Wednesday, October 7, 2009
QD: News Every Day--obesity, H1N1 and faking illness vs. "presenteeism"
ACP Internist's daily digest of internal medicine in the news continues with obesity programs, H1N1 updates and employees who fake calling in sick vs. those who won't when they really are.
Obesity
Schools, workplaces, food retailers and food and beverage makers are chipping in for the Healthy Weight Commitment Foundation, an effort to reduce obesity by balancing calorie consumption through physical activity. As just a few examples, food manufacturers will change product offerings, packaging, and labeling. Companies may provide exercise activities or facilities, offer weight management programs, and provide healthier foods in workplace cafeterias and vending machines. The Robert Wood Johnson Foundation, The National Business Group on Health and the University of California, Berkeley Center for Weight and Health will evaluate progress.
An internist is developing recommendations for physicians on how to guide and treat overweight patients on behalf of the STOP Obesity Alliance, a coalition of professional and labor groups, businesses, insurers and health care providers. The internist outlines his success in a case study.
H1N1 Flu
Health and Human Services Secretary Kathleen Sebelius further encouraged H1N1 vaccination, calling it "safe and secure" and adding that it's made the same way as seasonal flu vaccines.
Although H1N1 vaccination in the U.S. is slowly starting, states have ordered more than 2 million doses, mostly of nasal spray, for the first patients, according to Thomas Frieden, MD, director of the CDC. In Chicago, John Segreti, ACP Member, an infectious diseases expert at Rush University Medical Center, told Reuters his facility will distribute its first 2,000 doses to children and will wait for inactivated vaccine for health workers.
Emory University doctors licensed their interactive Web site to allow patients with potential H1N1 cases to self-screen using the same triage calculations their doctors and the CDC use. Questions about fever, symptoms and underlying health help patients determine whether they've got H1N1 flu, and what to do next--rest, call their doctor or seek immediate treatment. This site and related hot lines have been developed to keep people from flooding emergency departments. The materials, known as Strategy for Off-Site Rapid Triage (SORT) and Real-time Epidemiological Assessment for Community Health (REACH), were created and developed at Emory University. Ruth Parker, FACP, was one of the developers.
In case you missed it ...
The proportion of employees calling in sick when they're not hasn't changed among U.S. workers--at about one-third and holding--but fewer are getting fired for it, according to CareerBuilder.com as reported by Reuters. Of employers surveyed, 15% said they fired an employee for missing work without a legitimate excuse this year, compared to 18% last year.
The survey showed that most employers typically don't typically question absences (29% in 2009, 31% in 2008, 35% in 2007) and two-thirds of them let workers use sick days as "mental health days." The one-third of employers who do check on absenteeism require a doctor's note, call the person at home or have another worker call or drive by the employee's home. Employers cited stress and burnout from the recession as a reason they think employees fake illness.
The bigger fear is "presenteeism," those who show up to work no matter how sick they are. (They're also called "mucus troopers.")
Labels: H1N1, Nutrition, obesity, QD, Workplace issues
posted by Ryan DuBosar at
12:18 PM
0 Comments
Monday, June 1, 2009
Medical news of the obvious
People choose high-calorie over healthier drinks, especially when they're on sale. Sad but true, it often costs more to buy healthy or organic products than their high-fructose, saturated-fat-bearing cousins. A New Zealand study, published in Nutrition and Dietetics, corroborates this notion, concluding that of 1,500 supermarket discounts on non-alcoholic drinks, only 15% were considered "healthy." Although, researchers noted, the difference may have something to do with there being signficantly more non-healthy drinks on shelves than the alternatives, no doubt a savvy move by companies that are interested in making a profit as opposed to feeling good about their customers' eating habits. It turns out that water, plain reduced-fat milk and plain reduced-fat soy beverages (the "healthy" drinks) aren't as appealing as sodas and flavored sports drinks--sadly, I suspect that price has very little to do with it.
Driving everywhere is making us less healthy. By how much? A Reuters feature reported that driving cuts the average person's 10,000 steps a day to as few as 1,000. Because it cuts into potential time for exercise, each 30 minutes of driving translates into a 3% greater chance of being obese.
Labels: exercise, medical news of the obvious, Nutrition, obesity
posted by Janet Colwell at
9:00 AM
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Friday, April 10, 2009
Paging Big Brother...
Urine drug tests are de rigueur for new employees of many companies-- but what about a test to ensure that novel accountant is eating her leafy greens?
A Toronto research group has found that, by measuring levels of urinary potassium, one can get a good idea of whether a person is hitting the salad bar on her lunch breaks-- or taking a trip to Mickey D's.
Researchers evaluated urine samples from 220 people aged 18 to 50 with kidney stones, over a period of 24 hours. The patients also filled out questionnaires about the kind of food they ate over that same time period. Turns out, those with more potassium in their urine reported eating healthier foods like veggies, fruit, whole grains and low-fat dairy, while the low-potassium crowd more often reported eating fast food, red meat and sugary drinks. The study is in the April issue of the Journal of Nutrition.
The absurdist possibilities of such a test are endless. Will health nuts take to measuring their urine every few hours, to ensure they are getting the proper ratio of flax to wheat germ? Or will insurance companies require urine tests as pre-requisites, trying to spot heart-attacks-in waiting via a Whopper-a-day dinner habit? The mind reels...
Labels: Nutrition, urine tests
posted by Jessica Berthold at
4:50 PM
0 Comments
Thursday, April 9, 2009
Comparative effectiveness needs publicity, along with research
Since you're reading this blog, you probably already know that the evidence against vitamins has been piling up. Several recent studies have indicated that the disease-preventing properties of fruits and veggies don't carry through when extracted into vitamin pills.
But apparently the word has not gotten out to the general public. Or so it seems from a recent New York Times article which is likely to send shivers down the spine of any believer in evidence-based medicine. The article describes a recession-linked upturn in vitamin sales (new customers up 20% at the Vitamin Shoppe in the last six months) and quotes several economizing shoppers who are replacing their prescription meds and doctor visits with vitamin and supplement purchases. There's even a physician-assistant student who has cut back on fruits and vegetables to buy fish oil and antioxidant supplements.
Ack! It's one thing to spend a little disposable income on probably useless vitamins, but to buy them instead of healthy food? Of that $400 mill the government's planning to spend on comparative effectiveness research, maybe a little should go toward telling people about the things we already know are ineffective.
posted by Stacey Butterfield at
3:11 PM
5 Comments
Monday, April 6, 2009
Cancer study bullish on broccoli
New research shows that if you want to prevent stomach cancer it really helps to like broccoli. While scientists have known for a while about the green vegetable's potential cancer-protective effects, there isn't much hard evidence on whether it prevents bacterial infections in humans. But a small study in the April issue of Cancer Prevention Research reports that eating 70 grams of fresh broccoli stems a day for eight weeks significantly lowered Helicobacter pylori levels in 48 infected Japanese men and women.
Researchers assessed the severity of H. pylori in participants at enrollment and again at four and eight weeks using standard breath, serum and stool tests, according to an American Association for Cancer Research news release. Reducing H. pylori levels presumably will lead to a lower risk of developing stomach cancer, said researchers, noting the well-established link between the two.
It's food for thought, and many may deem broccoli the lesser of two evils considering the alternative: alfalfa sprouts. The study randomly assigned participants to an equivalent daily amount of the sprouts, which had no effect.
Labels: cancer, Nutrition, research
posted by Janet Colwell at
8:00 AM
0 Comments
Tuesday, March 24, 2009
Good news for dentists
One might think the recession could be useful in getting overweight patients to shed pounds. The less you eat, the less you pay for food, right? But an unexpected foe has emerged in the battle of the bulge: the cheap, nostalgic thrill of candy.
The New York Times reports candy sales have spiked in response to the recession, as consumers seek an inexpensive way to treat and comfort themselves amid all the rotten news of late. One woman, who runs Weight Watchers meetings in Manhattan, is quoted in the article as saying that candy comes up as a foil to dieters much more frequently than it used to.
Something to keep in mind when counseling patients about diet and nutrition in these unsteady economic times. Perhaps it'd be worthwhile to help patients think of other, more low-cal ways to soothe themselves when faced with a dwindling 401K balance. A few bags of M&Ms might score you a used yoga DVD, for example...
posted by Jessica Berthold at
3:39 PM
0 Comments
Friday, March 13, 2009
Pass the salt...and turn that frown upside down
We noted a while back that choosing between alcohol and abstinence may be akin to choosing between cancer and a heart attack. New research ups the ante a bit with another food-related choice: Would you rather by happy, or have low blood pressure?
Physicians have long labored to get hypertensive patients to cut down on salt, but new research suggests salt is a natural antidepressant. University of Iowa psychologists found that when rats are deficient in sodium chloride, they hang back from their favorite hobbies, "like pressing a metal bar that stimulates a pleasant sensation in their brains." (Hmm, do they make human-sized versions of this bar?)
Further, reports ScienceDaily: "Another strong aspect of addiction is the development of intense cravings when drugs are withheld. Experiments by Johnson and colleagues indicate similar changes in brain activity whether rats are exposed to drugs or salt deficiency."
Could salt-addiction treatment centers be on the horizon?
posted by Jessica Berthold at
2:58 PM
0 Comments
Monday, March 2, 2009
Urbanites have trouble finding healthy food
The availability of healthy food choices and quality of diet is worse for impoverished urban denizens than suburban residents, according to two studies conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The studies examined healthy food availability and diet quality in the city of Baltimore and its surrounding county.
They found 46% of lower-income neighborhoods had a low availability of healthy foods, items such as fresh fruits and vegetables, skim milk and whole wheat bread as recommended by the U.S. Department of Agriculture. Geography plays a larger role in dietary health than previously estimated. And, 24% of the black participants lived in neighborhoods with a low availability of healthy food compared with 5% of whites.
The second study examined the availability of healthy foods across 159 neighborhoods and 226 neighborhood stores in Baltimore and the surrounding county. Researchers found that 43% of predominantly black neighborhoods and 46% of lower-income neighborhoods had low availability of healthy foods, compared to 4% and 13%, respectively, in predominantly white and higher-income neighborhoods.
Where you live is a major determinant of your health, and staff at ACP Internist noted that this study could happen in our hometown of Philadelphia and probably get the same result. It could happen in any city, we suspect.
Labels: epidemiology, Nutrition
posted by Ryan DuBosar at
8:00 AM
1 Comments
Sunday, November 9, 2008
What to eat...and not to eat
New Orleans is an eatin' town, so it's apt that a slew of research is being presented on nutrition and heart health. Here's the scoop:
EAT!:
--Vegetables, soy, wine, green/black tea and fish. People who ate these things were less likely to have left ventricular dysfunction than those who ate processed meat/cheese and added fats. (researcher: Longjian Liu, MD)
--Non-soy legumes, like pinto beans, chickpeas and navy beans. Eat a bunch of these and there's a good chance your LDL will drop. (researcher: Lydia A.L. Bazzano, MD)
--Hibiscus tea, if you're mildly hypertensive (129+ systolic). You'll have to drink three cups a day, but if you follow the path of those studied, your systolic BP will drop 7.2 points in six weeks. (researcher: Diane McKay, PhD)
--Folic acid. People who took 2 mg/day along with 1 mg of Vitamin B12 had no extra risk of cancer or other adverse events. They weren't protected against CVD, either-- which was kind of a bummer, since the researchers hoped the B12 would lower homocystine levels and thus CVD risk. But at least the fortified bread is safe. (researcher: Dr. Jane Armitage)
--Fruits and veggies. "Well, duh", you say. What's fairly new in this study is the finding that, for each portion of fruit or vegetable, blood flow in hypertensive folks improved about 6%. So if your patients won't do it for the all the other reasons there are to eat healthfully, hit 'em with the vascular argument! (researcher: Damian McCall, PhD)
DON'T EAT:
--Vitamins E and C... at least if you're doing so to avoid heart problems. The 14,641-subject Physician's Health Study found neither supplement protects against cardiovascular disease when taken separately. Sure, antioxidants have been studied to death, but this study was large and long-term, with an average follow-up of 8 years. (researcher: J. Michael Gaziano, MD)
--Animal and industrial trans fats, which seems fairly obvious. Whether the source is animal or man-made, these acids give you a double shot of nastiness, raising your LDL and lowering your HDL in one fell swoop. (researcher: Ingeborg Brouwer, PhD)
No word yet on the healthful properties of jambalaya and gumbo.
Labels: AHA Sessions, Nutrition
posted by Jessica Berthold at
12:30 PM
0 Comments
Thursday, October 30, 2008
Some sobering news about wine
Adding to the good news about red wine, a new study in the November issue of Nutrition Research reports that red wine and other foods rich in the polyphenols found in grapes may help reduce LDL cholesterol, blood clotting, abnormal heart rhythms and blood vessel narrowing. "Supplementation with grape seed, grape skin or red wine products may be a useful adjunct to consider for a dietary approach in the prevention of cardiovascular diseases," the authors comment in a news release.
But you might want to put away the corkscrew after reading another new study that looked at the metal content of both red and white wines. The study, published in the open access Chemistry Central Journal, found that the vast majority of wines from 16 different countries contain hazardous levels of metal ions--potentially putting drinkers at risk for Parkinson's disease, chronic inflammatory disease and cancer. Using the Target Hazard Quotient (THQ)--a formula developed by the U.S. Environmental Protection Agency--as a basis for comparison, the researchers found that most wines far exceeded safe levels of metal--ranging from a low of 50 THQ to a high of 300 (a THQ over 1.0 is considered hazardous).
There were geographic differences, however, that might influence your next beverage purchase. Wines from Italy, Brazil and Argentina were on the low end of the THQ scale whereas Hungarian and Slovakian wines reached 300 THQ. Risk is based on consumption of one 250 ml glass of wine per day--researchers didn't get into how much the risks might increase as a result of binge drinking or mixing wine with other alcohol, or effects on the elderly, young or sick.
Labels: Nutrition
posted by Janet Colwell at
12:01 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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Previous Posts
- QD: News Every Day--waiting for the weekend
- QD: News Every Day--health care reform's eerie rep...
- Which patients sue for malpractice?
- Ties that bind, and make you gag
- QD: News Every Day--health care reform's 'sunshine...
- QD: News Every Day--health care reform splits urba...
- QD: News Every Day--the public option as a Straw M...
- The story of two little pigs
- Medical news of the obvious
- The vaccine that went away.
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