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Fixin' Healthcare

Friday, September 29, 2006

The Lifestyle Chronicles - Hazardous To Health

A multitude of substances hazardous to health are utilized in modern society. Regulations exist to prevent exposure to amounts that are known to be toxic and in most circumstances containment is a high priority. However, examples where hazardous substances can accumulate in nature include mercury in large fish and organic compounds in river sediments. And, little is known about long-term exposure to low levels of multiple chemicals or exposure of people who might be especially sensitive to certain chemicals.

California has passed legislation to try to measure if and how its residents are absorbing chemicals from common products. Whatever the results the database will be useful.

A study of construction workers in the Netherlands links low birth weight and birth defects to paternal, airborn exposure to organic solvents such as paints, thinner and cleansers. All levels of exposure to the solvents in the study were within Dutch regulations and occupational exposure limits established in the United States and Canada.

Dutch scientists analyzed food and found low levels of pesticides, flame retardants, non-stick chemicals, artificial musks used to scent products and phthalate chemical compunds used in plastic. The recent association of toxic E. coli with packaged spinach is further evidence of fragility within the food supply.

Studies have found organic pollutants in river sediment where run off will tend to accumulate in higher concentrations. Follow-up studies to the impact of Hurricane Katrina might yield some useful data about this issue.

Then, there are the examples of people eagerly consuming chemicals that are hazardous to health. The British Heart Foundation reported that half of British children eat a pack of potato chips daily and are ingesting the equivalent of five liters of cooking oil a year.

Be careful out there. Health has many facets.

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Wednesday, September 27, 2006

The Lifestyle Chronicles - Think Global And Act Local

The Robert Wood Johnson Foundation funded an Institute of Medicine Report entitled "Progress in Preventing Childhood Obesity: How Do We Measure Up?" They conclude that many promising efforts across the country are fragmented and small in scale. More people are aware of obesity, and the associated health problems, but national leadership is lacking.

How about that? Leadership still counts. And, I was beginning to think it didn't matter. Silly me.

Hmm, hospitals billed $740 billion and collected $470 billion in 2004, but they don't seem right for this job. The Administration, Congress and Medicare were busy providing drugs to seniors, so their attention was directed to that crucial job. However, an interesting viewpoint on the need for a costly drug program is posted on September 26th in Slate by Darshak Sanghavi. Turns out that the 31 percent reduction in risk of heart attack among men taking the statin pravastatin means taking the drug every day for five years reduced the incidence of heart attacks from 7.5 percent to 5.3 percent. In other words, 100 people with elevated cholesterol needed to be treated to avoid two heart attacks.

Childhood obesity is a multifaceted problem. It might be best approached in the community at multipe levels to determine what works. National leadership might be helpful but at this stage community commitment is essential.

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Sunday, September 24, 2006

The Lifestyle Chronicles - Don't Go It Alone

Treating medical care as a private matter is a social preference that has become health care policy. There is no evidence to support this policy as beneficial for therapeutic outcomes. However, there is substantial evidence that optimum health is best achieved with the support of family, friends, schools, workplace and formal or informal groups in the community.

It is not a private matter for the community to promote optimum health and prevention of disease. Each person must learn to access and benefit from community support and each person or group must learn how to provide support. Healthy lifestyle need not, and perhaps should not, carry any trappings of medical (sick) care. Achieving and maintaining optimum health has more in common with a barn raising than a visit to the emergency room.

The WATCH IT program is described in the September issue of the Archives of Diseases in Childhood. This community-based effort was developed to help obese children living in poor neighborhoods. It consists of counseling and motivational meetings with children and their parents plus group sports sessions. The results are promising and considerably better than results obtained in studies of clinical programs.

A program from Australia for prevention strategies in schools that move beyond health education to promoting positive social environments has demonstrated positive results for 13 and 14 year-old students. Health risks, such as heavy substance abuse, fighting and having sex were reduced. A progress report is included in the September issue of the American Journal of Public Health.

The World Heart Federation has joined the World Economoc Forum to launch a workplace wellness initiative entitled "Working Toward Wellness". The effort will focus upon expanding wellness programs in businesses and linking these programs to initiatives within the community.

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The Lifestyle Chronicles - First, Eat The Right Foods

The August issue of Mayo Clinic Women's HealthSource offers its top 10 picks for healthy foods:
Red beans
Sweet potatoes
Vegetable juice
Wheat germ

Adding and increasing the amounts of vegetables and fruits in the diet supplies more of the nutrients necessary for normal metabolism. Some vitamins are fat soluble and require fat in the diet for their absorption. This should not be saturated fat or fat that is chemically altered. Nuts supply useful forms of vitamin E and the calories can be controlled by mixing nuts with vegetables or fruit. Vegetables and fruit can promote weight loss because they contain important nutrients and their bulk is filling to satisfy appetite. Hopefully, this would replace high calorie, nutrition poor foods.

There are many nutrients necessary for normal metabolism. It would be impossible to obtain all of these by taking supplements. Supplements do not satisfy appetite and nutrients work in conjunction with each other. Humans long ago adapted to deriving essential nutrients from whole foods.

Are you eating enough vegetables and fruits? According to the U.S. Department of Agriculture and the National Cancer Institute, only 40 percent of Americans are eating at least five or more servings of vegetables and fruits daily.

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Tuesday, September 19, 2006

The Lifestyle Chronicles - Look, Think And Leap

If you are looking for an example of more effective and efficient delivery of health care, you can find it in the Veterans Health Administration. Paul Krugman believes the key to the V.A.'s success is the long-term relationship with its clients. I place my vote on enlightened leadership and development of concensus on clear and achieveable goals.

"Effectiveness is doing the right things and efficiency is doing things right." Peter Drucker was on to something there. The goal is to improve health and effectiveness is the way to learn efficiency.

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Monday, September 18, 2006

The Lifestyle Chronicles - A Task For The Ages

Healthy People 2000 has passed. Healthy People 2010 will pass and it must be followed by Healthy People 2020, 2030 and so on. Promoting optimum health for everyone is a task that never ends. The progress will become apparant with time and it will change society.

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The Lifestyle Chronicles - Moments In Time

A group of teachers, authors and psychologists have expressed concern that childhood creativity in the UK is being stifiled by a combination of junk food, school targets and mass marketing. The same could be said of childhood in the US.

"Modern life 'poisoning' childhood" is a headline to grab attention. Now, what do we do about it? How will it be done? Who will do it and when will it be done? The world is changing fast with moving targets, drifting attention and shifting priorities. And, who created this modern life?

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Wednesday, September 06, 2006

The Lifestyle Chronicles - Questions Determine Potential

Mayo Clinic has confirmed that moderate to severe heart valve disease develops with increasing age. The incidence is similar in the general population and in Olmsted County but valve disease was diagnosed less in women of Olmsted County. The range is from 0.7 percent of those 18 - 44 years old to 13.3 percent of those 75 years and older. This represents 2.5 percent of adults or approximately 5 million people in the U.S. The study is published online in The Lancet.

This is a significant finding that could represent increased morbidity, mortality and health care costs. However, it is a finding that demands additional study. Does this problem have clinical significance? Does it need treatment? What treatment is effective? Is this another health problem related to lifestyle? Can it be prevented? Mind-sets determine questions and the answers determine directions.

Will this be another health problem that fuels medical treatments or an opportunity to identify a route to better health?

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Monday, September 04, 2006

The Lifestyle Chronicles - Healthy Lifestyle 1, High Technology 0

Tom Kottke has selected an example of preventive health care and presented it in a manner that might bring understanding to people. The study is published in the October issue of the American Journal of Preventive Medicine. A computer-simulated community of 100,000 people resembling the population of Olmsted County, Minnesotta in the year 2000 was used to compare automated external defibrillators in homes and public places, implanted defibrillators and ingestation of omega-3 fatty acids for prevention of sudden deaths.

The automated external defibrillators reduced death rates by 0.8% (7 lives saved per year), the implanted defibrillators reduced death rates by 3.3% (30 lives saved per year) and raising the blood levels of omega-3 fatty acids reduced death rates by 6.4% (58 lives saved per year). Three-quarters of the reduction in deaths from increased omega-3 fatty acids would come from raising levels among the healthy portion of the population.

The simulated population could raise their omega-3 fatty acid levels with daily supplements costing $5.8 million a year but they could accomplish the same result by eating fish high in omega-3 fatty acids. Also, eating the fish would be a source of lean protein and contribute to control of appetite. The benefits just keep going from there.

The highest use of technology that anyone can perform on this world is to take a walk.

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