WHAT’S NEW – Sunrise in New York’s Central Park – Fall 2016

 

Yes, there is nature in New York City. Central Park is both the heart and lungs of our great city. Our international clients and even those from the US, love to come to NY. Last week we hosted clients from Israel, Korea and of course the US. This week a favorite client from Sweden is arriving. Our doors are always open, even for a coffee.

 

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Sunrise in New York’s Central Park – Fall 2016 © Jules Mitchel, Target Health Inc.

 

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website, and if you like the weekly newsletter, ON TARGET, you’ll love the Blog.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

QUIZ

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Balneotherapy: How Much Do You Know?

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Bath in ZetaquiraBoyacaColombia – Source: Wikipedia Commons

 

Balneotherapy (Latin: balneum “bath“) is the treatment of 1) ___ by bathing, usually practiced at spas. While it is considered distinct from hydrotherapy, there are some overlaps in practice and in underlying principles. Balneotherapy may involve hot or 2) ___ water, massage through moving water, relaxation, or stimulation. Many mineral waters at spas are rich in particular minerals such as silica, sulfur, selenium, and radium. Medicinal clays are also widely used, which practice is known as ?angotherapy’.

 

The term “balneotherapy“ is generally applied to everything relating to spa treatment, including the drinking of waters and the use of hot 3) ___ and natural vapor baths, as well as of the various kinds of mud and sand used for hot applications. Balneotherapy refers to the medical use of these spas, as opposed to recreational use. Common minerals found in spa waters are sodium, magnesium, calcium, and iron, as well as arsenic, lithium, potassium, manganese, bromine, and iodine. All these may be contained in the peat that is commonly used in preparation of spa waters. Resorts may also add minerals or essential 4) ___ to naturally-occurring hot springs. Though balneotherapy commonly refers to mineral baths, the term may also apply to water treatments using regular hot or cold tap water. Mud-baths are also included in balneotherapy, and the dirt and water used to mix 5) ___ baths may also contain minerals which are thought to have beneficial properties.

 

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Treatment bath at a spa in Hot Springs, Arkansas, United States; Source: Wikipedia

 

 

Balneotherapy may be recommended for wide range of illnesses, including arthritis, skin conditions and fibromyalgia. As with any medical treatment, balneotherapy should be discussed with a 6) ___ before beginning treatment, since a number of conditions, like heart disease and pregnancy, can result in a serious adverse effect. Scientific studies into the effectiveness of balneotherapy tend to be neutral or positive, finding that balneotherapy provides no effect or a 7) ___ effect, or that there is a positive effect. However, many of these studies have methodological flaws, and so may not be entirely reliable. A 2009 review of all published clinical evidence concluded that, while available data suggest that balneotherapy may be truly associated with improvement in several rheumatological diseases, existing research is not sufficiently strong to draw firm conclusions.

 

In 1921, President Franklin D. Roosevelt contracted polio. One of the few things that seemed to ease his pain was immersion in warm 8) ___, and while in these Warm Springs, Georgia waters, to bathe and engage in physical exercise. FDR’s first time in Warm Springs was October 1924. He went to a resort in the town whose attraction was a permanent 88-degree natural spring, but whose main house was described as “ramshackle“. It is famous for the Little White House, where Roosevelt lived while president, because of his paralytic illness. He died there in 1945 and it is now a public 9) ___. Roosevelt first came in the 1920s in hopes that the warm water would improve his paraplegia from the dreaded disease, 10) ___. He was a constant visitor for two decades, and renamed the town from Bullochville to Warm Springs. The town is still home to the Roosevelt Warm Springs Institute for Rehabilitation (Roosevelt’s former polio hospital) which remains a world-renowned comprehensive rehabilitation center including a physical rehabilitation hospital and vocational rehabilitation unit. The springs are not available for public use as a bath/spa resort, but they are used by the Roosevelt Institute for therapeutic purposes.

 

ANSWERS: 1) disease; 2) cold; 3) baths; 4) oils; 5) mud; 6) physician; 7) placebo; 8) water; 9) museum; 10) polio

 

Simon Baruch MD (1840 – 1921)

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Public baths and public comfort stations by the Mayor’s committee of New York City (1897). Sources: Flickr‘s The Commons, no known copyright restrictions exist. Wikipedia Commons

 

 

Simon Baruch MD was a Jewish physician, scholar, and the foremost advocate of the urban public bathhouse to benefit public health in the United States. Simon Baruch, the son of Bernard and Theresa (Green), was born July 29, 1840 in Schwersenz, Poland (formerly Posen). He attended the Royal Gymnasium in Posen-West Prussia. In 1855, when Simon was15-years-old, his family emigrated to South Carolina to live with the Manus Baum family. Baruch worked for Manus Baum as a bookkeeper before beginning to study medicine in 1859. Baruch attended lectures at the Medical College of the State of South Carolina, and enrolled at the Medical College of Virginia (MCV), (now Virginia Commonwealth University) in Richmond, Virginia, where he received a medical degree in 1862.

 

Baruch began his career as a surgeon in the Confederate Army; reportedly entering the service “without even having lanced a boil.“ He initially accepted a commission as Assistant Surgeon of the 3rd South Carolina Battalion on April 4, 1864, and in August of that same year, he transferred to the 13th Mississippi Infantry Regiment, in the position of Surgeon. During the Civil War, Baruch gained considerable surgical experience. After the Confederate surrender at Gettysburg in July 1863, he stayed on to treat the wounded for six weeks. Afterwards, he was imprisoned at Fort McHenry in Baltimore, Maryland, and he returned to his unit in December 1863. Following a period of ill health, he returned to the 13th Mississippi Regiment 6-months later, and he served until the end of the war.

 

After the war, Baruch remained in the South during the Reconstruction Era, where he practiced medicine and authored a widely read pamphlet on “Bayonet Wounds.“ In 1865, Baruch went to New York City where he worked for one year in a post-graduate position as an attending physician to the Medical Polyclinic of the North-Eastern Dispensary in the Hell’s Kitchen, Manhattan district of Manhattan – a bastion of poor and working-class people. There, Baruch tended to patients who were suffering from communicable infection, most of whom lacked access to clean bath water, fresh air, and sunshine. A year later, Dr. Baruch returned to Camden, South Carolina, in 1867.

 

For 16-years Baruch practiced medicine in South Carolina. He also advocated for the smallpox vaccination for the children of the state, and he helped to reactivate the South Carolina State Medical Association, serving as president. He held a position on the faculty of the South Carolina State Medical College, and he was chairman of the Board of Health, later renamed South Carolina Department of Health and Environmental Control. However, Baruch grew increasingly dissatisfied with the indiscriminate use of unproven medical remedies. He studied the healing philosophies of Austrian physician Vincent Priessnitz (1799-1852), and in particular, the success of a therapeutic spa in the Silesian Foothills. The remedies where largely predicated upon frequent bathing and irrigation of the gastrointestinal tract; an alternative form of medicine called hydrotherapy. Patients recuperated in a restful, calm environment, ate a prudent diet, eliminated alcohol and tobacco, and engaged in physical activity. Later, Baruch also credited Wilhelm Winternitz for his pioneering work in hydrotherpy. Baruch would go on to introduce medicinal spring therapies, known as balneology, and hydrotherapy to the United States of America.

 

In 1881, Baruch took up residence in New York City with his wife Belle, and their four sons, Hartwig (“Harty“) Nathaniel (1868-1953), Bernard Mannes (1870-1965), Herman Benjamin (1872-1953), and Sailing Wolfe (1874-1963). He became known as an active public health advocate and medical writer. He also gained professional credibility for diagnosing the first case of perforating appendicitis successfully operated on, and in the widely publicized “child cruelty“ case involving the musical prodigy Josef Hofmann, Baruch was the consulting physician. After examining Hofmann, Baruch recommended the boy musician rest and resume the lifestyle of a child. In 1892, Baruch became a fellow of the New York Academy of Medicine. As a physician and scholar, Baruch’s enduring interest in hydrotherpy guided many of his professional and civic pursuits. He published the standard texts, “The Uses of Water in Modern Medicine“ (1892), “Therapeutic reflections: a plea for physiological remedies“ (1893), and “The Principles and Practice of Hydrotherapy“(1898).

 

From 1903 to 1913, he taught a course in hydro-therapeutics, or methods of using water to treat various diseases, at New York Post Graduate Medical School and Hospital of the University of the State of New York. He resigned when hydrotherapy was made an elective subject of study. In 1910, Baruch wrote “Lessons of half a century in medicine.“ In 1920, he authored “Epitome of hydrotherapy for physicians, architects and nurses.“ Notably, Baruch’s interest in hydrotherapy led to his role as the country’s foremost municipal bath advocate. Ever since his trip in the 1880s to study the public bath system of Germany, Baruch was a tireless advocate for free public baths in New York City, during a period of immigration in American history when newcomers flooded cities. After he studied hydrotherapy, and understood the utility of fresh water to the prevention of infection. Baruch worked tirelessly to educate public officials and the medical community about the importance of water to public health. For many years, the general public and civic leaders were skeptical about the debilitating effects of poor sanitation on physical health; pessimistic Mayor Hugh J. Grant (1852-1910) declared, “The people won’t bathe.“ Despite decades of opposition, Baruch managed to convince three successive Mayors of the utility of water, and in particular, the importance of a public bath system to the population health of the urban working class and poor. He wrote numerous journal and newspaper articles on the medical utility of water, including first article published in America on public baths for the Philadelphia Medical Times and Register on August 24, 1889. He reported on the structure, functioning, and health benefits of a public bath systems to the New York’s Committee on Hygiene, in his role as Chairman. Baruch also delivered addresses on the topic to medical and scientific societies. Moreover, Baruch was medical editor at the New York Sun, from 1912 to 1918, and he covered all the major health concerns of the period, and wrote articles on a variety of topics, from the common cold to malarial fevers.

 

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Free Public Baths 538 East 11th Street; Wikipedia Commons

 

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Asser Levy Recreation Center; Wikipedia Commons

 

 

Although Baruch met with continual resistance, by 1895, he successfully persuaded the State Legislature to pass a law to obligate cities exceeding a population of 50,000 to establish and maintain free bathhouse facilities, and an order from the local Board of Alderman to construct a public bath in the City of New York. In 1897, 9 Centre Market Place People’s Baths, located between Center and Mulberry Streets, served as a prototype public bathhouse. Financed by private contributions from the Association for Improving the Condition of the Poor (AICP), and built on land owned by the City Mission and the Tract Society, the facility provided more than 100,000 people a year with a bath, soap, and a towel for five cents. In 1901, Baruch and his colleagues, Deputy Commissioner of Health of the City of New York Fowler and Dr. Van Santvoord, presided over the opening of the first free public bathhouse, Rivington Street municipal bath, located at 326 Rivington, on the Lower East Side of Manhattan. The bathhouse facility featured indoor and outdoor bathing pools, 45 showers and five soaking tubs for men, and 22 showers for women. Other public baths of the period, credited to the advocacy of Baruch, include the Clarkson Street Bathhouse, located at 83 Carmine Street in Greenwich Village, which provided showers, tubs, and a gymnasium complex on two floors, as well as an open-air classroom on the rooftop for children in poor health. The facility has since become part of the Tony Dapolito Recreation Center. In 1904, several more free public baths opened in Manhattan, including the Milbank Memorial Bath, located on 325-327 East 38th Street, a gift to the City of New York by a Borden (company) heiress, which had the capacity to hold 3,000 people. That same year, the City opened West 60th Street Bathhouse, now Gertrude Elderle Recreation Center, providing 49 showers for men and 20 for women. In 1905, The Public Baths, designed by prominent architect Arnold W. Brunner, opened at 538 East 11th Street, between Avenues A and B, in the Alphabet City area of the East Village neighborhood of Manhattan; the building is also on the List of New York City Designated Landmarks in Manhattan below 14th Street. Asser Levy Public Baths opened in 1906, at the corner of Asser Levy Place and East 23rd Street, in the Kips Bay area. Also designed by architect Arnold W. Brunner and Martin Aiken, the facility has since become part of the Asser Levy Recreation Center, and the building is a designated historic landmark.

 

In 1912, Dr. Baruch was appointed the founding president of the American Association for Promoting Hygiene and Public Baths, a position he held until his death. Baruch said he had “done more to save life and prevent the spread of disease in my work for public baths than in all my work as a physician.“

 

In 1867, Simon Baruch married Isabelle (“Belle“) Wolfe (1850-1921), daughter of cotton farmer Sailing Wolfe of Winnsboro, South Carolina. Their son Bernard M. Baruch went on to a successful career on Wall Street and a financial advisor to U.S. Presidents from Woodrow Wilson to Harry S. Truman; his substantial fortune afforded him the opportunity to endow university chairs, medical school facilities, and public buildings in his father’s name. Herman B. Baruch followed his father’s footsteps to become a physician, and then a Diplomat, and president of the Simon Baruch Foundation. Hartwig Baruch was an actor, and Sailing Baruch was a banker and stockbroker.

 

Simon Baruch is the namesake of civil monuments, educational entities, and academic departments in New York City, and throughout the country, many of which were established by his son Bernard M. Baruch, including Simon Baruch Houses, a public housing complex in Manhattan, as well as buildings, halls, and academic chairs at Columbia University, Clemson University, New York University College of Medicine, and the Medical College of Virginia/ VCU. New York City Department of Education’s Middle School 104 is named Simon Baruch Middle School, along with an adjacent Simon Baruch Playground and Garden, under the auspices of the New York City Department of Parks. In 1933, the Simon Baruch Research Institute of Baleneology at Saratoga Springs Spa, Saratoga Springs, New York was established. In 1940, Bernard M. Baruch endowed in honor of Simon Baruch, the Simon Baruch Auditorium building on the campus of the Medical University of South Carolina, Charleston, South Carolina, the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University as well as the university’s Egyptian Building, designed by architect Thomas Somerville Stewart, now a National Historic Landmark. Biannually, the Richmond, Virginia chapter of the United Daughters of the Confederacy grants the Mrs. Simon Baruch University Award to a work of scholarly research on Southern history.

 

A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012

 

As the US population ages, it has been projected that this would lead to a large increase in the number of adults with dementia. However, some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

 

As a result, a study published online in JAMA Internal Medicine (21 November 2016), was performed to compare the prevalence of dementia in the United States in 2000 and 2012. For the study, data were used from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from 2000 (n=10,546) and 2012 (n=10,511). Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

 

Results showed that the study cohorts had an average age of 75.0 years in 2000 and 74.8 years in 2012. In 2000, 58.4% of the cohort was female compared with 56.3% in 2012 cohort (P?<?.001). Dementia prevalence among those 65 years or older decreased from 11.6% in 2000 to 8.8% in 2012 (P?<?0.001). Interestingly, more years of education was associated with a lower risk for dementia. The average years of education increased significantly from 11.8 years to 12.7 years (P?<0.001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and gender-adjusted increase between years in the cardiovascular risk profile (e.g., prevalence of hypertension, diabetes, and obesity) among older US adults.

 

According to the authors, the prevalence of dementia in the United States declined significantly between 2000 and 2012, and the increase in educational attainment was associated with some of the decline in dementia prevalence. However, the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. The authors added that continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

 

ONCOLOGY

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Association Between Palliative Care and Patient and Caregiver Outcomes

 

According to an article published in JAMA (2016;316:2104-2114) a study was performed to determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. The study was a meta-analysis of randomized clinical trials (RCTs) of palliative care interventions in adults with life-limiting illness. For the study two reviewers independently extracted data and performed a narrative synthesis for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-palliative care scale (FACIT-Pal) instrument (range, 0-184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0-90 [best-worst]; MCID, 5.7 points). The main outcomes and measures were quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures.

 

Forty-three (43) RCTs provided data on 12,731 patients (mean age, 67 years) and 2,479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting. In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up. When analyses were limited to trials at low risk of bias (n=5), the association between palliative care and QOL was attenuated but remained statistically significant, whereas the association with symptom burden was not statistically significant. There was no association between palliative care and survival. Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed.

 

FDA Approves Jardiance to Reduce Cardiovascular Death In Adults With Type 2 Diabetes

 

According to the Centers for Disease Control and Prevention, death from cardiovascular disease is 70% higher in adults with diabetes compared to those without diabetes, and patients with diabetes have a decreased life expectancy driven in large part by premature cardiovascular death.

 

The FDA has approved a new indication for Jardiance (empagliflozin) to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and cardiovascular disease. The FDA’s decision is based on a postmarketing study required by the agency when it approved Jardiance in 2014 as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Jardiance was studied in a postmarket clinical trial of more than 7,000 patients with type 2 diabetes and cardiovascular disease. In the trial, Jardiance was shown to reduce the risk of cardiovascular death compared to a placebo when added to standard of care therapies for diabetes and atherosclerotic cardiovascular disease.

 

Jardiance can cause dehydration and low blood pressure (hypotension). Jardiance can also cause increased ketones in the blood (ketoacidosis), serious urinary tract infection, acute kidney injury and impairment in renal function, low blood glucose (hypoglycemia) when used with insulin or insulin secretagogues (e.g. sulfonylurea, a medication used to treat type 2 diabetes by increasing the release of insulin in the pancreas), vaginal yeast infections and yeast infections of the penis (genital mycotic infections), and increased cholesterol. The most common side effects of Jardiance are urinary tract infections and female genital infections.

 

Jardiance is not intended for patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Jardiance is contraindicated in patients with a history of serious hypersensitivity reactions to Jardiance, severe renal impairment, end-stage renal disease, or dialysis.

 

Jardiance is distributed by Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.

 

Stuffed Cabbage Using Left-Over Turkey and Tomato Sour Cream Sauce

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Each time I create a new recipe, I hold my breath. You never know how it will come out and it’s not always good. Of course, I never publish those; why would I? Experiments in cooking are fun, with the proof in the eating, and when the recipe is a success, it gets shared. Jules gives this delicious low-cal, comfort dish, 5 out of 5 stars.  ©Joyce Hays, Target Health Inc.

 

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I thought this recipe might be boring; after all, everyone has tried stuffed cabbage and everyone has tried to use up left-over turkey, which after the first day, can be dry and not too interesting. This dish is so-o yummy, we couldn’t stop eating it.  ©Joyce Hays, Target Health Inc.

 

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This recipe was far from boring and/or dry. I couldn’t believe how good it was!

The two hour bake time, gave flavors a chance to mingle well. ©Joyce Hays, Target Health Inc.

 

 

Ingredients

 

1 Cabbage

1 onion

20 garlic cloves, thickly sliced

1/2 cup fresh dill, chopped well

1/2 cup fresh cilantro, chopped well

1/2 cup fresh parsley, chopped well

1 can Cento tomato paste, mixed with one cup chicken stock

1 egg

1 pound left-over turkey meat, dark or light or both (or fresh chopped turkey)

1 cup uncooked rice

Pinch salt

Pinch black pepper

Pinch chili flakes

1 teaspoon turmeric

1 cup Chicken stock or broth for liquid in baking dish + extra for sauce

2 teaspoons butter to cook onions & garlic

2 teaspoons butter for bottom of baking dish

 

Sauce Ingredients

 

1 can Cento tomatoes

A few teaspoons chicken stock or broth

1 pint (or to your taste) sour cream

Salt & pepper to your taste

3 garlic cloves, squeezed

 

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When you make your own dishes, you always know exactly what’s in everything. ©Joyce Hays, Target Health Inc.

 

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No processed meat, just the delicious left-over turkey from a Thanksgiving feast. ©Joyce Hays, Target Health Inc.

 

Directions

 

1. Preheat oven to 350 degrees.

2. Bring a large pot of lightly salted water to a boil. Place cabbage head into water, cover pot, and cook about 10 minutes, until cabbage leaves are slightly softened enough to remove from head.

3. While cabbage is cooking, puree the can of Cento in your food processer.

4. In a bowl or pan with a lip, mix together the can of tomato paste and the cup of chicken stock or broth and set aside.

 

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Puree the can of Cento tomatoes. ©Joyce Hays, Target Health Inc.

 

 

5. When soft, remove cabbage from pot and let cabbage sit until leaves are cool enough to handle, about 10 minutes.

6. While cabbage is cooking and/or cooling down, do all your cutting and chopping, including chopping the left-over turkey into tiny pieces. The tinier the pieces, the easier it will be to mix the turkey together with other ingredients, for the stuffing.

 

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Chopping garlic and onions; next all the herbs at once. ©Joyce Hays, Target Health Inc.

 

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Chop all the turkey into very small bits. ©Joyce Hays, Target Health Inc.

 

7 Follow the cooking directions for whatever type of rice you have, but cook the 1 cup of rice in chicken stock or broth, instead of water.

 

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Cook your rice in chicken stock or broth instead of water. When done, set aside. ©Joyce Hays, Target Health Inc.

 

 

8. Remove the hard, center core of the cabbage, also carefully, remove the whole leaves from the cabbage head, trimming off, any thick tough center ribs.

 

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With a good paring knife, take out the hard, center core of the cabbage. ©Joyce Hays, Target Health Inc.

 

 

9. Set about 10-12 whole cabbage leaves aside, for the rolls. Save two to four cabbage leaves to spread on the bottom of a casserole dish; and two to four leaves to go over the top of the casserole.

 

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You’re going to use from 10 to 12 leaves for rolls. Two to four leaves on bottom of baking dish and two to four leaves over the top of the completed rolls in the baking dish. ©Joyce Hays, Target Health Inc.

 

 

10. Add 2 teaspoons butter on top of the cabbage leaves spread over the bottom of casserole.

 

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Before you put the stuffed cabbage rolls into your baking dish, you will cover the bottom of the dish with two to four cabbage leaves and then add 2 Tablespoons of butter on top of those bottom leaves. ©Joyce Hays, Target Health Inc.

 

 

11. Melt butter in a large skillet over medium-high heat. Add the chopped onion and garlic to the butter and stir until tender, about 5 to 10 minutes.

12. Next, add the chopped turkey to the pan and stir well, for 2 or 3 minutes.

 

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Above, turkey has been added to the onion and garlic and about to be stirred together.  ©Joyce Hays, Target Health Inc.

 

 

13. With a spatula, scrape Into a large bowl, the cooked onion, garlic and turkey.

 

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The slightly cooked onion, garlic and turkey has been scraped into a large bowl.  ©Joyce Hays, Target Health Inc.

 

 

14. Add the cooked rice, pinch salt, pinch pepper, pinch chili flakes, turmeric, all chopped herbs, and the raw egg. Work this stuffing with your hands, until everything is very well combined. If you feel that this mixture is a little dry, add a few teaspoons of chicken stock or broth.

 

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All spices, as well as the cooked rice has been added to the mixing bowl, and then the raw egg.  Mix all these ingredients together with your hands; or if you don’t like that feeling, use a wooden spoon.  ©Joyce Hays, Target Health Inc.

 

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Herbs are added and about to be mixed together will all of the other ingredients that make up the delicious stuffing.  ©Joyce Hays, Target Health Inc.

 

 

15. Now you’re ready to stuff the cabbage leaves. Place a heaping Tablespoon of the turkey mixture on one cabbage leaf.

 

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Adding the stuffing to one cabbage leaf.  ©Joyce Hays, Target Health Inc.

 

 

16. Pull the right & left sides of the cabbage, tightly over the stuffing.

 

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On the left of this photo, you can see a hard part of the stem.  It will get trimmed off, or the cabbage leaf won’t roll up easily.  ©Joyce Hays, Target Health Inc.

 

 

17. Now, start from the bottom, to roll the stuffed cabbage up, creating a sort of envelope around the stuffing. Repeat with remaining leaves and turkey stuffing mixture.

18. Place cabbage rolls in rows, on top of the chopped cabbage in the casserole dish.

 

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Starting to pack into the baking dish, the rolled-up cabbage leaves.  ©Joyce Hays, Target Health Inc.

 

 

19. When all the rolls are in the baking dish, add two bay leaves on top. If you want more seasoning, (salt, pepper, etc.), add it now.

 

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Almost ready to go into the oven.  ©Joyce Hays, Target Health Inc.

 

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This yummy dish will be greatly appreciated on a cold winter night. Better make it soon, with global warming, who knows how many more cold nights we get to serve this wonderful comfort food. ©Joyce Hays, Target Health Inc.

 

20. Add the mixture of tomato paste and chicken broth or stock, to the baking dish.

21. Just before going into the oven, add one layer of the extra cabbage leaves, over the top of the stuffed cabbage.

 

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Here, you can see the extra cabbage leaves, covering the stuffed cabbage.  Next, the lid goes on.  ©Joyce Hays, Target Health Inc.

 

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Bake for 2 hours at 350 degrees.  ©Joyce Hays, Target Health Inc.

 

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Three ingredients for the sauce: Cento tomatoes, fresh garlic squeezed into the pan and 1 heaping Tablespoon (or more if you like) sour cream. Stir while heating up, then serve at the table. ©Joyce Hays, Target Health Inc.

 

 

Make the sauce

 

1. In a medium sauce pan, over medium heat, whisk 1 can pureed Cento tomatoes, with 3 squeezed garlic cloves, and 1 heaping Tablespoon of sour cream, together. Stir well until the sauce is hot.

2. Make pasta now, or more rice to serve with the cabbage rolls. Make a salad to serve with the cabbage rolls, or just heat up some sourdough rolls to sop up the delicious sauce.

 

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Now, you can see why the cabbage leaves cover over the stuffed rolls. In the event that something gets well cooked, it won’t be the stuffed cabbage rolls. When you take the baking dish out of the oven, discard the leaves, covering the cabbage rolls. ©Joyce Hays, Target Health Inc.

 

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Before you bring the baking dish to the table, discard the two bay leaves. For a more colorful presentation, spoon some of the tomato/sour cream sauce, over these cabbage rolls. ©Joyce Hays, Target Health Inc.

 

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Wish I could include the aroma with this photo -um um um! ©Joyce Hays, Target Health Inc.

 

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The nice hot tomato/sour cream sauce is the finishing touch to this marvelous meal! ©Joyce Hays, Target Health Inc.

 

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This delicious recipe goes into our category of top five comfort foods to serve on a cold winter night. By the way, here is one comfort food that is tasty but not high in calories. ©Joyce Hays, Target Health Inc.

 

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This chilled Pouilly-Fuisse went well with the stuffed cabbage. ©Joyce Hays, Target Health Inc.

 

 

From Our Table to Yours !

 

Bon Appetit!