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Health

Mather is one of four separate Northwell hospitals approved for a catheterization lab. The hospitals are looking to compete for services amongst some of the larger health entities in New York state. Photo from Northwell

Mather Hospital in Port Jefferson will soon be joining nearby Stony Brook as one of the few places on Long Island to contain a cardiac catheterization lab to provide less invasive heart-related services.

New York State approved Northwell Health, which includes Mather in its group, to open four cardiac labs at different locations in New York. Alongside Mather, Lenox Health Greenwich Village, Plainview Hospital and Northern Westchester Hospital in Mount Kisco have been approved for labs. The lattermost was approved in December.

According to a Northwell release, these labs specialize in using X-ray guided catheters help open blockages in coronary arteries or repair the heart in minimally invasive procedures — ranging from stenting to angioplasty and bypass surgery – that are less traumatic to the body and speed recovery. 

The approval means a big leap for the Port Jefferson hospital, which plans a $11.4 million, 3,644-square-foot addition that will include catheterization and electrophysiology labs. The construction is expected to finish and both labs be open by early 2021.

“With the investment in these four new PCI programs, we are able to advance our mission of improving access, as well as bringing high quality complex cardiovascular services to our patients in their local communities,” William O’Connell, executive director of cardiology services at Northwell Health, said in a release. 

Mather president, Kenneth Roberts, has said in a previous interview with the Port Times Record that a big reason the hospital signed on with the health care network is to have the ability and room to innovate at the hospital and keep up with the times. He echoed that sentiment in a statement.

“With Northwell’s guidance and the diligence of our Mather team, Mather received approval from the New York State Department of Health to provide advanced cardiology programs which include cardiac catheterization, PCI and electrophysiology services,” he said. “Approximately 150 patients every year are [currently] transferred from Mather or St. Charles to have these services elsewhere.”

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Increasing fiber may reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

Many patients say they have been diagnosed with diverticulitis, but this is a misnomer. Diverticulitis is actually a consequence of diverticular disease, or diverticulosis. Diverticulosis is one of the most common maladies that affects us as we age. For instance, 35 percent of U.S. 50-year-olds are affected and, for those over the age of 60, approximately 58 percent are affected (1). Many will never experience symptoms.

The good news is that it is potentially preventable through modest lifestyle changes. My goal in writing this article is twofold: to explain simple ways to reduce your risk, while also debunking a myth that is pervasive — that fiber, or more specifically nuts and seeds, exacerbates the disease.

What is diverticular disease? 

Diverticular disease is a weakening of the lumen, or wall of the colon, resulting in the formation of pouches or out-pocketing referred to as diverticula. The cause of diverticula may be attributable to pressure from constipation. Its mildest form, diverticulosis may be asymptomatic. 

Symptoms of diverticular disease may include fever and abdominal pain, predominantly in the left lower quadrant in Western countries, or the right lower quadrant in Asian countries. It may need to be treated with antibiotics.

Diverticulitis affects 10 to 25 percent of those with diverticulosis. Diverticulitis is inflammation and infection, which may lead to a perforation of the bowel wall. If a rupture occurs, emergency surgery may be required.

Unfortunately, the incidence of diverticulitis is growing. As of 2010, about 200,000 are hospitalized for acute diverticulitis each year, and roughly 70,000 are hospitalized for diverticular bleeding (2).

How to prevent diverticular disease

There are a number of modifiable risk factors, including fiber intake, weight and physical activity, to prevent diverticular disease.

In terms of fiber, there was a prospective (forward-looking) study published online in the British Medical Journal that extolled the value of fiber in reducing the risk of diverticular disease (3). This was part of the EPIC trial, involving over 47,000 people living in Scotland and England. The study showed a 31 percent reduction in risk in those who were vegetarian. 

But more intriguing, participants who had the highest fiber intake saw a 41 percent reduction in diverticular disease. Those participants in the highest fiber group consumed >25.5 grams per day for women and >26.1 grams per day for men, whereas those in the lowest group consumed less than 14 grams per day. Though the difference in fiber between the two groups was small, the reduction in risk was substantial. 

Another study, which analyzed data from the Million Women Study, a large-scale, population-based prospective UK study of middle-aged women, confirmed the correlation between fiber intake and diverticular disease, and further analyzed the impact of different sources of fiber (4). The authors’ findings were that reduction in the risk of diverticular disease was greatest with high intake of cereal and fruit fiber.

Most Americans get about 16 grams of fiber per day. The Institute of Medicine (IOM) recommends daily fiber intake for those <50 years old of 25-26 grams for women and 31-38 grams for men (5). Interestingly, their recommendations are lower for those who are over 50 years old.

Can you imagine what the effect is when people get at least 40 grams of fiber per day? This is what I recommend for my patients. Some foods that contain the most fiber include nuts, seeds, beans and legumes. In a study in 2009, specifically those men who consumed the most nuts and popcorn saw a protective effect from diverticulitis (6).

Obesity plays a role, as well. In the large, prospective male Health Professionals Follow-up Study, body mass index played a significant role, as did waist circumference (7). Those who were obese (BMI >30 kg/m²) had a 78 percent increased risk of diverticulitis and a greater than threefold increased risk of a diverticular bleed compared to those who had a BMI in the normal range of <21 kg/m². For those whose waist circumference was in the highest group, they had a 56 percent increase risk of diverticulitis and a 96 percent increase risk of diverticular bleed. Thus, obesity puts patients at a much higher risk of the complications of diverticulosis.

Physical activity is also important for reducing the risk of diverticular disease, although the exact mechanism is not yet understood. Regardless, the results are impressive. In a large prospective study, those with the greatest amount of exercise were 37 percent less likely to have diverticular disease compared to those with the least amount (8). Jogging and running seemed to have the most benefit. When the authors combined exercise with fiber intake, there was a dramatic 256 percent reduction in risk of this disease. 

Thus, preventing diverticular disease is based mostly on lifestyle modifications through diet and exercise.

References:

(1) www.niddk.nih.gov. (2) Clin Gastroenterol Hepatol. 2016; 14(1):96–103.e1. (3) BMJ. 2011; 343: d4131. (4) Gut. 2014 Sep; 63(9): 1450–1456. (5) Am J Lifestyle Med. 2017 Jan-Feb; 11(1): 80–85. (6) AMA 2008; 300: 907-914. (7) Gastroenterology. 2009;136(1):115. (8) Gut. 1995;36(2):276.  

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.   

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As the number of people infected with the new coronavirus climbs in China and countries limit travel to the beleaguered country, the incidence of infection in the United States remains low, with 11 people carrying the respiratory virus as of earlier this week.

“While the risk to New Yorkers is still low, we urge everyone to remain vigilant.”

— Gov. Andrew. Cuomo

American officials stepped up their policies designed to keep the virus, which so far has about a 2 percent mortality rate, at bay in the last week. For the first time in over half a century, the government established a mandatory two-week quarantine for people entering from China’s Hubei Province, which is where the outbreak began. The United States also said it would prevent foreign nationals who are not immediate family members of American citizens from entering within two weeks of visiting China.

Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, called the viral outbreak an “unprecedented situation” and suggested that the American government has taken “aggressive measures” amid the largely expanding outbreak.

The actions, Messonnier said on a conference call earlier this week, were designed to “slow this down before it gets into the United States. If we act now, we do have an opportunity to provide additional protection.”

The number of deaths from coronavirus, which has reached almost 500, now exceeds the number for the sudden acute respiratory syndrome, or SARS, in 2003. The number of infected patients worldwide has reached above 25,000, triggering concerns about a pandemic. More than 1,000 have recovered from the virus.

The CDC, which has been coordinating the American response to the virus, has been testing potential cases of the disease. Symptoms include fever, coughing and shortness of breath.

In New York, 17 samples have been sent to the CDC for testing, with 11 coming back negative and six pending. New York created a hotline, 888-364-3065, in which experts from the Department of Health can answer questions about the virus. The DOH also has a website as a resource for residents, at www.health.ny.gov/diseases/communicable/coronavirus.

“While the risk to New Yorkers is still low, we urge everyone to remain vigilant,” Gov. Andrew Cuomo (D) said in a statement.

The CDC sent an Emergency Use Authorization to the Food & Drug Administration to allow more local testing during medical emergencies. Such an effort could expedite the way emergency rooms respond to patients who they might otherwise need to isolate for longer periods of time while they await a definitive diagnosis.

By speeding up the evaluation period, the CDC would help hospitals like Stony Brook University Hospital maintain the necessary number of isolation beds, rather than prolonging the wait period in the middle of flu season to determine the cause of the illness.

As for the university, according to its website,  approximately 40 students have contacted the school indicating they are restricted from returning to the U.S. With university approval, the students will not be penalized academically for being out or for taking a leave of absence.

“The most important thing is to keep your hands clean.”

— Bettina Fries

Testing for the new coronavirus, which is still tentatively called 2019-nCoV, would miss a positive case if the virus mutated. In an RNA virus like this one, mutations can and do occur, although most of these changes result in a less virulent form.

The CDC, whose website www.cdc.gov, provides considerable information about this new virus, is “watching for that,” said Bettina Fries, the chief of the Division of Infectious Diseases in the Department of Medicine at Renaissance School of Medicine at Stony Brook University. At this point, there “doesn’t seem to be much mutation yet.”

In the SARS outbreak, a mutation made the virus less virulent.

Fries added that the “feeling with SARS was that you weren’t infectious until were you symptomatic. The feeling with this one is that you are potentially infectious” before demonstrating any of the typical symptoms.

Fries assessed the threat from contracting the virus in the United States as “low,” while adding that the danger from the flu, which has resulted in over 10,000 deaths during the 2019-20 flu season, is much higher.

In the hospital, Fries said the health care staff puts masks on people who are coughing to reduce the potential spread of whatever is affecting their respiratory systems.

While Fries doesn’t believe it’s necessary to wear a mask to class, she said it’s not “unreasonable” in densely populated areas like airports and airplanes to wear one.

Masks don’t offer complete protection from the flu or coronavirus, in part because people touch the outside of the masks, where viruses condense, and then touch parts of their face. Even with the mask on, people touch their eyes.

“The most important thing is to keep your hands clean,” Fries suggested.

Fries believes the 14-day quarantine period for people coming from an area where coronavirus is prevalent is “probably on the generous side.” Scientists come up with this time period to establish guidelines for health care providers throughout the country.

Fries suggested that the only way these precautions are going to work is if they are aggressive and done early enough.

“Once the genie is out of the bottle” and an epidemic spreads to other countries, it becomes much more difficult to contain, Fries said.

The best-case scenario is that this virus becomes a contained problem in China. If it doesn’t spread outside the country, it could follow the same pattern as SARS, which abated within about eight months.

While there is no treatment for this new coronavirus, companies and governments are working on a possible vaccine. This, Fries estimated, could take about a year to create.

Looking out across the calendar, Fries wondered what would happen with the Olympics this year, which are scheduled for July 24 through Aug. 9 in Tokyo. Athletes who have been training for years certainly hope the virus is contained by then. A similar concern preceded the 2016 Olympics, when Zika virus threatened to derail the games in Brazil.

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Lowering your meat intake may reduce cataract risk

By David Dunaief, M.D.

Dr. David Dunaief

Cataracts affect a substantial portion of the U.S. population. In fact, 24.4 million people in the U.S. over the age of 40 are currently afflicted, and this number is expected to increase approximately 61 percent by the year 2030 — only 10 years from now — according to estimates by the National Eye Institute (1).

Cataracts are defined as an opacity or cloudiness of the lens in the eye, which decreases vision over time as it progresses. It’s very common for both eyes to be affected. We often think of cataracts as a symptom of age, but we can take an active role in preventing them.

There are enumerable modifiable risk factors including diet; smoking; sunlight exposure; chronic diseases, such as diabetes and metabolic syndrome; steroid use; and physical inactivity. I am going to discuss the dietary factor.

Prevention

In a prospective (forward-looking) study, diet was shown to have substantial effect on the risk reduction for cataracts (2). This study was the United Kingdom group, with 27,670 participants, of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. Participants completed food frequency questionnaires between 1993 and 1999. Then, they were checked for cataracts between 2008 and 2009.

There was an inverse relationship between the amount of meat consumed and cataract risk. In other words, those who ate a great amount of meat were at higher risk of cataracts. “Meat” included red meat, fowl and pork. These results followed what is termed a dose-response curve. 

Compared to high meat eaters, every other group demonstrated a significant risk reduction as you progressed along a spectrum that included low meat eaters (15 percent reduction), fish eaters (21 percent reduction), vegetarians (30 percent reduction) and finally vegans (40 percent reduction). 

There really was not that much difference between high meat eaters, those having at least 3.5 ounces, and low meat eaters, those having less than 1.7 ounces a day, yet there was a substantial decline in cataracts. Thus, you don’t have to become a vegan to see an effect.

In my clinical experience, I’ve also had several patients experience reversal of their cataracts after they transitioned to a nutrient-dense, plant-based diet. I didn’t think this was possible, but anecdotally, this is a very positive outcome and was confirmed by their ophthalmologists.

Mechanism of action

Oxidative stress is one of the major contributors to the development of cataracts. In a review article that looked at 70 different trials for the development of cataract and/or maculopathies, such as age-related macular degeneration, the authors concluded antioxidants, which are micronutrients found in foods, play an integral part in prevention (3).

The authors go on to say that a diet rich in fruits and vegetables, as well as lifestyle modification with cessation of smoking and treatment of obesity at an early age, help to reduce the risk of cataracts. Thus, you are never too young or too old to take steps to prevent cataracts.

How do you treat cataracts?

The only effective way to treat cataracts is with surgery; the most typical type is phacoemulsification. Ophthalmologists remove the opaque lens and replace it with a synthetic intraocular lens. This is done as an outpatient procedure and usually takes approximately 30 minutes. Fortunately, there is a very high success rate for this surgery. So why is it important to avoid cataracts if surgery can remedy them?

Potential consequences of surgery

There are always potential risks with invasive procedures, such as infection, even though the chances of complications are low. However, more importantly, there is a greater than fivefold risk of developing late-stage age-related macular degeneration (AMD) after cataract surgery (4). This is wet AMD, which can cause significant vision loss. These results come from a meta-analysis (group of studies) looking at more than 6,000 patients. 

It has been hypothesized that the surgery may induce inflammatory changes and the development of leaky blood vessels in the retina of the eye. However, because this meta-analysis was based on observational studies, it is not clear whether undiagnosed AMD may have existed prior to the cataract surgery, since they have similar underlying causes related to oxidative stress.

Therefore, if you can reduce the risk of cataracts through diet and other lifestyle modifications, plus avoid the potential consequences of cataract surgery, all while reducing the risk of chronic diseases, why not choose the win-win scenario?

References:

(1) nei.nih.gov. (2) Am J Clin Nutr. 2011 May; 93(5): 1128-1135. (3) Exp Eye Res. 2007; 84: 229-245. (4) Ophthalmology. 2003; 110(10): 1960.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.    

Photo from Stony Brook Medicine

In a Q&A with TBR News Media, Carol Gomes, interim chief executive officer at Stony Brook University Hospital, discusses a variety of topics including patient safety, quality control and curbing infections. Here is what she had to say. 

1. Being the interim chief executive officer at the hospital, how important is patient safety and  quality control to the day-to-day operations?

Stony Brook Medicine physicians and staff are committed to providing high-quality, safe patient care.

SBU Hospital CEO Carol Gomes discusses what the hospital is doing to reduce infection potential. Photo from SBU Hospital

Quality and patient safety is priority number one, and we focus on safe patient care every day. The Stony Brook Medicine team convenes a safety huddle that is part of the day-to-day operations in every area, which includes critical leaders from all over the hospital.

We start the day with approximately 35 care team members from nursing leadership, physician leadership and operational leadership who report on important safety or quality opportunities.  Our huddles are highly structured meetings that allow the hospital to focus on process changes with direct follow-up. This drives accountability to help ensure that adequate safety measures are in place for our patients at all times. 

2. Interim SBU President Michael Bernstein mentioned to us that you were making an effort to curb infections at the hospital among other things. Could you discuss some of the initiatives you’ve been implementing to improve in that area?

Stony Brook University Hospital has three primary strategic quality priorities — clinical outcomes, patient safety and the patient experience.

Proactively, Stony Brook works to provide safe and effective care to every patient via our patient safety work groups. These groups analyze processes, review relevant data and implement process changes to enhance patient safety and prevent patient harm.

The vast majority of projects and improvement efforts are aimed at reducing hospital associated infections. There are teams that implement best practices for CLABSI, or central line associated bloodstream infections; hand hygiene; CAUTI, or catheter-associated urinary tract infections; C. diff, or Clostridium difficile infections; SSI, or surgical site infections; and sepsis. 

Working groups incorporate real-time data to implement best practices to ensure hospital units continue to drive improvement efforts in achieving patient safety goals.

3. In general could you talk about the threat of infections to patients at hospitals? Most people view hospitals as a place of recovery and necessarily don’t think of other germs, sick people around them. Can you speak on that and the challenges you and others face?

As a matter of standard practice, the hospital adheres to rigorous infection control guidelines every day to ensure a clean environment for patients, staff and visitors. These practices are especially important during the flu season.

Being within the close quarters of a hospital, there is an increased incidence of transmission for infections. Many patients have recent surgical wounds, IVs and other catheters placing them at higher risk of infection. These risks may be enhanced by the acquisition of an infection from a visitor.

Family members and other visitors who suspect they may have the flu or other viruses are advised to not visit the hospital.

To lessen the spread of the flu virus, hand hygiene and attention to reducing the effects of droplets from respiratory illnesses such as the flu can enhance patient safety.

Hand washing prevents infection. It is one of the most important actions each of us can implement before and after every encounter with a patient.

The goal is to minimize that transmission while the patient is in the hospital.

4. Other practices/guidelines at the hospital?

The flu virus most commonly spreads from an infected person to others. It’s important to stay home while you’re sick, not visit people in the hospital and to limit close contact with others.

Visitors should wash their hands before entering a patient room and after seeing a patient, whether or not there is patient contact. 

As added protection, patients who have been identified as having infections are isolated appropriately from other patients in order to prevent accidental spread.

Therefore, if a patient has the flu or flulike symptoms, the hospital will place them in respiratory isolation. Likewise, a patient with measles or chicken pox is kept in appropriate isolation.

Visitors may be asked to wear masks on certain units.

5. How do patient safety grades affect how the hospital looks to improve
its quality? 

Stony Brook University Hospital supports the public availability of quality and safety information about hospitals. We are constantly looking for ways to improve and ensure the highest quality of care.

There is a wide variation of quality reports with different methodologies and results.

Clinical outcomes define our success as a hospital. Better clinical outcomes means we’re taking better care of our patients. Stony Brook Medicine initiated a major initiative to improve clinical outcomes. We have multidisciplinary groups improving outcomes in the following areas:

  Increasing our time educating patients prior to their discharge in order to prevent hospital readmissions.

  Improving the care of our patients receiving surgery to reduce postoperative complications.

  Enhancing the diagnosis and care of patients with diabetes.

  Improving the speed of diagnosis and treatment of sepsis.

In short, great effort is expended in identifying opportunities for improvement with a detailed and focused approach on enhancing patient outcomes.

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While the risk from the new deadly coronavirus that has closed cities in China remains low in New York, Long Island hospitals, including Stony Brook, are working with the New York Department of Health to prepare in case it makes its way to the New York area.

The respiratory virus, which originated at a seafood market in Wuhan Province in China during contact between humans and an animal that reportedly could have been a snake, has claimed the lives of 132 people as of Jan. 29. The virus has spread to three states, with single cases in Seattle, Washington, and Chicago, Illinois, and two cases in California.

The reported deaths from the virus are all in China, although people have also tested positive for coronavirus in countries including Australia, Canada, France, Japan and Vietnam, among others.

As of earlier this week, New York State had sent samples for nine people to the Centers for Disease Control and Prevention for testing. Four samples tested negative, while the state is awaiting results for the other five.

A Q&A with  Susan Donelan, Medical Director of Health Care Epidemiology, Stony Brook University Hospital, About the New Coronavirus

1. Is the outbreak plan for this new coronavirus any different than the plan for SARS or MERS at Stony Brook?

The 2019 novel coronavirus (2019-nCoV), a new virus that causes respiratory illness in people and can spread from person to person, shares a lot of similarities to other coronaviruses we have seen such as SARS and MERS-CoV. At Stony Brook Medicine, our teams are incorporating best practices from the Pandemic Influenza Plan. These practices are especially important during the flu season.

2. Is everyone in the emergency room taking a history on admission, particularly for people presenting with respiratory infections and a fever, that includes questions about travel to China?

As a matter of standard practice for many years, the hospital has asked all patients with any influenza-like illness [ILI] about recent travel history and is well versed in obtaining this information. Additionally, regardless of the presence or absence of travel, any patient presenting with an ILI immediately will be given a surgical mask to place over the nose and mouth, in order to limit the spread of any respiratory pathogen they may be harboring.

3. How much space could Stony Brook make available if the hospital needed to isolate people who might have this virus?

Stony Brook Medicine has already performed a walk-through of our facility to identify where patients could be cohorted if there were suspicions for this illness, and should they need hospitalization. As per the [CDC], people confirmed to have the 2019-nCoV infection, who do not need to be hospitalized, can receive care at home.

4. What is the current recommended treatment plan if someone either has or is suspected to have this virus?

Currently, there is no vaccine available to protect against 2019-nCoV and no specific antiviral treatment is recommended for the infection. People infected with 2019-nCoV should receive supportive care to help relieve symptoms.

“These five individuals remain in isolation as their samples are tested at CDC,” Gov. Andrew Cuomo (D) said in a statement. “While the risk for New Yorkers is currently low, we are still working to keep everyone informed, prepared and safe.”

China has been working to contain the virus by enforcing lockdowns in cities like Wuhan. Indeed, an unnamed Stony Brook scientist, who was visiting his family, has been unable to leave China to return to Long Island. Through a spokeswoman, Stony Brook said it is grateful for the help of Sen. Chuck Schumer (D-NY), the State Department and the university community in trying to bring him home.

When he returns to the United States, the professor will remain in quarantine until he could no longer be a carrier for the virus. 

Area hospitals, meanwhile, are watching carefully for any signs of coronavirus.

“There are procedure plans in place in every hospital,” said Dr. Bettina Fries, chief of the Division of Infectious Diseases in the Department of Medicine at Stony Brook University’s Renaissance School of Medicine. “There is always a concern when these outbreaks are announced.”

At this point, however, the World Health Organization has not declared the outbreak an emergency. The CDC has classified the new coronavirus threat level as “low.”

The coronavirus, called 2019-nCoV, is in the same family as sudden acute respiratory syndrome and the Middle East respiratory syndrome. The initial mortality rate from the current coronavirus is lower than the 10 percent rate for SARS, which spread in 2002, or the 30 to 35 percent rate from MERS, which started in Saudi Arabia in 2012.

The timing of the virus is challenging because the symptoms are similar to those for the flu, which has become more prevalent in New York and around the country this winter. Coronavirus symptoms, according to the CDC, include coughing, fever and shortness of breath.

While airports like John F. Kennedy Airport in Queens are screening people who arrive from Wuhan, efforts to determine whether they may be carrying the virus could be limited, in part because the incubation period could be as long as two weeks, during which time an infected person could be contagious.

Infectious disease experts suggested practicing the kind of hygiene that would reduce the likelihood of contracting the flu. This includes: washing hands for at least 20 seconds, using hand sanitizer and maintaining a distance of about 3 feet from anyone who has the sniffles or appears to be battling a cold. Infectious disease experts also suggest cutting back on handshakes, especially with people who appear to be battling a cold.

“If you have immunocompromised people, they should be extra careful,” Fries said, adding that the CDC, which has been regularly updating its web page, www.cdc.gov, has been working tirelessly with national and state health officials to coordinate a response to this virus, wherever it hits.

“The New York State Department of Health and the CDC need to be praised for all the work” they are doing, she said. “They have a task force that doesn’t do anything else but prepare for patients coming from outbreak areas.”

Scientists around the world have also been working to develop a vaccine for this new virus. According to a recent report in The Washington Post, researchers anticipate developing such a vaccine in as little as three months, which is considerably shorter than the 20 months it took to develop a vaccine for the SARS virus. The Post, however, suggested that the development of a vaccine would require testing before it received approval.

Fries said the concern about the coronavirus comes less with the current death toll than it does with the effect as it continues to spread.

“It’s important to see how far it spreads and what the real mortality is,” which is tough to track because the outbreak is still at the beginning and scientists and public health officials are still processing new information, she added.

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Hospital Prez Looks Back at His 34 Years, End of Community Hospitals Across LI

Kenneth Roberts, Mather Hospital president, signs a banner that will be hung shortly outside the hospital to celebrate its 90th year. Photo by Kyle Barr

By Julianne Mosher

It all started with a dream from a local businessman and third-generation shipbuilder who lived in Port Jefferson. 

John Titus Mather passed away in 1928, but he was a huge part of the shipbuilding community during the later 19th century and early part of the 20th century. Before he died, he knew that he wanted to leave a legacy that would help the Port Jeff community for years to come. If only he could see it nine decades later. 

Mather held its cornerstone dedication ceremony May 4, 1929. Photo from Stu Vincent

This year celebrates the 90th anniversary of Mather Hospital, formally known as the John T. Mather Memorial Hospital, named after the man who envisioned the institution. His will clearly outlined that his family and loved ones were to be taken care of, and instructed his executor to “incorporate under the laws of the State of New York a nonsectarian charitable hospital, to be located in said village of Port Jefferson … so designed and constructed as to permit future enlargement, assuming that future needs may justify such action. It is my sincere hope that the citizens of Port Jefferson and vicinity will give their liberal and devoted support to said institution and endeavor to make it a success and a credit to the community,” the Mather website stated. Today, the hospital is decorated with a nautical theme to honor its founder. 

Opening Dec. 29, 1929, the hospital became a staple on Long Island, featuring 54 beds and state-of-the-art technology of its time. 

“Mather Hospital was the first community hospital in the Town of Brookhaven,” said Kenneth Roberts, president of the hospital. “So, for a long time, it was the gem of the community and it remains so to this day.”

And every 10 years or so, it seems like the hospital is adding a new service or wing, constantly evolving to become better than before. In 1962, a new surgical suite, emergency facility and an intensive care unit joined in. The expansion resulted in additional beds, totaling 110. A new psychiatric unit was added in 1973, upgrading the hospital to 203 beds and by 1997, the hospital reached its
current bed count of 248 spots. 

The reason for the constant upgrades was to continue better serving the community, the hospital president said. 

“Technology has changed dramatically,” Roberts said, “And has changed the delivery of health care here.”

Roberts became president of Mather in 1986 and has pioneered dozens of changes throughout the campus. For starters, people don’t smoke on the campus, anymore, which if one weren’t around at that time, came as a shock to the multitudes of hospital staff who weren’t shy of smoking. 

Mather Hospital was also the first hospital on Long Island, including Brooklyn and Queens, to have a successful in vitro fertilization program that started up in 1988. Being a leader in that program, it eventually became available elsewhere, so in 2008, the program closed to make room for others. 

“We just change with what the community needs,” Roberts said. 

Alongside the hospital, Roberts has also seen the community expand. 

Mather Hospital’s original facade. Photo from Stu Vincent

“I think it’s grown a lot,” he said. “Obviously the traffic, the expansion, the adding of lights on 347, the construction of the third lanes… there’s been a lot of growth in housing and in population out in this area. So basically, we made an attempt to change with the needs of the population.”

As the area grew, so did the competition from St. Charles Hospital down the road, and Stony Brook University Hospital just 15 minutes away. 

“We were the first community hospital and then St. Charles converted itself from a polio institution to a community hospital and we work closely with them to not compete in major services,” Roberts said. “But at the same time, to provide all the services that the community needed.” 

When St. Charles redesigned itself to a hospital in the 1940s, it actually ended up helping Mather which was at 120 percent patient occupancy. 

In 2013, it was recognized as a Magnet-designated hospital by the American Nurses Credentialing Center, which recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice. 

Mather employs over 2,600 people, and has more than 600 staff and affiliated physicians. In 2016, the hospital cared for more than 12,500 inpatients and over 40,000 emergency patients. 

In December 2017, Mather formally joined the Northwell Health system as its 23rd hospital, something the hospital president constantly lauded. 

“It was a once-in-a-century decision going from an independent hospital to joining a larger system,” Roberts said. “Once you join a larger system, you’re in that larger system forever and it’s a big decision to make. We were extremely happy and pleased with the amount of resources that Northwell brings to the table.”

A group of nurses at Mather during its early years. Photo from Stu Vincent

Roberts added that there are no independently owned community hospitals on Long Island anymore. It’s a trend that’s predicated on costs and need, something, he said, a single standalone hospital would have a very difficult time doing on its own. Roberts said he sees a future where all hospitals and similar institutions are consolidated under just four or five health care companies.

“There’s a whole host of reasons why hospitals are going the same route, like all the other industries,” he said. “We see in the whole economy everybody’s changing: Airlines are basically consolidating, the big accounting firms … newspapers are consolidating.”

And although things have changed at Mather, Roberts is happy with what the
future holds. 

“I think that the future of Mather Hospital looks very good because of our affiliation with Northwell,” he said. “The services we will provide on a very high-quality basis, and we will continue to innovate and provide the services that the community needs.” 

He added that he is waiting on an approval to start a cardiac catheterization and electrophysiology service at Mather, and plans to grow its outpatient care over the next decade.

A sedentary lifestyle can increase heart attack risk. Stock photo
Maintaining your mobility is crucial
Dr. David Dunaief

We have made great strides in reducing mortality from heart attacks. When we compare cardiovascular disease — heart disease and stroke — mortality rates from 1975 to the present, there is a substantial decline of approximately one-quarter. However, if we look at these rates since 1990, the rate of decline has slowed (1). We need to reduce our risk factors to improve this scenario.

Some risk factors are obvious. Others are not. Obvious ones include age (men at least 45 years old and women at least 55 years old), family history, high cholesterol, high blood pressure, obesity, sedentary lifestyle, diabetes and smoking. Less obvious ones include gout, atrial fibrillation and osteoarthritis. Lifestyle modifications, including a high-fiber diet and exercise, may help allay the risks.

Let’s look at the evidence.

Obesity

Obesity continually gets play in discussions of disease risk. But how substantial a risk factor is it?

In the Copenhagen General Population Study, results showed an increased heart attack risk in obese (BMI >30 kg/m²) individuals with or without metabolic syndrome (high blood pressure, high cholesterol and high sugar) and in those who were overweight (BMI >25 kg/m²) (2). The risk of heart attack increased in direct proportion to weight. Specifically, there was a 26 percent increase in heart attack risk for those who were overweight and an 88 percent increase in risk for those who were obese without metabolic syndrome. This study had a follow-up of 3.6 years.

It is true that those with metabolic syndrome and obesity together had the highest risk. But, it is quite surprising that obesity, by itself, can increase heart attack risk when a person is “metabolically healthy.” Since this was an observational trial, we can only make an association, but if it is true, then there may not be such a thing as a “metabolically healthy” obese patient. Therefore, if you are obese, it is really important to lose weight.

Sedentary lifestyle

If obesity were not enough of a wake-up call, let’s look at another aspect of lifestyle: the impact of being sedentary. An observational study found that activity levels had a surprisingly high impact on women’s heart disease risk (3). Of four key factors — weight, blood pressure, smoking and physical inactivity — age was the determinant as to which one had the most negative effect. Those under the age of 30 saw smoking as most negatively impactful. For those over the age of 30, lack of exercise became the most dominant risk factor for heart disease, including heart attacks.

For women over the age of 70, the study found that increasing physical activity may have a greater positive impact than addressing high blood pressure, losing weight or even quitting smoking. However, since high blood pressure was self-reported and not necessarily measured in a doctor’s office, it may have been underestimated as a risk factor. Nonetheless, the researchers indicated that women should make sure they exercise on a regular basis to most significantly reduce heart disease risk.

Osteoarthritis

The prevailing thought with osteoarthritis is that it is best to suffer with hip or knee pain as long as possible before having surgery. But when do we cross the line and potentially need joint replacement? Well, in a study, those with osteoarthritis of the hip or knee joints that caused difficulty walking on a flat surface were at substantially greater risk of cardiovascular events, including heart attack. (4) Those who had surgery for the affected joint saw a substantially reduced heart attack risk. It is important to address the causes of osteoarthritis to improve mobility, whether with surgery or other treatments.

Fiber

There have been studies showing that fiber decreases the risk of heart attacks. However, does fiber still matter when someone has a heart attack? In a recent analysis using data from the Nurses’ Health Study and the Health Professional Follow-up Study, results showed that higher fiber plays an important role in reducing the risk of death after a heart attack (5).  

Those who consumed the most fiber, compared to the least, had a 25 percent reduction in post-heart attack mortality. Even more impressive is that those who increased their fiber after the cardiovascular event had a 31 percent reduction in mortality risk. In this analysis, it seemed that more of the benefit came from fiber found in cereal. The most intriguing part of the study was the dose-response. For every 10-g increase in fiber consumption, there was a 15 percent reduction in the risk of post-heart attack mortality. Since we get too little fiber anyway, this should be an easy fix.

Lifestyle modifications are so important. In the Nurses’ Health Study, which followed 120,000 women for 20 years, those who routinely exercised, ate a quality diet, did not smoke and were a healthy weight demonstrated a whopping 84 percent reduction in the risk of cardiovascular events such as heart attacks (6).

What have we learned? We can substantially reduce the risk of heart attacks and even potentially the risk of death after sustaining a heart attack with lifestyle modifications that include weight loss, physical activity and diet — with, in this case, a focus on fiber. While there are a number of diseases that contribute to heart attack risk, most of them are modifiable. With disabling osteoarthritis, addressing the causes of difficulty with mobility may also help reduce heart attack risk.

References:

(1) Heart. 1998;81(4):380. (2) JAMA Intern Med. 2014;174(1):15-22. (3) Br J Sports Med. 2014, May 8. (4) PLoS ONE. 2014, Mar 14, 2014 [https://doi.org/10.1371/journal.pone.0091286]. (5) BMJ. 2014;348:g2659. (6) N Engl J Med. 2000;343(1):16.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.    

Studies have shown that eating fresh fruit and cinnamon may be beneficial to diabetics. Stock photo
Fresh fruit and cinnamon may reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

What causes Type 2 diabetes? It would seem like an obvious answer: obesity, right? Well, obesity is a contributing factor but not necessarily the only factor. This is important because the prevalence of diabetes is at epidemic levels in the United States, and it continues to grow. The latest statistics show that about 12.2 percent of the U.S. population aged 18 or older has Type 2 diabetes, and about 9.4 percent when factoring all ages (1).

Not only may obesity play a role, but sugar by itself, sedentary lifestyle and visceral (abdominal) fat may also contribute to the pandemic. These factors may not be mutually exclusive, of course.

We need to differentiate among sugars, because form is important. Sugar and fruit are not the same with respect to their effects on diabetes, as the research will help clarify. Sugar, processed foods and sugary drinks, such as fruit juices and soda, have a similar effect, but fresh fruit does not.

Sugar’s impact

Sugar may be sweet, but it also may be a bitter pill to swallow when it comes to its effect on the prevalence of diabetes. In an epidemiological (population-based) study, the results show that sugar may increase the prevalence of Type 2 diabetes by 1.1 percent worldwide (2). This seems like a small percentage, however, we are talking about the overall prevalence, which is around 9.4 percent in the U.S., as we noted above.

Also, the amount of sugar needed to create this result is surprisingly low. It takes about 150 calories, or one 12-ounce can of soda per day, to potentially cause this rise in diabetes. This is looking at sugar on its own merit, irrespective of obesity, lack of physical activity or overconsumption of calories. The longer people were consuming sugary foods, the higher the incidence of diabetes. So the relationship was a dose-dependent curve. Interestingly, the opposite was true as well: As sugar was less available in some countries, the risk of diabetes diminished to almost the same extent that it increased in countries where it was overconsumed.

In fact, the study highlights that certain countries, such as France, Romania and the Philippines, are struggling with the diabetes pandemic, even though they don’t have significant obesity issues. The study evaluated demographics from 175 countries, looking at 10 years’ worth of data. This may give more bite to municipal efforts to limit the availability of sugary drinks. Even steps like these may not be enough, though. Before we can draw definitive conclusion from the study, however, there need to be prospective (forward-looking) studies.

Effect of fruit

The prevailing thought has been that fruit should only be consumed in very modest amounts in patients with — or at risk for — Type 2 diabetes. A new study challenges this theory. In a randomized controlled trial, newly diagnosed diabetes patients who were given either more than two pieces of fresh fruit or fewer than two pieces had the same improvement in glucose (sugar) levels (3). Yes, you read this correctly: There was a benefit, regardless of whether the participants ate more fruit or less fruit.

This was a small trial with 63 patients over a 12-week period. The average patient was 58 and obese, with a body mass index of 32 (less than 25 is normal). The researchers monitored hemoglobin A1C (HbA1C), which provides a three-month mean percentage of sugar levels.

It is very important to emphasize that fruit juice and dried fruit were avoided. Both groups also lost a significant amount of weight while eating fruit. The authors, therefore, recommended that fresh fruit not be restricted in diabetes patients.

What about cinnamon?

It turns out that cinnamon, a spice many people love, may help to prevent, improve and reduce sugars in diabetes. In a review article, the authors discuss the importance of cinnamon as an insulin sensitizer (making the body more responsive to insulin) in animal models that have Type 2 diabetes (4).

Cinnamon may work much the same way as some medications used to treat Type 2 diabetes, such as GLP-1 (glucagon-like peptide-1) agonists. The drugs that raise GLP-1 levels are also known as incretin mimetics and include injectable drugs such as Byetta (exenatide) and Victoza (liraglutide). In a study with healthy volunteers, cinnamon raised the level of GLP-1 (5). Also, in a randomized control trial with 100 participants, 1 gram of cassia cinnamon reduced sugars significantly more than medication alone (6). The data is far too preliminary to make any comparison with FDA-approved medications. However, it would not hurt, and may even be beneficial, to consume cinnamon on a regular basis.

Sedentary lifestyle

What impact does lying down or sitting have on diabetes? Here, the risks of a sedentary lifestyle may outweigh the benefits of even vigorous exercise. In fact, in a recent study, the authors emphasize that the two are not mutually exclusive in that people, especially those at high risk for the disease, should be active throughout the day as well as exercise (7).

So in other words, the couch is “the worst deep-fried food,” as I once heard it said, but sitting at your desk all day and lying down also have negative effects. This coincides with articles I’ve written on exercise and weight loss, where I noted that people who moderately exercise and also move around much of the day are likely to lose the greatest amount of weight.

As a medical community, it is imperative that we reduce the trend of increasing prevalence by educating the population, but the onus is also on the community at large to make lifestyle changes. So America, take an active role.

References:

(1) www.cdc.gov/diabetes. (2) PLoS One. 2013;8(2):e57873. (3) Nutr J. published online March 5, 2013. (4) Am J Lifestyle Med. 2013;7(1):23-26. (5) Am J Clin Nutr. 2007;85:1552–1556. (6) J Am Board Fam Med. 2009;22:507–512. (7) Diabetologia online March 1, 2013.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.      

Reducing inflammation can reduce disease risk. Stock photo
C-reactive protein can be measured to identify disease risk

By David Dunaief, M.D.

One of the most widely studied biomarkers for inflammation in our bodies is high-sensitivity C-reactive protein (hsCRP), also referred to as CRP. High sensitivity means that we can measure levels as low as 0.3 mg/L more accurately.

What is the significance of the different levels? Individuals who have levels lower than 1.0 mg/L are in the optimal range for low risk for a host of diseases that are indicated by high inflammation. 

For example, with heart disease, levels of 1 to 3 mg/L represent the average risk range, and greater than 3.0 mg/L is a higher risk profile. Above 10.0 mg/L is more likely associated with other causes, such as infection and autoimmune diseases (1, 2). This biomarker is derived from the liver.

CRP is not specific to heart disease, nor is it definitive for risk of the disease. However, the upside is that it may be helpful with risk stratification, which helps us understand where we sit on a heart disease risk spectrum and with progression in other diseases, such as age-related macular degeneration, diabetic retinopathy, depression and autoimmune diseases. Let’s look at the evidence.

Stock photo

Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in patients over the age of 65 (3). Therefore, it is very important to help define risk stratification for this disease. In a prospective study, results showed that hsCRP levels were inversely associated with the risk of developing AMD. The group with an hsCRP greater than 3.0 mg/L had a 50 percent increased risk of developing overall AMD compared to the optimal group with hsCRP lower than 1.0 mg/L. But even more interestingly, the risk of developing neovascular, or wet, AMD increased to 89 percent in this high-risk group.

The significance of wet AMD is that it is one type of advanced-stage AMD that results in blindness. This study involved five studies where the researchers thawed baseline blood samples from middle-aged participants who had hsCRP levels measured. There were more than 2,000 participants with a follow-up as long as 20 years. According to the study’s authors, annual eye exams and lifestyle modifications, including supplements, may be able to stem this risk by reducing hsCRP.

These results reinforce those of a previous prospective study that showed that elevated hsCRP increased the risk of AMD threefold (4). This study utilized data from the Women’s Health Study, which involved over 27,000 participants. Like the study mentioned above, this one also defrosted blood samples from baseline and looked at follow-up incidence of developing AMD in initially healthy women.

The highest group had hsCRP levels over 5.2 mg/L. Additionally, when analyzing similar cutoffs for high- and low-level hsCRP, as the above trial used, those with hsCRP over 3.0 had an 82 percent increased risk of AMD compared to those with an hsCRP of lower than 1.0 mg/L.

Diabetic retinopathy

We know that diabetes affects just under 10 percent of the U.S. population and is continuing to rise. One of the complications of diabetes is diabetic retinopathy, which affects the retina (back of the eye) and is a leading cause of vision loss (5). One of the reasons for the vision loss is macular edema, or swelling, usually due to rupture of tiny blood vessels below the macula, a portion of the back of the eye responsible for central vision.

The Diabetes Control and Complications Trial (DCCT), a prospective study involving over 1,400 Type 1 diabetes patients, showed an 83 percent increased risk of developing clinically significant macular edema in the group with the highest hsCRP levels compared to those with the lowest (6). Although these results were with Type 1 diabetes, patients with Type 2 diabetes are at equal risk of diabetic retinopathy if glucose levels, or sugars, are not well controlled.

Depression

Depression is a very difficult disease to control and is a tremendous cause of disability.

Well, it turns out that inflammation is associated with depression. Specifically, in a prospective observational trial, rising levels of CRP had a linear relationship with increased risk of hospitalization due to psychological distress and depression (7). In other words, compared to levels of less than 1 mg/L, those who were 1 to 3 mg/L, 3 to 10 mg/L and greater than 10 mg/L had increased risk from 30 to 84 to 127 percent, respectively. This study involved over 70,000 patients.

How can you reduce inflammation?

This is the key question, since we now know that hsCRP is associated with systemic inflammation. In the Nurses’ Health Study, a very large, prospective observational study, the Dietary Approaches to Stop Hypertension (DASH) diet decreased the risk of both heart disease and stroke, which is impressive. The DASH diet also decreases the levels of hsCRP significantly, which was associated with a decrease in clinically meaningful end points of stroke and heart disease (8). The DASH diet is nutrient dense with an emphasis on fruits, vegetables, nuts, seeds, legumes and whole grains and a de-emphasis on processed foods, red meats, sodium and sweet beverages.

Conclusion

As the evidence shows with multiple diseases, hsCRP is a very valuable nonspecific biomarker for inflammation in the body. To stem the effects of inflammation, reducing hsCRP through lifestyle modifications and drug therapy may be a productive way of reducing risk, slowing progression and even potentially reversing some disease processes.

The DASH diet is a very powerful approach to achieving optimal levels of hsCRP without incurring potential side effects. This is a call to arms to have your levels measured, especially if you are at high risk or have chronic diseases such as heart disease, diabetes, depression and autoimmune diseases. HsCRP is a simple blood test with easy-to-obtain results.

References:

(1) uptodate.com. (2) Diabetes Technol Ther. 2006;8(1):28-36. (3) Prog Retin Eye Res. 2007 Nov;26(6):649-673. (4) Arch Ophthalmol. 2007;125(3):300-305. (5) Am J Ophthalmol. 2003;136(1):122-135. (6) JAMA Ophthalmol. 2013 Feb 7;131:1-8. (7) JAMA Psychiatry. 2013;70(2):176-184. (8) Arch Intern Med. 2008;168(7):713-720.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.