As good as pills: Mediterranean diet prohibits nothing that was recognized as food by your great-grandmother

From NYTimes: The Times's Gina Kolata talks about a new study, published on The New England Journal of Medicine's Web site, focusing on the health benefits of a Mediterranean diet.



When Diet Meets Delicious - The Mediterranean Approach http://buff.ly/XCsvTJ -- Mediterranean diet prohibits nothing that was recognized as food by your great-grandmother.

Here is the original research from NEJM:

In a multicenter trial in Spain, 7447 participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment (age range, 55 to 80 years, 57% were women), were randomly assigned to one of three diets:

- a Mediterranean diet supplemented with extra-virgin olive oil
- a Mediterranean diet supplemented with mixed nuts
- a control diet (advice to reduce dietary fat)

Participants received quarterly educational sessions and, and depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts.

The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years.

The two Mediterranean-diet groups had good adherence to the intervention. A primary end-point event occurred in 288 participants.

The multivariable-adjusted hazard ratios were 0.70 and 0.72 for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events).

Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events (the study was funded by the Spanish government).

References:

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. February 25, 2013DOI: 10.1056/NEJMoa1200303
http://www.nejm.org/doi/full/10.1056/NEJMoa1200303

Comments from Twitter and Facebook:

Dr Kelly Sennholz @MtnMD: Better! RT .@DrVes: As good as pills: Mediterranean diet prohibits nothing recognized as food by ur grt-grandmother bit.ly/WuFQKv


Matthew Bowdish: My grandmother used to serve bacon-wrapped asparagus. Is that in the Mediterranean diet?

Ionized gas plasma is the new disinfectant for hands, wounds and materials (video)

Plasma research for combating bacteria: A spin-off of space research may help solve a huge medical problem. It turns out that plasma, a form of ionized gas may help to heal chronic wounds by killing off multidrug resistant bacteria and stimulating tissue growth. Here is a video from Deutsche Welle:



Comments from Twitter:

Dr John Weiner @AllergyNet: Nice video. That’s why there is physics in physician MT @DrVes Gas plasma: disinfectant for wounds? bit.ly/V6JgXx

Formula for Happiness = S (Set range, personal biology) + C (Circumstances) + V (Voluntary control)

Martin Seligman, a professor of psychology at the University of Pennsylvania, has proposed a formula for the causes of happiness that accounts for stable and variable components of long-term happiness; H (enduring level of happiness) = S (personal set range) + C (circumstances) + V (factors under personal voluntary control).

Voluntary/intentional activities have similar level of influence (40%) compared to genetic set-point for happiness (50%)

The happiness set-point (estimated influence 50 %) “is genetically determined and assumed to be fixed, stable over time, and immune to the influence of control”.

Circumstances' estimated influence is only 10 %. These include the geographical region where a person resides, demographic factors such as age and gender, and major life-status factors such as marriage, and being sufficiently wealthy.

Intentional Activities' estimated influence is 40 %. Activities are more controllable than genetic factors, personality and most circumstances and offer the greatest potential to sustainably increase happiness. They have similar level of influence (40%) compared to the genetic set-point for happiness (50%).

Happiness enhancing strategies fall into 3 activity types:

1. Behavioral activity reflects a person’s actions:

- physical activities
- meditation and mindfulness
- social activities such as deliberate acts of kindness and gratitude

2. Cognitive activity indicates a person’s attitudes:

- cultivating gratitude
- forgiveness
- cognitive approaches to coping with adversity

3. Volitional activity is motivated towards achieving goals:

- pursuing goals that are concordant with one’s values and interests
- maintaining hope
- meaning in life

The dominance of social relationships for happiness

In a recent study, the most striking finding was the dominance of the Social Relationships dimension. People are happier when they are around others and relationships are necessary for happiness.

Therefore, individuals pursuing happiness should spend time and energy developing and maintaining their relationships. Does that involve online relationships developed via Twitter and Facebook?

A recipe for long-lasting happiness

Happy people are those who:

- are involved in a number of close relationships and practice their social values
- do not overrate the importance of circumstances or spend undue energy striving for circumstantial change
- enjoy satisfying and active leisure pursuits
- pursue (behavioral) activities and (cognitive) attitudes that are rewarding and in line with their broader sense of purpose
- have a philosophy of living that helps them to navigate life’s complexities

“Optimism is the belief that good things will happen to you and that negative events are temporary setbacks to be overcome” - a classical definition from the Mayo Clinic (http://goo.gl/wZ6Rh)

References:

Exploring the Causes of Subjective Well-Being: A Content Analysis of Peoples’ Recipes for Long-Term Happiness. Journal Journal of Happiness Studies, 2012. http://goo.gl/kN5OQ
Image source: OpenClipArt.org, public domain.

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Please email your suggestions for inclusion to clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

What’s your favorite thing about being a doctor? Dr. Schwimmer answers: http://buff.ly/10Dtln7

The case for slow medicine - BMJ blogs http://buff.ly/Ttkldd

Does WaxVac or EarVac Actually Remove Earwax? http://buff.ly/T8srbo

Should You Get Medical Books Via iBooks? Krafty (medical) Librarian shares her expertise: http://buff.ly/R62fQ7

Is there a looming family physician shortage, or not? http://buff.ly/10Dtuqp

Lance Armstrong in the scientific literature: Questions abound http://buff.ly/10GnH3w

Life as a Healthcare CIO: Building Unity Farm http://buff.ly/Zt1FQ0

Indiana Jones Mystery Package - UChicago College Admissions http://buff.ly/Sj4wsL

Top medicine articles for January-February 2013

Here are my suggestions for some of the top articles in medicine for January-February 2013:

Why Most Published Research Findings Are False - PLOS Medicine http://buff.ly/Tca847

New York City Ties Doctors’ Income to "Quality of Care" http://buff.ly/WTwDdm

"After a string of digital dating disasters, Amy Webb dug into the data…and found her husband" - WSJ http://buff.ly/10thOqi

Know Thyself—Via Gadgets and Apps - a new self-tracking movement is afoot http://buff.ly/10ti8Fo

A Cycle of Contamination - and Cancer - That Won’t End - NYTimes http://buff.ly/X6ZsUo

Malpractice Risks With NPs and PAs in Your Practice http://buff.ly/10Gl5m4

Online Professionalism Investigations by State Medical Boards: First, Do No Harm http://buff.ly/10GozFe

A 13-item score based on readily available risk factors predicted risk for 3-year mortality in heart failure http://buff.ly/10GoFgd

No evidence to support the use of vitamin and antioxidant supplements for prevention of cardiovascular diseases http://buff.ly/10GoNMH

Eight Questions About Physician-Rating Websites - JMIR 2013 http://bit.ly/12ifjXA

Diabetics can eat right after using insulin: study http://buff.ly/X2JVXp

Why are we seeing a large increase in type 1 diabetes in young children? http://buff.ly/X2K790

Concerns About A.D.H.D. Practices, Amphetamine Addiction, and tunnel-like focus the medicines provide - NYTimes http://buff.ly/X8SpMo

Successful and Schizophrenic - NYTimes http://buff.ly/YuLHVW

They may be difficult to pronounce, but pharmaceutical companies are returning to drug names starting with X and Z http://buff.ly/X8SYpH

WHO recommends that adults consume less than 2 grams of sodium (5 grams of salt) from food daily http://buff.ly/WOAg8F

Use of vitamin C (ascorbic acid) supplements is associated with development of kidney stones http://buff.ly/WOArku

A variety of sledding injuries associated with late night partying and alcohol - BMJ http://buff.ly/14DVh8t

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases AT gmail.com and you will receive acknowledgement in the next edition of this publication.

Lessons from 12 Years of Blogging (from woodtang)

Spoken like a true blogger:

"I started this site 12 years ago. That’s longer than my marriage, longer than any job I’ve held, longer than I’ve lived anywhere since I was a kid. Even though I stopped a started blogging here too many times to count, that’s a long time. I feel like that counts for something on the web and I ought to give it some love.

My interest in blogging waned when I started using Twitter, but I’ve always felt something missing when I wanted to write a few paragraphs about something and be done with it."

Read the rest at woodtang.com http://bit.ly/VPuEaP

“Painting is just another way of keeping a diary”, said Pablo Picasso. Blogging is similar in a way but it also helps to collect important ideas, archive news items and create an educational portfolio that is easily shareable with students, colleagues and patients.

In my personal experience, blogging fits nicely in what I call the Cycle of Online Information and Physician Education (click here to enlarge the image).





Comments from Twitter:

Heidi Allen @dreamingspires: Lessons from 12 Years of Blogging (from woodtang) casesblog.blogspot.com/2013/02/lesson… impressive - and makes it sound simple

The Brain of a Murderer - Are You Good Or Evil? (BBC video)

Professor James Fallon from University of California, Irvine explains the beginnings of his work studying the brains of criminals and murders. Would his work prove the existence of a signature brain profile of a serial killer or are there other factors to consider?



Jim Fallon recently made a disquieting discovery: A member of his family has some of the biological traits of a psychopathic killer. "These results will cause some problems at the next family party," he said, reviewing the data on his laptop in his backyard. Fallon had already been studying the brains of psychopathic killers for years when his mother told him that he comes from a long line of murderers. Is he one of them?

After a PET scan, Professor Jim Fallon made a shocking discovery about his own brain - that he had the neurological and genetic correlates of psychopathy. However, he is not concerned by the findings and believes that his positive experiences in childhood negated the genetic susceptibility to violence and emotional issues.



References:

What's on Jim Fallon's Mind? A Family Secret That Has Been Murder to Figure Out - WSJ.com http://on.wsj.com/9CUbjG
A Neuroscientist Uncovers A Dark Secret - NPR http://n.pr/V2LMNl
Jim Fallon: Exploring the mind of a killer | Video on TED.com http://bit.ly/V2LNAI
Three Ingredients for Murder: Neuroscientist James Fallon on psychopaths - YouTube http://bit.ly/V2M2M9

Comments from Twitter:

Gia Sison MD @giasison: Wow To Watch! Great share Ves!!!!

Mild traumatic brain injury (MTBI)

What is Mild traumatic brain injury (MTBI)?

Mild traumatic brain injury (MTBI) is commonly known as concussion. A universally accepted definition is lacking.

Mild traumatic brain injury and concussion are classified by:

- transient loss of consciousness
- amnesia
- altered mental status
- a Glasgow Coma Score of 13 to 15
- focal neurological deficits following an acute closed head injury

"Red flag' symptoms include: progression of physical, cognitive, and behavioral symptoms, seizure, progressive vomiting, and altered mental status.

What is the prognosis of mild traumatic brain injury (MTBI)?

Most patients recover quickly, within 1-2 weeks.

However, persistent symptoms may be noted in 5-20% of persons who have mild traumatic brain injury (MTBI):

- Physical symptoms include headaches, dizziness, and nausea, and changes in coordination, balance, appetite, sleep, vision, and hearing.

- Cognitive and behavioral symptoms include fatigue, anxiety, depression, and irritability, and problems with memory, concentration and decision making.

Who is at greatest risk after a mild traumatic brain injury (MTBI)?

Women, older adults, less educated persons, and those with a previous mental health diagnosis are more likely to have persistent symptoms.

Protecting the brain from concussion: $20-helmet is a good way to protect $100,000 education



Neuropsychologist Kim Gorgens makes the case for better protecting our brains against the risk of concussion -- with a compelling pitch for putting helmets on kids: A $20-helmet is a good way to protect $100,000 education. "Mind your (brain) matter."

References:
Subacute to chronic mild traumatic brain injury. Mott TF, McConnon ML, Rieger BP. Am Fam Physician. 2012 Dec 1;86(11):1045-51.
Image source: Hippocampus, from Wikipedia, public domain.

Snow Blower and Shoveling Safety (video)

Using a snow blower is not as physically taxing as shoveling, but its powerful blades have the potential to severely injure hands and feet. Dr. David Shapiro, an orthopaedic surgeon at Cleveland Clinic, explains the most common injuries he sees with snow blowers:



Snow shoveling injuries land thousands of people in the emergency room every year. 96 percent of them happen at home: