Author Interviews, Heart Disease, JAMA / 26.08.2013

Dr Pamela N Peterson MD Denver Health Medical Center, CO MedicalResearch.com Interview with: Dr Pamela N Peterson MD Denver Health Medical Center, CO   MedicalResearch.com: What are the main findings of the study? Answer: We assessed the outcomes of mortality, rehospitalization, and procedural complications among 24,169 patients in the NCDR-ICD Registry with left ventricular systolic dysfunction receiving a cardiac resynchronization device in addition to an implantable defibrillator for the primary prevention of sudden cardiac death between 2006 and 2009. After stratification by the QRS complex morphology and duration on the ECG and adjustment for measured differences in other characteristics, patients with left bundle branch block (LBBB) and QRS durations of at least 150 msec had significantly lower rates of mortality and rehospitalization at 3 years compared with patients with non-LBBB QRS morphology and/or QRS duration of 120-149 msec. Rates of mortality and readmission were generally highest in patients with non-LBBB and QRS duration of 120-149 msec. Rates of procedural complications at 30- and 90-days were similar across strata of QRS morphology and duration. (more…)
Author Interviews, JAMA, Pediatrics / 23.08.2013

Bjarke Feenstra, Ph.D. Senior Research Scientist Statens Serum Institut Artillerivej 5, 2300 Copenhagen S DenmarkMedicalResearch.com Interview with: Bjarke Feenstra, Ph.D. Senior Research Scientist Statens Serum Institut Artillerivej 5, 2300 Copenhagen S Denmark MedicalResearch.com: What are the main findings of the study? Dr. Feenstra: We discovered a new genome-wide significant locus for infantile hypertrophic pyloric stenosis (IHPS) in a region on chromosome 11 harboring the apolipoprotein (APOA1/C3/A4/A5) gene cluster and also confirmed three previously reported loci. Characteristics of the new locus led us to propose the hypothesis that low levels of circulating lipids in infants are associated with increased risk of IHPS. We addressed this hypothesis by measuring plasma lipid levels in prospectively collected umbilical cord blood from a set of 46 IHPS cases and 189 matched controls. We found that levels were on average somewhat lower in the children who went on to develop the condition. (more…)
Author Interviews, JAMA, Rheumatology / 22.08.2013

MedicalResearch.com Interview with: Matthew Parkes Research Statistician Research in Osteoarthritis Manchester (ROAM) Arthritis Research UK Epidemiology Unit Centre for Musculoskeletal Research Institute of Inflammation and Repair The University of Manchester Manchester Academic Health Science Centre Manchester M13 9PT MedicalResearch.com: What are the main findings of the study? Answer: Looking at all trials of lateral wedge insoles, they seem to reduce pain slightly. However, looking at trials which compare lateral wedges to flat wedges, they don’t appear to differ in terms of pain reduction. (more…)
Author Interviews, Autism, General Medicine, JAMA / 20.08.2013

MedicalResearch.com:  Interview with: Therese Koops Grønborg PhD student/ph.d.-studerende, MSc Section of Biostatistics/Sektion for Biostatistisk Department of Public Health/Institut for Folkesundhed Aarhus University Bartholins Allé 2, DK-8000 Aarhus C, Denmark MedicalResearch.com: What are the main findings of the study? Answer: There are three important findings in our study. We estimated a population-based Autism Spectrum Disorder (ASD) sibling recurrence risk relative to the background population and found an almost seven-fold increase. While this indeed is an increased risk, it is also lower than what other recent studies have suggested. We also compared the relative recurrence risk for full and maternal/paternal half siblings and found a lower relative recurrence risk in half siblings than in full siblings, which supports the genetic pathway to ASD. The recurrence risk for maternal half siblings is still higher than for the background population suggesting that factors unique to the mother, such as the intrauterine environment and perinatal history, may contribute to ASD. Last, but not least, we estimated the time trends in the relative recurrence risk. While the ASD prevalence has been increasing for several years, we found no time trends in the relative recurrence risk, suggesting that the factors contributing to the risk for ASDs recurrence in siblings (perhaps a combination of genes and environment) have not changed over time. (more…)
Author Interviews, JAMA, Outcomes & Safety, Yale / 20.08.2013

Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, ConnecticutMedicalResearch.com Interview with: Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut MedicalResearch.com: What are the main findings of the study? Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:
  • 40% of patients could not understand or explain the reason they were in the hospital in the first place;
  • A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand;
  • Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist;
  • Only 44% accurately recalled details of their appointments.
In other words, we didn't do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home. We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients - that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients - we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn't even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn't find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies. (more…)
Author Interviews, JAMA, Weight Research / 17.08.2013

  MedicalResearch.com Interview with: Michiyo Yamakawa MHSc Department of Epidemiology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan MedicalResearch.com: What are the main findings of the study? Answer: We found that breastfeeding was associated with decreased risk of  overweight and obesity at the age of 7 and 8 years compared with formula feeding. Moreover, the protective associations for obesity were greater than those for overweight. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, Vitamin D / 14.08.2013

Miles D. Witham, PhD Aging and Health, University of Dundee, Dundee, United KingdomMedicalResearch.com Interview with: Miles D. Witham, PhD Aging and Health, University of Dundee, Dundee, United Kingdom MedicalResearch.com: What are the main findings of the study? Answer: We gave high dose vitamin D3 (100,000 units) or placebo every 3 months to people aged 70 or over, who all had isolated systolic hypertension (ISH). The main focus of the trial was to test whether vitamin D supplementation could reduce blood pressure in this group of patients – this pattern of blood pressure, whether the systolic (top number) is high, and the diastolic (bottom number) is normal, is very common in older people. Previous studies have suggested a link between low vitamin D levels and higher blood pressure, but no trial has yet tested this idea in older patients with ISH. Despite the treatment causing a significant increase in circulating vitamin D levels, we saw no significant reduction in blood pressure with vitamin D supplementation, despite the trial running for a year. We tested whether certain groups might still benefit – e.g. those with very high blood pressure or very low vitamin D levels, but even these groups did not show a reduction in blood pressure. We also tested whether vitamin D supplementation reduced the health and stiffness of arteries – both important predictors of future heart attack or stroke. Unfortunately, vitamin D did not affect these measures either, and didn’t reduce cholesterol or glucose levels. On the more positive side, vitamin D supplements did appear safe, and the number of falls in the vitamin D group was slightly lower than in those people who received placebo. This is reassuring, as an earlier study (Sanders et al) had suggested that very high doses of vitamin D might make falls more likely, in contrast to previous low dose studies that show a protective effect of vitamin D against falls. (more…)
General Medicine, JAMA, University of Pennsylvania / 08.08.2013

MedicalResearch.com Interview with Edna B. Foa, PhD Department of Psychiatry, University of Pennsylvania, Philadelphia MedicalResearch.com: What are the main findings of the study? Dr. Foa: Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder during active treatment.  Six months after treatment discontinuation, participants who received prolonged exposure therapy for PTSD drank less than those who did not receive prolonged exposure.  Participants who received a combined treatment of prolonged exposure and naltrexone had the lowest drinking level after six-month treatment discontinuation. The main message of the study is that simultaneous treatment of alcohol dependence and PTSD yield superior outcome than each treatment alone. Importantly, the findings indicated that prolonged exposure therapy was not associated with increased drinking or alcohol craving, a concern that has been voiced by some investigators. In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts that common view that trauma-focuses therapy is contraindicated for individuals with alcohol dependence and PTSD, because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use. (more…)
Author Interviews, Colon Cancer, JAMA / 07.08.2013

MedicalResearch.com: Interview with: Samir Gupta, MD, MSCS San Diego Veterans Affairs Healthcare System Associate Professor of Clinical Medicine Division of Gastroenterology, Department of Internal Medicine Moores Cancer Center University of California San Diego MedicalResearch.com: What are the main findings? Dr. Gupta: In a randomized, comparative effectiveness study among uninsured individuals not up to date with screening, we found that mailed outreach invitations to complete colonoscopy outreach, and mailed outreach to complete a non-invasive fecal immunochemical test (FIT) tripled screening rates compared to usual care. Additionally, we found that outreach was almost twice as effective with offers for FIT versus colonoscopy screening. (more…)
Author Interviews, JAMA, Ophthalmology, Pain Research / 07.08.2013

MedicalResearch.com Interview with: Jelle Vehof PhD Department of Twin Research & Genetic Epidemiology King’s College London, St Thomas’ Hospital, Waterloo, London, England Department of Ophthalmology & Epidemiology University Medical Center Groningen, Groningen, the Netherlands MedicalResearch.com: What are the main findings of the study? Dr. Vehof: The current study provides the first empirical evidence that individuals with dry eye disease show altered pain sensitivity. Specifically, this study demonstrates that subjects with DED pain and discomfort complaints have lower pain threshold and pain tolerance of heat-based stimulus compared to those without. These findings support the hypothesis that a subset of persons with DED is more sensitive to pain. (more…)
Author Interviews, JAMA, Mental Health Research, UT Southwestern / 07.08.2013

Carol S. North, MD, MPE The Nancy and Ray L. Hunt Chair in Crisis Psychiatry Director, Program in Trauma and Disaster, VA North Texas Health Care System 4500 S. Lancaster Rd., Dallas, TX 75216 Professor of Psychiatry and Surgery/Division of Emergency Medicine UT Southwestern Medical Center 6363 Forest Park Rd. Dallas, TX 75390-8828MedicalResearch.com Interview with: Carol S. North, MD, MPE The Nancy and Ray L. Hunt Chair in Crisis Psychiatry Director, Program in Trauma and Disaster, VA North Texas Health Care System 4500 S. Lancaster Rd., Dallas, TX 75216 Professor of Psychiatry and Surgery/Division of Emergency Medicine UT Southwestern Medical Center 6363 Forest Park Rd. Dallas, TX 75390-8828 MedicalResearch.com: What are the main findings of the study? Answer: In post-disaster settings, a systematic framework of case identification, triage, and mental health interventions can guide overall mental health response and should be integrated into emergency medicine and trauma care responses. (more…)
Author Interviews, Heart Disease, JAMA, Kidney Stones / 27.07.2013

Dr. Pietro Manuel Ferraro Division of Nephrology–Renal Program, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli Hospital, Rome, ItalyMedicalResearch.com Interview with Dr. Pietro Manuel Ferraro Division of Nephrology–Renal Program, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli Hospital, Rome, Italy MedicalResearch.com: What are the main findings of the study? Dr. Ferraro: We analyzed three large cohorts over time to see if those with prevalent or incident kidney stones might have a higher risk of developing coronary heart disease (fatal or non fatal myocardial infarction or the need for coronary revascularization). The cohorts consisted of over 200,000 participants without any prior history of coronary heart disease. After a median follow-up of over 8 years, we observed that women affected with stones seem to have a greater risk of developing coronary heart disease independent of a number of other known cardiovascular risk factors such as diabetes or high blood pressure. We did not observe a significant association among men. (more…)
Author Interviews, Cost of Health Care, JAMA, Mayo Clinic / 24.07.2013

Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo ClinicMedicalResearch.com Interview with: Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo Clinic What did you set out to find, what was your objective in this study?
  • We wanted to know physicians perceived roles and responsibilities in addressing health care costs as well as their enthusiasm for proposed strategies to contain health care spending.
Who did you study and what did you look at?
  • Practicing US physicians under age 65, we randomly selected 3900 physicians representing all specialties and mailed them an 8-page survey entitled “Physicians, Health Care Costs, and  Society.” We received 2,556 completed surveys (65% response rate). (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Radiology, UT Southwestern / 24.07.2013

Susan Matulevicius, MD, MSCS Department of Medicine, The University of Texas Southwestern Medical Center, DallasMedicalResearch.com Interview with: Susan Matulevicius, MD, MSCS Department of Medicine, The University of Texas Southwestern Medical Center, Dallas MedicalResearch.com: What are the main findings of the study? Dr. Matulevicius: In our cohort of 535 transthoracic echocardiograms performed at a single academic medical center, we found that the majority (92%) of echocardiograms were appropriate by the 2011 Appropriate Use Criteria; however, only 1 in 3 echocardiograms lead to an active change in patient care while 1 in 5 resulted in no appreciable change in patient care. (more…)
Author Interviews, JAMA, Surgical Research / 15.07.2013

Aneel Bhangu, MBChB, MRCS and Douglas M. Bowley, FRCS Royal Centre for Defense Medicine, Birmingham, EnglandMedicalResearch.com Interview with: Aneel Bhangu, MBChB, MRCS and Douglas M. Bowley, FRCS Royal Centre for Defense Medicine, Birmingham, England MedicalResearch.com: What are the main findings of the study?  Answer: Our study was a meta-analysis, which combined the findings from 8 randomized controlled trials that included a total of 623 patients. The key finding was that delayed primary skin closure (DPC) for contaminated and dirty abdominal incisions may reduce the rate of surgical site infection. However, due to high risk of bias from the included studies, including flaws in study design, definitive evidence is lacking. We believe that this meta-analysis represents an exciting development in biomedical publishing; this was a true collaboration between US and UK military surgeons to examine an area of major concern and interest to surgeons everywhere. This work uses experience hard-won on the battlefields of Iraq and Afghanistan, combined with published surgical trials, to inform both future research activity as well as military and civilian surgical practice. This cross-fertilization of ideas is one positive consequence of all the sacrifice and suffering of recent conflicts. (more…)
Author Interviews, Diabetes, Infections, JAMA, Respiratory / 15.07.2013

Andreas Beyerlein, PhD Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, GermanyMedicalResearch.com Interview with: Andreas Beyerlein, PhD Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes der Technischen Universität München, Munich, Germany MedicalResearch.com What are the main findings of the study? Dr. Beyerlein: We identified respiratory infections in early childhood, especially in the first year of life, as a risk factor for islet autoimmunity, which is known as a precursor of type 1 diabetes (T1D). We also found some evidence for short term effects of infectious events on development of autoimmunity. (more…)
Author Interviews, Diabetes, JAMA, Nutrition, Pediatrics / 11.07.2013

MedicalResearch.com Interview with Jill M. Norris, MPH, PhD Colorado School of Public Health, University of Colorado, Aurora MedicalResearch.com: What were the most significant findings? How do they relate to what was already known about this subject? Dr. Norris: One of the most intriguing findings is that if mothers are still breast-feeding when they introduce gluten-containing foods to their baby, they may reduce the risk for T1D.  This is similar to a finding from a Swedish study that found that breast-feeding while introducing gluten-containing foods may reduce the risk for celiac disease, an autoimmune condition that has several similarities with T1D. In children at increased genetic risk for T1D, our data suggest that parents should wait to introduce any solid foods until after the 4 month birthday.  And when the baby is ready, solid foods should be introduced by the 6 months birthday or soon thereafter, preferably while the mother is still breast-feeding the baby, which may reduce the risk of T1D. (more…)
Author Interviews, Cost of Health Care, JAMA / 10.07.2013

MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Sheehy: There were three main findings of our study. First, we found that observation in clinical practice is very different from the CMS definition of observation. CMS states that observation should rarely last longer than 48 hours, yet 16.5% of our observation encounters lasted longer than 48 hours. CMS also states that observation care is “well-defined”. We found there were 1141 distinct observation codes for our 4578 observation encounters, indicating that observation care is not well defined. Second, we found that observation care disproportionately affects the general medicine population, as over half of our observation encounters were on the general medicine services. These patients also had longer length of stay, were older, more likely to be female, were more likely to need discharge to a skilled facility, and were more likely to have government insurance as compared to patients on other services. This indicates that observation care adversely affects the adult general medicine population more than other patients on other types of services. Finally, we found that observation cost was greater than reimbursement, resulting in a net negative financial margin. (more…)
Author Interviews, Cancer Research, JAMA, Nutrition, Prostate Cancer / 10.07.2013

Maarten C. Bosland, DVSc, PhD Professor of Pathology Department of Pathology University of Illinois at Chicago College of Medicine Chicago, IL 60612MedicalResearch.com Interview with: Maarten C. Bosland, DVSc, PhD Professor of Pathology Department of Pathology University of Illinois at Chicago College of Medicine Chicago, IL  60612 MedicalResearch.com: What are the main findings of the study? Dr. Bosland: Daily consumption of a supplement containing soy protein isolate for two years following radical prostatectomy did not reduce recurrence of prostate cancer in men at high risk for this (radical prostatectomy is surgical removal of the prostate to treat prostate cancer). The study showed that this soy supplementation was safe. It is not clear whether this result indicates that soy does not prevent the development of prostate cancer, but men that have the disease probably do not benefit from soy supplementation. (more…)
JAMA, Rheumatology / 04.07.2013

MedicalResearch.com Interview with: Jonas Eriksson, PhD-student Clinical Epidemiology Unit Karolinska Institutet, T2 171 76 STOCKHOLM Sweden Biological vs Conventional Combination Treatment and Work Loss in Early Rheumatoid Arthritis A Randomized Trial MedicalResearch.com:  What are the main findings of the study? Answer: The main finding from this study is that in patients with early rheumatoid arthritis and with an insufficient response to methotrexate, addition of biologic (infliximab) or conventional combination therapy (sulfasalazine+hydroxychlorquine) resulted in significant improvements in work ability over 21 months. However, at 21 months, no significant difference could be detected in work ability change between patients randomized to addition of biologic or conventional therapy. When comparing the randomized early rheumatoid arthritis patients to matched general population comparators, the average number of days of work loss did not return to the level of the general population, underscoring the need for more effective treatment strategies and earlier diagnosis. (more…)
Author Interviews, Baylor College of Medicine Houston, Cost of Health Care, Heart Disease, JAMA / 03.07.2013

 MedicalResearch.com Interview with Salim S. Virani, MD, PhD Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas MedicalResearch.com: What are the main findings of the study? Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients.  Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up. Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing. (more…)
Author Interviews, Cancer Research, JAMA, Melanoma, Stanford / 03.07.2013

Susan Swetter, MD Professor of Dermatology Director, Pigmented Lesion & Melanoma Program Stanford University Medical Center & Cancer InstituteMedicalResearch.com Interview with: Susan Swetter, MD Professor of Dermatology Director, Pigmented Lesion & Melanoma Program Stanford University Medical Center & Cancer Institute  

Melanoma Survival Disadvantage in Young, Non-Hispanic White Males Compared With Females

MedicalResearch.com: What are the main findings of the study? Dr. Swetter: Women diagnosed with melanoma tend to fare better than men in terms of improved survival, and this has mostly been attributed to better screening practices and behaviors in women that result in thinner, more curable tumors, and/or more frequent physician visits in older individuals that result in earlier detection.  Our study focused on survival differences between young men and women (ages 15-39 years) diagnosed with cutaneous (skin) melanoma, who constitute a generally healthy population compared to the older adults that have usually been studied. We found that young men were 55% more likely to die of melanoma than age-matched women, despite adjustment for factors that may affect prognosis, such as tumor thickness, histology and location of the melanoma, as well as presence and extent of metastasis. Our results present further evidence that a biologic mechanism may contribute to the sex disparity in melanoma survival, since adolescent and young adults see physicians less frequently and are less likely to have sex-related behavior differences in skin cancer screening practices than older individuals. (more…)
Cost of Health Care, JAMA / 28.06.2013

Genevieve Kenney Ph.D Senior Fellow and Co-Director, Health Policy Center The Urban Institute 2100 M Street NW Washington DC 20037MedicalResearch.com  Interview with Genevieve Kenney Ph.D Senior Fellow and Co-Director, Health Policy Center The Urban Institute 2100 M Street NW Washington DC 20037 MedicalResearch.com: What are the main findings of the study? Dr. Kenney: Our study is the first published analysis that draws on physical examinations, laboratory tests, and patient reports to assess the health needs and health risks of uninsured adults who could be eligible for Medicaid coverage under the Affordable Care Act relative to the adults who are already enrolled in Medicaid. Our main findings are that the uninsured adults who could enroll under the ACA are less likely than the adults with Medicaid coverage to be obese and to have functional limitations and chronic health problems, such as hypertension, hypercholesterolemia, or diabetes, but that the uninsured adults with these chronic conditions are less likely to be aware that they have them and less likely to have the condition under control. In comparison to the Medicaid population, the uninsured adults in our study were also less likely to have seen a health professional in the prior year and to have a routine place for care.  The rates of undiagnosed and uncontrolled chronic health care problems found in our study indicate that millions of low-income uninsured adults are currently at risk of premature mortality and other significant health issues.  These findings provide new evidence of the potential health benefits associated with the Medicaid expansion under the Affordable Care Act. (more…)
Author Interviews, Diabetes, JAMA, Nutrition, Red Meat / 28.06.2013

MedicalResearch.com: An Pan, PhD

Research Associate, Dept Nutrition 655 Huntington Avenue Building 2, Room 351 Boston, Massachusetts 02115

Changes in Red Meat Consumption and Subsequent Risk of Type 2 Diabetes Mellitus: Three Cohorts of US Men and Women MedicalResearch.com: What are the main findings of the study? Answer: -- Compared with people who did not change their intake of red meat, those who increased it by as little as half a serving a day (about 1.5 ounces) over a four-year period had a 48% increased risk of developing type 2 diabetes in the subsequent 4 years. -- People who decreased their intake by half a serving a day over four years did not have an acute reduced risk in the next four years compared to people who did not change their intake, but had a reduced risk of developing the disease by 14% in the entire follow-up period, suggesting a prolonged effect. -- The findings included both processed meat such as lunch meat and hot dogs and unprocessed meats such as hamburger, steak and pork. And the association was generally stronger for processed red meat compared to unprocessed red meat. -- Adjusting for weight modestly reduced the association between red meat consumption and diabetes suggesting that weight gain played a role in the development of the disease. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Medical Research Centers / 26.06.2013

Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public HealthMedicalResearch.com Interview with Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public Health MedicalResearch.com: What are the main findings of the study? Dr. Joynt:  The main findings of the study were two-fold. First, high-cost patients in Medicare (the top decile of spenders) are responsible for about 80% of inpatient spending in the Medicare program, so understanding more about these patients' patterns of care is really important. Second, we found that only about 10% of acute-care spending for these high-cost Medicare patients were for causes that we generally think of as preventable in the short term, like uncontrolled diabetes, COPD, or heart failure. The rest of the spending was for acute conditions that we generally don't think of as preventable (at least in the short term), such as orthopedic procedures, sepsis, and cancer. (more…)
Author Interviews, Heart Disease, JAMA, Yale / 25.06.2013

Dr. Kumar Dharmarajan MD MBA Yale School of Medicine Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart FailureMedicalResearch.com  Interview with Dr. Kumar Dharmarajan MD MBA

Yale School of Medicine Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure MedicalResearch.com: What are the main findings of the study? We found that among a large contemporary cohort of heart failure hospitalizations, beta blockers are frequently started in patients with markers of clinical instability such as residence in an intensive care unit (ICU), volume overload requiring intravenous diuresis, and poor cardiac output requiring intravenous inotropes. Approximately 40% of patients in whom a beta blocker is started has at least one of these three potential contraindications to treatment. This finding is concerning, as recent performance measures for heart failure recommend that a beta blocker be started during hospitalization for heart failure among patients with left ventricular systolic dysfunction. However, these performance measures also state that persons in whom a beta blocker is started "should not be hospitalized in an ICU, should have no or minimal evidence of fluid overload or volume depletion, and should not have required recent treatment with an intravenous positive inotropic agent." Moving forward, we are concerned that the unselective application of the new performance measure may lead to the further use of beta blocker therapy in patients at higher risk for adverse consequences of therapy. (more…)
HIV, Infections, JAMA, Race/Ethnic Diversity / 21.06.2013

MedicalResearch.com Interview with Dr. H. Irene Hall, PhD Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC 1600 Clifton Road, MS E-47, Atlanta, GA 30333 MedicalResearch.com: What are the main findings of the study? Dr. Hall: Our research finds that, across all populations, far too few Americans with HIV receive the care they need to stay healthy and reduce risk of transmission. According to our research, gaps in care are the largest among African Americans and young people. Moving forward, improving care for all HIV-infected people will be critical to achieving the goal of an AIDS-free generation in America. More specifically, some of the key findings of the study include:
  • Overall, only a quarter of all Americans with HIV have a suppressed viral load – meaning the level of HIV in their bodies is low enough to stay healthy and dramatically reduce the chance of transmitting to others.
  • By race/ethnicity, African-Americans and Hispanics or Latinos are less likely to be aware of their infection compared to whites.
  •  By age, younger Americans are less likely to be in ongoing care and have a suppressed viral load; HIV care and viral suppression generally improved with age. For example:
  • Fifteen percent of those aged 25-34 were virally suppressed, compared to 36 percent of those aged 55-64.
  • In terms of ongoing care, 28 percent of those 25-34 years old were retained in care, compared to 46 percent of those aged 55-64. (more…)
Diabetes, JAMA, Pediatrics / 20.06.2013

MedicalResearch.com Interview with:  Dr. Ezio Bonifacio, Ph.D. Professor, Preclinical Stem Cells/Diabetes Center for Regenerative Therapies Dresden Technische Universität Dresden MedicalResearch.com:  What are the main findings of the study? Dr. Bonifacio: Children who develop multiple islet autoantibodies are destined to develop diabetes. Only a minority will be diabetes-free 15 years after developing islet autoantibodies. This is regardless of whether they have a family history of type 1 diabetes. Progression to diabetes after seroconversion varied from weeks to decades, and 20% of children had diabetes within 2 years from seroconverting. Progression was fastest in children who developed their islet autoantibodies before age 3 years. MedicalResearch.com:  Were any of the findings unexpected? Dr. Bonifacio: Unexpected is probably not the right word. The Eisenbarth model of chronic disease proposes that diabetes will happen some time after autoimmunity and the findings show the reality of it. Perhaps the unexpected finding is that it is not always chronic and that for a number of children, intervention would need to be applied quickly. (more…)