Health for life

Science and technology may be making a nation be great. However, the progress of a nation would be difficult to achieve if you do not have one of the important foundations, namely health.

However, public awareness of the importance of health has not been adequate. Based on data from 2010 Health Research Association, the national percentage of people who smoke every day as much as 28.2 percent of households have latrines new healthy 55.4 percent, mothers who do a pregnancy with a 6-8 type of examination is only 56.8 percent, and the habit of washing hands with soap less than 34 percent.

The incidence of various infectious diseases in Indonesia, such as diarrhea, thypus, and dysentery are also quite high. Outbreaks of diarrhea were reported in 16 provinces in 2006 (according to World Bank data). Meanwhile thypus cases in Indonesia the average estimate of 900,000 cases per year and 91 percent occurred at the age of 3-19 years.

In fact, infectious diseases can be prevented with simple and inexpensive steps such as washing hands with soap. A study conducted Katie Greendland from the London School of Hygiene & Tropical Medicine, UK, found that washing hands with soap at critical time can prevent the incidence of diarrhea by up to 47 percent.

Conversely, do not wash hands with soap at critical moments can cause diarrhea, including cholera, pneumonia, influenza pandemic, the new-born infections, and infections among AIDS patients.

"The bacteria that cause diarrhea are actually derived from human waste brought flies, water, soil, and fingers that contaminate food. Prevention is quite simple, ie, good sanitation and hand washing with soap," he said in media education held PT.Unilever Indonesia in Jakarta (14/10/11).

World Health Organization (WHO) also stated that both of our hands is the main route entry of germs into the body. That is why, in addition to running a healthy lifestyle, the habit of washing hands with soap will reduce and prevent the occurrence of disease.

But the fact is, the people of Indonesia have not been considered important hand washing. This was lected in the research conducted Yunita Wahyuningrum, health communication researchers from the Johns Hopkins Bloomberg School of Public Health, which found lack of awareness in the public health aspects.

From her research revealed a new community washing her hands using soap if hands look dirty or smelly. "Visual aspect to be a major boost in washing hands with soap. If hands look clean, then they suggest washing hands using enough water," she said.

Added to her, people still consider washing hands with soap is a waste of time activities. "The reasons do not have the sink is also a major cause of why many people are reluctant to wash her hands," she added.

Coffee consumption is associated with a lower risk of prostate cancer recurrence and progression, according to a new study by Fred Hutchinson Cancer Research Center scientists that is online ahead of print in Cancer Causes & Control.

Corresponding author Janet L. Stanford, Ph.D., co-director of the Program in Prostate Cancer Research in the Fred Hutch Public Health Sciences Division, conducted the study to determine whether the bioactive compounds in coffee and tea may prevent prostate cancer recurrence and delay progression of the disease.

Stanford and colleagues found that men who drank four or more cups of coffee per day experienced a 59 percent reduced risk of prostate cancer recurrence and/or progression as compared to those who drank only one or fewer cups per week.

They did not, however, find an association between coffee drinking and reduced mortality from prostate cancer, although the study included too few men who died of prostate cancer to address that issue separately.

First study to assess the link between tea and prostate cancer outcomes

Regarding tea consumption, the researchers did not find an associated reduction of prostate cancer recurrence and/or progression. The study also did not draw any conclusions regarding the impact of tea drinking on prostate-specific death.

“To our knowledge, our study is the first to investigate the potential association between tea consumption and prostate cancer outcomes,” the authors wrote. “It is important to note, however, that few patients in our cohort were regular tea drinkers and the highest category of tea consumption was one or more cups per day. The association should be investigated in future studies that have access to larger populations with higher levels of tea consumption.”

The population-based study involved 1,001 prostate cancer survivors, aged 35-74 years old at the time of diagnosis between 2002-2005, who were residents of King County, Wash. Participants answered questions regarding their diet and beverage consumption two years prior to prostate cancer diagnosis using a validated food frequency questionnaire, and were interviewed about demographic and lifestyle information, family history of cancer, medication use and prostate cancer screening history.

The researchers followed up with patients more than five years after diagnosis to ascertain whether the prostate cancer had recurred and/or progressed. Those who were still living, willing to be contacted and had been diagnosed with non-metastatic cancer were included in the follow-up effort.

Of the original 1,001 patients in the cohort, 630 answered questions regarding coffee intake, fit the follow-up criteria and were included in the final analysis. Of those, 61 percent of the men consumed at least one cup of coffee per day and 12 percent consumed the highest amount: four or more cups per day.

The study also evaluated daily coffee consumption in relation to prostate cancer-specific death in 894 patients using data from the initial food frequency questionnaire. After the median follow-up period of eight-and-a-half years, 125 of the men had died, including 38 specifically from prostate cancer. Daily coffee consumption was not associated with prostate cancer-specific mortality or other-cause mortality, but with few deaths these analyses were limited.

“Our study differs from previous ones because we used a composite definition of prostate cancer recurrence/progression,” said first author Milan Geybels, a doctoral student at Maastricht University in the Netherlands who was a graduate student in Stanford’s Prostate Studies group at Fred Hutch when the study was conducted. “We used detailed information on follow-up prostate-specific antigen levels, use of secondary treatment for prostate cancer and data from scans and biopsies to assess occurrence of metastases and cause-specific mortality during follow up. Using these detailed data, we could determine whether a patient had evidence of prostate cancer recurrence or progression.”

The results are consistent with findings from Harvard’s Health Professionals Follow-up Study, which found that men who drank six or more cups of coffee per day had a 60 percent decreased risk of metastatic/lethal prostate cancer as compared to coffee abstainers.

Phytochemicals in coffee have anti-inflammatory and antioxidant effects

Further research is required to understand the mechanisms underlying the results of the study, but biological activities associated with consumption of phytochemical compounds found in coffee include anti-inflammatory and antioxidant effects and modulation of glucose metabolism. These naturally occurring compounds include:

Caffeine, which has properties that inhibit cell growth and encourage apoptosis, or programmed cell death. Previous studies have found that caffeine consumption may reduce the risk of several cancer types, including basal-cell carcinoma, glioma (a cancer of the brain and central nervous system) and ovarian cancer.
Diterpenes cafestol and kahweol, which may inhibit cancer growth.
Chlorogenic acid, which, along with caffeic acid, can inhibit DNA methylation, a biochemical process involved in the development and progression of many cancer types.
Additional studies needed to confirm whether coffee can prevent cancer recurrence

The researchers emphasize that coffee or specific coffee components cannot be recommended for secondary prevention of prostate cancer before the preventive effect has been demonstrated in a randomized clinical trial. Further, there’s ongoing debate about which components in coffee are anti-carcinogenic, and additional large, prospective studies are needed to confirm whether coffee intake is beneficial for secondary prevention.

Coffee drinking may even be problematic for some men, Geybels said.

“Although coffee is a commonly consumed beverage, we have to point out that increasing one’s coffee intake may be harmful for some men. For instance, men with hypertension may be vulnerable to the adverse effects of caffeine in coffee. Or, specific components in coffee may raise serum cholesterol levels, posing a possible threat to coronary health. Patients who have questions or concerns about their coffee intake should discuss them with their general practitioner,” he said.

The investigators also noted limits to their study, which included a lack of data on how coffee consumption might have changed following diagnosis, whether the coffee that participants consumed was caffeinated or decaffeinated, and how the coffee was prepared (espresso, boiled or filtered), a factor that may affect the bioactive properties of the brew.

Is that a fish eye or an EKG monitor?

While the sputtering skeptics in medical academia continue to demonstrate what doesnt work, the telemonitoring industry continues to evolve at a furious pace.

To wit:

Publishing in the Archives of Internal Medicine, Mayo Clinic researcher Paul Takahashi and colleagues examined the impact of telemonitoring by randomly assigning high risk and community dwelling elderly patients to either:

1) daily use of a multifunctional blood sugar, breathing airflow, blood pressure, blood oxygen and weight monitoring device. The devices data feeds were "overseen" by a nurse who communicated with the patients as necessary and alerted the patients physicians.

or

2) to usual care. 

Over 500 persons were screened for study participation. Ultimately 102 were assigned to the device and 103 were assigned to usual care.  The average age of the participants was just over 80 years and the mean SF-36 quality of life score was 35.

During the twelve months of follow-up, 89% of the planned telemonitoring was completed.
 
Compared to the usual care group, the persons assigned to the telemoniting had an increased rate of having had at least one hospitalization or an emergency room visit: 64% vs. 57%. This difference, however, failed to achieve statistical significance. Looking at the individual measures that made up the composite index likewise showed no meaningful outcomes differences between telemonitoring or usual care.  The only thing that was statistically different was the death rate, which was increased in the telemonitoring group: 15% vs. 4% (p=0.008).

The authors concluded that telemonitoring did not work.

The authors also pointed out that their study had limitations. It wasnt blinded, the results may not be applicable outside the Mayo system and the outcomes were based on billing, not medical, records. They also recognize that the difference in death rates could indicate that, despite randomization, there may have been a preponderance of "healthier" persons in the control group. That could have biased the results.

The Disease Management Care Blog agrees that those are limitations, but it also also offer three additional observations:

1. The mean SF-36 score of 35 and age of 80 suggests this was a very sick group of patients.  As the DMCB has pointed out before, telemonitoring-backed population health management is better suited for those patients who are in the "sweet middle" between the catastrophically ill on one side and those who are stable on the other.  Persons in their 80s with a low SF score are frail elderly who warrant a more intensive case management program. In other words, they are probably destined to be high consumers of health care resources no matter what you do.

2. The study was performed at Mayo, where health care utilization is notoriously low. So, while the study population was sick, they were already in a system and a Minnesota culture configured to only use the hospital and emergency room when it was really necessary.

3. Just because the data is given to the patients physicians, it doesnt follow that they can act on it. Raw telemonitoring is notorious for not fitting into a physicians office workflows.

In other words, telemonitoring is not a panacea for any sick patient anywhere in the United States. The DMCB thinks its an excellent option in areas of the U.S. where baseline utilization is high. It should be offered to patients who are most likely to benefit: those with moderate levels of risk that can be mitigated.

As an aside, the DMCB notes that 10% of the telemonitoring was never completed. Enter mc10s "stretchable silicon technology" that can apparently be stretched and wrapped over a patients skin in a fashion that makes it resemble a tattoo. Given its ease of use, the DMCB suspects that once its ready for prime time, a) 100% compliance b) use by the right patients and c) being adapted to clinical workflows, it will represent a high value proposition. Thats where the population health management service providers and vendors will come in.

Of course, by the time the academic community passes judgement on that, the industry will have moved on.

Image from Wikipedia

Eating an apple a day might in fact help keep the cardiologist away, new research suggests.

In a study of healthy, middle-aged adults, consumption of one apple a day for four weeks lowered by 40 percent blood levels of a substance linked to hardening of the arteries.

Taking capsules containing polyphenols, a type of antioxidant found in apples, had a similar, but not as large, effect.

The study, funded by an apple industry group, found that the apples lowered blood levels of oxidized LDL -- low-density lipoprotein, the "bad" cholesterol. When LDL cholesterol interacts with free radicals to become oxidized, the cholesterol is more likely to promote inflammation and can cause tissue damage.

"When LDL becomes oxidized, it takes on a form that begins atherosclerosis, or hardening of the arteries," said lead researcher Robert DiSilvestro, professor of human nutrition at Ohio State University and a researcher at the universitys Ohio Agricultural Research and Development Center. "We got a tremendous effect against LDL being oxidized with just one apple a day for four weeks.”

The difference was similar to that found between people with normal coronary arteries versus those with coronary artery disease, he said.

The study is published online in the Journal of Functional Foods and will appear in a future print edition.

DiSilvestro described daily apple consumption as significantly more effective at lowering oxidized LDL than other antioxidants he has studied, including the spice-based compound curcumin, green tea and tomato extract.

“Not all antioxidants are created equal when it comes to this particular effect,” he said.

DiSilvestro first became interested in studying the health effects of eating an apple a day after reading a Turkish study that found such a regimen increased the amount of a specific antioxidant enzyme in the body.

In the end, his team didnt find the same effect on the enzyme, but was surprised at the considerable influence the apples had on oxidized LDL.

For the study, the researchers recruited nonsmoking healthy adults between the ages of 40 and 60 who had a history of eating apples less than twice a month and who didnt take supplements containing polyphenols or other plant-based concentrates.

In all, 16 participants ate a large Red or Golden Delicious apple purchased at a Columbus-area grocery store daily for four weeks; 17 took capsules containing 194 milligrams of polyphenols a day for four weeks; and 18 took a placebo containing no polyphenols. The researchers found no effect on oxidized LDLs in those taking the placebo.

“We got a tremendous effect against LDL being oxidized with just one apple a day for four weeks.”

"We think the polyphenols account for a lot of the effect from apples, but we did try to isolate just the polyphenols, using about what youd get from an apple a day," DiSilvestro said. "We found the polyphenol extract did register a measurable effect, but not as strong as the straight apple. That could either be because there are other things in the apple that could contribute to the effect, or, in some cases, these bioactive compounds seem to get absorbed better when theyre consumed in foods."

Still, DiSilvestro said polyphenol extracts could be useful in some situations, "perhaps in higher doses than we used in the study, or for people who just never eat apples."

The study also found eating apples had some effects on antioxidants in saliva, which has implications for dental health, DiSilvestro said. He hopes to follow up on that finding in a future study.

Drinking two cups of hot chocolate a day may help older people keep their brains healthy and their thinking skills sharp, according to a study published in the August 7, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study involved 60 people with an average age of 73 who did not have dementia. The participants drank two cups of hot cocoa per day for 30 days and did not consume any other chocolate during the study. They were given tests of memory and thinking skills. They also had ultrasounds tests to measure the amount of blood flow to the brain during the tests.

"Were learning more about blood flow in the brain and its effect on thinking skills," said study author Farzaneh A. Sorond, MD, PhD, of Harvard Medical School in Boston and a member of the American Academy of Neurology. "As different areas of the brain need more energy to complete their tasks, they also need greater blood flow. This relationship, called neurovascular coupling, may play an important role in diseases such as Alzheimers."

Of the 60 participants, 18 had impaired blood flow at the start of the study. Those people had an 8.3-percent improvement in the blood flow to the working areas of the brain by the end of the study, while there was no improvement for those who started out with regular blood flow.

The people with impaired blood flow also improved their times on a test of working memory, with scores dropping from 167 seconds at the beginning of the study to 116 seconds at the end. There was no change in times for people with regular blood flow.

A total of 24 of the participants also had MRI scans of the brain to look for tiny areas of brain damage. The scans found that people with impaired blood flow were also more likely to have these areas of brain damage.

Half of the study participants received hot cocoa that was rich in the antioxidant flavanol, while the other half received flavanol-poor hot cocoa. There were no differences between the two groups in the results.

"More work is needed to prove a link between cocoa, blood flow problems and cognitive decline," said Paul B. Rosenberg, MD, of Johns Hopkins School of Medicine in Baltimore, who wrote an editorial accompanying the study. "But this is an important first step that could guide future studies."