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MEDICATION ERRORS ON THE RISE:
Are You Taking Your Medication Correctly?

Joanna Hayden, PhD, CHES

Using data from national Poison Control Centers, researchers analyzed the more than 67,000 reports of medication errors occurring outside of a health care facility between 2000 - 2012 and found the rate of serious medical consequences doubled during this period. The greatest number of errors involved cardiovascular medications and the greatest number of deaths were from pain medication errors. This study was published last week in the journal Clinical Toxicology.

Full journal article: http://www.tandfonline.com/doi/full/10.1080/15563650.2017.1337908

Use this News

According to a 2016 CDC report,  almost half (48.9%) of all Americans take at least one prescription drug and about 12% take more than five. With people taking more medication than ever before, medication errors are on the rise. To put the problem in perspective, the National Academy of Sciences - Institute of Medicine estimates that at least 1.5 million preventable medication errors occur each year, or about 171 per hour. While the majority occur in health care facilities (nursing homes, hospitals, etc.,) 93% of the errors analyzed in this study, occurred at home.  The most common medication error at home was taking/giving an incorrect dose, followed by taking/giving the medication twice, taking/giving someone else’s medication, and taking/giving the wrong medication.

Medication errors can have very serious consequences especially so with errors involving blood thinners, pain medications and cancer treatments.  About a third of those in the study above were admitted into the hospital for treatment as a result of the error, including intensive or critical care for 17% of them. For 414 people, the medication error resulted in death.

Below are some tips for preventing medication errors:

  • If you take/give a number of medications everyday, keep a written record of the time you  take/give them
  • If more than one person in the house takes medications: 
                o   get different color organizers for each person
                      and put their names on them.

                        o   color code the pill bottle caps with permanent
                              marker (ex. blue for dad, pink for mom, green for
                              granddad).
  • If you have trouble swallowing a large pill, ask if the medication can be made as a liquid rather than trying to cut a pill in half.
  • Ask the health professional giving you the prescription to print on a separate piece of paper, the name of the drug, why you are taking it, how much you are to take and how often. When you pick up your prescription, check it against what you have written.
  • When you pick up your prescription, ask the pharmacist what you should do if you miss a dose.
  • Make sure of the dose before leaving the pharmacy. Is it the whole pill, half a pill or two pills.
  • Know the generic and brand names of any new medication so you can check to see if you are already taking it under a different name. (For example, the heart medication Lanoxin is the brand name of digoxin –they are the same medication. Coumadin and warfarin sodium are the same medication used to prevent blood clots).
  • If the prescription is liquid, use the measuring cup that comes with it.  Do NOT use spoons from your kitchen.

If you take or give an incorrect dose, incorrect medication, take/give the medication twice, give the wrong person medication, or make any other medication error, call Poison Control immediately.

                                             Poison Control
                                
1-800-222-1222


For more information:

Preventing medication errors
National Academy of Sciences – Institute of Medicine
http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.ashx

How to prevent medication errors
Institute for Safe Medication Practices
https://www.ismp.org/pressroom/Patient_Broc.pdf

Strategies to reduce medication errors
FDA
https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm

Taking medication safely
National Institutes of Health – senior health
https://nihseniorhealth.gov/takingmedicines/takingmedicinessafely/01.html

Medication safety basics
Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/medicationsafety/basics.html

American Association of Poison Control Centers
http://www.aapcc.org/

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MOST OF US DON’T HAVE ADVANCE  DIRECTIVES …AND WE SHOULD
Joanna Hayden, PhD, CHES

After researchers reviewed data from 150 studies conducted on almost 800,000 people between 2011- 2016 they found that only 36% had completed advance directives and for 29% of them, it was a living will. The results of the study were published last week in the journal Health Affairs.

Article summary: https://medlineplus.gov/news/fullstory_167074.html
Journal article abstract: http://content.healthaffairs.org/content/36/7/1244.abstract

Use this news

Advance directives is not a comfortable topic of conversation for many people. So, the low rates of completed documents found in the study above comes as no surprise.   An advance directive is an umbrella term that covers different types of written, legal documents used to guide your health care if you become incapacitated. The two main documents are a living will and medical power of attorney. Other advance directives can include documents for do not resuscitate orders, organ donations, feeding tube insertion, and blood transfusions.

To help clarify the differences between the most important of these document -

A Living Will is a written legal document that informs medical personnel of the types of treatment you want if you are dying, unconscious, or otherwise incapacitated and cannot make emergency health care decisions. A living will indicates your wishes about being resuscitated, put on a ventilator, or having a feeding tube inserted.

A Medical Power of Attorney  or health care power of attorney is a written legal document that specifically names someone (called a health care proxy, surrogate, or health care agent) to make medical decisions for you at times when you are not able to make those decisions for yourself. The person you choose will be speaking for you should the situation arise, so he/she should know what you would want done. A medical power of attorney covers more than a living will does, so it can be used instead of, or in addition to a living will.

Having a medical power of attorney is not just for older people or people with life threatening illnesses. It is particularly important for parents when their children turn 18. Once a child turns 18, he/she is legally an adult. With this birthday, parental rights to medical information and to make medical decisions, vanish. What this means is - if your 18 year old child is lying in an emergency room, you have no right to any information about his/her condition or any right to make medical decisions. HIPPA privacy rules in fact, make it illegal for medical personnel to share information with you once your child turns 18.

Other documents

DNR – Do Not Resuscitate – informs medical personnel that you do not wish to have your heart
“shocked” or restarted if it stops beating or is beating so abnormally that it is life threatening.

Organ and tissue donation - informs your family/significant others and medical personnel of your wishes to donate organs or tissues for transplantation.

Durable Power of Attorney – gives someone else the power to conduct your business on your behalf. For example, sign checks for you to pay bills, sign tax returns, access your bank account.

There are a number of websites with “do it yourself” legal forms, including those for advance directives. Just make sure you use the ones for your state and follow the instructions exactly. Given the complexities of the law and minor nuances of each state, a better option is to seek out the services of an attorney who specializes in elder law, even for your 18 year old’s medical power of attorney.  The emergency room is the last place you want to find out that the document you have is useless.

For more information

NIH – National Institute on Aging
Advance Care Planning Tips
https://www.nia.nih.gov/health/publication/advance-care-planning

Mayo Clinic
Living wills and advance directives
http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303?p=1

AARP
Advance directive
http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html

HIPPA
https://www.hhs.gov/hipaa/index.html

 


 
 
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BAD REACTION TO A COSMETIC?
Report it to the FDA.

Joanna Hayden, PhD, CHES

A study published in the Journal of the American Medical Association – Internal Medicine this week found adverse reactions from cosmetic products are seriously underreported to the Food and Drug Administration (FDA). Over a period of 12 years from 2004-2016, there were on average 400 adverse reactions to cosmetic products reported each year. In contrast, one company alone received 21,000 complaints of adverse reactions from consumers about their hair conditioner products. The FDA received 127 complaints about the same products.

The journal article is available here: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2633256

Use this news

Cosmetics are defined by the FDA as "articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body...for cleansing, beautifying, promoting attractiveness, or altering the appearance" (FD&C Act, sec. 201(i)).  This includes skin moisturizers, perfumes, lipsticks, nail polish, eye and face makeup, cleansing shampoos, hair dyes, and deodorants, as well as any substance intended for use as a component of a cosmetic product.

Have you ever had a bad reaction to a cosmetic products? Given the sheer number of these products we use on a regular basis, it’s probably pretty safe to assume you have. Now, think about what you did when it happened - Did you register a complaint with the FDA, contact the company, bring the product back to the store or just throw it away?  Chances are good you either returned it or threw it away. Maybe a few of you contacted the company. But, how many registered a complaint with the FDA? Based on the results of the research above, we all need to be more vigilant in doing this for each other and here’s why -  

        There is no FDA, approval process for cosmetics before they         can be sold, as there is for drugs. Instead, the cosmetic                     companies are legally responsible to ensure their products             are safe. However, the companies are not legally required to         conduct safety testing of any  products or ingredients and if         they do test, they are not required to share the results with             FDA.    

So, the next time you have an adverse reaction to a cosmetic product, bring it back to the store, but also use the link below to register a complaint with the FDA.

For more information:

Food and Drug Administration

To report a cosmetic related complaint
https://www.fda.gov/cosmetics/complianceenforcement/adverseeventreporting/default.htm

Center for Food Safety and Applied Nutrition
Data base of Adverse Events -
https://www.fda.gov/Food/ComplianceEnforcement/ucm494015.htm

FDA authority over Cosmetics
https://www.fda.gov/Cosmetics/GuidanceRegulation/LawsRegulations/ucm074162.htm#Who_is_responsible



 
 
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VITAMIN D:  ARE YOU TAKING MORE THAN IS GOOD FOR YOU?
Joanna Hayden, PhD, CHES

The results of a study published in the Journal of the American Medical  Association last week found that about 3 percent of adults in the U.S. are taking more than 4,000 international units (IUs) (IU - is a unit of measurement) of Vitamin D a day, an amount beyond the upper limit considered safe. This is up from 0.2 percent 10 years ago. The recommended daily amount of Vitamin D is 600 IUs for adults under 70 and 800 IUs for those 70 and older.

Journal article preview: http://jamanetwork.com/journals/jama/article-abstract/2632494

Article summary: https://medlineplus.gov/news/fullstory_166773.html

Use this News

Vitamin D is the sunshine vitamin.  We make it in our bodies when ultraviolet light from the sun interacts with substances in our skin,  from the foods we eat and from supplements we take. We need it to absorb calcium from our intestines, to maintain calcium and phosphorus balance for bone health, and for proper immune system, nervous system and muscle function.

We need between 600-800 IUs of vitamin D a day from all sources. However, as the results of this study show, more of us than ever are taking amounts in excess of what may be safe. Yes, taking vitamins in excess can be hazardous to our health. Think of vitamins like you would aspirin or acetaminophen. If you have a head ache, you take two tablets. You wouldn’t take 10 tablets figuring if two stops the pain, 10 will do it better – yet some of us are doing just that with vitamin D.

According to the National Institutes of Health, Office on Dietary Supplements, (NIH-ODS) long term (three months or more) vitamin D intake greater than 4,000 IU a day, can have a negative effect on health. When intakes rise above 10,000 IU a day, there is a greater risk of some cancers  particularly cancer of the pancreas, greater risk of heart attack, and greater risk of fractures among older adults. When intake goes beyond 40,000 IU a day, it can result in toxicity which causes high calcium levels in the blood, or hypercalcemia. Hypercalcemia can weaken bones, affect nerve, heart and brain function and cause kidney stones. The risk of toxicity occurs with high intakes from supplements and food. It does not happen with vitamin D produced in body from sun exposure.

Knowing that the recommended daily amount is between 600 – 800 IU, from all sources, talk with your health care provider before taking quantities above the recommended amounts. If you’ve been taking vitamin D supplements, talk to your health care provider about having your vitamin D blood levels tested to see if you  need as much as you’re taking. If you are taking any of the following prescription medications - prednisone or cortisone, cholesterol lowering drugs or seizure medications - make sure your health care provider knows you are taking vitamin D supplements. Some of these interact with vitamin D.

Use the list  below from the NIH-ODS to re-evaluate your intake of supplements in light of the amount of vitamin D you’re getting in your diet.


                     Food                                               IUs per serving   
                    
Cod liver oil, 1 tablespoon                                       1,360          

Swordfish, cooked, 3 ounces                                      566

Salmon (sockeye), cooked, 3 ounces                         447

  Tuna fish, canned in water,  3 ounces                    154

  Orange juice  1 cup                                                       137
(check product labels, as amounts vary)

Milk, nonfat, reduced fat, and whole,               115- 124
vitamin D-fortified, 1 cup

Yogurt 6 oz (check label amounts vary)                    80

Margarine, fortified, 1 tablespoon                               60

Sardines, canned in oil, drained, 2 sardines            46

Liver, beef, cooked, 3 ounces                                        42

Egg, 1 large (vitamin D is found in yolk)                    41

  Ready-to-eat cereal .75 - cup                                        40
(check label, amounts added vary)

Cheese, Swiss, 1 ounce                                                       6


For more information see:

Vitamin D Council
https://www.vitamindcouncil.org/about-vitamin-d/

National Institutes of Health – Office of Dietary Supplements
Vitamin D Fact Sheet
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/


 
 
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REDUCING SATURATED FATS CAN LOWER HEART DISEASE RISK AS MUCH AS STATINS
Joanna Hayden, PhD, CHES

Based on the results of a rigorous review of the scientific research, The American Heart Association published an advisory this week in the journal Circulation  recommending replacement of saturated fats in the diet with poly-unsaturated and mono-saturated fats as this was found to reduce the risk of cardiovascular disease by as much as 30%, a result comparable to the reduction achieved with statins or cholesterol lowering drugs.

For the complete journal article: http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510


For a summary of the article: https://medlineplus.gov/news/fullstory_166625.html

Use this news

If you have been diagnosed with high cholesterol, this information is for you!

Cholesterol is actually a wax- like substance that our livers make. We use it to make hormones and the walls of our cells.  Cholesterol by itself doesn’t mix well in our blood so, it attaches to a lipoprotein (fat and protein).  You know two of these, LDL or low density lipoprotein and HDL or high density lipoprotein. LDL or  ‘bad’ cholesterol is the one that sticks to the walls of our arteries and increases the risk of heart attacks and strokes.  HDL or high density lipoprotein is the type that keeps our arteries clean by bringing cholesterol it back to the liver so it can be broken down.

Think of this like bags of garbage and garbage trucks. LDL is the bag of garbage you put in the street in front of your house on garbage day. HDL is the garbage truck. On garbage day, you put  bags of garbage (LDL) in the street in front of your house. The garbage truck (HDL)  comes along and picks up the bags and your street is clear. But,  if you put out more  garbage bags than the truck can fit, some bags are left in the street. If you do the same thing the next week, and the next, eventually your street will be blocked with garbage bags.  – i.e. you’ll have a heart attack. So, it makes sense to have enough garbage trucks (HDL) to pick up all the garbage bags (LDL). A good number is 1 garbage truck (HDL) for every 4 garbage bags (LDL).  More garbage trucks per garbage bag, the better. This is the HDL, LDL ratio you might have heard about. So, someone with a HDL:LDL ratio of 1 to 2 (one truck for every two bags) has less of a heart attack risk than someone with a 1 to 6 ratio (one truck for every 6 bags).

What does this have to do with saturated fat in the diet, you ask? A lot.  The liver uses saturated fat to make cholesterol - the more saturated fat we eat, the more cholesterol we make and the extra gets carried in the blood as LDL.  If we don’t have enough HDL to offset it, it collects in our arteries and increases our risk of heart attack and stroke.

Saturated fats are abundant in our typical American diets. They are in animal products (meats, full fat dairy, butter, cheese, ice cream, etc.) and some vegetable oils especially coconut and palm kernel oils. (Yes, coconut oil – see the journal article for studies on this.) What the results of the American Heart Association review found was when saturated fat in the diet is reduced,  LDL goes down and along with it cardiovascular disease risk. 

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The American Heart Association recommends a saturated fat intake of about 13 grams a day for someone who eats around 2000 calories or between 5-6 % of the total number of calories. (To figure out how many grams of saturated fat is right for you do some simply math:
1. add up your daily calorie intake.
2. multiply by 5 or 6%
3. divide the number by 9 (fat = 9 calories per gram of food)
4. Now you have the number of grams you should aim for each day.

(If you eat 1500 calories, 6% = 90 calories or 10 grams of fat)

Saturated fat grams are listed on food labels, so it’s easy to count them up, just be mindful of the serving sizes. 











The Texas Heart Institute offers these suggestions for reducing your intake of saturated fat:

  1. Eat more fruits and vegetables.
  2. Eat more fish and chicken. Substitute ground turkey or chicken for ground beef. Remove the skin from chicken before cooking.
  3. Eat leaner cuts of beef and pork, and trim as much visible fat as possible before cooking.
  4. Bake, broil, or grill meats; avoid frying. Avoid breaded meats and vegetables.
  5. Use fat-free or reduced-fat milk instead of whole milk. Instead of sour cream, try nonfat plain yogurt or a blend of yogurt and low-fat cottage cheese. Use low-fat cheeses.
  6. In recipes, use two egg whites instead of one whole egg.
  7. Avoid cream and cheese sauces, or make recipes with low-fat milk and cheese.
  8. Instead of chips, snack on pretzels or unbuttered popcorn.
  9. Limit hydrogenated fats (shortening, lard) and animal fats (butter, cream) if you can. Use liquid oils, particularly canola, olive, safflower, or sunflower.
  10. Read the nutrition labels on all products. Many "fat-free" products are very high in carbohydrates, which can raise your triglyceride levels.
  11. Compare the fat content of similar products. Do not be misled by terms like "light" and "lite."
  12. When eating in a restaurant, ask that the sauces and dressings be served on the side.
  13. Look for hidden fat. For example, refried beans may contain lard, or breakfast cereals may have significant amounts of fat.
  14. Try cooking with herbs, spices, lemon juice, etc., instead of butter or margarine.

            Use the chart below to help you choose healthier fats.
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EVEN DRINKING IN MODERATION IS TOO MUCH FOR OUR BRAINS!

A 30 year study published in the British Medical Journal this week found an association between alcohol consumption, brain shrinkage in the area responsible for cognitive skills, and diminished “language fluency” ( a measure of memory and thinking skills). Regular, moderate drinkers (4-7 drinks a week) were 3 times more likely to have more brain shrinkage and less language fluency, (i.e. memory and thinking  skills), as compared to non-drinkers. Further, the greater amount of alcohol consumed, the faster the mental decline.

Summary of the study is at: https://medlineplus.gov/news/fullstory_166301.html
Complete journal article is at: http://www.bmj.com/content/bmj/357/bmj.j2353.full.pdf

Use this news

While the association between alcohol and cognitive decline is not the news here, what is newsworthy is the amount of alcohol found associated with it – amounts within the U.S. guidelines for safe drinking.  Presently, the U.S. 2015-2020 guidelines suggest if alcohol is consumed, it be done so in moderation. Moderation is defined as no more than 1 drink per day for women (7 per week) and 2 drinks for men (14 per week). For men, the amount is well above the 4-7 drinks a week found associated with brain shrinkage and cognitive decline in the study.

One drink is defined as the following:

12 fluid ounces of regular beer (5% alcohol)
5 fluid ounces of wine (12% alcohol)
1.5 fluid ounces of 80 proof distilled spirits (40% alcohol)

The tricky part is that not all beers, wines or distilled spirits (hard liquors) are created equal. So, while a 5 oz. glass of one wine may be equal to one drink, a 5 oz glass of another might be equivalent to 1.4 drinks. It all has to do with the alcohol content of the beverage and of course,  the amount you pour in your glass!

Use the chart below to help you determine the number of ‘drinks’ you take in each week.

              Alcoholic Drink-Equivalents of Select Beverages

Drink Description                                   Drink-Equivalents

Beer, beer coolers, and malt beverages 

12 fl oz at 4.2% alcohol                                                      0.8
12 fl oz at 5% alcohol (reference beverage)                      1
16 fl oz at 5% alcohol                                                            1.3
12 fl oz at 7% alcohol                                                           1.4
12 fl oz at 9% alcohol                                                           1.8

Wine

5 fl oz at 12% alcohol (reference beverage)                    1
9 fl oz at 12% alcohol                                                            1.8
5 fl oz at 15% alcohol                                                             1.3
5 fl oz at 17% alcohol                                                            1.4

Distilled spirits

1.5 fl oz 80 proof distilled spirits (40% alcohol)           1
Mixed drink with more than 1.5 fl oz 80 proof
     distilled spirits (40% alcohol)                                   > 1



Given the findings of this study, if you drink, it may be wise to bring your drinking more in line with the 2016 U.K. guidelines of no more than 5 drinks per week. See the links below for tips on  cutting back on alcohol.             

For more information 

Rethinking Drinking
National Institute on Alcohol and Alcohol Abuse  
https://www.rethinkingdrinking.niaaa.nih.gov/Thinking-about-a-change/strategies-for-cutting-down/Tips-To-Try.aspx

Tips on cutting down
UK National Health Service
http://www.nhs.uk/Livewell/alcohol/Pages/Tipsoncuttingdown.aspx


U.S. Dietary Guidelines 2015-2020 for alcohol: https://health.gov/dietaryguidelines/2015/guidelines/appendix-9/


 
 
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JUST WASH YOUR HANDS –
THE TEMPERATURE OF THE WATER DOESN’T MATTER!

Joanna Hayden, PhD, CHES

A study published in the Journal of Food Protection looking into the effectiveness of handwashing with cold water vs hot/warm found cold water just as effective at removing bacteria as hot/warm water.


Summary of the journal article: http://www.medicalnewstoday.com/articles/317712.php

Journal article abstract: http://jfoodprotection.org/doi/10.4315/0362-028X.JFP-16-370?code=fopr-site

Use this news

This study challenges the long held belief that warm/hot water is needed for handwashing to effectively remove bacteria. As it turns out, cold water works just as well and washing hands for as little as 10 seconds does a decent job.

As far as antibacterial soap goes, according to the results of this study, it wasn’t that much more effective than using regular soap. Given the rising problem with antibiotic resistant bacteria, it’s best to avoid using it.

We all know that handwashing helps prevent infections, but the Centers for Disease Control (CDC) reminds us that:

  • Handwashing helps prevent diarrhea, respiratory infections and may even help prevent skin and eye infections because:

                     Bacteria, viruses and other disease causing germs get  
                      into the body through the eyes, nose and mouth
                      without us realizing it when we touch our faces with
                      our hands.


                      Bacteria, viruses and other disease causing germs
                      from unwashed hands can get into food and drinks
                      when people prepare or consume them. Some can
                      multiply in certain types of foods or drinks, under
                      certain conditions, and  make people sick – for
                      example botulism or salmonella.


                        Bacteria, viruses and other disease causing germs
                        from unwashed hands can be transferred
                        to objects, like handrails, table tops, or toys, and
                        then picked up by another person’s hands.

  • Handwashing not only keeps us individually healthier, it helps keep our communities healthier too.    
                       Handwashing:

                               Reduces the number of people who get sick with
                               diarrhea by 31%
                              
                                Reduces diarrheal illness in people with
                                weakened immune systems by 58%
                              
                                Reduces respiratory illnesses, like colds, in the
                                general population by 16-21%

  • Remember to wash your hands:

                     Before eating food
                     Before, during, and after preparing food
                     Before and after caring for someone who is sick
                     Before and after treating a cut or wound
                   
                    After using the toilet
                    After changing diapers or cleaning up a child who has                         used the toilet
                     After blowing your nose, coughing, or sneezing
                     After touching an animal, animal feed, or animal                                 waste
                     After handling pet food or pet treats
                     After touching garbage

  • To properly wash your hands, the CDC recommends the following:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. ...
  3. Scrub your hands for at least 20 seconds. ...
  4. Rinse your hands well under clean, running water.
For more information:

Centers for Disease Control – How and When to Wash Your Hands
https://www.cdc.gov/handwashing/when-how-handwashing.html

Mayo Clinic – Handwashing Do’s and Don’ts
http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-washing/art-20046253




 
 
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Three lifestyle changes to reduce risk of breast cancer after menopause
Joanna Hayden, PhD, CHES

A report last week from The American Institute for Cancer Research (AICR) and the World Cancer Research Fund based on the results of 119 studies, concluded that three lifestyle behaviors - maintaining a healthy weight, regular exercise and limiting alcohol - can reduce the risk of breast cancer after menopause.                                           
Complete report is at: http://www.aicr.org/continuous-update-project/reports/breast-cancer-report-2017.pdf

Use this news

The risk of breast cancer increases each decade as women age with the greatest incidence of the disease occurring after menopause. Overall, a woman has a 1 in 8 chance of developing breast cancer during  her lifetime.

There are a number of risk factors associated with breast cancer, some that can be controlled and others that cannot. Among the uncontrollable risk factors are those that increase lifetime exposure of breast tissue to the hormones estrogen and progesterone including:

  •   Early menarche - Menstruation beginning before age 12
  • Late menopause – after age 55
  • Never having children
  • First child after age 30

Other uncontrollable risk factors include:

  • Family history – especially first degree relative (mother, sister, daughter)
  • Genetic mutations – BRCA I and BRCA 2

Since there is relatively little we can do to change the uncontrollable risk factors, it makes sense to do all we can to address the controllable risk factors, especially those cited in the report above.

1.        Weight

There is strong, convincing evidence that greater body fatness throughout adulthood (greater BMI, waist-hip ratio, waist circumference) is a cause of post-menopausal breast cancer

There is strong, convincing evidence that greater weight gain in adulthood is a cause of breast cancer.

The AICR recommendations:

o   Keep weight as low as you can within the healthy range.

o   Don’t rely on supplements for cancer prevention –eat a
      healthy diet.

     Avoid high calorie foods and sugary drinks
     Eat more whole grains, vegetables, fruits and beans
     Limit red meat to one pound per week (beef, pork, lamb, etc.)
            

2.       Alcohol Consumption

There is strong, convincing evidence that alcohol consumption is a cause of post-menopausal breast cancer.

The AICR recommendation:

o   Don’t drink
     For cancer prevention, alcohol should be avoided altogether.

3.      Physical Activity

There is strong evidence that physical activity probably protects against post menopausal breast cancer

The AICR recommendations:

o   Move More
      Aim for 30 minutes of physical activity every day

o   Sit less

The preventative lifestyle changes above don’t negate the need for regular screening for early detection. As a reminder, the American Cancer Society recommends women at average risk of breast cancer begin yearly mammograms at age 45 and switch to every – other year at age 55.

For more information:

National Cancer Institute – Breast Cancer Risk Assessment Tool
https://www.cancer.gov/bcrisktool/

American Cancer Society – Breast Cancer
https://www.cancer.org/cancer/breast-cancer.html

 


 
 
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Possible record breaking tick season made worse by Powassan
Joanna Hayden, PhD, CHES

















The Centers for Disease Control is expecting this summer to be the worse tick season on record made even more troubling by Powassan, a potentially fatal viral disease transmitted by ticks. 

Summary article: https://medlineplus.gov/news/fullstory_165462.html

Use this news

While there are many benefits to a mild winter including lower heating bills and fewer snow days, one down side is the tick population. Our mild winter allowed more ticks to survive – which means more ticks will be looking for food this spring, summer and fall.  Unfortunately, their meals consist of blood – yours, your children’s, your pets’…they aren’t very picky about the source. And in exchange for feeding them, they sometimes leave you with the bacteria that causes Lyme disease. If you are an unfortunate recipient, antibiotic treatment is effective.

Not so with Powassan, a troubling new viral tick-borne disease.  There are no medications (antibiotics don’t work on viruses) to treat it or  vaccine to prevent infection. More troubling is that since Powassan virus can attack the nervous system, it can cause encephalitis (brain inflammation) and meningitis (inflammation of the membranes around the spinal cord). Although it’s not very common, with a record breaking tick season unfolding, the risk of Powassan transmission is increased.  

According to the CDC, it takes anywhere from about 7 – 30 days after being bitten by a tick carrying the Powassan virus for symptoms to begin, if they occur at all.

Because Powassan virus can infect the central nervous system, symptoms to look for  include:

  • fever
  •  headache
  •  vomiting
  •  weakness
  • confusion
  •  loss of coordination
  •  trouble speaking
  •  seizures
About half of those who survive a Powassan infection have permanent health issues such as recurrent headaches, muscle wasting and memory problems. 

Approximately 10% of people who develop viral encephalitis caused by Powassan virus, die.

Since there is no treatment and a possibility of fatality, the best way to protect you and your family from this or any tick-borne disease is to follow these CDC recommendations:

1.       Avoid contact with ticks
 
2.       Walk in the center of trails or paths through woods or
           tall grasses

3.      Use repellent:

On exposed skin use repellent with 20% or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.

On clothing (pants, boots, socks) and gear (tents) use repellant with 0.5% permethrin.

4.      Bathe or take a shower as soon as possible after coming
         indoors (preferably within two hours) to wash off and more
         easily find ticks that are crawling on you.

5.      Check your whole body for ticks and use a mirror to check
         your back, neck,  under the arms, in and around the ears,
         inside the belly button, behind the knees,   between the 
          legs, around the waist, and especially in your hair or on
          your head.

6.     Check pets, coats, backpacks, etc. as ticks can come into the
         house on them and attach to a person later.

7.     Put clothes in a dryer on high heat for 10 minutes to kill          
         ticks on dry clothing.

          If the clothes are damp, additional time may be needed.

          If the clothes need to be washed, wash them in HOT water.
          Cold and medium temperature water will not kill ticks
           effectively.

          For clothes that cannot be washed in hot water, tumble
          dry them for on low heat for 90 minutes or high heat for 60
          minutes. The clothes should be warm and completely dry.

Remember, it takes about 24 hours before a tick begins feeding on your blood, so don’t panic if you find one crawling on your skin.

               Use tweezers to take it off.
               Submerge the live tick in alcohol until it’s dead.
               Then, either flush it down the toilet or put it in a bag,  
                seal it, tape it and put it in the  garbage.
              

If you find a tick after it has attached, remove it using the following CDC recommended method:

  1. Using a fine-tipped tweezers - grasp the tick as close to the skin's surface as possible.

  2. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.

  3. If the tick is alive submerge it in alcohol to kill it and then placing it in a sealed bag/container, wrapping it tightly in tape, or flush it down the toilet. Never crush a tick with your fingers.

  4. After removing the tick, clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.

 DO NOT use nail polish, nail polish remover, petroleum jelly, gasoline, or the heat from a match to get the tick to detach from the skin. You want to remove it as quickly as possible–not wait for it to “let go.” (https://www.cdc.gov/ticks/).

For more information

Centers for Disease Control and Prevention
Powassan
https://www.cdc.gov/powassan/

Ticks
(https://www.cdc.gov/ticks/).

Tick removal
https://www.cdc.gov/ticks/removing_a_tick.html

Environmental Protection Agency
Find the insect repellant that is right for you
https://www.epa.gov/insect-repellents/find-insect-repellent-right-you


 
 
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Ah-choo?
No antibiotics for you!

Joanna Hayden, PhD, CHES

In a study of more than 180,000 people age 66 or older published recently in the Annals of Internal Medicine, almost half (46%) of the people seen by their physicians for a cold, acute bronchitis, sinusitis, or laryngitis were given antibiotics even though none of these are caused by bacteria, which is the only thing antibiotics work on. The likelihood of getting an antibiotic prescription was greatest from physicians in the mid to latter part of their careers, those who received their medical education outside of the U.S. or Canada, and from those who saw more than 25 patients a day.

Journal article abstract: http://annals.org/aim/article/2625386/antibiotic-prescribing-nonbacterial-acute-upper-respiratory-infections-elderly-persons

Article summary: http://www.medicalnewstoday.com/releases/317409.php

Use this News

Why is this important, you ask? Because inappropriate use of antibiotics has unintended consequences, among them: increased health care cost, increased risk of antibiotic resistance, and increased risk of drug induced complications  like allergic reactions and diarrhea - with the most serious of which is caused by Clostridium difficile (C. diff) - which can be fatal.

What can you do to avoid being prescribed antibiotics when you don’t need them? The CDC recommends the following actions:

·        Don’t pressure your health care provider for antibiotics.

·        Ask your health care provider about ways to treat your
          symptoms without antibiotics.

·       Tell your health care provider you are concerned about
         using antibiotics unless they are absolutely necessary to treat
         a bacterial  infection.

·         Practice good hand hygiene to prevent infection in the first
          place.

Remember -  taking antibiotics for a viral infection:

Will NOT cure you

Will NOT prevent those around you from getting sick

Will NOT make you feel better


For more information see:

Centers for Disease Control and Prevention
Antibiotics aren’t always the answer
https://www.cdc.gov/features/getsmart/

Protecting yourself and your family
https://www.cdc.gov/drugresistance/protecting_yourself_family.html

About antibiotic use and resistance
https://www.cdc.gov/getsmart/community/about/