Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

Posted on November 26, 2015 by Maurice Preter MD
J Clin Epidemiol. 2015 Sep 21. pii: S0895-4356(15)00429-1. doi: 10.1016/j.jclinepi.2015.08.021. [Epub ahead of print]

Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

Abstract

OBJECTIVES:

To identify the impact of industry involvement in the publication and interpretation of meta-analyses of antidepressant trials in depression.

STUDY DESIGN AND SETTING:

Using MEDLINE, we identified all meta-analyses evaluating antidepressants for depression published in January 2007-March 2014. We extracted data pertaining to author affiliations, conflicts of interest, and whether the conclusion of the abstract included negative statements on whether the antidepressant(s) were effective or safe.

RESULTS:

We identified 185 eligible meta-analyses. Fifty-four meta-analyses (29%) had authors who were employees of the assessed drug manufacturer, and 147 (79%) had some industry link (sponsorship or authors who were industry employees and/or had conflicts of interest). Only 58 meta-analyses (31%) had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001].

CONCLUSION:

There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS:

Antidepressants; Competing interests; Conflicts of interest; Depression; Industry sponsor; Meta-analyses

Posted in Aging, Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology | Tagged , , , , , |

Smartphone apps in epilepsy care

Posted on November 26, 2015 by Maurice Preter MD

Abstract

Objectives

To evaluate the applications of mobile phones in the day to day care of epileptic patients as a diagnostic, prognostic and therapeutic tool.

Methods

Detailed search of various mobile applications in the field of epileptology was made in MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, LILACS and corresponding developer websites of mobile applications were also looked into regarding their technical specifications and user friendliness.

Results

A plethora of apps are available across various mobile platforms especially Android, iOS and Windows. Careful selection and application of such apps by both the healthcare providers, the epileptic patients and their caregivers with proper understanding of their potential benefits as well as limitations will result in better diagnosis, prognosis and treatment of epilepsy.

Conclusion

The field of medicine is rapidly inculcating advanced cutting edge technologies for better diagnosis of diseases and better targeted therapy to such diseases. Hi tech electronic gadgets, in particular, are now becoming part and parcel of patient care in many specialties. The advent of the modern portable computers has revolutionised almost every specialty. The field of mobile technology is advancing with a break neck pace, with increase in mobile subscribers, advanced handsets practically like digital personal assistants with advanced capabilities. The possibilities of using such rapidly evolving mobile technology in the field of medicine are endless. This article explores such possibilities in the field of epileptology after analysing the current and existing applications of mobile phones in care of the epileptic patients worldwide.

Posted in Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology | Tagged |

Coconut Oil for Alzheimer’s Disease

Posted on October 29, 2015 by Maurice Preter MD 
















Coconut Oil for Alzheimer’s Disease:


Overall Status:




Recruiting








Brief Description:




The goal of this randomized study is to determine the efficacy of coconut oil as a possible treatment for older adults with mild to moderate Alzheimer’s disease.










Patient Qualifications:
























Min Age
Max Age
Gender
Healthy Volunteers












60 Years












85 Years












Both












No






















Inclusion Criteria:






    

  • Diagnosis of mild to moderate Alzheimer’s disease
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  • Study partner who spends at least 10 hours/week with the participant and can attend clinic visits and provide information about the participant
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  • Mini-Mental State Examination score of 16-26; Rosen Modified Hachinski Ischemic score of ≤4
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  • Must undergo ApoE genetic laboratory testing at the baseline visit
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  • If taking Alzheimer’s disease medications such as cholinesterase inhibitors (donepezil, rivastigmine, or galantamine) and/or memantine, must be on stable dose for at least 3 months prior to screening and agree not to change these medications during the course of the study, unless medically necessary
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  • If taking memory-enhancing nonprescription supplements (for example, gingko biloba, huperzine, resveratrol, or docosahexaenoic acid), must be on stable dose for at least 3 months prior to screening and agree not to change these medications during the course of the study
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  • Fluent in English
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Exclusion Criteria:






    

  • Significant neurological or medical disease, other than Alzheimer’s, that may affect cognition
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  • Current major psychiatric disorder or symptoms that could affect the participant’s ability to complete the study
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  • Geriatric Depression Scale score of more than 6 or suicidal ideation
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  • Current, clinically significant chronic illness, such as uncontrolled diabetes or diabetic ketoacidosis, that is likely to result in deterioration of the participant’s condition or safety during the study
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  • History of clinically evident stroke, history of clinically significant carotid or vertebrobasilar stenosis, plaque or other risk factors for thromboembolic stroke
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  • History of seizures
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  • Myocardial infarction within the last 2 years; abnormal electrocardiogram at screening visit; uncontrolled hypertension within 6 months prior to screening
    • 

  • Cancer within the last 3 years, with the exception some carcinomas of the skin
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  • Clinically significant infection within 30 days prior to screening.
    • 

  • Use of experimental or other investigational medications/devices for treatment within 90 days prior to screening
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  • Laboratory findings of fasting total cholesterol greater than or equal to 240 mg/dL, fasting triglycerides greater than or equal to 200 mg/dL, or fasting glucose greater than or equal to 126 mg/dL
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  • Other clinically significant abnormality seen on physical, neurological, laboratory, vital signs, or ECG examination (for example, changes consistent with recent infarction, ischemia, clinically significant arrhythmias, and clinically significant conduction defects)
    • 

  • Have taken coconut oil as a supplement or Axona™ (a medical food) within the last 30 days
    • 











Detailed Description:




This randomized, double-blind, placebo-controlled trial is designed to determine the effect of taking coconut oil on the cognition, functioning, and behavior of older adults with mild to moderate Alzheimer’s. Participants will take a proprietary blend of coconut and medium-chain triglyceride oils, administered as a 1-ounce drink three times daily, for either Months 1-3 or Months 4-6 of the study; a placebo will be taken during the other 3-month period. The study medication formula is Cognate Nutritionals’ Fuel for Thought™.










Locations:



































Lead Sponsor:





















Agency












University of South Florida
























Collaborator Sponsor:












Facility Investigators:























Name
Role
Affiliation












Amanda G. Smith, MD












Principal Investigator












USF Health Byrd Alzheimer’s Institute
























Study Contact:























Name
Phone
Email












Jill Smith












813-974-4355































ClinicalTrials.gov ID




NCT01883648 (follow link to view full record on ct.gov in new window)








Official Title:




A Randomized, Double-Blind, Placebo-Controlled, 6 Month Cross-Over Study to Evaluate the Efficacy of Coconut Oil (Fuel for Thought™) Treatment for Subjects With Mild to Moderate Alzheimer’s Disease








Study Start Date:




June 2013








Study End Date:




December 2015








Disease Stage:




Early


Middle








Enrollment:




65 

















								
					


				
			

							
													
					
					Posted in Aging, China, dietary, Events, Fifth Avenue Concierge Medicine, Health, keto, News, Psychiatry/Neurology					
									
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DNA Damage in Buccal Mucosa Cells of Pre-School Children Exposed to High Levels of Urban Air Pollutants


				

						Posted on October 17, 2015 by Maurice Preter MD				


											
					

								
					













    

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PLOS










    

  • Published: May 2, 2014
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  • DOI: 10.1371/journal.pone.0096524
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Abstract


Air pollution has been recognized as a human carcinogen. Children living in urban areas are a high-risk group, because genetic damage occurring early in life is considered able to increase the risk of carcinogenesis in adulthood. This study aimed to investigate micronuclei (MN) frequency, as a biomarker of DNA damage, in exfoliated buccal cells of pre-school children living in a town with high levels of air pollution. A sample of healthy 3-6-year-old children living in Brescia, Northern Italy, was investigated. A sample of the children’s buccal mucosa cells was collected during the winter months in 2012 and 2013. DNA damage was investigated using the MN test. Children’s exposure to urban air pollution was evaluated by means of a questionnaire filled in by their parents that included items on various possible sources of indoor and outdoor pollution, and the concentration of fine particulate matter (PM10, PM2.5) and NO2 in the 1–3 weeks preceding biological sample collection. 181 children (mean age±SD: 4.3±0.9 years) were investigated. The mean±SD MN frequency was 0.29±0.13%. A weak, though statistically significant, association of MN with concentration of air pollutants (PM10, PM2.5 and NO2) was found, whereas no association was apparent between MN frequency and the indoor and outdoor exposure variables investigated via the questionnaire. This study showed a high MN frequency in children living in a town with heavy air pollution in winter, higher than usually found among children living in areas with low or medium-high levels of air pollution.











								
					


				
			

							
													
					
					Posted in Aging, China, epigenetics, Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology					
									
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Household Ventilation May Reduce Effects of Indoor Air Pollutants for Prevention of Lung Cancer: A Case-Control Study in a Chinese Population


				

						Posted on October 17, 2015 by Maurice Preter MD				


											
					

								
					






Household Ventilation May Reduce Effects of Indoor Air Pollutants for Prevention of Lung Cancer: A Case-Control Study in a Chinese Population













    

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PLOS










    

  • Published: July 14, 2014
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  • DOI: 10.1371/journal.pone.0102685
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Abstract


Background


Although the International Agency for Research on Cancer (IARC) has classified various indoor air pollutants as carcinogenic to humans, few studies evaluated the role of household ventilation in reducing the impact of indoor air pollutants on lung cancer risk.


Objectives


To explore the association between household ventilation and lung cancer.


Methods


A population-based case-control study was conducted in a Chinese population from 2003 to 2010. Epidemiologic and household ventilation data were collected using a standardized questionnaire. Unconditional logistic regression was employed to estimate adjusted odds ratios (ORadj) and their 95% confidence intervals (CI).


Results


Among 1,424 lung cancer cases and 4,543 healthy controls, inverse associations were observed for good ventilation in the kitchen (ORadj = 0.86, 95% CI: 0.75, 0.98), bedroom (ORadj= 0.90, 95% CI: 0.79, 1.03), and both kitchen and bedroom (ORadj = 0.87, 95% CI: 0.75, 1.00). Stratified analyses showed lung cancer inversely associated with good ventilation among active smokers (ORadj = 0.85, 95% CI: 0.72, 1.00), secondhand smokers at home (ORadj = 0.77, 95% CI: 0.63, 0.94), and those exposed to high-temperature cooking oil fumes (ORadj = 0.82, 95% CI: 0.68, 0.99). Additive interactions were found between household ventilation and secondhand smoke at home as well as number of household pollutant sources.


Conclusions


A protective association was observed between good ventilation of households and lung cancer, most likely through the reduction of exposure to indoor air pollutants, indicating ventilation may serve as one of the preventive measures for lung cancer, in addition to tobacco cessation.











								
					


				
			

							
													
					
					Posted in Aging, China, epigenetics, Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology					
									
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