Wake Forest / 23.05.2013

MedicalResearch.com eInterview with Dr. Giuseppe Orlando, M.D., Ph.D. Instructor, General Surgery Specialty Areas: Transplant Urology, Kidney Transplantation, Pancreas Transplantation, Transplant Immunology, Transplant Immunosuppression, Transplant Surgery Wake Forest Baptist Medical Center Medical Center Boulevard, Winston-Salem, NC 27157.MedicalResearch.com eInterview with Dr. Giuseppe Orlando, M.D., Ph.D.

Instructor, General Surgery Specialty Areas: Transplant Urology, Kidney Transplantation, Pancreas Transplantation, Transplant Immunology, Transplant Immunosuppression, Transplant Surgery Wake Forest Baptist Medical Center Medical Center Boulevard, Winston-Salem, NC 27157. MedicalResearch.com:  What are the main findings of the study? Dr. Orlando: Our study shows that we can use discarded kidneys from deceased human donors as platform for kidney regeneration investigations. As of now, we are using porcine models, after having developed smaller scale models (mainly in rodents, as it normally occurs in health science ie we need to provide the proof of concept in small animals before scaling up to larger animals which, for obvious reasons, are clinically more relevant). In regenerative medicine we know that cells do not survive if they are not seeded on supporting platforms which we call "scaffolds". There are several types of scaffolds, but probably the most effective are the ones that we can produce from animal/human organs. Basically, every organ consists of a cellular component which is endowed within the framework of the so-called extracellular matrix. When we strip cells out of an organ, what remains is the acellular extracellular matrix. Quite strikingly, the acellular organ in question maintains the same shape and volume that it had before stripping. What counts is that the so-obtained scaffold contains most information that cells require to grow, be viable and exert their function. It looks like this happens also for discarded human kidneys which may represent the most promising platform for our research
Author Interviews / 23.05.2013

MedicalResearch.com eInterview with  William A. Bauman, MD Veterans Affairs Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury Suite 7A-13, James J. Peters Veterans Affairs Medical Center 130 West Kingsbridge Road, Bronx, NY 10468; Dr. William A. Bauman, MD Veterans Affairs Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury Suite 7A-13, James J. Peters Veterans Affairs Medical Center 130 West Kingsbridge Road, Bronx, NY 10468; MedicalResearch.com: What are the main findings of the study? Dr. Bauman: In a prospective, randomized two-group, double-blind, placebo-controlled, intention-to-treat clinical trial, we determined whether SCI in-patients with a full thickness (Stage III or IV) pressure ulcers of the pelvic region who received 24 weeks or less of optimized clinical care and an oral anabolic steroid agent, oxandrolone, have a greater percent of healed target pressure ulcers than those who received placebo and the same clinical care. There was no significant difference in proportion of pressure ulcers that healed between the treatment and placebo groups [treatment recipients 24.1% (95% CI, 16.0% to 32.1%) and placebo recipients 29.8% (CI, 21% to 38.6%) with a difference, -5.7 percentage points (CI, -17.5 to 6.8 percentage points)]. Also, the rate of healing of wounds at 28 days was not significantly different between the groups (50.9% of the oxandrolone group and 43.3% of the placebo group had healing of ≥30.0%), nor was the number of wounds that remained closed at 8 weeks significantly different (16.7% of the oxandrolone group and 15.4% of the placebo group). No serious adverse events were related to drug administration but a significantly greater proportion of patients had elevated liver enzymes in the treatment group [treatment recipients 32.4% (95% CI, 23.6% to 41.2%) and placebo recipients 2.9%% (CI, 0.0% to 6.1%). Thus, oxandrolone showed no benefit over placebo for improving healing of chronic pressure ulcers of the pelvic region or the proportion that remained closed after 8 weeks of treatment.
Author Interviews, JAMA, Stroke / 22.05.2013

Dr. Rishi Gupta, MD Associate Professor of Neurology, Neurosurgery and Radiology Emory University School of Medicine Director, Vascular Neurology Fellowship Program Director, Multi-Hospital Acute Stroke Network Marcus Stroke and Neuroscience Center Grady Memorial Hospital MedicalResearch.com: What are the main findings of the study? Dr. Gupta: The main findings of this study are that patients with more proximal cerebral arterial occlusion involving the middle cerebral artery and internal carotid artery appear to be the targets for endovascular reperfusion therapy trials. Moreover, previous clinical trials have used a NIHSS > 8 or > 10 threshold to include patients into randomzed trials comparing endovascular therapy versus IV tPA. The threshold may need to be higher and in our analysis we found that threshold to be 14 or greater.
Author Interviews, Mental Health Research, Sleep Disorders, University of Pennsylvania / 18.05.2013

MedicalResearch.com eInterview with: Linden Oliver, MA, Clinical Research Coordinator University of Pennsylvania Behavioral Sleep Medicine Research Program Philadelphia, Pa MedicalResearch.com: What are the main findings of the study? Answer: We found that less sleep is associated with greater suicide risk in those with insomnia. Specifically, we looked at suicide risk in people with insomnia, and also asked how much sleep they got in the past month. In those with some suicide risk, the likelihood of being high risk (versus low risk) decreased by 72% for every hour of sleep that person reported getting at night.
Author Interviews, JAMA, Nutrition / 14.05.2013

MedicalResearch.com eInterview with: Mary Scourboutakos PhD student at the University of Toronto Mary R. L'Abbe, PhD Earle W. McHenry Professor, and Chair, Department of Nutritional Sciences Faculty of Medicine, University of Toronto FitzGerald Building, 150 College Street, Rm 315 Toronto, ON, Canada M5S 3E2 MedicalResearch.com: What are the main findings of the study? Answer: We found that chain restaurant meals on average contained half a day's worth of calories, almost a full day's worth of fat and saturated fat, and more than a day's worth of sodium.
JAMA, Macular Degeneration, Ophthalmology / 10.05.2013

MedicalResearch.com eInterview with: Emily Y. Chew, MD Division of Epidemiology and Clinical Applications National Eye Institute (NEI)/National Institutes of Health (NIH), Bethesda, Maryland MedicalResearch.com: What are the main findings of the study?
 Dr. Chew: For patients who have intermediate age-related macular degeneration (AMD) or those with advanced AMD in one eye, we have recommended a mixture of vitamins and minerals (vitamin C, E and beta-carotene, and zinc oxide and cupric oxide), known as Age-Related Eye Disease Study (AREDS) formulation.  We tested the effects of adding carotenoids, lutein/zeaxanthin, or omega-3 fatty acids or both to the AREDS formulation.  Omega-3 fatty acids did not have any effect on AMD.  Addition of lutein/zeaxanthin provided an additional 10% increase in the reduction of progression to advanced AMD.  In persons with the lowest dietary intake of lutein/zeaxanthin, supplementation with lutein/zeaxanthin provided 25% reduction in rates of developing advanced AMD When we tested lutein/zeaxanthin directly against beta-carotene, the risk of progressing to advanced AMD was reduced by 20%. Furthermore, beta-carotene was found to increase the risk of lung cancer.  To improve the safety and efficacy of the AREDS formulation, we would suggest the elimination of beta-carotene and adding lutein/zeaxanthin.  Omega-3 fatty acids added no further benefit.
Allergies, Author Interviews / 09.05.2013

MedicalResearch.com eInterview with Author Peter S. Creticos, M.D. (corresponding author) Dr. Creticos' Comments: This paper reports the first successful randomized, double-blind, pivotal trial of sublingual immunotherapy with a ragweed tablet. The relevance of this lies in the recognition that ragweed is the dominant seasonal allergen in North America (~26% of US population is allergic to this noxious weed which pollinates from early August to early October). An alternate (sublingual) approach to immunotherapy for allergic respiratory disease would be a welcome addition to our armamentarium, as the current mode of treatment in the U.S., that of subcutaneous injection immunotherapy, is saddled with a burdensome injection regimen that requires frequent office visits over a 4-5 year course of treatment.
Author Interviews, Diabetes, Race/Ethnic Diversity, Stroke / 08.05.2013

MedicalResearch.com eInterview with Jane C Khoury, PhD

Associate Professor Division of Biostatistics and Epidemiology Cincinnati Children’s Hospital Medical Center MLC 5041, 3333 Burnet Avenue Cincinnati, Ohio 45229-3039 MedicalResearch.com: What are the main findings of the study? Dr. Khoury: Over all age groups, those with diagnosed diabetes have at least 3-fold increased risk of incident ischemic stroke compared to those without diabetes. This is even more pronounced in those less than 65 years of age, with 5-fold and 12-fold increase for those of black and white race respectively.  All rates are adjusted to the 2000 population.
Author Interviews, Hematology, Surgical Research, Transfusions / 08.05.2013

MedicalResearch.com eInterview with Luca Weltert, MD Cardiac Surgery Department of the European Hospital in Rome, Presentation during the Plenary Scientific Session of the 93rd AATS Annual Meeting in Minneapolis. MedicalResearch.com: What are the main findings of the study? Dr. Luca Weltert: This study illustrates the efficacy of Human Recombinant Erythropoietin (HRE) in avoiding blood transfusions in the heart surgery setting. And aside from complicated number, tables and statistics tells that HRE can reduce Blood Transfusions as much as 65%, while at the same time not exposing patients to any substantial added risk.
Author Interviews, Race/Ethnic Diversity / 08.05.2013

MedicalResearch.com eInterview with Annette Langer-Gould, MD, PhD From the Department of Research and Evaluation Kaiser Permanente, Southern California, Pasadena; and Neurology Department Kaiser Permanente, Southern California Los Angeles Medical Center, CA. MedicalResearch.com: What are the main findings of the study? Dr. Langer-Gould: The main findings of the study were that multiple sclerosis is more common in black women than in white women, which run contrary to the widely accepted belief that blacks are less susceptible to MS. In particular, we found that black patients had a 47 percent higher risk of MS than white patients, while Hispanic and Asian patients had a 50 percent and 80 percent lower risk compared to white patients, respectively. We also found that 70 percent of MS cases occurred in females, but this preponderance of females diagnosed was more pronounced among black patients than white patients. In addition, black women had a higher incidence of MS than white patients of both genders, while black men had a similar risk of being diagnosed with MS compared to white men. The lower risk among Hispanic and Asian patients was true for both sexes.
Author Interviews, Cancer Research, CT Scanning, Medical Imaging / 07.05.2013

MedicalResearch.com eInterview with Dr. Waël C. Hanna University of Toronto departments of Thoracic Surgery and Diagnostic Radiology, MedicalResearch.com: What are the main findings of the study? Dr. Hanna: By using Minimal Dose CT Scan (MnDCT) for surveillance of patients after lung cancer resection, we can detect 94.2% of recurrent or new lung cancer in this patient population. When we use chest x-ray (CXR) to conduct surveillance on the same cohort of patients, we can only detect 21.1% of new or recurrent lung cancer cases. Therefore, while MnDCT scan subjects the patient to a similar effective dose of radiation as CXR (0.2 mSV vs. 0.16 mSv), it is a vastly superior test for follow-up of this high risk population. More importantly, when we use MnDCT for surveillance, we can detect new or recurrent lung cancer at the asymptomatic locoregional stage in 78% of patients, and there quarters of those patients are candidates for further treatment in the form of surgery or radiation. In the patients who were treated, median survival was 69 months after initial operation, versus 25 months in those who received no treatment.
Heart Disease / 03.05.2013

MedicalResearch.com eInterview with: Dugald Seely ND, MSc, FABNO
 Founder & Executive Director; Ottawa Integrative Cancer Centre
Director; Research & Clinical Epidemiology; Canadian College of Naturopathic Medicine
Affiliate Investigator; Ottawa Hospital Research Institute 
29 Bayswater Ave Ottawa, ON, K1Y 2E5 www.oicc.ca


MedicalResearch.com: What are the main findings of the study? Answer: A significant and measurable reduction in risk of developing cardiovascular disease when naturopathic care is provided alongside conventional care. This is  evidenced by a 17% reduction in prevalence of metabolic syndrome and over 3% reduction in the 10-year Framingham cardiovascular risk profile for patients receiving care from a regulated naturopathic doctor in addition to community based care with a general practitioner.
Author Interviews, Emergency Care, Stroke / 03.05.2013

MedicalResearch.com eInterview with with Dr. O. James Ekundayo, MD, DrPH Assistant Professor Department of Family & Community Medicine Meharry Medical College 1005 Dr. D.B. Todd Jr. Blvd. Nashville, TN 37208 Written Interview conducted with author by Editor Marie Benz, MD MedicalResearch.com What are the main findings of the study? Answer: The key findings are: ·         One third of stroke patients did not activate Emergency Medical Services (EMS). ·         Subgroups of patients who were less likely to use EMS include younger patients, patients of minority race or ethnicity, and those living in rural communities. ·         Prior history of stroke /TIA does not confer greater likelihood of EMS activation during subsequent stroke. ·         Patients who used EMS had shorter pre-hospital and in-hospital delay. They arrived early, had prompter evaluation, and received more rapid treatment. ·         More patients, who were eligible for clot-busting drug, received them. These happened because EMS gives the receiving hospital pre-notification about the arrival of the patient and the ER staff is ready to act as soon as the patient arrives.
Author Interviews, Cancer Research / 02.05.2013

MedicalResearch.com eInterview with Christian Löw, Ph.D. Department of Medical Biochemistry and Biophysics Karolinska Institutet SE-171 77 Stockholm Sweden MedicalResearch.com: What are the main findings of the study? Dr. Löw: In order to grow, cells need fuels such as sugars. Specialized proteins that reside in the cell envelope transport these nutrients into the cell; XylE is a bacterial transport protein that is highly similar to members of the human GLUT transporters. Our study describes for the first time the mechanistic details of how cells import sugars by resolving the different steps of the transport cycle at almost atomic resolution. Tumors are especially dependent on the uptake of sugars and other nutrients via these transporter systems in order to be able to grow rapidly. A possible strategy for cancer treatment therefore would be to block these transporters in the cell membrane, thus starving out and killing the cancer cells. Our structures can be used for initial structure based drug design studies to develop efficient and specific inhibitors against members of the GLUT family. We believe that our detailed mechanistic insights could become the basis for new strategies to fight cancer cells. Specialized proteins that reside in the cell envelope transport these nutrients into the cell; XylE is a bacterial transport protein that is highly similar to members of the human GLUT transporters
Author Interviews, Emergency Care, Nature, Weight Research / 02.05.2013

MedicalResearch.com eInterview with Professor David McDonald Taylor Emergency Department, Austin Health PO Box 5555, Heidelberg, Vic. 3084, Australia MedicalResearch.com: What are the main findings of the study? Answer: Overall, obese and non-obese patients have similar experiences during their ED stay. However, while obese patients tend to be younger and less sick, their more frequent presentation with potentially cardiac-related disease is reflected in their management. The excess of liver function tests and abdominal xrays performed on obese patients is likely to reflect examination difficulties and over investigation. Obese patients do experience more attempts at IV cannulation.
Author Interviews, Diabetes / 02.05.2013

MedicalResearch.com: Dr. Kyoung-bok Min Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, Republic of Korea MedicalResearch.com: What are the main findings of the study? Answer: The aim of this study was to investigate the prospective association of serum C-peptide with all-cause, cardiovascular disease, and coronary heart disease mortality in a non-diabetic population. We also estimated the observed mortality as C-peptide increased across the strata of glycated hemoglobin and fasting blood glucose. We found a linear association between serum C-peptide levels and death from all-cause and cause-specific mortality among adults without non-diabetes mellitus at baseline. Our finding suggests that elevated C-peptide levels may be a marker of subsequent mortality in non-diabetic subjects.
Author Interviews, Diabetes, Nutrition / 30.04.2013

This interview content is written by Dr Dae-Kyu Song, the corresponding and responsible author of the manuscript shown at “Park, Jae-Hyung et al. (2013). Green tea extract with polyethylene glycol-3350 reduces body weight and improves glucose tolerance in db/db and high-fat diet mice. Naunyn-Schmiedeberg’s Archives of Pharmacology. DOI 10.1007/s00210-013-0869-9“. Dr Jae-Hyung Park is the first author of the manuscript and a graduate student of Dr. Dae-Kyu Song MedicalResearch.com: What are the main findings of the study? Answer: At doses which could be achieved by drinking green tea on a daily basis, it has been known that green tea extract (GTE) inhibits intestinal glucose and lipid absorption when it is present in the intestinal tract. It is a reason why green tea consumption has been known to be beneficial for controlling obesity and type 2 diabetes. However, we have found that, after the intestinal absorption of GTE itself, the circulating GTE can elevate blood glucose levels by blocking cellular glucose uptake in most tissues, thereby limiting glucose utilization of the tissues. Therefore, we have tried to prolong the residence time of GTE in the intestine and block the intestinal absorption of GTE, by adding non-toxic polymer polyethylene glycol (PEG) to GTE. As a result, in 4 week treatment, the GTE+PEG regimen dramatically helps obesity-induced diabetic mice lose body weight and ameliorate glucose intolerance. Interestingly, GTE alone is without any effect.
Cost of Health Care, Emergency Care, Stanford / 27.04.2013

Sridhar Sri SeshadriMedicalResearch.com eInterview with: M. Kit Degado, MD, MS Instructor, Emergency Medicine Affiliated Faculty, Centers for Health Policy/Primary Care and Outcomes Research Stanford University School of Medicine kdelgado@stanford.edu MedicalResearch.com: What are the main findings of the study? Dr. Degado:
  • We found that if an additional 1.6% of patients flown by helicopter survive or if there is any improvement in disability outcomes, then helicopter EMS should be considered cost-effective over transporting patients by ground EMS.
Author Interviews, HIV / 27.04.2013

MedicalResearch.com eInterview with Dr. Sara Gianella Weibel, M.D. Center For Aids Research (CFAR) University of California San Diego La Jolla CA, 92093-0679 Email: gianella@ucsd.edu MedicalResearch.com: What are the main findings of the study? Answer: In this study we evaluated a large number of seminal samples from HIV-infected sexually active gay men treated with antiretroviral therapy (ART) using an extensive battery of tests for viral and bacterial co-infections. Around 10% of enrolled subjects presented detectable levels of HIV RNA in semen despite being on suppressive ART.
Author Interviews, JAMA, Medical Imaging, Mental Health Research, MRI / 26.04.2013

Medical Research.com eInterview with: Prof. Jean Decety PhD Irving B. Harris Professor of Psychology and Psychiatry The University of Chicago 5848 S. University Ave. Chicago, IL 60637 - USA SCNL Web page: www.scnl.org Child NeuroSuite: www.childneurosuite.org MedicalResearch.com: What are the main findings of the study? Dr. Decety: In our study, psychopaths exhibited significantly less activation in the ventromedial prefrontal cortex, lateral orbitofrontal cortex, and brainstem relative to controls, but surprisingly showed greater activation in the insula.  The major difference in brain response between psychopaths compared to controls during the perception of others in pain was the lack of engagement of regions in the brainstem, orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC).
Author Interviews, Hepatitis - Liver Disease / 26.04.2013

MedicalResearch.com: eInterview with: Soo Aleman Department of Gastroenterology and Hepatology, and Infectious Diseases Karolinska University Hospital, at Karolinska Institute 171 76 Stockholm, Sweden,Soo Aleman Department of Gastroenterology and Hepatology, and Infectious Diseases Karolinska University Hospital, at Karolinska Institute 171 76 Stockholm, Sweden, MedicalResearch.com: What are the main findings of the study? Answer: In this long-term, prospective study of 351 hepatitis C infected patients with liver cirrhosis, we found a reduced but persistent risk for hepatocellular cancer after successful treatment with eradication of the virus. This risk for hepatocellular cancer remained at a level of 1% per year for those with sustained virological response, and could persist as long as 8 years after eradication.
Alzheimer's - Dementia, Author Interviews, JAMA, Mental Health Research, UCSF / 26.04.2013

MedicalResearch.com eInterview with Dr. David Perry UCSF School of Medicine Clinical Fellow in Neurology 675 Nelson Rising Lane San Francisco CA 94158 MedicalResearch.com: What are the main findings of the study? Dr. Perry: We described two patients with clinical syndromes and brain imaging patterns that are consistent with Alzheimer’s disease. Both were found to have mutations in GRN, which are typically associated with inherited frontotemporal dementia. They both showed evidence of underlying Alzheimer’s pathology, in one case through autopsy confirmation (demonstrating Alzheimer’s disease in addition to TDP-43 pathology), and in the other case from a positive amyloid PET scan.
Author Interviews, Cancer Research, Case Western, Cleveland Clinic, Mental Health Research / 25.04.2013

MedicalResearch.com: eInterview with Siran M. Koroukian, Ph.D. Population Health and Outcomes Research Core, Clinical & Translational Science Collaborative Associate Professor Department of Epidemiology and Biostatistics School of Medicine Case Western Reserve University Cleveland, OH 44106-7281 MedicalResearch.com: What are the main findings of the study? Dr. Koroukian: Among individuals who died of cancer, those with mental illness (MI) died an average of 10 years earlier than those without MI. Overall, there was excess mortality from cancer associated with having mental illness in all the race/sex strata: SMR, 2.16 (95% CI, 1.85-2.50) for black men; 2.63 (2.31-2.98) for black women; 3.89 (3.61-4.19) for nonblack men; and 3.34 (3.13-3.57) for nonblack women. We note statistically significant higher SMRs for every anatomic cancer site in nonblack men and women and for most cancer sites in black men and women.
Author Interviews, Cancer Research, Chemotherapy, Hormone Therapy / 23.04.2013

MedicalResearch.com eInterview with Andrew Weickhardt, MBBS, DMedSc, FRACP MedicalResearch.com: What are the main findings of the study? Dr. Weickhardt: The study was hoping to confirm our earlier published observation that crizotinib use led to low testosterone in male patients. The earlier study was based on our observation of symptoms of low testosterone in some patients treated with the drug, and had suggested strongly that crizotinib led to rapid decrease in testosterone levels, however this was based only on a single center's patients, and only 19 patients. We hoped to do this by surveying a larger population of crizotinib treated patients across multiple institutions. We serially measured several relevant hormones.
Author Interviews, Mammograms, Medical Imaging / 22.04.2013

Nancy L. Keating MD, MPH Harvard Medical School Department of Health Care Policy 180 Longwood Avenue Boston, MA 02115-5899MedicalResearch.com eInterview with Nancy L. Keating MD, MPH Harvard Medical School Department of Health Care Policy 180 Longwood Avenue Boston, MA 02115-5899 MedicalResearch.com: What are the main findings of the study? Dr. Keating: We examined data from the 2005, 2008 and 2011 waves of the National Health Interview Survey (NHIS) a national population-based in person survey to assess whether mammography rates changed following the Nov 2009 USPSTF recommendations.   Prior to 2009 the USPSTF recommended routine screening every 1-2 years for all women older than 40 years old. In 2009, the USPSTF advised against routine mammography screening in women under 50, and recommended biennial screening for women 50-74.
Author Interviews, CT Scanning, Mayo Clinic, Medical Imaging, Orthopedics / 17.04.2013

MedicalResearch.com:  Katrina N. Glazebrook, MB, ChB Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 MedicalResearch.com:  Why did you do the study? Dr. Glazebrook: We felt CT was being underutilized for evaluation of knee injuries. The utility of CT has been well documented in the assessment of fractures, but little attention has been made on soft tissue evaluation. CT now has high spatial resolution with very thin reconstructions in any desirable plane, and we have previously noted that this allowed injured soft tissue structures such as cruciate ligaments to be well visualized [presented at Society of Skeletal Radiology meeting March 2013]. We had determined in that prior study that the best reconstruction plane to evaluate both normal and torn anterior cruciate ligaments was the oblique sagittal plane parallel to the lateral femoral condyle as routinely used in MRI imaging of the knee The soft tissue window, single energy bone removal and Dual energy bone removal were the best reconstructions to determine the presence or absence of ACL disruption The bone removal techniques removed the distracting bone so the soft tissue structures were more apparent.
Author Interviews, Exercise - Fitness, Heart Disease, JAMA, Smoking, Tobacco Research / 16.04.2013

MedicalResearch.com Author Interview with Dr. Koon Teo, MB, PhD Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada MedicalResearch.com: What are the main findings of the study? Dr. Teo: In this study we examined the prevalence of smoking cessation or avoidance, eating a healthy diet and undertaking regular physical activities in nearly 8000 individuals who had previously experienced a coronary heart disease event or stroke, on average 5 years after their events. The individuals were recruited from over 600 communities in 17 countries with varying incomes and economic development.  We found that although these healthy lifestyle activities could reduce the risk of further heart or stroke events, about one fifth of individuals continued to smoke, only one third undertook regular leisure or work related physical activities and about two fifths ate a healthy diet.