HEALTH TRAIN EXPRESS
Mission: To promulgate health education across the internet:
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My first experience with a BP monitoring watch was the Omron model in the middle, which, despite its digital nature, remained quite bulky and uncomfortable for daily use. Moving on, we have the fourth device in the lineup, YHE's BP monitoring smartwatch which works quite well and is definitely a more comfortable choice than the Omron one.
The Apple Watch, unfortunately, nor does the Galaxy Watch do not have a built-in blood pressure (BP) monitor. While it can track heart rate, ECG, and other health metrics, measuring blood pressure typically requires an external device. Some third-party apps and accessories can sync with the Apple Watch to provide BP readings, but these require additional hardware. Always check the latest Apple product features, as they may have been updated since then.
The Apple Watch was the first consumer-targeted device to offer monitoring. However, it can transmit results to a provider.
Several continuous glucose monitors (CGM) track, and graph and are connected to a smartphone app. These devices have a memory chip for analysis at a later date.
Next up is Aktiia's watch, (about the size of a fitbit) known for its comfort and user-friendly design. This device employs optical sensors and PPG technology to continuously track blood pressure levels throughout the day and night. The collected data is securely transmitted to a cloud server via the Aktiia App, where advanced algorithms analyze the optical data to estimate your blood pressure.
And last, but not least, another great option is Biobeat's chest-worn BP monitor. I particularly appreciated its portability and lack of discomfort. However, before using it, I had to take reference measurements with a traditional blood pressure monitor. Additionally, to ensure the device remains securely in place, you must refrain from exercising or showering for 24 hours after application.
I think this image shows just how well the evolution of BP monitoring aligns with the digital health paradigm shift in healthcare. Have you tried any of these devices before?
The effect of ultra-processed food vs unprocessed foods
A group in Brazil introduced this new way of classifying foods that completely ignores the nutrient composition and says what we should be doing is classifying foods based on the extent and purpose of processing foods. And so, they categorize these four different categories. In the fourth category of this so-called NOVA classification scheme (see graphic below), they identified something called ultra-processed foods. There's a long formal definition and it's evolved a little bit over the years and continues to evolve. But the basic idea is that these are foods that are manufactured by industries that contain a lot of purified ingredients made from relatively cheap agricultural commodity products that basically undergo a variety of processes and include additives and ingredients that are not typically found in home kitchens, but are typically exclusively in manufactured products to create the wide variety of mostly packaged goods that we see in our supermarkets.
There are considerable competing theories about obesity, including calories consumed and calories burned. as well as the balance of carbohydrates fats, and protein, fasting, and ketogenic diets. It may be these categories may be complementary. It may be that polygenic features are at work. There are other factors to be ruled out in specific individuals such as genetic and hormonal effects.
The basic message is that we have lots of competing theories about what is driving obesity. There are a few things that we all agree on. One is that there is a genetic component. That adiposity in a given environment is somewhere between 40% to 70% heritable, so our genes play a huge role. It seems like certain genes can play a major role. Like if you have a mutation in leptin, for example, or the leptin receptor, then this can have a monogenic cause of obesity
If a country’s average doctor visits are high, it could be easy to assume the population isn’t healthy. At the same time not going enough may seem like there’s an accessibility issue. As with most sociological data, the devil is in the details. And differences in payment systems, insurance plans, and how healthcare is delivered all play a part in why going to the doctor is more common or not. This chart tracks the number of in-person doctor visits per year by country. Data is sourced from the OECD, as of 2021, or the latest year available. Figures are rounded.
As with most sociological data, the devil is in the details. And differences in payment systems, insurance plans, and how healthcare is delivered all play a part in why going to the doctor is more common or not.
Let's compare the United States which has an average number of doctor visits per year (2-3) and So. Korea (13-16)
Comments:
I happened to do one of my master's projects on South Korea’s healthcare system….they have one of the best, low-cost, high-access, low-mortality systems in the world, with a pharmacy attached to nearly every outpatient clinic. In the US, access is sparse for nearly all outpatient specialties and is on a trajectory to get even worse. All while we pay extraordinarily high rates for our health insurance and have deplorable numbers on our mortality rates despite the advanced technology that we boast over other nations. Sad.
Gatekeeping primary care (with well-trained professionals and adequately organized) is one of the best measures to improve health systems in terms of cost-efficiency, quality, person-centredness, and prevention …only 6% to 10% of people are referred to specialist care (and accordingly they can focus on the matters they’re trained for) and the rest can be better solved at primary care level: all supported by evidence 😊 and a key message for all institutions dealing with health systems improvement.
Note: a well-trained family doctor is a specialist…in general medicine 😉
the future for health systems looks pretty grim. Many of the populist and autocratic-dominated governments don’t show much realistic plans for sustainable health systems. The good news is, that we have a lot of knowledge, evidence, and practices on how to make better health and social care systems. Strong leadership and executive power are desperately needed in most systems more than ever, but voters should understand this is something different than populist rhetoric ☺️…in this respect, also the academic community has something to answer for…
Useful tips
The article from Visual Capitalist explores global variations in the frequency of doctor visits by country, based on OECD data. Key insights include: South Korea leads with 16 annual doctor visits per person, thanks to its efficient healthcare system and national insurance that covers over 70% of costs. Japan and Slovakia follow with 11 visits annually, while Germany and Hungary average 10.
Conversely, Americans have one of the lowest averages, just two visits annually, largely due to high co-payments and reliance on nurse practitioners and other medical staff. Variations are influenced by differences in healthcare systems, payment models, accessibility, and the roles of non-doctor healthcare professionals.
Countries like Sweden, Canada, and Finland also report lower visits due to reliance on nurse practitioners and similar professionals. The analysis highlights the complexities in interpreting healthcare data and the evolving demand for medical professionals worldwide.
Editor's commentary
Wow, I had no idea I was such an overachiever when it comes to doctor visits! Maybe I should start a loyalty program. On a serious note, it's interesting to see how different countries approach healthcare.
Today, I received a call about a child swallowing a soft earbud. I advised him, "This too shall pass," but be sure to wash it well before using it again.
Aim: Children frequently ingest coins (generally with minimal reported side effects); however, ingesting other items has been subject to less academic study. Parental concern regarding ingestion applies across a range of materials. In this study, we aimed to determine typical transit times for another commonly swallowed object: a Lego figurine head.
Methods: Six pediatric healthcare professionals were recruited to swallow a Lego head. Previous gastrointestinal surgery, inability to ingest foreign objects, and aversion to searching through fecal matter were all exclusion criteria. Pre-ingestion bowel habit was standardized by the Stool Hardness and Transit (SHAT) score. Participants ingested a Lego head, and the time taken for the object to be found in the participant's stool was recorded. The primary outcome was the Found and Retrieved Time (FART) score.
Results: The FART score averaged 1.71 days. There was some evidence that females may be more accomplished at searching through their stools than males, but this could not be statistically validated.
Conclusions: A toy object quickly passes through adult subjects with no complications. This will reassure parents, and the authors advocate that no parent should be expected to search through their child's feces to prove object retrieval.
In an age where convenience often trumps nutritional value, a growing body of research is raising concerns about the health implications of eating ultra-processed foods. These foods undergo extensive industrial processing, resulting in products that are convenient, hyper-palatable, and potentially detrimental to long-term health. While processing itself is not inherently negative (think pasteurized milk or extra virgin olive oil), the extent of processing and its impact on nutrient density are critical factors to consider. Ultra-processed foods, which are commonly defined under a classification known as NOVA, contain additives and undergo significant alterations from their natural state. They tend to be energy-dense, nutrient-poor, and often have long shelf lives. It’s raising concerns about their role in diet-related health outcomes such as heart disease, diabetes, and obesity, as our busy lifestyles may push us to reach for easy, quick, or low-cost, rather than cooking and eating more unprocessed or minimally processed foods like fruits, vegetables, eggs, nuts, or seeds.
Consider the level of food processing, the overall nutrient density of foods, and your overall dietary patterns, Passerrello suggested. Packaged cookies and sodas are energy dense but lack the nutrients our bodies need. While they may provide some energy and calories, they’re not supplying vitamins or minerals. This may lead to nutrient deficiencies over time, as well as unintended weight gain, according to Passerrello, who is also an instructor at the University of Pittsburgh.
However, there’s a spectrum. “The way our bodies respond to the calories and nutrients varies, depending on our age, activity level, and overall dietary patterns,” she says.
While the NOVA classification system provides the most common framework for understanding the continuum of food processing, several other classification systems, including one from the International Food Information Council, or IFIC, use slightly different criteria to define ultra-processed and processed foods. Generally, however, these guidelines agree that highly processed foods contain high amounts of total and added sugars, fats, and/or salt, low amounts of dietary fiber, use industrial ingredients, whether derived from foods or created in labs, and typically contain little to no whole foods.
It’s easy to find these highly processed foods on supermarket shelves:
mass-produced bread
carbonated drinks
breakfast cereals
ice cream
These are just some products that typically contain artificial
This week on a special TUESDAY episode of VSRF LIVE we host an extraordinary episode featuring Jonathan Marko, the Michigan attorney behind one of the most significant vaccine mandate cases in recent history, and Lisa Domski, the plaintiff awarded nearly $13MM in damages.
Jonathan Marko will share the story behind his client Lisa Domski, a Catholic woman who was awarded nearly $13 million in damages after being fired by Blue Cross Blue Shield of Michigan for refusing the COVID-19 vaccine. This groundbreaking case has major implications for vaccine mandates, workplace discrimination, and religious freedom. Lisa, an IT specialist, was terminated despite working remotely and providing ample documentation of her sincerely held religious beliefs.
Hear firsthand from Marko about the legal battle, the broader implications of this verdict, and what lies ahead for others seeking justice. Also joining us for a quick check-in will be our NYC firefighter friends with an update on their own case battling the tyrannical vaccine mandates in their city.
Pushmeet Kohli, Vice President of Science, Google DeepMind
Topol goes on with his introductory comments.
LLM is moving at a pace we've never seen. Just last week, Evo was published in Science. This Wednesday, the Human Cell Atlas Foundation Model will be published in Nature. We've had multiple human methylome models, published in the last couple of weeks at [? Bolts One ?] yesterday. It's just dizzying.
That's, of course, the kind of life science side, and of course, it's much broader as already introduced by James and Jennifer in terms of the biomedical applications.
The science of AI is having an immense effect on researchers just beginning to explore the possibilities. All of these experts realized the ethical considerations of having a machine make decisions about human beings.
Some suggested LLMs be used in developing nations. where oftentimes access to healthcare is non-existent. If this is coupled with telemedicine its potential could be unlimited.
1. Diagnosis and Treatment
Medical Imaging: AI algorithms analyze medical images (like X-rays, MRIs, and CT scans) to detect anomalies such as tumors or fractures more accurately and quickly than traditional methods.
Predictive Analytics: AI can predict disease outbreaks and patient outcomes by analyzing vast datasets, helping healthcare providers make informed decisions.
2. Personalized Medicine
Genomics: AI assists in analyzing genetic information to tailor treatments based on individual genetic profiles, improving effectiveness and reducing side effects.
Treatment Plans: By analyzing historical data, AI can suggest personalized treatment plans that are more likely to succeed for individual patients.
3. Operational Efficiency
Resource Management: AI optimizes hospital operations by predicting patient admissions, managing staff scheduling, and reducing wait times.
Supply Chain Optimization: AI helps manage inventory, ensuring that necessary medical supplies are available without overstocking.
4. Patient Engagement
Chatbots and Virtual Assistants: AI-powered tools provide patients with instant answers to their questions, schedule appointments, and offer medication reminders, improving patient engagement and satisfaction.
Telemedicine: AI enhances telehealth services by providing real-time data analysis and support during virtual consultations.
5. Drug Discovery and Development
Accelerated Drug Discovery: AI models analyze biological and chemical data to identify potential drug candidates more quickly than traditional methods.
Clinical Trials: AI helps identify suitable candidates for clinical trials, improving recruitment efficiency and trial outcomes.
6. Monitoring and Care Management
Wearable Devices: AI analyzes data from wearables to monitor patient health in real-time, alerting healthcare providers to potential issues before they become critical.
Chronic Disease Management: AI systems support patients with chronic diseases by providing ongoing monitoring and personalized health recommendations.
Challenges and Considerations
While the potential of AI in healthcare is significant, challenges remain, including:
Data Privacy: Ensuring patient data is secure and used ethically.
Bias and Fairness: Addressing biases in AI algorithms to ensure equitable healthcare for all populations.
Integration: Effectively integrating AI systems into existing healthcare workflows and technologies.
Overall, AI is poised to revolutionize healthcare by improving outcomes, enhancing efficiency, and enabling more personalized care.
Conclusion
The integration of AI in healthcare is a dynamic and rapidly evolving field. By enhancing diagnostic accuracy, personalizing treatment, and improving operational efficiencies, AI has the potential to significantly improve patient outcomes. However, addressing the challenges of data privacy, bias, and integration is essential to fully realize its benefits in healthcare.
A rare and potentially fatal skin infection with nightmarish outcomes may soon have a cure.
The infection starts as a seemingly harmless rash, and before a person knows it, more than 30 percent of the skin on their body begins to blister and peel off in sheets, usually starting with the face and chest before progressing to the mouth, eyes, and genitals.
Without treatment the TEN has a 60% mortality rate
Infections, organ failure, and pneumonia can soon follow. In a third of all cases, the condition proves fatal. For those who survive, recovery can take months and usually requires similar treatment to burn victims.
The debilitating infection is an immune response to medication, called toxic epidermal necrolysis (TEN). While it is thankfully scarce, impacting a million or two people worldwide every year, its onset is highly unpredictable.
TEN is linked with more than 200 medications, and it can impact all age groups and ethnicities, although it tends to be more common in females than males and is 100 times more prevalent in those with the human immunodeficiency virus ( HIV).
The infection starts as a seemingly harmless rash, and before a person knows it, more than 30 percent of the skin on their body begins to blister and peel off in sheets, usually starting with the face and chest before progressing to the mouth, eyes, and genitals.
Infections, organ failure, and pneumonia can soon follow. In a third of all cases, the condition proves fatal. For those who survive, recovery can take months and usually requires similar treatment to burn victims.
The debilitating infection is an immune response to medication, called toxic epidermal necrolysis (TEN). While it is thankfully sporadic, impacting a million or two people worldwide every year, its onset is highly unpredictable.
TEN is linked with more than 200 medications, and it can impact all age groups and ethnicities, although it tends to be more common in females than males and is 100 times more prevalent in those with the human immunodeficiency virus ( HIV).
An international team of researchers, led by biochemists at the Max Planck Institute in Germany, now claim to have cured seven patients with TEN or a slightly less severe version of the infection, known as Stevens-Johnson syndrome (SJS). None of the patients reported side effects.
Key steps of the JAK-STAT pathway. JAK-STAT signaling is made of three major proteins: cell-surface receptors, Janus kinases (JAKs), and signal transducer and activator of transcription proteins (STATs). Once a ligand (red triangle) binds to the receptor, JAKs add phosphates (red circles) to the receptor. Two STAT proteins then bind to the phosphates, and then the STATs are phosphorylated by JAKs to form a dimer. The dimer enters the nucleus, binds to DNA, and causes transcription of target genes. The JAK-STAT system consists of three main components: (1) a receptor (green), which penetrates the cell membrane; (2) Janus kinase (JAK) (yellow), which is bound to the receptor, and; (3) a Signal Transducer and Activator of Transcription (STAT) (blue), which carries the signal into the nucleus and DNA. The red dots are phosphates. After the cytokine binds to the receptor, JAK adds a phosphate to (phosphorylates) the receptor. This attracts the STAT proteins, which are also phosphorylated and bind to each other, forming a pair (dimer). The dimer moves into the nucleus, binds to the DNA, and causes the transcription of genes. Enzymes that add phosphate groups are called protein kinases.[5]
The class of drugs, called JAK inhibitors (JAKi), seem to work by suppressing an overactive immune pathway. Altogether, they identified six proteins involved in the JAK/STAT pathway that are upregulated in those with the skin infection.
The JAK/STAT pathway is the main driver of skin inflammation, damaged skin cells, and epidermal detachment.
Testimony by Carter J Carter who became a therapist to help young people.
Rosemarie Marmor wanted to support victims of emotional trauma.
Kendra F. Dunlap wanted to serve people of color.
To understand the forces that drive even the most well-intentioned therapists from insurance networks, ProPublica plunged into a problem most often explored in statistics and one-off perspectives. Reporters spoke to hundreds of providers in nearly all 50 states, from rural communities to big cities.
The interviews underscore how the nation’s insurers — quietly, and with minimal pushback from lawmakers and regulators — have assumed an outsize role in mental health care.
It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get, and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.
All the while, providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to music and sending faxes into the abyss.
Several insurers told ProPublica that they are committed to ensuring access to mental health providers, emphasizing that their plans are in compliance with state and federal laws. Insurers also said they have practices in place to make sure reimbursement rates reflect market value and to support and retain providers, for which they continually recruit.
Therapists have tried to stick it out.
They have forgone denied payments.
They have taken second jobs.
They have sought therapy for their own support.
But the hundreds who spoke with ProPublica said they each faced a moment in which they decided they had to leave the network.
Why I left the network
Health Care
What Mental Health Care Protections Exist in Your State?
Insurers have wide latitude on when and how they can deny mental health care. We looked at the laws in all 50 states and found that some are charting new paths to secure mental health care access.
by Annie Waldman and Maya Miller
Co-published with NPR News
Aug. 27, 7 a.m. EDT
Series: America’s Mental Barrier: How Insurers Interfere With Mental Health Care
Accessing mental health care can be a harrowing ordeal. Even if a patient finds a therapist in their network, their insurance company can overrule that therapist and decide the prescribed treatment isn’t medically necessary.
This kind of interference is driving mental health professionals to flee networks, which makes treatment hard to find and puts patients in harm’s way.
ProPublica sought to understand what legal protections patients have against insurers impeding their mental health care.
Most Americans — more than 164 million of them — have insurance plans through employers. These are generally regulated by federal law.
Although the law requires insurers to offer the same access to mental health care as to physical care, it doesn’t require them to rely on evidence-based guidelines or those endorsed by professional societies in determining medical necessity. Instead, when deciding what to pay for, the government allows insurers to set their own standards.
“If insurers are allowed to home bake their own medical necessity standards, you can pretty much bet that they’re going to be infected by financial conflicts of interest,” said California psychotherapist and attorney Meiram Bendat, who specializes in protecting access to mental health treatment.
Federal lawmakers who want to boost patient protections could look to their counterparts in states who are pioneering stronger laws.
Although these state laws govern only plans under state jurisdiction, such as individual or small-group policies purchased through state marketplaces, experts told ProPublica they could, when enforced, serve as a model for broader legislation.
“States are laboratories for innovation,” said Lauren Finke, senior director of policy at The Kennedy Forum, a nonprofit that has advocated for state legislation that improves access to mental health care. “States can take it forward and use it for proof of concept, and then that can absolutely be reflected at the federal level.”
ProPublica reporters delved into the laws in all 50 states to determine how some are trying to chart new paths to secure mental health care access.
Many of the new protections are only just starting to be enforced, but ProPublica found that a few states have begun punishing companies for violations and forcing them into compliance.
Board-Certified Psychiatrist. Board-certified Addiction Medicine
I don't know about you, but for me, it is extremely difficult to know and implement all the recommended psychiatric medication monitoring. A big part of the problem is that we don't have a great resource for this.
I built an animated, touchscreen website to tell you what needs to be monitored for each psych med and when to check it. It is evidence-based with links directly to FDA documents. There is no pharma input, no download is needed, and it's free for anyone to use.
Even psychiatrists are challenged to use these medications.
All the side effects are verified on the label required by the FDA
Many of us are visual learners. The graphic presentation allows for rapid learning and recognition.
Most patients are reticent to take psychotropic medications when they are already suffering from emotional problems.
You can find the FDA list of side effects from psychotropic medications by visiting the official FDA website. Here are the steps to access this information:
Search for the specific medication: Use the search bar to enter the name of the psychotropic medication you are interested in.
Check the drug's label: Look for the medication's prescribing information or package insert, which includes detailed information on side effects, warnings, and other pertinent data.
Review the Drug Safety Information: You can also explore the "Drug Safety" section for updates and announcements regarding various medications.
For a comprehensive list of psychotropic medications, you might also consider resources like the National Institutes of Health (NIH) or the National Library of Medicine's MedlinePlus
Living a long and fulfilling life involves a combination of healthy habits, a positive mindset, and strong social connections. Here are some key factors to consider:
### 1. **Balanced Diet**
- **Eat Whole Foods:** Incorporate plenty of fruits, vegetables, whole grains, and lean proteins into your diet.
- **Stay Hydrated:** Drink plenty of water and limit sugary drinks.
### 2. **Regular Exercise**
- **Stay Active:** Aim for at least 150 minutes of moderate aerobic activity each week. Activities can include walking, cycling, or swimming.
- **Strength Training:** Include muscle-strengthening activities at least twice a week.
### 3. **Mental Well-being**
- **Manage Stress:** Practice mindfulness, meditation, or yoga to help reduce stress levels.
- **Stay Curious:** Engage in lifelong learning and hobbies to keep your mind sharp.
### 4. **Social Connections**
- **Build Relationships:** Maintain strong ties with family and friends. Social engagement is linked to longer life.
- **Volunteer:** Helping others can enhance your sense of purpose and community.
### 5. **Regular Health Check-ups**
- **Preventive Care:** Regular check-ups and screenings can help catch potential health issues early.
### 6. **Avoid Harmful Behaviors**
- **Limit Alcohol and Quit Smoking:** Reducing or eliminating these can significantly improve health outcomes.
### 7. **Positive Outlook**
- **Practice Gratitude:** Focusing on positive aspects of life can improve mental resilience.
- **Find Purpose:** Engage in activities that give you a sense of purpose and fulfillment.
By integrating these practices into your daily routine, you can enhance not only the length of your life but also its quality.
