MedicalResearch.com Interview with: Prof. Peter Nordström Department of Community Medicine and Rehabilitation Geriatrics, Umeå University Umeå, Sweden MedicalResearch: What is the background for this study?...
MedicalResearch.com Interview with:
Yeyi Zhu, PhD
IRTA Postdoctoral Fellow
Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development,
NIH
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Zhu: Currently in the US, nearly two thirds of reproductive-aged women are overweight or obese. Moreover, the amount of weight gained during pregnancy can have immediate and long-lasting impacts on health of a woman and her infant. Previous evidence implicates that excessive gestational weight gain above the Institute of Medicine guidelines is related to high birthweight (>4000 g), a marker of intrauterine over-nutrition which may impose a greater risk of offspring’s obesity and metabolic diseases in later life.
Given that more than one third of children and adolescents are overweight or obese in the US, it is of great public health significance to improve our understanding of determinants and mediators of childhood obesity. The length of breast feeding and age at introduction of solid foods are infant feeding practices that are potentially modifiable in early life. We therefore examined whether birthweight and infant feeding practices, specifically length of breast feeding, mediate the relationship between maternal gestational weight gain and childhood growth in the National Children’s Study Formative Research in Anthropometry, a cross-sectional multi-ethnic study of 1387 mothers and their children aged 0-5.9 years in the US (2011-2012).
We illustrated that the intergenerational relationship between maternal gestational weight gain and early childhood growth (i.e., z scores for weight-for-age, weight-for-height, and body mass index-for-age) largely acts through birthweight rather than directly on childhood growth. Further, given the negative association of breastfeeding duration with childhood anthropometrics, longer length of breastfeeding suppressed the positive associations of gestational weight gain and birthweight with childhood growth. In addition, analysis by ethnicity revealed that these associations were only significant in non-Hispanic White and non-Hispanic Black participants as opposed to Hispanics and other ethnicities.
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MedicalResearch.com Interview with:
Ekaterina Maslova PhD
Doctor of Science in Nutrition and Epidemiology
Center for Fetal Programming
Copenhagen, Denmark
Medical Research: What is the background for this study? What are the main findings?
Response: From prior studies we know that excessive gestational weight gain (GWG) in pregnancy is associated with complications for both the mother and the child, including gestational diabetes, hypertension, and high birth weight. Understanding the factors that determine gestational weight gain would allow for interventions early on to improve pregnancy outcomes. Dietary intake has been found to influence gestational weight gain in other studies, but evidence is conflicting and still quite limited. In non-pregnant populations a high-protein diet was shown to decrease weight and improve weight maintenance. We therefore hypothesized that a similar relation may exist for gestational weight gain in pregnant women.
In this study we had data on dietary intake of more than 45,000 Danish women who were pregnant between 1996 and 2002. We examined the relation between their intake of protein and carbohydrates and the rate of gestational weight gain (in grams per week). We found that women who consumed a high protein-to-carbohydrate (PC) ratio gained less gestational weight gain compared to women with a lower PC ratio in their diet. The results was stronger in women who started their pregnancy already overweight compared to normal weight women.
Since a high PC ratio may result from either a high protein intake or low carbohydrate intake, we decided to focus on a component of carbohydrates that may increase gestational weight gain: added sugar. We found that pregnant women with higher intake of sugar gained more weight in pregnancy compared to those who consumed less added sugar. This averaged out to about 1.4 kg (or 7%) higher weight gain across the entire pregnancy.
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MedicalResearch.com Interview with:
Dr Cristina Renzi
Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Renzi: Only a minority of symptomatic individuals undergoing cancer investigations are diagnosed with cancer and more than 80% receive an 'all-clear' or non-cancer diagnosis (here called a 'false alarm'). This makes it important to consider the possible unintended consequences of a false alarm.
Several studies have shown that investigations for a suspected cancer can have negative psychological effects, even for individuals ultimately diagnosed with a benign condition. In addition, an association between false alarms and subsequent delayed diagnosis has been reported for various cancers, with both patients and healthcare providers contributing to delays.
Our review published by BMJ Open focused on 19 research papers which reported information on false alarms and subsequent symptom attribution or help-seeking. By integrating the available evidence from qualitative, quantitative and mixed methods studies this review allowed us to identify areas that need to be addressed in order to reduce the risk of delayed help-seeking after a previous false alarm. In particular, over-reassurance and under-support of patients can be an unintended consequence of a false alarm leading to delays in help-seeking, even years later, if patients notice possible symptoms of the disease again.
The review, funded by Cancer Research UK, looked only at adult patients who had a false alarm after raising concerns about their symptoms; the effect of a false alarm might be different in patients who are investigated for suspected cancer following cancer screening.
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MedicalResearch.com Interview with:
Karen Thorpe PhD
Professor, Developmental Psychology
Program Leader, Early Education and Development Group
Program leader, Sleep in Early Childhood Group
School of Psychology and Counseling
Queensland University of Technology Australia
MedicalResearch: What is the background for this study?
Professor Thorpe: Sleep is undoubtedly important not only for how well we think, feel and behave in our daily lives but also for longer-term health. In childhood, the quantity and quality of night-time and 24 hour sleep have consistently been identified as predictor of health. For example, night sleep predicts weight status. These findings have led to the hypothesis that increasing quantity of sleep through promoting daytime sleep would benefit child health. We sought to look for evidence on the independent effects of daytime sleep on child health, learning and behavior to assess whether this hypothesis was supported. (more…)
MedicalResearch.com Interview with:
Dr. Alexander Turchin M.D.,M.S.
Director of Informatics Research
Division of Endocrinology, Brigham and Women’s Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Turchin: Hypertension is the most common risk factor for cardiovascular events. High blood pressure increases the risk for stroke, myocardial infarction, heart failure and kidney failure. Treatment of high blood pressure reduces these risks. However, our understanding of optimal treatment of hypertension is incomplete. In particular, there is little information to guide clinicians on how quickly they should achieve blood pressure control in their patients. There have been no clinical trials focusing on this question. Current guidelines are sparse and are based only on expert opinion.
Our study analyzed treatment of nearly 90,000 patients in primary care practices in the U.K. between 1986 and 2010. We found that patients whose blood pressure medications were adjusted within 1.4 months after systolic blood pressure reached over 150 mm Hg and whose blood pressure was re-assessed within 2.7 months after their treatment was adjusted had the lowest risk for acute cardiovascular events and death from any cause.
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MedicalResearch.com Interview with:
Christopher Michael Petrilli MD
Division of General Internal Medicine
The Department of Medicine
University of Michigan, Ann Arbor, Michigan
Medical Research: What is the background for this study? What are the main findings?
Dr. Petrilli: Our team took note of the broad spectrum of physician attire that was worn in health care settings. We found a lack of specific guidance with regards to “appropriate” physician attire. Then we began to find anecdotal evidence that physician attire may be an important early determinant of patient confidence, trust and satisfaction. Studies have shown that patients are more compliant with their medications and treatment regimens when they perceive their doctors as being competent, supportive and respectful. Therefore, given the increasingly rushed patient–physician encounter, the ability to gain a patient’s trust and confidence are highly desirable. We hypothesized that if physician attire matched patients’ preferences and expectations, it would improve the overall patient experience.
Our findings supported our hypothesis. In general, we found that people prefer their physicians dress on the formal side -- and definitely not in casual wear. Doctors of either gender in suits, or a white coat, are more likely to inspire trust and confidence. But fashion takes a back seat when it comes to emergency, surgical or critical care, where data show clothes don't matter as much -- and patients may even prefer to see doctors in scrubs. In general, Europeans and Asians of any age, and Americans over age 50, trusted a formally dressed doctor more, while Americans in Generation X and Y tended to accept less-dressy physicians more willingly.
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MedicalResearch.com Interview with:
James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute
Medical Research: What is the background for this study? What are the main findings
Response: There were 6 randomized controlled dietary trials performed before the government dietary fat recommendations were released. When we performed a systematic review and meta-analysis of the available trials at this time, there was no significant difference in all-cause mortality or cardiovascular heart disease mortality. In essence, there was no support from randomized controlled trials at the time to support a reduction in fat and saturated fat (and there still isn't from recent meta-analysis including newer trials).
The reductions in mean serum cholesterol levels were significantly higher in the intervention groups but this did not result in significant differences in cardiovascular heart disease or all-cause mortality. (more…)
MedicalResearch.com Interview with:
Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford
Department of Primary Care and Public Health Sciences
King’s College London, London, UK
Medical Research: What is the background for this study? What are the main findings?
Response: Overweight and obesity in children have increased dramatically since the 1960s with important clinical and economic impacts, especially among those who become obese adults. Consequently, understanding trends in obesity is of increasing importance for monitoring population health and informing policy initiatives. Current trends suggest that a majority of the world’s population will be either overweight or obese by 2030. However, recent reports suggest that the increasing trend in overweight and obesity in children may have leveled off since 2000. But, in many countries data are based on a limited number of time points and relatively small surveys, limiting definitive conclusions and not allowing examining trends in subgroups by sex and age. Moreover, only a few countries have data on younger children (aged under 6 years).
Our study aimed to use primary care electronic health records to examine prevalence of overweight and obesity in 2 to 15 year old children in England and to compare trends over two decades, from 1994 to 2003 and from 2004 to 2013.
Medical Research: What are the main findings?
Response: We found that currently about a third of children in the UK are overweight or obese. We also found that overweight and obesity prevalence increased during decade 1 (1994-2003) but stabilized in decade 2 (2004-2013). This was observed in both sexes and the in younger age groups (2-5 year and 6-10 year). However, rates continued to increase in older children (11-15 year), albeit at a slower speed than in decade 1 (1994-2003).
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MedicalResearch.com Interview with:
Dr Laila J Tata PhD
Associate Professor in Epidemiology
Faculty of Medicine & Health Sciences
University of Nottingham
Medical Research: What is the background for this study? What are the main findings?
Response: Over the last decades there has been increased clinical awareness of coeliac disease (CD) partially because of improvements in the accuracy and availability of diagnostic tests, however, we do not have current estimates of actual celiac disease diagnoses in children and it is important to know whether diagnostic patterns vary socioeconomic group. Funded by CORE/Coeliac UK and conducted at the University of Nottingham, this study analysed 2,063,421 children aged less than 18 years who were registered with general practices (primary care doctors) across the United Kingdom contributing to their routine electronic health records to The Health Improvement Network (THIN) database between 1993 and 2012. The study found 1,247 children were diagnosed with coeliac disease, corresponding to about 1 new case in every 10,000 children each year. Girls consistently had more diagnoses than boys and whilst the incidence of new celiac disease cases among children up to age 2 years remained stable over time, diagnoses in older children almost tripled over the past 20 years. Moreover, the study found a socioeconomic gradient in celiac disease diagnoses, such that children living in less socioeconomically deprived areas were about twice as likely to be diagnosed as those from more deprived areas. This pattern held for boys and girls and for all ages.
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MedicalResearch.com Interview with:
Sarah Hanson
Norwich Medical School
University of East Anglia
Medical Research: What is the background for this study? What are the main findings?
Response: Physical inactivity is a global problem. Walking is an easy way to increase physical activity. One way to increase physical activity may be through the use of outdoor walking groups. Walking groups are increasingly popular but until now we have not known if there are wider health benefits from walking groups, apart from increasing physical activity.
Medical Research: What was the study method?
Response: A systematic review and meta-analysis of outdoor walking group interventions found 42 studies which met the eligibility criteria. These studies involved 1,843 participants in 14 countries doing approximately 74,000 hours of walking.
(more…)MedicalResearch.com Interview with: Philipe de Souto Barreto (PhD) Toulouse University Hospital (CHU Toulouse) Gérontopole of Toulouse - Head of Department: Prof Bruno Vellas Medical...
MedicalResearch.com Interview with:
Professor Marianna Virtanen PhD
Unit of Expertise for Work and Organizations
Finnish Institute of Occupational Health
Helsinki, Finland.
Medical Research: What is the background for this study? What are the main findings?
Professor Virtanen: Risky alcohol use is common among working populations but the contribution of work-related factors such as long working hours has rarely been studied. In the present study we performed the first systematic analysis on published studies regarding long working hours and risky alcohol use and added unpublished individual participant data to the analyses. Altogether 61 studies were included in the cross sectional analysis and 20 studies in the prospective analysis. The pooled cross sectional analysis showed 11% higher alcohol use associated with long working hours. In the prospective analysis we found that working 49-54 hours a week was associated with a 13% increase in the probability of new-onset risky alcohol use and working 55 hours or more with a 12% increased risk.
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MedicalResearch.com Interview with:
Dr Aneel Bhangu
Clinical Lecturer in Surgery
Queen Elizabeth Hospital, Edgbaston,
Birmingham UK
Medical Research: What is the background for this study? What are the main findings?
Dr. Bhangu: Randomised clinical trials are widely regarded as the type of evidence in medical research most likely to change practice and improve patient care. However, they are challenging to perform, expensive to deliver and rely on patients’ willingness to participate for the benefit of their wider community. Results of these studies should be disseminated widely in order to promote new medical knowledge. Unfortunately, some clinical trials are terminated early or fail to reach publication after completion. This leads to lost data and wastage of finite resources. Clinical trials within surgical disciplines present unique challenges, which may further impact on dissemination of evidence. We aimed to investigate the fate of surgical trials.
Disappointingly, we found that 1 in 5 surgical trials are terminated early before completion, most commonly due to poor recruitment of research participants. Of trials which do reach completion, 1 in 3 are not published, indicating a significant waste of resources. A systematic approach to contact trial investigators during the study proved largely unsuccessful, implicating further hidden barriers to identifying trial data.
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MedicalResearch.com Interview with:
James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. DiNicolantonio: Cardiovascular disease is the leading cause of premature mortality in the developed world, and hypertension is its most important risk factor. Controlling hypertension is a major focus of public health initiatives, and dietary approaches have historically focused on sodium.
A reduction in the intake of added sugars, particularly fructose, and specifically in the quantities and context of industrially-manufactured consumables, would help not only curb hypertension rates, but would also help address broader problems related to cardiometabolic disease.
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MedicalResearch.com Interview with:
Immaculata De Vivo PhD
Associate Professor Harvard Medical School
Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core
Facility. Channing Division of Network Medicine
Boston, MA 02115
MedicalResearch: What is the background for this study? What are the main findings?
Dr. De Vivo: Our study found that greater adherence to the Mediterranean diet is associated with longer telomeres. Following a diet closer to the Mediterranean diet, can prevent accelerated telomere shortening. Our unique contribution to the literature is that we provide a potential molecular mechanism, preventing telomere shortening. Telomeres are bits of DNA that protect your chromosomes.
MedicalResearch: Is telomere shortening reversible?
Dr. De Vivo: Telomere shortening is a biological process, the shorten with age.
However, lifestyle choices can help to prevent accelerated shortening.
Fruits, vegetables, olive oil and nuts – key components of the Mediterranean diet have well known antioxidant and anti-inflammatory effects that could balance out the “bad effects” of smoking and obesity.
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MedicalResearch.com Interview with:
Stefan Johansson, MD PhD
consultant neonatologist
Stockholm, Sweden
Medical Research: What is the background for this study?
Dr. Johansson: Maternal obesity (BMI ≥ 30) has previously been linked to increased infant mortality. However, research has not produced consistent results. For example, there are disagreements whether infants to overweight mothers (BMI 25-29) are at increased risk, and research on BMI-related specific causes of death is scarce.
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MedicalResearch.com Interview with:
Marco Valgimigli, MD, PhD
Associate Professor of Medicine
Erasmus MC, Thoraxcenter,
Rotterdam The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Valgimigli: Drug-Eluting Stents are regarded as more thrombogenic devices as compared to Bare Metal Stents. We have pooled all available datasets comparing a specific second generation Drug-Eluting Stent, namely cobalt chromium everolimus eluting stent (co-Cr EES) versus Bare Metal Stents and found that cardiac mortality along with all other non-fatal endpoints investigated, including myocardial infarction or stent thrombosis were reduced after co-Cr EES.
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MedicalResearch.com Interview with:
Dr. Philip Tucker
Department of Psychology | Yr Adran Seicoleg
College of Human and Health Sciences | Coleg y Gwyddorau Dynol ac lechyd
Swansea University | Prifysgol Abertawe
Singleton Park | Parc Singleton Swansea | Abertawe
Medical Research: What is the background for this study? What are the main findings?
Dr. Tucker: Shift work, like jet-lag, is known to disrupt workers’ normal circadian rhythms (i.e. their body clocks) and their social life. It is also associated with greater risk of developing ulcers, cardiovascular disease, metabolic syndrome, breast cancer and reproductive problems. Several studies have also shown that shift workers experience heightened fatigue and sleepiness, particularly at night, and this may affect job performance and safety. However, very little is known about the long-term consequences of shift work on cognitive abilities. We followed a large sample of shift workers and non-shift workers over 10 years, testing their cognitive performance every 5 years. We found that the shift workers’ cognitive performance was lower than that of the day workers. The difference was greatest for those who had worked shifts for more than 10 years. The shift workers’ cognitive function recovered after they quit shift work, but this recovery took at least 5 years from time that they stopped working shifts. The effects could not be attributed to poorer sleep quality among shift workers. Rather, it seems likely that the findings reflect the disruption of the shift workers’ circadian rhythms, which as been shown by other researchers to have an impact on brain structures involved in cognition and mental health over the lifespan.
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MedicalResearch.com Interview with:
Ben Van Calster PhD
Department of Development and Regeneration
KU Leuven, Herestraat Leuven, Belgium
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Van Calster: Ovarian cancer is a very common type of cancer among women, with over 200,000 new cases per year worldwide. It is the most lethal of gynecological malignancies. Research has shown that the referral of patients with ovarian cancer to specialized gynecological oncologists in high volume centers improves survival. However, audits in Europe and the United States also show that only a minority of women with ovarian cancer are appropriately triaged to receive specialist care. In addition, different types of malignancies are not treated in the same way. Hence optimal personalized management of an ovarian tumor hinges on the detailed preoperative diagnosis of its nature. Unfortunately, current prediction models focused on the discrimination between benign and malignant tumors without further specification of the likely type of malignancy.
Various prediction models and rules have been developed to help predict whether an ovarian mass is benign or malignant. A recent systematic review meta-analysis has shown that the IOTA model LR2 and simple rules perform better than any other previous test. However none of these tests give anything other than a dichotomous outcome – i.e. cancer or non-cancer. In practice the position is more nuanced.
The ADNEX model estimates the likelihood that a tumor is benign, borderline malignant, stage I cancer, stage II-IV cancer, or secondary metastatic cancer. This model is the first that is able to differentiate between benign and these four subtypes of malignancy. To do so, ADNEX uses three clinical predictors (age, serum CA-125 level, and type of center), and six ultrasound characteristics of the tumor (maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites). The model is based on data from almost 6,000 women recruited at 24 centers in 10 countries.
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