Accidents & Violence, Alcohol, Author Interviews, CMAJ / 10.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21473" align="alignleft" width="170"]Dr. Russ Callaghan, PhD Associate Professor Northern Medical Program University of Northern British Columbia Prince George, British Columbia Dr. Russ Callaghan[/caption] [wysija_form id="5"]Dr. Russ Callaghan, PhD Associate Professor Northern Medical Program University of Northern British Columbia Prince George, British Columbia  Medical Research: What is the background for this study? Dr. Callaghan: In Canada, the minimum legal drinking age (MLDA) is 18 years in Alberta, Manitoba and Québec, and 19 in the rest of the country. Given that public-health organizations not only have recommended increasing the MLDA to 19 years, but also have identified 21 years as ideal, the current study tested whether drivers slightly older than the MLDA had significant and abrupt increases in alcohol-impaired driving (AID) crimes, compared with their counterparts just younger than the MLDA. Data on the effectiveness of Canadian drinking-age laws is lacking, and the current study provides important information for the current national and international MLDA debates.
Allergies, Asthma, Author Interviews, JAMA, Pediatrics, Pulmonary Disease / 09.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21421" align="alignleft" width="180"]Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD Dr. Meghan Azad[/caption] Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba and Children’s Hospital Research Institute of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study Medical Research: What is the background for this study? Dr. Azad: Asthma is the most common reason for children to miss school or be admitted to hospital, and accounts for over 30% of Canadian healthcare billings for children. Although many treatments exist to manage asthma symptoms, it is a lifelong disease and there is no cure.  Prevention is the best approach to reduce the global burden of asthma, and our study provides important new information to inform asthma prevention strategies.   Medical Research: What are the main findings? Dr. Azad: Wheezing is common in babies and young children.  Our study looked at the long-term implications of wheezing in early life, using data from the Canadian Asthma Primary Prevention Study (CAPPS). We followed 320 children from Winnipeg and Vancouver from before birth until adolescence, and found that specific patterns of early wheezing (from age 0 to 7) were associated with decreased lung function and increased risk for asthma by age 15. By age 15, children who wheezed consistently through infancy and early childhood had the worst lung function (9% lower compared to non-wheezers) and the highest asthma risk (11 times higher). Even children with “transient early wheeze” (those who wheezed as babies but not as young children) had reduced lung function (5% lower) and increased asthma risk (4 times higher) as teenagers.
Annals Internal Medicine, Author Interviews, Kidney Disease, Weight Research / 09.02.2016

MedicalResearch.com Interview with: Yoosoo Chang MD PhD Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: There is substantial controversy and a lot of interest on the health implications of metabolically healthy obesity, that is, subjects who are obese but do not have metabolic abnormalities in spite of their high body mass index. The risk for chronic kidney disease (CKD) among obese patients without metabolic abnormalities is unknown. In this cohort study of South Korean men and women, metabolically healthy overweight and obese participants had increased incidence of Chronic Kidney Disease (CKD) compared with normal-weight participants.
Author Interviews, Brain Injury, CMAJ, Mental Health Research / 09.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21256" align="alignleft" width="144"]Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) Physician at Sunnybrook Health Sciences Centre Toronto, Ontario Dr. Donald Redelmeier[/caption] Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) Physician at Sunnybrook Health Sciences Centre Toronto, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Redelmeier: Head injury can lead to suicide in military veterans and professional athletes; however, whether a mild concussion acquired in community settings is also a risk factor for suicide is unknown. Medical Research: What should clinicians and patients take away from your report? Dr. Redelmeier: We studies 235,110 patients diagnosed with a concussion and found that  667 subsequently died from suicide. The median delay was about 6 years. This risk was about 32 per 100,000 patients annually, which is 3x the population norm and especially high if the concussion occurred on a weekend (from recreation) rather than a weekday (from employment).
Author Interviews, Biomarkers, JAMA, Prostate Cancer / 09.02.2016

MedicalResearch.com Interview with: [caption id="attachment_20288" align="alignleft" width="120"]Quoc-Dien Trinh MD Assistant Professor, Harvard Medical School Brigham and Williams Hospital Dr. Trinh[/caption] Dr. Quoc-Dien Trinh MD Assistant Professor, Harvard Medical School Brigham and Williams Hospital  Medical Research:  Please briefly explain the potential benefits and harms of PSA testing, the rationale for screening all men, and the reason U.S. guidelines now recommend against routine screening.  Response: The goal of cancer screening is to detect the disease early, and consequently treat it before it becomes more aggressive and spread to other parts of the body (which ultimately leads to death). However, cancer screening may lead to overdiagnosis (detecting cancers that would not have been a problem for a while) and overtreatment. The latter is a problem for prostate cancer, because surgery and radiation therapy (the currently accepted first-line treatments for localized prostate cancer) have significant long-term adverse effects on sexual and urinary function. I wouldn't say that 'US' guidelines are against screening. Many professional societies continue to recommend some form of joint decision-making with regard to PSA screening. the USPSTF recommends against screening for all - they argue that the harms mentioned above outweigh the benefits.
Author Interviews, Diabetes, Exercise - Fitness, JAMA, Lifestyle & Health, Pediatrics / 08.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21397" align="alignleft" width="160"]Mélanie Henderson, MD, FRCPC, PhD Mélanie Henderson[/caption] Mélanie Henderson, MD, FRCPC, PhD Pediatric Endocrinologist and Assistant Clinical Professor Division of Endocrinology and Diabetes University of Montreal/Centre Hospitalier Universitaire Ste-Justine Montréal, Québec Medical Research: What is the background for this study? What are the main findings? Dr. Henderson: Dysregulation in insulin sensitivity and insulin secretion are the basic elements in the pathophysiology of type 2 diabetes. There is extensive data suggesting that better lifestyle habits are associated with the prevention or the delay in onset of type 2 diabetes in adults, with improved lifestyle habits having been more effective than pharmacologic agents at diabetes prevention in one study. Little work however has been done to determine whether this holds true in children. Cross-sectional studies in youth have found conflicting results and no study has considered the combined effect of physical activity, fitness and sedentary behavior on insulin dynamics in children. Understanding the impact of lifestyle habits on insulin dynamics in childhood has become paramount, given that less than 7% of Canadian children are currently meeting physical activity guidelines and that 1/3 of school-aged Canadian children and 2/3 of Canadian teenagers are exceeding the current guidelines in terms of screen time, which advocate for a maximum of 2 hours daily. Our study shows that adiposity is the central predictor of insulin dynamics in children, and that physical activity and screen time play an important role, in part through their effect on adiposity. Thus, establishing and maintaining a highly physically active lifestyle early on in life, while minimizing sedentary behaviour (specifically screen time) appear to be important strategies to consider to prevent type 2 diabetes in youth.
Author Interviews, Frailty, Hip Fractures, Parkinson's, PLoS / 08.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21392" align="alignleft" width="200"]Helena Nyström MD, PhD Candidate Department of Community Medicine and Rehabilitation Umeå University Umeå, Sweden Helena Nyström[/caption] Helena Nyström MD, PhD Candidate Department of Community Medicine and Rehabilitation Umeå University Umeå, Sweden Medical Research: What is the background for this study? Response: Parkinson’s disease (PD) has an insidious onset and the prodromal phase, preceding the onset of the characteristic PD symptoms, may last for decades. Most prodromal signs previously reported are of non-motor type, such as sleep and mood disorders. However, recent studies have reported balance problems and an increased risk of accidental injuries in the last 3-5 years before diagnosis of Parkinson’s disease , and in a previous study we found a lower muscle strength at military conscription in men who were diagnosed with  Parkinson’s disease three decades later. In this study, we aimed to investigate if such subtle strength deficits may translate into an increased risk of fall-related injuries. Medical Research: What are the main findings? Response: The median study time was 20 years before the diagnosis of  Parkinson’s disease , and during this time more individuals with PD (18%) than controls (11.5%) had at least one fall-related injury. The risk was most increased in the last few years before the diagnosis of  Parkinson’s disease , but a difference between the groups appeared already a decade before the PD diagnosis. The risk of hip fracture was increased during the entire study time of 26 years before the diagnosis of Parkinson’s disease .
Author Interviews, Cancer Research, Heart Disease, Journal Clinical Oncology / 07.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21310" align="alignleft" width="200"]Saro H. Armenian, DO, MPH Associate Professor Departments of Pediatrics and Population Sciences City of Hope Comprehensive Cancer Center Director of the Childhood Cancer Survivorship Clinic Duarte, CA Dr. Saro Armenian[/caption] Saro H. Armenian, DO, MPH Associate Professor Departments of Pediatrics and Population Sciences City of Hope Comprehensive Cancer Center Director of the Childhood Cancer Survivorship Clinic Duarte, CA     Medical Research: What is the background for this study? What are the main findings? Dr. Armenian: There are an estimated 14 million cancer survivors living in the U.S. today, and this number is expected to reach 19 million by 2024. Among these cancer survivors, nearly two-thirds will have survived more than five years beyond their cancer diagnosis, and two out of every five will be considered a ten-year survivor, contributing to a growing population of aging cancer survivors. Until now, very little was known about the cardiovascular health of adult long-term cancer survivors. For the current study, we relied on diagnosis/procedures routinely recorded in a large integrative healthcare system that includes racially/ethnically and socioeconomically diverse members who are broadly representative of the residents in Southern California. Cardiovascular outcomes were captured from a wide variety of healthcare delivery settings (inpatient and outpatient, primary and sub-specialty care). Importantly, cancer survivors included in the current study continued to receive their primary and subspecialty care within this system well-beyond their initial cancer diagnosis (5- and 10-year retention rate: 81% and 70%, respectively), providing us with reliable population-based estimates of long-term cardiovascular disease (CVD) risk. We found an up to 70% higher risk of CVD (ischemic heart disease, stroke, or cardiomyopathy/ heart failure) in patients diagnosed with breast, kidney, lung/bronchus, multiple myeloma, non-Hodgkin lymphoma, and ovarian cancer when compared with an age- sex- and zip-code matched non-cancer controls. Cancer survivors who had multiple modifiable risk factors such as hypertension, diabetes, dyslipidemia were at highest risk of developing cardiovascular disease  later in life, irrespective of cancer diagnosis. Importantly, cancer survivors who developed CVD were significantly more likely to die from all causes when compared to cancer survivors who did not develop CVD. While the reasons for these findings are not clear, it is possible that the presence of CVD can markedly diminish treatment options or planned duration of therapy at the time of cancer recurrence, thus compromising the optimal long-term management of a cancer patient.
Author Interviews, BMJ, Clots - Coagulation, Heart Disease, Stroke / 06.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21352" align="alignleft" width="194"]Dr. Deborah Cohen Dr. Deborah Cohen[/caption] Dr. Deborah Cohen Associate Editor BMJ BMA House, Tavistock Square London Medical Research: What is the background for this study? What are the main findings? Dr. Cohen: Anyone familiar with warfarin understands the critical role of INR values in determining the proper dose for warfarin patients. The INR value in an individual patient is the most important piece of information a doctor considers when determining the warfarin dose. If the doctor gives too little warfarin then the patient may be at undue risk of stroke; if too much, the patient may be at undue risk of a major bleed. The BMJ investigation revealed that the INR device used to manage the ~7,000 warfarin patients in the ROCKET trial (which served as the basis for approval of the non-valvular atrial fibrillation indication) was defective. As such – doctors were relying upon a defective device in determining the dose of the warfarin patients – which has a direct influence on the stroke and bleeding risk in that patient. Since this was a comparative trial – any deficiency in the performance of the comparator arm (warfarin) would skew the results in favour of the study drug (rivaroxaban). Since INR directly influences strokes and bleeds – the primary efficacy and safety endpoints – it very much questions, if not undermines, the overall results of this trial.
Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Psychological Science, Technology / 06.02.2016

[caption id="attachment_21105" align="alignleft" width="180"]Dr. Jesper Enander Department of Clinical Neuroscience Karolinska Institutet Dr. Jesper Enander[/caption] MedicalResearch.com Interview with: Dr. Jesper Enander Department of Clinical Neuroscience Karolinska Institutet MedicalResearch: What is the background for this study? Dr. Enander: Body dysmorphic disorder (BDD) is a common anxiety disorder affecting about 2% of the general population, and is associated with hospitalization, substance dependence and suicidality. The disorder is characterized by a intense preoccupation with perceived defects in physical appearance, despite looking perfectly normal. It is common for people with BDD to seek non-psychiatric care, such as dermatological treatment or plastic surgery, however, such treatments rarely work, and can even lead to a deterioration of symptoms. The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that patients with Body dysmorphic disorder should be offered cognitive behavior therapy (CBT), however, there is a gap between supply and demand of CBT. One way of increasing access to CBT is to deliver it using the Internet. In this randomized clinical trial we tested the efficacy of a Internet based CBT program for Body dysmorphic disorder called BDD-NET and compared it to supportive therapy. MedicalResearch: What are the main findings? Dr. Enander: Our study shows that BDD-NET was associated with large and significant improvements in  Body dysmorphic disorder symptom severity. 56% of those receiving BDD-NET were responders (defined as at least a 30% reduction in symptoms), compared to 13% of those receiving supportive therapy. At the six months follow-up, 39% of those who received BDD-NET no longer met diagnostic criteria for Body dysmorphic disorder. No serious adverse events were reported, and most participants were satisfied with BDD-NET, despite no face-to-face contact with a therapist, and deemed the treatment as highly acceptable.
Author Interviews, Diabetes, Diabetologia, Lifestyle & Health / 06.02.2016

MedicalResearch.com Interview with: Julianne van der Berg  PhD candidate Social Medicine Universiteitssingel Maastricht The Netherlands  Medical Research: What is the background for this study? What are the main findings? Response: The study investigated in data from The Maastricht Study, a large study in the Netherlands, associations of total duration and patterns of sedentary behavior with type 2 diabetes. We show that participants with type 2 diabetes spent the most time of day sedentary, 26 min more than participants without diabetes. Each additional hour of sedentary time was associated with a 22% increased risk of type 2 diabetes. Important is that these results were independent of high-intensity physical activity.
Author Interviews, Cancer Research, Heart Disease, JAMA, Pharmacology / 06.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21344" align="alignleft" width="200"]Jonathan Douxfils Pharm.D. - Ph.D. Research assistant Faculty of Medicine - Department of Pharmacy NAmur Research Institute for LIfe Sciences (NARILIS) Namur Thrombosis and Hemostasis Center (NTHC) Dr. Jonathan Douxfils[/caption] Jonathan Douxfils Pharm.D. - Ph.D. Research assistant Faculty of Medicine - Department of Pharmacy NAmur Research Institute for LIfe Sciences (NARILIS) Namur Thrombosis and Hemostasis Center (NTHC) Medical Research: What is the background for this study? What are the main findings? Dr. Douxfils: We decided to perform this study based on the release of the FDA regarding the risk of arterial occlusive events associated with ponatinib. We then hypothesize that the risk was not only restricted to ponatinib but also to other TKIs. This study shows that dasatinib, nilotinib and ponatinib increase the risk of vascular occlusive events compared to imatinib. Medical Research: What should clinicians and patients take away from your report? Dr. Douxfils: We suggest that patients treated with these molecules should be more frequently monitored, i.e. by an intensive support of associated comorbidities. In addition, even if they appear to have a better efficacy in terms of molecular response, new generation TKIs does not improve the overall survival at one year. As we have not access to individual data, it was impossible to clearly identify categories of patients for whom the risk of cardiovascular occlusive events is predominant. Therefore, the intensive monitoring proposed should be applied to all patients treated with these molecules. Regarding the choice of the therapy, the physician should certainly consider the goals of the treatment. For elderly patients, improving survival is the main objective and in this context, imatinib remains an excellent choice. For patients with a life expectancy greater than 10 years in whom we aim to achieve a deep molecular response to potentially reach a point of treatment cessation, dasatinib and nilotinib could be preferred. However, the choice of dasatinib or nilotinib as first-line treatments should involve a screening for potential risk factors such as diabetes, prior vascular occlusive events or any risk that could increase these adverse events. For second- and third-line treatments, the choice of the treatment has to be based on mutational analysis, previous adverse events, and the medical condition of the patient. Thus, in case of intolerance or resistance, the switch to one of the other TKIs approved for first-line therapy is an option. If treatment failure still occurs, a more potent TKI, i.e. bosutinib, is preferred. Importantly, ponatinib is reserved to patients with the T315I mutation and must be avoided in patients with good prognosis.
Author Interviews, Education, NYU/NYMC, Pediatrics, Pediatrics, Social Issues / 05.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21333" align="alignleft" width="112"]Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Dr. Alan Mendelsohn[/caption] Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Adriana Weisleder, PhD [caption id="attachment_21334" align="alignleft" width="100"]Adriana Weisleder, PhD Research scientist, Department of Pediatrics NYU Langone Medical Center Dr. Adriana Weislander[/caption] Research scientist, Department of Pediatrics NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise. The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals. The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half.  These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school.
Author Interviews, Genetic Research, JAMA, Schizophrenia / 04.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21290" align="alignleft" width="90"]Hannah J. Jones, PhD Centre for Academic Mental Health, School of Social and Community Medicine, 2Medical Research Council (MRC) Integrative Epidemiology Unit University of Bristol, Bristol, England Dr. Hannah Jones[/caption] Hannah J. Jones, PhD Centre for Academic Mental Health, School of Social and Community Medicine, Medical Research Council (MRC) Integrative Epidemiology Unit University of Bristol, Bristol, England MedicalResearch: What is the background for this study? What are the main findings? Dr. Jones: Schizophrenia is a highly heritable condition characterised by relatively diverse symptoms and frequent comorbid disorders. However, at present we don’t know how genetic risk for schizophrenia is expressed in children/adolescents in the general population. To investigate this, we studied data from individuals within the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort which consists of approximately 14,000 children born to women living in the former Avon Health Authority area in England with an expected delivery date from April 1, 1991, to December 31, 1992. We used genetic data from approximately 5,000 ALSPAC children and measures from adolescence relating to psychopathology to determine whether genetic risk for schizophrenia is associated with variation in psychotic experiences (e.g. delusions, hallucinations), negative symptoms (e.g. apathy, withdrawal), depressive disorder and anxiety disorder during this developmental period. We derived a score of genetic risk for schizophrenia in each individual within our study. This score is normally distributed such that most people have some genetic risk and a few people have very high or very low genetic risk. We found very weak evidence of an association between genetic risk for schizophrenia and psychotic experiences in adolescence and no evidence of an association with depressive disorder. However, we found strong evidence of association between genetic risk for schizophrenia and negative symptoms and anxiety disorder. 
Allergies, Asthma, Author Interviews, JAMA / 04.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21055" align="alignleft" width="124"]Prof Dr. Dr. h.c. Claus Bachert Head Upper Airways Research Laboratory (URL) Chief of Clinics ENT-Department University Hospital Ghent Ghent, Belgium Prof. Claus Bachert[/caption] Prof Dr. Dr. h.c. Claus Bachert Head Upper Airways Research Laboratory (URL) Chief of Clinics ENT-Department University Hospital Ghent Ghent, Belgium Medical Research: What is the background for this study? What are the main findings? Prof. Bachert: Chronic sinusitis with nasal polyposis represents mucosal inflammation, and polyps in the nasal cavity and sinuses, which result in long-term symptoms of nasal obstruction and congestion, reduction in or loss of sense of smell, and loss of quality of life. Patients with nasal obstruction or congestion have a two-fold higher risk of sleep dysfunction, increased fatigue, and decreased work productivity. About 40 percent of chronic sinusitis with nasal polyps patients develop asthma, which often is non-allergic late-onset disease. Treatment options consist of nasal and systemic glucocorticosteroids; long-term or repeated treatment with oral GCS carries a great risk of side effects in these patients. Surgery of the sinuses is another option, but recurrence of polyps is frequent. Further treatment options are highly needed. About 85% of nasal polyps represent a type 2 inflammation, with increased eosinophils and IgE formation. Dupilumab is an investigational therapy that inhibits signaling of IL-4 and IL-13, two key cytokines required for type 2 (Th2) immune responses. Dupilumab has been successfully administered in patients with asthma and atopic dermatitis. The current randomized, double-blind, placebo-controlled group study enrolled 60 adult patients with chronic sinusitis with nasal polyposis refractory to intranasal corticosteroids at 13 sites in the United States and Europe. Following four weeks of mometasone furoate nasal spray (MFNS) run-in, patients in the study received 300 milligrams (mg) of dupilumab or placebo once per week subcutaneously for 16 weeks, after an initial loading dose of 600 mg. All patients in the study continued to receive daily MFNS. Eligible patients had bilateral nasal polyposis and showed chronic symptoms of sinusitis, despite treatment with an intranasal corticosteroid for at least two months. Fifty-eight percent of patients in the study had received prior nasal surgery for their condition.  ​ We found that dupilumab treatment was associated with significant improvements in endoscopic, clinical, radiographic, and pharmacodynamic end points after 16 weeks. Significant improvements in quality of life and in major symptoms, such as sense of smell, nasal congestion, and nocturnal awakenings,were reported. In those patients with asthma, also lung function and asthma control were significantly better with Dupilumab compared to placebo. Dupilumab was generally well tolerated, and no serious adverse events were considered to be related to dupilumab.​
Author Interviews, Compliance, HIV, Lancet / 03.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21259" align="alignleft" width="134"]Dr Marcel Yotebieng, PhD Department of Epidemiology Ohio State University, 304 Cunz Hall Columbus, OH Dr. Marcel Yotenbieng[/caption] Dr Marcel Yotebieng, PhD Department of Epidemiology Ohio State University, 304 Cunz Hall Columbus, OH Medical Research: What is the background for this study? What are the main findings? Response: With the current World Health Organization recommended treatment for the prevention of mother-to-child HIV transmission (PMTCT), the risk of transmission of HIV from an infected mother to her baby can be cut from 35-45% to less than 5% in breastfeeding population and <1% in non-breastfeeding population. But in sub-Saharan Africa where over 90% of HIV-infected pregnant women worldwide live, transportation costs and opportunity costs to attend regular clinic visits (to collect drugs) have been identified as important barriers to PMTCT. The provision of economic incentives has the potential to help women overcome these economic barriers. In addition, by creating immediate rewards that “nudge” individuals towards positive health behaviors, financial incentives can also address psychological barriers to health-seeking behavior of HIV-infected pregnant and breastfeeding women. This is the first study to use small cash incentives to encourage women to attend clinic visit and received available PMTCT care. We found that, among newly diagnosed HIV-infected women, small, incremental cash incentives resulted in increased retention along the  prevention of mother-to-child HIV transmission cascade and uptake of available services.
Author Interviews, Genetic Research, JAMA, Pediatrics, Surgical Research / 03.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21247" align="alignleft" width="144"]Silje Steinsbekk PhD Associate Professor Dept. of Pschology Norwegian University of Science and Technology Dr.Steinsbekk[/caption] Silje Steinsbekk PhD Associate Professor Dept. of Pschology Norwegian University of Science and Technology  Medical Research: What is the background for this study? Dr. Steinsbekk:  More than every third American child is overweight or obese. Childhood obesity is associated with multiple negative health outcomes such as metabolic syndrome and hypertension, as well as mental health problems, reduced self-esteem and impaired quality of life. Further, overweight and obesity tend to persist from childhood into adulthood, and the risk of adult overweight increases the longer a child has been overweight. Identifying modifiable factors contributing to the development and continuity of unhealthy weight is therefore needed. Genome-wide association studies (GWAS) have identified genetic risks for obesity and these genetic risks have shown to influence development of obesity partly by accelerating weight gain in childhood. Identification of mechanisms through which genetic risks for obesity accelerate weight gain in childhood can therefore provide insight into the developmental pathogenesis of obesity and thus inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Appetite traits may therefore be targets of intervention to protect children against the effect of genetic predispositions to develop obesity. However, such a preventive approach presupposes that appetite traits indeed transmit the genetic effect upon later development of obesity. Notably, cross-sectional studies cannot establish whether appetite traits precede the development of obesity or are caused by it—a critical piece of information for clinicians seeking treatment targets to prevent childhood obesity. We therefore aimed to test whether genetic risk for obesity was associated with rapid childhood BMI growth and if this genetic effect was mediated by appetite traits, following a representative sample of Norwegian children from age 4 to 8.
Author Interviews, Genetic Research, JAMA, Pediatrics, Weight Research / 02.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21225" align="alignleft" width="180"]Profa. Patrícia Pelufo Silveira, MD, PhD Universidade Federal do Rio Grande do Sul Brazil Profa. Silveira[/caption] Profa. Patrícia Pelufo Silveira, MD, PhD Universidade Federal do Rio Grande do Sul Brazil Medical Research: What is the background for this study? What are the main findings? Response: Previous studies have shown that women who carry a certain gene variant (namely the 7-repeat allele of the dopamine type 4 receptor) have increased risk for obesity, especially if they also suffer from eating disorders. We have also demonstrated that girls who have this gene variant prefer to eat more fat when allowed to choose. However, for some neuropsychiatric conditions, this gene was shown to function as a “plasticity gene”. That is to say that being a carrier makes the individual more or less vulnerable to the disease, depending if the environment in which the person lives is bad (more risk) or good (less risk for the disease). This is called the “differential susceptibility” model. Therefore, in this paper, we wondered if the above described higher fat intake already reported in 7-repeat girls could be modified by the social environment in which they are raised. We saw that if a girl has the gene variant and is raised in a poorer environment, she is more likely to prefer to eat fat in her diet as we knew. However, if she has the gene variant but is raised in a better socioeconomic environment, she actually eats less fat in her regular diet compared to her counterparts who do not carry the gene variant. This is important because we change the focus from the gene (previously "blamed" for increasing fat preference and obesity as the years pass by) to the environment, as the genetic association will increase or decrease the risk according to the conditions in which the child is raised.
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Lancet, Pediatrics, Radiation Therapy / 02.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21220" align="alignleft" width="120"]Dr. Torunn Yock, MD Director, Pediatric Radiation Oncology Associate Professor, Harvard Medical School Radiation Oncology Quality Assurance Massachusetts General Hospital, Proton Center Boston, MA Dr. Torunn Yock[/caption] Dr. Torunn Yock, MD Director, Pediatric Radiation Oncology Associate Professor, Harvard Medical School Radiation Oncology Quality Assurance Massachusetts General Hospital, Proton Center Boston, MA Medical Research: What is the background for this study? Dr. Yock: Proton radiotherapy is a highly targeted form of radiation therapy that can spare normal tissues better than standard x-ray/photon based radiotherapy. Because, all side effects from radiotherapy come from radiation dose to normal healthy tissues, it is widely believed that proton radiotherapy has great potential to mitigate the side effects of treatment, both acute and long term side effects. There have been many planning studies that show that proton radiation can achieve a more highly conformal dose distribution and appear to spare 50% or more normal tissue from unnecessary irradiation.  However, there have been only a handful of retrospective studies that report disease control and side effects of treatment. While the technology looked promising, the definitive clinical data has been lacking to date. Because of this lack of clinical outcome data, the role and benefit of proton radiotherapy has been a subject of great debate in the oncology community.  Critics assert that proton radiotherapy is expensive and unproven and therefore a leading culprit in escalating costs of oncologic health care. Proponents assert that when used in the appropriate patient setting, the margin of benefit in terms of improved health outcomes, outweighs the increased cost of treatment. We embarked on this study to answer help answer the call for prospectively collected clinical outcome data to better define the most appropriate role for proton radiotherapy. Importantly, this study addresses both disease control and side effects of treatment in a pediatric medulloblastoma cohort of children. Medical Research: What are the main findings? Dr. Yock: This study shows that disease control in the pediatric medulloblastoma population is very much the same as that which is achieved by photon based radiotherapy treatments. However, more importantly, late side effects commonly attributed to radiotherapy such as neurocognitive decline over time and hearing loss appear to be improved compared with published photon treated cohorts of pediatric medulloblastoma patients.  Additionally, adverse late side effects on the cardiopulmonary, GI, and reproductive systems were essentially eliminated.
Author Interviews, BMJ, Brigham & Women's - Harvard, Nutrition, Pediatrics / 02.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21216" align="alignleft" width="144"]Dr. Maryam S. Farvid, PhD Takemi Fellow Harvard T.H. Chan School of Public Health Dr. Maryam Farvid[/caption] Dr. Maryam S. Farvid, PhD Takemi Fellow Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Farvid: Previous studies of fiber intake and breast cancer have almost all been non-significant, but none of them examined diet during adolescence or early adulthood, a period when breast cancer risk factors appear to be particularly important. Current study supports protective role of dietary fiber intake on breast cancer. The women who reported the highest amount of fiber consumed during high school, about 28 grams daily, had a 16% lower risk of overall breast cancer compared with those who said they consumed an about 15 grams a day. Also highest verses lowest intake of fiber during early adulthood was associated with a 19% lower risk of overall breast cancer. The associations were more apparent for premenopausal breast cancer than postmenopausal breast cancer. Each 10 grams increase in adolescent fiber intake may lead to a 20% lower risk of premenopausal breast cancer, as was a 15% for overall breast cancer.
Author Interviews, Depression, JAMA, NYU/NYMC, Pediatrics / 01.02.2016

[caption id="attachment_21201" align="alignleft" width="200"]Briannon O'Connor PhD New York University Child Study Center Department of Child and Adolescent Psychiatry New York University School of Medicine, New York Dr. Briannon O'Connor[/caption] MedicalResearch.com Interview with: Briannon O'Connor PhD New York University Child Study Center Department of Child and Adolescent Psychiatry New York University School of Medicine New York Medical Research: What is the background for this study? What are the main findings? Dr. O'Connor: a.      As the health care system continues to emphasize accountability for providing high quality care, the development of meaningful quality standards is critical.  This study came from NCQA’s work to develop these quality measures for adolescent depression care.  Prior to this study, little was known about what routine care looked like for adolescents who showed up at their primary care visits with significant symptoms of depression. This study looked at follow up care documented in an electronic health record in the three months after an adolescent was first identified with significant symptoms of depression. Medical Research: What is the background for this study? What are the main findings? Dr. O'Connor:    Key findings from this study include:
  1. Most adolescents (nearly two-thirds) with newly prescribed depression symptoms received some treatment, usually including psychotherapy, within the first 3 months after depression symptoms were first identified.
  2. Among those adolescents who were prescribed antidepressant medications, 40% had no other follow up care in three months, which is quite concerning since current black box warnings highlight the risk for increased suicidality for youth prescribed antidepressants and clearly recommend close monitoring in the few months following initial prescription.
  3. There were low rates of other follow up care events in the three month follow up period:  19% of adolescents  did not receive any follow up care at all, 36% did not receive any treatment, and the majority (68%) lacked documentation that symptoms were monitored or re-assessed using a valid questionnaire
  4. The sites that participated in the study are highly regarded health care institutions, often looked to as leaders in cutting-edge care. Thus, results from this study, discouraging as they are, may overstate the quality of care in other settings.
Aging, Author Interviews, Cognitive Issues, JAMA, Mayo Clinic, Weight Research / 01.02.2016

[caption id="attachment_21196" align="alignleft" width="125"]Rosebud O. Roberts, M.B., Ch.B. Mayo Clinic Rochester, Minn. Dr. Rosebud Roberts[/caption] MedicalResearch.com Interview with: Rosebud O. Roberts, M.B., Ch.B. Mayo Clinic Rochester, Minn.  Medical Research: What is the background for this study? Dr. Roberts: Decline in weight has been observed 10-20 years prior to onset of dementia. We wanted to study whether this decline also occurs for mild cognitive impairment (an intermediate stage in the progression from normal cognition to dementia). Medical Research: What are the main findings? Dr. Roberts: The main finding was that there was indeed a decline in weight (from the maximum weight in midlife to weight assessed in late life) was associated with a increased risk of mild cognitive impairment.
Author Interviews, Microbiome, Nature, NYU/NYMC, OBGYNE / 01.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21187" align="alignleft" width="150"]Maria Dominguez-Bello, PhD Associate Professor, Department of Medicine, Division of Translational Medicine NYU Langone Medical Center Dr. Dominguez-Bello[/caption] Maria Dominguez-Bello, PhD Associate Professor, Department of Medicine, Division of Translational Medicine NYU Langone Medical Center and [caption id="attachment_21188" align="alignleft" width="150"]Jose Clemente, PhD Assistant Professor, Departments of Genetics and Genomic Sciences, and Medicine Icahn School of Medicine at Mount Sinai Dr. Jose Clemente[/caption] Jose Clemente, PhD Assistant Professor, Departments of Genetics and Genomic Sciences, and Medicine Icahn School of Medicine at Mount Sinai       Medical Research: What is the background for this study? What are the main findings? Response: Humans and animals are a composite of their own cells and microbes. But where they get their microbes from?  For mammals, labor and birth are major exposures to maternal vaginal bacteria, and infants are born already with a microbiota acquired from the mother. Mom’s birth canal is heavily colonized by bacteria that are highly related to milk: some will use milk components and become dominant during early development, an important window for maturation of the immune system, the intestine and the brain. Thus, the maternal vaginal microbiota is thought to be of high adaptive value for newborn mammals. Indeed, studies in mice confirm that microbes acquired at birth are important to develop adequate immune and metabolic responses, and the mature adult microbiome will continue to modulate host metabolism and immunity. Humans are the only mammals that interrupt the exposure to maternal vaginal microbiota, by delivering babies by Cesarean section. C-sections save lives of babies and moms, and they are estimated necessary in 10-15% of the cases. But most Western countries have rates above 30%, with the notable exception of the Scandinavian countries, Holland and Japan, which have excellent health systems and low maternal-infant mortality rates. Previous work by us an others has shown that infants born by C-section acquire different microbiota at birth, and those differences are sustained over time, altering the normal age-dependent maturation of the microbiome. The fundamental questions are then, can we restore the microbiota of Cesarean delivered babies? And if we can, does that reduce the associated disease risks? In relation to the first question, we present here the results of a pilot study in which infants born by Cesarean delivery were exposed to maternal vaginal fluids at birth. A total of 18 infants were recruited for the study. Seven of them were vaginally delivered, the remaining 11 were born by scheduled C-section. Among the C-section infants, 4 were exposed to maternal vaginal fluids at birth and 7 were not. We sampled all infants and their mothers for the first month of life across different body sites (oral, skin, anal, maternal vagina) and determined the microbiome composition on a total of over 1,500 samples.
Author Interviews, Compliance, JAMA, Technology / 01.02.2016

[caption id="attachment_21177" align="alignleft" width="64"]Dr. Clara Chow PhD Director of the Cardiovascular division The George Institute, Westmead Hospital Sydney, Australia Dr.  Chow[/caption] MedicalResearch.com Interview with: Dr. Clara Chow PhD Director of the Cardiovascular division The George Institute, Westmead Hospital Sydney, Australia Medical Research: What is the background for this study? What are the main findings? Dr. Chow: Text messaging has immense potential in healthcare. Not only for supporting medication adherence, but we have shown in the “TEXT ME” study its ability to simultaneously influence multiple lifestyle domains like increasing physical activity, embarking on healthier diets and reducing smoking rates. With increasing penetration of mobile phone use in developed as well as developing countries, there is a potential for wider reach, however there remains a need to evaluate the value of text messaging programs in various patient populations to establish the generalizability of these research findings.
Author Interviews, BMJ, Colon Cancer, Gastrointestinal Disease, Global Health / 31.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21039" align="alignleft" width="200"]Dr. Melina Arnold Section of Cancer Surveillance International Agency for Research on CancerLyon, France Dr. Melina Arnold[/caption] Dr. Melina Arnold Section of Cancer Surveillance International Agency for Research on Cancer Lyon, France MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Arnold: In this study, we looked at patterns and time trends in the incidence in and mortality from colorectal cancer on the global scale. In the analyses, we used data from the Globocan database, Cancer Incidence in Five Continents, both hosted by the International Agency for Research on Cancer (IARC), and the World Health Organisation mortality database. We documented a ten-fold variation in colorectal cancer incidence and mortality rates worldwide. We also found distinct gradients across human development levels, meaning that changes in patterns and trends of this cancer could be linked to economic development and that the adoption of a Western lifestyle may have a role. While incidence and mortality rates are on the increase in many countries in socioeconomic transition, stabilizing or decreasing trends are seen in highly-developed countries where rates remain among the highest in the world. These observations point to widening disparities and an increasing burden in transitioning countries.
Author Interviews, Diabetes, Lancet / 31.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21036" align="alignleft" width="200"]Dr Abbas Dehghan PhD Assistant Professor, Department of Epidemiology Erasmus University Medical Centre Rotterdam, Netherlands Dr. Abbas Dehghan[/caption] Dr Abbas Dehghan PhD Assistant Professor, Department of Epidemiology Erasmus University Medical Centre Rotterdam, Netherlands MedicalResearch.com: What is the background for this study? Dr. Dehghan: Diabetes is an important health treat given its serious complications including cardiovascular disease, blindness, kidney failure, and lower-extremity amputations. Descriptive studies have so far either reported the prevalence of diabetes which is a snapshot of the percentage of people who have diabetes or the risk that people will develop diabetes in next 5 or 10 years. These estimates are not optimal since they overlook the risk of developing diabetes later in life. We calculated the lifetime risk of type 2 diabetes which is the risk that every person carries to develop type 2 diabetes up to end of his life. Moreover, we provided estimates for prediabetes, a high risk status that people experience before developing diabetes, and need for insulin therapy that might indicates severity of the disease. MedicalResearch.com: What are the main findings?  Dr. Dehghan: Our data suggest that the lifetime risk of developing prediabetes for a normoglycemic individual aged 45 years is one in two, and one in three nondiabetic individuals aged 45 years will develop diabetes. Three-quarters of individuals with prediabetes at age 45 years will eventually progress to diabetes, and half of the patients with diabetes at the same age will start insulin treatment. Stratification by BMI showed that normoglycemic people with healthy weight at age 45 years had a significantly lower prediabetes lifetime risk compared with overweight and obese individuals. Stratification by waist circumference showed similar effects on lifetime risks for diabetes in individuals with prediabetes. Similarly, in individuals with diabetes, the lifetime risk for insulin use among patients with diabetes was higher with increasing BMI and waist circumference.
Author Interviews, Autism, Genetic Research, JAMA, Schizophrenia / 30.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21154" align="alignleft" width="171"]Andrea J. Gonzalez-Mantilla, M.D. Postdoctoral Fellow Andrea J. Gonzalez-Mantilla, M.D.[/caption] Andrea J. Gonzalez-Mantilla, M.D. Postdoctoral Fellow [caption id="attachment_21155" align="alignleft" width="163"]Andres Moreno-De-Luca, M.D. Investigator I Andres Moreno-De-Luca, M.D.[/caption] Andres Moreno-De-Luca, M.D. Investigator I Autism & Developmental Medicine Institute Department of Radiology Geisinger Health System Danville, PA 17822 Medical Research: What is the background for this study? What are the main findings? Response: Developmental brain disorders (DBD), such as autism, intellectual disability, and schizophrenia are a group of heterogeneous conditions characterized by deficits that affect multiple functional domains, such as cognition, behavior, communication, and motor skills. Previous studies provide strong evidence of common underlying molecular pathways and shared genetic causes among apparently different DBDs. Large-scale genomic studies of individuals with developmental brain disorders have found that identifying multiple, independent de novo pathogenic loss-of-function (pLOF) variants in the same gene among unrelated individuals is a powerful statistical approach to reliably identify disease-causing genes. However, genomic data from smaller cohorts and case reports are not routinely pooled with data from larger studies. Moreover, most previous studies have been restricted to cohorts of individuals ascertained based on a single diagnosis (e.g., a study will focus on only individuals with a diagnosis of autism and not consider other genomic data from individuals with a different diagnosis). Therefore, genomic data from individuals across DBD are not being jointly analyzed in search of pLOF variants in the same gene that may help build evidence for a causative role in developmental brain disorders. In this study, we carried out data mining of previously published data to identify genes related to the DBD phenotype. We expanded the aforementioned method and developed a multilevel data-integration approach, which capitalizes on three genotype-phenotype data sources: (1) genomic data from structural and sequence pLOF variants, (2) phenotype data from six apparently distinct DBD (autism, intellectual disability, epilepsy, schizophrenia, bipolar disorder and attention-deficit/hyperactivity disorder), and (3) data from large scale studies, smaller cohorts, and case reports. We identified 241 candidate genes for developmental brain disorders, including 17 genes that had not previously been associated with developmental brain disorders.
Author Interviews, BMJ, Heart Disease, Tobacco, Toxin Research / 29.01.2016

[caption id="attachment_21132" align="alignleft" width="143"]Maciej Goniewicz Dr. Maciej Goniewicz[/caption] MedicalRearch.com Interview with: Maciej Goniewicz, PhD, PharmD Assistant Professor of Oncology, Department of Health Behavior Roswell Park Cancer Institute (RPCI Medical Research: What is the background for this study? What are the main findings? Dr. Goniewicz: In addition to nicotine and its solvents (like propylene glycol and vegetable glycerin), a majority of e-cigarettes contain flavorings. Users of e-cigarettes can choose their favorite flavor among hundreds of various options, including fruit, coffee, menthol, vanilla, chocolate, candy flavors, and tobacco.  Although many flavorings used in e-cigarettes are recognized as safe when used in food products, little is known about their potential toxicity when inhaled. In this study we measured one such flavoring, benzaldehyde. This flavoring is commonly used in food and cosmetics. We know that there is little to no toxicity if we eat this compound or if we apply it on our skin. However, workers who regularly inhale a high concentration of benzaldehyde often report irritation of their eyes and throat. In this study, we tested 145 e-cigarette products, and we found benzaldehyde in 108 products. Interestingly, the highest levels of benzaldehyde were detected in cherry-flavored products. 
Author Interviews, BMJ, Nutrition / 29.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21118" align="alignleft" width="80"]Helmut Schröder, Ph.D. Head Cardiovascular Epidemiology and Nutrition Research Group, CIBER Epidemiology and Public Health Senior Research Scientist Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC) IMIM-Hospital del Mar Medical Research Institute Parc de Recerca Biomèdica de Barcelona Barcelona,Spain Dr. Helmut Schröder[/caption] Helmut Schröder,  Ph.D. Head Cardiovascular Epidemiology and Nutrition Research Group, CIBER Epidemiology and Public Health Senior Research Scientist Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC) IMIM-Hospital del Mar Medical Research Institute Parc de Recerca Biomèdica de Barcelona Barcelona,Spain Medical Research: What is the background for this study? What are the main findings? Dr. Schröder: A healthy diet is paramount for physical and mental health. Healthy dietary patterns are more expensive than unhealthy choices. But it is unknown how increases in individual diet cost, driven by rising food prices, affects consumers’ food choices and, consequently, overall diet quality. It is of particular concern that low diet quality is more often found in segments of the population with the lowest socioeconomic status. The he aim of our research was to determine the prospective association between changes in individual diet cost and changes in diet quality in the REGICOR (Registre Gironí del Cor) cohort, a representative Spanish population. Additionally, we determined the impact of changes in diet cost on body weight. We have found that an increase in the energy-adjusted diet cost predicted a shift to a healthier diet and to better weight management. Diet quality strongly increased if money previously spent on unhealthy food choices such as fast food and pastry is instead spent on vegetables and fruits. Furthermore, we have seen that a 1.4€ increase in average spending on food is associated with the consumption of 74 grams more vegetables and 52 grams more fruit, per person per day, for a 1000 kcal diet. Conversely, a reduction of 0.06€ in average spending is linked to a decrease of 121 grams of vegetables and 94 grams of fruit, as well as increased consumption of foodstuffs like fast food and baked goods.