Health for life

Consumption of whole walnuts or their extracted oil can reduce cardiovascular risk through a mechanism other than simply lowering cholesterol, according to a team of Penn State, Tufts University and University of Pennsylvania researchers.

"We already know that eating walnuts in a heart-healthy diet can lower blood cholesterol levels," said Penny Kris-Etherton, Distinguished Professor of Nutrition, Penn State. "But, until now, we did not know what component of the walnut was providing this benefit. Now we understand additional ways in which whole walnuts and their oil components can improve heart health."

In a randomized-controlled trial, the researchers gave 15 participants with elevated blood cholesterol one of four treatments -- either 85 grams of whole walnuts, 6 grams of skin, 34 grams of defatted nutmeat, or 51 grams of oil. The team evaluated biochemical and physiological responses in the participants before the treatments were administered and again 30 minutes, one hour, two hours, four hours and six hours after administering the treatments. The researchers repeated this process for each of the remaining three treatments.

Results -- which will appear in the June 1 issue of the Journal of Nutrition and are now online -- showed that a one-time consumption of the oil component in walnuts favorably affected vascular health. In addition, consumption of whole walnuts helped HDL -- good cholesterol -- perform more effectively in transporting and removing excess cholesterol from the body.

"Our study showed that the oil found in walnuts can maintain blood vessel function after a meal, which is very important given that blood vessel integrity is often compromised in individuals with cardiovascular disease," said Claire Berryman, graduate student in nutritional sciences, Penn State. "The walnut oil was particularly good at preserving the function of endothelial cells, which play an important role in cardiovascular health."

According to the researchers, walnuts contain alpha-linolenic acid, gamma-tocopherol and phytosterols, which may explain the positive effects of the walnut oil treatment.

"Implications of this finding could mean improved dietary strategies to fight heart disease," said Berryman. "The science around HDL functionality is very new, so to see improvements in this outcome with the consumption of whole walnuts is promising and worth investigating further."

Further studies are needed to determine the mechanisms that account for cardiovascular disease risk reduction with walnut consumption, according to Kris-Etherton.

"Our study indicates that simple dietary changes, such as incorporating walnuts and/or their oil in a heart healthy diet, may reduce the risk of heart disease," she said.

Talk about a compelling story that went ignored.
In the November 19 issue of the Annals of Internal Medicine, Caroline Lubick Goldzweig and colleagues examined the published science on the purported advantages of electronic health record (EHR) portals.

Recall that portals are web-based entryways that on-line health consumers can reportedly use to access their records, request medications, correspond with their doctors, manage their health conditions, reduce health care costs, increase U.S. life expectancy, reduce our national dependency on jumbo-sized sugary drinks and fix everything else that ails the U.S. health system.

Unfortunately, facts have intruded.  After looking at fourteen randomized prospective trials, 21 observational, hypothesis-testing studies, five descriptive studies and six qualitative studies, the authors concluded...

 "...evidence that patient portals improve health outcomes, cost, or utilization is insufficient."

Ouch. 

In particular, any impact on diabetes care was short-lived or nonexistent, patients with heart failure had no meaningful improvement, blood pressure control did not improve and adherence to prevention recommendations were marginal.  One observational study found persons with heart failure were more likely to use the emergency room.  The only study that found any benefit involved a single randomized control trial that examined the impact of portals in the co-management of depression.

After looking at this review, depressed advocates of EHR portals may have to personally use their own portals to communicate with their docs health care medical neighborhood.

The only good news is that there were some data that suggested that a substantial number of consumers liked using the portals.  But the DMCB likes channel surfing too, but that doesnt mean that the spouse agrees that its television-watching quality has improved or that the cost of all those premium channels is moderating.

The authors pointed out that it was difficult to isolate the impact of a portal vs. a portal plus care management.  To the DMCB, that means that portals are at best a means-to-an-end of enabling care managers to better communicate with their enrollees. 

To the thousands of DMCB readers, that is not a surprise.

In the meantime, the Feds and the NCQA have one more reason to re-examine their many cherished assumptions about health information technology and the stand-alone electronic record. The last time the DMCB looked, the federal government continues to extoll portals stand-alone virtues. The National Committee on Quality Assurance (NCQA) still includes two way communication for appointments, errals and prescription errals as a standard for the medical home.  Finally, the Feds promotion of the electronic health record (EHR) approves of portals as an option in meeting meaningful use criteria.

Image from Wikipedia

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, Sweden, report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the babys pacifier.

Allergies are very common in industrialized countries. It has been suggested that exposure to harmless bacteria during infancy may be protective against the development of allergy. However, it has been difficult to pinpoint which bacteria a baby should be exposed to, and at what time and by which route this exposure should ideally occur.

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, now report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the babys pacifier.

In a group of 184 children, who were followed from birth, the researchers registered how many infants used a pacifier in the first 6 months of life and how the parents cleaned the pacifier. Most parents rinsed the pacifier in tap water before giving it to the baby, e.g., after it had fallen on the floor. However, some parents also boiled the pacifier to clean it. Yet other parents had the habit of putting the babys pacifier into their mouth and cleaning it by sucking, before returning it to the baby.

It was found that children whose parents habitually sucked the pacifier were three times less likely to suffer from eczema at 1.5 years of age, as compared with the children of parents who did not do this. When controlled for other factors that could affect the risk of developing allergy, such as allergy in the parents and delivery by Caesarean section, the beneficial effect of parental sucking on the pacifier remained.

Pacifier use per se had no effect on allergy development in the child. Boiling the pacifier also did not affect allergy development in a statistically proven fashion.

No more upper respiratory infections were seen in the children whose parents sucked on their dummies, as compared with the other children, as evidenced by diaries kept by the parents in which they noted significant events, such as infections.

Saliva is a very rich source of bacteria and viruses, and the researchers believe that oral commensal microbes are transferred from parent to infant when they suck on the same pacifier. When the composition of the bacterial flora in the mouth was compared between infants whose parents sucked on their pacifiers and those whose parent did not, it was found to differ, supporting this hypothesis.

According to "the hygiene hypothesis", the development of allergy can be attributed in part to a paucity of microbial stimulation during early infancy.

"Early establishment of a complex oral microflora might promote healthy maturation of the immune system, thereby counteracting allergy development", says professor Agnes Wold who led the study.

The study, which is published in the scientific journal Pediatrics, was performed by a team that consisted of paediatricians specialized in allergic diseases, as well as microbiologists and immunologists. The research team has previously conducted large-scale studies on the gut microbiota in relation to allergy development and showed in 2009 that a complex gut microbiota very early in life reduces the risk of allergy development.

A CAT scan. Wheres that big spleen?

Years ago, the Disease Management Care Blog ordered an abdominal CAT scan for one of its patients. The study was reassuringly normal except for the unexpected - and most likely benign - finding of an enlarged spleen. In the absence of any other worrisome findings, the interpreting radiologist recommended that another CAT scan should be done in six months to make sure it wasnt getting bigger. The patient agreed. The DMCB then fired up the electronic health record (EHR), scheduled the CAT scan order for six months, closed the encounter and moved onto the next patient.

Approximately one year later the patient returned for an appointment. Thats when it was discovered that the CAT scan had never been scheduled. The DMCB was later told that the EHR wasnt configured to schedule tests 6 months in advance.*

Its on behalf of patients like this and their physicians that the DMCB welcomes this Institute of Medicine report on Health IT and Patient Safety. It recognizes what most front-line EHR-using physicians have known for years:

"The evidence in the literature about the impact of health information technology (IT) on patient safety, as opposed to quality, is mixed but shows that the challenges... involve people and clinical implementation as much as the technology. The literature describes significant improvements in some aspects of care in health care institutions with mature health IT.  For example, the use of computerized prescribing and bar-coding systems has been shown to improve medication safety. But the generalizability of the literature across the health care system may be limited. While some studies suggest improvements in patient safety can be made, others have found no effect. Instances of health IT–associated harm have been reported. However, little published evidence could be found quantifying the magnitude of the risk." (bolding from the DMCB)

In other words, selective reporting involving best case scenarios fail to account for the reality that the old safety issues of a paper-based system are being displaced by new safety issues of an IT system and, whats worse, we dont know the extent of the problem.

Here are the IOMs (paraphrased) recommendations to Health and Human Services (HHS):

1. HHS, working with the EHR vendors, should develop a health IT surveillance plan.

2. HHS should foster the free exchange of information and address the "legal clauses" in contracts that shift liability from the vendors to the doctors (The AMA has erred to these as "hold harmless" clauses).

3. Data is needed that allows health IT users to publicly compare and share experiences among multiple vendors.

4. "A Health IT Safety Council" that assesses and monitor health IT safety should be established.

5. A public register of all health IT vendors should be established.

6. Its time to specify those processes that reduce risk and make the vendors adopt them.

7. Health IT related deaths, serious injuries and unsafe conditions need to be centrally reported.

8. An independent federal entity should be established that is empowered to any investigate deaths, injuries or unsafe conditions.

9. HHS should report annually on its progress.

10 More cross-disciplinary research is needed to improve the design, testing and use of health IT.

Bravo says the DMCB, bravo!



*many of the facts are changed, but you get the gist

Disease Management Care Blog readers may recall this post on the benefits of exercise in combating depression among persons with chronic disease. Thanks to the GlassHospital, the DMCB became aware of this entertaining, informative, accurate and savvy video on the benefits of putting limits on sitting, eating and sleeping to 23 1/2 hours a day.

Its very interesting:



Contrast the video above (by the way, its Canadian) with this CDC website (and practically nothing from the Feds on YouTube) and ask yourself two questions:

1) which approach to health promotion more likely to have a greater impact, and

2) is Washington D.C. really giving the taxpayers their moneys worth when it comes to awareness of the benefits of prevention?

How to Get Your Children to Eat Their Greens - As adults we know just how important it is that we get our greens and our fruit in our diet. We know that its here that we get the all-important minerals and nutrients that ensure we have strong bones, that ensure we have healthy teeth and nails, and that help us to avoid getting colds and other illnesses by keeping our immune system strong.

However the unfortunate fact is that kids dont know all this as well, and that they only really see vegetables and fruit as a frustrating obstacle to getting their pudding. This is the reason for the age old war between kids and parents that come every dinner time and makes meals a lot more dragged out and a lot less pleasant than they otherwise could be.

Here we will look at how to keep your kids happily eating their greens so that you can avoid a fight and keep them healthy and strong.

Dont Make a Big Deal of It
One mistake a lot of parents make is to make a big deal of their children eating their greens and to draw a lot of attention to them in the process. If you say to your children make sure you eat all your greens before they have even started eating, then this is only going to have the effect of making them not want to at all; no one ever wants to do something theyre told to do...

Likewise if they really dont want to eat something then theres no point in absolutely forcing them to or making them sit there for hours – its not worth it for one last carrot and all it will do is scar them and completely put off vegetables forever. Let them win some battles, as long as you win the war...

Mix Them In
At the same time you can easily trick your children into eating a lot of fruits and vegetables without them really being aware if you mix them into bigger meals. Stews for instance are ideal ways to sneak the veg into their diet, and this way even if they are crafty and decide to try and eat around the vegetables, they will still get a lot of goodness simply from the gravy and the sauce which will have absorbed some of the nutrients and goodness – lets see them wriggle out of that one!

Likewise you can also include fruit and vegetables in other ways that are less obvious – for instance you can put fruit onto your childrens morning cereal (bananas or strawberries for instance) and you can even include it in deserts – like meringue but with sliced fruits on top. This way they will actually look forward to their fruit.

Think Outside the Box
If your child absolutely loathes the sight of broccoli then theres no point in having an unpleasant stand off every night – dinner time should be an enjoyable time for the whole family. Instead then concede to the vegetables they dont like, and instead think about using some of the fruit they maybe dont know about next time. Maybe you could have some aubergine or some cauliflower, or some swede. There must be something they like... right?

Change the Presentation
Meanwhile you might also find that they simply dont like the vegetables the way youre doing them. If they wont eat cauliflower for instance, then they may eat cheesy cauliflower. Likewise if they dont like carrots, then try grated carrot with suede.

Blend
And in general grating things is a great way to get your children to eat them. So they wont eat the carrots in your bolognaise? Then try just grating the carrot on top of the spag and they wont even be able to see it. Likewise you can blend fruits up into a juice, or you can even give them soup or ice cream with the nutrition too finely chopped to see.

Dont Be Fooled
Dont be fooled last of all by foods and particularly puddings that claim to be one of your childrens five a day. Very rarely is this true, and even if it is it probably wont contain the same fiber content. Real fruit and veg is always preferable to things claiming to have the same benefits.