Thursday, July 23, 2015

Best Hospitals 2015-16: an Overview

Rankings by region and specialty, with an Honor Roll of hospitals that excel in complex specialty care.

Nearly 100,000 Americans are hospitalized each day. That adds up to nearly 40 million hospitalizations per year. With so many lives at stake and so many opportunities to hone their care, hospitals could be expected to meet demanding quality standards. After all, manufacturing, commercial aviation and other major industries have achieved high degrees of consistency and safety.
But health care is different. Some hospitals excel in treating exceedingly difficult cases, while others too often fail even patients whose medical needs are relatively straightforward. As a result, health care consumers need to take care when they choose a hospital. To help patients make smart, well-informed choices, U.S. News has published annual hospital rankings for more than two and a half decades. These rankings and the quality data from which they're derived highlight hospitals that perform best in specific areas of care.

Saturday, July 11, 2015

The Scary Way Diabetes Affects Thinking Skills And Brain Function

A growing body of research is finding that diabetes can take as devastating a toll on the brain as it takes on the body.
A new study published this week in the journal Neurology shows that people with type 2 diabetes demonstrate a decline in cognitive skills and ability to perform daily activities over the course of only two years.
These changes are linked with an impaired ability to regulate blood flow in the brain, due in part to inflammation, which is a common component of type 2 diabetes.
Normally, the brain distributes blood as needed to areas of increased neural activity. In diabetic individuals, however, this process becomes impaired.
"We have shown that people with diabetes have abnormal blood flow regulation in the brain, namely impaired ability to increase blood flow and deliver sugar and oxygen to the brain during episodes of increased mental activity," the study's lead author, Dr. Vera Novak of the Harvard Medical School, told The Huffington Post in an email. "Inflammation further alters blood flow regulation in diabetic people and contributes to mental and functional decline."
For the study, the researchers recruited 65 men and women with an average age of 66, half of whom had Type 2 diabetes and half of whom did not. The participants were given a series of memory and cognition tests at the outset of the study and again two years later. They also received brain scans to measure brain volume and blood flow and blood tests to measure inflammation and blood sugar control.
Here are some of the key findings:
  • After two years, the people with diabetes showed greater declines in gray matter as well as impairments in their ability to regulate blood flow in the brain than the people without.
  • Blood flow regulation decreased by an average of 65 percent in the participants with diabetes.
  • Among participants with diabetes, scores on thinking and memory tests decreased by an average of 12 percent, from 46 to 41 points, while test scores of the participants without diabetes stayed the same at 55 percent.
  • Higher levels of inflammation were correlated with greater difficulties with blood flow regulation.
  • Those with the highest levels of blood flow regulation impairment at the outset of the study had more difficulties performing daily activities (such as cooking and bathing) after two years.

Monday, July 6, 2015

on Cholesterol: Ask the Expert with Dr. Walter Willett:

3. Even if dietary cholesterol doesn’t raise blood cholesterol levels, is it possible that other foods – like refined carbohydrates  – might raise cholesterol levels?
 Dietary cholesterol doesn’t raise blood cholesterol levels very much. It’s not that there’s no effect on blood cholesterol levels; there’s a small effect. It can raise both good and bad cholesterol in the blood so that makes it more complicated, and that’s why we need to look at the whole food, not just cholesterol content.
 The other main factor that increases blood cholesterol levels is saturated fat in the diet, and that actually has more of an impact than cholesterol in the diet. Then there are other aspects of the diet that can reduce cholesterol levels, specifically the bad cholesterol levels – for example unsaturated fat reduces blood cholesterol, and fiber can reduce blood cholesterol levels. Refined starches don’t have a major effect on bad cholesterol but they drop the good cholesterol. There are other aspects of diet that affect blood cholesterol, both the good and the bad parts of it.

Most People Have Cholesterol All Wrong

Do you know which foods contain good cholesterol, and which contain bad cholesterol? If you think you do, ha! That’s a trick question! Cholesterol in our food doesn’t come in “good” and “bad” varieties, but cholesterol readings from blood tests do, and the two aren’t as closely connected as we used to think.
We make cholesterol in our bodies. It’s a key part of cell membranes, and we use it as a building block to make important chemicals like hormones, vitamin D, and bile.
Other animals make cholesterol too, so you’ll find it in animal foods like meat, dairy, and eggs. Since cholesterol is a lipid (it mixes well with oil, but not with water) you’ll tend to find it in the fatty parts of food. But it’s not a type of fat!
Plants don’t make cholesterol, so anything vegan (like vegetable oil) is automatically cholesterol-free.
More importantly, since we make our own cholesterol, the amount we eat isn’t very important. Cholesterol, while important in our bodies, is not essential in our diet. If you never eat another cholesterol again in your life (hi, vegans!) your body will still make plenty and do just fine.
In fact, we make far more cholesterol than we eat (even if you’re a devoted carnivore). The liver adjusts its cholesterol production to account for what we eat, and will get rid of any cholesterol it doesn’t need, so even if you eat a ton of cholesterol, it will have little to no effect on what’s in your blood.

Some folks confuse fat with cholesterol. There are good and bad fats, but the cholesterol you eat has no such distinction. When it’s sitting on your plate, it’s just plain cholesterol. It only becomes “good” or “bad” when it’s packaged into particles in your bloodstream.
Those good and bad packages are lipoproteins: little particles that transport fat and cholesterol to specific destinations in your body. The low-density lipoproteins, or LDLs, are considered bad because people who have a lot of them are more likely to develop heart disease. The LDLs can get stuck in the walls of arteries, in a process that leads to atherosclerosis, the hardening of the arteries that can lead to heart attacks and stroke.
high-density lipoproteins, or HDLs, help remove the LDL particles to avoid forming plaques. So it’s good to have a lot of HDLs (think H for “happy”) and bad to have a lot of LDLs.