MedicalResearch.com - Medical Research Interviews Week in Review

MedicalResearch.com
Exclusive Interviews with Medical Research and
Health Care Researchers
Editor: Marie Benz, MD
info@Hemodialysis.com
January 16 2014
For Informational Purposes Only: Not for Specific Medical Advice.

Medical Disclaimer | Terms and Conditions
•

•

•

The contents of the Hemodialysis.com Site, such as text, graphics, images, and
other material contained on the Hemodialysis.com Site ("Content") are for
informational purposes only. The Content is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. Always seek the advice of
your physician or other qualified health provider with any questions you may have
regarding a medical condition. Never disregard professional medical advice or
delay in seeking it because of something you have read on the Hemodialysis.com
Site!
If you think you may have a medical emergency, call your doctor or 911
immediately. Hemodialysis.com does not recommend or endorse any specific
tests, physicians, products, procedures, opinions, or other information that may be
mentioned on the Site. Reliance on any information provided by Hemodialysis.com
or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on
the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is
solely at your own risk.
The Site may contain health- or medical-related materials that are sexually explicit.
If you find these materials offensive, you may not want to use our Site. The Site
and the Content are provided on an "as is" basis.

Read more interviews on Hemodialysis.com

Heavy Alcohol Consumption Bad for the Aging Brain
MedicalResearch.com Interview with:
Séverine Sabia, PhD
Epidemiology & Public Health, Div of Population Health
University College London – Gower Street – London

•

•
•

•
•
•
•
•

•
•
•

Séverine Sabia, PhD
Epidemiology & Public Health, Div of Population Health
University College London – Gower Street – London
MedicalResearch.com: What are the main findings of the study?
Dr. Sabia: The present study shows a detrimental effect of heavy alcohol consumption on cognitive ageing, and the effects
are seen as early as 55 years old.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Sabia: Heavy alcohol consumption is known to be detrimental for health. So the results were not surprising. They add
that heavy alcohol consumption is also detrimental for the brain and the effects can be observed as soon as 55 years old.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Sabia: The findings are in agreement with previous studies and suggest that moderate alcohol consumption is probably
not deleterious for cognitive outcomes. However, this study adds to the evidence that heavy alcohol consumption (≥36
g/day, ≥ 4 UK drinks per day) is deleterious for cognitive ageing.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Sabia: In the present study, it was not possible to examine the effect of heavy drinking on cognitive ageing as only a
small number of women were heavy drinkers. It would be interesting to test whether the results found in men are also true
in women.
Citation:
Alcohol consumption and cognitive decline in early old age
Sabia, Alexis Elbaz, Annie Britton, Steven Bell, Aline Dugravot, Martin Shipley, Mika Kivimaki, and Archana Singh-Manoux
10.1212/WNL.0000000000000063;
published ahead of print January 15, 2014

Read the rest of the interview on MedicalResearch.com

SSRIs During Late Pregnacy and Infant Pulmonary Hypertension
Sophie Grigoriadis, MD, MA, PhD, FRCPC
Head, Women’s Mood and Anxiety Clinic: Reproductive Transitions,
Associate Professor, Faculty of Medicine, University of Toronto

•
•

•

Dr. Grigoriadis: Infants of women exposed to selective serotonin reuptake inhibitors (SSRIs)
during late pregnancy (but not early) are at risk for developing persistent pulmonary
hypertension of the newborn (PPHN). PPHN is a condition in which blood pressure remains
high in the lungs following birth and which results in breathing difficulties. The symptoms
can range from mild to severe, but the condition can be managed successfully typically after
SSRI exposure. It is important to note that the baseline risk for PPHN in the general
population is low (about 2 per 1,000 live births), and so the increase in risk with SSRIs still
represents a low overall risk for developing PPHN following SSRI exposure in late pregnancy
(increasing to approximately 5 per 1,000 live births). This increased risk means that 286 to
351 women would have to be treated with an SSRI during late pregnancy in order to result in
1 additional case of PPHN.
Dr. Grigoriadis: The findings of this study were not wholly unexpected, although the research
evidence had been mixed prior to our meta-analysis. More surprising, was that we did not
find a moderating effect for any of the known risk factors for PPHN that we were able to
examine (i.e., meconium aspiration or congenital malformations) but this may be a reflection
of the fact that there were few studies and the way these studies handled the risk factors.


SSRIs During Late Pregnacy and Infant Pulmonary Hypertension
Sophie Grigoriadis, MD, MA, PhD, FRCPC
Head, Women’s Mood and Anxiety Clinic: Reproductive Transitions,
Associate Professor, Faculty of Medicine, University of Toronto

•
•

•
•

•
•

MedicalResearch.com What should clinicians and patients take away from your report?
Dr. Grigoriadis: Women and their families should be counseled about PPHN and the potential for the development of it
following exposure to SSRIs during late pregnancy although the risk remains low. As well, women and their families must
know that the condition can often be managed favorably if PPHN does occur. Clinicians should be aware of the risk and
clinical presentation of PPHN in the infant. Depression should not be left untreated as there are risks for untreated
depression for both the mother and baby that can also extend into the postpartum period. Various treatment options exist
for depression; treatment selection is based on several factors and sometimes antidepressant drugs are needed.
MedicalResearch.com What recommendations do you have for future research as a result of this study?
Dr. Grigoriadis: Future research should determine whether other classes of antidepressants, besides SSRIs, also show an
association with PPHN, as well as whether known risk factors (i.e., preterm delivery, c-section or obesity) and if clinical
depression itself play a role in any association. Antidepressants are also prescribed for other psychiatric disorders that may
also have an independent association with development of PPHN and thus psychiatric diagnosis should also be identified.
Furthermore, future research in this field would benefit from a more uniform definition of early and late antidepressant
exposure, and from studies in which exposure to the medication under examination is more assured. This last point speaks
to the fact that reliance upon prescription database registries or retrospective self-report of exposure may mean that
women categorized as exposed may not have been done so accurately. Lastly, it is important that future studies examine the
severity of PPHN and the factors important for those with increased severity.
Citation:
Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and metaanalysis
Grigoriadis S ,VonderPorten EH ,Mamisashvili L ,Tomlinson G ,Dennis C ,Koren G ,et al. Prenatal exposure to antidepressants
and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ 2014;348:f6932


Adverse Events Reporting: Room for Improvement MedicalResearch.com Interview with:
Sunita Vohra MD MSc FRCPC FCAHS
Director, CARE Program
Professor, Dept of Pediatrics Faculty of Medicine & Dentistry
Edmonton Continuing Care Centre, Edmonton, Alberta Canada
•
•

•

•
•

•
•

•
•
•

Dr. Vohra: Our main findings were: (i) relative to how often systematic reviews
evaluate the effectiveness of health interventions, the systematic review
of harms is quite neglected; and (ii) even when systematic reviews do aim
to evaluate harms, there is considerable room for improvement in reporting.
Dr. Vohra: All health interventions have the potential for benefit and the potential
for harm. It is surprising that even though clinicians and patients need
information about both, there are so few systematic reviews that evaluate
harms. It is worrying that harms are under-studied, under-reported, and
that this is compounded by the lack of synthesis of harms data in
systematic reviews (and the poor reporting we found in those reviews). This
suggests that decision-makers don’t have the information they need, in
order to choose the best therapy.
Dr. Vohra: Clinicians and patients need to demand better quality evidence with which to make decisions, and they need to ask this of all parties: e.g.
funders
(who often spend taxpayer money on evaluating therapies), journal editors
(who publish health research), and researchers (who conduct/report health
research). At every stage, an equal emphasis on the investigation and
reporting of harms is warranted, so that high quality data about benefits
and harms are available to decision-makers.
Dr. Vohra: We think reporting guidelines to improve the reporting of harms in
systematic reviews are warranted (e.g. PRISMA harms extension). Hopefully
it will have the same positive impact to improve the quality of reporting
that PRISMA has had on systematic reviews.
Citation:
Quality of reporting in systematic reviews of adverse events: systematic
review
Zorzela L ,Golder S ,Liu Y ,Pilkington K ,Hartling L ,Joffe A ,et al.
Quality of reporting in systematic reviews of adverse events: systematic review.
BMJ 2014;348:f7668


Alcohol Still Sold to Obviously Drunk Patrons
Professor Karen Hughes
Professor in Behavioural Epidemiology Centre for Public Health
Liverpool John Moores University Liverpool L3 2ET

•
•

•

Answer: We used trained actors to test whether servers in pubs, bars and nightclubs would sell
alcohol to people showing signs of extreme intoxication, despite this being illegal in the UK. In over
four fifths (83.6%) of purchase attempts, bar servers sold alcohol to the pseudo-drunk actors – even
though many clearly identified the actors as being drunk. We also collected data on bar
environments, looking specifically at ten factors that have been associated with alcohol-related
harm in previous studies: low levels of seating, loud noise, crowding, poor lighting, dirtiness, cheap
drink promotions, young bar staff, young customers, rowdiness, and customer drunkenness. We
found that the more of these characteristics bars had, the more likely they were to sell alcohol to
drunks, with 100% of bars with 8 or more of these characteristics serving the pseudo-drunk actors.
However, even in bars with none of these characteristics, two thirds of purchase attempts resulted
in an alcohol sale. Having security staff managing entrance to the premises was also associated with
alcohol service; possibly suggesting that bar servers in premises with door staff believe
responsibility for vetting customers lies with such staff.
Answer: Along with the very high level of alcohol service to pseudo-drunk actors, in almost one in
five alcohol sales actors’ notes identified that bar servers had tried to sell them a larger drink (i.e. a
double rather than a single vodka). This was an unexpected finding, and as actors were not
specifically asked to record this information the actual extent of such ‘up-selling’ might have been
even higher. Thus, not only were most alcohol servers ignoring the law preventing sales of alcohol
to drunks, they often saw no problem in providing vulnerable individuals with more alcohol than
they had actually asked for.


Alcohol Still Sold to Obviously Drunk Patrons
Professor Karen Hughes
Professor in Behavioural Epidemiology Centre for Public Health
Liverpool John Moores University Liverpool L3 2ET

•

•
•

•
•
•

Answer: Excessive alcohol use has a huge impact on health and the provision of health services, with
emergency departments in England struggling to cope on weekend nights and alcohol-related hospital
admissions continuing to rise. The enforcement of legislation to prevent the sale of alcohol to people who
are drunk has the potential to reduce excessive drinking and change harmful nightlife cultures, yet this
legislation is hardly used anywhere in England (with just 3 convictions nationally in 2010). With strategies
such as minimum alcohol pricing having been stalled in England, health professionals have a major role to
play in advocating for other mechanisms to reduce drunkenness and the harms it causes, and preventing
sales to drunks should be a key priority.
Answer: Measures that can effectively reduce sales of alcohol to drunks need to be identified,
implemented and evaluated in UK. Such measures may include those to raise public awareness of
legislation on sales of alcohol to drunks, provide training to bar servers in service refusal techniques, and
specifically to increase enforcement activity to identify and punish those breaking the law. Studies such as
this can serve as a baseline to measure the effectiveness of such measures.
Citation:
Does legislation to prevent alcohol sales to drunk individuals work? Measuring the propensity for nighttime sales to drunks in a UK city
Karen Hughes, Mark A Bellis, Nicola Leckenby, Zara Quigg, Katherine Hardcastle, Olivia Sharples, David J
Llewellyn
Centre for Public Health, WHO Collaborating Centre for Violence Prevention, Liverpool
John Moores University,
J Epidemiol Community Health
Published Online First: Jan 15 2014 doi:10.1136/


Gout: Rising Prevalence and Incidence
MedicalResearch.com Interview with: Weiya Zhang, BPH, MEpi, PhD
Associate Professor & Reader
Division of Rheumatology, Orthopaedics and Dermatology The University of Nottingham
Clinical Sciences Building City Hospital Nottingham NG5 1PB

•

•
•
•
•
•
•
•
•
•
•
•

Weiya Zhang, BPH, MEpi, PhD
Associate Professor & Reader
Division of Rheumatology, Orthopaedics and Dermatology
The University of Nottingham
Clinical Sciences Building City Hospital
Nottingham NG5 1PB
Dr. Zhang: We found the prevalence and incidence of gout keep rising from 1997 to 2012, but the management (percentage
of patients treated with the recommended effective drugs) remains poor.
Dr. Zhang: it is unexpected that the management of gout remains constantly poor (only a third receive proper treatment)
irrespective of all national and international treatment guidelines published in the past decade.
Dr. Zhang: Gout is the prevalent condition affecting 1 in 40 people in the UK population. The prevalence increased rapidly
(4% per year) from 1997 to 2012. It is one of a few medical conditions which have effective treatment, but unfortunately it
has been poorly managed.
Dr. Zhang: Research in the identification of the factors related to the poor management of gout and how to improve it
would be very useful.
Citation:
Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study
Kuo C-F, Grainge MJ, Mallen C, et al
Ann Rheum Dis Published Online First: 1/15/2013
doi:10.1136/annrheumdis- 2013-204463


Allergic March of Asthma Eczema and Rhinitis
MedicalResearch.com Interveiw with:
Mariona Pinart, PhD
CREAL-Centre for Research in Environmental Epidemiology ISGlobal alliance
Doctor Aiguader, 88 | 08003 Barcelona

•
•

•

•
•

Answer: The study examined 23.434 children at 4 and 8 years from 12 ongoing European
population-based birth cohort studies that recorded information on current eczema, rhinitis, and
asthma from questionnaires and serum-specific IgE to six allergens. We wanted to assess how often
eczema, rhinitis and asthma coexist in the same children (comorbidity) and whether the occurrence
of comorbidities was due to causality or casualty and finally we wanted to examine whether the
occurrence of comorbidity was modified by IgE sensitization.
We found that comorbidity affects about 4% of children aged 4–8 years and that about 50% of this
comorbidity is due to causality, suggesting that these diseases share common pathophysiological
mechanisms. In addition, we found that children comorbidity at age 4 are 30 to 60 times more
likely to have comorbidity at age 8 years, suggesting that the presence of comorbidity at age 4 years
is a strong determinant of comorbidity at age 8 years. Even children with one single disease are also
at high risk of developing comorbidity by age 8 years. Interestingly, we found that not only
comorbidity is present in children both sensitized and not sensitized to IgE but also that only 38% of
incident comorbidity at age 8 years is explained by the presence of IgE sensitization at age 4 years.
Answer: Evidence supports that the atopic march is a useful paradigm to describe the sequential
progression of eczema, rhinitis and asthma suggesting that atopy (IgE sensitization) could be the
underlying mechanism linking these diseases to each other. Unexpectedly, we found that the
tendency of these diseases to overlap is stronger in children without IgE sensitization and that
incident comorbidity is not fully explained by IgE sensitization, suggesting that IgE sensitization can
no longer be considered the dominant causal mechanism of the coexistence for these diseases.


Allergic March of Asthma Eczema and Rhinitis
MedicalResearch.com Interveiw with:
Mariona Pinart, PhD
CREAL-Centre for Research in Environmental Epidemiology ISGlobal alliance
Doctor Aiguader, 88 | 08003 Barcelona

•
•

•
•

•
•
•

Answer: First, comorbidity is more often observed than it would have been expected by chance, which means that
comorbidity is a substantial public health problem and second, those children with one disease at age 4 years are 4-7 times
more likely to develop comorbidity by age 8 years regardless of IgE sensitization, suggesting that clinicians have new
evidence to support the design and implementation of health-care strategies for the management of comorbidity.
Answer: Further research is needed to unravel the role of IgE sensitization as well as the other non-IgE-related underlying
mechanisms linking these diseases to each other and that are therefore causally related to comorbidity. In this regard, our
study is one the studies conducted in the EU-funded MeDALL (Mechanisms of the Development of Allergy) project which
aims to generate novel knowledge on the mechanism of initiation of allergy from early childhood to young adulthood. We
are currently conducting other studies examining the inter-relationships between these diseases using other statistical
approaches. Other on-going experimental studies on epigenetics, proteomics and transcriptomics within the frame of
MeDALL may unravel the contribution of IgE sensitization to the development of allergic comorbidty as well as other
pathophysiological mechanisms causally related to comorbidity, improve diagnostic and control strategies and ultimately
may discover new targets for therapy.
Citation:
Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a populationbased cohort study
Mariona Pinart PhD,Marta Benet BStat,Isabella Annesi-Maesano DSc,Andrea von Berg MD,Prof Dietrich Berdel MD,Prof Karin
C L Carlsen MD,Prof Kai-Håkon Carlsen MD,Prof Carsten Bindslev-Jensen MD,Esben Eller PhD,Maria P Fantini MD,Jacopo
Lenzi BStat,Ulrike Gehring PhD,Joachim Heinrich PhD,Cynthia Hohmann Dipl Psych,Prof Jocelyne Just MD,Thomas Keil
MD,Marjan Kerkhof PhD,Prof Manolis Kogevinas MD,Prof Sibylle Koletzko MD,Prof Gerard H Koppelman MD,Inger Kull
PhD,Prof Susanne Lau MD,Erik Melén MD,Prof Isabelle Momas PhD,Daniela Porta MSc,Prof Dirkje S Postma PhD,Fanny
Rancière PhD,Prof Henriette A Smit PhD,Renato T Stein MD,Christina G Tischer PhD,Maties Torrent PhD,Prof Magnus
Wickman MD,Alet H Wijga PhD,Prof Jean Bousquet MD,Prof Jordi Sunyer MD,Xavier Basagaña PhD,Stefano Guerra MD,Judith
Garcia-Aymerich PhD,Prof Josep M Antó MD
The Lancet Respiratory Medicine – 14 January 2014
DOI: 10.1016/S2213-2600(13)70277-7


Type 1 Diabetes: Retinopathy and Cerebral Microbleeds
Dr. Eelco van Duinkerken
Vrije Universiteit Medical Center, Amsterdama

•
•

•

Answer: In our study we assessed the relationship between cerebral small vessel disease and
peripheral microvascular function in type 1 diabetes patients. By MRI cerebral small vessel disease
was assessed as white matter hyperintensities and lacunar infarcts (markers of ischemia) and
cerebral microbleeds (expression of vascular leakage). We hypothesized that subgroups, i.e. those
with (proliferative) retinopathy, are more at risk to develop cerebral small vessels disease. To this
end, we selected type 1 diabetes patients with proliferative retinopathy, type 1 diabetes patients
without microvascular complications and healthy controls. The main finding of our study was that
only cerebral microbleeds, but not ischemic markers of cerebral small vessel disease were more
prevalent in type 1 diabetes patients with proliferative retinopathy relative to the other groups.
Cerebral microbleeds were also related to microvascular function in skin. This suggest that cerebral
microbleeds are part of generalized microangiopathy in patients with type 1 diabetes.
Answer: The prevalence of markers of ischemic small vessels disease were not more prevalent in
type 1 diabetes patient with proliferative retinopathy, only cerebral microbleeds were more
prevalent. This was a somewhat unexpected finding, as the hypothesis was that small vessel
disease in the brain is linked to vascular retinal damage. We speculated that this is due to the
differences in aetiology of the lesions. White matter hyperintensities and lacunes are considered as
markers of ischemia, whereas cerebral microbleeds represents hemosiderin leakage mainly at the
capillary level and thus be more comparable to the microangiopathy measured in the retina and
the skin. Although caution should be taken as only a small number of lesions were observed.


Type 1 Diabetes: Retinopathy and Cerebral Microbleeds
Dr. Eelco van Duinkerken
Vrije Universiteit Medical Center, Amsterdama

•
•

•
•

•
•
•
•

Answer: This report shows that microvascular functioning in the skin is related to vascular
leakage in the brain, but only in type 1 diabetes patients with proliferative retinopathy. It
shows that microvascular complications are part of a generalized microangiopathy. Thus,
prevention of vascular complications is import to prevent type 1 diabetes related brain
changes.
MedicalResearch.com: What recommendations do you have for future research as a result
of this study?
Answer: This is a first study in a limited sample to address the relationship between cerebral
and peripheral vascular changes in type 1 diabetes. Further studies are needed in larger
samples to understand the exact relationship between cerebral small vessel disease and
peripheral vascular functioning. In such studies the effects of cerebral small vessel disease on
brain functioning and cognitive functioning should be included.
Citation:
Proliferative retinopathy in type 1 diabetes is associated with cerebral microbleeds, which is
part of generalized microangiopathy.
Woerdeman J, van Duinkerken E, Wattjes MP, Barkhof F, Snoek FJ, Moll AC, Klein M, de Boer
MP, Ijzerman RG, Serné EH, Diamant M.
Diabetes Care. 2013 Dec 6. [Epub ahead of print]


Dietary Fiber Intake and Cardiovascular Risk
Prof. Victoria J Burley
Senior Lecturer in Nutritional Epidemiology School of Food Science and Nutrition
University of Leeds Biostatistics, University of Leeds, UK

•
•

•
•
•

•
•
•
•

Prof. Burley: Although it’s been suggested for a long time that foods rich in dietary fiber may protect individuals from having
a heart attack or stroke because they lower some of the risk factors for these diseases, trying to determine how much
dietary fibre might be beneficial and whether these benefits are apparent in all populations around the world has been less
easy to research. Our research at the University of Leeds has pooled the results of published large-scale follow-up studies
and has demonstrated a consistent lowering of risk of cardiovascular and coronary heart disease with increasing dietary
fiber intake. This dose-response trend suggests that even small additional increments in intake may be beneficial in the long
term.
MedicalResearch.com:  Were any of the findings unexpected?
Prof. Burley: Because there are now more studies available for us to look at, we were able to look separately at the food
sources of fiber. When we did this, we were able to see apparently greater benefits from increasing cereal foods rich in
dietary fibre, rather than perhaps the ‘traditional’ sources of fibre – fruit and vegetables.
MedicalResearch.com: What should clinicians and patients take away from your report?  
Prof. Burley: That they should continue to encourage patients to eat plenty of fiber-rich foods, regardless of their current
state of health – we observed these benefits in populations who were originally healthy. In most high-income countries,
average intakes of dietary fiber have remained well below government recommendations, and clinicians can have an
important advisory role to play here. Clinicians do not have to advocate consuming herculean amounts of dietary fiber –
benefits seem to be apparent even with modest increases in consumption, such as may be observed by swapping refined or
white cereal foods for wholegrain or whole-wheat versions.
Prof. Burley: We would like to continue to research how dietary fibre is able to bring about these benefits, but also to
explore why patients seem to have resisted dietary advice so far to eat more whole grains and high fiber food sources.
Citation:
Dietary fibre intake and cardiovascular disease: A systematic review and meta-analysis


Rotavirus Vaccination and Intussusception Risk
W. Katherine Yih Ph.D., M.P.H
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care Institute

•
•

•
•
•

•

Dr. Yih: The main findings are that vaccination with the first dose of RotaTeq is associated with a small
increase in the risk of intussusception, which is concentrated in the first week after vaccination. The
estimated risk is about 1.5 excess cases per 100,000 first doses administered. This risk is fairly small,
amounting to roughly 1/10 of the risk seen after the original rotavirus vaccine (called Rotashield) that was
used in 1998-1999, before it was withdrawn from the market.
We also found evidence that Rotarix increases the risk of intussusception. However, the number of infants
receiving Rotarix and the number getting intussusception after Rotarix were too small to allow us to
estimate the risk after Rotarix with any precision.
Dr. Yih: The findings of an increased risk of intussusception after rotavirus vaccination were not entirely
unexpected, given that studies conducted in other countries had pointed to an increased risk after one or
the other of the two vaccines. However, several studies conducted in the United States had not found an
increased risk. The state of knowledge about the risk of intussusception after rotavirus vaccination in the
United States changed in May-June 2013 with a publication by the Vaccine Adverse Event Reporting
System (Haber et al., in Pediatrics), which found an increased risk after RotaTeq, and a public presentation
by the Vaccine Safety Datalink (VSD) project to the Advisory Committee on Immunization Practices
(Weintraub et al., in the New England Journal of Medicine), which found an increased risk after Rotarix.
At this point, our results for both vaccines are broadly compatible with those of other published studies
that have been conducted internationally and in the United States. Although the VSD study did not find a
statistically significant increase in the risk of intussusception after RotaTeq, their point estimate of the risk
from Dose 1 was elevated and the 95% confidence interval around this estimate overlaps with
ours. Therefore, I do not consider our results to be inconsistent with the VSD results.


Rotavirus Vaccination and Intussusception Risk
W. Katherine Yih Ph.D., M.P.H
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care Institute

•
•

•

•
•

•
•
•
•

Dr. Yih: Both rotavirus vaccines provide a high level of protection against severe diarrhea from rotavirus infection. The
benefits of rotavirus vaccination in preventing severe diarrhea and hospitalization in several countries, including the United
States, have been amply documented in the scientific literature. After carefully evaluating the results of this study and of
other recent studies of the association between rotavirus vaccination and intussusception, the CDC continues to
recommend that all U.S. infants (following the age and precaution/contraindication criteria) receive rotavirus vaccine. This
recommendation is based on their assessment that the benefits of vaccination with either of the two rotavirus vaccines
outweigh the risks of intussusception. For instance, it is estimated that routine rotavirus vaccination will prevent more than
53,000 hospitalizations for severe diarrhea in a U.S. birth cohort of 4.3 million infants followed to 5 years of age. This
number of hospitalizations averted is far greater than the projected number of vaccine-associated intussusception cases.
Although the risk of intussusception is low, if, after rotavirus vaccination, a child appears to have severe abdominal pain
(indicated by, for example, severe crying, pulling their legs up to their chest, vomiting, or passing blood in their stool), the
parent/guardian should promptly seek medical attention and mention the date and other details of the recent rotavirus
vaccination.
Dr. Yih: A formal risk-benefit evaluation would be helpful in order to establish unequivocally that the benefits of vaccination
outweigh the risks. It would also be useful to have a rigorous comparison of the safety of the two vaccines, with adequate
statistical power, since if the risk from one is significantly greater than the risk from the other, this would have policy
implications.
Citation:
Intussusception Risk after Rotavirus Vaccination in U.S. Infants
W. Katherine Yih, Ph.D., M.P.H., Tracy A. Lieu, M.D., M.P.H., Martin Kulldorff, Ph.D., David Martin, M.D., M.P.H., Cheryl N.
McMahill-Walraven, M.S.W., Ph.D., Richard Platt, M.D., Nandini Selvam, Ph.D., M.P.H., Mano Selvan, Ph.D., Grace M. Lee,
M.D., M.P.H., and Michael Nguyen, M.D.
January 14, 2014DOI: 10.1056/NEJMoa1303164


Risk of Diabetes and Fish Intake
MedicalResearch.com Interview with: Jyrki Virtanen, PhD
Adjunct Professor of Nutritional Epidemiology
University of Eastern Finland
Institute of Public Health and Clinical Nutrition Kuopio, Finland
•
•

•
•

•
•

•
•

•
•

Dr. Virtanen: The main finding was that serum long-chain omega-3 polyunsaturated fatty acid (PUFA) concentration, an objective
biomarker of fish and long-chain omega-3 PUFA intake, was associated with a lower risk of incident type 2 diabetes during the average
follow-up of 19.3 years in middle-aged and older men from Eastern Finland. The risk was 33% lower in the highest vs. the lowest
quartile after adjustment for potential confounders. In contrast, hair mercury, a marker for long-term exposure to mercury, was not
associated with the risk. Previously in this study population, high hair mercury content has been associated with higher risk of
cardiovascular diseases and attenuation of the beneficial impact of long-chain omega-3 PUFA on the risk. Also, we did not find
associations with the intermediate-chain length omega-3 PUFA alpha-linolenic acid, either, which is a plant-based omega-3 PUFA. This
suggests that the findings were specific to the long-chain omega-3 PUFAs from fish.
Dr. Virtanen: It was slightly unexpected that the long-chain omega-3 PUFA concentration did associate with the risk. In the previous
studies a beneficial effect has been found mainly in the studies in Asian populations and no association or even an increased risk with
higher fish consumption has been found in studies in Europe and the USA. One of the reasons that we were able to find an association
may be that we had very detailed information about type 2 diabetes incidence in this study population, so we were able to catch those
who got the diagnosis during the follow-up.
Dr. Virtanen: As with the recommendations for cardiovascular disease prevention, it may be beneficial to have a few fish meals per
week, preferably with fatty fish, in order to reduce also the risk of type 2 diabetes.
Dr. Virtanen: In the previous studies no association has been found in the studies from Europe, whereas in the studies from
Asia/Australia fish or long-chain omega-3 PUFA intakes were associated with lower risk of type 2 diabetes and in the studies from the
USA with higher risk. However, in the US studies where an objective biomarker was used, circulating long-chain omega-3 PUFA
concentrations were not found to be associated with higher risk. This suggests that the increased risk observed with dietary intakes may
be related to the dietary assessment method. Because of these issues, there is a need for further research from diverse study
populations and with objective biomarkers of exposure in order to clarify the role of the omega-3 PUFAs on the prevention of type 2
diabetes.
Citation:
Serum Omega-3 Polyunsaturated Fatty Acids and Risk of Incident Type 2 Diabetes in Men: The Kuopio Ischaemic Heart Disease Risk
Factor Study
Virtanen JK, Mursu J, Voutilainen S, Uusitupa M, Tuomainen TP.
Diabetes Care. 2014 Jan;37(1):189-96. doi: 10.2337/dc13-1504. Epub 2013 Sep 11.


Rotavirus Vaccine and Risk of Intussusception
MedicalResearch.com Interview with Eric S. Weintraub, M.P.H.
Epidemiologist at Centers for Disease Control and Prevention
•
•

•
•
•

•
•

•
•

•

Mr. Weintraub: While current rotavirus vaccines were not associated with intussusception in large pre-licensure trials,
recent post-licensure data (from international settings) suggest the possibility of a low risk of intussusception occurrence
after receipt of monovalent rotavirus vaccination (RV1). We examined the risk of intussusception following RV1 vaccination
in a U.S. population. In this study of more than 200,000 doses of RV1, a slight increased risk of intussusception was
observed after vaccination, which should be considered in light of the benefits of preventing rotavirus associated illness.

Mr. Weintraub: These findings were not unexpected based upon recent international studies from Mexico, Brazil and
Australia.
Mr. Weintraub: CDC continues to recommend that all US infants receive rotavirus vaccine. The risk-benefit analysis
continues to demonstrate that the benefits of rotavirus vaccination continue to outweigh the risks associated with
vaccination, including the small risk of intussusception. Providers should be aware of the risks and educate parents about
the risk of intussusception and the benefits of rotavirus vaccines.
Mr. Weintraub: Steps moving forward will include continued monitoring to further quantify the risk of intussusception and
education for health care professionals and parents. A systematic evaluation of data from all the U.S. and international
studies and research to try to elucidate the biological mechanisms of intussusception following rotavirus vaccination would
also be of value.
Citation:
Risk of Intussusception after Monovalent Rotavirus Vaccination
Eric S. Weintraub, M.P.H., James Baggs, Ph.D., Jonathan Duffy, M.D., M.P.H., Claudia Vellozzi, M.D., M.P.H., Edward A.
Belongia, M.D., Stephanie Irving, M.H.S., Nicola P. Klein, M.D., Ph.D., Jason M. Glanz, Ph.D., Steven J. Jacobsen, M.D., Ph.D.,
Allison Naleway, Ph.D., Lisa A. Jackson, M.D., M.P.H., and Frank DeStefano, M.D., M.P.H.
January 14, 2014DOI: 10.1056/NEJMoa1311738


Probiotics to Prevent Infantile Colic, Regurgitation and Functional Constipation
Flavia Indrio, MD
Department of Pediatrics Aldo Moro University of Bari
Bari, Italy

•
•

•
•
•
•
•
•
•

Answer: The main finding is that for the first time the use in prevention instead of treatment
with a probiotic for the colic regurgitation and constipation.

Answer: Yes because is the first time that we attempt to use this probiotic in prevention.
Answer: Clinicians should know this possibility and inform their patients.
of this study?
Answer: The study needs to be repeated and also the children need to have a long term
follow up.
Citation:
Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic Use of a Probiotic in the Prevention of Colic,
Regurgitation, and Functional Constipation: A Randomized Clinical Trial. JAMA Pediatr.
2014;():. doi:10.1001/jamapediatrics.2013.4367.


Emergency Room Screening for Delirium
Dr. Michael A. LaMantia
Regenstrief Institute, Inc. Investigator and
Assistant Professor of Medicine Indiana University School of Medicine

•
•

•

•
•
•
•
•
•
•

Dr. LaMantia: We conducted a systematic review of existing studies on delirium in emergency
departments and found that neither completely validated delirium screening instruments nor an
ideal schedule to perform delirium assessments exist there.
Dr. LaMantia: We had hoped that there would be more available information to support the use of
a particular delirium screening tool in the emergency department. Unfortunately, there was limited
data to support a choice of one tool.
Dr. LaMantia: Unrecognized delirium presents a major health challenge to older adults and an
increased burden on the health care system.
MedicalResearch.com: What recommendations do you have for future research as a result of this
study?
Dr. LaMantia: Further work is needed to develop and validate emergency department-specific
screening instruments and to determine how often to administer screenings in the rapid-paced
environment.
Citation:
Screening for Delirium in the Emergency Department: A Systematic Review
Ann Emerg Med. 2013 Dec 16. pii: S0196-0644(13)01584-9.
doi: 10.1016/j.annemergmed.2013.11.010. [Epub ahead of print]
Lamantia MA1, Messina FC2, Hobgood CD3, Miller DK4.

Cataracts: Quitting Smoking Decreases Risk
Birgitta Ejdervik Lindblad, MD PhD
Department of Ophthalmology
Örebro University Hospital Örebro, Sweden

•
•
•
•

•

•
•
•
•
•
•
•
•

Answer: We have investigated the association between smoking cessation and risk of having a cataract extraction among 44
371 Swedish men aged 45-79 years. During 12 years of follow up we identified 5713 incident cases of cataract extraction.
Smoking cessation significantly decreased the risk with time.
Men who currently smoked more than 15 cigarettes per day had a 42 % increased risk of cataract extraction compared with
men who had never smoked.
More than 20 years since quitting smoking, men who had smoked more than 15 cigarettes per day had a 21% increased risk
of having a cataract extraction compared with men who had never smoked.
The effect of smoking cessation was observed earlier among men who smoked less than 15 cigarettes per day but more than
2 decades since smoking cessation the risk had not decreased to the level of never smokers.
Answer: Smoking is an established risk factor for cataract, but the effect of smoking cessation is unclear. Few studies have
examined the effect of smoking cessation on risk of cataract.
Answer: Smoking cessation seems to decrease the risk of cataract. It is never too late to stop smoking but the higher the
smoking intensity the longer it takes for the increased risk to decline. This finding emphasizes the importance of early
smoking cessation and preferably avoidance of smoking.
More longitudinal studies with regular updated information on smoking status are needed to confirm these results.
Citation:
Smoking Cessation and the Risk of CataractA Prospective Cohort Study of Cataract Extraction Among Men
Lindblad B, Håkansson N, Wolk A. Smoking Cessation and the Risk of Cataract: A Prospective Cohort Study of Cataract
Extraction Among Men. JAMA Ophthalmol. 2014;():. doi:10.1001/jamaophthalmol.2013.6669.


Commercialism in School Food and Beverages
Yvonne M. Terry-McElrath, MSA
Institute for Social Research, University of Michigan, Ann Arbor

•
•
•

•

Answer: This study examined 2007-2012 commercialism trends in schools attended by
nationally representative samples of US elementary and secondary students.
While some measures showed significant decreases over time (especially
beverage vending measures), most students at both elementary and secondary
school levels continued to be exposed to school-based commercialism.
Commercialism increased significantly with grade level. The most frequent
type of commercialism varied by school level: food coupons used as
incentives was most common at the elementary school level, while exclusive
beverage contracts were the most prevalent type of commercialism for middle
and high school students.
Answer: Exposure to elementary school coupons, as well as middle and high school exclusive
beverage contracts, was significantly more likely for students
attending schools with mid or low (versus high) student body socioeconomic
status.


Commercialism in School Food and Beverages
Yvonne M. Terry-McElrath, MSA
Institute for Social Research, University of Michigan, Ann Arbor
•
•

•
•

•

•

Answer: Children at all levels of education–from 1st through 12th grade–are exposed to significant commercial and marketing efforts
within the nation’s
schools. Exposure to such commercialism appears to be highest for students
in socioeconomically disadvantaged schools. The majority of foods and
beverages marketed in any venue towards children and adolescents are high
in calories, sugars, salt, and fat, and are low in essential nutrients;
data indicate that the same is true for in-school marketing. In-school
marketing for less healthy foods and beverages clearly counteracts
educational programming aimed at developing good nutritional habits. The
continuing high prevalence of school-based commercialism supports calls
for, at minimum, clear and enforceable standards on the nutritional content
of all foods and beverages marketed to youth in school settings.
Answer: The recently-published USDA interim final rule governing school competitive nutrition environments provides standards for all
competitive venue foods and beverages served and sold in schools participating in the National
School Lunch Program and School Breakfast Program. The new standards should significantly improve the nutritional quality of foods
and beverages sold
in school competitive venues; however, they do not address in-school
marketing. This leaves open an interesting opportunity for companies to
continue to extend brand recognition and loyalty efforts, as well as
promote less-healthy items. For example, vending machines may be stocked
with items meeting the most recent Dietary Guidelines for Americans, yet
the visual advertising on the machine may still promote items of low
nutritional value. Future research is needed to examine the extent to which
the commercialism environment in America’s schools supports or undermines
efforts to improve student health.
Citation:
Commercialism in US Elementary and Secondary School Nutrition Environments
Trends From 2007 to 2012
Terry-McElrath YM, Turner L, Sandoval A, Johnston LD, Chaloupka FJ. Commercialism in US Elementary and Secondary School Nutrition
Environments: Trends From 2007 to 2012. JAMA Pediatr. 2014;():. doi:10.1001/jamapediatrics.2013.4521.


Prostate Cancer: African American Men and Screening
David M. Albala, MD
Associated Medical Professionals of NY, PLLC Syracuse, NY 13210

•
•

•

•

•
•

•

Dr. Albala: Prostate cancer is the second leading cause of cancer death and American man. Prostate cancer diagnosis and
mortality differences between African American and Caucasian populations have been highlighted in the literature. Research
has shown that African American males are at a biological predisposition for prostate cancer and that additional
socioeconomic and physician-patient educational factors may contribute to a higher mortality rate among this group – over
two times greater than that of Caucasian American males.
At present the most commonly used to detection tools for prostate cancer are the serum prostatic specific antigen test (PSA)
and a digital rectal examination (DRE). These complementary tests provide physicians with an indication of whether to
proceed with biopsy for a definitive pathological diagnosis. Despite ongoing disputes regarding the effectiveness of PSA
screening as an indicator for prostate cancer, a superior alternative test as yet to become available for men at risk.
The American Urological Association (AUA) emphasizes the value of early detection and that sheared decision-making
should not be overlooked and that shared decision making should be integral to screening decisions. The AUA urges
individuals to personally assess, with their physicians, whether a PSA screen is necessary. Emphasis should be placed on the
proper education of African American men who are at increased risk for the disease, as well as on their participation in
repeated screening practices for the earliest possible detection of prostate cancer.
Dr. Albala: Today, two notable trials have investigated the value of PSA screening and reducing prostate cancer mortality,
each yielding slightly different results. The Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial of valuated over
75,000 subjects from 10 US healthcare centers; male participants were stratified and randomized according to center and
age. This study did not find screening to be associated with mortality rate; cancer incidence and mortality among the
screening group were found to be 1.17 and 1.11 times that of the control group respectively.
The European randomized study of screening for prostate cancer in (ERSPC) randomized 162,243 subjects from seven
healthcare centers and various countries into 2 groups: screening and control. A serum PSA measurement was the primary
screening methodology employed by the participating sites; DRE and transrectal ultrasonography were utilized as secondary
test in some countries. Indication for biopsy following screening varied slightly among the sites as well. Despite the observed
decrease in mortality (25%), the investigators did conclude a high risk of over-diagnosis was associated with this reduction;
they reasoned that 1,410 additional men would need to be screened and 48 extra cases treated to prevent one additional
prostate cancer death.


Prostate Cancer: African American Men and Screening
David M. Albala, MD
Associated Medical Professionals of NY, PLLC Syracuse, NY 13210

•
•

•

•
•
•

Dr. Albala: Numerous studies have sought to discover any baseline biological differences
relating to prostate cancer risk among men of various racial backgrounds. Given the recent
findings and increasing knowledge about the possible discrepancies between PSA serum
levels and prostate cancer invasiveness for distinct individuals, it is recommended that
multiple patient aspects be considered before administering a biopsy following a PSA test.
The AUA warns against recent publish skepticism surrounding the current methods of
prostate cancer screening and urges individuals to personally assess, in conference with their
physicians, whether a PSA screen is necessary. Late detection of prostate cancer for African
American populations is a legitimate issue of healthcare access, the burden of which can be
lessened by more active discussion with and education of patients by family practitioners.
We urge primary caregivers to be forward and open about prostate cancer screening with
their patients of all racial and family backgrounds. Additionally, emphasis should be placed on
the proper education of African American men who are at increased risk for the disease, as
well as their participation in repeated screening practices for the earliest possible detection
of prostate cancer.
Citation:
PSA Screening for the African American Male: When and Why?
Tyler A. Luthringer, Ilija Aleksic, Vladimir Mouraviev, and David M. Albala.
Journal of Men’s Health. November 2013, 10(3): 86-90. doi:10.1089/jomh.2012.00026

Patient Preferences for Cancer Screening
MedicalResearch.com Interview with: Dr Jonathan Banks
Programme Manager: The Discovery Research Programme
Centre for Academic Primary Care NIHR School for Primary Care Research
School of Social and Community Medicine
University of Bristol Bristol BS8 2PS

•
•

•

Dr. Banks: We asked members of the public attending their local general practice or
primary care centre to consider a series of hypothetical scenarios or
vignettes which depicted cancer symptoms, their risk of cancer and the
investigative processes involved in testing for cancer. We wanted to
measure the point at which the risk of cancer outweighed the burden and
inconvenience of testing in relation to lung, colorectal and pancreas
cancers. Most people, around 88%, opted for testing even at the lowest risk
of cancer which in our vignettes was 1%. Further analyses showed variation
between cancers with fewer people opting for testing for colorectal cancer
at a low (1%) risk and more people choosing to be tested for all cancers in
the 60-69 age group.
Dr. Banks: We did expect to see more a gradient across all the cancers with more
people choosing to be tested at higher risk levels. However, there was no
strong evidence of such a gradient except in the case of colorectal cancer
and respondents cited the demands and unpleasantness of the diagnostic test
(colonoscopy) as influencing their decision. We were pleasantly surprised
at the numbers of participants we were able to recruit to the study, we had
thought that there may have been some resistance to discussing and thinking
about cancer symptoms in this way but the public were very responsive to
the survey.


Patient Preferences for Cancer Screening
MedicalResearch.com Interview with: Dr Jonathan Banks
Programme Manager: The Discovery Research Programme
Centre for Academic Primary Care NIHR School for Primary Care Research
School of Social and Community Medicine
University of Bristol Bristol BS8 2PS

•
•

•

•
•

Dr. Banks: Clinical guidelines in the UK highlight the importance of including
patients in decision making around referral for testing. We think that the
way the public engaged with this study and the considered responses that
they gave which are reflected in the subtle variations in choice around
colorectal cancer and age suggest that clinicians at the primary care level
can be bolder in incorporating patient views and preferences into the
decision making process. On a wider level we feel that these findings
should also feed into the ongoing revision of cancer referral guidelines.
of this study?
Dr. Banks: We feel that it would be valuable to measure GP preferences for referral
and compare these to the patient viewpoint.
Citation:
Preferences for cancer investigation: a vignette-based study of primary-care attendees
Dr Jonathan Banks PhD,Sandra Hollinghurst PhD,Lin Bigwood MA,Prof Tim J Peters PhD,Fiona
M Walter MD,Prof Willie Hamilton MD
The Lancet Oncology – 14 January 2014
DOI: 10.1016/S1470-2045(13)70588-6


Age-Related Macular Degeneration: Ten Year Follow Up Study
MedicalResearch.com Interview
Emily Y. Chew, M.D.
Deputy Director, Division of Epidemiology and Clinical Applications
National Eye Institute National Institutes of Health (NIH), Bethesda, MD
•
•

•

•
•
•
•
•
•
•

•
•
•

•

Dr. Chew: We provided 10 year rates of development of advanced age-related macular degeneration (AMD), either neovascular (NV)
AMD or central geographic atrophy (CGA). We also presented the risk factors associated with progression to advanced AMD. These
risk factors that were associated with an increased risk of progression included drusen status at baseline (small drusen, intermediate,
large drusen), presence of advanced AMD in the fellow eye, increasing age, female gender, smoking, and the white race.
This is the last cohort of patients in whom anti-vascular endothelial growth factor agents were not available during the course of the
study. The natural history of the vision loss for those who developed advanced is relentless, more gradual in those with geographic
atrophy than neovascular AMD, and may occur even 1 year prior to the detection of advanced AMD by stereoscopic fundus
photographs in obtained at study visits.
Dr. Chew: We knew that the presence of large drusen increased the risk of developing advanced AMD. However, we found that 36% of
participants with medium sized drusen in one eye and 71% of those with bilateral medium sized drusen at baseline would develop large
drusen by 10 years.
The risk of developing advanced AMD by 10 years was very low in participants with no drusen and in those with small drusen at
baseline but 14% of participants with medium drusen in both eyes at enrollment developed advanced AMD by 10 years.
Dr. Chew: The risk of progression to advanced AMD, neovascular or central geographic atrophy was increased in persons with large
drusen, AMD retinal pigmentary changes, presence of advanced AMD in the fellow eye. In addition, medium sized drusen may be
another important risk for potential progression to advanced AMD. The visual acuity loss is relentless once advanced AMD develops.
What recommendations do you have for future research as a result of this study?
Dr. Chew: We hope the progression rates found in this study will help facilitate future clinical research, both epidemiologic studies and
clinical trials by providing accurate information for sample size calculations and for evaluation of risk factors. Early AMD consisting of
medium sized drusen may be an important stage for future evaluations of therapies. We look forward to using other modalities of
imaging to give us data on progression rates of AMD.
Citation:
Ten-Year Follow-up of Age-Related Macular Degeneration in the Age-Related Eye Disease Study: AREDS Report No. 36.
Chew EY1, Clemons TE2, Agrón E1, Sperduto RD2, Sangiovanni JP1, Davis MD3, Ferris FL 3rd1; for the Age-Related Eye Disease Study
Research Group.
JAMA Ophthalmol. 2014 Jan 2. doi: 10.1001/jamaophthalmol.2013.6636.
[Epub ahead of print]


MRSA and Nursing Home Admission Denials
Courtney Reynolds, PhD
Medical Scientist Training Program
University of California Irvine, School of Medicine
•
•

Dr. Reynolds: Our survey of factors influencing admission to 13 nursing homes in Orange County, California showed that MRSA carriers
are denied admission more often than non-carriers, even after accounting for other important factors such as insurance status,
required level of care and previous experience at the facility. In 80% of cases where MRSA carriage was responsible for denial of
admission, nursing home administrators cited a lack of available single or cohort (MRSA only) rooms to accommodate these potential
residents.

•
•

Dr. Reynolds: Yes, we were interested to find that there was substantial variation in admission rates across nursing homes for both
MRSA carriers and non-carriers (from no rejections to about 2/3 of applicants rejected). This variation likely reflects that the most
desirable nursing homes receive a higher volume of applicants and are able to be more selective in their admissions process.
Another surprising finding was that among accepted applicants, MRSA carriage did not lead to delays in placement. We had
hypothesized that since most nursing homes attempt to place MRSA carriers in single or cohort rooms, there could be a delay
associated with waiting for such a room or with moving current residents around to create one. It now seems that nursing homes may
simply reject an MRSA carrier if such a room isn’t already available. It is also possible that any delays in finding a room occur when the
facility is contacted but before the applicant is officially accepted; this type of delay was not captured in our study.
Dr. Reynolds: Our finding that MRSA carriage negatively impacts the ability to find nursing home placement is highly concerning since
many hospital patients require short or long term nursing home care after discharge. As nursing homes have limited space and thus
ability to accommodate MRSA carriers in single or cohort rooms, consideration may need to be given to decolonizing known carriers
before discharge in order to prevent difficulty in placement.
Dr. Reynolds: An important question given our results is whether placing MRSA carriers in single or cohort rooms is actually effective in
the nursing home setting, where residents are allowed and encouraged to interact socially. Transmission risk has been found in a few
recent studies to be linked to this socialization rather than to having an MRSA positive roommate. Again, decolonization may be a more
efficient strategy to prevent transmission and future infection in the nursing home setting.
Citation:
Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers?
Courtney Reynolds, Diane Kim, Sherrie H. Kaplan, Dana B. Mukamel, Eric Cui, Cameron Lee, Susan S. Huang
AJIC: American Journal of Infection Control – January 2014 (Vol. 42, Issue 1, Pages 63-65, DOI: 10.1016/j.ajic.2013.07.015)

•

•
•

•
•

•
•
•
•


Preventing Sharps Injuries in Medical Undergraduates
Anna-Christina Lauer, MD
Department of Audiology and Phoniatrics
Charité-University Medicine Berlin Berlin, Germany

•
•

•
•

•

•

•

Dr. Gross: We could show that the injury rates depend on the undergraduate medical training the students attended. This
demonstrates that medical
undergraduatue education, especially a hands-on training, is critical in
the prevention of needlestick- and sharps injuries.
Also the use of safety devices has proven to reduce injury rates
significantly.
Given the large size of our study we could not only comfirm that
needlestick and sharps injuries are still a common problem, looking at an
injury rate of about 20% per year, we also learned a lot about the
accident circumstances: Most accidents occur at bedside during
venepuncture and intravenous cannulation. The second most common setting
is the operating room, where suturing and instrument transfers can lead to
injuries.
Since we analyzed official reports and the anonymous surveys at the same
time we could affirm an underreporting rate of more than 50%.
Dr. Gross: We did not expect to find such clear data regarding the prevention of
needlestick and sharps injuries. The introduction of safety instruments
resulted in a reduction of the official injury count by about 50%.
Furthermore the comparison of the different study programs showed us that
practical training is a significant factor in the prevention of injuries
and reassures us that specific practical training in safety instruments,
safe techniques and instrument disposal should be part of medical
undergraduate education.
Also we could see in our survey that students are very much interested in
learning safe techniques and first aid measures.


Preventing Sharps Injuries in Medical Undergraduates
Anna-Christina Lauer, MD
Department of Audiology and Phoniatrics
Charité-University Medicine Berlin Berlin, Germany

•
•

•

•
•
•
•
•
•

Dr. Gross: Clinicians and students should take away that many needlestick and sharps injuries can
be avoided. Key factors are the medical undergraduate
training and the supply with safety devices. Based on our findings safety
devices can be recommended and might be considered in different fields as
well.
Of course, not all accidents will be prevented. Therefore students and
staff have to be informed and trained in first aid measures to avoid
transmission of blood-borne diseases, part of which is the reporting of
the injury to ensure the proper treatment.
study?
Dr. Gross: In order to gain an overview and also find the major accident causes at a faculty a crosssectional study at different time points can provide a
detailed insight.
To go further an interesting field of research will be to investigate the
effects of preventive measures, especially the medical undergraduate
training, in longitudinal studies.
Citation:
Needlestick and sharps injuries among medical undergraduate students
American Journal of Infection Control
Available online 2 January 2014Anna-Christina Lauer,Andreas Reddemann,Claus-Peter MeierWronski, MD,Harald Bias, Karin Gödecke, Dipl-Ing, Michael Arendt, Dipl-Phys,Harm Peters, MD,
PhD, Manfred Gross, MD, PhD, MBA

Childhood Type I Diabetes: Brain White Matter Changes
Naama Barnea-Goraly M.D.
Center for Interdisciplinary Brain Sciences Research
Stanford University

•
•

•
•

Answer: Our main findings showed that compared with age and sex matched controls,
children with type 1 diabetes have significant differences in white matter structure in
widespread brain regions. Within the type 1 diabetes group, earlier onset of diabetes and
longer duration were associated with greater alterations in white matter structure. In
addition, measures of hyperglycemia and glucose variability, but not hypoglycemia were
associated with white matter structure; however, hypoglycemia exposure and the number of
severe hypoglycemia events in our sample were too small to identify statistically meaningful
differences. Finally, we observed a significant association between white matter structure
and cognitive ability in children with type 1 diabetes, but not in controls.
Answer: The findings were what we had hypothesized based on previous observations in
smaller samples. However, unlike previous studies, our study used continuous glucose
monitors which allowed us to measure the blood sugars continuously every five minutes for
up to 6 days and provided a more accurate measures of dysglycemia. Our results showed that
beyond the previously observed effects of hyperglycemia on white matter structure, glucose
fluctuations (as measured by standard deviation of glucose and Mean Amplitude of Glycemic
Excursions, MAGE) also were associated with white matter structure in children with type 1
diabetes.

Childhood Type I Diabetes: Brain White Matter Changes
Naama Barnea-Goraly M.D.
Center for Interdisciplinary Brain Sciences Research
Stanford University

•
•

•
•

•
•

MedicalResearch.com: What should clinicians and patients take away from your report? 
Answer: Fear of hypoglycemia in young children with type 1 diabetes often results in
caregivers maintaining relatively higher blood glucose levels to avoid lows altogether.
However, our study suggests that this approach, which often results in hyperglycemia, may
not be optimal and may be detrimental to white matter structure development in young
children.
of this study?
hyperglycemia It is still unknown whether better glucose control would eliminate structural
brain differences between children with T1D and controls. Longitudinal studies of how brain
changes with age would be important to show how brain structure and cognition change in
children with type 1 diabetes as they go through puberty and beyond.
Citation:
Naama Barnea-Goraly, Mira Raman, Paul Mazaika, Matthew Marzelli, Tamara Hershey, Stuart
A. Weinzimer, Tandy Aye, Bruce Buckingham, Nelly Mauras, Neil H. White, Larry A. Fox,
Michael Tansey, Roy W. Beck, Katrina J. Ruedy, Craig Kollman, Peiyao Cheng, Allan L. Reiss,
and for the Diabetes Research in Children Network (DirecNet)*


Health IT: Focus on Meaningful Use
Robert S. Rudin, Ph.D.
Associate Policy Researcher
RAND Corporation Boston, MA 02116

•
•

•

•
•

•
•
•
•

Dr. Rudin: We found that most published health IT implementation studies report positive effects
on quality, safety, and efficiency. Most evaluations focus on clinical decision support and
computerized provider order entry. However, not all studies report equally positive results, and
differences in context and implementation are one likely reason for these varying results, yet
details of context and implementation are rarely reported in these studies.
Dr. Rudin: The number of health information technology (IT) evaluation studies is rapidly
increasing, driven primarily by increased evaluation of commercial health IT applications.
Commercial studies accounted for more than half of evaluated health IT products, an enormous
increase over previous literature reviews.
Dr. Rudin: Clinicians and patients should realize that health IT can be a great enabler of improving
the quality and value of health care. However, by itself health IT will not accomplish these goals.
Health IT needs to be part of a strategy. In order to produce the most value, health IT needs to be
fitted to the organizational and clinical context, and how best to do this is not always well known.
study?
Dr. Rudin: The most important improvement that can be made in health IT evaluations is increased
measurement, analysis, and reporting of the effects of contextual and implementation factors.
Citation:
Spencer S. Jones, Robert S. Rudin, Tanja Perry, Paul G. Shekelle; Health Information Technology: An
Updated Systematic Review With a Focus on Meaningful Use. Annals of Internal Medicine. 2014
Jan;160(1):48-54

Alzheimer Disease: Effect of Vitamin E on Slowing Functional Decline
MedicalResearch.com Interview Invitation
Maurice Dysken, MD
Professor, School of Medicine Department of Psychiatry
Minneapolis VA Health Care System, Minneapolis, Minnesota

•
•

•

Dr. Dysken: In patients with mild-to-moderate Alzheimer’s disease who were taking an
acetylcholinesterase inhibitor, a dosage of 2000 IU/d of vitamin E significantly slowed
functional decline compared to placebo by 6.2 months over the mean follow-up period of
2.27 years. Over this period of time caregiver time increased least in the vitamin E group
compared to the other three groups (memantine alone, vitamin E plus memantine, and
placebo) although the only statistically significant difference was between vitamin E alone
and memantine alone. There were no significant safety concerns for vitamin E compared to
placebo and mortality was lowest in the vitamin E alone group. It should be noted that
patients who were on warfarin were excluded from the study because of a possible
interaction with vitamin E that could have possibly increased bleeding events.
Dr. Dysken: The combination of vitamin E and memantine did not significantly slow
functional decline compared to placebo. Although one measure of cognition (ADAS-cog)
favored vitamin E compared to placebo, after adjustment for multiple comparisons, this
difference was not statistically significant.


Alzheimer Disease: Effect of Vitamin E on Slowing Functional Decline
MedicalResearch.com Interview Invitation
Maurice Dysken, MD
Professor, School of Medicine Department of Psychiatry
Minneapolis VA Health Care System, Minneapolis, Minnesota

•
•

•
•

•
•

Dr. Dysken: We concluded that 2000 IU/d of vitamin E appears to be beneficial in patients
with mild-to-moderate Alzheimer’s disease by slowing functional decline and decreasing
caregiver burden. Vitamin E appears to be safe and is also inexpensive. It should be
emphasized that our study was not a prevention trial in subjects without a diagnosis of
Alzheimer’s disease and as a consequence, vitamin E should be recommended only to
patients who have a diagnosis of Alzheimer’s disease.
of this study?
Dr. Dysken: It would be interesting to study different dosages of vitamin E and the
effectiveness of other antioxidants as well. A combination study with aerobic exercise would
be interesting since aerobic exercise also appears to have benefit in slowing decline in AD
patients. Although vitamin E is an antioxidant, basic studies are needed to elucidate vitamin
E’s specific mechanism of action in Alzheimer’s disease. Additional safety data are needed on
the interaction between warfarin and vitamin E.
Citation:
Dysken MW, Sano M, Asthana S, et al. Effect of Vitamin E and Memantine on Functional
Decline in Alzheimer Disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA.
2014;311(1):33-44. doi:10.1001/jama.2013.282834.


MedicalResearch.com - Medical Research Interviews Week in Review

Recommended

Recommended

More Related Content

More from Marie Benz MD FAAD

More from Marie Benz MD FAAD (20)

Recently uploaded

Recently uploaded (20)

MedicalResearch.com - Medical Research Interviews Week in Review