Study: Bariatric Surgery may lead to alcohol abuse

Risk of Alcohol Abuse May Increase After Bariatric Surgery

CHICAGO – Among patients who underwent bariatric surgery, there was a higher prevalence of alcohol use disorders in the second year after surgery, and specifically after Roux-en-Y gastric bypass, compared with the years immediately before and following surgery, according to a study in the June 20 issue of JAMA. This study is being published early online to coincide with its presentation at the annual meeting of the American Society for Metabolic and Bariatric Surgery. 

“As the prevalence of severe obesity increases in the United States, it is becoming increasingly common for health care providers and their patients to consider bariatric surgery, which is the most effective and durable treatment for severe obesity. Although bariatric surgery may reduce long-term mortality, and it carries a low risk of short-term serious adverse outcomes, safety concerns remain. Anecdotal reports suggest that bariatric surgery may increase the risk for alcohol use disorders (AUD; i.e., alcohol abuse and dependence),” according to background information in the article. 

The authors add that there is evidence that some bariatric surgical procedures (i.e., Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy) alter the pharmacokinetics of alcohol. “Given a standardized quantity of alcohol, patients reach a higher peak alcohol level after surgery compared with case-controls or their preoperative levels.”

Wendy C. King, Ph.D., of the University of Pittsburgh, and colleagues conducted a study to determine whether the prevalence of AUD changed following bariatric surgery, comparing reported AUD in the year prior to surgery with the first and second years after surgery. The prospective study included 2,458 adults who underwent bariatric surgery at 10 U.S. hospitals. Of these participants, 1,945 (78.8 percent female; 87 percent white; median [midpoint] age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011. The primary outcome measure for the study was past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (AUDIT) (indication of alcohol-related harm, alcohol dependence symptoms, or score 8 or greater). 

The researchers found that the prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6 percent vs. 7.3 percent), but was significantly higher in the second postoperative year (9.6 percent). Frequency of alcohol consumption and AUD significantly increased in the second postoperative year compared with the year prior to surgery or the first postoperative year.

“More than half (66/106; 62.3 percent) of those reporting AUD at the preoperative assessment continued to have or had recurrent AUD within the first 2 postoperative years,” the authors write. “In contrast, 7.9 percent (101/1,283) of participants not reporting AUD at the preoperative assessment had postoperative AUD. Nonetheless, more than half (101/167; 60.5 percent) of postoperative AUD was reported by those not reporting AUD at the preoperative assessment."

The researchers also found that male sex, younger age, smoking, regular alcohol consumption, AUD, recreational drug use, lower score on a measure of a sense of belonging at the preoperative assessment and undergoing a RYGB were independently related to an increased likelihood of AUD after surgery. RYGB accounted for 70 percent of surgeries and doubled the likelihood of postoperative AUD compared with laparoscopic adjustable gastric banding.

The authors note that although the 2 percent increase (7.6 percent to 9.6 percent) in prevalence of AUD from prior to surgery to the 2-year postoperative assessment may seem small, the increase potentially represents more than 2,000 additional people with AUD in the United States each year, with accompanying personal, financial, and societal costs.

“This study has important implications for the care of patients who undergo bariatric surgery. Regardless of alcohol history, patients should be educated about the potential effects of bariatric surgery, in particular RYGB, to increase the risk of AUD. In addition, alcohol screening and, if indicated, referral should be offered as part of routine preoperative and postoperative clinical care. Further research should examine the long-term effect of bariatric surgery on AUD, and the relationship of AUD to postoperative weight control.”

Study: A look at Hispanic patient and caregive interactions

White Paper by Global Advertising Strategies Explores the Importance of Patient-Pharmacist Interaction among Hispanic Patients and Caregivers

NEW YORK, May 24, 2012 (BUSINESS WIRE) -- A new white paper looks at the cultural nuances behind the relationship between Hispanic patients and pharmacists in the United States. Published by the cross-cultural marketing agency Global Advertising Strategies, the white paper analyzes an opportunity for the healthcare and pharmaceutical industry to connect with the Hispanic patient through the pharmacist. 

Easier accessible than a physician, a pharmacist often becomes the Hispanic patient's or caregiver's primary information resource on medication therapies, with an opportunity to provide critical patient counseling. The growing prevalence of chronic diseases among the U.S. Hispanics along with the increasing shortage of primary care physicians is affecting the Hispanic community more severely than non-Hispanic whites. Culturally, the Hispanic patient is more receptive to dealing with the pharmacist, often developing a closer connection. With the appropriate training and education programs, U.S. pharmacists can increase their awareness of multicultural issues, and create a healthcare environment that fosters trust from the Hispanic patient. 

"Predisposition of Hispanic patients and caregivers to seek medical advice from a pharmacist opens up an untapped communication pathway with that audience," said Andy Bagnall, Global's VP of Client Services and the Cross-Cultural Healthcare Practice Leader. "We wanted to look at the characteristics behind that interaction through a cultural lens, and explore the opportunities to improve the overall healthcare experience for Hispanics." 

"Next year the U.S. healthcare system will implement a switch to electronic health records, giving pharmacists access to the diagnosis and the patient's medical history," said Bruce Briggs, RPh, CEO of Briggs PRN and former SVP of the National Association of Chain Drug Stores (NACDS). "With the increased ability to counsel patients and caregivers, culturally-competent knowledge and education are critical to the success of the treatment." 

For a limited time, the whitepaper is available for a free download at www.global-ny.com/insights.

Latinos with lung-cancer live longer

A study by the University of Miami's Miller School of Medicine shows that Hispanic lung-cancer patients seem to live longer than white or African American patients.

MIAMI, FL -- Research performed by Miller's Sylvester Comprehensive Cancer Center says that, "as with several other types of cancer, certain yet-to-be-defined genetic and/or environmental factors put Hispanic patients at a survival advantage."

UM said in a communique that to carry out this study, published Monday online in CANCER, a peer-reviewed journal of the American Cancer Society, a team of scientists led by Brian Lally and Ali Saeed studied the cases of 172,398 adult patients diagnosed with non-small-cell lung cancer (the most common) between 1988 and 2007.

"Compared with white patients, Hispanic patients had a 15 per cent lower risk of dying during the years of the study, whether they were born in the United States or not," UM said.

That fact is significant, according to Lally, "because it shows that our findings are indicative of the Hispanic population in general and not specific to specific groups of Hispanics."

"Our findings will motivate researchers and physicians to understand why Hispanics have more favorable outcomes and may shed light on potential environmental factors and/or genetic factors that can explain our observations," Saeed said.

Researchers also found that Hispanics are the most likely to develop the kind of lung cancer called bronchioalveolar carcinoma, which tends to be less dangerous than other types.

Saeed said that this could result from genetic predispositions or lower smoking rates.

He said the results of this study could be included in the "Hispanic paradox," the fact that Hispanics diagnosed with certain illnesses tend to show more favorable results than the average, regardless of socio-economic factors that could lead one to believe the opposite.

This paradox is seen, for example, in breast and prostate cancer, as well as in cardiovascular disease, but until now was never shown to be true in cases of lung cancer.

The US Centers for Disease Control and Prevention, or CDC, estimates that lung cancer is the second-most diagnosed type of cancer and the biggest cause of cancer-related deaths nationwide.

According to its figures, 1.4 million people were diagnosed between 1998-2006 with lung cancer.

Hispanics were the ethnic group with the lowest incidence of lung cancer with 37.3 per cent, while blacks were highest at 76.1 per cent, followed by whites with 69.7 per cent, native Americans, 48.4 per cent, and Asian Americans, 38.4 per cent.

Expanded screenings appear to detect breast cancer earlier

Addition of screening ultrasound or MRI to annual mammography appears to provide benefit for women at increased risk of breast cancer

CHICAGO, Ill – The addition of a screening ultrasound or magnetic resonance imaging (MRI) to annual mammography in women with an increased risk of breast cancer and dense breast tissue resulted in a higher rate of detection of incident breast cancers, according to a study in the April 4 issue of JAMA.

“Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging may reveal additional breast cancers missed by both mammography and ultrasound screening,” according to background information in the article.

Wendie A. Berg, M.D., Ph.D., formerly of the American College of Radiology Imaging Network, Philadelphia, and colleagues conducted a study to determine the supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer. The study included 2,809 women (with increased cancer risk and dense breasts) at 21 sites who consented to 3 annual independent screens with mammography and ultrasound in randomized order. Median age at enrollment was 55 years. Nearly 54 percent of women had a personal history of breast cancer. After 3 rounds of both screenings, 612 of 703 women who chose to undergo an MRI had complete data.

A total of 2,662 women underwent 7,473 mammogram and ultrasound screenings, 110 of whom had 111 breast cancer events. Fifty-nine cancers (53 percent) were detected by mammography, including 33 (30 percent) that were detected by mammography only; 32 (29 percent) by ultrasound only; and 9 (8 percent) by MRI only after both mammography and ultrasound screens failed to detect cancer. Eleven cancers (10 percent) were not detected by any imaging screen. A total of 16 of 612 women (2.6 percent) in the MRI substudy were diagnosed with breast cancer.

Among 4,814 incidence screens in the second and third years combined, 75 women were diagnosed with cancer. The researchers found that supplemental ultrasound increased cancer detection with each annual screen beyond that of mammography, adding detection of 5.3 cancers per 1,000 women in the first year; 3.7 women per 1,000 per year in each of the second and third years; and averaging 4.3 per 1,000 for each of the 3 rounds of annual screening. The addition of MRI screening further increased cancer detection with a supplemental cancer detection yield of 14.7 per 1,000 women. The number of screens needed to detect 1 cancer was 127 for mammography; 234 for supplemental ultrasound, and 68 for supplemental MRI after negative mammography plus ultrasound screening results. “Despite its higher sensitivity, the addition of screening MRI rather than ultrasound to mammography in broader populations of women at intermediate risk with dense breasts may not be appropriate, particularly when the current high false-positive rates, cost, and reduced tolerability of MRI are considered,” the authors conclude.

Latino role models in Medicine

Latinos in medicine: Role models for those who dare to dream

By Luna Garcia

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Photo: Jose Luis Pelaez

Very early in my education, I started looking around for someone I could look up to, unsuccessfully. Instead, I found many models of what not to become: a drop-out, mediocre, a cat lady, a frustrated immigrant, or prostitute. Nowadays, since I’ve already decided to go to medical school and become a doctor, I question whether that’s a good choice and look again for hope of success in those who made it.
But where are those who made it? Who are the Latinos who – just like me – came to the U.S. with a dream and pursued education to become health professionals? Once I started doing research I found there’s little to no information on Latino doctors online (apparently if you’re not a celebrity you’re not worth knowing about).  So I did what nerds do best: I went to the library. If you look on the bottom of the shelves, under all the books on statistics you may find pretty interesting resources on successful Latinos in any field.
I felt rushes of random joy every time I read a brother’s name with a fancy looking job tittle like biomedical engineer, or psychopharmacologist, or geneticist, and a little sadness to see the discrepancy between the number of men and women in the sciences. I hand-picked two doctors who I believe stand out in the field for being well known and respected, over-achievers, and, of course, Latinos:
Rodolfo Llinas: (Colombian-American, born 1934) currently teaching at NYU, Llinas is mostly known for his position as editor-in-chief of Neuroscience Journal and for his extensive research on neurobiology and electrophysiology. His research on neuronal systems and the evolution of the central nervous system led Llinas to develop his very own theory of brain’s functioning which could in turn lead to new developments on the treatment of mental illness. His research is summarized in the book I of the Vortex: From Neurons to Self. *
Antonia Coello Novello:  (Puerto Rican, born 1944), mostly recognized for being the first woman and the first Hispanic U.S. surgeon general. She completed her medical education in the University of Puerto Rico; later on she obtained a master’s degree in public health from Johns Hopkins University. She worked in private practice of pediatrics and nephrology, before joining the Public Health Service. She served as representative of health and nutrition for UNICEF, also as a professor of health policy at Johns Hopkins, and as New York State’s health commissioner, appointed by governor Pataki.*
Latinos like these prove to each of us que si se puede. We can, with enough dedication and determination get as far as we wish in our careers. And even though becoming a doctor seems like the most unattainable of dreams due to the insane tuition rates, it is a rewarding career that promises stable employment and personal satisfaction. Also with the current shortage of Latino doctors, many universities and hospitals are constantly recruiting motivated Latino students.  Take advantage of every opportunity you encounter and move fearlessly in the direction of your dreams.
*Biographies taken from The Hispanic American Almanac. Third Editition. Benson & Kanellos, Gale Group 2003.

Filed Under: Career Tagged With: Latinos in medicine, role models

 

About Luna Garcia
Luna was born in Barranquilla, Colombia. She moved to Brooklyn at the age of 16 leaving her family and her homeland behind. In 2010 she obtained a BA in Psychology from Baruch College that she is probably never going to use since she decided to go to Medical School and is now pursuing her pre-medical degree in Chemistry. Her experience as a young immigrant places her in-between the American born open minded young Latinos and the old school Born-There generation, allowing her to see any conflict from many perspectives.
Luna has always been a big fan of literature in both English and Spanish. Her obsession turned later into a love for writing and for all things Latino. Currently, Luna is trying to survive her second undergrad while exploiting New York City and looking for more opportunities to write. Her dream is to write fiction but most of her stories escape as soon as they’re about to be written.

Hispanic and Non-Hispanic hospital survival differs

Hospital Survival Differs Among Hispanic and Non-Hispanic Heart Failure Patients Depending on Heart Function

DALLAS, March 13, 2012 (GLOBE NEWSWIRE) -- The odds of surviving their hospital stay for heart failure differ between Hispanic and non-Hispanic white patients according to their level of heart function, even when they received equal care in hospitals participating in the American Heart Association's Get With The Guidelines(R)--Heart Failure quality improvement program, researchers said.

The study, published in the American Heart Association journal, Circulation: Heart Failure, is the first in which researchers compare the care and outcomes of Hispanic to non-Hispanic heart failure patients admitted to U.S. hospitals with either preserved (normal) or reduced heart function.

"Hispanics have multiple risk factors for heart failure and many face barriers to receiving health care," said Rey P. Vivo, M.D., lead author of the study and a fellow in the Division of Cardiology at the University of Texas Medical Branch in Galveston and the Methodist DeBakey Heart and Vascular Center in Houston, Texas. "Hispanics make up the largest and fastest growing ethnic minority in the United States. Yet, we know very little about the quality and results of care for Hispanic heart failure patients."

Researchers reviewed data from 247 U.S. hospitals in the Get With The Guidelines-Heart Failure program in 2005-2010. They divided Hispanic and non-Hispanic white patients into groups based on preserved or reduced ejection fraction.

Ejection fraction measures a heart's contracting ability by how much blood the left ventricle pumps out with each heartbeat. Heart failure patients with reduced heart function have lower than normal ejection fraction measures.

The researchers found:

·      Among patients with preserved (normal) heart function, Hispanic patients were 50 percent less likely than non-Hispanic whites to die during their hospital stays.

·      There were no differences in hospital survival between Hispanic and non-Hispanic heart failure patients with reduced heart function.

·      There were no major differences in quality of care among any Hispanic and non-Hispanic whites, regardless of heart function.

·      The quality of care at Get With The Guidelines-Heart Failure hospitals improved consistently during the five years of the study.   

"One possible reason for the survival difference between heart failure patients with preserved heart function is that Hispanics tend to be younger and may not be as sick as hospitalized white heart failure patients," Vivo said. "That could be because Hispanics are more likely to have inadequate or no health insurance. So, they are more likely to go to the hospital for their care, versus seeking care in doctors' offices or outpatient clinics."

The finding that hospitals improved their adherence to quality of care guidelines for all heart failure patients, regardless of ethnic background, is encouraging, according to Vivo.

"The study suggests that participation in quality of care initiatives, such as Get With The Guidelines, is a positive step toward reduction in healthcare disparities, in terms of delivering quality of care to all heart failure patients," he said.

In future studies, researchers should focus on what happens to heart failure patients from diverse ethnic groups after they leave the hospital, such as looking at readmission rates for six months or one year, Vivo said.

Co-authors are Selim R. Krim, M.D.; Nassim R. Krim, M.D.; Xin Zhao, M.S.; Adrian F. Hernandez, M.D., M.H.S.; Eric D. Peterson, M.D., M.P.H.; Ileana L. Piña, M.D., M.P.H.; Deepak L. Bhatt, M.D., M.P.H.; Lee H. Schwamm, M.D.; and Gregg C. Fonarow, M.D.

Author disclosures are on the manuscript. The Get With The Guidelines-Heart Failure program is provided by the American Heart Association and is currently supported in part by Medtronic and Ortho-McNeil and has been funded in the past through support from GlaxoSmithKline.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

SOURCE: American Heart Association