Only 15 percent of preventable spina bifida and anencephaly being prevented worldwide, study finds

Woodruff Health Sciences Center

Approximately only 15 percent of global cases of spina bifida and anencephaly that are preventable through folic acid fortification are actually being prevented according to a study led by epidemiologists and nutrition scientists from the Departments of Epidemiology and Global Health at Emory’s Rollins School of Public Health and the Food Fortification Initiative.

Published in the July edition of Birth Defects Research Part A Clinical and Molecular Teratology, the study emphasizes the preventable morbidity and mortality caused by the lack of cost-effective, easily implementable, and proven strategy of government-required folic acid fortification of food (also termed mandatory fortification). The researchers measured the current status of folic acid-preventable spina bifida and anencephaly (FAP SBA) worldwide. This was particularly significant as it was the 25th anniversary of the Medical Research Council study that proved unequivocally that folic acid prevents a majority of spina bifida and anencephaly.

According to study results, in the year 2015, there were about 35,500 fewer births with spina bifida and anencephaly, a commendable prevention achieved in 58 countries through mandatory folic acid fortification of wheat and maize flour. However, this also points to the urgency of preventing about 233,000 other FAP SBA cases that are still occurring in the remaining countries without effective folic acid interventions, say the authors. Most of Europe, Africa, and Asia is not implementing mandatory fortification with folic acid. Researchers believe that the implementation of mandatory fortification with folic acid offers governments a rapid way to prevent FAP SBA-associated disability and mortality, and to help countries achieve their health-related Sustainable Development Goalsrelated to reduction in infant and under-five mortality.

"No baby in the world should develop preventable birth defects such as FAP SBA and congenital rubella syndrome, because we have a known preventable strategy to aid against these conditions," says Dr. Godfrey P. Oakley Jr., MD, a pediatrician and the director of the Center for Spina Bifida Prevention at Emory’s Rollins School of Public Health. "Ignoring a preventable strategy for preventing serious birth defects can be compared to having a vaccine for Zika virus and not using it."

Contact

Melva Robertson
404-727-5692
[email protected]

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Only 15 percent of preventable spina bifida and anencephaly being prevented worldwide, study finds

Majority of Physicians Have Favorite Patients, Study Finds

Despite having favorites, physicians report striving to provide the best care for everyone

Physicians like the majority of their patients, but a majority like some more than others, a study led by researchers at the Johns Hopkins Bloomberg School of Public Health finds.

The study, published online in the journal Patient Education and Counseling, is thought to be among the first to explore the positive aspects of physicians’ attitudes towards their patients. Of the 25 physicians interviewed, 22 respondents reported having favorite patients, with some characterizing them as a type of patient they regularly encounter in their practice and others as several standout patients they had treated over the course of their career.

The researchers say that understanding this aspect of physician-patient relationships sheds light on how patients and physicians might best work with each other, from patients making sure they see their doctors regularly and doctors appreciating the rewards of their practice, thus avoiding burnout.

“For patients, these findings highlight the importance of having a usual source of care, a primary care doctor with whom they can establish a relationship,” says study leader Joy Lee, PhD, MS, a postdoctoral fellow in the Department of Health Policy and Management at the Bloomberg School. “Favorite patients might not be consistently sick, but when a crisis comes they have an existing relationship to work off of.”

Surprisingly, Lee says, many physicians reported that their favorite patients were not necessarily the most compliant or those who were most similar to them. Rather, they were patients who the physician had known over a period of time – anywhere from one year to several decades – and who were or had been very sick, which meant the physicians saw them more frequently and spent more time with them.

Three of the respondents reported not having any favorite patients, and voiced concerns that the label suggested preferential treatment. The other physicians in the study, those indicating they had some sort of favorite patient, voiced the same concern. In their responses, physicians often used the term “it’s not about me” to convey that instead of thinking about how they felt about their patients they were endeavoring to provide them their best care regardless of their feelings about them – favorable or otherwise.

“This concern demonstrates that physicians are striving to be fair and to give all their patients the best possible care,” Lee says. “We discovered that doctors really thought about their relationship with patients, which is encouraging from a patient perspective. Their thinking really humanizes the patient-physician relationship.”  Some of those with favorite patients, for example, indicated they were mindful of the boundaries around the physician-patient relationship, and did not socialize with patients outside of their practice or connect with them on social media channels such as Facebook.

For the study, a researcher interviewed 25 primary care physicians working in clinical settings across the Johns Hopkins medical system. Participants were mostly white (21, or 84 percent) and just over half were female (14, or 56 percent). The interviews were open ended but mainly centered around eight questions about participants’ perceptions of a favorite patient – a term for which there is no consensus definition. All but three of the interviews were recorded and transcribed for analysis. (For three, the recordings failed and the interviewer relied solely on detailed notes.) The responses were coded, and three themes around favorite patients emerged: physicians’ perspectives, characteristics of favorite patients and effects of the favorite patient relationship.

From a policy perspective, the findings highlight the importance of health insurance and consistent access to health care where patients can see the same doctor or practice over time. Uninsured patients tend to see a variety of practitioners, often seeking treatment at emergency rooms, instead of developing relationships with a specific doctor.

In fact, the most tangible perceived benefit for favorite patients might be that their physicians, having spent significant amounts of time with them, are best suited to care for their patients because of their knowledge of their cases. Otherwise, physicians did not identify substantial benefits favorite patients had over others except that they were better known to them. Though one did observe, “There is a truth to the fact that my favorite patients probably hear back from me more rapidly than my less favorite patients.”

“I think it would be surprising if doctors didn’t have favorites,” says Albert Wu, MD, MPH, a professor in the Bloomberg School’s Department of Health Policy and Management and senior author on the paper. “Doctors are human too, and as humans we like some people more than others - in both our personal and professional lives. We want our doctors to be humanistic, and patients benefit from positive regard. It is good to recognize it, to avoid playing favorites, which is different than having favorites.”

While physicians reported that their favorite patients enriched their professional experience, a fourth theme, about challenging patients, emerged in the responses, largely unprompted by the interviewer. Many challenging patients, the respondents said, lacked an understanding of the limits of what physicians could do. Many respondents reported that formerly challenging patients often became their favorites over time, reinforcing the benefits of patients seeing the same physician when possible. Observed one participant: “Patients who I never thought I would even come to like grow into some favorites [through the] shared experience of knowing them for over a decade.”

“A Qualitative Exploration of Favorite Patients in Primary Care” was written by Joy L. Lee, PhD, MS; Mary Catherine Beach, MD, MPH; Zackary D. Berger, MD, PhD; Elizabeth R. Pfoh, PhD, MPH; Joseph J. Gallo, MD, MPH, Sydney M. Dy, MD, MSc; Albert W. Wu, MD, MPH.

Joy Lee was supported in part by an Agency for Healthcare Research and Quality National Research Service Award (NRSA) pre-doctoral institutional training grant (#T32HS000029).

# # #

Media contacts for the Johns Hopkins Bloomberg School of Public Health:Barbara Benham at 410-614-6029 or [email protected] and Stephanie Desmon at 410-955-7619 or [email protected].

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Depression’s stigma can be a barrier to African-Americans seeking treatment, study finds

Athens, Ga. - The stigma attached to mental illness creates a barrier for many seeking treatment, but it has a particularly negative impact on the help-seeking behaviors of black Americans, a small in-depth qualitative study by researchers at the University of Georgia suggests.

Writer: Erica Hensley

Rosalyn Denise Campbell, an assistant professor in the UGA School of Social Work, advocates for removing that stigma and fostering intervention that increases mental health service use and overall wellness.

In a study published in the Journal of Ethnic and Cultural Diversity in Social Work, her recent research focuses on African-Americans with depression—some self-diagnosed, others clinically—and how they experience mental illness and navigate the mental health system.

Campbell's research comprises individual participant interviews that focus on each person's history and battle with depression. She then connects themes to apply the stories to the wider context of service-use patterns and the impact on the black American community.

One of the major themes emerging from her research is the necessity for black Americans experiencing depression to challenge the stigma throughout their disclosure and recovery journey, as they reconcile a new identity.

"I can't tell you how many times in these interviews people have said, ‘I don't talk about this,'" Campbell said. "Some of them actually felt like participating in the study was pushing back against the stigma. By admitting, ‘I identify as a person who has experienced depression, and I'm going to share my story for this study,' they felt like by adding another voice, that that was pushing back against the stigma."

The socio-cultural barriers to seeking mental health services, which Campbell said are often rooted in the history and identity of being black in America, is another emerging theme in her research. She mandates the importance of contextualizing each person's background as a part of their help-seeking patterns, especially populations that come from a history being shut out of services.

"Because African-Americans are already marginalized, there is no rush to adopt another marginalized, stigmatizing identity," she said. "There is a lot to lose with accepting a mental health diagnosis."

Her research suggests that black Americans are often thwarted from seeking depression treatment before they even enter the system, due to fears of being stigmatized by their friends and family as "less than African-American," and hesitancy to trust in treatment, Campbell said.

A pervasive misunderstanding of mental illness also contributes to the power of the stigma, she said, often due to a lack of education regarding what depression is and is not. Her research suggests depression is often seen as a weakness or a temporary condition, rather than the illness it is.

"We're all aware of historically what African-Americans have gone through in this country—through slavery, the civil rights movement, discrimination," Campbell said, and overcoming those obstacles created a sense of strength and perseverance within the community. "So, anything that pushes against that seems antithetical to what it means to be black."

Campbell's research derives deeply from community and identity contextualization, which she said affects both individual and group health outcomes.

"That goes for how we are evaluating people, how we are treating people, how we are intervening—we cannot remove that context, because if we are not addressing that and that's what a person embodies, you're not reaching them," she said. "It's not just you in present day in 2016—it's you and your ancestors from 1816, and their experience that's helped shaped your identity and who you are."

As part of that contextualization, Campbell makes a point to discuss her own experiences with mental illness, and said it's a key component of her mission to de-stigmatize it.

"The only way to combat stigma is to take its power away, and you take its power away by talking about it and disclosing it," she said.

Orion Mowbray, an assistant professor in UGA's School of Social Work, is the study's co-author.

The study, "The Stigma of Depression: Black American Experiences," is available at http://ift.tt/2aekkMp.

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Protein that protects tumour cells associated with improved survival in some breast cancer patients, study finds

A family of proteins that help cancer cells survive and spread around the body may be associated with improved prognosis for some women receiving treatment for breast cancer, research has shown.

The study, led by academics at The University of Nottingham and published online by the academic journal Oncotarget, discovered that when high levels of the protein calpain were detected in large primary breast tumours from patients given chemotherapy treatment to shrink their tumour before surgery, these patients were more likely to survive.

The work, which was funded by the breast cancer research charity Breast Cancer Now, was conducted in the laboratory of Professor Stewart Martin, in the University’s Translational and Radiation Biology Research group.

Professor Martin said: “We are passionate about understanding how breast cancer gains the ability to spread around the body, and what makes certain cancers resistant to treatment, so we can improve survival.

“The results increase our understanding of this important protein in breast cancer, particularly in poor prognostic groups, which may be the key to unlocking effective ways to target these proteins to improve patient outcomes.”

Improved survival rate

The latest research involved biopsy specimens taken from women aged between 23 and 83 years old who were treated at the Leeds Teaching Hospitals NHS Trust between 2005 and 2009 for inflammatory and non-inflammatory breast cancer.

It looked at the expression of calpain in the initial tumour biopsy and again in the biopsied tumour removed following adjuvant chemotherapy which is designed to shrink the cancer before surgery.

The levels of calpain and the resulting survival rates were analysed and those patients with higher levels of calpain were associated with an improved survival rate.

The study also involved researchers at the Leeds Institute of Cancer Medicine and Pathology and the Department of Breast Surgery at St James’ University Hospital in Leeds, Breast Screening Unit Leeds/Wakefield at Seacroft Hospital in Leeds and Histopathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre and the University of Birmingham.

The full academic paper, The Calpain System is Associated with Survival of Breast Cancer Patients with Large but Operable Inflammatory and Nob-Inflammatory Tumours Treater with Neoadjuvant Chemotherapy, can be found on the Oncotarget website.

Stopping cancer in its tracks

Additional research funding to continue the work is currently being raised through the University’s Life Cycle 6 campaign, which will see a team of University of Nottingham staff undertaking a gruelling 1,400 mile endurance bike ride this August to the four corners of Britain.

As well as sponsoring the endurance cyclists and taking part in the community bike ride, the University is encouraging people to hold their own fundraising events such as bake sales, dress down days, sky dives and charity discos. A list of ideas and more information features on the Life Cycle website.

The fundraising will support experts at Nottingham who are working on stopping the spread of breast cancer. The research focusses on understanding how breast cancer can spread outside of the breast and grow in other places around the body and what we can do to stop this process.

— Ends —

Our academics can now be interviewed for broadcast via our Media Hub, which offers a Globelynx fixed camera and ISDN line facilities at University Park campus. For further information please contact a member of the Communications team on +44 (0)115 951 5798, email [email protected] or see the Globelynx website for how to register for this service.

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Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with a “distinct” approach to internationalisation, which rests on those full-scale campuses in China and Malaysia, as well as a large presence in its home city.’ (Times Good University Guide 2016). It is also one of the most popular universities in the UK among graduate employers and the winner of ‘Outstanding Support for Early Career Researchers’ at the Times Higher Education Awards 2015. More than  97% of research at The University of Nottingham is recognised internationally and it is 8th in the UK by research power according to the Research Excellence Framework 2014. It has been voted the world’s greenest campus for four years running, according to Greenmetrics Ranking of World Universities.

Impact: The Nottingham Campaign, its biggest-ever fundraising campaign, is delivering the University’s vision to change lives, tackle global issues and shape the future. More news…

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Simple, widely available and inexpensive recreational activities may be as effective as virtual reality technology in stroke rehabilitation, study finds

Sometimes in health care, simple activities CAN be just as effective as the latest technology.

Dr. Gustavo Saposnik

A new study has found that simple, widely available and inexpensive activities such as playing cards or repeatedly throwing a foam ball or wad of paper into a wastepaper basket are just as effective in helping people regain strength and co-ordination following a stroke as playing virtual reality games.

The study, published today in the journal Lancet Neurology, is encouraging news for the 15 million people worldwide who suffer a stroke each year and may not live near a stroke rehabilitation centre or in a country with a sophisticated health-care system, or have health-care insurance, said lead author Dr. Gustavo Saposnik, a neurologist at St. Michael’s Hospital in Toronto.

The study was based on a clinical trial conducted at 14 centres in four countries in which patients were randomized into two groups. In addition to conventional rehabilitation therapy, one group received 10, one-hour sessions of virtual reality using the Nintendo Wii system and the other spent the same amount of time doing simple recreational activities such as playing cards or dominoes.

Patients randomized to both groups saw a 30 per cent and 40 per cent improvement in motor performance at the end of two weeks of the intervention and four weeks after the intervention, respectively.

“But there was no significant difference between the two groups in terms of strength, dexterity, gross motor skills, quality of life or activities of daily living,” said Dr. Saposnik, who is also a scientist in St. Michael’s Li Ka Shing Knowledge Institute. “We all like technology and have the tendency to think that new technology is better than old-fashioned strategies, but sometimes that’s not the case. In this study, we found that simple recreational activities that can be implemented anywhere may be as effective as technology.”

Dr. Saposnik said he was surprised by the results, because many previous studies, including his own, had a different conclusion, and because virtual reality has become an emerging strategy to enhance motor skills in stroke rehabilitation. Previous studies and review, including Dr. Saposnik’s pilot study published in 2010, suggested up to 20 to 30 per cent improvements in the motor skills of patients who had virtual reality therapy.

Dr. Saposnik said the new findings could be the result of the fact this clinical trial was the largest of its kind and used a more accurate comparison of the total time of therapy each group had. Both groups of randomized patients received the same amount of conventional therapy and then the same amount of time of either recreational activities or virtual reality. In previous studies, groups who received conventional and virtual reality therapy were compared to those who received only conventional therapy, with no add-ons.

This study received funding from the Heart and Stroke Foundation of Canada, the Ontario Stroke Strategy and the Ontario Ministry of Health and Long-Term Care.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Media contacts

For more information or to arrange an interview with Dr. Saposnik, please contact:

Leslie Shepherd
Manager, Media Strategy, St. Michael's Hospital
416-864-6094
[email protected]

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Simple, widely available and inexpensive recreational activities may be as effective as virtual reality technology in stroke rehabilitation, study finds

Most antidepressant drugs ineffective for children and teens, study finds

But researchers warn that lack of available data from published and unpublished trials leads to great uncertainty around true effects

Most available antidepressants are ineffective, and some may be unsafe, for children and teenagers with major depression, according to the most comprehensive comparison of commonly prescribed antidepressant drugs so far, published in The Lancet.

The findings indicate that out of 14 antidepressant drugs, only fluoxetine was more effective at relieving the symptoms of depression than placebo, whilst taking venlafaxine was linked with an increased risk of engaging in suicidal thoughts and attempts compared with placebo and five other antidepressants.

Without access to individual-level data it is difficult to get accurate effect estimates and we can't be completely confident about the accuracy of the information contained in published and unpublished trials. It has been widely argued that there needs to be a transformation of existing scientific culture to one where responsible data sharing should be the norm.

Dr Andrea Cipriani, Department of Psychology

However, the true effectiveness and risk of serious harms such as suicidal thoughts and attempts remains unclear because of the small number and poor design of clinical trials assessing these antidepressants, and the selective reporting of findings in published trials and clinical study reports, caution the authors.

'The balance of risks and benefits of antidepressants for the treatment of major depression does not seem to offer a clear advantage in children and teenagers, with probably only the exception of fluoxetine. We recommend that children and adolescents taking antidepressants should be monitored closely, regardless of the antidepressant chosen, particularly at the beginning of treatment,' explained co-author Professor Peng Xie from The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

'Without access to individual-level data it is difficult to get accurate effect estimates and we can't be completely confident about the accuracy of the information contained in published and unpublished trials. It has been widely argued that there needs to be a transformation of existing scientific culture to one where responsible data sharing should be the norm,' says lead author Dr Andrea Cipriani at the University of Oxford. 'Hundreds of thousands of people worldwide have agreed to participate in trials aiming to find better treatments for their disorders and, ultimately, help the progress of medical science. Patients' privacy must be guaranteed by adequate policies and technological measures, but delay in implementing responsible data sharing policies has negative consequences for medical research and patient outcomes, as demonstrated by this study. Access to raw clinical trial data provides the unique opportunity not only for validation and replication of results but also the in-depth study of specific factors that may affect treatment outcome at the individual patient level.'

Major depressive disorder is common in children and adolescents, affecting around 3% of children aged 6 to 12 years and about 6% of teenagers aged 13 to 18 years. Psychological treatments are recommended as the first-line treatment for depression in many clinical guidelines, and in 2004 the US Food and Drug Administration (FDA) issued a black box warning against the use of antidepressants in young people up to 24 years old because of concern about increased risk of suicidal thoughts. However, use of antidepressants has slowly increased between 2005 and 2012. The proportion of US children and teenagers (aged 0–19) taking antidepressants increased from 1.3% to 1.6%, and in the UK from 0.7% to 1.1%. Sertraline is the most widely prescribed antidepressant in the USA and fluoxetine is the most common in the UK.

Cipriani and colleagues did a systematic review and network meta-analysis of all published and unpublished randomised trials comparing the effects of 14 antidepressants in young people with major depression up to the end of May 2015. They ranked antidepressants by efficacy (change in depressive symptoms and response to treatment), tolerability (stopping the medication due to adverse events), acceptability (stopping the medication due to any cause), and associated serious harms (suicidal thoughts and attempts). They took into account the quality of included studies (Cochrane risk of bias) and also assessed the overall quality of the retrieved evidence (GRADE).

Analysis of 34 trials involving 5260 participants aged 9 to 18 showed that the benefits outweighed the risks in terms of efficacy and tolerability only for fluoxetine. Nortriptyline was less effective than seven other antidepressants and placebo. Imipramine, venlafaxine, and duloxetine had the worst profile of tolerability, leading to significantly more discontinuations than placebo. Venlafaxine was linked with an increased risk of engaging in suicidal thoughts or attempts compared with placebo and five other antidepressants. The authors warn that due to the lack of reliable data, it was not possible to comprehensively assess the risk of suicidality for all drugs.

22 (65%) trials were funded by pharmaceutical companies. Ten (29%) trials were rated as high risk of bias, 20 (59%) as moderate, and four (12%) as low.

Overall quality of evidence for primary outcomes was rated as very low for most comparisons, which restricts the implications of the results for clinical practice.

Writing in a linked Comment, Dr Jon Jureidini at the University of Adelaide in Australia questions how many more suicidal events might have been revealed had individual patient-data been available. 

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Most antidepressant drugs ineffective for children and teens, study finds

Obese Young Adults Unaware of Kidney Disease Risk, Study Finds

Many young adults with abdominal obesity exhibit a readily detectable risk factor for chronic kidney disease (CKD), yet the vast majority don’t know they’re at risk, according to a study of nationwide health data led by Albert Einstein College of Medicine researchers that was published online today in the journal PLOS ONE.

Michal L. Melamed, M.D.Einstein researchers analyzed health data on nearly 7,000 non-pregnant young adults. They found that 11 percent of obese Mexican Americans have albuminuria (elevated levels of the protein albumin in the urine), which signals that the kidneys aren’t functioning normally and that a person faces a heightened risk for developing CKD. This is four times the prevalence in Hispanics of normal weight. About six percent of whites and blacks with abdominal obesity had elevated levels of the protein.

An estimated one in three Americans is at risk for developing CKD over the course of their lifetime, usually later in adulthood. “Even though chronic kidney disease typically manifests in older people, the disease can start much earlier but often is not recognized early on,” said study leader Michal L. Melamed, M.D., associate professor of medicine and of epidemiology & public health at Einstein and attending physician, nephrology at Montefiore Health System. “Because treatment options for CKD are limited, prevention is the best approach for those at risk. A healthier lifestyle in young adults will go a long way toward promoting kidney health later in life.”

Previous studies had suggested that abdominal obesity may damage kidney function even before—and perhaps independent of—kidney damage associated with hypertension and diabetes, which are both associated with obesity.

“In this study we wanted to evaluate whether obesity is associated with CKD even in an otherwise healthy young adult population and to identify risk factors that may promote this association,” said first author Harini Sarathy, M.D., formerly a resident physician at Jacobi Medical Center, an Einstein clinical affiliate. “We also wanted to see whether race or ethnicity plays a role in linking abdominal obesity with CKD, as studies have suggested.”

“Even though chronic kidney disease typically manifests in older people, the disease can start much earlier but often is not recognized early on.”

– Michal L. Melamed, M.D.

The Einstein researchers found that excess albumin was present even in the urine of obese individuals with normal blood pressure, glucose levels, and insulin sensitivity, confirming a direct connection between obesity and the albuminuria associated with kidney disease. These findings also suggest that obesity should be considered an independent risk factor for CKD and that doctors should be testing for kidney damage when evaluating obese young adults.

The Einstein researchers analyzed health data on 6,918 non-pregnant adults ages 20 to 40. The data were gathered between 1999 and 2010 by the National Health and Nutrition Examination Survey (NHANES), a program of studies designed to assess the health and nutritional status of adults and children in the United States. The participants self-identified as non-Hispanic white, non-Hispanic black, or Mexican-American. Abdominal obesity (defined as a waist circumference ≥102 cm (40 inches) in males and ≥88 cm (35 inches) in females) was present in 45 percent of blacks, 40 percent of Mexican-Americans, and 37 percent of whites.

The study also found that among all young adults with albuminuria, fewer than 5 percent had ever been told they have kidney disease. “Clearly, clinicians and public health officials need to do more to identify and treat young people at risk for early progressive kidney disease so they can adopt the behavioral changes to prevent CKD from occurring,” said Dr. Melamed.

The paper is titled “Abdominal Obesity, Race and Chronic Kidney Disease in Young Adults: Results from NHANES 1999-2010.” Other Einstein authors were Gabriela Henriquez, M.D., Matthew K. Abramowitz, M.D., Tanya Johns, M.D., Amy Skversky, M.D. and Frederick Kaskel, M.D., Ph.D. Additional authors include: Holly Kramer, M.D., M.P.H., of Loyola University Health Sciences Center, Maywood, IL, Sylvia E. Rosas, M.D, of Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Boston, MA, and Juhi Kumar, M.D., M.P.H., of Weill Cornell Medical Center, New York, NY.

The project was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (R01 DK102952, K23 DK084339, R34 DK102174M, T32 DJ007110, K23DK102925 AND K23 DK099438), and by the American Society of Nephrology.

The authors declare no financial conflict of interest.

Contact
Deirdre Branley
718.430.3101
[email protected]

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Obese Young Adults Unaware of Kidney Disease Risk, Study Finds

Alternating diet between high fat, balanced may help control obesity, study finds

Researchers at the University of Georgia's College of Pharmacy have discovered that alternating between a high fat and a more nutritionally balanced diet at regular intervals may help prevent or treat obesity and its associated metabolic disorders. They published their findings recently in the journal Scientific Reports.

For their study, scientists fed mice a high fat diet for five days before switching the animals to regular feed for a period of one, two or five days. They repeated this cycle for several weeks and observed the effects.

They found that switching to a regular diet for two or five days between periods of high fat intake not only helped control body weight, it also improved insulin sensitivity and prevented the accumulation of fat in the liver, two common side effects of obesity.

"Maintaining a proper diet requires a lot of willpower, and one of the problems we see very often with modern weight loss programs is that people cannot sustain a restricted diet over long periods of time," said Dexi Liu, the Panoz Professor of Pharmacy at UGA. "The temptation to eat becomes overwhelming, and many people end up regaining the weight they've lost, so we wanted to see if there may be an alternative to these diets."

Mice were allowed to eat as much food as they wanted during every phase of the study. The researchers also maintained two control groups, one of which received only a high fat diet and another that received only regular feed.

While mice that received only a high fat diet predictably gained weight, those fed an alternating diet closely mirrored the control group that received only regular feed in terms of their body weight, liver health and glucose sensitivity.

"The mice that received an alternating diet maintained body weight similar to mice that only received a regular diet," Liu said. "They also had much lower levels of inflammation, which can contribute to the development of metabolic disorders like diabetes."

Liu and his co-authors Yongjie Ma and Mingming Gao also found that an alternating diet can reverse obesity in mice. To test this, they fed a group of obese mice an alternating diet for five weeks, which led to a 12 percent reduction in fat mass compared to control animals.

"These results suggest that it may be possible to eat the foods you like, and to do so with pleasure, as long as those habits are tempered with periods of rest," Liu said.

While he cautions that their results in an animal model do not necessarily translate directly to humans, Liu and his colleagues think that an alternating diet similar to the one used in their experiments could serve as the foundation for new dietary guidelines.

"Obesity is a complex disorder, and there are many factors that can contribute to excessive weight gain," Liu said. "There are, for example, genetic differences that may influence how easily a person gains or loses weight, but we believe that diet is still the dominant factor.

"Ultimately, we want to find ways to help make people healthy, and an alternating diet may be a more practical way for people to live a healthier life."

The study, "Alternating Diet as a Preventive and Therapeutic Intervention for High Fat Diet-induced Metabolic Disorder," is available at http://ift.tt/1WOeQIV.

This study was supported in part by the National Institutes of Health under grant number RO1HL098295.

By:
James Hataway
Work: 706-542-5222
Email: [email protected]

Contact:
Dexi Liu
Work: 706-542-7385
Email: [email protected]

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Alternating diet between high fat, balanced may help control obesity, study finds

Bioengineered blood vessel is safe for dialysis patients, study finds

By Ziba Kashef - Bioengineered blood vessels may prove to be safer and last longer than synthetic vessels for patients on dialysis.

(Photo courtesy of Humacyte)

A Yale scientist collaborated with researchers at Duke University and surgeons in Poland and the United States to create bioengineered blood vessels for kidney-disease patients on dialysis. The man-made vessels appeared to be both safe and more durable than commonly used synthetic versions, said the investigators.

Their study findings — which set the stage for further investigation in randomized controlled trials — were published May 12 in The Lancet.

Individuals with kidney failure require dialysis, which is often administered through a synthetic graft implanted in the arm. However, those grafts are prone to infection, clotting, and other complications. Studies of alternative grafts — derived from the patient, a donor, or animal tissue — have found they perform no better than synthetics.

Dr. Laura Niklason, the Nicholas Greene Professor of Anesthesiology and of biomedical engineering at Yale, and her co-authors created novel bioengineered vessels to provide dialysis access to 60 patients at six research sites. Known as human acellular vessels (HAVs), they were produced by Humacyte, Inc., a company that Niklason co-founded.

To create the vessels, the researchers first isolated vascular cells from human donors and grew them in tissue culture. They then placed the cells on a degradable scaffold shaped like a blood vessel. As the tissue grew, it was bathed in nutrients and stretched to acquire the physical properties of real blood vessels.

“After that process, which takes eight weeks, the scaffold degrades and what we have left is engineered tissue that we have grown from scratch,” said Niklason.

The final step was to wash away the cellular components with a special solution, leaving behind a protein structure that the cells made during culture. This protein structure is mostly collagen, along with other non-living components. This “decellularized” tissue retains the structure of the vessel but none of the components that would cause tissue rejection.

“The bioengineered blood vessel represents a critical step in tissue engineering,” said Dr. Jeffrey Lawson, professor of surgery and pathology at Duke, chief medical officer of Humacyte, and a long-time collaborator with Niklason. “Because these vessels contain no living cells, patients have access to off-the-shelf engineered vessels that can be used without any waiting period associated with tailor-made products.”

One year after implantation, the bioengineered vessels appeared to be both safe and functional. “They are safe and maintain their mechanical integrity,” said Niklason. They also showed no sign of rejection.

While there were cases of adverse events such as clotting, the rates of those events were comparable to alternatives. Notably, the durability of the bioengineered vessels at one year was 90% compared to the historically observed 60% rate of synthetic grafts.

Additionally, the researchers noted that after implantation, the bioengineered vessels had been repopulated with the patient’s own cells. “We’re taking a nonliving tissue, and it becomes living over time,” said Niklason. “This is regenerative medicine in the truest sense.”

Because many vessels could be developed from a single donor, the findings, if confirmed, could transform care for patients with kidney failure and other diseases, said Niklason. “The fact that acellular tissue becomes human tissue has implications for regenerative medicine more broadly.”

Other study authors are Dr. Marc H. Glickman; Dr. Marek Ilzecki; Dr. Tomasz Jakimowicz; Dr. Andrzej Jaroszynski; Dr. Eric K. Peden, Alison J. Pilgrim; Heather Prichard; Dr. Guziewicz Malgorzata; Dr. Stanisław Przywara; Dr. Jacek Szmidt; Dr. Jakub Turek; Dr. Wojciech Witkiewicz; Dr. Norbert Zapotoczny; and Dr. Tomasz Zubilewicz.

The study was funded by Humacyte, Inc, which performed data collection, analysis, and interpretation in consultation with the authors.

Contact Ziba Kashef [email protected] 203-436-9317

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Breast cancer patients who lack knowledge about their own tumor are less likely to receive recommended treatment, study finds

Women with breast cancer who know the characteristics of their tumor are more likely to receive the treatment recommended for their type of cancer, Dana-Farber Cancer Institute investigators report in a new study that reinforces the potential risks of being underinformed about one’s cancer.

Rachel Freedman, MD, MPH

The study, published today by the Journal of Oncology Practice, is based on a survey of more than 400 patients who were asked the stage and grade of their breast cancer, whether it tested positive for the HER2 protein, and whether it was sensitive to estrogen. Each of these factors influences the treatment regimen that patients receive.

Patients who correctly reported their breast cancer as HER2-positive were likely to receive chemotherapy, the recommended treatment for that form of the disease. Those who correctly reported their cancer as estrogen-sensitive were likely to receive hormonal therapy, as treatment guidelines advise. And those who correctly identified their tumor stage were likely to receive radiation therapy. By contrast, patients who were less knowledgeable about their cancer were less likely to receive the recommended treatment.

“Previous studies have shown that knowledge about breast cancer in general is poor across many populations, but what isn’t known is whether knowledge of one’s own disease affects one’s receipt of treatment,” says study lead author Rachel Freedman, MD, MPH, of the Susan F. Smith Center for Women’s Cancers at Dana-Farber. “For this study, we hypothesized that such knowledge is associated with receiving the recommended therapies. Our findings support that hypothesis.”

She notes that although the link between knowledge and appropriate treatment was confirmed by the study’s results, the direction of that link is unclear. In other words, are women apt to receive the recommended treatment because they’re knowledgeable about their disease, or are they knowledgeable about their disease because they’ve received the recommended treatment?

Freedman and her colleagues are planning a study to answer this and other questions about patients’ understanding of their disease and the decisions surrounding its treatment. “We want to focus specifically on the clinical, emotional, and social consequences of poor knowledge and how information can be delivered to patients more effectively,” she remarks. “The next step will be to test whether efforts to improve patients’ knowledge can lead to better care.”

The senior author of the study is Nancy Keating, MD, MPH, of Dana-Farber and Brigham and Women’s Hospital (BWH). Co-authors are Elena Kouri, PhD, Dee West, PhD, and Joyce Lii, MS, all of Dana-Farber and BWH.

Financial support for the study was provided by grants from Susan G. Komen, the American Cancer Society, and National Cancer Institute (grant no. K24CA181510).

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'Liquid biopsy' blood test accurately detects key genetic mutations in most common form of lung cancer, study finds

A simple blood test can rapidly and accurately detect mutations in two key genes in non-small cell lung tumors, researchers at Dana-Farber Cancer Institute and other institutions report in a new study – demonstrating the test’s potential as a clinical tool for identifying patients who can benefit from drugs targeting those mutations.

Geoffrey Oxnard, MD

The test, known as a liquid biopsy, proved so reliable in the study that Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) expects to offer it soon to all patients with non-small cell lung cancer (NSCLC), either at the time of first diagnosis or of relapse following previous treatment.

NSCLC is the most common form of lung cancer, diagnosed in more than 200,000 people in the United States each year, according to the American Cancer Society. An estimated 30 percent of NSCLC patients have mutations in either of the genes included in the study, and can often be treated with targeted therapies. The study is being published online today by the journal JAMA Oncology.

The liquid biopsy tested in the study – technically known as rapid plasma genotyping – involves taking a test tube-full of blood, which contains free-floating DNA from cancer cells, and analyzing that DNA for mutations or other abnormalities. (When tumor cells die, their DNA spills into the bloodstream, where it’s known as cell-free DNA.) The technique, which provides a “snapshot” of key genetic irregularities in a tumor, is a common tool in research for probing the molecular make-up of different kinds of cancers.

“We see plasma genotyping as having enormous potential as a clinical test, or assay – a rapid, noninvasive way of screening a cancer for common genetic fingerprints, while avoiding the challenges of traditional invasive biopsies,” said the senior author of the study, Geoffrey Oxnard, MD, thoracic oncologist and lung cancer researcher at Dana-Farber and Brigham and Women’s Hospital. “Our study was the first to demonstrate prospectively that a liquid biopsy technique can be a practical tool for making treatment decisions in cancer patients. The trial was such a success that we are transitioning the assay into a clinical test for lung cancer patients at DF/BWCC.”

The study involved 180 patients with NSCLC, 120 of whom were newly diagnosed, and 60 of whom had become resistant to a previous treatment, allowing the disease to recur. Participants’ cell-free DNA was tested for mutations in the EGFR and KRAS genes, and for a separate mutation in EGFR that allows tumor cells to become resistant to front-line targeted drugs. The test was performed with a technique known as droplet digital polymerase chain reaction (ddPCR), which counts the individual letters of the genetic code in cell-free DNA to determine if specific mutations are present. Each participant also underwent a conventional tissue biopsy to test for the same mutations. The results of the liquid biopsies were then compared to those of the tissue biopsies.

The data showed that liquid biopsies returned results much more quickly. The median turnaround time for liquid biopsies was three days, compared to 12 days for tissue biopsies in newly diagnosed patients and 27 days in drug-resistant patients.

Liquid biopsy was also found to be highly accurate. In newly diagnosed patients, the “predictive value” of plasma ddPCR was 100 percent for the primary EGFR mutation and the KRAS mutation – meaning that a patient who tested positive for either mutation was certain to have that mutation in his or her tumor. For patients with the EGFR resistance mutation, the predictive value of the ddPCR test was 79 percent, suggesting the blood test was able to find additional cases with the mutation that were missed using standard biopsies.

“In some patients with the EGFR resistance mutation, ddPCR detected mutations missed by standard tissue biopsy,” Oxnard remarked. “A resistant tumor is inherently made up of multiple subsets of cells, some of which carry different patterns of genetic mutations. A single biopsy is only analyzing a single part of the tumor, and may miss a mutation present elsewhere in the body. A liquid biopsy, in contrast, may better reflect the distribution of mutations in the tumor as a whole.”

When ddPCR failed to detect these mutations, the cause was less clear-cut, Oxnard says. It could indicate that the tumor cells don’t carry the mutations or, alternatively, that the tumor isn’t shedding its DNA into the bloodstream. This discrepancy between the test results and the presence of mutations was less common in patients whose cancer had metastasized to multiple sites in the body, researchers found.

The ddPCR-based test, or assay, was piloted and optimized for patients at the Translational Resarch lab of the Belfer Center for Applied Cancer Science at Dana-Farber. It was then validated for clinical use at Dana-Farber’s Lowe Center for Thoracic Oncology.

An advantage of this form of liquid biopsy is that it can help doctors quickly determine whether a patient is responding to therapy. Fifty participants in the study had repeat testing done after starting treatment for their cancer. “Those whose blood tests showed a disappearance of the mutations within two weeks were more likely to stay on the treatment than patients who didn’t see such a reduction,” said the study’s lead author, Adrian Sacher, MD, of Dana-Farber and Brigham and Women’s Hospital.

And because tumors are constantly evolving and acquiring additional mutations, repeated liquid biopsies can provide early detection of a new mutation – such as the EGFR resistance mutation – that can potentially be treated with targeted agents.

“The study data are compelling,” said DF/BWCC pathologist Lynette Sholl, MD, explaining the center’s decision to begin offering ddPCR-based liquid biopsy to all lung cancer patients. “We validated the authors’ findings by cross-comparing results from liquid and tissue biopsies in 34 NSCLC patients. To work as a real-world clinical test, liquid biopsy needs to provide reliable, accurate data and be logistically practical. That’s what we’ve seen with the ddPCR-based blood test.

“The test has great utility both for patients newly diagnosed with NSCLC and for those with a recurrence of the disease,” she continued. “It’s fast, it’s quantitative (it indicates the amount of mutant DNA in a sample), and it can be readily employed at a cancer treatment center.”

The co-authors of the study are Cloud Paweletz, PhD, Allison O’Connell, BSc, and Nora Feeney, BSc, of the Belfer Center for Applied Cancer Science at Dana-Farber; Ryan S. Alden BSc, and Stacy L. Mach BA, of Dana-Farber; Suzanne E. Dahlberg, PhD, of Dana-Farber and Harvard T.H. Chan School of Public Health; and Pasi A. Jänne, MD, PhD, of Dana-Farber, the Belfer Center, and Brigham and Women’s Hospital.

The study was supported by grants from the United States Department of Defense, the National Cancer Institute (grants R01CA135257, R01CA114465 and P50CA090578), the Phi Beta Psi Sorority, the Stading-Younger Cancer Foundation, the International Association for the study of Lung Cancer, the Canadian Institutes of Health Research, the Canadian Association of Medical Oncologists, the Gallup Research Fund, and the Kaplan Research Fund.

Media Contacts For all inquiries, call 617-632-4090 and ask to speak to a member of the media team.

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Two-fold higher risk of concussions for NFL players during colder game-days, study finds

By Kendra Stephenson - NFL players had a two-fold greater risk of concussions and 1.5 times higher risk for ankle injuries when games were played at colder temperatures, a new St. Michael’s study has found.

The higher rates occurred during games played in 10 degrees Celsius or colder when compared with games played in temperatures of 21 degrees Celsius or warmer.

Researchers also found an increased rate of shoulder injuries when games were played on natural grass compared to synthetic turf – about 1.36 times higher.

The study, published today in the Orthopedic Journal of Sports Medicine, examined risk factors associated with the five most common NFL injuries during two regular seasons between 2012 and 2014.

“There has been a lot of discussion recently about the significant risk of injury in the NFL and general player safety, particularly regarding concussions,” said Dr. David Lawrence, lead author of the study and a clinical fellow at St. Michael’s Hospital. “The first step in improving player safety and lowering that risk is to identify the factors affecting injury rates. Once we can answer those questions, we can begin to modify player exposure.”

Previous research by Dr. Lawrence found that the overall risk of injury in the NFL is about three times higher than professional rugby and 25 times higher than the NHL. Similarly, the concussion risk for NFL players is three times higher than rugby and five times higher than the NHL, according to his research.

“Early evidence suggests that musculoskeletal and repeated concussive injuries associated with football can cause long-term complications such as osteoarthritis and neurophysiological conditions,” said Dr. Lawrence. “It’s important that we better understand these factors and prevent as many injuries as possible.”

The most frequent injuries were knee-related, followed by ankle, hamstring, shoulder and concussions. External influences examined in the study included playing surface, climate factors, travel times and game outcomes.

“There is limited research looking at the external risk factors for injuries in the NFL,” said Dr. Lawrence. “Given this is one of the first studies to look at these variables, we can only speculate at this time on the underlying causes for the associations we observed with specific injuries on game-days.”

For example, Dr. Lawrence suggested players could mistake symptoms of a concussion during warmer temperatures for heat-related illness. Equipment and materials in the playing environment have lower elasticity at colder temperatures and may increase the impact force. There could also be higher reporting of injuries during colder games because players interact more closely with athletic staff in lower temperatures.

“Our findings contribute to the growing body of evidence surrounding this topic, but further research is needed” said Dr. Lawrence. “Applying this information may help inform future injury prevention strategies in the NFL, or other professional sports, and highlight the effects of these seemingly small external factors.”

This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Media contacts

For more information or to arrange an interview with Dr. Lawrence, please contact:

Kendra Stephenson
Communications Advisor - Media
416-864-5047

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Narcissism linked to sexual assault perpetration in college, study finds

Athens, Ga. - Almost 20 percent of college men have committed some kind of sexual assault, and 4 percent have committed rape, according to a study published by University of Georgia researchers who were examining the link between different kinds of narcissism and the perpetration of sexual assaults.

The study found a strong connection between pathological narcissism and sexual assault perpetration through a survey of 234 male university students, mostly in their first and second years of college. Its findings related to perpetration rates were mostly consistent with previous studies, said the study's lead author Emily Mouilso, a clinical assistant professor in the Franklin College of Arts and Sciences' psychology department.

People who demonstrate characteristics of pathological narcissism have difficulties when it comes to relating to others, Mouilso explained.

Non-pathological narcissism, on the other hand, can be somewhat beneficial because it manifests in high self-esteem and makes it easier for people to shake off failures, study co-author Karen Calhoun said, explaining that it's what some researchers call the "healthy" form of narcissism.

"As we predicted, the aspects of narcissism that we thought would be related were (related)—the lack of empathy, the entitlement aspects of narcissism," Mouilso said.

What surprised them was the link between vulnerable narcissism and rape perpetration.

Vulnerable narcissists express high levels of self-esteem but are actually very insecure, Mouilso said.

The study found that men with vulnerable narcissistic traits were more likely to use alcohol or other date-rape drugs to incapacitate their victims, a finding that is especially concerning on a college campus, Mouilso said.

"I think people don't realize how prevalent drinking is" in colleges, said Calhoun, a professor emerita in the psychology department. "It's not so much how much they drink total for women that makes them vulnerable; it's how much they drink at a time, the binge drinking, the getting drunk and just not being alert and aware of their surroundings or the risks involved. That really puts women at risk."

Mouilso and Calhoun explained their results in the context of the theory that there are two general pathways that frequently lead to perpetration.

"If the end product is perpetration, there's more than one kind of profile that would make you more likely to perpetrate a sexual assault," Mouilso said. "One of those streams is promiscuity—so people who have higher levels of sexual interest and more frequent sexual partners, they're more OK with impersonal sex. That's one stream of risk factors.

"The second path is the hostile masculinity path. That has more to do with how you look at women, so having a hostile and angry orientation toward women in general and thinking that relationships are adversarial ... it's more about, what can I get out of this person that I want? I don't really care all that much about what they want."

She explained that people can be high or low on factors in both of those tracks, but if a person has both of them together, it makes that person much more likely to perpetrate a sexual assault, according to current theory.

Narcissists feel a sense of entitlement to anything they want, something that makes it easier for them to rationalize their aggressive and sometimes illegal behaviors, Mouilso said.

Many previous studies have used incarcerated sex offenders as their sample pool, which makes it more difficult to generalize results to other populations. Mouilso and Calhoun's sample of college men is fairly representative of large Southeastern university male populations.

Often the view of college men tends to be an old-fashioned, "boys will be boys" attitude when it comes to acts of sexual aggression, Mouilso said.

"I just don't think that that's accurate," Mouilso said, "so this research helps to shed light on some of the commonalities in the personality profile between men who end up in prison and men who are walking around because they haven't been caught."

The idea that most sexual assault perpetrators are strangers who grab women in dark alleyways isn't accurate, Mouilso said.

"It's less likely to be a stranger who jumps out of the bush," she said. "It's more likely to be someone you know like the guy sitting next to you in your intro psych class."

The societal belief in "stranger danger" puts people at risk because they are looking for the deranged person on the corner rather than at the individuals in their lives who have much greater access and opportunity to perpetrate, the researchers said.

Studies of non-incarcerated perpetrators are useful in developing prevention programs that could give women a more accurate idea of what to look out for.

Although the percentage of college men who committed sexual assaults is unsettling, the findings suggest that it's a "small percentage of men who are doing most of" the assaults, something that gives the researchers hope, Calhoun said.

"If we could identify them and intervene in some way, that would give you some better hope of preventing it," she said.

The study, "Personality and Perpetration: Narcissism Among College Sexual Assault Perpetrators," published in the journal Violence Against Women, is available online at http://ift.tt/1LZgfJ0.

Writer:

Leigh Beeson

Contact:

Emily Mouilso

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Mismatched Expectations are the Most Common Reason for Patients Not Completing the HPV Vaccine Series, Study Finds

BOSTON— Conflicting expectations between parents and medical providers about who is responsible for scheduling follow-up appointments is resulting in a failure of young girls completing the Human Papilloma Virus (HPV) vaccination series, according to a new study led by Boston Medical Center researchers.

The study, which is published online ahead of print in the journal Human Vaccines and Immunotherapeutics, involved interviews with both parents and providers in order to determine why, despite the known benefits of the vaccine, patients are not receiving all three doses.

HPV, the most common sexually transmitted infection, is diagnosed in approximately 14 million people each year in the United States and can lead to various cancers including cervical, mouth and throat cancer. The HPV vaccine is administered in a three-part series over six months and is currently recommended for boys and girls ages 11 and 12 and up to age 26. Recently, the Centers for Disease Control and Prevention (CDC) encouraged expanding the vaccine’s availability to 9- and 10-year-olds if they have a history of sexual abuse and officially endorsed using the HPV-9 vaccine, which protects against nine strains of the virus.

“There has been a heightened awareness within the medical community in recent years about the need to address HPV and get more children vaccinated in order to prevent long-term health issues,” said Rebecca Perkins, MD, MSc, an obstetrician at BMC and lead author of the study. “Yet, we’re finding that many pre-teens aren’t getting all three doses, which is imperative to preventing HPV.”

Over a one-year period, researchers interviewed 65 parents whose daughters received at least one dose of the HPV vaccine and divided them into groups whose daughters had completed the series (28) and those who had not (37).  Of the group whose daughters did not finish the series, 65 percent said they expected the clinic to contact them regarding scheduling additional doses. Twenty-four percent cited inconvenience, such as long commutes to the clinic, for failing to complete the series, only 4 parents made a conscious decision to halt the series.

Next, 27 providers were interviewed about their specific plans to ensure patients completed the series. Fifty-two percent said they informed parents about when the next doses were due, but relied on the parents to schedule the follow-up visits. Forty-one percent planned on scheduling the second dose when the first dose was given and 7 percent hoped to immunize patients when they returned for a different appointment. Providers stated that most failures to complete the series were due to a lack of reminder systems.

Interestingly, no provider identified the need for three doses as a barrier to completion, and more than two-thirds of the parents in both groups stated that they felt that the benefits of HPV vaccination outweighed the risks.

“What we’ve learned is that there is a great opportunity to close the non-completion gap by improving education and dialogue between providers and parents about scheduling future visits to finish the three-dose vaccination series,” Perkins said.

Researchers had several suggestions for increasing vaccination completion rates, including scheduling follow-up appointments as the child receives the first dose; implementing reminder and recall systems in clinics, such as phone calls, educational brochures, and text messages; having patients receive reminders directly from state immunization registries, which are independent from individual medical practices; and offering vaccines at alternative sites that are more convenient for parents such as schools and pharmacies.

“By implementing a reminder system, we hope that more children will complete the vaccination series, which can help improve the overall health of our next generation,” Perkins said.

###

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 496-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $119 million in sponsored research funding in fiscal year 2015. It is the 11th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving more than 315,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet – 13 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.

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School breakfasts contribute to healthy weight, study finds

By Michael Greenwood - Middle school students who eat breakfast at school — even if they have already had breakfast at home — are less likely to be overweight or obese than students who skip breakfast, says a new study by the Community Alliance for Research and Engagement (CARE) at the Yale School of Public Health and the Rudd Center for Food Policy & Obesity at the University of Connecticut.

The findings, published today in the journal Pediatric Obesity, bring new evidence to the ongoing debate over policy efforts to increase daily school breakfast consumption. Previous research has shown that eating breakfast is associated with improved academic performance, better health, and healthy body weight for students. But there have been concerns that a second breakfast at school following breakfast at home could increase the risk of unhealthy weight gain.

“Our study does not support those concerns,” said Jeannette Ickovics, the paper’s senior author, director of CARE, and a professor at Yale School of Public Health. “Providing a healthy breakfast to students at school helps alleviate food insecurity and is associated with students maintaining a healthy weight.”

The study involved 584 middle school students from 12 schools in an urban school district where breakfast and lunch are provided to all students at no cost. Researchers tracked the students’ breakfast-eating locations and patterns, and their weight over a two-year period from 5th grade in 2011-2012 to 7th grade in 2013-2014.

Specifically, the study found that:

• Students who skipped or ate breakfast inconsistently were more than twice as likely to be overweight or obese compared with students who ate double breakfasts.

• The weight changes from 5th to 7th grade for the students who ate double breakfasts was no different than the weight changes measured for all of the other students.

“When it comes to the relationship between school breakfast and body weight, our study suggests that two breakfasts are better than none,” said Marlene Schwartz, a study author and director of the Rudd Center.

The study holds implications for advocates and policy makers working to reverse the nation’s childhood obesity problem. Approximately one-third of American children between the ages of 6 and 11 are overweight or obese, with higher rates among black and Hispanic children than white children. School breakfast promotion initiatives have begun, but evidence is needed to ensure these efforts do not lead to the consumption of excess calories among children at risk for obesity.

Study co-authors include Margaret Read of the UConn Rudd Center, Kathryn Henderson of Henderson Consulting, and Fatma Shebl and Sisi Wang of the Yale School of Public Health.

(Photo courtesy of Shutterstock)

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