Category Archives: Research
The National Institutes of Health’s Office of Emergency Care Research (OECR), established in 2012, will now be under the leadership of Jeremy Brown, MD. Brown was recently appointed as the first permanent director of OECR, which is housed in NIH’s National Institute of General Medical Sciences.
Before joining NIH, Brown was an associate professor of emergency medicine and chief of the clinical research section in the Department of Emergency Medicine at The George Washington University. Additionally, he served as an attending physician in the emergency department of the Washington, D.C., VA Medical Center. According to the acting director of the National Institute of General Medical Sciences, Judith H. Greenberg, PhD, “Brown brings an impressive mix of clinical expertise, research experience, management abilities and communication skills to this important new position.”
Part of Brown’s research includes how to introduce routine HIV screening—a public health intervention—in hospital emergency departments. Previous studies have found these screenings to be cost-effective and frequently welcomed by patients. This is just one of the many ways in which steps could be taken in the emergency room setting to help improve the data available to assist public health efforts across the country. By using emergency departments as sites for collecting data on the status of the public’s health, more targeted efforts for prevention can be implemented.
NewPublicHealth spoke with Dr. Brown on the evidence that shows support for the collaboration between emergency departments and efforts to improve public health, as well as his new role and what he sees for the future of emergency departments.
NewPublicHealth: How is the transition into this new position going so far and how are you pulling from previous experiences to help with new challenges in this position?
Jeremy Brown: This is the beginning of my fourth week here; it is a new program and a new project really for both me as its first permanent director and for the NIH as well. They’ve never had an office that has addressed this particular part of our nation’s health and I think it’s going to be a learning experience on both sides.
So far, I’ve been really struck by the extremely warm reception that I’ve had from people within institutes and centers with whom I’ve had meetings. Currently, my agenda is really to meet with as many people as possible within NIH whose work touches on emergency medicine and other time sensitive medical issues.
In terms of the latter, I started a brand new HIV screening project from scratch at GW, it hadn’t been done there previously and it really had only been done in a couple of places in the U.S. before. That required the marshaling of a lot of different aspects of both the hospital, the nursing staff, and emergency physicians to get that up and running.
NPH: What other public health initiatives do you think emergency departments can take the lead on to improve public health?
NCI Releases Massive Data Set to Help Cancer Researchers
The National Cancer Institute (NCI) has released a massive data set of cancer-specific genetic variations to help the cancer research community gain a better understanding or both drug response and drug resistance to cancer treatments. The data set was published in Cancer Research, a journal of the American Association for Cancer Research. The database—the largest worldwide—includes 6 billion data points connecting “drugs with genomic variants for the whole human genome across cell lines from nine tissues of origin, including breast, ovary, prostate, colon, lung, kidney, brain, blood, and skin,” said Yves Pommier, MD, PhD, NCI’s chief of the Laboratory of Molecular Pharmacology. “Opening this extensive data set to researchers will expand our knowledge and understanding of tumorigenesis [the process by which normal cells are transformed into cancer], as more and more cancer-related gene aberrations are discovered,” he said. “This comes at a great time, because genomic medicine is becoming a reality, and I am very hopeful this valuable information will change the way we use drugs for precision medicine.” Read more on cancer.
FDA Approves Device that Uses the Brain’s Electrical Impulses to Diagnose ADHD
The U.S. Food and Drug Administration (FDA) has approved the marketing of the first medical device that will look at a brain’s electrical impulses to help determine whether children and adolescents have attention-deficit/hyperactivity disorder (ADHD). The 15-20 minute test for people ages 6 to 17, which utilizes electroencephalogram technology, can be used to confirm an ADHD diagnosis or help health professionals decide whether further testing should focus on ADHD. “Diagnosing ADHD is a multistep process based on a complete medical and psychiatric exam,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health. “The NEBA System along with other clinical information may help health care providers more accurately determine if ADHD is the cause of a behavioral problem.” Read more on technology.
Study: Divorce When a Child is Young Negatively Impacts Later Parental Relationship Security
Young children whose parents divorce may have more difficult and less secure relationships with their parents later in life, according to a new study in the journal Personality and Social Psychology Bulletin. Researchers looked at date from 7,335 men and women with the average age of 24, finding those whose parents divorced when they were age 5 or younger had less secure parental relationships as adults. A secure relationship means that the child feels “they can trust them and depend on them and that the parent will be available psychologically,” according to HealthDay. The negative effect was especially true for relationships with the father. The study found that participants were more likely to have a “strained” relationship with the parent they did not live with after the divorce; about 74 percent of the participants lived with their mothers and only 11 percent lived with their fathers. Omri Gillath, an associate professor of social psychology at the University of Kansas, said the results demonstrate the need for divorcing parents to be as civilized as possible. Read more on pediatrics.
Hospital Inpatient Discharge Data Can Help Prepare for Future Patient ‘Safety Events’
Hospital administration data—specifically inpatient discharge data—can be used to track the incidence of patient “safety events” now so that physicians and other health care providers are better able to treat them in the future, according to a new study in the Journal of Healthcare Risk Management. The study found that an average of 9 percent of inpatient discharges in the sample experienced a safety event, which increased the cost of a hospital stay by about $35,000. “While this figure may be a bit startling, it is not a cause for alarm, in that many of the events that we found are adverse events for which there are no known prevention strategies,” said Jennifer Taylor, MD, an assistant professor in the Department of Environmental and Occupational Health in Drexel University’s School of Public Health. “While such events may not be deemed to be preventable now, we need to start tracking them so our research and development colleagues know what’s next in the prevention pipeline.” Read more on research.
Over-Testing of Cholesterol Levels Wastes Time, Money
One-third of people with heart disease have their cholesterol levels checked too often, which can waste time, cost unneeded money and not actually improve their health, according to a new study in JAMA Internal Medicine. Possible reasons for the over-testing include the desired to reach or exceed American Heart Association performance measures, as well as the additional payment that comes with running a cholesterol panel. "I think a lot of it is because of the habit of (ordering) labs on patients…without really thinking about, ‘What am I going to do with this information with someone who is at target for cholesterol?'" said Salim Virani, MD, of the Michael E. DeBakey Veterans Affairs Medical Center in Houston. Michael Johansen, MD, of The Ohio State University in Columbus, said physicians might be better off placing patients with heart disease on a statin, while ensuring they eat properly and get the right amount of exercise. Read more on heart health.
‘Active’ Video Gaming Boosts Kids’ Physical Activity
While playing most video games is not more physically stimulating than watching television, newer-generation “active” games may in fact boost a kid’s physical activity in the home, according to a new study in the journal BMJ Open. The study first removed all games from the home for eight weeks, then had eight weeks of passive gaming followed by eight weeks of active gaming. While the positive findings were only minor, the researchers said they could prove significant because of kids’ increased exposure to technology. "Therefore small changes across a variety of these platforms could result in a more substantial clinical impact. While our study focused on the home setting, school offers another opportunity for more active technologies such as sit-stand desks or active-input electronic media as part of lessons.” Read more on technology.
A major theme at this year’s AcademyHealth Annual Research Meeting was the need to become more aggressive on translating and disseminating health research. Just last month, the Mailman School of Public Health at Columbia University announced that is was becoming the first school at the university and one of the first of U.S. schools of public health to adopt an open access resolution. The resolution calls for faculty and other researchers at the school to post their papers in openly available online repositories such as Columbia’s Academic Commons, where content is available free to the public, or in another open access repository, such as the National Institutes of Health’s PubMed Central.
“A wider dissemination of research and information has been a number one priority of our faculty, who are motivated by the belief that scientific knowledge belongs to everyone,” said Linda P. Fried, MD, MP, the dean at Mailman. “It is in the interest of all of us to take every measure possible to improve and simplify the process of gaining access to our research findings,” Fried said.
NewPublicHealth spoke with Bhaven N. Sampat, PhD, Assistant Professor of health policy and management at Mailman and a lead faculty member on the open access endeavor.
NewPublicHealth: Why haven’t many journals been open access before and what is making researchers, particularly in the field of public health, interested in more widely disseminating their research?
An anniversary session at the AcademyHealth Annual Resarch Meeting yesterday looked back at the organization’s thirty years of translating research into policy. It’s an important topic. A number of recent meetings focusing on public health, including last week’s public meeting of the Commission to Build a Healthier American, stressed the need for evidence in order to consider planning and community improvement decisions. The Affordable Care Act has a number of new initiatives that call on clinical and public health practitioners to seek and rely on an evidence base, including the Patient-Centered Outcomes Research Institute (PCORI), which is authorized by Congress to evaluate the best available evidence to help patients and their health care providers make more informed decisions.
Decades of research is beginning to pay off, according to the panelists. For example, according to Sherry Glied, PhD, professor of health policy and management at the Columbia University Mailman School of Public Health, the experts involved in crafting the Affordable Care Act drew on a body of research to inform the expected cost of implementing the law.
Gail Wilensky, senior fellow at Project HOPE, an international health foundation, who directed the Medicare and Medicaid programs from 1990 to 1992, pointed out that sometimes evidence has limitations. “Getting legislation passed also has to do with, among other things, the political mood of the country,” said Wilensky, who added that sometimes policy passes and sometimes it doesn’t, which is important for younger researchers to realize. “Important legislation has passed with minimal analysis including Medicaid and Medicare,” Wilensky pointed out.
NewPublicHealth is on the road this week at the AcademyHealth Annual Research Meeting in Baltimore, Maryland and the International Making Cities Livable Conference meeting in Portland, Oregon.
AcademyHealth is a key organization in the United States for the study of health services research—a discipline that looks at how people get access to health care, how much care costs and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance and deliver high-quality care; reduce medical errors; and improve patient safety.
An important focus of this week’s Annual Research Meeting is the translation and dissemination of research into health practice. The Public Health Systems Interest Group, AcademyHealth’s largest interest group with close to 3,000 members, is meeting this week as well and has a particular focus on translating and disseminating public health systems and services research to the public health practitioners who could benefit from practical findings.
NewPublicHealth recently spoke with Paul Erwin, MD, MPH, and head of the department of public health at the University of Tennessee School of Public Health, about the importance of having strong evidence available for public health practitioners.
NewPublicHealth: Why is the translation and dissemination of Public Health Services and Systems Research (PHSSR) so important?
Paul Erwin: Ultimately PHSSR is meant to go out into the practice community so that research can actually make a difference. I think historically that is part of what has set PHSSR apart from closely related research disciplines. PHSSR really is intended to help produce the kinds of evidence-based practices that are more effective with limited resources, and likely to move the needle on population health.
NIH: $12.7M in Grants to Explore New Uses for Existing Compounds
Approximately $12.7 million in National Institutes of Health (NIH) grants will go toward helping academic research groups explore new treatments in eight disease areas. They include Alzheimer’s disease, Duchenne muscular dystrophy and schizophrenia. The “Discovering New Therapeutic Uses for Existing Molecules” hopes that, by finding new uses for existing compounds, new treatments can advance to clinical trials more quickly. “Innovative, collaborative approaches that improve the therapeutic pipeline are crucial for success,” said NIH Director Francis S. Collins, MD, PhD. “This unique collaboration between academia and industry holds the promise of trimming years from the long and expensive process of drug development.” Read more on research.
Emergency Contraception Officially Available to All Women Without a Prescription
The U.S. Food and Drug Administration (FDA) has officially followed through on its plan to make the Plan B One-step emergency contraceptive available to all women regardless of age and without a prescription. It was previously available over-the-counter only to women age 17 or older and with a prescription for women who were younger than 17. Earlier this year it the nonprescription age was lowered to 15, but a U.S. District Court ruling ordered it be made to all women and girls without a prescription, at the time calling the FDA’s decision to reject a citizen petition related to the restrictions "arbitrary, capricious and unreasonable." Read more on sexual health.
Study: Listening to Music While Driving Doesn’t Negatively Impact Response Time
Listening to music while driving does not have the same negative effective on response time as other actions marked as distractions, and in fact might even improve focus under certain conditions, according to a new study. "Speaking on a cellphone or listening to passengers talking is quite different than listening to music, as the former types are examples of a more engaging listening situation," said study author Ayca Berfu Unal, an environmental and traffic psychologist. "Listening to music, however, is not necessarily engaging all the time, and it seems like music or the radio might stay in the background, especially when the driving task needs full attention of the driver.” The study looked at college-aged drivers, finding that louder music actually improved the response time to changes in the speed of cars ahead of the driver. Approximately nine people are killed and more than 1,000 are injured each day in the United States because of distracted driving, according to the U.S. Centers for Disease Control and Prevention. Read more on safety.
American Institute of Architects, Others Launch Ideas Competition to Rebuild Sustainable Communities
The American Institute of Architects (AIA), Make It Right, St. Bernard Project and Architecture for Humanity have launched a new “Designing Recovery” ideas competition to help rebuild sustainable, resilient communities in areas hit by natural disasters. The announcement came at the annual Commitment to Action at CGI America. "The cities of New Orleans, New York and Joplin are all stark reminders of the emerging threat of severe-weather disasters brought on by a changing climate,” said Eric Cesal, Director of Reconstruction and Resiliency at Architecture for Humanity. “Every city can learn from the successes and failures of these three cities and their response to disaster. Designers and architects have a responsibility to do more — and to do better. We hope this competition will draw out the best and brightest new ideas for a world of new risks." Read more on disasters.
On World Blood Donor Day, HHS Highlights Need for More Resources
Today is World Blood Donor Day. The United States is one of only 62 countries that collect 100 percent of their blood from voluntary, unpaid donors; the World Health Organization has this goal for all countries by the year 2020. About 8 million people donate blood in the United States each year. While this number is substantial, the U.S. Department of Health and Human Services (HHS) says even more donations are needed to help surgical patients, cancer patients, victims of natural disasters and people who suffer battlefield injuries.
According to HHS:
- Forty or more units of blood may be needed for a single trauma victim
- Eight units of platelets may be required daily by leukemia patients undergoing treatment
- A single pint of blood can sustain a premature infant’s life for two weeks
Read more on global health.
Supreme Court Rules Naturally Occurring Human Genes Cannot be Patented
In a unanimous decision, the U.S. Supreme Court ruled that naturally occurring human genes cannot be patented, although synthetically produced genetic material can be. The ruling struck down Myriad Genetics Inc.’s patents on the BRCA1 and BRCA2 genes linked to breast and ovarian cancer. Robert Darnell, MD, president and scientific director of the New York Genome Center, said the ruling "sets a fair and level playing field for open and responsible use of genetic information" and that “it does not preclude the opportunity for innovation in the genetic world." Read more on research.
New funding by the National Institutes of Health (NIH) is aimed at improving treatment for bacterial infections, treating alcohol dependence and determining effective drugs for long-term diabetes treatment.
- Antibiotic Resistance: Duke University has been awarded $2 million by the NIH for a clinical research network focused on antibacterial resistance. Funding could rise to close to $70 million by 2019. According to the NIH, bacterial infections resistant to antibiotic drugs were first reported more than 60 years ago and since then have become more common in both health care and community settings. In some cases, no effective antibiotics exist. The funding will be used to conduct clinical trials on new drugs, optimizing use of existing ones; testing diagnostics and conducting research on best practices for infection control.
- Alcohol Dependence: A new study funded by the NIH and published in the Journal of Addiction Medicine finds that the smoking-cessation drug varenicline (brand name Chantix), significantly reduced alcohol consumption and craving among people who are alcohol-dependent. “Current medications for alcohol dependence are effective for some, but not all, patients. New medications are needed to provide effective therapy to a broader spectrum of alcohol dependent individuals,” said says Kenneth R. Warren, PhD, acting director of the National Institute on Alcohol Abuse and Alcoholism, part of NIH. Participants who took varenicline, compared with those taking a placebo, decreased their heavy drinking days per week by nearly 22 percent.
- Diabetes: The NIH is currently recruiting volunteers for a study to compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes. The study is important because if doctors find that metformin is not effective enough to help manage type 2 diabetes, they often add another drug to lower blood glucose levels. However, there have been no long-term studies on which of the add-on drugs are most effective and have fewest side effects. The study will compare drug effects on glucose levels, adverse effects, diabetes complications and quality of life over an average of nearly five years and will enroll about 5,000 patients at 37 study sites.
Do we need an endgame strategy to finally end the devastating hold tobacco has on its users? Scholars, scientists and policy experts grapple with endgame proposals in a special supplement to the journal Tobacco Control. Some of the articles are based on a workshop held last year at the University of Michigan, with financial support from the Robert Wood Johnson Foundation and the American Legacy Foundation. The workshop was hosted by Kenneth Warner, PhD, a former dean at the University of Michigan School of Public Health and now a professor at the School.
Although smoking has declined significantly in most developed nations in the last half-century, due to policy changes and increased education about the health hazards, says Warner, too many people continue to die from the most preventable cause of premature death and illness. It's estimated that worldwide six million people a year die from illnesses caused by cigarettes, including more than 400,000 in the U.S. alone."There is a newfound interest in discussing the idea of an endgame strategy. The fact that we can talk about it openly reflects a sea change,” says Warner.
>>Read the articles in the tobacco endgame supplement.
Some of the strategies in the supplement include:
- Requiring manufacturers to reduce nicotine content sufficiently to make cigarettes nonaddictive.
- A "sinking lid" strategy that would call for quotas on sales and imports of tobacco, which would reduce supply and drive up price to deter tobacco purchases.
- A "tobacco-free generation" proposal calling for laws that would prevent the sale of tobacco to those born after a given year, usually cited as 2000, to keep young people from starting to smoke; or ban the sale of cigarettes altogether.
"What we are doing today is not enough," says Warner. "Even if we do very well with tobacco control, as we have for several decades now, we'll have a huge number of smokers for years to come, and smoking will continue to cause millions of deaths.”
NewPublicHealth recently spoke with Dr. Warner about some of the strategies proposed for ending tobacco use.
NewPublicHealth: Why is there a need for novel, even radical, endgame strategy?
Ken Warner: While a lot of people have quit smoking, if you look at the rate at which people are quitting in the United States, in the last few years it may actually have declined. In Canada, there is some concern that their very low rates of smoking may actually have gone up. In Singapore, which had the lowest smoking prevalence among developed nations, the smoking rate went up from 12.6 percent to 14.3 percent between 2004 and 2010. So what we're observing is that in some of the countries that have had pretty good success with tobacco control, smoking is now being reduced somewhat more slowly, or possibly even increasing. And if we stay at the current rate of smoking, or even if the smoking rate continues to decline slowly, smoking will remain the leading cause of preventable premature death for many years to come.
NPH: What are some of the reasons that we’re seeing a plateau in the reduction of tobacco use?