Aging, Author Interviews, FASEB / 11.12.2014

MedicalResearch.com Interview with: Jane Tarry-Adkins BSc Biochemistry Research Assistant University of Cambridge · Institute of Metabolic Science

Medical Research: What is the background for this study? What are the main findings? Response: From epidemiological and animal studies, it has been known for several years that a suboptimal in utero environment that causes low birth weight combined with accelerated postnatal growth is strongly linked to increased risk of cardiovascular disease (CVD). However underlying molecular mechanisms for this phenomenon, known as ‘developmental programming’ are still unknown. In this study, we used a rat model where animals are born small because their mother ate a low protein diet during pregnancy but grow quickly during lactation when they are suckled by a control diet fed mum. These ‘recuperated’ rats displayed indices of accelerated aortic cellular aging and damage which was associated with a deficit in coenzyme Q (CoQ); (the most abundant endogenous antioxidant in the body), compared to offspring of a normal birth-weight. When these ‘recuperated’ offspring were supplemented with a clinically relevant dose of coenzyme Q, this corrected these markers of aortic cellular aging and aortic damage. Importantly, measurement of CoQ in white blood cells (WBCs) a clinically accessible tissue demonstrated a coenzyme Q deficit in these ‘recuperated’ offspring. Importantly, this strongly correlated with aortic CoQ levels. Furthermore, we also showed a highly significant relationship between CoQ levels and aortic telomere length in WBCs, suggesting that low WBC CoQ levels can predict short aortic telomeres, and therefore susceptibility to aortic disease. (more…)
Author Interviews, PLoS, Weight Research / 11.12.2014

MedicalResearch.com Interview with: Peter Würtz, PhD, Docent Head of Molecular Epidemiology, Computational Medicine, Institute of Health Sciences, University of Oulu, Finland

Medical Research: What is the background for this study? What are the main findings? Dr. Würtz: Obesity is linked with unfavorable cholesterol and blood sugar levels, but the fine-grained metabolic consequences of excess body weight remain unclear. We used a novel profiling technology developed in our research group to examine the metabolic consequences of excess body weight. We profiled over 12,000 healthy young volunteers from the general population to determine the detailed metabolic effects of having higher BMI (body mass index). We found that higher BMI is causing adverse metabolic changes in the blood levels of many amino acids and lipids, as well as an altered balance of omega-fatty acids and sex hormones. These measures have been linked with higher risk for developing heart disease and type 2 diabetes. Importantly, the metabolic deviations were not limited to obese individuals, but were observed in a continuous manner including for those who are lean or overweight. In other words, the metabolic profile becomes more adverse for any increase in BMI, with no threshold below which an increase in BMI would not affect the cardiometabolic risk profile. Genetic information was used to demonstrate that the metabolic effects are actually caused by having higher BMI. On the positive side, even a modest weight loss helped to diminish the adverse metabolic influences of excess body fat. (more…)
Author Interviews, Hepatitis - Liver Disease, JAMA, University of Pittsburgh / 11.12.2014

Adeel A. Butt, MD, MS, FACP, FIDSA Vice Chair for Faculty Affairs Department of Medicine Hamad Medical Corporation, Doha, Qatar Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of MedicineMedicalResearch.com Interview with: Adeel A. Butt, MD, MS, FACP, FIDSA Vice Chair for Faculty Affairs Department of Medicine Hamad Medical Corporation, Doha, Qatar Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Butt: Precise rate of progression of liver disease in Hepatitis C (HCV) infection is unknown because the precise time of infection with HCV is seldom known. Knowledge of liver disease progression is critical to determine the optimal time for treatment. We found that progression of liver disease starts early after acquiring HCV infection. This is more rapid than was previously thought. About 18% of HCV infected persons develop cirrhosis within 10 years of acquiring HCV infection, which is 3-fold higher than demographically similar HCV uninfected persons. (more…)
Author Interviews, Heart Disease, Lipids, PLoS / 11.12.2014

MedicalResearch.com Interview with: Prof. Erik Ingelsson, MD, PhD, FAHA Professor of Molecular Epidemiology and Andrea Ganna PhD student Uppsala University Medical Research: What is the background for this study? What are the main findings? Response: Coronary heart disease (CHD) comprises a major cause of morbidity and mortality throughout the world. Measurement of metabolites, small molecules, in the blood could allow earlier diagnosis and inform about mechanisms leading to CHD. We examined the metabolic profiles (including thousands of metabolites) of blood samples from more than 3,600 individuals from Sweden that had been followed-up for up to 10 years, and found two lipid-related metabolites, lysophosphatidylcholine and sphingomyelin that reduced the risk of developing coronary heart disease and another lipid metabolite, monoglycerides, that was instead associated with increased risk. (more…)
Author Interviews, Case Western, Education, JAMA, Surgical Research / 10.12.2014

Ravi Rajaram MD Division of Research and Optimal Patient Care, American College of Surgeons Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies in the Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with: Ravi Rajaram MD Division of Research and Optimal Patient Care, American College of Surgeons Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies in the Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Rajaram: The Accreditation Council for Graduate Medication Education (ACGME) first implemented restrictions to resident duty hours in 2003. In surgical populations, these reforms have not been associated with a change in patient outcomes. However, in 2011, the ACGME further restricted resident duty hours to include: a maximum of 16 hours of continuous duty for first-year residents (interns), direct supervision of interns at all times, a maximum of 4 hours for transitions in care activities for residents in-house for 24 hours, and that these residents be given 14 hours off prior to returning to work. The association between the 2011 ACGME resident duty hour reform with surgical patient outcomes and resident education has not previously been reported. The 2011 resident duty hour reform was not associated with a change in death or serious morbidity in the two years after the reform was implemented. Additionally, the 2011 duty hour reform was not associated with a change in any of the secondary outcomes examined, including any morbidity, failure to rescue, surgical site infection, and sepsis. Furthermore, common measures of surgical resident education, such as in-training examination scores and board certification pass rates, were unchanged after the implementation of the 2011 duty hour reform when compared to scores prior to the reform. (more…)
Author Interviews, Education, JAMA / 10.12.2014

Lisa Diamond, MD, MPH, FACP | Assistant Attending Memorial Sloan-Kettering Cancer Center Immigrant Health and Cancer Disparities Service Department of Psychiatry & Behavioral Sciences | Department of Medicine Evelyn Lauder Breast Center New York, NY 10065MedicalResearch.com Interview with: Lisa Diamond, MD, MPH, FACP | Assistant Attending Memorial Sloan-Kettering Cancer Center Immigrant Health and Cancer Disparities Service Department of Psychiatry & Behavioral Sciences | Department of Medicine Evelyn Lauder Breast Center New York, NY 10065 Medical Research: What is the background for this study? What are the main findings? Dr. Diamond: More than 25 million U.S. residents have limited English proficiency, an 80 percent increase from 1990 to 2010. Limited English proficiency (LEP) may impede participation in the English­ language-dominant health care system. Little is known about the non-English-language skills of physicians in training. In our analysis of the non-English-language skills of applicants to residency programs in the U.S., we found that although applicants are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with Limited English proficiency. (more…)
Author Interviews, Autism, JAMA, OBGYNE, UC Davis / 10.12.2014

Cheryl K. Walker, MD Associate Professor Department of Obstetrics & Gynecology Faculty, The MIND Institute School of Medicine, University of California, Davis MedicalResearch.com Interview with: Cheryl K. Walker, MD Associate Professor Department of Obstetrics & Gynecology Faculty, The MIND Institute School of Medicine, University of California, Davis Medical Research: What is the background for this study? What are the main findings? Dr. Walker: Autism spectrum disorder (ASD) is a neurobehavioral condition identified in 1 in 68 U.S. children and is part of a broader group of developmental disabilities that affects 1 in 6 children.  Growing evidence suggests that Autism spectrum disorder and developmental delay originate during fetal life.  Preeclampsia is a complicated and frequently dangerous pregnancy condition that appears to arise from a shallow placental connection and may increase the risk of abnormal neurodevelopment through several pathways. Medical Research: What are the main findings? Dr. Walker: Children with Autism spectrum disorder were more than twice as likely to have been exposed to preeclampsia compared with children with typical development.  Risk for ASD was increased further in children born to mothers with more severe presentations of preeclampsia.  Mothers of children with developmental delay were more than 5 times more likely to have had severe forms preeclampsia – often with evidence of reduced placental function – compared with mothers of children with typical development. (more…)
Annals Internal Medicine, Author Interviews, Breast Cancer, Radiology / 09.12.2014

Brian L. Sprague, PhD Office of Health Promotion Research, University of Vermont, Burlington, VT MedicalResearch.com Interview with:  Brian L. Sprague, PhD Office of Health Promotion Research, University of Vermont, Burlington, VT MedicalResearch: What is the background for this study? Dr. Sprague: Mammographic breast density refers to the appearance of breast tissue on a mammogram.  High breast density means that there is a greater amount of glandular tissue and connective tissue, which appears white on a mammogram.  It is more difficult to detect breast cancer on a mammogram when there is greater breast density.  It has also been shown that women with dense breasts are at a higher risk of developing breast cancer.  Because of these two factors, women with dense breasts have a greater chance of developing breast cancer after a normal screening mammogram than women whose breasts are not dense.  Many states have now passed laws that require mammography facilities to inform women with dense breasts so that they are aware of this.  Similar legislation is now under consideration at the national level.  More than 40% of women undergoing mammography screening have dense breasts. Researchers are trying to determine whether supplemental breast cancer screening with other tools would improve outcomes for women with dense breasts.  One possible approach is to use ultrasound imaging to screen for breast cancer in women with dense breasts after they have had a normal mammogram.  We wanted to estimate the benefits, harms, and cost-effectiveness of this approach compared to mammography screening only.  No randomized trials or observational studies have assessed long term outcomes after ultrasound screening for women with dense breasts, but we have short term data on how often cancer is diagnosed by ultrasound screening and how often false positive exams occur.  We used computer simulation modeling to estimate long term outcomes by combining the currently available data on mammography and ultrasound screening with the best available data on breast cancer risk and survival. (more…)
Author Interviews, Heart Disease, JAMA, Johns Hopkins, Outcomes & Safety / 09.12.2014

Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins UniversityMedicalResearch.com Interview with: Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins University   Medical Research: What is the background for this study? What are the main findings? Response: Current guidelines recommend timely reperfusion in patients presenting with ST-elevation myocardial infarction, with primary PCI being the preferred method if delivered in an expedient fashion. Otherwise, guidelines recommend that eligible patients should be treated with fibrinolysis prior to transfer to a PCI capable hospital. In our study, we used Google Maps to estimate drive times between the initial presenting hospital and the PCI-capable hospital looked at the association between estimated drive time and reperfusion strategy (primary PCI or fibrinolysis) selection. We found that less than half of eligible patients with an estimated drive time of more than 30 minutes received primary PCI in time, and only half of patients with more than an hour’s drive received lytics before transfer. This suggests that neither primary PCI nor pre-transfer fibrinolytic therapy is being used optimally. Among eligible patients with a drive time of 30-120 minutes, we found no significant mortality difference but higher bleeding risk among patients receiving lytics prior to transfer; this increased bleeding risk was focused in patients that required rescue PCI. (more…)
AHA Journals, Author Interviews, Stroke / 08.12.2014

Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, The Ottawa Hospital Epidemiology Program, F6 The Ottawa Hospital, Civic Campus Ottawa, Ontario MedicalResearch.com Interview with Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario Medical Research: What is the background for this study? What are the main findings?

Dr. Perry: Currently many patients with a TIA or non-disabling stroke have a subsequent stroke which may be very disabling or result in death prior to having all investigations completed and maximal stroke prevention implemented.  Prior to this study, the utility of CT findings for predicting subsequent stroke was incompletely understood in this patient population. Dr. Perry: Main findings: Compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was:

  • 2.6 times greater if the CT image revealed newly damaged tissue due to poor circulation (acute ischemia);
  • 5.35 times greater if tissue was previously damaged (chronic ischemia) in addition to acute ischemia;
  • 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the small vessels (microangiopathy), in addition to acute ischemia;
  • 8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.
(more…)
Author Interviews, Outcomes & Safety, PLoS, UCSF / 06.12.2014

Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610MedicalResearch.com Interview with: Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco

MedicalResearch: What is the background for this study? What are the main findings? Dr. Drew: Hospital cardiac monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening arrhythmia may be missed in this milieu of sensory overload. Our study is the largest prospective study to date on the alarm fatigue problem. We found a staggering total number of alarms (>2,500,000 in one month) in 461 consecutive patients treated in our 77 adult intensive care unit beds. Although many of these alarms were configured to be visual text messages, we still found a high audible alarm burden of 187 audible alarms per bed per day. A noisy alarm environment interrupts patients’ sleep and invokes fear in patients and their families. We analyzed nearly 13,000 arrhythmia alarms and found that 88% of them were false alarms. (more…)
Author Interviews, PLoS, Smoking, Weight Research / 05.12.2014

Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United KingdomMedicalResearch.com Interview with: Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Munafo: We were conducting an analysis of data on smoking behaviour and body mass index (BMI), in order to better understand the potential causal effects of smoking on different measures of adiposity. Mendelian randomisation uses genetic variants associated with the exposure of interest (in this case smoking) as proxies for the exposure, in order to reduce the risk of spurious associations arising from confounding or reverse causality. As expected, we found that, among current smokers, a genetic variant associated with heavier smoking was associated with lower BMI, providing good evidence that smoking reduces BMI. However, we also unexpectedly found that the same variant was associated with higher BMI in never smokers. This suggests that this variant might be influencing BMI via pathways other than smoking. (more…)
Alcohol, Author Interviews, Nature, University Texas / 05.12.2014

MedicalResearch.com Interview with: R. Dayne Mayfield PhD and Sean Farris Post Doc Fellow Harris Lab Waggoner Center for Alcohol and Addiction Research University of Texas at Austin MedicalResearch: What is the background for this study? Response: Alcoholism is psychiatric disorder adversely affecting the health of millions of individuals worldwide. Despite considerable research efforts, alcoholism cannot be attributed to any individual gene. We sought out to identify coordinately regulated gene networks, rather than a single candidate gene, that may be collectively driving the consumption of alcohol. (more…)
Author Interviews, BMJ, Cost of Health Care, Pediatrics / 05.12.2014

MedicalResearch.com Interview with Rosemary Dodds Senior Policy Adviser NCT (formerly National Childbirth Trust), London, UK Medical Research: What is the background for this study? What are the main findings? Response: The study, which was commissioned by UNICEF UK, was designed to take an in-depth look at how raising breastfeeding rates might save money for the health service through reducing illness. It found that low breastfeeding rates in the UK are costing the health service millions of pounds.  We calculated that from reducing rates of illnesses, where the evidence is strongest, moderate increases in breastfeeding could see potential annual savings to the health service of around £40m per year. It should be noted however, that this figure is likely to be only the tip of the iceberg when the full range of conditions affected by breastfeeding are taken into account. Economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterocolitis (NEC) in the baby), show that moderate increases in breastfeeding would translate into the following cost savings for the NHS:
  •  If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:
-      865 fewer cases of breast cancer -      With cost savings to the NHS of over £21million -      Improved quality of life equating to more than £10million[1] Over the lifetime of each annual cohort of first-time mothers.
  • If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfeeding at discharge, each year there would be:
-      3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million -      5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million -      21,045 fewer GP visits for ear infection, saving £750,000 -      361 fewer cases of the potentially fatal disease necrotising enterocolitis, saving more than £6million (more…)
Aging, Author Interviews, BMJ, Brigham & Women's - Harvard, Mediterranean Diet / 05.12.2014

Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115MedicalResearch.com Interview with: Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115 MedicalResearch: What is the background for this study? What are the main findings? Dr. De Vivo: Our study found that greater adherence to the Mediterranean diet is associated with longer telomeres. Following a diet closer to the Mediterranean diet, can prevent accelerated telomere shortening. Our unique contribution to the literature is that we provide a potential molecular mechanism, preventing telomere shortening. Telomeres are bits of DNA that protect your chromosomes. MedicalResearch: Is telomere shortening reversible? Dr. De Vivo: Telomere shortening is a biological process, the shorten with age. However, lifestyle choices can help to prevent accelerated shortening. Fruits, vegetables, olive oil and nuts – key components of the Mediterranean diet have well known antioxidant and anti-inflammatory effects that could balance out the “bad effects” of smoking and obesity. (more…)
Author Interviews, Lung Cancer, PLoS / 03.12.2014

dr_Martin_C_TammemägiMedicalResearch.com Interview with: Dr. Martin C. Tammemägi Professor (Epidemiology), Brock University Department of Health Sciences St. Catharines, Ontario, Canada L2S 3A1 Medical Research: What is the background for this study? What are the main findings? Dr. Tammemägi: Lung cancer is the leading cause of cancer death in North America and the world. Lung cancer survival following diagnosis is generally poor, in the range of 10% to 15%, and has improved little over the last four decades. The biggest recent breakthrough for reducing lung cancer mortality came with the findings of the National Lung Screening Trial (NLST), a large, well-conducted randomized screening trial, which demonstrated that low dose computed tomography (LDCT) screening versus chest X-ray (CXR) screening can reduce lung cancer mortality by 20%. Currently, most guidelines for selecting screenees for lung screening use the NLST enrolment criteria of 30 or more pack-years smoked, former smokers must have quit smoking within 15 years and ages between 55 and 74, or use a variant of the NLST criteria. The US Preventive Services Task Force (USPSTF) essentially recommends using the NLST criteria but extended the inclusion age to 80 years. The current study applied the PLCOm2012 lung cancer risk prediction model1 to NLST data and identified that the risk above which lung cancer mortality is consistently lower in the LDCT arm compared to the CXR arm, is ≥1.51% 6-year risk (65th percentile). The USPSTF and the PLCOm2012 risk ≥0.0151 criteria were then applied to the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) intervention arm smokers (the PLCOm2012 was developed in PLCO controls) to determine who would be selected for lung cancer screening. Compared to USPSTF criteria, the PLCOm2012 risk ≥0.0151 threshold selected 8.8% fewer individuals, but identified 12.4% more lung cancers (sensitivity 80.1% vs. 71.2%), and had fewer false positives (specificity 66.2% vs. 62.7%). 26% of smokers who were USPSTF criteria positive had risks below the PLCOm2012 risk ≥0.0151 threshold. Of PLCO former smokers who quit more than 15 years ago, 8.5% had PLCOm2012 risk ≥0.0151, suggesting that they might benefit from screening (2.9% of them developed lung cancer in 6 year). None of 65,711 never-smokers in the PLCO had PLCOm2012 risk ≥0.0151, indicating that never-smokers should not be screened. Individuals age ≥65–80 years had significantly higher risks and more lung cancers than those 55-64 years. (more…)
Author Interviews, BMJ, OBGYNE, Weight Research / 03.12.2014

Stefan Johansson, MD PhD consultant neonatologist Stockholm, SwedenMedicalResearch.com Interview with: Stefan Johansson, MD PhD consultant neonatologist Stockholm, Sweden Medical Research: What is the background for this study? Dr. Johansson: Maternal obesity (BMI ≥ 30) has previously been linked to increased infant mortality. However, research has not produced consistent results. For example, there are disagreements whether infants to overweight mothers (BMI 25-29) are at increased risk, and research on BMI-related specific causes of death is scarce. (more…)
Author Interviews, General Medicine, Genetic Research, Nature / 03.12.2014

Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, SwitzerlandMedicalResearch Interview with: Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, Switzerland   MedicalResearch: What is the background for this study? What are the main findings? Prof. Mansuy: It is recognised that being exposed to traumatic stress in early life increases the susceptibility to psychiatric and metabolic diseases later in life. This is true for people directly exposed but also for their progeny across generations. It is also known that sometimes, stress exposure in early life can help an individual develop response strategies and be better prepared for later stressful experiences. The mechanisms of such beneficial effects and the question of whether they can be transmitted or not are not known. This study in mice was designed to answer these questions. The main findings are that exposure to traumatic stress of mouse newborns makes the animals and their progeny more efficient in challenging tasks when adult. For instance, they are more able to adapt to rules that change in a complex task to get a water ration when they are thirsty. This suggests more adaptive behaviours in challenging situations that are transmitted across generation. The study identifies the mineralocorticoid receptor, a stress hormone receptor in the brain, as an important molecular mediator of this effect and demonstrates that its expression is altered in the brain by epigenetic mechanisms. (more…)
Author Interviews, JAMA, Osteoporosis, Pharmacology, Testosterone / 03.12.2014

MedicalResearch.com Interview with: Shabbir M. H. Alibhai, MD, MSc and Husayn Gulamhusein, BHSc Department of Medicine, University Health Network Toronto, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? MedicalResearch: In 2009, we published a research letter in JAMA which examined the rate of bone mineral density (BMD) testing in men starting androgen deprivation therapy (ADT) in the province of Ontario, Canada, between 1995 and 2008. Despite being recommended as a tool to better characterize fracture risk and optimize bone health, use of bone mineral density testing was low throughout the study period. This current study focuses on another aspect of bone health, which is the use of bisphosphonates among men undergoing androgen deprivation therapy for prostate cancer. Bisphosphonates are generally safe and effective medications that can reduce fracture risk particularly in those at higher risk of future fracture. Throughout the 17-year study period, we found that rates of new prescriptions for bisphosphonates remained low. Even when focusing on those men who should be receiving bisphosphonates as per Canadian guidelines due to their high risk for future fracture, i.e. those with a prior fragility fracture or prior diagnosis of osteoporosis, prescription rates remained low. Moreover, in all three groups, new bisphosphonate prescriptions dipped between the 2007-09 and 2010-12 time periods. This may be partly due to recent negative media attention regarding the association of bisphosphonates with rare but serious side effects (i.e. osteonecrosis of the jaw and atypical femoral fracture). (more…)
Annals Internal Medicine, Author Interviews, Hospital Readmissions / 02.12.2014

Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705MedicalResearch.com Interview with: Amy Jo Haavisto Kind, M.D., Ph.D. Assistant Professor, Division of Geriatrics University of Wisconsin School of Medicine and Public Health William S Middleton VA- GRECC Madison, WI 53705 MedicalResearch: What is the background for this study? What are the main findings? Dr. Kind: By way of background: Socioeconomic disadvantage is a complex theoretical concept which describes the state of being challenged by low income, limited education and substandard living conditions for both the person and his or her neighborhood or social network. It is plausible that disadvantage would influence rehospitalization because vulnerable patients depend upon their neighborhood supports for stability, generally, and these needs are likely to be increased after a hospitalization. Yet, it is difficult to assess socioeconomic disadvantage during clinical encounters, yet the ADI provides an option for beginning such a discussion. ADI or Area Deprivation Index is a composite measure of neighborhood disadvantage, similar to other geographic measures of disadvantage employed in other countries for resource planning and health policy development. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 02.12.2014

Prof. Denise Kendrick Professor of Primary Care Research Division of Primary Care, University Park Nottingham UKMedicalResearch.com Interview with: Prof. Denise Kendrick Professor of Primary Care Research Division of Primary Care, University Park Nottingham UK Medical Research: What is the background for this study? What are the main findings? Prof. Kendrick: More than 1 million US children aged 0-4 years attend emergency departments because of  a fall each year. Approximately half of all ED attendances in this age group are for falls, and most of these are falls from furniture, most commonly from beds, chairs , baby walkers, bouncers, changing tables and high chairs. In the US around 18,000 0-4 year olds are admitted to hospital following a fall each year  and in 2012 there were 31 deaths in the US in 0-4 year olds from falls. Healthcare costs for falls in the US  were estimated at $439 million for hospitalised children and $643 million for  ED attendances in 2005. We found that children were more likely to attend hospital because of a fall from furniture in families that did not use safety gates across doorways or on stairs. For infants (aged 0-12 months) we found they were more likely to attend hospital because of a fall from furniture if they had been left on a raised surface (e.g. beds, sofas, work tops etc), had diapers changed on a raised surface or been put in a car seat or bouncing cradle on a raised surface. We also found that children aged over 3 years who had climbed or played on furniture were more likely to have a fall requiring a hospital visit than children who had not. Finally we found that children whose parents had not taught their children rules about climbing on objects in the kitchen were more likely to have a fall needing a hospital visit than children whose parents had taught these rules. (more…)
Author Interviews, General Medicine, Heart Disease, JAMA, Kidney Disease / 30.11.2014

Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, MilanMedicalResearch.com Interview with: Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, Milan Medical Research: What is the background for this study? Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective. Medical Research: What are the main findings? Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension. (more…)
Author Interviews, JAMA, Surgical Research / 30.11.2014

Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, KoreaMedicalResearch.com Interview with: Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: Although autologous rib cartilage is a useful graft material for rhinoplasty, surgeons sometimes encounter unpleasant complication such as warping or donor-site morbidity. These complications are not infrequent, but there has been no systematic review with regarding this matter. For evidence-based practice, we aimed to assess the long-term safety of using rib cartilage by means of meta-analysis. By reviewing the 10 selected, eligible articles after extensive screening, we found that rates of warping, resorption, infection, and displacement were 3.1, 0.2, 0.6, and 0.4%, respectively. Hypertrophic scar at chest was found in 5.5%, with highest report of 23.8%. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon’s attention (more…)
Author Interviews, Cancer Research, Lancet / 28.11.2014

Dr Claudia Allemani PhD FHEA MFPH Senior Lecturer in Cancer Epidemiology Cancer Research UK Cancer Survival Group Department of Non-Communicable Disease Epidemiology London School of Hygiene and Tropical Medicine, London UKMedicalResearch.com Interview with: Dr Claudia Allemani PhD FHEA MFPH Senior Lecturer in Cancer Epidemiology Cancer Research UK Cancer Survival Group Department of Non-Communicable Disease Epidemiology London School of Hygiene and Tropical Medicine, London UK Medical Research: What is the background for this study? Dr. Allemani:  Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. The first CONCORD study was published in 2008.1 It brought together data from 101 cancer registries in 31 countries, and included 1.9 million patients diagnosed during 1990-94 with a cancer of the colon, rectum, breast or prostate and followed up to the end of 1999. It revealed very wide international differences in five-year survival, and it confirmed the well-known racial discrepancy in cancer survival in the USA. CONCORD-2 is the most comprehensive international comparison of trends in population-based cancer patient survival to date. It extends the first study in three ways:
  • it covers 10 common cancers: collectively, these account for almost two-thirds (63%) of all cancer patients diagnosed each year in both developed and developing countries
  • it includes data on more than 25 million cancer patients, provided by 279 cancer registries in 67 countries, in 40 of which the data provide complete (100%) coverage of the national population
  • it examines trends in cancer survival for patients diagnosed over the 15-year period 1995-2009 (more…)
Author Interviews, JAMA, Johns Hopkins, Mental Health Research / 28.11.2014

Daniel Safer MD Department of Psychiatry Johns Hopkins University School of Medicine Baltimore, Maryland Medicalresearch.com with: Daniel Safer MD Department of Psychiatry Johns Hopkins University School of Medicine Baltimore, Maryland Medical Research: What is the nature of this study? Dr. Safer: A large national sample of annual physician office-based visits by youth (aged 2-19) covering 12 years (1999-2010), focusing on trends in psychiatric DSM-IV diagnoses, with psychiatric diagnostic data analyzed proportionally comparing diagnoses that were subthreshold (not otherwise specified) with those that met full diagnostic criteria. (more…)
Author Interviews, BMC, Brigham & Women's - Harvard, Diabetes, Nutrition / 27.11.2014

Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public HealthMedicalresearch.com with: Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public Health Professor of Medicine Harvard Medical School Boston, MA 02115 Medical Research: What is the background for this study? Dr. Hu: Type 2 diabetes (T2D) affects approximately 26 million people in the United States and 366 million people worldwide, and thus primary prevention of T2D has become a public health imperative. The relation between consumption of different types of dairy and risk of type 2 diabetes remains uncertain.  (more…)
Author Interviews, CMAJ, Orthopedics, Surgical Research / 27.11.2014

MedicalResearch.com Interview with: NatNathan Evaniew MD Division of Orthopaedics McMaster Universityhan Evaniew MD Division of Orthopaedics McMaster University   Medical Research: What is the background for this study? Dr. Evaniew: Symptomatic cervical and lumbar spinal disc diseases affect at least 5% of the population and they cause a great deal of pain, disability, social burden, and economic impact. For carefully selected patients that fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results. Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less destructive, but they require specialized equipment and expertise, and they may involve increased risks for technical complications. (more…)
Author Interviews, Depression, Obstructive Sleep Apnea, PLoS / 26.11.2014

Dr. Marcus Povitz MD Department of Community Health Sciences University of Calgary, Calgary, Alberta, Canada Adjunct Professor and Clinical Fellow Western University Department of Medicine, Western University, London, Ontario, CanadaMedicalResearch.com Interview with: Dr. Marcus Povitz MD Department of Community Health Sciences University of Calgary, Calgary, Alberta, Canada Adjunct Professor and Clinical Fellow Western University Department of Medicine, Western University, London, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Povitz: Both depression and obstructive sleep apnea are important causes of illness and have overlapping symptoms. Both feature poor quality sleep, difficulty with concentration and memory as well as daytime sleepiness or fatigue. Previous research showed that depression is common in individuals with sleep apnea, but studies investigating the effect of treating sleep apnea on depressive symptoms have had conflicting results. Our study combined the results of all randomized controlled trials of participants who were treated for sleep apnea with CPAP or mandibular advancement devices where symptoms of depression were measured both before and after treatment. We found that in studies of individuals without a lot of symptoms of depression there was still a small improvement in these symptoms after treatment with CPAP or mandibular advancement device. In 2 studies of individuals with more symptoms of depression there was a large improvement in symptoms of depression. (more…)
Author Interviews, CHEST, Nutrition, Pulmonary Disease / 26.11.2014

Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina UniversityMedicalResearch.com Interview with: Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina University Medical Research: What is the background for this study? What are the main findings? Dr. Hegazi: This study stems from the need to address the financial and health burdens that Chronic Obstructive Pulmonary Disease (COPD) places on the United States. It is the third leading cause of death in the U.S. and costs us about $50 billion a year. It’s a devastating and chronic condition that plagues patients on a daily basis, and previous studies have shown that proper nutrition is essential for proper pulmonary function and rehabilitation. In a retrospective study of inpatient medical records, we found that by ensuring the nutritional needs of COPD patients were met with oral nutritional supplements (ONS), we were able to tackle the issue of cost, as well as better health outcomes. Specifically, the COPD patients that received oral nutritional supplements, experienced reduced length of hospitalization, lower average hospital costs, and lower readmission rates within 30 days, compared to those that did not. (more…)