Small Increased Risk of Diabetes with Common Drug for Prostate Enlargement Interview with:

Professor Ruth Andrew PhDChair of Pharmaceutical EndocrinologyUniversity/BHF Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of Edinburgh

Dr. Andrew

Professor Ruth Andrew PhD
Chair of Pharmaceutical Endocrinology
University/BHF Centre for Cardiovascular Science
Queen’s Medical Research Institute
University of Edinburgh What is the background for this study? What are the main findings?

Response: Our research group has been interested for a number of years in how stress hormones (called glucocorticoids) influence the risk of heart disease and diabetes. Glucocorticoids help us control stress and regulate how the body handles its fuel, for example the carbohydrate and fat we eat. However exposure to high levels of glucocorticoids, can increase the risk of diabetes, obesity and high blood pressure.

We studied men with prostate disease who took 5α-reductase inhibitors, because over and above the beneficial actions of these drugs in the prostate, they also slow down inactivation of glucocorticoids. We had carried out some short term studies with the drugs in humans and found that they reduced the ability of insulin to regulate blood glucose. Therefore in the study we have just published in the BMJ, we examined how patients receiving these drugs long-term responded and particularly we were able to show that over an 11 year period that there was a small additional risk of developing type 2 diabetes, the type of disease common in older people, compared with other types of treatments. Continue reading

Stress from Traumatic Events Linked to Increased Risk of Heart Disease Interview with:

Huan Song Associated Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Huan Song

Huan Song, PhD
Center of Public Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavík, Iceland
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet, Stockholm, Sweden What is the background for this study?  

Response: Cardiovascular disease (CVD) presents a group of diseases that are common and sometimes fatal in general population. The possible role of stress-related disorders in the development of CVD has been reported. However, the main body of the preceding evidence was derived from male samples (veterans or active-duty military personnel) focusing mainly on posttraumatic stress disorder (PTSD) or self-reported PTSD symptoms. Data on the role of stress-related disorders in CVD in women were, until now, limited. Although incomplete control for familial factors and co-occurring psychiatric disorder, as well as the sample size restriction, limit the solid inference on this association, especially for subtypes of CVD.

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Do Elevated Troponins Always Indicate a Heart Attack? Interview with:

Prof. Nick Curzen  BM(Hons) PhD FRCPProfessor of Interventional Cardiology/Consultant CardiologistUniversity Hospital SouthamptonSouthampton

Prof. Curzen

Prof. Nick Curzen  BM(Hons) PhD FRCP
Professor of Interventional Cardiology/Consultant Cardiologist
University Hospital Southampton
Southampton What is the background for this study?

Response: The commonest blood test now used to assess whether a patient has had a heart attack or not is called high sensitivity troponin (hs trop).  The test is supplied with an Upper Limit of Normal, which is based upon results from relatively healthy people.  When doctors take the hs trop, they then use this ULN to decide if the patient had has a heart attack.

This study set out to see what the hs trop level is in a large number of patients attending the hospital for any reason, either inpatient or outpatient, in most of whom there was no clinical suspicion of heart attack at all.  We therefore took hs trop measurements on 20,000 consecutive patients attending our hospital and having a blood sample for any reason.  Continue reading

Long Term Hormone Use May Raise Risk of Alzheimer’s Disease Interview with:

Tomi Mikkola MDAssociate ProfessorHelsinki University HospitalDepartment of Obstetrics and GynecologyHelsinki, Finland

Dr. Mikkola

Tomi Mikkola MD
Associate Professor
Helsinki University Hospital
Department of Obstetrics and Gynecology
Helsinki, Finland What is the background for this study? What are the main findings?

Response: In Finland we have perhaps the most comprehensive and reliable medical registers in the world. Thus, with my research group I have conducted various large studies evaluating association of postmenopausal hormone therapy use and various major diseases (see e.g. the references in the B;MJ paper). There has been various smaller studies indicating that hormone therapy might be protective for all kinds of dementias, also Alzheimer’s disease.

However, we have quite recently shown that hormone therapy seems to lower the mortality risk of vascular dementia but not Alzheimer’s disease (Mikkola TS et al. J Clin Endocrinol Metab 2017;102:870-7). Now in this upcoming BMJ-paper we report in a very large case-control study (83 688 women with Alzheimer’s disease and same number of control women without the disease) that systemic hormone therapy was associated with a 9-17% increased risk of Alzheimer’s disease.

Furthermore, this risk increase is particularly in women using hormone therapy long, for more than 10 years. This was somewhat surprising finding, but it underlines the fact that mechanisms behind Alzheimer’s disease are likely quite different than in vascular dementia, where the risk factors are similar as in cardiovascular disease. We have also shown how hormone therapy protects against cardiovascular disease, particularly in women who initiate hormone therapy soon after menopause. Continue reading

HPV Testing for Primary Cervical Cancer Screening Interview with:

Matejka Rebolj, PhD King’s College London, London, UK

Dr. Rebolj

Matejka Rebolj, PhD
King’s College London, London, UK

Henry Kitchener, MD FRCOG FRCS University of Manchester, Manchester, UK

Dr. Kitchener


Professor Henry Kitchener, MD FRCOG FRCS
University of Manchester, Manchester, UK What is the background for this study?

Response: We now have reliable and affordable technologies to detect human papillomavirus (HPV), a virus which is universally accepted as the cause of cervical cancer. Various large trials confirmed that cervical screening could be improved by replacing the smear (cytology) test that has been in use for decades, with HPV testing. Many countries are now making the switch. In England, this is planned for the end of 2019. To test how to run HPV testing within the English National Health Service, a pilot was initiated in 2013 in six screening laboratories. We also wanted to determine whether the encouraging findings from the trials could be translated to everyday practice. This is important not only because we will be using different HPV tests, but also because women undergoing screening in trials are much more selected than those who are invited to population-based screening.  Continue reading

Going to Bed Right After Dinner May Raise Diabetes Risk Interview with:
Chiyori Haga, R.N. P.H.N Ph.D
Department of Community Nursing
Graduate School of Health Science
Okayama University in Japan What is the background for this study? What are the main findings?

Response: In Japan, we have a health checkup system for middle and elderly people to prevent their non-communicable diseases (NCDs) including the Metabolic Syndrome (MetS) and give them some health guidance based a guideline. The guideline has suggested that short duration between bed time and dinner time will be a risk factor of metabolic syndrome or diabetes mellitus for some duration.

However, there may be no association between them, it is the main findings.  Continue reading

Shorter Casting Period May Be Sufficient For Many Ankle Fractures Interview with:

Tero Kortekangas, MD, PhD Orthopaedic trauma surgeon Oulu University Hospital Oulu, Finland

Dr. Kortekangas

Tero Kortekangas, MD, PhD
Orthopaedic trauma surgeon
Oulu University Hospital
Oulu, Finland What is the background for this study? What are the main findings?

Response: Isolated, stable, Weber B type fibula fracture is by far the most common type of ankle fracture. Traditionally these fractures are treated with below the knee cast for six weeks. Although the clinical outcome of this treatment strategy has been shown to be generally favourable, prolonged cast immobilisation is associated with increased risk of adverse effects, prompting attempts to streamline the treatment. However, perhaps because of absence of high quality evidence on the effectiveness and safety of more simple non-operative treatment strategies, the current tenet of six weeks of cast immobilisation still remains the “gold standard” treatment of stable Weber B type fractures.

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Female Genital Mutilation of Young Girls Declines in Africa, Not in Western Asia Interview with:
Professor Ngianga-Bakwin Kandala Professor of Biostatistics Department: Mathematics, Physics and Electrical Engineering Northumbria University, UKProfessor Ngianga-Bakwin Kandala

Professor of Biostatistics
Department: Mathematics, Physics and Electrical Engineering
Northumbria University, UK What is the background for this study? What are the main findings? 

Response: The background “UNICEF (2014) estimates that worldwide more than two hundred million women have undergone some form of FGM/C, and approximately 3.3 million girls are cut each year. Recent estimates show that if FGM/C practices continue at current, 68 million girls will be cut between 2015 and 2030 in 25 countries where FGM is routinely practiced and more recent data are available (UNJP, 2018).”

Main findings: The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. We found evidence of significant decline in the prevalence of FGM/C in the last three decades among children aged 0–14 years in most of the countries and regions, particularly in East, North and West Africa. We show that the picture looks different in Western Asia, where the practice remains and affects the same age group.

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Who is Really Sick? Eyeball Assessment vs Formal Triage Interview with:

Dr Anne Kristine Servais Iversen, Anne Kristine Servais Iversen Department of Obstetrics and Gynecology Rigshospitalet Copenhagen, Denmark 

Dr. Servais Iversen

Dr Anne Kristine Servais Iversen,
Anne Kristine Servais Iversen
Department of Obstetrics and Gynecology
Copenhagen, Denmark What is the background for this study? What are the main findings?

Response: Systematic triage has been implemented worldwide with different triage scales in use all over the world. Prior to the introduction of formalised triage, patients were prioritised based on clinical assumption.

After the introduction of formalised triage only a few studies have assessed agreement between formal and informal triage. Additionally, the majority of formalised triage scales are supported by limited and often insufficient evidence. This is troublesome since formalised triage forces clinicians to follow an algorithm rather than use their experience and clinical judgement. During my own residency at a Danish Emergency ward I was often contacted by the nurse performing formalised triage telling me that a patient she was assessing scored to be very acute (high triage level), but that she didn’t believe that to be the case. In order for her to prioritise the patient to a lower (less acute) triage level the patient had to be assessed by a doctor.

Very often my colleagues and I would agree with the nurse in that the scoring was to high, and we therefore had to overrule the formalised triage decision. In cases like these you ask yourself whether or not we are using the most effective and best form of triage for initial patient sorting.

Our study found that agreement between formalised triage and a quick clinical assessment in the form of Eyeball triage is poor. It also suggest that eyeball triage better predicts those at highest risk of death within 48-hours and 30 days after assessment.

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Genetic Locus Linked to Migraine Risk in African American Children Interview with:
"DNA model" by Caroline Davis2010 is licensed under CC BY 2.0Hakon Hakonarson, MD, PhD
Corresponding Author
Xiao Chang, PhD
Lead Author
The Center for Applied Genomics
Children’s Hospital Philadelphia
PhiladelphiaPennsylvania What is the background for this study? What are the main findings?

Response: Migraine is a genetic disorder characterized by recurrent and intense headaches often accompanied by visual disturbances. Genome-wide association studies (GWASs) are a powerful hypothesis-free tool for investigating the genetic architecture of human disease. Currently, multiple GWASs have been conducted on European adults with migraine that have successfully identified several migraine susceptibility genes involved in neuronal and vascular functions.

Considering the prevalence of migraines varies across ethnicities, the genetic risk factors may be different in patients of African ancestries and European ancestries. In addition, if migraine presents at an early age (childhood), it may reflect elevated biological predisposition from genetic factors or increased susceptibility to environmental risk factors.

We performed the first GWAS to investigate the susceptibility genes associated with migraine in African-American children. The main out come was that common variants at the 5q33.1 locus in the human genome are associated with migraine risk in African-American children. The genetic underpinnings at this locus responsible for this finding are less relevant in patients of European ancestry.  Continue reading

SMArT Work: Stand More AT Work Increased Work Engagement and Quality of Life Interview with:
Dr Fehmidah Munir CPsychol, AFBPsS

Reader in Health Psychology
Athena SWAN School Champion
School of Sport, Exercise & Health Sciences
National Centre for Sports and Exercise Medicine
Loughborough University What is the background for this study? What are the main findings?

Response: Given the evidence of the harmful effects of high levels of sitting time on health and the high proportion of time the majority of adults spend in this behaviour, particularly in the workplace, methods to reduce overall and prolonged sitting were needed.

Our SMArT Work (Stand More AT Work) programme was delivered to NHS office workers and involved brief education about the impact of sitting on health and benefits of reducing sitting, feedback on sitting behaviour, providing staff with a height-adjustable desk to enable them to work either standing up or sitting down, motivational posters and brief chats with a researcher to see how they were getting on. They received this programme over 12 months.

We found that office workers in our study spent nearly 10 hours/day sitting down, which can be bad for health, but we’ve shown that those office workers who received our SMArT Work programme had lower sitting time by around 80mins per day after 12 months compared to those who didn’t receive our programme. Those who received SMArT Work also reported an increase in work engagement, job performance and quality of life and less musculoskeletal issues such as back and neck pain, they felt less tired after a day at work, had less feelings of anxiety and lower sickness presenteeism (working whilst sick). We didn’t find any differences in the number of days absent at work though. Whether you work remotely from home or in an office environment, it may also be good to invest in new Office Furniture. This could also help combat the issue of back and neck pains that you may be experiencing.
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Combination Oral Contraceptives Associated With Reduced Ovarian Cancer Risk Interview with:

Dr Lisa Iversen PhD; MSc Epidemiology Research Fellow Academic Primary Care Institute of Applied Health Sciences University of Aberdeen

Dr. Iversen

Dr Lisa Iversen PhD; MSc Epidemiology
Research Fellow
Academic Primary Care
Institute of Applied Health Sciences
University of Aberdeen What is the background for this study?

Response: Everyday at least 100 million women worldwide use hormonal contraception. Previous research has found a reduced risk of ovarian cancer in women using combined oral contraceptives but this evidence related to older products. It is important for users of contemporary combined oral contraceptives to know whether they are likely to experience the same patterns of reduction in risk of ovarian cancer and whether the benefit is specific to a particular formulation. Users of other hormonal contraceptives such as those with non-oral routes of administration and progestogen-only products should also know whether they have a reduced risk of ovarian cancer.

We investigated the influence of all contemporary hormonal contraceptives on ovarian cancer risk in over 1.8 million women in Denmark aged 15-49 years, over a 20 year period from 1995-2014. What are the main findings? 

Response: Compared to never users, current or recent users of hormonal contraceptives and former users had a reduced risk of ovarian cancer. The reduced risk became stronger the longer time period hormonal contraceptives were used and the protection remained several years after stopping. We found most of the hormonal contraceptive use was of combined oral contraceptives. There was little evidence of important differences between products containing different progestogens. The reduced risk of ovarian cancer for combined products was seen for most ovarian cancer types. There was no firm evidence to suggest any protective effect among women who had used progestogen-only products but few women exclusively used these contraceptives so their limited data might not be powerful enough. We estimate that hormonal contraception prevented 21% of ovarian cancers in our study What should readers take away from your report?

Response: Our findings are reassuring to women of reproductive age, contemporary combined oral contraceptives (which generally contain lower doses of oestrogen and newer progestogens) are still associated with a reduced risk of ovarian cancer. What recommendations do you have for future research as a result of this work?

Response: It is still to be established how long the protective effects associated with contemporary combined oral contraceptives persist. We were unable to investigate this as our study examined contemporary products and did not include older women. Is there anything else you would like to add?

Response: Although our observational study is unable to draw conclusions about cause and effect, it is noteworthy that our findings are consistent with studies of older products.

All authors have completed the ICMJE uniform disclosure form and declare Professor Lidegaard reports grants from Novo Nordisk Foundation, during the conduct of the study; and has been an expert witness in two legal cases in the US on hormonal contraception and venous thrombosis for the plaintiff in 2011 and 2012. Dr Mørch reports grants from Novo Nordisk Foundation, during the conduct of the study. Professor Hannaford and Drs Iversen, Fielding and Skovlund have nothing to disclose.


Association between contemporary hormonal contraception and ovarian cancer in women of reproductive age in Denmark: prospective, nationwide cohort study

BMJ 2018362 doi: (Published 26 September 2018)Cite this as: BMJ 2018;362:k3609

Oct 1, 2018 @ 2:44 pm 

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