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MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
MedicalResearch.com:  Medical Research Interviews March 2014
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MedicalResearch.com: Medical Research Interviews March 2014

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Exclusive Interviews with Medical Research and Health Care Researchers from major and specialty medical journals and health care meetings. …

Exclusive Interviews with Medical Research and Health Care Researchers from major and specialty medical journals and health care meetings.

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  • 1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD info@medicalresearch.com March 14 2014 For Informational Purposes Only: Not for Specific Medical Advice.
  • 2. Medical Disclaimer | Terms and Conditions • The contents of the MedicalResearch.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. MedicalResearch.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 MedicalResearch.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of MedicalResearch.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 MedicalResearch.com
  • 3. HPV Vaccination and Prevention of Cervical Abnormalities MedicalResearch.com Interview with: Dr Julia Brotherton Victorian Cytology Service, Melbourne, Victoria, Australia Dr Elizabeth Crowe The University of Queensland, School of Population Health, Brisbane, Australia Prof. David Whiteman Group Leader / Department Coordinator QIMR Berghofer Medical Research Institute Royal Brisbane Hospital, QLD 4029 • MedicalResearch.com: What are the main findings of the study? • 1. We conducted a case-control study in which we retrieved the HPV vaccination histories of young Australian women who were notified to the Pap smear registry with high-grade cervical lesions or with other types of cervical lesions, and compared them with the vaccination histories of women whose Pap smears showed only normal cytology. • 2. We found that women with high grade cervical lesions were significantly less likely than women with normal cytology to have received 3 doses of the quadrivalent HPV vaccine, equivalent to a vaccine effectiveness of 46%. • 3. The vaccine effectiveness among 15-19 year old women was even higher at 57%. We believe this reflects the fact that HPV16 causes an even higher proportion of high grade disease in young women due to its higher oncogenicity and shorter latent period. • 4. The HPV vaccine had 34% effectiveness against other cervical lesions (i.e. those not proven to be high grade lesions on histology). • 5. We also observed that 2 doses of the vaccine were 21% effective in preventing both high grade lesions and other grade lesions. MedicalResearch.com: Were any of the findings unexpected? • 1. Before this study was performed, we did not know whether less than three doses of vaccine would provide any protection. Our findings that 2 doses conferred 21% protection against both high grade lesions and other lesions are encouraging, but suggest that three doses are required for best protection using the current dose schedule. • MedicalResearch.com: What should clinicians and patients take away from your report? • 1. This report demonstrates the effectiveness of the HPV vaccine in the ‘real world’ population setting (i.e. outside of clinical trials). • 2. The vaccine is targeted against two HPV types (16 and 18) that are known to cause about 50% of high grade cervical lesions. Among women receiving the vaccine, we observed a 46% reduction in the risk of high grade lesions, consistent with the vaccine preventing almost all high grade lesions that are caused by HPV 16 and 18. • 3. Importantly, because the vaccine does not target other HPV types known to cause the remainder of high grade lesions, it is essential that women continue to be screened, even if they have received the vaccine. Read the rest of the interview on MedicalResearch.com
  • 4. HPV Vaccination and Prevention of Cervical Abnormalities MedicalResearch.com Interview with: Dr Julia Brotherton Victorian Cytology Service, Melbourne, Victoria, Australia Dr Elizabeth Crowe The University of Queensland, School of Population Health, Brisbane, Australia Prof. David Whiteman Group Leader / Department Coordinator QIMR Berghofer Medical Research Institute Royal Brisbane Hospital, QLD 4029 • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • 1. We need to continue to monitor trends in HPV vaccination rates, and also closely monitor trends in cervical lesions and cancers into the future as it is predicted that vaccine effectiveness will be seen to improve with longer follow-up times. • 2. The performance of the Pap smear programs must be monitored to rapidly flag any changes in screening practices among women. • 3. While we estimated the effectiveness of 2 doses of the vaccine as 21%, this needs to be confirmed in other studies. • Citation: • Effectiveness of a quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalitites MJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1458 (Published 4 March 2014) • Cite this as: BMJ 2014;348:g1458 Read the rest of the interview on MedicalResearch.com
  • 5. Atrial Fibrillation, Warfarin and Kidney Function after Heart Attack MedicalResearch.com Interview with: Juan Jesus Carrero PhD (Pharm and Med) Associate Professor in Renal Medicine Karolinska Institutet, Sweden. • MedicalResearch.com: Why did you choose to study this particular question? • Answer: We chose this question because there is currently an important knowledge gap regarding safety and effectiveness of common drugs in individuals with chronic kidney disease. Because kidney dysfunction interferes with drug metabolism and drug elimination, patients with kidney dysfunction have traditionally been excluded from randomized controlled trials. Yet, practice guidelines are afterwards extrapolated to those in the absence of formal evaluation. • MedicalResearch.com: Tell us about your study…. What did you set out to discover? • Answer: We studied outcomes associated to warfarin treatment in patients with both atrial fibrillation and kidney disease. These individuals are at a markedly increased risk of bleeding and ischemic stroke. Although such patients have a clear indication for anticoagulant therapy, recent observational studies in advanced chronic kidney disease have provided conflicting results, suggesting that warfarin treatment may instead confer harm. • Our study considered all consecutive Swedish patients with Atrial Fibrillation admitted to the hospital for an acute myocardial infarction. Because of availability of creatinine assessments, we were able to estimate the severity of underlying chronic kidney disease. Our pre-specified outcomes were the composite of death, myocardial infarction and stroke, as well as the risk of bleeding, within one year from discharge date. • MedicalResearch.com: What were your findings? • Answer: We observed that more than 50% of the included patients were considered to have chronic kidney disease, evidencing the commonness of kidney dysfunction in individuals with cardiovascular disease. • Our main finding was that warfarin treatment was associated with a lower risk for the composite outcome without increased risk of bleeding. This was observed not only for individuals with normal kidney function but also for those with moderate, severe or end-stage kidney disease. • MedicalResearch.com: What are the implications of the study findings? • Answer: Our study may therefore suggest that patients with Atrial Fibrillation and renal disease not requiring dialysis can also benefit from warfarin therapy and thus should not be excluded from this treatment option. • MedicalResearch.com: What additional research is needed? • Answer: This study includes individuals with kidney disease not requiring dialysis. The evaluation of warfarin safety in dialysis patients still is not fully established. Finally, because ours is an observational study, further clinical trials are necessary to definitely answer this question. • Citation: • Warfarin, Kidney Dysfunction, and Outcomes Following Acute Myocardial Infarction in Patients With Atrial Fibrillation • Juan Jesús Carrero PhD(Pharm and Med), Marie Evans MD, PhD, Karolina Szummer MD, PhD, Jonas Spaak MD, PhD, Lars Lindhagen PhD, Robert Edfors MD, Peter Stenvinkel MD, PhD, Stefan H Jacobson MD, PhD, Tomas Jernberg MD, PhD • JAMA. 2014;311(9):919-928. doi:10.1001/jama.2014.1334 Read the rest of the interview on MedicalResearch.com
  • 6. Hepatitis C: About 1% US Population Infected MedicalResearch.com Interview with: Scott D. Holmberg, MD, MPH Chief, Epidemiology and Surveillance Branch Division of Viral Hepatitis. • MedicalResearch.com: What are the main findings of the study? • Dr. Holmberg: Based on interview and testing of over 30, 000 National Health and Nutrition and Examination Survey (NHANES) participants from 2003 to 2010, 273 US residents or about 1%, are chronically (actively) infected with hepatitis C virus (HCV). This translates to about 2.7 million chronic HCV-infected persons in the non-institutionalized population. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Holmberg: This analysis indicated that the number of chronically infected persons are about 500,000 fewer than a similar NHANES analysis done between 1999 and 2002. This may be related to statistical variation between the two samples, or, as we have observed, increasing mortality in HCV-infected patients. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Holmberg: Hepatitis C virus is a widely prevalent infection that causes more morbidity and mortality than most other infectious diseases. Because of the long incubation period between infection and overt disease—often 20, 30, or more years—infected patients and even clinicians may be inclined to dismiss HCV as an indolent, even benign infection. This study underscores the importance of CDC and US Preventive Services Task Force recommendations that all persons born between 1945 and 1965, about 75% of all cases, should get tested at least once for hepatitis C virus. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Holmberg: This analysis needs to be repeated in future years as an important index and measure of trends in chronic hepatitis C. • Citation: • Chronic Hepatitis C Virus Infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010 • Ann Intern Med. 2014;160(5):293-300-300. doi:10.7326/M13-1133 • Maxine M. Denniston, MSPH; Ruth B. Jiles, PhD, MS, MPH; Jan Drobeniuc, MD, PhD; R. Monina Klevens, DDS, MPH; John W. Ward, MD; Geraldine M. McQuillan, PhD; and Scott D. Holmberg, MD, MPH Read the rest of the interview on MedicalResearch.com
  • 7. Herbal Cannabis Not Proven Effective For Rheumatic Diseases MedicalResearch.com Interview with: Mary-Ann Fitzcharles, MB, ChB, MRCP(UK), FRCP(C) McGill University Health Centre Division of Rheumatology and Alan Edwards Pain Management Unit • MedicalResearch.com: What are the highlights of your review? • Dr. Fitzcharles: Thank you for your interest in the review article which will shortly be published in Arthritis Care & Research. This was not a research study but rather a review focused towards the use of herbal cannabis for patients with rheumatic diseases. • The essence of our message after a thorough review of the literature is that there is not a single study published regarding efficacy or side effects of herbal cannabis in the rheumatic diseases. It is notable that almost 2 thirds of persons using herbal cannabis for therapeutic reasons report use for musculoskeletal complaints. In the 21st century, we cannot rely upon heresay or anecdote to justify use of a treatment intervention. It is unacceptable to recommend use of a substance without knowledge of concentration of molecules in the product, any knowledge of blood concentrations that might have a positive or negative effect, and formal study in defined patient populations with acceptable endpoint criteria and evidence for short and long term risks. • With the knowledge of short and long term risks that are emerging from study of recreational user, we recommend that the herbal product should only be used in the extreme and very rare situation when a patient with rheumatic disease is suffering severe pain that has been unresponsive to trials of standard medical therapy. • Citation: • The Dilemma of Medical Marijuana Use by Rheumatology Patients • Mary-Ann Fitzcharles, Daniel J. Clauw, Peter A. Ste-Marie and Yoram Shir Arthritis Care and Research Accepted manuscript online: 3 MAR 2014 07:30AM EST | DOI: 10.1002/acr.22267 Read the rest of the interview on MedicalResearch.com
  • 8. Obesity Rates Triple in Canada Over 25 Years MedicalResearch.com Interview with: Dr. Laurie K. Twells, PhD School of Pharmacy, Memorial University, St. John’s Faculty of Medicine, Memorial University St. John’s Newfoundland and Labrador • MedicalResearch.com: What are the main findings of the study? • Dr. Twells: Obesity rates in Canada tripled between 1985 and 2011. Although class I obesity (BMI ≥ 30) appears to have increased at a slower rate, obese classes II (BMI ≥ 35) and III (BMI ≥40) continued to increase disproportionately. Over the last decade, every province in Canada experienced increases in obesity rates. Overall obesity rates were lower in the west and higher in the eastern provinces and people over age 40 years were more likely to be overweight/obese than younger people. By 2019 it is projected that twenty-one per cent of Canadians will be obese but this will vary by province from 15.7% in British Columbia to 34.6% in Newfoundland and Labrador. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Twells: The provincial comparisons in Canada were interesting and presenting the data in this format uncovered the differences in obesity rates (current and predicted) across the country. The predicted prevalence rates for some provinces are very concerning given the health system burden and impact on quality of life associated with being in the excessive weight categories. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Twells: In Canada, the number of individuals with a BMI greater than 35 and 40 are predicted to increase over the next five years. These individuals are at a much higher risk of developing serious comorbid conditions such as hypertension, dyslipidemia, diabetes, reporting impaired quality of life and dying prematurely. Clinicians will need to be resourced to manage and treat affected individuals effectively. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Twells: One area for future research is the need to help explain why such significant inter-provincial variations exist in Canada. This might include a focus on evaluating existing provincial policies, programs and approaches to the prevention, management and treatment of obesity. For example, provincial variation exists in the provision of bariatric surgery, the training or lack of training of health professionals in weight management and in patient access to other types of expertise in weight loss such as dieticians and psychologists. There is the potential in Canada for provinces to share effective practices to improve the overall health of the country. • Citation: • Current and predicted prevalence of obesity in Canada: a trend analysis • Laurie K. Twells PhD, Deborah M. Gregory PhD, Jacinta Reddigan MSc, William K. Midodzi PhD cmajo 2:E18-E26; published online March 3, 2014, doi:10.9778/cmajo.20130016 Read the rest of the interview on MedicalResearch.com
  • 9. Hospital Mortality: Association With Nurses’ Work Load and Education MedicalResearch.com Interview with: Professor Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology Director of the Center for Health Outcomes and Policy Research Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing • MedicalResearch.com: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. Against that backdrop, can you start by letting us know the background of the study? • Prof. Aiken: European Surgical Outcomes Study in 28 countries showed higher than necessary deaths after surgery. • A comparable study in the US showed that despite the nation spending hundreds of millions of dollars on improving patient safety, there were no improvements in adverse outcomes after surgery in US hospitals between 2000 and 2009. Clearly it is time to consider new solutions to improving hospital care for surgical patients, who make up a large proportion of all hospital admissions. Our study was designed to determine whether there are risks for patients of reducing hospital nurse staffing, and what, if any, are the benefits to patients of moving to a more educated nurse workforce. • MedicalResearch.com: Could you tell us a little about what the average workload of nurses were in the countries you studied is? • Prof. Aiken: The average patient to nurse ratio in hospitals in the 9 countries is 8.3 patients per nurse (which compares to about 5.5 in the USA) but these ratios varied from hospitals in which nurses care for 3 patients each to others where nurses care for 18 patients each. On average nurses’ workloads are lowest in Norway and highest in Spain but within every country there is substantial variation in hospital nurse staffing. In England with a national health service where standardization might be expected, the workloads of nurses in some hospitals were double those of others, ranging from 5 patients per nurse to over 11 patients per nurse. It is this difference in nurse staffing levels across hospitals within every country that contributes to what we found to be a 7-fold difference in death rates after surgery for similar kinds of patients. We found every one patient increase in a nurses work load was associated with a 7% increase in the risk of death for patients– which illustrates the hazards of increasing nurses’ workloads in attempts to save money. These findings in Europe mirror the findings of papers we have published on nurses and mortality in the USA. Read the rest of the interview on MedicalResearch.com
  • 10. Hospital Mortality: Association With Nurses’ Work Load and Education MedicalResearch.com Interview with: Professor Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology Director of the Center for Health Outcomes and Policy Research Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing • MedicalResearch.com: Can you tell us a little more about your findings with regard to nurses’ education? • Prof. Aiken: Generally we think of educational attainment as a characteristic of an individual. But the educational composition of a hospital’s nursing staff is also an attribute of an institution. In Norway and Spain, all nurses must have a bachelor’s degree but in other countries, hospitals may employ nurses with and without university education. There has been a contentious debate within the European Union on standardization of nursing education, and whether the goal of standardization should be the bachelor’s degree as in other professions. Currently two very different levels of education for nurses are recognized within the EU: nurses with 12 years of general schooling plus university education and nurses with only 10 years of general schooling followed by vocational training. Like nurse staffing, the educational composition of nurses in hospitals varies substantially with some hospitals having no nurses with bachelor’s qualifications and some hospitals having 100% bachelor’s qualified nurses. In England, for example, the NHS hospitals studied varied from 10% of bachelor’s educated nurses to 49%. That hospital-level variation in the proportion of nurses with bachelor’s education was significantly associated with patient deaths, after taking into account other possible explanations including nurses’ workloads and how sick the patients were before surgery. We found that every 10% increase in the proportion of nurses in a hospital with bachelor’s qualifications was associated with a 7% decline in patient deaths. The Institute of Medicine of the National Academy of Sciences has acted upon our similar findings in the USA and has proposed that by 2020, at least 80% of USA nurses should hold the bachelor’s degree in nursing. • MedicalResearch.com: Were there any unusual findings you’d like to comment on? • Prof. Aiken: Patients have the highest risk of death after surgery in hospitals where nurses with lower education care for more patients each. • Our most important finding for policymakers and consumers is that there is an unjustifiable difference in death rates following common surgery across hospitals in every country, and differences in nursing resources are a contributing factor to high death rates in many hospitals. • In every country there are well performing hospitals suggesting that even under less than optimal economic circumstances it is possible to achieve a high quality of hospital care. A reasonable strategy to proceed in reducing preventable hospital deaths would appear to be improving nurse staffing in the hospitals in every country where nurses’ workloads are high, and transitioning to bachelor’s education for nurses. • Some might say that university education for nurses is not feasible for a variety of reasons. The fact that both Norway, a well-resourced country, and Spain, a country struggling more to contain spending, could have successfully transitioned to an all university educated nurse workforce suggests that all countries in Europe could make the transition, and our results suggest that such a transition is in the public interest. • MedicalResearch.com: What conclusions can be drawn from your results, and what are the implications for the future? • Prof. Aiken: While our study was immensely complicated to conduct, the conclusions and recommendations are remarkably simple. Modern hospitals exist to provide 24 hour professional nursing care to people too sick to recover at home. Thus it is foolish at best, and fatal at worst to under invest in nursing which is the primary service provided by hospitals. Health reform initiatives and austerity measures, both of which tend to focus on reducing hospital nurses, put patients at serious risk of unnecessary death and other adverse outcomes. • Given the aging of Europe (and the USA), more nurses will be needed in the future. It is unrealistic to expect the best and brightest of next generations to enter careers that do not provide a university education. There won’t be enough talented and committed professional nurses to take on impossible burdens of unreasonable workloads and unsafe patient care. Improving quality of hospital care now and for the future requires serious investments in professional nurses. • Citation: • Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, Diomidous M, Kinnunen J, Kozka M, Lesaffre E, McHugh M, Moreno-Casbas MT, Rafferty AM, Schwendimann R, Tishelman C, van Achterberg T, Sermeus W. 2014. Association of nurse staffing and education with hospital mortality in 9 European countries. The Lancet. http//dx.doi.org/a0.1016/S0140-6738(13)62631-8 February 26, 2014. Read the rest of the interview on MedicalResearch.com
  • 11. Gaining Prescription Drug Insurance Reduced Inpatient Medicare Payments MedicalResearch.com Interview with: Prof. Robert Kaestner University of Illinois at Chicago – Institute of Government and Public Affairs Chicago, IL 60607 and National Bureau of Economic Research New York, NY 10016-4309 • MedicalResearch.com: What are the main findings of the study? • Prof. Kaestner: Gaining prescription drug insurance through Medicare Part D was associated with a 8% reduction in the probability of a hospital admission, a 7% reduction in Medicare payments for inpatient services per person (who obtained insurance), and a 12% reduction in hospital resource use per person. MedicalResearch.com: What should clinicians and patients take away from your report? • Prof. Kaestner: Prescription drugs are, on average, a substitute for inpatient care. The greater use of prescription drugs that comes with insurance prevents hospitalizations. MedicalResearch.com What recommendations do you have for future research as a result of this study? • Prof. Kaestner: Future research should try to identify the specific biological and clinical mechanisms underlying the finding that prescription drug use decreased hospitalization. • Citation: Kaestner, Robert and Long, Cuiping and Alexander, G. Caleb, Effects of Prescription Drug Insurance on Hospitalization and Mortality: Evidence from Medicare Part D (February 2014). NBER Working Paper No. w19948. Available at SSRN: http://ssrn.com/abstract=2403672 Read the rest of the interview on MedicalResearch.com
  • 12. After Outgrowing One Food Allergy, Some Patients Develop Second Allergic Reaction to Same Food MedicalResearch.com Interview with: Jonathan M. Spergel, M.D., Ph.D. The Children’s Hospital of Philadelphia Chief, Allergy Section Associate Professor of Pediatrics Perelman School of Medicine at the University of Pennsylvania • MedicalResearch.com: What are the main findings of the study? • Dr. Spergel: We were examining patients with Eosinophilic Esophagitis, an unique food allergy of the esophagus. We found a subset of patients, who in the past had IgE mediated reaction to the food (hives, anaphylaxis) and had outgrown it. Two-three years after outgrowing the food, then the patients developed Eosinophilic Esophagitis to the same food. MedicalResearch.com: Were any of the findings unexpected? • Dr. Spergel: Yes, this finding indicated two important things: • You can get two different reactions to the same food. • The mechanism of the reactions for IgE-mediated reactions and Eosinophilic Esophagitis are different. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Spergel: For patients and clinician, if someone has outgrown the food allergy. But, then gets new symptoms, it could be the food that they had outgrown. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Spergel: This research raises two important questions. • How often does this happen? How many patients that outgrown their food allergy will develop a different reaction to the same food? • Is there a better to treat patients with Eosinophilc Esophagitis or food allergy due to this difference in mechanism? • Citation: • Maggadottir et al, “Development of Eosinophilic Esophagitis to Food after Development of IgE Tolerance to the Same Food, abstract 990, presented March 2, 2014 at the AAAAI Annual Meeting. Read the rest of the interview on MedicalResearch.com
  • 13. Pneumonia Risk Increased From Sleep Apnea MedicalResearch.com Interview with: Dr. Vincent Yi-Fong Su Department of Chest Medicine Taipei Veterans General Hospital Taipei, Taiwan • MedicalResearch.com: What are the main findings of the study? • Answer: We found interestingly that patients with sleep apnea experienced a 1.20-fold (95% CI, 1.10-1.31; p <0.001) increase in incident pneumonia compared to patients without sleep apnea. We also demonstrated an “exposure-response relationship,” in that the patients with more severe sleep apnea might have a higher risk for pneumonia than did those of milder severity. MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Based on our results, primary care generalists are suggested to survey sleep disorders among pneumonia patients without other identified risk factors or among patients with recurrent pneumonia. For sleep specialists, our finding may broaden the spectrum of sleep apnea-related complications, which may not limited to the cardiovascular or neurocognitive aspects. As well, while caring CPAP users, every effort should be made to minimize the risk of pneumonia, such as enhanced cleaning of CPAP tubing and humidifier or being vigilant if recurrent pneumonia was noted among CPAP users. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future more elaborate prospective research is needed to confirm our finding and elucidate the possible underlying mechanisms. • Citation: • Sleep apnea and risk of pneumonia: a nationwide population-based study • Vincent Yi-Fong Su, Chia-Jen Liu, Hsin-Kai Wang, Li-An Wu, Shi-Chuan Chang,Diahn-Warng Perng, Wei-Juin Su,Yuh-Min Chen, Elizabeth Ya-Hsuan Lin ,Tzeng-Ji Chen and Kun-Ta Chou • CMAJ cmaj.131547; published ahead of print March 3, 2014, doi:10.1503/cmaj.131547 Read the rest of the interview on MedicalResearch.com
  • 14. Chronic Urticaria: Supplemental Vitamin D3 for Hives Management MedicalResearch.com Interview with: Dr. Jill A Poole MD Pulmonary, Critical Care, Sleep, and Allergy Division, Department of Medicine College of Medicine, University of Nebraska Medical Center The Nebraska Medical Center, Omaha, Nebraska • MedicalResearch.com: What are the main findings of the study? • Dr. Poole: Our study found that adding vitamin D 4000 IU daily to a cocktail of anti-allergy medications resulted in a further 40% reduction in hive symptom scores at 3 months. There was no further reduction in hive symptoms when 600 IU of vitamin D was added to the anti-allergy medications. The anti-allergy regimen utilized was triple drug therapy with cetirizine (twice daily), ranitidine (twice daily), and montelukast (once daily). No adverse reactions occurred. Dr. Poole: Were any of the findings unexpected? • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Poole: Clinicians and patients might want to consider adding 4000 IU of vitamin D with their anti-allergy medications to gain further reduction in hive symptoms. They should note that supplemental vitamin D should be taken for 3 months. Vitamin D has a long half life, meaning, it takes 6-8 weeks to replenish vitamin D stores and/or reach a steady state. Our findings of a beneficial role for add-on vitamin D were independent of patient’s vitamin D status; therefore, a minimum of a 3 month trial of supplemental vitamin D might be a consideration for management, even in patients with normal serum vitamin D levels. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Poole: Future research should consider extending the observation time past 3 months, as benefits with vitamin D supplementation were not at 6 weeks, but at 3 months. It is not known whether further improvement would occur beyond 3 months. Next, our study was a single center study, and a multi-center study could be considered. Next, our study population was representative of persons in our Mid-West region, and we would recommend studying the effects of supplemental vitamin D in other diverse and under-represented, minority populations. • Citation: • Beneficial role for supplemental vitamin D3 treatment in chronic urticaria: a randomized study • Annals of Allergy, Asthma & Immunology • Available online 5 February 2014 Andy Rorie, Whitney S. Goldner, Elizabeth Lyden, Jill A. Poole Read the rest of the interview on MedicalResearch.com
  • 15. Should Dental Extractions Be Done Prior to Heart Surgery? MedicalResearch.com Interview with: Dr. Kendra J. Grim Department of Anesthesiology Mayo Clinic, Rochester, MN 55905 • MedicalResearch.com: What are the main findings of the study? • Dr. Grim: “The current guidelines say that if possible, treating the dental problems that patients have before heart surgery is best, to try to prevent both early and late heart infections. But the data is very unclear, because it’s very difficult to study. We found in our study that their risk of serious complications after having teeth removed may be higher than we thought. We were primarily looking at stroke, heart attack, renal failure and death. We found that actually the incidence of having one of those major morbidities was 8 percent. Of that 8 percent, we had six patients, or 3 percent, of the total group who died between their dental surgery and scheduled heart surgery, so these patients never made it to their heart surgery. An additional 3 percent of patients died after heart surgery. “ • MedicalResearch.com: Were any of the findings unexpected? • Dr. Grim: “Yes. The risk of having a serious complication after tooth extraction before heart surgery was higher than we expected, at 8%. Current ACC/AHA guidelines that rate dental extraction a low-risk procedure (<1% risk of major complication or death) may not apply to this patient population.” MedicalResearch.com Dr. Grim: “Our take-home message is that discussion among the specialists – the cardiologist, cardiac surgery, the oral surgeon and the anesthesiologist – would be in the best interest of the patient, to try to ascertain the risk for this particular patient. If we think the risk from taking the teeth out is low, but the benefit is perceived to be high, then we would proceed with the tooth extraction. But if we think the risk of having the teeth extracted before heart surgery is too high, then we would consider not proceeding with the tooth extraction. We really feel that it’s important, because the data is unclear, that rather than following a general rule of thumb, physicians assess each patient’s individual risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Grim: “Our hope is that this will spark further conversation that will lead to further research. It’s difficult to study, because the incidence of the infection in the new artificial heart valve is very low. Infection rates have not been studied in patients for bypass grafts, for the ventricular assist devices, total artificial hearts, and there has been minimal research in heart transplantation. So there are a lot of additional avenues open for research in this area to better understand the risk/benefit.” • Citation: • Morbidity and Mortality Associated With Dental Extraction Before Cardiac Operation • Mark M. Smith, David W. Barbara, William J. Mauermann, Christopher F. Viozzi, et al • The Annals of Thoracic Surgery Vol. 97, Issue 3, Pages 838-844 Read the rest of the interview on MedicalResearch.com
  • 16. Stroke: Speedier Thrombolysis Therapy Prolongs Disability-Free Life MedicalResearch.com Interview with: Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, Finland • MedicalResearch.com: What are the main findings of the study? • Dr. Meretoja: We used observational prospective data of consecutive stroke patients (n=2258) treated with intravenous thrombolysis in Australian and Finnish centers and a pooled analysis of thrombolysis trials to model the shift in patient outcomes with reducing treatment delays. We found out that each minute the treatment can be delivered faster granted on average 1.8 days of extra healthy life (95% prediction interval 0.9 to 2.7). In practice, this means that each 15 minute decrease in treatment delays provides an average equivalent of one month of additional disability-free life. MedicalResearch.com: Were any of the findings unexpected? • Dr. Meretoja: The magnitude of benefit from small realistically achievable gains in streamlining thrombolysis services has not been quantified before. This study provides a meaningful metric and an impetus to take action. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Meretoja: Even small achievements in streamlining acute stroke services provide very large health benefits for the patient. Co-operation of the ambulance service, ED, and the stroke team is critical, and validated methods for achieving this have been described by us and others. Best practice centers currently achieve <20 minutes median in-hospital delays, while most hospitals take more than an hour, effectively losing months of healthy life with every treated patient. Every hospital should know its door-to-needle times for stroke thrombolysis, take action to reduce these, and monitor the results. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Meretoja: Intravenous thrombolysis remains the only evidence-based acute recanalization therapy in stroke. Translation to practice has been slow, with the therapy most often contraindicated due to delays. This research should promote service streamlining for the benefit of our patients. Future research should concentrate on methods to further reduce delays and increase rate of use. • Citation: • Stroke Thrombolysis Save a Minute, Save a Day • Atte Meretoja,Mahsa Keshtkaran,Jeffrey L. Saver,Turgut Tatlisumak,Mark W. Parsons,Markku Kaste,Stephen M. Davis,Geoffrey A. Donnan,and Leonid Churilov • Stroke. 2014;STROKEAHA.113.002910published online before print March 13 2014, doi:10.1161/STROKEAHA.113.002910 Read the rest of the interview on MedicalResearch.com
  • 17. Sports-Related Concussion Diagnosis Using Blood Biomarker Tau MedicalResearch.com Interview with: Pashtun Shahim, MD Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Department of Neurochemistry Sahlgrenska University Hospital, Mölndal Sweden • MedicalResearch.com: What are the main findings of the study? • Dr. Shahim: Sports-related concussion in professional ice hockey players is associated with acute axonal and astroglial injury. Plasma total tau, which is a highly central nervous system-specific protein, is a promising biomarker to be used both in the diagnosis of concussion and in the decision-making when an athlete can be declared fit to return to play. MedicalResearch.com: Were any of the findings unexpected? • Dr. Shahim: The levels of total tau correlated with the duration of post-concussive, and the levels even at 144 h after concussion remained significantly elevated in players with persistent post- concussive symptoms > 6 days compared with the levels after a friendly game. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Shahim: Blood biomarkers, specifically total tau is a promising biomarker to be used in the diagnosis and prognosis of athletes with sports-related concussion, as well as patients seeking emergency clinics due to concussion or mild traumatic brain injury. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Shahim: These results are from an on going multi center study on professional ice hockey players from the Swedish Hockey League. These findings need to be replicated in a larger sample size. The promising results should also be evaluated in relation to general concussion in emergency care units. • Citation: • Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Player • Shahim P, Tegner Y, Wilson DH, et al. Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players. JAMA Neurol. 2014;():. doi:10.1001/jamaneurol.2014.367. Read the rest of the interview on MedicalResearch.com
  • 18. Ocular Injuries from Laser Pointers MedicalResearch.com Interview with: Glenn Yiu, MD, PhD Duke Ophthalmology Duke University Medical Center • MedicalResearch.com: What are the main findings of the study? • Dr. Yiu: This paper reported a child who suffered injury to both eyes from a powerful blue laser pointer purchased via the internet from overseas. Our report reviews the scientific basis for laser injuries in eyes and the factors that may affect outcomes, such as power, wavelength, duration, and distance of exposure. Newer green and blue lasers, especially high- powered ones, may be more prone to inducing eye injuries. We summarized the clinical features of ocular laser injuries, methods of prevention, and discussed how consumer availability of high powered lasers may require careful federal regulations. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Yiu: In this case, the laser caused retinal hemorrhages in both eyes resulting in severe loss of vision. This is uncommon since laser injuries over short distances are typically unilateral. The circumstances are unclear surrounding the young victim playing with an adult who directed the laser at him in jest. Fortunately, the hemorrhages resolved after several months and did not appear to result in permanent damage. This is not always the case, as some patients may suffer permanent scarring or recurrent bleeding from abnormal growth of blood vessels (known as choroidal neovascularization) as a result of the laser damage. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Yiu: Unlike trained personnel in occupational settings, the average consumer may not be familiar with laser safety practices. Ocular laser injuries among consumers may be underreported, and prompt referral to an ophthalmologist is necessary for diagnosis, possible treatment, and documentation for medicolegal purposes. Laser goggles are important for prevention of laser injuries, and care should be taken to ensure that the laser goggles are specific for the wavelength of the laser being used. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Yiu: Increased available of lasers in the consumer market requires careful regulation. High powered devices, particularly those with shorter-wavelengths, should be clearly labeled and safety instructions provided to ensure use of appropriate laser safety goggles or other barriers. Improved consumer awareness will be important for preventing future incidents from occurring. • Citation: Ocular Safety of Recreational Lasers • JAMA Ophthalmol. 2014 Jan 9. doi: 10.1001/jamaophthalmol.2013.5647. [Epub ahead of print] • Yiu G, Itty S, Toth CA. Read the rest of the interview on MedicalResearch.com
  • 19. CABG Surgery in Patients with Acute Coronary Syndromes and Chronic Kidney Disease MedicalResearch.com Interview with: Martin Holzmann, MD, PhD Department of Emergency Medicine, Karolinska University Hospital Stockholm Sweden. • MedicalResearch.com: What are the main findings of the study? • Dr. Holzmann: The main finding is that patients with renal dysfunction are at increased risk of cardiovascular events after undergoing CABG for acute coronary syndromes. MedicalResearch.com: Were any of the findings unexpected? • Dr. Holzmann: We would have expected that the association would have been stronger than it was. We found an association only in patients with severe renal dysfunction. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Holzmann: Cardiologists should not hesitate to send their patients with renal dysfunction to undergo CABG in case it is needed. The prognosis after CABG is excellent even in patients with rather advanced renal dysfunction. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Holzmann: More research is needed to elucidate if there is a causal association between renal dysfunction and cardiovascular outcomes. Maybe renal dysfunction is merely a marker of increased risk or a composite of other cardiovascular risk factors. • Citation: • Long‐term Cardiovascular Outcomes in Patients With Chronic Kidney Disease Undergoing Coronary Artery Bypass Graft Surgery for Acute Coronary Syndromes • Citation: • Long‐term Cardiovascular Outcomes in Patients With Chronic Kidney Disease Undergoing Coronary Artery Bypass Graft Surgery for Acute Coronary Syndromes • Martin Holzmann, Tomas Jernberg, Karolina Szummer, and Ulrik Sartipy • J Am Heart Assoc. 2014;3:e000707, originally published March 4, 2014, doi:10.1161/JAHA.113.000707 Read the rest of the interview on MedicalResearch.com
  • 20. Surgical Safety Checklists Did Not Substantially Improve Surgical Outcomes MedicalResearch.com Interview with: David R. Urbach, M.D From the Institute for Clinical Evaluative Sciences Department of Surgery Institute of Health Policy, Management and EvaluationUniversity of Toronto, the University Health Network Toronto, ON M5G 2C4, Canada • MedicalResearch.com: What are the main findings of the study? • Dr. Urbach: After surgical safety checklists were adopted by hospitals in Ontario, surgical outcomes—death after surgery, complications, length of stay, readmissions—did not improve substantially. MedicalResearch.com: Were any of the findings unexpected? • Dr. Urbach: These findings were unexpected because previous research suggested that there were large benefits from introducing surgical safety checklists. For example, the risk of death after surgery was reduced between 30% and 50% among early studies. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Urbach: Improving surgical safety requires more than just introducing safety checklists. Meaningful improvements in safety will probably require comprehensive, team-based interventions that result in a lasting change in culture. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Urbach: We need to continue to explore how safety and quality can be improved in surgery. Checklists are an important part of this, but not sufficient by themselves to cause major improvements. • Citation: • Introduction of Surgical Safety Checklists in Ontario, Canada • David R. Urbach, M.D., Anand Govindarajan, M.D., Refik Saskin, M.Sc., Andrew S. Wilton, M.Sc., and Nancy N. Baxter, M.D., Ph.D. • N Engl J Med 2014; 370:1029-1038 • March 13, 2014DOI: 10.1056/NEJMsa1308261 Read the rest of the interview on MedicalResearch.com
  • 21. Bipolar Disorder: Genome-Wide Association Study MedicalResearch.com Interview with: Prof. Dr. Sven Cichon, PhD Director, Division of Medical Genetics University Hospital Basel Human Genomics Research Group Department of Biomedicine University of Basel Basel, Switzerland • MedicalResearch.com Interview with: Prof. Dr. Sven Cichon, PhD Director, Division of Medical Genetics University Hospital Basel Human Genomics Research Group Department of Biomedicine University of Basel Basel, Switzerland • MedicalResearch.com: What were the main findings of the study? • Answer: We have identified two new gene regions that represent pieces of the jigsaw puzzle of genetic and non-genetic factors that lead to the development of bipolar disorder. One is the gene ADCY2 (Adenylate Cyclase 2) which is involved in signal transmission within nerve cells. The other region comprises two genes, both presumably playing a role in neurodevelopmental processes (MIR2113 and POU3F2). Importantly, these results come out of the largest of these kinds of studies so far, involving altogether more than 24,000 people. MedicalResearch.com: Were the findings unexpected? • Answer: The exact nature of the identified genes and their involvement in bipolar disorder is new to us. We have indication from other susceptibility genes found in previous studies of bipolar disorder that both nerve cell signalling as well as neurodevelopmental processes may play a role in this common neuropsychiatric disorder. However, there are literally thousands of genes that are somehow related to these biological functions in the human brain. Our study now support the importance of these biological functions in disease development and specify more of the involved genes. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The most important message is that these kinds of studies help to understand the biological foundations of bipolar disorder. It is a long way because the disease is so complex, but step by step we are getting there. Biological knowledge of the disease will eventually be the starting point for new therapies. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: The recent successes in identifying genetic factors involved in bipolar disorder and other complex diseases are the result of large international collaborations. In the present study, we have joined data generated by the MooDS consortium –involving researchers from Europe, Australia, and Canada- and the largest international consortium in the field of psychiatric genetic research, the Psychiatric Genomics Consortium (PGC). This enabled us to assemble the most powerful data set to date for such a systematic genetic study. Large numbers are necessary to clearly see the minor genetic differences of individual genes between patients and controls against the ‘background noise’ of genetic differences. • It is therefore of utmost importance to continue and extend large, international collaborations involving numerous psychiatrists, geneticists and statisticians world-wide. • Citation: • Genome-wide association study reveals two new risk loci for bipolar disorder • Nature Communications 5, Article number:3339 doi:10.1038/ncomms4339 Read the rest of the interview on MedicalResearch.com
  • 22. Long-Term Risk of Stroke Raised by PreHypertension MedicalResearch.com Interview with: Dingli Xu, MD From Department of Cardiology Nanfang Hospital, Southern Medical University, Guangzhou, China • MedicalResearch.com: What are the main findings of the study? • Answer:Our study showed that after controlling for multiple cardiovascular risk factors, the blood pressure range at 120-139/80-89 mm Hg (defined as ‘prehypertension’ in JNC 7), is significant associated with long-term risk of stroke. The results were consistent across stroke type, stroke endpoint, age, study characteristics, follow-up duration, and ethnicity. More importantly, even low- range prehypertension (BP 120-129/80-84mmHg) increased the risk of stroke compared with optimal BP (<120/80 mm Hg), and the risk was higher in individuals with high-range prehypertension (BP 130-139/85-85mmHg). In particular, we found that compared with individuals with optimal blood pressure individuals with low-range prehypertension were 44% more likely to develop stroke, and this risk was even greater (95%) in individuals with high-range prehypertension. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Yes, we believed that two findings are very interesting. First, prehypertension, which seemed “normal” in the past, is significant associated with risk of stroke, even after adjusted multiple cardiovascular risk factors. This means that the mild elevation of blood pressure could directly increases the risk of stroke. • Second, even low range prehypertension, which is defined as ‘normal blood pressure’ in some hypertension guideline, could also increase the risk of stroke significantly. This result is different with prior studies and meta analysis. Therefore, our findings reaffirms the importance of the definition of “prehypertension” rather than being “normal”. Read the rest of the interview on MedicalResearch.com
  • 23. Long-Term Risk of Stroke Raised by PreHypertension MedicalResearch.com Interview with: Dingli Xu, MD From Department of Cardiology Nanfang Hospital, Southern Medical University, Guangzhou, China • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: These findings have important clinical and public health implications. First, clinicians and patients should be aware of that blood pressure range at 120-139/80-89mmHg is not “normal”. These individuals are at a high risk to progress to sustained hypertension, as well as CVD, especially stroke, so periodic screening is important. Second, considering the robust evidence of an association between prehypertension and the risk of stroke shown in our study, it is preferable to consider earlier interventions for prehypertension among the general population. Currently, lifestyle modification is the mainstay of treatment for prehypertension in the general population (e.g. quit smoking, increased physical activity, maintain proper body weight.). This should be recommended to every individuals with prehypertension. • However, because of the significant difference in the risk of stroke for BP between 120–129/80–84 mm Hg and 130–139/85– 89 mm Hg, we suggest that, for clinicians, this category should be subdivided into low- and high-range prehypertension. Further studies are needed to reveal better predictors of high-risk subpopulations with prehypertension (especially in high- range prehypertension) to select subpopulations for future controlled trials of pharmacological treatment. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: In our study, we found that prehypertension, even in the low range, elevates the risk of stroke after adjusting for multiple cardiovascular risk factors. However, whether treatment of prehypertension can reduces the risk of target organ damage is still with controversies. Based on the lack of prospective, randomized trials examining the effects of anti- hypertensive therapy on reducing target organ damage specifically in prehypertensives, professional societies do not recommend drug treatment in prehypertension, even in high-range prehypertension. • So we think that there is a great gap to be covered between epidemiological studies and randomized controlled studies in prehypertension. Prehypertensive individuals are at a high risk to progress to sustained hypertension, as well as CVD, especially stroke. So for therapeutic implications, we emphasize that lifestyle intervention, but not medical intervention is the mainstay of treatment for prehypertension. However, high-risk subpopulations with prehypertension are needed to be selected for future controlled trials of pharmacological treatment. • Citation: • Prehypertension and the risk of stroke A meta-analysis • Yuli Huang, MD, Xiaoyan Cai, MD, Yingying Li, MD, Liang Su, MD, Weiyi Mai, MD, PhD, Sheng Wang, MD, Yunzhao Hu, MD, Yanxian Wu, MD and Dingli Xu, MD • Published online before print March 12, 2014, doi: 10.1212/WNL.0000000000000268 Neurology Read the rest of the interview on MedicalResearch.com
  • 24. Low Birth Weight Babies at Higher Risk of Infertility Later in Life MedicalResearch.com Interview with: Dr Josefin Vikström Division of Obstetrics and Gynecology Department of Clinical and Experimental Medicine Faculty of Health Sciences Linköping University, Linköping, Sweden • MedicalResearch.com: What are the main findings of the study? • Dr. Vikström: Our study showed that women with a female infertility factor were more than two times more likely to have been born with a low birth weight (less than 2500g) or small for gestational age compared to women where the cause of infertility was unknown and/or male. MedicalResearch.com: Were any of the findings unexpected? • Dr. Vikström: We hypothesized that being born with a low birth weight (<2500g) would increase the risk of infertility since the risk of other diseases such as cardiovascular disease and the metabolic syndrome is increased in these individuals. However, since this study is the first of its kind it was difficult to predict the results. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Vikström: Women born with a low birth weight might be at increased risk of infertility later on in life but more studies are needed to verify these results. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Vikström: More studies are needed to determine that there is an association between low birth weight and infertility in women and in that case why these women are at increased risk of infertility. • Citation: • Birth characteristics in a clinical sample of women seeking infertility treatment: a case–control study • Josefin Vikström, Mats Hammar, Ann Josefsson, Marie Bladh, Gunilla Sydsjö • BMJ Open 2014;4:3 e004197 doi:10.1136/bmjopen-2013-004197 Read the rest of the interview on MedicalResearch.com
  • 25. Sleep Decreased In Children Who Watch Excessive Television MedicalResearch.com Interview with: Marcella Marinelli, MSc, PhD Center for Research in Environmental Epidemiology Hospital del Mar Research Institute Spanish Consortium for Research on Epidemiology and Public Health Barcelona, Spain • MedicalResearch.com: What are the main findings of your study? • Answer: We found that each hour a day of television viewing decreased sleep by 13 % in the Joint group. I also examined the changes in terms of television behavior: Children who increased television exposure at 4 years in Sabadell and Valencia reduced sleep duration of a 20%. While children who reduced the amount of time spent in front of the television had some recovery of sleep duration. • Also children who watched more or exactly 1.5 hours of television at 2 years in Sabadell and Valencia reduced their sleep duration of a 30% compared to children who watched television for less than 1.5 hours per day. Moreover children that change their behavior and at 4 years reduced the amount of time spent in front of television (in this case children who pass from the >=1.5 hours per day group to the <1.5 hours per day group) had a recovery effect, increasing their sleep duration, although the coefficient is not statistically significant. Also children who pass from watching television for less than 1.5 hours per day and increase the amount of time spent in front of the television (more or equal to 1.5 hours per day) at 4 years decrease their sleep duration of 30%. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Yes I could not believe that some of the children in my study watch television for 6-8 hours per day! • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Clinicians should recommend parents to limit the use of television and other devices. Parents should avoid continuous exposure of children in front of the television and mobile phones and stimulate them with other activities such as music, sport or family life. Also play together will be beneficial. Television should be limited to no more than an hour and also the content of TV program should be monitored. There are some studies that evaluated the relationship between TV viewing and aggressive behavior. So be careful! • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future research should consider the type of programs that children watch and other television habits in a longitudinal design. We could not distinguish between active and passive television exposure (TV is just switched on for example) so should be also interesting to evaluate if there is any differences on sleep duration. It will also important to evaluate more assessments for television and sleep during the all week. • I would like to add that I am very active in divulgating epidemiological research based on children in my life and for this reason I have created a blog for parents in Italy www.bambinofelice.it. • Citation: • Marinelli M, Sunyer J, Alvarez-Pedrerol M, et al. Hours of Television Viewing and Sleep Duration in Children: A Multicenter Birth Cohort Study. JAMA Pediatr. 2014;():. doi:10.1001/jamapediatrics.2013.3861. Read the rest of the interview on MedicalResearch.com
  • 26. Randomized Controlled Trials: 25% Discontinued, Mostly in Patient Studies MedicalResearch.com Interview with: Matthias Briel, MD, MSc Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada • MedicalResearch.com: What are the main findings of the study? • Dr. Briel: Using a retrospective cohort of 1017 randomized controlled trials (RCTs) based on archived protocols approved by six research ethics committees in Switzerland, Germany, and Canada between 2000 and 2003, we found that 25% of initiated RCTs were discontinued. While discontinuation was common with RCTs involving patients (28%), it was rare in RCTs with healthy volunteers (3%). The most commonly reported reason for RCT discontinuation was poor recruitment (10% of included RCTs). We found that trials with investigator sponsor (versus industry) and those with smaller planned sample sizes were at higher risk of discontinuation due to poor recruitment. Of discontinued RCTs, up to 60% remained unpublished. Trial investigators rarely informed research ethics committees about trial discontinuation and publication. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Briel: We did not expect such a poor reporting to ethics committees. Overall, only 96 of 253 discontinuations (38%) were reported to research ethics committees. For randomized controlled trials discontinued due to poor recruitment discontinuation was reported in 24 of 101 RCTs (24%), for RCTs discontinued due to futility it was 16 of 37 RCTs (43%), and for RCTs discontinued due to harm it was 13 of 24 RCTs (54%). • MedicalResearch.com: What should clinical researchers and patients take away from your report? • Dr. Briel: Our findings indicate that ethical obligations of RCTs are frequently not met. Failure to report premature discontinuation to ethics committees limits the ethics committees’ ability to carry out their mandate of ensuring ethical trial conduct and to monitor problematic randomized controlled trials. Not sharing with the scientific community the challenges resulting in RCT discontinuation removes any opportunity for learning within the trialist community, including identifying risks and instituting preventative action. Non- publication of inconclusive results leads to loss of valid evidence that could contribute to systematic reviews and meta-analyses. Our findings also highlight the necessity of current efforts to enhance the transparency, quality, and accessibility of trial protocols and results such as the ‘Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)’ and ‘AllTrials’ (www.alltrials.net) initiatives. Patient recruitment to trials should be closely monitored and contingency plans should be in place if it is lower than expected. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Briel: For investigator-initiated RCTs, stakeholders including trial investigators, funding agencies, and ethics committees need to develop strategies to prevent trial discontinuation. Based on our data retrospective or prospective screening of patients appears to hold little promise in estimating recruitment rates, but conducting a pilot study including patients’ consent to check that recruitment strategies are adequate might be effective. Further research is necessary to determine the optimal length of pilot trials and to develop reliable prediction models for recruitment performance. • Citation: • Prevalence, Characteristics, and Publication of Discontinued Randomized Trials • Kasenda B, von Elm E, You J, et al. Prevalence, Characteristics, and Publication of Discontinued Randomized Trials. JAMA. 2014;311(10):1045-1052. doi:10.1001/jama.2014.1361. Read the rest of the interview on MedicalResearch.com
  • 27. E-Cigarettes Use By Adolescents May Lead to Heavier Smoking MedicalResearch.com Interview with: Lauren Dutra, ScD Postdoctoral Scholar, UCSF School of Medicine Cardiovascular Research Institute San Francisco, CA 94143 • MedicalResearch.com: What are the main findings of the study? • Answer: Middle and high school students who used e-cigarettes were more likely to smoke tobacco cigarettes. They were also more likely to progress from experimenting with tobacco cigarettes to becoming regular smokers. • Teen smokers who used e-cigarettes were more likely to be planning to quit in the next year and less likely to have abstained from smoking recently, compared to smokers who had never used e-cigarettes. They were also more likely to be heavier smokers (smoke more cigarettes per day) than those who had never tried e-cigarettes. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: E-cigarettes are unlikely to be effective cessation aids for adolescents and may encourage cigarette smoking among adolescents. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Longitudinal research is needed to determine the precise role that e-cigarettes play in initiation to nicotine and precisely what fraction of kids start with e-cigarettes and progress to smoking cigarettes (and vice versa). The fractions of kids who use e-cigarettes who have never smoked (20% in middle school and 7% in high school) are the minimums for the rate of nicotine use among kids with e-cigs. • Citation: • Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents: A Cross-sectional Study • Lauren M. Dutra ScD, Stanton A. Glantz PhD • JAMA Pediatr. 2014;168(7):1-9. doi:10.1001/jamapediatrics.2013.5488 Read the rest of the interview on MedicalResearch.com
  • 28. Massachusetts Health Care Reform and the Working Poor MedicalResearch.com Interview with: Liane J. Tinsley, MPH Associate Research Scientist Department of Epidemiology New England Research Institutes, Inc. Watertown, MA 02472 • MedicalResearch.com: What are the main findings of the study? • Answer: For this study, we analyzed health insurance data from a cohort of community-dwelling individuals between the ages of 30-79 at baseline, in Boston, MA. Massachusetts health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage in our study population. Despite being targeted by the law, the working poor (those currently working for pay, either part- or full-time and earning less than 200% of the US federal poverty threshold for household size) continued to report lower rates of insurance coverage following reform (13.3% without insurance), compared to the both non-working poor (4.7% without insurance) and the not poor (5.0% without insurance). MedicalResearch.com: Were any of the findings unexpected? • Answer: Gains in insurance coverage among the working poor came overwhelmingly via public channels (e.g. Medicaid), while less than half of working poor reported private insurance coverage following reform. This was despite the fact that one of the main goals of the law was to tie private insurance coverage to employment (such as the employer mandate to provide health benefits to fulltime employees). This aspect of the law does not appear to have provided substantial benefits to the working poor in this study population. This may be related to occupational differences among subgroups: many of the study’s participants reported working in service or construction and repair occupations, jobs which are often part-time or seasonal in nature, and to which the employer mandate may not apply. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Despite overall gains in insurance coverage following healthcare reform, disparities persisted among the working poor, who represent a growing sector of the U.S. population. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Our findings may have implications for the 2014 rollout of the federal Patient Protection and Affordable Care Act (ACA), which is modeled on the MA health reform experiment. We believe our findings may be relevant for predicting the potential future success of the ACA among similar populations. • Citation: • Has Massachusetts health care reform worked for the working poor? Results from an analysis of opportunity Liane J. Tinsley, MPH Susan A. Hall, PhD, John B. McKinlay, PhD Annals of Epidemiology Volume 24, Issue 4, April 2014, Pages 312–318 Read the rest of the interview on MedicalResearch.com
  • 29. PTSD and Plasma Marker of Inflammation CRP MedicalResearch.com Interview with: Dr. Dewleen Baker MD Veterans Affairs (VA) San Diego Healthcare System, San Diego, California • MedicalResearch.com: What are the main findings of the study? • Dr. Baker: The main finding of this study is that a marker of peripheral inflammation, plasma CRP may be prospectively associated with PTSD symptom emergence, suggesting that inflammation may predispose to PTSD. MedicalResearch.com: Were any of the findings unexpected? • Dr. Baker: While these were new findings, they had been hypothesized, and were therefore not totally unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Baker: Implications for clinicians are that: • 1) In their patients with PTSD, they should be on the alert for physical co-morbidities known to be associated with inflammation, such as metabolic syndrome, cardiovascular disease, and arthritis in their patients with PTSD. Reduction in inflammation in those patients may help prevent these secondary physical conditions that are more frequent in PTSD patients. • Moreover, in light of the findings in the paper by Eraly et al., lowering inflammation may be a good strategy for primary prevention of PTSD in individuals exposed to extreme stress. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Baker: It will be important to replicate these findings. If they are replicated, the next step will be to better understand the causal relationships between psychiatric disorders and inflammation, which are likely to be complex. A better understanding may lead to better interventions and/or treatments, and may also help us understand the observed relationship between PTSD and co-occurring medical disorders, such as metabolic syndrome, heart disease and allergies/arthritis. • Citation • Assessment of Plasma C-Reactive Protein as a Biomarker of PTSD • Eraly SA, Nievergelt CM, Maihofer AX, et al. Assessment of Plasma C-Reactive Protein as a Biomarker of Posttraumatic Stress Disorder Risk. JAMA Psychiatry. 2014;():. doi:10.1001/jamapsychiatry.2013.4374. Read the rest of the interview on MedicalResearch.com
  • 30. Depression and Hearing Impairment in Adults MedicalResearch.com Interview with: Dr. Chuan-Ming Li MD, PhD Statistician (Health/Medicine) Division of Scientific Programs The National Institute on Deafness and Other Communication Disorders • MedicalResearch.com: What are the main findings of the study? • Dr. Chuan-Ming Li: We used data on adults 18 years or older from the National Health and Nutrition Examination Survey for the study and found that prevalence of moderate to severe depression was 4.9 percent for individuals who reported excellent hearing, 7.1 percent for those with good hearing and 11.4 percent for participants who reported having a little hearing trouble or greater hearing impairment (HI). Depression rates were higher in women than in men. The prevalence of depression increased as hearing impairment became worse, except among participants who were deaf. There was no association between self-reported HI and depression among people ages 70 years and older; however, an association between moderate HI measured by pure-tone threshold hearing exams and depression was found in women aged 70 years and older but not in men. MedicalResearch.com: Were any of the findings unexpected? • Dr. Chuan-Ming Li: We did not find a significant relationship between depression and self- reported hearing impairment among male or female adults aged 70 years and older. Rather, we found a significant association between depression and a threshold-based measure of “moderate” HI, defined as better ear pure tone average between 35 and 50 dB hearing level, among females. These apparently inconsistent results may reflect the tendency of people in different age groups to assess their HI differently. For example, older people may be less likely to self-report HI activity limitations compared with younger people. • In the present study, the prevalence of depression increased as hearing difficulty became greater, i.e., from “excellent” hearing to “a lot of trouble” but decreased among those who self-reported as “deaf”. The strongest association was for those with moderate trouble hearing. One reason for this result may be that people with severe to profound hearing impairment have had a different experience in their exposure and access to hearing health care. They are much more likely to have been ‘discovered’ and encouraged to try rehabilitation (hearing aids, alternative listening devices, cochlear implants, etc.). Thus, their lower prevalence of depression may be because a higher proportion of them have had access to hearing health care services and thereby have obtained more help and earlier interventions than those with mild to moderate hearing impairment. Read the rest of the interview on MedicalResearch.com
  • 31. Depression and Hearing Impairment in Adults MedicalResearch.com Interview with: Dr. Chuan-Ming Li MD, PhD Statistician (Health/Medicine) Division of Scientific Programs The National Institute on Deafness and Other Communication Disorders • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Chuan-Ming Li: People with any hearing impairment should access health care professional services and be willing to try rehabilitation (e.g. hearing aids, alternative listening devices, etc) if recommended. Health care professionals should be aware of increased risk of depression among adults with hearing loss and may be better able to improve the quality of life among people with hearing impairment by recognizing signs and symptoms of depression and referring patients for mental health services. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Chuan-Ming Li: Because of the cross-sectional nature of the survey, we cannot determine whether hearing impairment predates depression or to what extent self-reported depression may impact self-perceived hearing impairment. • According to WHO reports, depression ranks as the number 1 highest burden among chronic diseases and adult-onset hearing loss is likely number 2 (next highest burden) in ‘developed’ countries such as the US, Canada, Australia, Western Europe, etc. The “cause and effect” relationship between HI and depression is unknown. A longitudinal/prospective study may be needed. Further study is needed to find reasons why women suffer more depression than men. • Citation: • Hearing Impairment Associated With Depression in US Adults, National Health and Nutrition Examination Survey 2005-2010 • Li C, Zhang X, Hoffman HJ, Cotch M, Themann CL, Wilson M. Hearing Impairment Associated With Depression in US Adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngol Head Neck Surg. 2014;():. doi:10.1001/jamaoto.2014.42. Read the rest of the interview on MedicalResearch.com
  • 32. Alcohol in Early Pregnancy Associated with Preterm, Small Babies MedicalResearch.com Interview with: Camilla Nykjaer, PhD Student School of Food Science and Nutrition University of Leeds, Leeds, UK • MedicalResearch.com: What are the main findings of the study? • Answer: In our study, there was an association between the mother drinking alcohol during early pregnancy and being born preterm or small for gestational age. Babies of women who drank more than 2 units of alcohol per week in the first trimester were more likely to be born preterm, small for gestational age and with lower birth weight compared to non- drinkers, even after adjusting for a range of confounders including cotinine levels as a biomarker for smoking status. The association with preterm birth was present even in those mothers who reported drinking less than 2 units/week. MedicalResearch.com: Were any of the findings unexpected? • Answer: Alcohol is a known teratogen. Evidence regarding the damaging effects of heavy drinking in pregnancy is well established, the effect of low intakes is however unclear. We believe our study adds evidence that even very low intakes of alcohol in early pregnancy can have adverse effects on birth outcomes. Maternal alcohol intakes which exceeded 2 units/week in the period leading up to pregnancy were also found to be associated with fetal growth, suggesting that the peri-conceptual period may be particularly sensitive to the effects of alcohol on the fetus. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Clinicians should advise pregnant women and women planning to become pregnant to avoid drinking alcohol all together when trying to conceive and throughout pregnancy. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: This is an observational study so conclusions about causality cannot be drawn. Due to ethical reasons a randomised controlled trial cannot be conducted but it would be important to reproduce this study in other cohorts with bigger sample sizes in different countries., • Citation: • Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohortCamilla Nykjaer,Nisreen A Alwan,Darren C Greenwood,Nigel A B Simpson,Alastair W M Hay, Kay L M White, Janet E Cade • J Epidemiol Community Health jech-2013-202934Published Online First: 10 March 2014 doi:10.1136/jech-2013-202934 Read the rest of the interview on MedicalResearch.com
  • 33. ALS Amyotrophic Lateral Sclerosis: FDG-PET as Marker of Cerebral Involvement MedicalResearch.com Interview with: Prof. Dr. Philip Van Damme, MD, PhD Neuromuscular Reference Center, Neurology Department, University Hospitals Leuven Vesalius Research Center, VIB, Leuven Leuven Institute of Neurodegenerative Disorders (LIND) KU Leuven, Belgium • MedicalResearch.com: What are the main findings of the study? • Prof: Van Damme: Earlier FDG-PET studies carried out in the 80’ties already pointed out that patients with ALS had decrease glucose uptake in the brain that is more extended than the motor cortex, at least at the group level. Of course, this imaging technique has been improved since then. • We prospectively assessed the diagnostic and prognostic value of FDG-PET in patients that were referred to us because a diagnosis of ALS was suspected. • The most important finding of our study probably is that FDG-PET shows perirolandic and variable frontotemporal hypometabolism in most patients with ALS at the first presentation in our clinic. It suggests that FDG-PET is a very sensitive marker of cerebral involvement in ALS, which has a high sensitivity at the single patient level. • In addition our study revealed that the co-occurrence of extensive prefrontal or anterior temporal hypometabolism was present in about 10% of patients and had a negative effect on survival after disease onset. MedicalResearch.com: Were any of the findings unexpected? • Prof: Van Damme: Given the earlier studies with FDG-PET in ALS, we expected to find hypometabolism at the patient group level. However, the sensitivity of the abnormalities seen at the single patient level was quite unexpected. • Also, to find extensive regions of hypometabolism in the prefrontal and/or anterior temporal lobes in patients with ALS were you wouldn’t expect the co-occurrence of frontomporal dementia at first sight in about 10% of patients was remarkable. The detection of frontotemporal involvement becomes more and more important because it has consequences for the prognosis and management of the patients. FDG-PET may become an important ancillary test to look for frontotemporal involvement in patients with ALS, even if no cognitive or behavioral problems are reported by the patient and his or her family. Read the rest of the interview on MedicalResearch.com
  • 34. ALS Amyotrophic Lateral Sclerosis: FDG-PET as Marker of Cerebral Involvement MedicalResearch.com Interview with: Prof. Dr. Philip Van Damme, MD, PhD Neuromuscular Reference Center, Neurology Department, University Hospitals Leuven Vesalius Research Center, VIB, Leuven Leuven Institute of Neurodegenerative Disorders (LIND) KU Leuven, Belgium • MedicalResearch.com: What should clinicians and patients take away from your report? • Prof: Van Damme: There is an unmet need for an imaging biomarker of disease in ALS, both from the diagnostic as well as from the prognostic point of view. FDG-PET may play its role herein, but further studies are needed to confirm this. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Prof: Van Damme: Our results suggest that FDG-PET has diagnostic and prognostic value at the single patient level in ALS, but several questions remain unanswered. How specific is the finding of perirolandic and frontotemporal hypometabolism in ALS? It seems to be a very sensitive marker in patients with ALS, but we don’t know its specificity or its discriminative value for ALS mimic syndromes. • MedicalResearch.com: How good is the correlation between FDG-PET findings and neuropsychological scores? • Prof: Van Damme: How early in the disease course do these changes appear? In our study we scanned the patients when they first presented at our center, but we don’t know if these changes are already present in earlier disease stages or even in the presymptomatic stage. • Citation: • Value of 18Fluorodeoxyglucose–Positron-Emission Tomography in Amyotrophic Lateral Sclerosis: A Prospective Study • Van Laere K, Vanhee A, Verschueren J, et al. Value of 18Fluorodeoxyglucose–Positron-Emission Tomography in Amyotrophic Lateral Sclerosis: A Prospective Study. JAMA Neurol. 2014;():. doi:10.1001/jamaneurol.2014.62. Read the rest of the interview on MedicalResearch.com
  • 35. Orthopedic Trauma Patients: ‘Doctor Shopping’ and Increased Narcotics Use MedicalResearch.com Interview with: Brent J. Morris, M.D. Shoulder and Elbow Surgery Fellowship Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, Texas • MedicalResearch.com: What are the main findings of the study? • Dr. Morris: There are concerns that an increasing percentage of patients are receiving narcotics by “doctor shopping” or seeking narcotics from multiple providers. One in five of our postoperative orthopedic trauma patients received narcotics from one or more additional providers other than the treating surgeon. • Patients that doctor-shopped postoperatively had a significant increase in narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Morris: The prevalence of postoperative doctor shopping was surprising, and unfortunately, this number likely underestimates the true extent of postoperative doctor shopping. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Morris: This study highlights the importance of counseling our patients in the postoperative period about narcotic use. The treating surgeon is responsible for pain control in the immediate postoperative period, and additional narcotics should not be sought from multiple providers without alerting the treating surgeon. Pain control in the postoperative period is very important, especially in patients with traumatic injuries; however, there needs to be better awareness among patients and providers to ensure that patients do not engage in doctor shopping. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Morris: We now recognize that a high percentage of patients doctor shop postoperatively and research should be focused on combating postoperative doctor shopping and quantifying the impact of narcotic use on clinical outcomes and patient satisfaction. • Citation: • The American Academy of Orthopaedic Surgeons Meeting 2014 Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Read the rest of the interview on MedicalResearch.com
  • 36. Emergency Room Visits for Insulin-Related Hypoglycemia MedicalResearch.com Interview with: Andrew I. Geller, MD Medical Officer in the Division of Healthcare Quality Promotion at CDC. • MedicalResearch.com: What are the main findings of the study? • Dr. Geller: Using CDC’s national medication safety monitoring system, we estimated that, each year, there were about 100,000 visits made to U.S. emergency departments (EDs) for insulin-related hypoglycemia and errors during 2007-2011, or about half a million ED visits over the 5-year study period. This is important because many of these ED visits for insulin-related hypoglycemia may be preventable. • We also found these ED visits were more common with increasing age: every year, 1 in 49 insulin- treated seniors (aged 65 years or older) visited the ED because of hypoglycemia while on insulin or because of a medication error related to insulin. Among the very elderly (aged 80 years or older), this number was 1 in 8 annually. For cases where a medication error was involved, we found the number one contributing factor to the ED visit was a meal-related problem, such as a patient skipping a meal after taking a rapid- acting insulin or not adjusting their insulin doses when their food intake was reduced. • The second most common contributing factor to ED visits where medication errors were involved was mix-up between insulin products. Typically, this involved patients who intended to take a long- acting insulin (such as insulin glargine or insulin detemir), but instead took a rapid-acting insulin (such as insulin aspart or insulin lispro). MedicalResearch.com: Were any of the findings unexpected? • Dr. Geller: Insulin is a complicated drug to manage; we expected that it would cause many ED visits for adverse events. But we did not appreciate the full severity of these insulin-related ED visits. For example, almost two-thirds of emergency department visits involved hypoglycemia with either loss of consciousness, confusion, or injury (e.g., falling after fainting) and almost one-third of patients had to be hospitalized. Another marker of the severity of these cases was that over 50% involved very low blood glucose (50 mg/dL or lower). Read the rest of the interview on MedicalResearch.com
  • 37. Emergency Room Visits for Insulin-Related Hypoglycemia MedicalResearch.com Interview with: Andrew I. Geller, MD Medical Officer in the Division of Healthcare Quality Promotion at CDC. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Geller: It is important that patients on insulin and other diabetes medicines continue their medications. What our findings point to is an opportunity to improve how these patients can safely use their insulin. For example, we know that planning meals around dosing of certain types of insulin (e.g., rapid-acting insulin products) is one of the most important things that patients can do to prevent hypoglycemia. . Additionally, many patients take not just one type of insulin, but two or even three. For such patients, it is important that they pay close attention to which insulin products they are administering so as to prevent confusion or mix-up’s among products. It is also important for patients to recognize the signs and symptoms of hypoglycemia, educate their families and caregivers on recognizing hypoglycemia, and be ready to promptly treat hypoglycemia (with glucose tablets or orange juice, for example). • Clinicians are well acquainted with the risks of insulin for individual patients, but may not fully appreciate the public health burden of ED visits and hospitalizations from insulin-related hypoglycemia and errors. Until very recently, clinical guidelines emphasized the long-term benefits of blood glucose control through tight blood glucose control. This study supports more recent clinical guidance for the need to balance the short-term risks of tight blood glucose control with the potential long- term benefits. This includes taking into account an individual’s risk for hypoglycemia based on such factors as age, other chronic conditions, and their ability to safely manage insulin. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Geller: We recommend ongoing national public health surveillance to continue to follow trends in ED visits and hospitalizations for insulin-related hypoglycemia and errors, and to measure the impact of changing diabetes treatment guidelines and hypoglycemia prevention efforts. Future research could focus on additional specific risk factors that contribute to serious insulin-related hypoglycemia, such as types of insulin products involved, levels of glycemic control, and patient’s comorbidities. Moving forward, it will be important to identify best practices for preventing these types of events, including emphasizing importance of meal-planning and avoiding product mix-up’s in diabetes self-management education, as well as improving packaging of the various insulin products (pens, vials) so that they are more easily distinguished. • Citation: • National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations • Geller AI, Shehab N, Lovegrove MC, et al. National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations. JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.136. Read the rest of the interview on MedicalResearch.com
  • 38. Suicide in Children and Adolescents: Relationship Between Peer Victimization, Cyberbullying MedicalResearch.com Interview with: Mitch van Geel, PhD Institute of Education and Child Studies, Leiden University Leiden, the Netherlands • MedicalResearch.com: What are the main findings of the study? • Dr.van Geel: We performed a meta-analysis, which is a way to statistically summarize effect sizes from earlier studies. Individual studies often provide varying effect sizes, which makes it difficult to judge whether and how strong variables are related. Furthermore, study characteristics (sampling methods, response rates, controlling for certain confounders) might influence study results. By using a meta-analysis it can be analyzed to what extent study characteristics are related to results; if a particular result only tends to be established in studies with certain designs (for example a convenience sample), we might wonder whether such an effect really exists; but if we find that a particular outcome is unrelated to study characteristics or found in studies with relatively stronger designs, we might feel more certain in concluding that a relation between variables (bullying-suicide thoughts or attempts) exists. • By using a meta-analysis we established a significant relation between bullying and thoughts about suicide, and bullying and suicide attempts, and we found that these results were unrelated to study characteristics. MedicalResearch.com: Were any of the findings unexpected? • Dr.van Geel: Mostly the result that cyberbullying as more strongly related to suicide thoughts than traditional bullying. This may be because victims of cyberbullying feel denigrated for a wider evidence, or because the event is stored on the internet, they may relive denigrating experiences more often. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr.van Geel: Suicide is one of the most important causes of adolescent mortality; in the United States, between 5 to 8 percent of adolescents will attempt suicide within a year. We found that attempted suicides are significantly related to bullying, a highly prevalent behavior among adolescents, of which estimates suggest that between 15-20 percent of adolescents is involved as a bully, as a victim, or as both. This further stresses the need to reduce bullying and help the victims of bullying. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr.van Geel: Studies should continue to further establish how cyberbullying affects children and adolescents, but even more importantly, we should continue to study how both traditional and cyberbullying can be reduced. • Citation: • van Geel M, Vedder P, Tanilon J. Relationship Between Peer Victimization, Cyberbullying, and Suicide in Children and Adolescents: A Meta-analysis. JAMA Pediatr. 2014;():. doi:10.1001/jamapediatrics.2013.4143. Read the rest of the interview on MedicalResearch.com
  • 39. Excessive Substance Use: Training Family Physicians to Deliver Brief Intervention MedicalResearch.com Interview with: Dr. Dagmar Haller, MD, PhD Médecin adjointe agrégée Unité Santé Jeunes Hôpitaux Universitaires de Genève Suisse • MedicalResearch.com Interview with: Dr. Dagmar Haller, MD, PhD Médecin adjointe agrégée Unité Santé Jeunes Hôpitaux Universitaires de Genève Suisse • MedicalResearch.com: What are the main findings of the study? • Dr. Haller: One year after a consultation with a family doctor there was a 28% reduction in the proportion of excessive substance users among those who had reported excessive use at the start of the study but there was no significant difference between the group that received counseling and the one that did not. MedicalResearch.com: Were any of the findings unexpected? • Dr. Haller: The natural history of substance use in adolescence is that of an increase with age. Thus the important reduction in the proportion of excessive substance users at follow-up, particularly in the control group, was unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Haller: Consultations by family physicians have the potential to influence adolescent substance use trajectories, but the best way to exert this influence remains unknown. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Haller: Future research should explore the potential role of multisectoral collaborations, including the interaction between a disapproving community environment and interventions in the clinical setting. More research is also needed on the best models for effective screening of substance use in young people attending family practices. • Citation: • Effectiveness of training family physicians to deliver a brief intervention to address excessive substance abuse among young patients • Dagmar M. Haller, Anne Meynard, Daniele Lefebvre, Obioha C. Ukoumunne, Françoise Narring, and Barbara Broers • CMAJ cmaj.131301; published ahead of print March 10, 2014, doi:10.1503/cmaj.131301 Read the rest of the interview on MedicalResearch.com
  • 40. COPD: Using FEV6 to Identify More Affected Patients MedicalResearch.com Interview with: Surya P Bhatt MD Assistant Professor Division of Pulmonary and Critical Care Medicine University of Alabama at Birmingham • MedicalResearch.com: What are the main findings of the study? • Dr. Bhatt: The forced vital capacity (FVC) maneuver is a difficult maneuver for many patients and the forced expiratory volume in the first 6 seconds (FEV6) has been shown to be a reliable substitute. We used imaging findings on computed tomography, COPD questionnaires and tests of exercise capacity to compare these two spirometric measures (FEV1/FVC and FEV/FEV6) in the diagnosis of airflow obstruction, and showed that FEV6 can be reliably substituted for FVC. Our findings suggest that using FEV6 may in fact identify more patients with disease than by using FVC. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Bhatt: We expected FEV6 to be a good substitute for FVC. The finding that using FEV6 may in fact identify patients with more respiratory morbidity was unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Bhatt: FEV1/FEV6 can be reliably substituted for FEV1/FVC in the diagnosis of airflow obstruction. The FEV6 measurement is easier both for patients and for pulmonary function laboratory personnel. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Bhatt: These findings should be tested in a real world scenario where quality control is not as rigorous as in a clinical trial setting. We expect FEV6 to be even more reliable when quality control is not very stringent. • Citation: • FEV1/FEV6 to Diagnose Airflow Obstruction: Comparisons with Computed Tomography and Morbidity Indices • Bhatt SP1, Kim YI, Wells JM, Bailey WC, Ramsdell JW, Foreman MG, Jensen RL, Stinson DS, Wilson CG, Lynch DA, Make BJ, Dransfield MT; the COPDGene Investigators. • Ann Am Thorac Soc. 2014 Jan 22. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 41. Decreasing Bacterial Contamination from Surgical Gloves, Gowns MedicalResearch.com Interview with: William G Ward, Sr. MD Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line – Guthrie Clinic Sayre, Pennsylvania 18840 (Professor Emeritus – Wake Forest University Dept of Orthopaedic Surgery) • MedicalResearch.com: What are the main findings of this study? • Dr. Ward: The main findings of the study include: • The use of disposable spun-lace “paper” gowns was associated with a dramatic decrease in the likelihood of culture- detected bacterial contamination on the surgeon’s gloved hand and gown sleeve. • For a double-gloved surgeon, changing the outer glove just prior to implant handling should decrease bacterial contamination from the surgeon by about 50%. • Bacteria suspended in saline solution transgressed the material of standard reusable scrub attire in 96% (26/27) of tested gowns and in 0% (0/27) of spun-lace disposable “paper” gowns. • MedicalResearch.com: Were any of the findings surprising? • Dr. Ward: When we performed the first outer glove exchange study, we had simply recorded the gown type. The overpowering significant effect of gown type had not been anticipated. • MedicalResearch.com: What should patients and clinicians take away from this report? • Dr. Ward: Take Away Message: • Reusable cloth gowns do not provide an adequate barrier to bacterial transgression from the surgeon’s skin and should be abandoned and replaced with verifiable occlusive gowns such as spun-lace paper gowns. A similar recommendation regarding reusable cloth versus disposable “paper” drapes or other occlusive disposable drapes is also recommended, however this was not specifically tested in this project. • MedicalResearch.com: What future research do you recommend as a result of this study? • Dr. Ward: We have already performed additional research regarding glove donning technique, confirming that a technique whereby the surgeon is assisted in gloving and during which he keeps his fingertips withdrawn inside the gown sleeve until the sleeve is engaged within the cuff is associated with an almost seven-fold decrease in bacterial contamination, compared to gloving when the fingers extend beyond the cuff upon entering the opened glove, and over a seven-fold decrease in contamination compared to self-gloving. Additional studies of various drape materials are indicated, as well studies of various gloving techniques to decrease the contamination that inevitably occurs with current self-gloving techniques. • Citation: • Glove and Gown Effects on Intraoperative Bacterial Contamination Ward WG Sr1, Cooper JM, Lippert D, Kablawi RO, Neiberg RH, Sherertz RJ. Ann Surg. 2014 Mar;259(3):591-7. doi: 10.1097/SLA.0b013e3182a6f2d9. Read the rest of the interview on MedicalResearch.com
  • 42. Should Dental Extractions Be Done Prior to Heart Surgery? MedicalResearch.com Interview with: Dr. Kendra J. Grim Department of Anesthesiology Mayo Clinic, Rochester, MN 55905 • MedicalResearch.com: What are the main findings of the study? • Dr. Grim: “The current guidelines say that if possible, treating the dental problems that patients have before heart surgery is best, to try to prevent both early and late heart infections. But the data is very unclear, because it’s very difficult to study. We found in our study that their risk of serious complications after having teeth removed may be higher than we thought. We were primarily looking at stroke, heart attack, renal failure and death. We found that actually the incidence of having one of those major morbidities was 8 percent. Of that 8 percent, we had six patients, or 3 percent, of the total group who died between their dental surgery and scheduled heart surgery, so these patients never made it to their heart surgery. An additional 3 percent of patients died after heart surgery. “ • MedicalResearch.com: Were any of the findings unexpected? • Dr. Grim: “Yes. The risk of having a serious complication after tooth extraction before heart surgery was higher than we expected, at 8%. Current ACC/AHA guidelines that rate dental extraction a low-risk procedure (<1% risk of major complication or death) may not apply to this patient population.” MedicalResearch.com Dr. Grim: “Our take-home message is that discussion among the specialists – the cardiologist, cardiac surgery, the oral surgeon and the anesthesiologist – would be in the best interest of the patient, to try to ascertain the risk for this particular patient. If we think the risk from taking the teeth out is low, but the benefit is perceived to be high, then we would proceed with the tooth extraction. But if we think the risk of having the teeth extracted before heart surgery is too high, then we would consider not proceeding with the tooth extraction. We really feel that it’s important, because the data is unclear, that rather than following a general rule of thumb, physicians assess each patient’s individual risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Grim: “Our hope is that this will spark further conversation that will lead to further research. It’s difficult to study, because the incidence of the infection in the new artificial heart valve is very low. Infection rates have not been studied in patients for bypass grafts, for the ventricular assist devices, total artificial hearts, and there has been minimal research in heart transplantation. So there are a lot of additional avenues open for research in this area to better understand the risk/benefit.” • Citation: • Morbidity and Mortality Associated With Dental Extraction Before Cardiac Operation • Mark M. Smith, David W. Barbara, William J. Mauermann, Christopher F. Viozzi, et al • The Annals of Thoracic Surgery Vol. 97, Issue 3, Pages 838-844 Read the rest of the interview on MedicalResearch.com
  • 43. Transplant Recipients Contracted Microsporidiosis From Donor MedicalResearch.com Interview with: Dr. Susan N. Hocevar MD Centers for Disease Control and Prevention Atlanta, GA 30333; • MedicalResearch.com Interview with: Dr. Susan N. Hocevar MD Centers for Disease Control and Prevention Atlanta, GA 30333; • MedicalResearch.com: What are the main findings of the study? Dr. Hocevar: This public health investigation uncovered microsporidiosis transmitted to 3 organ recipients who received organs from a common donor. This illness cluster was the first recognized occurrence of donor-derived microsporidiosis. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hocevar: The diagnosis of microsporidiosis in all 3 organ recipients was surprising. The organ donor was asymptomatic at the time of organ procurement and risk factors or symptoms consistent with microsporidiosis were not reported on follow up questioning of the donor’s family. Despite lack of symptoms, the donor had elevated serum titers against the organism suggesting asymptomatic infection. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Hocevar: Physicians should consider donor derived disease in their transplant recipients. If donor derived disease is suspected, reporting to the organ procurement organization will aid in recognition of illness clusters and, when a specific organism is identified, may aid in the therapy of other organ recipients who received organs from the same donor. Infection with microsporidia may be asymptomatic and more common than we think. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Hocevar: The diagnosis of microsporidiosis requires a high index of suspicion and can be difficult to make. Microsporidiosis should be considered in the differential diagnosis especially when other, more commonly encountered illnesses have been ruled out or when recipients are poorly responsive to therapy. • Citation: • Microsporidiosis Acquired Through Solid Organ Transplantation: A Public Health Investigation • Susan N. Hocevar, MD; Christopher D. Paddock, MD; Cedric W. Spak, MD; Randall Rosenblatt, MD; Hector Diaz-Luna, MD; Isabel Castillo, RN, BSN; Sergio Luna, RN; Glen C. Friedman, MD; Suresh Antony, MD; Robyn A. Stoddard, DVM, PhD; Rebekah V. Tiller, MPH; Tammie Peterson, RN, MSN/MPH, CPTC; Dianna M. Blau, DVM, PhD; Rama R. Sriram, BS; Alexandre da Silva, PhD; Marcos de Almeida, PhD; Theresa Benedict, BS; Cynthia S. Goldsmith, MGS; Sherif R. Zaki, MD, PhD; Govinda S. Visvesvara, PhD; Matthew J. Kuehnert, MD, for the Microsporidia Transplant Transmission Investigation Team* • Ann Intern Med. 2014;160(4):213-220-220. doi:10.7326/M13-2226 Read the rest of the interview on MedicalResearch.com
  • 44. Stethoscopes Coated with Bacteria MedicalResearch.com Interview with : Professor Didier Pittet, MD, MS Director, Infection Control Program and WHO Collaborating Centre on Patient Safety University of Geneva Hospitals and Faculty of Medicine, Switzerland • MedicalResearch.com: What are the main findings of the study? • Prof. Pittet: The density of bacterial contamination of the stethoscope’s membrane is closely correlated with the density of bacterial counts on the doctor’s fingertips. • This is true for both common skin comensals and multi-resistant nosocomial pathogens such as MRSA. MedicalResearch.com: Were any of the findings unexpected? • Prof. Pittet: Yes, the amount of bacteria recovered was much higher than expected and as important of bacterial counts on fingertips responsible for cross-transmission. • MedicalResearch.com: What should clinicians and patients take away from your report? • Prof. Pittet: Stethoscopes should be disinfected after each use. • Citation: • Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities • Benedetta Allegranzi, Laurie Conway, Elaine Larson, Didier Pittet • AJIC: American Journal of Infection Control – March 2014 (Vol. 42, Issue 3, Pages 224-230, DOI: 10.1016/j.ajic.2013.11.015) Read the rest of the interview on MedicalResearch.com
  • 45. Urinary Tract Infections Reporting Change Reduced Antibiotic Use MedicalResearch.com Interview with: Dr. Jerome A. Leis, MD, MSc Sunnybrook Health Sciences Centre Toronto, ON, M4N 3M5, Canada • MedicalResearch.com: What are the main findings of the study? • Dr. Leis: We know that positive urine cultures from patients who lack signs and symptoms of urinary tract infection are a trigger FOR unnecessary antibiotic prescriptions in hospitals. This problem has not improved despite many educational initiatives. We identified a subset of patients in our hospital where only 2% of all urine specimens sent to the laboratory were associated with symptomatic infection and decided to no longer routinely report positive results from these specimens on the electronic medical record, unless a special telephone request was made. We found that with this simple change, unnecessary antibiotic prescriptions declined markedly and this did not require any education of care providers. Most importantly, based on our safety audits, patients who had a urinary tract infection all received appropriate treatment. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Leis: We wanted to test the hypothesis that the positive results themselves were driving the decision to treat with antibiotics among patients who would not otherwise have been considered to have a urinary tract infection. Once we asked care providers to call for the results, we received very few requests confirming that they had a low clinical suspicion of urinary tract infection in these patients. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Leis: Unnecessary testing is not only wasteful to the healthcare system, but can also lead to downstream harm to patients. Urine is the most common specimen to be sent for culture among hospitalized patients, yet we know that the number of urine cultures ordered far exceeds the number of urinary tract infections. These unnecessary urine cultures generate positive results from patients without symptoms of infection and prompt treatment with antibiotics that carry unneeded risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Leis: Although promising, this change in laboratory reporting is not ready to become standard practice. Larger studies in more than one institution are needed to better assess the full impact of this change. • Citation: • Reducing Antimicrobial Therapy for Asymptomatic Bacteriuria Clin Infect Dis. first published online February 26, 2014 doi:10.1093/cid/ciu010 • Jerome A. Leis, Gabriel W. Rebick, Nick Daneman, Wayne L. Gold, Susan M. Poutanen, Pauline Lo, Michael Larocque, Kaveh G. Shojania, and Allison McGeer Read the rest of the interview on MedicalResearch.com
  • 46. Most Febrile Childhood Illnesses Are Viral, Do Not Need Antibiotics MedicalResearch.com Interview with: Valérie D’Acremont, MD, PhD Group leader Swiss Tropical and Public Health Institute | Basel | Switzerland Médecin-adjointe, PD-MER Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | Switzerland • MedicalResearch.com: What are the main findings of the study? • Dr. D’Acremont: We discovered that, in a rural and an urban area of Tanzania, half of the children with fever (temperature >38°C) had an acute respiratory infection, mainly of the upper tract (5% only had radiological pneumonia). These infections were mostly of viral origin, in particular influenza. The other children had systemic viral infections such as HHV6, parvovirus B19, EBV or CMV. Overall viral diseases represented 71% of the cases. Only a minority (22%) had a bacterial infection such as typhoid fever, urinary tract infection or sepsis due to bacteremia. Malaria was found in only 10% of the children, even in the rural setting. MedicalResearch.com: Were any of the findings unexpected? • Dr. D’Acremont: It was unexpected to find so many respiratory infections, and so many viral diseases in general. We knew that malaria had decreased during the last years, but for the rural setting we did not expect the proportion to be so low. The other surprise was to identify mostly cosmopolitan diseases rather than tropical vector-born diseases such as Dengue or Rift Valley. The latter infections are however often epidemic, and the study might have taken place between two outbreaks. In fact, we have documented last month an outbreak of Dengue fever in Dar for the first time. The other reason for the predominance of cosmopolitan illnesses is that young children get mainly infected at home by their relatives, and less often outside at the river, from animals or at work, as it is the case for adults. Read the rest of the interview on MedicalResearch.com
  • 47. Most Febrile Childhood Illnesses Are Viral, Do Not Need Antibiotics MedicalResearch.com Interview with: Valérie D’Acremont, MD, PhD Group leader Swiss Tropical and Public Health Institute | Basel | Switzerland Médecin-adjointe, PD-MER Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | Switzerland • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. D’Acremont: The take-home message is that in Tanzania, as probably in other African countries and even continents, most febrile children do not need to be treated with antimicrobials (provided they do not present signs of severe disease and malaria has been excluded by a rapid test). In many places, clinicians tend to overprescribe antibiotics to be on the safe side, which leads to a rapid increase in drug resistance. The latter is known to be one of the major public health threat the world is facing today, including the African continent that has limited resources to fight it. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. D’Acremont: Among all these febrile children with self-limited infections, a few still suffer from a potentially dangerous disease. We have presently limited tools to distinguish between serious and benign infection (or even simple colonization), not only in Africa but also in Northern countries. New biomarkers need to be found, in particular host biomarkers that would have the advantage of identifying severe disease regardless of the microbiological cause. They should then be turned into point-of-care tests that can be used at primary care level, in conjunction with evidence based algorithms to ensure rational use of both tests and medicines. • Citation: Beyond Malaria — Causes of Fever in Outpatient Tanzanian Children • Valérie D’Acremont, M.D., Ph.D., Mary Kilowoko, M.P.H., Esther Kyungu, M.D., M.P.H., Sister Philipina, R.N., Willy Sangu, A.M.O., Judith Kahama-Maro, M.D., M.P.H., Christian Lengeler, Ph.D., Pascal Cherpillod, Ph.D., Laurent Kaiser, M.D., and Blaise Genton, M.D., Ph.D. • N Engl J Med 2014; 370:809-817 February 27, 2014DOI: 10.1056/NEJMoa1214482 Read the rest of the interview on MedicalResearch.com
  • 48. Blood Pressure Differences Between Arms Correlate With Negative Outcomes MedicalResearch.com Interview with: Dr. Ido Weinberg MD MSc MHA Massachusetts General Hospital, Vascular Medicine • MedicalResearch.com: What are the main findings of the study? • Dr. Weinberg: The study examined the relationship between blood pressure difference between arms and clinically meaningful outcomes such as death and new-onset (incident) cardiovascular disease including myocardial infarction and stroke. The main finding of the study was that an elevated inter-arm blood pressure difference correlated with these negative outcomes. We have also shown that the correlation was strong enough to be independent from the classic Framingham risk score. Adding an elevated inter-arm blood pressure to the risk score made it a more accurate. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Weinberg: In my opinion the findings were expected and in line with our hypothesis. However, this does not mean that they lacked in novelty. Overall the population that we studied was quite healthy. This means that there were relatively few cardiovascular events despite a prolonged period of observation. Previous studies have shown a more robust correlation between an elevated inter-arm blood pressure difference and cardiovascular outcomes in sicker populations. The novelty in our findings is that this is the first community based population study to show the correlation. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Weinberg: For clinicians I would say that the main message is that they should make it a habit to measure blood pressure in both arms at least once. I also think that blood pressure measurement should be done after the patient has indeed relaxed. I think it has several advantages. • First, it is compliant with current recommendations. • Second, it is probably more accurate than measuring blood pressure in one arm only and immediately upon patient arrival. • Third, as our findings point out, this is a cheap and efficient way to estimate patients’ risk of having unwanted cardiovascular events. Basically, it is another, easy to use, tool in clinicians’ toolbox. • As for patients – I think many patients today are aware of the importance of blood pressure control. Many patients use home monitoring as a means to control their blood pressure. I think that patients can serve themselves right by following their own blood pressure and taking it in both arms. If a consistent gap keeps showing up, I think they should discuss it with their caregivers. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Weinberg: Blood pressure measurements, despite being widespread and ubiquitous with clinical encounters, have not been yet fully utilized. I see two obvious next steps in the study of this field. • First, we should try and correlate inter-arm blood pressure differences with markers of subclinical atherosclerosis such as intima-media thickness and coronary and aortic calcifications. • Second, it would be interesting to know if intervention after early detection can improve outcomes. In other words, should finding an increased blood pressure difference between arms dictate any management changes. • Citation: • Am J Med. 2014 Mar;127(3):209-15. doi: 10.1016/j.amjmed.2013.10.027. Epub 2013 Nov 25. • The systolic blood pressure difference between arms and cardiovascular disease in the framingham heart study. • Weinberg I1, Gona P2, O’Donnell CJ3, Jaff MR4, Murabito JM5. Read the rest of the interview on MedicalResearch.com
  • 49. Advanced Paternal Age: Increased Risk of Psychiatric Problems in Offspring MedicalResearch.com Interview with: Brian D’Onofrio, PhD Associate Professor Department of Psychological and Brain Sciences Indiana University Bloomington, IN • MedicalResearch.com: What are the main findings of your study? • Dr. D’Onofrio: The main finding from our study is that the specific associations between advancing paternal age at childbearing and offspring psychiatric and academic problems were much larger than in previous studies. In fact, we found that advancing paternal age was associated with greater risk for several problems, such as Attention Deficit Hyperactivity Disorder, suicide attempts and substance use problems, whereas traditional research designs suggested advancing paternal age may have diminished the rate at which these problems occur. • MedicalResearch.com: Were any of the findings surprising? • Dr. D’Onofrio: When we conducted traditional analyses that compared the rates of psychiatric and educational problems between unrelated offspring our findings were generally consistent with previous studies. But, we were shocked when we conducted more advanced analyses that compared the rates of these problems among siblings—we compared offspring born when a father was younger to their siblings when the father was older. We did not expect that the magnitude of the associations between advancing paternal age at childbearing and offspring problems would be larger. As a result, we conducted a series of additional analyses, which provided similar results. • MedicalResearch.com: What should clinicians and patients take away from this report? • Dr. D’Onofrio: Certainly delaying childbearing is associated with numerous factors, such as advanced educational attainment and more financial security for the parents, that are associated with better adjustment in children. But, the implications of the study is that delaying childbearing is also associated with increased risk for psychiatric and academic problems in the offspring. • We are not saying that all offspring born to older fathers will have psychiatric or educational problems. Rather, the study found that advancing paternal age at childbearing is associated with greater risk for serious problems in offspring that are associated with great impairment. As such, the study adds to a growing body of research, that suggests families, doctors, and society as a whole must consider both the pros and cons of delaying childbearing. • MedicalResearch.com: What further research do you recommend as a result of these findings? • Dr. D’Onofrio: The findings need to be replicated by other studies that use advanced methods to examine the consequences of advancing paternal age. And, more research needs to examine the factors that account for the findings. The results are consistent with molecular genetic research that link advancing paternal age at childbearing to more genetic mutations in their sperm. But, there could be other explanations as well. • JAMA: • Paternal Age at Childbearing and Offspring Psychiatric and Academic Morbidity • D’Onofrio BM, Rickert ME, Frans E, et al. Paternal Age at Childbearing and Offspring Psychiatric and Academic Morbidity. JAMA Psychiatry. 2014;():. doi:10.1001/jamapsychiatry.2013.4525. Read the rest of the interview on MedicalResearch.com
  • 50. Diabetes: Greater Stroke Risk in Women than Men MedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana • MedicalResearch.com: What are the main findings of the study? • Dr. Gang Hu: Our study suggests a graded association between HbA1c and the risk of stroke among female patients with type 2 diabetes and poor control of blood sugar has a stronger effect in women older than 55 years. MedicalResearch.com: Were any of the findings unexpected? • Dr. Gang Hu: Diabetes poses a substantially greater increase in the risk of stroke among women than among men. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Gang Hu: More aggressive blood sugar treatments and better control of other risk factor levels in women with diabetes are likely to substantially reduce stroke in this subgroup. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Gang Hu: More researches are needed to elucidate the mechanism of this sex difference. • Citation: • Sex differences in the risk of stroke and HbA among diabetic patients • Wenhui Zhao, Peter T. Katzmarzyk, Ronald Horswell, Yujie Wang, Jolene Johnson, Gang Hu. Sex differences in the risk of stroke and HbA 1c among diabetic patients. Diabetologia, February 2014 DOI: 10.1007/s00125-014-3190- Read the rest of the interview on MedicalResearch.com
  • 51. Creutzfeldt-Jakob Disease: Cerebrospinal Fluid Total and Phosphorylated Tau MedicalResearch.com Interview with: Tobias Skillbäck, MD Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Department of Neurochemistry, Sahlgrenska Academy University of Gothenburg Mölndal, Sweden • MedicalResearch.com: What are the main findings of the study? • Dr. Skillbäck: There were two main findings in this study. • First; Levels of t-tau and the T-tau/P-tau ratio in CSF of CJD (Creutzfeldt-Jakob Disease) patients are markedly increased, as compared to patients with Alzheimer’s disease and other dementias, and they are high enough to distinguish CJD against these important differential diagnoses. • Secondly, levels of these biomarkers tend to increase rapidly with disease progress in Creutzfeldt-Jakob Disease. This trend could not be observed for Alzheimer’s disease and other dementias, and could also be used to clinically distinguish CJD and indicates that repeated CSF measurements might be of value if a clinical suspicion of Creutzfeldt-Jakob Diseaseis present. MedicalResearch.com: Were any of the findings unexpected? • Dr. Skillbäck: That the trend of increasing of tau-levels with disease progression was so clear was not entirely expected. Previous studies have shown more of an upside down U-shaped curve, with increasing tau-levels at the beginning of the disease that reach a peak to subsequently drop before the patients’ demise. This was something we could not find evidence for in this study. The high level of distinction against Alzheimer’s disease (sensitivity, specificity and LR+ was 78.5%, 99.6% and 196.6) and other dementias (78.5%, 99.3% and 109.3) obtained with the threshold values chosen was also a pleasant surprise. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Skillbäck: Assessment of T-tau and the T-tau/P-tau ratio in CSF provides important information in investigations of rapid progressive dementia, and repeated measurements might be of value since Creutzfeldt-Jakob Disease patients show increasing values with disease progress. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Skillbäck: The next step is to establish the positive and negative predictive values of the tau markers in patients with clinical symptoms making the physician consider Creutzfeldt-Jakob Disease, i.e., in the most relevant clinical context one could imagine. The results of our study suggest that the predictive values will be high and clinically relevant but the precise figures need to be determined. Another important step will be to standardize the T-tau and P-tau markers better. We need certified reference methods and materials for assay calibration making it possible to establish global reference limits and cut-points for the markers. • Citation: • Diagnostic Performance of Cerebrospinal Fluid Total Tau and Phosphorylated Tau in Creutzfeldt-Jakob Disease: Results From the Swedish Mortality Registry • Skillbäck T, Rosén C, Asztely F, Mattsson N, Blennow K, Zetterberg H. Diagnostic Performance of Cerebrospinal Fluid Total Tau and Phosphorylated Tau in Creutzfeldt-Jakob Disease: Results From the Swedish Mortality Registry. JAMA Neurol. 2014;():. doi:10.1001/jamaneurol.2013.6455. Read the rest of the interview on MedicalResearch.com
  • 52. Stroke: Symptomatic Intracranial Hemorrhage After Thrombolysis MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO Neurologist, Associate Professor Department of Neurology Helsinki University Central Hospital • MedicalResearch.com: What are the main findings of the study? • Dr. Strbian: That even if the SEDAN score had the best performance, none of the scores showed better than a moderate performance. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Strbian: Some of the scores did better, some worse, some similar compared with the data from the derivation and possible validation cohort. Nothing unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Strbian: That we are working on a reliable method to predict the most feared complications of stroke thrombolysis: symptomatic intracranial hemorrhage. However, we are still in the beginning of the process. We need to refine the scores, we need to consider other parameters. Currently, we cannot treat the patients based on the scores only, but the scores can give us an estimate of the hemorrhage risk nonetheless. MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Strbian: Future studies are ongoing. Afterwards, we will include some more relevant parameters, but I do not want to provide any premature data. • Citation: • Symptomatic Intracranial Hemorrhage After Stroke Thrombolysis: Comparison of Prediction Scores Daniel Strbian, Patrik Michel, David J. Seiffge, Jeffrey L. Saver, Heikki Numminen, Atte Meretoja, Kei Murao, Bruno Weder, Nina Forss, Anna-Kaisa Parkkila, Ashraf Eskandari, Charlotte Cordonnier, Stephen M. Davis, Stefan T. Engelter, and Turgut Tatlisumak Stroke. 2014;45:752-758 published online before print January 28 2014, doi:10.1161/STROKEAHA.113.003806 Read the rest of the interview on MedicalResearch.com
  • 53. OverEating Saturated Fat May Build More Fat But Less Muscle MedicalResearch.com Interview with: Dr. Ulf Risérus Associate Professor in Clinical Nutrition Department of Public Health and Caring Sciences Clinical Nutrition and Metabolism Faculty of Medicine, Uppsala university Sweden • MedicalResearch.com: What are the main findings of the study? • Dr. Risérus: It has previously been shown in animal studies that overfeeding polyunsaturated fat causes less fat accumulation than saturated fats, but this study is the first to suggest that this could be true also in humans. Overeating saturated fats caused significantly more accumulation of fat in the liver and intra-abdominally, as compared with overeating polyunsaturated fats from. This study suggests it does matter where the excess calories come from when we gain weight. If a high-caloric diet contains large amounts of saturated fats it seems to switch on some genes that may promote abdominal fat storage and insulin resistance, and thereby result in a more unfavorable fat storage. In contrast, such effects were not seen if the diet was lower in saturated fats but higher in polyunsaturated fats from non-tropical vegetable oils. This study also suggests a novel contributing factor regarding the tendency of some individuals to accumulate fat in the liver and abdomen, i.e. in some people excessive amounts of saturated fat in combination with sugars might induce more fat in their livers and a propensity towards abdominal visceral fat accumulation. MedicalResearch.com: Were any of the findings unexpected? • Dr. Risérus: The results regarding the increased muscle mass following consumption of polyunsaturated fat was unexpected but highly interesting, and thus a finding we will follow-up in future studies. In more simple words overeating saturated fat may build more fat but less muscle, whereas the opposite was found when instead overeating polyunsaturated fats. We are currently investigating this in additional studies and are trying to understand the mechanisms behind this finding. Read the rest of the interview on MedicalResearch.com
  • 54. OverEating Saturated Fat May Build More Fat But Less Muscle MedicalResearch.com Interview with: Dr. Ulf Risérus Associate Professor in Clinical Nutrition Department of Public Health and Caring Sciences Clinical Nutrition and Metabolism Faculty of Medicine, Uppsala university Sweden • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Risérus: It is previously known that replacing saturated fat with polyunsaturated fat lowers LDL cholesterol in the blood , but the current data also suggests that irrespectively of the calorie content of the diet, individuals could benefit from having a good balance between polyunsaturated fat and saturated fats in the diet to avoid exaggerated liver and visceral fat accumulation, which may also influence the risk of developing obesity-related diseases in the long-term. These new findings also support international and US dietary recommendations, which, among other things, recommend replacing some saturated fat from red meats, butter, and palm oil, for example, with unsaturated fats from plant oils, nuts and fatty fish. • As there is a strong, and potentially causal link, between visceral fat accumulation and fatty liver (including non-alcoholic fatty liver disease, NAFLD) on the one hand and type 2 diabetes and cardiovascular disease on the other, the present results are of high interest. If confirmed, the results may be clinically important for better and early prevention of NAFLD, visceral obesity and potentially type 2 diabetes. These results however needs further investigation before we know the true clinical implications of dietary fat modification in preventing NAFLD and metabolic disorders such as type 2 diabetes. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Risérus: The next step is now to find out in greater detail what happens in the body when we eat the respective fats and to study what the effects are in overweight individuals with elevated risk of type-2 diabetes. • Citation: • Overfeeding Polyunsaturated and Saturated Fat Causes Distinct Effects on Liver and Visceral Fat Accumulation in Humans • Diabetes. 2014 Feb 18. [Epub ahead of print] • Rosqvist F1, Iggman D, Kullberg J, Jonathan Cedernaes J, Johansson HE, Larsson A, Johansson L, Ahlström H, Arner P, Dahlman I, Risérus U. Read the rest of the interview on MedicalResearch.com
  • 55. Diabetes and Depression: Cognitive Therapy Improved Both MedicalResearch.com Interview with: Steven A. Safren, Ph.D., ABPP Professor of Psychology, Harvard Medical School Director, Behavioral Medicine, Department of Psychiatry Massachusetts General Hospital, Boston, MA 02114 • MedicalResearch.com: What are the main findings of the study? • Dr. Safren: The main findings of the study are that, in patients with uncontrolled type 2 diabetes and depression, a type of psychological treatment, cognitive behavioral therapy (CBT) that addressed both self-care and depression, resulted in improvements in both depressed mood, self-care, and glucose control. This was a randomized controlled trial, and this cognitive-behavioral treatment worked better than lifestyle adherence and nutrition counseling alone; and the effects were sustained over 8 months. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Safren: The only unexpected finding was that for the depression outcome, although patients who got the CBT intervention improved over and above those in the control group at the first follow-up, and their gains were maintained over follow up, the difference between the two groups in depression disappeared at the 8 and 12 month follow up. We think this is because of the design issue where we referred anyone who needed it for outside treatment of depression at the follow- up visits. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Safren: That combining counseling for adherence with an evidenced based (cognitive behavioral) psychosocial treatment for depression can result in mental health, self-care, and biomedical improvments in health for patients with uncontrolled type 2 diabetes and depression. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Safren: Test the cost-effectiveness of this approach with respect to decreased health care costs as a result of treating depression and improving self-care in patients with chronic medical illness and comorbid mental health problems. • Citation: • A Randomized Controlled Trial of Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Patients With Uncontrolled Type 2 Diabetes • Safren SA1, Gonzalez JS, Wexler DJ, Psaros C, Delahanty LM, Blashill AJ, Margolina AI, Cagliero E. • Diabetes Care. 2014 Mar;37(3):625-33. doi: 10.2337/dc13-0816. Epub 2013 Oct 29. Read the rest of the interview on MedicalResearch.com
  • 56. Disabilities Increase Risk of Diabetes MedicalResearch.com Interview with: Barbara H. Bardenheier PHD, MPH, MA Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, GA • MedicalResearch.com: What are the main findings of the study? • Dr. Bardenheier: Our main findings were that older adults who become disabled, even mildly, are at increased risk of developing diabetes. MedicalResearch.com: Were any of the findings unexpected? • Dr. Bardenheier: I would say, yes we were surprised, because we have traditionally thought of diabetes as preceding disability rather than the other way around. Controlling for mediators did not affect estimates very much. This suggests that there might be other intrinsic aspects of functional decline and disability that affect diabetes risk. If so, it is something that is currently poorly understood • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Bardenheier: Long-lasting exercise programs—including muscular strengthening exercises and walking, as well as programs to maintain healthy weight—may help maintain physical function and at the same time reduce diabetes. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Bardenheier: Further research might be done to assess the extent to which modifiable factors resulting from mobility disability hasten the onset of diabetes. • Citation: • Association of Functional Decline With Subsequent Diabetes Incidence in U.S. Adults Aged 51 Years and Older: The Health and Retirement Study 1998-2010 • Bardenheier BH1, Gregg EW, Zhuo X, Cheng YJ, Geiss LS. Diabetes Care. 2014 Feb 18. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 57. Alzheimer’s Disease: Subjective Memory Complaints May Predict Future Cognitive Decline MedicalResearch.com Interview with: Dr. Erin Abner Ph.D. Assistant Professor of Epidemiology University of Kentucky College of Public Health Lexington, Kentucky • MedicalResearch.com: What are the main findings of the study? • Dr. Abner: The findings from this study are preliminary results from The Prevention of Alzheimer’s Disease with Vitamin E and Selenium Study. This early look at the data indicates that very simple measures of memory change, in this case asking older men with no cognitive impairment about changes in their memory over the past year, and whether they believe those changes are a problem, can be used to predict cognitive impairment years later. Men who said at study baseline that the changes in their memory represented problems to them were over twice as likely as men who did not complain to develop clinically detectable cognitive impairment during follow-up. This is exciting because the field of Alzheimer’s research is moving toward earlier intervention in the disease process. As of now, our best methods for identifying individuals without cognitive impairment who are likely to develop Alzheimer’s disease in the future are procedures that many people find intimidating, like lumbar puncture and PET scanning. Identifying older adults at high risk for future cognitive impairment with low-cost, non-invasive screening techniques would help researchers to target potential therapies to the people who stand to benefit the most. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Abner: We found that memory complaints that presented problems were particularly important for men who did not carry the apolipoprotein-ε4 allele (an important genetic risk factor for Alzheimer’s disease). Compared to men without the allele who did not complain, these men were over four times as likely to develop cognitive impairment. For men with the allele, complaints only increased the risk by about 50%. Read the rest of the interview on MedicalResearch.com
  • 58. Alzheimer’s Disease: Subjective Memory Complaints May Predict Future Cognitive Decline MedicalResearch.com Interview with: Dr. Erin Abner Ph.D. Assistant Professor of Epidemiology University of Kentucky College of Public Health Lexington, Kentucky • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Abner: Clinicians should be encouraged to use a longitudinal perspective when they screen patients for memory problems. When research participants first begin to make memory complaints they usually perform no differently on memory tests than participants who do not make complaints. So, when a patient reports a decline in memory, particularly one that they find troubling, they may still make a perfect score on a memory screen. However, the patient is at an increased risk for future cognitive impairment. • Patients, on the other hand, should not be unduly alarmed by lapses in memory. Many people who complain about their memory never develop Alzheimer’s disease. The key is whether there has been a change from previous levels of functioning. If there has, and if the patient is concerned about it, a visit to a neurologist for a memory work-up may be in order. A diagnosis of mild cognitive impairment or early Alzheimer’s disease can be frightening, since we still don’t have effective treatments, but early diagnosis can also be very positive. The early stages of the disease often involve behavioral changes, such as paranoia and irritability, that can strain relationships, particularly when there is no explanation for what’s happening. Early diagnosis also allows patients to make plans for the future and to participate in clinical trials. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Abner: Ultimately, maximizing the clinical utility of memory complaints is the goal. We don’t yet have a good understanding of how to differentiate memory complaints that precede cognitive impairments from memory complaints that don’t progress. • Citation: • Subjective Memory Complaints May Predict Clinical Impairment • Presented at: Clinical Trials Conference on Alzheimer’s Disease San Diego, CA November 2013 Read the rest of the interview on MedicalResearch.com
  • 59. Obesity Prevalence: No Change in Youth or Adult Levels in 10 years MedicalResearch.com Interview with: Cynthia L. Ogden, PhD, MRP Epidemiologist and Analysis Branch Chief NHANES Program/NCHS/CDC Hyattsville, MD 20782 • MedicalResearch.com: What are the main findings of the study? • Dr. Ogden: We continue to track obesity levels in the US population using data from the National Health and Nutrition Examination Survey. New data are now available for 2011-2012. We found that 17% of youth and 35% of adults were obese. Overall there has been no change in obesity levels among either youth or adults in the last 10 years. The prevalence of obesity among youth was 16.9% – exactly the same as in 2009-2010. In separate age groups analyses we found a decrease in obesity among 2-5 year olds and an increase in obesity among older women 60+ years. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Ogden: Although there have been no overall trends in obesity prevalence in the last 10 years, there may be improvements in some groups and obesity may continue to be increasing in others. The decrease in obesity prevalence we saw among young children 2-5 years is consistent with some other studies showing a decrease in this age group (eg among children who participate in federal nutrition programs: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6231a4.htm). • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Ogden: It is important to continue surveillance of obesity in the US population, especially in relation to obesity prevalence among young children where we found an improvement. • Citation: • Prevalence of Childhood and Adult Obesity in the United States, 2011-2012 • Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814. doi:10.1001/jama.2014.732. Read the rest of the interview on MedicalResearch.com
  • 60. Routine Vaccinations May Also Protect Against Unrelated Infections MedicalResearch.com Interview with: Signe Sørup, PhD Research Center for Vitamins and Vaccines (CVIVA) Bandim Health Project, Statens Serum Institut Artillerivej 5, DK-2300 Copenhagen S, Denmark • MedicalResearch.com: What are the main findings of the study? • Dr. Sørup: We found that admissions with any type of infection was reduced with 14 % for Danish children having the live, attenuated vaccine against measles, mumps, and rubella (MMR) as the most recent vaccine compared with children having the inactivated vaccine against Diphtheria, Tetanus, Pertussis, Polio, and Haemophilus Influenzae type b (DTaP-IPV-Hib) as the most recent vaccine. In Denmark herd immunity against measles, mumps, and rubella is high and only 26 of the more 42,000 admissions was related to measles, mumps, and rubella; so this finding cannot be explained by the specific protection against the targeted diseases. • In Denmark MMR vaccination is recommended at 15 months of age, but only 50% of the children in the study had received MMR before 16 months of age. We estimated that one hospital admission between 16 and 24 months of age could be avoided for 201 children vaccinated with MMR before 16 months of age rather than later. • These results are based on a retrospective cohort study including approximately half a million Danish children. The analyses are adjusted for age and a long range of background factors, including socio-economic factors. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Sørup: In low-income settings, it has previously been found that measles vaccine is associated with reduced risk of mortality and admissions from other causes than measles. It is an important insight that similar observations have now been made in a high-income setting. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Sørup: It is important to follow the recommended vaccination programme and particularly to receive the MMR vaccine on time. This is important for protection against the targeted diseases, but our study showed that the MMR vaccine could have a general immune stimulating effect thereby increasing protection against unrelated infections. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Sørup: It is important to evaluate vaccines and vaccination programmes both in terms of protection against the targeted diseases and in terms of general morbidity. It is important with observational studies and randomised trials from different settings to secure that we use already available vaccines in the best possible way to reduce morbidity and mortality worldwide. • Citation: • Live Vaccine Against Measles, Mumps, and Rubella and the Risk of Hospital Admissions for Nontargeted Infections • Sørup S, Benn CS, Poulsen A, Krause TG, Aaby P, Ravn H. Live Vaccine Against Measles, Mumps, and Rubella and the Risk of Hospital Admissions for Nontargeted Infections. JAMA. 2014;311(8):826-835. doi:10.1001/jama.2014.470. Read the rest of the interview on MedicalResearch.com
  • 61. Chronic Kidney Disease: ACEI/ARB Use and Survival Benefit MedicalResearch.com Interview with: Dr. Csaba P. Kovesdy, MD FASN Clinical Associate Professor of Medicine Chief of Nephrology, Salem VA Medical Center • MedicalResearch.com: What are the main findings of the study? • Dr. Kovesdy: We describe significantly lower all-cause mortality rates in 141,413 non-dialysis dependent CKD (chronic kidney disease) patients who were de-novo users of ACEI/ARB. MedicalResearch.com: Were any of the findings unexpected? • Dr. Kovesdy: To the best of our knowledge this is the largest observational study examining the association of ACEI/ARB with mortality in CKD. These drugs are often poorly tolerated by this patient group due to hyperkalemia and effects on GFR. In spite of a high discontinuation rate in our study we still noted a survival benefit. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Kovesdy: It may be worth the extra effort to maintain patients on ACEI/ARB in cases when they develop hyperkalemia, which could be controlled by means other than discontinuation of these agents. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Kovesdy: It would be worthwhile examining the effects of ACEI/ARB on survival in clinical trials. • Citation: • Angiotensin-Converting Enzyme Inhibitor, Angiotensin Receptor Blocker Use, and Mortality in Patients With Chronic Kidney Disease • J Am Coll Cardiol. 2014 Feb 25;63(7):650-8. doi: 10.1016/j.jacc.2013.10.050. Epub 2013 Nov 21. • Molnar MZ1, Kalantar-Zadeh K2, Lott EH3, Lu JL4, Malakauskas SM5, Ma JZ6, Quarles DL4, Kovesdy CP7. Read the rest of the interview on MedicalResearch.com
  • 62. Post Menopause: Exercise Reduced Blood Pressure, Atherosclerosis Marker MedialResearch.com Interview with: Michael Nyberg Ph.D. Post-doc Human Physiology and Exercise Physiology Integrated Physiology Group Jens Bangsbo, Dr. Sci., Ph.D. Professor of Human Physiology and Exercise Physiology Head of Copenhagen Centre of Team Sports and Health Copenhagen Denmark • MedicalResearch.com: What are the main findings of the study? • Answer: The main findings of the study were that despite being of similar age, the postmenopausal displayed higher blood pressure and higher blood levels of an early marker of atherosclerosis than women that had not reached menopause. Furthermore, just 12 weeks of floorball training twice a week for one hour improved the women’s conditions and reduced their blood pressure significantly. In addition, there was positive development in levels of substances vital to blood vessel function, including a decrease in the early marker of atherosclerosis. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Estrogen is known to be important for the health of the cardiovascular system. It is was, however, surprising, that we in such an early phase after menopause found the significant differences in blood pressure and marker of atherosclerosis. Physical activity is known to have positive effects on the cardiovascular system. However, to what extent, and the volume and intensity of training needed, to reverse the unwanted changes in the cardiovascular systems associated with menopause were still to be investigated. The finding that only 2 weekly 60-min training sessions for 12 weeks were so efficient in improving cardiovascular health was unexpected, but is likely to reflect the high heart rates during the floorball training and that the training includes periods with very high intensity, which is known to be a potent stimulus for the heart and blood vessels to produce a large number of substances important for cardiovascular health. Read the rest of the interview on MedicalResearch.com
  • 63. Post Menopause: Exercise Reduced Blood Pressure, Atherosclerosis Marker MedialResearch.com Interview with: Michael Nyberg Ph.D. Post-doc Human Physiology and Exercise Physiology Integrated Physiology Group Jens Bangsbo, Dr. Sci., Ph.D. Professor of Human Physiology and Exercise Physiology Head of Copenhagen Centre of Team Sports and Health Copenhagen Denmark • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The intermittent training as conducted during floorball is certainly beneficial for post-menopausal women and a better alternative to hormone replacement in regards to improving cardiovascular health. The training is a time-conserving approach to improve the health of the heart and blood vessels, and it should be mentioned that the subjects had fun when playing floorball also creating close social interaction making them insisting on continuing playing together. Showing that floorball is an attractive activity having the potential to keep the women active. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Future studies should aim at identifying the biological systems responsible for the observed changes in the function and health of the cardiovascular system following menopause and which mechanisms are causing the improvements with exercise training. • Citation: Biomarkers of vascular function in pre- and recent post-menopausal women of similar age: effect of exercise training. • Am J Physiol Regul Integr Comp Physiol. 2014 Jan 29. [Epub ahead of print] • Nyberg M1, Seidelin K, Rostgaard Andersen T, Neumann Overby N, Hellsten Y, Bangsbo J. Read the rest of the interview on MedicalResearch.com
  • 64. Common Measurement of Kidney Function Altered by Poor Glycemic Control MedicalResearch.com Interview with: Eiji Ishimura, MD, PhD, FASN, FACP Osaka City University Hospital Professor,Department of Nephrology Osaka, JAPAN • MedicalResearch.com: What are the main findings of the study? • Dr. Ishimura: Poor glycemic control is a major factor in the overestimation of glomerular filtration rate (GFR) in diabetic patients. We found this simple conclusion by directly measuring GFR by use of inulin clearance. We have created new formulae to accurately assess the GFR in diabetic patients, with the correction of hemoglobin A1C (HbA1C) or glycated albumin (GA) as followings; • 1) eGFRcr corrected by HbA1c=eGFRcr / (0.428 + 0.085 × HbA1c) • 2) eGFRcr corrected by GA=eGFRcr / (0.525 + 0.028 × GA) • MedicalResearch.com: Were any of the findings unexpected? • Dr. Ishimura: All findings in our study were unexpected. Previously, most of nephrologists and diabetologists have known that eGFR in diabetic pateints are inaccurate. Unexpectedly, we found the major reason of inaccuracy of eGFR was the single factor of poor glycemic control. Simple correction of eGFR by hemoglobin A1C levels or glycated albumin levels was found to lead corrected eGFR values to very useful, feasible, accurate values of measured GFR (inulin clearance). • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Ishimura: Clinicians and patients have to know that eGFR in diabetic patients is inaccurate without correction by hemoglobin A1C or glycated albumin. They should use eGFR corrected by hemoglobin A1C in future clinical practice, in order to know true accurate GFR. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Ishimura: We have created the new formulae of eGFR corrected by hemoglobin A1C or glycated albumin in 80 Japanese patients. Further studies are needed to validate the formulae in other population in other countries, utilizing large number of patients. However, we are sure that our formulae of eGFR corrected by hemoglobin A1C or glycated albumin are accurate and clinically useful. • Citation: • Poor Glycemic Control Is a Major Factor in the Overestimation of Glomerular Filtration Rate in Diabetic Patients • Diabetes Care. 2014 Mar;37(3):596-603. doi: 10.2337/dc13-1899. Epub 2013 Oct 15. • Tsuda A1, Ishimura E, Ohno Y, Ichii M, Nakatani S, Machida Y, Mori K, Uchida J, Fukumoto S, Emoto M, Nakatani T, Inaba M. Read the rest of the interview on MedicalResearch.com
  • 65. ADHD and Acetaminophen During Pregnancy MedicalResearch.com Interview with: Jørn Olsen, M.D., Ph.D. Professor Institute of Public Health, Department of Epidemiology UCLA Aarhus University Aarhus,Denmark • MedicalResearch.com: What are the main findings of the study? • Dr. Olsen: Acetaminophen (paracetamol) is drug being used by many, including pregnant women. In our data about half of all pregnant women in 1995 to 2002 had used the drug all least once during their pregnancy. The drug has shown hormonal disruptor properties in animal studies. • We found that women who used this drug during pregnancy gave birth to children who 5 – 10 years later slightly more often had behavioral problems or were treated for ADHD. The risk was highest for those who took the medication late in pregnancy and/or had taken the drug several times. The increased risk was about 10-30%. MedicalResearch.com: Were any of the findings unexpected? • Dr. Olsen: The drug is by many considered without any side effects when taken in normal doses, also when taken during pregnancy. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Olsen: Much more research is needed but the drug should at present be avoided during pregnancy if it has no real clinical indication. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Olsen: If the drug interfers with fetal brain development a range of different outcomes should be studies from mental disorders to cognitive function. • Citation: • Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders • Liew Z, Ritz B, Rebordosa C, Lee P, Olsen J. Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders. JAMA Pediatr. 2014;():. doi:10.1001/jamapediatrics.2013.4914. Read the rest of the interview on MedicalResearch.com
  • 66. Programs That Protect Drug-Users from HIV Also Help General Population MedicalResearch.com Interview with: Samuel R. Friedman PhD Institute of Infectious Disease Research National Development and Research Institutes, Inc. Ny, NY Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, MD • MedicalResearch.com: What are the main findings of the study? • Dr. Friedman: The main finding is that programs that helped protect people who inject drugs from HIV and those that helped them to get medical care seem to be associated with less HIV disease and less death related to HIV disease among the heterosexual population of large United States metropolitan areas. • This is important. Drug users in the US are widely despised, and their has been a lot of political opposition to programs like syringe exchange and drug abuse treatment. Our findings show that these programs are associated with better health and less death in the broader population. It makes more sense to help people–even those you despise–stay uninfected, and to get medical care, than to restrict or attack programs for them. MedicalResearch.com: Were any of the findings unexpected? • Dr. Friedman: We had expected to find similar results for programs for men who have sex with men. We are not sure why we did not do so. More research on this is needed. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Friedman: This study is more oriented to public health than to clinical practice. However, I think that physicians and patients should learn from this that programs that protect the health of one group of people from an infectious disease can benefit other groups of people. Thus, instead of thinking in terms of “me and mine,” it is useful to think in terms of how helping other groups also benefits everyone. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Friedman: Most research on HIV/AIDS has been “siloed” in that it focuses on one key population or another. Thus, much of it has been about programs and epidemiology among men who have sex with men, or among people who inject drugs, or among heterosexuals. This research shows that we need to conduct research about how the epidemics among, and programs directed to, one key population affect other key populations. • Such research should be conducted at multiple levels of analysis. Thus, more research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations. • Citation: • Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals? • Samuel R. Friedman, Brooke S. West, Barbara Tempalski, Cory M. Morton, Charles M. Cleland, Don C. Des Jarlais, H. Irene Hall, Hannah L.F. Cooper • Annals of Epidemiology – 27 January 2014 (10.1016/j.annepidem.2014.01.008) Read the rest of the interview on MedicalResearch.com
  • 67. Body Shape Index and Death Rates MedicalResearch.com Interview with: Nir Y. Krakauer Ph.D Assistant Professor Department of Civil Engineering The City College of New York New York, New York • MedicalResearch.com: What are the main findings of the study? • Dr. Krakauer: We studied the association between the recently proposed body shape index (ABSI) — which combines waist circumference, height and weight measurements — and risk of death in a United Kingdom population sample. We found that high ABSI predicted greater mortality hazard, with death rates increasing by about 13% per standard deviation increase in ABSI. Further, ABSI was a stronger predictor of early death than BMI, waist circumference, or other indices based on waist circumference such as waist to height ratio and waist to hip ratio. For a given starting ABSI value, reducing A Body Shape Index over a 7-year period was associated with lowered mortality risk, . • MedicalResearch.com: Were any of the findings unexpected? • Dr. Krakauer: The findings were consistent with previous results with a USA population sample, but were unexpected in that ABSI is a new indicator that has been not been widely tested. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Krakauer: Since A Body Shape Index has been proposed recently, understanding of its significance is still evolving. However, lifestyle changes such as exercise that reduce waist circumference for given height and weight would reduce ABSI and may promote health. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Krakauer: Metabolic correlates of A Body Shape Index could be investigated: for example, high ABSI might be associated with more visceral fat, which is known to contribute to insulin resistance and inflammation processes. The usefulness of ABSI as a mortality predictor could be studied in different populations. Also, intervention trials could assess whether any metabolic and health benefits seen in those trials relate to change in ABS. • Citation: • Dynamic Association of Mortality Hazard with Body Shape Nir Y. Krakauer, Jesse C. Krakauer Research Article | published 20 Feb 2014 PLOS ONE 10.1371/journal.pone.0088793 Read the rest of the interview on MedicalResearch.com
  • 68. Acute Coronary Syndrome: Genotyping Guided Antiplatelet Therapy After Stent Surgery MedicalResearch.com Interview with: Dhruv S. Kazi, MD, MSc, MS Assistant Adjunct Professor Division of Cardiology San Francisco General Hospital Department of Medicine, and Department of Epidemiology and Biostatistics University of California San Francisco • MedicalResearch.com: What is the background of your study? • Dr. Kazi: When we first asked the research question -what is the role of genotyping among patients receiving a stent for ACS, we quickly realized that there were no RCTs that had directly compared ticagrelor with prasugrel. But in our opinion, that was precisely the reason to build a model and systematically synthesize the available literature. There are nearly half a million PCIs for ACS in the US each year, and each time, the physician and patients have to examine the trade-offs between the various alternatives. What our model does is that it explicates the trade-offs – makes them transparent, and quantifies them. So patients and physicians can make an informed decision on what is the optimal therapy for them. MedicalResearch.com: What are the main findings of the study? • Dr. Kazi: Genotype-guided antiplatelet therapy may improve the cost-effectiveness of prasugrel and ticagrelor after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). This is particularly true for prasugrel, where the benefit of the drug appears to be concentrated among patients who carry one or more loss-of-function alleles, so that risks may outweigh benefits in other sub-groups of patients. Ticagrelor for all patients independent of genotype may be an economically reasonable alternative in some populations and settings: particularly where the prevalence of loss-of-function alleles is high (e.g. patients with ancestry in Oceania) or where the cost of ticagrelor is relatively low. The availability of point-of-care genotyping makes it feasible to rapidly genotype patients undergoing PCI for ACS, and personalizing the choice of dual antiplatelet regimen based on the patient’s risk for thrombotic and bleeding events. Read the rest of the interview on MedicalResearch.com
  • 69. Acute Coronary Syndrome: Genotyping Guided Antiplatelet Therapy After Stent Surgery MedicalResearch.com Interview with: Dhruv S. Kazi, MD, MSc, MS Assistant Adjunct Professor Division of Cardiology San Francisco General Hospital Department of Medicine, and Department of Epidemiology and Biostatistics University of California San Francisco • MedicalResearch.com: Were any of the findings unexpected? • Dr. Kazi: One of our most exciting findings is that our results counter the general perception that personalized medicine is expensive. Our findings suggest that individualizing therapy based on genotype may be very cost-effective, but may be cost- saving in some settings, because it allows us to target the more expensive therapies at the subgroup of patients most likely to benefit. As the costs of genotyping continue to decline and newer therapies become pricier, a judiciously applied strategy of personalized care may in fact help reduce health care costs. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Kazi: Although there a reresidual clinical uncertainties about the role of genetic testing in personalizing cardiovascular care, a systematic synthesis of currently available evidence suggests that genotyping may help individualize the care of dual antiplatelet therapy in order to optimize clinical outcomes among patients undergoing PCI for ACS. Our results suggest that it may be time to move away from a one-size-fits-all approach that has traditionally dominated the choice of dual antiplatelet therapy for the past decade. Clinicians should note that our results do not apply to patients undergoing elective PCI – prasugrel and ticagrelor have not been studied in that setting. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Kazi: We urgently need randomized trials that compare ticagrelor for all patients irrespective of genotype with the selective use of ticagrelor among carriers of loss-of-function alleles and clopidogrel among non-carriers. The genotype- guided strategy has the potential to substantially lower drug costs – because two thirds of patients do not carry the loss-of- function allele and may have acceptable outcomes on clopidogrel. This cost-effectiveness analysis will need to be updated in the future when we have additional prospective data on the role of genotyping. Until then, the analyses provided in the paper can help clinicians optimize dual antiplatelet therapy among patients receiving PCI for ACS. • Citation: • UCSF news release, which is available here: • http://www.ucsf.edu/news/2014/02/111941/personalized-medicine-cost-effective-way-tailor-drug-therapy-after-stents 2.Dhruv S. Kazi, Alan M. Garber, Rashmee U. Shah, R. Adams Dudley, Matthew W. Mell, Ceron Rhee, Solomon Moshkevich, Derek B. Boothroyd, Douglas K. Owens, Mark A. Hlatky; Cost-Effectiveness of Genotype-Guided and Dual Antiplatelet Therapies in Acute Coronary Syndrome. Annals of Internal Medicine. 2014 Feb;160(4):221-232. Read the rest of the interview on MedicalResearch.com
  • 70. Vegetarian Diet and Blood Pressure Lowering Effect MedicalResearch.com Interview with: Yoko Yokoyama, Ph.D., M.P.H. National Cerebral and Cardiovascular Center, Osaka, Japan • MedicalResearch.com: What are the main findings of the study? • Dr. Yokoyama: We found consistent evidence that a vegetarian diet has a significant blood-pressure-lowering effect, and this was clear both in observational studies of individuals who had chosen vegetarian diets on their own and in intervention trials in which people were asked to make diet changes. • Our meta-analysis included 32 observational studies and 7 controlled clinical trials. In the observational studies, vegetarian diets were associated with blood pressures that were about 7 mmHg lower systolic and 5 mmHg lower diastolic. In the clinical trials, the reductions were about 5 mmHg systolic and 2 mmHg diastolic. These are pooled averages, so for some individuals, particularly those with higher body weights or higher blood pressures at the beginning, the blood-pressure-lowering effects could be much greater. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Yokoyama: Vegetarian diets have long been known to lower blood pressure. In fact, the DASH (Dietary Approaches to Stop Hypertension) study was inspired by exactly this observation. What is new is the consistency of this finding and our ability to quantify it. It is a clinically very important finding, because a drop of just 5 mmHg BP would be expected to result in a 9% reduction of mortality due to coronary heart disease and 14% for stroke. This change is approximately half the magnitude of pharmaceutical therapy. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Yokoyama: These findings establish the value of nonpharmacologic means for reducing BP. Unlike drugs, there is no cost to a diet adjustment of this type, and all the “side effects” of a plant-based diet are desirable: weight loss, lower cholesterol, and better blood sugar control, among others. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Yokoyama: • Studies to clarify which types of vegetarian diets are most strongly associated with lower BP. One might hypothesize that a vegan diet would be most effective because of the absence of dairy products, which are a major source of saturated fat, which is believed to have a negative effect on blood viscosity and, in turn, blood pressure. But that is yet to be shown. • Studies to clarify mechanisms how vegetarian diets could change health outcomes such as hypertension. Aside from effects on blood viscosity, the diet boosts potassium intake, among other factors. • We would like to see more studies on the best ways of assisting people in adopting plant-based diets. Because they don’t require limitations on calories, carbohydrates, etc., these diets are very attractive, and deserve more study. • Citation: • Vegetarian Diets and Blood Pressure A Meta-analysis • Yoko Yokoyama, PhD, MPH1,2,3; Kunihiro Nishimura, MD, PhD, MPH4,5; Neal D. Barnard, MD3,6; Misa Takegami, RN, PhD, MPH1,7; Makoto Watanabe, MD, PhD8; Akira Sekikawa, MD, PhD9; Tomonori Okamura, MD, PhD10; Yoshihiro Miyamoto, MD, PhD1,8 • JAMA Intern Med. Published online February 24, 2014. doi:10.1001/jamainternmed.2013.14547 Read the rest of the interview on MedicalResearch.com
  • 71. Maternal Influenza and Offspring Bipolar Disorder MedicalResearch.com Interview with: Alan S. Brown, M.D., M.P.H. Professor of Clinical Psychiatry and Clinical Epidemiology College of Physicians and Surgeons of Columbia University Director Unit in Birth Cohort Studies Division of Epidemiology New York State Psychiatric Institute New York, NY • MedicalResearch.com: What are the main findings of the study? • Dr. Brown: We found that a mother’s exposure to influenza during pregnancy, documented by antibodies in her serum, increased the risk of bipolar disorder with psychotic symptoms in her offspring. We did not show a relationship between influenza and bipolar disorder not accompanied by psychosis. MedicalResearch.com: Were any of the findings unexpected? • Dr. Brown: We had expected to find a relationship between influenza and bipolar disorder without psychotic symptoms based on my previous study; however, influenza was assessed differently between the two studies. And my lab previously showed that prenatal influenza increased the risk of schizophrenia, so the findings of our current study were consistent with an effect of prenatal influenza on psychosis in general, rather than on a particular type of psychotic disorder. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Brown: The study provides support for influenza vaccinations in women planning a pregnancy and to consider vaccination while pregnant as recommended by several health organizations. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Brown: We wish to replicate the finding in other samples and examine the pathway by which maternal influenza and other inflammatory insults alter fetal brain development to lead to psychosis outcomes. • Citation: • Serological Documentation of Maternal Influenza Exposure and Bipolar Disorder in Adult Offspring Sarah E. Canetta, Ph.D.; Yuanyuan Bao, M.S.; Mary Dawn T. Co, M.D.; Francis A. Ennis, M.D.; John Cruz, B.S.; Masanori Terajima, M.D., Ph.D.; Ling Shen, Ph.D.; Christoph Kellendonk, Ph.D.; Catherine A. Schaefer, Ph.D.; Alan S. Brown, M.D., M.P.H. • Am J Psychiatry 2014;:. doi:10.1176/appi.ajp.2013.13070943 Read the rest of the interview on MedicalResearch.com
  • 72. COPD: Risk from Chinese WaterPipe Smoking MedicalResearch.com Interview with: Chunxue Bai, MD & PhD Director, Shanghai Respiratory Research Institute Professor of Medicine, Chairman, Shanghai Leading academic discipline Chair, Chinese Alliance against Lung Cancer • MedicalResearch.com: What are the main findings of the study? • Dr. Bai: Recently, we found a dilemma phenomenon that the incidence of chronic obstructive pulmonary disease (COPD) and lung cancer has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. • However, little information is known to the public about a regional endemic related to Chinese waterpipe smoking, which is different from the Arabic waterpipe. The Chinese waterpipe has been traditionally misconceived as less harmful for three reasons: • (1) no charcoal was used in contrast to the Arabic waterpipe, • (2) tobacco smoke passed through the water as opposed to cigarette smoking and • (3) smoking through a large volume waterpipe could “improve lung function.” • In our study, we provide robust results that the large volume Chinese waterpipe use and exposure are associated with the elevated prevalence of COPD, which have been identified by epidemiologic, physiologic, radiology, and toxicologic findings for the first time. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Bai: Noted is the five individuals in our study who were tested and confirmed as having lung cancer by computed tomography (CT) and pathology evaluations: • 3 CWS (lung adenocarcinoma) • 1 CWPS (lung adenocarcinoma) and • 1 CS (lung squamous cell carcinoma). It will cause our attention and strengthen the monitoring of lung cancer. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Bai: The Chinese waterpipe has been mistaken as less harmful. Our study has provided evidence confirming this misconception. Exposure to active and passive Chinese waterpipe smoke may be a significant risk factor for developing COPD. The damage from Chinese waterpipe use and exposure are worse than cigarette. Our results highlight smoking cessation in Chinese waterpipe users is as important as in other tobacco products in preventive intervention of COPD. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Bai: In addition to Chinese waterpipe use and exposure are associated with COPD; the PM2.5 from the Chinese waterpipe smoke was twice as high as from cigarette smoke. Our results also predict the prevalence of COPD will be increased by long-term exposure to high concentrations of PM2.5, which will bring a huge economic and social burden to the globe and calls for more research to be directed toward preventive measures and efforts. • Citation: • Chinese waterpipe smoking and the risk of chronic obstructive pulmonary disease She J, Yang P, Wang Y, et al. Published online February 20, 2014. doi:10.1378/chest.13-1499. • Chest. 2014. doi:10.1378/chest.13-1499 Read the rest of the interview on MedicalResearch.com
  • 73. After Ear Tubes: Eardrops Found Superior to Oral Antibiotics for Ear Discharge MedicalResearch.com Interview with: Dr. T. M. A van Dongen, MD Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care, Dept Epidemiol Utrecht, Netherlands. • MedicalResearch.com: What are the main findings of the study? • Answer: We performed a pragmatic trial, in which we randomly assigned 230 children who had acute tympanostomy-tube otorrhea to receive antibiotic-glucocorticoid eardrops, oral antibiotics or to undergo initial observation. The primary outcome of our study was the presence of ear discharge, 2 weeks after study-group assignment. We also looked at, among others, the duration of the initial otorrhea episode and the total number of days of otorrhea and the number of otorrhea recurrences during 6 months of follow-up. We found that antibiotic–glucocorticoid eardrops were superior to oral antibiotics and initial observation for all outcomes. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Since acute tympanostomy-tube otorrhea, like acute otitis media, can be self- limiting, initial observation was thought by some to be a good alternative for antibiotic treatment. We are the first to compare the effectiveness of oral or topical treatment with initial observation. Approximately one in two children managed by initial observation still had otorrhea at 2 weeks and initial observation resulted in more days with otorrhea in the following months than did topical or oral antibiotics. So our results actually suggest that initial observation is not an adequate management strategy in such children. Read the rest of the interview on MedicalResearch.com
  • 74. After Ear Tubes: Eardrops Found Superior to Oral Antibiotics for Ear Discharge MedicalResearch.com Interview with: Dr. T. M. A van Dongen, MD Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care, Dept Epidemiol Utrecht, Netherlands. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: • · Standard patient information usually advises parents to contact a physician when their child’s symptoms of tube otorrhea persist for more than a week. At that stage, so when parents contact a physician, recommendations from clinical practice guidelines vary widely: some advise physicians to manage with oral antibiotics or more observation, while others suggest prescribing antibiotic eardrops. We recommend updating current patient information and clinical practice guidelines. Our results show it’s best to inform parents to contact a physician when otorrhea occurs, rather than waiting for a week or more to see if otorrhea abates without treatment. In addition, we recommend physicians to treat these children with eardrops shortly after onset of symptoms. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: For many years, the use of topical antibiotics in children with acute tympanostomy-tube otorrhea has been questioned for their presumed inability to reach the middle ear. In vivo studies in children with a ‘clean’ ear canal and patent tympanostomy tube as well as in vitro studies reported low rates of spontaneous penetration of eardrops into the middle ear. These studies raised even more doubt about eardrops reaching the middle ear in children with active tube otorrhea. Yet our study of children with middle ear fluid visibly draining through the tympanostomy tube into the ear canal showed that eardrops were highly effective, indicating that its active components do reach the site of infection. As such, one could therefore question whether antibiotic(-glucocorticoid) eardrops may also be effective in children without tubes who develop acute otitis media and present with spontaneous otorrhea. So far, this has not been evaluated in a randomized clinical trial, presumably based upon the same rationale, i.e. that the eardrops would not reach the infected middle ear. Since topical treatment is usually well tolerated, causes no systemic side effects and is less likely to cause antimicrobial resistance as compared to oral antibiotics, a trial of the effectiveness of topical antibiotics versus oral antibiotics in children with acute otitis media presenting with spontaneous otorrhea seems warranted. • Citation: • A Trial of Treatment for Acute Otorrhea in Children with Tympanostomy Tubes hijs M.A. van Dongen, M.D., Geert J.M.G. van der Heijden, Ph.D., Roderick P. Venekamp, M.D., Ph.D., Maroeska M. Rovers, Ph.D., and Anne G.M. Schilder, M.D., Ph.D. • N Engl J Med 2014; 370:723-733 February 20, 2014DOI: 10.1056/NEJMoa1301630 Read the rest of the interview on MedicalResearch.com

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