“Shall Issue” Gun Law States Associated With Higher Homicide and Firearm Death Rates

MedicalResearch.com Interview with:

Michael Siegel, MD, MPH Professor, Department of Community Health Sciences Boston University School of Public Health Boston, MA 02118

Prof. Siegel

Michael Siegel, MD, MPH
Professor, Department of Community Health Sciences
Boston University School of Public Health
Boston, MA 02118

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

Response: A central question in the debate about public policies to reduce firearm violence is whether easier access to concealed handguns increases or decreases the rate of firearm-related homicides. Previous studies on the impact of concealed carry permitting laws have yielded inconsistent results. Most of these studies were conducted more than a decade ago. This study provided a reexamination of this research question with more recent data, up to and including the year 2015.

While all states allow certain persons to carry concealed handguns, there are 3 major variations in permitting policy. In 9 states, law enforcement officials have wide discretion over whether to issue concealed carry permits; these are referred to as “may issue” states because police chiefs can deny a permit if they deem the applicant to be at risk of committing violence, even if there is not a criminal history. In 29 states, there is little or no discretion; these are referred to as “shall-issue” states because permits must be issued if requisite criteria are met. In an additional 12 states, no permit is necessary to carry a concealed handgun.

Continue reading

ACA Medicaid Expansion Linked To Decrease in Uninsured Cancer Patients

MedicalResearch.com Interview with:

Aparna Soni, MA Department of Business Economics and Public Policy Kelley School of Business Indiana University, Bloomington

Aparna Soni

Aparna Soni, MA
Department of Business Economics and Public Policy
Kelley School of Business
Indiana University, Bloomington

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

Response: Cancer is the leading cause of death among the non-elderly population in the United States. Unfortunately, uninsured people are less likely to get screened for cancer, and treatment is often unaffordable for those who are uninsured.

One of the key objectives of the Affordable Care Act (ACA) was to improve outcomes for cancer patients. Our objective in this study was therefore to assess changes under the ACA in insurance coverage among patients newly diagnosed with cancer.

Our main finding is that uninsurance among patients with newly diagnosed cancer fell by one-third in 2014.

Continue reading

Hospital Onset Clostridium difficile Infections Increased With Electronic Sepsis Alerts

MedicalResearch.com Interview with:

Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai

Dr. Hiensch

Dr. Robert Hiensch MD
Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine
Icahn School of Medicine at Mount Sinai.

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

Response: New sepsis guidelines that recommend screening and early treatment for sepsis cases appear to have significant positive impacts on patient outcomes. Less research has been published on what potential side effects may result from these guidelines.

Antibiotics are a cornerstone of sepsis treatment and early antibiotic administration is strongly recommended.  We examined whether the introduction of an electronic based sepsis initiative changed antibiotic prescribing patterns at our hospital. Antibiotics, even when appropriate, contribute to hospital onset Clostridium difficile infections (HO CDIs).  While the authors do not dispute the importance of antibiotic administration in sepsis, it is valuable to know whether the sepsis initiative coincided with both increased antibiotic administration and HO CDIs.

Continue reading

Insulin Pump Therapy May Be Superior to Multiple Injections in Young People With Type 1 Diabetes

MedicalResearch.com Interview with:
Prof. Dr. med. Reinhard Holl
Division of Endocrinology and Diabetes, Medical Faculty
Aachen University, Aachen,
Institute of Epidemiology and Medical Biometry
University of Ulm, Ulm
Germany 

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

Response: Today there are two accepted strategies to treat type-1 diabetes: pump or multiple daily injections. In a large group of patients we compared both strategies, and our results indicate advantages for pump therapy with fewer severe hypos, fewer events of diabetic ketoacidosis, and better metabolic control.

Continue reading

More Evidence for Zika as a Causal Agent Of Guillain-Barré Syndrome

MedicalResearch.com Interview with:

Emilio Dirlikov, PhD Epidemic Intelligence Service Officer CDC 

Dr. Dirlikov

Emilio Dirlikov, PhD
Epidemic Intelligence Service Officer
CDC 

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

Response: In December 2015, Puerto Rico Department of Health (PRDH) reported its first confirmed locally acquired case of Zika virus disease. In February 2016, PRDH reported the first person diagnosed with Guillain-Barré syndrome (GBS) who also had evidence of Zika virus infection. At the time, scientific evidence of the potential association between Zika virus infection and GBS was lacking, and rigorous studies were needed.

Through a collaboration between PRDH, CDC, and the University of Puerto Rico (UPR), we conducted a case-control study to determine risk factors for GBS during the 2016 Zika virus epidemic. By prospectively enrolling case-patients, we shortened the time to enrollment, increasing the likelihood of detecting Zika virus nucleic acids to confirm Zika virus infection.

As a result, we found that an acute Zika virus infection confirmed by laboratory testing is a risk factor for developing Guillain-Barré syndrome. This is the first case-control study to find laboratory evidence showing this given the difficulty of confirming Zika virus infection among people diagnosed with GBS.

Continue reading

Transfusions From Previously Pregnant Donors Add Risk To Younger Male Recipients

MedicalResearch.com Interview with:

Rutger Middelburg, PhD Assistant Professor in clinical epidemiology Sanquin Research and LUMC

Dr. Middelburg

Rutger Middelburg, PhD
Assistant Professor in clinical epidemiology
Sanquin Research and LUMC 

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

Response: Six years ago we found transfusions from female donor to be associated with increased mortality among male recipients, especially under 50 years of age. This was an unexpected observation and we considered the probability of a false positive finding (i.e. a chance association) to be relatively high. We therefore immediately started a follow-up study with two main objectives. First, we wanted to confirm our findings in an independent and much larger cohort. Second, since some complications of blood transfusion are known to be related to pregnancy history of the donor, we wanted to study a possible relationship with previous pregnancy of the blood donors.

Continue reading

Antidepressants in Youth Associated With Increased Risk of Type 2 Diabetes

MedicalResearch.com Interview with:
Mehmet Burcu, PhD, MS
Department of Pharmaceutical Health Services Research
University of Maryland, Baltimore 

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

Response: Antidepressants are one of the most commonly used psychotropic medication classes in U.S. youth, with serotonin reuptake inhibitors representing a large majority of total antidepressant use in youth.

The most interesting finding was that the current use of serotonin reuptake inhibitors in youth was associated with an increased risk of type 2 diabetes mellitus, and this increased risk intensified further with the increasing duration of use and with the increasing dose. A secondary analysis also revealed that the risk of incident type 2 diabetes was most apparent in youth who used serotonin reuptake inhibitors for longer durations AND in greater daily doses.

Continue reading

Refined Biomarker Model Can Guage Risk of Alzheimer’s In Patients With Mild Cognitive Impairment

MedicalResearch.com Interview with:
Ingrid S. van Maurik, MSc
Department of Neurology and Alzheimer Center
Department of Epidemiology and Biostatistics
Amsterdam Neuroscience
VU University Medical Center
Amsterdam, the Netherlands

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

Response: CSF and MRI biomarkers are increasingly used in clinical practice, but their diagnostic and prognostic value is not perfect. Furthermore, criteria do not specify how to deal with conflicting or borderline results, or how to take patient characteristics into account. Therefore, optimal use of these biomarkers in clinical practice remains challenging.

As part of the ABIDE project, we constructed biomarker-based prognostic models (CSF, MRI and combined) that enable prediction of future Alzheimer’s disease, or any type of dementia, in individual patients with mild cognitive impairment. When using these models, any value can be entered for the variables, resulting in personalized probabilities with confidence intervals.

Continue reading

Gestational Diabetes Associated With Greater Risk Of Heart Attack and Stroke

MedicalResearch.com Interview with:

Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Bethesda, MD 20817 

Dr. Zhang

Cuilin Zhang MD, PhD
Senior Investigator
Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health.
Bethesda, MD 20817

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

Response: Gestational diabetes (GDM) is a common pregnancy complication. The American Heart Association identifies gestational diabetes as a risk factor for cardiovascular disease (CVD) in women, based on consistent evidence for the relationships between gestational diabetes and subsequent hypertension, dyslipidemia, type 2 diabetes, vascular dysfunction and atherosclerosis. Also, previous studies identify GDM as a risk factor for intermediate markers of CVD risk; however, few are prospective, evaluate hard cardiovascular disease end points, or account for shared risk factors including body weight and lifestyle.

Continue reading

Modifiable Surgical Outcomes in ENT Cancer Surgery That May Improve Survival

MedicalResearch.com Interview with:
David Schoppy, MD PhD
Resident, Division of Head and Neck Surgery
Department of Otolaryngology
Stanford University School of Medicine
Stanford, Palo Alto, California

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

Response: There is a growing focus in healthcare on quality, and one component of this focus is the development of robust measures of quality. Currently, there are relatively few validated metrics of performance in oncologic surgery, and several of these indicators are relatively static metrics (such as hospital case volume and institution type).

This study examined the relationship between overall survival (one surrogate of quality cancer surgery) and two modifiable variables in Head and Neck surgery – achieving negative surgical margins around a primary tumor and 18 or more lymph nodes from a concurrent neck dissection. After controlling for multiple other patient variables, data collected from the National Cancer Database (NCDB) showed that treatment at hospitals where a high percentage of patients had a surgery with negative margins and 18 or more lymph nodes removed from their neck was associated with improved survival. Importantly, this survival benefit was independent of the individual, patient-level survival benefit conferred by having either of these surgical process measures reached.

This study therefore highlights two modifiable measures of institutional performance in Head and Neck surgery that may serve as targets for quality improvement programs.

Continue reading