Cardiovascular Disease Risk Factor Profile of Experienced Male Amateur Marathon Runners: A Systematic Review.

CONTEXT: Male amateur marathon runners represent a unique subset of the population who may be at increased risk of cardiovascular disease (CVD) due to their underlying risk factors and their involvement in vigorous exercise such as marathon running. OBJECTIVE: To assess the modifiable risk factors (MRFs) of CVD in experienced male amateur marathon runners and health interventions on CVD risk factors. DATA SOURCES: CINAHL, Cochrane Library, Embase, Medline, and SPORTDiscus. STUDY SELECTION: Studies selected according to the inclusion criteria. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: The publication dates included were from June 1, 2008 to February 29, 2020.Published primary epidemiological, observational, randomized controlled trial (RCT) and/or non-RCT studies assessing the MRFs of CVD and health interventions on CVD risk factors in male amateur marathon runners aged ≥18 years and written in the English language were included in the review. RESULTS: Five studies met the inclusion criteria for analysis. These included male amateur marathon runners (n = 862), aged 42 to 77 years. Hypertension, hyperlipidemia, smoking, and alcohol use were MRFs positively associated with an increased risk of coronary atherosclerosis found in a subset of male marathon runners. No studies examined health interventions on CVD risk factors in any of the included studies. All 5 studies were of good quality from the National Heart, Lung, and Blood Institute quality assessment tools used. The risk of bias was low to moderate. CONCLUSION: There is a paucity of observational studies evaluating the CVD MRFs. Negative lifestyle behaviors exist within this population despite their engagement in physical exercise through marathon running. Marathon running does not negate the long-term effects caused by past negative lifestyle behaviors. This systematic review identifies that this population may not be aware of their possible risk of atherosclerosis and, consequently, CVD.

Descriptive Analysis of International Bariatric Surgery Tourism Services.

Inadequate access to public bariatric surgical services has favoured the growth of bariatric tourism. This study analysed data extracted from bariatric surgical centres that care for patients travelling from abroad. The research highlights apparent deficits in accreditation, communication, perioperative care, and travel health advice. An international registry of accredited bariatric tourism providers and patient education may be indicated.

Integrating artificial intelligence into haematology training and practice: Opportunities, threats and proposed solutions.

There remains a limited emphasis on the use beyond the research domain of artificial intelligence (AI) in haematology and it does not feature significantly in postgraduate medical education and training. This perspective article considers recent developments in the field of AI research in haematology and anticipates the potential benefits and risks associated with its deeper integration into the specialty. Anxiety towards the greater use of AI in healthcare stems from legitimate concerns surrounding data protection, lack of transparency in clinical decision-making, and erosion of the doctor-patient relationship. The specialty of haematology has successfully embraced multiple disruptive innovations. We are at the cusp of a new era of closer integration of AI into routine haematology practice that will ultimately benefit patient care but to harness its benefits the next generation of haematologists will need access to bespoke learning opportunities with input from data scientists.

International stem cell tourism: a critical literature review and evidence-based recommendations.

Stem cell tourism is an emerging area of medical tourism activity. Frustrated by the slow translation of stem cell research into clinical practice, patients with debilitating conditions often seek therapeutic options that are not appropriately regulated. This review summarises recent developments in the field of stem cell tourism and provides clinicians with the information necessary to provide basic pretravel health advice to stem cell tourists. PubMed and Scopus databases were consulted for relevant publications, using combinations of the terms 'stem cell', 'tourism', 'regenerative medicine', 'international', 'travel medicine' and 'environmental health'. The leading countries in the international stem cell tourism market are the USA, China, India, Thailand and Mexico. As the majority of clinics offering stem cell therapies are based in low- and-middle-income countries, stem cell tourists place themselves at risk of receiving an unproven treatment, coupled with the risk of travel-related illnesses. These clinics do not generally provide even basic travel health information on their websites. In addition to often being ineffective, stem cell therapies are associated with complications such as infection, rejection and tumorigenesis. Physicians, researchers, regulatory bodies, advocacy groups and medical educators are encouraged to work together to improve patient and physician education and address current legislative deficiencies.

Analysis of web-based travel health advice provided to international travellers with chronic medical and psychiatric illnesses.

OBJECTIVES: The internet is an important source of travel health information. Individuals living with chronic illnesses consult patient organisation websites for illness-related information. We analysed the scope of online travel health information available to patients with pre-existing medical conditions. STUDY DESIGN: A descriptive content analysis of patient organisation websites was conducted. METHODS: The Google® search engine was interrogated using search terms related to the principal chronic diseases from the Global Burden of Disease Study. Data relating to 41 travel health variables were extracted from each eligible website. An aggregate quality score was derived for each organisation based on the presence of specific website information. Visitor usage and search analytics for each organisation's website were also described. RESULTS: We examined 145 official organisation websites relating to 10 major chronic illnesses. The largest number of websites was retrieved for patients with cancer (n = 36). Only 21 (16.5%) websites provided information on fitness-to-travel considerations. COPD websites had the highest average quality score (17.68%), followed by diabetes (14.91%) and dementia (13.28%). Mental health illness websites had the lowest score of 1.33%. There was a trend towards increased emphasis on pre-travel preparation and medications. Insect bite avoidance, malaria, animal bites, jet lag, and repatriation were addressed to the least extent. CONCLUSIONS: Our analysis exposes significant deficits in the coverage of travel health topics. Patient organisations should provide accessible pre-travel health advice to website users. Future research should elucidate the influence of web-based pre-travel health information on the behaviour of travellers with chronic disease.

Descriptive bibliometric analysis of global publications in lifestyle-based preventive cardiology.

BACKGROUND: Lifestyle-based preventive cardiology aims to combat the global burden of cardiovascular disease. There have been rapid advances in lifestyle and behavioural interventions aimed at preventing cardiovascular disease in individuals at high risk and in the general population. This study is the first bibliometric analysis of publications in the field of lifestyle-based preventive cardiology. METHODS: Journal articles relating to lifestyle-based preventive cardiology published from 1996 to 2017 were retrieved from the Scopus database. The publications were limited to those in the English language. The data were indexed using bibliometric methodology and exported to Microsoft Excel for analysis. VOS viewer software was used to conduct co-occurrence and collaboration analysis between authors, institutions and countries. RESULTS: A total of 3300 publications were identified. The annual growth rate of publications increased globally during the study period. The USA made the highest contribution to global publications (1402) and total citation counts (68,540). Harvard Medical School was the most prolific institution and David Wood was the most prolific author in the field. The European Journal of Preventive Cardiology published the largest number of articles in this field. Obesity was the most common theme. CONCLUSIONS: The current growth trends predict a large increase in the number of global publications on lifestyle-based preventive cardiology. Further research could focus on smoking cessation, which at present is under-represented in lifestyle-based preventive cardiology output.

Aesthetic journeys: a review of cosmetic surgery tourism.

Background: Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism. Methods: Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'. Results: This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed. Conclusion: This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.

Travel medicine physician adherence to guidelines for the emergency self treatment of malaria.

Few studies have examined emergency self treatment (EST) antimalarial prescribing patterns. 110 physician-members of the Travel Medicine Society of Ireland and British Global and Travel Health Association participated in this study. There was a trend towards the prescription of EST for travel to remote low-risk malaria areas; for long-term residents living in low-risk areas; and for frequent travellers to low-risk areas. This study provides insights into the use of EST in travellers' malaria.

Stem cell tourism--a web-based analysis of clinical services available to international travellers.

BACKGROUND: Stem cell therapies are advertised through online resources which describe a range of treatments with diverse clinical indications. Stem cell tourists may not be aware of the information they should seek when consulting these clinics, or of the potential risks involved. The aim of this study was to characterise the therapies offered by online stem cell clinics. METHODS: A web based search utilising five search terms was employed. The first twenty pages of each search result were screened against 340 variables. RESULTS: 224 out of 1091 websites advertised stem cell clinics. 68 eligible sites covering 21 countries were evaluated. The top five clinical indications for stem cell therapy were multiple sclerosis, anti-ageing, Parkinson's disease, stroke and spinal cord injury. Adult, autologous stem cells were the most commonly utilised stem cell, and these were frequently sourced from bone marrow and adipose tissue and administered intravenously. Thirty-four per cent of sites mentioned the number of patients treated while one quarter of clinics provided outcome data. Twenty-nine per cent of clinics had an internationally recognised accreditation. Fifteen per cent of clinics stated that their therapies posed no risk. Eighty-eight per cent of clinics claimed treatment effectiveness, with 16% describing their curative potential. Over 40% of sites did not specify the number or duration of treatments. Fifty-three per cent of clinics requested access to patients' medical records, and 12% recommended patients discuss the proposed therapy with their doctor. No clinic recommended that travellers consult a travel medicine specialist or receive vaccinations prior to their intended travel. One quarter of sites discussed contraindications to treatment, with 41% of sites detailing follow up patient care. CONCLUSIONS: There is potential for stem cell tourists to receive misleading or deficient information from online stem cell clinics. Both the stem cell tourist and travel medicine practitioner should be educated on the potential risks associated with stem cell clinical services advertised online.

Translating guidelines to practice: findings from a multidisciplinary preventive cardiology programme in the west of Ireland.

AIMS: The aim of this observational, descriptive study is to evaluate the impact of an intensive, evidence-based preventive cardiology programme on medical and lifestyle risk factors in patients at high risk of developing cardiovascular disease (CVD). METHODS: Increased CVD risk patients and their family members/partners were invited to attend a 16-week programme consisting of a professional multidisciplinary lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Smoking, dietary habits, physical activity levels, waist circumference and body mass index, and medical risk factors were measured at initial assessment, at end of programme, and at 1-year follow up. RESULTS: Adherence to the programme was high, with 375 (87.2%) participants and 181 (84.6%) partners having completed the programme, with 1-year data being obtained from 235 (93.6%) patients and 107 (90.7%) partners. There were statistically significant improvements in both lifestyle (body mass index, waist circumference, physical activity, Mediterranean diet score, fish, fruit, and vegetable consumption, smoking cessation rates), psychosocial (anxiety and depression scales and quality of life indices), and medical risk factors (blood pressure, lipid and glycaemic targets) between baseline and end of programme, with these improvements being sustained at 1-year follow up. CONCLUSIONS: These findings demonstrate how a holistic model of CVD prevention can improve cardiovascular risk factors by achieving healthier lifestyles and optimal medical management.