Author Interviews, Gastrointestinal Disease, Hepatitis - Liver Disease, Occupational Health, Outcomes & Safety / 30.04.2020
Over 80% of World Trade First Responders Have Fatty Liver Disease
MedicalResearch.com Interview with:
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D. Debashis Reja[/caption]
Mishal Reja, MD, MD
Resident in Internal Medicine
Robert Wood Johnson University Hospital
MedicalResearch.com: What is the background for this study?
Response: World Trade Center first responders were exposed to environmental toxicants that have resulted in negative health consequences.
Gastrointestinal aerodigestive disorders such as GERD and Barrett’s esophagus have been frequently reported in this population. Additionally, an increasing body of literature has shown that fatty liver disease is not only secondary to metabolic syndrome, diabetes, and obesity, as previously thought, but can also result from environmental and industrial toxicants. Chemicals such as Vinyl Chloride, Tetrachloroethylene, Perchloroethylene, and many others are frequently found in industrial occupations and have resulted in fatty liver disease, steatohepatitis, cirrhosis, and hepatocellular carcinoma. Many of these chemicals were also present at ground zero, thus exposing many of first responders to the hepatotoxic effects of these chemicals. To date this is the first study to look at liver disease in World Trade Center first responders.
D. Debashis Reja[/caption]
Mishal Reja, MD, MD
Resident in Internal Medicine
Robert Wood Johnson University Hospital
MedicalResearch.com: What is the background for this study?
Response: World Trade Center first responders were exposed to environmental toxicants that have resulted in negative health consequences.
Gastrointestinal aerodigestive disorders such as GERD and Barrett’s esophagus have been frequently reported in this population. Additionally, an increasing body of literature has shown that fatty liver disease is not only secondary to metabolic syndrome, diabetes, and obesity, as previously thought, but can also result from environmental and industrial toxicants. Chemicals such as Vinyl Chloride, Tetrachloroethylene, Perchloroethylene, and many others are frequently found in industrial occupations and have resulted in fatty liver disease, steatohepatitis, cirrhosis, and hepatocellular carcinoma. Many of these chemicals were also present at ground zero, thus exposing many of first responders to the hepatotoxic effects of these chemicals. To date this is the first study to look at liver disease in World Trade Center first responders.
![MedicalResearch.com Interview with: Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction. MedicalResearch.com: What are the main findings? Response: Disappointingly, studies evaluating the effectiveness and safety of flexible ICU visiting hours are scarce. To date, no large randomized trials have assessed the impact of a flexible visiting model on patients, family members, and ICU staff, and this evidence gap may constitute a barrier to the understanding of the best way to implement and improve ICU visiting policies. In the present pragmatic cluster-randomized crossover trial (The ICU Visits Study), we engaged 1,685 patients, 1,295 family members, and 826 ICU professionals from 36 adult ICUs in Brazil to compare a flexible visitation model (12 hours/day plus family education) vs. the standard restricted visitation model (median 90 minutes per day). We found that the flexible visitation did not significantly reduce the incidence of delirium among patients, but was associated with fewer symptoms of anxiety and depression and higher satisfaction with care among family members in comparison to the usual restricted visitation. Also, the flexible visitation did not increase the incidence of ICU-acquired infections and ICU staff burnout, which are major concerns when adopting this intervention. MedicalResearch.com: What should readers take away from your report? Response: Considering the evidence suggesting that most adult ICUs restrict the presence of family members, our results provide useful and relevant information that may influence the debate about current ICU visitation policies around the world. First, a flexible visitation policy that permits flexible family visitation in ICU (up to 12 hour per day) is feasible, given the high adherence of participant ICUs to implementation in The ICU Visits Study. Second, the flexible family supported by family education is safe regarding the occurrence of infections, disorganization of care or staff burnout. Third, family members - a commonly missing piece of the critical care puzzle - seem to benefit from the flexible visitation model through higher satisfaction with care and less symptoms of anxiety and depression. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future research might focus on the following topics: 1) methods of implementation of flexible visiting models in ICUs; 2) Family support interventions in the context of flexible ICU visiting hours (e.g.: psychological and social support, support for shared decision making, peer support, and comfort); and 3) How flexible ICU visiting hours affects patient, family member and staff outcome at long-term. Disclosures: The ICU Visits study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program (PROADI-SUS). Citation: Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.](https://medicalresearch.com/wp-content/uploads/hospital-ICU-intensive-care.jpg)
Dawn Wiest, PhD
Director, Action Research & Evaluation
Camden Coalition of Healthcare Providers
MedicalResearch.com: What is the background for this study?
Response: Understanding the role of care transitions after hospitalization in reducing avoidable readmissions, the Camden Coalition launched the 7-Day Pledge in 2014 in partnership with primary care practices in Camden, NJ to address patient and provider barriers to timely post-discharge primary care follow-up. To evaluate whether our program was associated with lower hospital readmissions, we used all-payer hospital claims data from five regional health systems. We compared readmissions for patients who had a primary care follow-up within seven days with similar patients who had a later or no follow-up using propensity score matching.
Nicholas Reed AuD[/caption]
Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health
MedicalResearch.com: What is the background for this study?
Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.
MedicalResearch.com: What are the main findings?
Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.
Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss. 
