Lowering Blood Pressure Target Would Greatly Increase Number of People Diagnosed with Hypertension

MedicalResearch.com Interview with:

Alexander A. Leung, MD, MPHDepartment of Community Health SciencesDepartment of MedicineUniversity of CalgaryCalgary, Alberta, Canada

Dr. Leung

Alexander A. Leung, MD, MPH
Department of Community Health Sciences
Department of Medicine
University of Calgary
Calgary, Alberta, Canada

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

Response: The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure guidelines redefined hypertension according to a blood pressure cutoff of ≥130/80 mm Hg, compared to the traditional cutoff of ≥140/90 mm Hg.

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High-Dose Vitamin D During Pregnancy Did Not Reduce Risk of Childhood Asthma

MedicalResearch.com Interview with:

Bo Chawes, MD, PhD, DMScAssociate ProfessorC‌openhagen Prospective Studies on Asthma in ChildhoodH‌erlev and G‌entofte H‌ospitalU‌niversity of C‌openhagen

Dr. Chawes

Bo Chawes, MD, PhD, DMSc
Associate Professor
C‌openhagen Prospective Studies on Asthma in Childhood
H‌erlev and G‌entofte H‌ospital
U‌niversity of C‌openhagen

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

Response: There has been a global surge in vitamin D deficiency happening in parallel with an increase in prevalence of childhood asthma, which suggests that low maternal vitamin D levels during pregnancy may increase asthma risk in the child.

Due to that we conducted a randomized double-blinded controlled trial within the Danish COPSAC2010 cohort (www.copsac.com) of 7-fold (2,800 IU/d) vs. standard dose (400 IU/d) of vitamin D supplementation from pregnancy week 24 aiming to reduce offspring asthma risk. At age 3, we observed a non-significant 24% reduced risk of recurrent asthma-like symptoms, ie. recurrent wheeze, in the high-dose vitamin D group. In the current study, we followed 545 of the 581 children in the study till age 6, where an asthma diagnosis can be established and observed no effect of the high-dose vitamin D supplement on the child’s risk of asthma. 

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Most Deaths From Sepsis Occur in Frail Older Adults and Are Not Preventable

MedicalResearch.com Interview with:

Chanu Rhee, MD,MPHAssistant Professor of Population MedicineHarvard Medical School / Harvard Pilgrim Health Care InstituteAssistant Hospital EpidemiologistBrigham and Women’s Hospital

Dr. Rhee

Chanu Rhee, MD,MPH
Assistant Professor of Population Medicine
Harvard Medical School / Harvard Pilgrim Health Care Institute
Assistant Hospital Epidemiologist
Brigham and Women’s Hospital 

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

Response: Sepsis is the body’s reaction to a serious infection that results a cascade of inflammation in the body and organ dysfunction, such as low blood pressure, confusion, or failure of the lungs, kidneys, or liver.   Sepsis is a major cause of death, disability, and cost in the U.S. and around the world.  Growing recognition of this problem has led to numerous sepsis performance improvement initiatives in hospitals around the country.  Some of these efforts have also been catalyzed by high-profile tragic cases of missed sepsis leading to death, which may have contributed to a perception that most sepsis deaths are preventable if doctors and hospitals were only better at recognizing it.

However, the extent to which sepsis-related deaths might be preventable with better hospital-based care is unknown.  In my own experience as a critical care physician, a lot of sepsis patients we treat are extremely sick and even when they receive timely and optimal medical care, many do not survive.  This led myself and my colleagues to conduct this study to better understand what types of patients are dying from sepsis and how preventable these deaths might be.  Continue reading

Supplements Did Not Prevent Depression in Study of Obese Adults

MedicalResearch.com Interview with:

Prof. Marjolein Visser PhDProfessor of Healthy AgingHead section Nutrition and HealthDepartment of Health Sciences, Vrije Universiteit AmsterdamAmsterdam Public Health research institute

Dr. Visser

Prof. Marjolein Visser PhD
Professor of Healthy Aging
Head section Nutrition and Health
Department of Health Sciences, Vrije Universiteit Amsterdam
Amsterdam Public Health research institute

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

Response: More than 40 million Europeans experience a major depressive disorder. One in ten men, and one in five women suffer from clinical depression at least once during their lifetime. Depression is one of the most prevalent and disabling disorders in the EU.

Given the increasing prevalence of depression, more people are actively searching for ways to decrease their risk through lifestyle modification, but are often overwhelmed by confusing and contradictory information.

The MooDFOOD prevention trial is the largest randomized clinical trial to study the effects of nutritional strategies on the prevention of major depressive disorder. Over 1000 overweight or obese participants identified as being at elevated risk for depression but who were not currently depressed, from four European countries -the Netherlands, the United Kingdom, Germany and Spain, took part in the study. Participants were randomized to either take nutritional supplements containing folic acid, vitamin D, zinc, selenium or to a pill placebo, and half of participants also received a behavioral lifestyle intervention intended to change dietary behaviors and patterns.

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Medical Research Metaanalyses Can Contain Corrupted Data

MedicalResearch.com Interview with:

Craig Alexander Garmendia, PhDOffice of Bioresearch Monitoring Operations, Office of Regulatory AffairUS Food and Drug AdministrationMiami, Florida

Dr. Garmendia

Craig Alexander Garmendia, PhD
Office of Bioresearch Monitoring Operations
Office of Regulatory Affairs
US Food and Drug Administration
Miami, Florida

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

Response: Clinical trials under the U.S. Food and Drug Administration’s (FDA) purview have been shown to suffer from falsified data. While the FDA warns researchers when falsified data are discovered, these data still make their way into medical literature.

In this novel study, Dr. Garmendia and colleagues conducted a systematic review to examine the effects of publications containing falsified data on meta-analyses using sensitivity analyses. Almost half of all meta-analyses had conclusions altered by publications containing falsified data, while nearly one-third of all analyses had considerable changes in outcomes. Continue reading

Is Behavioral Change Among Overweight Diabetics Feasible and Sustainable?

MedicalResearch.com Interview with:
Giuseppe Pugliese, MD, PhD
for the Italian Diabetes and Exercise Study 2 (IDES_2) Investigators
Department of Clinical and Molecular Medicine
‘‘La Sapienza’’ University
Diabetes Unit, Sant’Andrea University Hospital
Rome, Italy

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

Response: There is a growing epidemic of obesity and type 2 diabetes worldwide,
which are causally related to the increasing prevalence of “physical
inactivity”, i.e., an insufficient amount of moderate-to-vigorous
physical activity according to current guidelines, and
“sedentariness”, i.e., too many hours, especially if uninterrupted,
spent in a sitting or reclined position.  These two unhealthy
behaviors exert their detrimental effects independently of each other
and are very common among people suffering from type 2 diabetes, who
would therefore benefit from increasing physical activity and reducing
sedentary time, as recommended by current guidelines.

However, such a behavior change is generally difficult for a number of
internal and external barriers and requires behavioral interventions
targeting both physical activity and sedentary habits.  Unfortunately,
there is no definitive evidence that this is indeed feasible and,
particularly, that, if adopted, change in behavior can be maintained
in the long term.  Continue reading

How Does a Stroke Affect Cognitive Function?

MedicalResearch.com Interview with:

Sarah Parish, MSc, DPhil Professor of Medical Statistics and Epidemiology MRC Population Health Research Unit Nuffield Department of Population Health University of Oxford

Dr. Parish

Sarah Parish, MSc, DPhil
Professor of Medical Statistics and Epidemiology
MRC Population Health Research Unit
Nuffield Department of Population Health
University of Oxford

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

Response: Acquiring reliable randomized evidence of the effects of cardiovascular interventions on cognitive decline is a priority. In this secondary analysis of 3 randomized intervention trials of cardiovascular event prevention, including 45 029 participants undergoing cognitive testing, we estimated the association of the avoidance of vascular events with differences in cognitive function in order to understand whether reports of non-significant results exclude worthwhile benefit.  Continue reading

Lung Cancer: Screening Model Including Low-Dose CT Can Improve Risk Prediction

MedicalResearch.com Interview with:

Martin C. Tammemägi   PhDSenior Scientist | Cancer Care Ontario | Prevention & Cancer Control | Scientific Lead | Lung Cancer Screening Pilot for People at High RiskProfessor (Epidemiology) | Brock University | Department of Health SciencesOntario  Canada

Dr. Tammemägi

Martin C. Tammemägi PhD
Senior Scientist
Cancer Care Ontario | Prevention & Cancer Control
Scientific Lead
Lung Cancer Screening Pilot for People at High Risk
Professor (Epidemiology) | Brock University Department of Health Sciences
Ontario, Canada

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

Response: Some prediction models can accurately predict lung cancer risk (probability of developing lung cancer during a specified time). Good model predictors include sociodemographic, medical and exposure variables. In recent years, low dose computed tomography (LDCT) lung cancer screening has become widespread in trials, pilots, demonstration studies, and public health practice.

It appears that screening results provides added valuable, independent predictive information regarding future lung cancer risk, aside from the lung cancers directly detected from the diagnostic investigations resulting from positive screens. Continue reading

Low-Value Health Care: Measuring Hospital-Acquired Complications

MedicalResearch.com Interview with:

Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostatResearch Fellow,Value in Health Care Division,Menzies Centre for Health Policy

Mr. Badgery-Parker

Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostat
Research Fellow,Value in Health Care Division
Menzies Centre for Health Policy

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

Response: This is part of a large program of work at the Menzies Centre for Health Policy on low-value care in the Australian health system. We have previously published rates of low-value care in public hospitals in Australia’s most populous state, New South Wales, and a report on rates in the Australian private health insurance population is due for publication shortly. We have also done similar analyses for other Australian state health systems.

This particular paper extends the basic measurement work to focus on what we call the ‘cascade’ effects. That is, looking beyond how much low-value care occurs to examine the consequence for patients and the health system of providing these low-value procedures.

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Not All Polypharmacy for Schizophrenia is Bad

MedicalResearch.com Interview with:

Jari Tiihonen, MD, PhD Professor, Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden

Dr. Tiihonen

Jari Tiihonen, MD, PhD
Professor, Department of Clinical Neuroscience
Karolinska Institutet
Stockholm, Sweden 

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

Response: The effectiveness of antipsychotic combination therapy in schizophrenia relapse prevention is controversial, and use of multiple agents is generally believed to impair physical well-being. But the evidence for this are weak and antipsychotic polypharmacy is widely used.

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Accredited Hospitals Linked to Better Rectal Cancer Surgical Outcomes

MedicalResearch.com Interview with:

Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor

Alexis G. Antunez

Alexis G. Antunez MS
University of Michigan Medical School, Ann Arbor
Center for Healthcare Outcomes and Policy
University of Michigan, Ann Arbor

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

Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations.  Continue reading

Rheumatoid Arthritis: Study Finds No Benefit to MRI-Guided Treatment

MedicalResearch.com Interview with:

Signe Møller-Bisgaard MD, PhD Rigshospitalet Center for Rheumatology and Spine Diseases Copenhagen Center for Arthritis Research 

Dr. Møller-Bisgaard

Signe Møller-Bisgaard MD, PhD
Rigshospitalet
Center for Rheumatology and Spine Diseases
Copenhagen Center for Arthritis Research 

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

Response: The background was that to avoid long-term consequences of rheumatoid arthritis (RA) such as progressive joint damage progression leading to functional impairment and loss of quality of life, it is essential for patients with RA to achieve clinical remission, which is a disease state with no clinical signs and symptoms of disease activity. But despite treating our patients according to current clinical recommendations using targeted treatment strategies, so that the patients reach a state of remission, joint damage progression still occurs in one out of four patients. We knew, that MRI inflammatory findings such as synovitis and bone marrow edema are present in patients in clinical remission and are of prognostic value. In particular bone marrow edema has shown to be a strong predictor of erosive joint damage progression.

In the IMAGINE-RA randomized clinical trial we therefore wanted to investigate if an MRI treat-to-target strategy targeting absence of bone marrow edema versus a conventional disease activity-guided treat-to-target strategy would improve clinical and radiographic outcome in rheumatoid arthritis patients in clinical remission.  Continue reading

Does EEG Brain Monitoring During Surgery Reduce Post-Op Delirium?

MedicalResearch.com Interview with:

Michael Avidan, MBBCh, FCA SA Dr. Seymour and Rose T. Brown Professor of Anesthesiology Chief of the Division of Clinical and Translational Research Director of the Infrastructure of Quality Improvement, Research and Informatics Washington University School of Medicine St Louis, MO

Dr. Avidan

Michael Avidan, MBBCh, FCA SA
Dr. Seymour and Rose T. Brown Professor of Anesthesiology
Chief of the Division of Clinical and Translational Research
Director of the Infrastructure of Quality Improvement, Research and Informatics
Washington University School of Medicine
St Louis, MO 

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

Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death.

Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery.

Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery.

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Self-Compression During Mammography Evaluated

MedicalResearch.com Interview with:
"Kiki Gets a Mammogram" by kristiewells is licensed under CC BY-NC-SA 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by-nc-sa/2.0Philippe Henrot, MD
Radiology Department
Institut de Cancerologie de Lorraine
Vandoeuvre-les-Nancy 

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

Response: The initial observation was that daily practice of mammography shows a substantial proportion of women that report a negative experience after having a mammogram. Compression of the breast before delivering X-rays is mandatory to achieve the best image quality and to detect small cancers. Unfortunately, compression is uncomfortable, even sometimes painful.

We took into consideration a study of PJ Kornguth et al. published in 1993 reporting the self-compression technique. In this study one breast was compressed by the radiographer and the other with self-compression. The author reported a high level of patient satisfaction, and a lower discomfort, without compromising image quality. We performed a multicenter prospective randomized trial to demonstrate the feasibility of the self-compression technique in condition similar to routine screening or follow-up, compared with standard compression. The primary outcome was to demonstrate that self-compression did not lead to compress the breast less than standard compression, and that was done. The secondary outcomes were to evaluate pain, compression force and image quality.

The results indicated that compression force was higher when the women controlled themselves the compression of their breast, and the pain measured on a visual analogue scale was lower. Moreover, image quality was not compromised compared with standard compression.  Continue reading

Federal Incentives Did Not Reduce Catheter Infections in Hospitals

MedicalResearch.com Interview with:

Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

Dr. Hsu

Heather Hsu, MD MPH
Assistant Professor of Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, MA 02118

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

Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015.

Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown.

Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example.

We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.

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Should Hospitalized Asthma Patients Receive Antibiotics?

MedicalResearch.com Interview with:
Mihaela S Stefan, MD, PhD FACP

Research Scientist, Institute for Healthcare Delivery and Population Science
Associate Professor, UMMS-Baystate
Director of Perioperative Clinic and Medical Consultation Program
Academic Hospitalist
Director Quality Assessment, Division of Healthcare Quality
Springfield MA

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

Response: In a prior study we have found that roughly 41% of patients hospitalized with an asthma exacerbation receive antibiotics although the guidelines do not support this practice. We found that the evidence supporting the guidelines was however limited to 6 trials which included a total of only 681 adults and children and most trials’ outcomes were symptoms or lung function not length of stay, need for mechanical ventilation, readmissions or death.

We performed the largest observational study to-date of approximately 20 000 patients hospitalized for asthma exacerbation and found that patients treated with antibiotics did not have better outcomes but instead they had longer hospital stay and an increased risk for antibiotic-related diarrhea. Continue reading

Link Between Thyroid Function Genetics and Atrial Fibrillation Grows

MedicalResearch.com Interview with:

Joe-Elie Salem, MD, PhD Associate Professor - MCU-PH, Sorbonne Université - INSERM - CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology Clinical Pharmacology, Nashville, TN

Dr. Salem

Joe-Elie Salem, MD, PhD
Associate Professor – MCU-PH, Sorbonne Université – INSERM – CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France
Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology
Clinical Pharmacology, Nashville, TN

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

Response: A study by researchers at Vanderbilt University Medical Center has strengthened the link between thyroid function and atrial fibrillation (AF), an irregular heart rhythm that increases the risk of stroke and other heart-related complications.

They phenome-wide association study scanned the medical records of more than 37,000 people for an association between genetically determined variation in thyroid stimulating hormone levels (a measure of thyroid function) and AF risk.

Previous observational studies have found that subclinical hyperthyroidism, an overactive thyroid which does not meet the clinical threshold for diagnosis or treatment, nevertheless can increase the risk of atrial fibrillation.  But whether to treat subclinical hypo- or hyperthyroidism to reduce AF risk remains a matter of debate in the medical community.  Continue reading

Low Sugar Diet Reduced Liver Fat and Inflammation

MedicalResearch.com Interview with:

Miriam Vos, MD, MSPH Assistant professor of Pediatrics Emory University School of Medicine Physician on staff, Children’s Healthcare of Atlanta

Dr. Vos

Miriam Vos, MD, MSPH
Associate Professor of Pediatrics and Director
Pediatric Fatty Liver Program
Emory and Children’s Healthcare of Atlanta

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

Response: Fatty liver disease has quickly become a common problem in children and adolescents, affecting an estimated 7 million children in the U.S.  This study resulted from our previous research demonstrating that fructose increases cardiometabolic risk factors in children with NAFLD in addition to other research that had demonstrated associations between NAFLD and sugar.    Continue reading

Changing Attitudes Toward Liver Transplant for Alcohol-Associated Liver Disease

MedicalResearch.com Interview with:

Norah Terrault, MD MPH Professor, Gastroenterology Department of Medicine University of California San Francisco

Prof. Terrault

Norah Terrault, MD MPH
Professor, Gastroenterology
Department of Medicine
University of California San Francisco

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

Response: Rates of liver transplantation (LT) for alcohol-associated liver disease (ALD) are rising such that ALD recently became the most common reason for LT in the United States. Although some assume that the increase in LT for ALD is because LT for hepatitis C has declined since the advent of antiviral therapy, little research has been done to formally investigate this hypothesis, or other reasons for the increase.

This national registry study used the United Network for Organ Sharing database and included over 32,000 liver transplant recipients, including 9,438 patients with ALD. The main findings are that

1) liver transplantation for ALD has doubled in the past 15 years, but only 48% of the increase in LT for ALD can be explained by declining LT for hepatitis C;

2) Many liver transplantation centers require patients to be abstinent at least 6 months to be eligible for LT for alcohol-associated liver disease, but this is changing – our trends analysis strongly suggest that shifting attitudes of transplant providers to allow earlier LT for ALD are an important part of the increase in LT for ALD, and are variable across different geographic regions;

3) Late post- liver transplantation survival after 5-years is 11% lower for alcohol-associated liver disease (vs. non-ALD).  

MedicalResearch.com: What should readers take away from your report?

Response: Changing attitudes regarding liver transplantation for acute alcoholic hepatitis may be having broad effects on LT for alcohol-associated liver disease, as more LT providers believe that it is justified to pursue earlier LT for ALD. As attitudes continue to change with more data to suggest that early LT for ALD can be undertaken with acceptable outcomes, we may see further increases in liver transplantation for ALD in future years. Since attitudes are provider-specific, and there is no national transplant policy for LT eligibility in terms of pre-LT abstinence requirements, this study suggests that variable policies and provider attitudes may be leading to inequity in healthcare access for alcohol-associated liver disease patients in need of liver transplantation.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Given the significant increase in liver transplantation for alcohol-associated liver disease, which was different across regions, there would be value in a national policy to guide the management of LT for ALD. It is unclear why late survival for ALD is inferior for non-ALD, but other studies have shown recurrent alcohol use, malignancy, and infections to be important causes of late death after liver transplantation — these should be specifically investigated in future studies of liver transplantation for ALD.

No disclosures

Citation: 

Lee BP, Vittinghoff E, Dodge JL, Cullaro G, Terrault NA. National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States. JAMA Intern Med. Published online January 22, 2019. doi:10.1001/jamainternmed.2018.6536

Jan 22, 2019 @ 10:34 pm 

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Breast Cancer Survivors More Likely To Develop Subsequent Blood Cancers

MedicalResearch.com Interview with:
medicalresearch.comDr. Marie Joelle Jabagi, PharmD, MPH

University of Paris Sud, Paris-Saclay University, Paris
Health Product Epidemiology Department
French National Agency for Medicines and Health Products Safety
Saint-Denis, France

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

Response: Secondary hematologic malignant neoplasms that develop months or years after the diagnosis of breast cancer may be a consequence of genetic predisposition, environmental factors, previous cancer treatments or a combination of all those factors. These secondary malignant neoplasms are increasingly becoming a concern given that the population of breast cancer survivors is growing substantially. However, their frequency in real life has been poorly investigated to date.

The aims of our research were to estimate the frequency of various types of hematologic malignant neoplasm following a diagnosis of primary breast cancer among women aged 20 to 85 years in France during the past decade, and to compare it to the corresponding frequency in women of the French general population.

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Tinnitus: Study of Adoptees Suggests Genetic Predisposition

MedicalResearch.com Interview with:

Christopher R. Cederroth | Ph.D. Docent Associate Professor Experimental Audiology | Department of Physiology and Pharmacology Karolinska Institutet  Sweden

Dr. Cederroth

Christopher R. Cederroth | Ph.D. Docent
Associate Professor
Experimental Audiology | Department of Physiology and Pharmacology
Karolinska Institutet
Sweden

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

Response: Tinnitus is experienced is experienced by a large proportion of the population and affects more than 15% of the population worldwide (estimated 70 million people in Europe). However, for near 3% of the population, tinnitus becomes a chronic bothersome and incapacitating symptom. Severe tinnitus interferes with sleep, mood, and concentration and thus impacts life quality, ultimately leading to sick leave and disability pension. A high cost to society has been reported, and since the prevalence of tinnitus has been predicted to double in Europe by 2050, there is an important need for an effective treatment. And today there are none, with the exception of cognitive behavioral therapy, which helps coping with it but does not remove the tinnitus. There has been a number of innovative treatment approaches, but they are overall not successful and it is now agreed that it is likely because tinnitus is a heterogeneous condition – meaning that we cannot consider tinnitus a single entity but an ensemble of different forms or subtypes, which need to be defined.

Tinnitus has always been considered a condition influenced by environmental factors, but our initial studies suggested the opposite. Adoption studies are excellent in showing the influence of shared-environment effects and establish a genetic basis for a disease or a trait. It allows to test the transmission of a trait between the adoptee and their biological or their adoptive parent. Transmission via the biological parent is expected to be due to a heritable genetic effect, while transmission via the adoptive parent is associated with home-environment, the so-called shared-environmental effect. We used medical registry data to identify tinnitus patients and adoptees.

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Comparison of Local Public Health Departments Highlights Social Inequities

MedicalResearch.com Interview with:

Megan Wallace, DrPH Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland

Dr. Wallace

Megan Wallace, DrPH
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland

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

Response: Local health departments are often evaluated on a nationwide or statewide basis, however, given diversity among counties that exists even at the state level, we felt there might be a better way to group health departments for evaluation.

In this study, we created county-level clusters using local characteristics most associated with the outcomes of interest, which were smoking, motor vehicle crash deaths, and obesity. We then compared county-level percentile rankings for the outcomes within sociodemographic peer clusters vs nationwide rankings. We identified 8 groups of counties with similar local characteristics.

Percentile ranks for the outcomes of interest often differed when counties were compared within their peer groups in comparison with a nationwide scale.  Continue reading

Does Treatment with Vitamin D Reduce Cardiovascular Risk in Hemodialysis Patients?

MedicalResearch.comInterview with:

Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan
Dr. Shoji

Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan

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

Response: Vitamin D is known to be associated with health and disease of various organs such as bone, heart, brain, and others. Vitamin D is activated by the liver and kidneys to a hormone called 1,25-dihydroxyvitamin D which binds to vitamin D receptor in cells to exert its functions.

Vitamin D activation is severely impaired in patients with kidney disease requiring hemodialysis therapy, leading to mineral and bone disorder(MBD). Therefore, active form of vitamin D is one of the standard choices of treatment for MBD caused by kidney function loss.

Previous observational cohort studies showed that the use of active vitamin D in hemodialysis patients was associated with lower likelihood of all-cause death, cardiovascular death, and incident cardiovascular disease.Potentially cardio-protective effects of active vitamin D were shown by basic studies using cultured cells and animal models. Then, many nephrologists began to believe that active vitamin D is a “longevity hormone” or a “panacea” for kidney patients requiring dialysis therapy, although there was no evidence by randomized clinical trials. 

To show evidence for it, we conducted a randomized clinical trial namedJ-DAVID in which 976 hemodialysis patients were randomly assigned to treatment with oral alfacalcidol or treatment without active vitamin D, and they were followed-up for new cardiovascular events during the four-year period. The risk of cardiovascular events was not significantly different between the two groups. The risk of all-cause death was not significantly different either.

To our surprise, the risk of cardiovascular event tended to be higher in the patients who continued treatment with active vitamin D than those who continued non-use of active vitamin D, although the difference was not statistically significant.

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Visual Inspection Alone Can Miss Some Skin Cancers

MedicalResearch.comInterview with:

polarized-light-dermatoscope-wikipedia-image

Jac Dinnes PhD, MSc, MA, PGDip
Senior Researcher
Test Evaluation Research Group
Institute of Applied Health Research
University of Birmingham

MedicalResearch.com:  What is thebackground for this study? Would you briefly explain the benefits of dermoscopy?

Response: This systematic review was one of a series of Cochrane Reviews of studies evaluating different tests for diagnosing skin cancer. Within creasing rates of skin cancer and an increasing number of more specialised tests becoming available in both primary care and in specialist settings, a thorough review of all available evidence was timely.

The diagnosis of melanoma and other skin cancers fundamentally relies on clinical examination, including history taking, and visual inspection of the concerning skin lesion (mole or patch of skin) and surrounding skin (and other lesions). A dermatoscope is a handheld device using visible light (such as from incandescent or LED bulbs), that allows more detailed examination of the skin compared to examination by the naked eye alone.

Knowing the diagnostic accuracy of dermoscopy added to visual inspection alone, across a range of observers and settings, is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques.

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Using of Big Data to Estimate Prevalence of Defective DNA Repair Variants in the US

MedicalResearch.com Interview with:

Kenneth H. Kraemer,M.D.
Chief DNA Repair Section
Laboratory of Cancer Biology and Genetics, Center for Cancer Research
National Cancer Institute

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

Response: At the National Cancer Institute, we have been examining patients with xeroderma pigmentosum (XP), a rare, recessively inherited, cancer-prone disease for many years. Therefore, with the increasing use of exome sequencing, we decided to see how closely”big data” corresponded with our clinical observations.  

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