MedicalResearch.com: Medical Research Interviews Month in Review

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MedicalResearch.com: Exclusive interviews with medical researchers from major and specialty medical journals.

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MedicalResearch.com: Medical Research Interviews Month in Review

  1. 1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD info@Hemodialysis.com December 15 2013 For Informational Purposes Only: Not for Specific Medical Advice.
  2. 2. Medical Disclaimer | Terms and Conditions • • • The contents of the Hemodialysis.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site! If you think you may have a medical emergency, call your doctor or 911 immediately. Hemodialysis.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Hemodialysis.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is solely at your own risk. The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis. Read more interviews on Hemodialysis.com
  3. 3. Elite Athletes Have Lower Risk of Later Life Diabetes MedicalResearch.com Interview with: Dr. Merja K. Laine Department of General Practice and Primary Health Care University of Helsinki • • • • • • • • • MedicalResearch.com: What is the background of your study? Answer: We were interesting to know does a top-level sport during young adulthood protect against disturbances in glucose regulation in later life. In Finland, a unique study program including former male elite athletes and their age- and area-matched controls already initiated in 1985. In 2008, we invited those subjects who participated in the study earlier and were still alive. MedicalResearch.com: What are the main findings of your study? Answer: According to our study findings, the elite athletes (especially endurance athletes: crosscountry skiing, long- distance running) had a significantly lower risk to type 2 diabetes and impaired glucose tolerance than the controls in later life. The volume of current self-reported leisure-time physical activity was inversely associated with the prevalence of type 2 diabetes. It is important to enable possibilities to physical exercise throughout the life course. Citation: A former career as a male elite athlete-does it protect against type 2 diabetes in later life? Laine MK, Eriksson JG, Kujala UM, Wasenius NS, Kaprio J, Bäckmand HM, Peltonen M, Mertsalmi TH, Sarna S. Department of General Practice and Primary Health Care, University of Helsinki, Tukholmankatu 8 B, PL 20, 00014, Helsinki, Finland, Diabetologia. 2013 Nov 21. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  4. 4. ADHD: Using MRI to Measure Brain Iron MedicalResearch.com Interview with: Dr. Vitria Adisetiyo, Ph.D. Postdoctoral Research Fellow Medical University of South Carolina Center for Biomedical Imaging Charleston, SC 29425 • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Adisetiyo: Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls. MedicalResearch.com: Were any of the findings unexpected? Dr. Adisetiyo: Although it is known that brain iron is required for dopamine metabolism, little is known about the mechanistic details. Thus, it was unexpected that our findings paralleled a recent meta-analysis of ADHD molecular imaging studies that identified reduced dopamine biomarkers in medication-naive ADHD patients and increased dopamine biomarkers in patients with a history of psychostimulant treatment. This suggests that brain iron levels may indirectly reflect the disrupted dopamine pathway in ADHD that is targeted by psychostimulant medication. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Adisetiyo: Although the findings remain preliminary and require replication in a larger longitudinal study, clinicians and patients should know that with the advent of improved technology, we are making progress in identifying promising non-invasive biomarkers of ADHD that may help inform traditional clinical diagnosis. These early findings suggest that low brain iron (and not blood iron) may represent a potential non-invasive ADHD diagnostic biomarker that responds to psychostimulant use. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Adisetiyo: Our report highlights the importance of accounting for medication history in studies that examine potential ADHD biomarkers as these biomarkers may adapt and change as a result of medication. Citation: Radiological Society of North America 2013 Abstract Medication Naïve Attention- deficit/Hyperactivity Disorder Subjects Have Low Brain Iron Levels as Detected by Magnetic Field Correlation Imaging Coauthors: F. Xavier Castellanos, M.D., Adriana Di Martino, M.D., Kevin M. Gray, M.D., Els Fieremans, Ph.D., Ali Tabesh, Ph.D., and Rachael L. Deardorff, M.S Read the rest of the interview on MedicalResearch.com
  5. 5. Diabetes: Hyperglycemia Suppresses TGF, Contributing to Delayed Wound, Corneal Healing MedicalResearch.com Interview with: Fu-Shin X. Yu, Ph.D. Professor and Director of Research Kresge Eye Institute/Department of Ophthalmology Wayne State University School of Medicine Detroit, MI 48201 • • • • • • • • MedicalResearch.com: What are the main results of your study? Dr. Fu-Shin X. Yu: Using genome-wide cDNA array, we identified a large group of gene differentially expressed in healing corneal cells of diabetes mellitus, when compared to normoglycemia, corneas. Gene ontology analysis suggests transforming growth factor (TGFβ) signaling as a major signaling pathway affected by hyperglycemia in diabetes mellitus corneal epithelial cells. Surprisingly, we found that wound-induced upregulation of TGFβ3, but not TGFβ1, is dampened by hyperglycemia and that by adding TGFβ3 to the wound, epithelial wound closure was accelerated. This discovery may provide new treatment options for diabetic wound healing in tissues such as the cornea and the skin. Citation: Genome-wide transcriptional analysis of differentially expressed genes in diabetic, healing corneal epithelial cells: hyperglycemia-suppressed TGFβ3 expression contributes to the delay of epithelial wound healing in diabetic corneas Ilham Bettahi, Haijing Sun, Nan Gao, Feng Wang, Xiaofan Mi, Weiping Chen, Zuguo Liu, and Fu-Shin Yu Diabetes published ahead of print December 4, 2013, doi:10.2337/db13-1260 Read the rest of the interview on MedicalResearch.com
  6. 6. ADHD: Environmental Risk Factors MedicalResearch.com Interview with: Professor Desiree Silva MB BS, FRACP, MPH Consultant Paediatrician Suite 210 Specialist Centre, Joondalup Health Campus 60 Shenton Avenue, Joondalup WA 6027 • • MedicalResearch.com: What are the main findings of the study? Prof. Silva: Our study is one of the largest population based studies of 12,991 children with ADHD. We found that smoking in pregnancy, maternal urinary infections, preeclampsia, being induced and threatened pre-term labour increases the risk of ADHD with little gender differences. Prematurity also increased the risk of ADHD including babies born late preterm and early term marginally increased the risk of ADHD. • • MedicalResearch.com: Were any of the findings unexpected? Prof. Silva: Oxytocin augmentation of labour appears protective for girls which is an unexpected finding and warrants further research. Oxytocin has recently received more interest in the literature, especially its role in social behaviour, although there still remain a number of unanswered questions about plausible mechanisms and actions. Contrary to other studies we found no increased risk for low birth weight, being born post term and low Apgar scores including fetal distress. The rare cord prolapse had nearly a three- fold increased risk of ADHD in females only. MedicalResearch.com: What should clinicians and patients take away from your report? Prof. Silva: There is a genetic predisposition to ADHD, as well as some evidence of environmental factors playing a part. Maternal smoking in pregnancy increased the risk of ADHD in their offspring. Females should be advised not to smoke in pregnancy. Attention to inflammatory processes like preeclampsia and urinary tract infections. Early inductions for no obstetric reason should be discouraged. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Prof. Silva: Future research on the risk of early inflammatory processes on ADHD which also include the early post natal period. Studies designed to disentangle possible mechanisms, confounders and/or moderators of these risk factors are warranted. Citation: Environmental Risk Factors by Gender Associated With Attention-Deficit/Hyperactivity Disorder Desiree Silva, Lyn Colvin, Erika Hagemann, and Carol Bower Pediatrics peds.2013-1434; published ahead of print December 2, 2013, doi:10.1542/peds.2013-1434 • • • • • • • • Read the rest of the interview on MedicalResearch.com
  7. 7. Adolescent Girls: Early Puberty, Negative Peer Influence, and Problem Behaviors MedicalResearch.com Interview with: Sylvie Mrug, PhD Departments of Psychology and Health Behavior University of Alabama at Birmingham, Birmingham, Alabama; • • MedicalResearch.com: What are the main findings of the study? Dr. Mrug: Experiencing early puberty and having a best friend who misbehaves at age 11 both contribute to more aggressive and delinquent behavior in adolescent girls. Although most of these effects are transient and disappear by age 16, early maturing girls are at risk for continually higher delinquent behavior. Early puberty also seems to make girls more vulnerable to negative peer influences. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Mrug: Most of the main findings were not surprising, but it was somewhat unexpected that many of the effects of early puberty and friend’s problem behavior dissipated over the 5-year follow up period. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Mrug: First, the study shows that it may not be unusual for early maturing girls to show more problem behaviors in early adolescence, but that most of these problem behaviors will decrease over time. Second, the behavior of children’s and teens’ friends matters, and limiting friendships with peers who misbehave may help prevent problem behavior in the child. Third, girls who start puberty earlier than others are more vulnerable and may benefit from greater support and protection from their parents and other important people in their lives. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mrug: The findings indicate that it is important to evaluate the long-term effects of various risk factors for problem behavior, including early puberty and deviant friends. We also do not have solid understanding of why and how early puberty increases behavioral and emotional problems in girls, so more research on the mechanisms behind these effects is needed. • • • • • • • • • Citation: Early Puberty, Negative Peer Influence, and Problem Behaviors in Adolescent Girls Sylvie Mrug, Marc N. Elliott, Susan Davies, Susan R. Tortolero, Paula Cuccaro, and Mark A. Schuster Pediatrics peds.2013-0628; published ahead of print December 9, 2013, doi:10.1542/peds.2013-0628 Read the rest of the interview on MedicalResearch.com
  8. 8. Medical Research: Men Received More Funding Than Women MedicalResearch.com Interview with: Mike Head Network Manager Infectious Disease Research Network • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: The differences in total funding received between male and female principal investigators (PIs) is considerable. This can be partially explained by there being far more male senior scientists than female. But this in itself is not ideal, and there are two further causes for concern: 1. The median award size – male PIs receive larger awards than female PIs, across virtually every topic area and type of science. 2. The differences in median award size and total funding awarded by gender remain virtually unchanged across the fourteen years of this dataset. The gap is not closing. MedicalResearch.com: Were any of the findings unexpected? Answer: The two findings above are perhaps unexpected, and certainly concerning. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: The topic is of less immediate relevance to patients; however, clinicians who do research should be involved in discussions to close the clear gender gap in research. There are roughly equal numbers of men and women as early career researchers, but it appears to be harder for women to reach senior positions where they are able to apply for their own funding. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: We strongly urge policy-makers, funders and scientists to urgently investigate the factors leading to the observed differences and develop policies developed to address them, in order to ensure that women are appropriately supported in scientific endeavour. Excellent scientific minds are currently being lost to biomedical research, and this simply must be investigated. Citation: Differences in research funding for women scientists: a systematic comparison of UK investments in global infectious disease research during 1997–2010 Michael G Head, Joseph R Fitchett, Mary K Cooke, Fatima B Wurie, Rifat Atun BMJ Open 2013;3:12 e003362 doi:10.1136/bmjopen-2013-003362 Read the rest of the interview on MedicalResearch.com
  9. 9. Hepatitis C: Does Chemotherapy Cause Viral Relapse? MedicalResearch.com Interview with: Harrys A. Torres, MD, FACP Assistant Professor, Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center • • MedicalResearch.com: What are the main findings of the study? Dr. Torres: The main findings of the study were that patients with hepatitis C virus (HCV) infection who were successfully treated with antivirals and attained sustained virologic response (SVR) did not have a relapse of HCV infection after receiving immunosuppressive chemotherapy for cancer. Patients in the study received different chemotherapeutic agents, including rituximab and systemic corticosteroids. Durability of SVR was maintained up to 14 years after chemotherapy in cancer patients. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Torres: The current data on the durability of SVR are conflicting. Researchers have detected HCV RNA in liver cells and peripheral blood mononuclear cells after achievement of SVR. In theory, administration of cancer chemotherapy should create an immunosuppressive state and facilitate replication of this occult HCV infection. However, none of our HCV-infected patients had a relapse of their infection after chemotherapy. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Torres: Our observational data suggests that successful treatment of HCV infection leads to eradication of virus without relapse after post-SVR chemotherapy. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Torres: A prospective study with a large sample size can be conducted in HCV-infected cancer patients who have attained SVR. Serial HCV RNA levels can be measured during and after chemotherapy to determine HCV relapse. Citation: Does Chemotherapy Cause Viral Relapse in Cancer Patients with Hepatitis C Infection Successfully Treated with Antivirals? Mahale P, Okhuysen PC, Torres HA. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas School of Public Health, Houston, Texas. Clin Gastroenterol Hepatol. 2013 Nov 7. pii: S1542-3565(13)01726-6. doi: 10.1016/j.cgh.2013.10.034. [Epub ahead of print] • • • • • • • • • Read the rest of the interview on MedicalResearch.com
  10. 10. Pediatric Liver Transplant Outcomes: Racial, Socioeconomic Disparities MedicalResearch.com Interview with: Rachel Patzer, PhD, MPH Assistant Professor Emory University School of Medicine Department of Surgery, Division of Transplantation • • MedicalResearch.com: What are the main findings of the study? Dr. Patzer: We found significant racial/ethnic differences in important health outcomes among pediatric and adolescent patients who received a liver transplantation at a large transplant center in the Southeastern U.S., where rates of mortality and graft failure were higher among minorities compared to white patients. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Patzer: We expected that poverty would play a role in poor health outcomes for patients, which we did find in this study. Poverty explained some of the racial disparities we observed. However, we found that even after accounting for differences in poverty among patients, we still found racial differences in outcomes. For example, we observed racial disparities even among patients who were wealthier or had better access to care. It is unclear why these racial/ethnic differences persist. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Patzer:We hope that clinicians recognize that identifying patients who are at high risk for poor health outcomes, including mortality and graft failure, is important in ensuring equitable and quality healthcare. Identifying patients who are at higher risk will allow for closer monitoring of these patients to prevent poor health outcomes. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Patzer: The results of our study were from one large transplant center in the Southeast. It is unclear whether these disparities exist on a national level, but we expect that there is likely to be regional variation in disparities in outcomes among pediatric liver transplant recipients. We hope to examine this question using national data. In addition, more research is needed to identify the potential causes of racial/ethnic differences in outcomes, even after accounting for differences in poverty. Citation: Racial and Socioeconomic Disparities in Pediatric and Young Adult Liver Transplant Outcomes Thammana RV, Knechtle SJ, Romero R, Heffron TG, Daniels CT, Patzer RE. Emory University School of Medicine, Atlanta, GA; Rollins School of Public Health, Department of Epidemiology, Atlanta, GA. Liver Transpl. 2013 Oct 17. doi: 10.1002/lt.23769. [Epub ahead of print] • • • • • • • • Read the rest of the interview on MedicalResearch.com
  11. 11. Sexual Lifestyles Through Life Course: Attitudes Have Changed MedicalResearch.com Interview with: Catherine H. Mercer Ph.D. Senior Lecturer UCL Centre for Sexual Health & HIV Research Research Department of Infection & Population Health University College London London U.K. • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Mercer: Firstly, the National Surveys of Sexual Attitudes and Lifestyles, Britain’s nationallyrepresentative surveys of sexual behaviour (or Natsal for short), have captured substantial changes in sexual attitudes and lifestyles over the past 60 years, having collected data from over 45,000 people born between the 1930s and the 1990s – a period spanning much of the 20th Century. Secondly, the recent changes in behaviour that we have observed – so over the past decade – have however been considerably more marked for women than men, with the gender gap in reported behaviour narrowing, and in some cases, disappearing altogether. Thirdly, we’ve seen a greater acceptance of more diverse sexual lifestyles, such as same-sex sexual partnerships, but greater intolerance of what many people might consider as ‘disrespectful’ sexual partnerships, including non-exclusivity in marriage. MedicalResearch.com: Were any of the findings unexpected? Dr. Mercer: Between 1990 and 2000, so between the first and second Natsal studies, we witnessed almost universal increases – among men and women – in the number of sexual partners reported, in the reporting of same-sex behaviours, as well as a number of STI/HIV risk behaviours such as paying for sex and having unsafe sex. However, between Natsal-2 and Natsal-3, so since 2000, the picture is less clear-cut (see response to next question). Read the rest of the interview on MedicalResearch.com
  12. 12. Sexual Lifestyles Through Life Course: Attitudes Have Changed MedicalResearch.com Interview with: Catherine H. Mercer Ph.D. Senior Lecturer UCL Centre for Sexual Health & HIV Research Research Department of Infection & Population Health University College London London U.K. • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Mercer: While data from the latest Natsal study, Natsal-3, suggest that STI/HIV risk behaviours have not increased further since 2000, many have not declined, and so sexual health promotion messages, including encouraging safer sex and STI testing, remain a public health priority in Britain. Furthermore, from collecting data this time from people aged 16-74 years, we can see that sexual risk behaviour, although more prevalent among younger people, occurs throughout the lifecourse. Demographic trends such as increasing rates of partnership breakdown, and the new opportunities for people to meet and interact (e.g. via social media and the internet), mean that new sexual partnerships are formed at all ages, and so there is a need for protection from STIs, if not unplanned pregnancy, at all ages. However, sexual relationships, and sexual health more broadly, are not just about safe sex; as the other 5 papers in the Lancet series show, their focus needs to be broadened to promote informed, consensual, respectful, pleasurable, as well as safe, sexual relationships. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mercer: The scientific study of sexual behaviour needs to consider sex across the lifecourse, and to recognise that people have sexual health needs at all ages, although these needs may change. It is vital that population-based surveys of sexual behaviour continue in order that sexual health policy and practice – and public health policy and practice more broadly – are based on representative and reliable data. Although technological advances provide new opportunities for undertaking these studies, e.g. the use of computer-assisted self-interview, and the opportunities presented by web-surveys, consistent methods are essential to ensure that like can be compared to like, as this will ensure that there remains a strong evidencebase. Citation: Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal) Dr Catherine H Mercer PhD,Clare Tanton PhD,Philip Prah MSc,Bob Erens MA,Pam Sonnenberg PhD,Soazig Clifton BSc,Wendy Macdowall MSc,Ruth Lewis PhD,Nigel Field MBPhD,Jessica Datta MSc,Andrew J Copas PhD,Andrew Phelps BA,Prof Kaye Wellings FRCOG,Prof Anne M Johnson MD The Lancet – 30 November 2013 ( Vol. 382, Issue 9907, Pages 1781-1794 ) DOI: 10.1016/S0140-6736(13)62035-8 Read the rest of the interview on MedicalResearch.com
  13. 13. Resistant Hypertension: Better Control With Therapeutic Drug Monitoring MedicalResearch.com Interview with; Dr. Wanpen Vongpatanasin, MD Professor of Medicine Director, Hypertension Section, Cardiology Division UT Southwestern Medical Center • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Vongpatanasin: We found that more than 50% of patients with resistant hypertension were non-adherent to at least one drug prescribed by their primary care physicians for blood pressure control. When we provided this information back to the patients, as part of care in our hypertension specialty clinic, we found that many patients report difficulty taking prescribed medications due to either associated side effects or cost of the medication. When we adjusted patient’s medications to fit their needs, BP levels were substantially improved during subsequent visits without increasing the number of medications. MedicalResearch.com: Were any of the findings unexpected? Dr. Vongpatanasin: Yes, previous studies in the hypertension referral centers indicated that the prevalence of medication non-adherence is about 10%-20%. However, adherence was assessed by patient self-report or questionnaire, which may in fact underestimate the numbers. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Vongpatanasin: Non-adherence to medication is common in patients who appear to have resistant hypertension. Physicians caring for patients with resistant hypertension should be cognizant of the magnitude of the problem and maintain open communication with the patients to avoid factors that predispose to non-adherence, such as drug side effects or complex regimen with high co-payment. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Vongpatanasin: Therapeutic drug monitoring is a useful screening tool in clinical practice to uncover non- adherence in hypertension. This should be considered in patients with persistently elevated BP despite multiple medications. The cost effectiveness of therapeutic drug monitoring in improving adherence and BP in hypertensive patients in the primary care setting needs to be further tested in larger studies. Citation: Therapeutic drug monitoring facilitates blood pressure control in resistant hypertension Brinker S, Pandey A, Ayers C, et al. Therapeutic drug monitoring facilitates blood pressure control in resistant hypertension. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.10.067. Read the rest of the interview on MedicalResearch.com
  14. 14. Sugar-Sweetened Beverages and Endometrial Cancer MedicalResearch.com Interview with: Maki Inoue-Choi, PhD, MS, RD Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institute on Minority Health and Health Disparities, NIH Rockville, MD 20850 • • MedicalResearch.com: What are the main findings of the study? Answer: In our study, postmenopausal women who reported higher consumption of sugar-sweetened beverages were more likely to develop estrogen-dependent type I endometrial cancer, the most common type of this cancer. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Although we are the first to show this association, it is not surprising that women who drank more sugar-sweetened beverages had higher risk of type I endometrial cancer but not estrogen-independent type II endometrial cancer. Other studies have shown that the increasing consumption of sugar-sweetened beverages has paralleled the increase in obesity. Obese women are likely to have higher circulating levels of estrogens and insulin, which are known risk factors for type I endometrial cancer. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Although our study findings are interesting, we are the first to show the association between sugar-sweetened beverage consumption and the risk of endometrial cancer. Because ours is an observational study, it is not possible to establish a causal link between sugar-sweetened beverages and endometrial cancer. Therefore, our findings need to be replicated. Individuals should follow current dietary guidelines to avoid sugar-sweetened beverages. Too much added sugar from any source can elevate person’s overall calorie intake and may increase the risk of a number of health conditions such as obesity, diabetes, heart disease as well as cancer. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Because this study is the first to show the association between high sugar-sweetened beverage consumption and endometrial cancer, such findings may be due to chance and need replication in other studies. Citation: Cancer Epidemiol Biomarkers Prev. 2013 Nov 22. [Epub ahead of print] Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer among Postmenopausal Women. Inoue-Choi M, Robien K, Mariani A, Cerhan JR, Anderson KE. Authors’ Affiliations: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine; Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota; and Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, District of Columbia Cancer Epidemiology, Biomarkers & Prevention, November 2013 • • • • • • • • • Read the rest of the interview on MedicalResearch.com
  15. 15. Prostate Cancer: Potential Biological Factor Contributing to Racial Disparities MedicalResearch.com Interview with: Dr David P. Turner PhD Assistant Professor, Director of shRNA Technology Medical University of South Carolina Dept of Pathology & Lab Medicine Charleston SC 29425 • • • • • MedicalResearch.com Interview with: Dr David P. Turner PhD Assistant Professor, Director of shRNA Technology Medical University of South Carolina Dept of Pathology & Lab Medicine Charleston SC 29425 MedicalResearch.com: What are the main findings of the study? Dr. Turner: Our research has identified a potential mechanistic link between sugar derived metabolites and cancer associated pathways which may be a biological consequence of the socioeconomic and biological factors that are known to drive cancer health disparity. African Americans develop and die more frequently of cancer than any other population in the US. We examined the levels of reactive metabolites known as advanced glycation end-products, or AGEs for short, in serum and tumor samples from African American and Non-Hispanic White prostate cancer patients. In both the serum and tumor tissue, the levels of AGE metabolites were consistently higher in the African American prostate cancer patients than their White counterparts. AGE functions as a ligand for the receptor for AGEs, or RAGE for short. We also identified that RAGE protein levels were higher in African Americans with prostate cancer. MedicalResearch.com: Were any of the findings unexpected? Dr. Turner: AGEs are a consequence of normal metabolism and due to poor clearance accumulate within our tissues and organs as we grow older with pathogenic consequences. Low income, obesity and an inactive/sedentary lifestyle are established factors driving cancer health disparity. Significantly, apart from their production during normal metabolism, AGE’s are also formed through the ingestion of food and by external environmental factors such as lack of exercise. AGE content in the Western Diet has consistently increased over the last 50 years due to increased consumption of sugar laden and cheap processed/manufactured foods which are high in reactive AGE metabolites and can promote obesity. Due to the common links between the factors that drive health disparity and the increased accumulation of AGE metabolites we expected that AGEs may be higher in African Americans, what was unexpected was the particularly high levels of AGE metabolites observed in the prostate cancer tumor tissue. Read the rest of the interview on MedicalResearch.com
  16. 16. Prostate Cancer: Potential Biological Factor Contributing to Racial Disparities MedicalResearch.com Interview with: Dr David P. Turner PhD Assistant Professor, Director of shRNA Technology Medical University of South Carolina Dept of Pathology & Lab Medicine Charleston SC 29425 • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Turner: These preliminary studies indicate that increased activation of the AGE-RAGE signaling axis may represent a biological mechanism promoting prostate cancer and cancer health disparity. This has significant connotations for community education and outreach. As AGE accumulation is linked to poor lifestyle choices such as poor diet and a lack of physical activity, small changes to our everyday habits may make a significant contribution to reducing how much AGE metabolite accumulates in our bodies. Avoiding foods high in protein, sugar and fat as well as manufactured foods can reduce our everyday intake of AGEs. Poaching foods rather than frying also reduces the number of AGEs we consume form food. Moderate regular exercise can also maintain and even reduce AGE accumulation levels. Clinicians should be aware of the potential impact of these factors on their patient population and address them as part of their clinic/practice MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Turner: This study needs to be repeated in a larger cohort of samples to confirm our findings. We also need to further examine the mechanistic consequence of AGE accumulation and AGERAGE signaling on cancer associated processes and the effects of existing and novel therapeutics on AGE metabolite levels. Potential Biological Factor Contributing to Racial Disparities in Prostate Cancer Presented at: Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9 2013 Read the rest of the interview on MedicalResearch.com
  17. 17. Obesity: Sleep Quality, Anxiety-Depression, and Quality of Life MedicalResearch.com Interview with: Dr G. Neil Thomas, Regional Director, NIHR Research Design Service West Midlands Deputy Director, Master of Public Heath Programme Reader in Epidemiology Department of Public Health, Epidemiology and Biostatistics School of Health and Population Sciences
 College of Medical and Dental Sciences The University of Birmingham Edgbaston, Birmingham, B15 2TT • MedicalResearch.com: What are the main findings of the study? • Dr. Thomas: This population of severely obese individuals (mean BMI 47kg/m2) from a regional specialist weight management service poor sleep quality (Pittsburgh Sleep Quality Index, PSQI) and daytime sleepiness (Epworth Sleepiness Scale) were strongly associated with poorer quality of life (Impact of Quality of Life-Lite (IWQOL-Lite) • MedicalResearch.com: • ere any of the findings unexpected? • Dr. Thomas: The levels of problems in these patients was very high; 3/4 (74.8%) were poor sleepers (PSQI≥5), 52% were anxious (HADS-anxiety subscore>7) and 43% were depressed (HADS-depression subscore>7) which are much higher than in the UK general population (15-35%, 33%, and 11%, respectively), yet there was a clear association between the sleep problems such as short sleep duration and the psychological disorders and with the quality of life. These associations remained significant even after adjusting for a range of potential confounders. • • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Thomas: Despite the very high levels of problems in these patients, those involved with their care usually do not ask about sleep problems and often pay little heed to the psychological issues underlying the obesity. The focus is often on treating the obesity and its consequences, such as diet and exercise interventions, rather than addressing its underlying cause, which may be psychological in nature, such as an unhappy marriage, job stresses etc. • This may also in part contribute to the difficulty in maintaining weight loss if the drivers of the increasing adiposity are not removed it is unlikely that long term weight loss will be successful. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Thomas: There are issues of inferring causality in our study due to its cross-sectional nature in that the obesity may be leading to shorter sleep eg associated pains from joints, breathing disorders may disturb sleep leading to a shorter duration rather than the short sleep leading to increasing adiposity. Both approaches are possible, so we will need longitudinal data to help confirm the observations, those that have previously investigated this do support the contention that short sleep can contribute to the development of psychological conditions such as depression. That said, there is clearly an important problem in these patients that needs addressing. • Citation: • Araghi MH; Jagielski A; Neira I; Brown A; Higgs S; Thomas GN; Taheri S. The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. SLEEP 2013;36(12):1859-1865. Read the rest of the interview on MedicalResearch.com
  18. 18. Sleep disordered breathing as predictor of readmission and mortality MedicalResearch.com Interview with: Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan • • • • • • • • • • • MedicalResearch.com Interview with: Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan MedicalResearch.com: What are the main findings of the study? Dr. Kasai: Sleep disordered breathing, determined using predischarge nocturnal pulse oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kasai: They should know that before hospital discharge just a non-invasive assessment using quite simple device can be a predictor of patients’ post-discharge prognosis. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kasai: Interventions to alleviate intermittent hypoxia will be particularly important. So, in a future research, the effectiveness of positive airway pressure therapy including continuous positive airway pressure (CPAP) or adaptive servo ventilation (ASV) should be assessed and compared between CPAP and ASV. Citation: Impact of Pre-discharge Nocturnal Pulse Oximetry (Sleep-Disordered Breathing) on Post-discharge Clinical Outcomes in Hospitalized Patients with Left Ventricular Systolic Dysfunction after Acute Decompensated Heart Failure Takayasu Ohmura, Yoshitaka Iwama, Takatoshi Kasai, Takao Kato, Shoko Suda, Atsutoshi Takagi, Hiroyuki Daida The American Journal of Cardiology Available online 23 November 2013 (10.1016/j.amjcard.2013.10.048) Read the rest of the interview on MedicalResearch.com
  19. 19. Probiotics Ineffective in Preventing Childhood Asthma MedicalResearch.com Interview with: Dr. Meghan Azad, PhD Banting Postdoctoral Fellow Department of Pediatrics University of Alberta • • MedicalResearch.com: What are the main findings of the study? Dr. Azad: In this study, our goal was to evaluate the clinical evidence for using probiotics (live “healthy bacteria”) to prevent childhood asthma. We reviewed the results of 20 clinical trials involving over 4000 infants, where probiotics were administered during pregnancy or the first year of life, and found no evidence to support the use of probiotics for asthma prevention. Children receiving probiotics were just as likely to develop asthma as children receiving placebo. Similarly, there was no effect of probiotic supplementation on the development of wheezing. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Azad: Yes, somewhat. We know that gut microbes help ‘educate’ the developing immune system, and that disruption of the gut microbiota is associated with allergic diseases (disorders of the immune system), including asthma. Using probiotcs to promote a healthy gut microbiota has therefore been proposed as a new strategy to prevent allergic disorders. In fact, there is good evidence that probiotics can prevent allergic eczema in young infants. However, our results show that – at least so far – probiotics are not effective in asthma prevention. Read the rest of the interview on MedicalResearch.com
  20. 20. Probiotics Ineffective in Preventing Childhood Asthma MedicalResearch.com Interview with: Dr. Meghan Azad, PhD Banting Postdoctoral Fellow Department of Pediatrics University of Alberta • • • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Azad: Probiotics cannot be recommended for asthma prevention at this time. Of course, probiotics remain useful for other purposes (for example, they are beneficial for preventing bowel disease among premature infants), but there is currently insufficient evidence to recommend probiotics for asthma prevention. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Azad: Our findings highlight the need for additional research. While there is currently insufficient evidence to recommend probiotics for asthma prevention, this strategy may still have potential. New studies are needed to address the following: First, we know relatively little about how probiotics work, and which ones are effective. It will be important to study the infant gut microbiota to better understand how gut microbes contribute to asthma development, in order to develop improved strategies for prevention. This is an objective of our research at the Canadian Healthy Infant Longitudinal Development (CHILD) Study (www.canadianchildstudy.ca). Second, studies have varied widely in the type, dose and duration of probiotic supplementation (among 20 trials, over 15 probiotic strains were tested, with a 1000-fold range in dose, administered for 1 to 24 months). It is possible that some strains are effective while others are not, or that a single strain may be effective with long-term, but not short-term supplementation. The dose may also be important. These issues need to be addressed in new basic and clinical studies. Third, most trials were not originally designed to detect asthma, so they did not follow the children long enough to accurately diagnose this condition. Asthma diagnosis is difficult before age 6, and only 5 of 20 trials conducted follow up beyond 6 years. This issue could be addressed by extended follow up of existing studies, or with new long-term trials. Finally, it is also worth exploring whether probiotics are particularly effective among specific patient groups. For example, one study found that probiotics were especially beneficial among infants delivered by cesarean section (who are known to have a disrupted gut microbiota). Infants receiving antibiotics may also stand to benefit, but more research is needed to establish whether targeting these specific patient groups would impact asthma development. Citation: Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and metaanalysis Azad MB ,Coneys JG ,Kozyrskyj AL ,Field CJ ,Ramsey CD ,Becker AB ,et al. Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and meta-analysis. BMJ 2013;347:f6471 Read the rest of the interview on MedicalResearch.com
  21. 21. Diabetes Increases Risk of Stillbirth and Infant Death MedicalResearch.com Interview with: Mr Peter Tennant Research Associate (Epidemiology) Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX. • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: For women with type 1 or type 2 diabetes, the prevalence of stillbirth or late miscarriage (3%) was around four times greater than in women without the condition, while the risk of their infant dying during the first year of life (0.7%) was nearly twice as high. There was no difference in risk between women with type 1 or type 2 diabetes. A woman’s blood glucose concentration around the start of pregnancy, estimated from her glycated haemoglobin concentration (HbA1c), was the most important predictor of risk. The risk increased by 2% for each 1mmol/mol (0.1% in traditional DCCT units) increase in HbA1c above the target of 53mmol/mol (7%) recommended by the American Diabetes Association (ADA). If all the women in our study had achieved that ADA target before pregnancy, we estimate that around 40% of the stillbirths, late miscarriages, and infant deaths could have been avoided. MedicalResearch.com: Were any of the findings unexpected? Answer: We were quite surprised to find that the association between HbA1c around the start of pregnancy and the risk of stillbirth, late miscarriage or infant death followed a J-shaped pattern. For almost all women, any reduction in their blood glucose levels – even a small one – is likely to be good for their baby. However, our results also suggest that repeated episodes of severe hypoglycaemia may also be harmful. It was also surprising to see that the risk of stillbirth, late miscarriage, and infant death appeared to be halved in women who took folic acid supplements before pregnancy. We already know that folic acid reduces the risk of certain congenital anomalies, such as spina bifida or cleft lip, which is why women with diabetes are advised to take high-dose supplements of 5 milligrams daily. This finding suggests there may be additional benefits even for babies without these conditions. Finally, it was disappointing to see that there was no apparent reduction over time in the excess risk of stillbirth, late miscarriage, and infant death; especially considering that – with the right care – most women with diabetes can and will have a healthy baby. Read the rest of the interview on MedicalResearch.com
  22. 22. Diabetes Increases Risk of Stillbirth and Infant Death MedicalResearch.com Interview with: Mr Peter Tennant Research Associate (Epidemiology) Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX. • • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Any woman with type 1 or type 2 diabetes who is thinking of having a baby should seek advice, as early as possible, from their diabetes team, who can help them to improve their blood glucose control. Even if they can’t manage to achieve the target of 7%; any reduction in blood glucose concentration towards that level is likely to be good for their baby. All women with diabetes should also try to take 5mg of folic acid per day for at least three months before trying to get pregnant. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: In highly specialised settings, women with diabetes can be helped to achieve similar outcomes to those without the condition, one of the goals of the 1989 St Vincent Declaration. Our study shows that in the general population – of the North of England, at least – this goal appears no closer to becoming reality. The next step, therefore, is to try and understand and address whatever barriers are preventing women with diabetes from achieving an ideal preparation for pregnancy. Citation: Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study Peter W. G. Tennant, Svetlana V. Glinianaia, Rudy W. Bilous, Judith Rankin, Ruth Bell Diabetologia November 2013 10.1007/s00125-013-3108-5 Read the rest of the interview on MedicalResearch.com
  23. 23. Multiple Births and Fertility Treatments MedicalResearch.com Interview with: Aniket D. Kulkarni, M.B., B.S., M.P.H Women’s Health and Fertility Branch Centers for Disease Control and Prevention Atlanta, Georgia • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Kulkarni: Our study estimates the contribution of fertility treatments and natural conception to multiple births. Fertility treatments include IVF and non-IVF treatments. Non-IVF treatments primarily include ovulation induction and ovarian stimulation coupled with timed intercourse or intrauterine insemination (IUI). All estimated proportions were adjusted for maternal age which makes this study unique. The incidence of twin births nearly doubled and the incidence of triplet and higher-order births quadrupled over the last 4 decades. Our study estimates that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments, after adjusting for maternal age. After initial increase, the incidence of triplet and higher order births decreased by 29% from 1998 to 2011. The decrease in triplet and higher order births has coincided with a 70% reduction in the transfer of 3 or more embryos during IVF and a 33% decrease in the proportion of triplet and higher order births attributable to IVF. The decline in the number of embryos transferred during IVF became possible due to monitoring of ART treatments and outcomes and the work of professional societies, which have repeatedly revised practice guidelines to include recommendations for lowering the number of embryos transferred. In contrast, non-IVF fertility treatments of ovulation induction and ovarian stimulation are estimated to contribute the increasing number of multiple births. Hence there is a need for surveillance of births from non-IVF fertility treatments. MedicalResearch.com: Were any of the findings unexpected? Dr. Kulkarni: This study shows trends over the last 15 years of the effect of fertility treatments on multiple births. The findings show that a lot of progress has been made by reducing the number of embryos transferred during IVF treatments although there is a room for improvement by increasing single embryo transfers. Non-IVF treatments have been previously shown to be significant contributors to multiple births and this study reinforces those findings along with giving maternal age adjusted estimates. Read the rest of the interview on MedicalResearch.com
  24. 24. Multiple Births and Fertility Treatments MedicalResearch.com Interview with: Aniket D. Kulkarni, M.B., B.S., M.P.H Women’s Health and Fertility Branch Centers for Disease Control and Prevention Atlanta, Georgia • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kulkarni: If considering fertility treatment, understand the potential risk of multiple births. The risk of multiples due to IVF can be greatly minimized by transferring just one embryo. It is much more difficult to prevent multiple births resulting from ovulation induction and ovarian stimulation because of unpredictable ovarian follicular growth dynamics. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kulkarni: We need better understanding of the use of non-IVF fertility treatments in the United States (types of treatments, their effectiveness and safety). Consideration should be given to establishing a national registry collecting data on non-IVF fertility treatments. It would be useful to estimate the contribution of fertility treatments and natural conception to multiple births by state. Citation: Fertility Treatments and Multiple Births in the United States Aniket D. Kulkarni, M.B., B.S., M.P.H., Denise J. Jamieson, M.D., M.P.H., Howard W. Jones, Jr., M.D., Dmitry M. Kissin, M.D., M.P.H., Maria F. Gallo, Ph.D., Maurizio Macaluso, M.D., Dr.P.H., and Eli Y. Adashi, M.D. N Engl J Med 2013; 369:2218-2225 December 5, 2013 DOI: 10.1056/NEJMoa1301467 Read the rest of the interview on MedicalResearch.com
  25. 25. Sexual function problems are common but distress about them much less so MedicalResearch.com Interview with: Dr Kirstin R Mitchell PhD Lecturer in Sexual and Reproductive Health Dept of Social and Environmental Health Research Faculty of Public Health & Policy London School of Hygiene and Tropical Medicine • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Mitchell: We explored the distribution of sexual function in the British population using a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15 162 individuals aged 16–74 years. We measured sexual function using the Natsal-SF, a novel validated measure, which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life. Men and women in the oldest age groups surveyed (55 – 74) were more likely to have low overall sexual function than those in the youngest age group (16 – 24). After taking account of age differences, low sexual function was associated in both men and women with being unemployed, with current depression, and with poor general health. It was also associated with higher numbers of lifetime partners (women only), paying for sex (men only), and reporting same-sex partners, as well as with other aspects of sexual health, such as being diagnosed with an STI and experiencing sex against their will. Low sexual function was associated with relationship breakdown, and with people not being happy with their relationship. Within relationships, the most common problem was an imbalance in level of interest in sex between partners, which affected around a quarter of both men and women. Just under one in five men and women said their partner had experienced sexual difficulties in the last year, and this proportion increased with age, particularly among women. Lack of interest in sex was one of the most commonly reported problems for both men and women, affecting three in every twenty (15%) men, and with women twice as likely as men to say that this had been an issue in the last year. Difficulty reaching climax (16%) and vaginal dryness (13%) were among common problems for women; and reaching a climax more quickly than desired (15%), and difficulty getting or keeping an erection (13%) among men. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Mitchell: Sexual dissatisfaction and avoidance of sex were higher among those who did not have sex in the past year than among those who did, but we were surprised to find that the majority of individuals who had not had sex in the past year reported no distress or dissatisfaction and had not avoided sex because of sexual difficulties. This cautions against assuming that sexual inactivity is necessarily problematic. Read the rest of the interview on MedicalResearch.com
  26. 26. Sexual function problems are common but distress about them much less so MedicalResearch.com Interview with: Dr Kirstin R Mitchell PhD Lecturer in Sexual and Reproductive Health Dept of Social and Environmental Health Research Faculty of Public Health & Policy London School of Hygiene and Tropical Medicine • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report?
 Dr. Mitchell: Sexual function is closely linked with other aspects of sexual health and with aspects of life stage and life events. It deserves to be given greater priority in sexual health policy. Sexual function problems are common but distress about them is much less so. Although 42% of men and 51% of women report one or more problem with sexual function lasting three months or more in the last year, only about 10% report being distressed about their sex life. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mitchell: In public health research and policy, sexual function tends to be overlooked as a component of sexual health. In future, we recommend greater efforts to include sexual function as an explanatory or outcome variable in epidemiological research. Sexual function could be included in quality of life measures or as an endpoint in studies assessing the success of sexual health interventions. Our data highlight the fact that we need to take account of the personal significance of sexual problems for men and women, and their partners. We hope that this study will encourage a move away from ways of measuring sexual function that over-medicalise sexual problems, towards one that takes into account the relationship in which they occur, and the level of personal dissatisfaction and distress they cause. Citation: Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Dr Kirstin R Mitchell PhD,Catherine H Mercer PhD,George B Ploubidis PhD,Kyle G Jones MSc,Jessica Datta MSc,Nigel Field MBPhD,Andrew J Copas PhD,Clare Tanton PhD,Bob Erens MA,Pam Sonnenberg PhD,Soazig Clifton BSc,Wendy Macdowall MSc,Andrew Phelps BA,Prof Anne M Johnson MD,Prof Kaye Wellings FRCOG The Lancet – 30 November 2013 ( Vol. 382, Issue 9907, Pages 1817-1829 ) DOI: 10.1016/S0140-6736(13)62366-1 Read the rest of the interview on MedicalResearch.com
  27. 27. Medical Residents and Nurse Practitioners: Effects of Communication Skills Training MedicalResearch.com Interview with: J. Randall Curtis, MD, MPH Professor of Medicine Director, UW Palliative Care Center of Excellence Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104 • • MedicalResearch.com: What are the main findings of the study? Dr. Curtis: We examined the effect of a communication-skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes. The study was funded by the National Institutes of Nursing Research of the National Institutes of Heatlh. We conducted a randomized trial with 391 internal medicine and 81 nurse practitioner trainees at two universities. Participants were randomized to either an 8-session simulation-based, communication-skills intervention or to usual education. We collected outcome data from a large number of patients with life-limiting illness and their families, including 1866 patient ratings and 936 family ratings. The primary outcome was patient-reported quality of communication and, overall, this outcome did not change with the intervention. However, when we restricted our analyses to only patients who reported their own health status as poor, the intervention was associated with increased communication ratings. Much to our surprise, the intervention was associated with a small but significant increase in depression scores among post-intervention patients. Overall, this study demonstrates that among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education improved communication skills acquisition, but did not improve quality of communication about end-of-life care for all patients. However, the intervention was associated with improved patient ratings of communication for the sickest patients. Furthermore, the intervention was associated with a small increase in patients’ depressive symptoms, and this appeared most marked among patients of the first-year residents. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Curtis: Yes, the finding of increased depressive symptoms among patients of trainees who had received the intervention was a surprise. Although statistically significant, it is important to point out that this change was small and is less than the “minimal clinically important difference” on this scale. Nonetheless, it is possible that patients could experience depressive symptoms or feelings of sadness as a result of discussion about end-of-life care. Our finding that the increase in patients’ depressive symptoms was significantly greater for first-year residents suggests this increase might be associated with the skill level of the clinician having the discussion. Future studies should explore the effect of discussing end-of-life care on patients’ psychological symptoms and satisfaction with care and consider ways to mitigate negative effects while achieving the positive effects of these discussions. Read the rest of the interview on MedicalResearch.com
  28. 28. Medical Residents and Nurse Practitioners: Effects of Communication Skills Training MedicalResearch.com Interview with: J. Randall Curtis, MD, MPH Professor of Medicine Director, UW Palliative Care Center of Excellence Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104 • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Curtis: We showed that simulation training improves communication skills, but we were not able to convincingly show the benefits with patient-reported outcomes. Our study suggests that patients and their families may not be sensitive raters of clinician communication because they don’t know what to expect from clinicians and suggests that some prompting or training may be necessary if patients and family members are to be able to identify improved communication. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Curtis: In an editorial about this article Drs. Jeffrey Chi and Abraham Verghese from Stanford University comment that this study “provides an important lesson in the nature of pedagogy in medicine: new and innovative ways are needed to teach skills, and continued measurement, reassessment, and validation are needed to determine if those teaching methods have been successful.” I agree with this assessment and believe this is an important area for future research. Citation: Curtis J, Back AL, Ford DW, et al. Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients With Serious Illness: A Randomized Trial. JAMA. 2013;310(21):2271-2281. doi:10.1001/jama.2013.282081. Read the rest of the interview on MedicalResearch.com
  29. 29. Medical School Minority Faculty Not Markedly Increased by Development Programs MedicalResearch.com Interview with: James Guevara, MD, MPH Associate Professor of Pediatrics & Epidemiology Senior Diversity Search Advisor, Perelman School of Medicine University of Pennsylvania,Director of Interdisciplinary Initiatives PolicyLab: Center to Bridge Research, Practice, & Policy The Children’s Hospital of Philadelphia,Philadelphia, PA 19104 • • • MedicalResearch.com: What did the study attempt to address? Dr. Guevara: Medical schools have sought to build more diverse faculty in their institutions through faculty development programs targeted to underrepresented minority faculty members. This study was conduct by THE CHILDREN’S HOSPITAL OF PHILADELPHIA’S POLICYLAB and The University of Pennsylvania and sought to determine if there was an association between minority faculty development programs and the representation, recruitment, and promotion of underrepresented minority faculty. MedicalResearch.com: What are the main findings from the study? Dr. Guevara: The study was a secondary analysis of faculty-level data from the Association of American Medical Colleges linked to a national survey of medical schools. Findings indicated that there was only a modest increase from 6.8% to 8.0% in faculty from underrepresented minority backgrounds from 2000 to 2010. Schools with faculty development programs targeted to minority faculty members did not see an increase that was different from schools without such programs. However, schools with more intensive minority faculty development programs outperformed schools with less intensive programs. Read the rest of the interview on MedicalResearch.com
  30. 30. Medical School Minority Faculty Not Markedly Increased by Development Programs MedicalResearch.com Interview with: James Guevara, MD, MPH Associate Professor of Pediatrics & Epidemiology Senior Diversity Search Advisor, Perelman School of Medicine University of Pennsylvania,Director of Interdisciplinary Initiatives PolicyLab: Center to Bridge Research, Practice, & Policy The Children’s Hospital of Philadelphia,Philadelphia, PA 19104 • • • • • • • MedicalResearch.com: What are the implications of these findings for medical school administrators? Dr. Guevara: Building a diverse medical school faculty is no easy task and likely will require intensive faculty development programs targeted to minority faculty. Findings from this study suggest programs may need five or more years to mature and provide multiple components including mentoring, career development, social climate, and research support. MedicalResearch.com: What recommendations would you make for future research? Dr. Guevara: Since the findings are primarily observational, future research should examine the effect of minority faculty development programs using experimental designs with standardized measures of success such as publication and grant numbers. Citation: Minority Faculty Development Programs and Underrepresented Minority Faculty Representation at US Medical Schools Guevara JP, Adanga E, Avakame E, Carthon M. Minority Faculty Development Programs and Underrepresented Minority Faculty Representation at US Medical Schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116. Read the rest of the interview on MedicalResearch.com
  31. 31. Antiretroviral Therapy: Survival Benefits in South Africa MedicalResearch.com Interview with: Michael D. April, MD, DPhil San Antonio Uniformed Services Health Education Consortium.Department Harvard Medical School The Medical Practice Evaluation Center • • • • MedicalResearch.com: What are the main findings of this study? Dr. April: Using a mathematical model, this study quantified the survival benefits associated with antiretroviral therapy to HIV-infected people in South Africa since 2004. Our results highlight the astounding benefits of treatment. In short, antiretroviral therapy has saved 2.8 million years of life in South Africa to date and is projected to save an additional 15.1 million years of life by 2030. MedicalResearch.com: What are the most important points or takeaway messages from these findings? Dr. April: The return on global investment in antiretroviral therapy has been impressive, but gains already achieved are merely the tip of the iceberg. Using very conservative estimates, our study projects that gains as of December 2011 comprise only 15.6% of the 17.9 million years of life to be saved by 2030 or 12.7% of the 21.7 million years of life projected to be saved over the lifetime of those patients currently receiving ART. What these estimates exclude is those who might benefit from ART in the future. As such, policy-makers have the power to magnify the future trajectory of survival gains further still by pursuing more aggressive HIV testing and treatment strategies. Increased case identification, early ART initiation and expanded treatment options might catapult our conservative survival projections even further. It is our hope that this study reminds stake-holders of the astounding efficacy of the global ART rollout while simultaneously invigorating efforts to redouble commitments toward expanding the availability of ART. Read the rest of the interview on MedicalResearch.com
  32. 32. Antiretroviral Therapy: Survival Benefits in South Africa MedicalResearch.com Interview with: Michael D. April, MD, DPhil San Antonio Uniformed Services Health Education Consortium.Department Harvard Medical School The Medical Practice Evaluation Center • • • • • • • • MedicalResearch.com: What should clinicians, patients, and decision makers take away from your report? Dr. April: Significant capital and manpower have already been invested into the impressive ART rollout in South Africa and throughout the globe spanning from early 2004 to the present day. Our results are a testament to the return already realized on that investment. However, the real story here is less the years of life already saved but rather the hard-won establishment of an effective ART delivery system responsible for treatment of 1.4 million HIV-infected persons according to recent WHO estimates. Having already expended significant resources to meet the start-up costs to establish this system, these results highlight the devastating opportunity cost of cutting international commitments to ART in the name of fiscal austerity to avoid current upkeep costs. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. April: Our results suggest that rather than a debate over continuation of current funding commitments, policy-makers and resources should be examining strategies to expand testing and treatment efforts, so increasing future potential survival gains. We are not advocating a blanket approach as we realize these investments need to be made efficiently. Future studies need to best understand where these investments can produce the largest survival yield. Moreover, future survival gains will rise significantly if increasing numbers of patients continue to initiate ART each year, leading to further financing needs. Approaches to reduce these cost may include expansion of access to second-line ART through, negotiations with pharmaceutical companies, competitive price reductions, infrastructure improvement, and examining alternatives to promote economies scale. Our study also highlights where current defaults in the system might have attenuated survival to date and where more work needs to be done. Patients are often limited in their benefits realized because they are diagnosed too late; expanding case detection through more aggressive HIV testing by using rapid tests, mobile testing centers, or home-based testing models are areas meriting further research. Furthermore, mechanisms for effectively tracking monitoring HIV-infected patients not yet eligible for ART must be improved to minimize loss-to-follow-up of potential future ART recipients. Finally, research should continue to examine clinical utility and costeffectiveness of liberalizing ART eligibility criteria to maximize the number of HIV-infected persons benefiting from ART. Citation: The Survival Benefits of Antiretroviral Therapy in South Africa Michael D. April, Robin Wood, Bethany K. Berkowitz, A. David Paltiel, Xavier Anglaret, Elena Losina, Kenneth A. Freedberg, and Rochelle P. Walensky J Infect Dis. first published online December 3, 2013 doi:10.1093/infdis/jit584 Read the rest of the interview on MedicalResearch.com
  33. 33. Alzheimer’s Disease: Connection with Rare Childhood Disorder MedicalResearch.com Interview with: Alessandra d’Azzo PhD Department of Genetics, St Jude Children’s Research Hospital 262 Danny Thomas Place, Memphis, Tennessee 38105 • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. d’Azzo: We have discovered a connection between a rare childhood disorder and Alzheimer’s disease that usually affects older people. The culprit is a metabolic enzyme called NEU1 that normally controls the recycling or disposal of proteins in a specific cell compartment, the lysosome. When NEU1 is defective, children develop the severe metabolic disease, sialidosis. Our study suggests that NEU1 also plays an important role in the development of Alzheimer’s disease. Based on this discovery, we decided to increase NEU1 enzyme activity in the brain of an Alzheimer’s disease mouse model that shows features characteristic of the human disease, namely the accumulation of toxic protein aggregates or plaques. Remarkably, we could significantly diminish the number of plaques in the brain of these mice by increasing NEU1 enzyme activity. MedicalResearch.com: Were any of the findings unexpected? Dr. d’Azzo: These findings were totally unexpected because we were studying a pediatric disease that, as it turns out, presents signs of premature aging, mimicking a severe and widespread condition in older people like Alzheimer’s disease. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. d’Azzo: This is the first time the NEU1 enzyme has been linked to Alzheimer’s disease. We hope that these findings can generate better tools to diagnose the disease and maybe slow down or even reverse disease progression. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. d’Azzo: We hope that these findings will propel Alzheimer’s disease research into areas that were not explored before, opening new avenues for the prevention or treatment of this devastating disease. Citation: Lysosomal NEU1 deficiency affects amyloid precursor protein levels and amyloid-β secretion via deregulated lysosomal exocytosis Ida Annunziata, Annette Patterson, Danielle Helton, Huimin Hu, Simon Moshiach, Elida Gomero, Ralph Nixon, Alessandra d’Azzo Nature Communications 4, doi:10.1038/ncomms3734 November 14 2013 Read the rest of the interview on MedicalResearch.com
  34. 34. Biphasic Allergic Reactions in ER Patients MedicalResearch.com Interview with: Brian Grunau MD Emergency Physician, St. Paul’s Hospital Clinical Assistant Professor, UBC Department of Emergency Medicine • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Grunau: Among 2819 consecutive Emergency Department visits of patients with allergic reactions or anaphylaxis, five clinically important biphasic reactions were identified (0.18%; 95% confidence interval [CI] 0.07% to 0.44%), with two occurring during the ED visit and three post-discharge. There were no fatalities. When examining patients who satisfied the definition for anaphylaxis and those who did not separately, clinically important biphasic reactions occurred in 2 patients (0.40%; 95% CI 0.07% to 1.6%) and 3 patients (0.13%; 95% CI 0.03% to 0.41%), respectively. MedicalResearch.com: Were any of the findings unexpected? Dr. Grunau: We expected to identify biphasic reactions in the anaphylaxis group and that the incidence would be low. We did not, however, expect to identify biphasic reactions in the patients who did not satisfy the definition for anaphylaxis on the index visit. We also did not expect to identify biphasic reactions which occurred many days after the index visit (the longest duration was 143 hours). MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Grunau: Biphasic reactions are rare, however do occur and may take place many hours or days after the index visit. Patients in our cohort who had a biphasic reaction after ED discharge appropriately presented back to the ED for treatment and there were no deaths. Extended monitoring (for example, over four hours) after ED treatment appears to be unnecessary for the majority of patients whose symptoms have resolved. A careful discussion on when to return to the ED and the importance of an epinephrine autoinjector, however, is essential before discharge. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Grunau: A prospective blinded randomized study examining the efficacy of various ED treatments in preventing biphasic reactions would be ideal, however with such a low incidence of reactions an extremely large sample size would be required. Citation: Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients With Allergic Reactions or Anaphylaxis Brian E. Grunau, Jennifer Li, Tae Won Yi, Robert Stenstrom, Eric Grafstein, Matthew O. Wiens, R. Robert Schellenberg, Frank Xavier Scheuermeyer Annals of Emergency Medicine – 18 November 2013 (10.1016/j.annemergmed.2013.10.017) Read the rest of the interview on MedicalResearch.com
  35. 35. Fentanyl for Pain: Intranasal Use in the Out-of-Hospital Setting MedicalResearch.com Interview with: Dr. Morten Sejer Hansen Department of Anaesthesia 4231 Centre of Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Answer: Out-of-hospital administration of intranasal fentanyl in doses of 50 and 100 microgram appears to be safe and well tolerated, with a low incidence of side effects Secondly, intranasal fentanyl appeared effective in a wide range of patients, although no firm conclusions on analgesic efficacy can be provided due to the lack of a placebo control. MedicalResearch.com: Were any of the findings unexpected? Answer: The low frequency of side effects, with no serious adverse events, was an uplifting result, considering the ambiguous safety profile provided by earlier studies where the frequency of adverse events varied from 3.3% to 39%. Likewise the applicability of intranasal fentanyl in the pediatric (age > 8 years and/or weight >30 kg) out-of-hospital population MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Intranasal fentanyl appears to be a safe and well-tolerated out-of-hospital analgesic in a wide range of patients. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Future studies are needed in order to establish a safety profile for rare adverse events. Furthermore, in order to validate the analgesic efficacy of intranasal fentanyl as an out-of-hospital analgesic, future placebo controlled randomized trials are needed. Citation: Safety of Intranasal Fentanyl in the Out-of-Hospital Setting: A Prospective Observational Study Anders P.H. Karlsen, Danny M.B. Pedersen, Sven Trautner, Jørgen B. Dahl, Morten S. Hansen Annals of Emergency Medicine – 25 November 2013 (10.1016/j.annemergmed.2013.10.025) Read the rest of the interview on MedicalResearch.com
  36. 36. PTSD and Medication Non-Adherence MedicalResearch.com Interview with: Ian Kronish, MD, MPH Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Division of General Medicine Columbia University Medical Center • • • MedicalResearch.com: What are the main findings of the study? Dr. Kronish: Among primary care patients with persistently uncontrolled blood pressure despite medication treatment, we found that medication non-adherence was more than twice as common in patients with PTSD (68%) as compared to patients without PTSD (26%). The association between PTSD and medication non-adherence remained present after adjustment for key covariates including regimen complexity and depression. Recent research shows that PTSD not only contributes to psychological distress, but is also associated with increased risk for incident and recurrent cardiovascular disease. The data from our study suggest that medication non-adherence may be an important mechanism by which PTSD increases risk for cardiovascular disease. MedicalResearch.com: Were any of the findings unexpected? Dr. Kronish: While the overall prevalence of non-adherence to blood pressure medications in our sample (41% were non-adherent defined as taking <80% of their antihypertensive doses as prescribed) was typical of other studies, we were surprised that non-adherence to blood pressure medications was so prevalent among patients with PTSD. We were also surprised that the association between PTSD and non-adherence did not appear to be weakened by including depression in the multivariable model. Read the rest of the interview on MedicalResearch.com
  37. 37. PTSD and Medication Non-Adherence MedicalResearch.com Interview with: Ian Kronish, MD, MPH Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Division of General Medicine Columbia University Medical Center • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kronish: PTSD is common in medical settings, and unfortunately, often goes unrecognized. Clinicians who are aware of significant PTSD symptoms in their patients should carefully assess medication adherence, particularly if their patients are not reaching goals for risk factor control. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kronish: This study was conducted in a single primary care clinic that serves an inner-city, economically vulnerable community. Future research should confirm the association between PTSD and medication non-adherence in other study populations. Future research should also seek to understand which aspects of PTSD lead to non-adherence. We hypothesize that patients with PTSD may be avoidant of stimuli that remind them of their own mortality and this avoidance may lead them to miss important life-preserving cardiovascular medications such as antihypertensives. Future studies should also examine whether nonadherence is an important mediator of the association between PTSD and increased cardiovascular risk. Finally, future research should consider the risks and benefits of screening for PTSD in primary care; if increased awareness of PTSD can help with the identification of patients who will benefit from adherence monitoring and improvement interventions, then there may be an increased benefit to PTSD screening. Citation: Posttraumatic Stress Disorder and Medication Nonadherence in Patients With Uncontrolled Hypertension Kronish IM, Lin JJ, Cohen BE, Voils CI, Edmondson D. Posttraumatic Stress Disorder and Medication Nonadherence in Patients With Uncontrolled Hypertension. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.12881. Read the rest of the interview on MedicalResearch.com
  38. 38. Beside Nursing Handover: Patients’ Views MedicalResearch.com Interview with: Dr. Lianne Jeffs PhD Nurse and researcher at St. Michael’s Hospital University of Toronto • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Jeffs: The main findings of the study include: 1. Patients described the bedside nursing handover as engaging, personal and informative. The bedside nursing handover created a a space to connect with their nurses in a more personal manner (e.g., provided an introduction between patient and nurse at the beginning of the shift) 2. Patients found the experience increased their engagement in their own care, and kept them informed about their health status and care plan. It also gave the patient an opportunity to identify important needs to the nurse (e.g., daily activities) 3. Not all patients wanted to participate in the bedside nursing handover. This was typically exemplified by long-term-stay patients. MedicalResearch.com: Were any of the findings unexpected? Dr. Jeffs: Our findings were consistent with other studies found in the body of literature on this topic. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Jeffs: Bedside nurse handover is beneficial to both clinicians and patients as they improve and strengthen communication between both parties; reduce errors (e.g., medication) and strengthen the concept of patient centred care. It is important to note that some patients may not want to participate in this type of handover and their preference should be acknowledged and accepted. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Jeffs: Future research would look at pre and post implementation of the intervention in regards to patient satisfaction and medication errors. Citation: Patients’ Views on Bedside Nursing Handover: Creating a Space to Connect J Nurs Care Qual. 2013 Nov 18. [Epub ahead of print] Jeffs L, Beswick S, Acott A, Simpson E, Cardoso R, Campbell H, Irwin T. St. Michael’s Hospital (Drs Jeffs and Cardoso and Mss Beswick, Acott, Simpson, Campbell, and Irwin) Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation, University of Toronto (Dr Jeffs), Toronto, Ontario, Canada. Read the rest of the interview on MedicalResearch.com
  39. 39. Stem Cells: Generating Lung Cells from PluriPotent Stem Cells MedicalResearch.com Interview with: Hans-Willem Snoeck MD, PhD Columbia University Medical Center • • • MedicalResearch.com: What are the main findings of the study? Dr. Snoeck: We were, for the first time, able to differentiate human embryonic stem cells and induced pluripotent stem cells into at least 6 different types of lung and airway epithelial cells. Furthermore, we could demonstrate function of surfactant-producing type II alveolar epithelial cells, and the lung progenitors we generated could generate airway after transplantation under the kidney capsule of immunodeficient mice. MedicalResearch.com: Were any of the findings unexpected? Dr. Snoeck: Differentiation of ES and iPS cells into various cell types of other organs has been relatively successful. Differentiation into lung and airway has been very challenging. We used paradigms from mouse lung development as a guide to differentiation of human stem cells. We also found however that certain signaling pathways required for lung development in the mouse appear redundant in the human system. On the other hand, manipulation of other signaling pathways was essential for human differentiation, while studies in mouse development have not shown evidence for this requirement. Read the rest of the interview on MedicalResearch.com
  40. 40. Stem Cells: Generating Lung Cells from PluriPotent Stem Cells MedicalResearch.com Interview with: Hans-Willem Snoeck MD, PhD Columbia University Medical Center • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Snoeck: It will now be possible to model at least some human lung diseases in the laboratory. This will then hopefully lead to strategies to screen for drugs that might treat these diseases. One example is idiopathic lung fibrosis, a disease where the aforementioned type II alveolar epithelial cells are believed to play a major role, but of which the pathogenesis or disease mechanism is not understood. This disease yearly kills 40,000 people in the US, and there is no curative treatment, except for lung transplantation, which carries a high mortality from transplant-related complications. In addition, this work may allow the development of autologous (the patient’s own) lungs for transplantation. This approach involves harvesting lungs from donors, removing all of the donor’s cells, and replacing those with stem cells derived from the patient. This would alleviate rejection problems. This application is still far away, but this work is a first and critical step in this direction. Finally, this work will shed light on human lung development, and on a number of congenital diseases affecting lung and airways. Examples are tracheo-esophagal fistulas and tracheal atresia. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Snoeck: Future research should focus on disease modeling and drug discovery, and on strategies to seed lung scaffolds with iPS-derived lung and airway epithelial cells. Questions that will arise in this area are, for example: how do we generate the adult stem cells that endow a lung with regenerative capacity after damage, how will cells home to their correct location in the lung, and how will we ensure that cilia will coordinately beat in the correct direction to allow removal of mucus and debris from the lung, and how can we scale up this system to generate sufficient numbers of cells for a human lung. Furthermore, we also need to determine to what extent the cells we generated are fully mature (in an adult as opposed to a late fetal stage of development), and how we can mature these further if needed. Citation: Efficient generation of airway and lung epithelial cells from human pluripotent stem cells Sarah X L Huang, Mohammad Naimul Islam, John O’Neill, Zheng Hu, Yong-Guang Yang, Ya-Wen Chen,Melanie Mumau,Michael D Green, Gordana Vunjak-Novakovic, Jahar Bhattacharya & Hans-Willem Snoeck Nature Biotechnology (2013)doi:10.1038/nbt.2754 Received 14 August 2013 Accepted 30 October 2013 Published online 01 December 2013 Read the rest of the interview on MedicalResearch.com
  41. 41. Health Effects on Sex Life MedicalResearch.com Interview with: Dr Nigel Field MBPhD Research Department of Infection and Population Health University College London, London, UK • • • • • MedicalResearch.com: What are the main findings of the study?
 Dr. Field: This study, published in The Lancet on Tuesday 26 November, reports data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal), interviewing over 15,000 participants aged 16-74 years, to systematically assess the association between people’s health and their sexual lifestyles in Britain. The key findings from the study are that close to one in six (17%) of men and women feel that their health had affected their sex life in the past year. This rises to three fifths (60%) among men and women who say that they are in bad health. However, only a quarter of men (24%) and under a fifth of women (18%) who say that ill-health affects their sex life had sought help from a health profession, usually a family doctor. The also study shows that the proportion of people who had recently had sex (within the past four weeks) declined with age, and was lower among those who reported being in bad health, compared to those who reported being in very good health. The association remained after adjustment to account for age and whether participants were in a relationship. We also found that lower levels of satisfaction were associated with poorer health, with the association again remaining after adjustment for age and relationship status. Even though the overall results show a clear association between ill-health and individual’s sex lives, we note that many people in bad health reported being sexually active and/or satisfied. About one third of participants reported recent sexual activity and just under half of the same group were satisfied with their sex lives. MedicalResearch.com: Were any of the findings unexpected? Dr. Field: For the first time, we asked people whether they feel that their health affects their sex lives, and our findings indicate that many patients in chronic ill-health are well aware of an effect on their sex lives. Yet few of these people had sought help from health professionals about sexual problems.
 Read the rest of the interview on MedicalResearch.com
  42. 42. Health Effects on Sex Life MedicalResearch.com Interview with: Dr Nigel Field MBPhD Research Department of Infection and Population Health University College London, London, UK • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Field: Our study suggests that sexual lifestyles are strongly linked to overall health and wellbeing. However, most people reporting a health condition affecting their sex life had not sought clinical advice. There may be barriers on both sides, with patients sometimes unwilling to discuss problems, and health professionals sometimes lacking sufficient awareness and training about advising and communication with patients about sexual problems. For clinicians, this study suggests that assessments of sexual health should form part of a holistic approach to care of patients at all ages with chronic ill health. For patients, while the study shows that many people in bad health report being sexually active and/or satisfied with their sex life, it also suggests that concerns about the effect of people’s health on their sex lives are common. Patients might benefit from discussing these concerns with their doctor. Citation: Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) Dr Nigel Field MBPhD,Catherine H Mercer PhD,Pam Sonnenberg PhD,Clare Tanton PhD,Soazig Clifton BSc,Kirstin R Mitchell PhD,Bob Erens MA,Wendy Macdowall MSc,Prof Frederick Wu FRCP,Jessica Datta MSc,Kyle G Jones MSc,Amy Stevens BSc,Philip Prah MSc,Andrew J Copas PhD,Andrew Phelps BA,Prof Kaye Wellings FRCOG,Prof Anne M Johnson MD The Lancet – 30 November 2013 ( Vol. 382, Issue 9907, Pages 1830-1844 ) DOI: 10.1016/S0140-6736(13)62222-9 Read the rest of the interview on MedicalResearch.com
  43. 43. Autism Risk: Antidepressant Exposure in Pregnancy? MedicalResearch.com Interview with: Jakob Christensen Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Merete Juul Sørensen Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Denmark • • MedicalResearch.com: What are the main findings of the study? Answer: We found that the risk of autism spectrum disorder was increased by 50% in children of mothers who took antidepressants during pregnancy. However, when we controlled for other factors related to the medication, by comparing with children of mothers with a diagnosis of depression or with un-exposed siblings, the risk was smaller and not significantly increased. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Previous studies have found increased risk of autism spectrum disorder in children of women who took antidepressant medication during pregnancy. We could not find that, when we took into account the disorder in the mother. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Even though there may be risks associated with use of antidepressant medication during pregnancy, the specific risk of autism spectrum disorder may be partly or completely explained by factors other than the medication itself. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: Future research should aim to study possible risks in individaul antidepressant drugs in order to inform decision making in treating pregnant women with depression. Citation: Antidepressant exposure in pregnancy and risk of autism spectrum disorders Merete Juul Sørensen,Therese Koops Grønborg,Jakob Christensen, Erik Thorlund Parner, Mogens Vestergaard,Diana Schendel, Lars Henning Pedersen • • • • • • • Read the rest of the interview on MedicalResearch.com
  44. 44. High Fat Diet: Pubertal Effect on Breast Cancer Development MedicalResearch.com Interview with: Richard Schwartz, Ph.D. Professor, Associate Dean for Graduate Academic and Student Affairs College of Natural Science Michigan State University Department of Microbiology and Molecular Genetics Michigan State University East Lansing, MI 48824-4320 • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Schwartz: The main finding is that exposure to a high fat diet from the age of puberty onwards hastened the development of chemical carcinogen-induced breast cancer in absence of weight gain. We also found that prior to the appearance of any tumors, we could detect changes in the mammary gland that included increased cellular proliferation, increased vascularity, and changes in immune function. MedicalResearch.com: Were any of the findings unexpected? Dr. Schwartz: The biggest surprise was the magnitude of the effect. The median time of occurrence of tumors was reduced by about 3 months in the mice tested. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Schwartz: We already know that an extreme high fat diet and consequent obesity (in our experiments we used lard, saturated animal fat) has negative consequences for heart disease and diabetes. This adds another potential negative consequence of such a diet, even perhaps for those who do not gain weight. These studies give another reason to avoid excessive fat in our diets. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Schwartz: The directions for future research are many. 1. What are the consequences of exposure to a high fat diet at various life stages? We have preliminary data that puberty is a critical period. 2. What are the effects of various kinds of fats? And how do they interact with various carcinogenic agents? 3. Are the early occurring proliferative, vascular, and immune function perturbations observed in our experimental system causally linked to the development of breast cancer? Citation: Pubertal high fat diet: effects on mammary cancer development. Zhao Y, Tan YS, Aupperlee MD, Langohr IM, Kirk EL, Troester MA, Schwartz RC, Haslam SZ. Breast Cancer Res. 2013 Oct 25;15(5):R100. [Epub ahead of print] PMID: 24156623 PubMed – as supplied by publisher] Read the rest of the interview on MedicalResearch.com
  45. 45. Menopause: Effects of Sex Hormones on Cognition and Mood MedicalResearch.com Interview with: Dr. Victor W. Henderson MD Professor of Health Research and Policy and of Neurology and Neurological Sciences Stanford University, Stanford, CA 94305 • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Henderson: Estrogen or hormone therapy effects on some health outcomes differ by age, harmful at one age and beneficial at another. This difference is sometimes referred to as the “critical window” or “timing” theory. It is controversial whether the so-called critical-window applies to memory or other cognitive skills. In assessing the critical window hypothesis, we found that the relation between blood levels of estrogen and memory or reasoning skills is the same in younger postmenopausal women as in older postmenopausal women. Essentially, there is no association at either age. MedicalResearch.com: Were any of the findings unexpected? Dr. Henderson: Our findings for estradiol were different from what we had predicted from the critical window hypothesis, and from other studies that suggest there should be a relation between blood levels of estradiol and memory. Read the rest of the interview on MedicalResearch.com

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