How To Provide Care for the Medicare Medicare Duals The Population Health Management Playbook

The Care Continuum Alliance (CCA) has come out with an important report on how to improve the care of the 9 million persons who are "dual eligible."  These individuals are among the most economically vulnerable and sickest Americans.  They simultaneously qualify for both Medicare and Medicaid and their health care costs are staggering.

The CCA recommendations for the care of duals on a regional or state basis should not be unfamiliar to regular readers of the Disease Management Care Blog: collect the necessary data, risk-stratify the individuals, maximize coordinated care for those at greatest risk, work with the docs, measure outcomes, lather, rinse repeat.

No knowledge base on disease and population health management and dual eligibles is complete without this download.  Check it out and youll learn that....

Data on this population should be centralized, comprehensive and interconnected: This means pooling insurance claims, electronic records, labs and pharmacy and making the data available in health information exchanges.  How else will program planners understand the duals needs, plan programs, foster communication among providers and evaluate outcomes?

The population should be risk stratified.  Health risk assessments are a good option because these persons may drift in and out of dual eligibility.  Incentives should be offered to increase the likelihood that the HRA surveys will be completed.

Professional care planning should be used to to best "position" patients in a coordinated, patient centered and streamlined manner.  This coordination should include providers, pharmacy, behavioral health and long term care to maximize mental health support, rehab, end-of-life care, additional counseling needs and erral to community-based programs.

Provider incentives should use all possible options including capitation, shared savings and bonus payments.  Training and tools should be made available.

Goals for the dual population should be defined and there should be measurement of progress toward those goals.

How to get rid of bedwetting

If your child wakes up in the morning, soaked in urine, and you feel helpless and frustrated. Don,t despair, bed-wetting isnt a sign of toilet training gone bad. Its often just a normal part of a childs development. 

Bedwetting problem is common during the pre-adolescent stage of life and affects both boys and girls. It is a process of unknowingly passing urine while sleeping., until the age of six to eight years, bedwetting is a normal phenomenon that fades over time, but some children continue to wet their bed even after eight years of age. 

What cause bed-wetting?

This often occurs because children have small bladders and cannot hold their urine all night or the urge to urinate is not strong enough to wake them up. OR your child may still be developing nighttime bladder control. 

The common thought among both parents and many pediatricians is that bedwetting is a medical or psychological problem. Often, the patient undergoes a comprehensive and unnecessary medical assessment with no findings. Only 2% cases have been detected and diagnosed due to neurological or urological problems.

In fact, 75-80% bed-wetters are normal, healthy children who have not learned to activate the appropriate lex system during sleep. Typically, when a person sleeps and pressure is built up inside the bladder, a signal is sent to the brain. Among enuretics, the signal is not recognized by the sub-conscious lex system and instead of contracting the sphincter muscle, the circular muscle that keeps the bowel closed, the child relaxes the muscle and urinates during sleep.

Psychological causes, such as family problems, social adjustment, or fears are the reasons among the remaining 18-25% bed-wetters. 

Bedwetting is more common among males; approximately two thirds of enuretics are males, while one third are females. As the age progresses, the proportion is changes and gradually is equal in adolescence. Among individuals ages 17 and up, two thirds of enuretics are females while one third are males.

How to cure bed wetting?

If your child wets the bed, dont punish, blame, or embarrass your child. Your child is neither consciously nor unconsciously choosing to wet the bed. Give your child understanding, encouragement, love, and positive support. Let your child help solve the problem, if he or she is older than 5. 

Praise and reward your child for dry nights. Involve your child in planning the reward system. Encourage your child to take responsibility for changing clothes and linens after a bed-wetting accident. For example, use washable sleeping bags as bedding so your child can easily replace one that is wet with one that is dry.

Monitor your childs consumption of liquids. As a rule of thumb, children should be encouraged to consume 40% of their total daily liquids in the morning, 40% in the afternoon, and 20% in the evening. Talk with the doctor about how much fluid your child needs. Restrict your childs intake of caffeine. Caffeine is a diuretic, which means that it promotes the excretion of urine. Avoid giving any liquids at bedtime, and train your child to urinate before sleeping.

A child should first be allowed to overcome bed-wetting on his or her own. Most children gain bladder control and often overcome bed-wetting as they age, but it can be embarrassing and cause your child to shy away from social activities such as slumber parties or sleepover invitations from friends.

You can help your child stop bed-wetting by using bedwetting alarms. These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your childs pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the bedwetting alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.

If you try a moisture alarm, give it plenty of time. It often takes at least two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does.

If bladder training and bedwetting alarm didnt work try these easy and simple natural remedies. 

Natural home remedies for treating bed wetting:

1) Cranberry Juice

Giving your child cranberry juice before bedtime is a popular bedwetting remedy. The juice will help your child control his muscles and wet the bed less at night, or hopefully not at all. Cranberry juice is good for the kidneys, bladder, and urinary tract. You can give your child fresh cranberry juice one hour before going to bed. Repeat this process daily for a few months.

2) Apple Cider Vinegar

Apple cider vinegar helps reduce the acid levels in the stomach and will reduce the urge to urinate frequently. It also breaks down calcium deposits in the body. Simply stir two tablespoons of apple cider vinegar in a glass of water and have your child drink it with each meal.

3) Jaggery
This is because jaggery has a heating effect on the body from within. When the body remains warm from inside, the problem of bedwetting will vanish soon. Give your child a little amount of jaggery with lukewarm milk every morning. After around one hour or so, make your child eat a little bit of roasted sesame seeds and celery seeds which should be taken in equal amounts. Do this for around two months to see results.

4) Cinnamon
Cinnamon powder is one of the simplest home remedies for your child to stop bedwetting.
Have your child chew cinnamon bark thoroughly once a day. You can also combine sugar and cinnamon powder and then sprinkle it on buttered toast. Give this toast to your child for breakfast.

5) Indian Gooseberry 

Also known as amla, Indian goosberry is yet another effective home remedy for bedwetting. Take pulp of gooseberry and mix to it a pinch of black pepper powder. Give it to your child daily before he goes to bed. or 

Crush 2 Indian gooseberries remove seeds mix a tablespoon of honey and a pinch of turmeric. Give one tablespoon of this mixture to your child every morning. You can also make a mixture of Indian gooseberry powder, ground cumin seeds and sugar candy. Give it to your child two times a day.

6) walnuts and raisins

Walnuts and raisins are tasty home remedies for preventing bedwetting in children. Just give your child 2-3 walnuts and 8-10 raisins before they go to sleep. This will cure the problem within a few weeks.

7) Banana
For years banana has been proved beneficial in binding stomach. You can feed your child 2 -3 bananas every day to prevent the problem of bed wetting. You can give one ripe banana in the breakfast and another at night.

8) Mustard powder

Mustard powder too has been found useful to stop bedwetting in children. Take a pinch of dry mustard seed powder and add it to warm milk. This should be given to the child one hour before he goes to bed at night. Mustard seeds are said to be good even for those suffering from urinary diseases. Do this for a few weeks, and your child will certainly stop bedwetting at night.

9) Fennel seeds

Try this natural home remedy using milk, fennel seeds and sugar: Take 4 tbsp of sugar, add 1 glass of water to this sugar, heat this mixture till it becomes a thick syrup, add 2 tbsp of this sugar syrup to 1 glass warm milk, add 1 tsp fennel seeds and mix well. Give it daily to your child.

10) Try this herbal tea

Take small amounts of oak bark, barberry and horsetail put in bowl pour water and boil it for about two hours at low speed. You can give this herbal tea to your child two times a day and one cup about an hour before bed time. Consuming this herbal tea on a regular basis will reduce the bed wetting problems in your child significantly.

Bedwetting is not a problem that can be solved quickly. Be patient and allow some time for these remedies to work. Also, be sure to teach your child to go to the bathroom before going to bed. Do not punish or yell at a child for wetting their bed. They will feel bad enough about it without you coming down hard on them. Praise them for effort and for success. Reassure them that you understand their embarrassment.

How to eat smart to lose weight

Try these simple eating tips for weight loss

If you tried everything for that quick weight loss and still failing in your mission, and loosing weight is your high priority these days. Let us help you in your weight loss. In our opinion to loose weight is very simple. ................... guess what ............ diet ..no....... gym.....no.............................Just eat smart guys

Are you one of the thousands of people out there wondering what the real secrets of eating right are? With so many fad diets and gimmicks available on the TV and in the media today, its hard to sort out fact from fiction................... Have you resolved to lose weight?

Do you think thin = healthy = not eating? ................ Oh hell ..........Get real guys!

Let me explain How "Eating Smart" Can Help You Lose Weight?

Eat smart

Eating right can help you knock off those extra pounds.  So have you taken care of your annual donation to the gym knowing that you’re never going to step into it? Paying that gym membership makes you think “I’ll make it some day”. 

But let’s face it; most of us can barely make the time to draw a deep breath, let alone find a couple of hours, that includes fighting traffic and finding parking space, to work out.  Also many have a mental block about the gym and your body will never respond to anything you force it into.  So what do you do? You learn to compensate.  By eating; only this time correctly. How do you know how to eat smart?

Frequency

Do you wake up sluggish to a large cup of coffee/tea? Do you have a couple of bites for breakfast and then wake up ravenous late in the afternoon to bite into whatever you see? That’s because you probably eat your big meal at sunset.  Now its impossible to change habits overnight, so start slow. Wake up to the heaviest platter and get through the day in descending order.

Go “figure”
First, study your body; structure, metabolism, hunger pangs, thirst, eating patterns.  It’s very important to know when you feel hungry, how much and when not;

Note down the time and contents of your meal for a week so that you realize what you’re chomping and what you’re missing in terms of essential nutrients. Create a basket that includes all food groups; carbohydrates, proteins, vitamins and even fat.  Keeping track of all that you eat is also a foolproof system to put an end to bingeing; once you actually see how much you’re putting into your body, it’ll automatically put your meals into perspective. 

One simple rule: your body burns most calories as soon as you wake and then goes into slow mode thereafter.  So eat your chocolates, fried food, sweets, cakes when you wake up and make the later mouthfuls healthier as the sun goes down.

Eat with your mind
It’s essential to finish with supper at sundown because your fat burning ability vanishes with the sunlight.  And since you’ve had your dinner early, you’re guaranteed to wake up with an appetite.  If you cannot stomach the idea of combine protein, carbohydrates and fats that early, start with a fruit.  High carbs like banana or apple are ideal to kick start that metabolism and also acts as a buffer to that cup you’ll sip on.  Never, I mean Never, begin your day with caffeine as your body will automatically go into slump mode.  Water constitutes 70 per cent of Human body so when we gulp some down as much as possible through the day to eliminate toxins.

The golden Cycle

Every time hunger pangs strike, replace every one out of three meals with water and watch the fat melt away.  If you ever want to lose weight eat!! The 3 W’s are the deal breakers-what, when and where you eat, for e.g eating dal chawal( plain rice with dal) at a restaurant at midnight can do more damage than a big piece of ladoo (sweet) in the morning.  Simply because one, your ability to burn fat at midnight is almost zilch and two even dal may have unhealthy ingredients when made outside whereas the bhaji you fry in good oil at home is absorbed into your system pronto because you’re burning most fat in the morning.

7 Ways to prevent cardiovascular disease

7 Ways to prevent cardiovascular disease - Heart disease and stroke are some examples of cardiovascular disease. Stress, lifestyle, and diet are often the cause of this disease. So how do I prevent it? Listen more, as reported by the following Idiva.

Routine inspection

Most cardiovascular diseases strike suddenly without any symptoms. Before its too late, it would be better if your routine check-ups or medical examination to know the hidden risk of cardiovascular disease.

Yoga

Through yoga breathing exercises is one way to prevent cardiovascular disease. Besides being able to launch an oxygen intake through breathing exercises, yoga also reduce stress and prevent cardiovascular disease.

Actively engaged

As already mentioned, an inactive lifestyle to be one of the causes of cardiovascular disease. Theore, how to prevent it is to be actively engaged. For example, to get used to walking more often every day.

Quitting smoking

Smoking is not only bad for the lungs, but also the heart and blood circulation. So if you have a smoking habit, stop start now to prevent cardiovascular disease.

During pregnancy

Research never mentions that during pregnancy a woman who had suffered from pre-eclampsia or swelling of limbs doubled risk of cardiovascular disease. Thus arrived during pregnancy, pregnant women should be extra to maintain good health.

Understanding the symptoms

By understanding the symptoms, cardiovascular disease can be dealt with more quickly. Examples of symptoms of heart disease are pain in the chest area to the left arm and shoulder. In addition, pain in the back, neck, jaw until sometimes also be a symptom of cardiovascular disease in women.

Sun

Vitamin D is an important nutrient for the heart. So make sure you get vitamin D from the sun by sunbathing. Some foods can also be used as an alternative to meet the needs of vitamin D.

So many ways to prevent cardiovascular disease. Come live a healthy lifestyle fitness for your body!

6 important reasons to eat blueberries

6 important reasons to eat blueberries - Blueberry, one of the families that are often erred berries contain high antioxidants. There are at least six important reasons why you should eat this one super fruit. What is it? Listen more, as quoted from Care2 follows.

Eye health

Anthocyanins which is one of the compounds in blueberries proved able to protect the retina from damage threat.

Cardiovascular health

Blueberries also proven to improve the balance of body fat, including controlling the levels of bad cholesterol and increase good. In addition, eating blueberries are also good for blood circulation so that the whole fruit is able to maintain cardiovascular health.

Controlling blood sugar

Blueberry - as well as other berries family - are the best foods to control blood sugar levels in order to prevent attacks of type 2 diabetes.

Cognitive gains

Research has shown that regular consumption of blueberries can improve cognitive function in the elderly brain. For example, an increase in memory and other cognitive problems associated with aging.

Anti-cancer agent

Various studies suggest that blueberries including anti-cancer agents breast, colon, esophagus, and small intestine.

High antioxidant

Every organ system and basically get the health benefits of eating blueberries as antioxidants in it are so high. For example, reducing the risk of muscle damage during exercise, protect the nervous system, as well as maintaining digestion.

Blueberries can be enjoyed directly, used as a salad topping, processed into cakes, or consumed as a juice. One way or another, enjoy blueberries and get all the health benefits mentioned above.

Diabetes Link To Bacteria

Diabetes is often accompanied by chronic low-grade inflammation.  Recent research indicates that inflammation may be linked to molecules derived from bacteria.

It has been hypothesized that bacterial endotoxins, lipopolysaccharides (LPS) located on the outer membrane of Gram-negative bacteria, can increase the risk for type 2 diabetes by activating components of the immune system which promote insulin resistance and other metabolic abnormalities.

In this large prospective study from last year:

Endotoxemia Is Associated With an Increased Risk of Incident Diabetes, Diabetes Care, February, 2011

Endotoxemia was associated with an increased risk for type 2 diabetes. Notably, the increased risk was independent of established diabetes risk factors such as blood glucose, serum lipids, C-reactive protein (CRP), and body mass index (BMI). The risk was also independent of factors known to affect serum endotoxin activity, such as total cholesterol, triglyceride levels, HDL cholesterol levels, and smoking.

"Our results indicate for the first time that endotoxemia is a key player in the pathogenesis of diabetes and that microbes may have a central role."

________
This study from last month:

High Fat Intake Leads to Acute Postprandial Exposure to Circulating Endotoxin in Type 2 Diabetic Subjects, Diabetes Care, December 2011

Found that a high-fat meal elevated levels of endotoxins, especially in people with diabetes.

"These studies have highlighted that exposure to a high-fat meal elevates circulating endotoxin irrespective of metabolic state, as early as 1 h after a meal. However, this increase is substantial in IGT and type 2 diabetic subjects, suggesting that metabolic endotoxinemia is exacerbated after high-fat intake.

In conclusion, our data suggest that, in a compromised metabolic state such as type 2 diabetes, a continual snacking routine will cumulatively promote their condition more rapidly than in other individuals because of the greater exposure to endotoxin."

Previous studies implicated dietary fat in levels of endotoxins (LPS):

"In mice fed a high-carbohydrate diet, the increase in plasma LPS was blunted compared with mice fed a high-fat diet." 
...
"In this large sample of healthy men from a population-based sample, we found a link between food intake and plasma LPS. Experimental data suggest that fat was more efficient in transporting bacterial LPS from the gut lumen into the bloodstream."
- Energy intake is associated with endotoxemia in apparently healthy men, American Journal of Clinical Nutrition, May 2008

How does dietary fat assist endotoxin absorption?  Its been proposed that fat-soluble endotoxins mix with and are absorbed in conjunction with the fat contained in a meal:

"Dietary fat is incorporated from the gut into triglyceride-enriched lipoproteins, chylomicrons, whose formation promotes LPS absorption."
- Endotoxemia Is Associated With an Increased Risk of Incident Diabetes, Diabetes Care, February, 2011

Another hypothesis is that the absorption of endotoxins is assisted by inflammation present in the gut.  This novel study found that orange juice, taken with a meal, could lower levels of circulating endotoxins:

"Whether this increase of endotoxemia is due to the lipid solubility of endotoxin and its absorption into the circulation with the fat contained in the meal or is secondary to other factors such as the inflammation of the intestinal epithelium is not clear. If it is secondary to other factors, the potential antiinflammatory effect of orange juice intake could lower postprandial endotoxin increase."
- Orange juice neutralizes the proinflammatory effect of a high-fat, high-carbohydrate meal and prevents endotoxin increase and Toll-like receptor expression, American Journal of Clinical Nutrition, April 2010

________
The following study found a strong correlation between endotoxins and features of the Metabolic Syndrome (in line with the findings of the study at the top of this post which found an association between endotoxins and type 2 diabetes):

Bacterial Endotoxin Activity in Human Serum Is Associated With Dyslipidemia, Insulin Resistance, Obesity, and Chronic Inflammation, Diabetes Care, August 201

It is known that HDL cholesterol assists in the elimination of endotoxin from the circulation.  (In healthy individuals, endotoxins are bound mainly to HDL).  This study found that diabetic patients with low HDL often had high endotoxin activity.

"Of all the tested clinical variables, the strongest correlation was observed between the LPS/HDL ratio and serum triglyceride concentrations.  High fasting concentrations of triglycerides predict postprandial hypertriglyceridemia and the development of insulin resistance."

The study also found an inverse correlation between serum LPS activity and insulin sentitivity in both diabetic and nondiabetic groups.  High endotoxin activity was linked to insulin resistance.

The contribution of a high-fat diet was also noted:

"Human and animal studies have both highlighted the importance of the composition of the diet for its influence on the endotoxin absorption process. Consumption of an energy-rich high-fat diet may result in increased levels of gut-derived bacterial endotoxins in circulation."

The authors concluded:

"Taken together, these data show that endotoxins derived from gram-negative bacteria are strongly associated with the MetS variables in vivo. These observations may have clinical implications, because high LPS activity is more often found in subjects who show signs of dyslipidemia, insulin resistance, overweight, and inflammation—factors that increase the risk for diverse micro- and macrovascular complications."

What Men Want Women to Know

Men Will Talk About Feelings

Was your guy raised as a traditional, stoic, mans man? If so, let me walk you through 18 relationship secrets, gathered from psychologists who study gender roles. Secret No. 1: It may be easier for your man to talk about feelings indirectly. Ask what hed do during a romantic weekend. Or what he thought the first time he met you. His answers will reveal how he feels and bring you closer.

Men Say "I Love You" With Actions

Some men per to express their feelings through actions rather than words. Your guy may say "I love you" by fixing things around the house, tidying up the yard, or even taking out the trash -- anything that makes your world a better place.

Men Take Commitment Seriously

Men have a reputation for being afraid to commit. But the evidence suggests men take marriage seriously. They may take longer to commit because they want to make sure they are onboard for good. In a survey of currently married men, 90% say they would marry the same woman again.

He Really Is Listening

When youre listening to someone talk, you probably pipe in with a "yes" or "I see" every now and then. Its your way of saying, "Im listening." But some guys dont do this. Just because a man isnt saying anything doesnt mean hes not listening. He may per to listen quietly and think about what youre saying.

Shared Activities Form Bonds

Men strengthen their relationships primarily through shared activities more than by sharing thoughts or feelings. For many men, activities like sports and sex make them feel closer to their partner.

Men Need Time for Themselves

While shared activities are important, men also need time for themselves. Whether your guy enjoys golf, gardening, or working out at the gym, encourage him to pursue his hobbies, while you make time for your own. When both partners have space to nurture their individuality, they have more to give to each other.

Men Learn From Their Fathers

If you want to know how a man will act in a relationship, get to know his dad. Some say men learn about their relationship role by watching and listening to their fathers. How they are with each other and how the father relates to the mother can predict how a man will relate to his wife.

Men Let Go Faster Than Women

Women tend to remember negative experiences longer and may have lingering feelings of stress, anxiety, or sadness. In contrast, men are less likely to dwell on unpleasant events and tend to move on more quickly. So while you may still want to talk about last nights argument, your guy may have already forgotten about it.

Men Dont Pick Up on Subtle Cues

Men are more likely to miss subtle signals like tone of voice or facial expressions. And they are especially likely to miss sadness on a womans face. If you want to make sure your guy gets the message, be direct.

Men Think About Sex ... A Lot

OK, so maybe this one is no secret. The majority of men under age 60 think about sex at least once a day, compared with only a quarter of women. And thats not all. Men fantasize about sex nearly twice as often as women do, and their fantasies are much more varied. They also think more about casual sex than women do. But thinking is not the same as doing.

Men Find Sex Significant

Its a myth that most men think sex is just sex. For many, sex is a very important act between two committed people. And just like most women, men find sexual intimacy to be most satisfying in the context of a committed relationship. One reason is that long-term partners know how to please one another better than strangers do.

He Likes It When You Initiate Sex

Most guys feel as though theyre the ones who always initiate sex. But they also like to be pursued and wish their partner would take the lead more often. Dont be shy about letting your guy know youre in the mood. Initiating sex some of the time may lead to a higher level of satisfaction for both of you.

Guys Arent Always Up for Sex

Men, much to many womens surprise, arent always in the mood for sex. Just like women, men are often stressed by the demands of work, family, and paying the bills. And stress is a big libido crusher. When a guy says, "not tonight," it doesnt mean hes lost interest in you. He just means he doesnt want to have sex right then.

Men Like Pleasing Their Partner

Your pleasure is important to your man. But he wont know what you want unless you tell him. Too many women feel uncomfortable talking about what they like and dont like. If you can tell him clearly in a way that doesnt bruise his ego, hell listen. Because he knows hell feel good if you feel good.

Guys Get Performance Anxiety

Most men get performance anxiety on occasion, especially as they age. Your guy may worry about his physique, technique, and stamina. If you can help him learn to relax and stay focused on the pleasures of the moment, sex will become less stressful.

Men May Stray When Needs Arent Met

If a man doesnt feel loved and appreciated in his relationship, he may turn elsewhere for satisfaction. For one man, that may mean burying himself in work. Another may develop a fixation on sports or video games. And some men cheat. To avoid this, partners need to work together to meet each others needs.

Hes Vested in You

Most men realize theres a lot to lose if a long-term relationship goes sour – not just each others company, but the entire life youve built together. If youre willing to work to strengthen your marriage, chances are your man will be, too.

5 Ways to prevent mother to child obesity

5 Ways to prevent mother to child obesity - Since childhood, the childs diet should be monitored in order to maintain health and well-balanced weight. Mothers can prevent obesity in children, as reported by The Telegraph the following.

Do not make separate meals

Just because kids like picky eaters, do not create a separate menu for them. Instead, learn to make kids love all kinds of healthy foods that you cook yourself.

Always have vegetables and fruits

Best diet should contain healthy vegetables. Meanwhile, the fruit must also be at home as a snack for children and other family members. Avoid chips and other unhealthy foods as a snack.

Buying seasonal produce

In addition to less expensive, seasonal products obviously much fresher. You can also maximize the processing methods of healthy foods in various forms.

Cook fast and healthy

In addition to healthy food can also be cooked quickly. For example, make a salad or a healthy sandwich. If children are taught from childhood to love healthy food, until today they would still get used to eating them.

Involve children while cooking

You can also invite children to shop, cook, and involve them in all things while preparing food. That way, they will learn to recognize a variety of vegetables and want to eat them on a regular basis.

So many ways to prevent maternal obesity in children. The point is, get used to eating healthy foods so that the childs weight is always awake.

Saturday Throwback Dr Veg Love or How I Learned to Stop Worrying and Love Seasonal Produce

Every Saturday we post an older piece from CHG’s archives. Today’s article comes from August 2007. Thems was good times.

I’ll be honest: when I started researching this article, I assumed 90% of it would focus on cash. Specifically, I thought the money saved from buying in-season fruits and vegetables would far outweigh any other benefit.

Man alive, was I wrong.

Between Google and Nexis, it took approximately 2.2 seconds to discover that snagging chronologically-appropriate produce has massive political, nutritional, emotional, and environmental perks. What’s more, it tastes better. And that’s gotta count for something.

So, without further ado, nine reasons you should raid crops from the seasonal section:

It costs WAY less. Simple economics here: an abundance of anything lowers its price. Plus, because in-season produce is often grown domestically, overseas transportation costs are cut. All told, this means you can save between 10% and 50% on beans, greens, and all the in-betweens. Need proof? Check your berry section, where writer Briony Harmer notes, “strawberries in November … will cost nearly three times more than what you would have paid in June."

It tastes better. When fruits and vegetables are imported off-season, they’re often harvested prematurely, because that way they hold up better in transit. Once the food arrives here, it’s then sprayed with ethylene gas to ripen it artificially. By the time it reaches grocery stores, you’ll see decent color, but the flavor blows. See for yourself: eat a plum tomato in winter, and write down your thoughts. Try another one at the end of the summer. Odds are, the winter tomato will taste like air in comparison.

It’s better for the Earth (probably). The expert consensus is that an average pound of produce travels about 1500 miles. Imported off-season crops can raise that number significantly since they’re coming from all over the world. That scrumptiousness has to be shipped somehow, and it’s usually via truck, train, plane, or boat, all of which consume energy and add to pollution. To give some perspective, in England, “importing just a kilogram of strawberries from America is the equivalent of running a 100 watt light bulb for a week.” Buying seasonal produce can help offset the waste.

(That is, unless you buy this alarmingly convincing article from the New York Times, which pokes some pretty big holes in the transportation argument. Still, it concedes, “the connection between lowering food miles and decreasing greenhouse gas emissions is a no-brainer.”)

It’s healthier. Off-season fruits and veggies tend to lose their nutritional punch over time, since they’re shipped long-distance for weeks and months. As the London Observer reports, “freshly dug potatoes have about 21mg vitamin C per 100g which falls to 9mg after three months of storage.”

What’s more, that produce may not have started out on equal footing to begin with. A 2002 Japanese study found that Vitamin C and carotene are “significantly influenced by the cropping season,” meaning that a carrot grown in winter is missing half the carotene it would have had in the summer. For some reason, spinach, tomatoes, carrots, and broccoli are particularly affected by this, while “sweet peppers, celery, and kiwifruit [are] fairly stable.”

It’s less poisonous. You probably won’t croak eating off-season produce from abroad, but there’s a good chance it harbors more toxins than its in-season counterparts. Why? Well, according to the BioDiversity Project, “Many countries have neither the pesticide regulations nor the labor safety practices that are the law in the U.S., so theres no telling what is on or in your imported fruits and vegetables.” That added flavor you detect? It’s the bitter taste of uncertainty.

It’s in better condition. “Handling and storage … is one of the main problems in the deterioration of produce. From the way the grower packs it, to the loading and off-loading in the truck yard, to the handling in the markets, it all contributes to knocks and bruises that will quickly affect the quality of the produce,” says the Canberra Times. If you’ve ever flown cross-country, you can relate: the further something travels, the worse shape it’s in when it arrives at its destination.

It can be frozen or canned for future use. Imagine having a sweet, delicious blueberry in the middle of March. Now imagine that same piece of fruit hasn’t lost an iota of vitamins, minerals, or flavor because it was iced right after being picked. NOW imagine you’re not spending $6 on a pint of blueberries from the farthest corners of the planet, because you bought it for $2 six months ago and had the forethought to shove it in your freezer. Okay, you’re done imagining. Pat yourself on the back and eat a blueberry.

It’s politically correct (and not in an annoying way). This is a bit difficult to summarize, but I’ll give it a shot: essentially, Third World farmers make more (but not a lot of) money importing specialized off-season produce to richer countries than by growing food for themselves. According to Briarpatch, this not only “threatens the extinction of [their] local crops,” but leads to hunger and “[slavery] to international commodity prices.” Meanwhile, local farmers are hosed by big-name suppliers who purchase cheaper goods from abroad. Buying seasonally benefits everyone more in the long-run.

It’s a mental trigger for the good times. BabyFit.com’s Rebecca Pratt makes a fabulous point: “[Food is] tied to the special days and seasons of our lives: sweet, luscious watermelon paired with the memory of filies and fireworks; fragrant hearty soups that temper winter’s chill; sweet young vegetables that accompany spring’s first warm day.” Think about it: on Christmas, do you crave gazpacho? When Easter rolls around, do you drool over the light, airy taste of parsnips? Food is key to socialization, and in-season fruits and veggies can play major parts in our memories.

Of course, none of this information is any good unless you know what produce is ripe at which times. The guides at Food Network, Nutritiously Gourmet, and Cornell University are all good places to start. Consumo felice!

Sources:

• “Buy Organic and Locally Produced Foods,” BioDiversityProject.org.
• Dowden, Angela. “The food thats travelled 35,000 miles to reach your plate,” The Daily Mail (London). September 2005.
• Harmer, Briony. “How to become a vegetarian without increasing grocery bills,” Essortment.com. 2002. essortment.com/food/vegetarianincre_skfk.htm.
• “How Food Finds its Way to Your Plate,” Talk of the Nation. NPR Radio. November 2006.
• Lempert, Phil. “The squeeze and sniff test: Tips on how you can pick out fresh fruits and vegetables,” SupermarketGuru.com. April 2002. supermarketguru.com/page.cfm/287.
• McWilliams, James E. “Food That Travels Well,” New York Times. August 2007.
• Monks, Helen. “How to buy food that doesnt cost the Earth,” The Independent (London). April 2006.
• “Pass the fresh test,” Canberra Times (Australia). August 2006.
• Pratt, Rebecca. “Seasonal Foods Exceptional Flavor & Nutrition that Fits in Your Budget,” Babyfit.com. babyfit.sparkpeople.com/articles.asp?id=669.
• Ross, Alicia and Beverly Mills. “Save Money: Buy in Season.” Dallas Morning News. July 2007.
• “Seasonal Vegetables in Temperate Countries,” Food & Fertilizer Technology Center for the Asian and Pacific Region. January 2001. agnet.org/library/pt/2001002/
• Watson, Julia, “Eat To Live: Buy seasonally, eat healthily,” UPI. Jaunary 2006.
• Wiebe, Nettie. “Whos cooking the food system? Globalization & the struggle for food sovereignty,” Briarpatch. February 2007.

Exercises to Prevent Heart Attacks

Heart disease may be a leading cause of death, but that doesnt mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take. 

An inactive lifestyle is one of the major risk factors for heart disease. Fortunately, its a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. Taking steps for preventing heart disease and all cardiovascular diseases means making smart moves now that will pay off the rest of your life.

Anyone at any age can take advantage of simple steps to keep their heart healthy. Weather you are in 20s or 60+ here’s what you can do to prevent heart disease.

Healthy diet

First of all you need to choose a healthy eating plan. The food you eat can decrease your risk of heart disease and stroke. Choose foods low in saturated fat, trans fat, cholesterol, sodium and added sugars and sweeteners. Eat plenty of fruits and vegetables, fiber-rich whole grains, fish, nuts, legumes and seeds. Also try eating some meals without meat. Select fat-free and low-fat dairy products and lean meats and poultry. Limit sugar-sweetened beverages and quit smoking.

Physical exercise: What Type of Exercise Is Best?

Cardiovascular or aerobic is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the bodys ability to use oxygen. You can slowly work up to at least 2½ hours (150 minutes) of moderate-intensity aerobic physical activity like brisk walking every week.

Or  you can indulge in a vigorous intensity aerobic physical activity such as jogging or running or a combination of both for an hour and 15 minutes (75 minutes) of  every week. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help your blood pressure and improve your breathing. Other aerobic exercises include: walking, jogging, jumping rope, bicycling, skiing, skating, rowing, and aerobics.

Additionally, on two or more days a week you need muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest shoulders and arms). Strengthening exercises are repeated muscle contractions. They help tone muscles, improve strength, and increase your metabolism.

So, now you know what to do, but before you start any exercise program ask your doctor. Your doctor can help you find a program that matches your level of fitness and physical condition. Your exercise session should include a warm-up, a conditioning phase, and a cool-down.

Warm-up helps your body to adjust slowly from rest to exercise. It reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature.

Conditioning follows the warm-up. All the benefits of exercise are gained and calories are burned during this phase. 

Cool-down is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean taking rest right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity.

When you start any exercise program maintain a moderate level not too heavy exercise, always maintain a good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises. 

Choose an activity that you enjoy. Youll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Find an exercise "buddy". Plan to exercise at the same time every day (such as in the mornings when you have more energy). If you exercise regularly, it will soon become part of your lifestyle.

Here are some simple exercise you can do.

Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.

Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.

Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)

Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.

Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.

Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.

Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.

Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.

Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

If you have chest pain or pain anywhere else in the body, do not allow the activity to continue. Performing an activity while in pain may cause stress or damage to the joints. If you experience chest pain, significant breathlessness, or dizziness, you should stop exercising and let your doctor know about your symptoms. 

References:

1) http://www.heart.org

2) http://www.webmd.com/heart-disease/guide

CoQ10 Can Lower High Blood Pressure to Prevent Congestive Heart Failure

Reporting in the journal Biofactors, researchers found that patients with congestive heart failure that were supplemented with the active form of coenzyme Q10 (ubiquinol) improved ejection fraction by 39%. Ejection fraction is a critical marker of heart function used to determine the volume of blood pumped by the heart through the vascular system.

CoQ10 is essential to convert nutrients to energy and power the cellular engine, and natural production in the body declines with age. Extensive research explains how you can benefit from daily supplementation with this powerful co-enzyme to restore healthy energy balance and prevent age-related heart disease.

CoQ10 Improves Quality of Life for Heart Failure Patients

The study conducted at the East Texas Medical Center and Trinity Mother Francis Hospital focused on patients with advanced congestive heart failure that were classified as Stage IV, the most severe form of the disease. Patients were supplemented with 580 mg of the ubiquinol form of coenzyme Q10 daily to increase plasma blood levels by a factor of four.

The researchers found “the improvement in plasma CoQ10 levels is correlated with both clinical improvement and improvement in measurement of left ventricular function.” Prior to CoQ10 supplementation, most of the participants were considered critically ill and confined to bed or a wheel chair. After a regimen of ubiquinol, patients typically improved two classification levels (Stage IV to II or III to I) and were able to carry on a productive lifestyle.

CoQ10 Improves Blood Vessel Elasticity to Lower Blood Pressure

Hypertension is a serious problem that affects as many as one in three adults in the US today. High blood pressure is closely associated with coronary artery closure due to plaque formation and arterial stiffening as the normally elastic vessels require more pressure to fully circulate blood to the body. The result of a study published in the journal Nutrition and Metabolism found that coenzyme Q10 supplemented along with other potent antioxidant nutrients (vitamin C, vitamin E, and selenium) significantly increased small and large arterial elasticity that led to lower blood pressure and risk of a heart attack.

Subjects in this study received 60 mg of CoQ10 for a period of six months along with moderate amounts of the other nutrients. In addition to improved arterial elasticity, researchers found a significant decline in HbA1C blood sugar control and an increase in protective HDL cholesterol levels. The authors of the research concluded that the CoQ10 nutrient antioxidant cocktail “has beneficial effect on glucose and lipid metabolism, blood pressure and arterial compliance in patients with multiple cardiovascular risk factors.”

It comes as no surprise to most alternative health-minded individuals that nutrients obtained from natural sources exert a powerful influence on human health. Adults will want to supplement with 50 to 100 mg per day (higher amounts may be necessary for existing cardiovascular disease) of the ubiquinol form of co-enzyme Q10 to maintain optimal health, energy and protection from age-related diseases of the heart.

Green Kitchen Five Delicious Ways To Eat Broccoli Stalks

Green Kitchen is a bi-weekly column about nutritious, inexpensive, and ethical food and cooking. Its penned by the lovely Jaime Green.

Okay, so, for how long am I allowed to open my column with some erence to my continuing, undiminished excitement to have a working oven? Because Im still grateful and a little surprised every time I hear that tick-tick-tick-whoosh of the flame igniting, and I may never lose my renewed appreciation for oven cooking. Mainly the part where I put something in the oven and, as I never could with a pan on a hot plate, walk away. 45 minutes later I have food, and that is glorious.

From El_Matador

More times than not, what Im pulling out of the oven is a sheet of roasted broccoli. I might be addicted. Broccolis not the cheapest vegetable around – I can eat three or four dollars worth in one sitting – but the recipe is super easy and delicious, and since when is eating a pound of dark green vegetables a bad thing?

The only problem is all the stalks left behind. Theyre good enough sliced into discs and roasted along with the florets, but theyre not amazing that way, and Id rather devote baking sheet space to more delectable florets. And so all too often the broccoli stems end up with my eggshells and banana peels, going to compost.

Compost is a very silly – and wasteful, and lazy – fate for perfectly good, edible, healthy vegetable parts. Of course, “edible” isnt exactly high praise, or high incentive for the expenditure of kitchen effort, especially when the couch is so comfy. So here – for you and for me – are five recipes and ideas to keep our broccoli stalks out of the trash, and in our happy mouths and bellies. (Theyre happy because of the broccoli stalks.

1) Fridge pickles. You can make your own pickling brine, or go even more frugal and reuse the brine from a jar of tasty store-bought pickles. Once in a while I splurge on a jar of Ricks Picks, a delicious NYC brand. (Pickling is very chic among Brooklyn hipsters.) When the pickles are gone there is still plenty of goodness left behind in the brine. Peel your broccoli stalks and slice into spears. Pour the brine into a saucepan and bring to a boil, and wash out the pickle jar. Put the broccoli stalks in the jar, then pour in the brine. (Add some white vinegar and water if theres not enough liquid.) Screw on the lid, and pop that jar in the fridge. After two or three days: pickles!

From Cookthink

2) Crudite. Peel and slice into spears and use along with carrots, peppers, and any other raw veggies you like to dip into hummus, dressing, or your spread of choice. You get all the broccoli flavor without the awkward mouthful (and teeth full) of floret.

3) Slaw. Use a mandoline, grater, food processor with a grater wheel, or caul hands and a sharp knife to shred broccoli stems. Add some shredded carrot and mix with your favorite cole slaw dressing.

4) Stir fry. I think part of the reason I love roasting broccoli is that I can never get stir fried broccoli quite right – its always either underdone or mushy, never as delicious as at a Chinese restaurant or my moms house. (Mom! What is your secret!) But broccoli stalks – being flatter and more uniform than florets – are a cinch. They make a delicious stir-fry with Chinese flavors – soy sauce, garlic, and five-spice powder are a favorite combination of mine – and cook to a delicious combination of golden exteriors with creamy insides.

5. Soup. Once your favorite cream of broccoli soup (vegan or dairy) is pureed, no one will know if it started as tiny trees or trunks. Ditto chopped up in a quiche or casserole.

Thats what Ive got so far. (Ive also heard that some cats love broccoli, and so also broccoli stalks, but unfortunately my creature isnt inclined to any such adorable predilections.) Do you use – and enjoy – your broccoli stalks? Are there any other often discarded parts of vegetables (or animals) youve got a great use for?

Why Were Obese An Intro to Food Reward

Obesity is complex. I think we all know that at this point. There is no one reason why any of us become obese; its a combination of several factors including genetics, physical activity, hormones, calories, fat, carbs, junk food, and much, much more. We can of course say that we get fat from eating more calories than we expend, thats a fact... but that doesnt tell us anything about why were consuming more food than we need. Likewise, we dont truly know the best way to lose excess weight. We need to eat fewer calories than we expend, duh. But we have to worry about complicated things like hunger, willpower, and cravings... and why it feels like your body just wants to hold onto that extra fat.

Enter: Food Reward.  Ive touched on this in the past but I havent given it a proper explanation.  I first heard of the concept via Stephen Guyenet a couple years ago, as most people in the ancestral health community did.  Its taken me a while to fully warm up to it and truly understand it, but Im now convinced that this is a major reason, perhaps the major reason, for the obesity epidemic.  Allow me to explain.

The Reward System
Our brains contain a "reward" system that is critical to our survival.  Actions that promote our survival are reinforced by the brain by making us feel good... this makes us want to do them again.  For example, running around in the sun playing frisbee makes us feel good; the sun is good for our health (in moderation), physical activity promotes fitness and survival in the most primal sense, and it gives us a sense of community and kinship with our friends.  Our brains tell us that playing frisbee in the sun is a good thing, and were likely to do it again in the future.  But the reward system also works the other way, discouraging actions that harm us.  If we pick up a baking dish out of the oven with our bare hands, well burn our skin, and so our brains send a very strong signal for us to STOP (pain).  Addictive drugs essentially hijack this reward system.  Heroin, for example, will bypass the environmental sensory aspect of the reward system and latch on to the receptors in the brain.  Drugs like these provide a super strong stimulus, hence they are reinforced by happy feelings, and youll want to do it again and again until you become addicted.

The same goes for the food we eat.  We do need to eat to survive, after all.  Something sweet, tender, and high in calories?  Rewarding.  Something bitter and fibrous?  Not so much. Think of humans in the wild, or in hunter-gatherer times... the foods that best help us survive elicit the strongest reward signal, and were motivated to eat more. There are several qualities of food that have been found to be inherently rewarding (1):

• Fat
• Starch
• Sugar
• Salt
• Meatiness (glutamate)
• The absence of bitterness
• Certain textures (soft, crunchy, liquid)
• Certain aromas (fruits)
• Calorie density
• Variety

The Reward System in the Modern Food World
Now thats all well and good for survival.  This reward system works perfectly in a natural setting to guide us in what to eat.  Were perfectly happy eating fresh fruits, meats, potatoes, veggies, etc., and well eat just as much as we need until were full and we stop.  Even 50 years ago, we ate mostly natural, unprocessed foods, we ate as much as we wanted until we were full, and we stayed lean.

Since the 1950s, the average American has increased his/her caloric intake by about 500 calories.  In that same time period, the prevalence of obesity has nearly tripled (2). 

What changed?  The food industry figured out how to sell more food to the same number of people, something that was previously thought to be impossible.  Once they figured out that they could make food that is so appealing and rewarding, combining all of the factors listed above, that we would continue eating it regardless of our hunger cues... the game was over.  Theyre preying on our most primal of instincts.  And we cant stop, because our bodies are telling us to keep eating.  Were designed to keep eating.  Its not our fault.  Sounds a lot like heroin doesnt it?


How exactly do they do this?  Lets count.

1. By combining fat, sugar, and salt with calorie density, crunchy, and chewy... The Oreo, for example.
2. By drizzling sweet, salty, fat condiments on top of already sweet, salty, fatty foods... TGI Fridays Jack Daniels Grill.
3. By increasing portion sizes... McDonalds burgers.
4. By adding MSG, a meaty flavor, to already hyperpalatable snacks... Doritos, or even worse, that ridiculous Doritos Locos Taco.
5. Through convenient product placement... Candy bars at the checkout line.
6. By adding sugar, salt, and fat to already-addicting caffeinated drinks... Starbucks anyone?
7. By marketing junk food to children... How cool is the Kool-Aid man?
8. By offering a variety of food from all around the world in unlimited quantities... Home Town Buffet.
9. By capitalizing on the drunk munchies at the local diner... Disco fries.
10. By putting Coke machines everywhere... Everywhere...

This is deliberate, its no accident.

Just look at that shirt... God hes cool.

The Conclusion
The goal of the food reward system is to get us to eat enough real food to satisfy our nutritional needs, no more and no less.  The reward system is NOT designed for processed, hyperpalatable food.  We are designed to eat sugar, fat, starch, and salt, but not excess sugar, fat, starch and salt... and definitely not at the convenience and in the sheer quantity that were getting it in today.  

I know food companies need to make a profit, but somethings gotta give.  The cost of the obesity epidemic is immense... we cant keep this up.

The solution isnt sexy. Just eat real food. Call it Paleo, call it ancestral eating, call it what you will. Just opt out. Get back to basics and eat real food again. Take your health into your own hands and keep it real. Im out.

5 How to shrink the fat in calf

5 How to shrink the fat in calf - Cause of excess weight is fat in certain body parts, one of them calves. So how do I shrink the fat in the calves? Listen more, as reported by Mag for Women following.

1. Squat
Squat is one of the best exercise to shrink the fat in the calf. The trick, try to stand up straight with legs wide open position. After that, put your hand on the waist and the knees bent. Hold for a few seconds, do repeatedly every day.

2. Lunges
The next physical exercise a powerful shrink the fat in the calf is lunges. Begin in a standing position and both legs wide open, one foot forward and knees bent up rear knee touches the floor. Repeat 15-18 times each perform the movement.

3. On foot
Cheap, easy, and did not take much, thats the walking exercise. In addition to healthy, walking can also shrink the fat in the calf. Try to select a time in the morning for a walk. Refreshing morning air will make the activity more enjoyable walk.

4. Jogging
Jogging is another option that can be done to shrink the fat in the calf. In fact it is also a powerful sports to keep in shape as a whole.

5. Squat on the floor
Want to exercise while lying down? Heres the answer. Squat on the floor can be done by tilting the body on the floor with one foot in the lift to the top. Do alternately for a few seconds. Not just fat in the calves that can shrink, thigh muscles will also be formed to squat on the floor.

Thats a variety of ways to shrink the fat in the calf. Do not forget to eat nutritious food to maximize business shrink fat in the calf.

Ask the Internet Best Meals to Bring the Laid Up

Hey folks! Today’s question is inspired by chilly, sneezy weather in the Northeast.

Q: We’ve all had loved ones confined to pregnancy bedrest or a few days of quiet recovery from surgery. And during those times, it’s tough for them to put clothes on, never mind cook.

So, what are your favorite make-ahead or freezer-ready dishes to bring laid up friends and family?

A: Readers, I don’t have much experience in this area, though I’ve made a few chilis that folks seem to appreciate. What are your best all-time healing meals?

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

On the Invisibility of Selection Bias and Regression to the Mean in Population Health Management

A DMCB Vacation....

While the Disease Management Care Blog is neglectfully vacationing at the New Jersey shore, the spouse is slathering it and the spawn with SPF 100³.  Thats why the DMCB cant help but recall the recent advice of a media dermatologist: fear the sun.  Every melanoma patient he had ever cared for "recalled at least one severe sunburn!"

The population health management providers would be well advised to remember that skin doctors silliness.  While every patient we recall "got better" also ask yourself the simple question that should have been posed by the radio-show host:

"What about the patients you didnt take care of?"

Talk to any telephonic-coach nurse or any medical home care manager, and he or she will likely be able to rattle off dozens of HIPAA-protected encounters that started with an expensive clueless patient and ended with a less-expensive empowered patient. They and their manager-supervisor-vice-presidents are sure they had an impact. They see little reason to believe otherwise and see no need for "proof."

Theyre wrong.

Unfortunately, for both dermatology and PHM, it cuts both ways.  Plenty of patients have had severe sunburns and never had to see a dermatologist.  And there are plenty of patients who go from high to low intensity without the benefit of care management.

Of course, dont credit the DMCB for this example of selection bias with regression to the mean.  Skeptic Francis Bacon commented on the invisibility of drowned worshippers centuries ago.

The DMCB wont mention that problem to the spouse when it enters the surf.

Image from Wikipedia

Bialys Chewy Rolls topped with Caramalised Onions We Knead to Bake 5

After pull apart bread,croissants,hokkaido bread and torcettini cookies, we are here with an another bread, something interesting and savoury as well, yes this months We Knead to Bake is this beautiful Bialys, an incredible monthly baking event b Aparna. The bialy is pronounced as bee-AH-lee ressembles like bagel but its quite diferent from it. Bialys are baked while bagels are boiled and then baked. Bialys are chewy rolls which are round with depressed middle not a hole and usually filled with cooked onions or else sometimes onions with poppy seeds.People enjoy bialys with butter or cheese but i felt that bialys without any spread itself tastes fabulous.

The name Bialy comes from Bialystocker Kuchen which translates as bread from Bialystok from Poland. Bialys are rarely seen or made in Bialystick nowadays, but earlier its seems that this Bialys are eaten by rich Jews with their meals while its was the whole meal for the poor Jews. In early 1900, many Eastern Europeans including Polish immigrated to US and settled down in New York, obviously they also brought their Bialys making skills with them and that is how the New York Bialys are famous.

Bialys will have usually a thin layer of caramelised onions and poppy seeds, but i prepared my caramalised onions with dry fenugreek leaves and garlic.And this filling was amazing with a wonderful garlic and dry fenugreek aka kasuri methi flavour.

Recipe Source: King Arthur Flour
Dough:
3cups All purpose flour
1tsp Salt
1+1/4cup Water
1tbsp Sugar
1tsp Instant yeast
Milk for brushing the dough

For onion filling:
3nos Medium onions (finely chopped)
1tbsp Oil
2nos Garlic cloves (crushed)
1tbsp Kasuri methi
Salt

Take the yeast,sugar,salt and flour in a food processor,pulse it and add the warm water in a steady stream.

Knead until the dough comes together and let the dough rest for few minutes, this way the dough will absorb the water.

Knead again by adding little water or flour if needed until the dough turns smooth,elastic but not sticky.

Trasner the dough to a greased bowl,cover it and let it sit in a warm place to double.

Meanwhile,heat oil in a pan, add the crushed garlic, saute for few minutes, add the onions and cook in medium low flame.

Sprinkle some salt and saute until they turns golden brown in colour, finally add the crushed kasuri methi and put off the stove.

Keep aside and let this caramelised onions gets cool.

After 2hours, take out the doubled dough and divide into 8equal pieces, dust the pieces with enough flour and roll them as smooth balls and keep aside for an hour.

When the rolls are ready, pick up one and using fingers form a depression in the middle.

Hold the roll like a steering wheel with ur thumbs in the middle and your fingers around the edges.

Pinch the dough between your thumb and fingers, rotate it, gradually make the depression widers without poking a hole.

Once shapped, prick the centre of the bialy with a fork, transfer it over a baking sheet lined over a baking tray and fill it with already prepared onion filling.

Brush the outer dough generously with milk.

Bake bialys at 230C for 15 minutes till the crust turns golden brown.

Cool them and serve when they are slightly warm or at room temperature.

Oatmeal Beats Ready To Eat Breakfast Cereal at Improving Appetite Control

While obesity is a complex and multifaceted problem, much of the strategy behind combating it boils down to healthy eating habits. Taking into account the primary role of subjective appetite sensations in said habits, a group of researchers recently compared the satiety impact of two popular breakfast choices: oatmeal and ready-to-eat breakfast cereal (RTEC). Their study, "Acute Effect of Oatmeal on Subjective Measures of Appetite and Satiety Compared to Ready-to-Eat Breakfast Cereal: A Randomized Crossover Study" is now available in the Journal of the American College of Nutrition, the Official Publication of the American College of Nutrition and a publication from Routledge.
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A sample of 48 healthy subjects 18 years of age and older were tested on 2 days, one including a breakfast of prepared oatmeal and the other an RTEC. Satiety feedback was collected prior to and at several points over the 4 hours following consumption, using visual analogue scale (VAS) ratings of hunger, fullness, stomach fullness, hedonic "satisfaction," and desire to eat. In addition, each breakfast treatment was run through physiochemical testing of β-glucan characterization, in vitro starch digestion kinetics and viscosity.

The findings indicate that "…the oatmeal breakfast resulted in a greater increase in perceptions of fullness and a greater decrease in perceptions of hunger, desire to eat, and prospective intake in the 4-hour period postprandial when compared with the RTEC," while ratings of satisfaction didnt differ significantly. These findings are consistent with physiochemical test results indicating that the β-glucan content of the oatmeal was more viscous due to its higher concentration and molecular weight, signaling a more satiating form of fiber.

While further research into other aspects of oatmeals nutrient content and glucose/ endocrine satiety markers is called for, the results of this study suggest that choosing oatmeal for breakfast can prolong the period between meals and thus help establish habits conducive to weight loss.

Get in Shape! 5 ways to get started

1. Set a fitness goal. And give yourself enough time to reach it. Your mission is the motivation that will keep you going on days when you feel like giving up. Be sure to create smaller goals too (such as doing 15 sit-ups), and reward yourself when you reach them, to help propel you toward your big one.

2. Formulate a workout plan. Aim for three 40-minute workouts each week, at specific times. Your exercise schedule needs to be as important as any other appointment you have. Vary your routine — maybe its tennis one day and a dance class on another — to challenge yourself and ward off workout boredom.

3. Do a reality check. Be completely honest with yourself about how fit you are. Getting in shape is a personal journey that requires a realistic self-perspective; some novice exercisers are overly ambitious and begin a workout plan or set goals that are too hard on their bodies. So take it slow. Keep your focus on where you are and the progress youve made.

4. Seek support. Youre less likely to bail on a workout if you know a friend is waiting for you, and having a partner is good for emotional support too. Seek out people who have a contagious "You can do it!" attitude and who embody the fitness lifestyle you want. Dont compare yourself to über- fit types — trying to match their high standards may just make you want to quit.

5. Eat right. Make sure youre eating the best foods to fuel your body — including lots of fresh fruits and veggies, lean proteins, and healthy fats. And drink at least six cups of water a day — or more on the days you work out — to keep your hardworking body hydrated and energized.

Choosing Wisely Unnecessary Testing and the Simplistic Use of Web 1 0 to Attempt Physician and Patient Behavior Change

The Model T

There are certain Disease Management Care Blog behaviors that the spouse finds.... objectionable.  She has verbally educated the DMCB about them and has left written notes about them.  Since these communications havent worked all that well, are there any other "channels" she could use? 

The DMCB spouse may be tempted to use the approach of the Choosing Wisely web-site. It provides lists of widely used medical tests and treatments that are typically unnecessary.  The lists (located here) were compiled as part of a joint physician and education project by organizations such as the American College of Cardiology (dont do stress tests in patients without cardiac symptoms) and the American College of Physicians (dont get back x-rays if the ache is non-specific). According to the press reports heralding the availability of this just opened web-site (for example), its purpose is to prompt patients and physicians "to work together" to not only make clinically wise choices, but save the U.S. health care system a lot of money.

The DMCB knows that the academic experts and organizations that developed these lists have been talking and writing about these wasteful tests and treatments for decades.  Waste has been the subject of infinite numbers of continuing education programs, grand rounds, published review articles, national meetings and guidelines.

Those approaches havent worked. 

So is the fix is to repackage the information and post it as simple text on a web page?

The DMCB cant say its impressed.  While the evidence underlying the clinical recommendations themselves is superb, there isnt any evidence that internet-based physician instruction is any better than traditional methods.  And if the purpose of the Choosing Widely web site is to prompt patient behavior change, the evidence that web-based education is better than print is pretty skinny there too. 

Its ironic that the intellectual rigor of the lists themselves wasnt matched by the same evidence-based approach to using the internet for this exercise in the first place.

Whats more, if these groups insisted on using the internet, the least they could have done was deploy a Web 2.0 approach.  The current Choosing Wisely site is so.... has been. 

That being said, there is some information that could be of use to the population health management service providers.  In contrast to the physician organizations, the DMCB is confident that theyll know how to package and present the information so that it can have a real impact.

The DMCB wishes Choosing Wisely good luck.  And in the meantime, it looks like the DMCB spouse will have to continue to rely on verbal and written feedback.... for now.