Mismanaged expectations—maternal morbidity in the USA

“Despite substantially higher spending on health care per person than comparable high­income countries, maternal deaths and severe maternal morbidity levels in the USA more closely resemble some low­ income countries. The steep increase of deaths is mirrored by another troubling trend in the past decade, the notable increase in serious, but often preventable, obstetric complications.”

Source: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)32120-2.pdf

 

Posted in Fifth Avenue Concierge Medicine, Health, keto, News |

Association Between Ambient Air Pollution and Cardiac Morpho-Functional Phenotypes

Association Between Ambient Air Pollution and Cardiac Morpho-Functional Phenotypes

Insights From the UK Biobank Population Imaging Study
Originally publishedCirculation. 2018;0:CIRCULATIONAHA.118.034856

Background:

Exposure to ambient air pollution is strongly associated with increased cardiovascular morbidity and mortality. Little is known about the influence of air pollutants on cardiac structure and function. We aim to investigate the relationship between chronic past exposure to traffic-related pollutants and the cardiac chamber volume, ejection fraction, and left ventricular remodeling patterns after accounting for potential confounders.

Methods:

Exposure to ambient air pollutants including particulate matter and nitrogen dioxide was estimated from the Land Use Regression models for the years between 2005 and 2010. Cardiac parameters were measured from cardiovascular magnetic resonance imaging studies of 3920 individuals free from pre-existing cardiovascular disease in the UK Biobank population study. The median (interquartile range) duration between the year of exposure estimate and the imaging visit was 5.2 (0.6) years. We fitted multivariable linear regression models to investigate the relationship between cardiac parameters and traffic-related pollutants after adjusting for various confounders.

Results:

The studied cohort was 62±7 years old, and 46% were men. In fully adjusted models, particulate matter with an aerodynamic diameter <2.5 µm concentration was significantly associated with larger left ventricular end-diastolic volume and end-systolic volume (effect size = 0.82%, 95% CI, 0.09–1.55%, P=0.027; and effect size = 1.28%, 95% CI, 0.15–2.43%, P=0.027, respectively, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 µm) and right ventricular end-diastolic volume (effect size = 0.85%, 95% CI, 0.12–1.58%, P=0.023, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 µm). Likewise, higher nitrogen dioxide concentration was associated with larger biventricular volume. Distance from the major roads was the only metric associated with lower left ventricular mass (effect size = -0.74%, 95% CI, -1.3% to -0.18%, P=0.01, per interquartile range increment). Neither left and right atrial phenotypes nor left ventricular geometric remodeling patterns were influenced by the ambient pollutants.

Conclusions:

In a large asymptomatic population with no prevalent cardiovascular disease, higher past exposure to particulate matter with an aerodynamic diameter <2.5 µm and nitrogen dioxide was associated with cardiac ventricular dilatation, a marker of adverse remodeling that often precedes heart failure development.

Posted in Fifth Avenue Concierge Medicine, Health, keto, News |

How Sound Affects Our Health

https://www.wsj.com/articles/how-sound-affects-our-health-1537149781

 

 

Posted in Fifth Avenue Concierge Medicine, Health, keto, News |

Eastern and Western Medicine Integration – A Conversation with Jin Shin Institute’s Alexis Brink

LinkLive HAPPENING RIGHT NOW!!! Sitting down with Alexis Brink and
Maurice Preter MD Psychiatry and Neurology ????

You can find Maurice Preter, M.D. at https://psychiatryneurology.net/ and on his Facebook page (linked above).

#LinkLiveJSI

Posted by Jin Shin Institute on Monday, July 30, 2018

The following is a quote from Dr. Preter’s page on Clinical Approach:

What exactly is integrative psychiatry/ neurology /neuropsychiatry?

It is well known that effectively restoring (and/or promoting) health requires an integrated understanding of how mind, brain, body, personal history and current life circumstances interact with each other. All these factors contribute to a person’s illness experience; their interaction often represents an opportunity for a change for the better. Neuropsychiatry is the application of this integrative principle in clinical neurology and psychiatry. It has for the past decades guided my clinical work as Board-certified neurologist, Board-certified psychiatrist, neuropsychiatrist, psychopharmacologist, and practitioner of psychotherapy.

A stepwise approach to diagnosis pays off: First come fundamental, sometimes easily treated physiological disturbances that can affect a person’s immediate emotional, cognitive and general well-being, and threaten health later in life. A sleep disorder, a thyroid imbalance, vitamin D and other nutritional deficiencies, the unwanted effects of multiple, perhaps improperly dosed, sometimes entirely unnecessary medications all impair the day-to-day functioning of the mind and the brain, and can cause or exacerbate illness and distress. Why would anyone wait to treat them? However, just as important as these biological, pharmaceutical and nutritional “basics” is a longer-term, psychologically informed perspective that helps us to make sense of a person’s unique experience. This often forces us to look beyond simple diagnostic labels and requires a scientifically informed reassessment and integration of often isolated pieces of information: Biographic information, memories, but also imaging data, medication lists, blood tests, neuropsychological test reports etc.

A treatment approach that integrates standard biological, complementary-alternative and psychotherapeutic techniques (not necessarily replaces one to the exclusion of the others)

  • Psychodynamic Psychotherapy

  • Special attention to long-term brain and mind health, preventative neurology, healthy aging and cognitive rejuvenation measures

  • Neurological and psychopharmacological medications, based on a thorough, result-oriented assessment of the risks and benefits of these medications in a given situation.

  • Promising old and novel compounds (e.g., polyunsaturated Omega-3 (“PUFAs”) for the treatment of mood disorders/bipolar depression; N-Acetyl Cysteine for Depressive Symptoms in Bipolar Disorder and obsessive-compulsive disorder; Rhodiola Rosea, benfotiamine and others).

  • Promising, novel non-drug modalities such as Transcranial Magnetic Stimulation (currently done as out-referral after full diagnostic work-up). I am currently testing portable electrical devices such as the Fisher-Wallace device.

  • Preventative Neuropsychiatry through control of biochemical and life-style risk factors

  • The Preter Protocol – a program using the ketogenic diet developed at Johns Hopkins as part of an overall treatment plan for disabling illnesses such as chronic body pain, migraine headache and neurodegenerative diseases (mild cognitive impairment/MCI, Alzheimer’s disease, Parkinson disease).

In addition, our patients also benefit from an ultra-efficient network of world-class, private doctors who can provide other specialty consultations (and many of whom are located within walking distance). Our patients have priority access to any ancillary services such as MRI, MRA, PET imaging, EEG, private blood draws at their residence, neuropsychological testing, polysomnography/sleep study, as might be required by their unique, individual situation.

Posted in Aging, China, dietary, epigenetics, Events, Fifth Avenue Concierge Medicine, Health, keto, News, Psychiatry/Neurology | Tagged , , , , , , , , , , , , , , , , , |

This Friday 10:30am – A Facebook Link Live conversation with Jin Shin Institute President, Alexis Brink.

Exploring the overlap between Eastern philosophy and Western medicine.

Looking forward to this :-).

 

Jin Shin 35721714_1845036455541938_4244295666978783232_o

Posted in Aging, Fifth Avenue Concierge Medicine, Health, keto, News, Psychiatry/Neurology |