Geographic Primary-Stroke-Center Placement

I've noticed several comments from heart attack and/or stroke survivors lately regarding the lack of available facilities where they reside.  The article below (courtesy of International Media News Group http://egmnblog.wordpress.com ) peaked my interest; heck, there is a map included which would explain exactly why survivors are expressing frustration about lack of facilities.  Look at all of the gaping white spaces on the map pictured below - I'm very thankful to the writer, Mitchel Zoler, for making this information available:

The Uncoordinated U.S. Primary Stroke Centers

From the International Stroke Conference in San Antonio

The good news for U.S. stroke patients is that in March 2010, 685 certified primary stroke centers existed in America. The bad news is that no one makes sure they’re optimally placed to maximize coverage of the U.S. population.

The Joint Commission, a U.S. hospital accreditation organization, began certifying primary stroke centers in December 2003. The idea was that these centers would specialize in state-of-the-art stroke care and become the prime locations for acute stroke patients to receive care.

The concept has certainly taken root. According to Dr. Karen C. Albright, a neurologist at the University of California, San Diego, 524 certified American primary stroke centers existed by November 2008, and another 102 came on board during the following year, through late September, 2009. The pace for new center certifications has held steady, with another 59 centers added to the list during a little more than another 5 months.

Stroke patients who live in the white areas have a greater than 60 minute trip to their nearest primary stroke center (photo by Mitchel Zoler).

But according to Dr. Albright, many of the new centers added during Nov. 2008-Sept. 2009 were “in proximity to existing centers.” No person or group controls where new stroke centers open, and they’ve left big gaps of uncovered population. Based on the centers that existed last September, Dr. Albright estimated that roughly 63 million to 135 million Americans lived more than 60 minutes away from the closest primary stroke center (see map). The upper end number, 135 million, applied if all emergency stroke transport was by ambulance. The number fell to 63 million if all centers had helicopter transport available, but that’s a big if because in reality many centers don’t use air transport.

Some excellent models exist for better emergency-care coordination, most notably the way trauma care is integrated and delivered across the U.S., particularly by regional systems like the Southeast Texas Trauma Regional Advisory Council.  Recently, SETTRAC set up regional coordination of emergency stroke care in the Houston area.

Now all that has to happen is for this approach to spread through the rest of Texas, and then the rest of the United States.

—Mitchel Zoler

Are You Properly Storing Vitamins & Supplements?

I'm guilty! Vitamins and prescriptions that I take on a daily basis have been in a basket on a kitchen counter (I don't have children in my home). Fortunately, I had already moved items everyone hopes to avoid anyway - you've got bigger problems if you need any of these - (cough drops, tablets, cold medicine tablets) used on a non-regular basis into a hallway storage area. That was the germ freak in me in action. Who knows that happened to the germ freak who didn't worry about the daily vitamins and prescriptions and all that takes place in the kitchen, go figure!

Kitchens, Bathrooms No Place for Vitamins

By Jennifer Warner
WebMD Health News

Reviewed by Laura J. Martin, MD

Humidity in Kitchens and Bathrooms Degrades Shelf Life of Vitamins, Study Finds

March 4, 2010 -- The kitchen or bathroom may be the worst place in the house to store your vitamins.

A new study shows high humidity and temperatures, such as those found in the bathroom and kitchen, can quickly degrade the potency of vitamin C and shorten the shelf life of vitamin supplements -- even if the bottle cap is on tightly.

Researchers found the most common types of vitamin C used in vitamin supplements and other fortified products are prone to a process called deliquescence, in which humidity causes a water-soluble substance to dissolve.

"Opening and closing a package will change the atmosphere in it. If you open and close a package in a bathroom, you add a little bit of humidity and moisture each time," researcher Lisa Mauer, associate professor of food science at Purdue University, says in a news release. "The humidity in your kitchen or bathroom can cycle up quite high, depending on how long of a shower you take, for example, and can get higher than 98%."

"If you get some moisture present or ingredients dissolve, they'll decrease the quality and shelf life of the product and decrease the nutrient delivery," Mauer says. "Within a very short time -- in a week -- you can get complete loss of vitamin C in some products that have deliquesced."

Humidity and Vitamin C Don't Mix

Powdered vitamin C is a popular ingredient for food fortification and is one of the most commonly added nutrients to vitamin supplements. Researchers say because vitamin C is very unstable and its content must be declared on nutrient labels, it is commonly used as an indication of the shelf life of foods and supplements.

For example, monitoring deterioration of vitamin C until it no longer meets its declared label value is one way to determine a product's shelf life.

Researchers say temperature and water are the two most frequently cited factors affecting shelf life. But information on deterioration and shelf life of vitamin C is based on models in which temperature and relative humidity were varied at the same time.

In contrast, this study looked at how various changes in relative humidity and temperature, such as those found in a bathroom or kitchen, affect the deterioration of two common forms of powdered vitamin C, ascorbic acid and sodium ascorbate.

The results, published in the Journal of Agricultural and Food Chemistry, showed relative humidity had the largest impact on vitamin C degradation, and this effect was magnified at elevated storage temperatures.

The study showed that at room temperature, sodium ascorbate and ascorbic acid deliquesce at 86% and 98% humidity, respectively. Once the humidity or temperature level was brought back down, the product will solidify again, but researchers say the damage has already been done.

"Any chemical changes or degradation that have occurred before resolidification don't reverse. You don't regain a vitamin C content after the product resolidifies or is moved to a lower humidity," Mauer says. "The chemical changes we've observed are not reversible."

They say keeping vitamin supplements away from warm, humid environments is the first step to maintaining their effectiveness.

The first signs of nutrient degradation are usually brown spots, especially on children's vitamins. Maurer recommends discarding any vitamin supplement that is showing signs of moisture in the container or browning.

"They're not necessarily unsafe, but why give a vitamin to a kid if it doesn't have the vitamin content you're hoping to give them?" Mauer says. "You're just giving them candy at that point with a high sugar content."