Do Flexible Family Visitation Hours Reduce Delirium in ICU Patients?

MedicalResearch.com Interview with:
MedicalResearch.com Interview with: Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction. MedicalResearch.com: What are the main findings? Response: Disappointingly, studies evaluating the effectiveness and safety of flexible ICU visiting hours are scarce. To date, no large randomized trials have assessed the impact of a flexible visiting model on patients, family members, and ICU staff, and this evidence gap may constitute a barrier to the understanding of the best way to implement and improve ICU visiting policies. In the present pragmatic cluster-randomized crossover trial (The ICU Visits Study), we engaged 1,685 patients, 1,295 family members, and 826 ICU professionals from 36 adult ICUs in Brazil to compare a flexible visitation model (12 hours/day plus family education) vs. the standard restricted visitation model (median 90 minutes per day). We found that the flexible visitation did not significantly reduce the incidence of delirium among patients, but was associated with fewer symptoms of anxiety and depression and higher satisfaction with care among family members in comparison to the usual restricted visitation. Also, the flexible visitation did not increase the incidence of ICU-acquired infections and ICU staff burnout, which are major concerns when adopting this intervention. MedicalResearch.com: What should readers take away from your report? Response: Considering the evidence suggesting that most adult ICUs restrict the presence of family members, our results provide useful and relevant information that may influence the debate about current ICU visitation policies around the world. First, a flexible visitation policy that permits flexible family visitation in ICU (up to 12 hour per day) is feasible, given the high adherence of participant ICUs to implementation in The ICU Visits Study. Second, the flexible family supported by family education is safe regarding the occurrence of infections, disorganization of care or staff burnout. Third, family members - a commonly missing piece of the critical care puzzle - seem to benefit from the flexible visitation model through higher satisfaction with care and less symptoms of anxiety and depression. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future research might focus on the following topics: 1) methods of implementation of flexible visiting models in ICUs; 2) Family support interventions in the context of flexible ICU visiting hours (e.g.: psychological and social support, support for shared decision making, peer support, and comfort); and 3) How flexible ICU visiting hours affects patient, family member and staff outcome at long-term. Disclosures: The ICU Visits study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program (PROADI-SUS). Citation: Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit  [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
Regis Goulart Rosa, MD, PhD
Responsabilidade Social – PROADI
Hospital Moinhos de Vento 

MedicalResearch.com: What is the background for this study?

Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction. 

Continue reading

Drug Overdoses and Mental Disorders Tied to Drop in Longevity in US

MedicalResearch.com Interview with:

Samuel Preston, Ph.D. Professor of Sociology University of Pennsylvania 

Dr. Preston

Samuel Preston, Ph.D.
Professor of Sociology
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Life expectancy at birth in the United States is low by international standards and has been declining in recent years. Our study aimed to identify how these trends differed by age, sex, cause of death, metropolitan status, and region.

We found that, over the period 2009-11 to 2014-16, mortality rose at ages 25-44 in large metropolitan areas and their suburbs as well as in smaller metropolitan areas and non-metropolitan areas. Mortality at ages 45-64 also rose in all of these areas except large metropolitan areas. These were the ages responsible for declining life expectancy.

Changes in life expectancy were particularly adverse for non-metropolitan areas and for women. The metropolitan distinctions in mortality changes were similar from region to region.

The cause of death contributing most strongly to mortality declines was drug overdose for males and mental and nervous system disorders for women. Continue reading

No Cognitive Deterioration Found After Two Years of Youth Football

MedicalResearch.com Interview with:

Sean C. Rose, MD Pediatric sports neurologist and co-director of the Complex Concussion Clinic Nationwide Children’s Hospital 

Dr. Rose

Sean C. Rose, MD
Pediatric sports neurologist and co-director of the
Complex Concussion Clinic
Nationwide Children’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Very limited data has been collected in children while they are playing contact sports to study the relationship between repetitive head impacts and neurocognitive outcomes.  We previously published a 1-year analysis of youth tackle football players and found no association between the number or severity of head impacts and performance on neurocognitive testing before to after the football season.  We are now reporting the results from the 2nd year of our study, tracking children through two seasons of football participation.

We measured head impacts using helmet sensors during the 2016 and 2017 football seasons.  In the total group of 166 players age 9-18, one outcome measure (processing speed), out of the 23 outcome measures studied, declined over time.  However, several other measures that also assessed processing speed did not decline.  Neither the total burden of head impacts nor the intensity of individual impacts were associated with changes in testing performance over the course of the two seasons.

Continue reading

Brain Aging in Women Linked to Obesity and Lower Estradiol Levels

MedicalResearch.com Interview with:

Rachel Zsido PhD student Department of Neurology  International Max Planck 

Rachel Zsido

Rachel Zsido
PhD student
Department of Neurology
International Max Planck

MedicalResearch.com: What is the background for this study?

Response: We integrated measures of brain network structure, visceral adipose tissue (VAT), serum estradiol levels, and cognitive performance from 974 participants in order to shed light on potential mechanisms underlying cognitive health. We believe it is imperative to assess sex-specific risk trajectories in brain aging and cognitive decline, especially given the known sex differences in both VAT accumulation patterns and estradiol fluctuations across the lifespan.

Thus, we aimed to answer three questions in men and in women:

1) Does visceral adipose tissue exacerbate the association between age and brain network structure,
2) Does estradiol mitigate the negative association between VAT and brain network structure, and
3) What does this imply for healthy cognitive aging in men and women?  Continue reading

Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurologic Diseases

MedicalResearch.com Interview with:

Charlotte E. Teunissen,

Prof. Teunissen

Charlotte E. Teunissen, PhD
Neurochemistry Laboratory, Department of Clinical Chemistry
VU University Medical Centre, Neuroscience Campus Amsterdam
Amsterdam, the Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Several reports have shown increased in NfL in various neurological disorders, separately. We wanted to know how the levels are in these disorders relative to each other. Moreover, some reports showed absence of age effects in Multiple Sclerosis (MS) patients, which is normally present in controls. So, we thought that it would be good to study age effects in a large group of controls, and if these effects are absent in other diseases, similarly as in MS.

Continue reading

Acute Brain Injury: Detection of Brain Activation in Unresponsive Patients

MedicalResearch.com Interview with:

Jan Claassen, MD, PhD, FNCS Associate Professor of Neurology Division of Division of Critical Care and Hospitalist Neurology Columbia University Medical Center

Dr. Claassen

Jan Claassen, MD, PhD, FNCS
Associate Professor of Neurology
Division of Division of Critical Care and Hospitalist Neurology
Columbia University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Unconsciousness is common and predicting recovery is challenging – often inaccurate. Many patients do not show movements on commands and typically this is interpreted as unconsciousness. Some of these patients may be able to have brain response to these commands raising the possibility of some preservation of consciousness. This has previously been shown months or years after the injury mostly using MRI.

We were able to detect this activation at the bedside in the ICU shortly after brain injury. For this we applied machine learning to the EEG to distinguish the brain’s responses to commands. Patients that showed this activation were more likely to follow commands prior to discharge and had better outcomes one year later.  Continue reading

Measles Vaccine in Early Childhood Associated with Long Term Health and Cognitive Benefits

MedicalResearch.com Interview with:

Arindam Nandi  PhD Center for Disease Dynamics, Economics & Policy

Dr. Nandi

Arindam Nandi  PhD
Center for Disease Dynamics, Economics & Policy 

MedicalResearch.com: What is the background for this study?  

Response: The motivation for this study comes from a small but growing body of evidence on the potential long-term benefits of vaccines. The recent resurgence of measles outbreaks in several countries which had previously eliminated the virus makes our study additionally relevant. There have been over 1,000 measles cases reported across 28 states in the US so far in 2019, which is the largest number of cases the country has seen in almost 3 decades. Similarly high number of cases have been reported in several European countries in recent years. This study reiterates the importance of vaccination and proves the long-term benefits of the measles vaccine in low- and middle-income countries, which account for a large proportion of global measles cases.

Continue reading

CTE Brain Pathology Found More Commonly in Former Athletes and Men

MedicalResearch.com Interview with:

Kevin F. Bieniek, Ph.D. Assistant Professor, Department of Pathology & Laboratory Medicine Joe R. & Teresa Lozano Long School of Medicine Director, Biggs Institute Brain Bank Core Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases University of Texas Health Science Center San Antonio San Antonio, Texas 78229

Dr. Bieniek

Kevin F. Bieniek, Ph.D.
Assistant Professor, Department of Pathology & Laboratory Medicine
Joe R. & Teresa Lozano Long School of Medicine
Director, Biggs Institute Brain Bank Core
Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases
University of Texas Health Science Center San Antonio
San Antonio, Texas 78229

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by CTE?  

Response: CTE, or chronic traumatic encephalopathy, is a progressive neurodegenerative disorder that is linked to prior exposure to repetitive traumatic brain injuries.  CTE pathology, characterized by a distinct deposition pattern of the protein ‘tau’, is most often observed in the brains former contact sport athletes and military veterans.  The public health impacts of this disorder are largely unknown, as this disease is often studied in individuals which advanced levels of exposure, particularly professional American football player.

This study aimed to understand what the presence of this disorder might be in the general population by studying athletes and non-athletes, a number of different sports, different levels of participation, and both males and females.

Continue reading

Sleep History as a Predictor For Late-Life Alzheimer’s Disease Later In Life

sleep-alzheimers-dementia-insomniaSleep patterns can predict the increase of Alzheimer’s pathology proteins tau and β-amyloid later in life, according to a June 2019 study published in the Journal of Neuroscience. The findings shed hope on earlier diagnosis of Alzheimer’s and the adoption of preventive measures earlier in life. Researchers found a decrease in sleep spindle synchronization, which is linked to higher tau levels. Reduced amplitude of slow wave activity, meanwhile, is closely related to higher β-amyloid levels. In younger people, both slow oscillations and sleep spindles are synchronized. This changes as people grow older, with less coordination between the two being visible. The researchers also noted that subjects who slept less had a higher chance of having Alzheimer’s proteins when they were older. The findings show that both reduced sleep quantity and quality can serve as important warnings of the onset of Alzheimer’s.

Continue reading

Study Finds Antidepressants Blunt Empathy

MedicalResearch.com Interview with:

Dr. Markus Rütgen Post-doctoral researcher Social, Cognitive and Affective Neuroscience Unit Faculty of Psychology University of Vienna

Dr. Ruetgen

Dr. Markus Rütgen PhD
Post-doctoral researcher
Social, Cognitive and Affective Neuroscience Unit
Faculty of Psychology
University of Vienna 

MedicalResearch.com: What is the background for this study?

Response: Previous research has reported empathy deficits in patients with major depressive disorder. However, a high percentage of patients taking part in these studies were taking antidepressants, which are known to influence emotion processing. In our study, we wanted to overcome this important limitation. We were interested in whether the previously reported empathic deficits were attributable to the acute state of depression, or to the antidepressant treatment.

To this end, we performed a longitudinal neuroimaging study, in which we measured brain activity and self-reported empathy in response to short video clips showing people in pain. We measured acutely depressed patients twice. First, before they started their treatment, second, after three months of treatment with a state-of-the-art antidepressant (selective serotonin reuptake inhibitors).

Continue reading

PTSD: Comparative Effectiveness of Medications, Psychotherapeutic and Combination Treatments

MedicalResearch.com Interview with:

Dr. Heike Gerger | Senior Postdoc University of Basel | Faculty of Psychology | Clinical Psychology and Psychotherapy Basel | Switzerland

Dr. Gerger

Dr. Heike Gerger | Senior Postdoc
University of Basel | Faculty of Psychology | Clinical Psychology and Psychotherapy
Basel | Switzerland

MedicalResearch.com: What is the background for this study?

Response: Posttraumatic stress disorder (PTSD) is one of the most prevalent mental disorders, with a high risk of chronicity, comorbidity, and functional impairment. PTSD is complicated to treat, and the debate on the most efficacious treatment approach is ongoing. Treatment guidelines for the treatment of PTSD typically recommend different types of trauma-focused psychotherapeutic treatments as first-line PTSD treatment. However, concerning pharmacological therapies recommendations are inconsistent.

Continue reading

More Scooters Means More Head and Face Injuries

MedicalResearch.com Interview with:

Amishav Bresler MD Department of Otolaryngology - Head and Neck Surgery Rutgers - New Jersey Medical School

Dr. Bresler

Amishav Bresler MD
Department of Otolaryngology – Head and Neck Surgery
Rutgers – New Jersey Medical School 

MedicalResearch.com: What is the background for this study?

Response: This study was inspired by a personal experience with the rental scooters.

The most recent American Academy of Otolaryngology-Head and Neck Surgery annual conference was in Atlanta this year. At the time of the conference, the scooter rental industry had recently entered the region. A friend of mine, another ENT resident, was encouraging others to use these scooters for transportation for both the novelty and convenience. However, he didn’t even have a helmet!

Here was a well-educated doctor who takes call for craniofacial injuries, who was about to get on a scooter without a helmet. This experience made me wonder if scooters were dangerous scooters and their overall impact on public health.

In terms of the backgroud, the personal transportation industry is undergoing a revolution. The search for efficient and environmentally-friendly urban transportation ignited an ongoing debate in the United States regarding the role of motorized scooters. Although known to be a popular method of transportation in Europe and Asia, motorized scooters have only recently begun to make inroads in the United States. The gradual rise in popularity has been attributed to their convenience, affordability, and status as a “green” alternative to vehicles with combustion engines. These advantages combined with the fact electric scooters enable users to travel longer distances than conventional scooters present an attractive method of transportation to school, work, and leisure.

Continue reading

Fewer Psychiatrists Willing To Accept Medicaid Patients

MedicalResearch.com Interview with:

Hefei Wen, PhDAssistant Professor, Department of Health Management & PolicyUniversity of Kentucky College of Public Health

Dr. Wen

Hefei Wen, PhD
Assistant Professor,
Department of Health Management & Policy
University of Kentucky College of Public Health 

MedicalResearch.com: What is the background for this study?

Response: Medicaid is the principal payer of behavioral health services in the U.S. and expected to play an increasing role in financing behavioral health services following Medicaid expansions under the ACA.

Continue reading

What Kind of Personality Goes to the Emergency Room Often?

MedicalResearch.com Interview with:

Stephen L. Ristvedt, Ph.D. Associate Professor of Anesthesiology Washington University St. Louis, MO  63110-1093

Dr. Ristvedt

Stephen L. Ristvedt, Ph.D.
Associate Professor of Anesthesiology
Washington University
St. Louis, MO  63110-1093 

MedicalResearch.com: What is the background for this study?

Response: Having a usual source of healthcare – either with a regular doctor or a medical clinic – is the best way to manage one’s health in a proactive way.  Doctors and clinics can provide ongoing guidance with regard to the use of preventive medical screenings as well as the management of chronic illness.  Unfortunately, a significant proportion of US adults do not have a usual source of healthcare.  Also, many people often rely for their healthcare needs on a hospital emergency department, where there is neither sufficient continuity of care nor counseling for prevention.

We wanted to investigate what factors might contribute to suboptimal utilization of healthcare resources.  We were particularly interested in looking at individual psychological factors that might play a role in the choices that people make when seeking healthcare.  One specific psychological characteristic proved to be important in our study.  That characteristic is called “threat sensitivity,” and it is measured with a simple questionnaire.  People who are relatively high in threat sensitivity are prone to experience high levels of anxiety in potentially threatening situations  Continue reading

Team Sports Benefits Teens With a Troubled Childhood

MedicalResearch.com Interview with:
Molly C. Easterlin, MD

Fellow, UCLA National Clinician Scholars Program
Clinical Instructor, Pediatrics, Cedars-Sinai Medical Center 

MedicalResearch.com: What is the background for this study?

Response: Adverse childhood experiences or ACEs (including physical or emotional neglect or abuse, sexual abuse, domestic abuse, exposure to household substance misuse or mental illness, parental separation or divorce, and parental incarceration) are common with about half of children experiencing 1 and one-quarter of children experiencing 2 or more.

Children exposed to adverse childhood experiences have worse mental health throughout life, including higher rates of depression and anxiety. However, little is known about what factors improve long-term mental health in those exposed to ACEs. Additionally, as far as we are aware, no studies have looked at team sports participation as a potential factor that may be associated with improved mental health among those with adverse childhood experiences.

Continue reading

Can Mindfulness-Based Training Reduce Stress and Burnout in Surgeons?

MedicalResearch.com Interview with:

Carter Lebares, MDAssistant Professor of SurgeryDirector, Center for Mindfulness in SurgeryDepartment of Surgery, UCSF

Dr. Lebares

Carter Lebares, MD
Assistant Professor of Surgery
Director, Center for Mindfulness in Surgery
Department of Surgery, UCSF 

MedicalResearch.com: What is the background for this study?

 Response: This study was inspired by extensive evidence of the effectiveness of mindfulness-based interventions (MBIs) for mitigating stress and enhancing performance in other high-stress populations like police and the military.  We know that overwhelming stress is related to burnout and to cognitive errors – two critical issues within surgery, today. This prompted us to tailor and streamline an MBI specifically for surgeons, and to test it in our trainees.

Continue reading

Women Think Better When Its Warmer

MedicalResearch.com Interview with:
Tom Chang PhD, BS, MIT
Associate Professor of Finance and Business Economics
Marshall School of Business

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been many studies showing that women prefer higher indoor
temperatures than men, however nobody looked at the effect of temperature
on performance. We show that the battle for the thermostat is not just
about the comfort. It is much more – in our experiment, women’s cognitive
functioning is the best at high temperatures, whereas men’s at low temperatures.

Significantly, the positive effect of increased temperatures on women’s performance is much stronger than the negative effect on men.

The most surprising was that the effect of temperature on women is so
strong. For instance, at low temperatures, men outperform women in a simple math task. However, when we increase the temperature, women become better and better (1.76% increase of solved tasks with each 1 Celsius increase), and at high temperatures women and men perform on the same level – the gender difference disappears.  Continue reading

Cariprazine Demonstrated Efficacy in Bipolar Depression and Concurrent Manic Symptoms

MedicalResearch.com Interview with:

Dr. Stephen Stahl MD PhDProfessor of Psychiatry University of California San Diego

Dr. Stahl

Dr. Stephen Stahl MD PhD
Professor of Psychiatry
University of California San Diego 

MedicalResearch.com: What is the background for this study? How does cariprazine differ from other medications for bipolar depression? 

MedicalResearch.com: It is important to note that cariprazine, a dopamine D3-preferring D3/D2 receptor and serotonin 5-HT1A receptor partial agonist, is approved for the treatment of schizophrenia (1.5-6 mg/d) and bipolar mania (3-6 mg/d) in adults. It is not yet approved for depressive episodes related to bipolar I disorder (bipolar depression).

In these data that focus on the investigational use for the treatment of bipolar depression, cariprazine has demonstrated efficacy vs placebo (PBO) in 3 phase 2/3 studies of patients with bipolar depression (NCT01396447, NCT02670538, NCT02670551). These analyses investigated the efficacy of cariprazine in patients with bipolar depression and concurrent manic symptoms (mixed features).  Continue reading

BrainHQ Computerized Training Program Improved Cognitive Parameters after Mild TBI

MedicalResearch.com Interview with:

Dr.. Mahncke

Dr. Mahncke

Dr. Henry W. Mahncke PhD
Research neuroscientist
CEO of Posit Science Corporation 

MedicalResearch.com: What makes this study newsworthy? 

Response: Mild Traumatic Brain Injury (mTBI) is a complex condition to treat. Patients can report many symptoms (e.g., cognitive deficits, depression, anxiety, stress, fatigue, pain, sleep difficulties, disorientation, emotional issues). Prior to this study, conducted at five military and veterans’ medical centers, there has been no highly-scalable intervention to treat the cognitive deficits associated with mTBI. This study showed that a plasticity-based, computerized, brain-training app can drive statistically and clinically significant gains in overall cognitive performance. Given the number of service members and vets with persistent cognitive deficits from TBIs, that’s a big deal. Continue reading

Combat-Related Mild Traumatic Brain Injury: Magnetoencephalography Can Detect Abnormal Gamma Band

MedicalResearch.com Interview with:

Dr. Mingxiong Huang, PhDProfessor, Electrical and Computer EngineeringUniversity of California, San Diego

Dr. Huang

Dr. Mingxiong Huang, PhD
Professor, Electrical and Computer Engineering
University of California, San Diego

MedicalResearch.com: What is the background for this study?  

Response: Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and Veterans. Yet, conventional neuroimaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) are typically insensitive to physiological alterations caused by mild and some moderate TBIs.

With funding from the VA, we have pursued in developing sensitive imaging markers based on magnetoencephalography (MEG) for mTBI. This paper reflects the news MEG findings in this research field.  Continue reading

Computerized Brain Training BrainHQ Can Reduce Neglect Symptoms of Stroke and Brain Injury

MedicalResearch.com Interview with:

Thomas M Van Vleet PhDPosit Science 

Dr. Van Vleet

Thomas M Van Vleet PhD
Posit Science 

Dr. Tom Van Vleet,  presented results on a common symptom of stroke and acquired brain injury (hemi-spatial neglect) at the American Academy of Neurology May 2019

MedicalResearch.com: What makes this study newsworthy?

Response For the first time ever a highly-scalable intervention — computerized brain training (BrainHQ made by Posit Science) —was found to improve symptoms of hemi-spatial neglect, which is a common and often intractable and debilitating problem after stroke or other acquired brain injury.

MedicalResearch.com: What can you tell us about the medical condition (hemi-spatial neglect) investigated in this study?

Response About a third of patients with a brain injury exhibit a complex and debilitating array of neurological deficits known as the “neglect syndrome” (sometimes called, “hemi-spatial neglect” or “neglect”).

The most apparent symptom of neglect is the inability of patients to efficiently process information on the side of space opposite the injury; often completely missing relevant events without awareness. As a result, patients often fail to adopt compensatory strategies or respond to other conventional rehabilitation protocols.

The cost is significant, as patients with neglect experience longer hospital stays and have higher requirements for assistance, including greater skilled nursing home placements relative to patients with similar extent of brain injury without neglect.

To date, there’s been no broadly-applicable and highly-scalable intervention for addressing neglect. An alarming reality given the increasing cost of stroke, which is currently estimated to exceed $34 billion per annum

Continue reading

Amyloid and Tau Biomarkers Help Distinguish Alzheimer’s from Other Forms of Mild Cognitive Impairment

MedicalResearch.com Interview with:
Lauren McCollum, MDCognitive and Behavioral Neurology FellowPenn Memory Center / Cognitive Neurology DivisionLauren McCollum, MD

Cognitive and Behavioral Neurology Fellow
Penn Memory Center / Cognitive Neurology Division

MedicalResearch.com: What is the background for this study?  

Response: Alzheimer’s Disease (AD) is a heterogenous condition, with considerable variability in cognitive symptoms and progression rates.

One major reason for this heterogeneity is “mixed pathology,” – i.e., both AD- and non-AD pathology. Examples of non-AD pathology include cerebrovascular disease (CVD), Lewy Bodies, and TDP-43. Pathologically, Alzheimer’s Disease is defined by characteristic amyloid plaques and neurofibrillary tangles, which can be assessed for in living patients with CSF- or PET-based biomarkers for amyloid and tau, respectively. Classically, amyloid deposition begins years or even decades before pathologic tau accumulation, which is in turn associated with brain atrophy and cognitive decline.

The recently developed NIA-AA “ATN” research framework allows for the classification of individuals with regard to 3 binary biomarkers: Amyloid (A), Tau (T), and Neurodegeneration (N). An individual’s ATN biomarker status indicates where along the “Alzheimer’s Disease continuum” they lie. Additionally, some ATN statuses are on the “typical AD” continuum, while others are not. Research has shown that 15-30% of cognitively normal older adults have elevated amyloid. It stands to reason that some portion of cognitively impaired individuals with elevated amyloid and neurodegeneration have something other than AD driving their neuronal injury. Within the context of the ATN research framework, this subset of people is the A+T-N+ group (i.e., people who have elevated amyloid and neurodegeneration, but are tau-negative), as amyloid alone (that is, amyloid without tau) is not thought to cause significant cognitive impairment or brain atrophy. Our hypothesis was that, compared to A+T+N+ (a set of typical-AD biomarkers), A+T-N+ have cognitive and neuroimaging profiles that deviate from a typical Alzheimer’s Disease pattern – i.e., with less memory loss and less atrophy in AD-signature regions – and may have biomarkers suggestive of alternate non-AD pathologies [e.g., white matter hyperintensities (WMHs), a marker of CVD].

Continue reading

Some with Elevated Alzheimer’s Biomarkers Interested in Aid-in-Dying Information

MedicalResearch.com Interview with:

Emily Largent, PhD, JD, RNAssistant Professor, Medical Ethics and Health PolicyPerelman School of MedicineLeonard Davis Institute of Health EconomicsUniversity of Pennsylvania

Dr. Largent

Emily Largent, PhD, JD, RN
Assistant ProfessorMedical Ethics and Health Policy
Perelman School of Medicine
Leonard Davis Institute of Health Economics
University of Pennsylvania 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response:  Public support for aid in dying in the United States is rapidly growing.  As a result, we’re now seeing debates about whether to expand access to aid-in-dying to new populations – such as people with Alzheimer’s disease – who wouldn’t be eligible under current laws.

With those debates in mind, we asked currently healthy people who recently learned about their risk for developing Alzheimer’s disease dementia (i.e., due to the presence of amyloid, an Alzheimer’s disease biomarker) whether they would be interested in aid-in-dying.

Our findings suggest that about 20% of individuals with elevated amyloid may be interested in aid-in-dying if they become cognitively impaired.  

Continue reading

Kids with Head Injuries More Likely to Be Involved with Criminal Justice System

MedicalResearch.com Interview with:

Dr. Joseph A Schwartz PhD Public Affairs and Community Service, Criminology and Criminal Justice University of Nebraska Omaha, 6001 Dodge Street, Omaha, NE

Dr. Schwartz

Dr. Joseph A Schwartz PhD
Public Affairs and
Community Service, Criminology and Criminal Justice
University of Nebraska Omaha, Omaha, NE 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: My larger research agenda is focused on identifying the ways in which environmental and biological influences work collectively to shape behavioral patterns across major stages of the life course. I am particularly interested in identifying environmental influences that can change biological functioning or activity to result in behavioral change.

Brain injury was a natural progression of these interests since brain injury is expected to result in changes in the structure and functioning of the brain, which has been linked to meaningful changes in behavior. There have also been a sizable number of studies that indicate that justice involved populations experience brain injury at a rate that is between five and eight times what is observed in the general population. I was fascinated by this finding and thought that brain injury may be a good candidate influence to investigate further. Continue reading

Is It Always Your Fault? Taking Too Much Responsibility Can Lead to OCD

MedicalResearch.com Interview with:
Yoshinori SUGIURA Ph.D.

Associate Professor
Hiroshima University
Graduate School of Integrated Arts and Sciences
Behavioural Sciences Section
Higashi-Hiroshima, Japan 

MedicalResearch.com: What is the background for this study?

Response: Lengthy worrying or repeated checking if the door is locked are common manifestations of anxiety in the general population. However, if their frequency, intensity, and interference become too much, they are diagnosed as Generalized Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD) respectively.

People with OCD are tortured by repeatedly occurring negative thinking and they take some strategy to prevent i. GAD is a very pervasive type of anxiety. GAD patients worry about everything.

Despite their burden, both are relatively difficult to treat. Furthermore complicated, as they are two different disorders, mental health professionals have to master separate strategies. To overcome such situation, transdiagnostic research, which seeks common causes for different disorders, is now eagerly pursued by psychologists/psychiatrists. As one of such endeavors, we predicted that inflated responsibility is the common predictor of both OCD and GAD symptoms.

Continue reading

Brief Sexual Contact Between Parents Linked to Greater Risk of Schizophrenia

MedicalResearch.com Interview with:

Dolores Malaspina MD, MS, MSPHPROFESSOR | Psychiatry, Neuroscience, Genetics and Genomic SciencesIcahn School of Medicine at Mt SinaiDepartment of PsychiatryNew York, NY 10128, USA

Dr. Malaspina

Dolores Malaspina MD, MS, MSPH
Professor or Psychiatry, Neuroscience,
Genetics and Genomic Sciences
Icahn School of Medicine at Mt Sinai
Department of Psychiatry
New York, NY 10128, USA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Schizophrenia is a severe disorder that presents in late adolescence or early adulthood with declining function, social withdrawal and psychotic symptoms such as auditory hallucinations and fixed false beliefs. It is a common condition, affecting 1% of the population, which can be not yet be prevented or cured. Its causes are still puzzling.

Evidence from many different research approaches now suggests that an overactive immune system plays some role in causing schizophrenia, but the origins of the immune dysfunction are not known.

We considered that too brief a period of sexual contact between parents could cause immune activation in offspring and thus be a risk factor for schizophrenia.

With repeated sexual contact the maternal immune system develops tolerance to genetic material from the father. Otherwise, inflammatory processes may restrict the placental blood supply between the fetus and mother.

Continue reading

Early Childhood Infections Associated With Eating Disorders In Adolescence

MedicalResearch.com Interview with:

Lauren Breithaupt, PhDDepartment of PsychologyGeorge Mason UniversityFairfax, Virginia

Dr. Breithaupt

Lauren Breithaupt, PhD
Department of Psychology
George Mason University
Fairfax, Virginia 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Our study provides novel insight into the relationship between the immune system and eating disorders characterized by chronic restriction (e.g., anorexia nervosa) and binge eating and/or purging (e.g., binge eating disorder, bulimia nervosa). These findings also add to the growing body of literature linking the immune systems broadly and mental disorders.

We found that infections in early childhood were associated with an increased risk of anorexia nervosa, bulimia nervosa, and other eating disorders such as binge eating disorder in adolescence. These relationships appear to be both time and dose-dependent, meaning that the onset of eating disorder diagnosis is greatest in the first three months following the infection, and the more infections, the greater the risk.    Continue reading

Afraid of Spiders? Maybe Spiderman Can Help

MedicalResearch.com Interview with:
"xIMG_6547" by platycryptus is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0
Yaakov Hoffman, PhD.
Senior Lecturer and Clinical Psychologist
Interdisciplinary Department of Social Sciences
Max & Anna Webb St. Ramat-Gan, Israel, 5290002

 

MedicalResearch.com: What is the background for this study?  

Foundation: This study was conceptualized during a conversation we had, namely, Dr. Yaakov Hoffman, Interdisciplinary department of social sciences, Bar Ilan University, and Professor Menachem Ben-Ezra School of Social Work, Ariel University, following the release of the Antman movie. We are both psychologists who are also avid Marvel  superhero fans. In this meaningful conversation we discussed the issue of fear of insects which led to the idea that positive exposure to phobic stimuli (exposure to spider or ants) within the context of Marvel superheroes will lead to robust reduction in phobic symptoms. As most of the conventional treatments for specific phobias use exposure to the phobic stimuli in neutral contexts, we thought that framing the exposure in a positive fun, albeit fantasy context would yield robust results, as well as perhaps reducing stigma.

Continue reading

NYU Researchers Develop Siri-Like Application to Identify PTSD by Speech Analysis

MedicalResearch.com Interview with:

Charles R. Marmar, MDThe Lucius N. Littauer Professor Chair of the Department of PsychiatryNYU Langone School of Medicine

Dr. Marmar

Charles R. Marmar, MD
The Lucius N. Littauer Professor
Chair of the Department of Psychiatry
NYU Langone School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Several studies in recent years have attempted to identify biological markers that distinguish individuals with PTSD, with candidate markers including changes in brain cell networks, genetics, neurochemistry, immune functioning, and psychophysiology. Despite such advances, the use of biomarkers for diagnosing PTSD remained elusive going into the current study, and no physical marker was applied in the clinic.

Our study is the first to compare speech in an age and gender matched sample of a military population with and without PTSD, in which PTSD was assessed by a clinician, and in which all patients did not have a major depressive disorder. Because measuring voice qualities in non-invasive, inexpensive and might be done over the phone, many labs have sought to design speech-based diagnostic tools 

Continue reading

DNA Copy Number Variants Linked to Increased Risk of Depression

MedicalResearch.com Interview with:

Dr Kimberley Kendall MBBChWellcome Trust Clinical Research Fellow

Dr. Kendall

Dr Kimberley Kendall MBBCh
Wellcome Trust Clinical Research Fellow

Professor James WaltersMRC Centre for Neuropsychiatric Genetics and GenomicsProfessor, Division of Psychological Medicine and Clinical Neurosciences

Prof. Walters

Professor James Walters
MRC Centre for Neuropsychiatric Genetics and Genomics
Professor, Division of Psychological Medicine and Clinical Neurosciences

Cardiff University
 

MedicalResearch.com: What is the background for this study?

Response: Copy number variants (CNVs) are the deletion or duplication of large sections of DNA. Large, rare CNVs have been shown to increase the risk of neurodevelopmental disorders including autism spectrum disorder (ASD), intellectual disability (ID), attention deficit/hyperactivity disorder (ADHD) and schizophrenia. However, the impact of these CNVs on risk of depression was unclear from the existing literature. Continue reading