Author Interviews, JAMA, Smoking, Tobacco / 13.08.2016 Interview with: Anna Pulakka PhD, Postdoctoral Researcher Department of Public Health University of Turku, Finland What is the background for this study? Response: Smoking is the one of the leading health risks globally. Finland, among some other countries, has set a target for a tobacco-free society by 2040. However, with the current rate of decline in smoking prevalence, the target will not be met. It is therefore important to explore new avenues for helping people to quit smoking. Recently, researchers have become more interested in availability of tobacco as one determinant for smoking habit. We have learned from cross-sectional studies that people who live in neighborhoods with many stores that sell tobacco, smoke more than those who have less tobacco stores in their neighborhood. What has been lacking is more robust evidence from longitudinal studies on the association between availability of tobacco in neighborhoods and smoking behaviours. We sought to determine whether change in the location of tobacco stores nearby people’s place of residence was associated with the odds of quitting smoking or smoking relapse in a longitudinal setting. (more…)
Author Interviews, JAMA, Obstructive Sleep Apnea, Pulmonary Disease, Sleep Disorders / 11.08.2016 Interview with: Ken Kunisaki, MD, MS Associate Professor of Medicine Minneapolis Veterans Affairs Health Care System and University of Minnesota and Roxanne Prichard, PhD Associate Professor of Psychology and Neuroscience University of St. Thomas What is the background for this study? What are the main findings? Response: CPAP devices, or continuous positive airway pressure devices, are used to treat obstructive sleep apnea, a common condition that causes people to intermittently stop breathing during their sleep. This leads to poor sleep quality and often results in symptoms like excessive sleepiness in the daytime. In the United States, CPAP devices are classified by the Food and Drug Administration as Class II medical devices with possible risks; their sale requires a medical prescription. We were aware of online advertisements for secondhand, used CPAP machines, but we have not seen publications that have analyzed this practice. Once a week, our research team monitored online advertisements for secondhand CPAP devices on in 18 U.S. cities and areas over a one-month period. During that time, we found 270 advertisements, most of which did not describe who previously had used the device or why it was being sold. Only 5 of the advertisements mentioned anything about the legal requirements of a prescription and 61 percent of the devices included a used mask without information about its age or how it was cleaned. CPAP devices create air pressure and attach to a nose or face mask that delivers that pressure to a patient’s airway, thereby keeping him or her breathing during sleep. The amount of air pressure delivered by the devices is adjusted for each patient and usually is determined by a medical exam that includes an overnight stay in a laboratory. Our study found that most of the Craigslist advertisements failed to mention the devices’ pressure settings—settings that were prescribed for the original owners. The average price for a CPAP device listed on Craigslist was $291, much less than the $600 to $2,000 cost of a new device. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, Mental Health Research / 11.08.2016 Interview with: Helene Lund-Sørensen BM Department of Biomedical Sciences Section of Cellular and Metabolic Research University of Copenhagen What is the background for this study? What are the main findings? Response: Accumulating research has shown that inflammation and infections are associated with psychiatric diagnoses and interactions between infectious agents, known to affect the brain, and suicidal behavior have been reported. We find an increased risk of death by suicide among individuals hospitalized with infections. The risk of suicide increased in a dose-response relationship with the number of hospitalizations with infections and with the number of days hospitalized with infections. We also examined the risk of suicide association with the time since the last hospitalization with infection and found that infection was linked to an elevated risk with the strongest effect after 1 and 2 years compared with those without infections. (more…)
Author Interviews, Genetic Research, JAMA, Melanoma / 11.08.2016 Interview with: Ulrich Pfeffer, PhD Laboratory of Molecular Pathology Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino–IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy What is the background for this study? What are the main findings? Response: The melanoma of the eye or uveal melanoma is well controlled by radiotherapy or surgery but very aggressively growing metastases often develop and therapy has only marginally improved in decades. On the other hand, uveal melanoma is probably the best studied cancer in absolute: we know its development in great detail and we can make very precise prognosis. An important piece of information that is lacking is the effect of a chromosomal alteration, amplification of a part of chromosome 6, that is often encountered in a subset of uveal melanomas that show features of bad prognosis but actually perform better. Many have guessed that the immune system or more generally, inflammation might protect uveal melanomas with this alteration from progression to metastasis. Therefore we have set out to analyze a candidate gene, the putative immunomodulatory BTNL2, that is located on chromosome 6. We found highly variable expression of this gene in uveal melanoma samples where it is expressed by tumor cells and by infiltrating immune cells. The type of infiltrate is strongly associated with the risk to develop metastases. We also analyzed genetic variants of BTNL2 in 209 patients but we could not find a significant association with uveal melanoma risk. (more…)
Author Interviews, JAMA, Lipids, Pediatrics / 10.08.2016 Interview with: Paula Lozano, MD MPH Associate Medical Director, Research and Translation Group Health Physicians Senior Investigator Group Health Research Institute Metropolitan Park East Seattle, WA 98101 What is the background for this study? Response: This wasn’t a study, but rather a study of studies, to support the US Preventive Services Task Force in updating its previous recommendation of I: insufficient to assess the balance of benefits and harms. We conducted two systematic evidence reviews of screening children and adolescents: 1. for familial hypercholesterolemia (FH, a genetic disorder that interferes with the body’s ability to metabolize cholesterol and can result in early coronary heart disease); and 2. for multifactorial dyslipidemia—which we defined as elevated LDL cholesterol or total cholesterol, not caused by familial hypercholesterolemia. LDL and total cholesterol were of interest because they are considered atherogenic. One of the challenges of lipid screening in youth is that blood levels of these atherogenic lipids are known to fluctuate during the course of childhood and adolescence. It’s sort of a W-shaped curve, with a peak at age 9-11 years. So for a given child, the definition of what’s an elevated LDL or total cholesterol level will change with age. Also, two-thirds of kids identified as having high cholesterol through universal screening would not go on to have high cholesterol as adults. (more…)
Author Interviews, Diabetes, JAMA, Kidney Disease / 10.08.2016 Interview with: Ian de Boer, MD, MS Associate Professor of Medicine Adjunct Associate Professor of Epidemiology Division of Nephrology and Kidney Research Institute University of Washington, Seattle, WA What is the background for this study? What are the main findings? Response: From the perspective of patients with diabetes, kidney disease can be a devastating complication, leading to end stage renal disease requiring dialysis or kidney transplantation and markedly increasing the risks heart disease, stroke, peripheral vascular disease, and amputation. From a public health perspective, diabetes is the most common cause of end stage renal disease in the US, so understanding, preventing, and treating diabetic kidney disease is critical to reduce the numbers of people needing dialysis and kidney transplants. There have been major changes in the treatment of patients with diabetes over the last 30 years, so we were interested in evaluating how diabetic kidney disease was changing in this context. We observed that the clinical manifestations of kidney disease have indeed changed among US adults with diabetes over the last 30 years. Albuminuria, or elevated levels of albumin in the urine, has traditionally been thought of as the first evidence of kidney damage for people with diabetes. Reduced GFR, or a reduced ability of the kidneys to filter out waster products, has typically been thought of as a late stage of diabetic kidney disease. But from 1988 to 2014, we saw a significant decrease in the prevalence of albuminuria accompanied by a significant increase in reduced GFR. (more…)
Author Interviews, JAMA, Opiods, Toxin Research / 10.08.2016 Interview with: Ann M. Arens, MD California Poison Control Center San Francisco, CA 94110 What is the background for this study? What are the main findings? Response: Prescription opioid abuse is a significant public health threat that has garnered the attention of health care providers throughout medicine. With efforts to curb the number of prescriptions for opioid pain medications, users may begin to purchase prescription medications from illegal sources. Our study reports a series of patients in the San Francisco Bay Area who were exposed to counterfeit alprazolam (Xanax®) tablets found to contain large amounts of fentanyl, an opioid 100 times more potent than morphine, and in some cases etizolam, a benzodiazepine. The California Poison Control System – San Francisco division identified eight patients with unexpected serious health effects after exposure to the tablets including respiratory depression requiring mechanical ventilation, pulmonary edema, cardiac arrest, and one fatality. Patients reportedly purchased the tablets from drug dealers, and were unaware of their true contents. In one case, a 7 month-old infant accidentally ingested a counterfeit tablet dropped on the floor by a family member. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 08.08.2016 Interview with: Benjamin D. Sommers, M.D., Ph.D Assistant Professor of Health Policy & Economics Department of Health Policy & Management Harvard T.H. Chan School of Public Health Assistant Professor of Medicine Division of General Medicine & Primary Care Brigham & Women’s Hospital / Harvard Medical School What is the background for this study? What are the main findings? Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches - vs. not expanding at all - in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident - the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015). (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 08.08.2016 Interview with: Dong W. Chang, MD, MS Dong W. Chang, MD, is a lead researcher at LA BioMed, one of the nation’s leading independent nonprofit research institutes. His research interests include improving the delivery of care to patients with a focus on identifying new healthcare models for reducing hospital re-admission. He also is the director of Medical-Respiratory ICU at Harbor-UCLA Medical Center in Torrance What is the background for this study? What are the main findings? Response: With the use of intensive care units (ICUs) on the rise in many hospitals, researchers at LA BioMed and UCLA examined ICU usage. They found patients who were admitted to these units underwent more costly and invasive procedures but didn’t have better mortality rates than hospitalized patients with the same medical conditions who weren’t admitted to the ICU. The study, published in JAMA Internal Medicine, examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary:diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure. The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions. Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied that did larger hospitals. The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU. (more…)
Author Interviews, Emory, Heart Disease, JAMA / 06.08.2016 Interview with: Dr. Amit J. Shah MD MSCR Research Assistant Professor Assistant Professor of Epidemiology Rollins School of Public Health Emory University Adjunct appointment in Medicine (Cardiology) Atlanta VA Medical Center What is the background for this study? What are the main findings? Response: Nearly ½ of sudden cardiac deaths occur in individuals who were not aware that they had heart disease; this increases the need for primary prevention. We studied whether the electrocardiogram could be a useful tool in helping to measure risk of cardiovascular disease in approximately 10,000 community-based adults aged 40-74 with a simple risk equation that is based on age, sex, and 3 numbers from the ECG: heart rate, T-axis, and QT interval. We found that such an equation estimates risk as well as the Framingham risk equation, which is the standard of care (based on traditional risk factors like smoking and diabetes). When combining both the Framingham and ECG risk assessments together, the accuracy improved significantly, with a net 25% improvement in the risk classification of cardiovascular death compared to using the Framingham equation alone. (more…)
Author Interviews, JAMA, Lifestyle & Health, Ophthalmology / 05.08.2016 Interview with: Paul Dinneen Loprinzi, PhD Health, Exercise Science and Recreation Management University of Mississippi What is the background for this study? What are the main findings? Response: Previous research demonstrates that adults who have higher daily sedentary behavior tend to have worse cardiometabolic health profiles. The extent to which sedentary behavior is associated with diabetic retinopathy has yet to be evaluated in the literature before our study. Our findings provided some suggestive evidence that more sedentary behavior was associated with a higher odds of having diabetic retinopathy. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Weight Research / 04.08.2016 Interview with: Prof. Peter Nordström PhD Department of Community Medicine and Rehabilitation Geriatrics, Umeå University Umeå, Sweden What is the background for this study? What are the main findings? Response: Numerous studies has shown an association between BMI, CVD and death. However, it is not known to what extent genetic factors influence this relationship. We used over 4000 monozygous twin pairs that had different BMI. This mean that the difference in BMI must be due to environmental factors since the genetic setup is similar in monozygous twins. Since the fatter twin did not have a higher risk of myocardial infarction (MI) or death, environmental factors that increase BMI is very unlikely to increase the risk of myocardial infarction or death. By inference the strong association between BMI, MI and death must be explained by the fact that the same genes control both obesity, MI and death. By contrast, the fatter twin had a higher risk of diabetes. (more…)
Author Interviews, Brigham & Women's - Harvard, Electronic Records, JAMA, Outcomes & Safety / 04.08.2016 Interview with: Stephanie Mueller, MD MPH FHM Division of General Medicine Brigham and Women's Hospital Boston, MA 02120 What is the background for this study?  Response: Failures in communication among healthcare personnel are known threats to patient safety, and occur all too commonly during times of care transition, such as when patient care responsibility is transferred from one provider to another (i.e., handoff). Such failures in communication put patients at risk for adverse outcomes. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Nutrition, Protein, Vegetarians / 02.08.2016 Interview with: Mingyang Song Sc.D, research fellow Clinical and Translational Epidemiology Unit and Division of Gastroenterology MGH and Department of Nutrition Harvard T.H. Chan School of Public Health What is the background for this study? What are the main findings? Response: Previous studies have been focused on the amount of protein intake, while little is known regarding the health effect of different food sources for protein intake. In this study, we found that high animal protein intake was associated with higher mortality, whereas high plant-based protein was associated with lower mortality. Replacement of animal protein with plant protein was associated with lower mortality. Overall, the findings support the importance of food sources for protein intake for long-term health outcomes. (more…)
Author Interviews, Brain Injury, JAMA, Pediatrics / 02.08.2016 Interview with: Danny G. Thomas, MD, MPH Department of Pediatrics, Emergency Medicine Children’s Hospital of Wisconsin Corporate Center Milwaukee, WI What is the background for this study? What are the main findings? Response: This was a secondary analysis of a randomized controlled trial of strict rest after concussion published last year. We wanted to find out how mental and physical activity levels related to symptom spikes or sudden increases in concussion symptoms. We found that one in three patients had symptoms spikes in recovery. Patients who had symptom spikes tended to have higher symptoms in the emergency department and throughout recovery. Most symptom spikes were not associated with an increase in physical and mental activity level the day prior. We did find that a sudden increase in activity like returning to school did increase the risk of having a symptom spike, but the good news is these symptom spikes seemed to resolve the following day and did not impact recovery by 10 days. (more…)
Author Interviews, Gastrointestinal Disease, Genetic Research, JAMA / 29.07.2016 Interview with: Amitabh Chak, MD University Hospitals Case Medical Ctr Cleveland, OH, 44106 What is the background for this study? What are the main findings? Response: About 20 years ago we discovered that Barrett's esophagus and esophageal cancer aggregate in a small proportion of families suggesting there might be a genetic basis to these complex diseases. As we started looking at these families, we identified a rare family with multiple members who had Barrett's esophagus and multiple members who had passed away from esophageal cancer at a young age. Advances in exome sequencing have now allowed us to identify a mutation in a gene whose function is not known that predisposes this family to develop Barrett's esophagus. Functional studies suggest that this gene, VSIG10L, is involved in maturation of normal squamous esophagus. (more…)
Author Interviews, JAMA, Melanoma / 29.07.2016 Interview with: Dr. Michael Pignone MD MPH Task Force member Professor of medicine and Inaugural Chair Department of Internal Medicine Dell Medical School The University of Texas at Austin. Editor’s note: Dr. Pignone discusses the recent US Preventive Services Task Force Recommendation Statement on the effectiveness of screening for skin cancer with a clinical visual skin examination What is the background for this recommendation? How Does the USPSTF Grade Preventive Services? Response: The Task Force’s primary concern is the health of Americans, and all of our recommendations are based on an assessment of the evidence of both the benefits and harms of a particular preventive service. For this recommendation statement, we looked at all available evidence on a visual skin exam, including studies of exams conducted by both primary care clinicians and dermatologists, to see how effective this exam was at preventing death from skin cancer. Unfortunately, there is not enough evidence to know with certainty whether or not a visual skin exam leads to a reduction in death from skin cancer, which resulted in the Task Force issuing an I statement. The Task Force encourages more research that could provide future evidence on the effectiveness of visual screening to prevent death from skin cancer. (more…)
Author Interviews, Breast Cancer, JAMA, Technology / 29.07.2016 Interview with: Lauren P. Wallner, PhD, MPH Assistant Professor, Departments of Medicine and Epidemiology University of Michigan Ann Arbor, MI What is the background for this study? What are the main findings? Response: Online communication tools like email and social media could be used to support patients through their cancer treatment decision making and ongoing care. Yet, we know very little about whether and how newly diagnosed cancer patients use these tools and whether using online communication influences patients appraisals of their treatment decision making process. We surveyed 2,460 women with newly diagnosed breast cancer as part of the iCanCare Study about their use of email, texting, social media and web-based support groups following their diagnosis. Our findings suggest that women who more often used these online communication tools deliberated more about their surgical treatment and were more satisfied with their treatment decision. However, the use of social media in this diverse population was lower than we expected (12%), and was less common in older women, those with less education, and Black and Latina women. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA, Surgical Research / 28.07.2016 Interview with: Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati What is the background for this study? What are the main findings? Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance. In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either 1) reducing their mortality, 2) reducing their patients’ comorbidities and complications, or 3) sending their patients to non-safety-net hospitals for their surgery. While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy. (more…)
Author Interviews, JAMA, Schizophrenia / 26.07.2016 Interview with: Professor Jayashri Kulkarni MBBS, MPM, FRANZCP, PhD Director, Monash Alfred Psychiatry research centre Vic Australia What is the background for this study? What are the main findings? Response: Schizophrenia is a complex psychiatric disorder and many patients are not able to achieve remission on the available treatments. There are clear sex differences in many aspects of the illness, which not only implicates a role for the sex hormone estrogen in schizophrenia, but also highlights the need for sex-specific treatments. Our group has conducted many clinical trials using adjunctive estradiol treatment, with excellent improvement in psychotic symptoms- however, there can be physical side effects with longer term estradiol use. Raloxifene and other selective estrogen receptor modulators ( SERMs) - the so-called "brain estrogens", with their more specific brain impacts and less body side effects - provide an option to use longer term estrogen in people with refractory schizophrenia. We conducted the first ever pilot study of raloxifene in 2010, and now present findings from a bigger study of adjunctive raloxifene treatment in schizophrenia. (more…)
Author Interviews, Genetic Research, JAMA, Pediatrics, Surgical Research / 26.07.2016 Interview with: Dr. Katherine Nelson MD Staff Paediatrician with the Paediatric Advanced Care Team at SickKids and PhD student University of Toronto What is the background for this study? Response: Trisomy 13 and 18 are rare genetic conditions that cause problems in multiple organ systems, including heart defects and severe neurologic impairment.  A majority of children with trisomy 13 and 18 die in the first days to weeks after birth, though a small number survive beyond one year.  For years, health care providers have debated the effectiveness and ethics of surgical interventions in these populations. (more…)
Author Interviews, Cannabis, JAMA, Pediatrics / 25.07.2016 Interview with: George Sam Wang MD FAAP Assistant Professor of Pediatrics Section of Emergency Medicine, Medical Toxicology Department of Pediatrics University of Colorado Anschutz Medical Campus Children's Hospital Colorado What is the background for this study? Response: Many states have allowed medical and now recreational marijuana. The impact on pediatric population has not been fully described. What are the main findings? Response: Unintentional exposures presenting to our children's hospital and calls to our regional poison center significantly increased after our state allowed recreational marijuana. What should readers take away from your report? Response: Exposures in children are increasing in our state that allows medical and recreational Marijuana, many were edible products. Marijuana products should be treated like medications and household products in home and properly and safely stored. States looking to legalize marijuana need to consider safety rules and regulations during rule making processes. (more…)
Author Interviews, Health Care Systems, JAMA, Stroke / 25.07.2016 Interview with: Kimon Bekelis, MD Chief Resident Department of Neurosurgery Dartmouth-Hitchcock School of Medicine What is the background for this study? Response: Physicians often must decide whether to treat acute stroke patients locally, or refer them to a more distant Primary Stroke Center (PSC). There is little evidence on how much the increased risk of prolonged travel time offsets benefits of specialized  Primary Stroke Center care. (more…)
Author Interviews, Cost of Health Care, JAMA / 25.07.2016 Interview with: James C. Robinson PhD Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Division Head, Health Policy and Management University of California School of Public Health Berkeley, CA What is the background for this study? Response: To moderate the increase in insurance premiums, employers are increasing consumer cost sharing requirements. Under reference pricing, the employer establishes a limit to what it will contribute towards each service or product, typically set at the 60th percentile or other midpoint in the distribution of prices in the market. If the patient selects a facility charging less than or equal to this contribution, he/she receives full coverage, but if a more expensive facility is chosen, the patient must pay the full difference. (more…)
Author Interviews, JAMA, Johns Hopkins, Race/Ethnic Diversity, Stroke / 25.07.2016 Interview with: Romanus Roland Faigle, M.D., Ph.D. Assistant Professor of Neurology The Johns Hopkins Hospital What is the background for this study? Response: Stroke care entails a variety of procedures and interventions, which generally fall into one of the two following categories: 1) curative/preventative procedures (such as IV thrombolysis and carotid revascularization), which intent to prevent injury and restore function; and 2) life-sustaining procedures (such as gastrostomy, mechanical ventilation, tracheostomy, and hemicraniectomy), which intent to address complications from a stroke and to prevent death. The use of curative/preventative procedures is supported by excellent evidence and is guided by well-defined criteria, while those are largely lacking for life-sustaining procedures. Therefore, curative/preventative are desirable for eligible patients, while life-sustaining procedures indicate the need to address undesired complications and in itself have questionable utility. We wanted to determine whether race differences in the use of the individual stroke-related procedures exist, and whether presence and directionality of differences by race follow a pattern unique to each of the 2 procedure groups. (more…)
Author Interviews, Infections, JAMA / 25.07.2016 Interview with: Dr. Ane Uranga MD Department of Pneumology, Galdakao-Usansolo Hospital Galdakao, Bizkaia, Spain What is the background for this study? What are the main findings? Response: Despite clear benefits of shorter antibiotic treatments, reducing the duration of treatment remains challenging in daily clinical practice. Actually, IDSA/ATS recommendations for Community Acquired Pneumonia (CAP) suggested a minimum of 5 days of treatment based on clinical stability criteria. However, in our study the median of duration of antibiotic treatment in the control group was as high as 10 days. The main finding is that receiving 5 days antibiotic treatment in hospitalized patients suffering from CAP is not inferior to arbitrary treatment schedules in terms of clinical success. (more…)
Author Interviews, Dermatology, JAMA / 22.07.2016 Interview with: G. Thomas (Tom) Ray Division of Research, Kaiser Permanente 2000 Broadway Oakland, CA 94612-2304 What is the background for this study? Response: Basal cell carcinoma (BCC) is the most common cancer in the United States. BCCs tend to develop on sun-exposed areas such as the head and neck and are typically treated with various surgical techniques in an outpatient setting. Although BCCs are rarely fatal, they have been estimated to be among the most costly cancers in the Medicare population due to their high incidence. Yet because these cancers are not tracked by national registries the way, for example, melanoma is, basal cell carcinomas have been difficult to study. Incidence rates in the past have tended to rely on surveys such as those by the National Cancer Institute. And studies using disease codes have, until recently, been difficult because the codes used for basal cell carcinoma and squamous cell carcinoma were the same. Since 1997, Kaiser Permanente Northern California (KPNC) has had computerized pathology results that allowed us to develop an internal registry of BCC cancers. In addition to having detailed information about basal cell cancer patients, we also had detailed information on the underlying population - KPNC members – which allowed us to determine incidence rates of BCC by age, sex, and most importantly for this study, by geographic location. This is because we know the residential location of all KPNC members at any given time – both those that get basal cell cancer and those who do not. This combination of a validated BCC registry with a well-defined population at-risk gave us the unique ability to investigate the spatial distribution of BCC in Northern California and assess whether there existed geographic clustering of basal cell cancers. Although the investigation of spatial clustering of other cancers is fairly common, no such analyses have been performed for basal cell cancer in the United States. (more…)
Author Interviews, Environmental Risks, Hearing Loss, JAMA, Occupational Health / 22.07.2016 Interview with: Harrison W. Lin, M.D. Assistant Professor Department of Otolaryngology-Head & Neck Surgery UC Irvine Medical Center Orange, CA 92868 What is the background for this study? What are the main findings? Response: We reviewed the data from the Integrated Health Interview Series, which is a project funded by the National Institutes of Health to supplement the National Health Interview Survey (NHIS), a household-based, personal interview survey administered by the US Census Bureau and Centers for Disease Control and Prevention since 1957. The NHIS serves as the largest source of health information in the civilian population of the United States. Analyzing the available data on tinnitus symptoms from this survey, we found that approximately 1 in 10 Americans have chronic tinnitus. Moreover, durations of occupational and leisure time noise exposures correlated with rates of tinnitus – people who reported higher rates of loud noise exposures at work and recreationally more frequently reported chronic tinnitus. Finally, health care providers provided advice and treatment plans to patients with chronic tinnitus that were infrequently in line with the clinical practice guidelines published by the American Academy of Otolaryngology-Head & Neck Surgery Foundation. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA / 21.07.2016 Interview with: Dr Fiona Bragg Clinical Research Fellow Clinical Trial Service Unit and Epidemiological Studies Unit Nuffield Department of Population Health University of Oxford What is the background for this study? Response: Diabetes is known to be a risk factor for cardiovascular disease. It is less clear, however, whether higher blood glucose levels in individuals without diabetes are also associated with higher risk for cardiovascular diseases. It is important to examine this association because it may help us to understand the mechanisms underlying these diseases as well as appropriate approaches to preventing them. We therefore looked at this association in the China Kadoorie Biobank study of 0.5 million Chinese adults, examining the relationship between blood glucose levels and the subsequent risk for cardiovascular diseases among participants with no history of diabetes at the time of recruitment to the study. (more…)
Author Interviews, JAMA, Surgical Research / 21.07.2016 Interview with: Dr. David A. Hyman, MD Division of Otolaryngology–Head and Neck Surgery Department of Surgery University of Wisconsin School of Medicine and Public Health Madison What is the background for this study? What are the main findings? Response: Motor vehicle collisions represent a significant source of facial fractures seen at US trauma centers. In the last few decades there have been significant advances in airbag technology as well as a national legislative push regarding seat belt use which has led to increased safety device use. With these trends, we sought to assess the incidence of facial fractures in patients who present to US trauma centers as well as to analyze what effect restraint devices have on the likelihood of facial fractures after motor vehicle collisions. This analysis was performed using National Trauma Data Bank data from 2007-2012. We found the incidence of at least one facial fracture after a motor vehicle collision was 10.9% with nasal fracture being the most common facial fracture. Based on our analysis of more than 56 thousand patients with a facial fracture, we found that use of an airbag alone reduced the likelihood of a facial fracture by 18% while use of a seat belt alone reduced likelihood by 43%. Use of both reduced the likelihood of facial fractures in a crash by 53%. Younger age, male sex, and use of alcohol increased the likelihood of facial fracture. (more…)