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MedicalResearch.com: Medical Research Updates and Interviews March 27 2014

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MedicalResearch.com presents interviews with medical researchers from major and specialty medical research journals and health care meetings.

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MedicalResearch.com: Medical Research Updates and Interviews March 27 2014

  1. 1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD info@medicalresearch.com March 27 2014 For Informational Purposes Only: Not for Specific Medical Advice.
  2. 2. Medical Disclaimer | Terms and Conditions • The contents of the MedicalResearch.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site! • If you think you may have a medical emergency, call your doctor or 911 immediately. MedicalResearch.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by MedicalResearch.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of MedicalResearch.com or EDI, or other visitors to the Site is solely at your own risk. • The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis. Read more interviews on MedicalResearch.com
  3. 3. Decision Making Accuracy Improved by Slightly Delaying Decision Onset MedicalResearch.com Interview with: Dr Tobias Teichert Assistant Professor of Psychiatry University of Pittsburgh Pittsburgh, PA 15261 • MedicalResearch.com: What are the main findings of the study? • Dr. Teichert: • ”Our study provided three main findings: • First, we measured how long it takes subjects to allocate attention to a relevant target and how effectively they can block out the distractors. We found that after 120 msec selective attention is fully engaged and completely blocks out the distractor. Based on this finding, we predicted that subjects should be able to improve decision accuracy by delaying decision onset, and that this should be more effective than simply prolonging the whole decision process. • Most importantly, we found that subjects indeed use this more effective way of improving decision onset: On average, subjects delayed decision onset by about 50 msec when we asked them be as accurate as possible. The good news is that people seem to use this more optimal mechanism automatically, without being told to do so and without being aware of what they do. The bad news is that we don’t seem to be using this skill quite as effectively as we could. In our case, subjects could have improved accuracy even further by delaying decision onset by an additional 50 ms. However, taken together, our findings show that decision onset is to some degree under cognitive control, and that we might be able to devise training strategies to harness its full potential” MedicalResearch.com: Were any of the findings unexpected? • Dr. Teichert: • “Yes. It is typically assumed that subjects improve decision accuracy by prolonging the decision process, ie., by working longer or harder. Here we identified a more effective mechanism that requires decision makers to merely delay the onset of the decision process by a couple of tens of milliseconds to a more beneficial point in time. Waiting enables the brains attentional system to focus on the most relevant information. In realistic situations with salient distractors, delaying decision onset can be a much more effective way for improving response accuracy.” • MedicalResearch.com: What are the implications for every-day decision making? • Dr. Teichert: ”We all know that we can’t make accurate decisions if we don’t pay attention to the relevant information. Our study highlights the fact that while selective attention is an extremely powerful mechanism, it is effortful and takes time to engage. Hence, especially in emergent situation when we are pressured to respond as fast as possible, it is very important to first identify and focus on the relevant information before even considering any potential courses of action. Our study was the first to quantify this effect. In the specific situation created for the experiment, subjects could have improved information transfer from 1.5 to 2.5 bits per second, indicating that they could have made one additional correct decision per second, simply by allowing the attentional system a little extra time to focus on the relevant information.” • “In our study, subjects were making rather simple decisions very quickly: average reaction times varied between 500 and 600 milliseconds. However, the main principle that we identified can be translated to more complicated decisions that happen on a slower time-scale–for example, buying a car. On this slower time-scale, our findings translate into the following strategy: rather than immediately writing a list with pros and cons of the cars that you are considering, you should first write a list of features that are important to you. This is indeed common (and very useful) advice that your friends or the internet will give you when you ask them about how to decide on a car. So it is not all that surprising that the same principle should help you make simpler decisions on a faster time-scale. What is pretty amazing though, is that, unconsciously, our brains seem to have figured out this strategy presumably long before we even invented the wheel.” • MedicalResearch.com: What are the clinical implications of your research? • Dr. Teichert: ”The research methodology that we developed for our study may help shed light on how the allocation of selective attention is altered in certain neuropsychiatric conditions such as ADHD and schizophrenia. Do people with these conditions take longer to fully engage selective attention? Or is their attentional system less effective even after it is fully engaged? If we assume that the dynamics of selective attention are slowed down, our study provides a novel approach to help them make better decisions in the future, simply by delaying decision onset accordingly.” • Citation: • Humans optimize decision-making by delaying decision onset • Tobias Teichert, Vincent P. Ferrera, Jack Grinband PLOS ONE • Published: March 05, 2014 • DOI: 10.1371/journal.pone.0089638 Read the rest of the interview on MedicalResearch.com
  4. 4. Diabetes: Medication Adherence Improves with Information, Motivation and Skills MedicalResearch.com Interview with: Chandra Y. Osborn, PhD, MPH Assistant Professor of Medicine & Biomedical Informatics Division of General Internal Medicine & Public Health Center for Health Services Research Vanderbilt University Medical Center Nashville, TN 37232-8300 • MedicalResearch.com: What are the main findings of your study? • Dr. Osborn: We found that knowing how to take your diabetes medications (e.g., what to do if a dose is missed), believing medications are good for you, and having the appropriate skills to take them regardless of the situation (e.g., when life is busy, when in public) accounts for 41% of why people successfully take their diabetes medications, which, in turn, explains 9% of their glycemic control. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Osborn: Other studies have found that enhancing patients’ medication adherence-related knowledge, motivation, and skills improves their medication adherence, but these studies have been largely with HIV patients whose main self-care task is taking medications. Our study brings that line of work into the diabetes space. Diabetes patients have a larger constellation of self-care requirements, including eating well, being active, and checking blood sugars. As a result, efforts to improve medication adherence has historically taken a backseat to helping patients eat better, be active, and monitor their blood sugars — even though medication adherence alone predicts glycemic control. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Osborn: Unlike well-known barriers to medication adherence that are hard to address (e.g., cost, transportation to pharmacies), our study highlights intervenable factors that are addressable. Providers and diabetes educators should: • (1) Aim to improve patients’ knowledge of how and when to take their medications and what to do when a dose is missed, • (2) Explain to patients why their medications are beneficial and dispel myths that medications do more harm than good, and • (3) Help patients develop skills to be adherent regardless of the situation (e.g., plan ahead for schedule disruptions, trips and travel, and how to discretely take medications/insulin in public). • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Osborn: Interventions aimed at improving adherence to diabetes medications should enhance patients adherence- related information, motivation, and behavioral skills, and test whether improvements in these mechanisms explain improvements in diabetes medication adherence, and, in turn, glycemic control. • Citation: • Empirical Validation of the Information–Motivation–Behavioral Skills Model of Diabetes Medication Adherence: A Framework for Intervention • Lindsay S. Mayberry andChandra Y. Osborn • Diabetes Care published ahead of print March 5, 2014, doi:10.2337/dc13-1828 1935-5548 Read the rest of the interview on MedicalResearch.com
  5. 5. Calcium-Vitamin D Supplementation: Effects on Vitamin D and Cholesterol Levels MedicalResearch.com Interview with: Peter F. Schnatz, D.O. Associate Chair & Residency Program Director The Reading Hospital Department of OB/GYN Reading, PA 19612-6052 • MedicalResearch.com: What are the main findings of the study? • Dr. Schnatz: In a subsample of 576 women from the parent WHI CaD (calcium plus vitamin D supplementation) trial* , there was a significant (38%) increase in mean serum 25OHD3 concentrations after two years (95% CI 1.29-1.47, p< 0.001) for women randomized to CaD (24.3ng/mL vs. 18.2 ng/mL). • Women randomized to CaD had a 4.5 mg/dL mean decrease in LDL-C which was statistically significant. After accounting for serum 25OHD3 concentration, the effect of CaD was attenuated, suggesting that higher concentrations of 25OHD3, in response to CaD supplementation, are associated with improved LDL-C. • In observational analyses, higher concentrations of 25OHD3 were associated with significantly higher HDL-C along with significantly lower LDL-C and TG concentrations. • * 1,000 mg of elemental calcium plus 400 IU of vitamin D3 daily MedicalResearch.com: Were any of the findings unexpected? • Dr. Schnatz: The fact that in this prospective study women randomized to CaD had a statistically significant decrease in LDL-C was expected, since this had been shown previously. Also as expected, CaD did not have a significant effect on HDL-C and triglycerides. • This study is unique, however, because it suggests the mechanism behind how CaD lowers LDL-C. These results support the hypothesis that higher concentrations of 25OHD3, in response to CaD supplementation, are associated with improved LDL-C. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Schnatz: The jury is still out on whether Vitamin D supplementation has any extra skeletal benefits. There is a clear association between Vitamin D and many non-skeletal benefits, but this has been seen in observational and retrospective studies – with a strong possibility of bias and confounding factors leading to the association seen. More conclusive evidence, from our study and the previously published results from the parent WHI randomized trial, show that CaD led to a significant, albeit modest, reduction in LDL-C. • Maintenance of healthy cholesterol levels is an important public health goal. A healthy diet, regular physical activity, and avoiding tobacco smoke should be considered the basic tenants of preventing hyperlipidemia. And for some people, lifestyle changes alone aren’t enough to reach healthy cholesterol levels and medication may be necessary. Our findings do not alter current recommendations for the maintaining/attaining healthy cholesterol levels. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Schnatz: We need more and well-designed studies to bring the pieces of the puzzle together. • Citation: • Calcium/vitamin D supplementation, serum 25-hydroxyvitamin D concentrations, and cholesterol profiles in the Women’s Health Initiative calcium/vitamin D randomized trial. • Schnatz PF1, Jiang X, Vila-Wright S, Aragaki AK, Nudy M, O’Sullivan DM, Jackson R, Leblanc E, Robinson JG, Shikany JM, Womack CR, Martin LW, Neuhouser ML, Vitolins MZ, Song Y, Kritchevsky S, Manson JE. • Menopause. 2014 Mar 3. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  6. 6. Emergency Room Prescriptions for Opioid Pain Medications Markedly Increase MedicalResearch.com Interview with: Maryann Mazer-Amirshahi PharmD, MD The Department of Emergency Medicine, The George Washington University The Department of Clinical Pharmacology, Children’s National Medical Center, Washington, DC • MedicalResearch.com: What are the main findings of the study? • Answer: We found a significant increase in the prescribing of opioid pain medications in the emergency department. At the same time, this was not accounted for by a similar increase in pain-related visits and prescribing patterns of non-opioid analgesics did not change. • MedicalResearch.com: Were any of the findings unexpected? • Answer: We were surprised by the fact that the most profound increases were for opioid medications that are very potent and have high abuse potential, such as hydromorphone. In addition, we found very significant increases in opioid prescribing for conditions for which opioids are not recommended for first-line treatment, such as headache and chest pain. • MedicalResearch.com: What should clinicians and patients take away from this study? • Answer: These findings are very concerning given the current rates of opioid abuse, overdoses, and related-fatalities. We hope this report encourages emergency medicine providers to consider evidence-based recommendations for opioid prescribing, optimize available non-opioid therapies whenever possible, and if opioids are prescribed, to facilitate appropriate follow up. • MedicalResearch.com: What recommendations do you have for future research as a result of your study? • Answer: Ideally, future areas of study would include to further describe the link between the prescription and subsequent misuse or abuse, the effect of prescription drug monitoring programs and other initiatives on opioid prescribing in emergency departments, and to further develop evidence-based recommendations to guide opioid prescribing. • Citation: • Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001–2010 Maryann Mazer-Amirshahi PharmD, MD, Peter M. Mullins MA, Irit Rasooly, John van den Anker MD, PhD and Jesse M. Pines MD, MBA, MSCE • Article first published online: 13 MAR 201 • Academic Emergency Medicine 2014;21:236–243 © 2014 by the Society for Academic Emergency Medicine Read the rest of the interview on MedicalResearch.com
  7. 7. Osteoarthritis: Total Hip, Knee Replacements Reduce Cardiovascular Risk MedicalResearch.com Interview with: Bheeshma Ravi, MD Orthopedic Surgery University of Toronto Medical Center • MedicalResearch.com: What are the main findings of the study? • Dr. Ravi: This study suggests that in persons with moderate-severe osteoarthritis of the hip or knee, total joint replacement is associated with a significant reduction in the risks for serious cardiovascular events. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Ravi: The main finding of this study is provocative and warrants further investigation, hopefully in larger studies. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Ravi: Osteoarthritis is associated with significant medical morbidity, and this morbidity is likely proportional to the severity of their underlying OA. This study indicates that managing their Osteoarthritis also has a benefit on these other morbidities. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Ravi: Any future work should utilize a cohort of persons with confirmed arthritis, and hopefully capture information on the same scale as the current project. • Citation: • American Academy of Orthopedic Surgeons Abstract March 2014 • TJA Appears Cardioprotective in Patients with Moderate-severe OA: A Propensity-score Matched Landmark Analysis • Bheeshma Ravi, MD, Toronto, Canada Ruth Croxford, MSc, Toronto, Canada Peter Austin, Toronto, Canada Lorraine Lipscombe, Toronto, Canada Arlene Bierman, MD, MS, Toronto, Canada Paula Harvey, MBBS, PhD, Toronto, Canada Gillian Hawker, MD, Toronto, Canada Read the rest of the interview on MedicalResearch.com
  8. 8. Do patients Need to Fast Prior to Coronary Interventions? MedicalResearch.com Interview with: Dr Tahir Hamid MRCP (UK), FESC Department of Cardiology, Royal Albert Edward Infirmary NHS Trust, Wigan, UK • MedicalResearch.com: What are the main findings of the study? • Dr. Hamid: Traditionally patients undergoing diagnostic and interventional coronary artery procedures are kept Nil-by- mouth, but until yet there exists neither evidence nor clear guidance about the benefits of this practice in such patients. In our study performed at two National Health Services (NHS) institutes, we demonstrated in our 1916 patients, that such procedures could be undertaken without the need for being 4-6 hours fasting. None of our patients had major complications leading to pulmonary aspiration or emergency cardiac surgery. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Hamid: Our study demonstrates that although there are coronary interventions related risks but emergency intubations leading to pulmonary aspiration was not common to our surprise. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Hamid: This study is a prime example of quality improvement in providing safe and effective services to the patients. Our study is the starting point for global discussion to the traditional strict rules of pre-procedural fasting. As from our on- call cardiology commitments, we know that patients coming for Primary Percutaneous coronary interventions following acute myocardial infarction are not starved in the community and still they do well. • We recommend that based on the local guidance, clinician should start thinking of relaxing such strict rules of nil-per-mouth, which will have impact on health economics, patient satisfaction, less risk of missing medications, less overnight admissions for pre-hydrations and similarly less possibility of renal impairment. • Similarly, we demonstrated these results could well be applicable to physicians who are radial or femoral operators. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Hamid: This is a retrospective study with no randomization or control arm. We recommend a randomised control study. We would suggest relaxing the stringent rules of pre-procedural fasting should be relaxed in low risk coronary interventions but this should be based on the local guidelines. • Citation: • Pre-procedural fasting for coronary interventions: is it time to change practice • • Citation: Pre-procedural fasting for coronary interventions: is it time to change practice? • Tahir Hamid, Qaiser Aleem, Yeecheng Lau, Ravi Singh, John McDonald, Sanjay Sastry, Sanjay Arya, Anthony Bainbridge, Telal Mudawi, Kanarath Balachandran • Heart heartjnl-2013-305289Published Online First: 12 February 2014 doi:10.1136/heartjnl-2013-305289 Read the rest of the interview on MedicalResearch.com
  9. 9. Headache Imaging Costs $1 Billion Dollars Per Year MedicalResearch.com Interview Invitation with: Dr. Brian C. Callaghan MD Department of Neurology University of Michigan Health System, Ann Arbor • MedicalResearch.com: What are the main findings of the study? • Dr. Callaghan: The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time. MedicalResearch.com: Were any of the findings unexpected? • Dr. Callaghan: Yes, given that multiple guidelines recommend against neuroimaging in most patients with headaches, the magnitude of neuroimaging in this population is surprising. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Callaghan: Patients and physicians should re-evaluate when to order or ask for headache neuroimaging. The number one reason physicians state they order these tests is for patient reassurance. However, $1 billion is a lot to spend for reassurance. Also, these tests can lead to false positive results and unnecessary procedures. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Callaghan: Future studies should investigate ways to improve guideline adherence, which has the potential to decrease healthcare costs substantially. • Citation: • Headaches and Neuroimaging: High Utilization and Costs Despite Guidelines • Brian C. Callaghan, MD, MS; Kevin A. Kerber, MD, MS; Robert J. Pace, MD; Lesli E. Skolarus, MD, MS; James F. Burke, MD, MS JAMA Internal Medicine. 2014. Read the rest of the interview on MedicalResearch.com
  10. 10. Saturated Fatty Acid Not Associated with Coronary Artery Disease? MedicalResearch.com Interview with: Rajiv Chowdhury MD, PhD Cardiovascular Epidemiologist Department of Public Health and Primary Care University of Cambridge • MedicalResearch.com: What are the main findings of the study? • Dr. Chowdhury: Total saturated fatty acid, whether measured as a dietary intake variable or in the bloodstream as a biomarker, was not associated with coronary disease risk in combining all available prospective observational studies. Similarly, there were non-significant overall associations in the prospective studies that involved assessments of total monounsaturated fatty acids, long-chain omega-3 and omega-6 polyunsaturated fatty acids. • However, we found diversity in the observational associations between specific circulating long-chain omega-3 and omega-6 fatty acids with coronary risk, with some evidence that circulating levels of eicosapentaenoic and docosahexaenoic acids (ie, the two main types of long-chain omega-3 polyunsaturated fatty acids), and arachidonic acid are each associated with lower coronary risk. Similarly, within saturated fatty acids, there were positive, however, non-significant associations observed for circulating blood composition of palmitic and stearic acids (found largely in palm oil and animal fats, respectively), whereas circulating margaric acid (a milk fat) had a significant inverse association. • Additionally, when we investigated the randomised controlled trials that reported on the effects of omega- 3 and omega-6 fatty acids on reducing coronary outcomes, there was no significant overall association observed. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Chowdhury: The pattern of findings from this review does not lend support to cardiovascular guidelines that promote high consumption of long-chain omega-3 and omega-6 polyunsaturated fatty acids and that suggest reduced consumption of total saturated fatty acids. Also, interestingly, when specific fatty acid subtypes were examined, there was diversity in the associations across individual fatty acids with coronary risk within the same broad family of fatty acid considered. Read the rest of the interview on MedicalResearch.com
  11. 11. Saturated Fatty Acid Not Associated with Coronary Artery Disease? MedicalResearch.com Interview with: Rajiv Chowdhury MD, PhD Cardiovascular Epidemiologist Department of Public Health and Primary Care University of Cambridge • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Chowdhury: There was a lack of association for “total” fatty acid groups and an important heterogeneity of association across “individual” subtype fatty acids with in broad fatty acid groups. This suggests that the current (typically composite) nutrient-based guidelines should perhaps consider this diversity (and potential interplay) of different individual nutrients which may have divergent biological and health effects. We believe that a more “food-focused” approach should be considered so that the patients can consume the fatty acid food sources that are beneficial (or not harmful) to cardiovascular health. When certain foods such as red and processed meat are avoided, they should be replaced them with nuts, fatty fish, and healthy oils—but importantly not with white rice, white bread, potatoes, sugary drinks, or other refined carbohydrates. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Chowdhury: There were moderate amount of available data on some specific circulating fatty acids that future large-scale and more detailed studies should look at. Additionally, the effect of omega-3 and omega-6 fatty acids in general populations are required. • Citation: • Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis • Rajiv Chowdhury, MD, PhD; Samantha Warnakula, MPhil*; Setor Kunutsor, MD, MSt*; Francesca Crowe, PhD; Heather A. Ward, PhD; Laura Johnson, PhD; Oscar H. Franco, MD, PhD; Adam S. Butterworth, PhD; Nita G. Forouhi, MRCP, PhD; Simon G. Thompson, FMedSci; Kay-Tee Khaw, FMedSci; Dariush Mozaffarian, MD, DrPH; John Danesh, FRCP*; and Emanuele Di Angelantonio, MD, PhD • Ann Intern Med. 2014;160(6):398-406-406. doi:10.7326/M13-1788 Read the rest of the interview on MedicalResearch.com
  12. 12. Gestational Diabetes Increases Risk of Future Heart Disease MedicalResearch.com Interview with: Erica P. Gunderson, PhD, MS, MPH Senior Research Scientist, Cardiovascular and Metabolic Section Division of Research, Kaiser Permanente Northern California Oakland, CA 94612-2304 • MedicalResearch.com: What are the main findings of the study? • Dr. Gunderson: The study found that: • - Gestational diabetes is a pregnancy complication that reveals a woman’s greater risk of future heart disease. • - Women who experience gestational diabetes face an increased risk of subclinical atherosclerosis (early heart disease) even if they do not develop type 2 diabetes or the metabolic syndrome years after pregnancy. • - Study participants with a history of gestational diabetes who did not develop diabetes or metabolic syndrome showed a greater carotid artery wall thickness (marker of early atherosclerosis) compared to those who never experienced gestational diabetes. The vessel narrowing also could not be attributed to obesity or other risk factors for heart disease that were measured before pregnancy. • - Weight gain and blood pressure elevations in women with gestational diabetes were responsible for these differences in the artery wall thickness. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Gunderson: This is the first longitudinal study, and is unique in that pre-pregnancy risk factors were measured and controlled. Read the rest of the interview on MedicalResearch.com
  13. 13. Gestational Diabetes Increases Risk of Future Heart Disease MedicalResearch.com Interview with: Erica P. Gunderson, PhD, MS, MPH Senior Research Scientist, Cardiovascular and Metabolic Section Division of Research, Kaiser Permanente Northern California Oakland, CA 94612-2304 • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Gunderson: Cardiovascular disease is the leading cause of death in U.S. women. • Women who have a history of Gestational diabetes, and their health practitioners, should be aware that Gestational diabetes history reveals an increased risk of early atherosclerosis before overt metabolic disease develops. • Practitioners should consider monitoring women with previous Gestational diabetesmore closely by screening them for traditional heart disease risk factors after pregnancy. • Our finding that Gestational diabetes history reveals risk of early atherosclerosis before overt metabolic disease is important to primary prevention efforts, particularly for weight and blood pressure control. • Body size, blood pressure control and insulin resistance are important modifiable risk factors that may influence progression of atherosclerosis in women with previous GDM during midlife. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Gunderson: Future studies are needed to examine other modifiable behaviors in postpartum women such as breastfeeding, and their impact on lowering risk of early atherosclerosis in women with a history of gestational diabetes. • Citation: • History of Gestational Diabetes Mellitus and Future Risk of Atherosclerosis in Mid‐life: The Coronary Artery Risk Development in Young Adults Study • Erica P. Gunderson, Vicky Chiang, Mark J. Pletcher, David R. Jacobs, Charles P. Quesenberry, Stephen Sidney, and Cora E. Lewis • J Am Heart Assoc. 2014;3:e000490, originally published March 12, 2014, doi:10.1161/JAHA.113.000490 Read the rest of the interview on MedicalResearch.com
  14. 14. Higher Risk Young Women May Be Less Likely to be Offered, Accept HPV Vaccine MedicalResearch.com Interview with: Dr Rachel J Sacks Jefferiss Wing, St Mary’s Hospital Imperial College Healthcare NHS Trust, London UK • MedicalResearch.com: What is the background of this study? • Dr. Sacks: 2247 anonymous questionnaires were completed by young women, aged 13-19 years old, attending sexual health services across England, looking at their HPV vaccination outcomes and prevalence of risk factors associated with HPV acquisition and cervical cancer development, and comparing the survey results with national data where available. Known HPV acquisition and cervical cancer development risk factors include cigarette smoking, early age at first intercourse, increasing number of lifetime partners, co-infection with other sexually transmitted infections. • MedicalResearch.com: What are the main findings of the study • Dr. Sacks: • Young women, aged 13 to 19 years old attending sexual health services across England had higher prevalence of known risk factors associated with HPV acquisition and cervical cancer development, compared with national data. • Survey respondents had lower HPV vaccination offer and lower HPV vaccination completion rates than nationally. • Subgroups within the survey respondents were identified as having a significantly lower offer and significantly lower completion rate of the HPV vaccination. These subgroups included respondents from London, those of non-white ethnicities, 17 to 19 year olds, smokers and those not in education, employment or training (NEETs). • The highest risk individuals, in terms of HPV related risk factors, were the least likely to be offered and additional the least likely to complete the HPV vaccination course. • Currently sexual health services in England are not involved in the delivery of the HPV vaccination programme and this is felt to be a huge missed opportunity for the primary prevention of HPV acquisition and its potential sequelae. Sexual health services should be included as a supplementary HPV vaccination delivery site in order to target these particularly vulnerable young women and to increase the success of the HPV vaccination programme in England. Read the rest of the interview on MedicalResearch.com
  15. 15. Higher Risk Young Women May Be Less Likely to be Offered, Accept HPV Vaccine MedicalResearch.com Interview with: Dr Rachel J Sacks Jefferiss Wing, St Mary’s Hospital Imperial College Healthcare NHS Trust, London UK • MedicalResearch.com: Were any of the findings unexpected? • Dr. Sacks: We were expecting to demonstrate that young women attending sexual health services were vulnerable in terms of risk factors associated with HPV acquisition and cervical cancer development based on previous research. However, we were surprised by the extent of the prevalence of these risk factors in our survey respondents compared with the comparative UK national data, particularly in terms of smoking rates (48% vs. 14% of 15 year olds), rates of coitarche under 16 (52% vs. 38%), inconsistent/no condom use (88% vs. 76% in 16 to 19 year olds) and previous sexually transmitted infections (25% vs. 4%). • We were also surprised by the high proportion of survey respondents who were not in education, employment or training (NEETs). We believe this sub group of young people are particularly vulnerable: not only do they have even higher rates of risk factors making them more vulnerable to acquiring HPV and developing cervical cancer but they were the subgroup with the lowest HPV vaccination completion rates. Respondents living in London, those of non white ethnicity, those aged 17 to 19 and smokers were also found to have lower HPV vaccination offer and lower completion rates than the survey respondents overall, but to a lesser extent than seen in NEETs. • Although no HPV vaccine uptake target has been set in the UK, previous research has demonstrated that an 80% uptake of the 3-dose course should have a significant impact on cervical cancer rates. National UK data demonstrated a 66% completion rate of HPV vaccination in eligible women in the first 3 years of the UK programme, which was introduced in 2008. We were surprised to find that the overall completion rates of the HPV vaccination in our survey respondents was even lower at just 47%. Not only were the respondents less likely to complete the vaccination but also less likely to be offered the vaccination in the first place. There is evidence from previous research that some schools in England are opting out of the HPV vaccination delivery programme which may result in even lower offer rates in the future. • Overall we are concerned that young women attending sexual health services are particularly vulnerable to acquiring HPV and cervical cancer but are less likely to be offered and less likely to complete the HPV vaccination course that might have reduced their risk of acquiring oncogenic HPV. The subgroups discussed above (namely NEETs, London respondents, those of non-white ethnicities, 17 to 19 year olds and smokers) are at additional risk and the concern is that the reasons they didn’t receive the HPV vaccination (i.e. lack of awareness of risk and poor engagement with healthcare services) may follow them into adulthood, which ultimately may result in them not attending for cervical cytological screening, further increasing their vulnerability to the effect of HPV. • In addition, we were surprised that those who were offered the vaccination, but declined it, reported that they might have accepted the offer had they, their parents and their friends received better information re indications efficacy safety of the vaccination and those who did not complete the course the most common reason was not being adequately followed up. • Currently sexual health services in the UK are not participating in the vaccination delivery programme and we believe that this is a huge missed opportunity. We feel that sexual health services are ideally placed to access these at risk women, to counsel them so that they can make an informed decision and encourage and support them in completing the course. Read the rest of the interview on MedicalResearch.com
  16. 16. Higher Risk Young Women May Be Less Likely to be Offered, Accept HPV Vaccine MedicalResearch.com Interview with: Dr Rachel J Sacks Jefferiss Wing, St Mary’s Hospital Imperial College Healthcare NHS Trust, London UK • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Sacks: All eligible should be counselled thoroughly by Healthcare professionals about HPV infection (it’s transmission, asymptomatic and symptomatic presentations, and potential sequelae) about the HPV vaccination (it’s indication, efficacy and safety) and about the cervical cytological screening programme. • Healthcare professionals may be able to identify young women who have not had the HPV vaccination through routine delivery programmes and in addition identify those at higher risk of developing cervical cancer in order to target these women. • Healthcare professionals can play an important role in raising awareness of these issues and supporting young women to access the HPV vaccination programme and complete the course, as well as to offer advice on how to reduce their risks of acquiring HPV and developing cervical cancer. This advice could include promoting safe sex and condom use, encouraging regular attendance for sexual health screening, offering smoking quitting programmes and continuing to provide regular cervical screening to eligible women. • This research will hopefully raise patients’ awareness of HPV infection, it’s potential sequelae and the HPV related modifiable risk factors. These modifiable risk factors include smoking, early age at first sexual intercourse, increasing numbers of lifetime sexual partners, co-infections with other sexually transmitted infections and attending for cervical cytological screening. We hope that this research will highlight the importance of completing the HPV vaccination course. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Sacks: We would like to extend this research to look at young men, who are not currently part of the UK HPV vaccination delivery programme, attending sexual health services to ascertain whether by including them in the programme in future could improve overall herd immunity. In addition we would like to look at HIV positive young people and their risk factors of acquiring HPV and its sequelae. We know that immunocompromised people are particularly susceptible to oncogenic HPV effects and believe that HIV positive individuals should be offered the HPV vaccination. • Citation: • Uptake of the HPV vaccination programme in England: a cross-sectional survey of young women attending sexual health services • Rachel J Sacks, Andrew J Copas, Dawn M Wilkinson, Angela J Robinson • Sex Transm Infect sextrans-2013-051179Published Online First: 17 March 2014 doi:10.1136/sextrans-2013-051179 Read the rest of the interview on MedicalResearch.com
  17. 17. Hematuria and Cancer Evalution: Guidelines Mostly Not Followed By Physicians MedicalResearch.com Interview with: Dr. Atul Shinagare MD Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 • MedicalResearch.com: What are the main findings of the study? • Answer: We evaluated 100 randomly selected patients from a cohort of 1771 patients evaluated for asymptomatic hematuria in 2004 at our institution in order to assess physician adherence to the 2001 American Urological Association (AUA) guidelines for evaluating patients and its impact on the diagnosis of urologic cancer. We found that most (64%) patients were not evaluated according to the guidelines, that there was substantial variation in the evaluation, and that the evaluation depended largely on the type of hematuria and physician specialty. Only 5% of patients were found to have urologic cancer, and all of them were evaluated according to the guidelines. No additional urologic cancers were diagnosed in patients in whom guidelines were not followed; however, since not all patients were tested thoroughly, occult malignancies may have been present. • MedicalResearch.com: Were any of the findings unexpected? • Answer: Other than urologists, most physicians did not follow the guidelines. We had expected a larger proportion of physicians to adhere to the guidelines. We were surprised to find that no urologic cancers were diagnosed in patients who were not evaluated according to the guidelines. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The approach to patients with asymptomatic hematuria was highly variable, and largely not guideline adherent. This could be in part due to lack of awareness or acceptance of the guidelines by clinicians. Hematuria can be the only sign of a urologic cancer, but most of the time hematuria is not due to cancer, and therefore effective guidelines are needed to maximize the chance of detecting cancer while limiting the over-utilization of diagnostic tests. Since no urologic cancers were diagnosed in patients who were not evaluated according to the 2001 guidelines (barring occult cancers) it is hoped that future guidelines could be devised such that fewer patients would need to be tested. Additional studies will be needed to evaluate the impact of the current, 2012 AUA guidelines. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: The current 2012 version of AUA guidelines have been devised to minimize the possibility of missing urologic malignancies as high quality evidence on which patients with hematuria can be safely spared an evaluation is lacking. Future research to help develop such high quality evidence will be needed before existing guidelines can be effectively improved. • Citation: • Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis Atul B. Shinagare, Stuart G. Silverman, Esteban F. Gershanik, Steven L. Chang, Ramin Khorasani The American Journal of Medicine – 24 February 2014 (10.1016/j.amjmed.2014.02.013) Read the rest of the interview on MedicalResearch.com
  18. 18. Prostate Cancer Detection: Accuracy of Multiparametric MRI For Detection MedicalResearch.com Interview with: Dr. Maarten de Rooij MD, PhD Candidate Department of Radiology Radboud University Nijmegen Medical Centre Nijmegen, Gelderland 6525 GA, The Netherlands • MedicalResearch.com: What are the main findings of the study? • Dr. de Rooij : Prostate cancer is the most common cancer in men and the second leading cause of cancer related death. The current diagnosis is based on ‘random or blind’ systematic transrectal ultrasound guided prostate biopsies in men with an elevated PSA. This can lead to over-diagnosis and over-treatment of prostate cancer, but can also miss important tumors. The role of multiparametric MRI (mpMRI) to improve the diagnosis of prostate cancer is evolving. In this meta-analysis we determined the diagnostic accuracy of mpMRI for the detection of prostate cancer. Our analysis included 7 studies using mpMRI which showed high overall specificity (0.88; 95% CI 0.82-0.92), with variable but high negative predictive values (0.65 – 0.95) and sensitivities (0.74; 95% CI 0.66-0.81). MedicalResearch.com:Were any of the findings unexpected? • Dr. de Rooij: One of the things we encountered was the difference in quality of reporting between the included studies. The overall quality was fair, but the quality assessment showed that there is still room for improvement. Two factors that contribute to the loss of quality are methodological weaknesses and failure to report sufficient information to reproduce a study. When performing a diagnostic meta-analysis it is important to systematically assess the quality of the included studies with the QUADAS-2 tool. An overview of the quality can give readers insight into the value of the outcomes of the meta-analysis. • MedicalResearch.com:What should clinicians and patients take away from your report? Dr. de Rooij:Our study shows the potential of mpMRI to improve prostate cancer detection. Recent prospective studies support our findings and show the benefits of an MRI based diagnostic pathway in which MRI is performed before MR-targeted prostate biopsy. As with mp-MRI predominantly significant Prostate Cancer is seen and indolent cancer is not diagnosed, this technique has the potential to solve the problems of the current TRUSGB driven diagnostic pathway. • MedicalResearch.com:What recommendations do you have for future research as a result of this study? • Dr. de Rooij: Researchers should be aware of the available guidelines for reporting (STARD guidelines) and the criteria that are used to assess the study quality (QUADAS-2 tool). Furthermore, it is important to involve someone with sufficient methodological knowledge to prevent flaws in the study design. The STARD guideline and QUADAS-2 tool provide recommendations and a checklist which can help researchers improve their future diagnostic research. • Citation: • Accuracy of Multiparametric MRI for Prostate Cancer Detection: A Meta-Analysis • Maarten de Rooij1, , Esther H. J. Hamoen1, 3, Jurgen J. Fütterer1, Jelle O. Barentsz1 and Maroeska M. Rovers, • American Journal of Roentgenology February 2014, Volume 202, Number 2 • Read the rest of the interview on MedicalResearch.com
  19. 19. Infant Feeding: Racial and Ethnic Differences Require Culturally-Tailored Counseling MedicalResearch.com Interview Invitation with: Dr. Eliana M. Perrin, MD, MPH Associate Vice Chancellor for Research, and Director, Office of Research Development University of North Carolina at Chapel Hill and Associate Professor Chapel Hill, NC 27599-7225 • MedicalResearch.com: What are the main findings of the study? • Dr. Perrin: The study included a large, diverse sample of 863 low-income parents of two-month-olds participating in Greenlight, an obesity prevention trial taking place at four medical centers: UNC, New York University, Vanderbilt University and the University of Miami. Among all of the parents, behaviors that are thought to be related to later obesity were highly prevalent. Exclusive formula feeding was more than twice as common (45 percent) as exclusive breastfeeding (19 percent). Twelve percent had already introduced solid food, 43 percent put infants to bed with bottles, 23 percent propped bottles instead of holding the bottle by hand (which can result in overfeeding), 20 percent always fed when the infant cried, and 38 percent always tried to get their children to finish their milk. In addition, 90 percent of the infants were exposed to television and 50 percent actively watched TV (meaning parents put their children in front of the television in order to watch). There were differences in these behaviors by race and ethnicity, and study results show that culturally-tailored counseling should be offered to parents of different backgrounds who may feed and play with their children differently. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Perrin: Yes, the high rates of both television exposure as well as active television watching were really unexpected. These are two month old children, so we really just did not expect them to be “watching” television! • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Perrin: We as pediatricians need to begin obesity prevention even earlier, and we can help parents learn some of the ways we think will keep their children healthy. We cannot wait until the 12 or 18 month well child visit to begin to talk with families about television. We also should talk with families about not over-feeding. We should encourage parents to pay attention to cues as to whether their children are hungry or full. Parents look to us to provide guidance on these issues. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Perrin: Since counseling should be probably be culturally-tailored, we are hoping that our research and that of others sheds light on the best ways to do that. Also, we need to learn which of these potentially “obesogenic” behaviors are the most related to obesity and health problems later on in life. • Citation: • Racial and Ethnic Differences Associated With Feeding- and Activity-Related Behaviors in Infants Eliana M. Perrin, Russell L. Rothman, Lee M. Sanders, Asheley C. Skinner, Svetlana K. Eden, Ayumi Shintani, Elizabeth M. Throop, and H. Shonna Yin • Pediatrics peds.2013-1326; published ahead of print March 17, 2014, doi:10.1542/peds.2013-1326 Read the rest of the interview on MedicalResearch.com
  20. 20. COPD and Risk of Mild Cognitive Impairment MedicalResearch.com Interview with: Michelle M. Mielke, Ph.D. Associate Professor Department of Health Sciences Research, Division of Epidemiology Department of Neurology Mayo Clinic Rochester, MN 55905 • MedicalResearch.com: What are the main findings of the study? • Dr. Mielke: Using a population-based sample of cognitively normal individuals, aged 70-89 at baseline, we found that a medical-record confirmed diagnosis of COPD was associated with an increased risk of mild cognitive impairment, specifically non-amnestic mild cognitive impairment. The risk of mild cognitive impairment increased with a longer duration of COPD such that individuals who had COPD for more than 5 years had a 2.5-fold increased risk of developing non-amnestic mild cognitive impairment. MedicalResearch.com: Were any of the findings unexpected? • Dr. Mielke: Two cross-sectional studies reported a higher frequency of COPD among individuals with MCI (Singh et al., 2013; Villeneuve et al., 2012). However, only one longitudinal study had been previously conducted. This study, among a population-based sample with medical-record confirmed diagnoses of COPD, provides further evidence that COPD is associated with MCI. Specifically, in the present study, we found that COPD was primarily associated with the non-amnestic type of mild cognitive impairment. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Mielke: It is important to aggressively treat COPD early, in an effort to prevent or delay the onset of mild cognitive impairment. It is also important to regularly assess cognitive function among people who have COPD. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Mielke: This research further suggests that COPD is associated with risk of mild cognitive impairment, specifically non-amnestic mild cognitive impairment. A next step is to understand the mechanisms by which COPD increases the risk of mild cognitive impairment. • Citation: • A Prospective Study of Chronic Obstructive Pulmonary Disease and the Risk for Mild Cognitive Impairment • Singh B, Mielke MM, Parsaik AK, et al. A Prospective Study of Chronic Obstructive Pulmonary Disease and the Risk for Mild Cognitive Impairment. JAMA Neurol. 2014;():. doi:10.1001/jamaneurol.2014.94. Read the rest of the interview on MedicalResearch.com
  21. 21. Fried Food Consumption and Obesity Linked to Genetic Predisposition MedicalResearch.com Interview with: Prof. Lu Qi, Assistant Professor, Department of Nutrition Harvard School of Public Health and Channing Division of Network Medicine Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA • MedicalResearch.com: What are the main findings of the study? • Dr. Lu Qi: In this study, we for the first time provide reproducible evidence from three large cohort studies to show that the association between regular consumption of fried foods and higher BMI was particularly pronounced among people with a greater genetic predisposition to obesity. On the other hand, the adverse genetic effects on BMI were also amplified by consuming more fried foods, the effects among those who ate fried foods more than four times a week was about twice as large compared with those who ate them less than once a week. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Lu Qi: It has been increasingly accepted human genome make-up may interplay with our lifestyle and diet in determining obesity, but know little about which lifestyle or dietary factors play roles in such interactions. Our findings are ground breaking. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Lu Qi: We encourage everyone to reduce fried food intakes and follow a healthy lifestyle. However, it appears time to start to consider how to integrate the novel genomic knowledge into our future health recommendations and practices. The new knowledge hold great promise to improve the efficacy of prevention and treatment of obesity and other metabolic disease, especially in those genetically at high risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Lu Qi: Large scale international collaborations are highly needed to further validate our findings, especially in those of various ethnicities. Our study only included adults, it is equally important to address the gene-fried food interactions in children. I also look forward to collaborations with experts in functional research to explore the potential mechanisms underlying the gene-diet interactions. • Citation: • BMJ: Fried Food Consumption, Genetic Risk and Body Mass Index Gene-Diet Interaction Analysis in Three US Cohort Studies • Qi Q ,Chu AY ,Kang JH ,Huang J ,Rose LM ,Jensen MK ,et al. Fried food consumption, genetic risk, and body mass index: gene- diet interaction analysis in three US cohort studies. BMJ 2014;348:g1610 Read the rest of the interview on MedicalResearch.com
  22. 22. Optimizing Neonatal Organ Donations MedicalResearch.com Interview with: Dr Joe Brierley Great Ormond Street Hospital for Children Ormond Street, London WC1N 3JH, UK • MedicalResearch.com: What are the main findings of the study? • Dr. Brierley: In the UK babies under 2-months of age cannot be verified as having died using ‘neurological criteria,’ due to national guidelines; whereas in North America, Australasia and other European countries his is possible. Because of this no organ donation from those under 2-months occurs in the UK contributing to the lack organs for small children who could benefit from such lifesaving interventions. • Our study finds that if the rules were changed to be compatible with other countries their would be a significant yield of organs from one specialist children’s hospital, and likely to be many more nationally. MedicalResearch.com: Were any of the findings unexpected? • Dr. Brierley: Our study showed that of 84 infants dying over the 6.5-year period: 45 were potential donors (34 after circulatory definition of death, 11 possible neurological determination of death). • Given an annual UK rate of 40-50 deceased donors under 19-years annually there is a significant potential to impact on this from one specialist children’s hospital NICU. Other factors such as parental consent rates, organ suitability and retrieval factors are also key factors. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Brierley: Reconsideration of current infant UK death verification guidelines is required to allow parents the opportunity of donation. Mandatory training in organ donation for neonatal teams should also be introduced. • The families of dying babies ought to given this option to help other people during this most tragic of times for times. For some babies this remains their only option at survival and archaic medical guidelines cannot be permitted to prevent this. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Brierley: Similar studies on neonatal organ donation – both in other UK units, and in other countries – would be helpful to compare and optimize practice in this under-researched area. • Citation: • The potential for neonatal organ donation in a children’s hospital, Archives of Disease in Childhood, Online First, DOI: 10.1136/archdischild-2013-304803 Read the rest of the interview on MedicalResearch.com
  23. 23. Alzheimer’s Disease: Repairing Golgi Structures May Reduce Toxic Plaques MedicalResearch.com Interview with: Yanzhuang Wang, PhD Associate professor Dept. of Molecular, Cellular and Developmental Biology and Dept. of Neurology University of Michigan Ann Arbor, MI 48109-1048 • MedicalResearch.com: What are the main findings of the study? • Dr. Wang: We learned how to repair a cellular structure called the Golgi apparatus that is broken in Alzheimer’s disease. This helps us understand how to reduce the formation of the toxic plaques that kill cells in the brain of Alzheimer’s patients. The formation of amyloid plaques is a hallmark of Alzheimer’s disease; but exactly how much the plaques contribute to the disease is still not known. Our study found that the broken Golgi in the disease may be a major source of the toxicity of amyloid plaques. We showed in this study that repairing the Golgi can reduce the formation of the toxic plaques and thus may delay the disease development. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Wang: It is unexpected to see that amyloid plaques exert their toxicity by affecting the Golgi structure and function. The Golgi is a cellular organelle that functions like the post office in the cell. It sends proteins where they are supposed to go; many of these proteins need to go to the right places to perform cellular functions. When the Golgi malfunctions it’s like the post office stops sending mail or sends it to the wrong place. This can cause health problems. Because Golgi defects contribute to the formation of the toxic plaques in the brain, repairing the Golgi can reduce the formation of these plaques and missorting of proteins in the cell. Read the rest of the interview on MedicalResearch.com
  24. 24. Alzheimer’s Disease: Repairing Golgi Structures May Reduce Toxic Plaques MedicalResearch.com Interview with: Yanzhuang Wang, PhD Associate professor Dept. of Molecular, Cellular and Developmental Biology and Dept. of Neurology University of Michigan Ann Arbor, MI 48109-1048 • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Wang: Alzheimer’s patients have these plaques, but exactly how they cause the disease is still not known. The finding of Golgi defects may help us understand the cause of the disease, and repairing the Golgi may reduce the formation of the toxic plaques. In this sense we have identified the Golgi as a new drug target for the treatment of the disease because molecular tool that can restore Golgi structure and function may delay disease development. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Wang: So far our idea is mainly based on experiments in cells in the petri dish. In the next a few years we will test this idea in mouse models and screen for small molecules that could potentially be used to repair the Golgi in the brain of Alzheimer’s patients. If our findings go well, we may be able to develop a potent drug to help slow the formation of these plaques and delay the disease development in patients in the future. • Citation: • Gunjan Joshi, Youjian Chi, Zheping Huang, and Yanzhuang Wang • Aβ-induced Golgi fragmentation in Alzheimer’s disease enhances Aβ production PNAS 2014 ; published ahead of print March 17, 2014, doi:10.1073/pnas.1320192111 • Read the rest of the interview on MedicalResearch.com
  25. 25. Gene Variant Influencing Cholesterol and Myocardial Risk Discovered MedicalResearch.com Interview with: Cristen J. Willer, PhD Assistant Professor Division of Cardiovascular Medicine, Dept of Internal Medicine Dept of Human GeneticsDept of Computational Medicine and Bioinformatics University of Michigan Ann Arbor, MI 48109-5618 • MedicalResearch.com: What are the main findings of the study? • Dr. Willer: We wanted to find new genes related to heart disease, so we examined the DNA of approximately 10,000 Norwegian individuals and found 10 genes that are important regulators of blood cholesterol levels. Nine of these were well known to be related to lipids, but one gene was new. It turned out to be in a region we’d previously noticed to be related to cholesterol, but it was a big region and we hadn’t been able to pinpoint the gene yet. Using this new approach, focusing on DNA differences that result in slightly different proteins in people, we zeroed in on the gene. We then altered this gene in mice, and saw the predicted changes in cholesterol levels in mice. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Willer: We were not sure if we would find any new genes with this approach and a modest sample size (only 10,000 individuals) and were excited when we did. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Willer: The major scientific advance is that TM6SF2 is a gene that plays an important role in blood lipid levels, risk of heart attack, and risk of fatty liver disease. More research will be needed to understand exactly how this gene and its protein alter disease risk. Another important concept is that none of these discoveries would be possible without people being generous and donating DNA samples to genetics research. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Willer: I think continuing on genetic discovery experiments to understand the secrets of disease susceptibility hiding in our DNA is really important. Also, further exploration of the role of this gene in heart disease, liver disease and other metabolic diseases will help us understand if this gene will be a good drug target. We owe the success of this experiment to collaborative science where different people work together, in this case the Norwegians who donated their samples, clinicians and epidemiologists from the Norwegian University of Science and Technology, and statistical geneticists and molecular biologists from the University of Michigan. • Citation: • Systematic evaluation of coding variation identifies a candidate causal variant in TM6SF2 influencing total cholesterol and myocardial infarction risk • Oddgeir L Holmen, He Zhang, Yanbo Fan, Daniel H Hovelson, Ellen M Schmidt, Wei Zhou, Yanhong Guo, Ji Zhang, Arnulf Langhammer, Maja-Lisa Løchen, Santhi K Ganesh, Lars Vatten, Frank Skorpen, Håvard Dalen, Jifeng Zhang, Subramaniam Pennathur, Jin Chen, Carl Platou, Ellisiv B Mathiesen, Tom Wilsgaard, Inger Njølstad, Michael Boehnke, Y Eugene Chen, Gonçalo R Abecasis, Kristian Hveem & Cristen J Willer Read the rest of the interview on MedicalResearch.com
  26. 26. Diagnosing Pulmonary Embolism: Using Age-Adjusted D-Dimer Cutoff Levels Medical Research.com Interview with: Marc Righini, MD Division of Angiology and Hemostasis Geneva University Hospital, Geneva, Switzerland • MedicalResearch.com: What are the main findings of this study? • Dr. Righini: The study shows that when compared with a fixed D-Dimer cutoff of 500 ng/ml, the combination of pretest clinical probability assessment with age-adjusted D-dimer cut-off was associated with a larger number of patients in whom Pulmonary Embolism could be excluded, with a low likelihood of recurrent VTE. The benefit was the most important in patients 75 years or older, in whom using the age-adjusted cutoff instead of the 500 ng/ml cutoff increased five-fold the proportion of patients in whom PE could be excluded on the basis of D-dimer measurement. MedicalResearch.com: Were any of the findings unexpected? • Dr. Righini: These findings were not unexpected as our retrospective analysis on more than 5000 with suspected PE Pulmonary Embolism suggested a potential interest of the adjusted D-dimer cut-off. • MedicalResearch.com: What should patients and clinicians take away from this report? • Dr. Righini: The age adjusted D-dimer cut-off, defined as age per 10 in patients 50 years or more, is associated with an increased yield of the D-dimer test in elderly patients. • MedicalResearch.com: What future research do you recommend as a result of this study? • Dr. Righini: Overall, the age-adjusted D-dimer cut off has been tested retrospectively in many different clinical settings in more than 10.000 patients and the ADJUST-PE study brings also a prospective confirmation of the interest of the cut-off. Whether the age-adjusted cutoff can result in improved cost- effectiveness or quality of care remains to be demonstrated. • Citation: • Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism: The ADJUST-PE Study • Righini M et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: The ADJUST-PE Study. JAMA 2014 Mar 19; 311:1117. (http://dx.doi.org/10.1001/jama.2014.2135) Read the rest of the interview on MedicalResearch.com
  27. 27. H. influenzae In Pregnancy Associated with Invasive Infections, Poor Pregnancy Outcomes MedicalResearch.com Interview with: Shamez Ladhani, MRCPCH PhD Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London • MedicalResearch.com: What are the main findings of the study? • Dr. Ladhani: Pregnancy was associated with an increased of serious infection by a bacterium called Haemophilus influenzae which is usually associated with respiratory tract infections. Nearly all the H. influenzae were unencapsulated; that is, they did not have an outer sugar capsule which is often required to make the bacterium more virulent. The encapsulated H. influenzae type b (Hib), for example, was the most common cause of bacterial meningitis in your children prior to routine immunisation. We also found that infection with unencapsulated H. influenzae was associated with poor pregnancy outcomes, including miscarriages, stillbirth and premature birth. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Ladhani: Previous studies with small number of cases had indicated a possible increase associated with pregnancy but there are few case reports of severe unencapsulated H. influenzae infection during pregnancy, but none of the studies have been large enough to accurately estimate the increased risk during pregnancy or to assess pregnancy outcomes. Read the rest of the interview on MedicalResearch.com
  28. 28. H. influenzae In Pregnancy Associated with Invasive Infections, Poor Pregnancy Outcomes MedicalResearch.com Interview with: Shamez Ladhani, MRCPCH PhD Health Protection Services, Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Ladhani: • 1. Invasive unencapsulated H. influenzae infections are uncommon in healthy adults, but can cause serious illness in pregnant women. • 2. We only assessed cases where unencapsulated H. influenzae was isolated from an sterile site. The true burden of infection may be higher if we also consider non-invasive infections such as pneumonia and lower genital tract infections, which were not captured in our surveillance. • 3. Clinicians should consider unencapsulated H. influenzae as a serious pathogen during pregnancy and ensure that appropriate microbiological tests are done to identify this bacterium not only in pregnant women who develop a serious infection but also those with early miscarriage, stillbirth and premature birth. • 4. We also have to move towards merging maternal and infant case notes in order to better understand the true burden of perinatal infection. We identified a number of newborn babies who were seriously unwell at birth but the causative pathogen was not identified, most likely because their mother had received antibiotics during labor. Integrated case notes would allow us to better assess the devastating effects of specific infections in pregnant women as well as newborn babies • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Ladhani: • 1. We need to determine the true burden of unencapsulated H. influenzae and other bacteria such as group A and group B streptococci on early pregnancy fetal losses. Such cases are often under-investigated, especially for infection. A systematic assessment of all early pregnancy losses over a period of time would provide invaluable information on the contribution of serious infections and identify strategies for prevention • 2. Further studies are also needed to test whether the unencapsulated H. influenzae causing serious infections in pregnancy are genetically the same as those causing respiratory tract infections. This information would be vital for developing vaccines for preventing unencapsulated H. influenzae infections in the future. • Citation: • Risk of Invasive Haemophilus influenzae Infection During Pregnancy and Association With Adverse Fetal Outcomes Sarah Collins, MPH; Mary Ramsay, FFPHM; Mary P. E. Slack, FRCPath; Helen Campbell, MSc; Sally Flynn, FIBMS; David Litt, PhD; Shamez N. Ladhani, MRCPCH, PhD JAMA. 2014;311(11):1125-1132. doi:10.1001/jama.2014.1878 Read the rest of the interview on MedicalResearch.com
  29. 29. Psychiatric Diagnosis Increased After Critical Illness and Mechanical Ventilation MedicalResearch.com Interview Invitation Dr. Christian Fynbo Christiansen Clinical Associate Professor Department of Clinical Epidemiology Aarhus University Hospital • MedicalResearch.com: What are the main findings of the study? • Dr. Christiansen: We included 24,179 critically ill nonsurgical patients receiving mechanical ventilation in intensive care units in Denmark, and matched comparison groups of hospitalized patients and the general population. We assessed psychiatric diagnoses and medication prescriptions before and after critical illness. • We found an increased prevalence of psychiatric diagnoses in the 5 year period before critical illness, compared to both other hospitalized patients and the general population. • Among the 9,921 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low, but higher than that for hospitalized patients (0.5% vs 0.2% over the first 3 months) and the general population group (0.02%). The proportion of patients given new psychoactive medication prescriptions was also increased in the first 3 months (12.7% vs 5.0% percent for the hospital group, and 0.7% for the general population), but these differences in new diagnoses and medications largely resolved by the end of the first year of follow-up. Hypnotics, anxiolytics and antidepressants were the most frequently prescribed drugs. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Christiansen: Although the relative increase in new psychiatric diagnosis and medication use after critical illness were similar, the absolute risks were very different. We found a surprisingly high risk of new psychoactive medication use but a much smaller proportion with a psychiatric diagnosis (from a subsequent psychiatric admission or outpatient clinic visit). This can, however, largely be explained by the Danish health care system with many patients being treated for depression and anxiety by general practitioners. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Christiansen: We believe patients, caregivers and physicians should be aware of the increased risk. • Discharge planning for these patients may require more comprehensive discussion of follow-up psychiatric assessment and provision of information to caregivers and other family members regarding potential mental health care needs. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Christiansen: We identified an increased risk of psychiatric illness, but we need to know more about how to prevent and treat psychiatric illness among survivors of critical illness. • In addition we need to know more on the long-term impact of the new psychiatric illness occurring early after hospital discharge. • Citation: • Psychiatric Diagnoses and Psychoactive Medication Use Among Nonsurgical Critically Ill Patients Receiving Mechanical Ventilation • Wunsch H, Christiansen CF, Johansen MB, et al. Psychiatric Diagnoses and Psychoactive Medication Use Among Nonsurgical Critically Ill Patients Receiving Mechanical Ventilation. JAMA. 2014;311(11):1133-1142. doi:10.1001/jama.2014.2137. • Read the rest of the interview on MedicalResearch.com
  30. 30. Colorectal Cancer: New Noninvasive Stool DNA Test MedicalResearch.com Interview Invitation with: Dr. Thomas Imperiale MD Professor of Medicine, Indiana University School of Medicine Research Scientist, Indiana University Center for Health Services and Outcomes Research Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc. • MedicalResearch.com: What are the main findings of the study? • Dr. Imperiale: The main findings are the performance characteristics of the multi-target test (sensitivity of 92.3%, specificity of 86.6%) and its performance as compared with the commercial FIT: more sensitive for colorectal cancer and advanced precancerous polyps, but less specific. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Imperiale: The new non-invasive test may be an option for colorectal cancer screening among persons who prefer initial non-invasive testing. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • 1. Determine the optimal testing frequency or interval for the test. • 2. Determine what, if anything, should be done for a positive test and “negative” colonoscopy. • Citation: • Multitarget Stool DNA Testing for Colorectal-Cancer Screening • Thomas F. Imperiale, M.D., David F. Ransohoff, M.D., Steven H. Itzkowitz, M.D., Theodore R. Levin, M.D., Philip Lavin, Ph.D., Graham P. Lidgard, Ph.D., David A. Ahlquist, M.D., and Barry M. Berger, M.D. • March 19, 2014DOI: 10.1056/NEJMoa1311194 Read the rest of the interview on MedicalResearch.com
  31. 31. No Cardiovascular Benefit Found With Omega 3 Fatty Acids or Macular Xanthophylls Supplementation MedicalResearch.com Interview with: Denise Bonds, MD, MPH National Heart, Lung, and Blood Institute (NHLBI) • MedicalResearch.com Interview with: Denise Bonds, MD, MPH National Heart, Lung, and Blood Institute (NHLBI) • MedicalResearch.com: What are the main findings of the study? • Dr.Bonds: We found no cardiovascular benefit to supplementation of the diet with either omega-3 fatty acids or with the macular xanthophyll’s lutein and zeaxanthin. • MedicalResearch.com: Were any of the findings unexpected? • Dr.Bonds: Previous studies that have examined the impact of omega-3 fatty acids on cardiovascular disease have been mixed with some showing a benefit and others showing no effect. There have been very few studies that have examined the effect of the macular xanthophylls on cardiovascular disease. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr.Bonds: There was no benefit and no adverse events from taking a supplement of omega 3 fatty acids or macular xanthophylls. Patients should continue to eat a heart healthy diet that includes fish. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr.Bonds: NIH is sponsoring a large clinical trial called VITAL that is also looking at the impact of omega-3 fatty acids in a somewhat different population. The result of that trial will provide us with additional information on the potential impact of omega-3 fatty acids on cardiovascular disease. • Citation: • Effect of Long-Chain ω-3 Fatty Acids and Lutein + Zeaxanthin Supplements on Cardiovascular Outcomes Results of the Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial • Writing Group for the AREDS2 Research Group. Effect of Long-Chain ω-3 Fatty Acids and Lutein + Zeaxanthin Supplements on Cardiovascular Outcomes: Results of the Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.328. Read the rest of the interview on MedicalResearch.com
  32. 32. Age-Related Macular Degeneration: Algorithm and App as Practical Prediction Tools MedicalResearch.com Interview with: Chung-Jung Chiu DDS PhD Scientist II, JM USDA Human Nutrition Research Center on Aging Assistant Professor, School of Medicine Tufts University Boston MA 02111 • MedicalResearch.com: What are the main findings of the study? • Answer: In this study, we found that advanced age-related macular degeneration (AMD) is predictable by using clinically readily available information. We devised a simple algorithm to summarize the clinical predictors and showed the validity of our prediction model in both clinic-based and community-based cohorts. We also develop an application (App) for the iPhone and iPad as a practical tool for our prediction model. • MedicalResearch.com: Were any of the findings unexpected? • Answer: It has been recognized that genetic factors play a significant role in the development of age-related macular degeneration. However, we found that even without genetic information, a combination of readily available, noninvasive, clinical risk factor information provided in the patient history and eye examinations allows clinicians to predict eye-specific risk for advanced age-related macular degeneration at an accuracy comparable to that in models including genetic predictors. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Our data showed that, in addition to age, gender, education level, race, and smoking status, a fundus photographic eye examination is of great value in the prediction of advanced age-related macular degeneration. Patients aged 55+ years should consult their eye doctors to schedule regular eye examinations to rule out early retina signs, such as pigment abnormality and drusen. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Many systemic disorders have retinal manifestations that are valuable in screening, diagnosis, staging, and management of the conditions, such as diabetes, cardiovascular disease, etc. While physicians’ primary concern may be in these systemic disorders, they can play a key role in the early identification of blinding retinal diseases, such as age-related macular degeneration. Therefore, an easy-to-use retina imaging and grading system in conjunction with our prediction model will be very helpful for screening of patients at risk of developing advanced AMD. The value of such a system will be even more profound if the system could be tractable enough for public health practitioners or nurses to use in communities. • Citation: A Risk Score for the Prediction of Advanced Age-Related Macular Degeneration: Development and Validation in 2 Prospective Cohorts • Chung-Jung Chiu, Paul Mitchell, Ronald Klein, Barbara E. Klein, Min-Lee Chang, Gary Gensler, Allen Taylor • Ophthalmology – 19 March 2014 (10.1016/j.ophtha.2014.01.016) Read the rest of the interview on MedicalResearch.com
  33. 33. Falling-Related Deaths in Elderly Increased by Cardiovascular Diseases, Medications MedicalResearch.com Interview with: Judy A. Stevens PhD National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta GA 30341 • MedicalResearch.com: What are the main findings of the study? Dr. Stevens: The fall death rate among persons aged 65 and older has been increasing rapidly. We used vital statistics data to examine the circumstances and contributing conditions to fall deaths. • We found that of 21,649 fall deaths in 2010, the largest proportion (35%) occurred from falling on the same level, followed by falling on stairs or steps (6.5%). From 1999 to 2010, there was a trend toward more specific reporting of falls circumstances. However, information about the circumstances of 49% of the 2010 fall deaths was not available. • In 2010, 49% of fall deaths involved a head injury and 30% involved a hip fracture. The most important contributing causes to fall deaths were circulatory diseases, especially hypertension, and respiratory diseases. • Factors that may partially explain the rapid increase in the fall death rate include changing trends in the death rates for underlying chronic diseases strongly associated with falls, such as reductions in cardiovascular disease deaths, as well as better reporting on death certificates of falls as the underlying cause of death. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Stevens: We expected to find that fall-related traumatic brain injury, which has been increasing, would be largely responsible for the increasing fall death rates. However, our study results did not support this. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Stevens: Health care professionals should be aware that people with cardiovascular diseases, especially hypertension, are at increased risk of falling. Medications such as beta blockers and thiazide diuretics also increase fall risk. Carefully monitoring patients and addressing gait and balance problems through referrals to physical therapy or community exercise programs can reduce these patients’ fall risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Stevens: The fall death rate in older adults and the number of older adults at risk of falling are both increasing. More research is needed to better understand the factors driving the increasing fall death rate. Research is also needed to find ways to improve dissemination and uptake by clinicians, community organizations and older adults of existing evidence- based fall prevention interventions. • Citation: • Circumstances and Contributing Causes of Fall Deaths among Persons Aged 65 and Older: United States, 2010 J Am Geriatr Soc 62:470–475, 2014. Judy A. Stevens PhD* andRose A. Rudd MSPH Read the rest of the interview on MedicalResearch.com
  34. 34. Heart Attack: Feminine Traits May Delay Cardiac Treatment MedicalResearch.com Interview with: Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology McGill University Health Centre (Montreal, Qc • MedicalResearch.com: What made you want to study this disparity between men and women and heart attacks? • Dr. Pelletier: Despite enhanced medical treatment and decrease in the incidence of heart diseases, important sex disparities persist in the risk of mortality following a cardiac event: the risk of mortality is higher in women compared to men, and this sex difference is even more important in younger adults. Therefore, we aimed to investigate potential mechanisms underlying this sex difference in mortality. MedicalResearch.com: Were you surprised by your findings? • Dr. Pelletier: We were partly surprised by our findings. We hypothesized that there would be sex differences with regards to the process of care in these patients. Indeed, previous studies in older men and women have suggested that women had poorer access to care when undergoing a cardiac event, compared to men. However, we were quite surprised to observe that overall, it is not so much biological sex that matters but rather gender-related characteristics. Unlike sex, which is biologically determined (i.e. male or female), gender has a wider scope and incorporates social norms and expectations for men and women in a society (e.g. social roles such as child caring, housework responsibility, stress management, personality traits, employment characteristics). We expected gender-related characteristics to interact with biological sex to affect access to care. However, we rather observed that no matter patient’s biological sex, those with typically feminine traits and roles, were more likely to experience delays before some procedures and were less likely to receive invasive procedures as well. Read the rest of the interview on MedicalResearch.com
  35. 35. Heart Attack: Feminine Traits May Delay Cardiac Treatment MedicalResearch.com Interview with: Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology McGill University Health Centre (Montreal, Qc • MedicalResearch.com: What are “feminine character traits” according to your study? • Dr. Pelletier: We used a validated questionnaire (the Bem Sex Role Inventory, [Bem, SL., 1974]) to assess gender-related traits of personality, where men and women had to rate themselves using a scale from 1 (never true) to 7 (always true) on the following “typically feminine” traits of personality (according to the Bem Sex Role Inventory): Tender; Sympathetic; Sensitive to needs of others; Understanding; Compassionate; Eager to sooth hurt feelings; Warm; Affectionate; Loves children; Gentle. • It is also important to note that we observed not only feminine traits to be in cause in the experience of poorer access to care, but also feminine roles such as being the person who is mainly responsible for doing housework. • These feminine traits and roles increased delays before treatment and lowered the odds of receiving invasive treatment procedures in both men and women. • MedicalResearch.com: What was the difference between men and women heart attack patients when it came to access to care? • Dr. Pelletier: We observed that women were less likely than men to receive an electrocardiogram within the recommended 10 minutes from arrival to the emergency. Compared to men, women were also less likely to receive fibrinolysis (a medication injected in order to unblock obstructed arteries) within the recommended 30 minutes from arrival to the emergency. Our results further suggested that women were less likely than men to actually receive these invasive procedures, which aim to unblock the obstructed arteries. • It is important to note that the objective of our study was not to extensively assess the appropriateness of treatment in men and women. Therefore, further studies should carefully assess whether the sex differences in access to care we observed was appropriate according to men and women’s clinical characteristics • We think that the overall message should be that it might not be biological sex that matters the most, but rather what type of gender-related roles and traits men and women exhibit when they present to the emergency with a heart attack. Read the rest of the interview on MedicalResearch.com
  36. 36. Heart Attack: Feminine Traits May Delay Cardiac Treatment MedicalResearch.com Interview with: Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology McGill University Health Centre (Montreal, Qc • MedicalResearch.com: Why would men receive faster access to ECGs and fibrinolysis? Why do you think there was this disparity between men and women when it came to care? And how could it affect health outcomes? • Dr. Pelletier: Multiple and various reasons may explain longer delays in women. As an example, we observed that patients presenting to the emergency with multiple health problems related to heart disease (e.g. diabetes, hypertension, high cholesterol, obesity, a family history of heart disease) were waiting longer before getting an electrocardiogram. This probably happens because it takes longer for the triage nurse to assess these people’s medical history and it may also complicate the treatment algorithm for these patients. Women in our study had a heavier burden of these health problems such as diabetes and a family history of heart disease compared to men. This may be one explanation for the longer delays before electrocardiogram in women. • Another reason may relate to the symptoms men and women experience and report to the triage nurse. As an example, women in our study were slightly less likely than men to report chest pain. This atypical presentation of heart attack may lead triage personnel to initially dismiss a cardiac event in these patients. It is also noteworthy that above biological sex, the way the person presents itself and the way the symptoms are reported and described can have an important influence on the process of care. As an example, it is possible that patients with more typically feminine characteristics, such as being tender or shy, give these patients the appearance that they are too fragile to support undergoing invasive procedures. Also, patients who appear fragile and weak, or who are shy, when compared with those with strong personality and leadership abilities, may be less likely to convince themselves that they require an intervention. Additionally, these characteristics may alter the care provider’s need for an invasive procedure. • Men and women need to be assertive when expressing their needs, and they need to be precise and concise when reporting their symptoms. Also, if they feel chest pain as well as other symptoms, chest pain must always be the first symptom to be reported and the emphasis should be placed on this symptoms. • Delays before receiving an electrocardiogram can indeed have important consequences on health. More specifically, it has been reported by other researchers that patients presenting to the emergency with an ST-elevation myocardial infarction (the most severe type of heart attack) and who do not receive an electrocardiogram within 10 minutes of arrival to the hospital, may have a close to 4- fold higher risk of having another heart attack or to die within the months following their heart attack. • MedicalResearch.com: Aren’t there distinct differences in how men and women have heart attacks? Could this have anything to do with your study? • Dr. Pelletier: We observed that women are slightly less likely to present with chest pain, which can partly explain longer delays in women. Indeed, when patients report atypical symptoms of heart attack when arriving to the emergency, it is more complicate to identify the cardiac event and it brings complexity to the treatment algorithm for these patients. However, it is very important to understand that the majority of the women (and men) in our study reported chest pain. Read the rest of the interview on MedicalResearch.com
  37. 37. Heart Attack: Feminine Traits May Delay Cardiac Treatment MedicalResearch.com Interview with: Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology McGill University Health Centre (Montreal, Qc • MedicalResearch.com: What should health officials, doctors, nurses and patients do to try to avoid this disparity in treatment? • Dr. Pelletier: The general population must first be sensitized about this situation. Patients should know that the way they present to the emergency, the way they report their symptoms and express their needs can have an important influence on their access to care. As mentioned earlier, men and women have to be assertive and specific when they report their needs and symptoms. If they experience chest pain along with other symptoms, this should be the first symptom that they mention and they should put the emphasis on this. Medical personnel should, on their side, be aware of the factors influencing access to care and keep in mind that when a patient presents with cardiac-like symptoms, even though they are young or they are depressed, reserved or anxious, they need to be careful not to dismiss a cardiac event in these patients, and to follow the usual treatment algorithm. Also, may be this algorithm should be revised in order to include gender-related aspects such as child care, housework responsibility, and level of stress when assessing patients at the emergency department. • MedicalResearch.com: What are your next steps with this research in mind? • Dr. Pelletier: We currently aim to focus on sensitizing the general public and the medical personnel to the results we observed in our study. We would like these results to help enhance access to care in younger men and women who experience a heart attack. • Our next steps are to further assess whether these differences in access to care influence the risk for these younger men and women of having another cardiac event or to die following this heart attack. We will also assess whether the differences in access to care have an impact on patients’ quality of life and symptoms of depression and anxiety. • Citation: • Sex-related differences in access to care among patients with premature acute coronary syndrome • Roxanne Pelletier, Karin H. Humphries, Avi Shimony, Simon L. Bacon, Kim L. Lavoie, Doreen Rabi, Igor Karp, Meytal Avgil Tsadok, and Louise Pilote • Sex-related differences in access to care among patients with premature acute coronary syndrome CMAJ cmaj.131450; published ahead of print March 17, 2014, doi:10.1503/cmaj.131450 Read the rest of the interview on MedicalResearch.com
  38. 38. Military Combat Increases Risk of Subsequent Coronary Heart Disease MedicalResearch.com Interview with: Dr. Nancy Crum-Cianflone MD Deployment Health Research Department, Naval Health Research Center, San Diego, CA • MedicalResearch.com: What are the main findings of the study? • Dr. Nancy Crum-Cianflone: There have been several studies examining the health outcomes of service members who recently deployed to the conflicts in Iraq and Afghanistan. However, none of these studies to date had examined the potential role of military deployment experiences and PTSD on coronary heart disease (CHD) among young US service members. We believed that this would be an important study to undertake since these data would not only be useful to the US military, but may also have implications regarding job-related stressors on the health of young adults in the general population. • After studying over 60,000 current and former US military personnel, we found that those who deployed and experienced combat were at a 60%- 90% increased risk of subsequently developing CHD. This finding was noted when we examined both self-reported CHD and medical record validated coronary heart disease. These data suggest that experiences of intense stress may increase the risk for coronary heart disease over a relatively short period among young, previously healthy adults. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Nancy Crum-Cianflone: Although we found that PTSD symptoms were associated with self-reported coronary heart disease, this finding was no longer significant after adjusting for depression and anxiety, and we found no relationship between PTSD and medical record validated coronary heart disease. • This was somewhat surprising since prior studies had found a modest relationship between PTSD and CHD. However, our study examined the potential acute effects of PTSD symptoms on CHD among young service members who recently returned from deployment. In contrast, prior studies had been based on older cohorts with more remote military experiences and persistent PTSD symptoms. Hence, it is possible that the relationship between PTSD and coronary heart disease may be dependent on the impact of cumulative PTSD symptoms over a long time period. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Nancy Crum-Cianflone: Our study showed that service members who experienced intense job-related stresses (i.e., deployment with combat exposure) may have a higher risk for developing heart disease. Clinicians and patients should consider the diagnosis of heart disease among persons with symptoms suggestive of CHD despite the patient’s relatively young age. Although our study was confined to examining military members, these data may have implications for other young adults with jobs involving intense stress. Since this is the first study of its kind conducted among US service members, future research is needed to validate our study’s findings. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Nancy Crum-Cianflone: Our study found that exposure to stressful events, such as combat, may play an important role in the development of coronary heart disease in a young, otherwise healthy population of US service members. Further longitudinal research should be conducted among both service members and young adults in the general population to assess the long-term effects of both acute and chronic job-related stressors on CHD. Furthermore, studies should be designed to examine the effects and interrelationships of life stressors, PTSD, anxiety, and depression on coronary heart disease. • Citation: • Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces • Nancy F. Crum-Cianflone, Melissa E. Bagnell, Emma Schaller, Edward J. Boyko, Besa Smith, Charles Maynard, Christi S. Ulmer, Marina Vernalis, and Tyler C. Smith • Circulation. 2014;CIRCULATIONAHA.113.005407published online before print March 11 2014, doi:10.1161/CIRCULATIONAHA.113.005407 Read the rest of the interview on MedicalResearch.com
  39. 39. Physical Activity Associated With Lower Risk of Breast Cancer MedicalResearch.com Interview with: Professor Mathieu Boniol PhD International Prevention Research Institute Lyon, France • MedicalResearch.com: What are the main findings of the study? • Prof. Boniol: We conducted a meta-analysis of all prospective epidemiological studies on physical activity and risk of breast cancer. It includes 37 studies, so covers more than 4 million women among which more than 100,000 breast cancer were diagnosed. We showed that when comparing the most active women (about 20% of the population) to least active women (another 20% of the population), vigorous physical activity reduce the risk of breast cancer by 11%. And the good news is that this decline is irrespective of age, BMI, menopausal status, country,… It is also true for the most aggressive breast cancer (ER-/PR-). However, we also showed that this decline is not observed for women taking hormonal replacement therapies, as if these treatments (which are already infamous for poor efficacy and increasing the risk of breast cancer) would nullify any benefit from physical activity. • MedicalResearch.com: Were any of the findings unexpected? • Prof. Boniol: The magnitude of the preventive effect of breast cancer from physical activity is lower than expected. The WHO for example reported that 21-25% of breast cancer could be prevented by physical activity, with a broad definition of physical activity, this figure was much too optimistic. However, a 11% decline when the least active women become very physically active is already quit something: when you compare to some small benefit of treatments, decreasing risk of breast cancer (and mortality) by 11% with such a cheap method, it is encouraging. In particular, physical activity is also known to have beneficial affect on colorectal cancer, cardiovascular disease, diabetes, weight control, etc… Read the rest of the interview on MedicalResearch.com

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