patients with Staphylococcus aureus bloodstream infections with high-vancomycin MIC was not statistically different from patients with Staphylococcus aureus bloodstream infections with low-vancomycin MIC.
15 Oct Apolipoprotein E Research May Open New Door to Alzheimer Research
MedicalResearch.comInterview with: Mary Malloy, M.D. Co-director of the Adult Lipid Clinic and the director of the Pediatric Lipid Clinic UCSF Medical Center Medical Research: What are the main findings of the study? Dr. Malloy: We studied an individual whom we found to be homozygous for a rare loss of function mutation in apolipoprotein E. Because apolipoprotein E is necessary for clearance of lipoproteins from plasma, he has very high levels of cholesterol and triglycerides in blood, and unusual and very severe xanthomas. He had no evidence of neurocognitive or retinal defects.13 Oct BPA Exposure During Pregnancy Linked With Childhood Wheezing
MedicalResearch.com Interview with:
Adam Spanier, MD, PhD, MPH, FAAP
Associate Professor of Pediatrics
Division Head, General Pediatrics & Developmental and Behavioral Pediatrics
Medical Director, Pediatrics at Midtown Department of Pediatrics
University of Maryland Midtown Campus Baltimore, MD 21201
Medical Research: What are the main findings of the study?
Dr. Spanier: Bisphenol A (BPA) is a chemical that is present in many consumer products (lining of canned foods, some plastics, some receipt paper, etc).
We found that higher maternal Bisphenol A levels during pregnancy were associated with increased odds of persistent wheezing in children and a decrease in lung function at age four. Child BPA levels were not associated with these poor lung health outcomes.
13 Oct Resistant C. Diff Infections Treatable With Pill Form of Fecal Bacterial Transplant
MedicalResearch.com Interview with:
Dr. Ilan Youngster, MD, MMSc
Division of Infectious Diseases, Massachusetts General Hospital,
Harvard Medical School,
Division of Infectious Diseases, Boston Children’s Hospital
Boston, Massachusetts
Medical Research: What are the main findings of the study?
Dr. Youngster: The main finding is that oral administration seems to be as safe and effective as more traditional routes of delivery like colonoscopy or nasogastric tube. This is important as it allows Fecal microbiota transplantation (FMT) to be performed without the need of invasive procedures, making it safer, cheaper and more accessible to patients.
09 Oct Placebo Responses to Anti-Psychotic Medications Increasing
MedicalResearch.com Interview with:
Bret R Rutherford, MD
Assistant Professor ,Clinical Psychiatry Columbia University College of Physicians and Surgeons
Division of Geriatric Psychiatry
New York State Psychiatric Institute
New York, NY 10032
Medical Research: What are the main findings of the study?
Dr. Rutherford: In this meta-analysis of 105 trials of acute antipsychotic drugs for schizophrenia, the placebo response was shown to be significantly increasing from 1960 to the present. Conversely, the treatment change associated with effective dose medication significantly decreased over the same time period. The average participant of a randomized clinical trial (RCT) receiving an effective dose of medication in the 1960s improved by 13.8 points in the BPRS, whereas this difference diminished to 9.7 BPRS points by the 2000s. The consequence of these divergent trends was a significant decrease in drug-placebo differences from 1960 to the present.
09 Oct Cardiometabolic Risks Begin Early in Schizophrenic Spectrum Disorders
MedicalResearch.com Interview with:
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
Hofstra North Shore LIJ School of Medicine
Medical Director, Recognition and Prevention (RAP) Program
The Zucker Hillside Hospital Investigator
Feinstein Institute for Medical Research
North Shore Long Island Jewish Health System
Medical Research: What are the main findings of the study?
Dr. Correll: The main findings of the study of 398 patients with first-episode schizophrenia-spectrum disorders who were on average in their mid twenties are that:
- 1) despite their young age, an average of only 47 days lifetime antipsychotic exposure and overweight/obesity figures that were comparable to similarly aged US population members, there was a clear pattern of increased smoking and several metabolic risk parameters compared to similarly aged persons in the general US population;
- 2) dyslipidemia, a constellation of at least one relevant abnormal blood fat value, was as frequent as in a 15-20 years older general US population;
- 3) body composition related risk markers were significantly associated with longer total psychiatric illness duration, whereas metabolic risk markers were significantly associated with the overall very short mean lifetime antipsychotic treatment duration; and
- 4) relevant for treatment choice and recommendations for patients, significantly higher continuous metabolic risk factor values were associated with olanzapine treatment and, less so, with quetiapine treatment.
09 Oct Community Acquired Pneumonia May Require Two Antibiotics
MedicalResearch.com Interview with: Dr. Nicolas Garin MD Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland Division of Internal Medicine, Hôpital Riviera-Chablais, Monthey, Switzerland Medical Research: What are the main findings of the study? Dr. Garin: Empiric treatment with a betalactam drug (monotherapy) was not equivalent to the combination of a betalactam and a macrolide in patients hospitalized for moderate severity pneumonia (proportion of patients not having reached clinical stability at day 7 was 41.2 % in the monotherapy vs. 33.6 % in the combination therapy arm, between arm difference 7.6 %). This occurred despite systematic search for Legionella infection in the monotherapy arm. There was no difference in early or late mortality, but patients in the monotherapy arm were more frequently readmitted. Patients with higher severity of disease (in PSI category IV, or with a CURB-65 score higher than 1) seemed to benefit from combination therapy (HR 0.81 for the primary outcome of clinical instability at day 7), although it was statistically not significant. There was no difference in the primary outcome for patients in PSI category I to III.08 Oct Prior Bird Flu Vaccination Offers Some Protection Against Newer Strains
MedicalResearch.com Interview with:
Robert B Belshe, MD
Division of Infectious Diseases, Allergy & Immunology
Saint Louis University School of Medicine
Medical Research: What are the main findings of the study?
Response: A vaccine that protects against an old strain of avian flu primes the immune system to mount a rapid response when a vaccine designed to protect against a related but different and new strain of avian flu is given a year later, according to Saint Louis University research findings reported in JAMA.
In addition, when combined with an adjuvant, which is a chemical that stimulates the immune system to produce more antibodies, a lower dose of the new avian flu vaccine worked better in triggering an immune response than a stronger dose without adjuvant. That means the amount of vaccine against a new strain of bird flu can be stretched to protect more people if an adjuvant is added.
Both findings represent important strategies researchers can continue to study to fight new strains of bird flu that people previously have not been exposed to, and consequently can rapidly turn into a pandemic outbreak and public health emergency, said Robert Belshe, M.D., professor of infectious diseases, allergy and immunology at Saint Louis University and the lead author of the article, which appeared in the Oct. 8, 2014 issue of JAMA.
08 Oct US Dietary Quality Better But Leaves Room For Improvement
MedicalResearch.com Interview with:
Daniel (Dong) Wang MD, MSc
Department of Nutrition, Harvard School of Public Health
Boston, MA 02115
Medical Research: What are the main findings of the study?
Dr. Wang:
- The overall dietary quality in US adults improved modestly from 1999 to 2010, but the quality of US diet remains far from optimal and huge room exists for further improvements.
- The improvement in dietary quality was greater among adults with higher socioeconomic status and healthier body weight, thus disparities that existed in 1999 increased over the next decade.
- More than half of the improvement in diet quality was due to a large reduction in consumption of trans fat.
03 Oct Bariatric Surgery Effective For Both Weight Loss and Diabetes Remission
Posted at 02:54h
in Author Interviews, JAMA, Surgical Research, University of Pittsburgh, Weight Research
MedicalResearch.com Interview with:
Anita P. Courcoulas M.D., M.P.H., F.A.C.S
Professor of Surgery
Director, Minimally Invasive Bariatric & General Surgery
University of Pittsburgh Medical Center
Medical Research: What are the main findings of the study?
Dr. Courcoulas: This paper was not a study but a summary of findings from a multidisciplinary workshop (and not a consensus panel) convened in May 2013 by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute. The goal of the workshop was to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research.
01 Oct Bioprosthetic vs Mechanical Aortic Valves: Similar Safety, Different Complications
MedicalResearch.com Interview with: Joanna Chikwe MD Associate Professor Department of Cardiovascular Surgery Mount Sinai Medical Center and Natalia N. Egorova, PhD Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai New York, New York Medical Research: What are the main findings of the study? Answer: This is one of the largest studies to date on the long-term outcomes of patients after aortic valve replacement. We found that bioprosthetic valves are as safe as mechanical valves in younger patients (age 50-69) - specifically, long-term death rates and stroke risk were very similar in patients who had either valve type. The main differences lay in the risk of other long-term complications: patients who had bioprosthetic valves were more likely to need repeat surgery in the long-term, whereas patients who had mechanical valves were more likely to experience a major bleeding event.01 Oct Effect of High-Dose Vitamin D Supplementation In Critically Ill Patients
MedicalResearch.com Interview with:
Karin Amrein, MD, MSc
Assistant Professor Department of Internal Medicine
Division of Endocrinology and Metabolism
Medical University of Graz
8036 Graz, Austria
Medical Research: What are the main findings of the study?
Dr. Amrein: This is the first large clinical trial on vitamin D in critical care. In a double-blind, randomized, placebo-controlled clinical trial, a population of mixed adult ICU patients with vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] level ≤ 20ng/ml) was assigned to receive either vitamin D3 or placebo. We used a high loading dose of vitamin D3 followed by monthly maintenance doses of 90,000 IU for a total of 5 months. Because of a substantially increased risk for skeletal complications below 12ng/ml of 25-hydroxyvitamin D, we used this threshold for a predefined subgroup analysis.
Overall, high-dose vitamin D3 compared with placebo did not reduce hospital length of stay (primary endpoint), intensive care unit (ICU) length of stay, hospital mortality, or 6 month-mortality