Mediterranean Diet Linked to Lower Long-Term Cardiovascular Events in Women

MedicalResearch.com Interview with:

Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA

Dr. Mora

Samia Mora, MD, MHS
Associate Professor of Medicine
Harvard Medical School
Director, Center for Lipid Metabolomics
Brigham and Women’s Hospital
Boston, MA

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

Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit.

Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors.

Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites.  Continue reading

Younger Siblings of Children with Autism or ADHD More Likely To Be Similarly Diagnosed

MedicalResearch.com Interview with:

Meghan Miller, Ph.D. Assistant Professor Department of Psychiatry & Behavioral Sciences UC Davis MIND Institute Sacramento, CA 95817

Dr. Miller

Meghan Miller, Ph.D.
Assistant Professor
Department of Psychiatry & Behavioral Sciences
UC Davis MIND Institute
Sacramento, CA 95817

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

Response: This study evaluated within-diagnosis sibling recurrence and sibling cross-aggregation of ADHD and autism spectrum disorder among later-born siblings of diagnosed children. We specifically chose to include only families who had at least one subsequent child after the diagnosis of an older child because failing to do so could bias recurrence risk estimates.

We found that, compared to later-born siblings of non-diagnosed children, later-born siblings of children with autism were more likely to be diagnosed with autism or with ADHD. Likewise, compared to later-born siblings of non-diagnosed children, later-born siblings of children with ADHD were more likely to be diagnosed with ADHD or with autism.

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After Menopause, High Body Fat Associated with Doubled Risk of Estrogen+ Breast Cancer

MedicalResearch.com Interview with:

Neil M. Iyengar, MD Breast Medicine Service Department of Medicine Memorial Sloan Kettering Cancer Center Evelyn H. Lauder Breast And Imaging Center New York, NY

Dr. Neil Iyengar

Neil M. Iyengar, MD
Breast Medicine Service
Department of Medicine
Memorial Sloan Kettering Cancer Center
Evelyn H. Lauder Breast And Imaging Center
New York, NY 

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

Response: Obesity is one of the leading modifiable risk factors for the development of hormone receptor positive breast cancer in postmenopausal women.

Traditionally, physicians use a person’s body mass index (weight in kilograms divided by height in squared meters, kg/m2) to estimate body fat levels. A BMI of 30 or greater is considered to be obese, and this level of BMI increases the risk of at least 13 different cancers.

However, BMI is a crude measure of body fat and can be inaccurate. For example, some normal weight individuals (BMI less than 25) have obesity-related problems like diabetes and high blood pressure. Before our study, it was unknown whether high body fat levels in normal weight women contributes to obesity-related cancers such as breast cancer.

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Diversity Standards Linked to More Female, Black and Hispanic Students in Medical Schools

MedicalResearch.com Interview with:

Dr. Dowin H. Boatright, MD Assistant Professor of Emergency Medicine Yale School of Medicine

Dr. Boatright

Dr. Dowin H. Boatright, MD
Assistant Professor of Emergency Medicine
Yale School of Medicine

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

Response: This observational study looked at changes in student makeup by sex, race and ethnicity at U.S. medical schools after an accrediting organization introduced diversity standards in 2009.

An analysis of data from 120 medical schools suggests implementation of the diversity standards were associated with increasing percentages of female, black students, and Hispanic students.

MedicalResearch.com: What should readers take away from your report? 

Response: Accreditation standards may be an effective policy lever to increase diversity in the physician workforce. Nevertheless, while study results are promising, women, black, and Hispanic physicians remain underrepresented in the physician workforce.  

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

Response: Future studies should evaluate changes in student demographics at individual medical schools. Institutions that have proven to be successful in recruiting diverse medical school classes could serve as a model for other schools looking to improve medical student diversity.

No dislosures

Citation:

Boatright DH, Samuels EA, Cramer L, et al. Association Between the Liaison Committee on Medical Education’s Diversity Standards and Changes in Percentage of Medical Student Sex, Race, and Ethnicity. JAMA.2018;320(21):2267–2269. doi:10.1001/jama.2018.13705

Dec 5, 2018 @ 12:58 pm 

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RAS Inhibitor Linked to Reduced Heart Failure and Mortality After TAVR

MedicalResearch.com Interview with:

Taku Inohara MD, PhD Duke Clinical Research Institute,  Duke University Medical Center, Durham, North Carolina Department of Cardiology  Keio University School of Medicine, Tokyo, Japan

Dr. Inohara

Taku Inohara MD, PhD
Duke Clinical Research Institute,
Duke University Medical Center,
Durham, North Carolina
Department of Cardiology
Keio University School of Medicine, Tokyo, Japan

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

Response: Transcatheter aortic valve replacement (TAVR) has been increasingly used for treating patients with severe aortic stenosis.

Owing to the advancement of TAVR technology, the mortality and heart failure (HF) readmission after TAVR is decreasing over time, but 4.3% experienced readmission due to HF and 23.7% died within 1 year after TAVR. Inhibition of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin-receptor blockers (ARBs) is known to improve clinical outcomes in patients with heart failure, but there remains unknown whether a RAS inhibitor is associated with a reduction in mortality and heart failure readmission after TAVR.

Using the STS/ACC TVT Registry, a nationwide TAVR Registry in the US, we analyzed 15896 propensity-matched patients who underwent TAVR and found that receiving a prescription for a RAS inhibitor at discharge, compared with no prescription, was associated with a reduced risk for mortality ( 12.5% vs 14.9%) and HF readmission (12.0% vs 13.8%).

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Computer Simulation Study Favors Tomosynthesis over Digital Mammography

MedicalResearch.com Interview with:

Aldo Badano, Ph.D. Deputy Director, Division of Imaging, Diagnostics, and Software Reliability Office of Science and Engineering Laboratories Center for Devices and Radiological Health Silver Spring, MD 20993

Aldo Badano, Ph.D.
Deputy Director, Division of Imaging, Diagnostics, and Software Reliability
Office of Science and Engineering Laboratories
Center for Devices and Radiological Health Silver Spring, MD 20993 

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

Response: Expensive and lengthy clinical trials can delay regulatory evaluation of innovative technologies, affecting patient access to high-quality medical products. Although computational modeling is increasingly being used in product development, it is rarely at the center of regulatory applications.

Within this context, the VICTRE project attempted to replicate a previously conducted imaging clinical trial using only computational models. The VICTRE trial involved no human subjects and no clinicians. All trial steps were conducted in silico. The fundamental question the article addresses is whether in silico imaging trials are at a mature development stage to play a significant role in the regulatory evaluation of new medical imaging systems. The VICTRE trial consisted of in silico imaging of 2986 virtual patients comparing digital mammography (DM) and digital breast tomosynthesis (DBT) systems.

The improved lesion detection performance favoring DBT for all breast sizes and lesion types was consistent with results from a comparative trial using human patients and radiologists.  Continue reading

Wisdom Teeth Extractions Can Lead to Opioid Addiction in Adolescents and Young Adults

MedicalResearch.com Interview with:

Alan Schroeder MD Associate chief for research Division of pediatric hospital medicine Lucile Packard Children’s Hospital Stanford

Dr. Schroeder

Alan Schroeder MD
Associate Chief for Research
Division of pediatric hospital medicine
Lucile Packard Children’s Hospital Stanford

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

Response: Third molar “wisdom teeth” extractions are one of the most common surgeries performed in adolescents and young adults, but an adequate appraisal of risks and benefits is lacking. Most patients who undergo this procedure are exposed to opioids post-operatively.

We demonstrate that, for privately-insured opioid-naïve patients 16-25 years of age, exposure to opioids from a dental provider is associated with persistent use at 90-365 days in 7% of patients and a subsequent diagnosis relating to abuse in 6% of patients. In contrast persistent use and abuse were significantly lower in control patients not exposed to dental opioids (0.1% and 0.4%, respectively). The median number of pills dispensed for the initial prescriptions was 20.

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Polycystic Ovary Syndrome Linked to Increased Risk of Some Cancer Types

MedicalResearch.com Interview with:

Dr. Weimin Ye, MD MSC, PhD Department of Medical Epidemiology and Biostatistics Karolinska Institue

Prof. Ye

Dr. Weimin Ye, MD MSC, PhD
Department of Medical Epidemiology and Biostatistics
Karolinska Institue

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

Response: Polycystic ovary syndrome (PCOS) is the most common endocrine    disorder affecting 5-10% of women of reproductive age. Characterized by hyperandrogenism and metabolic abnormalities, PCOS is known to be related to various long-term health consequences, including diabetes, cardiovascular disease and endometrial cancer. Besides, inconsistent results have been reported for the associations between PCOS and the risk of ovarian and breast cancer. Studies addressing the risks of other cancers are scarce. Thus, we conducted a large, population-based cohort study with a long follow-up and rather sufficient confounding adjustment to explore the full picture of associations between PCOS and the risks of various cancer types.

We found that PCOS is a risk factor for certain types of cancer, including cancers of the endometrium, ovary, endocrine gland, pancreas, kidney and skeletal & hematopoietic system. Continue reading

Majority of Patients Withhold Important Information From Their Health Care Providers

MedicalResearch.com Interview with:

Dr. Gurmankin Levy

Dr. Andrea Gurmankin Levy, PhD MBE
Department of Social Sciences
Middlesex Community College, Middletown, Connecticut

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

Response: It is so important for clinicians to get accurate information from their patients so that they can make accurate diagnoses and appropriate recommendations. But we know that people tend to withhold information from others, and that this is especially true when it comes to sensitive information. And in fact, in medicine, there is a long-standing conventional wisdom that clinicians need to adjust patients’ answers (e.g., doubling patients’ report of alcohol consumption) to get a more accurate picture. So we wanted to explore this. How many patients withhold medically-relevant information from their clinicians, and why do they do so?  There have been surprisingly few studies looking at this question in a comprehensive way.

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Machine Learning Program Superior to Humans in Non-Pigmented Skin Lesions

MedicalResearch.com Interview with:
Philipp Tschandl, MD PhD, Priv.Doz. Department of Dermatology Medical University of ViennaPhilipp Tschandl, MD PhD, Priv.Doz.
Assistant Professor
Department of Dermatology
Medical University of Vienna

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

Response: Dermatoscopy is a non-invasive imaging technique, where the surface of the skin is rendered translucent and additional important morphologic features become visible from deeper layers. This is achieved through use of immersion fluid or cross-polarised light – equivalent to the effect when using a pair of goggles to look underwater, or polarised sunglasses to reduce glare on glass surfaces. After the first description of “Dermatoskopie” almost 100 years ago by a German dermatologist (Johann Saphier), this technique has evolved to a successful, low-cost, state-of-the-art technique for clinical skin cancer detection in the last decades.

Convolutional neural networks (“CNN”) are powerful machine learning methods, and frequently applied to medical image data in the recent scientific literature. They are highly accurate for basic image classification tasks in experimental settings, and found to be as good as dermatologists in melanoma recognition on clinical or dermatoscopic images. In this study we trained a CNN to diagnose non-pigmented skin lesions (where melanomas are only a minority) through analysis of digital images, and compared the accuracy to >90 human readers including 62 board-certified dermatologists. This study expands knowledge in the following ways compared to previous work:

– We applied the network for the detection of non-pigmented skin cancer, which is far more common in the (caucasian) population than melanoma.

– We created a prediction model that combines analysis of a dermatoscopic and clinical image (“cCNN”) which is able to further increase diagnostic accuracy.

– We compared accuracy not only to experts, but users with different level of experience Continue reading

Chronic Kidney Disease Rate Rising Faster Than Other Noncommunicable Diseases

MedicalResearch.com Interview with:

Dr. Ziyad Al-Aly, MD Associate Chief of Staff for Research and Education Veterans Affairs St. Louis Health Care System

Dr. Al-Aly

Dr. Ziyad Al-Aly, MD
Associate Chief of Staff for Research and Education
Veterans Affairs St. Louis Health Care System
Institute for Public Health
Washington University, St. Louis MO

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

Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years.
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USPSTF: Interventions to Prevent Child Maltreatment

MedicalResearch.com Interview with:

Alex Kemper, M.D., M.P.H., M.S. 

Dr. Kemper

Alex Kemper, M.D., M.P.H., M.S. 

Dr. Kemper is a board-certified pediatrician and chief of the Division of Ambulatory Pediatrics at Nationwide Children’s Hospital. He is also the deputy editor of Pediatrics.

MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations? 

Response: Child maltreatment, which includes abuse and neglect, is a serious health problem that affects too many children in the United States.  Abuse and neglect can have devastating health consequences, including long-term disabilities, depression, physical injury, and even death. In 2016, approximately 676,000 children were subjected to maltreatment, and more than 1,700 children died as a result.

Because this is such an important public health issue, the U.S. Preventive Services Task Force looked at the most recent evidence on whether primary care clinicians can help prevent child maltreatment and its negative consequences.

We found that, unfortunately, there is not enough evidence to recommend for or against these interventions. The Task Force is calling for more research on this important subject so that we can help prevent children from being abused and neglected.    Continue reading

What are the Patient Preferences that Determine Chose of Bariatric Surgery?

MedicalResearch.com Interview with:

Michael Rozier, S.J., Ph.D. Assistant Professor, Health Management and Policy College for Public Health and Social Justice St. Louis University

Dr. Rozier

Michael Rozier, S.J., Ph.D.
Assistant Professor, Health Management and Policy
College for Public Health and Social Justice
St. Louis University

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

Response: Patients considering surgery for weight loss have several options, which differ in significant ways, such as expected weight loss, risk of complication, modification of diet, effect on other medical conditions, and more. Previous studies have asked patients why they chose one procedure over another.

Instead, we quantified the relative importance of the key characteristics of surgical options. Using a discrete choice experiment, potential patients were given profiles of two weight loss options. They were asked to select one profile based on key characteristics such as out-of-pocket costs, total weight loss, risk of complication, and five other factors.

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Stroke: Cerebellar Stimulation Improved Motor Function

MedicalResearch.com Interview with:

Giacomo Koch, MD, PhD Laboratorio di Neurologia Clinica e Comportamentale Fondazione S. Lucia I.R.C.C.S. taly

Dr. Koch

Giacomo Koch, MD, PhD
Laboratorio di Neurologia Clinica e Comportamentale
Fondazione S. Lucia I.R.C.C.S.
Italy

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

Response: We show in this paper that non invasive stimulation of the cerebellum in patients with stroke is able to improve motor functions.

In particular we found that after three weeks of repetitive TMS of the intact cerebellum patients with hemiparesis due to stroke in the cerebral hemisphere remarkably improved their ability to walk and keep their balance, thus highly reducing the risk of fall. 

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Use of Biosimilar Growth Factor Increases in Supportive Cancer Care

MedicalResearch.com Interview with:

Abiy Agiro, PHD HealthCore Inc Wilmington, Delaware

Dr. Agiro

Abiy Agiro, PHD
HealthCore Inc
Wilmington, Delaware 

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

Response: Biosimilar approval pathway, authorized in 2010 by the Biologics Price Competition and Innovation Act as part of the Affordable Care Act, aims to increase adoption of biosimilar products and generate significant cost savings to payers and patients alike. Biosimilar filgrastim, used to prevent febrile neutropenia, is one of the first biosimilars to be approved in the United States. A large scale, post-approval real-world analysis was needed that compares biosimilar filgrastim to the original drug for safety and efficacy.

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Second Generation 3-Drug Combination Found Safe & Effective for Newly Diagnosed Multiple Myeloma

MedicalResearch.com Interview with:

Ola Landgren, MD, PhD Professor of Medicine  Chief, Myeloma Service  Department of Medicine  Memorial Sloan Kettering Cancer Center New York, NY 10065

Dr. Landgren

Ola Landgren, MD, PhD
Professor of Medicine
Chief, Myeloma Service
Department of Medicine
Memorial Sloan Kettering Cancer Center
New York, NY 10065

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

Response: Meta-analysis show that minimal residual disease (MRD) negativity is a strong predictor of longer progression-free survival (PFS). Emerging data show that an increasing proportion of newly diagnosed multiple myeloma patients obtain MRD negativity after modern combination therapy, even in the absence of bone marrow transplant. The first generation of 3-drug combination therapy (RVd) was associated with quite high rates of peripheral neuropathy which may be life-long.

The current study was designed to define the rates of peripheral neuropathy in newly diagnosed multiple myeloma treated with the second generation of 3-drug combination therapy (KRd), and per default delayed transplant (i.e. collection of stem cells which were stored for potential future use).

This single arm, phase 2 study found no cases of grade 3 peripheral neuropathy. The rates of MRD negativity wereunprecedented; 28 of 45 patients achieved MRD-negative CR (62%). The durability of MRD-negative CR has been observed up to 70 months (median duration 52.4 months). Patients who achieved MRD negativity by the end of cycle 8 had a 78% reduced risk of progression. The results were regardless of age or cytogenetic risk category.

The results from this second generation of 3-drug combination therapy (KRd) without transplant,  compare favorably to first generation of 3-drug combination therapy (RVd) followed by stem cell transplant.

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Cardiology Articles Pertaining to Lifestyle and Nutrition Receive Most Media Attention

MedicalResearch.com Interview with:

Ravi B. Patel, MD Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois

Dr. Patel

Ravi B. Patel, MD
Division of Cardiology, Department of Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois

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

Response: The digital attention of scientific articles can be readily quantified using the Altmetric score. The Altmetric score is a weighted measure, incorporating a variety of media platforms.

We aimed to characterize the Top 10% of articles by Altmetric score among 4 major cardiovascular journals (Circulation, European Heart Journal, Journal of the American College of Cardiology, and JAMA Cardiology) in 2017.

Our primary findings were:

1) nearly half of the most disseminated articles were not original research investigations,

2) the most common article topic was nutrition/lifestyle, and

3) there was a weak but significant correlation between Altmetric scores and citation number.  Continue reading

Novel Use of Tazarotene Gel To Treat Acne Scarring

MedicalResearch.com Interview with:

Dr Tarun Narang MD MNAMS Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh, India

Dr. Narang

Dr Tarun Narang MD MNAMS
Department of Dermatology, Venereology, and Leprology
Postgraduate Institute of Medical Education and Research
Chandigarh, India

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

Response: Acne is one of the most common dermatological problem for which the patients seek medical care. Post acne scarring is a complication of acne, resulting in long lasting physical disfigurement and low self esteem in the affected individuals. Even though there are various methods like microneedling, chemical peeling, cryorolling and ablative lasers to address the post acne atrophic scarring, these procedures are office based hence physician dependent. A home based treatment modality that can treat post acne atrophic scarring with a comparable efficacy to the procedural modalities of treatment will be beneficial to the patient.

Our study was done to assess the efficacy of a topical modality of treatment, tazarotene gel, 0.1% in the management of post acne atrophic scarring in comparison to an established method, the microneedling. Continue reading

Risk Factors for Melanoma in Women

MedicalResearch.com Interview with:

One example of malignant melanoma, courtesy of skin cancer foundation

One example of malignant melanoma, courtesy of Skin Cancer Foundation

Reza Ghiasvand, PhD
Oslo Centre for Biostatistics and Epidemiology
Faculty of Medicne
University of Oslo
Oslo, Norway 

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

Response: Melanoma is the most dangerous type of skin cancer. It is estimated that about 288,000 individuals will be diagnosed and about 61,000 will die from it in 2018, with the majority of patients in Australia, New Zealand, Europe and North America. Ultraviolet (UV) exposure (from both the sun and tanning beds) is the most important preventable risk factor for melanoma. However, the association between UV exposure and melanoma is complex and does not accord with a simple model in which risk increases directly with exposure. An individual risk of melanoma also depends on personal characteristics such as skin color and skin sensitivity to the UV exposure, hair color, number of moles, and age.

It has been hypothesized that the pattern of UV exposure may play a role in melanoma development in different body sites. For example, melanoma on the trunk (chest and back) has been linked to the recreational UV exposure such as sunbathing and frequent sunburns in people with high number of moles on their body. In contrast, melanomas on the head and neck have been linked to constant sun exposure such as occupational UV exposure, mainly in older people. Epidemiologic and molecular evidence in support of this hypothesis has been published based on analyses of small datasets. Also, melanoma on legs and arms is less studied under this hypothesis.

In our study, we examined UV exposure (sunbathing, sunburn and sunbed use) and pigmentary factors (skin, eye, and hair color, freckling, and number of moles), and risk of melanoma on different body sites. We used information from the Norwegian Women and Cancer Study, a population-based cohort study that started in 1991, and includes more than 161,000 Norwegian women followed for an average of 18 years.

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Almost Half of US Adults Get No Leisure Time Physical Activity in Typical Week

MedicalResearch.com Interview with:

Emily Neusel Ussery, MPH PhD Epidemiologist, Physical Activity and Health Branch CDC

Dr. Ussery

Emily N Ussery, PhD
Epidemiologist
LT, US Public Health Service
Physical Activity and Health Branch
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention 

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

Response: Sitting for too long and being physically inactive can have negative health consequences, and it is important to understand how common these behaviors are among US adults.

This study describes sitting time and leisure-time physical activity reported by US adults in a national survey. Continue reading

Serious Mental Illness Raises Risk of 30 Day Readmission

MedicalResearch.com Interview with:

Hayley D. Germack PHD, MHS, RN Assistant Professor, School of Nursing University of Pittsburgh

Dr. Germack

Hayley D. Germack PHD, MHS, RN
Assistant Professor, School of Nursing
University of Pittsburgh

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

Response: As nurse scientists, we repeatedly witness the impact of having a serious mental illness (i.e. schizophrenia, bipolar disorder, and major depression disorder) on patients’ inpatient and discharge experience. As health services researchers, we know how to make use of large secondary data to illuminate our firsthand observations.

In 2016, Dr. Hanrahan and colleagues (https://www.sciencedirect.com/science/article/pii/S0163834316301347) published findings of a secondary data analysis from a large urban hospital system that found 1.5 to 2.4 greater odds of readmission for patients with an  serious mental illness diagnosis compared to those without. We decided to make use of the AHRQ’s HCUP National Readmissions Database to illuminate the magnitude of this relationship using nationally representative data. We found that even after controlling for clinical, demographic, and hospital factors, that patients with SMI have nearly 2 times greater odds of 30-day readmission.  Continue reading

Obesity Threat to Health of Individuals and Populations May Be Underestimated

MedicalResearch.com Interview with:

Ching-Ti Liu, PhD Department of Biostatistics Boston University School of Public Health Boston, Massachusetts

Dr. Liu

Ching-Ti Liu, PhD
Department of Biostatistics
Boston University School of Public Health
Boston, Massachusetts

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

Response: Being overweight and obese are increasing worldwide and this obesity epidemic threatens to reverse the gains in life expectancy achieved over the past century. However, many investigators have observed, paradoxically, that overweight individuals are associated with a lower mortality risk. These results may suffer from a potential confounding due to illness or reverse causality in which preexisting conditions may alter both body weight and the risk of death.  Recently published studies have tried to mitigate this reverse causal bias by implementing sample exclusion and they came to a different conclusion: between BMI and all-cause mortality there is an increased risk of death for the entire range of weights that are in the overweight and obesity ranges.

However, the elimination strategies may lead to the loss of generalizability or precision due to over-adjustment. In addition, the traditional investigations have only utilized a subject’s weight at a single point in time, which makes it difficult to adequately address bias associated with reverse causality.

Currently, the idea incorporating a subject’s weight history has been proposed to deal with the concern of reverse causality, but the existing works had been based on a subject’s recall or self-reported data, which may lead to misclassification and, therefore, result in overestimating the risk of mortality.

To help assess the relevance of being overweight or obese to the risk of death in the general population, we conducted a prospective study, using an individuals’ maximum BMI before the beginning of survival follow-up instead of their weight status at a single point in time, using data from the Framingham Heart Study (FHS).

We observed increasing risk of mortality across various BMI categories (overweight < obese I < obese II) relative to normal weight using maximum BMI over 24 years of weight history.

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Primary Care Providers Should Ask All Adults About Alcohol Use

MedicalResearch.com Interview with:

Dr. Carol Mangione M.D., M.S.P.H., F.A.C.P Ronald Reagan UCLA Medical Center Division Chief of General Internal Medicine and Health Services Research Professor of Medicine. Barbara A. Levey, MD, and Gerald S. Levey, MD Endowed chair in medicine David Geffen School of Medicine University of California

Dr. Mangione

Dr. Carol Mangione M.D., M.S.P.H., F.A.C.P
Ronald Reagan UCLA Medical Center
Division Chief of General Internal Medicine and Health Services Research
Professor of Medicine.
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine David Geffen School of Medicine
University of California

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

Response: Unhealthy alcohol use is relatively common and is increasing among U.S. adults. Alcohol use is the third leading cause of preventable death in the U.S. and contributes to more than 88,000 deaths per year. In pregnancy, it also leads to birth defects and developmental problems in children. The Task Force found that screening tests and brief counseling interventions can help detect and reduce unhealthy alcohol use among adults, and in turn help prevent negative consequences related to alcohol use. For adolescents ages 12 to 17, clinicians should use their best judgment when deciding whether or not to screen and refer their patients to counseling, until we have better studies available.

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Obesity Strongly Related to Coronary Artery Disease and Diabetes

MedicalResearch.com Interview with:
"Obesity runs rampant in Indiana." by Steve Baker is licensed under CC BY-ND 2.0Haris Riaz MD
(Cardiology Fellow
Haitham Ahmed MD, MPH , Preventive Cardiologist,
Cleveland Clinic, Ohio

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

Response: Elevated cholesterol (specially low density lipoprotein) has been causally linked to the development of coronary artery disease whereas the causal relationship between obesity and cardiovascular disease has remained controversial. This is important because of increasing epidemic of obesity and metabolic syndrome. Mendelian randomization studies provide one way of determining a causal association where we can look at the outcomes of individuals stratified by the presence or absence of a particular allele. Since these alleles are randomly distributed in the population of interest, this is “nature’s randomized trial” in that the particular allele is naturally distributed and hence minimal risk of bias.

In other words, lets say that I hypothesize that a particular gene “A” is linked with coronary artery disease. If the given gene is indeed causally linked with coronary artery disease, patients with activation of that gene should have significantly greater risk of developing coronary artery disease.

Based on these principles, we conducted a systematic review and meta-analysis of the available evidence and found that the risk of developing coronary artery disease and diabetes is significantly increased with obesity. Although hypothesis generating, we think that these findings may suggest a causal association between obesity and cardiovascular disease.  Continue reading

Adults with Down’s Syndrome at High Risk of Alzheimer’s Disease

MedicalResearch.com Interview with:
"A neonate with Down's?" by Sadasiv Swain is licensed under CC BY 2.0Rosalyn Hithersay

LonDowns
Kings College, London 

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

Response: In our research group, we have been following a large group of adults with Down syndrome in the UK to track changes with ageing in their health and cognitive function. It has been known for some time now that people with Down syndrome are at high risk for developing dementia due to Alzheimer’s disease. This new study has shown the huge impact that this risk has on mortality for these adults.

We found that dementia is now the likely underlying cause of death in more than 70% of adults with Down syndrome aged over 35 years. This is a much bigger proportion of deaths due to Alzheimer’s disease compared to the general population: in England and Wales only 17.5% of deaths past the age of 65 would be related to dementia of any kind.  Continue reading