AHA Journals, Author Interviews, Heart Disease, Sleep Disorders / 12.09.2015

Chan-Won Kim, M.D. Clinical Associate Professor Center for Cohort Studies Kangbuk Samsun Hospital Sungkyunkwan University School of Medicine Seoul, South KoreaMedicalResearch.com Interview with: Chan-Won Kim, M.D. Clinical Associate Professor Center for Cohort Studies Kangbuk Samsun Hospital Sungkyunkwan University School of Medicine Seoul, South Korea Medical Research: What is the background for this study? Dr. Chan-Won Kim: In modern society, inadequate sleep either in quantity or in quality is a common problem and widely recognized as a potential determinant of adverse health outcomes including cardiovascular health. Very long or very short duration of sleep are associated with an increased risk for clinical cardiovascular events such as coronary heart disease and strokes. In these previous studies, however, it was possible that extreme sleep duration or poor sleep quality was a consequence of previous co-morbidities such as depression and obesity, and it was still unclear if these co-morbidities were really responsible for the effects of sleep disturbances. Therefore, we evaluated the association of sleep duration and quality with early markers of subclinical arterial disease in asymptomatic apparently healthy men and women. Medical Research: What are the main findings? Dr. Chan-Won Kim:  In our study, we found that sleep duration had a U-shaped association with two early markers of vascular disease. Both short and long sleep duration were associated with a greater amount of calcification in the coronary arteries, a very good measure of subclinical atherosclerosis that predicts the risk of a heart attack. We also found a similar pattern of association with arterial stiffness, a marker of vascular aging. For both markers, we found the lowers risk in study participants who reported 7 hours of sleep. In addition, poor subjective sleep quality was also associated with these markers of vascular disease. Few studies had explored these associations before, and they were inconsistent partly because of small sample sizes. Our research also indicates that these associations were present irrespective of traditional risk factors such as hypertension, hypercholesterolemia, or diabetes.
Author Interviews, HIV, PLoS / 10.09.2015

MedicalResearch.com Interview with: Augustine T. Choko MSc Malawi–Liverpool–Wellcome Trust Clinical Research Programme Blantyre, Malawi Medical Research: What is the background for this study? Response: Despite rapid scale up of HIV testing in the sub Saharan African region, half of people living with HIV are unware of their status. We investigated a novel approach of HIV self testing as an additional strategy to existing HIV testing options. Medical Research: What are the main findings? Response: Population uptake of HIV self testing was high at the first offer and remained high at the second offer 12 months later. The approach saw high numbers of adolescents and men testing. Community participants with 8% illiterate were able to do the test and correctly interpret it on their own with minimal training. People who self-tested positive were able to link into the clinic for antiretroviral therapy eligibility assessment.
Accidents & Violence, Author Interviews, JAMA / 10.09.2015

Antti Latvala PhD Post-doctoral researcher Department of Public Health, University of Helsinki Helsinki, Finland MedicalResearch.com Interview with: Antti Latvala PhD Post-doctoral researcher Department of Public Health, University of Helsinki Helsinki, Finland   Medical Research: What is the background for this study? Dr. Latvala: Motivation for the study came from the fact that antisocial and aggressive behavior has been associated with lower resting heart rate in children and adolescents. Heart rate, being regulated by the autonomic nervous system, has been viewed as an indicator of stress responding or autonomic arousal, and the association has been hypothesized to indicate low levels of stress or a chronically low level of autonomic arousal in antisocial individuals. However, empirical evidence for such an association in adulthood has been very limited. Medical Research: What are the main findings? Dr. Latvala: We found that men with lower resting heart rate had an increased risk of violent and nonviolent criminality. Specifically, men in the lowest fifth of the heart rate distribution had an estimated 39% increased risk for violent criminality and a 25% increased risk for nonviolent crimes compared with men in the highest fifth. These are estimates after adjusting for physical, cardiovascular, cognitive and socioeconomic covariates. When we further adjusted for cardiorespiratory fitness, which was available in a subsample, the associations were even stronger. In addition to the crime outcomes, we found that low resting heart rate predicted exposure to assaults and accidents, such as traffic crashes, falls and poisonings, in a very similar fashion.
Author Interviews, HIV, Lancet, Sexual Health / 10.09.2015

Prof-Sheena-McCormack.jpgMedicalResearch.com Interview with: Professor Sheena McCormack Clinical Epidemiology Medical Research Council Clinical Trials Unit University College London Medical Research: What is the background for this study? What are the main findings? Prof. McCormack: PROUD is the first study of pre-exposure prophylaxis (PrEP) to prevent HIV carried out in the UK. The results show that PrEP could play a major role in reducing the number of new infections among men who have sex with men who are at risk of catching HIV. Pre-exposure prophylaxis (PrEP) is a HIV prevention strategy that involves HIV-negative people taking some of the drugs we use for treatment of HIV to reduce the risk of becoming infected. The PROUD study (www.proud.mrc.ac.uk) looked at whether offering daily PrEP to men who have sex with men was an effective way to prevent HIV infection. The results show that pre-exposure prophylaxis is highly protective, reducing the risk of infection for this group by 86%. The drug used in the trial – the antiretroviral Truvada – was already known to reduce the incidence of HIV infection compared to placebo (a dummy pill).  The PROUD study was designed to see how good Truvada would be found as pre-exposure prophylaxis in a real world situation when participants knew they were taking an active drug.  It aimed to address outstanding questions such as whether taking PrEP would change sexual risk behaviour – for example increasing the number of partners they did not use condoms with and increasing the rate of other sexually transmitted infections (STIs) – and whether or not it would be cost-effective to make it available on the NHS.
Author Interviews, JAMA, Surgical Research, Urology / 10.09.2015

MedicalResearch.com Interview with: Blayne Welk MD Assistant Professor in the Division of Urology The University of Western OntarioBlayne Welk MD Assistant Professor in the Division of Urology The University of Western Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Welk: Stress incontinence is a common problem among women. The most frequently used surgical treatment is a mesh-based midurethral sling. This procedure is commonly called a transvaginal sling, and is usually an outpatient procedure that takes about an hour in the operating room. However, there has been significant concern about some of the complications of this procedure, which include chronic pain, and mesh erosions into the urinary tract. This prompted the FDA and Health Canada to issue warnings regarding the use of transvaginal mesh, and numerous lawsuits have been launched against manufactures of transvaginal mesh products. This study by Dr Welk and colleagues identifies the long term rate of surgical treated complications among a group of almost 60,000 women who had mesh based incontinence procedures between 2002-2012. The rate of surgically treated complications at 1 year is 1.2%, however this increased to 3.3% after 10 years of followup. The FDA and Health Canada recommend that surgeons obtain training and experience in their chosen type of midurethral sling, and we demonstrated that patients of high volume surgeons (who frequently performed mesh based incontinence procedures) were 27% less likely to have one of these complications.
Addiction, Author Interviews, CMAJ, Mental Health Research / 09.09.2015

Dr. Evan Wood MD, PhD, ABIM, FRCPC, ABAM Diplomat Professor of Medicine, UBC Canada Research Chair in Inner City Medicine Co-Director, Urban Health Research Initiative Medical Director for Addiction Services, Vancouver Coastal Health Physician Program Director for Addiction, Providence Health CareMedicalResearch.com Interview with: Dr. Evan Wood MD, PhD, ABIM, FRCPC, ABAM Diplomat Professor of Medicine, UBC Canada Research Chair in Inner City Medicine Co-Director, Urban Health Research Initiative Medical Director for Addiction Services, Vancouver Coastal Health Physician Program Director for Addiction Providence Health Care  Medical Research: What is the background for this study? What are the main findings? Dr. Wood: Drugs with the potential to produce altered states of consciousness were once the focus of intensive study in the 1950s and 1960s. While promising, this field of research has been dormant for decades but is now re-emerging as an area of intensive investigation and showing real potential as a new therapeutic paradigm in addiction medicine and mental health. While in its infancy, this is expected to be an area of much study in the coming years. Medical Research: What should clinicians and patients take away from your report? Dr. Wood: Psychedelic medicine is in its infancy and not ready for implementation in clinical practice. Clinicians and the community of individuals suffering from addiction and other concerns will hopefully support this area of research so that critical information on impacts and safety can be gathered.
Author Interviews, Diabetes, JAMA / 09.09.2015

Dr. Andy Menke PhD Social & Scientific Systems Inc Silver Spring, MD 20910MedicalResearch.com Interview with: Dr. Andy Menke PhD Social & Scientific Systems Inc Silver Spring, MD 20910 Medical Research: What is the background for this study? What are the main findings? Dr. Menke: Previous studies have shown an increase in diabetes over time. We wanted to use the most recent data available to estimate the prevalence and trends in diabetes in the US population. We found that 14% of US adults had diabetes and the prevalence was higher in blacks, Hispanics, and Asians. About 1 in 3 people with diabetes were unaware that they had the condition and this was even higher in Asians and Hispanics where half were unaware that they had it. Also, among US adults, 1 in 3 people have prediabetes, which means that roughly half of all US adults have either diabetes or prediabetes. Between 1988-1994 and 2011-2012, diabetes prevalence increased by 25% among adults in the US population. The increase over time occurred in every age group, race group, and both genders.
Author Interviews, Heart Disease, JACC, NYU/NYMC / 08.09.2015

MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.Dr.Sripal Bangalore MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016, Principal Investigator ISCHEMIA-CKD trial  Medical Research: What is the background for this study? What are the main findings? Dr. Bangalore: Patients with chronic kidney disease are at high risk of coronary artery disease. However, they are also at risk for worsening kidney function from revascularization procedures and have been routinely excluded from clinical trials of stenting vs bypass surgery. In this registry study of over 5900 patients with multivessel coronary artery disease who underwent bypass surgery or stenting using the latest generation drug eluting stent (everolimus eluting stent), we showed that there are trade off between both procedures. With bypass surgery there was increase in the risk of death, myocardial infarction and stroke in the short term (in-hospital/30-days). For PCI, there was long term risk of repeat revascularization and also increase in myocardial infarction in those who achieved incomplete revascularization.
Author Interviews, Infections, JAMA, OBGYNE / 08.09.2015

Dr. Martin N. Mwangi Researcher Division of Human Nutrition, Nutrition and Health over the lifecourse International Nutrition Unit Wageningen University The Netherlands MedicalResearch.com Interview with: Dr. Martin N. Mwangi Researcher Division of Human Nutrition, Nutrition and Health over the lifecourse International Nutrition Unit Wageningen University The Netherlands   Medical Research: What is the background for this study? Dr. Mwangi : Anemia in pregnancy is a moderate or severe health problem in more than 80 percent of countries worldwide, but particularly in Africa, where it affects 57 percent of pregnant women. Iron deficiency is the most common cause, but iron supplementation during pregnancy has uncertain health benefits. There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria. Our main objective was to measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes. We randomly assigned 470 pregnant Kenyan women living in a malaria endemic area to daily supplementation with 60 mg of iron (n = 237 women) or placebo (n = 233) until 1 month postpartum. All women received 5.7 mg iron/day through flour fortification during intervention and usual intermittent preventive treatment against malaria. Medical Research: What are the main findings? Dr. Mwangi : Overall, we found no effect of daily iron supplementation during pregnancy on risk of maternal Plasmodium infection. Iron supplementation resulted in an increased birth weight [5.3 ounces], gestational duration, and neonatal length; enhanced maternal and infant iron stores at 1 month after birth; and a decreased risk of low birth weight (by 58 percent) and prematurity. The effect on birth weight was influenced by initial maternal iron status. Correction of maternal iron deficiency led to an increase in birth weight by [8.4 ounces].
Author Interviews, C. difficile, JAMA, UC Davis / 08.09.2015

Christopher R. Polage, M. D. Associate Professor of Pathology and Infectious Diseases University of California, Davis School of Medicine Medical Director, Microbiology Laboratory and SARC UC Davis Health System MedicalResearch.com Interview with: Christopher R. Polage, M. D. Associate Professor of Pathology and Infectious Diseases University of California, Davis School of Medicine Medical Director, Microbiology Laboratory and SARC UC Davis Health System   Medical Research: What is the background for this study? Dr. Polage: Clostridium difficile is a frequent cause of diarrhea and infection in U.S. hospitals but common diagnostic tests often disagree about which patients are infected or need treatment. We compared clinical symptoms and outcomes in hospitalized patients with different C. difficile test results to determine which type of test (molecular or PCR test versus toxin test) was the better predictor of need for treatment and disease. Medical Research: What are the main findings? Dr. Polage: Twice as many patients were positive by the molecular test versus the conventional toxin test. However, patients with a positive molecular test only had a shorter duration of symptoms than patients with toxins, and outcomes that were similar to patients withoutC. difficile by all test methods. Virtually all traditional complications of C. difficile infection occurred in patients with a positive toxin test; none occurred in patients with a positive molecular test only, despite little or no treatment.
Author Interviews, Cost of Health Care, JAMA / 08.09.2015

James C. Robinson PhD MPH Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Head, Division of Health Policy & Management School of Public Health, University of California– Berkeley University Hall, Berkeley, CA MedicalResearch.com Interview with: James C. Robinson PhD MPH Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Head, Division of Health Policy & Management School of Public Health, University of California– Berkeley University Hall, Berkeley, CA   Medical Research: What is the background for this study? What are the main findings? Dr. Robinson: Employers and insurers face wide variation in the prices of similar tests and procedures within the same local communities, resulting from the indifference to price on the part of well-insured patients.  They are raising deductibles to increase price sensitivity, but deductibles mostly target low-cost primary care services whereas their concerns often center on high-cost specialty and facility services.  Some are adopting reference pricing, which sets a maximum insurer contribution for a particular type of test or procedure and then requires consumers selecting more expensive options to pay the difference themselves.  The insurers contribution limit typically is set at the median or other midpoint in the market distribution of prices. We studied the implementation of reference pricing for colonoscopy, using data from the California Public Employees Retirement System (CalPERS) from 2009-13, with a control group from Blue Cross of California.  Our data include detailed claims from almost 300,000 colonoscopy procedures and patients.  We find that patients who must pay the extra fees themselves are much more likely to select cheaper ambulatory facilities for their colonoscopies, compared to consumers who do not face reference pricing.  This leads to lower prices being paid by the employer and significant savings.  Detailed analyses of gastroenterological and cardiovascular complications of the colonoscopy procedures found no adverse effect of reference pricing on quality.
Author Interviews, CHEST, Occupational Health, Pulmonary Disease / 08.09.2015

MedicalResearch.com Interview with: Metin Akgun, MD, FCCP Department of Pulmonary Medicine Atatürk University, Faculty of Medicine Erzurum, Turkey Medical Research: What is the background for this study? What are the main findings? Dr. Akgun: The first cases of silicosis due to denim sandblasting were reported in 2005. In 2007, we evaluated 145 former male denim sandblasters who had an exposure history to at least 1 month with a latency period at least ten months; 77 (53%) were diagnosed as silicosis according to the profusion category of opacities of 1/0 or greater. In this study, we reported 4-year follow-up results of this cohort. Out of 83 sandblasters who were evaluated in this follow-up study, nine died and of the remaining 74, 96% had radiographic evidence of silicosis based on the same criteria and 66% had pulmonary function loss, which was defined as at least 12% or more decrease on FVC, predicted.
Author Interviews, Dermatology, JAMA, Melanoma / 03.09.2015

Simone Ribero, M.D., Ph.D. University of Turin Department of Medical Sciences Turin Italy and King’s College London Department of Twin Research and Genetic Epidemiology St Thomas’ campus London, UKMedicalResearch.com Interview with: Simone Ribero,  M.D., Ph.D.  University of Turin Department of Medical Sciences Turin Italy and King’s College London Department of Twin Research and Genetic Epidemiology St Thomas’ campus London, UK Medical Research: What is the background for this study? What are the main findings? Response: The histologic regression is a discussed feature and its prognostic role is debated in literature. Our group has previously described a favorable prognostic role of histological regression in stage I-II melanoma patients. Some clinicians still perform Sentinel Lymph Node biopsy on the basis of regression in thin melanoma considering this feature as able to underestimate Breslow Thickness. In this study we described in a metanalyses with more then 10000 melanoma patients that histological regression is inversely associated with Sentinel Lymph Node positivity.
Author Interviews, BMJ, Depression, Nutrition / 03.09.2015

Dr. Mila Kingsbury PhD Senior Research Associate at Department of Epidemiology and Community Medicine University of Ottawa MedicalResearch.com Interview with: Dr. Mila Kingsbury PhD Senior Research Associate at Department of Epidemiology and Community Medicine University of Ottawa   Medical Research: What is the background for this study? Dr. Kingsbury: Eating a healthy diet, including enough fruits and vegetables, is good for physical health, and some evidence suggests that it may be good for mental health, too. Specifically, intake of fruits and vegetables has been associated with lower risk of depression. However, there are very few longitudinal studies on this topic. Most studies haven’t accounted for the effects of other related lifestyle factors such as smoking and exercise, nor for the fact that the links between lifestyle and mental health are bidirectional (i.e., depression can also hinder our ability to engage in healthy behaviours). Medical Research: What are the main findings? Dr. Kingsbury: While we found an association between fruit and vegetable consumption and psychological distress and depression two years later, depression and distress also predicted future fruit and vegetable consumption. Importantly, these associations became non-significant when we controlled for lifestyle factors like smoking and exercise.
Author Interviews, CDC, HIV, JAMA / 02.09.2015

Dr. John Weiser MD MPH Medical epidemiologist Division of HIV/AIDS Prevention CDC MedicalResearch.com Interview with: Dr. John Weiser MD MPH Medical epidemiologist Division of HIV/AIDS Prevention CDC  Medical Research: What is the background for this study? What are the main findings? Dr. Weiser: Ryan White was an Indiana teenager diagnosed with AIDS in the late 1980s. As a result of fear and stigma, he was barred from school and went on to become a national advocate for HIV education and acceptance. This year marks the 25th anniversary of his death and passage of the Ryan White CARE Act creating The Ryan White HIV/AIDS Program (RWHAP) which provides funding for healthcare facilities to deliver needed medical care and support services for hundreds of thousands of poor, uninsured, and underinsured Americans. While increased access to Medicaid and private insurance under the Affordable Care Act will provide coverage for medical care, it might not provide coverage for support services so it is likely that the RWHAP will continue to play a key role in providing these crucial services. Overall, 34.4 percent of facilities received Ryan White HIV/AIDS Program funding and 72.8 percent of patients received care at RWHAP-funded facilities. Many of the patients at Ryan White HIV/AIDS Program -funded facilities had multiple social determinants of poor health, with patients at RWHAP-funded facilities more likely to be ages 18 to 29; female; black or Hispanic; have less than a high school education; income at or below the poverty level; and lack health care coverage. Despite the greater likelihood of poverty, unstable housing and lack of health care coverage, nearly 75 percent of patients receiving care at RWHAP-funded facilities achieved viral suppression. The percentage of ART (antiretroviral therapy) prescribing was similar for patients at RWHAP-funded compared with non-funded facilities. Patients at RWHAP-funded facilities were less likely to be virally suppressed. However, individuals at or below the poverty level and those ages 30 to 39 who received care at a RWHAP-funded facility compared with those who received care at a non-RWHAP-funded facility were more likely to achieve viral suppression.
Annals Thoracic Surgery, Author Interviews, Heart Disease, Outcomes & Safety / 02.09.2015

Dr. Ansar Hassan MD PhD Department of Cardiac Surgery New Brunswick Heart Centre Saint John Regional Hospital Saint John, New BrunswicMedicalResearch.com Interview with: Dr. Ansar Hassan MD PhD Department of Cardiac Surgery New Brunswick Heart Centre Saint John Regional Hospital Saint John, New Brunswick Medical Research: What is the background for this study? What are the main findings? Dr. Hassan: For years, geographic place of residence and one’s proximity to a tertiary care center has been identified as a predictor for access to care.   Little is known regarding the effect of geography on patient outcomes.   The purpose of this study was to explore the relationship between geography and in-hospital / 30-day outcomes among patients undergoing cardiac surgery.  What we found was that despite there being no relationship between geography and in-hospital outcomes, those who lived further away from hospital clearly had worse 30-day outcomes. Medical Research: What should clinicians and patients take away from your report? Dr. Hassan: While patients from a differing geographic places of residence appear to have similar in-hospital outcomes following cardiac surgery, their clinical courses following discharge from hospital differ considerably.   Clinicians and patients need to realize that where one lives is tremendously important as it relates to his or her health and that particular attention needs to be paid to cardiac surgery patients who live further away from their tertiary care center, especially within the first 30 days following surgery.
Accidents & Violence, Author Interviews, JAMA, UCSF / 02.09.2015

Benjamin N. Breyer MD, MAS, FACS Associate Professor in Residence Department of Urology University of California, San Francisco Chief of Urology, San Francisco General Hospital Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship MedicalResearch.com Interview with: Benjamin N. Breyer MD, MAS, FACS Associate Professor in Residence Department of Urology University of California, San Francisco Chief of Urology, San Francisco General Hospital Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship   Medical Research: What is the background for this study? What are the main findings? Dr. Breyer: Our group has studied genitourinary-specific injuries associated with bicycles using a national surveillance injury database called NEISS (National Electronic Injury Surveillance System), that monitors injuries associated with specific products.  In the current study, we examined trends in all bicycle-related injuries from  1997 to 2013.  We found an increase in bicycle-related injuries over the study period, even after adjusting for growth in the US population.  Even more concerning, we found the percentage of bicycle-related injuries resulting in admission increased 120%, suggesting the injuries sustained while cycling are becoming more severe.  These trends appear to be driven by a substantial rise in both injuries and admissions in individuals over 45 years of age, which likely reflects a change in the demographic of cyclists in the US - multiple studies have shown an increase in the cycling participation of adults over the age of 45. Bicycles are no longer children's toys - they are increasingly being used by adults as a means of transportation and physical activity. The rise in cycling in adults over the age 45 appears to be driving both the increase in injuries and admissions, suggesting that older individuals are at increased risk for sustaining severe injury while cycling.
Author Interviews, Diabetes, JAMA, Kidney Disease / 01.09.2015

George L. Bakris MD Professor of Medicine Director, Comprehensive Hypertension Center University of Chicago MedicineMedicalResearch.com Interview with: George L. Bakris MD Professor of Medicine Director, Comprehensive Hypertension Center University of Chicago Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Bakris: Aldosterone receptor antagonists such as spironolactone are known to reduce mortality from heart failure and reduce albuminuria, a well-known marker of diabetic kidney disease progression. Finerenone is a novel nonsteroidal aldosterone receptor antagonist and is associated with less hyperkalemia (high blood potassium levels) compared to traditional aldosterone receptor blockers like spironolactone. The current study was a dose finding study to ascertain the optimal dose of finerenone for reducing urine albumin (a key risk marker in people with diabetic kidney disease) that is also associated with the smallest rise in serum potassium. The main findings are that in a dose dependent manner finerenone reduced albuminuria and at the highest dose a modest rise in serum potassium. Finerenone was also very well tolerated. 
Author Interviews, Endocrinology, JCEM, Menopause, Mineral Metabolism / 01.09.2015

MedicalResearch.com Interview with: Emily Krantz (né Amundson) MD Södra Älvsborgs Hospital Borås, Sweden Medical Research: What is the background for this study? What are the main findings? Response: This study is a 10-year follow up of a double-blind placebo controlled trial in which women with post menopausal osteoporosis received Growth Hormone (GH) for 3 years (Landin-Wilhelmsen JBMR 2003;18:393-404). Positive effects of the treatment on the patients bone mineral density and bone mineral content were seen after another 7 years. Furthermore and most interestingly, fracture incidence decreased dramatically from 56% to 28% (p=.0003) in the osteoporosis patients while fractures increased significantly in the control group, from 8% to 32% (p=.0008). Health Related Quality of Life was also measured throughout the study’s duration and it did not change nor did it differ from the control group.
Author Interviews, Heart Disease, JAMA, Thromboembolism / 01.09.2015

Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg DenmarkMedicalResearch.com Interview with: Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg Denmark Medical Research: What is the background for this study? What are the main findings? Response: In recent years, use of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death has extended beyond the original disease state (atrial fibrillation) for which it was proposed. In addition, it is recognized that the cluster of multiple stroke risk factors included within the CHA2DS2-VASc score increases the risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation is present. Thus, there is a need to study the extent to which concomitant atrial fibrillation modifies the pattern of the association between CHA2DS2-VASc score and the risk of ischemic stroke, thromboembolism, and death in patients with heart failure.
  • Our principal findings were that patients with heart failure had a high risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation was present.
  • Second, the CHA2DS2-VASc score was able to modestly predict these endpoints, and had a moderately high negative predictive value at 1-year follow-up.
  • Third, at high CHA2DS2-VASc scores (≥4), patients with heart failure without atrial fibrillation had high absolute risk of ischemic stroke, thromboembolism, and death, and the absolute risk increased in a comparable manner in patients with heart failure with and without atrial fibrillation, exhibiting a clear dose-response relationship. Indeed, the absolute risk of thromboembolic complications was higher among patients without atrial fibrillation compared to patients with concomitant atrial fibrillation at high CHA2DS2-VASc score (≥4).
Author Interviews, JAMA, Multiple Sclerosis, OBGYNE / 01.09.2015

PD Dr. Kerstin Hellwig Neurologische Abteilung Universitätsklinikum St. Josef Hospital BochumMedicalResearch.com Interview with: PD Dr. Kerstin Hellwig Neurologische Abteilung Universitätsklinikum St. Josef Hospital Bochum Medical Research: What is the background for this study? What are the main findings? Dr. Hellwig: The relapse risk is elevated in women with Multiple Sclerosis after delivery. We found that women with Multiple Sclerosis who breastfed exclusively had a significant lower relapse risk, than women who did not breastfed at all or breastfed some but not exclusively. After the introduction of supplemental feedings, the relase risk was similar between both groups.
Author Interviews, BMJ, Nutrition, Weight Research / 28.08.2015

Dr Aseem Malhotra MBChB, MRCP Honorary Consultant Cardiologist - Frimley Park Hospital Consultant Clinical Associate to the Academy of Medical Royal Colleges Science Director- Action on Sugar Saving Londoners Lives - External Advisory Board MemberMedicalResearch.com Interview with: Dr Aseem Malhotra MBChB, MRCP Honorary Consultant Cardiologist - Frimley Park Hospital Consultant Clinical Associate to the Academy of Medical Royal Colleges Science Director- Action on Sugar Saving Londoners Lives - External Advisory Board Member   Medical Research: What is the background for this study? What are the main findings? Dr. Malhotra: It is a review of all the research up to date on what is the impact of diet on health. What type of diet has the most robust evidence for weight and health and how this can be translated into policy to rapidly reduce the burden of chronic disease. Medical Research: What should clinicians and patients take away from your report? Dr. Malhotra:
  • That "low fat" diets to do not improve health outcomes and the public should stop counting calories.
  • That a high fat Mediterranean diet is more powerful in reducing the risk of heart attack and stroke than any medical treatment.
  • That it's effect is independent of cholesterol lowering.
  • That rapid weight loss through calorie counting combined with exercise doesn't only not improve health outcomes in the long term for diabetics but can also be potentially harmful by increasing CVD risk.
Author Interviews, PLoS, Vaccine Studies / 28.08.2015

Dr Javier Martin PhD Principal Scientist Division of Virology National Institute for Biological Standards and Control (NIBSC) Medicines and Healthcare products Regulatory Agency (MHRA) Blanche Lane, South Mimms, Potters Bar United KingdomMedicalResearch.com Interview with: Dr Javier Martin PhD Principal Scientist Division of Virology National Institute for Biological Standards and Control (NIBSC) Medicines and Healthcare products Regulatory Agency (MHRA) United Kingdom Medical Research: What is the background for this study? Dr. Martin: The global eradication of polio appears to be within reach.  There has been no case of poliomyelitis caused by circulating wild type 2 poliovirus since 1999, no case of type 3 since November 2012 and the last case of type 1 in Africa was in August 2014, leaving some areas of Pakistan and Afghanistan as the main remaining reservoirs of circulating wild type 1 poliovirus. Poliovirus strains in the live-attenuated oral polio vaccine (OPV) are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation. These vaccine-derived poliovirus (VDPV) strains can transmit from person to person in populations with low immunity potentially leading to poliomyelitis outbreaks.
Author Interviews, Breast Cancer, Duke, Genetic Research, JAMA / 27.08.2015

Michaela Ann Dinan Ph.D. Assistant Professor in Medicine Member of Duke Cancer Institute Duke University School of MedicinMedicalResearch.com Interview with: Michaela Ann Dinan Ph.D. Assistant Professor in Medicine Member of Duke Cancer Institute Duke University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Dinan: For many years we have known that overall, women with early stage, hormone receptor positive breast cancer show an overall survival benefit from the receipt of adjuvant chemotherapy.  However, depending on the age of the patient, we have also known that between 3 to 10% of patients appear to be truly experiencing this survival benefit and that we are treating a lot of women unnecessarily.  The use of the Oncotype DX assay has provided additional information for patients to assess who at low risk of disease progression and can forgo chemotherapy. In this study we looked to see whether the adoption of this assay was associated with reduce rates of chemotherapy in women over the age of 65.  We found that somewhat surprisingly, there was no overall association with receipt of the assay and use of chemotherapy.  However, in women who had high risk disease, receipt of the assay was associated with reduced rates of chemotherapy use.  In patients with low risk disease, receipt of the assay was associated with increased chemotherapy use.
Author Interviews, Heart Disease, JAMA / 27.08.2015

Jay R. Desai, PhD, MPH HealthPartners Institute for Education and Research Minneapolis, MN 55425MedicalResearch.com Interview with: Jay R. Desai, PhD, MPH HealthPartners Institute for Education and Research Minneapolis, MN 55425 Medical Research: What is the background for this study? What are the main findings? Dr. Desai: SUPREME-DM is a consortium of 11 integrated health systems throughout the United States that serve a culturally and economically diverse population of 16 million members. This study monitors changes in cardiovascular outcomes from 2005 through 2011 among the 1.2 million members identified with diabetes and a matched sample of 1.2 million members without diabetes. We found very encouraging and sustained declines in the rates of myocardial infarction/acute coronary syndrome (MI), stroke, heart failure (HF), and all-cause mortality among adults with and without diabetes.   Declines were greatest among the 15% adults who were already at high risk for cardiovascular events (such as people with diabetes or a prior history of heart disease). There was less improvement in cardiovascular event rates and mortality among the other 85% of members with low to moderate cardiovascular risk.
Author Interviews, JAMA, Social Issues / 26.08.2015

Adi V. Gundlapalli, MD, PhD Associate Professor of Internal Medicine University of Utah School of Medicine and University of Utah Hospitals and ClinicsInformatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System, Salt Lake City, Utah MedicalResearch.com Interview with: Adi V. Gundlapalli, MD, PhD Associate Professor of Internal Medicine University of Utah School of Medicine and University of Utah Hospitals and ClinicsInformatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System, Salt Lake City, Utah   Medical Research: What is the background for this study? What are the main findings? Dr. Gundlapalli: We wanted to explore the hypothesis that those separated for misconduct-related reasons would have more difficulty reintegrating into their communities post-deployment, with homelessness as an extreme example of such difficulties. Misconduct-related separations from the military are associated with subsequent adverse civilian outcomes that are of substantial public health concern. This study analyzed the association between misconduct-related separations and homelessness among recently returned active-duty military service members. Using US Department of Veterans Affairs (VA) data, investigators identified 448,290 Veterans who were separated from the military (end date of last deployment) between October 1, 2001 and December 31, 2011; had been deployed to Iraq and/or Afghanistan; and had subsequently used VA healthcare. Homelessness was determined by an assignment of “lack of housing” during a VA healthcare visit, by participation in a VA homelessness program, or both. Veterans’ housing status was followed through April 30, 2012. We assessed risk for homelessness as a function of separation category (e.g., normal, misconduct, early release), controlling for patient demographics and military service covariates, including service-related disability, branch, rank, and combat exposure. In our opinion, the most significant finding was that 26% of Veterans who were separated for misconduct related reasons were homeless at their first VA encounter; and this number climbed to 28% within one year after their first VA encounter. Additionally, the likelihood of being homeless at the first VA encounter was nearly 5 times greater for those separated for misconduct-related reasons as compared to normal separations; this climbed to nearly 7 times greater at one year after the first VA encounter. Collectively, these results represent the strongest risk factor for homelessness among US Veterans observed to date, and helps to explain the higher risk of homelessness observed among Veterans, despite access to VA benefits and services.
Author Interviews, BMJ, Outcomes & Safety / 26.08.2015

Alicia A. Bergman, Ph.D. Research Health Scientist VA Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation & Policy North Hills, CA 91343MedicalResearch.com Interview with: Alicia A. Bergman, Ph.D. Research Health Scientist VA Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation & Policy North Hills, CA 91343  Medical Research: What is the background for this study? What are the main findings? Dr. Bergman: The impetus for this study comes from several sources but most notably the IOM report of 2002 entitled, Crossing the Quality Chasm in which the IOM estimated that between 44,000 and 98,000 lives are lost each year due to preventable medical errors in the hospital.  The IOM further reported that 80% of all adverse outcomes in the hospital can be traced back to breakdowns in communication during handoffs and transfers of care.  A 2005 study by our VA research team found that only 7% of medical schools in the US teach the handoff as part of the formal curriculum. As such, handoffs represent a vulnerable gap in the quality and safety of patient care. We were interested to know how end of shift handoffs in medicine, nursing, and surgery were enacted and audio and videotaped them in a single VA hospital. We found that there was a great deal of variation in how the handoffs were conducted and similar variations in the ways in which language was used to characterize technical and interpersonal aspects of care. We were especially interested in what we term “anticipatory management communication” and its functions during handoffs. While much technical information can easily be conveyed in the electronic medical record, some types of psychological or social information that are more informal in nature, such as “Mr. Smith’s been our problem child today,” do not lend themselves to being transmitted in the electronic medical record. However, such ‘heads up’ information and communication is often critical to understanding a patient’s context, course, and outcome of care. We also found that indirect anticipatory management communication was used among all dyads but more commonly among nurse dyads, with instructions and tasks implied and often inferential. We conclude that contextually sensitive information about anticipated events is best communicated directly (and ideally face-to-face), and that talk-backs and more explicit use of language can improve handoff quality, making them safer for patients.
Alzheimer's - Dementia, Author Interviews, JAMA / 26.08.2015

Dr. Eric Reiman MD Executive Director, Banner Alzheimer’s Institute (BAI) Chief Executive Officer, Banner Research, Clinical Director of the Neurogenomics Division at the Translational Genomics Research Institute (TGen) Professor of Psychiatry, University of Arizona Director, Arizona Alzheimer’s ConsortiumMedicalResearch.com Interview with: Dr. Eric Reiman MD Executive Director, Banner Alzheimer’s Institute (BAI) Chief Executive Officer, Banner Research Clinical Director of the Neurogenomics Division at the Translational Genomics Research Institute (TGen) Professor of Psychiatry, University of Arizona Director, Arizona Alzheimer’s Consortium Phoenix Arizona   Medical Research: What is the background for this study? What are the main findings? Dr. Reiman: Beta-amyloid plaque deposition is a cardinal feature of Alzheimer’s disease. Recent positron emission tomography (PET) have suggested that about one-fourth of patients with the clinical diagnosis of mild-to-moderate Alzheimer’s dementia—and more than a third of those who had no copies of the APOE4 gene, the major genetic risk factor for Alzheimer’s—do not have appreciable amyloid plaque deposition. We wondered whether this finding reflected an absence of appreciable brain amyloid, particularly in APOE4 non-carriers, or instead an underestimation of amyloid plaques using PET. In those patients with minimal plaque deposition, we also wondered what percentages had neuropathological evidence of another dementia-causing disease, neurofibrillary tangle pathology (the other cardinal feature of Alzheimer’s, or no known pathological contribution. We surveyed data from the 100 APOE4 non-carriers and 100 APOE4 carriers who had the clinical diagnosis of mild-to-moderate Alzheimer’s dementia during their last visit at any of the nation’s Alzheimer’s Disease Centers and had an autopsy performed within the next 2 years. As we reported in JAMA Neurology, 37 percent of APOE4 non-carriers and 13 percent of APOE4 carriers with a clinical diagnosis of mild-to-moderate Alzheimer’s had minimal evidence of neuritic or diffuse amyloid plaques—and those for whom we had brain samples had no evidence of increased soluble amyloid. A proportion of individuals had a different neuropathological diagnosis. While nearly half of those patients with minimal amyloid or any other pathology had extensive tangle formation, a similar percentage was found in cognitively unimpaired persons in the same age range. Our findings suggest the PET findings are correct – that a quarter of all patients (and more than a third of APOE4 non-carriers) with the clinical diagnosis of Alzheimer’s dementia do not have appreciable amyloid pathology, and that about 10 to 15 percent of patients do not have a clear explanation for their dementia.
Author Interviews, Chemotherapy, Journal Clinical Oncology / 25.08.2015

Anna Lin, MBA, PHD Senior Epidemiologist, Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303MedicalResearch.com Interview with: Anna Lin, MBA, PHD Senior Epidemiologist, Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 Medical Research: What is the background for this study? Dr. Lin: Evidence-based guidelines recommend the use of adjuvant chemotherapy in patients with Stage III colon cancer within 90 days of colectomy to improve disease-free and overall survival; however, a substantial proportion of patients do not receive this treatment.  Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. Medical Research: What are the main findings? Dr. Lin: The main findings of this study indicate that patients traveling more than 50 miles were less likely to receive adjuvant chemotherapy for Stage III node-positive colon cancer.  In addition, patients who had either no insurance or public (non-private) insurance and resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy.
Annals Internal Medicine, Author Interviews, Colon Cancer / 25.08.2015

Søren Friis, Senior Scientist, Associate Professor, MD Danish Cancer Society Research Center Danish Cancer Society Department of Public Health University of Copenhagen Faculty of Health Institute of Clinical Medicine Department of Clinical Epidemiology Aarhus University DenmarkMedicalResearch.com Interview with: Søren Friis, Senior Scientist, Associate Professor, MD Danish Cancer Society Research Center Danish Cancer Society Department of Public Health University of Copenhagen Faculty of Health Institute of Clinical Medicine Department of Clinical Epidemiology Aarhus University Denmark Medical Research: What is the background for this study? Dr. Friis: Although laboratory, clinical, and epidemiological studies have all provided strong evidence for protection against colorectal cancer from regular use of aspirin, the optimal dose and duration of use for cancer prevention remain to be established. Medical Research: What are the main findings? Dr. Friis: Continuous use of low-dose aspirin for five or more years was associated with a reduced risk of colorectal cancer, but overall long-term use (continuous or non-continuous) was not. Long-term, high-intensity use (average of ≥0.3 daily doses) of non-aspirin NSAIDs was associated with a substantially reduced risk of colorectal cancer, particularly for NSAIDs with the highest COX-2 selectivity. The results for long-term continuous users of low-dose aspirin should be interpreted cautiously, since these patients comprised only a small proportion of the low-dose aspirin users and might have a risk profile different from that of the general population.