Archive for July, 2009

US Best Hospitals: Where To Go for the Best Care and Where To Train…

July 30, 2009

It is noteworthy to share with you the recent ranking of the US Best Hospitals

This post will help us make wise decisions where in the US can we get the best care… and the best specialty training for those planning to go the US for further studies.

New Rankings of the 2009 Best US Hospitals

from WebMD — a health information Web site for patients

Hospitals are listed below by total points. Here are the 21 hospitals that made the magazine’s honor roll (two are tied for 10th place):

  1. Johns Hopkins Hospital, Baltimore
  2. Mayo Clinic, Rochester, Minn.
  3. Ronald Reagan UCLA Medical Center, Los Angeles
  4. Cleveland Clinic
  5. Massachusetts General, Boston
  6. New York-Presbyterian University Hospital of Columbia and Cornell
  7. University of California-San Francisco Medical Center
  8. Hospital of the University of Pennsylvania, Philadelphia
  9. Barnes-Jewish Hospital/Washington University, St. Louis
  10. Brigham and Women’s Hospital, Boston
  11. Duke University Medical Center, Durham, N.C.
  12. University of Washington Medical Center, Seattle
  13. UPMC-University of Pittsburgh Medical Center
  14. University of Michigan Hospitals and Health Centers, Ann Arbor
  15. Stanford Hospital and Clinics, Stanford, Calif.
  16. Vanderbilt University Medical Center, Nashville, Tenn.
  17. New York University Medical Center
  18. Yale-New Haven Hospital, New Haven, Conn.
  19. Mount Sinai Medical Center, New York
  20. Methodist Hospital, Houston
  21. Ohio State University Hospital, Columbus

Top Hospitals by Specialty

Here are the No. 1 hospitals in each specialty, according to U.S. News and World Report:

  • Cancer: M.D. Anderson Center, University of Texas, Houston
  • Diabetes and endocrine disorders: Mayo Clinic, Rochester, Minn.
  • Digestive disorders: Mayo Clinic
  • Ear, nose, throat: Johns Hopkins Hospital, Baltimore
  • Geriatric care: Ronald Reagan UCLA Medical Center, Los Angeles
  • Gynecology: Brigham and Women’s Hospital, Boston
  • Heart and heart surgery: Cleveland Clinic
  • Kidney disorders: Brigham and Women’s Hospital
  • Neurology and neurosurgery: Mayo Clinic
  • Ophthalmology: Bascon Palmer Eye Institute, University of Miami
  • Orthopaedics: Mayo Clinic
  • Psychiatry: Massachusetts General, Boston
  • Rehabilitation: Rehabilitation Institute of Chicago
  • Respiratory disorders: National Jewish Hospital, Denver
  • Rheumatology: Johns Hopkins Hospital
  • Urology: Johns Hopkins Hospital

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Johns and Hopkins and the Mayo Clinic have been consistent topnotcher with only few points separating the two.  And their ranking have been the same since the time I had the privilege to train at the Mayo Clinic for my Endocrinology Fellowship from 1993 to 1996. 

Consistency with the best of care and the best team for specialty training therefore is the name of the game! 

And having grabbed the opportunity to be part of a great system and to be trained by great teachers will forever be one of the best achievements of my career!

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The Benefits of Exercise Go Beyond Prevention….

July 23, 2009

We all know the benefits of exercise.  It has been shown to afford a better lifestyle due to prevention of chronic diseases associated with sedentary behavior. 

What we dont know is how following a rigorous physical activity and being FIT can have an impact on a patients recovery from certain illnesses that unfortunately can happen due to the NON modifiable risk factors like family history and age!

A study from the Mayo Clinic published in BMJ this month shows us that indeed the benefits of exercise can go beyond Prevention:

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Background: The importance of physical activity as a modifiable risk factor for stroke in particular and cardiovascular disease in general is well documented. The effect of exercise on stroke severity and stroke outcomes is less clear. This study aimed to assess that effect.

Methods: Data collected for patients enrolled in the Ischemic Stroke Genetics Study were reviewed for prestroke self-reported levels of activity and 4 measures of stroke outcome assessed at enrollment and approximately 3 months after enrollment. Logistic regression was used to assess the association between physical activity and stroke outcomes, unadjusted and adjusted for patient characteristics.

Results: A total of 673 patients were enrolled; 50.5% reported aerobic physical activity less than once a week, 28.5% reported aerobic physical activity 1 to 3 times weekly, and 21% reported aerobic physical activity 4 times a week or more. Patients with moderate and high levels of physical activity were more likely to have higher Barthel Index (BI) scores at enrollment. A similar association was detected for the Oxford Handicap Scale (OHS). After 3 months of follow-up, moderate activity was still associated with a high BI score. No significant association was detected for activity and the OHS or Glasgow Outcome Scale at follow-up after adjustment for patient characteristics.

Conclusions: Higher levels of self-reported prestroke physical activity may be associated with functional advantages after stroke. Our findings should be seen as exploratory, requiring confirmation, ideally in a longitudinal study of exercise in an older population.

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Theoritically, the study results are obvious in that according to the author….”A brain that generally has good blood and oxygen flow from aerobic exercise will be in a better position to compensate for neurological deficits caused by a stroke.”

The results also say it all: that Exercise indded can be beneficial in all phases of the disease from prevention to recovery.  

 Among patients who reported less exercise in the year before their stroke those individuals were significantly more likely to have one or more bad outcomes while those who were into moderate to high levels of activity, the odds of a better outcome were higher. 

Likewise, in terms of recovery and functional capacity post stroke after three months , individuals who had both moderate and high exercise levels were associated with significantly better functional outcomes.  Great News specially to our diabetic patients who love to exercise! 

There you go… the many wonders of exercise !!!

You Get Everything GOOD with EXERCISE!  

The 20-40 RULE in Fitness and Disease

July 13, 2009

My 20-40 rule:

A low fitness level in your teens translate to a high level of risk for developing diabetes by age 40! 

That’s the message I got from this study published in Diabetes Care called the CARDIA Fitness Study.

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Objective: Test the association of fitness changes over 7- and 20-years on the development of diabetes in middle-age.

Research Design and Methods: Fitness was determined based on the duration of a maximal graded exercise treadmill test (Balke protocol) at up to three examinations over 20-years from 3989 black and white men and women from the Coronary Artery Risk Development in Young Adults study. Relative fitness change (%) was calculated as the difference between baseline and follow-up treadmill duration/baseline treadmill duration. Diabetes was identified as fasting glucose ≥126 mg/dL, post-load glucose ≥200 mg/dL, or use of diabetes medications.

Results:

  • Diabetes developed at a rate of 4 per 1000 person-years in women (n=149) and men (n=122) and lower baseline fitness was associated with a higher incidence of diabetes in all race-sex groups (hazard ratios from 1.8 to 2.3).
  •  On average, fitness declined 7.6% in women and 9.2% in men over 7 years.
  • The likelihood of developing diabetes increased per standard deviation decrease (19%) from the 7-year population mean change (−8.3%) was in women (hazard ratio [HR]=1.22, 95% CI: 1.09, 1.39) and men (HR=1.45, 95% CI: 1.20, 1.75) following adjustment for age, race, smoking, family history of diabetes, baseline fitness, body mass index (BMI), and fasting glucose.
  • Participants who developed diabetes over 20 years experienced significantly larger declines in relative fitness over 20 years vs those who did not..

Conclusions: Low fitness is significantly associated with diabetes incidence and explained in large part by the relationship between fitness and BMI.

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This study shows that inidviduals risk to develop lifestyle related diseases especially diabetes are at increasing overtime depending on the level of fitness:

  • Women were at 22% increased risk of developing diabetes
  • men were at a 45% increased risk…

 for every standard deviation decrease from the mean fitness change.  This relationship continued to exists even after adjusting for age, smoking, family history of diabetes, and baseline fasting glucose.  In fact the researchers noted that the baseline BMI was a better predictor for developing diabetes than the baseline fasting glucose as well as baseline fitness.

What Do These Data MEAN?

  • If two individuals have similar fitness level; the bigger person with a higher BMI is more likely to develop diabetes than the smaller frame guy overtime in the next 10-20 years.
  •  The possible mechanism by which fitness decreases risk for diabetes is most likely related to the regulation of body mass.  A lower BMI means better insulin sensitivity and less production of toxic substances by increased adiposity that can lead to further cardiovascular complications associated with obesity and diabetes. 

The authors conlcuded:

That regular physical activity to “improve and maintain cardiorespiratory fitness is an important component of a healthy lifestyle.” 

 AMEN!

Walk and Jog or The WOG… A Perfect Exercise!!!

July 7, 2009

Since the time Ive lost weight, Ive been apporached several times by my friends how I did it.  Ive posted in thia website my diet regimen…now I am posting my exercise routine.  To lose weight…the right food and the right discipline are both essential.  To maintain your weight, then the right kind of exercise that you feel good and you can do for years should be the best way to increase your metabolic rate!

Can we call it the WOG?  Short for Walk and Jog!!!

Ive been a brisk walker for sometime.  I find it a good exercise that’s not too tiring nor too destructive for my joints.  But overtime, after several articles touting the benefits of short bouts of exercise in between breaks that I thought of trying to alternate my walking exercise with jogging.

The intensity of exercise is more…the surge of adrenaline is more and boy…you feel better and better everytime you do the routine.  Lots and lots of sweat too!  Besides, you allow you body to rest in between the jogging by brisk walking.

Jogging being a high-intensity exercise kicks your metabolism up and by doing so,  your metabolic rate stays up longer (five times longer after a vigorous workout than after an easy one).   By doing the same routine, one therefore tends to add up the number of calories burned because the jogging can easily add up another 200 calories compared to walking alone.

Here’s what I do:

Before I walk, warming up by stretching the muscles is very important.  Then I start my brisk walking slowly increasing the pace  until I start jogging. 

 I then do the alternate walk and jog routine every 3 minutes until 40 to 40 minutes!!!!  

Initially it may seem “laborious” compared to walking alone but soon…you will be running a marathon as the running becomes easier.  But at this time, I have no plans to pursue a running career!  I just want to burn more calories and make myself healthier and hopefully avoid myself getting the risk of developing diabetes!

To stay Fit and Slim…Discipline is the KEY!

You are What You Eat and Do the WOG!

Sleep Well To Prevent High Blood Pressure!!!

July 4, 2009

A simple measure to reduce BP is to have a good night’s sleep!!!

Here’s a new study that shows us one tip to have a better controlled blood pressure  published in Archives of Internal Medicine:

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BACKGROUND: Epidemiological studies have reported an association between self-reported short sleep duration and high blood pressure (BP). Our objective was to examine both cross-sectional and longitudinal associations between objectively measured sleep and BP.

METHODS: This study is ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. Blood pressure was measured in 2000 and 2001 and in 2005 and 2006. Sleep was measured twice using wrist actigraphy for 3 consecutive days between 2003 and 2005. Sleep duration and sleep maintenance (a component of sleep quality) were calculated. Analyses included 578 African Americans and whites aged 33 to 45 years at baseline. Outcome measures were systolic BP (SBP) and diastolic BP (DBP) levels, 5-year change in BP, and incident hypertension.

RESULTS: After we excluded the patients who were taking antihypertensive medications and adjusted for age, race, and sex,

  • shorter sleep duration and lower sleep maintenance predicted significantly higher SBP and DBP levels cross-sectionally as well as more adverse changes in SBP and DBP levels over 5 years (all P < .05).
  • Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio, 1.37; 95% confidence interval, 1.05-1.78).
  •  Adjustment for 16 additional covariates, including snoring and daytime sleepiness, slightly attenuated the associations between sleep and BP.

 CONCLUSION: Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.
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There you go guys… nake sure you sleep better..and rest well. 

Dont let worries or pressure bother you too much. 

Associate the bed with a good night’s sleep…  not only will you feel refreshed the next day BUT healthier too!

For a Healthier Heart… Sleep Well!!!

What’s Really the IDEAL Weight To Live Longer?

July 2, 2009

My brother in law’s blog article had this title: A Little Extra Weight can Make you Live Longer! 

That obviously caught my attention.  So searching the source of the article was actually published in the  OBESITY journal  June 2009.  Below is the abstract:

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Although a clear risk of mortality is associated with obesity, the risk of mortality associated with overweight is equivocal. The objective of this study is to estimate the relationship between BMI and all-cause mortality in a nationally representative sample of Canadian adults.

A sample of 11,326 respondents aged 25 in the 1994/1995 National Population Health Survey (Canada) was studied using Cox proportional hazards models.

  • A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P < 0.001) and obesity class II+ (BMI >35; RR = 1.36, P <0.05).
  • Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P < 0.05).
  • The RR was close to one for obesity class I (BMI 30–35; RR = 0.95, P >0.05).

Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality. Obesity class I was not associated with an increased risk of mortality.

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But a Word of Caution …..

As clearly stated by Mark Kaplan, DrPH, the coauthor: “Our study only looked at mortality, not at quality of life, and there are many negative health consequences associated with obesity, including high blood pressure, high cholesterol, and diabetes.”

What made the study interesting were the following outcomes:

  • Overweight individuals were 17 percent less likely to die than normal weight inidividuals. 
  • Not surprising are the outcomes for the underweight people as they were noted to be 70 percent more likely than people of normal weight to die. 
  • The same outcome was noted with the extremely obese people who were 36 percent more likely to die.

The problem of the study is it only looked at mortality data and nothing else. One may have lived longer but the quality of life due to disabling complications arising from chronic conditions associated with obesity is poor. 

And this has always been our battle cry for a healthy lifestyle and achieve a healthy normal weight:

  •  To reduce the risk for chronic diseases that can cause disability and that
  •  Excess weight can shorten your lifespan…

The bottom line is: 

  • A Little overweight is better than having excess weight BUT
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  • Normal weight should continue to be The Goal … and always
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  • AIM to Achieve a healthy lifestyle to live longer because:

 Quality is More Important Than Quantity!