Asaf Bitton

Growing Epidemic of Coronary Heart Disease in Low- and Middle-Income Countries

Coronary heart disease (CHD) is the single largest cause of death in the developed countries and is one of the leading causes of disease burden in developing countries. In 2001, there were 7.3 million deaths due to CHD worldwide. Three-fourths of global deaths due to CHD occurred in the low- and middle-income countries. The rapid rise in CHD burden in most of the low- and middle-income countries is due to socio-economic changes, increase in lifespan, and acquisition of lifestyle-related risk factors. The CHD death rate, however, varies dramatically across the developing countries. The varying incidence, prevalence, and mortality rates reflect the different levels of risk factors, other competing causes of death, availability of resources to combat cardiovascular disease, and the stage of epidemiologic transition that each country or region finds itself. The economic burden of CHD is equally large but solutions exist to manage this growing burden.

Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia.

Aims/hypothesisPostprandial hypoglycaemia following gastric bypass for obesity is considered a late manifestation of the dumping syndrome and can usually be managed with dietary modification. We investigated three patients with severe postprandial hypoglycaemia and hyperinsulinaemia unresponsive to diet, octreotide and diazoxide with the aim of elucidating the pathological mechanisms involved.MethodsGlucose, insulin, and C-peptide were measured in the fasting and postprandial state, and insulin secretion was assessed following selective intra-arterial calcium injection. Pancreas histopathology was assessed in all three patients.ResultsAll three patients had evidence of severe postprandial hyperinsulinaemia and hypoglycaemia. In one patient, reversal of gastric bypass was ineffective in reversing hypoglycaemia. All three patients ultimately required partial pancreatectomy for control of neuroglycopenia; pancreas pathology of all patients revealed diffuse islet hyperplasia and expansion of beta cell mass.Conclusions/interpretationThese findings suggest that gastric bypass-induced weight loss may unmask an underlying beta cell defect or contribute to pathological islet hyperplasia, perhaps via glucagon-like peptide 1-mediated pathways.

The Future Of Health Information Technology In The Patient-Centered Medical Home

Most electronic health records today need further development of features that patient-centered medical homes require to improve their efficiency, quality, and safety. We propose a road map of the domains that need to be addressed to achieve these results. We believe that the development of electronic health records will be critical in seven major areas: telehealth, measurement of quality and efficiency, care transitions, personal health records, and, most important, registries, team care, and clinical decision support for chronic diseases. To encourage this development, policy makers should include medical homes in emerging electronic health record regulations. Additionally, more research is needed to learn how these records can enhance team care.

A Nationwide Survey of Patient Centered Medical Home Demonstration Projects

BackgroundThe patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country.DesignCross-sectional key-informant interviews.ParticipantsLeaders from existing PCMH demonstration projects with external payment reform.MeasurementsWe used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design.ResultsA total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was

E-Cigarettes: A Rapidly Growing Internet Phenomenon

22,834 (range

Clinical Risk Factors for Severe Clostridium difficile–associated Disease

720 to

The global cost of nonoptimal blood pressure

91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans.ConclusionCurrent PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

The Framingham Heart Study's impact on global risk assessment.

Electronic cigarettes (e-cigarettes) aerosolize nicotine and produce a vapor that emulates that of cigarettes but purportedly has fewer traditional toxins than secondhand smoke. Although e-cigarettes are widely sold online and by retailers, new research suggests that they may contain unexpected toxins and may provide unreliable nicotine delivery. Many countries have already banned or strictly regulated e-cigarettes. Currently in the United States, e-cigarettes are exempt from regulation as drug-delivery devices. Meanwhile, the presence of e-cigarettes on the Internet, including in Web searches, virtual user communities, and online stores where people sell e-cigarettes on commission, is increasing rapidly. Physicians should be aware of the popularity, questionable efficacy claims, and safety concerns of e-cigarettes so that they may counsel patients against use and advocate for research to inform an evidence-based regulatory approach.

Patient-Centered Medical Home Initiatives Expanded In 2009–13: Providers, Patients, And Payment Incentives Increased

Rapidly available information, such as age and laboratory and radiologic data, can be used to identify adverse outcomes.

Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis

Objective Suboptimal blood pressure including established nonoptimal blood pressure has been shown to have significant economic consequences in developed countries. However, no exhaustive study has been done to evaluate its potential costs, globally. We, therefore, set out to estimate the global economic cost of nonoptimal blood pressure. Methods Estimates for healthcare costs attributed to suboptimal blood pressure for those over the age of 30 were made for all the World Bank regions. Annual and 10-year estimates using Markov models were made for the cost of treating nonoptimal blood pressure and its main sequelae: stroke and myocardial infarction. Results Suboptimal blood pressure cost US