Change in cognitive function following physical mental activity in older adults

A randomized controlled trial finds that 12 weeks of physical plus mental activity in inactive older adults with cognitive complaints was associated with significant improvement in cognitive function but there was no difference between intervention and control groups, according to a report published Online First by JAMA Internal Medicine, a JAMA Network publication.

An epidemic of dementia worldwide is anticipated during the next 40 years because of longer life expectancies and demographic changes. Behavioral interventions are a potential strategy to prevent or delay dementia in asymptomatic individuals, but few randomized controlled trials have studied the effects of physical and mental activity together, according to the study background.

"We found that cognitive scores improved significantly over the course of 12 weeks, but there were no significant differences between the intervention and active control groups. These results may suggest that in this study population, the amount of activity is more important than the type of activity, because all groups participated in both mental activity and exercise for [60 minutes/per day, three days/per week] for 12 weeks. Alternatively, the cognitive improvements observed may be due to practice effects," the authors note.

The study by Deborah E. Barnes, Ph.D., M.P.H., of the University of California, San Francisco, and colleagues included 126 inactive, community-dwelling older adults with cognitive complaints. All the individuals engaged in home-based mental activity (1 hour/per day, 3 days/per week) plus class-based physical activity (1 hour/per day, 3 days/per week) for 12 weeks and were assigned to either mental activity intervention (MA-I, intensive computer work); or mental activity control (MA-C, educational DVDs) plus exercise intervention (EX-1, aerobic) or exercise control (EX-C, stretching and toning). The study design meant there were four groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1 and MA-C/EX-C.

Global cognitive scores improved significantly over time but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise), the comparison between EX-I and EX-C (ignoring mental activity), or across all four randomization groups, according to the study results.

"The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects," the study concludes.

Its Easy to Get In But Harder to Get Out Post Hospital Syndrome or PHS

Bad for your health?

When the Disease Management Care Blog was told by the intern, the hospital social worker, the VP for Medical Affairs or the family that an inpatient "was ready for discharge," it had a favorite test to see if it was really true.  The DMCB would walk into its patients room and ask her to do what she had easily done before she was admitted to the hospital: swing your legs out of bed, stand up and walk across the room.

The DMCB was impressed by how often elderly patients were unable to perform that simple but telling task.

Of course, the best approach was to not let the patient become that debilitated in the first place.  Thats the point of Harlan Krumholzs article on "Post-Hospital Syndrome" that was recently published in the January 10 New England Journal.

In it, Dr. Krumholz shares an important secret: being in the hospital can result in starvation, sleep deprivation, muscular deconditioning, confusion and myriad poly-pharmacy side effects.  In fact, its probably those issues, not the original medical problem that led to the hospitalization, that account for much of the infamous 20% 30-day readmission rate for Medicare beneficiaries.

Dr. Krumholz recommends that hospitals be more attentive to assuring better nutrition, provide a less noisy environment, promote early activity and keep the use of sedative, pain and hypnotic (i.e., sleeping pill) drugs to a minimum. The DMCB seconds that motion and suggests that many of its more savvy colleagues think of this as discharge planning that begins the minute the patient is admitted to the hospital.

And when patients are ready to go home, its not a matter of continuing outpatient treatment for the initial diagnosis.  These patients need comprehensive assessment and planning.  While the author doesnt come out and say it, the DMCB will: these patients need nurse-led care planning and management that addresses the full spectrum of needs that are too often ignored by hospital personnel in the rush to collect on the DRG and minimize length of stay.

Last but not least, the DMCB recommends adoption of the term "post-hospital syndrome" and wonders if it may not deserve the "PHS" acronym.

Anyone who has ever witnessed a previously well person be unable to stand up and walk will know exactly what it means.

5 bad habits in the morning

5 bad habits in the morning - It has often been mentioned that skipping breakfast is a bad habit that should be stopped. But other than that, there are many other bad routines that are often done in the morning. What is it? Check out more as reported by the Huffington Post following.

Difficult to wake up in the morning

Many people are having trouble up early fault of their own, which was late in the day before. Though keeping the ration was still trying to wake up early and important to do in order to maintain the bodys biological clock.

Delaying alarm

Alarm delay will not make feel more reshed because youve got a chance to sleep longer, but it can damage the sleep system and make the body feel weak. Instead of delaying alarm, better install an alarm and put it in a place away from the reach of the hand.

Sleep and wake up at will

As mentioned previously, keeping the bodys biological clock needs to be done in a way to sleep and wake up at the same time. If you accustom yourself to sleep and wake up at will, the body will feel weak and lethargic.

Exercise on an empty stomach

Exercise after waking up is a good habit. But what makes it worse is exercising on an empty stomach. Better wake up 15 or 20 minutes early, enjoy fruit and hurried exercise.

Skipping breakfast

Research shows that skipping breakfast can increase the risk of diabetes. Not only that, no breakfast also affect mood and memory of the men. So stop this bad habit as soon as possible.

Thats bad habits in the morning. Hopefully you are not one of those people who always do.

Excess Salt Consumption Implicated in Millions of Heart Disease Deaths Worldwide

New cases of cardiovascular disease continue to mount in the US and worldwide, making this the leading killer of men, women and children in western cultures. Enlightened, health-conscious individuals now understand that heart disease is not only preventable, but also treatable in all but the most advanced stages. Lifestyle modifications including elimination of processed and fried foods, smoking cessation, stress reduction and adequate physical activity are among some of the changes that promote heart health and dramatically lower future disease risk.

Excess Dietary Sodium Increases Blood Pressure, Dramatically Raising Incidence of Heart Attack and Stroke

Excess salt consumption from synthetic salt products is a known risk factor for early heart disease, but researchers now report that sodium, largely coming from the disproportionate amount of processed foods that many people eat, is killing millions around the globe. Scientists from the Harvard Medical School and the Harvard School of Public Health now report the result of their research that found how eating too much salt contributed to 2.3 million deaths from heart attacks, strokes and other heart-related diseases throughout the world in 2010, representing 15 percent of all deaths due to these causes.

Researchers presented their findings to the American Heart Associations Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions. Lead study author, Dr. Dariush Mozaffarian commented “National and global public health measures, such as comprehensive sodium reduction programs, could potentially save millions of lives.” To conduct their study, scientists analyzed data from 247 surveys of adult sodium intake, sorted by age, gender, and region spanning 50 countries over a 20 year period.

Lower Daily Salt Intake to 1,000 mg or Below to Limit Vascular Disease

The team then determined how the amount of sodium people were consuming was affecting their risk for cardiovascular disease in a large cohort of 107 randomized trials that determined the impact of sodium consumption on elevation of blood pressure. They determined that an optimal daily sodium intake of 1,000 mg was optimal. The current target in the US for adults is 2,300 mg per day, and many people who eat regularly at fast food restaurants and prepare meals using processed and ined foods can consume 3,500 to 5,000 mg per day, placing them at considerable risk for chronic vascular disease.

Researchers determined that nearly one million deaths occurring during the study period were due to excessive sodium consumption. This represented forty percent of all deaths recorded, as sixty percent occurred in men and forty percent in women. The US ranked nineteenth out of the thirty largest countries where 429 deaths per million (one in ten) were attributable to excess sodium intake. Nutrition experts explain that added salt should always be from natural salts containing the full-spectrum of minerals that encourage healthy cellular metabolism. Eliminating canned and ined food consumption, and closely monitoring processed salt usage could prevent the early demise of millions worldwide over the next decade.

Higher omega 3 fatty acids in blood reduced risk of hip fractures

Higher levels of omega-3 fatty acids in the blood may reduce the risk for hip fractures in postmenopausal women, recent research suggests.

Scientists analyzed red blood cell samples from women with and without a history of having a broken hip. The study showed that higher levels of omega-3 fatty acids from both plant and fish sources in those blood cells were associated with a lower likelihood of having fractured a hip.

In addition to omega-3s, the researchers looked at omega-6 fatty acids, which are generally plentiful in a Western diet. The study also showed that as the ratio of omega-6 fatty acids to omega-3s increased, so did the risk for hip fracture.

Though the study did not define the mechanisms for these relationships, the researchers hypothesized that inflammation may contribute to bone resorption, the breaking down of bone caused by the release of cells called osteoclasts.

“Inflammation is associated with an increased risk of bone loss and fractures, and omega-3 fatty acids are believed to reduce inflammation. So we asked if we would see fractures decrease in response to omega-3 intake,” said Rebecca Jackson, the study’s senior author and a professor of endocrinology, diabetes and metabolism at The Ohio State University.

“One thing that was critically important was that we didn’t use self-report of food intake, because there can be errors with that. We looked directly at the exposure of the bone cell to the fatty acids, which is at the red blood cell level,” said Jackson, also associate dean for clinical research in Ohio State’s College of Medicine. “Red blood cell levels also give an indication of long-term exposure to these fatty acids, which we took into account in looking for a preventive effect.”

Broken hips are the most common osteoporosis-related fractures, with an estimated 350,000 occurring annually in the United States. About 20 percent of people die in the year following a hip fracture.

The research is published in a recent issue of the Journal of Bone and Mineral Research.

The observational study did not measure cause and effect, so the researchers say the findings are not definitive enough to suggest that taking omega-3 supplements would prevent hip fractures in postmenopausal women.

“We don’t yet know whether omega-3 supplementation would affect results for bone health or other outcomes,” said Tonya Orchard, assistant professor of human nutrition at Ohio State and first author of the study. “Though it’s premature to make a nutrition recommendation based on this work, I do think this study adds a little more strength to current recommendations to include more omega-3s in the diet in the form of fish, and suggests that plant sources of omega-3 may be just as important for preventing hip fractures in women.”

Omega-3 and omega-6 fatty acids are both polyunsaturated fatty acids and essential fatty acids, meaning they contribute to biological processes but must be consumed because the body does not produce them on its own. Previous research has suggested that while both types of fatty acids are linked to health benefits, omega-3 fatty acids have anti-inflammatory properties and omega-6 fatty acids seem to have both anti- and pro-inflammatory effects.

The researchers used blood samples and hip fracture records from the Women’s Health Initiative (WHI), a large national prospective study of postmenopausal women that enrolled participants between 1993 and 1998 and followed them for 15 years. For this new work, the sample consisted of red blood cell samples and records from 324 pairs of WHI participants, half of whom had broken their hips before Aug. 15, 2008, and the other half composed of age-matched controls who had never broken a hip.

The analysis showed that higher levels of total omega-3 fatty acids and two other specific kinds of omega-3s alone were associated with a lower risk of hip breaks in the study sample.

On the other hand, women who had the highest ratio of omega-6 to omega-3 fatty acids had nearly twice the risk of hip fractures compared to women with the lowest ratios. The current typical American diet contains between 15 and 17 times more omega-6 than omega-3, a ratio that previous research has suggested should be lowered to 4-to-1, or even 2-to-1, by increasing omega-3s, to improve overall health. The primary omega-6 fatty acid in the diet is linoleic acid, which composes about 99 percent of Americans’ omega-6 intake and is found in corn, soybean, safflower and sunflower oils.

The specific omega-3 sources associated with lower risk for broken hips were ALA (alpha-linolenic acid), which comes from plant sources such as flaxseed oil and some nuts, and EPA (eicosapentaenoic acid), which is found in fatty types of fish. The other marine-sourced omega-3, DHA (docosahexaenoic acid), on its own did not have a significant link to lower hip-fracture risk, “but all three omega-3s were in the protective direction,” Orchard said.

Jackson, who was a vice chair of the WHI for more than a decade, said continuing analyses of data from the WHI will dig down to the genetic influences on metabolism and absorption of nutrients, and whether such genetic differences could affect health risk factors in postmenopausal women.

Antidepressants increase the risk of diabetes in women

Antidepressants increase the risk of diabetes in women? - Women who are elderly should be caul if you want to take anti-depressant drugs. Recent research suggests that the anti-depressant drug could increase the risk of diabetes and cardiovascular disease in older women.

The results obtained after the researchers looked at data from several hundred women who have undergone menopause for eight years. Women taking anti-depression drugs are known to have a higher BMI, had a circumference larger dish, as well as signs of inflammation are more than women who did not take anti-depressant drugs.

All symptoms are associated with increased risk of cardiovascular disease and diabetes, as reported by U.S. News. These results are reported researchers in the American Journal of Public Health, published on 13 June.

"Its important to keep an eye on the depressed women after menopause and taking antidepressant medication. They must be vigilant to prevent diabetes and cardiovascular disease," said lead researcher Dr. Yunsheng Ma of the University of Massachusetts Medical School.

Although this study suggests that the consumption of anti-depressant drugs associated with increased risk of cardiovascular disease and diabetes, but this study did not show a causal link.

Sunlight may help ward off rheumatoid arthritis in women

Use of sunblock could lessen protective effects, suggest authors

[Exposure to ultraviolet-B and risk of developing rheumatoid arthritis among women in the Nurses Health Study Online First doi 10.1136/annrheumdis-2012-202302]

Regular exposure to sunlight—specifically ultraviolet B (UVB)—may reduce the risk of developing rheumatoid arthritis, indicates a large long term study published online in the Annals of the Rheumatic Diseases.

But the effect of UVB exposure was only evident among older women, possibly because younger women are more aware of the hazards of sunlight and so cover up with sun block, suggest the authors.

They base their findings on participants in two phases of the US Nurses Health Study (NHS), the first of which has tracked the health of more than 120,000 nurses since 1976, when they were aged between 30 and 55, until 2008.

The second (NHSII) has tracked the health of a further 115,500 nurses since 1989, when they were aged between 25 and 42, until 2009.

Rather than simply relying on geography to quantify likely levels of UVB exposure, the researchers used a more sensitive assessment, known as UV-B flux, which is a composite measure of UVB radiation, based on latitude, altitude, and cloud cover.

It is measured in R-B units: a count of 440 R-B units over 30 minutes, for example, is sufficient to produce slight redness in untanned white skin.

Exposure was then estimated according to the US state of residence, and ranged from an annual average of 93 in Alaska and Oregon to 196 in Hawaii and Arizona. Likely estimates of UV exposure at birth and by the age of 15 were also included.

Over the study period, 1314 women developed rheumatoid arthritis. Among nurses in the first NHS cohort, higher cumulative exposure to UVB was associated with a reduced risk of developing the disease.

Those with the highest levels of exposure were 21% less likely to develop rheumatoid arthritis than those with the least, the analysis showed.

This backs up the findings of other studies, showing a link between geography and the risk of rheumatoid arthritis as well as other autoimmune conditions, including type 1 diabetes, inflammatory bowel disease, and multiple sclerosis, say the authors.

But no such association for UV-B exposure was found among women in NHSII. These women were younger than those in the first NHS, and so might have been more savvy about the potential hazards of acquiring a tan, suggest the authors.

"Differences in sun protective behaviours (eg greater use of sun block in younger generations) may explain the disparate results," they explain.

They add that it is unclear at what stage of life the protective effect of UV-B occurs. Many of the study participants didnt move house between birth and their teens, and there was no difference in the results for these time points.

But they conclude: "Our study adds to the growing evidence that exposure to UV-B light is associated with decreased risk of rheumatoid arthritis. The mechanisms are not yet understood, but could be mediated by the cutaneous production of vitamin D and attenuated by use of sunscreen or sun avoidant behaviour."

The Sweet Stuff A New Color in the Packet Rainbow

Part 1 in a 2-part series about sugar and sugar substitutes. (And sorry about the technical glitch we had this morning. Eegods!)

Hey y’all! It’s me, Leigh. On a Wednesday. I know, it feels a little weird to me too. But not to fear, we’re going to have a blast.

The great wide InterWeb is bursting with noise about sugar substitutes, particularly the artificial kind, and now a new color has jumped into the sky and affixed itself to the rainbow between yellow and blue.

How do we sort through all the shouting? Does Equal really cause cancer? Does Splenda really have chlorine in it? Is Sweet ‘N Low as deadly as Skinny n Sweet? And what in the name of Sweet Angela Lansbury is stevia?

Well, depending on which sources you trust, the answers questions one through three are Yes and No. Four, well get to in a bit. For the love of Angela.

The Skinny on Artificial Sweetners
Medical regulating and reporting agencies like the FDA, the Department of Health and Human Services, and the Mayo Clinic tout artificial sweeteners as safe and promote their use with little reservation. The Mayo Clinic does remind folks that “The FDA has established an ‘acceptable daily intake’ (ADI) for each sweetener,” and provides a handy chart for determining just how much fake sugar is acceptable to ingest in a day.

A lot, it turns out: 18-19 cans of aspartame-sweetened soda, 6 cans of sucralose-sweetened soda, or 9-12 packets of saccharine. Makes the 2-liter-a-day Diet Coke habit I kicked a few years ago seem minor.

But organic healthy practitioners are less confident in chemical sweetners. Natural News reports on an 11-year study conducted by doctors at Boston’s Brigham and Women’s Hospital which found that that beverages containing aspartame reduce kidney function. The same article sited a 2008 Journal of Toxicology and Environmental Health study which indicated that sucralose messes with the flora in the gastro-intestinal tract “and inhibits the assimilation of dietary nutrients.”

Okay, not so good news for my Diet Coke habit. The rumors of cancer, chlorine, and death by rat poison are still volleyed back and forth so often, it’s hard to know who or what to believe. Im going to keep picking on aspartame, because its so easy.

In 2005, Environmental Health Perspectives, a journal of the National Institute of Environmental Health Sciences (a division of the Department of Health and Human Services), published a study linking aspartame to lymphoma and leukemia in rats. Five minutes later, in 2006, the National Cancer Institute, also a branch of DHHS, published findings debunking that very study.

Then, in 2007, EHP produced yet another study demonstrating the link between aspartame and cancer. Your ball, NutraSweet.

Time for a breakdown
Aspartame aka Nutrasweet, Equal
Aspartame is widely used as a beverage sweetener, but because of its instability when heated, it is not recommended for baking or cooking. Aspartic acid and phenylalanine, both amino acids, are combined with methanol to give us that one-of-a kind flavor. Mmm...acidy.

Sucralose aka Splenda
Sucralose (aka Splenda), used in beverages and baked goods because of its heat stability, is marketed as “made from sugar.” Yes, that’s true. Chemists take sugar and add chlorine until its a completely different substance. So, yes, the natural foodies (like me) are right -- it does have chlorine in it. However, because of the way the body metabolizes sucralose, it pretty much scoots right out. But, um, its not sugar...not even close.

Saccharin aka Sweet ‘n’ Low
Saccharin, a delicious extract of antranilic acid, nitrous acid, sulfur dioxide, and ammonia, has been around since the late 19th century. But a series of questionable lab tests in the 1970s put a blight on its chemical-aftertasty name. Testify if you grew up on Tab. In the late 1990s, the methodology of the earlier studies was called into question, and now saccharin is back in action, or in the pink, or yeah.

Acesulfame potassium aka ACK, SweetOne, Sunsett
Usually blended with other sweeteners, acesulfame-K is heat stable and highly controversial. Its primarily used in gum and baked goods in the U.S., but questions about the rigor of its testing remain.

Sugar Alcohols
Isomalt, xylitol, mannitol, sorbitol, lactitol, and maltitol are the most common sugar alcohols found in sugar-free gum and candies, as well as toothpaste and mouthwash. Xylitol is often found the sweetener aisle in granulated form for use as a beverage additive/food topping. Sugar alcohols are often marketed to people with diabetes, as the sweeteners require little to no insulin to be metabolized. However, consumed in large quantities, sugar alcohols can have a laxative effect. Technically, sugar alcohols are natural sweeteners, but they require futzing.

Stevia: The “New” Color in the Rainbow
Truth is, stevia, a Paraguayan herb from the chrysanthemum family, is not new. It has been used in Japan since 1971,  available in the U.S. since 1995, and was kicking around South America for centuries before that. I’ve been using the sweet leaf in my tea for at least 12 years. Until 2008, however, Stevia rebaudiana was only available as a “dietary supplement” in health food stores, not approved by the FDA as a food additive.

But with a little push from Cargill and Whole Earth Sweeteners (a subsidary of Mericant, of Equal fame), the FDA has finally allowed a stevia derivative, Rebaudioside A into the sweetener game, dominated by aspartame and sucralose. Brands like Truvia (Cargill), PureVia (Merisant), and Stevia in the Raw (Cumberland Packaging, makers of Sweet N Low) combine Rebaudioside A with other sugars, bulking agents, and “natural flavors.”

Truvias first ingredient is erythitol, a sugar alcohol, followed by Rebiana, their trade name for Rebaudioside A, and "natural flavors," which can be "...flavoring constituents derived from a spice, fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products, or fermentation products thereof, whose significant function in food is flavoring rather than nutritional." (FDA: 21CFR501.22). So anything!

The first ingredient of PureVia is dextrose--a corn sugar--then "Reb A," cellulose powder--a perfectly respectable bulking agent--and once again, those pesky natural flavors. Stevia in the Raw is somewhat closer to the real thing: dextrose and stevia extract in their packet version, and maltodextrin plus stevia extract in their cup-for-cup baking product. Maltodextrin is a grain-sugar bulking agent which could come from any number of grains, but most likely wheat in the U.S. Bulking agents are what fill out the packet. Its all about consumer comfort.

The dietary supplement version of stevia is less likely to contain fillers, and is most commonly found in powdered and liquid forms at the health food store or natural market. Just a pinch or a drop sweetens as much as a teaspoon of sugar. And because it’s not heat-reactive, it’s recommended for sugar-free baking.

While some still have their reservations about the safety of stevia, Mother Earth News is convinced, citing several studies that show stevias health benefits, in particular a Danish study indicating that "stevia may be advantageous in the treatment of type-2 diabetes."

But what does stevia taste like? Well, it is very sweet, but like anything else that isnt sugar, it doesnt taste like sugar. There is a bit of an aftertaste that some equate with licorice, especially if you use too much. Me, I love it. I dont even notice the aftertaste, though I find other artificial sweeteners to be just awful-tasting. Everyones taste buds have a learning curve. Its a matter if you want them to learn.

We love our unprocessed, whole foods around these parts. But what about you, dear readers? Do you use artificial sweeteners or their delivery vehicles? Have you tried stevia or the new stevia products? What do you think? Have you tried baking or cooking with sucralose or stevia? Check back tomorrow for Veggie Might: Baking with Stevia.

Sources/Further Reading:
CSPI, Chemical Cuisine
NY Times, Artificial Sweeteners
NY Times, Graphic: How the Sugar Substitutes Stack Up
Yale New Haven Hospital Nutrition Advisor, Sugar Alcohol
Harvard Healthbeat, Are Artificial Sweeteners Safe?
Health.com, Stevia rebaudiana
Mother Earth News, Stevia: This Sugar Substitute Is Sweet and Healthy

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The Problem with Diet Foods
When to Splurge on Organic
Reader Replies: Healthy Defined

A Money Back Guarantee in Health Care You Bet!

Who cares about the color, so
long as it catches mice?

Talk about disruptive.

While an unholy alliance of CMS mandarins, fawning think-tank supporters and earnest academics continue to promote their top-down "mainframe" health care ideology, along comes AMCHealth and their money back guarantee.

While the Disease Management Care Blog can only speculate on the how the contracting details would work, AMCs fundamental value proposition is pretty compelling: it promises it will reduce a clients hospital readmissions by "at least 10% within 90 days of deployment" or your money back. AMC is confident it can use interactive voice response (IVR) technology and nurse case managers to identify and then help at-risk patients who might otherwise have to be rehospitalized when things are not going well.

In the meantime, the prevailing Washington DC health orm ideology is that hospitals, doctors, nursing homes and community organizations large and small should pool and sort existing resources under the twin banners of integration and coordination. Mix the solar power of CMS innovations, the fiscal wisdom of the White Houses insurance experts, the academispheres eternally funded prospective research studies and politically targeted community grants and, if the Feds have their way, the nations health care non-system will morph into large regional and regulated utilities. Twenty percent of the national GDP will be under the firm control of CMS.

Maybe the DMCB is being overly suspicious. That being said, many of the academics, regulators and government long-timers who are presiding over the medical-industrial complex have made no secret of their disdain of outsider-run care management to the DMCB in meetings and conversations. Using Deng Xiaopings famous observation, they want their cats to be only one color.

The entrepreneurial AMCs of the health care world are a threat to that vision.  Not only are they a viable business option for impressive organizations like this, theyve backed up their claims in the peer-reviewed literature.

If these for-profits succeed, the mainframe healthcare ideology could go the way of dinosaurs, FEMA and Amtrak. By offering solutions that are faster, cheaper and guaranteed, the ultimate success for health care institutions wont lay securing local monopolies but the decentralized and organic business approaches with a mix of build or buy being used in other sectors of the economy.

Image from Wikipedia

Diet may not impact certain health outcomes in older persons

Eating diets high in sugar and fat may not affect the health outcomes of older adults ages 75 and up, suggesting that placing people of such advanced age on overly restrictive diets to treat their excess weight or other conditions may have little benefit, according to researchers at Penn State and Geisinger Healthcare System.

"Historically people thought of older persons as tiny and frail," said Gordon Jensen, head of the Department of Nutritional Sciences at Penn State, "but that paradigm has changed for many older persons. Currently, 30 percent or more may be overweight, and by 2030, almost 30 percent are projected to be obese, not just overweight. Recent reports even suggest that there may be survival benefits associated with overweight and mild obesity status among the elderly."

"We all know that adverse dietary patterns, such as a Western diet containing high amounts of fat or a diet containing high amounts of ined sugar, both of which may contribute to obesity, are associated with adverse medical conditions and health outcomes for many people, but until now, the health effects of these types of poor diets have not been characterized for people who live to 75 years of age and older," said Pao Ying Hsao, postdoctoral fellow at Penn State.

The teams research is part of a decades-long collaborative study between Penn State and the Geisinger Healthcare System on the effects of nutritional status and diet on the health of more than 20,000 older people living in Pennsylvania. In the current study, the team followed 449 individuals for five years who were on average 76.5 years old at the beginning of the study.

"This is one of the first studies to examine obesity-related health outcomes and dietary patterns in such aged persons," Jensen said.

At study baseline, the team assessed the participants dietary patterns by calling each of them by telephone four or five times during a 10-month period and asking them about their diets over the previous 24 hours. The participants were categorized as adhering to one of three different dietary patterns. The "sweets and dairy" pattern was characterized by the largest proportions of energy from baked goods, milk, sweetened coffee and tea and dairy-based desserts, and the lowest intakes of poultry. The "health-conscious" pattern was characterized by relatively higher intakes of pasta, noodles, rice, whole fruit, poultry, nuts, fish and vegetables, and lower intakes of fried vegetables, processed meats and soft drinks. The "Western" pattern was characterized by higher intakes of bread, eggs, fats, fried vegetables, alcohol and soft drinks, and the lowest intakes of milk and whole fruit.

Using outpatient electronic medical records, the researchers identified whether the participants developed cardiovascular disease, diabetes mellitus, hypertension (high blood pressure) and metabolic syndrome during the five-year period. They found no relationship between dietary pattern and prevalence of cardiovascular disease, diabetes, metabolic syndrome or mortality in the participants; however, they did find an increased risk of hypertension in people who followed the "sweets and dairy" pattern.

The results appeared in this months issue of the Journal of Nutrition Health and Aging.

"We dont know if the participants had been following these dietary patterns their entire adult lives, but we suspect they had been because people dont usually change dietary practices all that much," Jensen said. "The results suggest that if you live to be this old, then there may be little to support the use of overly restrictive dietary prescriptions, especially where food intake may already be inadequate. However, people who live on prudent diets all their lives are likely to have better health outcomes."

Sitting for hours increase the risk of colon cancer in men

Man sitting too long can increase the risk of developing polyps in the colon, according to new research.

The polyps can be benign or malignant eventually leading to colon cancer. Although it can be removed medically, the presence of polyps is still regarded as one of the health threat.

As quoted from the Health , found similar risk does not seem likely in women who also sit for hours.

"Men who sit 11 hours or more a day had a 45 percent greater risk of suffering from polyps," said researcher Christine Sardo Molmenti of Columbia University Mailman School of Public Health.

Although active in sports, the researchers added that the habit of sitting for hours still have a bad effect on health.

Researchers also suggest that everyone sit down for hours activities should stand up and stretch every half hour. This is done to improve blood circulation and prevent a variety of other health problems.

The results are reported later in the meeting of the American Association for Cancer Research in Oxon Hill, Maryland.

Healthy eating tip 7 Put protein in perspective

Protein gives us the energy to get up and go—and keep going. Protein in food is broken down into the 20 amino acids that are the body’s basic building blocks for growth and energy, and essential for maintaining cells, tissues, and organs. A lack of protein in our diet can slow growth, reduce muscle mass, lower immunity, and weaken the heart and respiratory system. Protein is particularly important for children, whose bodies are growing and changing daily

Protein Rich Foods

Here are some guidelines for including protein in your healthy diet:

Try different types of protein. Whether or not you are a vegetarian, trying different protein sources—such as beans, nuts, seeds, peas, tofu, and soy products—will open up new options for healthy mealtimes.

• Beans:  Black beans, navy beans, garbanzos, and lentils are good options.
• Nuts: Almonds, walnuts, pistachios, and pecans are great choices.
• Soy products: Try tofu, soy milk, tempeh, and veggie burgers for a change.
• Avoid salted or sugary nuts and refried beans.

Downsize your portions of protein. Many people in the West eat too much protein. Try to move away from protein being the center of your meal. Focus on equal servings of protein, whole grains, and vegetables.

Focus on quality sources of protein, like fresh fish, chicken or turkey, tofu, eggs, beans, or nuts. When you are having meat, chicken, or turkey, buy meat that is free of hormones and antibiotics.

 

The Important Look AHEAD Action for Health in Diabetes Study No Benefit from Exercise and Weight Loss in Diabetes

Diabetes? Exercise and then die just as soon.

It makes sense, doesnt it? If persons are overweight and have diabetes, diet and exercise-based "prevention" should translate into fewer heart attacks, strokes and deaths, right?

Wrong.

It turns out that a just-published and high quality research study shows its not so simple.  Whats more, the Disease Management Care Blog brazenly suggests that the disease management/population health vendors discovered this years ago.

The just-published study is here in the prestigious New England Journal of Medicine. The DMCB suspects that, thanks to the mainstream medias fixation on Snowden, SCOTUS, and Shakira possibly hawking Obamacare, this important research may not get the front-page attention it deserves.  Considering that it was ten-year, prospective, randomized multi-center academic study involving over 5000 patients, thatd be a shame.

Heres the DMCBs summary:

Eligibility: Participants had to be between 45 and 75 years of age with adequately controlled (A1c less than 11) "type 2" diabetes, an "overweight" body mass index (BMI) of 25 or more, blood pressure less than 160/100, an ability to exercise and access to a primary care provider. 

Recruitment: This went from August of 2001 through April of 2004. It was also tailored to keep insulin-using participants to less than 30% of the study group.

Interventions That Were Compared: Participants were randomly assigned to an "intensive lifestyle intervention" study arm or a "support and education" study arm.  The intensive group received weekly group and individual counseling for six months that subsequently tapered over the subsequent duration of the study. The counseling included a 1200-1800 calorie diet plus 175 minutes of moderate physical activity per week that was aimed at achieving a weight loss of at least 7% of body weight.  The support group got only three group sessions per year. Medicines and their doses were generally left to the primary care provider.

Outcomes Studied: Participants waist circumference, weight, blood pressure, medications and exercise tolerance were assessed once a year. Hospital and other medical records were reviewed to assess the number of deaths and cardiovascular events, such has heart attack or stroke.

The Study Population: 5,124 persons were enrolled; 2570 were randomly assigned to the intensive group while 2575 were assigned to the support group. The average age was 59 years, 60% were women, the median duration of the diabetes diagnosis was 5 years and the average body mass index was a hefty 36. Only 4% were lost to follow-up.

Outcomes:  After a median of 9.6 years of follow-up......

• patients assigned to the intensive group lost approximately three cm. from their waist and six kg. in weight vs. zero cm. and four kg., respectively, in the support group. This translated to a weight loss of 6% of body weight (vs. the target of 7%) in the intensive group vs. about 3.5% in the support group.

• the A1c, which is a test of overall blood sugar control, was about two tenths of a point (7.4% vs. 7.2%) lower (i.e. better) in the intensive group. LDL cholesterol was also lower. Better control of the diabetes meant that the persons in the intensive group were taking fewer medicines at lower doses.

• But it was all for naught.  During the course of the study, there were 403 cardiovascular deaths, non-fatal heart attacks or heart-related ("angina") hospitalizations in the intensive group, vs. 418 in the support group. The calculated rates of 1.8 vs. 1.9 events per 100 person years was too small to be statistically significant and was more likely the result of chance or randomness.

The Disease Management Care Blogs take?

The early painful lesson of the "disease management" industry was that a broad life-style intervention applied to a large group of diabetics was not going to meaningfully improve outcomes. Critics believed that while the interventions were conceptually sound (diet, exercise, weight loss), the delivery was flawed. 

This just published NEJM study would suggest the intervention itself is futile. If so, that is bad news.

"Not so fast!" says the DMCB.

In addition to renaming itself (now "population health"), the industry responded to the science and the critics by retooling.  It learned to channel tailored interventions at population sub-segments who are most likely to experience a specific benefit. Instead of an "intensive" weight loss intervention for all overweight diabetics, population health can use baseline survey, insurance or clinical data to spot (risk stratify) those diabetics who are most likely to achieve a specific benefit that could range from (for example) a sustained 7% weight loss to reduced readmissions.

This NEJM study tried to benefit all diabetics.  A better approach is to find which diabetics will benefit.

As an aside there were some other issues with the study to bring up when debating the study with colleagues and foes:

The BMI of 36 suggests this was a very obese study population that lost only 6% of their body weight during the course of the study.  Since weight was still a health risk at the end of the study, the DMCB wonders if the intervention would have shown more benefit with a less heavy population.

The support group also lost weight and lowered their A1c, which could have obscured the clinically significant benefit in the intervention group. 

This accompanying editorial points out that lower statin and ACE drug use in the intervention group could have paradoxically increased their risk, since these drugs are known to lower the incidence of stroke and heart attack.

The editorial also points out that spin-off studies have already shown that the intervention group benefitted from higher quality of life.

Diabetes in Children A Growing Concern

The Centers for Disease Control and Prevention (CDC) warns that type 2 diabetes is a "growing problem among US children and adolescents," and recommends better physician awareness to combat the problem.

They cite the following markers for diabetes in this age group:

• Between 10 and 19 years old
  
• Obese
  
• Strong family history of type 2 diabetes
  
• Insulin resistance
  
• Poor glycemic control (A1C = 10% to 12%)

A recent study appearing in the August issue of Archives of Pediatrics & Adolescent Medicine found one more predictor - waist size:

"Waist circumference is a predictor of insulin resistance syndrome in children and adolescents and could be included in clinical practice as a simple tool to help identify children at risk."

WebMD features a summary of the study, including examples of risky waist sizes:

• A 5-year-old boy or girl with a waist size of 22 inches or more
  
• A 10-year-old boy with a waist size of 26 inches or more
  
• A 10-year-old girl with a waist size of 25 inches or more
  
• A 15-year-old boy with a waist size of 31 inches or more
  
• A 15-year-old girl with a waist size of 28 inches or more

________
For the study itself (abstract only, subscription required for full article):
Can Waist Circumference Identify Children With the Metabolic Syndrome?

For WebMDs summary:
Kids Waists May Show Pre-Diabetes Problem

For the CDCs fact page on children and diabetes:
Epidemiology of Type 1 and Type 2 Diabetes Mellitus Among North American Children and Adolescents

Keeping the Goal in Front of You

Hi,

I shared once before about watching the TV series "Heavy" on Netflix and hearing one of the coaches say: "Keep your goals in front of you. Sometimes to reach goals you have to do very difficult things."

I have those words on a sticky note stuck to the edge of my monitor and sometimes my eyes wander to it. It always encourages me.

The goals: 1. Normalize blood sugar levels, 2. Lose body fat, 3 Reduce body pain

Practical application to reach the goals:  eat only fresh raw vegetables and some kind of animal protein for every meal and snack for six days. On day seven for one meal, eat a high carb "no holds barred" cheat meal that can last up to one hour at some time during the day. On day eight begin again with the fresh raw veggies and protein.  Exercise three times a week.

I think I may begin referring to these two phases as "Six day" eating and "Cheat meal" eating for simplicity. (For complete information on lowering your blood sugar levels with this eating plan see: http://blogspot.com/2012/01/normal-0-false-false-false-en-us-x-none.html )

Is this diet for everyone? No. There are people out there who do not have Diabetes hanging over their heads. They can eat some other way and be healthy and happy. This diet is for that person who has pre-diabetes, or type II diabetes, and who is also grossly obese, too. This diet is for the one who has "tried everything" and nothing works. This one works even for the woman who is post-menopausal. Yippee!!  It took quite a while for me to figure this one out. I think it took a long time because it was difficult for me to accept that I had to do something that seems so drastic to the American eye.

I wanted to be able to eat anything I wanted. I still do. But if I am going to normalize my blood sugars, reduce my A1c to below 6.0 and keep it there, and also lose weight and reduce the body pain, I have to cleanly follow this program. Whenever I add in something that is not on the shopping list (see link above) I will see the effects  by the end of the day -- or in the morning.

For one thing, it will actually affect my emotions. It will be a very subtle change, but my body will feel "differently." I will put on water weight so my weight will go up the next morning instead of going down. My ankles will swell up a little larger than normal by the end of the day. I will feel a bit "foggy." And the feeling of "full" will have a different sensation to it. I am not sure I can describe it so another person can understand but in giving it a go I would say: when I eat the fresh raw veggies and protein, I feel full, clean, and satisfied. When I eat in some other way, including things that are not on this program, for a couple of days, I feel full and hungry at the same time. This means the addiction has kicked in and if I dont get myself back in line, I will be out of line for quite a while. This means my weight will steadily go up, day by day. My morning blood sugar numbers will start to creep up. And my aches and pains will become persistent, again.

This diet is supremely simple, but it is not easy if you have never done it before. Sometimes we need to be reminded why we are eating this way and not eating from the middle of the grocery store. I know I need to be reminded. I consider myself to be a relatively intelligent person with an addiction to processed foods and starchy carbohydrates. The addiction sometimes shows its ugly head in the form of "forgetfulness" or in "justifications" and most often it is both. I call it "magical thinking." Somehow my mind will just magically begin to think it is OK for me to eat a forbidden food and it will seem perfectly justified at the time. Dont laugh. It can sneak in at any moment.

The one thing that really keeps it real for me is to keep personal records and to blog -- so this blog is as much (and more so) for me as it is for you, the reader. The one thing that allows me to re-apply the practical habits I need is to make the decision to do so. The one decision that has the most positive effect and keeps me in line the most, is to decide not to eat "that forbidden food."

Keeping the goal in front of me, helps me to make the right decisions.

I hope you are doing well. Here is to the next meal being clean and good for us. Hear! Hear!

Be back soon,

Marcia

Dyslexia In Children

Dyslexia in children is a learning disability that deters person’s ability to read, write, spell and speak. The severity of dyslexia differs from mild to severe and sooner it is identified the better it is for the child. Children afflicted with dyslexia fail to understand language skills of reading, writing and spelling, despite pursuing conventional classroom experience.

Problems faced by children with Dyslexia

·Commonly, children affected by dyslexia are not able to grasp learning to read and write, even if they are provided with adequate opportunity to learn.

·Generally, dyslexia goes undetected in the early grades of schooling which makes parents and the child clueless about the child’s condition. Due to which child becomes frustrated and other problems therefore arise in that disguise dyslexia.

·All this may land child to high degree of depression and low self-esteem.

·He may become unmotivated and develop a dislike for school. This may further jeopardize child’s success in school.

·All these may cause behavioral problems at school and home, which may become difficult to cope with.

Types of Dyslexia and its causes

Dyslexia may afflict differently to children. One type of dyslexia is ‘visual dyslexia’, which is characterized by letter and number reversals. In such type dyslexia, child faces problem to write symbols in the correct sequence.

Another type is auditory dyslexia, which is child difficulty with sounds of letters especially in groups. To the dyslexic child, these sounds may appear jumbled or confusing.

"Dysgraphia" refers to the childs difficulty in holding and controlling a pencil properly. Due to which child is unable to write correctly and develops very bad handwriting.

As per the specialists, dyslexia is caused due to impairment of brain’s ability to decode the images received from eyes and ears into understandable language. Another reason is, it can be due to mental retardation, brain damage, or a lack of intelligence.

Symptoms

·The most common warning sign is letter and number reversals; this symptom begins to surface in the age of 7 or 8.

·The child in school may face difficulty in copying from the board or a book.

·General and often disorganization of written work.

·The child is unable to memorize or remember content even if it about his favorite storybook or video.

·The dyslexic child may appear to be uncoordinated and may have difficulty with organized sports and games.

·Children with dyslexia can have difficulty moving to the rhythm of the music.

NGO Support

Certain NGOs are working aggressively for certain learning related difficulties. Their main aim is to spread awareness about the topic and train children so that they can be switched from special schools to Mainstream schools. One such NGO is Sparsh which is instrumental in advancing Dyslexia awareness amongst teachers and parents.

Authors Resource Box

Sparsh aims to empower underprivileged with the necessary skills to manage life on their own. Sparsh is currently working on various projects, One of them is Savera Special School, a school not only provides education to underprivileged children but where these children get the right to life with respect and dignity. http://www.thesparsh.org/employment.html

Article Source : Dyslexia In Children

Author : pooja

Montly Important Health News in World Health Medicine

World Health Medicine begin to make nay health posting that posted in kkkmedicine blog monthly. So, any body can look more about some news that have been planted on the root of the blog.

Below are 5 Interesting post of the month

1. 5 Vital Nutrition to Children
Here are tell you about nutrient that are so important that consume by children, you can see and give your attention to this post to get more about nutrient that needed by children.

2. The Characteristics of a Healthy Breast
Beautiful breast shape is important, but far more important if breast is also healthy. Healthy breasts that means must be free of disease, especially breast cancer and functioning correctly. this news took from womanhealth website, this post is directed to women, in order they can guard their health rightly.

3. Avoid Child from Obesity
Really afraid, obesity is one of the danger disease, cause can form the other crucial disease. this post is important to know for all of us. we must know how to get away from obesity disease. So, i recommend you for read this one.

4. 9 side effect of drugs
Many of us may be consume drug without attention side effect. Eating while sleeping is one of the side effect of wrong in drug intake.So, this post is recommend you to be careful to drug that we intake and consume everyday.

5. Eating Fish Important to woman.
Cause this is can prevent them from heart disease, this statement based on the following quoted.

The researchers found that women of childbearing age who never ate fish had a 50 percent higher risk of cardiovascular problems affected than women who frequently eat fish.

OK, these 5 important posting of the month on this kkkmedicine will be make us more remember to our health. Hope keep more for read my next new Post about health. Thank :)

Pregnancy Risks in Mature Age

Pregnancy Risks in Mature Age - Not a few couples who choose to delay having a baby to a career and more established financially. True that pregnancy is necessary to plan, but the pregnancy at the age of maturity have a high risk.

Opportunities pregnant at the age of 35 years is smaller, because the number of ovum is reduced. Liked or not, but every woman born with a whole ovum has, and one by one will be issued every month during menstruation.

According to "Dr.Prashant Nadkarni" Fertility Center of Kuala Lumpur, the age of a womans fertility begins to decline at age 35. "Pregnancy should not be delayed too long, because the age will reduce the risk of fertilization success," he said.

Pregnancy at the ripe old age also increases the risk of miscarriage and babies born with abnormalities, given the quality of the chromosomes and the ovum is no longer as good at a young age.

He explained: today the world is facing a crisis of fertility, even in the most populous country like China. "But this is not a serious issue and the experts do not see it as a disease," he said.

In Asia, 80 percent of people estimated to suffer from infertility. Some countries are facing the most severe fertility problems were Singapore, Hong Kong and Macao.

Beyond the age at marriage are increasingly shifted, Nadkarni said there are many factors that cause a decrease in fertility, such as lifestyle, health, and environmental pollution.

Experts say obesity is a major cause of excessive difficulty many couples conceive. Ideally, body mass index for women is between 19-24.

Male sperm count is also influenced by body weight. "Unhealthy lifestyles, such as frequent alcohol consumption and smoking also reduce sperm count," he said.

7 Errors In The Kitchen Making You Fat

Without you knowing it, tableware and kitchen space arrangement can affect the success of a weight loss diet that you live. Small errors you normally do in the kitchen, it can sabotage your diet. 
The following seven signs that the kitchen has been sabotaging your diet:

1. Dinner plate is too big
 Most people have the habit to always spend their food and do not leave any food on the plate when finished eating. But people tend to take food in larger portions if it uses a large plate.It certainly can hinder your efforts to lose weight. Use a plate with a smaller size or diameter of about 10 inches and avoid filling plates with high-calorie foods such as meat, but vegetables reproduce.

2. Kitchen lights are too bright
 According to the study, the lighting is too bright can increase stress levels, stimulating excessive appetite and make you eat faster than usual. On the other hand, a few dim lights make someone eat slower and suppress appetite.Usually modern kitchen has several layers of light sources consisting of several different lighting lamps. When youre cooking food, turn on the kitchen light as you want, but when its time to eat, set the lamp becomes dimmer.

3. Conditions messy kitchen
Dinner leftovers that have not been cleaned, the dishes are piling up, and other conditions that make the kitchen a mess will cause stress, increased cortisol levels in the blood and increase hunger.Unfortunately, one would have difficulty in obtaining healthy food if the kitchen was a mess because they tend to opt for the lazy cook and eat cake or order food prepared between. Therefore, keep the cleanliness and tidiness of the kitchen so that you are more excited about cooking healthy food at home.

4. Using improper glasses 
According to recent research, people will tend to drink more soda or sugary syrup if using a short, wide glasses than tall drinking glass and thin. This is because the focus of someone when pouring the drink portions are at altitude.Use tall, thin glasses when drinking soda or sugary syrup and make sure not to fill it up.

5. The fridge is too big 
If your refrigerator or pantry is very large, a person will tend to spend more food to fill it. The researchers found that people prepare food when cooking from a larger container will eat 2 times more than people who prepare food from smaller containers. 
6. Jars filled with sweets 
According to research, just look tempting food alone can make a person hungry. It can also cause the release of dopamine, a brain chemical that produces pleasurable sensations and increase the desire for satisfaction, for example by eating.Place the sweet foods trigger weight gain in an opaque jar and store it in a safe place and not easy to reach. Instead, place the fruit in a basket that is easy to reach to reduce the desire to eat sweet snacks with healthier foods.

7. Putting a TV in the kitchen or dining room
Eating while watching TV shows will make you eat more and more often. Move the TV out of the kitchen or dining room and do not bring food into the TV room or bedroom to prevent overeating and weight gain.

Knowing Types Of Fat in Blood

Knowing Types Of Fat in Blood- In this post, lets we know about fat that obtain in blood, Cholesterol is one of the fat in blood flow. Beside that have any other types of fat, its lipid that called triglycerides. How the difference and contribution to cardiovascular disease?

Low density lipoprotein, cholesterol low density lipoprotein (LDL). It is the largest carrier of cholesterol in the blood. LDL transports cholesterol to sites throughout the body either for hoarding or to repair the cell membrane. However, like water that can produce crust stuck to the water pipes, as well as LDL cholesterol can cause buildup of cholesterol in the arteries that supply food to the brain and heart. Therefore, This cholesterol is often called by bad cholesterol.

High density lipoprotein, Imagine high-density lipoprotein (HDL) cholesterol as scavengers or cleaners. HDL helps reduce the amount of LDL cholesterol in the blood. The higher levels of HDL cholesterol, the lower the risk of atherosclerosis. Thats why HDL is called good cholesterol. To raise HDL cholesterol levels, do the exercise and reduce weight.

Triglycerides, Triglycerides are another type of body fat. When excessive amounts in the blood, then it is called hipertrigliseridemi. This condition is also considered to facilitate the formation of atherosclerosis (plaque deposits in arteries).