From the New York Times
January 24, 2009
By NICHOLAS BAKALAR
Drinking coffee may do more than just keep you awake. A new study suggests an intriguing potential link to mental health later in life, as well.
A team of Swedish and Danish researchers tracked coffee consumption in a group of 1,409 middle-age men and women for an average of 21 years. During that time, 61 participants developed dementia, 48 with Alzheimer’s disease.
After controlling for numerous socioeconomic and health factors, including high cholesterol and high blood pressure, the scientists found that the subjects who had reported drinking three to five cups of coffee daily were 65 percent less likely to have developed dementia, compared with those who drank two cups or less. People who drank more than five cups a day also were at reduced risk of dementia, the researchers said, but there were not enough people in this group to draw statistically significant conclusions.
Dr. Miia Kivipelto, an associate professor of neurology at the Karolinska Institute in Stockholm and lead author of the study, does not as yet advocate drinking coffee as a preventive health measure. “This is an observational study,” she said. “We have no evidence that for people who are not drinking coffee, taking up drinking will have a protective effect.”
Dr. Kivipelto and her colleagues suggest several possibilities for why coffee might reduce the risk of dementia later in life. First, earlier studies have linked coffee consumption with a decreased risk of type 2 diabetes, which in turn has been associated with a greater risk of dementia. In animal studies, caffeine has been shown to reduce the formation of amyloid plaques in the brain, one of the hallmarks of Alzheimer’s disease. Finally, coffee may have an antioxidant effect in the bloodstream, reducing vascular risk factors for dementia.
Dr. Kivipelto noted that previous studies have shown that coffee drinking may also be linked to a reduced risk of Parkinson’s disease.
The new study, published this month in The Journal of Alzheimer’s Disease, is unusual in that more than 70 percent of the original group of 2,000 people randomly selected for tracking were available for re-examination 21 years later. The dietary information had been collected at the beginning of the study, which reduced the possibility of errors introduced by people inaccurately recalling their consumption. Still, the authors acknowledge that any self-reported data is subject to inaccuracies.
Posted by Scott W. Yates, MD, MBA, MS, FACP
January 24, 2009
January 20, 2009
Dallas County Flu - 98% Are Resistant to Tamiflu
There are two types of influenza viruses commonly seen in North America; influenza A and B. The Dallas County Health Department reports that most of the cases of influenza seen so far this year have been Influenza A (H1N1). New this season however is that 98% of the influenza A viruses tested in the 2008 - 2009 season have been resistant to Tamiflu (oseltamivir) - one of the most commonly used flu treatments.
Fortunately, the Tamiflu-resistant influenza A strains are very similar to the type contained in this year's flu vaccine, so the vaccine should be protective for most patients who receive it.
If you have not yet had the 2008 - 2009 flu vaccine, it is not too late to do so. Flu season in North Texas lasts until late Spring. Flu vaccine supply remains very good and particularly with the drug - resistant virus seen in our area, we continue to recommend vaccination for all patients regardless of risk category.
We have reserved vaccine doses for each of our CEM members, please call us if you've managed to evade our efforts to shoot you!
Written by Scott W. Yates, MD, MBA, MS, FACP
Fortunately, the Tamiflu-resistant influenza A strains are very similar to the type contained in this year's flu vaccine, so the vaccine should be protective for most patients who receive it.
If you have not yet had the 2008 - 2009 flu vaccine, it is not too late to do so. Flu season in North Texas lasts until late Spring. Flu vaccine supply remains very good and particularly with the drug - resistant virus seen in our area, we continue to recommend vaccination for all patients regardless of risk category.
We have reserved vaccine doses for each of our CEM members, please call us if you've managed to evade our efforts to shoot you!
Written by Scott W. Yates, MD, MBA, MS, FACP
January 17, 2009
The Omnivore's Dilemma
Michael Pollan’s newest book is The Omnivore’s Dilemma. He discussed the $36 billion in food marketing dollars ($10 billion directed to kids alone) designed to get us to eat more, to eat more dubious “neofoods,” and to eat on more occasions. To eat better he proposed a few “rules”:
1. “Don’t eat anything your great-great-great-grandmother wouldn’t recognize as food.”
2. “Avoid foods containing high-fructose corn syrup (HFCS).” HFCS is present not only in cereals and soft drinks but also in ketchup, bologna, baked goods, soups, and salad dressings. HFCS was not part of the human diet until 1975, and now each of us consumes 40 pounds of it a year, some 200 calories a day. Avoiding it avoids thousands of empty calories. Cut out highly processed foods—the ones that contain the most sugar, fat, and salt.
3. “Spend more, eat less.” We spend only 10% of our income on food, a smaller share than any other nation, and we spend a larger percentage than any other nation on health care (16%). The cheap food is making us fat and unhealthy. Eat higher-quality food.
4. “Pay no heed to nutritional science or the health claims on packages.” The healthiest foods in the supermarket—fresh produce—are the ones that don’t make Food and Drug Administration (FDA)–approved health claims, which typically decorate the packages of the most highly processed foods.
5. “Shop at the farmers’ market.” Here you will begin to eat foods in season, when they are at the peak of their nutritional value and flavor.
6. “How you eat is as important as what you eat.” The lesson of the “French Paradox” is that we can eat all kinds of supposedly toxic substances as long as we follow our mother’s rule, “Eat moderate portions, don’t go for seconds or snacks between meals, never eat alone, and eat with pleasure.”
Pollan M. The Omnivore’s Dilemma: A Natural History of Four Meals. New York: Penguin Group, 2006 (464 pp).
In each edition of the Baylor University Medical Center Proceedings, William Roberts, MD (Editor in Chief) reviews books, summarizes medical news and sometimes rants about topics of the day. The section is called “Facts and ideas from anywhere” and the post above is an excerpt.
Posted by Scott W. Yates, MD, MBA, MS, FACP
1. “Don’t eat anything your great-great-great-grandmother wouldn’t recognize as food.”
2. “Avoid foods containing high-fructose corn syrup (HFCS).” HFCS is present not only in cereals and soft drinks but also in ketchup, bologna, baked goods, soups, and salad dressings. HFCS was not part of the human diet until 1975, and now each of us consumes 40 pounds of it a year, some 200 calories a day. Avoiding it avoids thousands of empty calories. Cut out highly processed foods—the ones that contain the most sugar, fat, and salt.
3. “Spend more, eat less.” We spend only 10% of our income on food, a smaller share than any other nation, and we spend a larger percentage than any other nation on health care (16%). The cheap food is making us fat and unhealthy. Eat higher-quality food.
4. “Pay no heed to nutritional science or the health claims on packages.” The healthiest foods in the supermarket—fresh produce—are the ones that don’t make Food and Drug Administration (FDA)–approved health claims, which typically decorate the packages of the most highly processed foods.
5. “Shop at the farmers’ market.” Here you will begin to eat foods in season, when they are at the peak of their nutritional value and flavor.
6. “How you eat is as important as what you eat.” The lesson of the “French Paradox” is that we can eat all kinds of supposedly toxic substances as long as we follow our mother’s rule, “Eat moderate portions, don’t go for seconds or snacks between meals, never eat alone, and eat with pleasure.”
Pollan M. The Omnivore’s Dilemma: A Natural History of Four Meals. New York: Penguin Group, 2006 (464 pp).
In each edition of the Baylor University Medical Center Proceedings, William Roberts, MD (Editor in Chief) reviews books, summarizes medical news and sometimes rants about topics of the day. The section is called “Facts and ideas from anywhere” and the post above is an excerpt.
Posted by Scott W. Yates, MD, MBA, MS, FACP
The Family Meal
Kids who dine with their parents are healthier, happier, and better students than those who do not. Recent surveys have shown that 55% of 12-year-olds have dinner with a parent every night vs 26% of 17-year-olds. Among teens, 54% of Hispanics eat with a parent most nights vs 40% of blacks and 39% of whites. The television is on during dinner in 37% of families with teens. The number of family meals, however, appears to be increasing. Groups like Ready, Set, Relax! have dispensed hundreds of kids to many towns, coaching communities on how to fight over scheduling and how to carve out family downtime. More schools are offering basic cooking instruction. When kids help prepare a meal, they are much more likely to eat it, and cooking is a useful skill that seems to build self-esteem.
Gibbs N. The magic of the family meal. Time, June 12, 2006.
In each edition of the Baylor University Medical Center Proceedings, William Roberts, MD (Editor in Chief) reviews books, summarizes medical news and sometimes rants about topics of the day. The section is called “Facts and ideas from anywhere” and the post above is an excerpt.
Posted by Scott W. Yates, MD, MBA, MS, FACP
Gibbs N. The magic of the family meal. Time, June 12, 2006.
In each edition of the Baylor University Medical Center Proceedings, William Roberts, MD (Editor in Chief) reviews books, summarizes medical news and sometimes rants about topics of the day. The section is called “Facts and ideas from anywhere” and the post above is an excerpt.
Posted by Scott W. Yates, MD, MBA, MS, FACP
January 16, 2009
Seven Habits (to Break) of Highly Effective People
The 7 worst habits of these workaholics include:
1. Forgetting to relax: Some stress can be good because it keeps you alert and motivated; too much stress, however, will take its toll on your body.
2. Eating on the go: Who has time to sit down for a healthy lunch? But beware of frozen meals, fast, and processed food that can be high in sodium, calories, and fat.
3. Putting off sleep for work: Lack of sleep can cause irritability, difficulty concentrating, memory problems, poor judgment, and obesity.
4. Not making time for exercise: Humans were not designed to sit at desks for 8 hours a day. Exercise has been shown to reduce the risk for nearly every major disease and to help fight anxiety and depression.
5. Working when sick: 3 common-sense reasons to stay home: avoid spreading the infection, you'll be less productive, and you need your rest to get better.
6. Drinking (too much): Moderate alcohol consumption has some proven health benefits , but excessive drinking can lead to alcoholism, liver disease, and some forms of cancer.
7. Skipping annual medical checkups: Depending on age, family history, and lifestyle, a comprehensive medical checkup and special screenings is recommended every 1 to 5 years.
Eventually, something's going to give. If your patients keep burning the candle at both ends, the flame will burn out faster. But, if they maintain a healthy balance, they will be happier and healthier overall.
That's my opinion. I'm Dr George Griffing, Professor of Medicine at St. Louis University and Editor in Chief of Internal Medicine for eMedicine.
George T. Griffing, MD
Professor of Medicine
St. Louis University
Posted by Scott W. Yates, MD, MBA, MS, FACP
1. Forgetting to relax: Some stress can be good because it keeps you alert and motivated; too much stress, however, will take its toll on your body.
2. Eating on the go: Who has time to sit down for a healthy lunch? But beware of frozen meals, fast, and processed food that can be high in sodium, calories, and fat.
3. Putting off sleep for work: Lack of sleep can cause irritability, difficulty concentrating, memory problems, poor judgment, and obesity.
4. Not making time for exercise: Humans were not designed to sit at desks for 8 hours a day. Exercise has been shown to reduce the risk for nearly every major disease and to help fight anxiety and depression.
5. Working when sick: 3 common-sense reasons to stay home: avoid spreading the infection, you'll be less productive, and you need your rest to get better.
6. Drinking (too much): Moderate alcohol consumption has some proven health benefits , but excessive drinking can lead to alcoholism, liver disease, and some forms of cancer.
7. Skipping annual medical checkups: Depending on age, family history, and lifestyle, a comprehensive medical checkup and special screenings is recommended every 1 to 5 years.
Eventually, something's going to give. If your patients keep burning the candle at both ends, the flame will burn out faster. But, if they maintain a healthy balance, they will be happier and healthier overall.
That's my opinion. I'm Dr George Griffing, Professor of Medicine at St. Louis University and Editor in Chief of Internal Medicine for eMedicine.
George T. Griffing, MD
Professor of Medicine
St. Louis University
Posted by Scott W. Yates, MD, MBA, MS, FACP
January 14, 2009
Lower Cholesterol Even More? Maybe so...
Majority of patients hospitalized with CAD at guideline-recommended LDL targets (from theheart.org)
Los Angeles, CA - A majority of patients hospitalized with coronary artery disease (CAD) have LDL-cholesterol levels considered normal by current guidelines, a new study has shown [1]. The findings suggest that current lipid targets are not low enough to prevent risk in patients who would benefit, say researchers.
"There have been modest improvements in LDL-cholesterol levels over time," lead investigator Dr Gregg Fonarow (University of California Los Angeles Medical Center) told heartwire. "One of the major findings of this study that should serve as a wake-up call for anyone interested in reducing death and disability due to cardiovascular disease is that nearly 75% of patients having first ACS events had LDL levels below 130 mg/dL, and nearly 50% had LDL levels below 100 mg/dL."
The study is published in the January 2009 issue of the American Heart Journal with lead investigator Dr Amit Sachdeva (University of California, Los Angeles Medical Center). GWTG database.
The new data, obtained from a national database sponsored by the American Heart Association Get With the Guidelines program, includes admission lipid levels on 137 000 individuals from more than 500 hospitals who were admitted with CAD. Admission diagnoses were most commonly related to acute coronary syndromes.
Before admission to the hospital, 21% of patients were taking lipid-lowering medications. Among patients with a medical history of CAD, other atherosclerotic vascular disease, or diabetes, just 29.4% were taking lipid-lowering therapy prior to hospital admission, compared with 14% of patients without a history of CAD.
The mean LDL-cholesterol level among hospitalized patients was 104.9 mg/dL. Of these, almost 50% of patients had LDL-cholesterol levels <100>
Los Angeles, CA - A majority of patients hospitalized with coronary artery disease (CAD) have LDL-cholesterol levels considered normal by current guidelines, a new study has shown [1]. The findings suggest that current lipid targets are not low enough to prevent risk in patients who would benefit, say researchers.
"There have been modest improvements in LDL-cholesterol levels over time," lead investigator Dr Gregg Fonarow (University of California Los Angeles Medical Center) told heartwire. "One of the major findings of this study that should serve as a wake-up call for anyone interested in reducing death and disability due to cardiovascular disease is that nearly 75% of patients having first ACS events had LDL levels below 130 mg/dL, and nearly 50% had LDL levels below 100 mg/dL."
The study is published in the January 2009 issue of the American Heart Journal with lead investigator Dr Amit Sachdeva (University of California, Los Angeles Medical Center). GWTG database.
The new data, obtained from a national database sponsored by the American Heart Association Get With the Guidelines program, includes admission lipid levels on 137 000 individuals from more than 500 hospitals who were admitted with CAD. Admission diagnoses were most commonly related to acute coronary syndromes.
Before admission to the hospital, 21% of patients were taking lipid-lowering medications. Among patients with a medical history of CAD, other atherosclerotic vascular disease, or diabetes, just 29.4% were taking lipid-lowering therapy prior to hospital admission, compared with 14% of patients without a history of CAD.
The mean LDL-cholesterol level among hospitalized patients was 104.9 mg/dL. Of these, almost 50% of patients had LDL-cholesterol levels <100>
"The conventional cholesterol guidelines are missing the majority of patients having cardiovascular events," said Fonarow. "While certainly there are other risk factors beyond LDL, there are hundreds of thousands of potentially preventable cardiovascular events occurring because the LDL levels for primary prevention are missing too many individuals."
Among patients without established vascular disease or diabetes, 42% of patients had LDL-cholesterol levels.
Low HDL was observed in a majority of patients presenting with first and recurrent cardiovascular events, noted Fonarow. "Finding safe, well-tolerated, and effective therapies to raise cardioprotective HDL appears to be very important," he added. "However, it is essential that large-scale trials be conducted to demonstrate reduction in clinical events incremental to LDL lowering with statin therapy and that the benefits of treating HDL outweigh potential risks."
The group also points out that a large proportion of patients included in the present study could reach the standard or optional National Cholesterol Education Program (NCEP) LDL goals without statin therapy or with a statin dose lower than used in clinical trials.
Sachdeva A, Cannon CP, Deedwania PC, et al. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With the Guidelines. Am Heart J 2009; 157:111-117.
Posted by Scott W. Yates, MD, MBA, MS, FACP
Posted by Scott W. Yates, MD, MBA, MS, FACP
January 10, 2009
Measles Resurgence
According to the Centers for Disease Control and Prevention, Measles is making a comeback. The absolute number of cases is small (there were about 150 cases reported in the first half of 2008) but the rate is much higher than past years (there wer only 42 cases reported in all of 2007). The CDC's review found that a number of cases involved home-schooled children not required to get the vaccines. Measles is a highly contagious virus that spreads through contact with an infected person and it can be deadly.
If you've not been vaccinated for Measles (most adults have been) or if you are high risk, ask your physician. Immunity to the measles virus (and others) can be confirmed by a simple blood test.
Written by Scott W. Yates, MD, MBA, MS, FACP
If you've not been vaccinated for Measles (most adults have been) or if you are high risk, ask your physician. Immunity to the measles virus (and others) can be confirmed by a simple blood test.
Written by Scott W. Yates, MD, MBA, MS, FACP
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