Wednesday, September 28, 2016

How to build healthier cities

Hey--the bikes are on the walking side.
A new study from Washington University in St. Louis suggests eight ways to achieve healthier cities in the future.

The key is to reduce pollution, climate change, noise, and crime (yes, those killings).

Published in The Lancet (Sept 23), the study titled City Planning and Population Health: A Global Challenge," was part of three-part series released during the annual meeting of the UN General Assembly.

Between now and 2030, we will need to find $58 trillion to upgrade cities globally.

Better planned and designed cities will provide multiple benefits--to health, traffic management, the environment, and the economy.

OK--what do we need?

In this study, eight interventions are suggested to encourage walking, cycling, public transport, and discouraging use of private vehicles.

--destination accessibility
--distribution of employment cross the city
--reducing availability and increasing cost of parking
--designing pedestrian and cycle-friendly networks
--optimal levels of residential density
--reducing distance to public transport
--increasing diversity (no ghettos)

Sounds good.

I once lived in a planned community--Reston, Virginia. It was kind of like a  little toy train town, townhouses, golf courses, little scenic lakes...But I read recently that it was deteriorating.

Can you have a beat-down golf course community? I guess.




Tuesday, September 27, 2016

Rx for an apple

An apple a day ... well, you know the rest. But what if the doctor did not stay away, but instead wrote a prescription for that fruit?

US food banks are promoting "food as medicine."

One-third of food banks are feeding someone with diabetes and 58% of the user families include someone with high blood pressure (according to Feeding America, a national network of 200 food banks).

Carla K. Johnson, Associated Press, wrote about this. The Oak Forest Health Center in Illinois, among others, hosts "Fresh Truck" visits, providing more than 100,000 fresh fruits and veggies to more than 3,200 households.

Thirty food banks work with health care providers to identify low-income patients who sometimes run out of food.

---Doctors in Idaho add small food pantries to their offices.

--In Delaware, pediatricians write prescriptions for fresh produce--a family can get up to 25 lbs a month.

--Two hospitals in Alabama and Florida offered free lunches during the summer to kids with relatives in the hospital.

Although nutritious food also costs food banks more, people are trying to figure out solutions. Some don't accept soda and sweets.

They are also doing studies on whether food banks can help people improve their blood sugar levels--results expected in 2018.

Instead of "take two aspirin and call me in the morning," we may get "Eat a salad and never call me."

Monday, September 26, 2016

"The wall of silence" in hospitals

I once suffered a terrible reaction to a medication--I was coughing up pints of goop, week after week, I could not breathe, all known side effects of  this medication, but the doctors said oh, no, it was just late-onset asthma.

I ended up in the hospital for five days and was told they didn't know if I was coming out alive.

Through all this, the nurses and doctors kept saying asthma...One nurse even said, "They told you you had asthma, right?" Uh--yes.

So that was their story and they were sticking to it. When I finally recovered, the weirdest thing--no asthma. (The medication dumped out of one's system over a nine-month half-life, they called it.)

The University of Michigan has been testing something they call the CANDOR toolkit since the early 2000s. CANDOR stands for Communication and Optimal Resolution.

The feds have now more or less endorsed this as a way for hospitals to handle an situation in which a person gets harmed in the hospital (not my exact situation--I was inadvertently harmed before the hospital).

With the Agency for Healthcare Research and Quality taking this toolkit to the national level, transparency and learning, with the patient at the center, is now possible.

In the 15 years of using this, UMHS has seen dramatic drops in the number of new lawsuits and the number of malpractice cases that make it to court.

Personnel are more free to report situations that cause harm or are a near-miss.

But also out in the open? Appropriate care.  There is a difference between a bad outcome, an allergy, a bad reaction, and bad care.

But at least don't lie. The coverup can be worse than the event.

Friday, September 23, 2016

Could horrible old nicotine ward off brain diseases?

No animals got smoke breaks...
Before you get too excited--this is not a story about how smoking is good for you. It's a story about one component of tobacco products--nicotine.

According to research at Texas A&M, nicotine--when given independently of tobacco--could protect the brain as it ages, warding off Parkinson's or Alzheimer's. Could--repeat, could.

Published in the Open Access J of Toxicology, the research was done using animal models. They added nicotine to the animals' drinking water.  There were three levels of nicotine--low, medium and high--and a control group with no nicotine.

The low and medium groups didn't show any nicotine in their blood and no changes in food intake, body weight or number of nicotine receptors. The highest concentration animals gained less weight and had more receptors--showing the drug got to the brain. But--even at high doses--it didn't make the animals more anxious, which was a fear.

Some people say smoking cuts anxiety, some say it increases it, the researchers say. They hoped it would be neither.

For anti-aging effects, they looked at whether the animals gained weight. But they could not conclude that lowering body mass translated into less degeneration in the brain.

So--bottom line--there is promise here, but people should not start smoking based on this. The negatives from smoking far outweigh any advantages as shown here.

Far outweigh.

Thursday, September 22, 2016

Malpractice insurance company tells why people sue

The Doctor's Company is a physician-owned malpractice insurer. In a recent study, it looked at 1,180 claims against internists (2007-2014).

The most common claims are diagnosis-related.

--39% of all claims alleged failed, delayed, or wrong diagnosis, with 56% of these alleging inadequate patient assessments (such as failure or delay in getting tests).

--58% of claims against internal medicine specialists were for high-severity injuries (with a third taking place in hospitals). Such claims added up to only 34% of claims against other specialties.

What contributed to patient injury?

--33% patient assessment (wrong tests or lack of)

--25% concompliance with the treatment plan

--21% communication breakdown between doctor and patient or family

The average primary care doctor diagnoses 400 different diseases a year, and occasionally may not have seen a condition before.

Continuing education is key.

Four hundred diseases a year seems high to me...