Author Interviews, JAMA, Lipids / 16.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27017" align="alignleft" width="142"]Dr. David Grossman M.D., M.P.H. Vice chair of the U.S. Preventive Services Task Force and Professor at the University of Washington Schools of Public Health and Medicine Dr. David Grossman[/caption] Dr. David Grossman M.D., M.P.H. Vice chair of the U.S. Preventive Services Task Force and Professor at the University of Washington Schools of Public Health and Medicine MedicalResearch.com: What is the background for this recommendation? Response: The Task Force recognizes the importance of cardiovascular health for young people. Children and adolescents with high cholesterol are more likely to become adults with high cholesterol, and high cholesterol in adulthood can lead to serious health outcomes such as heart attacks and strokes. However, when the Task Force reviewed evidence for cholesterol screening in children and adolescents without any signs or symptoms, we found that there is not enough evidence to recommend for or against screening. In the face of unclear evidence, the Task Force is calling on the research community to prioritize studies on screening and treatment of lipid disorders in children and teens to help us all learn more about the impact that screening at an early age may have on the cardiovascular health of adults.
Author Interviews, Bone Density, Calcium, Mineral Metabolism, Nature / 16.08.2016

MedicalResearch.com Interview with: Dr. Constance Hilliard Department of History University of North Texas Denton, TX MedicalResearch.com: What is the background for this study? What are the main findings? Response: As an evolutionary historian, I have devoted the last several years to researching the health implications of genetic diversity. I was particularly concerned with the tendency of medical researchers to unwittingly use the biology of people with Northern European ancestry as a universal standard for everyone. For instance, lactose intolerance may be a disorder in that community, which suffers high rates of osteoporosis. But since 65% of the world’s population are lactose intolerant and have low rates of osteoporosis, a one-size-fits-all approach to bone health can prove dangerous for those whose ethnic-specific biological needs are overlooked. This study shows that osteoporosis is not a global problem. It has a strong and devastating impact in dairy-farming societies and is virtually non-existent in the tsetse zone of West Africa, where cattle rearing and dairying are not possible. Previous studies have tried to correlate the degenerative bone disease with socio-economic income. However, this study compares two regions of Africa with similar socio-economic conditions. In dairy-farming East Africa, the incidence of osteoporosis is 245 per 100,000. However in the tsetse belt of West Africa, where people do not consume dairy products, it is 3 per 100,000. When regression analyses are performed on 40 countries around the world, the association between dairy consumption and osteoporosis is high (0.851). It only correlates with national Gross National Product at a regression rate of 0.447.
Author Interviews, Cleveland Clinic, Genetic Research, Heart Disease, PLoS / 14.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26978" align="alignleft" width="120"]MedicalResearch.com Interview with: Qing Kenneth Wang PhD, MBA Huazhong University of Science and Technology Wuhan, P. R. China and Department of Molecular Cardiology The Cleveland Clinic Cleveland, Ohio Dr. Qing Kenneth Wang[/caption] Qing Kenneth Wang PhD, MBA Huazhong University of Science and Technology Wuhan, P. R. China and Department of Molecular Cardiology The Cleveland Clinic Cleveland, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Coronary Artery Disease (CAD) and its complication myocardial infarction (MI or so called heart attacks) are the most common causes of deaths in the US and other parts of the world. Based on the American Heart Association statistics, 620,000 Americans have a new MI each year in the United States alone, 295 000 have a recurrent MI, and nearly 400,000 of them will die from it suddenly. Moreover, an estimated 150,000 silent first MI occur each year. CAD and MI are caused by an occlusion or blockage of a coronary artery, which disrupts blood flow to the heart region, leading to damage or death of cardiac cells, impairment of cardiac function and sudden death. Current treatment of CAD and MI relies on reperfusion therapy with reopening of the occluded coronary artery with percutaneous coronary intervention (PCA) and coronary artery bypass surgery (CABG). However, 12% of patients are not candidates for PCA or CABG due to an unfavorable occlusive pattern, diffuse coronary atherosclerosis, small distant vessels and co-morbidities. An alternative revascularization strategy has to be developed to benefit these patients.
Author Interviews, JAMA, Smoking, Tobacco / 13.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26969" align="alignleft" width="200"]Anna Pulakka PhD, Postdoctoral Researcher Department of Public Health University of Turku, Finland Dr. Anna Pulakka[/caption] Anna Pulakka PhD, Postdoctoral Researcher Department of Public Health University of Turku, Finland MedicalResearch.com: 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.
Author Interviews, NEJM, Neurological Disorders, Surgical Research / 12.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26807" align="alignleft" width="133"]Photograph: Douglas Levere Dr. Gil Wolfe[/caption] Gil I. Wolfe, MD, FAAN Irvin and Rosemary Smith Professor and Chair Dept. of Neurology/Jacobs Neurological Institute Univ. at Buffalo Jacobs School of Medicine and Biomedical Sciences/SUNY Buffalo General Medical Center Buffalo, NY 14203-1126 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Thymectomy has been used in myasthenia gravis (MG), in particular those patients who do not have a tumor of the thymus gland, known as a thymoma, for over 75 years without randomized data to support its use. A practice parameter in 2000 on behalf of the American Academy of Neurology stated that the benefits of thymectomy in this population of non-thymomatou smyasthenia gravis patients remained uncertain, classified thymectomy as a treatment option in this group, and called for rigorous, randomized studies. What we found is that compared to an identical prednisone protocol alone, that extended transsternal thymectomy confers significant benefits to non-thymomatous MG patients over a period of three years after the procedure. The benefits include better disease status, reduced prednisone requirements, fewer hospitalizations to manage  myasthenia gravis worsenings, and a lower symptom profile related to side effects from medications used to control the disease state.
Author Interviews, Brain Cancer - Brain Tumors, Cancer, Cost of Health Care / 12.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26739" align="alignleft" width="180"]Wuyang Yang, M.D., M.S. Research Fellow Department of Neurosurgery Johns Hopkins Hospital Baltimore, MD 21287 Dr. Wuyang Yang[/caption] Wuyang Yang, M.D., M.S. Research Fellow Department of Neurosurgery Johns Hopkins Hospital Baltimore, MD 21287 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The treatment for glioblastoma (GBM) patients involves a combined approach of surgery, radiation therapy and chemotherapy. Despite advancement in the therapeutic approaches for GBM, differing socioeconomic status result in disparities in health-care access, and may superimpose a significant impact on survival of glioblastoma patients. Insurance status is an indirect indicator of overall socioeconomic status of a patient, and has been shown to correlate with survival of patients with malignant tumor in other parts of the body. We conducted the first study to determine a relationship between different types of insurance and survival of GBM patients. In our study of 13,665 cases of GBM patients, we found that non-Medicaid insured patients have a significant survival benefit over uninsured and even Medicaid insured patients. This is the first time a study describes this relationship in glioblastoma patients, and also the first to compare and quantify the likelihood of poor prognosis between different insurance categories. A difference in insurance coverage was also uncovered, and patients with insurance were more likely to be older, female, white, and married. In addition, we found that younger, female, married patients with smaller tumor size survive longer than other patients, which confirmed findings in existing literature.
Author Interviews, Clots - Coagulation, Diabetes, Heart Disease, JACC / 12.08.2016

MedicalResearch.com Interview with: Raffaele Piccolo, MD Department of Cardiology Bern University Hospital University of Bern Bern, Switzerland MedicalResearch.com: What is the background for this study? Response: Over the past two decades, the prevalence of diabetes mellitus has doubled in Western countries and future projections are even worse by showing a 55% increase by 2035 when approximately 592 million of people are expected to live with diabetes all over the world. Acute myocardial infarction still represents the most common diabetes-related complication and its occurrence is associated with a higher risk of mortality. Timely recanalization of the occluded coronary vessel with primary percutaneous coronary intervention (PCI) represents the therapy of choice for acute ST-segment elevation myocardial infarction (STEMI). Our study investigated whether the direct application of an intracoronary bolus of abciximab, which is an antiplatelet drug blocking the glycoprotein IIb/III a receptor, at the time of primary PCI improves the outcomes at 1-year follow-up compared with the standard intravenous route. The study was in individual patient-level pooled analysis of 3 randomized trials including 2,470 patients, of whom 473 (19%) had diabetes.
Author Interviews, Heart Disease, JACC, Stroke, Surgical Research / 12.08.2016

MedicalResearch.com Interview with: [caption id="attachment_21314" align="alignleft" width="120"]Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada Dr. Josep Rodés-Cabau[/caption] Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future. While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR.
Author Interviews, JAMA, Obstructive Sleep Apnea, Pulmonary Disease, Sleep Disorders / 11.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26802" align="alignleft" width="150"]Ken Kunisaki, MD, MS Associate Professor of Medicine Minneapolis Veterans Affairs Health Care System and University of Minnesota Dr. Kunisaki[/caption] Ken Kunisaki, MD, MS Associate Professor of Medicine Minneapolis Veterans Affairs Health Care System and University of Minnesota and [caption id="attachment_26803" align="alignleft" width="98"]Roxanne Prichard, PhD Associate Professor of Psychology and Neuroscience University of St. Thomas Dr. Prichard[/caption] Roxanne Prichard, PhD Associate Professor of Psychology and Neuroscience University of St. Thomas MedicalResearch.com: 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 Craigslist.org 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.
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, Mental Health Research / 11.08.2016

MedicalResearch.com Interview with: Helene Lund-Sørensen BM Department of Biomedical Sciences Section of Cellular and Metabolic Research University of Copenhagen MedicalResearch.com: 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.
Author Interviews, Genetic Research, JAMA, Melanoma / 11.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26912" align="alignleft" width="150"]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 Dr. Ulrich Pfeffer[/caption] 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 MedicalResearch.com: 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.
Aging, Author Interviews, BMJ, Geriatrics, Mental Health Research / 10.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26773" align="alignleft" width="180"]Dr. Faiza Tabassum, PhD University of Southampton, Southampton Dr. Faiza Tabassum[/caption] Dr. Faiza Tabassum, PhD Southampton Statistical Sciences Research Institute  University of Southampton Southampton, UK MedicalResearch.com: What is the background for this study? Response: Previous research has shown that volunteering in older age is associated with better mental and physical health, but it’s unclear whether this extends to other age groups. We aimed to examine the association of volunteering with mental health or well-being among the British population across all ages. The British Household Panel Survey (BHPS) was used which has collected information from 1991 to 2008 from over 5000 households. The published study has analysed over 66,000 responses representing the whole of the UK. The BHPS included a wide range of questions on leisure time activities, which covered the frequency of formal volunteering—from at least once a week through to once a year or less, or never. The BHPS also included a validated proxy for mental health/emotional wellbeing known as the GHQ-12.
Author Interviews, JAMA, Lipids, Pediatrics / 10.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26893" align="alignleft" width="142"]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 Dr. Paula Lozano[/caption] 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 MedicalResearch.com: 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.
Author Interviews, Diabetes, JAMA, Kidney Disease / 10.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26816" align="alignleft" width="133"]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 Dr. Ian de Boer[/caption] 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 MedicalResearch.com: 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.
Author Interviews, JAMA, Opiods, Toxin Research / 10.08.2016

MedicalResearch.com Interview with: Ann M. Arens, MD California Poison Control Center San Francisco, CA 94110 MedicalResearch.com: 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.
Author Interviews, BMJ, Psychological Science, Sexual Health / 10.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26876" align="alignleft" width="205"]Steven Arnocky, PhD Associate Professor Department of Psychology Nipissing University North Bay, ON CAN Dr. Steven Arnocky[/caption] Steven Arnocky, PhD Associate Professor Department of Psychology Nipissing University North Bay, ON CAN  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our work was based on previous findings from hunter-gatherer populations showing that men who hunt and share meat often enjoy greater reproductive access to women.  Research in North America has shown that individuals prefer altruistic partners, especially for long-term mating, and that there may be a sex difference in these preferences such that women exhibit this preference more strongly than men. In line with this, some research has shown that men will sometimes compete with other men in order to make charitable donations to attractive female fundraisers (termed 'competitive altruism'). Taken together, these findings led us to hypothesise that individuals (and perhaps particularly men) who behave altruistically might experience greater mating success. In Study 1, undergraduate men and women completed a self-report altruism questionnaire (items such as “I have donated blood”), a personality measure, and a sexual history survey. We found that participants who scored higher on a self-report altruism measure reported they were more desirable to the opposite sex, as well as reported having more sex partners, more casual sex partners, and having sex more often within relationships. Moreover, altruism mattered more for men’s number of lifetime and casual sex partners relative to women’s. Given the possibility that in any survey research, there is a chance individual’s may report their altruism of sexual history in what they view to be a more positive light (who doesn’t want to think of themselves as altruistic!), in Study 2, we used a behavioral measure of altruism (each participant was entered onto a draw for $100, and at the end of the survey was given the choice to keep their winnings or to donate to a charity). Participants again reported on their sexual histories, as well as completed a personality measure, a scale to capture socially-desirable responding, and a measure of narcissism. Results showed that even when controlling for these potentially confounding variables, that altruists reported having more lifetime sex partners, more casual sex partners, and more sex partners over the past year. Men who were willing to donate also reported having more lifetime dating partners.
Author Interviews, Endocrinology, JCEM, NIH, Vitamin D / 08.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26830" align="alignleft" width="100"]Quaker Harmon M.D., Ph.D. Epidemiology Branch National Institute of Environmental Health Sciences Research Triangle Park, NC 27709 Dr. Quaker Harmon[/caption] Quaker Harmon M.D., Ph.D. Epidemiology Branch National Institute of Environmental Health Sciences Research Triangle Park, NC 27709 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Vitamin D is important for bone health. In the United States many women are vitamin D deficient. Vitamin D does not naturally occur in many foods, however some foods are fortified with vitamin D. Supplements and sunshine are the most reliable sources of vitamin D. Previous studies suggested that women using birth control pills containing estrogen had higher levels of vitamin D. These studies were generally small and were not always able to examine important factors such as time spent outside. We were interested in examining the association between hormonal contraception and vitamin D levels in a larger group of women. We found that women who use estrogen-containing contraception had a 20% increase in their vitamin D levels. This increase was not due to time spent outside or behaviors related to choice of contraception. The magnitude of increase for hormonal contraception was smaller than for regular use of a supplement containing vitamin D.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 08.08.2016

MedicalResearch.com Interview with: [caption id="attachment_24380" align="alignleft" width="123"]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 Dr. Benjamin D. Sommers[/caption] 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 MedicalResearch.com: 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).
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 08.08.2016

MedicalResearch.com 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 MedicalResearch.com: 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.
Author Interviews, Exercise - Fitness, Hematology, NEJM, Stanford / 08.08.2016

MedicalResearch.com Interview with: D. Alan Nelson, MPAS, PhD Postdoctoral research fellow Stanford Medicine MedicalResearch.com: What is the background for this study? Response: The study was inspired by the uncertainty surrounding sickle cell trait (SCT) and its association with serious exertional collapse events and mortality in active populations. I conducted initial, exploratory analyses on these topics in 2014-15 while examining a range of military readiness predictors and outcomes. The early work indicated that the risk of mortality, rhabdomyolysis and other exertional events arising from SCT might be substantially lower than that suggested by prior work in the research literature. Dr. Lianne Kurina and I decided to conduct further, focused study at the Stanford University School of Medicine to confirm or refute these findings. In considering best approaches, we noted that there was an absence of prior research in which the  sickle cell trait status of an entire, large, physically-active study population was known. This limitation could introduce bias to inflate the apparent impact of a theorized predictive factor. Aside from the challenges in studying the impact of SCT on exertional outcomes, with respect to prevention, a further concern is that  sickle cell trait is a non-modifiable trait. If it were a serious risk factor for rhabdomyolysis and/or mortality, despite careful exertional injury precautions such as those employed by the Army, this might present great challenges for prevention efforts. To maximize the potential for new research to provide actionable prevention information, our interests included examining a range of modifiable risk factors for rhabdomyolysis. Dr. Kurina and I have employed large, longitudinal military datasets for about five years to examine critical military health outcomes, making this study a natural progression of our joint work. The research proceeded with the support of the Uniformed Services University of the Health Sciences, and in cooperation with a distinguished group of experts who co-authored the paper and advised the project. The study was conducted using de-identified records of all SCT-tested African American US Army soldiers on active duty during 2011 - 2014 (N = 47,944).
Author Interviews, Heart Disease, JACC / 08.08.2016

MedicalResearch.com Interview with: Ruben Casado-Arroyo, MD, PhD Heart Rhythm Management Center Cardiovascular Division, UZ Brussel–Vrije Universiteit Brussel, Cardiology Department, Arrhythmia Section Erasmus Hospital, Université Libre de Bruxelles Brussels, Belgium MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study is to evaluate the evolution of the presentation of Brugada Syndrome (BrS) during the last 30 years. Only the first diagnosed patient of each family was included. The database was divided in two periods (early and latter group) in relation to the consensus conference of 2002. Aborted sudden death as the first manifestation of the disease occurred most frequently in the earlier period 12.1% versus 4.6% of the latter group. Inducibility (induction of ventricular fibrillation) during programmed electrical stimulation was achieved in 34.4% (earlier) and 19.2% (latter) of patients, respectively. A spontaneous type 1 electrocardiogram pattern that is a coved type ST elevation with at least 2 mm (0.2 mV) J-point elevation a gradually descending ST segment followed by a negative T-wave was presented at diagnosis 50.3% (earlier) versus 26.2% (latter patients). Early group patients had a higher probability of a recurrent arrhythmia (sudden cardiac death or ventricular arrhythmias) during follow-up (19%) than those of the latter group (5%). All these difference were significative. Overall, the predictors of recurrent arrhythmias were previous sudden cardiac death and inducibility. In the latter period, only previous sudden cardiac death was a predictor of arrhythmic events.
Author Interviews, Emory, Heart Disease, JAMA / 06.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26683" align="alignleft" width="133"]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 Dr. Amit Shah[/caption] 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 MedicalResearch.com: 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.
Anemia, Author Interviews, Hematology, Lancet, Surgical Research / 06.08.2016

MedicalResearch.com Interview with: Clinical Professor Alhossain A.Khalafallah Menzies Institute for Medical Research, University of Tasmania, Australia Consultant Haematologist Senior Staff Specialist Launceston General Hospital, Australia MedicalResearch.com: What is the background for this study? Response: 1. Iron deficiency is one of the most common nutritional deficiencies worldwide, affecting up to one third of the population worldwide. 2. Prevalence of anaemia in orthopaedic surgery ranges between 10-20% with the main cause of anaemia identified as nutritional deficiency. 3. New intravenous iron preparations have been developed at a higher purchase price than oral iron. Iron carboxymaltose, as one example, remains underutilised in the treatment of perioperative anaemia. 4. To our knowledge, this study is the first to compare the efficacy, safety and long term effect on iron stores and length of hospital stay in the postoperative anaemia setting.
Author Interviews, Infections, PLoS / 05.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26775" align="alignleft" width="153"]Dr Peter Monk BSc PhD Faculty Director of International Affairs Reader in Immunology Department of Infection, Immunity and Cardiovascular Disease Sheffield University Medical School Dr. Peter Monk[/caption] Dr Peter Monk BSc PhD Faculty Director of International Affairs Reader in Immunology Department of Infection, Immunity and Cardiovascular Disease Sheffield University Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: The tetraspanin proteins are found on the surface of all mammalian cells. The cell surface is the place where cells 'socialise': they talk to each other to coordinate activities, stick to each other to form tissues and sometimes crawl across each other to get to where they need to go. Tetraspanins have an important job to do in the organisation of the cell surface, amongst other things enabling the formation of 'sticky patches' (tetraspanin-enriched microdomains or TEM) that cause cells to adhere together or provide traction to allow movement. Some bacteria have evolved ways of hijacking the TEM for their own ends, adhering to tightly to these structures so that the normal things that sweep bacteria away (such as blood, sweat and tears!) are no longer effective. At this point, infection begins. We have found that the TEM can be partly disrupted, by adding small parts of tetraspanins (peptides) to cells. The peptides seem to work by weakening the tetraspanin glue that holds the TEM together and causing the other components that give the 'stickiness' to the TEM to become more spaced out. We use the analogy of Velcro(TM), where the fabric hooks and loops are held together in woven material; loosen the weave and the hooks and loops fall apart, no longer able to engage strongly with the loops in the opposing piece of fabric. Using reconstructed human skin, we were able to show that the tetraspanin peptides were both safe and effective; they did not affect wound healing in burned skin, but they could lower the bacterial load in the wound by 50%. This would allow the immune system (including the fluid that 'weeps' from wounds) to deal with the remaining bacteria more easily. Unlike conventional antibiotics that tend to kill bacteria, our peptides simply cause them to get washed away, so not invoking the evolutionary selective mechanisms that lead to resistance.
Author Interviews, Beth Israel Deaconess, Biomarkers, Lung Cancer, Science / 05.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26759" align="alignleft" width="200"]Dr. Elena Levantini, PhD Beth Israel Deaconess Medical Center Instructor, Medicine, Harvard Medical School Research Associate, Hematology-Oncology Beth Israel Deaconess Medical Center Dr. Elena Levantini[/caption] Dr. Elena Levantini, PhD Beth Israel Deaconess Medical Center Instructor, Medicine, Harvard Medical School Research Associate, Hematology-Oncology Beth Israel Deaconess Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lung cancer is one of the deadliest cancers in the world, accounting for 30% of tumor-related deaths. Like many solid tumours, lung cancer is very heterogeneous (consisting of cancer cells which behave and respond differently) and hence there is currently no single efficient drug which is able to treat all patients. Levantini and colleagues previously showed that non-small cell lung cancer (NSCLC) tumor cells frequently express too little or none of a transcription factor called C/EBPα, a protein that regulates gene expression and cell proliferation in lung tissues. It’s also known to play a role in a form of leukemia, as well as liver cancer, squamous cell skin carcinomas, squamous cell cancers of the head and neck and other cancers. In their previous work, the scientists suspected that C/EBPα may act as a tumor suppressant in normal cells, but the mechanism by which its absence promoted lung cancer tumors remained unclear. Dr. Levantini went on to develop a mouse model in which deleting C/EBPα resulted in NSCLC. Analysis of this model led to the discovery that C/EBPα suppressed lung tumor formation by inhibiting the expression of BMI1. Dr Levantini then demonstrated that reducing the levels of BMI1 in her mouse model by genetic means, or by using a drug reducing expression of BMI1, led to inhibition of tumor formation. This study has established an important link between C/EBPα and BMI1 for the first time.
Author Interviews, BMJ, Environmental Risks, Lung Cancer / 05.08.2016

[caption id="attachment_26722" align="alignleft" width="150"]Sandrah P. Eckel PhD Assistant Professor of Preventive Medicine USC Division of Biostatistics Dr. Sandrah Eckel[/caption] MedicalResearch.com Interview with: Sandrah P. Eckel PhD Assistant Professor of Preventive Medicine USC Division of Biostatistics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lung cancer is the most common cancer and it is responsible for 1 in 5 cancer deaths. There is a growing body of evidence that ambient air pollution exposures are linked to lung cancer incidence and mortality, but the effect on survival of exposures after diagnosis are unclear. The International Agency for Research on Cancer recently classified ambient air pollution as carcinogenic. We reasoned that if air pollution drives lung cancer development, it could impact lung cancer progression—and shorten survival—through the same biological pathways. We used 20 years of data on more than 300,000 newly diagnosed lung cancer cases from the California Cancer Registry and calculated average air pollution exposures at each patient’s residence from the date of diagnosis through the end of follow-up. We found that patients living in areas with higher pollution levels had shorter survival, particularly for patients who were diagnosed at an early stage and for those diagnosed at an early stage with adenocarcinoma histology. Interestingly, adenocarcinoma is the most common histological subtype of lung cancer in non-smokers.
Author Interviews, JAMA, Lifestyle & Health, Ophthalmology / 05.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26717" align="alignleft" width="132"]Paul Dinneen Loprinzi, PhD Health, Exercise Science and Recreation Management University of Mississippi Dr. Paul Loprinzi[/caption] Paul Dinneen Loprinzi, PhD Health, Exercise Science and Recreation Management University of Mississippi MedicalResearch.com: 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.
Author Interviews, OBGYNE, Science, Surgical Research / 05.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26708" align="alignleft" width="149"]Dr David A MacIntyre MRC Career Development Fellow Lecturer in Reproductive Systems Medicine Institute of Reproductive and Developmental Biology Department of Surgery and Cancer Imperial College London UK Dr. David Macintyre[/caption] Dr David A MacIntyre MRC Career Development Fellow Lecturer in Reproductive Systems Medicine Institute of Reproductive and Developmental Biology Department of Surgery and Cancer Imperial College London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preterm birth is the leading cause of death in children under 5 years of age. One of the first things that can happen to a women before suffering a preterm birth is early opening of the cervix, which is the neck of the womb. This also puts her and the baby at risk of infection. One of the few preventative treatments available for these women is a cervical cerclage. This is when a surgeon uses one of two types of suture thread to stitch the cervix closed. This provides mechanical support to the pregnancy and is thought to help prevent infections from ascending from the vaginal into the uterus. One type of suture thread used is thin, monofilament nylon, which appears similar to fishing line. The other is a thicker thread - around 5mm thick - that is comprised of smaller threads woven together like a shoe lace. The thicker woven thread - called multifilament - is used in around 80 per cent of procedures as surgeons believe it to be stronger, and more efficient at holding the cervix closed. In this study, we first looked at 671 women who had the procedure at five UK hospitals over the last ten years. Around half had the thinner 'fishing line' thread, while the other half had the thicker 'shoe lace' thread. The results revealed the thicker thread was associated with increased rate of intrauterine death compared to the thinner thread (15 per cent compared 5 per cent). The rate of intrauterine death in a normal pregnancy is around 0.5%. The thicker tape was also associated with an increased preterm birth rate compared to the thinner tape - 28 per cent compared to 17 per cent. The rate of preterm birth among the general population is around 7 per cent, but the cervical stitch procedure is only performed on women already deemed at high risk of premature birth. We then conducted a second study with 50 women who were due to have the cervical stitch procedure. Half received the thinner thread, while half received the thicker thread. We monitored the women at 4, 8 and 16 weeks after the procedure through ultrasound scans and analysis of bacteria in their reproductive tract. The results suggested that women who received the thicker thread had increased inflammation around the cervix. There was also increased blood flow, which is associated with the cervix opening before labour. Crucially, we also found that women who received the thicker thread had more potentially harmful bacteria in the vagina and around the cervix.
Author Interviews, Diabetes, Heart Disease, JAMA, Weight Research / 04.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26704" align="alignleft" width="150"]Prof. Peter Nordström PhD Department of Community Medicine and Rehabilitation Geriatrics, Umeå University Umeå, Sweden Prof. Peter Nordstrom[/caption] Prof. Peter Nordström PhD Department of Community Medicine and Rehabilitation Geriatrics, Umeå University Umeå, Sweden MedicalResearch.com: 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.