Is Human Lifespan Really Limited to 100 Years?

MedicalResearch.com Interview with:

Pr. Siegfried Hekimi PhD McGill University

Prof. Hekimi

Pr. Siegfried Hekimi PhD
McGill University

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

Response: We analyzed data about the longest living individuals over the period of time during which the record can be trusted.

We found that there was no detectable plateauing of the maximum possible lifespan. This is consistent with not clearly observed plateau in the currently increasing average lifespan as well.

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Metformin Reverses Some Autism Symptoms In Animal Model

MedicalResearch.com Interview with:
Ilse Gantois, PhD

Research Associate
Dr. Nahum Sonenberg’s laboratory
Department of Biochemistry
McGill University

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

Response: Fragile X syndrome (FXS) is a neurodevelopmental disorder characterized by cognitive impairment and affects 1 in 4000 males and 1 in 6000 females. About 60% of persons with Fragile X also have autism spectrum disorder. FXS is caused by absence of Fragile X protein (FMRP), which results in hyperactivation of ERK (extracellular signal-regulated kinase) and mTORC1 (mechanistic target of rapamycin complex 1) signaling. We show that treatment with metformin, the most widely used FDA-approved antidiabetic drug, suppresses translation by inhibiting the ERK pathway, and alleviates a variety of behavioural deficits, including impaired social interaction and excessive grooming. In addition, metformin also reversed defects in dendritic spine morphogenesis and synaptic transmission.
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Recreational Cocaine Use Activates Addiction Related Brain Mechanisms Sooner Than Previously Realized

MedicalResearch.com Interview with:

Marco Leyton, Ph.D. Professor, Department of Psychiatry McGill University

Dr. Marco Leyton

Marco Leyton, Ph.D.
Professor, Department of Psychiatry
McGill University

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

Response: Drug-related cues are potent triggers for eliciting conscious and unconscious desire for the drug. In people with severe substance use disorders, these cues also activate dopamine release in the dorsal striatum, a brain region thought to be involved in hard-to-break habits and compulsions.

In the present study we found evidence that drug cues also activate this same dopamine response in non-dependent ‘recreational’ cocaine users.

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Strong SSRIs Linked To Increase Risk of Intracranial Hemorrhage

MedicalResearch.com Interview with:
Christel Renoux, MD, PhD
Assistant Professor, Dept. of Neurology & Neurosurgery
McGill University
Centre For Clinical Epidemiology
Jewish General Hospital – Lady Davis Research Institute
Montreal  Canada

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

Response: Selective serotonin reuptake inhibitors (SSRIs) increase the risk for abnormal bleeding, in particular, gastrointestinal tract bleeding. Previous studies also suggested an increased risk for intracranial hemorrhage (ICH) in patients treated with SSRIs compared to non users. However, even if this risk exists, the comparison with a non-treated group may exaggerate the strength of a potential association and the comparison with a group of patients treated with other antidepressants may help better delineate the risk. The potential bleeding effect of antidepressants is linked to the strength of serotonin inhibition reuptake, and antidepressants that are strong inhibitors of serotonin reuptake have been associated with the risk for gastrointestinal or abnormal bleeding compared with weak inhibitors but the risk of ICH is unclear.

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Analysis of Multiple MRI and PET Images Detects Earliest Signs of Alzheimer’s Disease

MedicalResearch.com Interview with:

Dr. Yasser Iturria Medina PhD Post-doctoral fellow Montreal Neurological Institute

Dr. Y. M. Medina

Dr. Yasser Iturria Medina PhD
Post-doctoral fellow
Montreal Neurological Institute

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

Response: We used over 200 peripheral molecular biomarkers, five different neuroimaging modalities and cognitive/clinical measurements to detect spatiotemporal abnormalities in subjects with dementia or with mild signs of cognitive deterioration. By means of a mathematical framework, we reordered all the biomarkers/descriptors considered, according to how much they change during the disease process. The results suggested that, contrary as suggested by more traditional clinical analyses, there are multiple early signs of neurodegeneration, at the molecular level and at the brain’s macroscopic and cognitive state. In particular, we observed notable early signs of generalized vascular dysregulation, which may be supporting the vascular hypothesis of Alzheimer’s disease. However, we still need to perform deeper analyzes, in order to clarify the complex causal mechanisms that trigger the disease.

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Isolating Asymptomatic C. diff Carriers at Hospital Admission May Decrease Transmission

MedicalResearch.com Interview with:
Yves Longtin, MD, FRCPC
Chair, Infection Prevention and Control Unit
Montreal Jewish General Hospital – SMBD
Associate professor of Medicine, McGill University

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

Dr. Longtin: Clostridium difficile is a major cause of infection in hospitalized patients. Current infection control measures to prevent the spread of C. difficile in hospitals focuses almost entirely on patients who present symptoms. Patients with symptoms of diarrhea due to C difficile are placed under isolation in hospitals (for example, healthcare workers will wear a gown and gloves when caring for them). However, many studies have shown that some patients may be asymptomatic carriers of C. difficile. These patients carry the C difficile bacteria in their digestive tract without being sick. It was known that these asymptomatic carriers could spread the bacteria to other patients, but it was unclear whether putting them into isolation would help prevent the spread of the microbe in hospitals. Our study tested the hypothesis that placing asymptomatic carriers under isolation could lead to a decrease in the number of infections with C  difficile.

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Study Finds No Increased Risk of Heart Failure From Incretin-Based Diabetes Drugs

MedicalResearch.com Interview with:

Kristian B. Filion, Ph.D., FAHA Assistant Professor of Medicine, Division of Clinical Epidemiology, McGill University Principal Investigator, Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital Associate Member, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University

Dr. Kristian Filion

Kristian B. Filion, Ph.D., FAHA
Assistant Professor of Medicine, Division of Clinical Epidemiology, McGill University
Principal Investigator, Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital
Associate Member, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University

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

Dr. Filion:  Concerns regarding the cardiovascular safety of the antidiabetic incretin-based drugs arose following the unexpected finding of an increased risk of heart failure in the SAVOR-TIMI 53 trial of the DPP-4 inhibitor saxagliptin.  Although subsequent trials did not find an increased risk of heart failure with these drugs, concerns regarding their heart failure effects remained due to the conflicting available evidence.  Furthermore, with their highly-selected patient populations, the applicability of the results of these clinical trials to patients seen in a real world setting is unclear.

We therefore examined the risk of hospitalization for heart failure associated with incretin-based drugs in patients with type 2 diabetes in a real world setting using the health records of over 1.4 million patients from six jurisdictions (four Canadian provinces, the United Kingdom, and the United States). We used a common protocol in each database and statistically combined results across databases to obtain one overall estimate.  We found that there was no evidence of an increased risk, a finding that was consistent in separate analyses for patients with and without a history of heart failure.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Filion:  This study provides reassurance regarding concerns about the potential risk of heart failure with the use of incretin-based drugs compared with the use of combinations of oral antidiabetic drugs such as metformin and sulfonylureas.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Filion:  It would be helpful to do additional analyses by individual incretin-based drug (i.e., by molecule), which could explain some of the heterogeneity observed in some of the clinical trials in this area.

In addition, many of the patients included in our study had a relatively short history of diabetes. In secondary analyses, we checked if the association differed by duration of treated diabetes and, although we found that it did not, it would be helpful to revisit this question in a few years as additional information becomes available.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Filion:  This study was conducted by the Canadian Network for Observational Drug Effect Studies (CNODES), a pan-Canadian network funded by Health Canada and the Canadian Institutes of Health Research to study emerging drug safety issues.  CNODES has the ability to analyze a vast amount of de-identified data to efficiently respond to drug safety issues that arise after a drug is already on the market.

In this case, we were able to analyze the health records of over 1.4 million patients who were prescribed an antidiabetic medication in Canada, the United Kingdom, and the United States.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

A Multicenter Observational Study of Incretin-based Drugs and Heart Failure

Kristian B. Filion, Ph.D., Laurent Azoulay, Ph.D., Robert W. Platt, Ph.D., Matthew Dahl, B.Sc., Colin R. Dormuth, Sc.D., Kristin K. Clemens, M.D., Nianping Hu, M.D., Ph.D., J. Michael Paterson, M.Sc., Laura Targownik, M.D., M.S.H.S., Tanvir C. Turin, M.D., Ph.D., Jacob A. Udell, M.D., M.P.H., and Pierre Ernst, M.D., for the CNODES Investigators*

N Engl J Med 2016; 374:1145-1154
March 24, 2016 DOI: 10.1056/NEJMoa1506115

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Kristian B. Filion, Ph.D., FAHA (2016). Study Finds No Increased Risk of Heart Failure From Incretin-Based Diabetes Drugs MedicalResearch.com

Younger People May Benefit From Statins

MedicalResearch.com Interview with:

Dr George Thanassoulis MD MSc FRCPC McGill University Health Center and Research Institute Montreal, Quebec, Canada

Dr. George Thanassoulis

Dr George Thanassoulis MD MSc FRCPC
McGill University Health Center and Research Institute
Montreal, Quebec, Canada

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

Dr. Thanassoulis: Currently statins are recommended in most countries worldwide based on 10-yr risk of heart disease but because age is the best predictor of future heart disease this leads to many more older patients being eligible for statins at the expense of younger people.  This means that even young patients with higher levels of low-density cholesterol, a known cause of heart disease, are not eligible for statins until they are much older.  However, waiting for these individuals to become “old enough for treatment” permits their higher LDL  to continue to damage their arteries leading, in some cases, to advanced coronary disease at the time when statins are finally stated.  So we are missing an opportunity to effectively prevent heart disease.

What our analysis shows is that we need to consider not just someone’s risk of having a heart attack but also whether they would be expected to benefit from statins.  By integrating information from randomized trials we were able to show that there were over 9.5 million Americans who were at low risk (and not eligible for statin therapy) that would have the same absolute benefit as higher risk people who we currently treat.  These patients, as expected, were younger but had higher levels of LDL cholesterol.  We also showed that statin therapy in these individuals would avoid more than 250,000 cardiac events over 10 years. 

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Feminine Gender Characteristics Linked To Worse Cardiac Outcomes

MedicalResearch.com Interview with:

Dr. Roxanne Pelletier

Dr. Roxanne Pelletier

Roxanne Pelletier, PhD
Divisions of General Internal Medicine and of Clinical Epidemiology
Department of Medicine
The Research Institute of the McGill University Health Centre
Montreal, Quebec, Canada

Medical Research: What is the background for this study?

Dr. Pelletier: The increased risk of mortality in young females compared with males after acute coronary syndrome (ACS) remain difficult to understand. As gender-related characteristics has evolved considerably in the last decades (e.g. hours of paid work have increased significantly among women), we hypothesized that these sex differences in adverse outcomes following  acute coronary syndrome are partly explained by gender, rather than by biological sex itself.

As explained in our paper, “Gender reflects social norms and expectations ascribed to women and men, in contrast to biological characteristics that are captured by sex. Gender can be referred to as the nonbiological aspects of being male or female (e.g., social roles, personality traits).Our team had previously shown that sex differences in access to care for ACS were partly explained by these gender-related characteristics, such that both men and women presenting with acute coronary syndrome and with personality traits and social roles traditionally ascribed to women (e.g. sensitive to the needs of others, shy, household  responsibility, child care) were waiting longer before diagnostic tests and were less likely to receive invasive treatment procedures such as percutaneous coronary intervention, when compared to men and women with masculine gender-related characteristics. We then aimed to assess whether gender was also playing a role in sex differences in adverse outcomes following acute coronary syndrome.

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Who Should Have A Carotid Artery Stent vs Endarterectomy?

MedicalResearch.com Interview with:
Sophie Vincent, Medical Student
McGill University and
Kristian Filion, PhD FAHA
Assistant Professor of Medicine
Division of Clinical Epidemiology
Jewish General Hospital/McGill University

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

Response: Patients with carotid atherosclerosis causing vascular stenosis are at increased risk of stroke, which is the third leading cause of death in the United States and in Canada. Carotid artery stenting and carotid endarterectomy are the primary surgical options for the treatment of carotid stenosis. With the assumption that an endovascular approach would offer a more favorable safety profile than open surgical procedure, the use of stenting increased significantly following its entry into the market in the 1990s. However, despite this observed increase in use, the long-term safety and efficacy of stenting relative to endarterectomy remained unclear, which is why we decided to conduct this study.

Although carotid artery stenting has more favorable periprocedural outcomes with respect to myocardial infarction, hematoma, and cranial nerve palsy, the observed increased risk of stroke throughout follow-up with stenting suggests that endarterectomy remains the treatment of choice for the management of carotid stenosis.
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Off Label Prescriptions Risk More Adverse Drug Effects

MedicalResearch.com Interview with:
Tewodros Eguale, MD, PhD
Department of Epidemiology, Biostatistics, and Occupational Health,
McGill University, Montreal, Quebec, Canada
Research Fellow in Medicine
Brigham and Women’s Hospital

Medical Research: What is the background for this study?

Dr. EgualeOff-label prescribing is common and has been identified as a potentially important contributor to preventable adverse drug events (ADE). Significant deleterious effects were reported with off-label use of some drugs. Moreover, studies in children, where drugs are often used without sufficient scientific investigation, have shown that off-label uses increase the risk of ADE.  In adults, there has been no systematic investigation of the effects of off-label use in real world situation. The lack of knowledge is related to the methodological challenges of measuring off-label use and its effects; specifically the lack of link between prescribed drugs and their indication for use. The Medical Office of the XXI Century (MOXXI) electronic health record (EHR), developed by team of researchers at McGill University, facilitates the documentation of treatment indications, reasons for discontinuation of drug orders and adverse drug event. These new features provided the first opportunity to systematically monitor and evaluate off-label use and the occurrence of adverse drug events.  This study took advantage of the use of this new generation of software in a network of primary care practices to systematicaly evaluate the effect of off-label use on ADEs.

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Poor Lifestyle Linked to Acute Coronary Syndrome, Even After Event

MedicalResearch.com Interview with:
Sylvie S.L. Leung Yinko, MSc, RD

Division of Clinical Epidemiology
Research Institute of McGill University Health Centre (RI MUHC)
Montreal (QC) and
Louise Pilote, MD, MPH, PhD
Professor of Medicine McGill University and
Director of the Division of General Internal Medicine
McGill University Health Centre

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

Response: Patients with premature acute coronary syndrome (ACS) are a vulnerable population of young or middle-aged adults at risk for future cardiovascular events. However, while health behaviors such as diet, physical activity, smoking, alcohol consumption and recreational drug use are important lifestyle factors that can influence cardiovascular risk, there is limited information about health behaviors in this population group. Additionally, there is indication in the literature regarding sex and age differences in health behaviors, but whether such differences exist in patients with premature acute coronary syndrome remained to be explored.

Using data from GENESIS-PRAXY (GENdEr and Sex determInantS of Cardiovascular Disease from bench to beyond in PRemature Acute Coronary Syndrome), a large-scale prospective cohort study across Canada, US and Switzerland, we explored the health behavior profile of patients with premature ACS. As well, we examined whether there is a change in health behaviors 1 year post-ACS and assessed sex differences.

Our results showed that the health behavior profile of men and women with premature Acute Coronary Syndrome are worse than that of the general population. We found a high prevalence of poor health behaviors in a young population with only modest changes after Acute Coronary Syndrome. Health behaviors remained suboptimal and worse than the general population, especially with regards to diet, smoking and recreational drug use. Sex differences existed in the prevalence of these behaviors at baseline and 1 year post-ACS but not in the magnitude of change after the ACS event.

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Risky Decision Making May Run in Families Prone To Suicide

Fabrice Jollant, MD, PhD McGill University, Department of Psychiatry & Douglas Mental Health University Institute McGill Group for Suicide Studies Montréal (Québec), CanadaMedicalResearch.com Interview with:
Fabrice Jollant, MD, PhD
McGill University, Department of Psychiatry
& Douglas Mental Health University Institute
McGill Group for Suicide Studies
Montréal (Québec), Canada

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

Dr. Jollant: Suicide takes almost 1 million lives each year worldwide. Improving suicide prevention necessitates improving our understanding of the mechanisms leading to these complex acts. We know that while many people who died from suicide had experienced negative life events (divorce, job loss, grief), most people who experience these events will not commit suicide, not even think about suicide. Similarly, while more than 90% of suicide completers had suffered a major mental disorders (mainly depression and substance abuse) and treating these mental disorders can reduce suicide rates, 90% of patients will never die from suicide. Thus, research focuses now on the specific factors that make some individuals more vulnerable. We previously found that individuals who attempted suicide are more likely to make risky choices at a gambling task than patients who went through depression but never attempted suicide. They tend to choose the options that yield more gains immediately but are long-term disadvantageous. People who choose this way are also more likely to have problems in their interpersonal relationships, a classic trigger of suicidal crisis.

Medical Research: What are the main findings?

Dr. Jollant: This study continues our previous series of investigations. Here, we assessed decision-making in close biological relatives of suicide completers. We know that suicide is heritable and can run within some families. So, we were interested in knowing if risky decision-making could be one factor transmitted within families of suicide completers. We recruited healthy individuals who had lost a close biological relative from suicide, but never attempted suicide themselves. We found that these persons also tend to choose the riskiest options. However, we could not find some other cognitive deficits previously found in suicide attempters, e.g. deficient cognitive control. These normal cognitions may therefore counterbalance their deficits in decision-making and maybe protect them against suicide.

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Genetic Risk Score Did Not Predict Recurring Events After Myocardial Infarction

Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec CanadaMedicalResearch.com Interview with:
Christopher Labos MD CM, MSc FRCPC
Division of Epidemiology, Biostatistics and Occupational Health
McGill University
Montreal, Quebec
Canada

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

Response: There have been great advances in the field of genetics in recent years. Especially in cardiology, a number of genetic variants have been identified that are associated with cardiovascular disease. But it is not clear how useful these variants are in terms of predicting future evens in patients that have already suffered a myocardial infarction. What we found in our study is that a genetic risk score composed of the 30 most common genetic variants associated with cardiovascular diseases was not useful in predicting recurrent events in the first year after a patient suffered a myocardial infarction.

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Parkinson’s Disease Can Be Stratified Into Three Distinct Groups

Ron Postuma, MD, MSc Associate Professor Department of Neurology Montreal General Hospital Montreal, QuebecMedicalResearch.com Interview with:
Ron Postuma, MD, MSc
Associate Professor
Department of Neurology
Montreal General Hospital
Montreal, Quebec

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

Dr. Postuma: The background is that we often think about Parkinson’s Disease as a single disease.  However, every clinician knows that there is a great deal of variability from patient to patient.  If we can understand the main aspects that separate patients into groups, we can target therapy better.

The analysis used a semi-automated means to divide Parkinson’s patients into groups, using extensive information about motor and non-motor aspects of disease.  We found that the non-motor symptoms, especially cognition, sleep disorders, and blood pressure changes were the most powerful predictors of which group a patient would be in.  Based on these non-motor (and some motor aspects), the most accurate way to divide patients was into three groups – diffuse (many non-motor symptoms), pure motor, and intermediate (halfway between the other).  We then followed patients over time.  The diffuse group had, by far, the worse prognosis.  This was not only for the non-motor aspects, but the motor as well. Continue reading

Dual Hormone Artificial Pancreas Reduces Nocturnal Hypoglycemia in Type 1 Diabetes

MedicalResearch.com Interview with:
Dr Ahmad Haidar Ph.D. Division of Experimental Medicine Department of Medicine, McGill University Montreal, QC, CanadaDr. Ahmad Haidar Ph.D
Division of Experimental Medicine, Department of Medicine
McGill University, Montreal, QC, Canada

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

Dr. Haidar: This is the first head-to-head-to-head comparison in outpatient setting of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional pump therapy in children and adolescents with type 1 diabetes.

The main finding is that the dual-hormone artificial pancreas seems to outperform the other two systems in reducing nocturnal hypoglycemia in camp settings when the patients are very physically active during the day.

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

Dr. Haidar: Glucagon has the potential to reduce nocturnal hypoglycemia if added to the artificial pancreas. However, this needs to be confirmed in larger and longer studies as the single-hormone artificial pancreas might be sufficient in home settings (this study was conducted at a camp, which is an environment different that home).
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Epigenetics, Not Just Genes, Control Many Complex Traits

Prof. Moshe Szyf Ph.D. James McGill Professor of Pharmacology and Therapeutics McGill UniversityMedicalResearch.com Interview with:
Prof. Moshe Szyf Ph.D.

James McGill Professor of Pharmacology and Therapeutics
McGill University


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

Dr. Szyf: Humans exhibit a marked variation in traits both physical and behavioral and different susceptibilities  for developing disease. What causes this inter-individual variation? The prevailing dogma has been that changes in the sequences of genes or heritable genetic differences are responsible for these  differences. We tested here an alternative hypothesis that perhaps some of the reason for this natural variation in traits is not caused by differences in inherited genes but by “epigenetic” changes that alter the way genes work without changing the genes.  The main difference between genetic and epigenetic changes is that epigenetic changes could be introduced by experience and exposure to environment. The experiences that can cause epigenetic changes include physical as well as social environments. Although we had known that epigenetic differences occur in humans and animals we didn’t have evidence that these changes are behind the natural variation in traits that is observed in humans and animals. Ants are an exciting biological paradigm that exhibits quantitative variations in size and therefore provided a unique opportunity to test this hypothesis.

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Brain Functions May Be Affected By Chronic High Salt Intake

Charles Bourque PhD James McGill Professor Centre for Research in Neuroscience Montreal General Hospital Montreal QC, CanadaMedicalResearch.com Interview with:
Charles Bourque PhD
James McGill Professor
Centre for Research in Neuroscience
Montreal General Hospital Montreal QC, Canada

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

Dr. Bourque: Previous work has established that there is a link between a high level of dietary salt intake and the development of hypertension. In particular, so-called “salt-sensitive” individuals display increases in blood pressure that correlate with significantly increased levels of serum sodium concentration. Increased sodium levels are known to cause an excitation of vasopressin (VP)-releasing neurons of the hypothalamus. We therefore tested the hypothesis that this increase can contribute to the increase in blood pressure associated with high sodium intake in rats.

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HPV Vaccine Not Linked To Increased Risky Sexual Behavior

Leah M. Smith PhD Department of Epidemiology, Biostatistics, and Occupational Health (Smith, Kaufman, Strumpf) McGill University, Montréal, QuebecMedicalResearch.com Interview with:
Leah M. Smith PhD
Department of Epidemiology, Biostatistics, and Occupational Health  (Smith, Kaufman, Strumpf)
McGill University, Montréal, Quebec

 

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

Dr. Smith: The human papillomavirus (HPV) vaccine protects against types of HPV that cause cervical cancer and anogenital warts. The vaccine first became available in 2006. Since then, it has faced a great deal of controversy surrounding, in part, some of the unanswered questions about the real-world effects of the vaccine, especially on the young girls targeted for immunization. One issue that has received a great deal of public attention has been the concern that HPV vaccination might give girls a false sense of protection against all sexually transmitted infections that might lead them to be more sexually active than they would otherwise. As a result, some parents have been reluctant to have their daughters vaccinated. It is also reason why some religious groups have spoken out against the vaccine. This question is further important from a public health perspective because increases in risky sexual behaviour would inevitably also lead to increases in teen pregnancy and sexually transmitted infections (excluding anogenital warts), which would of course undermine the potential health benefits of the vaccine. 

In this study, we directly addressed the question of whether HPV vaccination has led to increases in pregnancy and non-HPV-related sexually transmitted infections (both of which are proxies for risky sexual behaviour) among adolescent girls.

In our study of over 260,000 girls, we did not find any evidence that the HPV vaccine had a negative impact on these outcomes.

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“Time-Outs” To Assess Antibiotics Reduce Both Antibiotics Use and Costs

MedicalResearch.com Interview with:
Todd Lee MD MPH FRCPC
Consultant in Internal Medicine and Infectious Diseases
Assistant Professor of Medicine, McGill University
Director, General Internal Medicine Consultation Service,
Chief of Service, 6 Medical Clinical Teaching Unit,
McGill University Health Centre

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

Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs.  Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use.  Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy.  Sometimes this means that no antibiotics should be given.

In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions.

Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform “antimicrobial self-stewardship”.  This concept tied the CDCs concept of antibiotic “time outs” (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist.  These audits were performed by our senior resident physicians in the context of providing their routine clinical care.  We also provided local antibiotic guidelines and regular educational sessions once a rotation.

We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority.  We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested.

Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. Continue reading

Family Support Mitigates Negative Impact of Cyberbullying

Frank J. Elgar, PhD Associate Professor of Psychiatry Canada Research Chair in Social Inequalities in Child Health Institute for Health and Social Policy, McGill University Montreal, Quebec, CanadaMedicalResearch.com Interview with:
Frank J. Elgar, PhD
Associate Professor of Psychiatry
Canada Research Chair in Social Inequalities in Child Health
Institute for Health and Social Policy, McGill University
Montreal, Quebec, Canada


Medical Research: What are the main findings of the study?

Dr. Elgar: Our study addressed two questions. The first was whether cyberbullying has unique links to adolescent mental health, or is an extension of traditional (face-to-face) bullying. We measured various forms of bullying and found that cyberbullying does indeed have a unique impact on mental health.

Our second question about protective factors in the home environment.  We examined the frequency of family dinners as potential a moderating factor – understanding, of course, that dinners are a proxy of various family characteristics that benefit adolescents, such as communication, support, and parental monitoring. We found that teens who were targeted by cyberbullying but had ate dinner with their families more often had significantly better mental health outcomes as a result.

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Antibiotics and Growth in Children From Low Income Countries

MedicalResearch.com Interview with:
Ethan K Gough, PhD candidate
Department of Epidemiology
Biostatistics and Occupational Health
McGill University, Montreal, QC, Canada

MedicalResearch.com: What are the main findings of the study?

Answer: Antibiotic use produces significant gains toward expected growth in children, for their age and sex, from low- and middle-income countries. Children included in our study were generally smaller in height and weight than adequately nourished children of the same age, reflecting the spectrum of stunting and wasting malnutrition seen in low- and middle-income countries. Antibiotic use had a larger impact on weight than height, and the effect on weight was larger in populations who may be at greater risk of infections and early mortality, such as populations with a high prevalence of HIV infection or exposure, and a high prevalence of severe acute malnutrition.

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After Stroke: Pharmacist Led Case Management Improved Blood Pressure Control

Finlay A McAlister MD Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit Epidemiology Coordinating and Research (EPICORE) Centre McGill University, Montréal, QuebecMedicalResearch.com Interview with:
Finlay A McAlister MD
University of Alberta, Edmonton, Canada

MedicalResearch.com: What are the main findings of the study?

Dr. McAlister: We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets).

The first (our “control” group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician.

The second (our “intervention” group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians.  However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor.

Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .

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Why Do Some Patients Fail To Get Their Prescriptions Filled?

Robyn Tamblyn BScN Msc PhD James McGill Chair Departments of Medicine and Epidemiology and Biostatistics McGill University Scientific Director Institute of Health Services and Policy Research Canadian Institutes of Health Research MedicalResearch.com Interview with:
Robyn Tamblyn BScN Msc PhD
James McGill Chair
Departments of Medicine and Epidemiology and Biostatistics
McGill University and Scientific Director
Institute of Health Services and Policy Research
Canadian Institutes of Health Research

MedicalResearch.com: What are the main findings of the study?

Dr. Tamblyn: Higher drug costs are associated with a higher probability of primary non-adherence, whereas better follow-up by the prescribing physician, and a policy to provide medication at no cost for the very poor increase the likelihood of adherence

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Dialysis Patients with Atrial Fibrillation: Warfarin and Risk of Stroke and Bleeding

Louise Pilote, MD, MPH, PhD Department of Medicine, McGill University Department of Epidemiology and Biostatistics, McGill UniversityMedicalResearch.com Interview with:
Louise Pilote, MD, MPH, PhD
Department of Medicine, McGill University
Department of Epidemiology and Biostatistics, McGill University


MedicalResearch.com: What are the main findings of the study?

Dr. Pilote: Our study found that in patients with atrial fibrillation (AF) undergoing dialysis, warfarin use, compared to no-warfarin use, did not reduce the risk for stroke (adjusted hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.78 to 1.67) but it was associated with a 44% higher risk for bleeding event (adjusted HR: 1.44, 95% CI: 1.13 to 1.85). However, warfarin use in non-dialysis patients with AF was associated with a 13% lower risk for stroke (adjusted HR: 0.87, 95% CI: 0.85 to 0.90) and only a 19% higher risk for bleeding event (adjusted HR: 1.19, 95% CI: 1.16 to 1.22).

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Heart Attack: Feminine Traits May Delay Cardiac Treatment

MedicalResearch.com Interview with:
Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology  McGill University Health Centre (MUHC) 687 Pine Avenue West, V Building, Room V2.17 Montreal, QcRoxanne Pelletier, PhD
Postdoctoral Fellow
Division of Clinical Epidemiology
McGill University Health Centre (MUHC)
687 Pine Avenue West, V Building, Room V2.17
Montreal, Qc

MedicalResearch.com: What made you want to study this disparity between men and women and heart attacks? 

Dr. Pelletier:  Despite enhanced medical treatment and decrease in the incidence of heart diseases, important sex disparities persist in the risk of mortality following a cardiac event: the risk of mortality is higher in women compared to men, and this sex difference is even more important in younger adults. Therefore, we aimed to investigate potential mechanisms underlying this sex difference in mortality.
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Herbal Cannabis Not Proven Effective For Rheumatic Diseases

Mary-Ann Fitzcharles, MB, ChB, MRCP(UK), FRCP(C) McGill University Health Centre Division of Rheumatology and Alan Edwards Pain Management UnitMedicalResearch.com Interview with:
Mary-Ann Fitzcharles, MB, ChB, MRCP(UK), FRCP(C)
McGill University Health Centre
Division of Rheumatology and Alan Edwards Pain Management Unit


MedicalResearch.com: What are the highlights of your review?

Dr. Fitzcharles: Thank you for your interest in the review article which will shortly be published in Arthritis Care & Research. This was not a research study but rather a review focused towards the use of herbal cannabis for patients with rheumatic diseases.

The essence of our message after a thorough review of the literature is that there is not a single study published regarding efficacy or side effects of herbal cannabis in the rheumatic diseases. It is notable that almost 2 thirds of persons using herbal cannabis for therapeutic reasons report use for musculoskeletal complaints. In the 21st century, we cannot rely upon heresay or anecdote to justify use of a treatment intervention. It is unacceptable to recommend use of a substance without knowledge of concentration of molecules in the product, any knowledge of blood concentrations that might have a positive or negative effect, and formal study in defined patient populations with acceptable endpoint criteria and evidence for short and long term risks.
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Autism Disorders after NICU Stays

Dr. Michael Shevell Chair of the Pediatrics Department at the McGill Faculty of Medicine and Pediatrician-in-Chief at the Montreal Children’s Hospital and the McGill University Health CentreMedicalResearch.com Interview
Dr. Michael Shevell
Chair of the Pediatrics Department at the McGill Faculty of Medicine and Pediatrician-in-Chief at the Montreal Children’s Hospital and the McGill University Health Centre

MedicalResearch.com: What are the main findings of the study?

Dr. Shevell: At risk term infants who have spent some time in a Level III NICU after birth are at substantially increased later risk for an autistic spectrum disorder. Frequently this disorder occurs in conjunction with substantial co-morbidity.
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Prostate Cancer: Statins after Diagnosis Decreased Mortality

Dr. Laurent Azoulay Project Leader, Lady Davis Institute Assistant Professor, Department of Oncology, McGill UniversityMedicalResearch.com Interview with:
Dr. Laurent Azoulay
Project Leader, Lady Davis Institute
Assistant Professor, Department of Oncology, McGill University


MedicalResearch.com: What are the main findings of the study?

Dr. Azoulay: Using large population-based databases from the UK, we assembled a cohort of men newly-diagnosed with non-metastatic prostate cancer. Within this group of men, the use of statins after prostate cancer diagnosis was associated with a 24% decreased risk in cancer-related mortality. We observed duration- as well as a dose-response relationships. Furthermore, in a secondary analysis, we observed that the benefits were greater among men who used also used statins before their diagnosis, with more modest yet significant benefits among men who initiated the treatment after their diagnosis. The latter result is one of the novelties of this study, as it provides an estimate of the potential benefits of statins, if used in the adjuvant setting.
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Biological Clock: Removing Protein Repressor Boosts Clock Function

MedicalResearch.com Interview with:

Ruifeng Cao, MD,PhD
Postdoctoral Fellow
Laboratory of Nahum Sonenberg
McGill University
Department of Biochemistry
Montreal, QC H3A 1A3, Canada

MedicalResearch.com: What are the main findings of the study?

Answer: Circadian (~24h) timing is a fundamental biological process, underlying cellular physiology in animals, plants, fungi, and cyanobacteria.  In mammals, including humans, a circadian clock in the brain drives daily rhythms in sleep and wakefulness, feeding and metabolism, and many other essential processes. We studied how protein synthesis, which is a fundamental process underlying many biological activities, is controlled in the brain clock in mice and identified a protein that functions as a clock repressor. By removing the repressor protein, the clock function is improved.

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HIV plus Hepatitis C : Marjuana Did Not Worsen Liver Disease

Marina Klein, MD, MSc, FRCP(C) Associate Professor of Medicine McGill University Health Centre Division of Infectious Diseases and Chronic Viral Illness Service 3650 Saint Urbain Montreal, Quebec H2X 2P4MedicalResearch.com Interview with:

Marina Klein, MD, MSc, FRCP(C)
Associate Professor of Medicine
McGill University Health Centre
Division of Infectious Diseases and Chronic Viral Illness Service
3650 Saint Urbain
Montreal, Quebec H2X 2P4

Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis               

MedicalResearch.com: What are the main findings of the study?

Dr. Klein: We showed that people with HIV and hepatitis C infection who smoked marijuana did not tend to progress more rapidly to liver fibrosis, liver cirrhosis or end-stage liver disease, even with increasing numbers of joints smoked per week. Previous studies that reported that marijuana was harmful to the liver were likely biased because they did not ensure that marijuana smoking occurred before the development of liver problems.

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Obesity in US: Aggravated by Agricultural Policy That Encourages High-Fat/Sugar Foods

MedicalResearch.com  Interview with: Caroline Franck, MSc
Dvisions of Cardiology and Clinical Epidemiology
McGill University, Montreal, Quebec, Canada

MedicalResearch.com: What are the main findings of the study?

Answer: We found that, although subsidies are needed to protect farmers from production risks, the current allocation of payments encourages the sustained overproduction of a handful of grains and oilseeds. Overproduction contributes to making the end products cheaper, which are then processed into energy-dense and high-fat/sugar foods. Obesity should be treated as a systems problem, in which farm production plays an important role.

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Study: Oral Probiotic Supplement Significantly Increased Circulating Vitamin D Levels

MedicalResearch.com Interview with:
Dr. Mitchell Jones, MD, PhD Faculty of Medicine at McGill University in MontrealDr. Mitchell Jones, MD, PhD
Faculty of Medicine at McGill University in Montreal

MedicalResearch.com: What are the main findings of the study?

Dr. Jones: We had previously reported on the cholesterol lowering efficacy of bile salt hydrolase active L. reuteri NCIMB 30242 due to reduced intestinal sterol absorption.

However, the effects of bile salt hydrolase active L. reuteri NCIMB 30242 on fat soluble vitamins was previously unknown and was the focus of the study.
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