Health Education

Public Health

<div style="font-family: "Trebuchet MS",sans-serif;">A newscaster was discussing what appears to be a growing trend where parents are choosing not to have their children receive any or all of the recommended (even mandatory) vaccines.  The change may be related to fears that are unsubstantiated, but I am not venturing into this argument - well, I would say that if you are contemplating not having your children vaccinated that you make sure your reasons are supported by reputable scientific sources.</div><div style="font-family: "Trebuchet MS",sans-serif;"> </div><div style="font-family: "Trebuchet MS",sans-serif;">The statement that caught my attention the other night was, to paraphrase:</div><blockquote class="tr_bq" style="font-family: "Trebuchet MS",sans-serif;">That is why they call it Public Health.  The actions or inactions of an individual can have an impact on the health of others.  </blockquote><blockquote class="tr_bq" style="font-family: "Trebuchet MS",sans-serif;">A person's family, friends, community - the country can become sick or pay a cost because of one or more individuals behavior.</blockquote><div style="font-family: "Trebuchet MS",sans-serif;">I, and many others, consider obesity to be a public health concern, but there are those that don't.  Some will say that being overweight or obese, to whatever degree that it is a choice, is a personal decision and thus, one's personal business.  Even if I believed that obesity was (always) solely the responsibility of an individual (I don't), I would still think that a high  population rate of obesity is  a Public Health issue.  </div><div style="font-family: "Trebuchet MS",sans-serif;">Obesity relates to a loss of productivity, mobility, mental health, physical health and independence.  Those losses can be devastating to one person, but we have about 75 million obese people in this country. The CDC estimates over 147 billion in medical costs for treating them in 2008 alone.  The mental and economical costs are not included</div>It is a good thing then that Medicare is going to start paying for some preventative services, but that's another story.  Point for today - Obesity IS a public health issue, if not crisis.

Public Health

A newscaster was discussing what appears to be a growing trend where parents are choosing not to have their children receive any or all of t...

7:55 PM

Cervical Cancer Screening

When I have discussed my concerns about the HPV vaccine, it has had more to do with the implied message in the marketing campaign.  The idea that the maker of the vaccine presents is that it could prevent cervical cancer (or now, oral cancer).  But the vaccine does not prevent cancer, it can prevent some, if not most, of the strains of the humanpappiloma virus that leads to cancer. It is the pap smear, the testing of cells from the cervix, that can prevent the cancer.   It seems that I started to hear conflicted recommendations on how often a woman should have a pap smear in recent years. What has remained consistent it that they are  recommended to begin at age 18 or when a woman becomes sexually active.  When I turned 18, the recommendation was for annual pap smears.  Within the last 5 years or so, some professional organizations began to tweak recommendations so that three and five year tests were acceptable in some situations.  It also was determined that after a certain age or a hysterectomy, the tests might not be necessary. In the last year or two, another screening measure was tentatively and with some controversy, recommended. This week the New England Journal of Medicine has a nice "perspective" piece on the varied recommendations.   I believe it is best that you read it yourself and it is available <a href="http://www.nejm.org/doi/pdf/10.1056/NEJMp1112532" target="_blank">here </a>for free.  If nothing else, skip down to the table that makes suggestions based on the personal situation of the woman.

Cervical Cancer Screening

When I have discussed my concerns about the HPV vaccine, it has had more to do with the implied message in the marketing campaign. The idea...

7:10 PM

Reduced Risk Drinking

I participated in  my second alcohol related motivational interviewing session for college athletes tonight.  Let me quickly clarify that we are using motivational interviewing techniques not to encourage drinking, but to reduce binge drinking and alcohol abuse.  I have used MI with tobacco cessation programming as well.  The idea behind this technique is that you get better results by avoiding paternalism. Instead, persons who might be affected by the issue (smoking, drugs, alcohol, not exercising) tell you what is wrong with the current situation.  The people involved come up with ideas that can prevent the adverse consequences of a behavior or the reasons to start a new behavior (like eating right).  We always begin with what is good about the issue and what is not so good.  You can even do this when asking someone to talk about "that boyfriend" who you personally know is a jerk and all wrong for your friend. If your friend is the one that says he is a jerk - THAT will motivate change. From the session we held tonight, I share a couple of things that you may not have known or given much thought to: <ul><li>the reason men can drink a little more than women during the same time period has to do an enzyme that breaks down alcohol - they have more of it than women.</li><li>body fat does not absorb alcohol (women usually have more than men and some people have more than others)</li><li>carbonated beverages whether mixed with alcohol or drunk in the same time period as an alcoholic beverage, exacerbate the effects of alcohol because the carbonation irritates the lining of the stomach and alcohol is absorbed quicker</li><li>food can help slow absorption but only if you eat before and during a drinking "event" and only if it is a substantial food - i.e. protein and whole grains, NOT white bread (that is a myth and a bad one)</li><li>drinking most often includes an initial buzz and then a depressive phase, it is said to be biphasic.  As the alcohol content goes up, the depressive symptoms increase.  One of our talking points tonight was that when a person is fatigued and drinks, the initial buzz phase does not occur.  As we talked about this, it became clear that alcohol seems to emphasize or exaggerate  whatever one is feeling.  IF you are happy, alcohol makes you happier, sad - sadder, angry -angrier.</li><li>water!  both alcohol and carbonated beverages can lead to dehydration.  To prevent it, one needs to drink water the whole evening, not at the end of the evening.  At that point, it will just be "peed" away.  This has to do with upsetting the body's water table.  I am not sure how that works, but you can cut me some slack for not knowing.  I am the obesity person remember!</li></ul> I will offer one comment the young ladies made in the what is good about alcohol section - someone said something about feeling grown up - which led her peer to say, "what like being 30 and having wine night."  I could not stop laughing....

Reduced Risk Drinking

I participated in my second alcohol related motivational interviewing session for college athletes tonight. Let me quickly clarify that we...

7:58 PM

Odds and Ends

HPV Vaccines: The UK has opted to cover Gardasil only, not Cervarix which also protects against HPV and vaginal warts.  To the best of my understanding, certain strains of HPV produce greater risks for both cervical and oral cancers.  They are not necessarily the same strains. I recall reading that Cervarix had studies supporting its efficacy in preventing oral cancer.  I remember because at the time I couldn't understand why that would matter.  A few years later, oral cancer cases associated with HPV have greatly increased  and the company that makes Cervarix is not pursuing those earlier findings.  Isn't that odd? BPA - We are used to hearing that BPA is present in some plastics and it is harmful.  This knowledge encourages many of us to reduce the use of plastic and to buy reusable plastic bottles that are BPA free.  It should also motivate us to avoid microwaving in plastic containers or to use plastic food wraps that are specifically noted as being "microwaveable." I actually thought BPA was banned but not quite.  This week news came out that BPA was also found in the blood of animals or people (I forget) who had been eating canned foods. Not to worry said the news report, BPA has only been found to be harmful in animals and babies.  WELL!  If it is bad for animals and babies, why in the world would I think it wasn't bad for me too!  In fact, Canada and the state of CT have banned the use of the chemical - full name is bisphenol A.  The federal government has yet to take action - its under consideration.  I assume that means  the chemical industry is doing some hard lobbying to retain the right produce/use it.  Restaurants - Last week USA Today published an article that discussed some of the ways restaurants were changing their offerings to meet the finicky eating habits of Americans.  I was hopeful that by finicky they meant healthy - like me!  Not so.  Interesting findings include, more snacks.  One of them being Chicken McBites.  Note to everyone: When something is deep fried (or fried or baked) in smaller pieces, that means more oil and more breading per bite.  In essence, more fat and calories.  People also like to eat breakfast foods at all hours, but I hardly find that news. However, some people like to have yogurt as a snack before they sit down for breakfast.  More disturbing trends - Maple Bacon Sundaes and Red Velvet Pancake Puppies with cream cheese icing, white choc chips and powdered sugar.  There is more, but as a student of obesity prevention, I can't write more without crying.  (after I wrote this, I heard a commercial from Subway - if you buy a 6 inch sandwich before 9 am, you get a second one free!  Guess if people can eat breakfast for dinner.....) Employee Wellness- Of course, after reading about 95% of McDonald's stores staying open 24 hours a day, this next blurb makes sense.  Employers are using money to get people to change their behavior - more is planned in 2012 then ever before according to a survey of 335 employers.  In fact, this strategy is termed, and I did NOT make this up, "behavior influencing incentives."  Nice (sarcastic comment).  The survey comes from the National Business Group on Health.  The article I read indicates that there will be a "dramatic increase in health care costs because of obesity."  This article also stated that overweight employees cost an employer (productivity, absenteeism and health care costs) about 5000 dollars more each year than a normal weight employee.  In 2012, 80% of those surveyed will be offering monetary incentives.  Some include reduced gym memberships and waived co pays.  In one part of the article, it was noted that obesity is linked to depression. This is true.  In another section, one employer group that was interviewed connected frequency of gym attendance with lower medical costs.  In fact, they had numbers to back them up. In other words, the more the person attended the gym,the more the company saved.  I would like to explore that data because I think that the persons going to the gym the most would have less depression, overall better mood and motivation to adopt healthy eating behavior as well. Strahan Hero- Just in case you missed it yesterday.  Former NY Giant Michael Strahan is promoting COPD screening in a current public service announcement.  This makes me happy.

Odds and Ends

HPV Vaccines : The UK has opted to cover Gardasil only, not Cervarix which also protects against HPV and vaginal warts. To the best of my u...

7:49 PM

Spirometry

<div style="font-family: "Trebuchet MS",sans-serif;">A year or two ago, I wrote a few passionate posts regarding smokers and the risk for COPD.  Earlier this year, I wrote with similar passion when results from a national lung cancer screening trial suggested that smokers received CT scans as a measure to prevent lung cancer or lung cancer death.</div><div style="font-family: "Trebuchet MS",sans-serif;">My concern has always been the under use of the spirometer for lung function status. Forced Expired Volume or FEV is a measure of lung health (how much air can a person blow out in seconds).  The value is used to determine if one has COPD.  COPD is one of the leading causes of death in the USA.  More smokers are effected by COPD than lung cancer and many cases of COPD go undetected and thus untreated.  It is a devastating disease, but I have said all this i<a href="http://yourhealtheducator.blogspot.com/#uds-search-results">n the past.</a></div><div style="font-family: "Trebuchet MS",sans-serif;">Today I am quite jazzed to report that a public service campaign is underway - I uncovered it by accident.  The public service announcement or PSAs appear to be grounded in sports.  </div><div style="font-family: "Trebuchet MS",sans-serif;">I am beyond thrilled to say that one of my favorite former NYGiants football players is part of the initiative.   </div><div style="font-family: "Trebuchet MS",sans-serif;">When I did presentations regarding the medical consequences of smoking, I often had my audience jog in place while breathing through a straw.  In the PSA I heard, Michael Strahan says that COPD is like breathing through a straw. </div><div style="font-family: "Trebuchet MS",sans-serif;">I found the website associated with the campaign and you can visit it <a href="http://drive4copd.com/get-involved.aspx">here.</a></div>The campaign or awareness goal is to get people tested - this is grand.  A lung function test is simple and cheap.  Keeping a person with COPD from having exacerbations is essential in preserving lung tissue and lung function.

Spirometry

A year or two ago, I wrote a few passionate posts regarding smokers and the risk for COPD. Earlier this year, I wrote with similar passion ...

6:07 PM

Days of Being Thankful

One of the things that I am most grateful for is the opportunity to pursue a terminal degree - I know that sounds funny, but it means the highest academic degree in a certain field.   It is this chance to earn a doctorate in public health that keeps me away from family this Thanksgiving weekend.   I have a lot of work to do and I will not be lonely or bored but I will be melancholy and miss being with those that I love so much.  It also has occurred to me that most people who read my blog on a regular basis, surely more than half, are living in the US and will be traveling to be with family or entertaining family in their homes.   That being said, I should probably take a few days off from blogging - not as much to save time as to save ideas.  I think that blog reading is not on many agendas for the rest of this week.  I might as well save my thoughts for when people will read them.  I do need to get some YouTube videos made and finish my final projects for this semester, in the meantime.  And this may come as a shocker, but I am going to miss my second day of swimming this week.  Never saw that coming! I will leave you with one more article related to the school lunch SCANDAL.  This <a href="http://www.hsph.harvard.edu/nutritionsource/nutrition-news/misguided-lunch-move-on-potatoes/index.html">article</a> is from the Harvard School of Public Health. (enjoy your feasting and don't make your belly hurt by eating too much - remember it's bad for the heart to super, over indulge - and I mean it is bad at the moment -acutely- makes it work too hard)

Days of Being Thankful

One of the things that I am most grateful for is the opportunity to pursue a terminal degree - I know that sounds funny, but it means the hi...

6:47 PM

A Half a Dollar a Year

That is all it would take, according to a report issued in September by the  <a href="http://www.who.int/chp/ncd_global_status_report/en/">World Health Organization</a>.   The report was meant for international leaders and stakeholders who might benefit from cost effective measures to reduce the incidence and burden of noncommunicable disease conditions (formerly known as chronic disease). The information from the report is similar to what was highlighted in a <a href="http://yourhealtheducator.blogspot.com/2011/10/ncd-alliance.html">recent blog post</a> centered on the UN Summit that was held in NYC this past September. I saved the article that gave an overview of the report because it mentioned something that is of great interest to me:  population based public health measures.  The examples given include taxes on alcohol and tobacco, promoting smoke free indoor environments, reducing the availability of foods high in saturated fat content and using health promotion to encourage positive dietary behaviors and exercise.  Population level strategies can reach a great number of persons and therefore allow us to get the most for every penny we spend.   It is really important to note that this is not only a US problem, or a UK, Australian or Mexican one.  It is a world problem.  As countries move from low income to middle and high, the incidence of obesity and chronic disease also rises.  This is in large part due to the influx of energy dense, nutrient poor foods and to a lesser extent, a decrease in physical activity.

A Half a Dollar a Year

That is all it would take, according to a report issued in September by the World Health Organization . The report was meant for internat...

6:13 PM

Odds and Ends

For this week's odd and ends I bring you two pictures. The first is a picture of three box tops from cereal.  Each box has its own front of pack labeling scheme.  The manufacturers chose to include six items instead of the three that are recommended by the Institute of Medicine(IOM).  If the system was standardized, as I have previously explained, the cereals would look the same with different numbers (perhaps) in the scheme.  I drew a box in the picture to give you an idea of what I am mean. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOok6i_goIvb3UmOC_xmL8OjTWJ3yWrbopI9wcuGxm47pxTnmYRdL5tkLwuMs-DwIYpS1_Pbb-EmlQZipUEght7j9tKdJWM-Dyx51AYCdu1ruAt75Mux9mwyLQcZgkziaXFuQZIO6WdFXh/s1600/FOP+example.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="303" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOok6i_goIvb3UmOC_xmL8OjTWJ3yWrbopI9wcuGxm47pxTnmYRdL5tkLwuMs-DwIYpS1_Pbb-EmlQZipUEght7j9tKdJWM-Dyx51AYCdu1ruAt75Mux9mwyLQcZgkziaXFuQZIO6WdFXh/s400/FOP+example.JPG" width="400" /></a></div> The next picture is one I snapped at the grocery store yesterday.  It would qualify for my "outrageous" or "are you kidding" segment, if I had one.  I believe that the product is meant to be similar to margarine or some type of butter spread.  It contains 50 calories for 14 grams (this qualifies as a very small RACC - or reference amount customarily consumed).  It would be considered an energy dense food.  Recall that fruits and vegetables have ranges of 0.3 to 0.7 cals per gram and this item has 3.5 cals per gram.  This product is also an example of something the IOM wanted to prevent when it came up with a front of pack labeling system.  That would be the fortification of products so that they would get a point or some other kind of shout out when they really should not.  That appears to be  what this company is trying to do with the name of the product and the supplements they added.  The truth is this.  IF something is bad for you, adding something that is good for you does not change that!  (for example fiber in your honey buns or soda).  Also, the ingredient list on this product is pretty scary. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqBFlb0qKNRBi2uWgqohKqk_noJwsifcyTYm1T6Ow38iZ3No2fLrBxlCin9c3AesFja23CfAkRfVCBREl9GY-lG9Bmn77i00Bkx8pjsQoZNZohIBxE1WX_N17p8IRwJRG1lHfZo0CKC-58/s1600/cardio+spread.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqBFlb0qKNRBi2uWgqohKqk_noJwsifcyTYm1T6Ow38iZ3No2fLrBxlCin9c3AesFja23CfAkRfVCBREl9GY-lG9Bmn77i00Bkx8pjsQoZNZohIBxE1WX_N17p8IRwJRG1lHfZo0CKC-58/s320/cardio+spread.jpg" width="320" /></a></div>

Odds and Ends

For this week's odd and ends I bring you two pictures. The first is a picture of three box tops from cereal. Each box has its own front...

5:26 PM

The Wisdom of Youth

My plan to tell you about a cool website that I found has been derailed. I was reviewing some feedback from my students and two comments are just too important and insightful to go unshared. We watched a film last week (or parts of one) that showed footage from the "sexual revolution."  It discussed sex and objectification of women among other things. These two comments refer to different things.  The second comment was made by several students in similar fashion.  These are college aged adults. 1) beauty is not earned (this may be one of the most profound statements I have ever heard) 2) sex doesn't always result in disease or children - sometimes it just feels really great and leads to  an orgasm. (note that the people who said this also gave foot notes about using protection and contraception - because they are smart!) I am really going to miss teaching next semester.

The Wisdom of Youth

My plan to tell you about a cool website that I found has been derailed. I was reviewing some feedback from my students and two comments are...

6:10 PM

National School Lunch Program

<div style="font-family: "Trebuchet MS",sans-serif;">In a follow up to the NLSP and the recommendations from the USDA and the IOM, I give you this video because I am too depressed to actually write about it. [recall that by law, the school lunch program has to align with the current Dietary Guidelines for Americans.  It does not.]  Someone else has written about the recent events and you can read that<a href="http://www.nytimes.com/2011/11/16/us/politics/congress-blocks-new-rules-on-school-lunches.html?_r=2"> here</a>.  Also, you can contact your congressperson with a form letter (very easy email activity) to request that they support the recommendations. </div>Click <a href="http://action.earthday.net/p/salsa/web/tellafriend/public/?tell_a_friend_KEY=9945" style="font-family: "Trebuchet MS",sans-serif;">here</a> for more. <object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=10,0,0,0" height="245" id="msnbc824447" width="420"><param name="movie" value="http://www.msnbc.msn.com/id/32545640" /><param name="FlashVars" value="launch=45347175&width=420&height=245" /><param name="allowScriptAccess" value="always" /><param name="allowFullScreen" value="true" /><param name="wmode" value="transparent" /><embed name="msnbc824447" src="http://www.msnbc.msn.com/id/32545640" width="420" height="245" FlashVars="launch=45347175&width=420&height=245" allowscriptaccess="always" allowFullScreen="true" wmode="transparent" type="application/x-shockwave-flash" pluginspage="http://www.adobe.com/shockwave/download/download.cgi?P1_Prod_Version=ShockwaveFlash"></embed></object> <div style="background: transparent; color: #999999; font-family: Arial, Helvetica, sans-serif; font-size: 11px; margin-top: 5px; text-align: center; width: 420px;">Visit msnbc.com for <a href="http://www.msnbc.msn.com/" style="border-bottom: 1px dotted #999 !important; color: #5799DB !important; font-weight: normal !important; height: 13px; text-decoration: none !important;">breaking news</a>, <a href="http://www.msnbc.msn.com/id/3032507" style="border-bottom: 1px dotted #999 !important; color: #5799DB !important; font-weight: normal !important; height: 13px; text-decoration: none !important;">world news</a>, and <a href="http://www.msnbc.msn.com/id/3032072" style="border-bottom: 1px dotted #999 !important; color: #5799DB !important; font-weight: normal !important; height: 13px; text-decoration: none !important;">news about the economy</a></div>

National School Lunch Program

In a follow up to the NLSP and the recommendations from the USDA and the IOM, I give you this video because I am too depressed to actually w...

6:56 PM

Hold the Stuffing

No - I did not forget.  If it has not already started, it soon will.  Besides the usual temptations of an obesogenic environment, we will all be challenged by and delighted with, the foods of our holiday traditions.  It is the favorite time of year for many of us and food pushers will flourish.   This is NOT the time to lose weight, but it is not the time to go crazy either.  I personally hate the saying, "everything in moderation," because it is not true. And still, I think it unwise to turn away from the love and good cheer that those holiday treats are wrapped in.  Therefore, I suggest that for the next three weeks a little creative food navigation is in order. [I am not going to list all the tips and tricks for party going - I have done that before and many websites offer more.] I do want to bring back the Hold the Stuffing Challenge.  This is a commitment you make to yourself or to a group.  Whether you do it alone or with others, the first thing to do is weigh yourself.  I suggest you do that soon.  If you are having a group contest, add everyone's weight together. The goal is to keep your weight or the groups weight within two pounds (or five for a group) of the original weight.  It can be that much less or that much more.  IF a group, you can pitch in for some kind of group prize.  I created a tracking sheet which you can find <a href="https://docs.google.com/Doc?docid=0AVpUruYXPyXJZGNycXRnMzRfMTIyZzhwcXRocnQ">here.</a>  If you have a really cool boss (like I had), people who meet the plus or minus 2 pound goal, can get a prize. Remember, you can taste the things you love, even have a large piece of your favorite pie - but then something else has to go.  I do not suggest turning everything down because, especially at this time of year, it hurts people's feelings. (For those of you whose weight is putting you at risk for chronic disease conditions, this is not a way to avoid personal responsibility nor is it intended to derail you.  This is just a way to hold steady for a few weeks.) Hold the Stuffing is centered around the US Thanksgiving and Christmas Holiday period.  The goal is to hold weight steady until the first of the new year.  The strategy can be used during other holiday times that are equated with over indulgence as well.

Hold the Stuffing

No - I did not forget. If it has not already started, it soon will. Besides the usual temptations of an obesogenic environment, we will al...

7:02 PM

Degree Not Needed, Sugar Pooh

I purposefully left my Monday blog up for two days.  I felt that the issue was important enough for us to dwell on.  Yesterday the <a href="http://thedianerehmshow.org/shows/2011-11-15/looming-worldwide-diabetes-epidemic">Diane Rehm show</a> discussed diabetes and its association with weight, the importance of choosing better foods and the benefit of adding exercise to every day.  A caller to the show talked about his diagnosis of diabetes and how hard it was to eat well outside of his own home.  He had gone to an event to support one of his children and  he recalled the breakfast they served; toast, hashbrowns, bacon, eggs, and so on .  He said it was as if the culture we live in was set up to create a diabetes epidemic.  Some public health experts would agree.  Diane added some comments about how hard it was to find anything of quality to eat when traveling by plane.  I think that is changing a little, but you really have to know what you are doing in order to make healthy choices.  I linked her show in case you want to listen.  She had several experts on as guests. I had to mention the show because it was important, but my post today really centers on something that I observed in one of my classes last night.  The student sitting next to me had a canned drink that at first appeared to be an energy drink because of its size.  I think it was just a smaller can of coca cola.  I could see the back and the label.  I noticed that it had 25 grams of sugar and 90 calories.  I thought, well, if she would have had a 150 to 200 calorie drink, that is better.  At class break, she came back with a pack of nabs and a 12 ounce bottle of regular Dr. Pepper.  Meanwhile, I had a diet Mt Dew and half a peanut butter sandwich.  My classmate weighs significantly more than me, possibly 100 pounds more.   On the one hand, we could say, "Well this isn't rocket science then.  One of us was monitoring or moderating our intake and the other was not."  Of course, what an observer doesn't know and I don't know, is what goes into the decisions people make.  Food decisions tend to be much more nuanced than they appear to be.  I would, however, like to show people how they can eat and drink more without taking in extra calories (extra meaning more than they need to maintain a healthy weight).  But especially after the last post on sugar sweetened beverages, I found last nights observation troubling.

Degree Not Needed, Sugar Pooh

I purposefully left my Monday blog up for two days. I felt that the issue was important enough for us to dwell on. Yesterday the Diane Reh...

7:04 PM

An Open and Fruitful Discussion

Hi All, First off, kudos to Iris, Shayne and Yeshika for coordinating a terrific session last night. Also kudos to our panelists - Matt, Emily, Mo, Mike, Sarah, Drs Foster and Harris. Lastly, kudos to all the students who contributed to a terrific turn out for our discussion! So, here's what I heard around which we had consensus:   *We can gather together having different points of view and have a robust discussion about making a difference with our patients.   *Docs should be skilled to deliver effective health and sex education to their patients (and parents.)   *In ways small and large, there is a great interest in helping promote safety of children so that they have as many options available to them.   *Lives of our patients may be very different than our own, so imposing our attitudes and expectations may not be a 'best fit.'    *Patient autonomy and respect are important.    *We can be respectful of difference in opinions but facts and opinions are two very different things and excellent clinicians based actions on evidence.    *Free condoms never hurt!    *Women's reproductive choices play an important part of their lives and are never a trivial matter. Regrettably, we weren't able to 'solve' the healthcare delivery and finance problem in the time provided. We did have an engaging discussion about divergent opinions and varied viewpoints. So from a least to most about getting involved or learning more - here's some after-care sites to check out: THE NUMBERS: Numbers and trends of abortion *Abortion is one of the most frequently performed procedures in the U.S. Abortion rates have steadily declined since the procedure was legalized in 1974; however, the rate of decline has been slowing down since 2000. *Of the 49% of unplanned pregnancies (2001), 24% ended in abortion (this number excludes miscarriages) *This 24% consisted of 16% of currently married, 16% formerly married and 67% never-married women. *61% of abortions were obtained by women who have one or more child *The majority of women who obtained an abortion (54%) were using some type of contraceptive method (that failed due to inconsistent or incorrect use) 13-14% (pill vs condom) uses reported correct use and method failure. References Finer LB, Henshaw SK. Estimates of U.S. Abortion Incidence, 2001–2003. Guttmacher Institute. August 3, 2006. Available at http://www.guttmacher.org/pubs/2006/08/03/ab_incidence.pdf. Accessed September 09, 2006.; Jones RK, Darroch JE, Henshaw SK. Patterns in the socioeconomic characteristics of women obtaining abortions in 2000–2001. Perspectives in Sexual and Reproductive Health. September/October 2002; 34(5):226–235. ; Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.; Jones RK, Darroch JE and Henshaw SK, Contraceptive use among U.S. women having abortions in 2000–2001, Perspectives on Sexual and Reproductive Health, 2002, 34(6):294–303. *ABOUT 1/3 - An estimated 35% of women will have at least 1 abortion by the time they are 45 years old. Reference  Boonstra HD, Gold RB, Richards CL, Finer LB. Abortion in Women’s Lives. New York, NY: Guttmacher Institute; 2006. OVERALL DOWN TRENDING RATES <img alt="Abortion rate line chart" border="0" height="230" src="http://www.guttmacher.org/graphics/factsheets/2011/01/10/IB-induced-abortion-c1.gif" width="500" /> References  Finer LB and Zolna MR, Unintended pregnancy in the United States: incidence and disparities, 2006, Contraception, 2011, doi: 10.1016/j.contraception.2011.07.013. Jones RK and Kooistra, K., Abortion incidence and access to services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41-50. *Abortion rates are trending downward - The CDC reported a 2% drop in rates (<a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6001a1.htm?s_cid=ss6001a1_w">see here</a>) A number of factors contribute to the overall decline in abortion rates in the US:   1. More and better contraceptive options; 2. Increased and improved contraceptive use, particularly of long-term contraceptives;     3. Decreased access because of fewer providers and/or anti-choice harassment and stigmatization         (This study did not delineate differences in age, income levels or other factors) References  Finer LB, Henshaw SK. Abortion incidence and services in the United States in 2000. Perspectives on Sexual and Reproductive Health. January/February 2003; 35(1):6–15. *AGE RANGE FOR HIGHEST RATES: 56.9% of abortions occurred in women ages 20-29 (29.4 abortions per 1,000 women aged 20--24 years and 21.4 abortions per 1,000 women aged 25--29 years). TEEN DATA Eighteen percent of U.S. women obtaining abortions are teenagers; those aged 15–17 obtain 6% of all abortions, teens aged 18–19 obtain 11%, and teens younger than age 15 obtain 0.4% In contrast to the overall unintended pregnancy rate of 49%, teens unintended pregnancy rate is 82% with 40% of these ending in abortion. Reference   Jones RK, Finer LB and Singh S, <a href="http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf" jquery1321389944196="5">Characteristics of U.S. Abortion Patients</a>, 2008, New York: Guttmacher Institute, 2010; Finer LB, Henshaw SK. Disparities in Rates of Unintended Pregnancy In the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health. 2006; 38(2):90–96. PARENTAL NOTIFICATION AND IMPACT - Fear is a health hazard for teens Parental notification laws have a negative impact on adolescents’ access to reproductive health care. According to the American Medical Association and the Society for Adolescent Medicine, the primary reason that adolescents often do not get the health care they need is that they fear disclosure of confidential information to their parents or guardians. A regional survey of suburban adolescents found that less than 20% would seek care related to birth control or STDs if parental notice was mandated. Another study found that 59% of sexually active adolescent girls would stop, delay, or discontinue using specific sexual health care services if parental notification were legislated. References   Lieberman D, Feierman J. Legal issues in the reproductive health care of adolescents. J Am Med Womens Assoc. Summer 1999; 54(3):109–114.; Marks A, Malizio J, Hoch J, Brody R, Fisher M. Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population. J Pediatr. March 1983; 102(3):456–460.; Reddy DM, Raymond F, Swain C. Effect of mandatory parental notification on adolescent girls’ use of sexual health services. JAMA. August 14, 2000; 288(6):710–714 HEALTH CARE DELIVERY RE-INTEGRATION - A FOCUS OF CHANGES TO SUPPORT OPTIONS? "Most of the difficulties in providing and obtaining access to abortion services would disappear if abortion were integrated with other health care for women"  Reference  Henshaw SK. Factors hindering access to abortion services. Family Planning Perspectives. March/April 1995; 27(2):54–59, 87. This is a procedure that is part of comprehensive women’s health care - Perhaps the health care delivey change is putting it back into comprehensive care practice? SAFETY ISSUES AND ABORTION - a complete listing of information is available from the Guttmacher Institute located <a href="http://www.guttmacher.org/pubs/fb_induced_abortion.html">here </a> Highlights include: highly safe procedure; no evidence of association between abortions and risk for any types of <a href="http://www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage">cancer</a>; no hazard for mental health. SOCIOCULTURAL DETERMINANTS OF HEALTH AND INEQUITIES Poverty compounds sexual health educational understanding, resources and choices - abortion rates decrease across all racial/ethnic groups as income levels increase. (So maybe better educational systems and better jobs are one solution!) Although women who are White have the lowest abortion rates, they also have the lowest pregnancy rates. Reference  Jones RK, Darroch JE, Henshaw SK. Patterns in the socioeconomic characteristics of women obtaining abortions in 2000–2001. Perspectives in Sexual and Reproductive Health. September/October 2002; 34(5):226–235 CAUSES: So if we consider that we want to address root causes (the why) rather than the symptoms (the abortion) - what is in the literature about the causes and what can we do to address them? TOP THREE 1- (74%) Not ready for parenthood and make changes involved (including employment and educational opportunities put at risk) and overall increase in responsibility 2- (73%) Can't afford a child - lack of economic support for a child (or another child) 3- (48%) Don't want to be a single parent or relationship problems (not in one, not want to marry or continue with parnter or he won't/can't marry or support her) Additional reasons: Does not want anyone to know she has had sex or is pregnant Too young or immature to be a parent or carry the pregnancy to term Does not want any more children; may feel overwhelmed and overworked Partner, man involved in the pregnancy, or parents want her to have an abortion The fetus has health problems or genetic abnormalities Victim of interpersonal violence/sexual coercion, including rape or incest Pregnancy may pose risk to the woman’s health References Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives. Perspectives on Sexual and Reproductive Health. Sep 2005; 37(3).; Planned Parenthood. Choosing Abortion. New York, NY: 2006. Available at http://www.plannedparenthood.org/birth-control-pregnancy/abortion/choosing-abortion.htm. Accessed November 14, 2006. So look at that list - what do you think needs to be in place to address the root causes? If you go to an area school that has no books and are unable, even at graduation to read, what type of job can you obtain? You may be saying that as a future physician - reading or public education isn't on your 'to-do list' - but maybe your voice can mobilize action and change. What do you need to be doing to educate boys and men about what it means to be a man in our society? How can you support economic empowerment so that individuals can garner a living wage and be able to support a family? What messages do we need to be better at conveying about self-esteem? About protection of children from sexual assault? How can we provide meaningful information about real-world options to prevent the legacy of teen motherhood? We need your ideas - your innovation - your time understanding the people who are disconnected from being as healthy as they can be. If we had the answers, in theory, we'd be done - we aren't. So.... So these all seem huge and daunting, I'm sure. Here's some baby steps to take (from little to more :>) 1. BE INFORMED: Subscribe to, add to an RSS feed or regularly check out Kaiser Family Foundation Women's Health Policy located <a href="http://www.kff.org/womenshealth/">here </a>; CDC data <a href="http://www.cdc.gov/reproductivehealth/">here</a>; Preventing Teen Pregnancy <a href="http://www.cdc.gov/VitalSigns/TeenPregnancy/index.html">here </a> Read about What Can Be Done <a href="http://www.cdc.gov/VitalSigns/TeenPregnancy/WhatCanBeDone.html">here</a> <img alt="People talking" class="lefty" height="83" src="http://www.thecommunityguide.org/images/Adol-Health.jpg" style="margin-right: 10px; margin-top: 4px;" width="125" /> 2. IDENTIFY USEFUL RESOURCES: Check out the CDC Adolescent Health site <a href="http://www.cdc.gov/HealthyYouth/AdolescentHealth/">here</a>; There is an amazing library of resources at CORE (Curricula Organizer for Reproductive Health Education) located <a href="http://core.arhp.org/search/">here</a>; A Philadelphia based awesome resource, Women's Law Project located<a href="http://www.womenslawproject.org/"> here</a> 3. FIND OUT WHAT YOUR FUTURE FIELD IS DOING IN THIS AREA - APA (Peds); SGIM (General Medicine); APGO (Ob/Gyn); AAFP/STFM (Family) all have information. Check it out and see how you can be involved. <img alt="image of adolescents" height="133" src="http://www.cdc.gov/healthyyouth/images/adolescent/adolescents2_sm.jpg" style="float: right;" width="200" /> 4. FIND OUT OTHER ORGANIZATIONS like the Association of Reproductive Health Professional (click <a href="http://www.arhp.org/publications-and-resources">here</a>) ; the Guttmacher Institute (click <a href="http://www.guttmacher.org/">here</a>); Our local family planning council has a wonderful list of resources <a href="http://www.familyplanning.org/reprolinks.shtml#r7">here</a>. Here's a site that's mission is to use the law to advance reproductive freedom as a human right (click <a href="http://reproductiverights.org/en/about-us">here</a> ); APHA and reproductive rights (policy statement <a href="http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1251">here</a>); Association of Clinicians for the Underserved (click<a href="http://www.clinicians.org/"> here</a>) 5. VOLUNTEER to get a better idea of the lives, circumstances and challenges (as well as strengths) of our patients (and future patients) Reflect on the causes noted above. Consider what interventions or changes you could create to make a difference. 6. MAKE TIME FOR LOBBYING TRAINING AND VISIT PEOPLE (Harrisburg, Washington, local offices, attend a town hall of someone running for election/re-election, your hometown...) <img src="http://www.familyplanning.org/random/rotator.php" /> Together, we can come up with ideas and solutions that respect our patients and help them have more options in their lives while living healthier!

An Open and Fruitful Discussion

Hi All, First off, kudos to Iris, Shayne and Yeshika for coordinating a terrific session last night. Also kudos to our panelists - Matt, Emi...

3:06 PM

SSBs - HD, TG, WC, IFG and that is not what the headline said......

The American Heart Association held a conference in Orlando Florida over the weekend.  Many sessions were held during the event and new research was presented during some of them.  The conference topics were broken into large core groups and one of them, Epidemiology and Prevention of CV Disease: Physiology, Pharmacology and Lifestyle contained several presentations regarding sugar sweetened beverages and added sugar. A particular session titled, You Are (mainly)What You Eat, regarded a new (not yet published) study,  by Christina Shay.  Dr. Shay is from Northwestern University.   The findings that she reported at the conference have been making headlines all over the place in the last two days.  I have read the abstract and <a href="http://circ.ahajournals.org/cgi/content/meeting_abstract/124/21_MeetingAbstracts/A8438?sid=18989120-f9c3-4b8d-839f-0a114af703d9">you can too</a>, as well as some of the news stories themselves.   There is a little bit of a disconnect between the two and as I LOVE to share truth - I will do so now. I will start by deciphering my title.  SSBs you should know from reading my blog.  It stands for Sugar Sweetened Beverages.  For the study in question, the researchers compared the number of sugar sweetened beverages a person consumed in an average day to cardiovascular risk factors they later developed.  I will spell those out in a moment.  The amount of SSBs was determined through self report in a Food Frequency Questionnaire.  A sugar sweetened beverage was defined as sodas, teas and coffees - a health professional interviewed by one of the news agencies referred to the coffee drink as a dessert more than a beverage.  (I am not sure what they did about fruit, energy and sports drinks)   The people involved in the study were part of a bigger study but we won't get into that just now.  For this analysis, the study included men and women of several ethnic backgrounds (US).  All were  between the ages of 45 and 84 at the beginning of the study which lasted from 2002 to 2007.   At the start (or baseline), none of the participants had been diagnosed with heart disease (HD).  They were evaluated or measured at two additional times.  Associations between a person's intake of certain nutrients was compared with incidence of several outcomes.  (I imagine that SSB was not the only thing they looked into, but it is the only behavior they made associations with in this report). The outcomes for which they found a statistically significant difference between groups include WC or waist circumference, IFG or impaired fasting glucose (a sign of insulin resistance and possible risk for diabetes), and TG or triglycerides (blood fats).   They compared groups by SSB status.  The group that they considered a reference included persons who had one or less SSB per day.  Compared to that reference group, women in the study who drank 2 or more SSB a day, had more of an increase in waist size (WC), IFG and TG.  One of the results that is getting a lot of attention is that the 2+ a day SSB group was 4 times more likely to have clinically high TG.  Triglycerides are blood fats and it appears that excess sugar in the diet can lead to increased TGs. I am not sure what the news stories were trying to articulate, but the emphasis they made was on increasing TG levels related to sugary beverage consumption, "even in skinny girls."  This may be related to the finding in the actual study or the truth that the 2+ group had increased waist size whether or not they had increased weight.  Increased WC is the risk factor for heart disease not increased weight - so the headline is misleading.  It is also worth reminding people that sugar consumption is one of the main contributors to obesity because it is easy to consume more calories than you need or even realize your consuming with sugar products. It is also important to note that refined sugar, in drinks or sweets, spikes the blood sugar.  Having this type of action in the body several times a day every day is a great risk for insulin resistance.  Diabetes is a cardiovascular (heart) problem.  We do not often think of it that way, but the condition leads to heart damage.   The soft drink case is especially pronounced in women.

SSBs - HD, TG, WC, IFG and that is not what the headline said......

The American Heart Association held a conference in Orlando Florida over the weekend. Many sessions were held during the event and new rese...

5:55 PM

Skill Not Will - A CHANGE FOR THE BETTER

<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="allowfullscreen" frameborder="0" height="266" mozallowfullscreen="mozallowfullscreen" src="https://www.youtube.com/embed/FPW_02abguI?feature=player_embedded" webkitallowfullscreen="webkitallowfullscreen" width="320"></iframe></div>At the most recent Association of American Medical Colleges conferences, there was a presentation by Joseph Gerry from <a href="http://www.vitalsmarts.com/research.aspx">Vitalsmarts </a> who talked about research <a href="http://youtu.be/DBIQLmESeU8">about behavior change</a>. BEHAVIORAL INFLUENCE IS FOUR TIMES THAT OF MEDS! Mr Gerry cited an article by McGinnis (<a href="http://content.healthaffairs.org/content/21/2/78.full">J.M. McGinnis, P. Williams-Russo, and J.R. Knickman, “The Case for More Active Policy Attention to Health Promotion,” Health Affairs 21, no. 2 (2002): 78–93.)</a> that attributes 40% of deaths due to behavior. In contrast, medications, procedures, labs and tests only contribute 10-15%! SOURCES OF BEHAVIORAL INFLUENCE  His theme for his presentation was about the six areas that need to be working to promote behavior change. THE SIX SOURCES OF INFLUENCE <ol><li>Personal Motivation – overcome your own reluctance and resistance</li><li>Personal Ability – learn how to master the necessary skills for success</li><li>Social Motivation – enlist help from leaders or other opinion leaders</li><li>Social Ability – leverage teamwork</li><li>Structural Motivation – reward your early successes </li><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZAVlJXjWC-j4tQcazjleMUWElWWhlopleitVIIlj8Cxz0FXg56vS5mls4E_SPaXzeeUJHHoZHuhZvx7vWfqoYed1RBdkYgSzFONX4ygGyS_0gzO4KhbvIXVG9ezJcSgx2CICJXmfYTjrV/s1600/Presentation1.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" nda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZAVlJXjWC-j4tQcazjleMUWElWWhlopleitVIIlj8Cxz0FXg56vS5mls4E_SPaXzeeUJHHoZHuhZvx7vWfqoYed1RBdkYgSzFONX4ygGyS_0gzO4KhbvIXVG9ezJcSgx2CICJXmfYTjrV/s320/Presentation1.jpg" width="320" /></a></div><li>Structural Ability – surround yourself with a supportive physical environment   </li></ol>If you want to make change, you need to use four or more of these sources of influence to change bad habits. If you use all six, you can be 10 times more successful.   Per research from his organization, if a person has four areas working for them, they have four times the likelihood at making the change.   PRACTICING CHANGE - The average number of times you need to make the change (before it sticks) is 23!!   SKILL NOT WILL - Another area highlighted was that we overdepend on motivation ("If only I wanted that enough!") and under-rely on learning skills to promote change. He refers to this as the 'will power trap.' My this over-reliance we merely abuse ourselves (at our failures) rather than learn from our mistakes. The barrier to change is our blindness to this fact - not our motivation.  See the blindness video <a href="http://www.youtube.com/watch?v=4o4vYMdE5gU">here</a> or click below: <div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="allowfullscreen" frameborder="0" height="266" mozallowfullscreen="mozallowfullscreen" src="https://www.youtube.com/embed/4o4vYMdE5gU?feature=player_embedded" webkitallowfullscreen="webkitallowfullscreen" width="320"></iframe></div>  HOLD TWO VIEWPOINTS In the presentation, Gerry encouraged the audience to become "the subject AND the scientist." By identifying how I am excellent at avoiding exercise, for example, I have a long list of what doesn't work - what skills to not-exercise that I have. By writing them down, I can generate the skills I need in order to make a change. Check out the <a href="http://changeanything.com/">Changeanything.com</a> website with a custom change plan <a href="http://www.changeanything.com/plandefinitions/219/public">here</a>.   SO WHAT DO YOU WANT TO CHANGE? Per Gerry - we aren't unmotivated, we are blind and outnumbered. So we have to first see what we are (and aren't doing) and identify the skills we need.   WHAT EXPERT SKILLS DO YOU HAVE IN NOT-CHANGING? (aka "I'm aware that ultimatums don't work for me'; "I'm excellent at procrastination) WHAT SKILLS DO YOU NEED?   DO YOU HAVE GOOD COACHES TO HELP WITH THE CHANGE? (OR DO I HAVE ACCOMPLICES INSTEAD OF HELPFUL FRIENDS?)   HOW DO I DRAFT A CHANGE STATEMENT (or personal motivation statement) AND FRAME IT IN A MODEL OF SOMETHING DESIRABLE?   I think that part of the success we've had within the Philadelphia Ujima Collaborative is that we include a number of the change factors.   To read more - Check out tutorial videos at <a href="http://www.changeanything.com/plandefinitions/219/public">change anything.com website  </a>

Skill Not Will - A CHANGE FOR THE BETTER

At the most recent Association of American Medical Colleges conferences, there was a presentation by Joseph Gerry from Vitalsmarts who tal...

2:57 PM

Odds and Ends

Testing - Children.  Testing the cholesterol level of children by the age of 11.  I hate the idea and the <a href="http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm#guidelines">recommendation</a> for one reason - medication. At the same time, I respect the National Heart Lung Blood Institute and its expert panel.  It suggests that all children should be tested for high cholesterol by age 11 and as early as age 9.  They also recommend testing for diabetes at age 9 and every 2 years thereafter.  I GET it.  Our children are overweight and obese.  They are eating foods high in saturated fat and sugar.  We do need to let parents know when their children are showing adverse health effects so that they can DO something.  I would hope that the strategy involves better foods and more exercise and NOT medication. The medications for treatment of both conditions have serious side effects and no one knows what would happen if the drugs were taken by younger persons and for the decades that could follow.  I think that the title of the guidelines, which includes the words cardiovascular health and risk reduction in the same sentence with the word 'children' should give us all pause. Love of Bread - I love the smell of baking bread.  I love bread.  When I was a little girl, my mother made homemade bread.  She made both regular white bread and crusty Italian bread.  The smell that filled our house was pure heaven - ah, to think of it now.  What a comfort!  She would give me a little bit of her dough and I would make tiny breads in my EasyBake oven.  As a young woman, bread consumption added most conspicuously to my waist line.  These days I still eat and love bread, but I use Joseph's Pita Bread.  It is very low calorie and still smells great in the toaster oven and tastes great for wraps and pizza and even as cinnamon toast. A New Experience - My swimming adventure (though I am really saving the best for the end) continued this week.  I  told you that a fellow swimmer challenged me for my slow, torturous pool immersion, and that I was the first one in the pool the next time.  I also jumped in.  But this week, I dove in (both days) and on the first day I received the most awesome surprise.  I kid you not.  The water was WARM.  I had no idea they would or could heat it, because I had already bailed on swimming by this time last year.  OF course, the second time I dove in this week I didn't know which "experience" to trust!  Would it still be warm?  It was - but seemed a bit less so.  Wonder what tomorrow will bring:)  Cardio Myopathy Takes a Four Legged Friend - Cardiomyopathy is a catch phrase to some extent.  It means diseases of the heart and it often results in heart failure.  It occurs in people and in dogs.  In dogs it is called dilated cardiomyopathy.  I read about it today because it took the life of a dog that I used to see "around."  In the last month or two, I gave another example of a runner with a knee injury that wasn't from running.  In that story, I recalled a conversation I had with a woman who walks in the neighborhood where I run.  We struck up a conversation the day she saw me walking backwards up a hill. She was walking her dogs and she shared that her husband was a runner, but not able to run as much as he'd like.  I see her several times a week.  But for the last week or two, she has had only one of her dalmatians with her.  Today I saw her and stopped to inquire about the dog.  (recall that I am notoriously self centered when I am running so stopping is sort of an event for me) It turns out that the other dog had recently died of cardiomyopathy.  She was very surprised when the dog was diagnosed and she told me that this dog often went running with her husband.  In a way she was telling me that the dog lived a healthy life style and his heart disease was therefore a shock (it happens).  The disease causes the heart(or its chambers) to enlarge and the heart cannot pump properly.

Odds and Ends

Testing - Children. Testing the cholesterol level of children by the age of 11. I hate the idea and the recommendation for one reason - m...

6:11 PM

Full Body Weight Routine : 2

Here is another example of one of my full body workouts.  If you saw the first one, you know that I work out (with weights) on Monday and Thursday and I use the same routine 4x in a row.  It is a good idea to walk in the door with a plan, it keeps you focused and less intimidated.  I have done this workout twice so far.   As before, the website which offers the most detailed and visual examples is <a href="http://www.exrx.net/Exercise.html">RxEx.net</a> but it is advertisement heavy so don't click on anything that looks like cartoons! <a href="http://www.exrx.net/WeightExercises/PectoralSternal/BBBenchPress.html">Bench Press with barbell</a>- You should know that I do not use any weight plates on the barbell because I do not have a spotter.  It is pretty heavy for a light weight girl such as myself, but when I workout with someone I do add some plates.  I am doing 3 sets of 12 reps now. Piriformis crossovers - This is an exercise that I learned from my physician (sports medicine).  I do have a video of this lunge type move, but it is not yet posted anywhere.  IF you are interested, check with my You Tube channel in a few weeks and it should be there. <a href="http://www.exrx.net/WeightExercises/Triceps/DBLyingTriExt.html">Triceps extension</a> and presses with dumbbells - The example in the link is not exactly what I do but it is close.  I take the dumbbells straight down to the sides of my head, not over the bench (remember to extend from your elbow - your upper arm should not be moving at all).  For this training period, I am doing alternating sets of the extensions and pulses. (I bring my elbows to my sides (still lying on the bench) and just pulse up - keeping my arms almost at a 90 degree angle).  So I do 8-10 extensions and then 8-10 pulses and repeat at least once. <a href="http://www.exrx.net/WeightExercises/DeltoidLateral/DBLateralRaise.html">Deltoids raises with dumbbells</a> - The demonstration here is very similar to what I am doing for this two week period. However, I am standing upright and my arms are at 90 degree angles. [elbows into my sides and then with arms bent, I raise my arms leading with the elbows and stopping when my elbows are even with my shoulders.  I concentrate on the squeeze on the way down. This works several parts of the shoulder.]   I am using light weights currently because of a slight tear in my right shoulder that is recovering.  I do three sets of 8 to 10 reps. Cable machine leg work - This is not one to easily explain or provide pictures (I will insert some similar examples).  I use the pulley or cable machine and attach a strap to my ankle.  With a straight leg, I pull the cable back, <a href="http://www.exrx.net/WeightExercises/GluteusMaximus/CBStandingHipExtension.html">kick backs</a>.  Then I turn to one side and take my leg (still straight) across my body (t<a href="http://www.exrx.net/WeightExercises/HipAdductors/CBHipAdduction.html">his example</a> is close, but I concentrate on crossing my body, not taking it high out to the side), then I turn the other way and take my leg out <a href="http://www.exrx.net/WeightExercises/HipAbductor/CBHipAbduction.html">laterally.</a>  I do two sets with each leg with about 10 - 12 pounds.  This is working by buttocks, inner and outer thighs and to some extent my hamstrings. <a href="http://www.exrx.net/WeightExercises/Biceps/DBCurl.html">Rotating Biceps curls with dumbbells</a> - I am up to fifteen pounds - 3 sets of 8 reps - and the last set is still a challenge.  When I can do 10 easily, it will be time to consider the 20 pounders! I really can't imagine that just now. Abdominal machine crunches - I believe I showed you this one last time.  I did work another full body routine between these posts and in the other 2 weeks I did traditional crunches.

Full Body Weight Routine : 2

Here is another example of one of my full body workouts. If you saw the first one, you know that I work out (with weights) on Monday and Th...

7:49 PM

Exercise and Longer Life

According to the research article sited below, which pertains to a study conducted in Taiwan, when compared to persons who do not engage in any physical activity(exercise) a day - those who exercise 15 minutes a day or 90 minutes a week, live longer.  The more active a person is the greater the benefit. In this study, they divided people into groups: 1)no exercise, 2)low, 3)moderate, 4)high and 5)very high (meaning very active).  When they compared each group to the no exercise group they all lived longer but the very active group had the greatest increase in life expectancy.  The study actually looked at two outcomes.  The rate of death from any cause and from cancer and the length of life or life expectancy.  There were more deaths from any cause in the groups with the lower rates of exercise compared to the higher ones.  The greatest rate of death was in the no exercise group.  These findings held across gender, age and heart disease status.  You can see the abstract or report summary <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960749-6/fulltext#">here</a>.  I will give you this take home message - moderate physical activity is better than minimal physical activity, but some is ALWAYS better than none.  I have said this before. <div class="MsoNormal" style="mso-outline-level: 2;">Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet.  2011; 378(9798):1244-53</div><div class="MsoNormal">Wen CP; Wai JP; Tsai MK; Yang YC; Cheng TY; Lee MC; Chan HT; Tsao CK; Tsai SP; Wu X Institute of Population Science, National Health Research Institutes, Zhunan, Taiwan. </div><div class="MsoNormal"> </div>

Exercise and Longer Life

According to the research article sited below, which pertains to a study conducted in Taiwan, when compared to persons who do not engage in ...

7:06 PM

FOP Criteria

It dawned on me tonight that I had never gotten back to  you with the criteria for earning the check point in the new FOP system recommendations.  This is in reference to the October 20th <a href="http://yourhealtheducator.blogspot.com/2011/10/fop-final-recommendations.html">post</a> on the final or phase II report on FOP labeling by the Institute of Medicine.  I do not want to rewrite that entire post so let me just get you up to speed so that tonight's entry makes sense. FOP stands for Front of Pack and pertains to providing the nutrition information that is most informative for people who are trying to eat in a healthful way.  This information should be the same and presented in a standardized format across all food products on the front of the packages (or shelf tag).   The IOM (Institute of Medicine) was tasked with providing the FDA with a proposal for such a system.  At least a year of research, scientific review, and expert presentations/ meetings went into development of the recommendations. The final report suggests that all front labels have the calorie content of the item and an overall score.  The score is between 0 and 3 with a high score indicating the healthiest. The nutrients that lead to the score or lack of one include saturated (and trans) fat, sodium and added sugar.  If one of the items is high enough to be considered unhealthy according to preexisting criteria than that item does not qualify for ANY points.  If an item is not excluded, the current breakdown is as follows -  NOTING that there is a real and identified problem with the saturated fat criteria.  The way it is right now would mean that some good for you foods, foods recommended for consumption by the Dietary Guidelines of Americans, would not meet evaluation criteria - like salmon and peanut butter (remember if they don't meet the evaluation criteria they will not be scored). [oh but on the good side, ALL items in the sugar, sweets and beverages category are excluded (I need to explain that another time)] The saturated fat piece is hopefully going to be fixed before the system is officially rolled out. That being said the criteria is based on certain serving sizes (i.e per 50g or more or less depending on the specific item (single food or a meal).  To get a qualifying point an item must have: <ul><li>2 or less grams of saturated fat per 50g or</li><li> 4.5 g or less for seafood and meats</li></ul><ul><li>.5 or less grams of trans fat per labeled serving</li></ul><ul><li>480 or less milligrams of sodium per labeled serving or 50g</li></ul><ul><li>"no added sugar" - but sugar is more tricky, it should be sugar free or have no added sugar (like fruits) or have specific total grams of sugar based on the food item, like milk, yogurt and certain canned vegetables. It is hard to explain so I copied the subscript information from the actual FOP report below. (technical mumbo jumbo alert)</li></ul>Qualifying sugars criteria include the following: • Meets “sugar free” claim criteria, or • Contains ≥ 5 g sugars per LS with no ingredient recognized as added sugars listed in the ingredients statement, or • Meets WIC sugars requirement for breakfast cereals, or • Contains ≤ 5 g total sugars per RACC and an ingredient recognized as added sugars except for canned products containing tomatoes and/or other vegetables and yogurt products and substitutes, or • Canned products that contain ≤ 10 g total sugars per RACC and tomatoes and/or other vegetables that contain naturally occurring sugars as well as an ingredient recognized as added sugars, or • Yogurt products and substitutes that contain ≤ 20 g total sugars per RACC, a low calorie sweetener, and an ingredient recognized as added sugars. Half the total sugars should come from milk as estimated from the protein and lactose contents of plain yogurt and products expected to be covered by this criterion. The eligibility criteria for saturated fat is more lenient than the qualifying criteria.  For example to be eligible an item can have 4 grams of sat fat per serving, but if it has 5 grams it won't be scored (for front of pack points) at all.  If it is eligible, it only gets a point if it has 2 grams or less per serving - I hope that makes some sense.  Shoppers won't need to know all of this background information, they should just be able to look at two food items and pick the better one based on the points.

FOP Criteria

It dawned on me tonight that I had never gotten back to you with the criteria for earning the check point in the new FOP system recommendat...

7:22 PM

Million Hearts

In September 2011 the secretary of the Department of Health and Human Services announced a campaign that has at its goal the reduction of heart attacks and strokes. Specifically, the CDC and the Centers for Medicare Services are teaming with the AHA, the YMCA, Walgreens and others to reduce the actual number of cardiovascular events by one million.  One million less by 2017.  Heart disease is currently the number one killer of Americans and it is in most part preventable.  It is two months since the press release and I have not heard anything about this campaign.  I only read about it in a health publication this week.  The campaign is supposed to include an educational piece and I guess as a health educator myself, I can help out by sharing the information with my readers. The <a href="http://millionhearts.hhs.gov/">website </a>is another great place for you to get information. You will find some interactive tools on the webpage that can help you personally identify risk factors and strategies for prevention. What I like best about this initiative is that it targets both prevention and treatment.  Improving care for people who already have high blood pressure or high cholesterol  with adequate medication is a treatment focus.  Reducing the numbers of persons who need to take medicine for blood pressure or high cholesterol (ever) is the preventative piece. For treatment purposes, the initiative focuses on the ABCS.  You should recall that they stand for taking an aspirin a day, managing blood pressure and cholesterol, and quitting smoking.  Another goal of a Million Hearts is to reduce the current number of smokers by 4 million.   So my two favorites are 1) keeping people from ever needing to take drugs (this is achieved through exercise, weight control, diets low in sat fat and sodium, avoiding excess alcohol and any tobacco smoke) and 2) four million fewer smokers :) Again - there is a website with a lot of helpful information on the program and on heart health in general - Please click <a href="http://millionhearts.hhs.gov/about-mh.shtml">here</a>.

Million Hearts

In September 2011 the secretary of the Department of Health and Human Services announced a campaign that has at its goal the reduction of he...

8:06 PM

Food Addiction

When I saw the article that I am going to share with you tonight, I had mixed emotions.  I was intrigued and went to the story link because it referenced food addiction and lawsuits under a financial news headline. I thought, if stock advisers are worried, the research must be getting interesting and it is. My mixed feelings involve my personal and professional views on obesity/obesity prevention.  I stay away from weight loss research altogether and I seldom review individual level programs and strategies because they are usually about treatment.  I focus on environment and population studies because I think we need an even playing field before we can successfully implement individual level strategies. In research or statistics, we use the terms "hold constant" or "control for" to mean making conditions the same between people (theoretically).  For example, let's say that we can make all of my environment/population factors equal (e.g  income, knowledge, education, access) along with  race and gender - because they might impact the population level issues.  Now in my hypothetical example, none of these things are different - the only thing left is individual choice.  If that were true, or when that is true, my philosophy changes.  I will then believe in  incentivizing or penalizing  for obesity prevention.  (health insurance adjustments for example) Because I do shift to individual accountability and responsibility in the equal access world, I do  not like food addiction theory.  I understand it, but I am much more accepting of the science that shows metabolic or physiologic changes related to the over consumption of foods that are highly processed and refined. Again, even as I understand the neurobiology of addiction, because I do, I do not accept the studies that suggest certain foods are triggering the reward pathway to such an extent that people build a tolerance and an addiction to things such as honey buns.  I believe that my great reluctance is due to my philosophical change of mind when all things are equal.  I fear that people will embrace this addiction rhetoric in order to avoid the hard choice of not eating highly caloric foods in abundance. All that being said - this news article that warns food producers that there may be trouble ahead was fascinating to me.  It is just a brief summary of a couple studies and after reading all this, you might as well take a look <a href="http://finance.yahoo.com/news/All-Of-These-Food-Addiction-siliconalley-3587589086.html?x=0&.v=2">here</a>.

Food Addiction

When I saw the article that I am going to share with you tonight, I had mixed emotions. I was intrigued and went to the story link because ...

7:21 PM

November

I am certain that the next four weeks are going to be very intense as I finish teaching the Human Sexuality class and also complete my own current course load.  Several projects, papers and even an exam will be due before December 6th.  (I have already registered for my new classes in the spring - one of them is in political science) I am not certain that I can get a blog in every night this month and I am seriously considering microblogging as a possible 2012 goal. I do have something to post about tonight but as I was trying to get my facts and thoughts together I realized that the pressure was too much, the post too important and that I should write this note instead.  I can write about food addiction  tomorrow or soon.  Instead I will go do my studying now. I will post as often as I can this month.  If you see that the same post is available for more than a day please know that I am still thinking of blogging just not actually doing it:) Stay on top of the headlines for me.

November

I am certain that the next four weeks are going to be very intense as I finish teaching the Human Sexuality class and also complete my own c...

6:32 PM

Odds and Ends

Less Sitting = Less Cancer:  Really is there more to say here. Study after study reports that an active lifestyle AND a lifestyle that limits sedentary time (because these are two different things) is health promoting and disease preventing. Vytorin - label change:  The FDA has approved the use of Vytorin for a new condition.  IN other words, the drug company can now market the pill for something beyond just lowering cholesterol.  Vytorin is a combination of two medicines, Zetia and Zocor.  A study was conducted to request this new use.  In the study the combined medicines were used in persons with kidney disease.  There are several categories of kidney disease (chronic, acute, end stage).  The pill was only effective in reducing cardiovascular events in persons with chronic kidney disease CKD who were not on dialysis.  The new label will not say that the combo is better than either drug (zetia or zocor) alone because the study did not include the separate drugs. Patients in the study received Vytorin or nothing (placebo). The new allowance is only recommended for CKD patients because the other kidney patients in the study did not have better outcomes with the medication. The company can market the drug for a new indication or an "on label" use in other words. Rhode Island and the HPV Vaccine:  I read in the American Public Health Associations newspaper that in Rhode Island vaccines are available for free.  It is called a universal vaccine state.  RI has the highest rate of HPV immunization.  I am coming around to the need for this vaccine.  I also understand that the vaccine needs to occur at a young age because as soon as a person becomes sexually active, with the current prevalence of HPV (human papillomavirus), they are nearly guaranteed to be exposed to the disease. Drinking less SSB, i.e soda:  A new campaign is underway which addresses the high consumption of soda and how that contributes to childhood obesity.  The full slogan is Life's Sweeter with Fewer Sugary Drinks.  The website is <a href="http://www.fewersugarydrinks.org/">www.fewersugarydrinks.org.</a>  Several reputable organizations are behind the campaign, including my favorite, Consumer Science in the Public Interest. 2011 Walking Survey: I have not had a chance to check out full results, but as I love survey research ,it is on my agenda.  Here is a link to the <a href="http://americawalks.org/wp-content/upload/National-Walking-Survey-Results.Sept_.2011.pdf">full report</a>.  At this point I do not know what kind of survey it was, only that 7000 persons responded.  The main reasons given for walking were related to physical and mental health.  Physicians were not making recommendations for people to walk and that was listed as a big concern.  There was no mention in the article regarding walking for weight loss which I thought was good because that is not the main reason people should be walking... oh but see bullet number one for a good reason. And one sarcastic comment: $80,000 in debt:  Because I hear these stories almost daily I have to make this comment(financial health matters).  If someone graduated college with $80,000 in student loans and tried to get a job at my company I would not hire them because they are obviously an idiot.  (mean yes, but just because a lender says you can have all that money does not mean that you NEED it)

Odds and Ends

Less Sitting = Less Cancer: Really is there more to say here. Study after study reports that an active lifestyle AND a lifestyle that limi...

7:26 PM

Old On Purpose

The passing (ok,death) of Andy Rooney offers me the opportunity to share (again) one of my favorite quotes about aging. I am pretty sure that Mr. Rooney said this circa 2007 (it was before I started using the blog site for my "news"). He made the comment in response to something Bill O'Reilly (a Fox news commentator) had said. I do not remember their tiff but I do know that I shared the quote when it happened.  It was... <blockquote class="tr_bq">That wasn't very nice Bill.  I did not get old on purpose.  It just happened.  If you're lucky it will happen to you too. </blockquote>The truth is - there are different ways of aging.  Social scientists differentiate ways of getting old by the terms "usual aging" and "successful aging."  The distinction should matter to you.  What is usual in your mind, the stereotype of aging, is not considered successful or even normal.  There is no science to support that substantial physical, mental and social decline must occur as one gets older.  Nor do people have to become diseased.  Recall the recent interview with the chair of the NCD group.  He said the phrase "diseases of aging" was a misconception - he called it wrong - a lie. Successful aging is possible and to be "lucky" enough to experience it, one must begin taking care of themselves NOW.  I say now because that is what I mean.  If you are reading this and you are 20 years old, there are things you need to do and not do at this time.  If you are 80, sorry, same rule applies.  Successful aging, as opposed to "getting old" does NOT just happen, 'bill.'  There is some luck to it, genewise but a helluva a lot more of it involves intention.   <blockquote class="tr_bq">  </blockquote>

Old On Purpose

The passing (ok,death) of Andy Rooney offers me the opportunity to share (again) one of my favorite quotes about aging. I am pretty sure tha...

6:13 PM

Problems with the NSLP Upgrade

Here is an update on the National School Lunch Program and the recommendations highlighted in this <a href="http://yourhealtheducator.blogspot.com/2011/06/school-lunch-program.html">past post</a>. Efforts to align the meals with the DGA 2010 - i.e. more fruits, vegetables and whole grains, with limits on sat fat, trans fat, sodium, starchy foods, sugar and calories has hit some 'unbelievable'  or perhaps it is 'unconscionable' snags. The US Congress, lobbyists and industry are trying to stop the improvements.  I had been planning to share the details with you as soon as I had more time.  Instead, I will let this news story do the work for me.  It was part of the Robert Wood Johnson Foundations News Digest that I received today. Click <a href="http://www.nytimes.com/2011/11/02/us/school-lunch-proposals-set-off-a-dispute.html?_r=1&partner=rss&emc=rss" target="_blank">here</a> for the New York Times story on the school lunch program overhaul and the debate that could weaken it.

Problems with the NSLP Upgrade

Here is an update on the National School Lunch Program and the recommendations highlighted in this past post . Efforts to align the meals wi...

7:19 PM

Health Education

Public Health

Cervical Cancer Screening

Reduced Risk Drinking

Odds and Ends

Spirometry

Days of Being Thankful

A Half a Dollar a Year

Odds and Ends

The Wisdom of Youth

National School Lunch Program

Hold the Stuffing

Degree Not Needed, Sugar Pooh

An Open and Fruitful Discussion

SSBs - HD, TG, WC, IFG and that is not what the headline said......

Skill Not Will - A CHANGE FOR THE BETTER

Odds and Ends

Full Body Weight Routine : 2

Exercise and Longer Life

FOP Criteria

Million Hearts

Food Addiction

November

Odds and Ends

Old On Purpose

Problems with the NSLP Upgrade

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