Author Interviews, JAMA, Lancet / 25.09.2014

Prof Mika Kivimäki PhD Department of Epidemiology and Public Health, University College London, London, UK Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, FinlandMedicalResearch.com Interview with: Prof Mika Kivimäki PhD Department of Epidemiology and Public Health, University College London, London, UK Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland Medical Research: What are the main findings of the study? Prof. Kivimäki: In our study, we pooled published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia. Of them, 4963 individuals developed type 2 diabetes during the mean follow-up of 7.6 years. This is the largest study to date on this topic. In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group, but was null in the high socioeconomic status group. The association in the low socioeconomic status group did not change after taking into account age, sex, obesity, physical activity, and shift working. So, the association was very robust. In brief, the main finding of our meta-analysis is that the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups. (more…)
Author Interviews, CDC, Pediatrics / 24.09.2014

Dr. Lorraine Yeung Division of Birth Defects and Developmental Disabilities National Center on Birth Defects and Developmental Disabilities, CDCMedicalResearch.com Interview with: Dr. Lorraine Yeung Division of Birth Defects and Developmental Disabilities National Center on Birth Defects and Developmental Disabilities, CDC Medical Research: What are the main findings of the study? Dr. Yeung: In this report, we looked at the percentages of children who received various recommended clinical preventive services. We found that millions of infants, children, and adolescents in the U.S. did not receive key clinical preventive services. This report provides a baseline snapshot of the use of 11 key clinical preventive services before or shortly after the Affordable Care Act went into effect. A focus of the Affordable Care Act is on improving prevention of illness and disability and it does so by requiring new health insurance plans to provide certain clinical preventive services at no additional cost — with no copays or deductibles. This is important because we know increasing the use of these services can improve children’s health and promote healthy lifestyles that will enable them to reach their full potential. Some of the important findings in this report were:          In 2007, parents of almost eight in 10 (79 percent) children aged 10-47 months reported that they were not asked by healthcare providers to complete a formal screen for developmental delays in the past year.          In 2009, more than half (56 percent) of children and adolescents did not visit the dentist in the past year and nearly nine of 10 (86 percent) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.          Nearly half (47 percent) of females aged 13-17 years had not received their recommended first dose of HPV vaccine in 2011.          Approximately one in three (31 percent) outpatient clinic visits made by 11-21 year-olds during 2004–2010 had no documentation of tobacco use status; eight of 10 (80 percent) of those who screened positive for tobacco use did not receive any cessation assistance.          Approximately one in four (24 percent) outpatient clinic visits for preventive care made by 3-17 year olds during 2009-2010 had no documentation of blood pressure measurement. (more…)
Author Interviews, Telemedicine, University of Michigan / 15.09.2014

Rashid Bashshur, PhD Senior Advisor for eHealth Professor Emeritus, Department of Health Management and Policy Executive Director, UMHS eHealth Center University of Michigan Health SystemMedicalResearch.com Interview with:  Rashid Bashshur, PhD Senior Advisor for eHealth Professor Emeritus, Department of Health Management and Policy Executive Director, UMHS eHealth Center University of Michigan Health System Medical Research: What are the Main findings of the study? Dr. Bashshur: The main findings can be summarized as follows:
  •  The prevalence of chronic disease is increasing due to the changing demographic composition of the population and unhealthy life styles. Chronic diseases are expensive, accounting for about 70% of health care expenditures;  but  they are amenable to telemedicine interventions.  These interventions consist of ongoing monitoring of patients living in their own home environments, engaging them in managing their health,  providing them with educational materials and the necessary tools to manage their life style mostly by avoiding risky behaviors and adopting healthy ones.
  • Telemedicine interventions consist of various configurations of technology (telephone, video, wired or wireless, automated or manual) , human resources (physicians, nurses, combinations, and patient populations at various levels risk levels or severity of illness, The interventions investigated to date also vary in terms of study design, duration of application (during the study period), and frequency of administration of the intervention.  Hence, the findings must be viewed from the perspective of the specific methodological attributes  of the studies that were performed.
  • Using only robust studies from 2000 to the near present, and limited to congestive heart failure, stroke and COPD.  With notable exceptions,  overall there is substantial and fairly consistent evidence of:
  • A decrease in use of service, including hospitalization, rehospitalization, and emergency depart visits as a result of the telemedicine intervention.
  • Improved health outcomes.
  • Improved event timing for stroke patients.
  • Reduced exacerbations of symptoms for COPD patients
  • Some interesting  trends  to be considered:
  • Frail and elderly patients, those with co-morbid conditions, and those in advanced stages of illness are not likely to benefit from telemedicine interventions, as compared to their counterparts.
  • Visual information as in videoconferencing proved superior to telephone only connection for the diagnosis and treatment of stroke patients.
  • There could be a tradeoff between extra nursing time versus reduced physician time in some settings, but the net effect is cost savings.
  • There seems to be a paradoxical telemedicine effect in terms of increasing longevity but no reduction in hospitalization, reported in few studies.
(more…)
Author Interviews, Ebola, Infections / 12.09.2014

Dr. Gerardo Chowell-Puente Ph.D. Associate Professor School of Human Evolution and Social Change College of Liberal Arts and Sciences Arizona State UniversityMedicalResearch.com: Interview with: Dr. Gerardo Chowell-Puente Ph.D. Associate Professor School of Human Evolution and Social Change College of Liberal Arts and Sciences Arizona State University Medical Research: What are the main findings of the study? Dr. Chowell-Puente: 1.We estimated the effective reproduction number of Ebola virus disease, i.e. average number of secondary cases produced by a single primary case at calendar time t (Rt), for the ongoing epidemic in West Africa from March to August 2014. Estimates of Rt for the Guinea, Sierra Leone and Liberia, countries that are experiencing sustained community transmission were consistently above 1.0 since June 2014. 2.Country-specific estimates of the reproduction number for Liberia and Sierra Leone lied between 1.0 and 2.0, reflecting continuous growth of cases in these countries 3. Effective reproduction number below 2 indicate that control could be attained by preventing over half of the secondary transmissions per primary case (e.g. by means of effective case isolation and contact tracing). (more…)
Flu - Influenza, Infections / 10.09.2014

Allison Weinmann MBBS, FRACP Senior Staff, Division Infectious Diseases Director HFHS Immunization Team Medical Director Infection Control and Prevention, West Bloomfield Hospital Henry Ford Health System Clinical Assistant Professor, Wayne State University Detroit, Mi 48202MedicalResearch.com Interview with: Allison Weinmann  MBBS, FRACP Senior Staff, Division Infectious Diseases Director HFHS Immunization Team Medical Director Infection Control and Prevention, West Bloomfield Hospital Henry Ford Health System Clinical Assistant Professor, Wayne State University Detroit, Mi 48202 Medical Research: What are the main findings of this study? Dr. Weinmann: The main findings included:
  • Mandatory influenza immunization for health care workers without allowing optional opt-out (and only allowing for documented medical or religious exemption) successfully raised our immunization uptake among all our employees to over 99% sustainable for the last 2 years which we consider a very important patient safety initiative.
  • Less than 2% of workers met a medical or religious exemption.
  • A prior optional opt out with mask wearing was problematic for staff and patients and did not reach our goal of close to 100% immunization uptake.
(more…)
Author Interviews, Heart Disease / 10.09.2014

Mintu Turakhia, MD MAS, FHRS FACC FAHA Assistant Professor of Medicine and (by courtesy) of Health Research & Policy Stanford University School of Medicine Director of Cardiac Electrophysiology Core Investigator, Center for Innovation to Implementation VA Palo Alto Healthcare SystemMedicalResearch.com Interview with: Mintu Turakhia, MD MAS, FHRS FACC FAHA Assistant Professor of Medicine and (by courtesy) of Health Research & Policy Stanford University School of Medicine Director of Cardiac Electrophysiology Core Investigator, Center for Innovation to Implementation VA Palo Alto Healthcare System Medical Research: What are the main findings of the study Dr. Turakhia: We found that the reported success rate of a study correlated with the number of times the study was cited in the literature, even after adjustment for a wide range of factors. (more…)
Aging, Author Interviews / 08.09.2014

MedicalResearch.com Interview with: Dr. Benedict Truman Associate Director for Science CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Medical Research: What are the main findings of the study? Dr. Truman: In 2008, healthy life expectancy, which isthe number of years a person is expected to live in good or better health after a particular age, varied by sex, race/ethnicity and geographical regions in the United States. In each of four U.S. census regions, females were expected to live longer and healthier lives than males; non-Hispanic whites were expected to live shorter but healthier lives than Hispanics; and non-Hispanic whites were expected to live longer and healthier lives than non-Hispanic blacks. (more…)
Author Interviews, JAMA, Johns Hopkins, Outcomes & Safety / 20.08.2014

MedicalResearch.com Interview with: Sosena Kebede, MD, MPH Assistant Professor of Medicine, Department of Medicine Associate Faculty, the Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine Faculty, Department of Health Policy and Management and Baltimore, MD 21287Sosena Kebede, MD, MPH Assistant Professor of Medicine, Department of Medicine Associate Faculty, the Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine Faculty, Department of Health Policy and Management and Baltimore, MD 21287 Medical Research: What are the main findings of the study? Dr. Kebede: There were 3 main findings in this study: 1.       Patients’ understanding of aspects of their hospital care is suboptimal on the domains of knowledge of diagnoses, indications for the medications they take and the types of procedures/tests they get. Some forms of poor shared understanding could have potentially serious implications for their health and for future care such as identifying a prescribed antidepressant as a blood thinner or mistaking an echocardiogram a left heart catheterization or thinking a liver cyst is a liver cancer. Other forms of poor shared understanding such as not accurately identifying why a procedure is done or what the results of the procedure show (a finding not discussed in the research letter) may seem less consequential  but raise the issue of informed consent, patient empowerment and may alsoraise questions about patient and physician behavior towards appropriate use of in-patient procedures. Some of the questions we could ask here include: would patients demand more or less procedures if they had better understanding of what the procedures entail, and why they are beingordered? Conversely, would physicians recommend more or less of in-patient procedures, when they encounter patients whose understanding of procedure indications are optimal? (more…)
Author Interviews, Sexual Health / 15.08.2014

MedicalResearch.com Interview with: Dr. Cicely Marston Senior Lecturer in Social Science Department of Public Health and Policy London School of Hygiene and Tropical Medicine London WC1H 9SH Medical Research: What are the main findings of the study? Dr. Marston: Young people talked to us about an oppressive environment where some men compete with each other to have anal sex with women, even if they expect women to find it painful. Women also reported they were repeatedly asked for anal sex by their male partners and on some accounts, women enjoy it websites like https://bitchtopia.com/true-sex-stories/ go into detail about how the women asked for anal sex but we have found this is largely the minority among those we spoke too. Their accounts also raise the real possibility of coercion for young women – who were sometimes put in situations where they are penetrated anally without their explicit consent. Young people often suggested that pain for women was inevitable, or that it was the woman’s fault, ideas that may make them less likely to change their practices to reduce pain. Some young people said they thought STIs were less of a problem for anal sex compared with vaginal sex. Some young men put their own desire to have anal sex ahead of the desires and needs of their partners. (more…)
Author Interviews, JAMA, Surgical Research / 13.08.2014

Dr. Thomas M. Scalea, MD R. Adams Cowley Shock Trauma Center, Program in Trauma University of Maryland School of Medicine, BaltimoreMedicalResearch.com Interview with: Dr. Thomas M. Scalea, MD R. Adams Cowley Shock Trauma Center, Program in Trauma University of Maryland School of Medicine, Baltimore Medical Research: What are the main findings of this study? Dr. Scalea:  The main findings of the study was that putting this financial incentive program in place had immediate and dramatic effects on first cases starting on time and turnaround times decreasing in our operating room. (more…)
AHA Journals, Author Interviews, Heart Disease / 13.08.2014

Susan Cheng MD Cardiovascular Division, Brigham and Women's Hospital Boston, MA 02115MedicalResearch.com Interview with: Susan Cheng MD Cardiovascular Division, Brigham and Women's Hospital Boston, MA 02115   Medical Research: What are the main findings of the study? Dr. Cheng: We've known for some time that smoking, high cholesterol, high blood pressure, diabetes, and obesity all contribute to a person’s risk of being at risk for heart disease. The goal of our study was to look back over the last two decades and see how we've been doing in reducing the impact of these major cardiovascular risk factors on the actual risk for developing heart and vascular disease. We found that, not surprisingly, we've been doing generally better over time at lowering the overall impact of some risk factors such as smoking and high cholesterol. On the other hand, the impact of hypertension and diabetes has been high and has remained high over time. (more…)
Author Interviews, Health Care Systems, Orthopedics / 05.08.2014

M. Susan Ridgely, JD Senior Policy Analyst RAND Corporation Santa Monica, CaliforniaMedicalResearch.com: Interview with: M. Susan Ridgely, JD Senior Policy Analyst RAND Corporation Santa Monica, California   Medical Research: What are the main findings of the study? Answer: We evaluated a three-year effort, coordinated by the Integrated Healthcare Association, to determine whether bundled payment could be an effective payment model for California. The pilot focused on bundled payment for orthopedic procedures for commercially insured adults under age 65. Bundled payment is a much-touted strategy that pays doctors and hospitals one fee for performing a procedure or caring for an illness. The strategy is seen as one of the most-promising ways to curb health care spending. Unfortunately, the project failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden and concerns about financial risk. At the outset of the project, participants included six of the state’s largest health plans, eight hospitals and an independent practice association. Eventually, two insurers dropped out because they believed the bundled payment model in this project would not lead to a redesign of care or lower costs. Another decided that bundled payment was incompatible with its primary type of business (health maintenance organization). Just two hospitals eventually signed contracts with the three remaining health plans to use bundled payments. Hospitals that dropped out cited concerns about the time and effort involved. The project was hurt by a lack of consensus about what types of cases to include and which services belonged in the bundle. In the end, most stakeholders agreed that the bundle definitions were probably too narrow to capture enough procedures to make bundled payment viable. (more…)
Author Interviews, Electronic Records / 01.08.2014

MedicalResearch.com Interview Celeste Campos-Castillo PhD Assistant Professor Department of Sociology University of Wisconsin-Milwaukee Medical Research: What are the main findings of the study? Dr. Campos-Castillo: Approximately 13% of adults in the U.S. have held back information from doctors out of privacy or security concerns. When we compare adults with the same characteristics (e.g., age and education, overall health, and health care characteristics like having insurance and seeing a doctor in the past year) based on whether their doctor uses an electronic health record (EHR) system or not, we find that those with a doctor that uses an electronic health record were more likely to hold back information than those whose doctor does not use an electronic health record. Other studies have looked at whether electronic health records are related to withholding information out of privacy concerns, but the evidence was mixed: sometimes patients with EHRs were more likely to hold back information from doctors, other times there but sometimes there was no difference in withholding between patients of doctors who used EHRs and those who did not. What makes our study unique is that we consider a range of factors in the analysis that can disguise the real relationship between EHRs and withholding information because of privacy concerns. In particular, we take into account how patient ratings of quality of care play a complicated role in this situation. Patients with doctors who use EHRs often rate the quality of care they receive higher than those with doctors who are not using these systems. At the same time, higher quality ratings generally mean that patients feel comfortable sharing information with doctors, even the sensitive information that we tend to keep to ourselves. Because quality ratings are associated both with EHRs and with holding back information from doctors, it is necessary to consider this in the analysis. Otherwise – as we show in the study – we would mistakenly conclude that EHRs are unrelated to holding back information. Instead, we show that when we accurately compare patients with the same characteristics, including quality ratings, patients with EHRs are more likely to withhold information from their doctors out of concerns for privacy. (more…)
Author Interviews, Johns Hopkins / 23.07.2014

Eva DuGoff, PhD, MPP Graduate Student Department of Health Policy and Management Johns Hopkins Bloomberg School of Public HealthMedicalResearch.com Interview with: Eva DuGoff, PhD, MPP Graduate Student Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health   Medical Research: What are the main findings of the study? Dr. DuGoff: In this study we investigate average life expectancy in older adults living with one to 10 or more different chronic conditions. Our main finding is that life expectancy decreases with each additional chronic condition. (more…)
Author Interviews, Weight Research / 23.07.2014

Jennifer Keogh PhD, MSc, APD Associate Professor Dietetics and Nutrition Fellow of the South Australian Cardiovascular Research Development Program School of Pharmacy and Medical Sciences University of South AustraliaMedicalResearch.com Interview with: Jennifer Keogh PhD, MSc, APD Associate Professor Dietetics and Nutrition Fellow of the South Australian Cardiovascular Research Development Program School of Pharmacy and Medical Sciences University of South Australia Medical Research: What is the background for this study? Dr. Keogh: A variety of weight loss strategies are needed to help individuals lose weight and maintain weight loss.  In this study we investigated the effects on weight loss of an intermittent energy restricted diet using a ‘week-on, week-off’ strategy compared to a continuous energy restricted diet after 8 weeks and on maintenance of weight loss at 12 months in healthy overweight and obese women. Using a group setting participants were advised to reduce their energy intake to approximately 5500 kJ per day when restricting their intake. The diet plan used was based on the previously published CSIRO Total Wellbeing Diet. (more…)
Infections / 22.07.2014

Dr. Dan Everitt Senior Medical Officer, TB Alliance.MedicalResearch.com Interview with: Dr. Dan Everitt Senior Medical Officer, TB Alliance. Medical Research: What are the main findings of the study? Dr. Everitt: The NC-002 trial tested a new, three-drug TB combination therapy, consisting of PA-824 (a new chemical entity), moxifloxacin (a re-purposed drug, not yet approved for TB treatment), and pyrazinamide (an existing TB drug currently used in standard TB treatment). This regimen is known as "PaMZ" and was tested in both drug-sensitive and multidrug-resistant TB (MDR-TB patients). In the eight-week trial, PaMZ killed more bacteria than standard therapy and did so at a faster rate, showing its potential to shorten therapy to as little as four months for drug-sensitive and some forms of MDR-TB. Additionally, the trial included HIV-positive patients and a formal statistical evaluation found no effect of HIV status on the outcome of the study. (more…)
Author Interviews, HIV / 22.07.2014

Dr. Nelli Westercamp PhD, MPH, MBA University of Illinois at Chicago School of Public Health Kenya, Epidemiology and Public HealthMedicalResearch.com Interview with: Dr. Nelli Westercamp PhD, MPH, MBA University of Illinois at Chicago School of Public Health Kenya, Epidemiology and Public Health Medical Research: What are the main findings of the study? Dr. Westercamp: The three clinical control trials in Kenya, Uganda and South Africa found that male circumcision reduces the risk of female to male transmission by up to 60%, prompting the endorsement of medical male circumcision as an HIV prevention intervention by the WHO and UNAIDS.  However, as medical male circumcision services for HIV prevention are being rolled out in the priority countries, questions remain whether the male circumcision promotion will actually translate into decreases in HIV infections. One factor that could reduce the effectiveness of male circumcision for HIV prevention at the population level is the behavioral risk compensation.  In other words, if men who become circumcised believe that they are fully protected against HIV and engage in higher sexual risk taking behaviors as a result of this belief, this could reduce or even negate the protective effect of male circumcision against HIV. To answer this question, we conducted a large prospective study concurrently with the scale up of male circumcision services in Western Kenya.  We recruited 1,588 men seeking circumcision services as well as 1,598 men who decided to remain uncircumcised  and assessed their sexual behaviors over 2 years, every 6 months.  We then compared the behaviors of circumcised men before and after circumcision and also the behaviors of circumcised and uncircumcised men over time. In the beginning of the study, we found that men choosing to become circumcised believed they were at higher risk of HIV than their uncircumcised counterparts. This perception of HIV risk declined significantly among the circumcised men after circumcision (from 30% at baseline to 14% at 24 months of follow up), while remaining relatively stable among the uncircumcised men (24% to 21%, respectively).  Looking at sexual risk behaviors, we saw that the overall level of sexual activity increased equally in both groups, mostly driven by the youngest age group (18-24 year old). However, despite the decrease in risk perception among circumcised men and the increase in sexual activity among all men, all other risky behaviors decreased in both groups and protective behaviors – such as condom use – increased, particularly among circumcised men. (more…)
Author Interviews, Flu - Influenza, Lancet / 22.07.2014

MedicalResearch.com Interview with: Prof. Jean-Francois Rossignol, FRSC, FRCPath Romark Laboratories, LC MedicalResearch: What are the main findings of the study? Prof. Rossignol: Nitazoxanide, a new orally administered drug in development for treating influenza, reduced the duration of symptoms of uncomplicated influenza compared to a placebo. The drug also reduced viral shedding. Side effects were similar for the drug and placebo treatment arms. The study was designed and conducted in compliance with FDA guidelines for studying new drugs for influenza. (more…)
Author Interviews, Brigham & Women's - Harvard, HIV, JAMA, Weight Research / 21.07.2014

Steven Grinspoon, MD Professor of Medicine, Harvard Medical School Director, MGH Program in Nutritional Metabolism Co-Director, Nutrition Obesity Research Center at Harvard Massachusetts General Hospital Boston, MA 02114MedicalResearch.com Interview with Steven Grinspoon, MD Professor of Medicine, Harvard Medical School Director, MGH Program in Nutritional Metabolism Co-Director, Nutrition Obesity Research Center at Harvard Massachusetts General Hospital Boston, MA 02114 Medical Research: What are the main findings of the study? Dr. Grinspoon: The primary finding is that tesamorelin, a hypothalamic peptide that increases the endogenous pulsatile secretion of growth hormone, reduced liver fat in HIV-infected patients with increased visceral (abdominal) fat.  Increased visceral fat is very closely linked with increased liver fat in HIV patients, but the effects on liver fat were not known.  Our data show that tesamorelin reduces liver fat in conjunction with decreasing visceral fat, which may be clinically important for patients with HIV-infection who have both increased abdominal fat and fatty liver disease. In addition the study demonstrated that this treatment strategy was neutral to glucose by the end of the 6 month study. (more…)
Author Interviews, CDC / 21.07.2014

MedicalResearch.com: Interview withDr. Sonia Singh Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA Dr. Sonia Singh Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA Medical Research: What are the main findings of the study? Dr. Singh: While there is a great deal of information about the epidemiology of HIV among MSM (men who have sex with men), there is much less information about a subset of MSM who also have sex with women – MSMW.  In this article, CDC researchers examined HIV diagnoses among MSMW and MSM only (MSMO) from 2008 to 2011 to obtain a better understanding of the characteristics of men diagnosed with HIV who have ever had sex with both men and women.  Of all MSM diagnosed with HIV during 2011, 26% also had sex with women with women in the past.  From 2008 to 2011, HIV diagnoses among MSMW were relatively stable while there was an increase among young MSMO aged 13 to 29 years. (more…)
Author Interviews, BMJ, End of Life Care / 15.07.2014

Dr. Kirsty Boyd Programme theme head (Clinical Communication) Honorary Clinical Senior Lecturer Primary Palliative Care Research Group Division of Community Health Sciences: General Practice University of EdinburghMedicalResearch.com Interview with: Dr. Kirsty Boyd Programme theme head (Clinical Communication) Honorary Clinical Senior Lecturer Primary Palliative Care Research Group Division of Community Health Sciences: General Practice University of Edinburgh Medical Research: What do we know already about people with ‘multimorbidity’? Dr. Boyd: We know that an increasing number of patients have multiple life-limiting illnesses or progressively deteriorating health due to several long term conditions or general frailty. Caring for them well poses major challenges and they are often hospitalised in the last year of life. They do not fit well into illness and healthcare models that focus on single conditions. Understanding the experiences of patients and their family caregivers is vital to inform improvements in best supportive care and palliative care. We wanted to build on care models for integrated care of people with long term conditions and consider the needs of those at risk of dying with multiple conditions in more detail. (more…)
Author Interviews, Blood Pressure - Hypertension, Cost of Health Care / 15.07.2014

Alejandro Arrieta, PhD Assistant Professor Department of Health Policy and Management Florida International UniversityMedicalResearch.com Interview with: Alejandro Arrieta, PhD Assistant Professor Department of Health Policy and Management Florida International University Medical Research: What are the main findings of the study? Dr. Arrieta: We found that it makes business sense for insurance companies to reimburse patients for the cost of blood pressure monitors that they can use at home. In just the first year, we estimate that insurance companies can produce returns that range from $0.85 to $3.75 per dollar invested in blood pressure monitors provided to their members. (more…)
Accidents & Violence, Author Interviews, Global Health, Lancet, Pharmacology / 03.07.2014

MedicalResearch.com Interview with: Tamara Haegerich, PhD Deputy Associate Director for Science Division of Unintentional Injury Prevention CDC - National Center for Injury Prevention and ControlMedicalResearch.com Interview with: Tamara Haegerich, PhD Deputy Associate Director for Science Division of Unintentional Injury Prevention CDC - National Center for Injury Prevention and Control MedicalResearch: What are the main findings of the study? Dr. Haegerich: In the first three decades of life, more people in the US die from injuries and violence than from any other cause. Approximately 60% of fatal injuries are unintentional (for example, from motor vehicle crashes, drug overdose, and falls), 20% are due to suicide, and 20% are due to homicide. Injuries and violence have been linked to a wide range of physical, mental health, and reproductive health problems, and chronic diseases. They take an enormous economic toll, including the cost of medical care and lost productivity. Importantly, injuries and violence are preventable through education, behavior change, policy, engineering, and environmental supports. For example, laws that promote the use of seat belts and child safety seats, and prevent drunk driving, can reduce motor-vehicle-related injuries. Early childhood home visitation, school-based programs, and therapeutic foster care are examples of evidence-based approaches to preventing violence. Improving proper prescribing of painkillers and access to treatment for substance misuse could prevent prescription drug overdoses. Improvements are possible by framing injuries and violence as preventable, identifying interventions that are cost-effective and based on research, providing information to decision makers, and strengthening the capacity of the health care system. (more…)
Author Interviews, Cost of Health Care, Global Health, Lancet / 01.07.2014

MedicalResearch.com Interview with:  M Luca Lorenzoni OECD Organisation for Economic Co-operation and Development Health Accounts, Asian Health and Social Policy Outreach ELS/Health Division MedicalResearch: What are the main findings of the study? Answer: 
  • The United States is an outlier in the scenery of OECD as it ranks first for health care expenditure, but last for coverage.
  • The slowdown in US health care spending during the past decade brought the growth rate closer to that of other high-spending countries -Canada, France, Germany, the Netherlands and Switzerland- at around 1%. Previously in 2002, the US's health expenditure growth was around 7%, much higher than the approximate 3% which was the average for the other countries examined in the study
  • Higher health-sector prices (e.g., hospital care and prescription drugs) are thought to be the main driver of expenditure differences between the US and other high-spending countries, and recent price dynamics largely explain declines in health expenditure growth. (more…)
Author Interviews, Diabetes, JAMA / 01.07.2014

MedicalResearch.com Interview with:Sandeep Vijan, MD, MS Center for Clinical Management Research Ann Arbor Veterans Affairs Hospital, Department of Internal Medicine, University of Michigan, Ann Arbor Michigan Sandeep Vijan, MD, MS Center for Clinical Management Research Ann Arbor Veterans Affairs Hospital, Department of Internal Medicine, University of Michigan, Ann Arbor Michigan MedicalResearch: What are the main findings of the study? Dr. Vijan: The main finding was that the burdens and side effects of intensive glycemic treatment significantly detract from the overall benefit of lower risks of diabetes complications, often to the point where the treatments cause more loss than gain in quality of life. It takes many (often 15-20) years to gain benefit from treatment, but the burdens begin right away and continue throughout treatment. By the time you might experience treatment benefit in terms of reduced complication risk, you've had a lot of years to have the downsides of treatment - which commonly include significant weight gain, low blood sugars, gastrointestinal symptoms, not to mention having to take multiple pills or injections on a daily basis. (more…)
Author Interviews, CMAJ, Compliance, Pharmacology, Statins / 25.06.2014

Dr. Heli Halava: Departments of Public Health and Pharmacology, Turku, FinlandMedicalResearch.com Interview with: Dr. Heli Halava: Departments of Public Health and Pharmacology, Turku, Finland MedicalResearch: What are the main findings of the study? Dr. Halava: The associations between lifestyle factors and nonadherence to statin therapy varied by cardiovascular comorbidity status. Of the participants without cardiovascular comorbidities (n = 6458), 3171 (49.1%) were nonadherent with their statin therapy. Of the participants with cardiovascular comorbidities (n = 2827), 1155 (40.9%) were nonadherent. People with cardiovascular comorbidities who had risky drinking behaviours or a cluster of lifestyle risks were at increased risk of nonadherence. (more…)
Author Interviews, Heart Disease, Lancet / 24.06.2014

Professor Lixin Jiang MD, PhD, F.A.C.C. National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital, National Center for Cardiovascular Diseases Beijing , ChinaMedicalResearch.com Interview with: Professor Lixin Jiang MD, PhD, F.A.C.C. National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital, National Center for Cardiovascular Diseases Beijing , China MedicalResearch: What are the main findings of the study? Professor Jiang: In this first representative nationwide assessment of quality of care in China, we studied 13,815 hospital admissions for STEMI in 162 hospitals across China over the past decade. We found that the incidence of hospital admission for STEMI quadrupled from 3.7 per 100,000 in 2001 to 15.8 per 100,000 in 2011. There were substantial changes in testing and treatment patterns. Over the study period, the rate of testing for troponin increased from 21.4% in 2001 to 66.5% in 2011. Additionally, based at the ideal patients’ analysis, the use of several highly effective treatments for STEMI, including aspirin, clopidogrel and statins, improved over the study period. However, other therapies known to reduce mortality in STEMI patients – such as β-blockers and ACE inhibitors – were underused with only 57.7% of patients receiving beta-blockers and 66.1% ACE inhibitors respectively in 2011. While the proportion of patients receiving reperfusion therapy remained constant, there was a notable shift away from fibrinolysis, which was the primary means of reperfusion in 2001, towards primary PCI. However, in 2011, only 27.6% of patients admitted to Chinese hospitals for STEMI received primary PCI, the gold standard of treatment, while 27.4% received fibrinolytic therapy in the ideal patients. Despite increasing overall intensity of treatment, procedure use, and testing, no significant change in the rate of in-hospital death from STEMI was seen over the study period. (more…)
Accidents & Violence, Author Interviews, Race/Ethnic Diversity / 23.06.2014

Krim K. Lacey, PhD Research Fellow, Research Center for Group Dynamics Program for Research on Black Americans (PRBA) Institute for Social Research University of Michigan Ann Arbor, MIMedicalResearch.com Interview with: Krim K. Lacey, PhD Research Fellow, Research Center for Group Dynamics Program for Research on Black Americans (PRBA) Institute for Social Research University of Michigan Ann Arbor, MI MedicalResearch: What are the main findings of the study? Dr. Lacey: The main findings from this nationally representative study were that U.S. Black women abused by a domestic partner, on a whole were vulnerable to various negative physical and mental health problems. While the findings of the study support the few previous studies conducted on women within this population, this study was the first population-based, predominantly black sample that used structured clinical assessments. Importantly, the study substantiates other arguments that the Black population is not culturally monolithic, that African American and Caribbean Black women are affected differently by severe intimate partner violence. Another key finding was the association identified between eating disorders and intimate partner violence, which in general, has been largely underexplored. Finally, the study provided national information on the health outcomes of Caribbean Black women; one of the fastest growing subgroups within the Black population. (more…)
Diabetes, Scripps / 20.06.2014

Athena Philis-Tsimikas, M.D. Corporate Vice President Scripps Whittier Diabetes Institute, a subsidiary of Scripps HealthMedicalResearch.com Interview with: Athena Philis-Tsimikas, M.D. Corporate Vice President Scripps Whittier Diabetes Institute, a subsidiary of Scripps Health MedicalResearch: What are the main findings of the study? Dr. Philis-Tsimikas: Findings from the Dulce Digital study suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes. Researchers recruited 126 Latinos with type 2 diabetes and HbA1c greater than 7.5% from federally-qualified health centers (FQHCs) that serve disadvantaged populations to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging. Cell phones were provided to patients who did not have them, along with text messaging instructions. Patients were randomized after completing clinical and self-reported measurements at baseline and these assessments were then repeated at 3 and 6 months. Both Dulce Digital and control groups received usual care.   The Dulce Digital group received three types of text messages — educational and motivational; medication reminders; and blood glucose monitoring prompts — two to three messages each day initially, with frequency tapering over 6 months. Project Dulce staff then monitored blood glucose responses, assessed reasons for hyperglycemia or hypoglycemia and encouraged follow up with providers as needed. Still ongoing, the current analyses included 106 completed participants (mean age= 49.25±9.49 years, 74% female), 52 of which were Dulce Digital participants. Findings showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.4%, vs. 9.5% to 9.3%, P<.05) at 6 month follow-up. No significant group differences, however, have been observed for lipids, weight or blood pressure. (more…)
Author Interviews, BMC, Cost of Health Care / 19.06.2014

MedicalResearch.com Interview with: Natasha K Brusco Manager of Physiotherapy Services, Cabrini Health PhD Candidate, Physiotherapy Department, Faculty of Health Science, La Trobe University, Bundoora, Victoria, Australia MedicalResearch: What are the main findings of the study? Answer: This economic evaluation reports that providing additional Saturday rehabilitation, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per quality adjusted life year gained and for a minimal clinically important difference in functional independence. This builds on previous literature that reports that additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and may reduce patient length of stay. (more…)