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Friday, January 23, 2015

Disease Risk -- Measles

There has been a concern about the recent increase in incidence of Rubeola (Measles)

Measles (also known as Rubeola or morbilli) is a viral infection of the respiratory system.  It is classically characterized by initial fever followed by a rash that covers most of the body.  Measles is highly infectious and is spread through aerosolized droplets from infected persons.  It is contagious from 2-4 days prior to and 2-5 days after the onset of the rash.  Prior to vaccination, 90% of the population in the US contracted measles by the time they turned 15.  Although it is generally a mild illness, it can be accompanied by very serious complications (pneumonia, encephalitis, SSPE) or death in a small number of cases. [1]    Measles can be very serious in immunocompromised persons.

There is considerable evidence that the risk from severe measles disease is highly variable depending on factors influenced by economic and living conditions.  Morbidity and mortality due to measles is far higher in the developing world.  In a study from the UK, Maclure found that the risk of hospitalization from measles in children living in deprived households was over 10 times higher than in areas where households were not deprived.[7]  For measles, overcrowding and unemployment were more correlated with measles hospitalization than vaccination rates.  In the developing world, the majority of complications occur in the younger children.  Gordon et al describe that in Guatemala, nutritional supplements reduced the annual mortality rate by 65% while medical care reduced it by almost 70% [8].

Measles typically begins with
  • high fever,
  • cough,
  • runny nose (coryza), and
  • red, watery eyes (conjunctivitis).

Measles Rash

Image of measles infection
Skin of a patient after 3 days of measles infection.

Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.
Three to five days after symptoms begin, a rashbreaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.
After a few days, the fever subsides and the rash fades.

Measles photo collection:

Don't wait.....Vaccinate !

Thursday, January 8, 2015

100 Ways To Change Your Life In 10 Minutes Or Less

The most effective way to meet any goal, experts say, is through a series of tiny changes. Here are 100 that work.

1. Wipe down your office doorknob.
Using disinfectant wipes on commonly touched objects like doorknobs can reduce the spread of cold- and flu-causing viruses by up to 90%, according to researchers from the University of Arizona.

2. Meditate in the morning.
"I start my day with a simple meditation practice; it sets the tone for my day and clears my head to prepare for what's ahead," says Tiffany Cruikshank, an internationally renowned yoga instructor and the founder of Yoga Medicine. 
3. Eat sardines twice a week.
They're packed with protein and omega-3s, and most worthy of a place on your plate. Try these 3 easy recipes with sardines—your heart will thank you.
4. Make your own salad dressing.
Skip the not-so-healthy bottled stuff; all you need are a handful of ingredients to bring out the best in your greens. Try these easy 5-ingredient salad dressings.
5. Cook with blood-pressure-lowering herbs.
Add these super-healthy spices to your recipes, and check out these 25 healing herbs you can use every day.

6. Get Sugar Smart.
Americans eat an insane amount of sugar—and much of that sugar is hidden in foods without you realizing it. Take back control with The Sugar Smart Diet, written by Prevention's own Anne Alexander (published by Rodale, which also published Prevention).
Answer an email in person.
Not only is it friendlier, but it also forces you to walk around, which you should do at least once every hour if you have desk job, says Martha Gulati, MD, director for preventive cardiology at Ohio State University Wexner Medical Center. Studies link sitting to weight gain and poor heart health.
Make a food plan for the week.
Chalkboards are trendy, but they're also good for guiding your mind and your mouth toward a healthy meal at the end of the day. (Fill your menu with these freezer-friendly recipes you can make ahead of time.)
Volunteer your time.You get what you give: Research shows volunteering regularly can lower your risk for death by up to 24%. All that usefulness and altruism might cause your brain to produce more oxytocin and progesterone—good-vibe chemicals that curb stress and reduce harmful inflammation. (Here's how to find the good deed that matches your personality.)

There are many more excellent ideas, such as 
Wear sunscreen every single day.
With a reduced risk of skin cancer, and fewer wrinkles and sunspots, there are a million reasons to protect your skin, says Alison Sweeney, author of Scared Scriptless and host of The Biggest Loser. "Each morning, I make a point of taking care of my skin by applying moisturizing sunscreen. It gives me a few minutes of quiet and I'm protecting myself for that day and the years ahead."
Spike your breakfast with cinnamon.
The spice has been shown to reduce insulin resistance and may help lower cholesterol and triglycerides, blood fats that could contribute to diabetes risk. Find it in these 12 energy-boosting breakfasts.

Take your walk to greener pastures.
The University of Essex in the UK found 30 minutes of walking in a green scene reduced depression in 71% of participants.


 Wearable Devices add a new flare to your fitness program

 Simple nasal irrigation is painless, eliminates many allergens such as pollern, mold, and reduces  frequency of colds.
Yogurt and honey.....what more to say.

6 inflammation-causing foods no one talks about..
There's a five-alarm fire sounding these days about inflammation, and with good reason. Heart disease, cancer, Alzheimer's, and acne are just some of the possible consequences of too much inflammation in the body.According to Nicholas Perricone, M.D., the pioneering nutritionist and dermatologist (who wrote the book on anti-inflammation eating), our bodies actually depend on temporary inflammation to help fight off sudden injuries or infection. But when that inflammation becomes chronic, "the immune system mistakenly attacks normal cells, and the process that ordinarily heals becomes destructive.Like so many health issues, the main culprit is too much sugar, and surprise, some Yogurts may not be healthy.
Not all frozen yogurts are created equal, says Andrew Weil, M.D., director of the Arizona Center for Integrative Medicine at the College of Medicine, and an anti-inflammatory evangelist. "Some frozen yogurts contain the milk proteincasein, which may increase inflammation," he explains. "Others contain specific probiotics that may actually reduce it." (And some frozen "yogurts" contain no dairy at all and use coconut milk.)

Froyo has two potential inflammatory culprits: sugar and dairy. Milk can boost insulin levels and male hormones, and it's a common allergen, which means it can trigger inflammatory reactions (anything from diarrhea to hives). 

Try some of these and make notes about your progress.

Sunday, January 4, 2015

What's happening in Vegas: the CES 2015 keynotes you won't want to miss

What's happening in Vegas: the CES 2015 keynotes you won't want to miss

What dedicated health technologist can miss CES ?

The biggest day of CES is the day before CES. Come to think of it, the day before that (today, Sunday) is pretty big too. But Monday is press conference day

The day some of the industry’s biggest and most important companies get on stage and launch somewhere between five and five thousand new products. (Some of them will be washing machines.) If you’re excited about the future of technology and the gadget industry, there’s no bigger day than CES Day Zero.
That day is tomorrow. Monday, January 5th, 2015. We’ll be live all over Las Vegas, following every event, every announcement, every time Michael Bay melts down during a Samsung event because he forgot his lines and should probably stick to directing. For the biggest events, we’ll be on the scene liveblogging, bringing you everything in real time as it happens.

To learn more:  Digital Health Space

Monday, December 29, 2014

Hey Doc, Please go Away

Aaron Carroll,  over at The Incidental Economist,summarizes a study suggesting that patients do better when cardiologists are away at academic meetings.

High risk patients admitted with heart failure during meetings had a 30-day mortality rate of 17.5%, compared to 24.8% when more cardiologists were there. Cardiac arrest 30-day mortality was 59% during meetings and 69.4% at other times. 
Why is this?
There are a number of ways to interpret this. Maybe the best cardiologists were the ones who stayed home. Maybe with fewer cardiologists available, fewer invasive procedures get done, and that leads to better outcomes. Maybe they tell more low-risk patients to wait when fewer cardiologists are available, which gets the higher risk patients more attention and better outcomes. Maybe it’s something else.
I favor the second explanation and am reminded of the excellent judgment of my PCP back in 2007 when I was asked by the touring company to take a stress test before a two-week long kayaking trip to Patagonia.
She says, “No. I refuse to order a stress test for you.”
“Huh?” I reply intelligently.
“Here’s the deal,” she says. “If I order the stress test, our especially attentive (knowing who you are) cardiologist will note some odd peculiarity about your heartbeat.

 He will then feel the need, because you are president of the hospital, to do a diagnostic catheterization. Then, there will be some kind of complication during the catheterization, and you will end up being harmed by the experience.”

Minor ST segment changes, may be non-specific.
” I will not authorize a stress test.”

Sunday, December 28, 2014

The Ideal Medical Practice

What and where is the 'ideal' medical practice?  Is it a solo, group, or hospital based setting? Is it a government position, or a federally qualified medical clinic?

The answer is "It is in the eyes of the beholder".  Like a valuable family heirloom it is a treasured asset, not defined by assets, or market value.

For some practiioners it may be independence, creativity, flexibility, self initiative, and freedom for independent decision making. Contolling your own schedule is an important factor for many solo doctors. Others may hold freedom from administrative duties, collegial interactions, the economic power of a group credit worthiness, or belonging to a larger institution with a standing reputation and/or receiving referrals from within the group itself.

Many disruptions have been caused by government interference, HMOs and insurance companies.

Innovative organizations such as accountable care organizations, PQRS,  and health reform such as the Affordable Care Act create confusion, and contribute to increasing cost which is counter to the perceived goals of improving quality and the cost of healthcare.

Jean Antonucci M.D. describes her IMP in the video

John Brady M.D.  talks about how the IMP model not only benefits his patients but drives his joy in practice and hope for the future of primary care. Dr. Brady questions if he can continue his practice model, a common concertn for IMPs. 

Choosing your medical practice model begins in medical school or training. It may be effected by a mentor, or a practice setting in which a trainee works. There may be an economic incentive with rewards such as loan forgiveness, lifestyle, or geographic location.

Preparation for each of these goals begins in training. Independent medical practice requires additional preparation in business and administration as well as organizational abililties. 

Ideal Medical Practices

Tuesday, December 23, 2014

Unlocking DNA secrets with a Canadian genome search engine - The Globe and Mail

Unlocking DNA secrets with a Canadian genome search engine - The Globe and Mail

Health Train Express Search Upgrade

The number of posts increases monthly and I have incorporated a "search"  function, located at the top of the right sidebar.  Note the 'advanced' drop down tab.  This will enable more specific ranges, by date and other. I trust this will enable you to search and find related posts for the days topic. There is also a Google Web Search available. Happy Holidays from Health Train Express.

 See more at: