MedicalResearch.com - Medical Research Interviews Week in Review
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MedicalResearch.com - Medical Research Interviews Week in Review

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MedicalResearch.com Interviews with researchers from major and specialty medical research journals and meetings.

MedicalResearch.com Interviews with researchers from major and specialty medical research journals and meetings.

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MedicalResearch.com - Medical Research Interviews Week in Review MedicalResearch.com - Medical Research Interviews Week in Review Presentation Transcript

  • MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD info@Hemodialysis.com January 16 2014 For Informational Purposes Only: Not for Specific Medical Advice.
  • Medical Disclaimer | Terms and Conditions • • • The contents of the Hemodialysis.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site! If you think you may have a medical emergency, call your doctor or 911 immediately. Hemodialysis.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Hemodialysis.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is solely at your own risk. The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis. Read more interviews on Hemodialysis.com
  • Heavy Alcohol Consumption Bad for the Aging Brain MedicalResearch.com Interview with: Séverine Sabia, PhD Epidemiology & Public Health, Div of Population Health University College London – Gower Street – London • • • • • • • • • • • MedicalResearch.com Interview with: Séverine Sabia, PhD Epidemiology & Public Health, Div of Population Health University College London – Gower Street – London MedicalResearch.com: What are the main findings of the study? Dr. Sabia: The present study shows a detrimental effect of heavy alcohol consumption on cognitive ageing, and the effects are seen as early as 55 years old. MedicalResearch.com: Were any of the findings unexpected? Dr. Sabia: Heavy alcohol consumption is known to be detrimental for health. So the results were not surprising. They add that heavy alcohol consumption is also detrimental for the brain and the effects can be observed as soon as 55 years old. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Sabia: The findings are in agreement with previous studies and suggest that moderate alcohol consumption is probably not deleterious for cognitive outcomes. However, this study adds to the evidence that heavy alcohol consumption (≥36 g/day, ≥ 4 UK drinks per day) is deleterious for cognitive ageing. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Sabia: In the present study, it was not possible to examine the effect of heavy drinking on cognitive ageing as only a small number of women were heavy drinkers. It would be interesting to test whether the results found in men are also true in women. Citation: Alcohol consumption and cognitive decline in early old age Sabia, Alexis Elbaz, Annie Britton, Steven Bell, Aline Dugravot, Martin Shipley, Mika Kivimaki, and Archana Singh-Manoux 10.1212/WNL.0000000000000063; published ahead of print January 15, 2014 Read the rest of the interview on MedicalResearch.com
  • SSRIs During Late Pregnacy and Infant Pulmonary Hypertension MedicalResearch.com Interview with: Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women’s Mood and Anxiety Clinic: Reproductive Transitions, Associate Professor, Faculty of Medicine, University of Toronto • • • MedicalResearch.com: What are the main findings of the study? Dr. Grigoriadis: Infants of women exposed to selective serotonin reuptake inhibitors (SSRIs) during late pregnancy (but not early) are at risk for developing persistent pulmonary hypertension of the newborn (PPHN). PPHN is a condition in which blood pressure remains high in the lungs following birth and which results in breathing difficulties. The symptoms can range from mild to severe, but the condition can be managed successfully typically after SSRI exposure. It is important to note that the baseline risk for PPHN in the general population is low (about 2 per 1,000 live births), and so the increase in risk with SSRIs still represents a low overall risk for developing PPHN following SSRI exposure in late pregnancy (increasing to approximately 5 per 1,000 live births). This increased risk means that 286 to 351 women would have to be treated with an SSRI during late pregnancy in order to result in 1 additional case of PPHN. MedicalResearch.com: Were any of the findings unexpected? Dr. Grigoriadis: The findings of this study were not wholly unexpected, although the research evidence had been mixed prior to our meta-analysis. More surprising, was that we did not find a moderating effect for any of the known risk factors for PPHN that we were able to examine (i.e., meconium aspiration or congenital malformations) but this may be a reflection of the fact that there were few studies and the way these studies handled the risk factors. Read the rest of the interview on MedicalResearch.com
  • SSRIs During Late Pregnacy and Infant Pulmonary Hypertension MedicalResearch.com Interview with: Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women’s Mood and Anxiety Clinic: Reproductive Transitions, Associate Professor, Faculty of Medicine, University of Toronto • • • • • • MedicalResearch.com What should clinicians and patients take away from your report? Dr. Grigoriadis: Women and their families should be counseled about PPHN and the potential for the development of it following exposure to SSRIs during late pregnancy although the risk remains low. As well, women and their families must know that the condition can often be managed favorably if PPHN does occur. Clinicians should be aware of the risk and clinical presentation of PPHN in the infant. Depression should not be left untreated as there are risks for untreated depression for both the mother and baby that can also extend into the postpartum period. Various treatment options exist for depression; treatment selection is based on several factors and sometimes antidepressant drugs are needed. MedicalResearch.com What recommendations do you have for future research as a result of this study? Dr. Grigoriadis: Future research should determine whether other classes of antidepressants, besides SSRIs, also show an association with PPHN, as well as whether known risk factors (i.e., preterm delivery, c-section or obesity) and if clinical depression itself play a role in any association. Antidepressants are also prescribed for other psychiatric disorders that may also have an independent association with development of PPHN and thus psychiatric diagnosis should also be identified. Furthermore, future research in this field would benefit from a more uniform definition of early and late antidepressant exposure, and from studies in which exposure to the medication under examination is more assured. This last point speaks to the fact that reliance upon prescription database registries or retrospective self-report of exposure may mean that women categorized as exposed may not have been done so accurately. Lastly, it is important that future studies examine the severity of PPHN and the factors important for those with increased severity. Citation: Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and metaanalysis Grigoriadis S ,VonderPorten EH ,Mamisashvili L ,Tomlinson G ,Dennis C ,Koren G ,et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ 2014;348:f6932 Read the rest of the interview on MedicalResearch.com
  • Adverse Events Reporting: Room for Improvement MedicalResearch.com Interview with: Sunita Vohra MD MSc FRCPC FCAHS Director, CARE Program Professor, Dept of Pediatrics Faculty of Medicine & Dentistry Edmonton Continuing Care Centre, Edmonton, Alberta Canada • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Vohra: Our main findings were: (i) relative to how often systematic reviews evaluate the effectiveness of health interventions, the systematic review of harms is quite neglected; and (ii) even when systematic reviews do aim to evaluate harms, there is considerable room for improvement in reporting. MedicalResearch.com: Were any of the findings unexpected? Dr. Vohra: All health interventions have the potential for benefit and the potential for harm. It is surprising that even though clinicians and patients need information about both, there are so few systematic reviews that evaluate harms. It is worrying that harms are under-studied, under-reported, and that this is compounded by the lack of synthesis of harms data in systematic reviews (and the poor reporting we found in those reviews). This suggests that decision-makers don’t have the information they need, in order to choose the best therapy. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Vohra: Clinicians and patients need to demand better quality evidence with which to make decisions, and they need to ask this of all parties: e.g. funders (who often spend taxpayer money on evaluating therapies), journal editors (who publish health research), and researchers (who conduct/report health research). At every stage, an equal emphasis on the investigation and reporting of harms is warranted, so that high quality data about benefits and harms are available to decision-makers. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Vohra: We think reporting guidelines to improve the reporting of harms in systematic reviews are warranted (e.g. PRISMA harms extension). Hopefully it will have the same positive impact to improve the quality of reporting that PRISMA has had on systematic reviews. Citation: Quality of reporting in systematic reviews of adverse events: systematic review Zorzela L ,Golder S ,Liu Y ,Pilkington K ,Hartling L ,Joffe A ,et al. Quality of reporting in systematic reviews of adverse events: systematic review. BMJ 2014;348:f7668 Read the rest of the interview on MedicalResearch.com
  • Alcohol Still Sold to Obviously Drunk Patrons MedicalResearch.com Interview with: Professor Karen Hughes Professor in Behavioural Epidemiology Centre for Public Health Liverpool John Moores University Liverpool L3 2ET • • • MedicalResearch.com: What are the main findings of the study? Answer: We used trained actors to test whether servers in pubs, bars and nightclubs would sell alcohol to people showing signs of extreme intoxication, despite this being illegal in the UK. In over four fifths (83.6%) of purchase attempts, bar servers sold alcohol to the pseudo-drunk actors – even though many clearly identified the actors as being drunk. We also collected data on bar environments, looking specifically at ten factors that have been associated with alcohol-related harm in previous studies: low levels of seating, loud noise, crowding, poor lighting, dirtiness, cheap drink promotions, young bar staff, young customers, rowdiness, and customer drunkenness. We found that the more of these characteristics bars had, the more likely they were to sell alcohol to drunks, with 100% of bars with 8 or more of these characteristics serving the pseudo-drunk actors. However, even in bars with none of these characteristics, two thirds of purchase attempts resulted in an alcohol sale. Having security staff managing entrance to the premises was also associated with alcohol service; possibly suggesting that bar servers in premises with door staff believe responsibility for vetting customers lies with such staff. MedicalResearch.com: Were any of the findings unexpected? Answer: Along with the very high level of alcohol service to pseudo-drunk actors, in almost one in five alcohol sales actors’ notes identified that bar servers had tried to sell them a larger drink (i.e. a double rather than a single vodka). This was an unexpected finding, and as actors were not specifically asked to record this information the actual extent of such ‘up-selling’ might have been even higher. Thus, not only were most alcohol servers ignoring the law preventing sales of alcohol to drunks, they often saw no problem in providing vulnerable individuals with more alcohol than they had actually asked for. Read the rest of the interview on MedicalResearch.com
  • Alcohol Still Sold to Obviously Drunk Patrons MedicalResearch.com Interview with: Professor Karen Hughes Professor in Behavioural Epidemiology Centre for Public Health Liverpool John Moores University Liverpool L3 2ET • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Excessive alcohol use has a huge impact on health and the provision of health services, with emergency departments in England struggling to cope on weekend nights and alcohol-related hospital admissions continuing to rise. The enforcement of legislation to prevent the sale of alcohol to people who are drunk has the potential to reduce excessive drinking and change harmful nightlife cultures, yet this legislation is hardly used anywhere in England (with just 3 convictions nationally in 2010). With strategies such as minimum alcohol pricing having been stalled in England, health professionals have a major role to play in advocating for other mechanisms to reduce drunkenness and the harms it causes, and preventing sales to drunks should be a key priority. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Measures that can effectively reduce sales of alcohol to drunks need to be identified, implemented and evaluated in UK. Such measures may include those to raise public awareness of legislation on sales of alcohol to drunks, provide training to bar servers in service refusal techniques, and specifically to increase enforcement activity to identify and punish those breaking the law. Studies such as this can serve as a baseline to measure the effectiveness of such measures. Citation: Does legislation to prevent alcohol sales to drunk individuals work? Measuring the propensity for nighttime sales to drunks in a UK city Karen Hughes, Mark A Bellis, Nicola Leckenby, Zara Quigg, Katherine Hardcastle, Olivia Sharples, David J Llewellyn Centre for Public Health, WHO Collaborating Centre for Violence Prevention, Liverpool John Moores University, J Epidemiol Community Health Published Online First: Jan 15 2014 doi:10.1136/ Read the rest of the interview on MedicalResearch.com
  • Gout: Rising Prevalence and Incidence MedicalResearch.com Interview with: Weiya Zhang, BPH, MEpi, PhD Associate Professor & Reader Division of Rheumatology, Orthopaedics and Dermatology The University of Nottingham Clinical Sciences Building City Hospital Nottingham NG5 1PB • • • • • • • • • • • • MedicalResearch.com Interview with: Weiya Zhang, BPH, MEpi, PhD Associate Professor & Reader Division of Rheumatology, Orthopaedics and Dermatology The University of Nottingham Clinical Sciences Building City Hospital Nottingham NG5 1PB MedicalResearch.com: What are the main findings of the study? Dr. Zhang: We found the prevalence and incidence of gout keep rising from 1997 to 2012, but the management (percentage of patients treated with the recommended effective drugs) remains poor. MedicalResearch.com: Were any of the findings unexpected? Dr. Zhang: it is unexpected that the management of gout remains constantly poor (only a third receive proper treatment) irrespective of all national and international treatment guidelines published in the past decade. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Zhang: Gout is the prevalent condition affecting 1 in 40 people in the UK population. The prevalence increased rapidly (4% per year) from 1997 to 2012. It is one of a few medical conditions which have effective treatment, but unfortunately it has been poorly managed. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Zhang: Research in the identification of the factors related to the poor management of gout and how to improve it would be very useful. Citation: Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study Kuo C-F, Grainge MJ, Mallen C, et al Ann Rheum Dis Published Online First: 1/15/2013 doi:10.1136/annrheumdis- 2013-204463 Read the rest of the interview on MedicalResearch.com
  • Allergic March of Asthma Eczema and Rhinitis MedicalResearch.com Interveiw with: Mariona Pinart, PhD CREAL-Centre for Research in Environmental Epidemiology ISGlobal alliance Doctor Aiguader, 88 | 08003 Barcelona • • • • • MedicalResearch.com: What are the main findings of the study? Answer: The study examined 23.434 children at 4 and 8 years from 12 ongoing European population-based birth cohort studies that recorded information on current eczema, rhinitis, and asthma from questionnaires and serum-specific IgE to six allergens. We wanted to assess how often eczema, rhinitis and asthma coexist in the same children (comorbidity) and whether the occurrence of comorbidities was due to causality or casualty and finally we wanted to examine whether the occurrence of comorbidity was modified by IgE sensitization. We found that comorbidity affects about 4% of children aged 4–8 years and that about 50% of this comorbidity is due to causality, suggesting that these diseases share common pathophysiological mechanisms. In addition, we found that children comorbidity at age 4 are 30 to 60 times more likely to have comorbidity at age 8 years, suggesting that the presence of comorbidity at age 4 years is a strong determinant of comorbidity at age 8 years. Even children with one single disease are also at high risk of developing comorbidity by age 8 years. Interestingly, we found that not only comorbidity is present in children both sensitized and not sensitized to IgE but also that only 38% of incident comorbidity at age 8 years is explained by the presence of IgE sensitization at age 4 years. MedicalResearch.com: Were any of the findings unexpected? Answer: Evidence supports that the atopic march is a useful paradigm to describe the sequential progression of eczema, rhinitis and asthma suggesting that atopy (IgE sensitization) could be the underlying mechanism linking these diseases to each other. Unexpectedly, we found that the tendency of these diseases to overlap is stronger in children without IgE sensitization and that incident comorbidity is not fully explained by IgE sensitization, suggesting that IgE sensitization can no longer be considered the dominant causal mechanism of the coexistence for these diseases. Read the rest of the interview on MedicalResearch.com
  • Allergic March of Asthma Eczema and Rhinitis MedicalResearch.com Interveiw with: Mariona Pinart, PhD CREAL-Centre for Research in Environmental Epidemiology ISGlobal alliance Doctor Aiguader, 88 | 08003 Barcelona • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: First, comorbidity is more often observed than it would have been expected by chance, which means that comorbidity is a substantial public health problem and second, those children with one disease at age 4 years are 4-7 times more likely to develop comorbidity by age 8 years regardless of IgE sensitization, suggesting that clinicians have new evidence to support the design and implementation of health-care strategies for the management of comorbidity. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Further research is needed to unravel the role of IgE sensitization as well as the other non-IgE-related underlying mechanisms linking these diseases to each other and that are therefore causally related to comorbidity. In this regard, our study is one the studies conducted in the EU-funded MeDALL (Mechanisms of the Development of Allergy) project which aims to generate novel knowledge on the mechanism of initiation of allergy from early childhood to young adulthood. We are currently conducting other studies examining the inter-relationships between these diseases using other statistical approaches. Other on-going experimental studies on epigenetics, proteomics and transcriptomics within the frame of MeDALL may unravel the contribution of IgE sensitization to the development of allergic comorbidty as well as other pathophysiological mechanisms causally related to comorbidity, improve diagnostic and control strategies and ultimately may discover new targets for therapy. Citation: Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a populationbased cohort study Mariona Pinart PhD,Marta Benet BStat,Isabella Annesi-Maesano DSc,Andrea von Berg MD,Prof Dietrich Berdel MD,Prof Karin C L Carlsen MD,Prof Kai-Håkon Carlsen MD,Prof Carsten Bindslev-Jensen MD,Esben Eller PhD,Maria P Fantini MD,Jacopo Lenzi BStat,Ulrike Gehring PhD,Joachim Heinrich PhD,Cynthia Hohmann Dipl Psych,Prof Jocelyne Just MD,Thomas Keil MD,Marjan Kerkhof PhD,Prof Manolis Kogevinas MD,Prof Sibylle Koletzko MD,Prof Gerard H Koppelman MD,Inger Kull PhD,Prof Susanne Lau MD,Erik Melén MD,Prof Isabelle Momas PhD,Daniela Porta MSc,Prof Dirkje S Postma PhD,Fanny Rancière PhD,Prof Henriette A Smit PhD,Renato T Stein MD,Christina G Tischer PhD,Maties Torrent PhD,Prof Magnus Wickman MD,Alet H Wijga PhD,Prof Jean Bousquet MD,Prof Jordi Sunyer MD,Xavier Basagaña PhD,Stefano Guerra MD,Judith Garcia-Aymerich PhD,Prof Josep M Antó MD The Lancet Respiratory Medicine – 14 January 2014 DOI: 10.1016/S2213-2600(13)70277-7 Read the rest of the interview on MedicalResearch.com
  • Type 1 Diabetes: Retinopathy and Cerebral Microbleeds MedicalResearch.com Interview with: Dr. Eelco van Duinkerken Vrije Universiteit Medical Center, Amsterdama • • • MedicalResearch.com: What are the main findings of the study? Answer: In our study we assessed the relationship between cerebral small vessel disease and peripheral microvascular function in type 1 diabetes patients. By MRI cerebral small vessel disease was assessed as white matter hyperintensities and lacunar infarcts (markers of ischemia) and cerebral microbleeds (expression of vascular leakage). We hypothesized that subgroups, i.e. those with (proliferative) retinopathy, are more at risk to develop cerebral small vessels disease. To this end, we selected type 1 diabetes patients with proliferative retinopathy, type 1 diabetes patients without microvascular complications and healthy controls. The main finding of our study was that only cerebral microbleeds, but not ischemic markers of cerebral small vessel disease were more prevalent in type 1 diabetes patients with proliferative retinopathy relative to the other groups. Cerebral microbleeds were also related to microvascular function in skin. This suggest that cerebral microbleeds are part of generalized microangiopathy in patients with type 1 diabetes. MedicalResearch.com: Were any of the findings unexpected? Answer: The prevalence of markers of ischemic small vessels disease were not more prevalent in type 1 diabetes patient with proliferative retinopathy, only cerebral microbleeds were more prevalent. This was a somewhat unexpected finding, as the hypothesis was that small vessel disease in the brain is linked to vascular retinal damage. We speculated that this is due to the differences in aetiology of the lesions. White matter hyperintensities and lacunes are considered as markers of ischemia, whereas cerebral microbleeds represents hemosiderin leakage mainly at the capillary level and thus be more comparable to the microangiopathy measured in the retina and the skin. Although caution should be taken as only a small number of lesions were observed. Read the rest of the interview on MedicalResearch.com
  • Type 1 Diabetes: Retinopathy and Cerebral Microbleeds MedicalResearch.com Interview with: Dr. Eelco van Duinkerken Vrije Universiteit Medical Center, Amsterdama • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: This report shows that microvascular functioning in the skin is related to vascular leakage in the brain, but only in type 1 diabetes patients with proliferative retinopathy. It shows that microvascular complications are part of a generalized microangiopathy. Thus, prevention of vascular complications is import to prevent type 1 diabetes related brain changes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: This is a first study in a limited sample to address the relationship between cerebral and peripheral vascular changes in type 1 diabetes. Further studies are needed in larger samples to understand the exact relationship between cerebral small vessel disease and peripheral vascular functioning. In such studies the effects of cerebral small vessel disease on brain functioning and cognitive functioning should be included. Citation: Proliferative retinopathy in type 1 diabetes is associated with cerebral microbleeds, which is part of generalized microangiopathy. Woerdeman J, van Duinkerken E, Wattjes MP, Barkhof F, Snoek FJ, Moll AC, Klein M, de Boer MP, Ijzerman RG, Serné EH, Diamant M. Diabetes Care. 2013 Dec 6. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • Dietary Fiber Intake and Cardiovascular Risk MedicalResearch.com Interview with: Prof. Victoria J Burley Senior Lecturer in Nutritional Epidemiology School of Food Science and Nutrition University of Leeds Biostatistics, University of Leeds, UK • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Prof. Burley: Although it’s been suggested for a long time that foods rich in dietary fiber may protect individuals from having a heart attack or stroke because they lower some of the risk factors for these diseases, trying to determine how much dietary fibre might be beneficial and whether these benefits are apparent in all populations around the world has been less easy to research. Our research at the University of Leeds has pooled the results of published large-scale follow-up studies and has demonstrated a consistent lowering of risk of cardiovascular and coronary heart disease with increasing dietary fiber intake. This dose-response trend suggests that even small additional increments in intake may be beneficial in the long term. MedicalResearch.com: 
Were any of the findings unexpected? Prof. Burley: Because there are now more studies available for us to look at, we were able to look separately at the food sources of fiber. When we did this, we were able to see apparently greater benefits from increasing cereal foods rich in dietary fibre, rather than perhaps the ‘traditional’ sources of fibre – fruit and vegetables. MedicalResearch.com: What should clinicians and patients take away from your report? 
 Prof. Burley: That they should continue to encourage patients to eat plenty of fiber-rich foods, regardless of their current state of health – we observed these benefits in populations who were originally healthy. In most high-income countries, average intakes of dietary fiber have remained well below government recommendations, and clinicians can have an important advisory role to play here. Clinicians do not have to advocate consuming herculean amounts of dietary fiber – benefits seem to be apparent even with modest increases in consumption, such as may be observed by swapping refined or white cereal foods for wholegrain or whole-wheat versions. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Prof. Burley: We would like to continue to research how dietary fibre is able to bring about these benefits, but also to explore why patients seem to have resisted dietary advice so far to eat more whole grains and high fiber food sources. Citation: Dietary fibre intake and cardiovascular disease: A systematic review and meta-analysis Read the rest of the interview on MedicalResearch.com
  • Rotavirus Vaccination and Intussusception Risk MedicalResearch.com Interview with: W. Katherine Yih Ph.D., M.P.H Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Yih: The main findings are that vaccination with the first dose of RotaTeq is associated with a small increase in the risk of intussusception, which is concentrated in the first week after vaccination. The estimated risk is about 1.5 excess cases per 100,000 first doses administered. This risk is fairly small, amounting to roughly 1/10 of the risk seen after the original rotavirus vaccine (called Rotashield) that was used in 1998-1999, before it was withdrawn from the market. We also found evidence that Rotarix increases the risk of intussusception. However, the number of infants receiving Rotarix and the number getting intussusception after Rotarix were too small to allow us to estimate the risk after Rotarix with any precision. MedicalResearch.com: Were any of the findings unexpected? Dr. Yih: The findings of an increased risk of intussusception after rotavirus vaccination were not entirely unexpected, given that studies conducted in other countries had pointed to an increased risk after one or the other of the two vaccines. However, several studies conducted in the United States had not found an increased risk. The state of knowledge about the risk of intussusception after rotavirus vaccination in the United States changed in May-June 2013 with a publication by the Vaccine Adverse Event Reporting System (Haber et al., in Pediatrics), which found an increased risk after RotaTeq, and a public presentation by the Vaccine Safety Datalink (VSD) project to the Advisory Committee on Immunization Practices (Weintraub et al., in the New England Journal of Medicine), which found an increased risk after Rotarix. At this point, our results for both vaccines are broadly compatible with those of other published studies that have been conducted internationally and in the United States. Although the VSD study did not find a statistically significant increase in the risk of intussusception after RotaTeq, their point estimate of the risk from Dose 1 was elevated and the 95% confidence interval around this estimate overlaps with ours. Therefore, I do not consider our results to be inconsistent with the VSD results. Read the rest of the interview on MedicalResearch.com
  • Rotavirus Vaccination and Intussusception Risk MedicalResearch.com Interview with: W. Katherine Yih Ph.D., M.P.H Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Yih: Both rotavirus vaccines provide a high level of protection against severe diarrhea from rotavirus infection. The benefits of rotavirus vaccination in preventing severe diarrhea and hospitalization in several countries, including the United States, have been amply documented in the scientific literature. After carefully evaluating the results of this study and of other recent studies of the association between rotavirus vaccination and intussusception, the CDC continues to recommend that all U.S. infants (following the age and precaution/contraindication criteria) receive rotavirus vaccine. This recommendation is based on their assessment that the benefits of vaccination with either of the two rotavirus vaccines outweigh the risks of intussusception. For instance, it is estimated that routine rotavirus vaccination will prevent more than 53,000 hospitalizations for severe diarrhea in a U.S. birth cohort of 4.3 million infants followed to 5 years of age. This number of hospitalizations averted is far greater than the projected number of vaccine-associated intussusception cases. Although the risk of intussusception is low, if, after rotavirus vaccination, a child appears to have severe abdominal pain (indicated by, for example, severe crying, pulling their legs up to their chest, vomiting, or passing blood in their stool), the parent/guardian should promptly seek medical attention and mention the date and other details of the recent rotavirus vaccination. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Yih: A formal risk-benefit evaluation would be helpful in order to establish unequivocally that the benefits of vaccination outweigh the risks. It would also be useful to have a rigorous comparison of the safety of the two vaccines, with adequate statistical power, since if the risk from one is significantly greater than the risk from the other, this would have policy implications. Citation: Intussusception Risk after Rotavirus Vaccination in U.S. Infants W. Katherine Yih, Ph.D., M.P.H., Tracy A. Lieu, M.D., M.P.H., Martin Kulldorff, Ph.D., David Martin, M.D., M.P.H., Cheryl N. McMahill-Walraven, M.S.W., Ph.D., Richard Platt, M.D., Nandini Selvam, Ph.D., M.P.H., Mano Selvan, Ph.D., Grace M. Lee, M.D., M.P.H., and Michael Nguyen, M.D. January 14, 2014DOI: 10.1056/NEJMoa1303164 Read the rest of the interview on MedicalResearch.com
  • Risk of Diabetes and Fish Intake MedicalResearch.com Interview with: Jyrki Virtanen, PhD Adjunct Professor of Nutritional Epidemiology University of Eastern Finland Institute of Public Health and Clinical Nutrition Kuopio, Finland • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Virtanen: The main finding was that serum long-chain omega-3 polyunsaturated fatty acid (PUFA) concentration, an objective biomarker of fish and long-chain omega-3 PUFA intake, was associated with a lower risk of incident type 2 diabetes during the average follow-up of 19.3 years in middle-aged and older men from Eastern Finland. The risk was 33% lower in the highest vs. the lowest quartile after adjustment for potential confounders. In contrast, hair mercury, a marker for long-term exposure to mercury, was not associated with the risk. Previously in this study population, high hair mercury content has been associated with higher risk of cardiovascular diseases and attenuation of the beneficial impact of long-chain omega-3 PUFA on the risk. Also, we did not find associations with the intermediate-chain length omega-3 PUFA alpha-linolenic acid, either, which is a plant-based omega-3 PUFA. This suggests that the findings were specific to the long-chain omega-3 PUFAs from fish. MedicalResearch.com: Were any of the findings unexpected? Dr. Virtanen: It was slightly unexpected that the long-chain omega-3 PUFA concentration did associate with the risk. In the previous studies a beneficial effect has been found mainly in the studies in Asian populations and no association or even an increased risk with higher fish consumption has been found in studies in Europe and the USA. One of the reasons that we were able to find an association may be that we had very detailed information about type 2 diabetes incidence in this study population, so we were able to catch those who got the diagnosis during the follow-up. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Virtanen: As with the recommendations for cardiovascular disease prevention, it may be beneficial to have a few fish meals per week, preferably with fatty fish, in order to reduce also the risk of type 2 diabetes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Virtanen: In the previous studies no association has been found in the studies from Europe, whereas in the studies from Asia/Australia fish or long-chain omega-3 PUFA intakes were associated with lower risk of type 2 diabetes and in the studies from the USA with higher risk. However, in the US studies where an objective biomarker was used, circulating long-chain omega-3 PUFA concentrations were not found to be associated with higher risk. This suggests that the increased risk observed with dietary intakes may be related to the dietary assessment method. Because of these issues, there is a need for further research from diverse study populations and with objective biomarkers of exposure in order to clarify the role of the omega-3 PUFAs on the prevention of type 2 diabetes. Citation: Serum Omega-3 Polyunsaturated Fatty Acids and Risk of Incident Type 2 Diabetes in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study Virtanen JK, Mursu J, Voutilainen S, Uusitupa M, Tuomainen TP. Diabetes Care. 2014 Jan;37(1):189-96. doi: 10.2337/dc13-1504. Epub 2013 Sep 11. Read the rest of the interview on MedicalResearch.com
  • Rotavirus Vaccine and Risk of Intussusception MedicalResearch.com Interview with Eric S. Weintraub, M.P.H. Epidemiologist at Centers for Disease Control and Prevention • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Mr. Weintraub: While current rotavirus vaccines were not associated with intussusception in large pre-licensure trials, recent post-licensure data (from international settings) suggest the possibility of a low risk of intussusception occurrence after receipt of monovalent rotavirus vaccination (RV1). We examined the risk of intussusception following RV1 vaccination in a U.S. population. In this study of more than 200,000 doses of RV1, a slight increased risk of intussusception was observed after vaccination, which should be considered in light of the benefits of preventing rotavirus associated illness. MedicalResearch.com: Were any of the findings unexpected? Mr. Weintraub: These findings were not unexpected based upon recent international studies from Mexico, Brazil and Australia. MedicalResearch.com: What should clinicians and patients take away from your report? Mr. Weintraub: CDC continues to recommend that all US infants receive rotavirus vaccine. The risk-benefit analysis continues to demonstrate that the benefits of rotavirus vaccination continue to outweigh the risks associated with vaccination, including the small risk of intussusception. Providers should be aware of the risks and educate parents about the risk of intussusception and the benefits of rotavirus vaccines. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Mr. Weintraub: Steps moving forward will include continued monitoring to further quantify the risk of intussusception and education for health care professionals and parents. A systematic evaluation of data from all the U.S. and international studies and research to try to elucidate the biological mechanisms of intussusception following rotavirus vaccination would also be of value. Citation: Risk of Intussusception after Monovalent Rotavirus Vaccination Eric S. Weintraub, M.P.H., James Baggs, Ph.D., Jonathan Duffy, M.D., M.P.H., Claudia Vellozzi, M.D., M.P.H., Edward A. Belongia, M.D., Stephanie Irving, M.H.S., Nicola P. Klein, M.D., Ph.D., Jason M. Glanz, Ph.D., Steven J. Jacobsen, M.D., Ph.D., Allison Naleway, Ph.D., Lisa A. Jackson, M.D., M.P.H., and Frank DeStefano, M.D., M.P.H. January 14, 2014DOI: 10.1056/NEJMoa1311738 Read the rest of the interview on MedicalResearch.com
  • Probiotics to Prevent Infantile Colic, Regurgitation and Functional Constipation MedicalResearch.com Interview with: Flavia Indrio, MD Department of Pediatrics Aldo Moro University of Bari Bari, Italy • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: The main finding is that for the first time the use in prevention instead of treatment with a probiotic for the colic regurgitation and constipation. MedicalResearch.com: Were any of the findings unexpected? Answer: Yes because is the first time that we attempt to use this probiotic in prevention. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Clinicians should know this possibility and inform their patients. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: The study needs to be repeated and also the children need to have a long term follow up. Citation: Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation: A Randomized Clinical Trial. JAMA Pediatr. 2014;():. doi:10.1001/jamapediatrics.2013.4367. Read the rest of the interview on MedicalResearch.com
  • Emergency Room Screening for Delirium MedicalResearch.com Interview with: Dr. Michael A. LaMantia Regenstrief Institute, Inc. Investigator and Assistant Professor of Medicine Indiana University School of Medicine • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. LaMantia: We conducted a systematic review of existing studies on delirium in emergency departments and found that neither completely validated delirium screening instruments nor an ideal schedule to perform delirium assessments exist there. MedicalResearch.com: Were any of the findings unexpected? Dr. LaMantia: We had hoped that there would be more available information to support the use of a particular delirium screening tool in the emergency department. Unfortunately, there was limited data to support a choice of one tool. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. LaMantia: Unrecognized delirium presents a major health challenge to older adults and an increased burden on the health care system. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. LaMantia: Further work is needed to develop and validate emergency department-specific screening instruments and to determine how often to administer screenings in the rapid-paced environment. Citation: Screening for Delirium in the Emergency Department: A Systematic Review Ann Emerg Med. 2013 Dec 16. pii: S0196-0644(13)01584-9. doi: 10.1016/j.annemergmed.2013.11.010. [Epub ahead of print] Lamantia MA1, Messina FC2, Hobgood CD3, Miller DK4. Read the rest of the interview on MedicalResearch.com
  • Cataracts: Quitting Smoking Decreases Risk MedicalResearch.com Interview with: Birgitta Ejdervik Lindblad, MD PhD Department of Ophthalmology Örebro University Hospital Örebro, Sweden • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: We have investigated the association between smoking cessation and risk of having a cataract extraction among 44 371 Swedish men aged 45-79 years. During 12 years of follow up we identified 5713 incident cases of cataract extraction. Smoking cessation significantly decreased the risk with time. Men who currently smoked more than 15 cigarettes per day had a 42 % increased risk of cataract extraction compared with men who had never smoked. More than 20 years since quitting smoking, men who had smoked more than 15 cigarettes per day had a 21% increased risk of having a cataract extraction compared with men who had never smoked. The effect of smoking cessation was observed earlier among men who smoked less than 15 cigarettes per day but more than 2 decades since smoking cessation the risk had not decreased to the level of never smokers. MedicalResearch.com: Were any of the findings unexpected? Answer: Smoking is an established risk factor for cataract, but the effect of smoking cessation is unclear. Few studies have examined the effect of smoking cessation on risk of cataract. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Smoking cessation seems to decrease the risk of cataract. It is never too late to stop smoking but the higher the smoking intensity the longer it takes for the increased risk to decline. This finding emphasizes the importance of early smoking cessation and preferably avoidance of smoking. MedicalResearch.com: What recommendations do you have for future research as a result of this study? More longitudinal studies with regular updated information on smoking status are needed to confirm these results. Citation: Smoking Cessation and the Risk of CataractA Prospective Cohort Study of Cataract Extraction Among Men Lindblad B, Håkansson N, Wolk A. Smoking Cessation and the Risk of Cataract: A Prospective Cohort Study of Cataract Extraction Among Men. JAMA Ophthalmol. 2014;():. doi:10.1001/jamaophthalmol.2013.6669. Read the rest of the interview on MedicalResearch.com
  • Commercialism in School Food and Beverages MedicalResearch.com Interview with: Yvonne M. Terry-McElrath, MSA Institute for Social Research, University of Michigan, Ann Arbor • • • • MedicalResearch.com: What are the main findings of the study? Answer: This study examined 2007-2012 commercialism trends in schools attended by nationally representative samples of US elementary and secondary students. While some measures showed significant decreases over time (especially beverage vending measures), most students at both elementary and secondary school levels continued to be exposed to school-based commercialism. Commercialism increased significantly with grade level. The most frequent type of commercialism varied by school level: food coupons used as incentives was most common at the elementary school level, while exclusive beverage contracts were the most prevalent type of commercialism for middle and high school students. MedicalResearch.com: Were any of the findings unexpected? Answer: Exposure to elementary school coupons, as well as middle and high school exclusive beverage contracts, was significantly more likely for students attending schools with mid or low (versus high) student body socioeconomic status. Read the rest of the interview on MedicalResearch.com
  • Commercialism in School Food and Beverages MedicalResearch.com Interview with: Yvonne M. Terry-McElrath, MSA Institute for Social Research, University of Michigan, Ann Arbor • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Children at all levels of education–from 1st through 12th grade–are exposed to significant commercial and marketing efforts within the nation’s schools. Exposure to such commercialism appears to be highest for students in socioeconomically disadvantaged schools. The majority of foods and beverages marketed in any venue towards children and adolescents are high in calories, sugars, salt, and fat, and are low in essential nutrients; data indicate that the same is true for in-school marketing. In-school marketing for less healthy foods and beverages clearly counteracts educational programming aimed at developing good nutritional habits. The continuing high prevalence of school-based commercialism supports calls for, at minimum, clear and enforceable standards on the nutritional content of all foods and beverages marketed to youth in school settings. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: The recently-published USDA interim final rule governing school competitive nutrition environments provides standards for all competitive venue foods and beverages served and sold in schools participating in the National School Lunch Program and School Breakfast Program. The new standards should significantly improve the nutritional quality of foods and beverages sold in school competitive venues; however, they do not address in-school marketing. This leaves open an interesting opportunity for companies to continue to extend brand recognition and loyalty efforts, as well as promote less-healthy items. For example, vending machines may be stocked with items meeting the most recent Dietary Guidelines for Americans, yet the visual advertising on the machine may still promote items of low nutritional value. Future research is needed to examine the extent to which the commercialism environment in America’s schools supports or undermines efforts to improve student health. Citation: Commercialism in US Elementary and Secondary School Nutrition Environments Trends From 2007 to 2012 Terry-McElrath YM, Turner L, Sandoval A, Johnston LD, Chaloupka FJ. Commercialism in US Elementary and Secondary School Nutrition Environments: Trends From 2007 to 2012. JAMA Pediatr. 2014;():. doi:10.1001/jamapediatrics.2013.4521. Read the rest of the interview on MedicalResearch.com
  • Prostate Cancer: African American Men and Screening MedicalResearch.com Interview with: David M. Albala, MD Associated Medical Professionals of NY, PLLC Syracuse, NY 13210 • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Albala: Prostate cancer is the second leading cause of cancer death and American man. Prostate cancer diagnosis and mortality differences between African American and Caucasian populations have been highlighted in the literature. Research has shown that African American males are at a biological predisposition for prostate cancer and that additional socioeconomic and physician-patient educational factors may contribute to a higher mortality rate among this group – over two times greater than that of Caucasian American males. At present the most commonly used to detection tools for prostate cancer are the serum prostatic specific antigen test (PSA) and a digital rectal examination (DRE). These complementary tests provide physicians with an indication of whether to proceed with biopsy for a definitive pathological diagnosis. Despite ongoing disputes regarding the effectiveness of PSA screening as an indicator for prostate cancer, a superior alternative test as yet to become available for men at risk. The American Urological Association (AUA) emphasizes the value of early detection and that sheared decision-making should not be overlooked and that shared decision making should be integral to screening decisions. The AUA urges individuals to personally assess, with their physicians, whether a PSA screen is necessary. Emphasis should be placed on the proper education of African American men who are at increased risk for the disease, as well as on their participation in repeated screening practices for the earliest possible detection of prostate cancer. MedicalResearch.com: Were any of the findings unexpected? Dr. Albala: Today, two notable trials have investigated the value of PSA screening and reducing prostate cancer mortality, each yielding slightly different results. The Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial of valuated over 75,000 subjects from 10 US healthcare centers; male participants were stratified and randomized according to center and age. This study did not find screening to be associated with mortality rate; cancer incidence and mortality among the screening group were found to be 1.17 and 1.11 times that of the control group respectively. The European randomized study of screening for prostate cancer in (ERSPC) randomized 162,243 subjects from seven healthcare centers and various countries into 2 groups: screening and control. A serum PSA measurement was the primary screening methodology employed by the participating sites; DRE and transrectal ultrasonography were utilized as secondary test in some countries. Indication for biopsy following screening varied slightly among the sites as well. Despite the observed decrease in mortality (25%), the investigators did conclude a high risk of over-diagnosis was associated with this reduction; they reasoned that 1,410 additional men would need to be screened and 48 extra cases treated to prevent one additional prostate cancer death. Read the rest of the interview on MedicalResearch.com
  • Prostate Cancer: African American Men and Screening MedicalResearch.com Interview with: David M. Albala, MD Associated Medical Professionals of NY, PLLC Syracuse, NY 13210 • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Albala: Numerous studies have sought to discover any baseline biological differences relating to prostate cancer risk among men of various racial backgrounds. Given the recent findings and increasing knowledge about the possible discrepancies between PSA serum levels and prostate cancer invasiveness for distinct individuals, it is recommended that multiple patient aspects be considered before administering a biopsy following a PSA test. The AUA warns against recent publish skepticism surrounding the current methods of prostate cancer screening and urges individuals to personally assess, in conference with their physicians, whether a PSA screen is necessary. Late detection of prostate cancer for African American populations is a legitimate issue of healthcare access, the burden of which can be lessened by more active discussion with and education of patients by family practitioners. We urge primary caregivers to be forward and open about prostate cancer screening with their patients of all racial and family backgrounds. Additionally, emphasis should be placed on the proper education of African American men who are at increased risk for the disease, as well as their participation in repeated screening practices for the earliest possible detection of prostate cancer. Citation: PSA Screening for the African American Male: When and Why? Tyler A. Luthringer, Ilija Aleksic, Vladimir Mouraviev, and David M. Albala. Journal of Men’s Health. November 2013, 10(3): 86-90. doi:10.1089/jomh.2012.00026 Read the rest of the interview on MedicalResearch.com
  • Patient Preferences for Cancer Screening MedicalResearch.com Interview with: Dr Jonathan Banks Programme Manager: The Discovery Research Programme Centre for Academic Primary Care NIHR School for Primary Care Research School of Social and Community Medicine University of Bristol Bristol BS8 2PS • • • MedicalResearch.com: What are the main findings of the study? Dr. Banks: We asked members of the public attending their local general practice or primary care centre to consider a series of hypothetical scenarios or vignettes which depicted cancer symptoms, their risk of cancer and the investigative processes involved in testing for cancer. We wanted to measure the point at which the risk of cancer outweighed the burden and inconvenience of testing in relation to lung, colorectal and pancreas cancers. Most people, around 88%, opted for testing even at the lowest risk of cancer which in our vignettes was 1%. Further analyses showed variation between cancers with fewer people opting for testing for colorectal cancer at a low (1%) risk and more people choosing to be tested for all cancers in the 60-69 age group. MedicalResearch.com: Were any of the findings unexpected? Dr. Banks: We did expect to see more a gradient across all the cancers with more people choosing to be tested at higher risk levels. However, there was no strong evidence of such a gradient except in the case of colorectal cancer and respondents cited the demands and unpleasantness of the diagnostic test (colonoscopy) as influencing their decision. We were pleasantly surprised at the numbers of participants we were able to recruit to the study, we had thought that there may have been some resistance to discussing and thinking about cancer symptoms in this way but the public were very responsive to the survey. Read the rest of the interview on MedicalResearch.com
  • Patient Preferences for Cancer Screening MedicalResearch.com Interview with: Dr Jonathan Banks Programme Manager: The Discovery Research Programme Centre for Academic Primary Care NIHR School for Primary Care Research School of Social and Community Medicine University of Bristol Bristol BS8 2PS • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Banks: Clinical guidelines in the UK highlight the importance of including patients in decision making around referral for testing. We think that the way the public engaged with this study and the considered responses that they gave which are reflected in the subtle variations in choice around colorectal cancer and age suggest that clinicians at the primary care level can be bolder in incorporating patient views and preferences into the decision making process. On a wider level we feel that these findings should also feed into the ongoing revision of cancer referral guidelines. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Banks: We feel that it would be valuable to measure GP preferences for referral and compare these to the patient viewpoint. Citation: Preferences for cancer investigation: a vignette-based study of primary-care attendees Dr Jonathan Banks PhD,Sandra Hollinghurst PhD,Lin Bigwood MA,Prof Tim J Peters PhD,Fiona M Walter MD,Prof Willie Hamilton MD The Lancet Oncology – 14 January 2014 DOI: 10.1016/S1470-2045(13)70588-6 Read the rest of the interview on MedicalResearch.com
  • Age-Related Macular Degeneration: Ten Year Follow Up Study MedicalResearch.com Interview Emily Y. Chew, M.D. Deputy Director, Division of Epidemiology and Clinical Applications National Eye Institute National Institutes of Health (NIH), Bethesda, MD • • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Chew: We provided 10 year rates of development of advanced age-related macular degeneration (AMD), either neovascular (NV) AMD or central geographic atrophy (CGA). We also presented the risk factors associated with progression to advanced AMD. These risk factors that were associated with an increased risk of progression included drusen status at baseline (small drusen, intermediate, large drusen), presence of advanced AMD in the fellow eye, increasing age, female gender, smoking, and the white race. This is the last cohort of patients in whom anti-vascular endothelial growth factor agents were not available during the course of the study. The natural history of the vision loss for those who developed advanced is relentless, more gradual in those with geographic atrophy than neovascular AMD, and may occur even 1 year prior to the detection of advanced AMD by stereoscopic fundus photographs in obtained at study visits. MedicalResearch.com: Were any of the findings unexpected? Dr. Chew: We knew that the presence of large drusen increased the risk of developing advanced AMD. However, we found that 36% of participants with medium sized drusen in one eye and 71% of those with bilateral medium sized drusen at baseline would develop large drusen by 10 years. The risk of developing advanced AMD by 10 years was very low in participants with no drusen and in those with small drusen at baseline but 14% of participants with medium drusen in both eyes at enrollment developed advanced AMD by 10 years. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Chew: The risk of progression to advanced AMD, neovascular or central geographic atrophy was increased in persons with large drusen, AMD retinal pigmentary changes, presence of advanced AMD in the fellow eye. In addition, medium sized drusen may be another important risk for potential progression to advanced AMD. The visual acuity loss is relentless once advanced AMD develops. What recommendations do you have for future research as a result of this study? Dr. Chew: We hope the progression rates found in this study will help facilitate future clinical research, both epidemiologic studies and clinical trials by providing accurate information for sample size calculations and for evaluation of risk factors. Early AMD consisting of medium sized drusen may be an important stage for future evaluations of therapies. We look forward to using other modalities of imaging to give us data on progression rates of AMD. Citation: Ten-Year Follow-up of Age-Related Macular Degeneration in the Age-Related Eye Disease Study: AREDS Report No. 36. Chew EY1, Clemons TE2, Agrón E1, Sperduto RD2, Sangiovanni JP1, Davis MD3, Ferris FL 3rd1; for the Age-Related Eye Disease Study Research Group. JAMA Ophthalmol. 2014 Jan 2. doi: 10.1001/jamaophthalmol.2013.6636. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • MRSA and Nursing Home Admission Denials MedicalResearch.com Interview with: Courtney Reynolds, PhD Medical Scientist Training Program University of California Irvine, School of Medicine • • MedicalResearch.com: What are the main findings of the study? Dr. Reynolds: Our survey of factors influencing admission to 13 nursing homes in Orange County, California showed that MRSA carriers are denied admission more often than non-carriers, even after accounting for other important factors such as insurance status, required level of care and previous experience at the facility. In 80% of cases where MRSA carriage was responsible for denial of admission, nursing home administrators cited a lack of available single or cohort (MRSA only) rooms to accommodate these potential residents. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Reynolds: Yes, we were interested to find that there was substantial variation in admission rates across nursing homes for both MRSA carriers and non-carriers (from no rejections to about 2/3 of applicants rejected). This variation likely reflects that the most desirable nursing homes receive a higher volume of applicants and are able to be more selective in their admissions process. Another surprising finding was that among accepted applicants, MRSA carriage did not lead to delays in placement. We had hypothesized that since most nursing homes attempt to place MRSA carriers in single or cohort rooms, there could be a delay associated with waiting for such a room or with moving current residents around to create one. It now seems that nursing homes may simply reject an MRSA carrier if such a room isn’t already available. It is also possible that any delays in finding a room occur when the facility is contacted but before the applicant is officially accepted; this type of delay was not captured in our study. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Reynolds: Our finding that MRSA carriage negatively impacts the ability to find nursing home placement is highly concerning since many hospital patients require short or long term nursing home care after discharge. As nursing homes have limited space and thus ability to accommodate MRSA carriers in single or cohort rooms, consideration may need to be given to decolonizing known carriers before discharge in order to prevent difficulty in placement. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Reynolds: An important question given our results is whether placing MRSA carriers in single or cohort rooms is actually effective in the nursing home setting, where residents are allowed and encouraged to interact socially. Transmission risk has been found in a few recent studies to be linked to this socialization rather than to having an MRSA positive roommate. Again, decolonization may be a more efficient strategy to prevent transmission and future infection in the nursing home setting. Citation: Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers? Courtney Reynolds, Diane Kim, Sherrie H. Kaplan, Dana B. Mukamel, Eric Cui, Cameron Lee, Susan S. Huang AJIC: American Journal of Infection Control – January 2014 (Vol. 42, Issue 1, Pages 63-65, DOI: 10.1016/j.ajic.2013.07.015) • • • • • • • • • Read the rest of the interview on MedicalResearch.com
  • Preventing Sharps Injuries in Medical Undergraduates MedicalResearch.com Interview with: Anna-Christina Lauer, MD Department of Audiology and Phoniatrics Charité-University Medicine Berlin Berlin, Germany • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Gross: We could show that the injury rates depend on the undergraduate medical training the students attended. This demonstrates that medical undergraduatue education, especially a hands-on training, is critical in the prevention of needlestick- and sharps injuries. Also the use of safety devices has proven to reduce injury rates significantly. Given the large size of our study we could not only comfirm that needlestick and sharps injuries are still a common problem, looking at an injury rate of about 20% per year, we also learned a lot about the accident circumstances: Most accidents occur at bedside during venepuncture and intravenous cannulation. The second most common setting is the operating room, where suturing and instrument transfers can lead to injuries. Since we analyzed official reports and the anonymous surveys at the same time we could affirm an underreporting rate of more than 50%. MedicalResearch.com: Were any of the findings unexpected? Dr. Gross: We did not expect to find such clear data regarding the prevention of needlestick and sharps injuries. The introduction of safety instruments resulted in a reduction of the official injury count by about 50%. Furthermore the comparison of the different study programs showed us that practical training is a significant factor in the prevention of injuries and reassures us that specific practical training in safety instruments, safe techniques and instrument disposal should be part of medical undergraduate education. Also we could see in our survey that students are very much interested in learning safe techniques and first aid measures. Read the rest of the interview on MedicalResearch.com
  • Preventing Sharps Injuries in Medical Undergraduates MedicalResearch.com Interview with: Anna-Christina Lauer, MD Department of Audiology and Phoniatrics Charité-University Medicine Berlin Berlin, Germany • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Gross: Clinicians and students should take away that many needlestick and sharps injuries can be avoided. Key factors are the medical undergraduate training and the supply with safety devices. Based on our findings safety devices can be recommended and might be considered in different fields as well. Of course, not all accidents will be prevented. Therefore students and staff have to be informed and trained in first aid measures to avoid transmission of blood-borne diseases, part of which is the reporting of the injury to ensure the proper treatment. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Gross: In order to gain an overview and also find the major accident causes at a faculty a crosssectional study at different time points can provide a detailed insight. To go further an interesting field of research will be to investigate the effects of preventive measures, especially the medical undergraduate training, in longitudinal studies. Citation: Needlestick and sharps injuries among medical undergraduate students American Journal of Infection Control Available online 2 January 2014Anna-Christina Lauer,Andreas Reddemann,Claus-Peter MeierWronski, MD,Harald Bias, Karin Gödecke, Dipl-Ing, Michael Arendt, Dipl-Phys,Harm Peters, MD, PhD, Manfred Gross, MD, PhD, MBA Read the rest of the interview on MedicalResearch.com
  • Childhood Type I Diabetes: Brain White Matter Changes MedicalResearch.com Interview with: Naama Barnea-Goraly M.D. Center for Interdisciplinary Brain Sciences Research Stanford University • • • • MedicalResearch.com: What are the main findings of the study? Answer: Our main findings showed that compared with age and sex matched controls, children with type 1 diabetes have significant differences in white matter structure in widespread brain regions. Within the type 1 diabetes group, earlier onset of diabetes and longer duration were associated with greater alterations in white matter structure. In addition, measures of hyperglycemia and glucose variability, but not hypoglycemia were associated with white matter structure; however, hypoglycemia exposure and the number of severe hypoglycemia events in our sample were too small to identify statistically meaningful differences. Finally, we observed a significant association between white matter structure and cognitive ability in children with type 1 diabetes, but not in controls. MedicalResearch.com: Were any of the findings unexpected? Answer: The findings were what we had hypothesized based on previous observations in smaller samples. However, unlike previous studies, our study used continuous glucose monitors which allowed us to measure the blood sugars continuously every five minutes for up to 6 days and provided a more accurate measures of dysglycemia. Our results showed that beyond the previously observed effects of hyperglycemia on white matter structure, glucose fluctuations (as measured by standard deviation of glucose and Mean Amplitude of Glycemic Excursions, MAGE) also were associated with white matter structure in children with type 1 diabetes. Read the rest of the interview on MedicalResearch.com
  • Childhood Type I Diabetes: Brain White Matter Changes MedicalResearch.com Interview with: Naama Barnea-Goraly M.D. Center for Interdisciplinary Brain Sciences Research Stanford University • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report?
 Answer: Fear of hypoglycemia in young children with type 1 diabetes often results in caregivers maintaining relatively higher blood glucose levels to avoid lows altogether. However, our study suggests that this approach, which often results in hyperglycemia, may not be optimal and may be detrimental to white matter structure development in young children. MedicalResearch.com: What recommendations do you have for future research as a result of this study? hyperglycemia It is still unknown whether better glucose control would eliminate structural brain differences between children with T1D and controls. Longitudinal studies of how brain changes with age would be important to show how brain structure and cognition change in children with type 1 diabetes as they go through puberty and beyond. Citation: Naama Barnea-Goraly, Mira Raman, Paul Mazaika, Matthew Marzelli, Tamara Hershey, Stuart A. Weinzimer, Tandy Aye, Bruce Buckingham, Nelly Mauras, Neil H. White, Larry A. Fox, Michael Tansey, Roy W. Beck, Katrina J. Ruedy, Craig Kollman, Peiyao Cheng, Allan L. Reiss, and for the Diabetes Research in Children Network (DirecNet)* Read the rest of the interview on MedicalResearch.com
  • Health IT: Focus on Meaningful Use MedicalResearch.com Interview with: Robert S. Rudin, Ph.D. Associate Policy Researcher RAND Corporation Boston, MA 02116 • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Rudin: We found that most published health IT implementation studies report positive effects on quality, safety, and efficiency. Most evaluations focus on clinical decision support and computerized provider order entry. However, not all studies report equally positive results, and differences in context and implementation are one likely reason for these varying results, yet details of context and implementation are rarely reported in these studies. MedicalResearch.com: Were any of the findings unexpected? Dr. Rudin: The number of health information technology (IT) evaluation studies is rapidly increasing, driven primarily by increased evaluation of commercial health IT applications. Commercial studies accounted for more than half of evaluated health IT products, an enormous increase over previous literature reviews. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Rudin: Clinicians and patients should realize that health IT can be a great enabler of improving the quality and value of health care. However, by itself health IT will not accomplish these goals. Health IT needs to be part of a strategy. In order to produce the most value, health IT needs to be fitted to the organizational and clinical context, and how best to do this is not always well known. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Rudin: The most important improvement that can be made in health IT evaluations is increased measurement, analysis, and reporting of the effects of contextual and implementation factors. Citation: Spencer S. Jones, Robert S. Rudin, Tanja Perry, Paul G. Shekelle; Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use. Annals of Internal Medicine. 2014 Jan;160(1):48-54 Read the rest of the interview on MedicalResearch.com
  • Alzheimer Disease: Effect of Vitamin E on Slowing Functional Decline MedicalResearch.com Interview Invitation Maurice Dysken, MD Professor, School of Medicine Department of Psychiatry Minneapolis VA Health Care System, Minneapolis, Minnesota • • • MedicalResearch.com: What are the main findings of the study? Dr. Dysken: In patients with mild-to-moderate Alzheimer’s disease who were taking an acetylcholinesterase inhibitor, a dosage of 2000 IU/d of vitamin E significantly slowed functional decline compared to placebo by 6.2 months over the mean follow-up period of 2.27 years. Over this period of time caregiver time increased least in the vitamin E group compared to the other three groups (memantine alone, vitamin E plus memantine, and placebo) although the only statistically significant difference was between vitamin E alone and memantine alone. There were no significant safety concerns for vitamin E compared to placebo and mortality was lowest in the vitamin E alone group. It should be noted that patients who were on warfarin were excluded from the study because of a possible interaction with vitamin E that could have possibly increased bleeding events. MedicalResearch.com: Were any of the findings unexpected? Dr. Dysken: The combination of vitamin E and memantine did not significantly slow functional decline compared to placebo. Although one measure of cognition (ADAS-cog) favored vitamin E compared to placebo, after adjustment for multiple comparisons, this difference was not statistically significant. Read the rest of the interview on MedicalResearch.com
  • Alzheimer Disease: Effect of Vitamin E on Slowing Functional Decline MedicalResearch.com Interview Invitation Maurice Dysken, MD Professor, School of Medicine Department of Psychiatry Minneapolis VA Health Care System, Minneapolis, Minnesota • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Dysken: We concluded that 2000 IU/d of vitamin E appears to be beneficial in patients with mild-to-moderate Alzheimer’s disease by slowing functional decline and decreasing caregiver burden. Vitamin E appears to be safe and is also inexpensive. It should be emphasized that our study was not a prevention trial in subjects without a diagnosis of Alzheimer’s disease and as a consequence, vitamin E should be recommended only to patients who have a diagnosis of Alzheimer’s disease. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Dysken: It would be interesting to study different dosages of vitamin E and the effectiveness of other antioxidants as well. A combination study with aerobic exercise would be interesting since aerobic exercise also appears to have benefit in slowing decline in AD patients. Although vitamin E is an antioxidant, basic studies are needed to elucidate vitamin E’s specific mechanism of action in Alzheimer’s disease. Additional safety data are needed on the interaction between warfarin and vitamin E. Citation: Dysken MW, Sano M, Asthana S, et al. Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014;311(1):33-44. doi:10.1001/jama.2013.282834. Read the rest of the interview on MedicalResearch.com