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The Dolomite Solution

Murder, suspense, and intrigue propel this third Jake Adams mystery thriller from the Dolomite mountains of northern Italy to the winding back streets of Innsbruck, Austria, and across the Atlantic to Rhode Island’s Narragansett Bay area. Two scientists have discovered the DNA link to heart disease in a remote Italian mountain village, and a way to synthesize it and begin selling it to the general public. They’re up for the Nobel Prize and set to make millions after teaming up with an Austrian biotechnology company. But there are factions who make a good living off the number one killer in America, and other companies that would like the solution for themselves. When someone kills one scientist and tries for the second, trying to steal this new cure, only one man can bring The Dolomite Solution to the public…Jake Adams!

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Breast cancer risk: animal food is not that bad

Animal food stuffs such as meat, poultry and dairy products have been incriminated as the bad guys behind many chronic diseases, especially cardiovascular disorders and cancer. Consumption of red meat has been associated to poor heart health. Consumption of processed meat such as sausages has been linked to colorectal cancer. The presence of “bad fat” in animal food especially makes a very good case against it.

The risk for cancer is linked to genetics as well as modifiable lifestyles factors. The latter include diet, smoking, alcohol consumption, weight, and physical activity. Diet is supposedly the easiest lifestyle factor to modify.

Those at high risk for breast cancer are especially warned against consuming food coming from animals in the form of meat, eggs, and dairy products. However, previous research studies did not provide conclusive evidence to support this belief.

A statement from the American Society for Nutrition based on three recent studies states:

“First we all need to remember that there are really no such things as ‘bad’ foods. Second, observational studies that show associations between diet and health need to be considered with a proverbial grain of salt.” The recent studies have investigated the role of animal food stuff consumption in cancer development, particularly breast cancer.  The results have been published in the September issue of The American Journal of Clinical Nutrition.

Results of these studies reveal that moderate animal food consumption does not influence (neither increases nor decreases) risk for breast cancer.

American Society for Nutrition spokesperson Dr. Shelley McGuire says

“These studies clearly provide additional and strong evidence that consumption of meat and dairy products by women does not, by itself, increase breast cancer risk. Further, moderate and mindful consumption of these foods can be very important in attaining optimal nutrition for most women who often do not consume sufficient iron and calcium.”

I suppose this is good news for those who would love a piece of steak or a cup of yoghurt once in a while. Remember, the key word is MODERATION. Besides, you can enjoy these foods without the bad fat. Go for lean meat, grill instead of fry. Buy low-fat yoghurt. And don’t forget, fresh fruit and vegetable go well with animal food, too.

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Controversy about Michael Jackson’s CPR and emergency care

Last week, the LA coroner’s office announced that they are treating the death of Michael Jackson as a homicide.

Apparently, lethal amounts of the anesthetic-sedative drug propofol and other drugs were found in Jackson’s body during autopsy. And Jackson’s personal physician Dr. Conrad Murray is the focus of the investigation.

Murray was also criticized about his delivery of emergency care to his celebrity patient. Here are some of the questions that have come up:

Did Murray perform CPR properly?

CPR, short for cardiopulmonary resuscitation is performed when a person suffers from cardiopulmonary/cardiac arrest, e.g. the victim stops breathing and/or the heart stops beating. (Possible causes of the cardiac arrest have been discussed in a previous post). CPR, which consists of rescue breathing and chest compressions, is applied immediately after collapse to keep the blood circulating to the brain while waiting for emergency services to arrive. Murray reportedly found Jackson in his bed with a weak pulse and immediately started CPR. Many people questioned the effectiveness of performing CPR chest compressions on a bed/mattress. It is recommended that CPR works best when a patient is lying on a hard, flat surface such as the floor. Should the doctor have moved Jackson to the floor before starting CPR?

Was there an AED in the house?

CPR alone cannot restart the heart. It needs an electric shock from a defibrillator to make beat again and this has to be done within 7 minutes of collapse, even with CPR before permanent brain damage and death occurs. Without CPR, this window of opportunity becomes shorter. Portable defibrillators, called automated external defibrillators (AEDs) are easily available and can be used even by laypersons. Could an AED have saved Jackson’s life?

Why did it take so long for the doctor to call 911?

The survival rate among cardiac arrest victims is very low. Every second counts if death is to be prevented. CPR alone cannot save a life. An AED within public access or by emergency medical services (EMS) is needed within the shortest time possible to restart the heart and the blood supply to the brain. CPR can minimize brain damage and extend the window of opportunity to save the victim’s life until professional emergency help comes. Unfortunately, it is unclear when the cardiac arrest happened and when the 911 call was made. It also reportedly took 25 to 30 minutes between the 911 call and the arrival of the paramedics. By then it was too late to save the King of Pop. So the next question is:

Why did it take so long for the EMS to arrive?

Photo credits: wikicommons

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Manzanita Grille @ Antelope Hills Golf Club

Whether you’re passing through town on business or pleasure, or a long time native to the Tri-City area, the Manzanita Grille has something for everyone. Our restaurant, overseen by local chef Joel Sagahara, offers traditional America fare with worldly influences. Our classic egg breakfast and casual lunch, featuring memorable Angus Burgers, Preskit Dip and Cranberry, Walnut Apple Chicken Salad are served daily. Our Dinner menu is offered four nights a week and includes: Liver and Onions, Chicken Marsala, All You Can Eat Pasta on Wednesday’s and All You Can Eat Fish Fry on Friday’s.Beyond just a great place for business lunch or family breakfast, we offer an array of banquet events. Plan your next tournament to include lunch on the patio. Perhaps your next anniversary, retirement party or even the excitement of a wedding! Our “Old Club House” is equipped with a full bar, stage and dance floor to make your next event a memorable one. Just like our Grille Menu, the banquet offers a variety of tastes and is open to personalization. Let our menu and reasonable prices entice you to return to our casual elegance and friendly service.Antelope Hills was founded in 1956 with the opening of the North Course. Designed by Lawrence Hughes, the course is a traditional layout, which features tree lined fairways, and fast bent grass greens. In 1992 the City of Prescott opened its second championship course. The South Course designed by Gary Panks, features open fairways, generous mounding, large undulating greens and a very panoramic views of the surrounding mountains and granite rock formations. At 5,000 feet in elevation, Antelope Hills makes for a great escape from the summer valley heat. Temperatures can average 15 to 20 degrees cooler than the Phoenix area. For those who would like to fly in and play a round of golf, Antelope Hills is located next to Prescott Municipal Airport (Ernest A. Love Field).

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Beyond Basic Yoga for Dummies (DVD)

The Beyond Basic Yoga Workout For Dummies is the next step for anyone who has enjoyed Basic Yoga Workout For Dummies and is ready to learn 12 more postures. It is a little more advanced than the Basic Yoga program, but still features the For Dummies format. You’ll discover ways to customize the workout to your level through modifications that make poses easier or more challenging according to your needs. Includes bonus guided meditation segment. Beyond Basic Yoga for Dummies presents 12 yoga poses that skilled instructor Sara Ivanhoe calls the “daily dozen.” 70 minutes

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Fitnex B70 Commercial Exercise Bike

The Fitnex B70 Commercial Exercise Bike is a Masterpiece in Form and Function.The B70 Upright Commercial Exercise Bike is Loaded with Premium Components including 8 user Programs with 16 Levels of Resistance, Heart Rate Control, Self Generating Electromagnetic Braking! Elegant Fitnex B70 is a Best buy Commercial Exercise Bike for Upscale Clubs; Gyms Rehab Facilities and Discriminating Home Users. Features Display: Matrix + LED Program: 8 Level of Resistance: 16 Torque: 250Watts Floor Space: 42″*21″ / 106*53cm Power: Self-Generating Max. User Weight: 400Lbs / 180Kgs Feedback: Time,Work Level, Distance, Watt,Speed, Calories, Heart rate, Mets

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What’s the latest in health care, August 28

What’s new about swine flu?

Here are the latest figures on the H1N1 (swine) flu:

• US, as of August 20
  hospitalized 7,983; deaths 522
• Europe, as of August 13
  hospitalized more than 32,000; deaths 53
• Worldwide, as of August 13
  hospitalized 182,166; deaths 1799

FDA Authorizes Emergency Use of H1N1 Test for U.S. Troops Serving Overseas
The US FDA issued and Emergency Use Authorization (EUA) earlier this week allowing testing for the H1N1 flu virus in US troops serving overseas. “An EUA authorizes the use of unapproved medical products or unapproved uses of approved medical products during a declared public health emergency.”

Duncan, Sebelius unveil new CDC H1N1 Guidance for Colleges, Universities, and Institutions of Higher Education
In anticipation of the start of the new school year, US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and US Department of Education (ED) Secretary Arne Duncan and Dr. Beth Bell, Deputy Director, National Center for Immunization and Respiratory Diseases at the CDC unveiled new guidance on how to mitigate and respond to the upcoming flu season. Schools, colleges, and dormitories are hotspots for epidemic outbreaks. Concerns about the H1N1 flu virus are especially big because young people seem to be highly susceptible. The new guidance suggests that the most important actions institutions can take are: to encourage and facilitate good hand washing and covering coughs and sneezes; to encourage flu vaccination for recommended groups when vaccine becomes available; and to separate sick people from well people as soon as possible.

WHO recommended use of antivirals
The World Health Organization (WHO) issued last week the latest guidleies for the use of antiviral agents in the management of H1N1 flu. The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays.

What’s new in health care?

Four in Ten Emergency Department Visits Billed Public Insurance
According to data from the Agency for Healthcare Research and Quality (AHRQ), 50 million emergency department visits were billed to Medicaid and Medicare in 2006. This indicates that a large number of emergency patients do not have health insurance coverage. These uninsured patients are also more likely to be “treated and released” rather than admitted, indicated that the patients use the ER for non-emergency issues.

America’s Seniors and Health Insurance Reform: Protecting Coverage and Strengthening Medicare
The HHS Secretary Kathleen Sibelius issued a new report on health reforms and how these can affect America’s senior citizens. The report highlighted problems with the status quo that includes

• Overpayments to Private Plans
• High Prescription Drug Prices
• Imminent Doctors’ Payment Cut will Limit Access
• Preventing Medicare from Going Bankrupt

The entire report is available for download.

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Cancer in the headlines, August 28

Another sunny weekend on my side of the world. However, our thoughts are with the victims of the bush and forest fires in many parts of the world. Such devastations have long-term effects on the environment, including the air we breathe.

I am also bring you the cancer news round up for this weekend. Happy reading.

News from the cancer victims

Senator Edward Kennedy passes away
Senator Edward “Ted” Kennedy lost the battle against brain cancer on Tuesday, August 25, 2009. He was 77 years old. The senator’s famous words:

“For those whose cares have been our concern, the work goes on, the cause endures, the hope still lives and the dream shall never die.”

News from the cancer summit

LIVESTRONG Global Cancer Summit in Dublin, Ireland in Support of Men’s Health
The first ever LIVESTRONG Global Cancer Campaign was held in Dublin, Ireland this week, from August 24 to 26. The Livestrong Summit is an initiative of the Lance Armstrong Foundation (LAF). More than 500 delegates from almost 70 countries met “to share their commitments to fight cancer.” The goal: a world without cancer. Photo from livestrong blog.

News from the airwaves

WEEI / NESN Jimmy Fund Radio-Telethon
Thursday and Friday, August 27 – 28, 2009 is the 8^th annual WEEI/NESN Jimmy Fund Radio-Telethon on WEEI Sports Radio Network and New England Sports Network. The 36-hour radio broadcast will feature stories and interviews of celebrities (inlcuding Red Sox players), cancer patients, doctors, and other medical professionals. Funds raised will be used to support research and care for both children and adults at Dana-Farber Cancer Institute. Here are the radio-telethon times:

• Thursday, August 27: 6 a.m. to midnight
• Friday, August 28: 6 a.m. to midnight

News from the researchers

“Worrisome” radiation doses with imaging, new study finds
Patients undergoing medical imaging procedures for clinical purposes are actually exposed to substantial doses of ionizing radiation, a trend which is “worrisome” according to researchers at the Emory University School of Medicine. Radiation exposure increases the risk for certain types of cancer. According to lead author Dr Reza Fazel

“Our findings that in some patients worrisome radiation doses from imaging procedures can accumulate over time underscores the need to improve their use. Unlike the exposure of workers in healthcare and the nuclear industry, which can be regulated, the exposure of patients cannot be restricted, largely because of the inherent difficulty in balancing the immediate clinical need for these procedures, which is frequently substantial, against the stochastic risks of cancer that would not be evident for years, if at all.”

Specific procedure found to be responsible for most of the radiation exposure are: myocardial perfusion imaging (22%); computer tomography (CT) scans of the abdomen, pelvis, and chest (38%).

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Obesity

Focusing on prevention rather than treatment, Obesity: Dietary and Developmental Influences reviews and evaluates the determinants of obesity. The book uses evidence-based research as a basis to define foods and dietary behaviors that should be supported and encouraged as well as those that should be discouraged. This comprehensive review represents a critical step forward in the quest to identify actionable strategies to prevent obesity. The book describes the potential role of 26 different dietary factors and 8 developmental periods in the prevention of obesity among children and adults. The dietary factors examined include macronutrients, micronutrients, specific types of foods and beverages, snack and meal patterns, portion size, parenting practices, breastfeeding, and more. The factors from each developmental period in the life cycle are examined in the context of the likelihood of obesity development. For each dietary factor and developmental period, four lines of evidence are examined: secular trends, plausible mechanisms, observational studies, and prevention trials. Providing easy access to information, the book features 38 tables that summarize observational studies, 38 graphs depicting trends in dietary intake, and 9 tables that summarize prevention trials. It provides a synopsis of the latest research on obesity, investigating all major lines of evidence, and clarifies common misconceptions while identifying which behaviors to target and which dietary factors show the most promise for prevention.

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Obesity leads to brain tissue loss

More bad news on the obesity problem. It is not only your heart that suffers from the extra pounds, it’s your brain as well. American researchers who initially looked at the cardiovascular effects of excess weight in the Cardiovascular Health Cognition study also took brain images of some patients. The researchers looked at 94 seniors in their 70s who did not exhibit any cognitive impairment. They were followed up five years after the brain scans were taken and checked for general, including body mass index (BMI). The participants were then classified as

• Normal weight = BMI of 18.5 to 25
• Overweight = BMI of 25 to 30
• Obese = BMI of above 30

The study results showed that the excess weight can lead to loss in tissue in the frontal and temporal lobes of the brain, areas of the brain critical for planning and memory. Specifically

• Overweight individuals had 4% less brain tissue compared to those with normal weight.
• Obese individuals had 8% less brain tissue.

According to Dr. Paul Thompson, senior author and a UCLA professor of neurology

“That’s a big loss of tissue and it depletes your cognitive reserves, putting you at much greater risk of Alzheimer’s and other diseases that attack the brain.”

Brain degeneration was evident in other areas of the brain of overweight and obese participants as well, namely:

• anterior cingulate gyrus, the area for attention and executive functions
• hippocampus, the area of long-term memory
• basal ganglia, the area regulating movement
• corona radiata, the white matter comprised of axons
• parietal or sensory lobe

Thompson describes:

“The brains of obese people looked 16 years older than the brains of those who were lean, and in overweight people looked eight years older.”

Current estimates from the World Health Organization put the number of obese people worldwide at more than 300 million. Those who are overweight number about 2 billion.

Obesity has been linked to increased risk for chronic disorders such as type 2 diabetes and cardiovascular disease. The current study is one of the very first to show that obesity also damages the brain. However, there is an upside to the findings. The areas of the brain loss affected by obesity are also areas that are targeted by neurodegenerative diseases such as Alzheimer’s. This could suggest that excess weight is a risk factor for Alzheimer’s, a risk factor that can be altered by changes in lifestyle, changes for the better. This means that being active, eating healthy and keeping weight under control can reduce the risk for Alzheimer’s. By keeping fit, we are protection our heart as well as our brain.

Photo credit: stock.xchng

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Pesticide exposure and Alzheimer’s

Can be pesticide exposure be a contributing factor in developing Alzheimer’s disease. This could well be, a recent study reports.

American researchers looked at 4,000 senior residents (aged 65 and older) of an agricultural county in Utah. The study participants were assessed for cognitive function (e.g. memory, attention span, and problem solving) at the start of the study was given at the outset and two other times over a six- to seven-year period and interviewed about exposure to environmental toxins such as pesticides.

The study results showed that pesticide exposure increases the likelihood of developing Alzheimer’s by 53%. The results were reported at the Alzheimer’s Association 2009 International Conference on Alzheimer’s Disease in Vienna, Austria last July.

Although Alzheimer’s has been closely linked to genetic factors, it hasn’t been clear while some individuals get and some not, regardless of genetic predisposition. Experts believe that environmental factors, e.g. pollutants and toxins may play a role.

Pesticides are environmental toxins that have been linked to a lot of chronic diseases including cancer. It may also have some long-term harmful effects on the nervous system that can lead to dementia and Alzheimer’s.

According to author Dr. Kathleen M. Hayden of Duke University Medical Center in Durham, N.C.

“While no cause for Alzheimer’s disease has been found, [non-inherited] cases are likely due to a combination of genetic and environmental factors.”

The researchers say that the use of pesticides has increased during the last 50 years, mainly in agriculture. It is estimated that in the US alone, more than 2 billion pounds of the 18,000 licensed pesticides are used and released into the environment.

Certain pesticides are believed to interfere with the production and release of acetylcholine, a neurochemical that plays a major role in memory.

The study results alone are not enough proof that pesticides cause Alzheimer’s. However, the association is so strong that it warrants further investigation of the role of environmental toxins (pesticides as well as others) in the pathogenesis of Alzheimer’s.

According to Dr. Ralph Nixon, vice chairman of the Medical and Scientific Advisory Council at the Alzheimer’s Association and an Alzheimer’s expert at New York University

“You can look at environmental toxins as being something that promotes the root cause of the disease, or as a second hit. If someone is already predisposed to Alzheimer’s due to genetics, cardiovascular disease, or some other risk factor, the environmental toxin may push their risk over the top,”

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Advances in Cancer Research

The Advances in Cancer Research series provides invaluable information on the exciting and fast-moving field of cancer research. This volume presents outstanding and original reviews on a variety of topics, including suppressor and oncogenic roles of TGF-b and its signaling pathways in tumorigenesis, hereditary diffuse gastric disease, the role of heparan sulfate proteoglycans in cell signaling and cancer, V-gene mutations in B-cell-derived human malignancy, MHC antigens and tumor escape from immune surveillance, the role of selection in progressive neoplastic transformation, and the genomic stability, neuronal development, and cancer cross paths of ATM.

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Breast cancer risk reduction: the upside of migraines?

That splitting headache that feels like your skull is about to crack open. Combine that with premenstrual cramps. That is something that many women have to suffer through at least once a month. However, it seems that there is a silver lining to migraines. Those who suffer from it have a much lower risk of developing breast cancer.

Researchers at the Hutchinson Cancer Research Center looked at more than 4,500 women with and without breast cancer and followed them up on lifestyle including incidence of migraines. The women who participated in this latest study were screened based on the following inclusion criteria:

• aged 34 to 64 years old (pre- and postmenopausal)
• never drank
• never smoked
• didn’t use hormones

The study results indicate that a clinical diagnosis of migraine is correlated to a reduction for risk of the most common subtypes of breast cancer, e.g. the estrogen-receptor and/or progesterone-receptor positive breast cancer.

This is not the first study to suggest the link between migraine and breast cancer risk. However, the previous studies had included a smaller number of participants (small sample size) and did not strictly screen them for lifestyle behaviours (e.g. alcohol consumption, smoking) that can contribute to both migraines and breast cancer development. This new study ruled out all these confounding factors but the association remains the same.

According to researcher and breast cancer epidemiologist Dr. Christopher Li

“We were able to look at whether this association was seen among both pre-menopausal and post menopausal women. In breast cancer this is relevant because there are certain risk factors that are different between older and younger women. In this study we saw the same reduction in breast cancer risk associated with a migraine history regardless of age.”

The how’s and the why’s are not fully understood but they probably have something to do with the circulating hormones in a woman’s body.

“Migraines seem to have a hormonal component in that they occur more frequently in women than in men, and some of their known triggers are associated with hormones. For example, women who take oral contraceptives – three weeks of active pills and one week of inactive pills to trigger menstruation – tend to suffer more migraines during their hormone-free week.”

This is why occurrence of migraines significantly decreases during pregnancy when a woman is in high estrogen state. Estrogen, too, is associated with certain types of breast cancer, especially the hormonally sensitive types.

However, the exact mechanism as to how hormones link migraine and breast cancer still needs to be closely investigated. The researchers are going one step further: they are investigating the type of migraines involved, including timing, intensity and duration, in the hope that with more knowledge will come understanding.

Now, you didn’t think you’d ever thank your lucky starts for those migraines, did you?

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The bad cholesterol you don’t know about

You think you know everything there is to know about cholesterol, the good, the bad, and the ugly? Well think again. There is another one that you might not know about and it might just be the baddest of them all.

Let’s backtrack a bit about cholesterol numbers

• There’s the low density lipoprotein cholesterol or LDL cholesterol, aka the bad cholesterol.
• Then there’s the high density lipoprotein cholesterol of the HDL cholesterol, aka the good cholesterol.
• Then there’s your total cholesterol which is basically an estimate of the all the cholesterol, good or bad, in your blood plus triglycerides.

The trick to cardiovascular health is to keep the bad and the total cholesterol low but keep the good one high.

But now there’s this report about the little known but high dangerous cholesterol – the so-called oxycholesterol which Chinese researchers introduced at the 238th National Meeting of the American Chemical Society.

According to lead researcher Dr. Zhen-Yu Chen of the Chinese University of Hong Kong. “Total cholesterol, low-density lipoprotein cholesterol (LDL), and the heart-healthy high-density lipoprotein cholesterol (HDL) are still important health issues. But the public should recognize that oxycholesterol is also important and cannot be ignored. Our work demonstrated that oxycholesterol boosts total cholesterol levels and promotes atherosclerosis [“hardening of the arteries”] more than non-oxidized cholesterol.”

Oxycholesterol is definitely oxidized cholesterol. It is found in fried and processed foods such as fried chicken, steaks, and grilled burgers. Oxidation occurs when fat-containing food stuffs are heated. However, according to the researchers, food manufacturer intentionally add oxidized oils such as trans-fatty acids and partially-hydrogenated vegetable oils to improve texture, taste and stability of the foodstuffs.

The researchers have tested oxycholesterol in hamsters and found that oxycholesterol consumption led to greater cholesterol deposition on the arterial lining as well as formation of larger atherosclerotic plaques. Oxycholesterol had undesirable effects on “artery function.” [It] reduced the elasticity of arteries, impairing their ability to expand and carry more blood.

The bad news is that it is not clear whether current anti-cholesterol medications are effective against oxycholesterol. The good news is that eating healthy food rich in antioxidants (fresh fruit, vegetables, whole grains and nuts) can counteract the effects of oxycholesterol since antioxidants can block the oxidation process that leads to the formation of oxycholesterol.

So which way do you go?

Photo credit: stock.xchng

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Pursuit E25 Total Body Exercise Bike

Small Parcel:Ships in 5 to 7 days Features: *Adjustable air resistance system that creates a cooling breeze as you work out *Self generating motor – efficient and energy saving *Crisp and clear LCD display that is easy-to-read *Displays the amount of time that you have been riding, speed, distance and approximate calories burned *Manual dial resistance *Upper and lower body workout Specifications: *Maximum user weight: 275 lbs Weight: 38.5 lbs

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Hospitals + hospitalists = better heart attack care

Hospitals with hospitalists seem to deliver better quality care than those without, especially in cases of myocardial infarction. This is based on a study by Massachusetts General Hospital researchers reported in the recent issue of Archives of Internal Medicine. But wait a minute… what are hospitalists?

The term “hospitalist” is rather new, so new that one cannot find it in the Medline medical encyclopedia. According to the Society of Hospital Medicine,

hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital care.The majority of hospitalists (85%) are specialized in general internal medicine and some underwent extra training pulmonary/critical care.

The study looked at 3619 hospitals and medical centers in the US. It compared two groups of hospitals, one group which employed hospitalists (N=1461, 40%) and another group which did not (60%).

The two groups of hospitals were assessed based on health care provided in patients who suffered from heart attack, heart failure and pneumonia, which are the three most common clinical diagnoses in inpatients in the US. The researchers looked at the performance of the hospitals in treatment and diagnosis, and counseling and prevention of these 3 conditions for a one-year follow up period.

The results indicate that hospitals with hospitalists scored better in evaluations that reflect adherence to Hospital Quality Alliance (HQA) care measures for acute heart attack and pneumonia. Other differences also noted. In general, hospitals employing hospitalists

• are more likely to be private, nonprofit teaching centers with at least 200 beds.
• are more likely to have intensive care units.
• have fewer Medicare patients and more Medicaid patients
• had higher nurse-staffing ratios and more nurses per patient-hour

The hospitals with hospitalists scored much better in the care and treatment of patients of with heart attack and pneumonia but not those with heart failure.

Those who had the lowest scores were hospitals which were public and with fewer that 50 beds.

The results indicate that hospitalists and nurses do play an important role in delivering quality care to patients. However, the researchers warn from jumping into conclusions. According to co-author Dr Leroi S Hicks

“We’re not saying it was the hospitalists themselves who improved the quality of care in these conditions. We adhered very closely to saying that if having a hospitalist were itself a metric, there’s something about these hospitals that is associated with better care.”

Other factors, including bedside manners, as well as the difference between outcomes in heart attack and heart failure, need to be looked into.

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Mentally ill: Victims rather than perpetrators of violence

Those with mental disorders are to be feared and looked upon a people of violent and criminal tendencies. This is the stereotype of the mentally disordered. However, contrary to this common misconception, individuals with mental disorders actually tend to be victims rather than the perpetrator of violence. This is according to a study by researchers at Georgia State University.

Lead researcher Brent Teasdale, an assistant professor of criminal justice found that patients suffering from symptoms like delusions, disorientation and hallucinations tend to be victimized.  These are also the people who are prone to alcohol use and homelessness, thus making them even more vulnerable.

“They actually have higher rates of victimization than they have of violence commission, which I think is counter to the stereotype that highly symptomatic, obviously delusional, visibly mentally disordered people are dangerous, unpredictable and violent. There’s no one size fits all approach to these delusions, but the odds of victimization are multiplied almost by a factor of two when a person experiences these delusions.”

Mental disorders come with a stigma and those without mental problems tend to misinterpret the symptoms, actions and behavior of the mentally disordered, become defensive, and may even strike preemptively, all in the name of self-defense. Teasdale, however, believe that people tend to become overdefensive.

Teasdale looked at the data from the MacArthur Violence Risk Assessment Study, which is a longitudinal study of psychiatric patients released from three psychiatric hospitals. During the study, the participants were interviewed about violence committed against them, stress, symptoms and social relationships. The interviews were performed every 10 weeks for one year. The study findings showed that when symptoms of mental disorders worsened, that is when the patients are most vulnerable to violent behaviour from others. This is because these are the times when the patients are “focused on their internal states and have fewer cognitive resources available to devote to interactions with other people.”

The finding…of the study suggest

• That clinicians …must pay attention to warning signs of worsening disorders as potential risk markers for violent behavior committed by their [patients].
• [a need for] …creation of assessment tools that focus on victimization risk and classes that better educate families about caring for the mentally ill.
• That clinicians also could provide [patients] suggestions for reducing victimization risk when they notice patients exhibiting greater than usual symptoms (e.g. spending less time in public spaces, increases in guardianship or mandated community treatment programs).

Teasdale concludes:

“The stereotypes persist because people are unaware of the victimization risk to people with mental illness. If they learned that victimization risk were higher than the violence commission rates, I think that would help alleviate some of that stigma and help people think about people with mental disorders in a different way.”

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AAASP Indoor Wheelchair Soccer Goal

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FDA warning: e-cigs contain carcinogens

Finally, the US FDA spoke up and issued a warning about electronic cigarettes last month. Lab analysis by the Center for Drug Evaluation, Division of Pharmaceutical Analysis (DPA) showed that the so-called “e-cigs” contain carcinogens and other toxic substances.

Electronic cigarettes, also called “e-cigarettes,” are battery-operated devices that generally contain cartridges filled with nicotine, flavor and other chemicals. The electronic cigarette turns nicotine…and other chemicals into a vapor that is inhaled by the user.

Last March, I wrote a post on e-cigs, purported to be healthy alternative to cigarette smoking. Here are some of the e-cig manufacturers’ health claims:

■E-cig has no fire, no tar, no carbon monoxide, no ash, no stub. The CEO of Smoking Everywhere tells CNN that e-cig does not contain any of the substances that cause cancer.

■It lets you enjoy those tactile taste sensations without the risks associated with smoking and tobacco.

■You can smoke e-cig without polluting the environment or passing on second hand smoke, thus circumventing the anti-smoking bans in bars and restaurants.

■”It can help you to quit nicotine without giving up the smoking habits.” It supposedly works just like a nicotine patch does but with the satisfaction of the oral fixation.

■E-cig even comes in different colors and different flavours.

Here are some concerns expressed the the US FDA and health experts regarding the potential dangers of e-cigs:

• E-cigs tested contain detectatble amounts carcinogenic (e.g. nitrosamines) and toxic substances (e.g. diethylene glycol, an ingredient used in antifreeze). See analysis report here.
• E-cigs contain high amounts of nicotiine which ius highly addictive.
• E-cig labels and packaging do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes.
• E-cigs haven’t been submitted to the FDA for evaluation or approval.
• FDA analysis suggest that the quality control during the manufacture of these products are either inconsistent or practically non-existent.

Currently, the jurisdiction of the US FDA over e-cigs, a relative new product  is being contested in court. The regulatory body states that e-cigs so far examine “meet the definition of a combination drug-device product under the Federal Food, Drug, and Cosmetic Act.”

What the health experts have to say (FDA media transcripts):

Dr. Jonathan Samet, Director for the Institute for Global Health at the University of Southern California:

“…we know very little about these devices and what they deliver to people. Consequently any claims as to possible benefits to health or utility in cessation just cannot be supported … Again it speaks to the needs of the public to understand that in using a product that is poorly characterized, inhaling a vapor, a heated vapor into their body’s that has had very little characterization is assuming potentially some unknown risks.”

Dr. Jonathan Winickoff, a practicing Pediatrician and Assistant Professor of Pediatrics at Harvard Medical School and the Chair of the American Academy of Pediatrics Tobacco Consortium:

“…electronic cigarettes are available on the market in a variety of flavors such as bubblegum, chocolate and mint. Past experience suggests that these products may be particularly appealing to young people… Flavored regular cigarettes promote youth initiation and help young occasional smokers to become daily smokers. Similarly e-cigarettes might encourage children, teens and young adults to take their first step toward smoking cigarettes. Young people may be attracted to these products due to their novelty, safety claims and the av- availability of the products in a variety of fruit, candy, cola and chocolate flavors. In addition these products are easily accessed online, in stores and at mall kiosks where young people often hang out… Once you’ve smoked the e-cigarette and are nicotine dependent the leap to a regular cigarette may not seem as great. Between 1/3 and 1/2 of all youth who try a regular cigarette will become daily smokers because of the highly addictive nature of nicotine. It is therefore vital to decrease exposure to products that would lead to experimentation with nicotine. It is not a safe drug to try.”

Photo credit: US FDA

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What’s the latest in healthcare, August 24

To start the week, I bring you the latest updates on healthcare.

What’s bad?

Heparin conflict-of-interest investigation of FDA drug director; FDA device chief resigns
Scandals and conflicts of interests are hounding the US FDA and giving the body’s commissioner Margaret Hamburg a lot of cleaning up to do.
Case 1: Dr Dan Shultz, director of the Center for Devices and Radiological Health (CDRH) is stepping down from his post. The medical device department of the FDA has been under scrutiny since last year following allegations of corruption.
Case 2: The Wall Street Journal reports that Janet Woodcock, head of FDA’s Center for Drug Evaluation and Research is being investigated for conflict of interest in connection with the approval of the generic version of the heparin Lovenox of Sanofi-Aventis. The complaint was put forward by Amphastar, who is developing another generic blood thinner.

What’s good?

AHRQ Releases Guides to Help Pregnant Women and Doctors Compare Treatments for Gestational Diabetes
The Agency for Healthcare Research and Quality (AHRQ) has issued new guides for the treatment of gestational diabetes. However, the guides come in two versions – one for the doctors and one for the patients. This way, the patients can make informed decisions about the different treatment options.

What’s new?

American Red Cross Adds Five New Celebrity Volunteers
The American Red Cross is happy to welcome five new celebrities into its National Celebrity Cabinet. The new supporters will donate their time and efforts not only during emergencies but to prepare others for emergencies and disasters. They are:

• Julianne Hough, country singer and professional ballroom dancer
• Anika Noni Rose, Tony Award-winning actress and singer (“The Princess and the Frog”)
• Demi Lovato, recording artists and TV star
• Sally Pressman, actress (Lifetime’s “Army Wives”)
• Amanda Peet, actress (Important Things with Demetri Martin)

What’s being celebrated?

August 19 was World Humanitarian Day
Last Wednesday, Augustt 19 was World Humanitarian Day, a day dedicated to pay tribute to humanitarian aid workers who work to help during emergencies, be they caused by natural disasters or armed conflicts. These workers often put their lives at risk. Thus, it is also a day to remember those workers who lost their lives in service of humanity.

What’s contaminated?

Cocaine Contaminates Majority of U.S. Currency
90% of US dollar bills tested was found to contain traces of the illegal drug cocaine. This is up from 67% two years ago.. Levels of cocaine ranged from .006 micrograms to more than 1,240 micrograms-the equivalent of 50 grains of sand-on U.S. bills, and $5, $10 and $20 bills on average carried more contamination than $1 or $100 bills. The bills were sample from 18 US cities and Washington, Baltimore, Boston and Detroit have the highest levels. Other currencies which tested with high levels were Canadian dollars (85%) and Brazilian reals (80%). The rate of contamination is due to the prevalent use of rolled up bills to snort cocaine powder.

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