Despite Evolution, Genetic Diseases Persist

MedicalResearch.com Interview with:

Carlos Eduardo G. Amorim PhD Columbia University Department of Systems Biology Irving Cancer Research Center

Dr. Amorim

Carlos Eduardo G. Amorim PhD
Columbia University Department of Systems Biology
Irving Cancer Research Center 

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

Response: More generally, we were interested in understanding the determinants of the frequencies of mutations that cause disease in humans.

More specially, we wanted to test if a long-standing theory in population genetics (namely mutation-selection balance) was a good explanation for the observed frequencies of disease mutations in humans.

Continue reading

Hip and Knee Replacements More Common In Patients With Transthryretin Cardiac Amyloidosis

MedicalResearch.com Interview with:

Dr. Mathew Maurer, Medical Director The Hypertrophic Cardiomyopathy Center NewYork-Presbyterian/Columbia University Medical Center.

Dr. Maurer

Dr. Mathew Maurer, Medical Director
The Hypertrophic Cardiomyopathy Center
NewYork-Presbyterian/Columbia University Medical Center.

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

Response: Transthryretin cardiac amyloidosis (TTR-CA) is an underdiagnosed type of cardiomyopathy in which TTR (transthyretin, also known as prealbumin), a protein that forms amyloid fibrils, deposits in the heart. The deposits cause thickening of the ventricular wall and diastolic as well as systolic dysfunction. It is usually discovered around age 75 and presents more commonly in men than in women. With advances in non-invasive diagnostic modalities and growing awareness, TTR-CA is being diagnosed increasingly more frequently. Additionally, there are several emerging treatments that are under active investigation. Most of these therapies prevent disease progression and don’t address the amyloid already deposited in the heart. Accordingly, it is imperative that we diagnose TTR-CA before patients develop significant amyloid heart disease. However, this presents a great challenge since there are few known clinical predictors that might alert even the most astute physician that a patient is at such risk. With identification of predictors that may appropriately raise the index of clinical suspicion, clinicians may begin to pick up more subtle (and perhaps not yet clinically significant) forms of TTR-CA and initiate treatment before significant damage occurs.

The few known clinical predictors of TTR-CA include bilateral carpal tunnel syndrome and lumbar spinal stenosis, and numerous studies found TTR on biopsies and autopsies of other musculoskeletal sites, particularly in hip and knee joints. (Just last week, and also discussed here on MedicalResearch.com, biceps tendon rupture was also shown to occur more frequently in TTR-CA!) We suspected that patients who ultimately develop TTR-CA may first develop clinically significant hip and knee disease, enough to even warrant a hip (THA) or knee (TKA) replacement.

Continue reading

Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation 

MedicalResearch.com Interview with:

Professor Christopher P. Cannon MD Executive Director, Cardiometabolic Trials, Baim Institute Cardiologist Brigham and Women's Hospital Baim Institute for Clinical Research Columbia University College of Physicians and Surgeons

Dr. Cannon

Professor Christopher P. Cannon MD
Executive Director, Cardiometabolic Trials, Baim Institute
Cardiologist Brigham and Women’s Hospital
Baim Institute for Clinical Research
Columbia University College of Physicians and Surgeons

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

Response: The trial explored whether a dual therapy approach of anticoagulation and P2Y12 antagonist – without aspirin – in non-valvular atrial fibrillation (AF) patients following percutaneous coronary intervention (PCI) and stent placement would be as safe, and still efficacious, as the current standard treatment – triple therapy. For more detailed background on the study, readers may want to review the first paragraph of the article in the New England Journal of Medicine.

Results showed significantly lower rates of major or clinically relevant non-major bleeding events for dual therapy with dabigatran, when compared to triple therapy with warfarin.

In the study, the risk for the primary safety endpoint (time to major or clinically relevant non-major bleeding event) was 48 percent lower for dabigatran 110 mg dual therapy and 28 percent lower for dabigatran 150 mg dual therapy (relative difference), with similar rates of overall thromboembolic events.

Continue reading

Praluent Plus Statins Reduce LDL In High Risk Cardiovascular Patients

MedicalResearch.com Interview with:

VP Head of Cardiovascular Development and Head Global Cardiovascular Medical Affairs Sanofi

Dr. Edelberg

Dr. Jay Edelberg MD, PhD
VP Head of Cardiovascular Development and
Head Global Cardiovascular Medical Affairs
Sanofi 

MedicalResearch.com: What should readers take away from the data that Sanofi and Regeneron is presenting at ESC Congress 2017?   

Response: This year at European Society of Cardiology (ESC,) we are pleased to present analyses that further demonstrate additional efficacy and tolerability of Praluent (alirocumab).

While statins remain the first-line treatment, Praluent has shown a consistent benefit as an additional therapy to high-intensity statins in patients with clinical atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH), allowing many patients to achieve low-density lipoprotein (LDL) cholesterol levels previously considered unattainable in this patient population.

Our data further emphasize the need for additional cholesterol-lowering options in these high cardiovascular (CV) risk patient populations, including individuals living with diabetes 

Continue reading

CALM Study Launches Trial of MobiusHD Carotid Implant For Resistant Hypertension

MedicalResearch.com Interview with:

Gregg W. Stone MD Professor of Medicine Columbia University Director of Cardiovascular Research and Education Center for Interventional Vascular Therapy New York Presbyterian Hospital/ Columbia University Medical Center Co-Director of Medical Research and Education The Cardiovascular Research Foundation New York, NY

Dr. Stone

Gregg W. Stone MD
Professor of Medicine
Columbia University
Director of Cardiovascular Research and Education
Center for Interventional Vascular Therapy
New York Presbyterian Hospital/ Columbia University Medical Center
Co-Director of Medical Research and Education
The Cardiovascular Research Foundation
New York, NY


MedicalResearch.com:
How does the MobiusHD system work?

Response: The MobiusHD System is a thin stent-like device which is implanted during a minimally invasive procedure into the carotid artery. The MobiusHD modifies the activity of baroreceptors located in the carotid artery, increasing arterial vasodilation to reduce blood pressure.

Continue reading

Diet Rich in Anti-Inflammatory Foods May Help Preserve Brain Function

MedicalResearch.com Interview with:
Yian Gu, PhD
Assistant Professor of Neuropsychology (in Neurology and
Taub Institute for Research on Alzheimer’s Disease and the Aging Brain)
Columbia University Medical Center

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

Response: We have previously shown that elderly individuals who consume healthier diet (certain foods, nutrients, and dietary patterns) have larger brain volume, better cognition, and lower risk of developing Alzheimer’s disease.

The current study aimed to examine the biological mechanisms for the relationship between diet and brain/cognitive health

Continue reading

Long Term Memories Can Be Selectively Erased

MedicalResearch.com Interview with:
Samuel Schacher, PhD and
Jiangyuan Hu, PhD,
Department of Neuroscience
Columbia University Medical Cente
New York State Psychiatric Institute
New York, NY 10032, USA

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

Response: It is well established that learning and memory requires changes in the properties of specific neural circuits in the brain activated by the experience. The long-term storage of the memory is encoded through changes in the function of the synapses within the circuit. Synapses are sites of communication between neurons, and the changes in their function come in two varieties: increases in strength and decreases in strength. The encoding of memories typically requires some combination of these synaptic changes, synaptic plasticity, which can last a long time to contribute to long-term memory. Thus the maintenance of a memory will require the persistent change (long-term synaptic memory) in the function of specific synapses.

But memories come in different flavors. In the original experiment by Pavlov, a neutral tone, which dogs ignore, came to predict the immediate appearance of a meal. After several of these pairings, the dogs would become happily excited just with the tone. The same type of conditioning could have a negative valence – the tone could proceed a shock to one of the dog’s paw. Now the neutral tone would predict a negative stimulus and the dog would express fearful behavior just with the tone (associative learning). A non-associative form of memory would be the same types of stimuli but without the preceding neutral stimulus. At random times the animal will be given a meal or a shock. The behavior of the animal for some time will take on the positive or negative features of its environment – a contented versus depressed condition.

Each of these forms of long-term memory would be maintained by increases in the strength of specific synapses.

The questions addressed in our study published in Current Biology, based on previous work in my lab and the lab of my colleague Wayne Sossin at McGill, were:

1) Do the same molecules maintain increases in synaptic strength in the neurons of the circuit after stimuli that produce long-term classical conditioning (associative learning) and long-term sensitization (non-associative learning)?
2) If different molecules maintain the different synaptic memories, is it possible to reverse or erase the different synaptic memories by interfering with the function of the different molecules?
3) If true, can we reverse the different synaptic memories expressed in the same neuron by interfering with the function of the different molecules.

Continue reading

Pot Plus Alcohol Raises Fatal Traffic Accident Risk Over 500%

MedicalResearch.com Interview with:

Guohua Li DrPH, MD Professor and Director Center for Injury Epidemiology and Prevention Department of Epidemiology Mailman School of Public Health Columbia University

Dr. Li

Guohua Li DrPH, MD
Professor and Director
Center for Injury Epidemiology and Prevention
Department of Epidemiology
Mailman School of Public Health
Columbia University

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

Response: Drugged driving has become a serious problem in the United States in the recent years due to increased consumption of marijuana and opioids. About 20% of fatally injured drivers used two or more substances, with alcohol-marijuana being the most commonly detected polydrug combination.

Our study of over 14000 fatal 2-car crashes indicates that drivers testing positive for alcohol, marijuana, or both are significantly more likely to be responsible for initiating these crashes than those using neither of the substances. Specifically, compared to drivers not using alcohol and marijuana, the risk of being responsible for initiating fatal crashes increases 62% for those testing positive for marijuana and negative for alcohol, 437% for those testing positive for alcohol and negative for marijuana, and 539% for those testing positive for both alcohol and marijuana. These results suggest that when used in combination, alcohol and marijuana have a positive interaction on the risk of fatal crash initiation.

The most common driver error leading to fatal 2-car crashes is failure to keep in proper lane, followed by failure to yield right of way and speeding.

Continue reading

Frequent Marijuana Use Linked To Increased Risk of Severe Periodontal Disease

MedicalResearch.com Interview with:

Jaffer A Shariff DDS MPH cert.DPH Periodontal Resident | Research Scientist Division of Periodontics, Columbia University College of Dental Medicine New York

Dr. Shariff

Jaffer A Shariff DDS MPH cert.DPH
Periodontal Resident | Research Scientist
Division of Periodontics,
Columbia University College of Dental Medicine
New York

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

Response: Marijuana use for both medical and recreational purposes has become increasingly common in recent years; it is the most commonly used recreational drug in the United States. Subsequent increase in its legalization among countries including the United States for recreational purposes, poses an emergent oral and periodontal health concerns.

Our study revealed that frequent recreational marijuana users exhibited deeper periodontal probing depths, clinical attachment loss and higher odds of having severe periodontal disease than the non-frequent users, even after controlling for other risk factors linked to gum disease, such as cigarette smoking.

Continue reading

Autism Increases Risk of Death From Injury, Especially Drowning

MedicalResearch.com Interview with:
Joseph Guan

MPH Candidate in Epidemiology, Certificate in Chronic Diseases Epidemiology
Columbia University Mailman School of Public Health

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

Response: The prevalence of autism has been increasing especially in the past two decades. With an estimate of more than 3.5 million people living with autism in the US, approximately 500,000 of them are children under 15 years old. Current studies show that males are approximately four times as likely than females to be diagnosed with autism. There is also evidence that people with autism are at a heightened risk of injury. However, the research on the relationship between autism and injury is understudied.

We found that 28% of deaths in individuals with autism were due to injury, compared to 7% of deaths in the general population. Injury deaths in individuals with autism occurred at a much younger age (29.1 years) on average compared to injury deaths in the general population (54.7 years). Our study show that drowning was the leading cause of injury death among individuals with autism, followed by suffocation and asphyxiation. Children under the age of 15 years were 160 times more likely to die from drowning.

Continue reading

No Increased Health Consequences After Chinese Famine Except Schizophrenia

MedicalResearch.com Interview with:

L. H. Lumey, MD, PhD Professor of Epidemiology Mailman School of Public Health Columbia University

Dr. Lumey

L. H. Lumey, MD, PhD
Professor of Epidemiology
Mailman School of Public Health
Columbia University

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

Response: The Chinese Great Leap Forward Famine in 1959-1961 is the largest famine in human history. Earlier studies have reported that overweight, type 2 diabetes, hyperglycemia, the metabolic syndrome and schizophrenia were more common among adults who were exposed to the famine. Our re-analysis of all previous studies shows no increases in diabetes, high blood pressure and other chronic conditions among famine births except for schizophrenia.

Continue reading

Ketamine Before Stressful Event May Reduce Risk of PTSD

MedicalResearch.com Interview with:

Christine Ann Denny, Ph.D. Assistant Professor Department of Psychiatry Columbia University Division of Integrative Neuroscience Research Foundation for Mental Hygiene, Inc. New York, NY 10032-2695

Dr. Christine Ann Denny

Christine Ann Denny, Ph.D.
Assistant Professor
Department of Psychiatry
Columbia University
Division of Integrative Neuroscience
Research Foundation for Mental Hygiene, Inc.
New York, NY 10032-2695

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

Response: Post-traumatic stress disorder (PTSD) is one of the most common psychiatric illnesses, affecting about 8 million adult Americans, and an annual prevalence of about 3.5% worldwide. At-risk populations such as soldiers and veterans are at a higher risk to develop PTSD. Stress exposure is one of the major risk factors for PTSD and major depressive disorder (MDD), a disorder which is often co-morbid with PTSD.

There are currently very limited treatments for PTSD and MDD. In addition, these disorders are treated in a symptom-suppression approach, which only mitigate symptoms and work in only a small fraction of patients. Prevention is rarely an approach considered except in the form of behavioral intervention. However, pharmacological approaches to preventing psychiatric diseases has not yet been developed.

Our laboratory has previously found that ketamine, a general anesthetic and rapid-acting antidepressant, administered sub-anesthetically prior to stress can prevent against stress-induced depressive-like behaviors. We decided to delve into the literature to determine whether ketamine has any effects on PTSD in the clinic. We found numerous reports linking ketamine to PTSD, but the results were varied. We realized that the main difference in all of these studies was the timing of administration. We decided to systematically test the efficacy of ketamine in mice at various time points relative to a stressor to determine when would be the most effective window to buffer against heightened fear expression.

We found that ketamine administered 1 week, but not 1 month or 1 day, prior to a stressor was the most effective time point to administer the drug to buffer fear. This is critical, as it suggests that a pharmacological approach to enhance resilience can be more effective at protecting against PTSD symptoms than attempting to mitigate symptoms after it has already affected an individual.

Continue reading

PCSK9 Inhibition with Alirocumab Increases Removal of LDL Cholesterol

MedicalResearch.com Interview with:
Henry N. Ginsberg, MD

Irving Institute for Clinical and Translational Research
Columbia University
Columbia College of Physicians and Surgeons
New York, NY

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

Response: Previous studies in mice and cells have identified increased hepatic low density lipoprotein (LDL) receptors as the basis for LDL lowering by PCSK9 inhibitors, but there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism, particularly effects on very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL) or LDL metabolism.

This study in 18 healthy subjects, found that alirocumab decreased the number of IDL and LDL particles in the circulation, and their associated cholesterol and apoB levels by increasing efficiency of the clearance of IDL and LDL. There were not effects on VLDL metabolism. The increased clearance of IDL meant that less LDL was produced from IDL, which is the precursor of LDL. Thus, the dramatic reductions in LDL cholesterol resulted from both less LDL being produced and more efficient clearance of LDL. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition.

Continue reading

AI plus Genetic Database Drives Personalized Cancer Treatment

MedicalResearch.com Interview with:

Dr. Kai Wang Zilkha Neurogenetic Institute, University of Southern California Institute for Genomic Medicine, Columbia University

Dr. Kai Wang

Dr. Kai Wang
Zilkha Neurogenetic Institute, University of Southern California
Institute for Genomic Medicine, Columbia University

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

Response: Cancer is a genetic disease caused by a small number of “driver mutations” in the cancer genome that drive disease initiation and progression. To understand such mechanism, there are increasing community efforts in interrogating cancer genomes, transcriptomes and proteomes by high-throughput technologies, generating huge amounts of data. For example, The Cancer Genome Atlas (TCGA) project has already made public 2.5 petabytes of data describing tumor and normal tissues from more than 11,000 patients. We were interested in using such publicly available genomics data to predict cancer driver genes/variants for individual patients, and design an “electronic brain” called iCAGES that learns from such information to provide personalized cancer diagnosis and treatment.

iCAGES is composed of three consecutive layers, to infer driver variants, driver genes and drug treatment, respectively. Unlike most other existing tools that infer driver genes from a cohort of patients with similar cancer, iCAGES attempts to predict drivers for individual patient based on his/her genomic profile.

What we have found is that iCAGES outperforms other tools in identifying driver variants and driver genes for individual patients. More importantly, a retrospective analysis on TCGA data shows that iCAGES predicts whether patients respond to drug treatment and predicts long-term survival. For example, we analyzed two groups of patients and found that using iCAGES recommend drugs can increase patients’ survival probability by 66%. These results suggest that whole-genome information, together with transcriptome and proteome information, may benefit patients in getting optimal and precise treatment. Continue reading

Fetal Structural Defects Detected Later in Pregnancy Than Chromosomal Abnormalities

MedicalResearch.com Interview with:
Sarah Horvath, MD
Paula M. Castaño, MD, MPH
Anne R. Davis, MD, MPH

Columbia University Medical Center

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

Response: Approximately 3% of pregnant women in the United States will receive a prenatal diagnosis of fetal aneuploidy (such as trisomy 21) or fetal structural abnormality (such as cardiac or CNS malformations). Many of these women will undergo abortion. Advances in screening over the past few decades have allowed earlier diagnosis of aneuploidy, but most structural abnormalities cannot be diagnosed until the anatomy ultrasound at 18-20 weeks gestational age because of fixed patterns of fetal development. Our analysis examines gestational age at time of abortion for these two types of fetal diagnosis from 2004-2014.

Our main finding was that median gestational age at time of abortion for fetal aneuploidy decreased from 19 weeks to 14 weeks. However, over the same 11 year period, median gestational age at time of abortion for fetal structural abnormalities remained unchanged and at or above 20 weeks gestation.

Continue reading

Association Between Dietary Intake and Function in Amyotrophic Lateral Sclerosis

MedicalResearch.com Interview with:

Dr. Jeri Nieves PhD Director of bone density testing New York's Helen Hayes Hospital

Dr. Jeri Nieves

Dr. Jeri Nieves PhD
Director of bone density testing
New York’s Helen Hayes Hospital

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

Response: Amyotrophic lateral sclerosis (ALS) is a devastating severe neurodegenerative disorder that causes progressive muscle atrophy, paralyses, and eventual respiratory failure.

Our objective was to evaluate the associations between nutrition and severity of ALS around the time of diagnosis. This was a cross-sectional analysis of data from a multicenter cohort of 302 patients with ALS. We assessed nutrient intake using a modified Block Food Frequency Questionnaire. The outcomes were respiratory function (measured using percentage forced vital capacity; FVC%) and functional performance measured by ALS Functional Rating Scale–Revised (ALSFRS-R), both considered important indicators of the severity of ALS. Results of the regression analysis were that higher intakes of antioxidants and carotenes from vegetable intake were associated with higher ALSFRS-R scores or better %FVC.

We used a novel analysis to evaluate the diet as a whole and found that higher intakes of antioxidants, fiber from grains, vegetables, fruit, eggs, fish, and poultry were all associated with higher function in patients with ALS. However, milk and lunch meats were associated with lower measures of function. These consistent results from two different statistical analyses indicate that diet may help minimize the severity of ALS. Perhaps these findings point to the role of oxidative stress in ALS severity.

In summary, increased consumption of antioxidant nutrients, foods high in carotenoids and fiber, vegetables and fruits, poultry and fish are associated with better function around the time of ALS diagnosis.

Continue reading

Risk of Pregnancy-Associated Stroke Across Age Groups

MedicalResearch.com Interview with:
Eliza Miller, M.D
.
Vascular Neurology Fellow
New York-Presbyterian Hospital/Columbia University Medical Center
We collaborated with researchers at the Massachusetts General Hospital and with the New York State Department of Health.

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

Response: Prior research has found that older women of childbearing age are at higher risk of stroke during pregnancy and postpartum than younger women. We hypothesized that their increased stroke risk might not be due to pregnancy-related factors, but just due to the fact that stroke risk increases with age for all people. We used billing data from New York State hospitals to calculate incidence risk ratios for four age groups: 12-24, 25-34, 35-44 and 45-55. In each age group, we compared the incidence of stroke in women who were pregnant or postpartum to the incidence of stroke in women of the same age who were not pregnant.

As in prior studies, we found that the incidence of pregnancy-associated stroke was higher in older women compared to younger women (about 47/100,000 deliveries in the oldest group, versus 14/100,000 deliveries in the youngest group). However, the incidence ratios showed that pregnancy increased stroke risk significantly in women under 35, but did not appear to increase stroke risk in women over 35. In the youngest group (age 12-24), pregnancy more than doubled the risk of stroke, and in the 25-34 age group, pregnancy increased stroke risk by 60%. In women aged 35 and older, pregnancy did not increase stroke risk. Women who had pregnancy-related strokes tended to have fewer traditional vascular risk factors like hypertension and diabetes, compared to same-aged women with non-pregnancy related strokes.

Continue reading

Maternal Use of SSRIs May Be Related to Speech and Language Disorders in Offspring

MedicalResearch.com Interview with:

Alan S. Brown, M.D., M.P.H. Professor of Psychiatry and Epidemiology Columbia University Medical Center Director, Program in Birth Cohort Studies, Division of Epidemiology New York State Psychiatric Institute

Dr. Alan Brown

Alan S. Brown, M.D., M.P.H.
Professor of Psychiatry and Epidemiology
Columbia University Medical Center
Director, Program in Birth Cohort Studies, Division of Epidemiology
New York State Psychiatric Institute 

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

Response: Maternal use of antidepressants during pregnancy has been increasing.  A previous study from a team that I led in a national birth cohort in Finland showed that mother’s use of a serotonin reuptake inhibitor antidepressant is related to an increased risk of depression in offspring.  We sought to evaluate whether these medications also increased risk of speech/language, scholastic, and motor outcomes in offspring.  We found an increased risk (37% higher risk) of speech/language disorders in offspring of mothers exposed to SSRIs in pregnancy compared to mothers who were depressed during pregnancy but did not take an SSRI during pregnancy.

Continue reading

Antibiotics Encourage Spread of C.diff To Subsequent Patients Who Occupy the Same Bed and Haven’t Received Antibiotics

MedicalResearch.com Interview with:

Dr. Daniel E. Freedberg MD M

Dr. Daniel E. Freedberg

Dr. Daniel E. Freedberg MD MS
Division of Digestive and Liver Diseases
Columbia University Medical Center
New York, New York

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

Response: We conducted this study because previous studies indicate that the gastrointestinal microbiome is easily shared between people who co-occupy a given space (such as a hospital room).  We wondered if antibiotics might exert an effect on the local microbial environment.

Continue reading

Sharp Rise in Heroin Use Among Young Adults Who Use Nonmedical Prescription Opioids

MedicalResearch.com Interview with:

Silvia S. Martins, MD, PHD Associate Professor of Epidemiology  Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032

Dr. Silvia Martins

Silvia S. Martins, MD, PHD
Associate Professor of Epidemiology
Department of Epidemiology
Mailman School Of Public Health
Columbia University
New York, NY 10032

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

Response: Given the high probability of nonmedical use among adolescents and young adults, the potential development of prescription opioid use disorder secondary to nonmedical use among youth represents an important and growing public health concern. Still, no study had investigated time trends, specifically if prescription opioid use disorder has increased in the past decade among adolescents, emerging adults and young adults who are nonmedical users of prescription opioids.

Continue reading

Romosozumab Has Potential To Reduce New Vertebral Fractures at 12 Months

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Felicia Cosman, M.D.

Dr. Felicia Cosman

Felicia Cosman, M.D.
Medical Director of the Clinical Research Center
Helen Hayes Hospital
Professor of Medicine
Columbia University College of Physician and Surgeons
New York
Editor-in-Chief, Osteoporosis International

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

Response: Amgen and UCB presented detailed data from the Phase 3 FRAME study in an oral session at ASBMR 2016, and the data were also published in the New England Journal of Medicine. Additionally, the FRAME abstract has been awarded the 2016 ASBMR Most Outstanding Clinical Abstract Award. The FRAME data show significant reductions in both new vertebral and clinical fractures in postmenopausal women with osteoporosis.

Patients receiving a monthly subcutaneous 210 mg dose of romosozumab experienced a statistically significant 73 percent reduction in the relative risk of a vertebral (spine) fracture through 12 months, the co-primary endpoint, compared to those receiving placebo (fracture incidence 0.5 percent vs. 1.8 percent, respectively [p<0.001]). By six months, new vertebral fractures occurred in 14 romosozumab and 26 placebo patients; between six to 12 months, fractures occurred in two versus 33 additional patients in each group, respectively.

Patients receiving romosozumab experienced a statistically significant 36 percent reduction in the relative risk of a clinical fracture, a secondary endpoint, through 12 months compared to those receiving placebo (fracture incidence 1.6 percent vs. 2.5 percent, respectively [p=0.008]).

In patients who received romosozumab in year one, fracture risk reduction continued through month 24 after both groups transitioned to denosumab treatment through the second year of the study: there was a statistically significant 75 percent reduction in the risk of vertebral fracture at month 24 (the other co-primary endpoint) in patients who received romosozumab followed by denosumab vs. placebo followed by denosumab (fracture incidence 0.6 percent vs. 2.5 percent, respectively [p<0.001]).

Clinical fractures encompass all symptomatic fractures (both non-vertebral and painful vertebral fractures; all clinical fractures assessed in the FRAME study were symptomatic fragility fractures. A 33 percent reduction in relative risk of clinical fracture was observed through 24 months after patients transitioned from romosozumab to denosumab compared to patients transitioning from placebo to denosumab (nominal p=0.002, adjusted p=0.096).

Continue reading

Medical Marijuana Laws Linked To Lower Opioid-Related Traffic Deaths

MedicalResearch.com Interview with:

June H. Kim Doctoral candidate,Department of Epidemiology Mailman School Public Health Columbia University

June Kim

June H. Kim
Doctoral candidate,Department of Epidemiology
Mailman School Public Health
Columbia University

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

Response: A previous study indicated that states with medical marijuana laws had a reduced rate of opioid overdoses. If this is true, we’d expect to see similar reductions in opioid use associated with these laws. For this study, we used data from the FARS, a national surveillance system that records any crash events on US public roads that result in a fatality. Some states provide uniform testing of the majority of their deceased drivers, year to year. Among these states, we found that there was a lower prevalence of positive opioid toxicology tests among drivers crashing in states with an operational medical marijuana versus drivers crashing in states before a future medical marijuana law is implemented, particularly among drivers aged 21-40.

Continue reading

Earned Income Tax Credits Linked To Improved Health Parameters

MedicalResearch.com Interview with:

Peter Muennig, MD, MPH Associate Professor Mailman School of Public Health Columbia University New York, NY 10032

Dr. Peter Muennig

Peter Muennig, MD, MPH
Associate Professor
Mailman School of Public Health
Columbia University
New York, NY 10032

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

Response: We looked that the supplemental Earned Income Tax Credit
( EITC ) programs offered by states to determine whether they have health impacts or not.

We found that, on average, folks who live in states that offer supplemental EITC showed improvements in health after EITC was implemented.

Continue reading

Long-Term Bone Loss Linked to Antidepressants May Be Ameliorated By Beta Blockers

MedicalResearch.com Interview with:

Patricia Ducy, PhD Associate Professor Department of Pathology & Cell Biology Columbia University New York, NY 10032

Dr. Patricia Ducy

Patricia Ducy, PhD
Associate Professor
Department of Pathology & Cell Biology
Columbia University
New York, NY 10032

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

Response: In the past few years, several large clinical studies have reported an association between the use of selective serotonin reuptake inhibitors (SSRIs) and an increased risk of bone fractures. Yet, a few studies conducted on small cohorts using these drugs for a short time showed a decrease in bone resorption parameters and thus minor bone gain.

To understand this paradox and to define how the deleterious effect of SSRIs could be prevented we conducted a series of studies in mice treated with fluoxetine, the active molecule of the widely prescribed SSRI Prozac.

Continue reading

Technetium Cardiac Imaging Predicts Prognosis of Cardiac Amyloidosis

MedicalResearch.com Interview with:

Adam Castano, M.D., M.S. Division of Cardiology Columbia University Medical Center New York Presbyterian Hospital

Dr. Adam Castano

Adam Castano, M.D., M.S.
Division of Cardiology
Columbia University Medical Center
New York Presbyterian Hospital

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

Response: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF). Traditionally, the gold standard for diagnosis has required an endomyocardial biopsy coupled with either immunohistochemistry or mass spectroscopy. These specialized tests are only performed at centers with experienced satff, do not yield prognostically useful information, may be inadvisable for frail older adults, and often present logistical challenges that lead to delayed care.

Fortunately, single center studies have demonstrated excellent diagnostic accuracy using technetium 99m pyrophosphate (Tc99mPYP) cardiac imaging for noninvasively detecting ATTR-CA and differentiating it from another major type of cardiac amyloidosis called light chain (AL). But the diagnostic accuracy of this technique in a multicenter study and the association of Tc99mPYP myocardial uptake with survival were not known prior to this study.

Therefore, we assessed in a multicenter study Tc99mPYP cardiac imaging as a diagnostic tool and its association with survival. We conducted a retrospective cohort study of 229 patients evaluated at 3 academic specialty centers for cardiac amyloidosis and also underwent Tc99mPYP cardiac imaging. We measured retention of Tc99mPYP in the heart using a semiquantitative visual score (range 0-3) and a more quantitative heart-to-contralateral (H/CL) ratio calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc99mPYP imaging.

Continue reading

Reducing Access to Guns Key to Reducing Successful Suicide Attempts

MedicalResearch.com Interview with:

J. John Mann MD Paul Janssen Professor of Translational Neuroscience Director, Molecular Imaging and Neuropathology Division Department of Psychiatry Columbia University/New York State Psychiatric Institut

Dr. Mann

J. John Mann MD
Paul Janssen Professor of Translational Neuroscience
Director, Molecular Imaging and Neuropathology Division
Department of Psychiatry
Columbia University/New York State Psychiatric Institute

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

Response: In 2014 there were 21,000 firearm suicides in the USA. Overseas, programs that have resulted in major reductions in firearm availability have reduced firearm suicide rates which have also been shown in the USA to be closely correlated with risk of firearm suicide. Reducing access to firearms to those at risk for suicide would help reduce firearm suicide rates in the USA. Most such suicides involve a firearm purchased many years earlier. We recommend methods for reducing such access including improved gun safety and smart gun technology.

Continue reading

Coronary Artery Disease Testing Underutilized in Heart Failure Patients

MedicalResearch.com Interview with:

Ajay J. Kirtane, MD, SM, FACC, FSCAI Associate Professor of Medicine at Columbia University Medical Center Chief Academic Officer, Center for Interventional Vascular Therapy Director, NYP/Columbia Cardiac Catheterization Laboratories New York, NY 10032

Dr. Ajay Kirtane

Ajay J. Kirtane, MD, SM, FACC, FSCAI
Associate Professor of Medicine at Columbia University Medical Center
Chief Academic Officer, Center for Interventional Vascular Therapy
Director, NYP/Columbia Cardiac Catheterization Laboratories
New York, NY  10032

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

Response: Patients with inpatient heart failure are a higher-risk patient population who can benefit from the identification and treatment of coronary artery disease. We sought to identify how frequently these patients in fact underwent testing for coronary artery disease.

Continue reading

Large Proportion of Pregnant Women Use Alcohol and Tobacco in First Trimester

MedicalResearch.com Interview with:

Dr. Qiana L. Brown, PhD, MPH, LCSW Postdoctoral Research Fellow Columbia University Mailman School of Public Health Department of Epidemiology Substance Abuse Epidemiology Training Progra

Dr. Qiana Brown

Dr. Qiana L. Brown, PhD, MPH, LCSW
Postdoctoral Research Fellow
Columbia University
Mailman School of Public Health
Department of Epidemiology
Substance Abuse Epidemiology Training Program

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

Dr. Brown: Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health. Tobacco and alcohol are the most commonly used substances among pregnant women and non-pregnant women of reproductive age, and are leading causes of preventable adverse health outcomes for both mother and baby. Women with health insurance have more prenatal visits, and present for prenatal care earlier than uninsured women, which may increase their exposure to health messaging around substance abuse prevention at prenatal visits. Additionally, treatment for substance use disorders and maternal and child health care are part of the Essential Health Benefits covered by the Affordable Care Act, which may encourage patients and providers to engage in discussions around alcohol and tobacco use prevention during pregnancy.

Given these factors, we examined the relationship between health insurance coverage and both past month tobacco use and past month alcohol use among a nationally representative sample of reproductive age women in the United States. We sampled 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health in 2010 to 2014. Among these women, 3.28% (n=3,267) were pregnant. We specifically investigated whether the relationship between health insurance and alcohol or tobacco use differed between pregnant and non-pregnant women.
Continue reading

Acute MI Often Changes Compliance With Prescribed Statins

MedicalResearch.com Interview with:

Ian Kronish, MD, MPH Florence Irving Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Columbia University Medical Center

Dr. Ian Kronish

Ian Kronish, MD, MPH
Florence Irving Assistant Professor of Medicine
Center for Behavioral Cardiovascular Health
Columbia University Medical Center

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

Dr. Kronish: Prior studies have shown that adherence to statins is suboptimal both in patients prescribed statins for primary prevention and in high-risk patients who are prescribed statins to prevent recurrent events. But, to our knowledge, prior studies had not examined the impact of a hospitalization for a myocardial infarction (MI) on subsequent adherence to statins. We wondered whether the hospitalization would serve as a wake-up call that led patients to become more adherent after the MI. At the same time, we were concerned that the physical and psychological distress that arises after a hospitalization for an MI may lead to a decline in statin adherence.

Continue reading

Childhood Trauma Associated With Lifetime Drug Use in Teens

MedicalResearch.com Interview with:

Hannah Carliner, ScD MPH Post Doctoral Fellow in Substance Abuse Epidemiology Mailman School of Public Health Columbia University

Dr. Hannah Carliner

Hannah Carliner, ScD MPH
Post Doctoral Fellow in Substance Abuse Epidemiology
Mailman School of Public Health
Columbia University

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

Dr. Carliner: We know from previous research that traumatic experiences in childhood can have far-reaching effects on the mental and physical health of adults, including increasing the risk for substance use disorders. There is a particularly strong body of evidence about this concerning exposure to child abuse and various other forms of family dysfunction and violence.

However, no previous studies have examined a wider range of traumatic childhood experiences and their link to experimentation with different kinds of drugs in adolescence. While some studies have interviewed adults about initiation of drug use at this age, those results are not as reliable as interviewing teens directly.

Using a nationally-representative sample of almost 10,000 non-institutionalized U.S. adolescents, we therefore determined that childhood trauma was associated with lifetime drug use in teens– not only with clinically-significant disordered drug use, but even with just trying drugs one time.

Continue reading

Limited Anesthesia in Young Children Not Link To Later Cognitive Impairment

MedicalResearch.com Interview with:

Lena S. Sun, MD E. M. Papper Professor of Pediatric Anesthesiology Professor of Anesthesiology and Pediatrics Executive Vice Chairman, Department of Anesthesiology Chief, Division of Pediatric Anesthesiology Columbia University Medical Center New York, New York 10032

Dr. Lena S. Sun

Lena S. Sun, MD
E. M. Papper Professor of Pediatric Anesthesiology
Professor of Anesthesiology and Pediatrics
Executive Vice Chairman, Department of Anesthesiology
Chief, Division of Pediatric Anesthesiology
Columbia University Medical Center
New York, New York 10032

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

Dr. Sun: The background for the study is as follow: There is robust evidence in both rodent and non-human primate studies that exposure of the developing brain leads to impairment in cognitive function and behavior later in life. The evidence from human studies derives mostly from retrospective studies and the results have been mixed. Some have demonstrated anesthesia in early childhood was associated with impaired neurocognitive function, while others have found no such association. Our study is the first to specifically designed to address the question of effects of general anesthesia exposure on cognitive function, comparing exposure with no exposure.

Continue reading

Lower Blood Pressure Goals Would Save Lives and Money

MedicalResearch.com Interview with:

Nathalie Moise, MD, MS Assistant Professor   Center for Behavioral Cardiovascular Health Department of Medicine  Columbia University Medical Center New York, NY 10032

Dr. Nathalie Moise

Nathalie Moise, MD, MS
Assistant Professor
Center for Behavioral Cardiovascular Health
Department of Medicine
Columbia University Medical Center
New York, NY 10032

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

Dr. Moise:  Our research aimed to compare the number of lives saved and changes in medical costs expected if intensive blood pressure goals of less than 120 mmHg were implemented in high cardiovascular disease risk patients.

In 2014, the 8th Joint National Committee (JNC8) on Detection, Evaluation, and Treatment of High Blood Pressure issued new guidelines recommending that physicians aim for a systolic blood pressure (SBP) of 140 mmHg in adults with diabetes and/or chronic kidney disease and 150 mmHg in healthy adults over age 60. The new guidelines represented a major departure from previous JNC7 guidelines recommending SBPs of 130 mmHg and 140, mmHg for these groups, respectively. Under the 2014 guidelines, over 5 million fewer individuals annually would receive drug treatment to lower their blood pressure, compared with the prior 2003 guidelines.

Recently, the Systolic Blood Pressure Intervention Trial (SPRINT) found that having a more intensive systolic blood pressure (SBP) goal of 120 mmHg in patients at high risk for cardiovascular disease reduced both cardiovascular events and mortality by about one quarter, compared with the current goal of 140 mmHg.

These recent studies and guidelines have created uncertainty about the safest, most effective and high-value blood pressure goals for U.S. adults with hypertension, but no prior study has compared the cost-effectiveness of adding more intensive blood pressure goals in high cardiovascular disease risk groups to standard national primary prevention hypertension guidelines like JNC8 and JNC7.

Our team at Columbia University Medical Center conducted a computer simulation study to determine the value of adding the lower, life-saving  systolic blood pressure goal identified in SPRINT to the JNC7 and JNC8 guidelines for high-risk patients between the ages of 35 and 74 years. (High risk was defined as existing cardiovascular disease, chronic kidney disease, or a 10-year cardiovascular disease risk greater than 15 percent in patients older than 50 years and with a pre-treatment SBP greater than 130 mmHg)

Continue reading

Prenatal BPA Exposure Linked To Childhood Obesity

MedicalResearch.com Interview with:

Dr-Lori-A-Hoepner

Dr. Lori Hoepner

Lori A. Hoepner, DrPH
Department of Environmental Health Sciences
Columbia University
New York, NY 10032

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

Dr. Hoepner: The Columbia Center for Children’s Environmental Health was funded starting in 1998.  Pregnant African American and Dominican mothers residing in Northern Manhattan and the South Bronx were enrolled from 1998 to 2006, and mothers and their children have been followed since this time.  We collected urine samples from the pregnant mothers in their third trimester and from the children at ages 3 and 5.  At ages 5 and 7 we measured the height and weight of the children, and at age 7 we also measured body fat and waist circumference.

MedicalResearch.com:  What are the main findings?

Dr. Hoepner:  We found a significant association between increased prenatal exposure to Bisphenol A (BPA) and increases in childhood body fat measures of waist circumference and percent body fat at age 7.  Our research builds on earlier findings of an association between prenatal exposure to BPA and body fat in children up to age 4, and this is the first study to report an association at age 7.

Continue reading

Data Exchange Between Public Health Records and Pediatricians’ EHRs Improves Vaccine Rates

MedicalResearch.com Interview with:

Melissa Stockwell, MD, MPH, FAAP Florence Irving Associate Professor of Pediatrics and Population and Family Health Columbia University - College of Physicians & Surgeons and Mailman School of Public Health Medical Director, New York-Presbyterian Hospital Immunization Registry (EzVac) Co-Director, Primary Care Clinician Research Fellowship in Community Health New York, NY 10032

Dr. Melissa Stockwell

Melissa Stockwell, MD, MPH, FAAP
Florence Irving Associate Professor of Pediatrics and
Population and Family Health
Columbia University – College of Physicians & Surgeons and
Mailman School of Public Health
Medical Director, New York-Presbyterian Hospital Immunization Registry (EzVac)
Co-Director, Primary Care Clinician Research Fellowship in Community Health
New York, NY 10032 

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

Dr. Stockwell: Fragmentation of immunization records place children at risk for underimmunization and overimmunization. Nearly all 50 states, 5 cities, and the District of Columbia operate an immunization information system, which is a system that collects and centralizes immunization data for children and adolescents from immunization providers at a regional or state level. More than 75% of US office-based physicians have adopted an electronic health record (EHR), but until recently, clinicians wanting to access patient immunization information in an IIS generally had to manually look up the patient data on a state or local IIS website, that data was not available to them within their own EHR. In this study, we demonstrated that exchange of immunization information between an immunization information system (IIS) and an EHR at point of care had a significant impact on up-to-date rates, overimmunization, and immunization record completeness for low-income, urban children and adolescents.

Continue reading

Carefully Chosen Liquid Biopsy Can Detect and Monitor Lung Cancer Mutations

MedicalResearch.com Interview with:

Adrian G. Sacher, M.D. Assistant Professor of Medicine Thoracic Oncology & Phase I Drug Development Columbia University/New York-Presbyterian Hospital

Dr. Adrian Sacher

Adrian G. Sacher, M.D.
Assistant Professor of Medicine
Thoracic Oncology & Phase I Drug Development
Columbia University/New York-Presbyterian Hospital 

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

Dr. Sacher: The aim of this prospective study was to determine the accuracy, turnaround time and robustness of ddPCR-based liquid biopsy for the detection of EGFR and KRAS mutations in patients with advanced non-small cell lung cancer (NSCLC). The detection of these mutations is key to selecting optimal therapy for patients with this disease. Currently, the standard of care is to perform tissue biopsies on patients in order to obtain material to detect these mutations and make decisions about treatment. Frequently, patients undergo multiple tissue biopsies during the course of their treatment. We sought to determine if liquid biopsy could quickly and accurately detect these mutations with the ultimate goal of understanding how to use these tests to select treatment for patients.

Continue reading

New Gene Pathway Underlies Some Tumors in Tuberous Sclerosis Complex

MedicalResearch.com Interview with:

Jeanine D'Armiento, M.D., Ph.D. Associate Professor of Medicine in Anesthesiology Director of the Center for Molecular Pulmonary Disease in Anesthesiology and Physiology and Cellular Biophysics Director, Center for LAM and Rare Lung Disease New York, NY 10032

Dr. Jeanine D’Armiento

Jeanine D’Armiento, M.D., Ph.D.
Associate Professor of Medicine in Anesthesiology
Director of the Center for Molecular Pulmonary Disease in Anesthesiology and Physiology and Cellular Biophysics
Director, Center for LAM and Rare Lung Disease
New York, NY 10032

Medical Research: What is the background for this study? What are the main findings?

Dr. D’Armiento: I am the Director of the Center for Lymphangiomyomatosis (LAM) and Rare Lung Disease at Columbia University; the Center focuses on this proliferative lung disease, which arises spontaneously or as the pulmonary manifestation of the Tuberous Sclerosis Complex (TSC). We have one of the largest cohorts of these patients in the country. Through an understanding of the pathogenesis of LAM our research aims to identify novel therapeutic targets of the disease to improve the care of these patients.

Building on our previous research we demonstrated that the HMGA2 gene and its signaling pathway (the route of information which begins an action within cells), are required to produce tumors in the lung and kidneys in individuals with Tuberous Sclerosis Complex.

Continue reading

Driving Cessation Contributes to Health Problems and Depression in Elderly

MedicalResearch.com Interview with:

Stanford Chihuri

Stanford Chihuri

Stanford Chihuri MPH
Center for Injury Epidemiology and Prevention
Department of Anesthesiology
Columbia University Medical Center
New York City, New York 

Medical Research: What is the background for this study? What are the main findings?

Response: For many older adults, driving is instrumental to their daily living and is a strong indicator of self-control, personal freedom and independence. This study assesses and synthesizes evidence in the research literature on the impact of driving cessation on subsequent health and well-being of older adults. The main findings are that driving cessation in older adults appears to contribute to a variety of health problems, particularly depression.

Continue reading

Poor Diet Means Poor Sleep

More on Sleep on MedicalResearch.com

MedicalResearch.com Interview with:

Marie-Pierre St-Onge, Ph.D, FAHA Assistant Professor, Department of Medicine New York Obesity Nutrition Research Center Institute of Human Nutrition College of Physicians & Surgeons, Columbia University New York, NY 10032

Dr. Marie St-Onge

Marie-Pierre St-Onge, Ph.D, FAHA
Assistant Professor, Department of Medicine
New York Obesity Nutrition Research Center
Institute of Human Nutrition
College of Physicians & Surgeons, Columbia University
New York, NY 10032  

Medical Research: What is the background for this study? What are the main findings?
Dr. St-Onge: We have shown that sleep affects food intake: restricting sleep increases energy intake, particularly from fat (others also find increased sugar intake).  We wanted to know if the reverse was also true: does diet affect sleep at night?

Medical Research: What should clinicians and patients take away from your report?

Dr. St-Onge: Diet quality can play an important role in sleep quality.  Sleep can be affect after only a single day of poor dietary intakes (high saturated fat and low fiber intakes).  It is possible that improving one’s diet can also improve their sleep.

Continue reading

Glaucoma Linked To Overall Higher Health Care Costs

More on Health Care Costs on MedicalResearch.com

MedicalResearch.com Interview with:
Alisa Prager BS
Bernard and Shirlee Brown Glaucoma Research Laboratory
Department of Ophthalmology
Edward S. Harkness Eye Institute
Columbia University Medical Center, New York, New York

MedicalResearch: What is the background for this study? 

Response: The goal of this research was to better understand the impact of glaucoma on non-ophthalmic healthcare use and costs. While there have been other studies assessing costs associated with glaucoma, these studies were primarily derived from either claims data or chart review. Our study used the Medicare Current Beneficiary Survey, which is a dataset that links claims data with survey results. The advantage of this is that the survey data allowed us to assess patient reported outcomes that did not necessarily prompt an encounter with the health care system, such as recent falls or feelings of sadness. The MCBS also provides complete expenditure and source of payment data on health services, including those not covered by Medicare, which allowed us to look at a more full spectrum of both private and public healthcare use and costs among Medicare beneficiaries.

MedicalResearch: What are the main findings?

Response: We found that Medicare beneficiaries with glaucoma have 27% higher likelihood of inpatient hospitalizations and home health aide visits compared to those without glaucoma, even after adjusting for covariates and excluding individuals who were admitted to the hospital with a diagnosis of glaucoma. When we stratified glaucoma patients based on self-reported visual disability, we found that those with self-reported visual disability were more likely to complain of depression, falls and difficulty walking compared to those without.

We also found that glaucoma patients incurred a predicted $2,903 higher mean annual total healthcare costs from all sources compared to those without glaucoma after adjusting for socioeconomic factors and comorbidities. Costs were higher among those who reported visual disability, and remained higher after excluding outpatient payments.

Continue reading

Insurance Issues Favor Wealthier Patients Receiving Multiple Transplants

Raymond Givens MD PhD Columbia University Medical Center

Dr. Givens
(photo Seth Wenig)

MedicalResearch.com Interview with:
Raymond Givens MD PhD 

Columbia University Medical Center 

Medical Research: What is the background for this study? What are the main findings?

Dr. Givens: Multiple listing- i.e., simultaneous placement on multiple organ transplant waiting lists- is allowed by the United Network for Organ Sharing (UNOS). Because insurance generally does not pay for the costs of transportation between multiple centers or of temporary housing, there has been concern that the multiple-listing policy gives an unfair advantage to wealthier patients. We examined the UNOS database from 2000-2013 and identified 33,928 patients who were listed for a first-time single-organ heart transplant, 2% of whom met our definition of multiple-listing. Compared to single-listed patients, multiple-listed patients lived in ZIP codes with significantly higher median incomes, and were more likely to have private insurance and less likely to be supported by Medicaid. They were also significantly more likely to have blood type O and to live in areas with higher predicted waiting times. Despite having lower listing priority at the start of the primary listing and lower predicted mortality, the multiple-listed patients were often upgraded at secondary listing and had a higher eventual transplant rate (74.4% vs 70.2%) and lower mortality rate while listed (8.1% vs 12.2%). When the multiple-listed cohort was compared against a propensity-score-matched single-listed subset the relative rare of transplant was 3.02. There were no differences in post-transplant survival.

Continue reading

Two Treatment Options Achieve Control in HIV Infected Children

Dr. Louise Kuhn PhD Professor, Epidemiology Sergievsky Center Columbia University

Dr. Kuhn

MedicalResearch.com Interview with:
Dr. Louise Kuhn PhD
Professor, Epidemiology
Sergievsky Center
Columbia University 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kuhn: Ritonavir-boosted lopinavir-based antiretroviral therapy is recommended as first-line treatment for HIV-infected infants and young children while efavirenz is recommended for adults and older children. There are several advantages of transitioning HIV-infected children to efavirenz-based treatment as they get older.  These advantages include the possibility of once-daily dosing, simplification of co-treatment for tuberculosis, avoidance of some metabolic toxicities, preservation of ritonavir-boosted lopinavir for second-line treatment, and alignment of adult and pediatric treatment regimens. However, there have been concerns about possible reduced viral efficacy of efavirenz-based treatment in children exposed to nevirapine for prevention of mother-to-child transmission.  This is because efavirenz and nevirapine are in the same drug class and the majority of children who become infected despite exposure to nevirapine used for prevention have mutations in their virus that usually predict resistance to this drug class.

In this study, we randomized HIV-infected children to two different treatment strategies: In the control strategy they remained on their initial ritonavir-boosted lopinavir regimen; in the alternative strategy they transitioned to an efavirenz-based regimen.  All children had been exposed to nevirapine used (unsuccessfully) to prevent mother to child HIV transmission and were virologically-suppressed (HIV in blood < 50 copies/ml) at the time of enrollment into the study.  We observed excellent virological control in both groups with fewer than 3% of children having levels of HIV in their blood greater than 1000 copies/ml.  Sustained suppression of virus in blood below 50 copies/ml throughout follow-up was achieved in 82% of the children transitioned to efavirenz-based treatment compared to 72% of children remaining on the control treatment.

Continue reading

High Pregnancy Weight Gain Linked To Long Term Increased Maternal Body Fat

Elizabeth M. Widen, PhD, RD Postdoctoral Fellow in the Department of Medicine, Institute of Human Nutrition & Department of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032MedicalResearch.com Interview with:
Elizabeth M. Widen, PhD, RD
Postdoctoral Fellow in the Department of Medicine, Institute of Human Nutrition & Department of Epidemiology
Columbia University
Mailman School of Public Health
New York, NY 10032

Medical Research: What is the background for this study? What are the main findings?

Dr. Widen: The Columbia Center for Children’s Environmental Health Mothers and Newborns Study was started in 1998 and is based in Northern Manhattan and the South Bronx. Pregnant African American and Dominican mothers were enrolled from 1998 to 2006, and mothers and their children have been followed since this time. Pregnancy weight gain and maternal size and body fat was measured at seven years postpartum, allowing us to examine the role of nutrition in pregnancy on long-term maternal health. We found that high pregnancy weight gain, above the Institute of Medicine 2009 guidelines, was associated with long-term weight retention and higher body fat at seven years postpartum among women who began pregnancy with underweight, normal weight and modest overweight body mass index (BMI). These findings suggest that prepregnancy BMI and high pregnancy weight gain have long-term implications for maternal weight-related health, especially among mothers who begin pregnancy with lower prepregnancy BMI values.

Continue reading

Marijuana Use Doubles Over Decade

Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032MedicalResearch.com Interview with:
Deborah S. Hasin, Ph.D.
Professor of Epidemiology
Columbia University
New York, New York 10032

 Medical Research: What is the background for this study? What are the main findings?

Dr. Hasin: This study is based on data from two large-scale national surveys conducted over an eleven-year period that are designed to provide information on many health-related conditions in U.S. adults, including use of marijuana and other substances, changes over time in the prevalence of marijuana users, changes over time in the prevalence of disorders such as marijuana abuse and dependence, and the correlates and predictors of those disorders. The main findings of the study are that between 2001-2002 and 2012-2013, the prevalence of marijuana users in the United States adult general population more than doubled, from 4.1% to 9.5%, while the prevalence of adults with marijuana use disorder (abuse or dependence) also increased substantially, from 1.5% to 2.9% of American adults. About three in ten adult marijuana users met criteria for a marijuana use disorder. The findings are consistent with other studies showing increases in rates of marijuana-related harms over the same general time period.

Continue reading

Asians and Hispanics May Underutilize EMS Services For Stroke Symptoms

Heidi Mochari-Greenberger Ph.D., M.P.H Associate research scientist Columbia University Medical Center New York, N.YMedicalResearch.com Interview with:
Heidi Mochari-Greenberger Ph.D., M.P.H
Associate research scientist
Columbia University Medical Center
New York, N.Y

MedicalResearch: What is the background for this study?

Dr. Mochari-Greenberger: Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity or sex among a contemporary, diverse national sample of hospitalized acute stroke patients.

MedicalResearch: What are the main findings?

Dr. Mochari-Greenberger: Use of EMS transport among hospitalized stroke patients was less than 60% and varied by race/ethnicity and sex; EMS use was highest among white females and lowest among Hispanic males. Our analyses showed that Hispanic and Asian men and women were significantly less likely than their white counterparts to use EMS; black females were less likely than white females to use EMS, but black men had a similar rate to white men. These observed associations between race/ethnicity and sex with EMS use persisted after adjustment for stroke symptoms and other factors known to be associated with EMS use, indicating they were not driven solely by stroke symptom differences.

Continue reading

Warming Climate May Not Reduce Winter Mortality

Prof. Patrick L Kinney Ph.D. Professor of Environmental Health Sciences and Director, Columbia Climate and Health Program Mailman School of Public Health Columbia University, New York, NYMedicalResearch.com Interview with:
Prof. Patrick L Kinney Ph.D.
Professor of Environmental Health Sciences and
Director, Columbia Climate and Health Program
Mailman School of Public Health
Columbia University, New York, NY

Medical Research: What is the background for this study?

Dr. Kinney: Many previous assessments have concluded that climate change will lead to large reductions in winter mortality.

Medical Research: What are the main findings?

Dr. Kinney: We carried out analyses that contradict this conclusion.  We argue that climate change won’t have much impact one way or the other on winter mortality.

Continue reading

Diabetes Medication Reduced Weight and Improved Metabolic Parameters in Obese Patients

Dr. F. Xavier Pi-Sunyer MD Division of Endocrinology and Obesity Research Center Columbia University, New YorkMedicalResearch.com Interview with:
Dr. F. Xavier PiSunyer MD
Division of Endocrinology and Obesity Research Center
Columbia University, New York

Medical Research: What is the background for this study? What are the main findings?

Dr. Pi-Sunye: In a large randomized trial, the drug Liraglutide was compared to placebo in overweight and obese non-diabetic volunteers. Over 52 weeks, in combination with diet and increased physical activity, Liraglutide lowered body weight by 8.4 kg as compared to 2.8 kg in placebo. 63% vs 27% lost at least 5% of baseline weight, 33% vs 10% lost more than 10% of baseline weight.
Continue reading

Women With PTSD At Higher Risk For Heart Disease

Jennifer A. Sumner, Ph.D.MedicalResearch.com Interview with:
Jennifer A. Sumner, Ph.D.
Columbia University Mailman School of Public Health
New York, NY 10032

Medical Research: What is the background for this study? What are the main findings?

Dr. Sumner: Cardiovascular disease, which includes conditions like heart attack and stroke, is the leading cause of death worldwide. Stress has long been thought to increase risk of cardiovascular disease, and posttraumatic stress disorder (PTSD) is the quintessential stress-related mental disorder. Some individuals who are exposed to traumatic events, such as unwanted sexual contact, the sudden unexpected death of a loved one, and physical assault, develop PTSD, which is characterized by symptoms of re-experiencing the trauma (e.g., nightmares), avoidance of trauma reminders (e.g., avoiding thinking about the trauma), changes in how one thinks and feels (e.g., feeling emotionally numb), and increased physiological arousal and reactivity (e.g., being easily startled). PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men.

My colleagues and I wanted to see whether PTSD was associated with the development of cardiovascular disease in a large sample of women from the general public. We looked at associations between PTSD symptoms and new onsets of heart attack and stroke among nearly 50,000 women in the Nurses’ Health Study II over 20 years, beginning in 1989. Women with the highest number of PTSD symptoms (those reporting 4+ symptoms on a 7-item screening questionnaire) had 60% higher rates of developing cardiovascular disease (both heart attack and stroke) compared to women who were not exposed to traumatic events. Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and hormone replacement use, accounted for almost 50% of the association between elevated PTSD symptoms and cardiovascular disease. We also found that trauma exposure alone (reporting no PTSD symptoms on the screening questionnaire) was associated with elevated cardiovascular disease risk compared to no trauma exposure.

Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women. These results add to a growing body of evidence suggesting that trauma and PTSD have profound effects on physical health as well as mental health.

Continue reading

Acid-Suppression Medications Linked To Increased Pediatric C. diff Infections

Daniel E. Freedberg, MD, MS Assistant Professor of Medicine Division of Digestive and Liver Diseases Columbia University, New YorkMedicalResearch.com Interview with:
Daniel E. Freedberg, MD, MS

Assistant Professor of Medicine
Division of Digestive and Liver Diseases
Columbia University, New York

Medical Research: What is the background for this study?

Dr. Freedberg: Acid suppression medications are increasingly prescribed to relatively healthy children without clear indications, but the side effects of these medications are uncertain.


Medical Research: What are the main findings?

Dr. Freedberg: Acid suppression with (proton pump inhibitors ) PPIs or (histamine-2 receptor antagonists) H2RAs was associated with increased risk for C. diff infection in both infants and older children.

Medical Research: What should clinicians and patients take away from your report?

Dr. Freedberg: Increased risk for C. diff should be factored into the decision to use acid suppression medications in children.  Our findings imply that acid suppression medications alter the bacterial composition of the lower gastrointestinal tract.

Continue reading

Higher Adolescent Marijuana Usage In States That Legalized Pot

Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032MedicalResearch.com Interview with:
Deborah S. Hasin, Ph.D.

Professor of Epidemiology
Columbia University
New York, New York 10032

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

Dr. Hasin: The background for the study was the need to identify the causes of the marked increase in marijuana use among U.S. adolescents over the last several years, given that early adolescent marijuana use leads to a number of adverse health and psychosocial consequences, including cognitive decline, into adulthood.

We had two main findings from the study:

  1. A comparison of the rates of adolescent marijuana use between states that ever passed a medical marijuana law and those that did not revealed that states with such laws had higher rates of teen marijuana use, regardless of when they passed the law; and
  2. When we compared the rates of teen marijuana use in these states before and after passage of the laws, we did not find a post-passage increase in the rates of teen marijuana use. This suggests that some common factor may be causing both the laws to be passed and the teens to be more likely to smoke marijuana in the states that passed these laws.

Continue reading

Spring Babies Have Highest Lifetime Risk of Cardiovascular Disease

Nicholas Tatonetti, PhD Department of Biomedical Informatics Department of Systems Biology, Department of Medicine Columbia University New York, NYMedicalResearch.com Interview with:
Nicholas Tatonetti, PhD
Department of Biomedical Informatics
Department of Systems Biology, Department of Medicine
Columbia University
New York, NY

Medical Research: What is the background for this study? What are the main findings?

Dr. Tatonetti: For decades, researchers have studied the link between disease incidence and the seasons. We’ve known, for example, that those born when the dust mite population is highest (summer) will have an increased chance of developing asthma. Traditionally, diseases have been studied one at a time to identify these seasonal trends. Because of the rapid adoption of electronic health records, it is now possible to study thousands of diseases, simultaneously. That is what we did in this study. We evaluated over 1,600 diseases and discovered 55 that showed this seasonal trend. Many of these had been studied previously, but several are new discoveries — most prominently, we found that the lifetime risk of developing cardiovascular disease is highest for those born in the spring.

Continue reading