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Although drinking moderate amounts of wine or beer is believed to reduce the risk of cardiovascular disease and type II diabetes and improve glycemic control in diabetics, this belief is based on observational, follow-up studies and not long-term clinical interventional trials. Now Israeli epidemiologists and other experts are conducting a multi-center trial to test this theory, and are seeking patients willing to raise a glass of wine, beer or spirits every day.
The two-year prospective study is being coordinated in Israel by Dr. Iris Shay of Ben-Gurion University's Abraham International Center for Health and Nutrition, and is looking for 160 participants who are not used to drinking. Other hospital facilities, including the diabetes unit at Hadassah University Medical Center in Jerusalem's Ein Kerem, are also taking part.
Moderate alcohol consumption - one glass of wine, a can of beer or a drink of spirits (13-gram alcohol equivalents) - has been associated with a beneficial effect on lipid metabolism, coagulation, fibrinolysis, inflammatory biomarkers and insulin sensitivity. However, due to the harmful effect of severe alcohol intake, physicians are poorly informed about how to guide their patients when it comes to alcohol use, especially among women and patients with type 2 diabetes. Interventional studies, which are required to prove the beneficial effect of moderate alcohol consumption, have not been performed for more than a few days or weeks.
Shay, a graduate of a Harvard School of Public Health post-doctoral fellowship, is working in collaboration with leading researchers from the Harvard School of Public Health and the Robarts Research Institute in Canada. During the project, participants who were not used to alcohol will be individually instructed by dietitians to include routine moderate alcohol consumption in their daily routine. They will be followed for measurements of glycemic control, traditional and novel biomarkers of cardiovascular diseases and genetic and biochemical parameters.
For this pilot stage, the team will distribute a total of 1,440 bottles of red and white wine and 720 bottles of non-alcoholic light beer donated by Tishbi Wines in Israel and Admiral Wine Imports in the US.
When the previous health minister, Dan Naveh, went along with Treasury demands to allow the sale of some over-the-counter (OTC) drugs in grocery stores, petrol stations and other places, he probably didn't think about the monkey business that has resulted. The Treasury (and Naveh) hoped that the increased competition would lower prices of fever reducers, pain killers, nose drops and ointments, but in fact it has raised prices because of the special packaging, printed instructions and displays.
Now Tel Aviv district health office pharmacists have seized OTC drugs sold without a permit in the Super-Baba (Super Reuveni) supermarket in Tel Aviv's Rehov Yirmiyahu. The action, carried out in cooperation with the police, followed the discovery by inspectors that an "OTC certificate of approval" for the sale of non-prescription drugs there was counterfeit. The district health office's legal adviser filed a police complaint.
In an additional case, the owners of the Super Reines minimarket in Tel Aviv's Rehov Reines were told that their OTC sale permit would be cancelled. District health office pharmacists suspected the minimarket owners of being involved in the counterfeiting of certificates in the Yirmiyahu Street store. The minimarket owners, who refused to cooperate, were ordered immediately to remove the OTC medications they sold, and their own permit was withdrawn.
Since last year, the ministry has allowed outlets that are not pharmacies to sell certain kinds of OTC drugs without a pharmacist being present. Pharmacists strongly opposed the move for obvious economic reasons, and also out of genuine concern that it would lead to overconsumption of OTCs and even overdoses. Permission is granted by the ministry's pharmaceutical division on an individual basis according to whether an outlet meets its criteria for such sales.
ELECTRONIC NURSE AT YOUR SERVICE
New York's Montefiore Medical Center is using a new hi-tech interactive disease management system - dubbed the "electronic nurse"- to supplement nursing visits to the homes of congestive heart failure (CHF) patients. This is an expansion of monitoring-over-the-phone devices available in many countries. Evidence already shows that increased proactive management of weight changes and other vital signs can improve quality of life and reduce hospitalizations.
"If anything is amiss with their weight, blood pressure, pulmonary function, blood sugar or heart rate, one of our staff contacts the patient and determines any necessary medical interventions," says Dr. Sandra Selikson, who heads the hospitals's Home Health Agency. "We can take vital signs electronically any time of the day and monitor disease processes more closely so we can treat problems before they require hospitalization."
Every day patients use the system to monitor their vital signs and transmit the data to Montefiore, where it is analyzed by the Home Health nursing staff. An electronic scale measures changes in weight (a key indicator of worsening heart failure); a peak flow meter checks lung capacity (an indicator of worsening asthma or chronic obstructive pulmonary disease); a glucometer measures blood sugar levels that are key to managing diabetes; blood pressure levels are monitored for hypertension, and a pulse oximeter reads oxygen levels in the blood - key information to determine interventions needed for patients with asthma and COPD. The interactive system also asks each patient a daily series of self-help medical questions.
"This focuses our patients on a self-care strategy and helps with things like medication adherence," said Selikson. "Since they must interact with the system at least once a day, it makes them more aware of their health and changes in their condition. It prompts more interaction with our medical team, which leads to better outcomes whether the condition is congestive heart failure, diabetes, asthma or hypertension."
Visits by CHF patients to emergency rooms decreased by 62% and readmissions to hospitals decreased by 66% as a result of the e-nurse. But the system is not for everyone; patients must be 50 or older, have a primary diagnosis of congestive heart failure, own a touch-tone telephone, and be able to stand on the system's scale by themselves.
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