Tips For Health

And heres another study, this time published in JAMA about Kaiser in Northern California that found that the following five components resulted in an increase of population-based blood pressure control: 

1. "Registry" (which the Disease Management Care Blog says is really a stand-alone database that is outside of the electronic health record);

2. "Control Rates" (which the DMCB figures is really an updated "dashboard" that displays key metrics to administrators and docs that provides feedback and helps keep everyone on the same page);

3. "Guideline" (in reality, it was a campaign to gain provider buy-in consisting of emails, publications, pocket cards, conferences, lectures and decision support);

4. "Medical assistant" follow-up operating under protocol to adjust medications (a.k.a population-based care management)

5. "Single" pill treatment (in other words, keep it simple by using pharmaceuticals that are combined in a single once a day prescription pill).

DMCB readers will not be surprised to know that the registry showed a progressive improvement in BP control (defined as less than 140/90 with the usual HEDIS® caveats) from 43.6% in 2001 to 80.4% in 2009.  Because everyone with hypertension at Kaiser was in the registry, there is no internal comparison group.  However, national and northern California HEDIS® rates for blood pressure control ranged from 55.4% to 69.4%.

While the results are 1) not necessarily generalizable outside of integrated systems like Kaiser (so we dont know for sure that this would work in a network of primary care clinics in Idaho), and 2) may have been influenced by an influx of patients with mild and easy-to-treat hypertension during the campaign), the DMCB is impressed. 

An 80% control rate for hypertension is damn good. 

The DMCB also figures that each of the interventions above are mutually supportive and even synergistic.  The whole is much greater than the sum of its parts.

How to translate this kind of success to networks of independent practices?  The answer, says the DMCB, is population health management: sponsored programs that can be owned by an insurer or a provider network that synergistically identify a population, maintain a data base, create a virtuous cycle of measurement and adjustment, get the doctors on board, deploy care managers and are smart about the pharmacy benefit.

If your a PHM service provider, vendor, consultant or stakeholder, the DMCB suggests this is one of those research papers you should bookmark, quote and aspire to.

Image from Wikipedia

A new study by researchers at the Hebrew University of Jerusalem and Tel Aviv University reveals that eating a good breakfast can have a positive impact on women with problems of infertility.

In recent years, nutritional research has found that our weight is affected not only by the level of calorie intake, but also by the question of when to consume large amounts of calories.

Now, research, conducted by Prof. Oren Froy, director of the Nutrigenomics and Functional Foods Research Center at the Robert H. Smith Faculty of Agriculture, Food and Environment of the Hebrew University, and Maayan Barnea, plus Prof. Daniela Jocabovitz and Dr. Julio Weinstein from Tel Aviv University and Wolfson Medical Center, shows that a big breakfast increases fertility among woman who suffer from menstrual irregularities.

The study examined whether meal times have an impact on the health of woman with menstrual irregularities due to Polycystic Ovary Syndrome (PCOS). PCOS affects approximately 6-10% of woman of reproductive age, disrupting their reproductive abilities. This syndrome creates a resistance to insulin, leading to an increase in male sex hormones (androgens), and can also cause menstrual irregularities, hair loss on the scalp though increase in body hair, acne, fertility problems and future diabetes.

The experiment was carried out at Wolfson Medical Center on 60 women over a 12-week period. The women, from the ages of 25 to 39, were thin with a BMI (body mass index) of less than 23 and suffered from PCOS.

The women were divided into two groups and were allowed to consume about 1,800 calories a day. The difference between the groups was the timing of their largest meal. One group consumed their largest meal, approximately 980 calories, at breakfast, while the other at dinner. Researchers wanted to examine whether the schedule of calorie intake affects insulin resistance and the increase in androgens among woman suffering from PCOS. The women kept records of exactly what they ate.

The findings, recently published in the journal, "Clinical Science," showed improved results for the group that consumed a big breakfast. Glucose levels and insulin resistance decreased by 8%, while the second group ("dinner") showed no changes. Another finding showed that among the "breakfast" group, testosterone (one of the androgens) levels decreased by nearly 50%, while the "dinner" group level stayed neutral. In addition, there was a much higher rate of ovulating woman within the "breakfast group" compared to the "dinner" group, showing that eating a hearty breakfast leads to an increase in the level of fertility among woman with Polycystic Ovary Syndrome.

According to Prof. Froy, "The research clearly demonstrates that indeed the amount of calories we consume daily is very important, but the timing as to when we consume them is even more important."

Lets talk about death today! Sorry, just trying to make it seem exciting. If you know me well, you may know that I live with my grandparents, who are 90+ years old. If you know me really well, you may also know that my grandfather is losing his mind... some sort of dementia, maybe Alzheimers, who knows. Regardless, much of the time he doesnt know who I am, nor where he is, and from time to time, he still thinks its the 1940s. He also has a hard time taking care of himself. He seems to forget how to perform even the most basic tasks, like brushing his teeth or shaving. Every day is a struggle for him and for those around him.

Essentially, his quality of life has diminished to the point where I question why he wants to keep fighting. Lately Ive been thinking hard about some of this stuff... yes, were living longer lives, but are we really living?


Disclaimer
Before I go any further, Id like to say a few things. First, no one close to me has ever died. At 28 years old, Im not quite sure how this is possible, but I havent personally experienced the loss of a close family member or friend. Second, I have no idea what its like to be close to death. Im young, and havent suffered from any life-threatening trauma myself, so Ive never personally been in a situation where I felt like I was dying. My point is, Im looking at death as an outsider, as someone with no first-hand experience. If you find anything I say to be offensive, or ignorant... now you know where Im coming from.

Im a firm believer in the idea that we die when were ready to die. You know, outside of trauma or something like that. How many times have you heard that someone "died with his family at his side, as if he knew it was time", or that "it was like she waited for everyone to leave so she could die in peace"? No matter how we want it to happen, it seems we have some control over when we let ourselves go. Its as if we have one foot in the afterlife, and its up to us to take that last step.

But today, with modern medicine leading the way, it seems that many of us hang onto that step for as long as is humanly possible. Ive met some who are far beyond the point my grandfather is at. Spending just a few minutes in a dementia ward at a local nursing home, Ive met people with virtually no mental function who need assistance in every activity of daily living. Its one of the most depressing things Ive ever seen. These people are simply no longer functioning human beings.

So this brings up some questions... Whats keeping people like this alive? Have we forgotten how to die? Why do we keep going, despite such a horrible quality of life?

I think we would benefit from thinking a little harder about death.

Looking at Death in a Positive Light
To me, death can be a beautiful thing. Were all born, and we all die. Those are just about the only certainties in this life, and I think theres something beautiful in the simplicity. To quote my favorite Bright Eyes song, "there is nothing as lucky, as easy, or free". Its the inevitable ending to a human life, the culmination of all that has been accomplished, and a celebration of the freedom of the soul from the confines of the body. Whats so bad about that?

I think its time we embrace death. Not literally of course, for most of us, but we should change the way we think about it. It marks an ending for sure, but with all endings come new beginnings. The death of a loved one will never be easy. But if we approach it with a different mindset, understanding the positives that can come from it and appreciating the beauty of a life that has run its course, we can appreciate it for what it is. Think of the death of a loved one as a chance for personal growth. You cant change it. You have no choice but to keep on going. Embrace it, accept it, and grow from it. Change is the only constant in life; its best we all learn how to use it to our advantage.

And when that time comes to face the end of our own lives, and I truly believe that we will know when that time comes, we shouldnt feel obligated to fight it. Sure, modern medicine can keep us alive for many years more than ever before, but as our quality of life declines, each of us needs to decide for ourselves whether thats a good thing. Theres nothing wrong with letting go if thats what we feel. And we should do it with smile, experiencing the full spectrum of emotions of the moment... happiness, sorrow, relief, hope, guilt, love, fear, all of it... knowing that we took the next step on our terms, not at the mercy of a respirator.


Phew, that was some heavy stuff. I just cant talk about death anymore, even if it is the positive side of it. Its killing my mood!! I wont even properly conclude this post, just take these musings for what theyre worth!

Ill leave you with something a little lighter... an article called "Top Five Regrets of the Dying". Its a great list that might just help you put things in perspective. Hint: be happy and love people. Now thats how you end a post about death on a happy note :)

If so, then why not agree with the governments regulation of hospital fee rates?

This article in JAMA explains how largely Democratic Maryland is using its "Health Services Cost Review Commission, or "HSCRC" to do precisely that to its 51 hospitals.  Its independent 7 member Board of Commissioners is appointed by the governor for four year terms.  Only 3 can be hospital administrators, hospital board members or hospital staff physicians.  Its budget of 7 million is paid for by a fee assessed on hospitals and much of it is used to collecting and publicly reporting cost and quality data.  The HSCRC uses patient risk adjustments, uncompensated care adjustments and other statistical factors to determine a "charge per case" which all insurers in the state are required to follow.  Medicare and Medicaid follows suit through a waiver system.

After the system was instituted in 1976, the rate of hospital cost inflation plummeted, making Maryland the lowest hospital charges of any state in the Union.  And by the way, the HSCRC is also incorporating pay-for-performance and a no-pay for certain complications in its fee schedule.

While the DMCB tends to be pro"market" and anti-regulation, thats not going to stop it from congratulating Maryland for taking a health care bull by the horns.  It thinks this is another example of a state that is stepping up with its own local version of health orm without having to necessarily wait for the federal government.  While the DMCB doubts that other states could pull this off, the HSCRC works in Maryland and the voters seem to like it.  Thats quite a contrast when its compared to  the Affordable Care Act.

Oh man, guys. I just had the best/worst idea for how to start today’s column.

It’s getting icy.

Brr, y’know, cause winter’s coming? But also because I want to talk about freezing food. Like, for storage.

I know, it’s awful. My dad would be proud.

I could also aim this in the direction of Thanksgiving sides. The recipe herein is an amazing Thanksgiving side, and I will be making it for my family next week. (Oh crap, next week?!) But the food-blog corner of the internet is already overflowing with Thanksgiving recipes right now, and they really just serve to make me panic about the fact that Thanksgiving is next week and how am I making two pies and four side dishes and cranberry sauce in half a day in my mom’s kitchen??!?

So, back to freezing.

As fall starts hinting that winter’s on its way, my mind turns toward my freezer. Not for the popsicles and other frozen goodnesses of summer, but because, like a squirrel with its acorns, I’m suddenly compelled to start putting food away. Every week in fall brings another visit to the farmers market, another fearful peek at the produce for sale, to see what’s gone out of season next.

In spring and summer, vegetables go out of season to be replaced by the next round of tasty produce – we go from asparagus to bell peppers to broccoli to kale, strawberries to raspberries to stone fruit to apples – but once we get to fall, foods end their season unreplaced. Or replaced by apples, onions, and potatoes. Piles and piles of apples, onions, and potatoes.

Now’s when I start to panic. What can I freeze? What can I save? Come February I’ll be wandering the supermarket aisles, pallid under the fluorescent lights, trying to decide between California kale and Mexican Brussels sprouts. I’ll make eggs with frozen spinach. I’ll mix frozen cherries into my yogurt. And I will feel sad, disconnected from my local growing season, like a poor steward of the Earth, and broke.

So I’m trying, this year, to shore up my stores of local, seasonal, cheap vegetables, to pack them away in ways they can last, and last tastily. (Let’s not talk about the frozen beet greens fiasco of 2009.) Sure, just about any home-frozen vegetable can feature passably in a soup, but I want food that actually tastes good.

The trick to freezing most vegetables is blanching. When you freeze raw vegetables their cell walls burst – thanks to waters magical expands-as-it-freezes-ness – and burst cell walls equal mush. Blanching vegetables – a quick boil or steam – eases that problem and neutralizes enzymes that can wreak havoc on icy goods. Unfortunately, I don’t like a lot of vegetables blanched – I rely on hot sautéing to make things like kale and Brussels sprouts delicious, and once you’ve blanched, you can’t go back. (Sorry, is that not an awesome new catchphrase?)

So far I’ve found two awesome recipes that freeze well. They’re easy to make in large batches, defrost without any degradation, and are preparations of these foods that I actually love. Points there. One is the spiced applesauce I wrote about a little while ago.

The other is mashed cauliflower.

Ignore any bad connotations it carries as a sad low-carb substitute for mashed potatoes; mashed cauliflower is delicious in its own right. It satisfied the creamy, salty, comfort food part of your heart/stomach/brain, but with a bit more flavor than plain potatoes. It’s still a great vehicle for anything mashed potatoes play with well, and, oh right, it’s a giant pile of super-good-for-you vegetables.

This is the time of year for cauliflower. At the big Union Square farmers market in New York City, giant 5-pound heads are going for two or three bucks each, and they’re fresh and gorgeous. I’ve got a stack of little one-cup containers of this stuff lining the back of my freezer (interspersed with apple sauce, of course). A few more weeks, a few more massive cauliflowers, and I should be set for winter.

I mean, set in terms of cauliflower. I can’t quite live on apples and cauliflower alone, though. So I ask you, dear readers – how do you freeze or store fall produce to last into the winter? Jaime-in-February-without-vitamin-deficiencies thanks you.

A note on this recipe: This is a very basic version. The options for embellishment are nearly endless. Anything you can do to mashed potatoes, you can do to this. Possible additions: roasted garlic, red pepper flakes, nutritional yeast, shredded cheese, olive oil, a little milk (cow, soy, or otherwise), paprika, scallions, roasted kale, sautéed zucchini, baked tofu, bacon, bacon bits, etc. I find that, just as with potatoes, a little fat goes a long way as long as the food’s thoroughly salted.

~~~

If you like this, get a load of:

• Cauliflower with Ginger, Garlic, and Green Chilies
• Miso Mashed Potatoes
• Swiss Chard with Pinto Beans and Goat Cheese

~~~

Mashed Cauliflower
Serves 4
NOTE: The picture didnt come out too great, so this is an amazing facsimile taken from Flickr Creative Commons user roolrool. Needless to say, its the stuff on the left.


1 large head of cauliflower (about 8 cups chopped)
1 Tablespoon butter
Salt and pepper, to taste

1) Chop cauliflower into florets.

2) Steam cauliflower until very tender, about 8-10 minutes. (Alternately, bring a large pot of water to a boil. Add cauliflower, and boil until tender. Timing here depends on the power of your stovetop to bring the cauliflower and water back up to temperature. Maybe 15-20 minutes? Or maybe my stovetop is weak.)

3) Drain cauliflower, and let cool until not too hot to touch. Pat cauliflower dry with paper towels.

4) Return cauliflower to pot, or to a big bowl, add butter, and puree with an immersion blender until creamy. (Alternately, puree in food processor.) Add salt and pepper to taste.

Approximate Calories, Fat, Fiber, Protein, and Price per Serving
76 calories, 3.1g fat, 5g fiber, 4g protein, $0.54

Calculations
8 cups cauliflower: 200 calories, 0.8g fat, 20g fiber, 15.8g protein, $2.00
1 T butter: 102 calories, 11.5g fat, 0g fiber, 0g protein, $0.10
1 T salt: 0 calories, 0g fat, 0g fiber, 0g protein, $0.03
1 t pepper: 0 calories, 0g fat, 0g fiber, 0g protein, $0.02
TOTALS: 302 calories, 12.3 g fat, 20g fiber, 15.8g protein, $2.15
PER SERVING (Total/4): 76 calories, 3.1g fat, 5g fiber, 4g protein, $0.54

Ahh, summer. Full of hazy days, humid nights, and lots and lots of blueberries. Those sweet orbs of azure joy are welcome anytime of year, but especially right now, when they provide a fruitacular (fruitacular?) balm for the grossest weeks of summer.

Thats a flowery way of saying that blueberries are currently on major sale at both my supermarket and Costco, going for about $0.16/ounce. Thats just about as cheap as theyll get around here, and I want to preserve the bounty for the winter months. (Thats when I  crave blueberry pancakes, but have to usually settle for acorn squash pancakes. Its just not the same.)

Fortunately, freezing blueberries for future use is easy as (blueberry) pie, and a heckuva lot cheaper than buying off-season ones come January. All you need to do is follow these simple steps. Youll thank me come Christmas (because surely, theres no one more deserving of expensive gift-like things than a babble-prone, extremely lax blogger you barely know.)

Anyway, lets get to it. 

Step 1: Cut a hole in the box. Buy an Ark-of-the-Covenant-sized carton of blueberries from your local farmers market, big box store, or perred fruit venue.


Step 1.5: Get some freezer baggies while youre at it. Honestly, theyre nice to have around, regardless. Tom Bosley was right on.


Step 2: Take a picture that you may someday use as a computer background. Make sure it is well-lit and in focus, so people (note: your mom) think(s) youre super awesome.


Step 3: Measure out your desired amount of blueberries. It could be in cup or half-cup increments, or by weight. Whatever you per. For my own nefarious purposes, I did eight ounces at a time.

Step 4: Place the blueberries on a small baking sheet. Stick that sheet right in your freezer.

NOTE: Blueberries are weird in that you should generally wait to wash them until right before using em. Less mushiness that way.


Step 5: Freeze for a few hours. Overnight is best.

Step 6: While the freezing process is occurring, watch the finale of Friday Night Lights and contemplate your values. Hope that someday you may make Coach Taylor proud.


Step 7: Once berries are frozen through, pour them into a freezer-safe Ziploc baggie. Get as much air out as possible, using a straw or your purty, purty mouth. Then, label that sucker.

NOTE: You do not have to write "Frozen Blueberries," as so brilliantly demonstrated here. Odds are youll know theyre frozen when you remove them from ... wait for it ... yep, the freezer.


And thats pretty much it. The blueberries should keep for a couple of months this way. (If you start seeing major freezer burn or frost buildup, its probably a pretty good indication they should be used soon.) Try them in smoothies, crisps, or the aforementioned flapjacks. Viva la France!