Archive for July 2008

An interesting result was presented at this year’s American Diabetes Association’s Scientific Sessions in June: children with type I diabetes are more likely to be born in the spring. The study followed more than 10,000 US children born between 1982 and 2003 and noted that in 85% of children who developed type 1 diabetes, there was a seasonal pattern in birth month that peaks in the spring and drops in the fall. Dr. Henry S. Kahn of the Centers for Disease Control and Prevention said it is not yet known why there are seasonal differences, but it could related to exposure to infectious agents, mother’s diet, or even exposure to solar radiation. Some reports from Europe and the Southern Hemisphere have found similar patterns, however, some have not. Understanding the nature of this connection could lead to preventative measures. Full story.

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If global warming has its way, the incidence of kidney stones may begin to escalate, according to a new study. Kidney stone incidence is actually higher in warmer parts of the US, especially in the southeast, presumably due to higher rates of dehydration. This phenomenon can be observed in people who move from mild to hot climates, as seen in military deployments to the Middle East. Why does this occur? Kidney stones form from minerals dissolved in urine. When dehydration occurs, lower urine volume leads to greater concentrations of these minerals and increases the risk of stone formation. Full story.

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If you haven’t heard of Monascus purpureus, perhaps you’ve heard of fermented red yeast rice. This edible rice product is produced by cultivating Monascus purpureus, a mold, on polished rice. It is currently considered a dietary supplement in the US that may be an alternative for people with high cholesterol but cannot tolerate the side effects of statins, a very effective class of anti-cholesterol drugs. Why shouldn’t it work? Afterall, lovastatin, a commonly prescribed statin, is derived from red yeast rice. In a study published in the journal Mayo Clinic Proceedings, when combined with fish oil and healthy lifestyle changes red yeast rice can help reduce cholesterol as effectively as the statin drug Zocor. An interesting note: red yeast rice has been used in Chinese medicine since 800 A.D. to “invigorate the body, aid in digestion, and remove ‘blood blockages’”. Full story.

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A study published in the American Journal of Orthodontics & Dentofacial Orthopedics assessed the attractiveness of various types of orthodontic braces. The results are of no surprise. Clear braces and trays, followed by ceramic braces, were considered more aesthetically pleasing than the traditional metal type, which happens to be the most effective. According to Henry Fields, professor and division chair of orthodontics at Ohio State University, “The stainless steel that we like to use, which is the most durable and efficient, is often ranked the lowest in attractiveness. These braces don’t wear out and you can get total control with them.” So what’s the solution? “Some of the kids are going for braces made in the shape of a star, or have colors put on the ties that hold the wires to their brackets,” he said. Full story.

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The six major movie studios have joined in a pact to include anti-smoking public service announcements in their DVD releases. Sony, Universal, Warner Bros., Fox, Paramount and Disney will feature these PSAs prior to feature movies rated G, PG and PG-13 that contain scenes which depict smoking. The American Medical Association Alliance has called for an even more stringent policy of giving R ratings to any movie that depicts scenes of “irresponsible or gratuitous tobacco images.” Full story.

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Some personalities are more difficult to deal with. That’s the nature of life. But, do difficult patients receive lesser medical care? That is the question Dr. Dena Rifkin is asking in her post from Poked & Prodded.

In her post Dr. Rifkin describes two scenarios – one steadfastly polite and appreciative patient, and the other a more coarse an persistently angered personality. Does one receive better care than the other? This got me thinking about my experiences with my own patients. There are times when 15 minutes spent with an ornery patient feels like an eternity, and times when 15 minutes fly by because a particular patient is so pleasant to engage with. There are times when I get frustrated that a patient isn’t following my advise, and times when I feel life as a physician is easy because a compliant patient received a good outcome. However, the trick is to treat all your patients equally, regardless of the nature of the encounter. How each physician does that it up to their style.

For every one physician there are thousands of patients, each with their own personalities and medical experiences. It is the job of the physician to be able to adapt to and understand each of his or her patients and be able to work with them in order to provide the best medical care possible. However, a patient’s personality can definitely be a factor in the doctor-patient relationship. To a certain extent, if someone isn’t willing to engage and share responsibility in their medical care, they may not receive the outcome they are hoping for. Just as much as we want patients to get well, we need the patient’s help in getting there. And when it comes to more “difficult” patients, I don’t believe that they necessarily get worse medical care. Doctors, as I have come to know them, tend to be perfectionists and their own worst critiques. I have faith that regardless of how difficult a patient or situation may be (within reasonable limits), a physician will do his or her best to offer the same quality of care to each patient.

Please leave your comments below.

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How many times have you heard that red wine is good for your health? We know that polyphenols (powerful antioxidants that are believed to be protective against cancer and heart disease) are abundant in red wine. But how they exert their beneficial influence was a mystery – until now. New research led by Dr. Joseph Kanner of the Hebrew University of Jerusalem has shown that polyphenols can act inside the stomach to reduce the formation of malondialdehyde, toxic byproducts produced during digestion of meats and high-fat foods. Based on these results, Dr Kanner and his colleagues argue that previous research looking for antioxidants from wine in the bloodstream was a mistake. They do not need to be in the blood to be useful. They just need to be in the stomach at the time the toxic metabolites are produced. Therefore, they recommend drinking wine with your meals. Their research also suggests that eating fruit at the end of a meal is a healthy habit since fruits are rich in polyphenols. Full story.

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Did you know that the rate of food inflation is currently double that of overall inflation? The US Department of Agriculture estimates the rate will be between 3% to 4% this year, the highest since the early 1990s. Figures show milk, beans, peas and lentils up 17%, cheese up 15%, bread up 12%, and eggs up 25% – all within this past year. In fact, the price of the world’s main grains – rice, corn, wheat – have all more than doubled. This may leave some to worry that fresh food choices may give way to less healthy alternatives. However, there are ways to eat healthy in the midst of rising food costs and lower budgets. Local farmers markets or co-operatives can be good sources of cheaper, fresh produce. And if you feel more industrious, planting your own produce, especially herbs, can save a you a great deal at the check out line. As well, the majority of flash-frozen vegetables actually retain most of their nutritional value, even after freezing. A tighter budget may even be an opportunity to eat healthier by cutting out expensive, fatty meats in favor of legumes as sources of protein. Read about more ways to cut food costs here.

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The American Academy of Pediatrics is set to revise a 10 year old policy on cholesterol screening in children. This issue is especially pressing because 30% of American children are now considered to be obese, which puts them at a much greater risk of developing type 2 diabetes, high blood pressure and cardiovascular diseases when they are older. The new recommendations propose children be screened for cholesterol beginning at 2 years of age (and no later than 10 years of age) if they have risk factors such as a family history of high cholesterol or early heart attacks. In addition, it’s recommended that overweight infants and babies be given low fat milk after their first twelve months of age. The AAP still recommends diet changes and exercise as the first priority in overweight children. As well, they are recommending the use of medication in children with especially high cholesterol levels beginning at the age of 8. Full story.

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This past weekend the CBS Early Show reported on the top 10 healthiest juices, according to a recent UCLA study. However, “healthy” is a relative term. It appears that the study evaluated the antioxidant levels of each juice type, rather than focusing on any nutritional component of the juices. The beverage that outscored all others was pomegranate juice, which contains the most of every type of antioxidant. Some studies show that it may protect against some cancers, such as prostate cancer , and it may be beneficial in fending off heart disease. It’s important to know that juices may contain substances like antioxidants that could be beneficial for our health, however, they can also contain a great deal of sugar, which can contribute to weight gain. The best way to get the positive benefits of fruit (including fiber , vitamins, and antioxidants) is to eat the real deal – go for the fruit themselves, rather than drinking the juice. Full story .

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