Showing posts with label role. Show all posts
Showing posts with label role. Show all posts
The Role Of The Environment In The Development Of Diabetes
Tuesday, May 20, 2014
The results of two studies published in Diabetes Care, one in 20061, and one in 20072, both led by Dr. Duk-Hee Lee, reveal a significant association between environmental pesticides and type 2 diabetes.The first study was a cross sectional analysis involving 2,016 adult participants from the National Health and Nutrition Examination Survey of 1999–2000. It examined the relationship between toxic persistent organic pollutants (POPs) and diabetes.
After adjusting for age, sex, race/ethnicity, poverty income ratio, BMI, and waist circumference, the odds ratios (ORs) were 1.0, 16.9, 15.8, 36.7, and 38.0 (P for trend < 0.001), for five categories of exposure. That means there was a 38-fold greater odds of having diabetes for those in the highest exposure group compared to those in the lowest exposure group.*
Another interesting finding of this study was that being obese was not associated with having diabetes if the subjects blood levels of POPs were low. So, being thin but having high levels of POPs could place you at greater risk for diabetes than being overweight but having low levels.
* This study cited the source of many of these toxins: "Greater than 90% of POPs comes from animal foods in the general population without occupational or accidental exposures."
The second study was a cross-sectional analysis involving 749 nondiabetic adults. It examined the relationship between POPs and insulin resistance.
The adjusted odds ratios were 1.8 for being equal to or above the 50th percentile for insulin resistance, 4.4 for the 75th percentile, and 7.5 for the 90th percentile. So, there was almost an 8-fold greater odds of having insulin resistance for those in the highest exposure group than the lowest.
The strongest associations were found for organochlorine (OC) pesticides or nondioxin-like polychlorinated biphenyls (PCBs).
An interesting finding of this study was that the association between OC pesticides and insulin resistance strengthened as waist circumference increased, suggesting that POPs may interact with obesity to increase the risk of type 2 diabetes.
Finally, a commentary that appeared in the January 26th edition of The Lancet3 drew attention to Dr. Lees findings:
"This result was a surprise for many people working in diabetes research, because most studies to date have focused on the effects of genetics and the westernisation of dietary habits and lifestyle, while ignoring the potential effect of xenobiotics."And note that:
"... an increasing number of reports suggest that chronic dietary exposure to, and accumulation of, low concentrations of environmental pollutants within the body might also be associated with diabetogenesis."
1 A Strong Dose-Response Relation Between Serum Concentrations of Persistent Organic Pollutants and Diabetes
2 Association Between Serum Concentrations of Persistent Organic Pollutants and Insulin Resistance Among Nondiabetic Adults
3 Environmental Pollution And Diabetes: A Neglected Association, The Lancet, Vol. 371, No. 9609, 26 January 2008.
The crucial role of the amount of water
Wednesday, April 30, 2014
Most people know they should drink plenty of water every day, but how many actually do?
You really if you pay close attention to your water intake maybe youd be surprised how little you actually consume.
What makes the appropriate amount of water so important amazingly?
Well for starters, its the most abundant element in the body. Ranked 2 only to oxygen as essential for life. Can survive your body for weeks without food, but without water you had died within a few days.
% Is made almost 80water of the body is composed of water, the brain is 85% water and lean muscle tissue is 70% water.
Research has shown that being a little dried up can reduce the strength and physical performance significantly. In fact, just a drop in water levels of 3-4% in the body leads to a 10-20% decrease in muscle contractions.
Water will not only increase your strength, but it also plays a big role in the prevention of injuries in the gym. Can be trained very intensely over a long period of time putting more pressure on the joints unwanted and connective tissue, and water helps to combat this tension by lubricating the joints and the formation of protective cushion around them.
The Remarkable Consensus Over the Next Steps for Health Reform Including the Role of Population Health Management
Friday, March 28, 2014
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| Lets fix it! |
Their important insight is that the Bipartisan Policy Center, Brookings Institution, Commonwealth Fund, Kaiser Family Foundation, the National Coalition on Health Care, Partnership for Sustainable Health Care and Urban Institute all have a remarkable degree of overlap in their recommendations for the next phases of health orm.
Most of these expert organizations agree on the merits of value-based payment as well as insurance orm (pay for quality), information technology, competition, tort orm, evidence-based benefit design (paying when theres evidence that it works), workforce changes (greater efficiency), orming Medicare, changing tax policy (the exemption for health insurance) and instituting regional or local caps (stick to a budget or theres consequences).
The DMCB wholeheartedly agrees and hopes that the bipartisan consensus evident among these think-tank institutions leads Congress (if not this one, the next) and the President (if not this one....) to use these ingredients to build on the successes and correct the many deficiencies of the Affordable Care Act.
And the lapse?
Jack Lewin et al were missing one thing. The DMCB looked in each of these organizations web sites and found that there was also considerable support for population health management.
To wit:
The Bipartisan Policy Center - while the emphasis of this report is on health information technology, the real dividends are pretty clear when it mentions "population health" 14 times:
This plan should address the development and adoption of policies and standards needed for the delivery of care, the empowerment of individuals, and improvements in population health based on national health and health care priorities.
The Commonwealth Fund:
Effective population health management requires fundamental change in care delivery that must be supported by changes in payment.
National Coalition
Real orm means engaging consumers in their own health and health care choices. In both Medicare and too many private plans today, benefit design neither supports self-management of chronic disease nor distinguishes between care that is effective and care that is not.
Partnership for Sustainable Health Care - see page 22:
Federal nurse education funding should be ocused to equip registered nurses to assume the roles of case manager and population health coordinator.
The Urban Institute - see page 17 on the topic of Medicaid orm:
States can start in select geographic areas or specific population groups (adults and children or specific chronic conditions), and then incrementally expand them after learning from experience and making program improvements and adjustments. Broader efforts typically mean additional stakeholders, increased collaboration and communication.
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