"How are you? Have you retired?"

Men with cardiovascular disease and ED were twice as likely to die from all causes than men who did not have erectile dysfunction. And those with ED were 1.6 times more likely to suffer from a serious cardiovascular problem such as a heart attack or stroke.

Erectile dysfunction is something that regularly should be addressed in the medical history of patients; it might be a symptom of early atherosclerosis.

Men with ED who are going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment. ED is an early predictor of cardiovascular disease.

References:
Study: Erectile dysfunction may indicate heart disease, death risk - CNN.com.

After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 55 hours per week in 1996-1998 to 51 hours per week in 2006-2008.

Excluding resident physicians, whose hours decreased by 9.8% due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7%.

Physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours.

A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees.

Medical Blog Anniversaries

Dr. Rob explains why he has been blogging for nearly 4 years http://goo.gl/seKp

Dr. Bates has been blogging for 3 years, leading to over 1,000 posts and many new friends http://goo.gl/eB1e

"On a typical morning, Sandip Patel, MD, a hospitalist employed by a health plan in Southern California, rounds on patients at the hospital, then meets with case managers and a medical director to review care plans and decide which patients will stay or go.

In the afternoon, Dr. Patel may see recently discharged patients—those coded "red" or "yellow," based on medical complexity—at an integrated-care center, which is also owned and run by the health plan. Then he might head to a nursing home to check on patients discharged a week ago.

Dr. Patel considers himself an "extensivist" with a goal to reduce readmissions. "Lowering readmission rates is within the purview of the hospitalists."

References:
Health-plan hospitalists cut readmissions—by sometimes leaving the hospital. Today's Hospitalist, 2010.

Video - TEDxCLE - Dr. C. Martin Harris, CIO of Cleveland Clinic talks about EMR. The Cleveland Clinic uses Epic Systems EMR and, although the system costs millions of dollars to purchase and maintain, it has been perceived as very useful by both physicians and patients.

ClevelandClinic — May 12, 2010 — "Innovation has made Cleveland Clinic a world leader in medicine, and is the only true long term solution to high quality affordable healthcare. The founders of Cleveland Clinic launched a revolutionary model of medicine, collaborative, patient centered, dedicated to innovation."

NatureVideoChannel — January 27, 2010 — Harvard professor Daniel Lieberman has ditched his trainers and started running barefoot. His research shows that barefoot runners, who tend to land on their fore-foot, generate less impact shock than runners in sports shoes who land heel first. This makes barefoot running comfortable and could minimize running-related injuries. Find the original research here: http://dx.doi.org/10.1038/nature08723

From the NYTimes:

Virtually unknown outside of the Amazon two decades ago, and not exported from Brazil — the major producer — until 2000, açaí berries have become famous around the world, riding the wave of the antioxidant craze and rain-forest chic.

Just a few years ago, farmers had trouble getting rid of the açaí that grows.

Diego Lopes, a 21-year-old açaí processor in Brazil, says he has açaí with lunch and dinner every day. “Fifteen years ago, it was like beans for us,” he said. “Now, it’s more expensive than beans."

“Think of it as a cheeseburger,” Mr. Lopes said, explaining to an American reporter. “You can’t have a meal there without a cheeseburger, right?”

The velvety texture of the thicker varieties is wonderful, but the taste is more — how to put this? — earthy. O.K., it tastes like dirt. Making matters worse, the manioc flour that’s often mixed in to thicken it has the consistency of sand.

References:

"The harder the experts try to save Americans, the fatter we get. Officials responded by advising Americans to shun fat, which became the official villain of the national dietary guidelines during the 1980s and 1990s. The anti-fat campaign definitely made an impact on the marketing of food, but as we gobbled up all the new low-fat products, we kept getting fatter. Eventually, in 2000, the experts revised the dietary guidelines and conceded that their anti-fat advice may have contributed to diabetes and obesity by unintentionally encouraging Americans to eat more calories.

“When you reduce salt, you reduce blood pressure, but there can also be other adverse and unintended consequences. As more data have accumulated, it’s less and less supportive of the case for salt reduction, but the advocates seem more determined than ever to change policy.”

References:
Findings - When It Comes to Salt, No Rights or Wrongs. Yet. - NYTimes.com.

Thomas Moyer, Ph.D., from Mayo Clinic's Department of Laboratory Medicine and Pathology, describes the four basic categories of patients as identified through this test, and how the doses of the blood-thinner warfarin would typically be adjusted to reflect differences in patients' metabolism of warfarin and also their sensitivity, to prevent stroke or hospitalization due to excessive bleeding.

Childhood onset diabetes is associated with increasing birth weight, equivalent to a 7% increase in risk for every 1000 g in weight.

Caesarean section increases the risk by around 20%.

The risk of childhood onset diabetes increases with maternal age: 5% for each five years of age.

References:
Maternal age and diabetes in childhood. BMJ 2010;340:c623.

From the NYTimes:

Wrong: Sitting at your cubicle. Better: Walking while clicking and talking.

Your chair is your enemy.

It doesn’t matter if you go running every morning, or you’re a regular at the gym. If you spend most of the rest of the day sitting — in your car, your office chair, on your sofa at home — you are putting yourself at increased risk of obesity, diabetes, heart disease, a variety of cancers and an early death.

According to the Environmental Working Group (EWG), farm-raised salmon has 16 times the polychlorinated biphenyls (PCBs) as wild-caught salmon. That’s because farm-raised salmon are often fed contaminated fish meal, which builds up in salmon’s fatty tissue.

Chilean-farmed fish had lower levels of toxins than fish raised in the U.S., Scotland, Canada and Norway. Those tested from Scotland had such high levels that the EWG recommended it be eaten no more than once per month.

References:

A UK study analysing samples from patients with chronic fatigue syndrome has found no evidence of a link with a retrovirus (XMRV). The virus was first described in 2006.

Patients with chronic fatigue syndrome, also known as myalgic encephalomyelitis, often report that their condition—a mix of symptoms including extreme fatigue—began after an otherwise normal viral infection.

Walters announced that she will undergo surgery to replace a "faulty" heart valve later this week.

"You know how I always say to you how healthy I am. ... I've never missed a day's work," she began. "Later this week, I'm going to have surgery to replace one faulty heart valve."

From her description, the valve defect sounds like aortic stenosis. For a variety of reasons, mitral stenosis is a less likely possibility in the differential diagnosis.

Best wishes for successful surgery and speedy recovery!

References:
Barbara Walters to Undergo Heart Surgery. ABC.

From Consumer Reports health blog:

Small toys and foods that are choking hazards should carry warning labels - and some hot dog brands already do.

About 17% of food-related asphyxiations were caused by hot dogs. In total, 41% were caused by food items including:

According to a new study, if you devote your lunch hour to a nap, you may perform and learn better in the afternoon.

Napping at midday, when the brain's ability to learn may have deteriorated, may clear the brain's memory "storage area" and make room for new information.

In the study, the nap group was given the chance for a 90-minute siesta at 2 p.m.; the no-nap group was asked to stay awake.

People in the group which didn't nap had a 10% reduction in their learning capacity. The people who had a nap improved their ability to learn by 10% (not much).

From the British tabloid Daily Mail:

"Sometimes we forget just how short and precious our time on this planet really is. It's for this reason that John Lewis's new television ad seems to have struck an uncharacteristic chord.

You won't find many people admitting to crying over the usual flood of formulaic adverts on our screens - yet this 'moving' ad has got Britain talking - and sobbing into their breakfast bowls.

At 91 seconds long, and costing £6 million, the ad shows the the life cycle of a woman from birth to old-age - infancy, a girl's birthday party, a clumsy kiss in a university corridor, marriage, pregnancy, parenthood and the path into old age."

Cocoa beans fresh from the tree are exceptionally rich in flavanols. Unfortunately, during conventional chocolate making, this high antioxidant capacity is greatly reduced due to manufacturing processes.

The researchers evaluated the photoprotective potential of chocolate consumption, comparing:

- conventional dark chocolate
- specially produced chocolate with preserved high flavanol (HF) levels.

A double-blind in vivo study in 30 healthy subjects was conducted, 15 subjects were randomly assigned to either a high flavanol (HF) or low flavanol (LF) chocolate group and consumed a 20 g portion of their allocated chocolate daily.

The minimal erythema dose (MED) was assessed at baseline and after 12 weeks.

In the high flavanol (HF) chocolate group the mean MED more than doubled after 12 weeks of chocolate consumption, while in the LF chocolate group, the MED remained without significant change.

The authors concluded that regular consumption of a chocolate rich in flavanols confers significant photoprotection and can thus be effective at protecting human skin from harmful UV effects. However, conventional chocolate has no such effect.

Video: Chocolate Rain by Tay Zonday.

References:
Eating chocolate can significantly protect the skin from UV light. Williams S, Tamburic S, Lally C. J Cosmet Dermatol. 2009 Sep;8(3):169-73.
Link via @DrShock.
Image source: Wikipedia.

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