Spring Ahead, It's Daylight Saving Time,and an 8% increase in chance for having a Stroke during the next two days.

Those of you who read my post of March 11, 2016 know that they are at higher risk for cardiovascular events such as stroke during the next two weeks.

The twice-yearly time change isn’t just an inconvenience, it may cause a variety of unfortunate health and public safety threats as our collective bodies reset to a new schedule.

Much of the research on the health effects of the time shift relate to the circadian rhythms, the body’s internal clock that, when in sync, helps people wake up, eat and sleep around the same time every day.

A 2013 study from the American Journal of Cardiology found that two Michigan hospitals saw more heart attacks in the week after “springing forward” than the two weeks before.

Preliminary research also suggests the same is true for strokes.

Finnish researchers presented a paper during the American Academy of Neurology conference in April 2015, in which they found the rate of strokes increased by 8 percent after the time change.

“Previous studies have shown that disruptions in a person's circadian rhythm, also called an internal body clock, increase the risk of ischemic stroke, so we wanted to find out if daylight saving time was putting people at risk," study author Dr. Jori Ruuskanen, of the University of Turku, in Finland, said in a statement.

To make matters worse, time shifts may trigger cluster headaches, according to Stewart Tepper, MD, headache pain specialist at the Cleveland Clinic.

For younger Americans, the biggest threat may be one less hour at a bar on a spring weekend, although Pacific Beach's Hookah Lab — one of several establishments that stay open past 2 a.m. — is ready for the disruption.

"When the time change happens, we move with it," said server Kyle Lias. "Usually it goes by smoothly when it happens."

The most widespread effect of the time change may be muddle-headed drivers.

***  Research published in the  New England Journal of Medicine suggests that groggy drivers make the roads more dangerous on the Monday following the time change. 

" Ischemic stroke is the most common kind of stroke, accounting for 87 percent of all cases. It is caused by a clot blocking blood flow to the brain.

"Previous studies have shown that disruptions in a person's circadian rhythm, also called an internal body clock, increase the risk of ischemic stroke, so we wanted to find out if daylight saving time was putting people at risk," said study author Jori Ruuskanen, MD, PhD, of the University of Turku in Turku, Finland.

For the study, researchers looked at a decade of data for stroke in Finland to find the rate of stroke. They compared the rate of stroke in 3,033 people hospitalized during the week following a daylight saving time transition to the rate of stroke in a group of 11,801 people hospitalized either two weeks before or two weeks after that week.

Researchers found that the overall rate of ischemic stroke was 8 percent higher during the first two days after a daylight saving time transition. There was no difference after two days.

People with cancer were 25 percent more likely to have a stroke after daylight saving time than during another period. The risk was also higher for those over age 65, who were 20 percent more likely to have a stroke right after the transition."

  A solution may be to avoid driving on the Monday and Tuesday after the time change Sunday A.M. Workplace efficiency is probably effected as well. 

As for me, I am returning to my bed for the next two days....so not call me until Wednesday 

Workplace injuries also jump after the change, according to research in the Journal of Applied Psychology. And that same journal has published research that indicates the grogginess translates to more “cyberloafing” the first Monday back.

The image did not transfer to the blog well. If readers will go to the New England Journal of Medicine  you will find it in mid article.  Clicking on the image will enlarge and refine the image.

However the studies make a good point

*** Two days after the time change, the rate returned to normal. Cancer patients and those over the age of 65 saw the greatest increase in strokes following the time change.

'Springing forward' may bring crashes, strokes |

"Spring forward" works as a mnemonic and a public-relations push for daylight saving time, but it’s just another term for "losing an hour of sleep."

At 2 a.m. Sunday, most of the country will set clocks forward one hour. For San Diegans, that means that the sun will rise at 6:59 a.m. on Monday, when the day before it rose a few minutes after six.

With most web-enabled devices switching time automatically, the task of adjusting a few analog timepieces isn’t as laborious as it once was. But it still irritates certain people, and may have broader health and safety implications as well.

In 2014, a survey of 14,000 Utahns found that they found the requirement to move clocks forward in the spring and back in the fall annoying.

"The strong, repetitive drumbeat in those comments was convenience," Michael O’Malley, a spokesperson from the Utah Governor’s Office of Economic Development, told National Geographic. "Many people don't want to move their clocks, whether it's backwards, forwards, or sideways. They just want to pick a time and stick with it."

San Jose Assemblyman Kansen Chu introduced a bill in February aimed at ending the practice in California.

The twice-yearly time change isn’t just an inconvenience, it may cause a variety of unfortunate health and public safety threats as our collective bodies reset to a new schedule.

Much of the research on the health effects of the time shift relate to the circadian rhythms, the body’s internal clock that, when in sync, helps people wake up, eat and sleep around the same time every day.

A 2013 study from the American Journal of Cardiology found that two Michigan hospitals saw more heart attacks in the week after “springing forward” than the two weeks before.

Preliminary research also suggests the same is true for strokes.

Finnish researchers presented a paper during the American Academy of Neurology conference in April 2015, in which they found the rate of strokes increased by 8 percent after the time change.

“Previous studies have shown that disruptions in a person's circadian rhythm, also called an internal body clock, increase the risk of ischemic stroke, so we wanted to find out if daylight saving time was putting people at risk," study author Dr. Jori Ruuskanen, of the University of Turku, in Finland, said in a statement.

Should daylight saving time be ended?

• Yes! It's a useless and unnecessary practice.
• No! The time switch is a welcome change.

SEE RESULTS

Two days after the time change, the rate returned to normal. Cancer patients and those over the age of 65 saw the greatest increase in strokes following the time change.

To make matters worse, time shifts may trigger cluster headaches, according to Stewart Tepper, MD, headache pain specialist at the Cleveland Clinic.

For younger Americans, the biggest threat may be one less hour at a bar on a spring weekend, although Pacific Beach's Hookah Lab — one of several establishments that stay open past 2 a.m. — is ready for the disruption.

"When the time change happens, we move with it," said server Kyle Lias. "Usually it goes by smoothly when it happens."

The most widespread effect of the time change may be muddle-headed drivers. Research published in theNew England Journal of Medicine suggests that groggy drivers make the roads more dangerous on the Monday following the time change.

Workplace injuries also jump after the change, according to research in the Journal of Applied Psychology. And that same journal has published research that indicates the grogginess translates to more “cyberloafing” the first Monday back.

So, go ahead and click that next U-T link.

Next: Sleep is elusive for more than a third

Lawmakers trying to get rid of daylight saving in Michigan

WSYM - Lansing, MI

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'Springing forward' may bring crashes, strokes | SanDiegoUnionTribune.com

Lemonaid Health - FAQs

Lemonaid Health - FAQs

The Affordable Care Act and Accountable Care Organizations (not your grandfather's Buick) or What is in it for the patient?

Building An ACO—What Services Do You Need And How Are Patients & Physicians Impacted?

The definition of an accountable care organization (ACO) involves two elements: organization and payment. First, an ACO is organized as one entity capable of taking both clinical and fiscal responsibility for care. Second, ACOs operate using a payment model centered on a budget target: if the ACO spends less than the budget target, it shares in the savings, while, in some models an ACO that exceeds its budget target might be required to pay more.

ACOs differ from past models like health maintenance organizations (HMOs) and preferred provider organizations (PPOs) in various ways. Most importantly, they are provider, not health plan focused. In ACOs, people are attributed to the model; they do not sign up as in insurance plan. Furthermore, ACOs, unlike insurance plans, do not set premiums, nor do they control benefit design.

In summary, patients will not at all be aware of transactions, and the overall effectiveness for cost containment are highly in doubt.

The strongest case for the ACO model may be that it allows organizations to capture the efficiencies if they can achieve them and thus succeed financially with lower revenue growth.Thus while it is not certain that organizations can make this transformative turnaround, the alternative looks particularly bad.



Blogger's note:

This post is part of a Health Affairs Blog symposium stemming from “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy. Links to all posts in the symposium will be added to Abbe Gluck’s introductory post as they appear, and you can access a full list of symposium pieces here or by clicking on the “Yale Health Care Ind



New Health Care Symposium: Building An ACO—What Services Do You Need And How Are Physicians Impacted?

Humans Trust This Emergency Robot more than Common Sense

Getting people to trust robots is as big a deal for the future of technology as building them. But, it turns out, acquiring that trust might not be that difficult. Test subjects at the Georgia Institute of Technology willingly followed an emergency robot to safety during a simulated fire, even when it led them away from clearly marked exit signs, New Scientist reports. The findings even surprised Paul Robinette, the graduate student in charge of the study: "We thought that there wouldn't be enough trust, and that we'd have to do something to prove the robot was trustworthy."

30 subjects started out the test by following the robot, a customized Pioneer P3-AT, down a hallway and into a room, where they were asked to fill out a survey. Eventually, a smoke alarm went off and simulated smoke filled the hall. The robot would then lead them through the smoke down a new path, and towards a doorthey've never seen before. All the while, the subjects could have easily exited through the clearly marked path they originally came through. 26 of the test subjects ended up following therobot, while two never left the room (the other two were kicked out of the study).


Humans trust this emergency robot more than common sense

Dueling Star Ratings May Confuse Some Home Health Patients | California Healthline

Dueling Star Ratings May Confuse Some Home Health Patients | California Healthline

Patients looking for home health care services will be impressed if they check out the federal government’s ratings of AccentCare. Two of the company’s home health agencies in California — in San Diego and Newport Beach and Rancho Cordova — each earned 4.5 or 4 stars, nearly the top quality score, primarily based on Medicare’s assessment of how often patients got better.

But further research may lead to confusion. Medicare also posts stars to convey how patients rate agencies after their care is over. There, these same three agencies earned two stars.

Such contradictory results between how patients view home health agencies and how the government rates them are hardly unusual. One in five agencies had clinical and patient ratings that differed by two stars or more, a Kaiser Health News analysis of government records shows.

In California, for instance, agencies were three times as likely to receive five stars for their patient reviews as they were for their clinical quality. Skilled home health services, where Medicare sends nurses, aides and physical and occupational therapists to people’s houses, are becoming more important amid pressures to keep homebound patients from going to the hospital. To help doctors and patients select among more than 12,000 agencies, Medicare last year published star ratings for clinical quality on its Home Health Compare website, and in January it added star ratings to reflect the views of patients.

Medicare was liberal in giving top marks based on patients’ opinion scores, awarding four or five stars to 74 percent of agencies it rated. Of those, 2,152 agencies got five stars.

Apparently Medicare is giving more attention to the "Patient experience". 

But in encapsulating clinical quality measures, Medicare used a different formula that ensured three-star ratings would be most common. Only 27 percent of agencies received four or five stars. Just 286 agencies received the maximum five stars.In a statement, the Centers for Medicare & Medicaid Service said the different star ratings should not be confusing. “CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” the statement said. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

As the number of quality metrics has proliferated, star ratings follow other Medicare efforts to distill sometimes complex quality assessments into a consumer-friendly format. Medicare also assigns stars for dialysis center quality, hospital patient experience and several aspects of nursing home care.

“We’re really talking about very different sets of metrics,” said Teresa Lee, director of the Alliance for Home Health Quality and Innovation, a nonprofit research group. “It’s unfortunate, but maybe it’s the truth that patient experience and clinical quality of care do not go hand in hand.”

Adding to the potential confusion, 41 percent of the star ratings summing up patient views are not reliable — by the government’s own admission — because fewer than 100 surveys were returned, records show. Home Health Compare warns consumers in footnotes to use the scores “with caution as the number of surveys may be too low to accurately tell how an agency is doing.” Medicare did not assign stars for agencies if fewer than 40 surveys were returned.

“It is important to point out that our patient population has an average age of 86 and often relies on family members, powers of attorney and/or guardians to complete” the survey, she said.

Some elder care experts have broader reasons to question the ratings.

While there is some confusion and questions about the validity of these surveys and the more objective Medicare quality measures,  patients' families now have somewhere to screen  possible caregiving agencies for their loved ones.

Health and Wellness 63rd St. Farm

Better health and wellness may be more than going to  your local supermarket to purchase 'vegan'. How about growing your own 'vegan' in a community supported agriculture'.

We all have local and/or regional parks which are common place. Why not have local government allot vacant land to community's who wish to grown their own food ? Living off the land, at least partially would provide some nutrition which could be organically grow and serve as an educational site for young people.  Perhaps schools should alot some of their land for this purpose as well. What better purpose than to provide leaning in nutrition, environmental impact, recycling and for other purposes.

In innumerable cities across America, these 'agricultural centers'  could provide healthy products such as lettuce, melons, tomatoes and other flavinoid rich foods in what are otherwise kinow as  'food deserts'  It is a well known fact that impoverished people have higher death rates, increased morbidity and obesity due to poor access to healthy foods.

63rd St. Farm — CSA

Disparity in Life Spans of the Rich and the Poor Is Growing - The New York Times

Disparity in Life Spans of the Rich and the Poor Is Growing - 

Experts have long known that rich people generally live longer than poor people. But a growing body of data shows a more disturbing pattern: Despite big advances in medicine, technology and education, the longevity gap between high-income and low-income Americans has been widening sharply.

The poor are losing ground not only in income, but also in years of life, the most basic measure of well-being. In the early 1970s, a 60-year-old man in the top half of the earnings ladder could expect to live 1.2 years longer than a man of the same age in the bottom half, according to an analysis by theSocial Security Administration. Fast-forward to 2001, and he could expect to live 5.8 years longer than his poorer counterpart.

New research released on Friday contains even more jarring numbers. Looking at the extreme ends of the income spectrum, economists at the Brookings Institution found that for men born in 1920, there was a six-year difference in life expectancy between the top 10 percent of earners and the bottom 10 percent. For men born in 1950, that difference had more than doubled, to 14 years.

For women, the gap grew to 13 years, from 4.7 years.

“There has been this huge spreading out,” said Gary Burtless, one of the authors of the study.

The growing chasm is alarming policy makers, and has surfaced in the presidential campaign. During the Democratic debate Thursday, Senator Bernie Sanders and Hillary Clinton expressed concern over shortening life spans for some Americans.

“This may be the next frontier of the inequality discussion,” said Peter Orszag, a former Obama administration official now at Citigroup, who was among the first to highlight the pattern.

An Expanding Longevity Gap

Wealthier Americans tend to live longer than poorer Americans. Despite advances in medicine and education, the difference in life span after age 50 between richest and poorest has more than doubled since the 1970s.

It is hard to point to one overriding cause, but public health researchers have a few answers. In recent decades, smoking, the single biggest cause of preventable death, has helped drive the disparity, said Andrew Fenelon, a researcher at the Centers for Disease Control and Prevention. As the rich and educated began to drop the habit, its deadly effects fell increasingly on poorer, uneducated people. Jessica Ho, of Duke University, and Mr. Fenelon calculated that smoking accounted for a third to a fifth of the gap in life expectancy between men with college degrees and men with only high school diplomas. For women it was as much as a quarter.

Obesity, which has been sharply rising since the 1980s, is more ambiguous. The gap between obesity rates for high earners and low earners actually narrowed from 1990 to 2010, according to an analysis by the National Academy of Sciences. By 2010, about 37 percent of adults at the lower end of the income ladder were obese, compared with 31 percent at the higher end.

More recently, the prescription drug epidemic has ravaged poor white communities, a problem that experts said would most likely exacerbate the trend of widening disparities.

Limited access to health care accounts for surprisingly few premature deaths in America, researchers have found. So it is an open question whether President Obama’s health care law — which has sharply reduced the number of Americans without health insurance since 2014 — will help ease the disparity.

At the heart of the disparity, said Elizabeth H. Bradley, a professor of public health at Yale, are economic and social inequities, “and those are things that high-tech medicine cannot fix.”

Life expectancy for the bottom 10 percent of male wage earners born in 1920 was 72.9, compared with 73.6 for those born in 1950, the Brookings researchers found. For the top 10 percent, life expectancy jumped to 87.2 from 79.1.

Many researchers believe the gap in life spans from lower- to upper-income Americans started widening about 40 years ago, when income inequality began to grow. 

“There are large swaths of the population that are not enjoying the pretty impressive gains the rest of us are having in life spans,” said Christopher J. L. Murray, director of the Institute for Health Metrics and Evaluation in Seattle. “Not everybody is sharing in the same prosperity and progress.”

Ref:  NY Times

In America, the art of doctoring is dying - The Washington Post

For almost 20 years  I practiced Ophthalmology and geriatrics in my own office. I had tens of thousands of face-to-face interactions with a group of folks who, with time, grew to trust me. I respected them as well; many I came to love — a term that I hesitate to use in this hypersensitive age. Given how geographically dispersed families are today, for many of my older patients I functioned as a surrogate son.

Things began to change abruptly in 1989, as HMOs, capitated reimbursement, as well as a flurry of eponyms guiding how medicine should be practiced.

There is no doubt that the kind of medicine I was fortunate to practice is disappearing. Most doctors are employed by large group practices, hospitals or insurance companies. Many want to have personal connections with their patients but have too little time. Young primary-care doctors are relegated to assembly-line clinics; their patients pass through as widgets, not as individuals with complex inner lives, wrought family structures, varied spiritual and cultural beliefs — not to mention their individual capacities to understand and deal with their medical symptoms, diagnoses and multiple medications, as well as their own hopes and fears.

There is no doubt that the kind of medicine I was fortunate to practice is disappearing. Most doctors are employed by large group practices, hospitals or insurance companies. Many want to have personal connections with their patients but have too little time. Young primary-care doctors are relegated to assembly-line clinics; their patients pass through as widgets, not as individuals with complex inner lives.

Physicians are now insulated from knowing too much about their patients. It is all about the technology, the testing, the imaging, the electronic health record, the data — once collected by the doctor, but now so regulated and overwhelming that paramedical professionals have been enlisted to record the so-called minutiae, the often rote information in which may lie important clues. Some of these may remain forever buried, the patient not wanting to share sensitive details with just anyone, especially someone who no longer makes eye contact, whose face remains buried behind a computer screen, who seems uninterested or just unskilled in reading body language — that downward glance, that shift in the chair, that half-swallowed response.

The art of being a physician has disappeared, and also the art of being a patient, replaced by EMR, patient portals, mobile health devices.  All of this in the 'name' of being more efficient, caring for more patients, and to  yield data for the government and insurance companies to manipulate using algorithms derived from 'big data' and analytics.The relative isolation of medicine as what was called a 'cottage industry' had a secondary purpose, one often not recognized.  The ability for physicians to make decisions in private, and protection of patients. Although HIPAA strives to set a standard to protect patient information, it does not. Physicians practice medicine according to the Hippocratic oath which contains the following phrase.

(Original translation from the Greek)

"I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humility and awareness of my own frailty. Above all, I must not play at God."

(Modern version)

 I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humility and awareness of my own frailty. Above all, I must not play at God.

Note that the two versions are identical.  Despite centuries of existence our oath remains unchanged, while the world around us has changed. It seems to parallel the existence and intepretation of the U.S. Constitution set forth over 250 years ago.  Today we alter the foundation based upon our present day needs.

For my younger colleagues, who ask, "What was it like to practice medicine in your day ?" My answer is "the patients are the same, the treatments are better. Isn't science wonderful ? " The Creative Destruction of Medicine.




In America, the art of doctoring is dying - The Washington Post