Author Interviews, Depression, JAMA, Mental Health Research / 27.05.2016
Recent Mental Health Problems Increase Risk of Suicide in Enlisted Soldiers
MedicalResearch.com Interview with:
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Dr. Robert Ursano[/caption]
Robert J. Ursano, M.D.
Professor and Chair
Department of Psychiatry/ Director
Center for the Study of Traumatic Stress
Uniformed Services University of the Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Ursano: This study is part of STARRS-LS (Study to address risk and resilience in service members-longitudinal study). STARRS is a group of studies that address suicide risk in the US Army. Suicidal behavior includes suicide ideation, plans, attempts and completions. Understanding the transitions between these is an important goal.
One component of STARRS is the examination of data available on all soldiers who were in the Army 2004-2009. This study examines suicide attempts in soldiers serving 2004-2009 in order to understand the association with deployment and the timing of suicide attempts as well as their association with mental health problems. STARRS is directed to identifying the who, when and where of service member risk. Then interventions can better be developed for these soldiers.
Dr. Robert Ursano[/caption]
Robert J. Ursano, M.D.
Professor and Chair
Department of Psychiatry/ Director
Center for the Study of Traumatic Stress
Uniformed Services University of the Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Ursano: This study is part of STARRS-LS (Study to address risk and resilience in service members-longitudinal study). STARRS is a group of studies that address suicide risk in the US Army. Suicidal behavior includes suicide ideation, plans, attempts and completions. Understanding the transitions between these is an important goal.
One component of STARRS is the examination of data available on all soldiers who were in the Army 2004-2009. This study examines suicide attempts in soldiers serving 2004-2009 in order to understand the association with deployment and the timing of suicide attempts as well as their association with mental health problems. STARRS is directed to identifying the who, when and where of service member risk. Then interventions can better be developed for these soldiers.
Nana Keum[/caption]
NaNa Keum, ScD|
Harvard T. H. Chan
School of Public Health Department of Nutrition
Departments of Nutrition and Epidemiology,
Harvard T.H. Chan School of Public Health
Boston, MA 02115
MedicalResearch.com: What is the background for this study?
Response: While general health benefits of physical activity are well-known, evidence on its specific benefits on cancer endpoints is limited and physical activity guidelines for cancer prevention lack details in terms of the optimal dose, type and intensity of physical activity.
MedicalResearch.com: What are the main findings?
Response: We found that the optimal exercise regime to prevent overall digestive system cancers may be to accumulate 30 MET-hours/week of physical activity primarily through aerobic exercise and regardless of its intensity.
Dr. Jiang He[/caption]
Jiang He, M.D., Ph.D.
Joseph S. Copes Chair and Professor
Department of Epidemiology
School of Public Health and Tropical Medicine
Tulane University, New Orleans
MedicalResearch: What is the background for this study?
Dr. Jiang He: Chronic kidney disease is associated with increased risk of end-stage renal disease, cardiovascular disease, and all-cause mortality. A positive association between sodium intake and blood pressure is well established in observational studies and clinical trials. However, the association between sodium intake and clinical cardiovascular disease remains less clear. Positive monotonic, J-shaped, and U-shaped associations have been reported. Methodologic limitations, including inconsistencies in dietary sodium measurement methods, could be contributing to these conflicting findings. Furthermore, no previous studies have examined the association between sodium intake and incident cardiovascular disease among patients with chronic kidney disease.
Dr. James Kirkpatrick[/caption]
James N. Kirkpatrick, MD
Director of the Echocardiography Laboratory
Division of Cardiology
Ethics Consultation Service
University of Washington, Seattle
MedicalResearch.com: What is the background for this study?
Dr. Kirkpatrick: With significant advances in technology, implanted cardiac devices like pacemakers and defibrillators, replacement heart valves, and mechanical pumps which assist or replace the pumping function of the heart have become standard therapies for patients with severe cardiac disease. Many patients who would previously have died after living with severe symptoms live longer and with improved quality of life. This is particularly true for elderly patients who receive transcatheter aortic valve replacement (TAVR—valve replacement that doesn’t require open heart surgery) and ventricular assist device (VAD—a durable mechanical heart pump) implantation.
However, like everyone, these patients will die, and some of the patients will experience device complications which will shorten their lives. Elderly patients, in particular, are at risk for device complications, high symptom burden, and loss of the ability to make healthcare decisions, due to illnesses like strokes or dementia. Symptom management and advance care planning are the hallmarks of the medical specialty of Palliative Care and are particularly important in patients with TAVR and VADs, yet patients and clinicians don’t often think of Palliative Care when considering high tech, life-prolonging therapies. The Palliative Care Working Group of the American College of Cardiology’s Geriatrics Section therefore sought to gather data on the attitudes toward Palliative Care among cardiovascular clinicians and the current state of involvement of Palliative Care in the care of patients with TAVR and VAD.
Prof. Luis. Rohde[/caption]
Luis Augusto Rohde MD, PhD
Full Professor
Department of Psychiatry
Federal University of Rio Grande do Sul
Director
ADHD Program
Hospital de Clínicas de Porto Alegre
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The idea that Attention-deficit/Hyperactivity Disorder always begins in childhood has been held for decades even without proper testing. The main manuals of psychiatric diagnoses require age at onset in childhood as a core feature of the disorder. In a large birth cohort followed until age 18, we identified many young adults presenting with a full impairing ADHD syndrome. They had consistently worse outcomes - criminality, substance abuse, traffic accidents, among others - than their counterparts without ADHD. However, most of these young adults (84.6%) presenting with a full impairing syndrome did not have a prior diagnosis in their childhood years. This surprising observation held after many secondary analyses exploring possible biases, like comorbidities in young adulthood, subthreshold ADHD in childhood and change of information source.
Dr. Steven Moore[/caption]
Steven C. Moore PhD, MPH
Division of Cancer Epidemiology and Genetics
Rockville, MD
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Moore: More than half of Americans fail to meet recommended levels of regular physical activity; physical inactivity has become a major public health concern.
Physical activity during leisure time is known to reduce risks of heart-disease and all-cause mortality, as well as risks of colon, breast, and endometrial cancers. However, less is known about whether physical activity reduces risk of other cancers.
Hundreds of prospective studies have examined associations between physical activity and risk of different cancers. Due to small case numbers, results have been inconclusive for most cancer types.
In this study, we examined how leisure-time physical activity relates to risk of 26 different cancer types in a pooled analysis of 12 prospective cohort studies with 1.44 million participants. Our objectives were to identify cancers associated with leisure-time physical activity, and determine whether associations varied by body size and/or smoking history.
Dr. Saroj Saigal[/caption]
Saroj Saigal, MD, FRCP(C)
Department of Pediatrics
McMaster University
Hamilton, Ontario Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Saigal: We started to follow infants who were born between 1977-82 and weighed less than 1000g or 2.2 pounds (extremely low birthweight, ELBW) because not much was known about the outcomes of these infants at the time.We have reported the findings at several ages, from infancy to adulthood, in comparison with normal birth weight (NBW) infants . In this report, 100 ELBW participants between 29-36 years of age were compared with 89 NBW participants. To our knowledge, this is the first longitudinal study that has followed infants from birth into their 30s.
Dr. Susan McCurry[/caption]
Dr. Susan McCurry
Principal Investigator
Clinical psychologist and research professor
School of Nursing
University of Washington
MedicalResearch.com: What is the background for this study?
Dr. McCurry: Every woman goes through menopause. Most women experience nighttime hot flashes/sweats and problems sleeping at some point during the menopause transition. Poor sleep leads to daytime fatigue, negative mood, and reduced daytime productivity. When sleep problems become chronic – as they often do – there are also a host of negative physical consequences including increased risk for weight gain, diabetes, and cardiovascular disease. Many women do not want to use sleeping medications or hormonal therapies to treat their sleep problems because of concerns about side effect risks. For these reasons, having effective non-pharmacological options to offer them is important.
Dr. Yvan Devaux[/caption]
Yvan Devaux, PhD
Associate Head of Laboratory
Cardiovascular Research Unit
Department of Population Health
Dr. Reshma Jagsi[/caption]
Reshma Jagsi, MD, DPhil
Department of Radiation Oncology, University of Michigan
Ann Arbor, MI 48109
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Jagsi: There has recently been considerable media attention to certain egregious individual cases of sexual harassment, but it has been less clear whether these cases were isolated and uncommon incidents or whether they are indicative of situations more commonly experienced by academic medical faculty. An excellent survey study had previously documented that 52% of female faculty in 1995 had experienced harassment, but many of those women had attended medical school when women were only a small minority of the medical students (let alone faculty). More recent estimates of faculty experiences are necessary to guide ongoing policies to promote gender equity in an era when nearly half of all medical students are women.
We found that in a modern sample of academic medical faculty, 30% of women and 4% of men had experienced harassment in their careers.
Dr. Hormuzd Katki[/caption]
Hormuzd A. Katki, PhD
Division of Cancer Epidemiology and Genetics
National Cancer Institute
National Institutes of Health Department of Health and Human Services,
Bethesda, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Katki: The National Lung Screening Trial (NLST) showed that 3 annual CT screens reduced lung cancer death by 20% in a subgroup of high-risk smokers. However, selecting smokers for screening based on their individual lung cancer risk might improve the effectiveness and efficiency of screening. We developed and validated new lung cancer risk tools, and used them to project the potential impact of different selection strategies for CT lung cancer screening.
We found that risk-based selection might substantially increase the number of prevented lung cancer deaths versus current subgroup-based guidelines. Risk-based screening might also improve the effectiveness of screening, as measured by reducing the number needed to screening to prevent 1 death. Risk-based screening might also improve the efficiency of screening, as measured by reducing the number of false-positive CT screens per prevented death.
Dr. Jack Resneck[/caption]
Jack Resneck, Jr, MD
Professor and Vice-Chair of Dermatology
Core Faculty, Philip R. Lee Institute for Health Policy Studies
UCSF School of Medicine
MedicalResearch.com: What is the background for this study?
What are the main findings?
Dr. Resneck: Telemedicine, when done right, can improve access and offer convenience to patients. We have seen proven high-quality care in telemedicine services where patients are using digital platforms to communicate with their existing doctors who know them, and where doctors are getting teleconsultations from other specialists about their patients. But our study shows major quality problems with the rapidly growing corporate direct-to-consumer services where patients send consults via the web or phone apps to clinicians they don’t know.
Most of these sites aren’t giving patients a choice of the clinician who will care for them or disclosing the credentials of those clinicians – patients should know whether their rash is being cared for by a board-certified dermatologist, a pain management specialist, or a nurse practitioner who usually works in an emergency department. Some of these sites are even using doctors who aren’t licensed in the US. We also found that these sites were regularly missing important diagnoses, and prescribing medications without discussing risks and side-effects, putting patients at risk. We observed that if you upload photos of a highly contagious syphilis rash but state that you think you have psoriasis, most clinicians working for these direct-to-consumer sites will just agree with your self-diagnosis and prescribe psoriasis medications, leaving you with a contagious STD.
Perhaps the biggest problem with many of these sites is the lack of coordinating care for patients – most of them didn’t offer to send records to a patient’s existing local doctors. And when patients end up needing in-person care if their condition worsens, or they have a medication side-effect, those distant clinicians often don’t have local contacts, and are unable to facilitate needed appointments.
Dr. Benjamin D. Sommers[/caption]
Benjamin D. Sommers, MD, PhD
Assistant Professor of Health Policy & Economics
Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital
Boston, MA 02115
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Molly E. Frean[/caption]
Molly E. Frean
Data Analyst
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
Boston, MA 02115
MedicalResearch.com: What is the background for this study?
Dr. Sommers: We conducted this study in an effort to see how Native Americans have fared under the Affordable Care Act. In addition to the law's expansion of coverage via Medicaid and tax credits for the health insurance marketplaces, the law also provided support for Native Americans’ health care specifically through continued funding of the Indian Health Service (IHS). We sought to see how both health insurance coverage patterns and IHS use changed in the first year of the law's implementation.
Dr. Tyler VanderWeele[/caption]
Dr. Tyler VanderWeele PhD
Professor of Epidemiology
Department of Epidemiology
Department of Biostatistics
Harvard T. H. Chan
School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. VanderWeele: There have been some prior studies on religious service attendance and mortality. Many of these have been criticized for poor methodology including the possibility of reverse causation – that only those who are healthy can attend services, so that attendance isn’t necessarily influencing health. We tried to address some of these criticisms with better methodology. We used repeated measures of attendance and health over time to address this, and a very large sample, and controlled for an extensive range of common causes of religious service attendance and health. This was arguably the strongest study on the topic to date and addressed many of the methodological critiques of prior literature. We found that compared with women who never attended religious services, women who attended more than once per week had 33% lower mortality risk during the study period. Those who attended weekly had 26% lower risk and those who attended less than once a week had 13% lower risk.
Dr. T. Dianne Langford[/caption]
Dr. T. Dianne Langford PhD
Associate Professor, Neuroscience and Neurovirology
Lewis Katz School of Medicine
Temple University
MedicalResearch.com: What is the background for this study?
Dr. Langford: The ocular-motor system has been shown to reflect neural damage, and one of ocular-motor functions, near point of convergence (NPC), was reported to worsen after a sport-related concussion (Mucha et al. Am J Sport Med). But the effects of subconcussive head impact, a milder form of head injury in the absence of outward symptoms remains unknown. Prior to this study, we found that in a controlled soccer heading experimental paradigm decreased NPC function, and even 24h after the headings, NPC was not normalized back to baseline (Kawata et al. 2016 Int J Sport Med). To extend our findings from the human laboratory study, we launched longitudinal clinical studies in collaboration with the Temple football team, to see if repetitive exposure to subconcussive head impacts negatively affects NPC.
Dr. Brian Boxer Wachler[/caption]
Dr. Brian Boxer Wachler MD
Boxer Wachler Vision Institute
Beverly Hills, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As an eye surgeon, I observed patients tended to have more age spots on the left side of their faces. I was examining a patient with Keratoconus and after I noted her age spots on her left cheeks, I began to look into this phenomenon. It turns out there are many studies that found more skin cancer on the left side of the face compared to the right side of the face. In Australia (where people drive on the left side of the road) it’s the opposite – more skin cancer on the right side of the face. Our study found that cars on average have significantly lower UVA (ultraviolet A) protection in the side windows compared to windshields which have universally high UVA protection. I believe this can be the missing link that can explain higher rates of skin cancer on the side of the face by the driver’s window. There are also more cataracts in left eyes vs right eyes. There was no relationship between high-end cars and low-end cars for side window UV protection – in other words many more pricey cars had just as poor side window UV protection as less expensive cars.
Dr. Erica Spatz[/caption]
Erica Spatz, MD, MHS
Assistant Professor, Section of Cardiovascular Medicine
Center for Outcomes Research and Evaluation
Yale University School of Medicine/Yale-New Haven Hospital
New Haven, CT 06520
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Spatz: Rates of heart attack have declined during the last 15 years. But whether communities of different economic status or in different geographic regions experienced similar declines is unknown, especially as efforts to prevent cardiovascular disease and manage heart attacks may not have been equally successful in communities with different resource capacity.
Our study shows that trends in the incidence of and mortality from heart attack were similar in low, average and high income communities. However, low-income communities had higher hospitalization rates than average and high income communities throughout the 15 year study period. Interestingly mortality rates were similar.
Dr. Yeh[/caption]
Dr. James Song-Jeng Yeh, MD
Brigham and Women's Hospital
Boston MA
MedicalResearch.com: What is the purpose for this study?
Dr. Yeh: A number of factors influence physicians’ prescribing behavior, including physician’s knowledge and understanding of the drugs. Pharmaceutical detailing and financial incentives may affect such behavior. My interest in evidence-based medicine and how medical knowledge is translated into practice lead me to think about how physicians’ financial relationships with the pharmaceutical industry may affect prescribing patterns.
In our study, we linked the Massachusetts physicians open payment database with the Medicare drug prescription claims database to determine if financial relationships with the industry are associated with increased brand-name statin drug prescribing. The open payment database reports payments that physicians receive from pharmaceutical and medical device industries. The open payment database when linked to the drug prescription claims database allowed us to answer this question.
We looked at year 2011, when two of the most commonly prescribed brand-name statin drugs (Lipitor and Crestor) were not yet available in generic formulation.
The outcome measured was what percentage of all statin prescription claims (both generic and brand-name) were brand-names.
Dr. Taylor-Phillips[/caption]
Dr Sian Taylor-Phillips PhD
Assistant Professor of Screening and Test Evaluation
Division of Health Sciences
Warwick Medical School
University of Warwick
Coventry
MedicalResearch.com: What is the background for this study?
Dr Taylor-Phillips : Psychologists have been investigating a phenomenon of a drop in performance with time on a task called ‘the vigilance decrement’ since World War 2. In those days radar operators searched for enemy aircraft and submarines (appearing as little dots of light on a radar screen). People thought that the ability to spot the dots might go down after too much time spent on the task. Many psychology experiments have found a vigilance decrement, but most of this research has not been in a real world setting.
In this research we wanted to know whether there was a drop in performance with time on a task for breast screening readers looking at breast x-rays for signs of cancer. (Breast x-rays or mammograms show lots of overlapping tissue and cancers can be quite difficult to spot). This was a real-world randomised controlled study in UK clinical practice.
In the UK NHS Breast Screening Programme two readers examine each woman’s breast x-rays separately for signs of cancer. They look at batches of around 35 women’s x-rays. At the moment both readers look at the x-rays in the same order as each another, so if they both experience a drop in performance, it will happen at the same time. We tested a really simple idea of reversing the batch order for one of the readers, so that if they have a low ebb of performance it happens when they are looking at different women’s breast x-rays.
Dr. Uscher-Pines[/caption]
Lori Uscher-Pines, PhD
RAND Corporation
Arlington, Virginia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although many communities in the U.S. are underserved by dermatologists, access is particularly limited among Medicaid patients. Teledermatology may be one solution to improve access. Our goal with this study was to assess the effect of a novel teledermatology initiative on access to dermatologists among enrollees in a Medicaid Managed Care Plan in California’s Central Valley.
Among all patients who visited a dermatologist after the introduction of teledermatology from 2012-2014 (n=8614), 49% received care via teledermatology. Among patients newly enrolled in Medicaid following Medicaid expansion in 2014, 76% of those who visited a dermatologist received care via teledermatology. Patients of primary care practices that engaged in teledermatology had a 64% increase in the fraction of patients visiting a dermatologist (vs. 21% in other practices) (p<.01). Compared with in-person dermatology, teledermatology served more patients under age 17, male patients, nonwhite patients, and patients without comorbid conditions. Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms.
Dr. Redlich[/caption]
Dipl.-Psych. R. Redlich
Neuroimaging Group
Klinik und Poliklinik für Psychiatrie und Psychotherapie
Westfaelische Wilhelms-Universitaet Muenster
MedicalResearch.com: What is the background for this study?
Response: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. The ability to advise psychiatrists and patients accurately regarding the chances of successful ECT is of considerable value, particularly since ECT is a demanding procedure and, despite having relatively few side effects, has a profound impact on patients. Therefore, the present study sought to predict ECT response in a psychiatric sample by using a combination of structural Magnetic Resonance Imaging data and machine-learning techniques.