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Synthetic patient data produced by Synthea was described in Chapter 6. That data is used to create a baseline for all patients, palliative patients, and deceased palliative patients. Distributions of comorbidities across the patient groups are examined and demographic characteristics. The factors used in palliative care groupings are presented with the synthesized data fields used. The size of the palliative population is again estimated to establish validity.

This chapter more clearly identifies the distinction between Electronic Health Record (EHR) and Electronic Medical Record (EMR), and states their value in obtaining individual-level data. Synthetic medical records may be used as a surrogate for EHR data in order to ensure digital data privacy is maintained during the development of the LHS. Synthea is an open-source simulation tool available through GitHub.¹ Extensive descriptive analysis of synthesized data is provided as a foundation for the analysis in Chapter 7.

The nutritive properties of various dietary components and their effects on health are regularly debated in the scientific literature and popular media. The study of the regular consumption of cake in relation to the risk of developing metabolic disorders is however an exciting new development in the field. This chapter suggests that cake consumption is amongst a number of factors that may explain The Ambridge Paradox: the extremely low incidence of metabolic disorders such as obesity and Type 2 diabetes observed in a small Borsetshire village. The chapter identifies 10 dietary and lifestyle habits observed in this population that may be beneficial for cardiovascular health, acting through a variety of mechanisms. Key amongst these may be the synergic properties of several biochemical components of cake, especially the phenolic compounds in varieties with a fruit-based element, such as lemon drizzle. The chapter concludes that the dietary and lifestyle habits of the Ambridge cohort show promise as a model for improving the metabolic health of wider populations. In particular, it suggests that cake consumption may be a promising therapeutic supplement to prevent and even treat metabolic disorders.

This chapter summarizes the knowledge on sleep and restitution. Sleep constitutes the recuperative process of the central nervous system. The use of the brain during wakefulness will lead to depletion of energy in the cortical areas locally responsible for activity. The level of depletion is monitored and sleep is initiated when critical levels are reached. The attempts to initiate sleep are perceived as sleepiness or fatigue. The ensuing sleep then actively restores brain physiology to normal levels. This also results in restored alertness, memory capacity, and mood. Also, peripheral anabolic processes (secretion of growth hormone and testosterone) are strongly enhanced and catabolic process (secretion of cortisol and catecholamines) are strongly suppressed. In the long run, reduced or impaired sleep leads to metabolic diseases, depression, burnout, and mortality. Stress and irregular hours are among the main causes of disturbed sleep.

Characteristics that impact the levels of palliative care are introduced. Patients with the potential to be classified as palliative may be overlooked or simply so not seek medical attention. The population is much higher than those being treated on an annual basis. Data from the American Community Survey (ACS) and the Behavioral Risk Factor Surveillance System (BRFSS) are applied to the characteristics of palliative care and used to estimate the size of the palliative population in the United States (US).

The chapter is an auto-ethnographic account of the self-management of a chronic illness within the context of a participatory research project on Mediterranean Diet (MD). A group of Italian women with type 2 diabetes is following a non-medical, personal interpretation of the Mediterranean-style diet. The research account is preceded by a critical appraisal of the scientific narratives of the MD.

Analysis of epidemiological research on MD examines some methodological aspects of gender blindness in its scientific approach. The ethnography concerns self-management of MD diet and redefinition of gender relations.

MD is analyzed as a case of transplantation of yesterday’s cultural and social capitals of the peasant classes, to today’s discourses on food considered as appropriate for affluent people suffering from satiety diseases. The ethnography highlights gender aspects of biographical work, examining in particular a “conversion” dietary model.

The ethnography must be amplified to include women and men from different social classes with various Mediterranean cooking habits, and family and gender patterns.

The chapter highlights cultural processes for women’s empowerment in self-managing type 2 diabetes.

This chapter may represent a seminal sociological work on chronic illness, gender and food studies in one of the “native” contexts of the Mediterranean-style diet.

The importance of anabolism and regeneration is related to lack or loss of control. This chapter discusses the psychophysiological basis for such relationships. In the threat of lost control, energy mobilisation is activated and regeneration is inhibited – since regeneration (repairing) has low priority in emergency situations. This pattern can be traced on several psychophysiological levels, from the brain to most of the cells in the body. Such a mechanism explains why the body becomes vulnerable and increasingly sensitive to load when threat of lost control is excessive and long lasting. In several empirical examples, various indicators of anabolism and regeneration have paralleled improvement versus deterioration in psychosocial conditions, in particular lack or loss of control. In these studies, indicators of anabolism and regeneration (such as concentration of sex hormones with anabolic and regenerative functions in blood and saliva) have been followed in subjects going through deteriorating versus improving life conditions. The demand-support model is used as a theoretical basis for the discussion.

Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes.

Population Health Management (PHM) provides a useful framework for designing integrated care programs for individuals with SMI.

This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program.

As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.

This chapter will identify readily accessible existing sources of public data. Thechallenges of using that data are considerable and require extensive time to ensure validity for reporting purposes. Summaries of data field selection and data wrangling requirements are presented in conjunction with data aggregation strategies.