Recipe Wednesday is from Soren Lascelles, Young chef of the year 2010, and one of the fabulous chefs cooking at Food for Thought Sydney 13 October at Dolton House. Soren is head chef at Assiette.

This dish helped him win the award.
Seared scallops with asparagus and lemon
Serves 4
Ingredients
12 scallops
20 spears of asparagus
1 lemon
100g butter
Spring onion
Parsley

Method
1. In a hot pan caramelise the scallops
2. Add the butter and cook it until it goes nut brown
3. Stop the cooking with lemon
4. Add parsley and arrange on the plate with steamed asparagus

For more information about Food for Thought Sydney event.

Introduction from Dr Bruce Bolam Divisional Director, Prevention and Awareness National Stroke Foundation.

Research shows that as more and more of us work in office-type environments, Australians are moving less at work. This is bad news for vascular disease generally and stroke in particular.

The National Heart Foundation has provided an important summary of the evidence on the impact of sedentary behaviour at work and because of the close relationship between physical inactivity and increased risk of disease, the findings of this report apply equally to stroke, heart disease and diabetes.

Article from the National Heart Foundation

Friday 18 March 2011

Two researchers presenting to an international conference in Melbourne this week explain how sedentary behaviour is a major cause of heart disease.

Research confirms that too much sitting increases your risk of developing heart disease by almost 50%, even though you may be meeting your daily minimum physical activity requirements.

Professor Marc Hamilton from Pennington Biomedical Research Center, Louisiana has made a career out of understanding what happens to the inside of the body when we are inactive.

He presents his research this week at the National Heart Foundation of Australia’s Conference 2011 Heart to Heart - From Access to Action, which runs from Thursday 17 March to Saturday 19 March at the Melbourne Convention and Exhibition Centre.

“Some people sit for up to 16 hours a day – as much as 70-85 hours a week! Over the last 10 years, we’ve studied the impact that too much sitting has on the body in terms of developing heart disease, type 2 diabetes and a string of other ailments. And the results are as compelling as they are alarming,” said Professor Hamilton.

“Regularly exercising is not the opposite of being inactive or sitting too much,” he said.

“Going for a run each day, although good for you and important to do, will not counter the effects of hours and hours of chair time.

“We now have the evidence to prove that diet and exercise are just part of what’s required to be truly healthy.

“We have just published the first of a series of studies testing the effects of sitting on people who exercise a fair bit and were not obese, yet even if we reduced their calorie intake to match their sedentary lifestyles, they showed sign of pre-diabetes after just one day of sitting. In contrast they tested healthy on another day when they were just pottering around or standing for 75% of the day.
“Our goal should be to eliminate as many of those sedentary hours as possible to prevent chronic disease.”

According to Professor Hamilton, the first thing the Australian Government can do is to help increase awareness of this issue.

“The problem is people feel safety in numbers. You look around and think that because everyone else is sitting all day at work and because your Government or Doctor has never warned you about it, you are safe,” he said.

“And once people become obese they’re in a catch 22. Being sedentary contributes to getting fat and being obese contributes to being sick and feeling so run down that you feel inclined to sit more.
“The good news is that my team is working with unbridled energy and passion to not only sound the alarm to prevent disease but to find solutions for people who are already too sick or unfit to exercise. And just by standing more, we can improve metabolism in people who cannot exercise.”

According to home grown expert, Associate Professor David Dunstan, the workplace has been identified as one of the settings for starting to reverse the damage of sedentary practices in the adult population.

Professor Dunstan is a VicHealth Public Health Research Fellow and is the Head of the Physical Activity laboratory in the Division of Metabolism and Obesity at Baker IDI Heart and Diabetes Institute.

Professor Dunstan and his team have spent the last two years identifying how employers can assist people to sit less at work and at the same time, maintain or even increase productivity.

“We now know enough about the damage sitting for 6 hrs a day or more causes to warrant recommending specific changes at organisational levels, individually and in the workplace to encourage more movement at work,” said Professor Dunstan.

“For example, organisations could introduce a policy recommending workers with desk roles, stand up and move around every 30 minutes which is already consistent with existing OH&S messages.
”Individuals can ban e-mailing colleagues in the same office; remove the rubbish bin from individual desks and use a central rubbish bin; take and make phone calls standing up and punctuate lengthy meetings by standing.

“Height adjustable standing hot desks and work stations are good examples of workplace changes that will be effective in encouraging a more active workforce. But these changes will take longer to realise because some expenditure is required,” said Professor Dunstan.

The Heart Foundation is grateful to our major conference sponsors, the Victorian Department of Health (Principal Partner) and Astra Zeneca (Platinum Sponsor), for their support.

For more information www.heartfoundation.com.au

Some stroke patients are experiencing long delays in getting to hospital and missing out on treatment because they call their GP rather than an ambulance at the onset of symptoms, a Melbourne study has found.

The treatment delays were particularly bad when GPs elect to examine patients before calling an ambulance, say researchers from the National Stroke Research Institute at Melbourne University.

Writing in BMC Family Practice (12:82), the researchers say GPs should be encouraged to screen all their calls for stroke and advise patients to immediately call an ambulance.

In the study of almost 200 patients with acute stroke, one third called an ambulance immediately and almost 40% of patients called or spoke to another contact first.

In almost a quarter of cases, a GP was contacted first, and this group had a significantly longer time before an ambulance was called. And in almost one third of calls to a GP, the doctor decided to examine the patient, and this resulted in delays averaging 412 minutes compared to calls where the doctor advised the patient to immediately call an ambulance (average 92 minute delay).

“In the future family physicians could be encouraged to screen calls and advise patients who may have stroke symptoms to immediately call an ambulance.,” they suggest.

Article written by Michael Woodhead www.6minutes.com.au

Image via www.facebook.com

How can implementing a population-wide salt-reduction program be so hard?

For most of human evolution, the average daily diet contained a fraction of a gram of salt and our physiology developed accordingly. A few thousand years ago, with the discovery that salt could preserve food, average intake started to rise. Now, with salt poured into the food supply, average Australian consumption levels are many times our physiological need. Populations eating the level of salt upon which we evolved are now few, but they provide a window into normal physiological processes. One of the most notable findings is that their blood pressure levels do not rise with age.

Despite recent highly publicised reports, there is little debate about the adverse impact of salt on human health. The totality of the evidence is convincing and the unbiased findings from randomised trials of salt reduction particularly so. While a number of non-randomised studies have suggested health benefits of salt consumption, the publicity they receive greatly exceeds their real significance. Observational nutritional epidemiology is incredibly difficult to do well, and the diversity of findings almost certainly reflects methodological challenges, not discrepant science. Although direct evidence from a single adequately powered mortality and morbidity trial of salt reduction is lacking, the circumstantial evidence remains striking and the likelihood that reduction in salt intake will not reduce vascular risk is small.

The strength of the evidence base has persuaded multiple national and international organisations of the need to reduce salt consumption. All hypertension guidelines advocate consuming less salt, and more than 30 countries now have some form of population-based salt-reduction program in place. A series of influential reports has highlighted the large health gains that might be achieved from such national programs and the low costs required to deliver them. The issue is no longer whether salt reduction should be a goal, but how it can be achieved.

The reason salt reduction presents such a great public health opportunity is that almost everyone eats far more than they need. Average consumption in Australia is between 8 and 10 grams per day, with immediate and long-term implications for blood pressure. The early effects occur within weeks and the chronic effects over decades. As shown by Huggins and colleagues in this issue of the Journal, and previously noted by the Intersalt study, a daily intake 6 grams above physiological need will push up systolic blood pressure by a few millimetres of mercury in the short term and thereafter by about half a millimetre each year. This chronic effect translates into 25mmHg over 50 years, with enormous implications for individual and population risks of vascular disease.

Blood pressure is a leading cause of disease burden in Australia, and our strategy for preventing disease attributable to high blood pressure is hypertension control — individuals are diagnosed as hypertensive and treated within the medical system. Hypertension is currently the most frequent reason for a primary care consultation, with annual direct health care costs of more than a billion dollars. For those who need and receive it, antihypertensive therapy is a highly effective intervention.

Unfortunately, the clinical approach also has some limitations. First and foremost among these is that half of all disease caused by high blood pressure occurs among people without hypertension. Risks start to accrue well below the blood pressure level of 140/ 90mmHg that generally defines hypertension, and systolic blood pressure levels of 125–135 mmHg are associated with greater risks than a level of 120mmHg. While more moderate than the risks faced by those with hypertension, these blood pressure levels  cause a very large number of adverse events because these are theblood pressure levels of most of the population.

The limited coverage achieved by the clinical hypertensioncontrol strategy further reduces its effectiveness. Only about half of hypertensive people are identified and treated;14 less than half ofthese get to target blood pressure levels,14 and almost none achieve a systolic pressure of 120 mmHg or below. Accordingly, clinicalmanagement of hypertension in Australia probably prevents only about a 10th of all blood pressure-related disease.

A plausible population-wide salt-reduction program thatremoved salt at the source could within a few years avert a similarproportion of disease burden at an annual cost of just $10–20 million. To achieve this, the Australian Government simply needsto set and enforce salt targets for foods, as has been done in the United Kingdom.7 Average salt consumption would fall, mean population blood pressure would immediately follow, and the long-term rise in blood pressure with age would be attenuated.

The real question is how this can be so hard. For almost no extra cost and at no risk, there is a high likelihood we could double the proportion of blood pressure-related disease averted within just a few years. With a proven overseas model to follow, our failure to take the action required is bordering on negligent. No one is going to lose their parliamentary seat and no one is going to go out of business if they make this happen. There are just going to be a lot of unnecessary strokes and heart attacks while the people pickling us figure this out.

Author Bruce C Neal, MB ChB, PhD, FRCP, Senior Director
The George Institute for Global Health, Sydney, NSW.

Published in the MJA 1 August 2011

Image via www.strokegenetics.com

Individuals are more likely to inherit a predisposition to MI than stroke, a population-based study finds, with potential implications for screening.

Having one or two parents with MI increased the odds of having a sibling with MI in a “dose-dependent” manner, which was not true for stroke, the researchers found.

From almost 1,000 probands with ACS and 1,000 people with cerebral events, the US researchers found that among the patients with ACS, having one parent with MI was linked with a 1.48-fold increased likelihood of having a sibling with MI.  Having two parents with MI was linked with a 5.97-fold increased likelihood of having a sibling with MI.

In the patients with cerebral events, parental stroke was not associated with sibling stroke. Furthermore, compared with the patients with TIA/stroke, those with ACS were five times more likely to have two or more siblings with MI.

The findings may be explained by the fact that the underlying pathophysiology in MI tends to be atheroslerosis and plaque instability,
whereas stroke may have greater association with thromboembolism and small vessel disease, the study authors wrote.

Their findings may have implications for clinical practice, they said.

“In particular, use of composite measures of family history of vascular disease in risk scores and screening may not be optimal since
the heritability of stroke is much less than that of MI,” they wrote in Circulation: Cardiovascular Genetics.

Their findings also have implications for the likely utility of genome-wide scanning in identifying causative gene loci for stroke.

“Given the relatively small number of major loci discovered in relation to MI to date, future genome-wide association scans should not be advocated in TIA/ stroke and are unlikely to yield more loci for ACS,” they concluded.

Speaking to Neurology Update, Associate Professor Chris Levi, director of the Priority Centre for Brain & Mental Health Research, University of Newcastle and Hunter Medical Research Institute, agreed.

“Unless the phenotypic evaluation is consistent and rigorous and pathophysiologically defined stroke subtypes are the focus of the work, epidemiological studies in stroke are unlikely to identify significant genetic contributions,” he said.

Article via Neurology Update 2 August 2011.