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Premature ‘Baby Bun’ is thriving, marks milestone with parents

 

It may be something that every child accomplishes, but it means even more to the parents of Kaleb Graves, also known as Baby Bun.

Arkell and Dana Graves of Virginia posted video of Kaleb sitting up on his own for 1 minute and 48 seconds on Facebook.

>> Read more trending news

Kaleb was an internet sensation even before he was born when his father’s reaction to his mother’s pregnancy news drew millions of video views on Facebook and YouTube.

After health issues with both mom and baby surfaced during the pregnancy, and with only a five percent chance of survival for the baby, Baby Bun was born at 24 weeks of gestation in October of 2015 and spent nearly his first year in the hospital.

His health and development has been improving ever since.

His parents called Baby Bun’s milestone last weekend a “blessing.”

Related: Baby born at 24 weeks celebrates first birthday

“The best is yet to come! We are thankful for his nurses, physical and occupational therapist, they’ve helped him achieve so much,” the proud parents said in a post.

 

21 Low-Impact Workouts That Are More Effective Than You Think

Every once in a while you should give your body a break from pounding the pavement, whether you're running, dancing, or playing sports. But before you take this as a sign to sink even deeper into the sofa, try a low-impact workout. They're easier on your body—your joints will thank you—and they can be a great way to get in a heart-pumping workout without worrying too much about injuries. Effects of low-impact, moderate-intensity exercise training with and without wrist weights on functional capacities and mood states in older adults. Engels HJ, Drouin J, Zhu W. Gerontology, 1998, Sep.;44(4):0304-324X. Impact and overuse injuries in runners. Hreljac A. Medicine and science in sports and exercise, 2004, Sep.;36(5):0195-9131. Physical activity at leisure and risk of osteoarthritis. Lane NE. Annals of the rheumatic diseases, 1996, Dec.;55(9):0003-4967.

Most trainers define low-impact as any exercise where one foot stays on the ground at all times. But rather than doing single-leg dead lifts until keeling over, we rounded up 21 low- (or no!) impact exercises worth trying:

1. Walking

Walking is a stress-free way to get moving. If taking a lesiurely stroll is too easy, there are plenty of ways to add intensity: Hit the hills or add weights (try dumbbells or ankle weights) to really get that heart rate up.  Intensity and energy cost of weighted walking vs. running for men and women. Miller JF, Stamford BA. Journal of applied physiology (Bethesda, Md. : 1985), 1987, Jul.;62(4):8750-7587.

2. Elliptical

Sorry, treadmills. Ellipticals take the cake when it comes to putting less stress on your legs. Try spicing up your routine on the elliptical with a 20-minute interval workout

3. StairMaster

Feel winded every time you go up a set of stairs? It's time to get acquinated with the StairMaster. No gym nearby? No problem. Any old stairs will work—just follow this workout.

4. Strength training

We already have a list of 19 reasons to strength train, and here's one more: Most strength training exercises are low impact, and they still work up a sweat.  Muscle Forces or Gravity: What Predominates Mechanical Loading on Bone? Kohrt, W.M., Barry, D.W., et al. Medicine and Science in Sports and Exercise. 2011 Feb 10. (Keep in mind monster box jumps wearing a weighted vest don't exactly qualify.) 

5. Cycling

We've loved biking ever since we finally took off our training wheels. It just so happens to be a great way to fit in some exercise without putting a strain on your joints. And you don't even need to sign up for an indoor cycling class to see results. Try this 30-minute at-home cycling workout.

6. Rowing

Here's a super-easy way to get in some cardio while also pretending that you're soaking up some sun on a boat. Of course, the florescent lights in the gym eventually snap you back to reality. But at least you'll be working out your arms, back, legs, and core. (Give this 30-minute rowing workout a go.) Score!

7. Kayaking

Want to actually hit the water? Grab a kayak and jump in (or maybe don't jump in, if you want to stay dry)! Kayaking works your arms and core (no crunches necessary), and you can see some stellar sights along the way.

8. Tai Chi

This gentle, fluid movement improves flexibility and may even ward off headaches. A randomized controlled trial of tai chi for tension headaches. Abbott RB, Hui KK, Hays RD. Evidence-based complementary and alternative medicine : eCAM, 2006, Aug.;4(1):1741-427X. (Whether that includes hangover headaches is unclear.)

9. Hiking

Looking to upgrade your walks? Take a hike! To keep things low impact, start with low-grade terrain. Save climbing Everest for later. 

10. Rock climbing

Climbing requires slow, controlled movements, which means your muscles get a serious workout without the added strain.  Functional ankle control of rock climbers. Schweizer A, Bircher HP, Kaelin X. British journal of sports medicine, 2005, Jul.;39(7):1473-0480.

11. Yoga

The ancient practice will have you feeling the burn without feeling the pain. So add some downward dogs and half moons to your fitness routine. Or try aerial yoga to really take your practice to new heights.

12. Pilates

You aren't going to get a strong core by doing crunches all day long. Try Pilates instead—plus, you'll seriously improve your flexibility without putting too much strain on your joints. 

13. TRX

TRX gets its name because it lets users do total-body resistance exercises using a strap suspension system (say that three times fast). The workout is easy on your joints but challenging for the rest of your body. Once you learn the ropes, see if you can master these 45 TRX exercises.

14. Swimming

Skip the inner tubes and start doing laps. Swimming is a great low-impact exercise with a boatload of benefits, from strengthening your shoulders to improving lung function.  Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound. Yung PS, Lai YM, Tung PY. British journal of sports medicine, 2005, Aug.;39(8):1473-0480.

15. Water aerobics

If swimming laps gets repetitive, bring aerobics class to the pool. Some gyms even offer underwater treadmills to really keep things interesting. (We may want to rethink calling them "dreadmills.")

16. Snowshoeing

For a different kind of walk in the park, strap on a pair of snowshoes. Walking on snow—like walking on sand—is more of a workout than walking on pavement. And it's still tame on your body. The energy expenditure of snowshoeing in packed vs. unpacked snow at low-level walking speeds. Connolly DA. Journal of strength and conditioning research, 2003, Mar.;16(4):1064-8011.

17. Step aerobics

For a good cardio workout without all the pounding, science suggests signing up for a step aerobic class.  Osteogenic+index+of+step+exercise+depending+on+choreographic+movements,+session+duration,+and+stepping+rate. Santos-Rocha,+R.A.,+Oliverira,+C.S.,+Veloso,+A.P.+Sports+Sciences+School+of+Rio+Maior,+Portugal.+British+Journal+of+Sports+Medicine,+2006+Oct;40(10):860-6;+discussion+866.+Epub+2006+Aug+18. Researchers found an hour of step aerobics gives you the same workout as a mid-distance run.

18. Ballroom dancing

Take a tip from Dancing With the Stars. Not only is dancing super sexy, it’s often gentle on the body.  The metabolic cost of two ranges of arm position height with and without hand weights during low impact aerobic dance. Carroll MW, Otto RM, Wygand J. Research quarterly for exercise and sport, 1992, Mar.;62(4):0270-1367. So go grab a partner and give those dips, twists, and twirls a try.

19. Rollerblading

Let’s take a trip back to the '90s and strap on some Rollerblades. Gliding on pavement puts less stress on your limbs while still burning calories. Just make sure you remember how to stop. 

20. Cross-country skiing

This flat-terrain travel keeps things heated—even in the cold. So put on your skis and start pumping those poles. You’ll keep the pressure light (as powdery snow) on your body.

21. Golf

Now, now—golf isn’t just for the pros (or the retired). Take a trip to the fairway and get swinging. Bonus points for skipping the golf cart and walking the course!

Originally posted April 2012. Updated March 2017. 

These 8 Kitchen Tools Will Make Sunday Meal Prep a Cinch

Deciding you want to start meal-prepping is easy; finding all the right tools is the tricky part. Just kidding—you have us! Need the best machine to do the chopping for you? Got it. A way to purée a massive stockpot of soup? Sure thing. These seven tools make meal prep a snap, leaving you even more time to cook... or watch Sunday-night TV.

Photo: Bed Bath and Beyond 1. Quirky Cutting Board With Storage Containers This sleek cutting board from Quirky is the ideal chopping block for a meal-prepper. Chop veggies and slide them into one of three drawers located underneath the board, and boom, tidy storage until the next step of your recipe. ($9.99; bedbathandbeyond.com) Photo: Amazon 2. Black and Decker Three-Cup Electric Food Chopper When meal-prepping, sometimes the last thing you have time for is dicing. Toss the veggies for dinner into the Black and Decker chopper to do the hard part while you move onto the next step of your recipe. ($24.99; amazon.com) Photo: Amazon 3. New Star Heavy Duty Three-Slice Egg Slicer Whether you’re slicing hard-boiled eggs to top a lunchtime salad, dicing mushrooms for a dinner side, or cutting a few strawberries to toss in your morning cereal, this New Star heavy duty slicer is the answer. Our favorite part is that you don’t need to dirty a cutting board. ($9.95; amazon.com) Photo: Amazon 4. Cuisinart Two-Speed Hand Blender Soup is a meal-prepper’s dream, but for recipes that require puréeing, the Cuisinart hand blender is a must. No more blending soup in batches in an upright blender; a hand-held version gets the job done right in the pot. PS. Using one also means there's less to wash. ($26.76; amazon.com) Photo: Amazon 5. Silpat Nonstick Silicone Baking Sheet If you’re meal-prepping, odds are there’s a lot of roasted veg in your future. Save money (and the environment) by buying less parchment paper in favor of a Silpat reusable baking sheet. ($23.99; amazon.com) Photo: Amazon 6. Wilton Silicone Muffin Pan Whether you're baking off a tray of classic blueberry or on-trend egg muffins, you're going to need a stellar muffin tin. This silicone version from Wilton is easy to clean and stain-resistant. Want to know our favorite way to use it? For making multiple hard "boiled" eggs in the oven—oh yeah, it's a thing! ($8.00; amazon.com) Photo: Target 7. Instant Pot Pressure Cooker Everyone should buy/try the Instant Pot. This pressure cooker helps you make anything you'd throw in a slow cooker (stew! steel-cut oatmeal! braised meat!) in dramatically less time. Fast + large quantities—that's the meal-prepping dream, folks. ($99.99; target.com) Photo: Amazon 8. Bentgo Stackable Lunch Box So you spent the weekend meal-prepping; now it’s time to eat. Fill these stackable lunch tins (with built-in plastic flatware) from Bentgo and you’ll be the envy of your office. ($14.99; amazon.com)

 

Want To Live Past 100? Centenarians Share Secrets Of Knee Bends And Nips Of Scotch

Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said.

John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets.

“Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.”

Mac Miller, who is 102, has a standard reply.

“People ask me ‘What is the secret?’ The answer is simple. Choose the right grandparents. They were in their 80s. My mother was 89, and my father was 93,” he said.

Genetics and behaviors do play roles in determining why some people live to be 100 or older while others don’t, but they aren’t guarantees. And now, as increasing numbers are reaching triple digits, figuring out the mysteries of longevity has taken on new importance among researchers.

Although those 100 and older make up a tiny segment of America’s population, U.S. Census reports show that centenarian ranks are growing. Between 1980 and 2010, the numbers rose from 32,194 to 53,364, an increase of almost 66 percent. The latest population estimate, released in July 2015, reflects 76,974 centenarians.

“The number of centenarians in the U.S. and other countries has been doubling roughly every eight years,” said James Vaupel, founding director of the Max Planck Institute for Demographic Research in Rostock, Germany.

“When the baby boomers hit, there’s going to be acceleration, and it might be doubling every five or six years,” he said.

Henderson and his wife of 77 years live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors, many of whom have ties to the University of Texas at Austin. Henderson is UT’s oldest-living former football player, arriving in 1932 as a freshman. They’re the only centenarians in the complex and are a rare breed: married centenarians.

Charlotte Henderson said she believes being married may have helped them reach these 100-plus years.

“We had such a good time when John retired. We traveled a lot,” she said. “We just stay busy all the time, and I’m sure that helps.”

Bernard Hirsh, 100, of Dallas agrees. His wife, Bee, is 102. They married in 1978 when both were in their early 60s and each had been widowed, she for the second time.

“I think it’s been such a wonderful marriage, and we’ve contributed to each other’s benefit,” he said.

Little research exists on the effects of marriage on longevity. One 2015 Belgian study of centenarians born between 1893 and 1903 did focus on their living arrangements during ages 60 and 100 and found “in very old age, living with a spouse is beneficial for men but not for women, for whom living alone is more advantageous than living with a spouse.” The study explained that “living with one’s spouse at the oldest ages does not provide the same level of protection as it does at younger ages. This may be explained by the decline of the caregiver’s own health as the needs of his or her spouse increase. Caregiving could also have negative consequences for the health and economic condition of the spouse who is the primary caregiver, especially for older women.”

However, Vaupel, who directs the Institute’s International Research Network on Aging, said being married is a positive for both.

“Especially if you’re quite old, it’s very helpful have a spouse. If you’re very old and don’t have a spouse, the chance of death is higher,” he said.

Siegel, who lives in a senior living community in Boca Raton, Fla., outlived two husbands. She never smoked and occasionally has a glass of dry, red wine.

“I am not a big eater. I don’t eat much meat,” said Siegel, who said she weighs 90 pounds and used to be 5 feet tall but is shrinking.

She stays active by walking inside the building about a half-hour each day, playing bridge twice a week and exercising.

“I feel that’s what really kept my body pretty good. It wasn’t sports. It was exercises,” she said of the routine she does daily twice a day for about 20 minutes.

Miller, of Pensacola, Fla., also outlived two wives.

He was a fighter pilot in the Marine Corps during World War II and spent eight years in active duty, which Miller said “was not so good for me because I sat in the cockpit of a plane for 5,000 hours.”

But, he was active as a youth — running track, playing football and spending hours surfing while living in Honolulu.

Miller is gluten-free because of allergies and doesn’t eat many carbohydrates. He also never smoked. And, he still enjoys a scotch in the evening.

The Hendersons usually have wine or a cocktail before dinner. She never smoked. He quit in 1950.

Hirsh, of Dallas, another non-smoker, attributes his long life to “good luck.”

“I was very active in my business and did a lot of walking during the day. I was not sedentary,” he said.

Now, exercise is limited to “some knee bends every morning to keep my legs stronger.”

“My father died of a heart attack in his early 50s, and my mother died in her early 60s of a stroke, so I don’t think my genes were very good,” Hirsh said.

Geriatrician Thomas Perls, director of the New England Centenarian Study at Boston Medical Center, said research shows that behaviors have a greater influence on survival up until the late 80s, since he said most people have the right genes to get there as long as their behaviors aren’t harmful. But once people reach the 90s and beyond, genetics play a more significant role.

“To get to these very oldest ages, you really have to have the right genes in your corner,” he said.

As an international leader in the field, Perls’ focus is on finding the right mix of behavior, environment and genetics to produce long lives. His work includes a National Institute on Aging study called the Long Life Family Study.

“There are always questions about environment versus genes,” said endocrinologist Nir Barzilai, founding director of the Institute for Aging Research at the Albert Einstein College of Medicine in Bronx, N.Y. “We are with our genes in this environment. It’s really 50-50, no matter how you look at it.”

Barzilai’s studies include centenarians and their children, as well as efforts to slow the process of aging.

Among those who reach the 100-year-old milestone, Perls’ said his research and that of Barzilai and others has found certain commonalities: few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.” Studies show that whatever their stress level, they manage its well. And they’re related to other centenarians or have a parent or grandparent who lived past 80.

These lessons of long life are playing well with the public, who have made changes for the better in the 21st century, Vaupel said.

“We don’t smoke or drink so much, and we’re better at exercise. People are taking better care of themselves. People are better educated, and the more educated know when to go to the doctor and follow the doctor’s advice,” he said, adding that people now tend to have higher income and can spend more on health care and improved diet.

“The most important thing is we’re living longer and living longer healthy,” Vaupel said.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life

Gerald Chinchar isn’t quite at the end of life, but the end is not far away. The 77-year-old fell twice last year, shattering his hip and femur, and now gets around his San Diego home in a wheelchair. His medications fill a dresser drawer, and congestive heart failure puts him at high risk of emergency room visits and long hospital stays.

Chinchar, a Navy veteran who loves TV Westerns, said that’s the last thing he wants. He still likes to go watch his grandchildren’s sporting events and play blackjack at the casino. “If they told me I had six months to live or go to the hospital and last two years, I’d say leave me home,” Chinchar said. “That ain’t no trade for me.”

Most aging people would choose to stay home in their last years of life. But for many, it doesn’t work out: They go in and out of hospitals, getting treated for flare-ups of various chronic illnesses. It’s a massive problem that costs the health care system billions of dollars and has galvanized health providers, hospital administrators and policymakers to search for solutions.

Sharp HealthCare, the San Diego health system where Chinchar receives care, has devised a way to fulfill his wishes and reduce costs at the same time. It’s a pre-hospice program called Transitions, designed to give elderly patients the care they want at home and keep them out of the hospital.

Social workers and nurses from Sharp regularly visit patients in their homes to explain what they can expect in their final years, help them make end-of-life plans and teach them how to better manage their diseases. Physicians track their health and scrap unnecessary medications. Unlike hospice care, patients don’t need to have a prognosis of six months or less, and they can continue getting curative treatment for their illnesses, not just for symptoms.

Before the Transitions program started, the only option for many patients in a health crisis was to call 911 and be rushed to the emergency room. Now, they have round-the-clock access to nurses, one phone call away.

“Transitions is for just that point where people are starting to realize they can see the end of the road,” said San Diego physician Dan Hoefer, one of the creators of the program. “We are trying to help them through that process so it’s not filled with chaos.”

The importance of programs like Transitions is likely to grow in coming years as 10,000 baby boomers — many with multiple chronic diseases — turn 65 every day. Transitions was among the first of its kind, but several such programs, formally known as home-based palliative care, have since opened around the country. They are part of a broader push to improve people’s health and reduce spending through better coordination of care and more treatment outside hospital walls.

But a huge barrier stands in the way of pre-hospice programs: There is no clear way to pay for them. Health providers typically get paid for office visits and procedures, and hospitals still get reimbursed for patients in their beds. The services provided by home-based palliative care don’t fit that model.

In recent years, however, pressure has mounted to continue moving away from traditional payment systems. The Affordable Care Act has established new rules and pilot programs that reward the quality rather than the quantity of care. The health reform law, for example, set up “accountable care organizations” networks of doctors and hospitals that share responsibility for providing care to patients. They also share the savings when they rein in unnecessary spending by keeping people healthier. Those changes are helping to make home-based palliative care a more viable option.

In San Diego, Sharp’s palliative care program has a strong incentive to reduce the cost of caring for its patients, who are all in Medicare managed care. The nonprofit health organization receives a fixed amount of money per member each month, so it can pocket what it doesn’t spend on hospital stays and other costly medical interventions.

[caption id="attachment_229486" align="aligncenter" width="770"] Gerald Chinchar’s medicine is packed in a kitchen drawer for a Sharp HealthCare Transitions program nurse to check. (Heidi de Marco/KHN)[/caption]

‘Something That Works’

Palliative care focuses on relieving patients’ stress, pain and other symptoms as their health declines, and it helps them maintain their quality of life. It’s for people with serious illnesses, such as cancer, dementia and heart failure. The idea is for patients to get palliative care and then move into hospice care, but they don’t always make that transition.

The 2014 report “Dying in America,” by the Institute of Medicine, recommended that all people with serious advanced illness have access to palliative care. Many hospitals now have palliative care programs, delivered by teams of social workers, chaplains, doctors and nurses, for patients who aren’t yet ready for hospice. But until recently, few such efforts had opened beyond the confines of hospitals.

Kaiser Permanente set out to address this gap. Nearly 20 years ago, it created a home-based palliative care program, testing it in California and later in Hawaii and Colorado. Two studies by Kaiser and others found that participants were far more likely to be satisfied with their care and more likely to die at home than those not in the program. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

One of the studies, published in 2007, found that 36 percent of people receiving palliative care at home were hospitalized in their final months, compared with 59 percent of those getting standard care. The overall cost of care for those who participated in the program was a third less than for those who didn’t.

“We thought, ‘Wow. We have something that works,’” said Susan Enguidanos, an associate professor at the University of Southern California’s Leonard Davis School of Gerontology, who worked on both studies. “Immediately we wanted to go and change the world.”

But Enguidanos knew that Kaiser Permanente was unlike most health organizations. It was responsible for both insuring and treating its patients, so it had a clear financial motivation to improve care and control costs. Enguidanos said she talked to medical providers around the nation about this type of palliative care, but the concept didn’t take off at the time. Providers kept asking the same question: How do you pay for it without charging patients or insurers?

“I liken it to paddling out too soon for the wave,” she said. “We were out there too soon. … But we didn’t have the right environment, the right incentive.”

A Bold Idea

Dan Hoefer’s medical office is in the city of El Cajon, which sits in a valley in eastern San Diego County. Hoefer, a former hospice and home health medical director and nursing home doctor, has spent years treating elderly patients. He learned an important lesson when seeing patients in his office: Despite the medical care they received, “they were far more likely to be admitted to the hospital than make it back to see me.”

When his patients were hospitalized, many would decline quickly. Even if their immediate symptoms were treated successfully, they would sometimes leave the hospital less able to take care of themselves. They would get infections or suffer from delirium. Some would fall.

His patients were like cars with 300,000 miles on them, he said. They had a lot of broken parts. “You can’t just fix one thing and think you have solved the problem,” he said.

And trying to do so can be very costly. About a quarter of all Medicare spending for beneficiaries 65 or older is to treat people in their last year of life, according to a report by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

Hoefer’s colleague, Suzi Johnson, a nurse and administrator in Sharp’s hospice program, saw the opposite side of the equation. Patients admitted into hospice care would make surprising turnarounds once they started getting medical and social support at home and stopped going to the hospital. Some lived longer than doctors had expected.

In 2005, the pair hatched and honed a bold idea: What if they could design a home-based program for patients before they were eligible for hospice?

Thus, Transitions was born. They modeled their new program in part on the Kaiser experiment, then set out to persuade doctors, medical directors and financial officers to try it. But they met resistance from physicians and hospital administrators who were used to getting paid for seeing patients.

“We were doing something that was really revolutionary, that really went against the culture of health care at the time,” Johnson said. “We were inspired by the broken system and the opportunity we saw to fix something.”

[caption id="attachment_229478" align="aligncenter" width="770"] Doctors, nurses and social workers gather in a small conference room for their bimonthly meeting to discuss patient cases for the Sharp HealthCare Transitions program in January. (Heidi de Marco/KHN)[/caption]

Despite the concerns, Sharp’s foundation board gave the pair a $180,000 grant to test out Transitions. And in 2007, they started with heart failure patients and later expanded the program to those with advanced cancer, dementia, chronic obstructive pulmonary disease and other progressive illnesses. They started to win over some doctors who appreciated having additional eyes on their patients, but they still encountered “some skepticism about whether it was really going to do any good for our patients,” said Jeremy Hogan, a neurologist with Sharp. “It wasn’t really clear to the group … what the purpose of providing a service like this was.”

Nevertheless, Hogan referred some of his dementia patients to the program and quickly realized that the extra support for them and their families meant fewer panicked calls and emergency room trips.

Hoefer said doctors started realizing home-based care made sense for these patients — many of whom were too frail to get to a doctor’s office regularly. “At this point in the patient’s life, we should be bringing health care to the patient, not the other way around,” he said.

Across the country, more doctors, hospitals and insurers are starting to see the value of home-based palliative care and are figuring out how to pay for it, said Kathleen Kerr, a health care consultant who researches palliative care.

“It is picking up steam,” she said. “You know you are going to take better care of this population, and you are absolutely going to have lower health care costs.”

Providers are motivated in part by a growing body of research. A study published in January showed that in the last three months of life, medical care for patients in a home-based palliative care program cost $12,000 less than for patients who were getting more typical treatment. Patients in the program also were more likely to go into hospice and to die at home, according to the study.

Two studies of Transitions in 2013 and 2016 reaffirmed that such programs save money. The second study, led by outside evaluators, showed it saved more than $4,200 per month on cancer patients and nearly $3,500 on those with heart failure.

The biggest differences occurred in the final two months of life, said one of the researchers, Brian Cassel, who is palliative care research director at the Virginia Commonwealth University School of Medicine in Richmond.

One reason for the success of these programs is that the teams really get to know patients, their hopes and aspirations, said Christine Ritchie, a professor at UC San Francisco’s medical school. “There is nothing like being in someone’s home, on their turf, to really understand what their life is like,” she said.

[gallery ids="713627,713628,713629"]

A Home Visit

Nurse Sheri Juan and social worker Mike Velasco, who both work for Sharp, walked up a wooden ramp to the Chinchars’ front door one recent January morning. Juan rolled a small suitcase behind her containing a blood pressure cuff, a stethoscope, books, a laptop computer and a printer.

Mary Jo Chinchar was already familiar with Transitions because her mother had been in the program before entering hospice and dying in 2015 at the age of 101. Late last year, Gerald Chinchar’s doctor recommended he enroll in it, explaining that his health was in a “tenuous position.”

Chinchar, who has nine grandchildren and four great-grandchildren, likes to tell stories about his time in the Navy, about traveling the country for jobs and living in San Francisco as a young man.

He has had breathing problems much of his life, suffering from asthma and chronic obstructive pulmonary disease — ailments he partly attributes to the four decades he spent painting and sandblasting fuel tanks for work. Chinchar also has diabetes, a disease that led to his mother’s death. He recently learned he had heart failure.

“I never knew I had any heart trouble,” he said. “That was the only good thing I had going for me.”

Now he’s trying to figure out how to keep it from getting worse: How much should he drink? What is he supposed to eat?

That’s where Juan comes in. Her job is to make sure the Chinchars understand Gerald’s disease so he doesn’t have a flare-up that could send him to the emergency room. She sat beside the couple in their living room, its bookshelves filled with titles on gardening and baseball. A basket of cough drops and a globe sat on a side table.

Any pain today? Juan asked. How is your breathing? Are you more fatigued than before? Is your weight the same? He replied that he had gained a few pounds recently but knew that was because he’d eaten too much bacon.

Posted on the couple’s refrigerator was a notice advising them to call the nurse if Gerald had problems breathing, increased swelling or new chest pain.

Juan checked his blood pressure and examined his feet and legs for signs of more swelling. She looked through his medications and told him which ones the doctor wanted him to stop taking. “What we like to do as a palliative care program is streamline your medication list,” she said. “They may be doing more harm than good.”

Mary Jo Chinchar said she appreciates the visits, especially the advice about what Gerald should eat and drink. Her husband doesn’t always listen to her, she said. “It’s better to come from somebody else.”

A Nearly Impossible Decision

On a rainy January day, doctors, nurses and social workers gathered in a small conference room for their bimonthly meeting to discuss patient cases. Information about the patients — their hospitalizations, medications, diagnoses — was projected on the wall. Their task: to decide if new patients were appropriate for Transitions and if current patients should remain there.

It’s nearly impossible to predict how long someone will live. It’s an inexact algorithm based on the severity of their disease, depression, appetite, social support and other factors. Nevertheless, the team tries to do just that, and they may recommend hospice for patients expected to live less than six months.

That was the case with an 87-year-old woman suffering from Alzheimer’s disease. She had fallen many times, slept about 16 hours a day and no longer had much of an appetite. Those were all signs that the woman may be close to death, so she was referred to hospice.

Patients typically stay in Transitions about seven or eight months, but some last as long as two years before they stabilize and are discharged from the program. Others go directly to hospice, and still others die while they are still in Transitions.

The group turned its attention to an 89-year-old woman with dementia, who believed she was still a young Navy wife. She suffered from depression and kidney disease, and had been hospitalized twice last year.

“She’s a perfect patient for Transitions,” Hoefer told the team, adding that she could benefit from extra help. Another good candidate, Hoefer said later, was El Cajon resident Evelyn Matzen, who is 94 and has dementia. She had started to lose weight and was having more difficulty caring for herself. They took her in because “we were worried that it was going to start what I call the revolving door of hospitalization,” Hoefer said.

[caption id="attachment_229481" align="aligncenter" width="770"] Evelyn Matzen, 94, has been a Sharp HealthCare Transitions patient for eight months. (Heidi de Marco/KHN)[/caption]

About eight months after she joined the program, Matzen sat in Hoefer’s office as he checked her labs and listened to her chest. Her body was starting to slow down, but she was still doing well, he told her. “Whatever you are doing is working.”

Bill Matzen, who accompanied his mom to the appointment, said she had started to stabilize since going onto Transitions. “She is on less medication, she is in better condition, physically, mentally, the whole nine yards,” he said.

Hoefer explained that frail elderly patients have fewer reserves to tolerate medical treatment and especially hospitalization. Bill Matzen said his mother leaned that the hard way after a recent fall. Though the Transitions nurse had come to see her, the Matzens decided to go to the hospital because they were still concerned about a bruise on her head. While she was in the hospital, Evelyn Matzen started hallucinating and grew agitated.

Being in the hospital “kicks her back a notch or two,” her son said. “It takes her longer to recover than if she had been in a home environment.”

A Changed Climate

Outpatient palliative care programs are cropping up in various forms. Some new ones are run by insurers, others by health systems or hospice organizations. Others are for-profit, including Aspire Health, which was started by former senator Bill Frist in 2013.

Sutter Health operates a project called Advanced Illness Management to help patients manage symptoms and medications and plan for the future. The University of Southern California and Blue Shield of California recently received a $5 million grant to provide and study outpatient care.

“The climate has changed for palliative care,” said Enguidanos, the lead investigator on the USC-Blue Shield project.

Ritchie said she expects even more home-based programs in the years to come, especially if palliative care providers work alongside primary care doctors. “My expectation is that much of what is being done in the hospital won’t need to be done in the hospital anymore and it can be done in people’s homes,” she said.

Challenges remain, however. In addition to questions about reimbursement, not enough trained providers are available. And some doctors are unfamiliar with the approach, and patients may be reluctant, especially those who haven’t clearly been told they have a terminal diagnosis.

Now, some palliative care providers and researchers worry about the impact of President Donald Trump’s plans to repeal the Affordable Care Act and revamp Medicare.

“It would be horrible,” Kerr said. “Before, we had an inkling that this was helping a lot of folks. Now we know it is really helping.”

Gerald Chinchar, who grew up in Connecticut, said he never expected to live into old age. His father, a heavy drinker, died of cirrhosis of the liver at 47. In his family, Chinchar said, “you’re an old-timer if you make 60.”

Chinchar said he gave up drinking and is trying to eat less of his favorite foods — steak sandwiches and fish and chips. He just turned 77, a milestone he credits partly to the pre-hospice program.

“If I make 80, I figured I did pretty good,” he said. “And if I make 80, I’ll shoot for 85.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

WATCH: Jokesters make case for 12-foot Paul Walker statue at council meeting

If you’re ever trying to get a city council to listen to your proposition, opening your argument with, “What up, council?” is probably not the best way to begin. But that’s exactly what a jokester in San Clemente, California, did, and we can’t stop laughing at this guy and his fellow "surfer bro" friend.

In a now-viral video from a recent San Clemente City Council meeting, the young man identified himself as "freelance journalist" Chad Kroeger, which just happens to be the same name as the lead singer in the band Nickelback. Then he passionately made his case to have a statue of the late Paul Walker erected in the town.

>> Watch the video here

Kroeger claimed that his love for the late actor came when he was 11 and “my first love Ashley betrayed me by moving to Newport Beach.” In hopes of cheering him up, his father took him to see “The Fast and the Furious,” and he’s never looked back.

The prankster was followed by his cohort, identified as Bodhi Johnson, who added that the film "was epically life-changing."

>> Read more trending news

"It gave me the courage to ask out Shelby; it taught me to never back down, even if a super-tough crew of street racers come at you – stand tall," he said.

KCBS reported that the pair, who previously spoke at a Burbank City Council meeting, are featured in several comedic videos on YouTube.

– The Cox Media Group National Content Desk contributed to this report.

11 Nice Ways to Say 'No' to Food Pushers

During family gatherings, food temptations are everywhere. From stuffing and pumpkin pie on Thanksgiving to eggnog and sugar cookies in December, to barbecues in the summer, the seasonal temptations are endless. It can be tough enough to navigate the buffet without having your great aunt force an extra helping of potatoes on your plate or resisting Grandma Dolly's pleas that you take a second piece of her famous apple pie. There's always some kind of event going on: birthday parties, family get-togethers, company meetings, bridal and baby showers--and all of these events have one thing in common (besides all the tempting food): food pushers.   Food pushers range from well-intentioned loved ones to total diet saboteurs. Regardless of their motivation, it's important to stick to your guns. You can always be honest and say that you're simply trying to eat healthier, but if that response gets ignored (or doesn't come easily), the following retorts to their food-forcing ways will keep you in control of what goes on your plate and in your mouth!   The Push: "It's my specialty, you have to try it!" Your Response: "I will in a bit!" Why It Works: Stalling is a great tactic with food pushers. Odds are the offender won't follow you around making sure you actually try the dish. If they catch up with you by the end of the party to ask what you thought, tell them that it slipped your mind but you'll be sure to try it next time.   The Push: "This [insert name of high-calorie dish] is my favorite. You'll love it!" Your Response: "I had some already—so delicious!" Why It Works: A white lie in this situation isn't going to hurt anybody. You'll get out of eating food you don't want or need, and the food pusher will have gotten a compliment on what probably is a delicious dish.   The Push: "It's just once a year!" Your Response: "But I'll probably live to celebrate more holidays if I stick with my diet plan!" Why It Works: People can sometimes see healthy eating as vain—a means to the end result of losing weight and looking better. It's harder for a food pusher to argue with you if you bring attention to the fact that you eat right and exercise for better health and a longer life. Looking good just happens to be a side effect!   The Push: "Looks like someone is obsessed with dieting…" Your Response: "I wouldn't say obsessed, but I am conscious of what I eat." Why It Works: Words like "food snob" or "obsessed" are pretty harsh when they're thrown around by food pushers. But don't let passive-aggressive comments like this bring you down—or make you veer away from your good eating intentions. Acknowledging your willpower and healthy food choices might influence others to be more conscious of what they eat. Sometimes you just have to combat food pushers with a little straightforward kindness.   The Push: "If you don't try my dish, I'm just going to have to force you to eat it!" Your Response: "Sorry, but I don't like (or can't eat) [insert ingredient here]." Why It Works: It's hard to argue with someone's personal food preferences. If someone doesn't like an ingredient whether its sweet potatoes, pumpkin, or butter, odds are that he or she hasn't liked it for a very long time. If you'd like to get creative with this one, go into detail about how you got sick on the ingredient as a kid or how your mom says you always threw it across the room as a baby. Who can argue with that?   The Push: "You need some meat on your bones." Your Response: "Trust me, I'm in no danger of wasting away!" Why It Works: This food push is definitely on the passive-aggressive side. Using humor to fight back will defuse any tension while making it clear where you stand.   The Push: "One bite isn't going to kill you." Your Response: "I know, but once you pop you can't stop! And I'm sure it's so delicious I wouldn't be able to stop!" Why It Works: This is another situation where humor will serve to distract the food pusher from his or her mission. It's a way to say "thanks, but no thanks" while making it clear that you're not interested in overindulging.   The Push: "But it's your favorite!" Your Response: "I think I've overdosed on it; I just can't eat it anymore!" Why It Works: If you have a favorite holiday dish that everyone knows you love, it can be especially tough to escape this push. If a loved one made the dish specifically for you, the guilt can be enough to push you over the edge. But people understand that food preferences change, and most have been in that situation of enjoying a dish so much that they can't touch it for awhile.   The Push: [Someone puts an extra helping on your plate without you asking.] Your Response: Push it around with your fork like you did as a kid to make it look like you tried it. Why It Works: While putting food on someone else's plate can be viewed as passive-aggressive, it was probably done with love. (Let's hope!) Making it look like you ate a bite or two can be an easy way out of the situation, but you can also just leave it alone and claim that you've already had your fill. (After all, you didn't add that extra helping!)   The Push: "Have another drink!" Your Response: "I have to drive." Why It Works: No one will argue with the fact that you want to drive home sober. If they do, you should have no qualms walking away from the conversation, period. If they offer a place for you to stay, you can always get out of the situation by blaming an early morning commitment or the fact that you need to get home to let the dog out. Kids will also get you out of everything.   The Push: "We have so many leftovers. Take some!" Your Response: "That's OK! Just think, you'll have your meals for tomorrow taken care of." Why It Works: Not every party guest wants to deal with the hassle of taking food with them, and this makes it clear that you'd rather the food stay. If the host is insistent, you can feign worry that they'll go bad in the car because you're not going straight home, or it'll go bad in your fridge because you've already been given so many leftovers at other parties recently. Or be polite and take them. You'll have more control of your food intake away from the party anyway. So whether you don't eat the leftovers at all or whether you split a piece of pie with your spouse, you're in control in this situation.   These tactics can work wonders in social situations, but honesty is sometimes the best policy. A simple "No, thank you" is hard for a food pusher to beat, especially if it's repeated emphatically. Remember, too, that it's okay to have treats in moderation, so don't deprive yourself of your favorite holiday foods. Just make sure that you're the one in control of your splurges—not a friend, family member or co-worker who doesn't know your fitness and health goals!     Do you have a favorite way to say, "No, thank you," to food pushers? Share your strategies in the comments section to the right. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1685

Foods That Keep You Healthy from Head to Toe

There are many motivations for sticking with a healthy diet. Eating more of the good stuff (and less of the junky stuff) can help you prevent cancer, extend your lifespan, protect your heart and manage your weight. But one thing we don't always remember is that your diet affects not just your weight, but your body from the top down, the inside to the outside. Your body transforms the foods you eat into the cells that make up your hair, nails, skin and bones, along with your brain, heart, blood and joints. You literally are what you eat.   Here are some of the key nutrients that keep your body in tiptop shape from head to toe.   Hair At its staggering growth rate of 0.4 millimeters per day, it takes more than 2 years to grow 12 inches of hair. Add lean meats and beans to your diet to make the most of every millimeter. These foods will also give you zinc to help keep your body in hormone balance and prevent hair loss. B-vitamins from leafy greens, peas, tomatoes and carrots also support cell growth for healthy hair.   Brain Boost your brainpower by noshing on foods with high ORAC (Oxygen Radical Absorption Capacity) scores—a sign that the food is rich in disease-fighting antioxidants. Plums, cherries, avocadoes, berries, navel oranges and red grapes top the ORAC charts. (Glance through the alphabetical list for more disease-fighting ratings at oracvalues.com.)   Considering your brain is about 80% water, drink at least 64 ounces of water per day. Essential fatty acids (named "essential" because your body cannot make them) help you grow brain cells and stay sharp, so feed your brain with regular doses of fish, nuts, seeds, avocado, and olive oil.     Eyes Good nutrition can keep your peepers peppy throughout the years. The antioxidants for brain health also help the eyes, but really keep your eye on including foods with lutein and zeazanthin (pronounced zay-a-za-thin). These carotenoids, found in spinach, collard greens and kale, protect the retina from macular degeneration.   Teeth & Bones Everyone knows you need calcium for bone health, but are you getting enough? Most adults need between 1,000 and 1,200 milligrams of calcium daily. Low-fat milk, cheese, yogurt, almonds, spinach and soybeans are all good sources of dietary calcium. And calcium doesn't act alone! Its partner-in-crime is vitamin D, which is necessary for proper calcium absorption. Some fish and eggs provide this key vitamin, but there are not many natural food sources of this bone builder. Instead, vitamin-D is often added to milk, margarine and some breads and cereals.   Joints Put a wiggle in your walk with gelatin and vitamin C. These nutrients are key precursors to collagen, the material that cushions our joints and keeps our tendons and connective tissue strong. Gelatin can be found in powdered supplement form or in your basic Jell-O mix. Boost your vitamin C intake with fruits and veggies, especially strawberries, oranges, pineapple, cauliflower and green peppers.   Heart Soy and flaxseed both pack double punches when it comes to heart protection. Soymilk, edamame, tofu and other soy products are packed with cholesterol-lowering phytochemicals and heart healthy soluble fiber. Flaxseed is also another source of soluble fiber that comes with a side of omega-3 fatty acids, which may help reduce your risk of heart disease. Sprinkle some ground flaxseed in your oatmeal or yogurt, or even add it to your favorite baking recipe.   Intestines Protect your gut with probiotics. These powerful little bacteria support the natural environment in your intestine and combat disease-causing microorganisms. You can find yogurt, kefir and milk supplemented with probiotics. They are often under the name L. Acidophilus.   Fiber is also essential to a healthy gut. Whole grains, especially oats and bran, beans, nuts, fruits and vegetables can help you reach your goal. Getting your daily 20-35 grams of fiber keeps your gut and colon health moving in the right direction.   Skin We'll wrap it all up, literally, with nutrition for the skin. It is important to nourish your body's largest organ. Maintain disease-free and healthy looking skin with alpha-lipoic acid (ALA). This antioxidant is more powerful than vitamins C and E, and protects your skin cells from damage and many of the elements it's exposed to each day. Get your fair share of ALA with spinach, broccoli and beef. Vitamins C, E, K, and A, as well as B-vitamins are also important for radiant, nourished skin. Enjoying a variety of colorful fruits and vegetables can help you reach the recommended amount of these vitamins.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1669

10 Tips to Keep from Overeating at a Party

Temptations abound at parties, but celebration doesn't have to mean overindulgence. Follow these tips to stay on track. Say no the first time to passed hors d'oeuvres. Chances are good that food will come around again. See what's being served before you decide what to eat. Limit your alcohol. Inhibitions are lowered with every drink, and those cocktails aren't calorie free. Alternate alcohol with water or another calorie free drink. And don't combine alcohol with caffeine. Caffeine speeds up the rate at which alcohol is metabolized, and it masks the effect of the alcohol. Eat before you go. Don't go to a party starving. Eat a hard-boiled egg and an apple, a banana with some peanut butter or a slice of turkey. The protein will fill you up for few calories. You'll be less likely to binge if you're not overly hungry. Treat appetizers as a meal. If you're going to eat 400 calories worth of appetizers, know that that's your dinner. Don't expect to go home and eat a "real" meal. Survey the spread before you fill your plate. Confronted by so many rich foods, you might want to start piling up the food, but stop and take a deep breath. Think before you serve yourself (and try to serve yourself, so you control the serving size). Keep track of what you're eating. Don't mindlessly eat, and try not to eat and make conversation at the same time. If your eating and drinking is spread out, you might not realize how many calories you're eating. Just because you're not eating an entire meal doesn't mean that those are free calories. Buddy up. If you're worried about eating too many sweets, share your dessert with someone else. You'll eat less and not do as much damage. Use a smaller plate, or commit to just one round of food. Don't pile your food so high that's it's falling off the plate. Be choosy, and stick to proper serving sizes. Take only those foods you really like, and don't overload on them. Bring a dish, if appropriate. If you bring something healthy, like salsa with vegetables, whole-grain crackers and light dip or a large salad, you know there's at least one option for you at the party. Take small helpings of other dishes and load up on your healthier one.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1355

The Truth about Alcohol and Heart Health

The idea that alcohol may be good for your heart has been around for a while. While moderate drinking may offer health benefits, drinking more can cause a host of health problems. So should you turn to alcohol to protect your heart? Here's what you need to know, from what alcohol can really do, to how much you should drink, to which types of drinks—if any—are healthier than others. Use this information in conjunction with your healthcare provider's advice. Research on Alcohol and Heart Disease In several studies of diverse populations, moderate alcohol consumption has been associated with a reduced risk for certain cardiovascular diseases, such as coronary heart disease. These studies were observational—not experimental—and therefore had some limitations. However, they showed the need for experimental studies regarding alcohol intake and heart disease. So in 1999, a meta-analysis was conducted on all experimental studies to date to assess the effects of moderate alcohol intake on various health measures (such as HDL "good" cholesterol levels and triglycerides), and other biological markers associated with risk of coronary heart disease. As research on this topic continued to expand, researchers conducted another systematic review of 63 studies that examined adults without known cardiovascular disease before and after alcohol use. This latest meta-analysis was published in a 2011 issue of the British Medical Journal (get a link to the full report in the Sources section below). The analysis of these numerous studies suggests that moderate alcohol consumption (defined below) helps to protect against heart disease by:

  • Raising HDL "good" cholesterol
  • Increasing apolipoprotein A1, a protein that has a specific role in lipid (fat) metabolism and is a major component of HDL "good" cholesterol
  • Decreasing fibrinogen, a soluble plasma glycoprotein that is a part of blood clot formation
  • Lowering blood pressure
  • Reducing plaque accumulation in the arteries
  • Decreasing the clumping of platelets and the formation of blood clots
However, these studies did not show any relationship between moderate alcohol intake and total cholesterol level or LDL "bad" cholesterol. And while some studies associated alcohol intake to increased triglycerides, the most recent analysis of moderate alcohol intake in healthy adults showed no such relationship. What's the Definition of "Moderate" Alcohol Consumption? A moderate alcohol intake is defined as up to 1 drink per day for women and up to 2 drinks per day for men. One drink contains 0.6 fluid ounces of alcohol and is defined as:
  • 12 fl. oz. of regular beer (5% alcohol)
  • 4-5 fl. oz. of wine (12% alcohol)
  • 1.5 fl. oz. of 80-proof distilled spirits (40% alcohol)
  • 1 fl. oz. of 100-proof distilled spirits (50% alcohol)
Are Certain Types of Alcohol Better Than Others? While a few research studies suggest that wine maybe more beneficial than beer or sprits in the prevention of heart disease, most studies do not support an association between type of alcoholic beverage and the prevention of heart disease. At present time, drinking wine for its antioxidant content to prevent heart disease is an unproven strategy. It still remains unclear whether red wine offers any heart-protecting advantage over white wine or other types of alcoholic beverages. Health Risks of Drinking Too Much While moderate drinking may have some health benefits, heavy or binge drinking can have a toxic effect on your health and your heart. Heavy drinking is the consumption of more than 3 drinks on any day or more than 7 drinks per week for women and more than 4 drinks on any day or more than 14 drinks per week for men. Heavy drinking in particular can damage the heart and lead to high blood pressure, alcoholic cardiomyopathy (enlarged and weakened heart), congestive heart failure, and stroke. Heavy drinking puts more fat into the circulation in your body, raising your triglyceride level. It's also associated with an increased risk of cirrhosis of the liver, cancer of the gastrointestinal tract and colon, breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes. Binge drinking is the consumption within 2 hours of 4 or more drinks for women and 5 or more drinks for men. Binge drinking is also associated with a wide range of other health and social problems, such as sexually transmitted disease, unintended pregnancy, and violent crimes. Who Should NOT Drink According to the 2010 Dietary Guidelines for Americans, the following people should not drink alcohol:
  • Adults who cannot restrict their alcohol drinking to moderate levels, as listed above
  • Anyone who is younger than the legal drinking age
  • Women who are pregnant or may become pregnant
  • Anyone taking a medication (prescription or over-the counter) that can interact with alcohol. Talk to your doctor or pharmacist about the medications you take and alcohol consumption
  • Individuals with certain medical conditions such as liver disease, hypertriglyderidemia, and pancreatitis. Talk to your doctor regarding your health history and alcohol consumption
  • Individuals who plan to drive, operate machinery or take part in other activities that require attention, skill, or coordination or in situations where impaired judgment could cause injury or death, such as swimming
Conclusion Research indicates that a moderate alcohol intake has been associated with a decreased risk for certain cardiovascular diseases, particularly coronary heart disease. However, health professionals and dietary guidelines suggest that if you don't drink, don't start. There are other, healthier ways to reduce your risk of heart disease like not smoking, eating right, getting regular exercise and maintaining a healthy weight. To find out if a moderate alcohol intake is appropriate for you, talk to your doctor about your consumption of alcohol, medical history, and any medications you use. Sources American Heart Association. "Alcohol, Wine and Cardiovascular Disease," accessed March 2011. www.americanheart.org. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA, "Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies," British Medical Journal 2011; 342:d636. doi: 10.1136/bmj.d636. Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ, "Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effect on lipids and haemostatic factor," British Medical Journal 1999; 319:1523-8. United States Department of Agriculture Center for Nutrition and Policy Information. "2010 Dietary Guidelines for Americans," accessed March 2011. www.cnpp.usda.gov.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1622

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