HealthWatch July 28, 2013

Health Watch1A

July 2013

GAINESVILLE HEART AND VASCULAR GROUP

PAGE 12

FEATURING

July 2013North Georgia’s Health & Prevention Magazine

IN THIS ISSUE• Digital Xrays New technology with a lot less radiation... page 2

• Back to SchoolWhat this time of year means to the local Health Department... page 8

• Women’s HealthNGMC earns national consecutive top awards... page 14

CARDIAC SCORING An approach to determining the

condition of your heart

www.gainesville.com

By Meredith [email protected]

While the medical field constantly works to advance technology, the dental field is doing the same.

Many dental offices now use only digital X-rays to examine patients. The use of digital X-rays is proven to expose the patient and staff to half the radiation of a regular X-ray.

According to a study by Dentsply, a company that provides dental prod-ucts and educational resources inter-nationally, a modern digital dental X-ray exposes a patient to only half the radiation to which the average person is already exposed on a regu-lar day.

Gainesville Dental Group is one office that uses digital X-rays and prefers them for a variety of reasons.

“They’re easier to use, they’re safer for the patient, they’re kinder to the patient as far as the ease

of access and the equipment that you use, not to mention that it is stored in the computer,” said Donna Shewbert, a registered dental hygien-ist at Gainesville Dental Group.

“If you move and change dentists, or if you have to go to a specialist, (your X-rays) don’t have to be cop-ied. They’re right in the computer in your chart.”

Shewbert said Gainesville Dental Group only uses digital X-rays and has done away with the film and hassle that goes along with conven-tional X-rays.

“In our office, we don’t give a choice. The digital X-rays are just easier,” Shewbert said. “It’s basically the same as using a digital camera. There’s no film involved.”

The technology also processes everything faster. While a regular X-ray would take up to 20 minutes

Health Watch2a

Since 1995, The Longstreet Clinic has grown to include more than 150 providers in some 16 specialties. By embracing compassionate, evidence-based quality standards of care, TLC consistently receives recognition from national organizations that measure and certify practices in key areas of clinic performance.

Suman Annambhotla, M.D. Vascular & Vein Specialists

Dr. Annambhotla is a graduate of the Georgia Institute of Technology and earned his medical degree at the University of Alabama School of Medicine.

He completed his General Surgery Residency and participated in the vascular research program at Baylor College of Medicine before entering Vascular Surgery Fellowship training at Northwestern University.To schedule an appointment, call (770) 534-0110.

The Longstreet Clinic, P.C. is pleased to welcome two

highly trained surgeons to Gainesville.

Betsy H. Grunch, M.D.Department of Neurosurgery

Dr. Grunch is a graduate of the University of Georgia and earned her medical degree at the Medical College of Georgia.

She completed her Neurosurgery Residency at Duke University Medical Center in Durham, N.C.To schedule an appointment, call (770) 533-7288.

Gainesville | www.longstreetclinic.com

2 Sunday, July 28, 2013 The Times, Gainesville, Georgia | gainesvilletimes com

Dental X-rays going digital

SCOTT ROGERS | The TimesMichelle Saco prepares to take a digital X-ray of Elizabeth Crawley’s teeth at The

Gainesville Dental Group. The digital process uses the same imaging equipment as with film, but uses smaller doses of radiation

Please see X-ray page 7

Health Watch3A

Salman Ashfaq MD FACC FSCAIDr. Salman Ashfaq (Dr. Ash) received his medical degree from King Edward Medical University. He completed his Internal Medicine internship and residency at Barnes-Jewish Hospital and Washington University School of Medicine in Saint Louis, where he was also selected to be Chief Resident. He completed his fellowship in Cardiology and Interventional Cardiology at Emory University School of Medicine in Atlanta, Georgia. A� er completion of his training, Dr. Ashfaq worked as an Assistant Professor of Cardiology at the University of Kansas. He also served as Director of the Cardiac Catheterization Lab at the Robert J. Dole Veteran A� airs Medical Center and also was part of a busy private practice. Since 2010, Dr. Ashfaq has served the patients of North Atlanta and Northeast Georgia. Dr. Ashfaq has a special interest in the treatment and eradication of heart attacks. He also has special expertise in Nuclear Cardiology and Cardiac and Vascular interventions including angioplasty, stents, and atherectomy procedures. Dr. Ashfaq has made several presentations at the American College of Cardiology Scienti� c sessions and also has authored numerous scienti� c publications and is a reviewer for renowned Cardiology journals. In addition to his passion for the care of heart patients, Dr. Ashfaq enjoys watching all kinds of sporting events, football, soccer and playing golf. He and his wife are the proud parents of a seven-year-old daughter and a baby boy.

Saurabh Dhawan MDDr. Dhawan received his medical degree at Seth G. S. Medical College. He completed his Internal Medicine Internship at Albert Einstein Medical Center in Philadelphia, Pennsylvania and completed an Internal Medicine Residency at University of Tennessee in Memphis. He then went on to do Post-doctoral Fellowship Vascular Biology and Atherosclerotic Plaque Imaging and completed Fellowship in Cardiology, Echocardiography, and Nuclear Cardiology at Emory University School of Medicine in Atlanta, Georgia. Dr. Dhawan is Board Certi� ed in Internal Medicine, Vascular Ultrasonography, and Nuclear Cardiology. He is also Board eligible in Cardiovascular Diseases and Echocardiography. He also has obtained special training in use and interpretation of Cardiac CT imaging. Dr. Dhawan has made several presentations at various national Cardiology conferences and also has authored numerous scienti� c publications. He is a member of the American College of Cardiology. Dr. Dhawan has lived in the Atlanta Metro area since 2007. He enjoys running and watching cricket. He and his wife are proud parents of a four year old boy and a baby girl.

Dawn Eckler MSN, NP-CDawn Eckler joined the practice in June 2013. She completed her training as a Nurse Practitioner in May 2013 from the University of North Georgia. She brings with her a wealth of experience and compassionate care from her years as a Cardiac Nurse and Emergency Room Nurse In Denver, Colorado and then at Northeast Georgia Medical Center.

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Th e best place for Heart and Vascular Care and prevention in Gainesville and Northeast Georgia.

Our physicans have been presented with numerous awards including the prestigious Patient Choice Award in 2012, Compassionate Care Award and have been nominated to be among America’s Top Cardiologists. Dr. Salman Ashfaq is also rated as one of the top rated Cardiologists in the Atlanta Metro area based on patient satisfaction surveys on HealthGrades.

We are always available for our patients 24/7. Same day and urgent appointments available.

MEET OUR PROVIDERS:

Sunday, July 28, 2013 3gainesvilletimes comThe Times, Gainesville, Georgia |

By: Charles [email protected]

Have you found yourself squinting to see? Or, fighting a headache due to blurry vision?

If so, then you may be feeling the effects of an eye condition known as astigmatism.

Astigmatism is where the front of the eye (or cornea) is shaped more like a football than a basketball, said Dr. Jack M. Chapman Jr., physician at Gainesville Eye Associates. As light rays go into the eye, they’re supposed to focus on one place. With astigmatism, Chapman said, light rays pass through the eye and hit different spots, not the focal point.

Not only can astigmatism occur in the cornea, but it can also occur in the lens of the eye, better known as lenticular astigmatism. This leaves the cornea normal-shaped.

Chapman said there are many symp-toms of astigmatism: blurred vision, headaches, sensitivity to light, exces-sive squinting and eye strain.

Chapman said astigmatism begins

when a person is still in developmen-tal stages as a child. Signs of astig-matism may start to show and can include weakness, pain, headaches and dimness of vision.

Astigmatism is also common with nearsightedness and farsightedness.

A lot of times, when people are younger, they just adapt and live with (astigmatism), Chapman said.

There’s no specific cause identified for astigmatism. However, it can be hereditary, said Tania Crow, certified ophthalmic assistant and team leader for Chapman.

She said if a child has astigmatism,

the condition can change as the child grows, and it may decrease or worsen over time.

There are different ways to correct astigmatism, Chapman said. Glasses

and contact lenses are the fastest fixes. He said Lasik eye surgery is another

way to fix astigmatism. Another sur-gery that corrects astigmatism is pho-torefractive keratectomy.

PRK removes tissue from the super-ficial and inner layers of the cornea. Lasik doesn’t remove tissue from the surface of the cornea, but only from its inner layer.

Both procedures allow light to focus on the retina (of the eye) by altering the shape of the cornea.

Chapman said all the different options change the optical system of a person who has astigmatism.

Health Watch4A

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Vision problems may be due to astigmatism

SCOTT ROGERS | The TimesDr. Jack Chapman Jr. meets with patient Jordan Collins for a routine eye exam at Chapman’s offices at Gainesville Eye Associates

Astigmatism is where the front of the eye (or cornea) is shaped more like a football than a

basketball

Advertorial provided by Northeast Georgia Diagnostic Clinic

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Health Watch5A


NGDC adds full-service pharmacy

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By Diane StaffordThe Kansas City Star

The student who hates mornings, who won’t sign up for an 8 a.m. class, may well be forging a career path and forecasting long-term job perfor-mance.

A new study distributed by the American Academy of Sleep Medicine injects a new consideration into the theory that people’s internal body clocks influence their “morningness” or “eveningness.”

The study authored by Frederick Brown, an associate professor of psychology at Pennsylvania State University, suggests that this “lark” ver-sus “owl” tendency — whether caused by nature or nurture — appears to influence students’ choices of college majors.

And that could have long-range job consequences. For instance, if a night

owl avoids early-morning classes, and all pre-med chemistry prerequisites are taught at 8 a.m., it’s unlikely that student will choose to become a doc-tor.

Brown had a group of students com-plete evaluations to rank their “morn-ingness” or “eveningness” tendencies. It then looked at their major fields of study.

“They end up with a declared major that depends on what they’re interest-ed in, what they’re good at, what they might have fun with, and what they might want to do for the rest of their lives,” Brown said in a phone interview. “But they also pay attention to when they’ll have to work.”

Brown found, for example, that stu-dents with high “eveningness” scores, gravitate to such majors as the per-formance arts, media or information systems, where work hours skew later in the day or even overnight.

A student’s “morningness-evening-ness influence” involves personality traits and a built-in biological tolerance for early or late or irregular job hours, he said.

The connection between college majors and body clocks needs further investigation with larger samples, and that is beginning, Brown said.

“Some people are what we call ‘invulnerables,’ “ Brown said. “They get by on short sleep or disruptions for long periods. But one of our conclu-sions is that a mismatch of genetics and job characteristics is important.

“The genetic component is well-established,” he said. “About half the population are daytime people, about one-quarter are moderate to extreme morning types, and about one-quar-ter are moderate to extreme evening types.”

Knowing one’s own type is impor-tant for workers who want to maxi-

mize job performance, productivity and personal health. There’s also a safe-ty issue. Sleepy workers can’t be as aware as they might need to be.

“It’s bad for your health and for employee engagement to have night or shift work if you’re not set up for it,” said Leigh Branham, a consultant with Keeping the People Inc. in Overland Park, Kan. “It’s a vicious cycle when sleep problems and stress interfere with job performance.”

Becky Wilson learned years ago that she can’t expect top performance from herself in the early morning. The chief visibility officer at WDS Marketing and Public Relations in Overland Park will drag herself to a breakfast meeting, but she avoids it if she can.

“I’ve been that way from the very young,” Wilson said. “It’s very challeng-ing for me to be up and somewhere at

Health Watch6A


Biological clock could affect career paths

Please see Ticktock page 11

to develop, the use of digital X-rays renders images almost instantly.

“We use a sensor, which instanta-neously puts the image up on the screen, or we use a sulphur phos-phate plate and we scan it through the machine and then it scans it into the computer,” Shewbert said. “So it’s more of a permanent image.”

The images are more permanent when transmitted digitally because with film, there’s no backups that can be produced, she said.

“You know, you take a traditional film, it’s just like a traditional pic-ture. Once you have that, it’s gone,” Shewbert said.

“But with digital, it’s backed up on your computer system. It’s in your file on the computer system.”

The dental office can email images to patients and make copies.

Another advantage of digital X-rays is that they allow dental offices to go green. A dental office using digital X-rays does not have to worry about disposing of hazardous chemi-

cal developers, which can harm the environment.

The hassle of paperwork in pro-cessing and sharing is eliminated by the use of digital technology

as well. The images can easily be transferred between dentists’ offices. Digital technology has been proven to provide a better diagnosis to the patient through clearer images.

Health Watch7A


X-rayContinued from page 2

SCOTT ROGERS | The TimesDental Hygienist Michelle Saco processes a digital x-ray plate in the offices at The Gainesville Dental Group. The digital process uses the

same imaging equipment as with film, but uses smaller doses of radiation. The patient can also easily view the X-rays on a monitor from the dental chair.

By Carly [email protected]

July and August aren’t only for purchasing school supplies or new outfits. Parents and students need to remember that certain immuniza-tions are required before stepping through those school doors.

There is no official partnership between the school systems and the county health department, but it’s an issue that does bring the entities together.

“We work closely with the schools,” said Dave Palmer, public informa-tion officer for Georgia’s Public Health District 2. “By law, children are required to have their immuniza-tions to be in school.”

Form 3231 must be filed with the schools before a child attends. The form is maintained by health depart-ments or licensed physicians. Parents

are asked to keep additional copies of immunization records, which is helpful in the event an official form is lost or misfiled.

Typically, children need a series of immunizations in entering school, then again in going from grade school to middle school, and then following high school graduation, particularly if they are planning to attend college.

From birth to 5 years of age, chil-dren will receive a variety of vac-cinations for different illnesses, like Hepatitis B, diphtheria, tetanus and pertussis. Up until 18 years of age, additional doses or booster shots are given based on factors like the child’s age or if the child is deemed at risk for a particular disease.

Palmer also mentioned that it’s a good idea to get the flu vaccination, which is optional but recommended.

“Usually in April and May we try to

remind parents,” Palmer said in refer-ence to upcoming vaccines.

In Georgia, immunization records are required to be filed with the school before admittance. They’re also required for college registra-tion, joining the military or traveling abroad, according to the state’s pub-lic health department website.

Since 2010, the number of immuni-zations from the health department has dropped, Palmer said. In 2010, 9,502 immunizations were given to children from birth to 18. In 2012, that number was 6,448.

So far in 2013, 2,604 children have had immunizations at the health department.

Palmer attributed the drop to a variety of factors, saying a declining birth rate may be one issue. He also said more families may be opting to get the immunizations at a private provider.

Immunizations are required but there are three recognizable exemp-tions to the law, according to Hall County Schools Health Services Coordinator Mamie Coker.

The state’s immunization form 3231 might be marked as “incom-plete,” showing that the student is working to get up-to-date on their shots. That’s an acceptable scenario, Coker said.

Another recognizable exemption would be a doctor’s excuse. “When the child’s medical doctor for medi-cal reasons determines they should not receive vaccines,” she explained. One example, she said, would be if the child had low immunity due to other treatments, like chemotherapy, so a vaccination would not be advis-able.

That exemption is also noted on

Health Watch8A


A new school year means vaccinations

Please see Vaccinations page 9

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the 3231 form, and is only good for one year. It would have to be resub-mitted annually if the child’s doctor continued to say a vaccine would not be advisable.

The final exemption is religious. “We accept a handwritten, legal

affidavit where the parent writes and makes a statement that immu-nizations are against their religious beliefs,” Coker said. The form has to be notarized.

That exemption only needs to be filed once, making it good for the student’s time spent at the school. Coker said that “less than a handful” of students use that exemption.

The rules are the same for Gainesville schools, health services coordinator Paula Sawyer said.

“We do send out letters for sixth-grade students because that is

when they have a change in what is required that’s different from when the student first enters school,” she said. “We follow the state guidelines

for immunizations.”Both Sawyer and Coker said that

the majority of students get their immunizations.

More information may be obtained from the schools, the public health department or the state’s public health website at health.state.ga.us.

Health Watch9A

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VaccinationsContinued from page 8

SCOTT ROGERS | The TimesJesus Gomes, holds his daughter Alexandra, 5, while she gets a vaccination shot from Seth Lee at the Hall County Health Department.

After her two shots, Gomez is ready to begin kindergarten

By Reid KanaleyThe Philadelphia Inquirer

Could a smartphone application save you in a heat wave?

On the job or at play outside, look for relief to the OSHA Heat Safety

Tool, available in English and Spanish from the U.S. Department of Labor. The free application for Android, Apple and BlackBerry devices calcu-lates a heat index — a combination of the temperature and humidity. But

what’s important is the accompany-ing page of precautions to be taken.

In high to extreme heat, the app says, outdoor work should be rescheduled for a cooler day. If it must go on, there needs to be drink-ing water on site, and there ought

to be shade. Workers should keep to a schedule that has them drinking about four cups of water an hour.

When things really get out of hand,

Health Watch10A

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Apps help to keep you healthy in the heat

Please see Heat page 11

In high to extreme heat, the app says, outdoor work should be rescheduled for a

cooler day.

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you’ll want to fire up the Army Survival Guide. This free version of a recent edition of the U.S. military guide is published for Android devic-es by AppOpus.com. An Apple App Store search turned up several ver-sions of the guide for Apple devices, but not one that is free.

Included in the survival guide is a chapter on desert survival, with advice that might translate well to cities and towns on staying sheltered in the heat of the day, switching trav-el plans to nighttime, and looking out for mirages. It also covers warn-ing signs of heat exhaustion, heat strokes and other ways you might become a “heat casualty.”

For would-be MacGyvers, the sur-vival guide is a gold mine of instruc-tion on how to be resourceful, how

to deal with stress — the “psychol-ogy of survival,” as the guide puts it — and how to read the clouds to know what sort of weather is com-ing over the horizon.

Weather Underground, the app by the company of the same name, is free for Android and Apple. Weather Underground claims to have built the first weather site on the Internet. These days, it offers apps and gad-gets and widgets for desktop and mobile platforms, as well as an app for Roku, a content-streaming device for TVs.

In the phone app, if a red alert icon appears on the home screen, tap it to see current heat and air-quality warnings. The app will send severe-weather alerts to your device, if you tell it to do so in the “settings” screens.

Tap “more” to play National Weather Service radio, read the WunderBlog, tweet weather reports, see a page on tropical-storm activity, or even check for ski conditions.

HeatContinued from page 10

Health Watch11A

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7:30 a.m. I really have no say about it. It’s not something I decided. It’s the way I am. “

Wilson has no trouble working until midnight, so she has to remind herself not to call colleagues who go to bed at 9 p.m. They’re the ones who bound out of bed at dawn or before, ready to start the day.

In the sleep lab at the University of Kansas Hospital, medical direc-tor Damien Stevens said the medical community continually debates the “lark” versus “owl” theories about how much of a person’s sleep preference is organic and how much is volitional — behavior developed by choice.

What is scientifically known is that an area of the brain, the suprachias-matic nucleus, sends signals that keep mammals on a 24-hour schedule, influ-enced mainly by light. But individuals’

24-hour schedules — their circadian rhythms — aren’t exact, and they often change with age.

“The problem with sleep research is that it’s difficult to sort out what’s endogenous (regulated by the internal body clock) and what’s exogenous (external input),” Stevens said.

But, he said, researchers do believe that individuals can adjust their body clocks if they’re consistent about changing sleep and wake times. That’s why changing shifts — alternating between day and night work hours — is a problem. There’s no chance for consistency.

Nancy Spangler, a consultant with Partnership for Workplace Mental Health, said failure to get the consis-tent sleep that an individual needs can lead to more than physical fatigue. It can lead to stress and depression.

“This can be a difficult problem in people who have chronic shift work, such as nurses, who alternate day and night shifts,” Spangler said. “It’s far better to have a shift and keep it. Fortunately, more employers are aware of that.”

TicktockContinued from page 6

Health Watch12A

7 0 5 Je s s e Je w e l l Pa r k w a y, S E , S u i t e 2 0 0 , G a i n e s v i l l e • P h o n e 7 7 0 . 5 3 4 . 9 0 1 4 • w w w. g h v g . n e t

At Gainesville Heart & Vascular Group, we believe that the patient is the center of our practice. We are committed to providing the best possible care through diligent clinical evaluation and appropriate use of state-of-the-art technology. Guided by compassion for each individual, we strive to provide convenience and peace of mind to our patients by providing most services

under one roof. Our ultimate goal — help our patients achieve a better quality of life.

GAINESVILLE HEART AND VASCULAR GROUPCardiovascular disease affects over

80 million people in the United States.

Risk factors associated with cardiovascular disease include age, diabetes, high blood pressure, high cholesterol, tobacco use and family history of cardiovascular disease. Symptoms associated with cardiovascular disease include chest pain, shortness of breath, arm/leg pain, loss of consciousness and fatigue.

We at the Gainesville Heart and Vascular Group specialize in prevention, diagnosis and treatment of cardiovascular disease.

Established in 1994, the Gainesville Heart & Vascular Group, formerly known as the Gainesville Heart Group, is recognized as the fi rst cardiology practice dedicated to the care of heart patients in Gainesville and surrounding areas.

Its founder, Dr. David P. Johnson is a Gainesville native who had a dream of providing full-time and full-service cardiac care to the community. He and his partners played an integral part in bringing the Open Heart Surgery Program to Gainesville in 2002.

Our staff has a reputation of applying a personal touch to our care and cherishing the relationship we have with our patients. Our staff, including physicians, enjoys residing and being an active part of the Hall County community.

Our offi ce has a wide variety of services, including general cardiology consultation, electrocardiography, echocardiography / 2-D Doppler, stress echocardiography, nuclear stress testing and ankle brachial pressure index. Our physicians are staffed round the clock, 365 days a year, at the Northeast Georgia Medical Center. Cardiac catheterizations, including coronary and peripheral artery stenting, stress testing, transesophageal echocardiography and pacemaker devices are performed at the Northeast Georgia Medical Center.

We would enjoy an opportunity to meet with you to prevent, diagnose and treat cardiovascular disease.

Dr. David Johnson Dr. Bernardine King Dr. Martin Siegfried

Dr. Nayyar Shamsi Lauren Beebe, PA-C

• Adult Consultative Cardiology• ECG, Holter and Event Monitoring• Exercise Treadmill Testing• Echocardiography• Transesophageal Echocardiography• Stress Echocardiography• Myocardial Perfusion Imaging (Nuclear Scans)• Peripheral Vascular (claudication) Testing• Cardiac Catheterization (leg and wrist access)

• Coronary Angioplasty and Stenting• Peripheral Vascular Angioplasty and Stenting• Renal Angioplasty and Stenting• Pacemaker Implants• Loop Recorder Implants• Pacemaker and ICD Management• Anticoagulation Management• Lipid Management• Pulmonary Hypertension Testing

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Health Watch13A

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At Gainesville Heart & Vascular Group, we believe that the patient is the center of our practice. We are committed to providing the best possible care through diligent clinical evaluation and appropriate use of state-of-the-art technology. Guided by compassion for each individual, we strive to provide convenience and peace of mind to our patients by providing most services

under one roof. Our ultimate goal — help our patients achieve a better quality of life.

GAINESVILLE HEART AND VASCULAR GROUPCardiovascular disease affects over

80 million people in the United States.

Risk factors associated with cardiovascular disease include age, diabetes, high blood pressure, high cholesterol, tobacco use and family history of cardiovascular disease. Symptoms associated with cardiovascular disease include chest pain, shortness of breath, arm/leg pain, loss of consciousness and fatigue.

We at the Gainesville Heart and Vascular Group specialize in prevention, diagnosis and treatment of cardiovascular disease.

Established in 1994, the Gainesville Heart & Vascular Group, formerly known as the Gainesville Heart Group, is recognized as the fi rst cardiology practice dedicated to the care of heart patients in Gainesville and surrounding areas.

Its founder, Dr. David P. Johnson is a Gainesville native who had a dream of providing full-time and full-service cardiac care to the community. He and his partners played an integral part in bringing the Open Heart Surgery Program to Gainesville in 2002.

Our staff has a reputation of applying a personal touch to our care and cherishing the relationship we have with our patients. Our staff, including physicians, enjoys residing and being an active part of the Hall County community.

Our offi ce has a wide variety of services, including general cardiology consultation, electrocardiography, echocardiography / 2-D Doppler, stress echocardiography, nuclear stress testing and ankle brachial pressure index. Our physicians are staffed round the clock, 365 days a year, at the Northeast Georgia Medical Center. Cardiac catheterizations, including coronary and peripheral artery stenting, stress testing, transesophageal echocardiography and pacemaker devices are performed at the Northeast Georgia Medical Center.

We would enjoy an opportunity to meet with you to prevent, diagnose and treat cardiovascular disease.

Dr. David Johnson Dr. Bernardine King Dr. Martin Siegfried

Dr. Nayyar Shamsi Lauren Beebe, PA-C

• Adult Consultative Cardiology• ECG, Holter and Event Monitoring• Exercise Treadmill Testing• Echocardiography• Transesophageal Echocardiography• Stress Echocardiography• Myocardial Perfusion Imaging (Nuclear Scans)• Peripheral Vascular (claudication) Testing• Cardiac Catheterization (leg and wrist access)

• Coronary Angioplasty and Stenting• Peripheral Vascular Angioplasty and Stenting• Renal Angioplasty and Stenting• Pacemaker Implants• Loop Recorder Implants• Pacemaker and ICD Management• Anticoagulation Management• Lipid Management• Pulmonary Hypertension Testing

SERVICES OFFERED


www.w w. g hv g . n e t

Health Watch14A



Northeast Georgia Medical Center has been recognized for its com-mitment to providing exceptional health care for women.

Healthgrades, the largest indepen-dent hospital rating company in the country, gave NGMC its Women’s Health Excellence Award for 2013. The Gainesville hospital was one of four total hospitals in the nation to receive the award and was one of two hospitals chosen in Georgia.

The problems associated with women’s health have become impor-tant at Healthgrades due to its recent study on mortality and complication rates in women.

According to a press release from NGMC, the study found that from the years 2009 to 2011, if all hospi-tals in the country had performed at the same level as the award winners, 46,317 women’s lives could poten-tially have been saved, and 21,285 women would have most likely been spared from suffering hospital-relat-ed complications.

Healthgrades took this into account and looked at mortality and complication rates in women treated at NGMC related to 15 main condi-tions and procedures. These include heart attacks, stroke and procedures such as heart valve replacement, hip replacement and spinal fusion. The company compared these to the rates of more than 4,500 hospi-tals nationwide in order to consider NGMC for the award. The hospital placed in the top 4 percent of hospi-tals in the nation.

“I think a lot of people think of women’s health as referring almost exclusively to child birth and things of that nature that we would handle over in our Women and Children’s Pavilion,” said hospital spokesman Sean Couch. “You would think that a women’s health award might apply

to that when, in actuality, it does not.”Dr. Alison Dupont, with Northeast

Georgia Heart Center at NGMC, knows that women’s health issues have much to do with the heart, she said. As one of only four female cardiologists at the hospital, she said she understands why women’s heart health should be a main focus.

“It kind of hits home because there’s so many women that are not recognized as having heart disease despite the fact that it’s the No. 1 killer of women,” Dupont said.

Dupont is an interventional cardi-ologist. Her female patients usually come in with heart attacks or need an angioplasty procedure done. She

says the need for women’s health care is not always reflected well in medical research.

“Women sometimes are under-represented in study populations,” Dupont said. “When we look at the cardiology studies that are published, there’s hardly ever any women in these studies, so we have to kind of extrapolate what we do into the female population even though it hasn’t really been thoroughly stud-ied.”

Dupont also said that heart cath-eterization has been changed in the hospital to better meet the needs of women specifically.

“The one thing that I think is an

important change in our practice is that we’ve started doing a lot more radial access procedures during our heart catheterization,” Dupont said.

This involves using access in the wrist instead of the leg in order to reduce the risk of severe bleeding since women are at a higher risk of bleeding during major procedures.

Dupont said major risk factors for heart diseases are the same in both women and men. Smoking, diabetes, high blood pressure, high choles-terol, family history of heart disease and obesity are all factors.

She also said the most important

Hospital recognized for women’s health care

Please see Women’s health page 15

SCOTT ROGERS | The TimesCardiologist Allison Dupont MD, prepares to examine patient Janet Bedsole at the Northeast Georgia Heart Center. NGMC has earned a

top national award for two consecutive years for exceptional health care for women

thing is recognizing the symptoms of heart disease in women.

“There have been studies actually that have shown that women who have heart attacks don’t do as well,” Dupont said. “The prognosis is poor in women.”

Women will sometimes either ignore their symptoms or simply develop heart disease later in their lives, particularly after menopause, she said.

“Whatever we can do to reduce the risk of death in women with a heart attack is what we aim to do,” she said.

Another major field determining excellence in women’s health care for the hospital is its performance in orthopedic surgery for women.

Dr. Charlie DeCook, an orthopedic surgeon who operates at NGMC but has an office at The Longstreet Clinic, is a hip replacement special-ist. He uses something called an anterior approach when performing a total hip replacement surgery.

“What led to the (Healthgrades) award was the results we got from (hip replacement surgeries on women),” DeCook said.

“Anterior hip replacements is a different way of doing hip replace-ments. We make our incision from the front of the hip and not the back of the hip, and because of that we don’t cut muscle, so there’s less pain and quicker recovery.”

DeCook said there is less risk of complications and the patient’s hos-pital stay can be shortened with an anterior hip replacement. Anyone in need of hip surgery may have this procedure done, he said.

“Anyone with hip arthritis is a can-didate for an anterior hip replace-ment, so anyone that would have any

kind of hip replacement would be a candidate for the anterior approach,” DeCook said.

“A lot of women when they get older develop that hip arthritis, and it significantly affects their quality of life. Everything they do, they’re mov-ing their hip and it’s painful.”

He said the concentration on wom-en’s health care has been advanced, but they have always had the same consideration for the health of female patients.

“I think there’s always been a commitment to women’s health,” DeCook said. “I think we’re just rec-ognizing and clarifying it more. So I think the types of procedures have changed. I think that’s what’s helped the most.”

This is the second consecutive year the hospital has earned the award. The hospital staff is proud to earn this award, said Brad Nurkin, president of NGMC, in a statement released by the hospital this month.

“Northeast Georgia Medical Center recognizes the unique health care needs of women across all of our services, not just the ones reviewed by Healthgrades,” Nurkin said. “We’re proud that this award recognizes

that our caregivers — including phy-sicians, nurses, techs, EMS and other clinical staff — are not only doing

all they can to save women’s lives, they’re doing it as well as the other best hospitals in the nation.”

Health Watch15A

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Women’s healthContinued from page 14

SCOTT ROGERS | The TimesCardiologist Allison Dupont MD, discusses medical care with Janet Bedsole at the Northeast Georgia Heart Center.

By Melissa PandikaLos Angeles Times

Researchers have further unrav-eled how a version of a gene linked to obesity risk causes people to gain weight — it makes them more likely to feel hungry after a meal and to prefer high-calorie foods.

Their study, published Monday in the Journal of Clinical Investigation, found that individuals who inher-ited the high-risk version of the FTO gene from both of their parents have higher levels of the appetite-stimulat-ing hormone ghrelin in their blood-stream, which leaves them hungry even after eating. Real-time brain imaging also revealed that the FTO gene regulates the brain’s responses to ghrelin and to images of food.

“This possibly explains why some people are more sensitive to over-weight and obesity than others,” said Dr. Jeremy Korman, a bariatric surgeon at Marina Weight Loss in Marina Del Rey, who was not part of the study.

A 2007 study found that people who have two copies of the “obesity-risk” version of FTO weighed about 6.5 pounds more, on average, than those who didn’t have any copies of the variant. Other studies have shown that people who had the high-obesity-risk gene variant ate more those who didn’t.

But exactly how FTO affected appetite and weight gain remained a mystery. Batterham’s group hypothe-sized that gut hormones that regulate appetite_and the brain’s responses_might be the missing link.

Their study marks the first exam-ination of how FTO variation in humans regulates ghrelin and leads to obesity, said study coauthor Rachel Batterham, an endocrine and obe-sity researcher at University College London.

Batterham’s group recruited 359 healthy, normal-weight European

men. Among them, 45 had two cop-ies of the obesity-risk version of FTO, while the rest carried the low-risk variant. The researchers matched the participants for body weight, fat dis-

tribution and social factors such as educational level, to make sure that any differences they saw were because of FTO and not to other physical or psychological character-istics.

A group of 10 men with the high-obesity-risk variant of FTO and 10 men with the normal version were asked to rate their hunger before and after a standard test meal. High-risk men felt hungrier than low-risk men after eating a meal, while blood tests revealed that they also had higher levels of ghrelin circulating through their bodies. Levels of ghre-lin_secreted by stomach cells_nor-mally peak right before a meal and subside immediately afterward.

The research team then used func-tional magnetic resonance imaging, or fMRI, in a different group of 24 subjects to measure their brain activ-ity in response to images of high-calorie and low-calorie foods, as well as non-food items, before and after a meal. They asked the participants to rate the appeal of each image and measured their blood ghrelin levels.

Compared with their low-risk counterparts, subjects with the high-risk version of FTO found the images of high-calorie foods more appeal-ing_even after a meal. The fMRI tests revealed that the brains of the two groups also responded differently to images of food before and after a meal and to circulating levels of ghrelin.

Researchers saw the most strik-

ing differences in the brain’s reward regions, as well as the hypothalamus, which controls appetite. For exam-ple, low-risk participants preferred high-calorie foods before the meal,

but preferred low calorie foods after eating. Researchers didn’t observe this shift in obesity-risk individu-als, who preferred high-calorie foods before and after eating.

The researchers also looked at mouse and human cells to tease out what was going on at the molecular level. Normally, FTO makes chang-es to ghrelin mRNA, which carries instructions for “building” the hor-

mone. When FTO was produced at high amounts in these cells, ghrelin levels were higher. They also found that blood cells from people with two copies of the high-risk version of FTO had more ghrelin mRNA than people with the low-risk versions of FTO.

The study results could have important clinical implications, Dr. Korman said. For example, it could prompt pharmaceutical companies to develop drugs that help regulate ghrelin signaling.

But “the problem is that it’s not as easy as it sounds,” he said. Besides ghrelin, the gut releases other hor-mones that send “an opposite signal” that tell us that we’re full and satis-fied. “There are so many other sig-nals interacting with the brain.”

Batterham agreed. “This is one piece of a jigsaw,” she said.

Health Watch16A

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Researchers link ‘obesity gene’ to hunger hormone

It makes them more likely to feel hungry after a meal and to prefer high-calorie foodsafter a meal and to prefer high-calorie foods

By Eryn BrownLos Angeles Times

Physicians are concerned about sky-rocketing health care costs — but most don’t think they have “major responsibility” for reducing those costs, according to survey results released Tuesday.

Mayo Clinic researcher Dr. Jon C. Tilburt and colleagues polled 2,556 doctors on health care costs in 2012, asking them to gauge their level of responsibility for controlling costs — as well as others’ responsibility. More than half of respondents said that trial lawyers, health insurance companies, hospitals and health systems, phar-maceutical and device manufacturers and patients had a major responsibil-ity for cutting costs. But only 36 per-cent said that physicians themselves had major responsibility. More than half said that doctors bore “some responsibility.”

The team also asked doctors to describe how enthusiastic they were about various approaches to cost-con-tainment. Most were very or some-what enthusiastic about reforms such as promoting quality of care and improving the quality of the data doc-tors have at their disposal to make better informed treatment decisions.

But “respondents’ ratings for chang-ing how care gets paid for were more mixed,” the team wrote, reporting that physicians were loath to endorse “more substantial financing reforms” such as eliminating fee-for-service reimbursement, cutting Medicare pay or imposing penalties when patients have to be readmitted to the hospital.

The researchers called the doctors’ opinions about cost-containment “complex” and “nuanced,” noting that 85 percent agreed that “trying to con-tain costs is the responsibility of every physician,” even as 78 percent agreed

with the statement that they “should be solely devoted to my individual patients’ best interests, even if that is expensive.”

A report summarizing the survey results was published in the Journal of the American Medical Association.

In a related editorial, University of Pennsylvania researchers Dr. Ezekiel J. Emanuel and Andrew Steinmetz called the physicians’ reported attitudes “a denial of responsibility,” writing that many doctors seemed enthusiastic only about cost-cutting efforts that “relieve the physician from being the decision maker.”

“If there ever was an ‘all-hands-on-deck’ moment in the history of health care, now is the time ... physicians must lead,” they wrote.

But, they added, “in the face of this new and uncertain moment in the reform of the health care system, physicians are lapsing into the well-known, cautious instinctual approach-es humans adopt whenever confront-ed by uncertainty: blame others and persevere with ‘business as usual.’ “

Survey: Most doctors say they don’t have ‘major responsibility’ for cutting costs

17

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By Pamela YipThe Dallas Morning News

Open enrollment for the health insurance exchanges created by the Affordable Care Act is less than three months away, and Marilyn Tavenner is busily trying to spread the word.

Tavenner manages the Centers for Medicare & Medicaid Services, the $820 billion federal agency charged with implementing the rollout of the exchanges.

The state-based exchanges will enable individuals and small busi-nesses to shop for health plans. The exchanges, or marketplaces, will help consumers and small businesses to compare and purchase qualified health plans.

The exchanges of 26 states will be operated by the federal government.

Tavenner sat down with the Dallas Morning News for an interview. Her comments are edited for brevity.

Q: Will you be ready when open enrollment starts Oct. 1?

A: We’re now at what I call the final touches in testing. We will be ready.

There’s the internal part, which is the technology and the testing and getting all the information loaded, particularly if you’re in a federally facilitated exchange.

We’re in the process of working with insurers, loading data, check-ing that data for completeness, accu-racy. That data will become public. People will actually be able to look at rates across the federally facilitated exchanges around Labor Day, which is another step in making it more mean-ingful for consumers.

So even before they sign up, they can actually look and see, if I’m a single person or if I’m a person with two dependents, what kind of rates, what kinds of plans, are going to be available in my hometown.

The external mechanisms are really preparing consumers. At the end of June, we launched our new website (at http://www.healthcare.gov), and

we launched our new call center information, both in English and in Spanish, and then we have a transla-tor for up to 150 other languages, with the idea of starting to get peo-ple excited or energized about what comes next.

(The toll-free number for the call center is 1-800-318-2596.)

Q: In your marketing, you obviously want to convince young people to sign up for health insurance to bal-ance out the insurance risk pool. How are you going to approach that with young people?

A: Media are targeted at different age groups, but there’s a big section that’s targeted to folks between 18 and 35, or really 26 and 35.

We’re trying to do it through sports, through media applications — your iPhone, iPad — the types of things that younger individuals tend to use.

We also have external marketing groups who are focusing energy on what’s appealing to a young person. It’s not the idea of cancer or a heart attack; it’s the idea of a sports injury. How do you get protected around these things?

For young couples, it’s about talk-ing about their family and taking care of their children. We’re (also) trying to appeal to parents. Parents tend to influence their children about having health care.

We are also trying to work with individual sports teams inside mar-kets.

Q: What’s the biggest challenge in all this for you?

A: It’s getting consumers comfort-able with what’s going to be available and helping to manage their expec-tations. It’s making people aware of how you get started.

You can go online, you can com-plete your own application, you can dial the 1-800 call center number, which will be available 24 hours a day, seven days a week.

Then we will always have a paper application that folks can complete,

but obviously, we’re going to try and steer away from that because the

more we automate it, the quicker the process, the easier it is.

Medicare chief confident health care reform is on schedule

Marilyn Tavenner

19

Let us help mark your territory!


By Noam N. LeveyTribune Washington Bureau

Stepping up efforts to enroll young Americans in health insur-ance this fall, the Obama administra-tion is enlisting the help of actors and entertainment industry officials to educate 20-something consum-ers about the need to get covered.

Senior administration officials met Monday morning with a group of entertainers to talk about media campaigns to reach young Americans about the Affordable

Care Act, according to a White House official.

Among those at the meeting were actors Jennifer Hudson, Kal Penn and Amy Poehler; Mike Farah of the web-site Funny or Die; Daniel Kellison of YouTube Comedy; Royal Pains sit-com creator Andrew Lenchewski; songwriter Bruce Roberts; and Troy Carter of the entertainment agency Atom Factory.

Also in attendance were repre-sentatives for Oprah Winfrey, Alicia Keys, Bon Jovi, the Latin Recording Academy and the National Academy

of Recording Arts and Sciences, which produces the Grammys.

The president stopped into the meeting, according to the White House.

The Obama administration is working with scores of commu-nity groups, health care companies, foundations and others to publicize the president’s 2010 health law, which will make guaranteed health coverage available to all Americans for the first time next year and also require most consumers to have health coverage or pay a fine.

Sufficient enrollment -- particular-ly of young, healthy consumers -- is viewed as critical to keeping premi-ums affordable next year; the admin-istration is aiming to get about 2.7 million currently uninsured young consumers enrolled in 2014.

But polls show many Americans still do not know about the law. And Republican critics of the Affordable Care Act have repeatedly attacked efforts to educate the public and pressured groups not to participate, including sports leagues such as the National Football League.

20


By Marie McCulloughThe Philadelphia Inquirer

Rationing medical care is denounced as immoral in the United States, yet it goes on daily in hospitals, clinics, nursing homes, ambulances and phar-macies.

Since 2006, this country has had worsening shortages of sterile gener-ic injectables — drugs given by shots or intravenously. Currently, more than 300 medicines crucial to treating can-cer, infections, cardiac arrest, prema-ture infants, pain and more are in short supply.

The reasons for this predicament are complex, and the fixes, elusive. The scope, however, is clear from sur-veys of medical and trade groups. The latest, a University of Pennsylvania poll of oncologists released last month, found 83 percent had dealt with shortages by delaying cancer treatments, omitting doses, using sec-ond-choice drugs or sending patients elsewhere.

“Oncologists are facing wrenching decisions about how to allocate life-saving drugs,” said cancer specialist Keerthi Gogineni, who led the Penn

survey.Why aren’t patients and families up

in arms?They may not realize their care was

compromised or complicated by a shortage unless their caregivers are unusually candid.

“Patients in an intensive care unit often don’t know they’ve been

impacted,” said pharmacist Erin Fox, who tracks shortages as manager of the University of Utah’s drug-informa-tion service. “And the hospitals don’t want folks to talk about it. They don’t want to admit, ‘We had a patient who died because we didn’t have this drug.’ “

The secret human toll is rising. In the last three years, dozens of deaths due to contaminated drugs have been linked to producers and vendors who

have capitalized on shortages. The Institute for Safe Medication Practices (ISMP) in Horsham received hun-dreds of reports of medication errors, near-disasters, and 15 deaths related to shortages when it surveyed 1,800 health-care practitioners in 2010.

“This is the worst I’ve ever seen in over 40 years as a pharmacist,” said

Michael Cohen, ISMP president, who contributes to The Inquirer’s Checkup blog. “It’s truly a public health crisis.”

One group of patients has been acutely aware and outspoken about the crisis because it threatens their health every day.

These 30,000 Americans cannot eat by mouth, usually from digestive dis-eases. They must get all nourishment — from vitamins to fat — in a cus-tomized, sterile solution pumped into

a heart vein.Total parenteral nutrition, or TPN, is

also vital temporarily for premature newborns and hospitalized patients who can’t eat.

“We were very vocal in outlining for (government officials) what we think needs to be done,” said Joan Bishop, director of the nonprofit Oley Foundation in Albany, N.Y., a TPN sup-port network. “You can’t just let peo-ple starve.”

Among the group’s stalwart activists is Bettemarie Bond, 42, of Levittown. She suffers from rare digestive and metabolic disorders and has been on TPN since 1990. A single bite of, say, pizza, would set off excruciating inflammation in her pancreas and gut.

In her teens, doctors told Bond to prepare to be an invalid. Instead, helped by her parents and TPN spe-cialists, she graduated from college, bought a house, and became a pediat-ric occupational therapist. She works with autistic preschoolers and hides her infusion pumps in a snazzy back-pack.

To do all this, Bond has to con-

Nation faces acute shortages of some medications

Please see Drug shortage page 21

Of 142 respondents with a shortage-prevention program, more than half said

“the company was still unable to prevent a drug shortage.

Entertainers asked to help promote health care law

serve energy; even taking a shower can exhaust her. The shortages add needless stress. Consider that severe selenium deficiency can cause heart damage, yet she has not had the trace element for almost a year. She has gone without IV multivitamins for months at a time. She also worries that her infusion pharmacist will run out of the only pain medication she can tolerate. “Without it, the pain would be unbearable,” she said.

Still, she considers herself lucky. “Some friends have had it much worse,” she said. “They’ve gotten lip-ids (fats) just once a week instead of daily. It’s affected their health.”

Though shortages occur in other developed countries, the U.S. is espe-cially vulnerable, experts agree.

In a recent analysis, Food and Drug Administration officials cited a root problem: U.S. factories that make sterile injectables are few, aging and inadequate, and manufacturers have no economic incentives to upgrade. When equipment breaks or inspec-tors find problems, it’s often easier to quit making the injectables — which have high production costs and low profit margins — and divert the capacity to more lucrative products.

Only seven companies now make virtually all sterile injectables in the U.S., their plants running round the clock. Six have received repeated FDA warnings about safety lapses.

Experts cite other factors behind shortages, including hospital group purchasing contracts that drive down prices, hoarding, and low insurance reimbursements.

“In Britain, prices are more regu-lated,” said Michael Link, a Stanford University pediatric oncologist. “The reimbursement rate for generics is higher, and on-patent drug reimburse-

ment is lower.”The FDA cannot order firms to

make drugs, but recent legislation and a presidential order gave the agency more muscle. Last year, it began requiring companies to give early warnings of permanent and tem-porary drug discontinuations.

The agency also allowed temporary importation of a key ovarian can-cer chemotherapy, as it did the year before for a leukemia drug.

But importation is not ideal. Many foreign factories do not meet FDA standards. And global transport of heavy glass vials adds to costs.

Last month, an industry group, the International Society for Pharmaceutical Engineering, released the first global survey of companies and others. The intent was to see if steps already taken by industry and regulators were working.

The answer was not so well.Of 142 respondents with a shortage-

prevention program, more than half said “the company was still unable to prevent a drug shortage.”

21

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Drug shortageContinued from page 20

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Out of all baby boomers of both sexes, 39 percent have cardiovascu-lar disease. This is caused by a silent problem — calcium buildup in the arteries.

The awareness factor can deter-mine how harmful heart conditions can be, and awareness is gener-ally low. In fact, only 13 percent of women see heart disease as a seri-ous threat, even though statistically, it is the No. 1 killer of women.

Fortunately, radiologists can now perform a relatively low-cost pro-cedure to determine exactly how much calcium a given person has in his or her coronary vessels and how that number compares to oth-ers in their age range.

In this case though, a higher score is not good. A young, healthy person would have no calcium in their

arteries. The high-resolution CT scan used

in cardiac scoring is performed with no contrast and lets you see the calcium in your arteries. It is fast and painless.

“You just stand in the scanner and it just takes a few seconds really to scan,” said Dr. Brian Gay, a radiolo-gist at MRI and Imaging of Georgia. “Then it gives an image and the computer will analyze the image, and it will tell you the amount of calcium in the coronary arteries.”

The comparison given by the computer can determine how high one’s risk is for coronary problems, including heart attacks. The score can be defined as good or bad based on a person’s age and gender.

Calcium level norms usually go up the scale with age, but the increase would be abnormally high for someone with heart issues. The baby boomer age bracket is nor-

mally the target market for this procedure.

“The calcium can start even at a young age, but typically we see people that are older, in their 50s, 60s, who want to know if they have calcium in their arteries,” Gay said.

He said insurance doesn’t usually cover this procedure, but it does give some added peace of mind to patients who believe they may be at risk for heart problems.

There is also a typical correlation with how wide or narrow blood vessels are and how much calcium is in them. The narrowing of blood vessels can lead to serious and even fatal heart conditions.

“You want to make sure your ves-sels aren’t getting so narrow that they would cause a heart attack, and the calcium scoring shows you how much calcium is there, but it doesn’t really show you how nar-row the vessels are,” Gay said.

Cardiac scoring uses a scale that mentions narrowing of the vessels as a possibility because of this cor-relation. A scale of 0 indicates no calcium and likeliness for no nar-rowing or plaque buildup.

Someone with a score numbered up to 10 is still highly unlikely to have any calcium or plaque in the arteries. However, if the score is in the 11-100 range, mild coronary calcium and/or narrowing may be possible.

From the range of 101-400, coro-nary artery disease and narrowing of the arteries both become a sig-nificant possibility and a concern. Any score higher than 400 is con-sidered serious, and further consul-tation from a physician would be recommended.

The availability of the scoring system is hoped to boost awareness and provide easy access for a more informed heart patient.

Cardiac scoring reveals calcium buildup in arteries

By Mary MacVeanLos Angeles Times

Even Elmo knows that breakfast is the most important meal of the day in his world, but there hasn’t been enough scientific evidence for the federal government to recommend it for grown-ups.

Still, it sounds like it might be a wise move to stock up on oatmeal and the like. In an article released Monday in the journal Circulation, researchers found that men who skipped breakfast had a 27 percent higher risk of coronary heart dis-ease than men who ate their morn-ing meal though we imagine that big daily plates of bacon and pan-cakes with syrup are not the ideal.

The researchers also found, using a large ongoing study of mostly white men, that those who ate late

at night had a 55 percent higher risk of coronary heart disease. They didn’t find an association with the number of times a day a person ate.

Those associations were true — if somewhat less so — when other habits and conditions that would cause coronary heart disease were factored in, said the research-ers, from Harvard University and Brigham and Women’s Hospital.

Snacking and skipping breakfast are common among Americans, the researchers noted. And such habits have been associated with weight gain, high blood pressure and diabe-tes, they wrote.

So they looked at the Health Professionals Follow-up Study, an ongoing look at 51,529 men who are questioned every two years about their health and habits.

The men who did not eat break-

fast were younger, more often single and more likely to smoke and less active than the other men. The late-night snackers were also more likely to smoke and to have hypertension and sleep less than seven hours a night, the researchers wrote.

But the quality of the men’s diets was on average very high.

“The timing of the meal may be directly responsible for the metabol-ic effects that may lead to CHD, or alternatively, eating habits may be a proxy for specific foods more likely to be consumed at breakfast or late at night such as breakfast cereals high in dietary fiber and fortified micronutrients like folate or late-night snack foods high in calories,” the researchers wrote.

They said they would like to see additional studies looking at women and ethnic groups.

Skipping breakfast linked with heart disease

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HealthWatch July 28, 2013