Health for life

Researchers from New England found that men who slept either less than 6 hours, or greater than 8 hours, increased their risk for type 2 diabetes. That risk remained after adjustments were made for age, hypertension, smoking status, self-rated health status, education, and waist circumference.

These results suggest that even though you have a handle on your weight, blood pressure and smoking, you may still court a diagnosis of diabetes if your sleep is consistently short-changed, or over-indulged.

The study included 1564, primarily white men, aged 40 to 70, who were enrolled in the Massachusetts Male Aging Study (MMAS), and who did not have diabetes at baseline. The men were followed for up to 15 years. Similar, although less marked results were found in women who partook in the Nurses Health Study.

The study appears in the March 2006 issue of Diabetes Care.

________
For the MMAS study:
Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes

For a summary of the MMAS study:
Diabetes Risk Raised By Too Much Or Too Little Sleep

For the Nurses Health Study:
A Prospective Study of Self-Reported Sleep Duration and Incident Diabetes in Women

Women who exercise regularly spend as much time sitting as women who don’t, according to a new Northwestern Medicine study.

Emerging research shows that prolonged sitting has significant health consequences---and the new Northwestern study suggests that being a dedicated exerciser doesnt prevent women from spending too much of their day sitting.

This research is the latest indication that public health recommendations should be established to encourage Americans to limit the amount of time they spend sitting every day, said Lynette L. Craft, first author of the study and an adjunct assistant professor in preventive medicine at Northwestern University Feinberg School of Medicine.

“We all know someone who gets a good workout in every day, but then spends a large portion of their day sitting in front of a computer with few breaks,” Craft said. “If these people could replace some of the sitting with light activity---just getting up, moving around, maybe standing up when talking on the phone, walking down the hall instead of sending an email---we do think they could gain health benefits.”

The Northwestern research was done in collaboration with Ted Zderic, of the Pennington Biomedical Research Center and was published in the International Journal of Behavioral Nutrition and Physical Activity.

Past studies have shown that people who sit for extended periods of time---even those meeting exercise recommendations---are more likely to develop chronic conditions such as diabetes, obesity, cardiovascular disease and some cancers.

This was the first study to use an objective measuring device to examine the relationship between the type of exercise recommended in the government’s Physical Activity Guidelines for Americans and sitting. The guidelines recommend adults engage in a minimum of 150 minutes of moderate intensity aerobic activity every week. Previous studies on physical activity and sitting have primarily relied on self-reported data.

While many of the women in the study met or exceeded 150 minutes of physical activity per week, in reality only a fraction of the women’s days were spent being physically active. The women in the study spent an average of nine hours a day sitting. That number is consistent with previous results from much larger studies that examined the number of hours Americans spend sitting every day.

“I think some people assume, ‘If I’m getting my 30 to 40 minutes of physical activity a day, I’m doing what I need to do for my health,’” Craft said. “Of course, exercise is very important and is associated with many positive health benefits, but negative health consequences are associated with prolonged sitting, and this study shows that just because you’re physically active doesn’t mean you’re sitting less.”

For the study, 91 healthy women ranging in age from age 40 to 75 wore an activPAL activity monitor device during waking hours for one week. The device, which was worn on the thigh, recorded time spent sitting, standing and stepping, and engaging in sustained 10-minute bouts of moderate-to-vigorous physical activity.

Trying to replace some sitting time with more light activity throughout the day---along with the recommended bouts of moderate and vigorous exercise---is an approach more Americans should try to take, Craft said.

Future studies are needed to further examine the relationship between the type of exercise recommended in the Physical Activity Guidelines for Americans and sitting. For example, various subgroups such as men, children and the elderly should also be studied, Craft said.

The Lynn Sage Breast Cancer Foundation, the Avon Foundation and the Edward G. Schlieder Educational Foundation supported the study.

You know when its August, but your iPod thinks its December, and it plays "Do They Know its Christmas," and you find yourself silently mouthing "Tonight thank god its them, instead of YOUUUUUUUUUUUUUU" at a nice Asian man who clearly thinks youre about to steal his bag of lychees?

I love that.

I also love bread, but have never in my whole puff attempted to make it until this summer, assuming it was roughly as complicated as re-wiring the Hadron Collider. Then, it dawned on me that, a few years ago, Mark Bittman  published a recipe for five-minute, idiot-proof, no-knead artisan bread. Its since been updated and ined by half the population of Guam, but the essentials are there: four ingredients, a bowl, a pot, and time. So I tried it myself, and whaddayaknow? Its the best. Seriously. In all seriousness. Squared. I will eat this and nothing else until I die, presumably, of choking on bread.

Heres how you make it. (Do it! Well have a bread party.)

First, gather your ingredients. They are:

• 3 cups of bread flour


• 1 little packet of active dry yeast


• 1 1/2 teaspoons salt


• 1 1/2 cups lukewarm water

If you plan on making this baby a lot in the future, bite the $4 bullet and purchase a package of yeast from CostCo or something. It is approximately four billion times cheaper than buying it envelope by envelope, a.k.a What Im Currently Doing.


Second, you get a large, non-reactive mixing bowl and combine your dry ingredients, a.k.a. The Ingredients You Didnt Get From the Tap.


Third, add water and stir until it becomes a spongy, dough-like mass, a.k.a. Mr. Squishy. Dont overstir, or something bad will happen. Im not exactly sure what, but arent you scared now?


Fourth, cover that baby. With plastic and rubber bands. Then, leave it out for at least four hours, but for as long as several days, rigerating after those first 240 minutes. (Note: The longer it sits, the better it will taste. Ive gone up to three days.) If you have a cat thats prone to eating dough (er, not that I know any cat like that) ...


... hide it somewhere, like the Cave of Caerbannog, where it will be guarded by a rabbit so foul, so cruel, that no man (or cat) has yet fought with it and lived.


A cabinet will also be sufficient.

Eventually, your dough will expand like crazy, to about three times its former size. It will also appear softer and slightly wetter. (Note cat in lower part of photo, stalking wet dough for potential lunching. His lobotomy is scheduled for tomorrow.)


Fifth, cover a clean cooking surface (a counter, mayhaps) with a thin sheen of olive oil. Turn the dough out on to the surface, and fold it over two or three times. Cover everything with plastic wrap, and let it sit at least 30 minutes, but for up to 2 hours. If its been rigerated, it must be given enough time to come to room temperature. It must!


Sixth, while the dough lounges around, move your oven rack to the lower third of your oven. Then, preheat that sucker to 450 degrees F. Grab a pot or Dutch oven, cover it, and stick it in there, to warm along with the oven.

This is mine. Its a 3-quart hard anodized piece of Calphalon, but Im fairly sure any sizable, oven-safe covered pot will do. (Have doubts about yours? Look it up on the interwebs.)


Seventh, once everything is good to go, CAREFULLY remove the hot pot from the oven and VERY CAREFULLY place the dough into it. SUPER CAREFULLY cover it, and COLOSSALLY CAREFULLY place it back into your oven. Bake for 30 minutes. I CANT EVEN EXPRESS HOW CAREFULLY YOU SHOULD remove the cover. Bake an additional 15 minutes, or until the top of your bread is nicely browned. If you see it starting to burn, get it out of there.

Eighth, flip the bread out on to a wire cooling rack. It should look something like this:


And one more time, in black and white, for posterity:


Ninth, once its cool enough to handle, eat that bread. It may seem like a big loaf at first, but I promise on all that is good and pure, none of it will go to waste. Heres the above loaf, 30 seconds later:


And finally:


Happy baking!

Im baaaaack!

When persons are admitted to a hospital, insurers payment rates are based on the diagnosis, not the number of days in the hospital (known as a "length of stay").  As a result, once the admission is triggered, the hospital has important economic incentive to discharge the patient as quickly as possible.  The Disease Management Care Blogs physician colleagues used to refer to this as "treat, then street."

Unfortunately, discharging patients too soon can result in readmissions.  Thats why the DMCB has agreed with others that diagnosis-based payment systems and a policy of "no pay" for readmissions were working at cross purposes.  Unified bundled payment approaches like this seem to be a good start.

But thats all theoretical.  Whats the science have to say?

Peter Kaboli and colleagues looked at the push-pull relationship between diagnosis-based payment incentives  and the likelihood of readmissions in a scientific paper just published in the Annals of Internal Medicine. 

The authors used the U.S. Veterans Administration (VA) Hospitals "Patient Treatment Files" to examine length of stay versus readmissions in 129 VA hospitals.  The sample consisted of over 4 million admissions and readmissions (defined as within 30 days and not involving another institution) from 1997 to 2010. The mean age started out at 63.8 years and increased to 65.5 years, while the proportion of persons aged 85 years or older increased from 2.5% to 8.8%. Over the years, admissions also grew more complicated with a higher rate of co-morbid conditions, such as diseases of the kidney (from 5% to 16%).

As length of stay went down, readmissions should have gone up, right?

The answer was yes and no.

Yes, if the data were trended over time: Over the 14 year period of observation, the number of days in the hospital (length of stay or LOS) decreased from 6.0 days to 4.3 days.  Yet, as LOS decreased, readmissions also decreased from 16.6% to 15.2%. 

The decreases held up when the LOS was risk-adjusted for hospital and patient characteristics.  There was also no increase in mortality rates

No, if hospitals were compared to each other:  Hospitals with risk-adjusted low lengths of stay had higher readmission rates compared to their average peers.  In that group, each day of saved LOS was associated with a 6% increased rate of 30-day readmissions.

It gets even more complicated.  As the LOS increased beyond the average, each additional day in the hospital was associated with a 3% increased rate of 30-day readmissions.

What should the DMCB learn from these data?  Keeping in mind that the VA is not necessarily generalizable to the typical community medical center,

1. Over 14 years of worth of VA data for 129 hospitals suggest it is possible to have your cake (a lower LOS) and eat it too (lower readmissions).  Thats the good news.

2. While overall performance improved over the years, between hospital comparisons showed there is a "U" shaped relationship between days in the hospital and the likelihood of readmission.  The DMCB agrees with the authors: premature discharge before the patient is ready is associated with an 6% per day readmission rate, while patients who are very sick and have to stay a few extra days in the hospital are also at risk to the tune of 3% per day.  Thats the sobering news.

What are the implications?

Overzealous efforts to discharge patients can backfire with readmissions.  It appears theres an optimum length of stay that minimizes, but will never eliminate, readmissions.

Patients who do go home "too soon" or need extra days in the hospital appear to be at special risk.  Accountable care organizations and population health management service providers should use this information to target patients at special risk of "treat, street and... repeat."

Limit vigorous exercise to 30 to 50 minutes a day max, say researchers

Vigorous exercise is good for health, but only if its limited to a maximum daily dose of between 30 and 50 minutes, say researchers in an editorial published online in Heart.

The idea that more and more high intensity exercise, such as marathons, can only do you good, is a myth say the US cardiologists, and the evidence shows that its likely to more harm than good to your heart.

"If you really want to do a marathon or full distance triathlon, etc, it may be best to do just one or a few and then proceed to safer and healthier exercise patterns," they warn.

"A routine of moderate physical activity will add life to your years as well as years to your life. In contrast, running too far, too fast, and for too many years may speed ones progress to towards the finishing line of life."

"Chronic extreme exercise appears to cause excessive ‘wear-and-tear’ on the heart, inducing adverse structural and electrical remodelling, which offsets some of the CV benefits and longevity improvements conferred by moderate physical activity. Thus, even though chronic extreme exercise may not kill you, it may erase many of the health advantages of regular moderate exercise. "

The statin medications you take for your heart may have an unexpected side benefit: They help reduce inflammation of the gums, according to new research.

Using advanced imaging techniques, researchers were able to see that when people with gum disease took higher doses of the commonly prescribed cholesterol-lowering drugs, their gum inflammation decreased.

During the 12-week study, the researchers also looked for evidence of inflammation or hardening of the blood vessels (atherosclerotic disease) in the study volunteers, and they found that reduced gum inflammation was correlated with improved blood vessel health.

"There is a building, growing body of literature that draws a line between gum disease and atherosclerotic disease. In our study, benefits in the gums correlated with benefits in the arteries," said the studys senior author, Dr. Ahmed Tawakol, co-director of the Cardiac Imaging Trials Program at Massachusetts General Hospital and Harvard Medical School in Boston. "People with [gum disease] and atherosclerotic disease should likely be that much more vigilant in treating their gum disease."

The study was published online Oct. 2 in the Journal of the American College of Cardiology. Funding was provided by drug manufacturer Merck and Co., which does not produce the statin used in this study.

Currently, statins are prescribed to lower high levels of "bad" cholesterol, also known as LDL cholesterol. When theres too much LDL cholesterol, it can start to build up on blood vessel walls, leading to hardening of the arteries.

In the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.

According to editorial author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, a "consistent stream of data" shows that statins have benefits beyond their cholesterol-lowering properties.

"There are three big categories of how statins likely exert their effects: lowering LDL, reducing inflammation, and by modulating plaque," said Blaha.

The current study lends support to the idea that statins can reduce inflammation. It included 83 adults who had risk factors for, or already had, atherosclerosis. They were randomly assigned to take either 10 or 80 milligrams of a statin called atorvastatin (brand name Lipitor) for three months.

Everyone underwent imaging at the start of the study, again after four weeks and then at 12 weeks.

At the end of the study, the investigators had complete data on 59 people. They found a significant reduction in gum inflammation for the people taking 80 mg of atorvastatin compared to those on the 10-mg dose. Changes began as early as four weeks after people started taking the higher-dose drug.

There was a more significant reduction in gum inflammation for people who had more serious gum disease at the start of the study and took a higher dose of the statin. The researchers also found that a reduction in gum inflammation correlated with reduced blood vessel inflammation.

"It was really those on the higher-dose statins that had the benefit," noted Tawakol. But, "I would not recommend the use of statins outside the current guidelines," he added. "We see this trial more as a proof-of-principle trial. Our findings need to be confirmed in a larger clinical trial."

Still, he said, theres little harm in telling people to take care of gum disease. "Patients with known heart disease and known gum disease should have their gum disease evaluated and treated," Tawakol said.

Blaha agreed that its too soon to change practice guidelines either for treating heart disease risk factors or for gum disease.

Still, "this study and others like it have tremendous implications," Blaha said. "Weve never had a drug that worked this well and for so many different groups of patients."