Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pharmaceutical Companies / 09.04.2018

MedicalResearch.com Interview with: Aaron Mitchell, MD Division of Hematology/Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center The Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hill MedicalResearch.com: What is the background for this study? What are the main findings? Response: Financial relationships between physicians and the pharmaceutical industry are very common. However, we are just beginning to figure out whether these relationships may lead to potentially concerning changes in physician behavior - whether physicians tend to prescribe more of the drugs made by a company that has given them money. We decided to ask whether oncologists who receive money from drugmakers are more likely to use the cancer drugs made by companies that have given them money in the past. In studying two specific groups of cancer drugs, one for kidney cancer and one for chronic myeloid leukemia (CML), we found that oncologists who had received payments such as meals, consulting fees, travel & lodging expenses from the manufacturer of one of these drugs tended to use that drug more. When looking at oncologists who received payments for research, we found increased prescribing among the kidney cancer drugs but not the CML drugs. (more…)
Author Interviews, JAMA, Mental Health Research, OBGYNE, Pediatrics / 09.04.2018

MedicalResearch.com Interview with: Claudia I. Lugo-Candelas, PhD Postdoctoral Research Fellow Columbia University Medical Center/ New York State Psychiatric Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have seen, in the last decade, an increase in the amount of mothers being prescribed SSRIs during pregnancy. While we know that untreated prenatal maternal depression has adverse consequences for both the mother and child, it’s not really clear what, if any, are the consequences of prenatal SSRI exposure on infant’s brain development. There have been some studies finding increased depression and anxiety in children prenatally exposed to SSRIs, but not all studies find these associations. We thus looked at 2-4 week old infants’ brains, using neuroimaging.  We found increased gray matter volume within the amygdala and insula, and increased white matter connectivity between these two structures in infants prenatally exposed to SSRIs. Of note, the statistical significance and the size of the effects we detected are quite large, even greater than the brain changes that we usually observe in our studies of children and adults with psychiatric disorders. Further, because these structures are involved in emotion processing, and alterations in volume and connectivity are sometimes seen in clinical populations, or in people at risk for anxiety, it important to learn more about what these volume and connectivity differences could mean for these infants. (more…)
ALS, Alzheimer's - Dementia, Author Interviews, JAMA / 09.04.2018

MedicalResearch.com Interview with: Celeste Karch, PhD Assistant Professor of Psychiatry Molecular mechanisms underlying tauopathies Washington University School of Medicine St Louis MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nearly half of all patients with amyotrophic lateral sclerosis (ALS), a fatal neuromuscular disorder, develop cognitive problems that affect memory and thinking. Why a disease that primarily affects movement also disrupts thinking has been unclear. Our findings suggest that genetic connections between the two disorders may explain why they share some of the same features and suggest that some drugs developed to treat ALS also may work against frontotemporal dementia and vice versa. We used a statistical method in almost 125,000 individuals with ALS, frontotemporal dementia (FTD), progressive supranuclear palsy, corticobasal degeneration, Alzheimer’s disease and Parkinson’s disease to determine whether there are common genetic variants that increase risk for multiple neurodegenerative diseases. We found that common variants near the MAPT gene, which makes the tau protein, increases risk for ALS. MAPT has previously had been associated with diseases including frontotemporal dementia and Alzheimer’s disease. But the gene hadn’t been linked to ALS. We also identified variations in a second gene, BNIP1, which normally plays an important role in protecting against cell death, increased the risk of both ALS and frontotemporal dementia. ImportantlyBNIP1 mRNA levels were altered in people who had ALS and in patients with frontotemporal dementia, suggesting the BNIP1 may be a potential therapeutic target for both disorders. (more…)
Author Interviews, JAMA, Mental Health Research / 07.04.2018

MedicalResearch.com Interview with: Dr. Aideen Maguire Centre of Excellence for Public Health Queen's University Belfast Institute of Clinical Sciences B Royal Hospitals Site, Belfast MedicalResearch.com: What is the background for this study?   Response: Consanguineous Marriage is the marriage between second or first cousins. Although not common practice in the Western world approximately 1 in 10 children worldwide are born to consanguineous parents. It is legal in all countries worldwide except the United States of America, North Korea and China. Cousin-marriage is associated with an increased risk of autosomal recessive genetic disorders in offspring but the association between cousin-marriage and the mental health of offspring has not been extensively studied. MedicalResearch.com: What are the main findings? Response: Children of consanguineous parents are over 3 times more likley to be in receipt of medications for common mood disorders (antidepressant and/or anxioltyic medication) compared to children of non-related parents and over twice as likley to be in receipt of antipsychotic medication compared to children of non-related parents.  (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA / 06.04.2018

MedicalResearch.com Interview with: Dr. Alvin Chandra  MD first author  and Dr. Scott David Solomon M.D. Director, Noninvasive Cardiology Professor, Harvard Medical School Cardiovascular Medicine Brigham and Women’s Hospital Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: In general, the quality of life of heart failure with reduced ejection fraction patients is quite impaired, and  similar to that of patients on dialysis. PARADIGM-HF was the largest trial of heart failure patients and showed that sacubitril/valsartan was superior to the gold-standard enalapril in reducing cardiovascular death, heart failure hospitalization and all-cause mortality. In addition, patients on sacubitril/valsartan, when compared to enalapril, showed significant improvement in overall quality of life. In this study we looked in more detail at the individual components of “quality of life” and found that in virtually all domains and activities, patients who were randomized to sacubitril/valsartan reported improvement in their limitations  compared to those who were randomized to enalapril. These activities included jogging, doing hobbies, and household chores, with the largest improvement seen in  sexual activities limitations. (more…)
Author Interviews, Genetic Research, Heart Disease, JAMA / 06.04.2018

MedicalResearch.com Interview with: Stella Aslibekyan, PhD Associate Professor PhD Program Director Department of Epidemiology University of Alabama at Birmingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: When the human genome was sequenced in 2003, there were somewhat unrestrained expectations of unraveling all etiologic mysteries and discovering breakthrough treatments. Needless to say, that did not happen, in part because individual genetic variants can only account for a small fraction of trait variability. Since then, epigenetics-- the study of mitotically heritable changes in gene expression-- has emerged as another promising avenue for understanding disease risk. The best studied epigenetic process in humans is DNA methylation, and earlier studies (including some from our group) have shown interesting associations between changes in methylation in specific genomic regions and cardiovascular disease traits, e.g. plasma cholesterol levels. In this project, we have combined DNA methylation data on thousands of individuals from multiple international cohorts and interrogated epigenetic contributions to circulating tumor necrosis factor alpha (TNFa), a marker of systemic inflammation. We identified and replicated several epigenomic markers of TNFa, linked them to variation in gene expression, and showed that these methylation changes (which were located in interferon pathway genes) were predictive of coronary heart disease later in life. Interestingly, the variants we discovered were not sequence-dependent (in other words, they were not associated with any genetic mutations), highlighting the role of the environment. (more…)
Author Interviews, Colon Cancer, Genetic Research, JAMA / 03.04.2018

MedicalResearch.com Interview with: Heather Hampel, MS, LGC Associate Director, Division of Human Genetics Associate Director, Biospecimen Research Professor, Internal Medicine Licensed Genetic Counselor The Ohio State University Comprehensive Cancer Center Columbus, OH  4322 MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: The background is that we had recently shown that some colorectal cancer patients who underwent traditional screening for Lynch syndrome were eventually found to have double somatic (two acquired) mutations in the MMR genes and they did not have Lynch syndrome at all. This was discovered after their tumor had already had MSI and/or IHC screening test, followed by MLH1 methylation and/or BRAF testing, followed by germline DNA testing on a blood sample from the patient for MMR gene mutations, then finally by sequencing their tumor. This gave us the idea to reverse the sequence and start with tumor sequencing since it might streamline testing, save time, and prevent several other tests. In addition, we knew that all stage IV colorectal cancer are already supposed to have tumor sequencing of the KRAS, NRAS, and BRAF genes and MSI testing for treatment purposes. Our hypothesis was that an upfront tumor sequencing test could replace all these separate tests with similar sensitivity and specificity. (more…)
Author Interviews, Cannabis, JAMA, Opiods / 02.04.2018

MedicalResearch.com Interview with: Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Medical and adult-use marijuana laws, has made marijuana available to more Americans. Yet no study to date has focused on the effect of medical and adult-use marijuana laws on opioid prescribing in particular. Our study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws between 2011 and 2016 was associated with lower opioid prescribing rates and spending among Medicaid enrollees.   (more…)
Author Interviews, Gender Differences, JAMA, Surgical Research / 02.04.2018

MedicalResearch.com Interview with: Neel Mansukhani, MD Department of Surgery Northwestern University and Melina R. Kibbe, MD, FACS, FAHA Colin G. Thomas Jr. Distinguished Professor and Chair Department of Surgery Professor, Department of Biomedical Engineering The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7050 Editor in Chief, JAMA Surgery  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study is a follow-up to our previous work that examined sex bias in surgical research. Previously, we examined sex bias in basic and translational science surgical research, as well as in clinical surgical research. We discovered previously that sex bias exists in basic and translational surgical research in the unequal inclusion of male and female research subjects. In clinical research, we found sex bias in the degree of sex matching of included subjects, and in the frequency of sex-based reporting, analysis, and discussion of the data. In this current work, we sought to understand the effect of author gender on sex bias in surgical research. In this work, we found that most authors are male, most authors work with other authors of the same gender, and sex bias is prevalent regardless of author gender. Most importantly, we found that sex inclusive research receives more citations after publication compared to sex-biased research.  (more…)
Author Interviews, Cannabis, JAMA, Opiods / 02.04.2018

MedicalResearch.com Interview with “Cannabis sativa” by Manuel is licensed under CC BY 2.0 David Bradford, Ph.D. Busbee Chair in Public Policy Department of Public Administration and Policy University of Georgia Athens, GA 30602 MedicalResearch.com: What is the background for this study? Response: To give you some background, in 2016, part of our research team (Bradford and Bradford) published the first study to directly examine the impact that medical cannabis laws (MCLs) may be having on prescription use. We used yearly physician-level Medicare Part D data, looked at nearly all prescription drugs used to treat 9 broad categories of illness/diagnoses, and found substantial reductions in prescriptions. We published a follow-up study in 2017, this time using data from Medicaid Fee-for-Service. Again, we found significant substitution away from prescription medications. In both of these studies, pain was included in the list of conditions for which cannabis may be used in patients, and in both studies, pain prescriptions fell. One of the unanswered questions from both of those studies, though, was what *type* of pain medications were being reduced.  From a public health standpoint, when we're worried about opioid overdose, it matters whether the substitution away from pain medications is coming from substitutions away from things like NSAIDs or whether there is substitution away from opioids. (more…)
Author Interviews, JAMA, Schizophrenia / 29.03.2018

MedicalResearch.com Interview with: Silvana Galderisi MD President of the European Psychiatric Association Professor of Psychiatry University of Campania "Luigi Vanvitelli" Italy MedicalResearch.com: What is the background for this study? Response: The goal of schizophrenia treatment has gradually shifted from reduction of symptoms and prevention of relapse to improvement of real-life functioning. In fact, these outcomes not always coincide and, in spite of progress in treatments reducing symptoms and preventing relapses, people with schizophrenia live 15-20 years less than the general population, are often unemployed, and show severe disabilities. Enhanced understanding of factors associated with real-life functioning is instrumental to design effective integrated and personalized treatment plans for persons with schizophrenia. To this aim, the Italian Network for Research on Psychoses, including 26 twenty-six Italian university psychiatric clinics and/or mental health departments, has focused on the identification of variables influencing real-life functioning, in particular on the interrelationships among illness-related variables, personal resources, context-related variables and real-life functioning. The number of variables and subjects included in the study was larger than in any other study on this topic, and for the first time the network analysis was used to model the interplay among cognitive, psychopathological and psychosocial variables in a large sample of community dwelling subjects with schizophrenia. The network analysis is a data-driven approach; it does not rely on an a priori model of relationships among variables, provides quantitative measures of variable centrality within the network, thus indicating which variables play a key role in the network, and which ones are instead more peripheral. In addition, by inspecting the network, it is possible to understand the extent to which variables belonging to the same construct are connected, and how different constructs are mutually interacting and reinforcing each other.  (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Parkinson's / 27.03.2018

MedicalResearch.com Interview with: Benjamin Dawson, B.Sc. MD Candidate 2020 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dementia in Parkinson’s Disease is one of its most feared complications, and may happen eventually to most patients if they reached advanced age. Identifying those at especially high risk of dementia has important potential implications - it would facilitate clinical counselling, it has treatment implications (e.g. knowing a person is likely to get dementia in the near future would probably steer you away from certain medications and towards others).  Most critically, it can help select patients for trials to prevent dementia. While several factors that show high risk for dementia in Parkinson’s disease have previously been described, these have yet to shape patient-care, either because they are not very strong predictors, or they are not user-friendly.  So, we designed a very simple clinical screening tool, called the Montreal Parkinson’s Risk of Dementia Scale (MoPaRDS).  It took predictors of dementia that were established from large-scale studies and boiled them down into a simple 8-point scale that uses information that you can get in a simple office visit.  The 8 predictors were being over 70, being male, having a blood pressure drop with standing, showing early mild cognitive changes, having a symmetric bilateral disease (that is, one side not clearly worse than the other), experiencing falls or freezing, having experienced hallucinations, and having symptoms of REM sleep behavior disorder ('acting out' the dreams at night). When we tested the scale in a combined cohort of 607 patients with Parkinson’s (of whom 70 developed dementia over mean follow-up of 4.4-years) a positive MoPaRDS screen (≥4 out of 8 items) identified 14-fold increased risk of dementia compared to a negative screen. We recommend dividing the scale into three categories; low-, intermediate- and high-risk. Those in the highest score group (MoPaRDS, 6-8) had a 14.9% risk of developing dementia each year, while those with the lowest scores (MoPaRDS, 0-3) had only 0.6% annual risk.  So, these simple measures can be pretty powerful predictors of dementia. (more…)
Author Interviews, Breast Cancer, Chemotherapy, JAMA, Novartis / 26.03.2018

MedicalResearch.com Interview with: Melanie E. Royce, MD, PhD Division of Hematology/Oncology University of New Mexico Comprehensive Cancer Center Albuquerque MedicalResearch.com: What is the background for this study? What are the main findings? Response: BOLERO-4 is an open label, single-arm, Phase II study that evaluates the combination of everolimus plus letrozole as a first-line treatment for hormone receptor (HR)-positive/human epidermal growth factor receptor (HER2)-negative advanced breast cancer patients, as well as the use of everolimus plus exemestane beyond initial progression. Results of the BOLERO-4 trial published in JAMA Oncology showed that everolimus in combination with endocrine therapy is an effective first-line treatment option for postmenopausal women with HR+/HER2- advanced breast cancer. A total of 202 patients received everolimus in combination with letrozole as first-line treatment between March 7, 2013 and December 17, 2014. Median progression-free survival (PFS) in the first-line setting was 22.0 months (95% CI 18.1-25.1) with an overall response rate of 45% (95% CI 38.1-52.2) and clinical benefit rate of 74% (95% CI 67.7-80.1). A total of 152 (75%) discontinued treatment, primarily due to disease progression (51%) or adverse events (16%). Data from a smaller number of patients in BOLERO-4 also show limited efficacy with continued everolimus, combined with exemestane, following disease progression. Second-line treatment was ongoing in 16 (32%) patients, while 34 (68%) had discontinued. The most frequent reason for second-line treatment discontinuation was disease progression (56%). In the second-line setting, median PFS was 3.7 months (95% CI 1.9-7.4) with an overall response of 6% (95% CI 1.3-16.5) and clinical benefit rate of 28% (95% CI 16.2-42.5). Safety findings from BOLERO-4 are consistent with previous studies of Afinitor in advanced breast cancer. The most common (≥ 20% incidence) first-line all-grade adverse events were stomatitis (69%), weight loss (44%), nausea (37%) and anemia (35%). Most were ‘low grade’ in severity (grade 1 or 2) and generally well managed. Safety findings show the most common (≥ 10% incidence) second-line adverse events were stomatitis (20%) and weight loss (20%). Lower rates of stomatitis in second-line were noted.  (more…)
Author Interviews, CDC, Infections, JAMA / 26.03.2018

MedicalResearch.com Interview with: Dr. Katherine Fleming-Dutra, MD, senior author Deputy Director Office of Antibiotic Stewardship CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: As noted in a previous study, antibiotics are prescribed more for sinus infections than any other illness in the United States. We found that almost 70% of antibiotic prescriptions were for 10 days or longer, whereas 5-7 days is recommended for most patients when antibiotics are needed. In addition, more than 20% of antibiotic prescriptions for sinus infections were for 5 days of azithromycin, even though guidelines recommend against prescribing azithromycin for sinus infections. (more…)
Author Interviews, Cancer Research, Hepatitis - Liver Disease, JAMA / 26.03.2018

MedicalResearch.com Interview with: Sang Min Park MD, MPH, PhD Chief, Department of Family Medicine, Seoul National University College of Medicine Director, Health Promotion Center, Seoul National University Hospital Professor, Department of Biomedical Science & Family Medicine Seoul National University College of Medicine Seoul, Korea What is the background for this study? What are the main findings? Response: Chronic hepatitis B patients have a higher risk of hepatocellular carcinoma than the general population, which has been well-established and known to be caused by progression of hepatitis B infection into severe liver diseases. However, whether obesity-related carcinogenesis plays a central role in the development of hepatocellular carcinoma in chronic hepatitis B patients remained unclear. Therefore, we assessed the association between body mass index and risk of hepatocellular carcinoma in chronic hepatitis B patients, and stratified all analyses by sex using healthcare big data in the Republic of Korea. We found positive association of trends between body mass index and risk of hepatocellular carcinoma in both men and women with hepatitis B infection. The magnitude of the association in women was stronger than that of men. In the severely obese category, the hazard ratio for hepatocellular carcinoma was significantly higher in women compared to men. Our findings highlight that high body mass index is associated with risk of hepatocellular carcinoma in chronic hepatitis B patients, especially in women, which may be partially explained by higher fat content for the same unit of body mass index in women compared to men. (more…)
Author Interviews, Global Health, JAMA, Pediatrics / 26.03.2018

MedicalResearch.com Interview with: Professor Jeffrey Braithwaite, PhD Dr. Braithwaite is founding director of the Australian Institute of Health Innovation at Macquarie University and Chief Investigator of the just-published CareTrack Kids Study the largest study of the quality of care to children ever undertaken. MedicalResearch.com: What is the background for this study?   Response: While seeking to improve health outcomes for patients, there has been substantial investment in developing clinical practice guidelines, to support the delivery of evidence-based healthcare. Prior to the CareTrack Kids study, little was known about the level of adherence to clinical practice guidelines for the care of Australian children. Our study examined care provided to children under 16 years of age treated for 17 important clinical conditions, such as asthma or fever, to assess adherence to these guidelines. We surveyed over 6500 medical records in four clinical settings (general practices; paediatricians offices; hospital emergency departments; and hospital inpatient wards) in South Australia, New South Wales and Queensland, and assessed visits during 2012 and 2013.  (more…)
Author Interviews, Cancer Research, Dermatology, Environmental Risks, JAMA, Melanoma / 23.03.2018

MedicalResearch.com Interview with: John W. Epling, Jr., M.D., M.S.Ed., Task Force Member Dr. Epling is is a professor of Family and Community Medicine at the Virginia Tech Carilion School of Medicine in Roanoke, VA. He is also the Medical Director of Research for Family and Community Medicine, Medical Director of Employee Health and Wellness for the Carilion Clinic, and maintains an active clinical primary care practice.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Skin cancer is the most common type of cancer in the U.S., affecting millions of people every year. The Task Force looked at the latest research to see if clinicians can help people prevent skin cancer by providing counseling about ways to reduce risk, including using sunscreen, wearing protective clothing, and avoiding sunlight during peak hours. Based on our review of the evidence, we found that counseling younger patients with a fair skin type and their parents is effective at encouraging these sun protective behaviors. By helping reduce their patients’ exposure to harmful UV rays, clinicians can decrease their risk for skin cancer. As such, we recommend that clinicians provide counseling to people who are six months to 24 years old and have a fair skin type. For adults over 24 with a fair skin type, clinicians should consider the individual’s risks for skin cancer when deciding whether or not to provide counseling.  (more…)
AHA Journals, Author Interviews, Hospital Readmissions, JAMA / 21.03.2018

MedicalResearch.com Interview with: Dr. Sahil Agrawal, MBBS MD Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA Dr Lohit Garg MD Division of Cardiology Lehigh Valley Health Network, Allentown  MedicalResearch.com: What is the background for this study? Response: Readmissions among advanced heart failure patients are common and contribute significantly to heath care related costs. Rates and causes of readmissions, and their associated costs among patients after durable left ventricular assist device (LVAD) implantation have not been studied in a contemporary multi-institutional setting. We studied the incidence, predictors, causes, and costs of 30-day readmissions after LVAD implantation using Nationwide Readmissions Database (NRD) in our recently published study. (more…)
ADHD, Author Interviews, Brain Injury, JAMA, Pediatrics / 20.03.2018

MedicalResearch.com Interview with: Dr. Megan E. Narad, PhD Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center | CCHMC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous research has shown that children with a history of traumatic brain injury (TBI) demonstrate difficulties with attention following injury; however, most studies only follow children 2-3 years after injury. Our study followed a group of children with a history of TBI 7-10 years after injury. The main finding is that those with severe TBI were at greater risk for developing secondary attention deficit hyperactivity disorder (SADHD) than those with orthopedic injury; however, it should also be noted that kids with less severe injuries were also at risk of developing SADHD. In addition to injury severity, environmental factors (maternal education and family functioning) also played a role in SADHD development. It should also be noted that a number of kids developed SADHD >3.5 years after injury suggesting that these difficulties may not surface until many years after injury. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Menopause, OBGYNE, Sexual Health / 20.03.2018

MedicalResearch.com Interview with: Caroline Mitchell, MD, MPH Vincent Center for Reproductive Biology Assistant Professor, Obstetrics, Gynecology & Reproductive Biology http://massgeneral.link/MitchellLab MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study we compared two commonly recommended treatments for menopausal vaginal discomfort - low dose vaginal estradiol tablets and a vaginal moisturizer - to placebo, and found no difference in reduction of symptom severity; all three groups improved over 12 weeks of treatment.  This is great news for women, as it means that using any treatment regularly is likely to have benefit, whether it costs $20 or $200. Symptoms of vaginal dryness, irritation and pain with sex, which occur in over half of postmenopausal women, cause a significant decrease in quality of life and negatively impact intimate relationships.  The significant impact of these symptoms is reflected in the fact that we enrolled all 302 participants in under a year, a faster enrollment than any of the four prior trials  conducted by the MsFlash research network that evaluated treatments for hot flashes.  Women were desperate for some kind of intervention for these symptoms. (more…)
Author Interviews, JAMA, Ophthalmology, University of Michigan / 16.03.2018

MedicalResearch.com Interview with: Maria A. Woodward, MD, MSc Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Many people go to emergency departments seeking care for their eye problems. We wished to investigate which factors are associated with the involvement of ophthalmologist consultants in the care of these patients and whether any disparities exist.  (more…)
Author Interviews, CDC, Dermatology, Environmental Risks, JAMA / 15.03.2018

MedicalResearch.com Interview with: “Sunburn” by Beatrice Murch is licensed under CC BY 2.0Dawn Holman, MPH Behavioral Scientist Division of Cancer Prevention and Control CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sunburn at any age increases a person’s chances of developing skin cancer in the future. Using a combination of strategies including staying in the shade, wearing clothing that covers the arms and legs, wearing a hat with a wide brim, and wearing sunscreen (SPF 15+) on exposed skin can protect skin from sun damage and reduce risk of sunburn. This study used national data to examine how often US adults used these sun protection strategies when outdoors in the sun for an hour or longer and how many US adults got sunburned in 2015. Among adult women, staying in the shade and using sunscreen were the most common sun protection methods. About 40% of women regularly used these strategies. Women were less likely to wear a wide-brimmed hat (14%) or wear clothing covering their arms (11%) and legs (23%). Among adult men, wearing pants or other clothing covering their legs and staying in the shade were the most common sun protection methods. Just over 30% of men regularly used these strategies. Men were less likely to use sunscreen (22%), wear a wide-brimmed hat (14%) or wear a shirt with long sleeves (13%). About one-third of US adults got sunburned in 2015. Sunburn was even more common among certain groups. For example, about half of individuals with sun-sensitive skin and about half of adults aged 18-29 got sunburned. Certain behaviors and health conditions were related to sunburn. For example, adults who used sunless tanning products to darken their skin, binge drank, engaged in aerobic activity, or were overweight or obese were more likely to get sunburned compared to other adults. Adults who regularly stayed in the shade when outdoors or avoided long periods of time in the sun were slightly less likely to get sunburned compared to other adults. Adults who regularly used sunscreen were slightly more likely to get sunburned. (more…)
Aging, Alcohol, Author Interviews, JAMA, Stanford / 15.03.2018

MedicalResearch.com Interview with: alcohol-cdc-imageEdith V. Sullivan, Ph.D. Professor Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford, CA 94305-5723  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Alcohol misuse is a major public health problem worldwide with profound health consequences on the body, brain, and function. Our research group has conducted naturalistic yet controlled studies of alcohol dependence for several decades to further our understanding of when and how alcohol misuse affects specific parts of the brain.  In addition, we wanted to know how alcohol misuse interacts with the typical changes in the brain as we grow older.  The studies are controlled in that we recruit healthy, non-alcohol dependence men and women from the community to undergo the same screening and neuroimaging procedures as our alcoholic recruits.  The studies are quantitative because we use neuroimaging methods (Magnetic Resonance Imaging) that enable us to measure specific regions of brain structural volumes.  Consistent collection of such data over the years positioned us to ask whether age and alcohol dependence interact to produce regional brain volume loss beyond the loss that occurs in normal aging. A number of cross-sectional studies pointed to the likelihood that the effects of alcohol dependence on brain structure would be exacerbated by normal aging, which we do know from longitudinal neuroimaging studies results in shrinkage of cortical gray matter volume and thinning of the cortex. What was particularly striking about our longitudinal study of men and women with alcohol dependence was the acceleration of the aging of brain structure that was especially prominent in the frontal cortex.  Critically, even those who initiated dependent drinking at an older age showed accelerated loss. Because our study sample was large enough, we could also test whether our findings were attributable to conditions that commonly co-occur with alcohol dependence, namely, illicit drug use and hepatitis C.  Although both drug use and hepatitis C infection may have exacerbated brain volume loss, these factors did not fully account for the alcoholism-aging interaction we identified. (more…)
Accidents & Violence, Addiction, Author Interviews, JAMA / 14.03.2018

MedicalResearch.com Interview with: Dr. Laura Dwyer-Lindgren PhD Assistant Professor at IHME Institute for Health Metrics and Evaluation  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study in the latest in a series of studies IHME has conducted on health and disease on the county level in the United States. We analyzed data provided by the National Center for Health Statistics, the U.S. Census Bureau, and other sources. Main findings include:
  • Nearly 550,000 deaths were attributed to drug use over the 35 years. Nationally, the age-standardized death date increased 238% between 1980 and 2000, and 112% between 2000 and 2014. The death rate from drug use disorders increased in every county, but some counties in Kentucky, West Virginia, Ohio, Indiana, and eastern Oklahoma has increases exceeding 5000%.
  • There were more than a quarter million deaths in the U.S. due to alcohol use; Western counties generally has higher levels than those in other parts of area of the nation, with especially high death rates in Wisconsin, North Dakota, South Dakota, Nebraska, Montana, New Mexico, Arizona, Utah, and Alaska.
  • Neatly 1.3 million suicides were recorded, with especially high rates in Alaska, Nevada, South Dakota, Utah, New Mexico, Arizona, Montana, North Dakota, Oregon, Wyoming and one county in Maryland. While the national death rate due to suicide decreased between 1980 and 2014, there was an increase in the death rate due to suicide in most counties.
  • More than three quarters of a million deaths by homicide occurred in the US between 1980 and 2015. Nationally, the age-standardized death rate due to homicide decreased by about 35% between 1980 and 2000, and by nearly 16% between 2000 and 2014. Counties with the largest decreases were found in Virginia, Florida, Texas, California and New York. 
(more…)
Author Interviews, Breast Cancer, JAMA, Schizophrenia / 13.03.2018

MedicalResearch.com Interview with: Chuanjun Zhuo, MD, PhD Department of Psychiatric Laboratory Department of Psychiatric Neuroimaging Faculty Tianjin Mental Health Center Tianjin, China  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: According to previous epidemiological studies, women with schizophrenia may be associated with significantly increased risk of breast cancer. However, the results of these studies were not always consistent. In view of the fact that medical care for patients with schizophrenia is becoming multidisciplinary, we aimed to evaluate the risk of breast cancer in women with schizophrenia via a meta-analysis of relevant cohort studies. We included twelve cohorts and adopted the recently proposed prediction interval to evaluate the heterogeneity among the included studies. We found that schizophrenia was associated with about 30% increased risk of breast cancer incidence in women. However, significant heterogeneity existed of the included studies, which indicates that more extensive researches into the potential mechanisms underlying the associations between schizophrenia and breast cancer risk are needed. (more…)
Author Interviews, Brain Injury, JAMA / 12.03.2018

MedicalResearch.com Interview with: Christopher Abeare, Ph.D. Associate Professor Clinical Neuropsychology Department of Psychology University of Windsor Windsor, Ontario MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In this study, we examined the prevalence of invalid performance on baseline neurocognitive testing in sport concussion. Baseline testing is a commonly employed practice in which the cognitive abilities of athletes are assessed pre-season. These baseline test results are then used as a point of comparison against which post-injury neurocognitive test results can be compared, thereby creating a more individualized approach to the assessment of neurocognitive functioning. However, there has been growing concern about the validity of baseline test results, meaning that there is concern over the degree to which the scores on these baseline tests actually reflect an athlete’s true cognitive ability. There are many reasons why their test scores might not reflect their actual ability, ranging from inattentiveness during testing and lack of appreciation of the importance of doing their best on testing to intentional underperformance (aka “sandbagging” or malingering). As a result of these concerns, 4 different validity measures have been developed. We compared these 4 validity measures, head to head, in a sample of 7897 athletes aged 10 to 21 years. We found that 56% of athletes failed at least 1 of these validity measures, suggesting that as many as 56% of  athletes have scores that may not reflect their true ability level. We then tested the hypothesis that age would be related to the proportion of athletes with invalid performance. Our findings supported this hypothesis in that nearly 84% of 10-year-olds failed at least one validity measure and 29% of 21-year-olds failed at least one.  (more…)
Author Interviews, JAMA, University of Michigan, Urinary Tract Infections / 12.03.2018

MedicalResearch.com Interview with: Keith S. Kaye, MD, MPH Professor of Medicine, Division of Infectious Diseases University of Michigan Medical School Ann Arbor MI  MedicalResearch.com: What is the background for this study? Response: Complicated complicated urinary tract infections (cUTI), including acute pyelonephritis, are a major cause of hospital admissions, and are associated with significant morbidity and mortality and can be difficult to treat. While the most common pathogen is Escherichia coli, the more problematic pathogens are multidrug-resistant (MDR) gram-negative organisms including other Enterobacteriaceae species. The prevalence of cUTI due to MDR gram-negative bacteria has risen. In some instances, MDR gram-negative bacteria isolated from the urinary tract can cause bacteremia. Vabomere was approved by the U.S. Food and Drug Administration (FDA) in August 2017 for the treatment of adult patients with cUTI, including pyelonephritis, caused by designated susceptible Enterobacteriaceae: Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae species complex.   Vabomere is a fixed-dose (2g/2g) combination product of a carbapenem and a β-lactamase inhibitor with potent in vitro activity against Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE), an important MDR organism associated with serious infections. The Targeting Antibiotic Non-susceptible Gram-negative Organisms (TANGO I) trial was the pivotal Phase 3 study that compared the efficacy and safety of Vabomere to piperacillin-tazobactam in the treatment of patients with cUTI and acute pyelonephritis. (more…)