Health Education: disease prevention

Showing posts with label disease prevention - health promotion -. Show all posts

Odds and Ends

Without preamble or follow through - a few notes 3 Ms - Received an email newsletter sometime this week. I wasn't able to spend much time with it, but it suggested that we consider these three Ms with regard to our eating. We should maximize variety, flavor and plant based foods, Moderate calories and meats and Minimize fats and sugar. Survey - I am not sure how much validity this survey would have nor why I should trust the <a href="http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/558/ctl/ReadCustom%20Default/Default.aspx">Harris Interactive Poll</a>, however, intuitively, the results make sense, do not surprise me and validate my professional objectives. An online poll (excluding millions of people right there) of a couple thousand adults showed two important things. People do not accurately perceive their own weight status and when they do see themselves as overweight or obese, they blame inactivity not overconsumption. Remember, physical activity is a strong mediator for health whereas calories are related to weight. CDC - another report - we are not eating enough fruits and vegetables. Let me encourage you to eat more plant based foods and to serve more as well. Fruits and vegetables contain nutrients and chemicals, sometimes called phytochemicals that can reduce the risk of some cancers. They are also - usually - lower in calories than many other foods. The CDC conducts a telephone survey where they ask Americans about their fruit and vegetable intake. The <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a1.htm?s_cid=mm5935a1_w">latest data </a>is from 2009 where over 75% of us report eating less than five servings of F&V a day. Vital Signs - Wow it is already another month. The report this month is on tobacco. You can see it <a href="http://www.cdc.gov/tobacco/data_statistics/vital_signs/index.htm">here.</a> Now - make your exercise plans for the week and fill your lunch box - YES, bring your lunch - with low calorie but nutritious foods.

Odds and Ends

Without preamble or follow through - a few notes 3 Ms - Received an email newsletter sometime this week. I wasn't able to spend much ti...

4:51 PM

medical marijuana

Dateline Bradenton, Fl: At the car wash where I can get on the Internet with my laptop. I am getting the car ready for the trip tomorrow. Slept much better last night. Ran and lifted weights today; my last of each with my two Saturday buddies. Mom and I are going to the movies later and I am hoping that my sister will come to tell me good-bye. Now for the news! I was going to write about cholesterol levels in young people, but adjacent to the article I was reading was another, on medical marijuana. The story was really about the dilemma that some employers are facing with staff who use this drug in compliance with certain state laws that allow it. I did not know that people used marijuana for pain. I had only heard of it for amelioration of nausea associated with cancer treatment. It was harder for me to find evidence for the health promoting effects of marijuana in the science journals that I trust. However, it has been associated with the two conditions above and also with boosting ones mood especially when that person is suffering chronic illnesses. That does make it a broad spectrum drug. Marijuana is primarily a psychoactive drug which basically means it alters the mood. I do not have a political opinion in regards to legalizing marijuana, but a public health one. With the current estimate of 4% of the population using marijuana once a year (WedMD) we do not know the true nature of health consequences. It was only when 42% of the country smoked cigarettes on a daily basis that the deleterious effects of tobacco came to light. That being said, I am concerned about the use of marijuana for additional indications. When the amount of users and the frequency of use increases so will the risk of lung and heart problems from the smoke and the chemicals in it, like tar and carbon monoxide. This is just another example of where we have got to think things through a little bit. To legalize it is to make it more accessible and that will increase the numbers of persons at risk for unintended consequences. Think about it. If you took a drug to reduce your nausea and the side effect was emphysema or lung cancer, the risk would outweigh the benefit. An adverse consequence such as that would get a pharmaceutical drug off the market.

medical marijuana

Dateline Bradenton, Fl : At the car wash where I can get on the Internet with my laptop. I am getting the car ready for the trip tomorrow. S...

4:40 PM

UV Awareness

July has been recognized for national UV Awareness. For this reason I encourage you to revisit the following two posts. <a href="http://yourhealtheducator.blogspot.com/2010/04/vitamin-d-sun-good-bad-extra.html">http://yourhealtheducator.blogspot.com/2010/04/vitamin-d-sun-good-bad-extra.html</a> <a href="http://yourhealtheducator.blogspot.com/2009/06/suncsreen-vitamin-d-and-skin-cancer.html">http://yourhealtheducator.blogspot.com/2009/06/suncsreen-vitamin-d-and-skin-cancer.html</a> I also bring this to your attention with renewed interest as one of my friends, and a loyal reader, recently saw a dermatologist who emphasized much of what was said in the above posts. Ultraviolet radiation from the sun reaches us in both UVA and UVB rays. Though they do not penetrate the skin at the same intensity, they are both cancer causing and both can lead to premature or accelerated aging and they damage our eyes. When choosing a product for protection, whether its a lotion, lip balm, window or tee shirt, there are certain terms, numbers and chemicals that are considered necessary for adequate coverage. For example: The Skin Cancer Foundation suggests that we look for a "sunscreen with an SPF of 15 or higher, plus some combination of the following UVA-screening ingredients: stabilized a avobenzone, ecamsule (a.k.a. Mexoryl™), oxybenzone, titanium dioxide, and zinc oxide." SPF is the term used to let you know how long the product will keep the skin protected from reddening. When your skin begins to redden you are putting yourself at risk for DNA damage which can effect aging acceleration and cancer incidence. My friend Melanie shared that her physician encouraged the use of sunblock over sunscreen. The Skin Cancer Foundation has recommendations for both. The SCF website can provide the information you need to choose a product and they have a good sized list of products that have their <a href="http://www.skincancer.org/seal/">seal of approval</a>. I expect to spend some time with the lists and the many categories for choosing my skin protection and my glasses. I may even consider upgrading my hat. I want you to go to their website because they are they experts, not me. OK - get on that - protect your skin now- you will be glad that you did!

UV Awareness

July has been recognized for national UV Awareness. For this reason I encourage you to revisit the following two posts. http://yourhealthedu...

4:54 PM

A New Cancer Mindset

We have made significant progress over the years in regards to cancer prevention, identification and treatment. With the help of technology, we are able to diagnose more cancers so the absolute numbers of cases may have gone up. However, the actual death rate for most, but not all, cancers has gone down. The hardest cancer to treat is still lung cancer (and possibly pancreatic), the hardest to differentiate appears to be prostate while the cancer with the greatest cure rate is breast cancer. Here is something else that has had an almost 360* change – lifestyle recommendations for prevention of initial cancer, during acute and or chronic treatment of cancer and to prevent cancer recurrence in original or distal site. By that last bit I mean that sometimes a person is seemingly cured of one cancer only to have it reappear in another part of the body. I wonder if you are going to be surprised by the newer medical advice – maybe it will depend on your age. The research continues to grow and a body of evidence exists to support that what one eats, how much one eats, the weight of a person and the amount of exercise they engage in will affect all of the situations noted earlier. Being overweight WILL increase the risk of cancer in all locations. Eating high fat and high salt foods can affect the inner mechanisms or metabolism of a body and put it at risk for cancerous conditions and exercise is something that is protective. In other words, regular daily exercise creates a system that is better able to fight off disease. Thus, overweight persons with cancer are often encouraged to lose weight – I KNOW – we have the old image in our heads of people getting chemo and losing a bunch of weight – wasting away, but the treatments have changed and even those that do cause loss of appetite are mediated by drugs that treat the side effects. All of us, cancer patients or no, are encouraged to eat a diet that is more plant than meat based and low in saturated fat, processing, simple carbs and salt. As soon as possible after any invasive treatment, cancer patients are encouraged to begin an exercise program. Research exists to support that this lifestyle change can prevent recurrence of cancer. It is therapeutic. It is a change in thinking but it works.

A New Cancer Mindset

We have made significant progress over the years in regards to cancer prevention, identification and treatment. With the help of technology,...

4:51 PM

Insulin and Cancer

I was able to hear some of an interesting discussion on a local radio station (WMNF) this afternoon. The premise related to results released during the just completed American Society of Clinical Oncologist annual meeting. The shows guest was a nutritionist out of Sarasota Florida named Eve or Eva. The show is available in archives on the radio station website, but the guest's name is not spelled out - sorry about that. That particular Monday show (1-2pm) is related to alternative medicine. I am most often not a fan of pills or alternatives to them if they include herbals and supplements, but that does not mean that I am closed "eared" to other views. A few interesting points were made by Eva and I would like to share them. <ul><li>Sometimes the medications that are created to treat cancer can cost up to 80,000 dollars a year to use and cost BILLIONS to create. Often the drug is able to prevent progression of a cancer temporarily or add a few months of life - Eva suggested that the money be used to address ways to prevent disease, perhaps through nutritional programs and also to address the toxicity of our environment - as opposed to adding 16 weeks to a persons life. I tend to agree with her - though she was clear that situations are different. A mother of small children for example, would most benefit from the extra months.</li><li>Insulin in the bloodstream is fuel for many cancers. Though I wasn't able to follow the entire discussion, I understood this to mean that insulin was food for the blood vessels that are created in some cancers - tumors feed on these blood vessels and become larger. For this reason, the nutritionist advised that people, with or without cancer, be mindful of the amount of sugar in their diets AND the amount of sugar consumption at one time. She said that more than 2 teaspoons at once was going to trigger a significant insulin release. She noted the glycemic index and spoke of fruit sugars in the context of fiber. She was not promoting juice and suggested that any "juicing" of fruits be of the organic kind - instead of making a concentrated pesticide brew. Read more about the fructose connection <a href="http://yourhealtheducator.blogspot.com/2009/08/perils-of-fructose.html">here.</a></li><li>In regards to treatment of cancer, Eva/Eve did NOT come out against traditional treatments and did say that the first thing to do was shrink that tumor with any means possible (including surgery, radiation, chemotherapy). I believe she said "debulk" the tumor. What she is against is ingesting daily doses of poison which in her opinion(based in research), has NOT been shown to prolong life or cure disease. She did say that there was substantial research to show that the more fruits and vegetables consumed the less cases of cancer incidence and cancer recurrence there is. I did not fact check her statements.</li></ul>That is all I have for today - I hope this blog made you want to eat an apple :)

Insulin and Cancer

I was able to hear some of an interesting discussion on a local radio station (WMNF) this afternoon. The premise related to results release...

5:04 PM

Healthy Weight Committment Foundation

In RE: yesterday's post: I guess my photo was not so clear - the object on the ground - i.e. "litter" was one of the new energy efficient light bulbs - Note to self - they help the environment when placed in lamps NOT the landscape. RE: Today's post and title: The motive may not be the purest, but in the end, with one possible exception, it doesn't matter. I am referring to an 80 member food industry coalition that has formed in response to growing restrictions or suggestions of restriction with regard to the content of our foods and point of purchase nutrition information. The industry group is called the <a href="http://www.healthyweightcommit.org/">Healthy Weight Commitment Foundation</a>. The goal of this group is to reduce the amount of calories in their products by 1.5 trillion. Yes, that is right - trillions of calories. They hope to accomplish this by the year 2015 with substantial progress towards that goal by 2012. The Foundation includes a few of my favorite companies - favorite in that I often purchase their products - General Mills, Kraft, Kellogg, Coca-Cola, Red Lobster and PepsiCo. Our national obesity reduction program is the Let's Move initiative begun and managed by Michelle Obama. Many nonprofit groups have joined the first lady's program and the Healthy Weight Commitment Foundation has made a pledge to these groups to contribute by reducing the amount of calories in their foods. The <a href="http://www.letsmove.gov/index.html">Let's Move </a>program calls from calorie reduction - through less fat and sugar, but also encourages an increase in nutrients. I was very happy to see in the press release and on its website, the involvement of the Robert Wood Johnson Foundation. They will be responsible for evaluation of the program. <a href="http://www.rwjf.org/childhoodobesity/product.jsp?id=63528">Please read their statement here</a>. I do have a concern - and I addressed it with RWJF through email. I will share that with you here (i tried to cut and paste but it did not work this time) - my concern is that the industry will take its current approach and apply on a grand scale. That is take out sugar, add water, reduce the serving size and increase the price. I have been in contact with Kathryn Thomas, a senior communications officer with RWJF and shared my concerns. She did respond with the evaluation goal, but it does not specifically address accessibility. I have asked that she forward my concern to program planners. I just feel that someone needs to say it because this could be a phenomenal intervention that in the ends fails to meet its goals because of that one detail. Remember socially possible interventions are what we need now.

Healthy Weight Committment Foundation

In RE: yesterday's post: I guess my photo was not so clear - the object on the ground - i.e. "litter" was one of the new energ...

5:20 AM

Chapter Four

In the most recent President's Cancer Panel (PCP) report, chapter four covers the issue of radiation from medical sources, and tonight I want to offer a synopsis from the first part of that chapter which covers medical imaging and nuclear medicine. I continue to read in the hopes of understanding this better myself so that I can share my new found knowledge. At times , while reading, I feared that I would instead only succeed in making it more confusing for all of us. The upshot and upside is that there are initiatives in place to educate not only patients, but physicians, technicians and other health care professionals on the dangers of over exposure to medical radiation. As indicated in previous posts on this issue, machines need to be calibrated, and doses lowered. Additionally, this report states that newer imaging machines have built in sensors that can reduce the amount of radiation used based on organ and person size. Of special concern has been reducing radiation to children. This is an issue for several reasons. One is that time of exposure is related to incidence of cancer, independent from frequency or amount. In other words, radiation causes damage and if that cellular damage is not corrected on a molecular level, then mutant cells continue to multiply over time and the more time they have - i.e 60 years of life vs 10 - the greater the chance that a cancer could develop. Secondly, children have smaller bodies to absorb the radiation, have more rapid cell changes at certain ages due to developmental issues, and if things don't get reined in, will have a life time of exposures that will accumulate. Another concern is the increased risk of breast cancer. The PCP report notes that breast cancer from radiation is an "important and controllable risk factor." The problem is that any imaging of organs or bones beneath the breast can expose the breast to this known carcinogen. Bear in mind that a mammogram exposes the patient to approximately .4 mSv of radiation while a coronary angiography can expose the breast and heart to 16 mSvs. The FDA is also working on a plan to have electronic or paper cards (smart cards) that we can use to keep up with all our imaging and dosing. This could reduce multiple scans of the same body part i.e lost records, patient recall, etc. There is also a program in the works that is intended to help patients talk to their doctors - much as I have suggested - why do I need this exam? Perhaps an alternative test can be used, such as ultra sound, MRI or a blood test. This is meant to address both sides of the unnecessary scan issue. The scans doctors order because they are afraid not to, and the ones they order because the patient insists that they do. One scientist from Columbia University suggested that a third of CT scans could be replaced by other tests. Even though this chapter explains the different units of measurement with regard to ionizing radiation - it doesn't provide a layperson with the tools necessary to fully grasp what is measuring what. I can tell you with certainty that whether it is an mGy, mSv , rads or rems - MORE of any of them is what you are trying to avoid. It does seem like most measures come back to the Sievert and then the millisievert or mSv. Several examples in the text use the mSv and that helps me make some good points. Remember there is no known safe dose of radiation - we just try to find what is sometimes referred to as the amount that will provide a result - the "as low as reasonably achievable" dose. Example one: the exposure to radiation from the atomic bomb(s) dropped on Hiroshima can be measured in mSv. It is expected that people were exposed to between 5 and 100 mSv. Regular xrays and mammograms expose people to less than 1mSv. CT scans will have a very wide range based on where the scan occurs, but also on the other factors which have been noted, so a coronary angiography CT can expose a person to 16 mSv and a PET scan even more. In nuclear medicine, where the radiation comes from within - i.e you take the radioactive isotopes into your body orally or through IV, the dose can be double that - esp. if the isotope is thallium 201. But I believe that my Aha moment really came when I read about the limits that are proposed for radiology technicians. Example two: there are two groups that cover this issue and the US one, OSHA allows workers to receive more annual and cumulative mSvs than the International Commission on Radiological Protection does. Well I think we should limit our exposure to the ICRP worker standard, at the very least (or most, depending how you look at that sentence!). So that is 20 a year and no more than 100 within 5 years. A chest CT may deliver 7 mSv with a range of 4-18. The virtual colonoscopy that I used to think was a neat idea, delivers 10 mSv with a range of 4-13. To learn more values, see chapter four of the current <a href="http://deainfo.nci.nih.gov/advisory/pcp/pcp.htm">President's Cancer Panel </a>annual report. Ionizing radiation comes from other sources as well, but about 48% of it comes from medical exposure. In the 1980s the medical amount was closer to 15% and that is the concern - the growing concern, regarding cancer incidence from medical imaging and nuclear medicine.

Chapter Four

In the most recent President's Cancer Panel (PCP) report, chapter four covers the issue of radiation from medical sources, and tonight I...

4:53 PM

Our Disease Numbers and Cost

Continuing from last night's post - I have scoured through more data sources, including the CDC and the AHRQ - including Vital Statistic Reports, Weekly Mortality and Morbidity Reports and the MEPS or Medical Expenditure Panel Surveys and Briefs. Here are the points that I wish to make: Cause of Death VS Cause of Cost - The leading causes of death are not always the top in medical expenditures. The top five causes of death are heart disease, cancer, stroke or cerebrovascular disease, chronic lower respiratory disease (which I learned DOES include asthma), and unintentional injury or accidents. Heart disease or heart conditions and cancer have remained the top two causes of death and expenditures over the decade. Together they account for about 49% of annual deaths and over 180 billion dollars. The five diseases that cost the most to treat include those two, and trauma related disorders which I am going to say are accidents, mental disorders and asthma. WOW. This is true for the past ten years and the costs to treat went up across the board. Most Shocking Info The information on mental illness, even knowing what I know about over-medication and misdiagnosis was still confounding to me. The largest increase in expenditure over the ten years (1996-2006) was for treatment of accidents and mental illness. I bet this has a lot to do with more treatment options for the accident victims and more diagnosis and medications for the mentally ill. According to the MEPS Statistical Brief #248, the number of people included in the category for mental health expenditures went from over 19 m to over 36 m in ten years. Some interesting Points According to the listed documents, cancer patients have the lowest out of pocket expenses, while the mentally ill have the highest. The highest amount for inpatient care was spent on heart disease and the highest emergency room fees were in the trauma category. Again, the one that shocked me the most and shouldn't have was the cost of prescription drugs for the mentally ill - the HIGHEST out of over 50 referenced conditions - 26,143.75 million dollars on drugs. The second highest drug category was for hyperlipidemia - cholesterol and triglycerides at 22,148.17 - it is all about the marketing of prescription drugs! Heart disease patients have a lot more ER visits than cancer patients. I find it interesting that asthma and COPD are more costly to treat than diabetes. Diabetes is sixth. Most Curious Data I think I was thinking of the asthma. I am surprised that it costs so much to treat and I checked to see where it fell on the causes of death list. I am still digesting that people die from asthma, but I believe the lungs become damaged from inflammation and scaring over time. Anyways, according to some sources and the CDC Vital Statistics document, asthma is included in the Chronic Lower Respiratory Disease CLRD category which is the 4th leading cause of death. There were over 124,000 deaths attributed to CLRD in 2006 and just under 4000 are related to asthma. The costs for treating asthma are the lowest in regards to the five stated above but the medication expenditures are second highest of the five. Most Brow Furrowing Statistic I work in public health and one of the issues we explore and target is disparities among genders and races. In this blog I have made note of higher incidence in many disease conditions in the black population. So I was surprised that in the leading causes of death, more white people die each year than black. This includes heart disease and cancer where as the difference in stroke death is .3 percent - and yet blacks have higher rates of hypertension. However there are some causes of death that are high for blacks, such as homicide and diabetes than are not as high for whites. Over all, many more black people die each year than white, per 100,000 persons the death rate is 982 black and 764 white. That has everything to do with access to prevention and treatment. Well I have done it again - hours writing a blog when I should be reading a novel - I hope you found this as interesting as I did!

Our Disease Numbers and Cost

Continuing from last night's post - I have scoured through more data sources, including the CDC and the AHRQ - including Vital Statistic...

4:57 PM

Preventing Oxidative Stress

Yes You Can! I believe I have found the missing message with regard to free radicals and aging and damage to our bodies through oxidative stress. Every action has a reaction – we know this. When our body experiences something either involuntary and internal or voluntary and applied – a reaction occurs. The residue is the release of chemicals or molecules that are referred to as free radicals. Some events produce a lot more of these chemicals than others – things such as smoking, exposure to radiation or disease, and even extreme exercise – like 100 mile races. I began learning about free radical damage when I took some graduate courses in Gerontology in 2000. I knew that the chemicals could be eaten up by little pac man like molecules called antioxidants and that oxidative stress was a result of the free radicals. Oxidative stress led to damage and aging. Recently I learned that antioxidants can be endogenous and exogenous – what the body produces and what we introduce to the body with our diet. I also learned that cigarette smokers not only have more free radical damage than nonsmokers, but have LESS endogenous antioxidant activity. Today I learned even more from an article in the ACSM’s Health and Fitness Journal (14;3) lead author Scott Powers, PhD and M.Ed (brainiac). According to the article, which I have no reason to doubt, the antioxidants don’t eat up free radicals but neutralize them. It is also true that oxidative stress is NOT a given, but occurs when the balance tips in the favor of the radicals. So our body can usually prevent any damage from occurring, especially if we are eating a diet that is high in foods with antioxidant properties, like our fruits and vegetables. Dr. Powers also pointed out that the body responds well to exercise in that it becomes even more adept at neutralizing radicals – becomes conditioned if you will. The article ends with the conclusion that people who are able to eat a plant based diet will have ample supply of antioxidants as long as they are not in a disease state that is inhibiting the bodies own antioxidant production and action. There was some discussion on how the type of activity (intense vs. moderate vs. easy, the duration of activity, and the environment such as heat or altitude) can cause more or less damage. In the end there is not sufficient evidence to suggest that supplemental antioxidants – pills and such, have any affect on the body and that they may indeed be counterproductive by preventing the body from using its own adaptive techniques.

Preventing Oxidative Stress

Yes You Can! I believe I have found the missing message with regard to free radicals and aging and damage to our bodies through oxidative st...

5:48 PM

Vitamin D - the sun - the good, the bad, the extra

Yesterday afternoon, my coworkers and I were taking a little stroll and along the way we discussed Vitamin D benefits, the sun and the risks to our health from sun exposure. I told them that I was very careful now to also cover my head to keep the sun from frying my hair and my scalp. We reminisced about putting lemon juice and oil treatments in our hair and I shared that I used to be excited about the red highlights that I would gain each summer. One of the women I work with who was not walking with us yesterday actually had a biopsy taken recently because of a suspicious area on the top of her head. The other day at the pool, she had on a visor NOT a hat - and she is one of the reasons I wear a hat. I have been keeping sunscreen on my face as well, since a wise, older running buddy pretty much besought me to do so – for wrinkle prevention! That got my attention the most. In the last year I can say that I have been paying more attention to other people’s habits and how they are aging – both internally or physically and externally – meaning their looks. I live in Florida so there are a lot of people to observe! Smoking and sun exposure are clearly the biggest age accelerators with regard to skin. Inactivity is the greatest ager with regard to functional ability. About a year ago, I blogged about sun exposure and that the FDA was looking at labeling changes for sun screens – I expect that the label rules will be finalized during this year, 2010. I believe that they will be as previously suggested – 50 SPF cap and removal of the phrases sun block and water proof. The benefits of Vitamin D also remain constant in the literature. They are bone health, heart health, mood enhancement and reduced risk of some cancers. It is said that 15-30 minutes of sun exposure two to three times a week would generate the right amount of vitamin D for health. There is a raging debate within the field of dermatology however and very few will ever recommend that one gets Vitamin D from the sun. The irony is this – my friends and I discussed this Monday and the WSJ had a feature piece on it Tuesday. In that article there is a good explanation of UVA and UVB rays. It is the UVA that DO accelerate aging by penetrating the skin and damaging the tissue enough to cause sagging – OM GOSH – and the UVB is more often the cause of skin cancer. Tanning booths, which I have been 100% in favor of banning since 2006 – have a lot of the UVA – want to tell those 20 something girls that they will look old before their time – they will likely be more worried, just as I am, about looking old than getting skin cancer. There are many factors involved with regard to sun exposure – the individual complexion, the geographical location – etc. Burning is certainly the biggest concern for the DNA damage that precedes skin cancer, but to be clear – the browning of the skin is also a symptom of damage. Finally, Vitamin D is available in supplement form and many people would benefit from taking it. Next time you are at the doctor’s office you might inquire about this. The extra for you is <a href="http://www.aad.org/media/background/news/Releases/New_Research_Finds_Six_Factors_Predictive_of_Melan/">this link </a>to another article which lists some factors that seem to be the most serious risks for melanoma. Melanoma is the rarer skin cancer, but the lethal one. The dermatologist who is featured here is a professor at NYU.

Vitamin D - the sun - the good, the bad, the extra

Yesterday afternoon, my coworkers and I were taking a little stroll and along the way we discussed Vitamin D benefits, the sun and the risks...

4:54 PM

Environmental Health (it is Earth Day)

I recently heard someone speaking about wind farms in regards to an option for generating energy. The person was on CNBC I believe and when she was asked for a final comment, she said that the only negative about wind farms were NOT having them. I did not find anything wrong with that statement. More recently, I came across a story about a big expansion in wind farming - I believe it was a Swedish proposal - and I had to do a double take when I was reading - as it said offshore wind farming. Offshore? Off shore - as in off shore oil drilling - as in "in the ocean?" I was (am) very concerned to hear about this. Certainly there is not the risk of oil spill or the pollution that is associated with other fossil fuel production - even on shore, but here again - we are exploiting an ecosystem. There is no way that building a structure and embedding it in the ocean floor will not disrupt the life cycles of countless species of marine life. I am surprised that I had not caught this before - as offshore wind farms are not a future plan, but a past, present AND future one. There are many off the coast of the UK and also off land from France, Portugal, Spain- Sweden make have the biggest off shore wind farm in Europe and in the USA one is planned, if not begun, in the Nantucket Sound. WOW. Yes the turbines generate a great deal of clean energy - I LOVE that part - but what of their adverse environmental impact? In fact, there is a term for what I am referring - EIA - or an Environmental Impact Assessment. Some countries require that the EIA be completed before a permit will be granted. In some cases, the studies are ongoing - and occur while the wind farms are created and used. In other words, well, let us build it and see what happens. It is less invasive to US (people) - it is not something we see or hear in our backyards - but it is certainly not neutral. At this time - looking into the matter just briefly, I see more reports on how to do an EIA than I can find results of one. Instead, there are guidelines on what to look for and examples of how it is less harmful than some other measures. A report that reports ocean based wind farming as nearly risk free comes from the Ocean Energy Council, but that is a group that wants to use the ocean for energy. I would like an independent source. Don't think for one minute that the brilliant scientists across the globe do not already know exactly what could happen - I just don't want something positive to cause something catastrophic for the aquatic world. And yes, it is a personal issue. We take things out (oil, orcas and more), we put things in(fuel,trash, emissions, ourselves) - we need to leave it alone....

Environmental Health (it is Earth Day)

I recently heard someone speaking about wind farms in regards to an option for generating energy. The person was on CNBC I believe and when...

4:29 PM

Tumor Analysis

This morning I read a brief news statement about a lung cancer clinical trial referred to as<a href="http://clinicaltrials.gov/ct2/show/NCT00409968"> BATTLE </a>that is underway at the M.D. Anderson Cancer Center in Texas. I have since contacted the reporter, reviewed the study website, read the study particulars on the US Institute of Health website for clinical trials, skimmed over several scholarly articles and then, read an article by another reporter which HAD the piece of information I needed in order to proceed with this post. The study is a promising one which is addressing the treatment of the deadliest cancer - cancer of the lung. In the Anderson study, persons who have late or end stage non small cell lung cancer (nsclc) and who meet certain inclusion criteria - including having been through one course of first line treatment - (FDA approved medication for lung cancer treatment) - which did not slow or stop the progression of their cancer are entered into part one of the study, or the umbrella phase. All of the persons have tumors ( small cell lung cancer, the most common one for smokers, tends to be diffuse) and these tumors are biopsied. Each tumor has characteristics and based on those characteristics, the volunteers are placed into one of four groups for part two of the study. This is a Phase II drug trial. They are put on a study medication for 8 weeks and then the tumor characteristics are reviewed again. A successful outcome is when the disease does not progress and people do not die. If progression has occurred, the person is taken out of the study and allowed to go on to receive standard treatment through their own provider. I understand that tumors can have different fuels and expression - we often hear a distinction between estrogen receptor positive or negative breast cancer. That is what I was trying to find out with regard to this study. So yes, lung cancer tumors can be fueled by different proteins, can be a result of expressions of certain genes, or be caused by a mutation on a certain gene. It is this distinction that the scientists make before putting the patient on one of the study drugs. Some success has been noted already with certain medications and tumor types. The study is not complete and full disclosure is pending. I wonder if the tumor histories are used to tell what type of nsclc a person has. I also wonder if tobacco use is allowed during the study and if the patients were tobacco users. I did not see tobacco use as an exclusion for the study, but I did see this statement: Any condition that is unstable or could jeopardize the safety of the patient and its compliance in the study, in the investigator's judgment. I would consider smoking during treatment of lung cancer something that could jeopardize safety - wouldn't you? This is a promising study - but to be clear, most persons with advanced stages of lung cancer do not live past a year. In the second article I read, it was noted that of the people in the study receiving this personalized approach to care, 38% survived to one year. I read that as 58% died. And nsclc is supposed to have a better survival rate that small cell lung cancer. I would like to know if the type of nsclc was determined, as there are three - adenocarcinoma, squamous cell carcinoma and large cell carcinoma. Do the proteins, mutations,or expressions determine that categorization or are their various biomarkers within disease type as well? Perhaps this will be answered when the study is published - if not - I will seek answers from a cancer organization. Over 80% of lung cancer is caused by tobacco smoke - the most common nonsmoker lung cancer is the nsclc described here - however, even that type is most often caused by smoking.

Tumor Analysis

This morning I read a brief news statement about a lung cancer clinical trial referred to as BATTLE that is underway at the M.D. Anderson C...

5:06 PM

The Biggest Loser is Often Not the Smartest Loser

I scanned over some negative press last night regarding the TV show, The Biggest Loser. The arguments made against the program were ones that made perfect sense to me. Some of the following points were in the news piece though I added things that I have learned through various workshops and research studies, as well. First the TV show is NOT real life! Very few of us can put our jobs, families and other commitments on hold and dedicate full days every day for weeks or months to engage in such a rigorous program. Second, the TV show ends, but the struggle to maintain a health promoting weight does not. Third, the competition is more likely to have a negative psychological impact on the "contestants" than a positive one. And I don't know about you, but when something upsets my psyche I am hard pressed to engage in positive coping skills - and if you are new to a behavior, the relapse potential is at least orange, if not RED. (I.e. high or severe threat!) Then there is the science behind weight loss and physical activity. Losing weight fast can cause health complications, including gall bladder problems and anemia. Going from being sedentary to engaging in vigorous physical activity most days of the week for hours at a time, can and probably will lead to muscle and joint injury. It is also a good way to get someone to hate exercise. The real weight loss winners are the ones who work with a physician and dietitian to determine the right caloric intake for them and then to follow the guidelines of health experts. For instance, Canada has this <a href="http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php">food guide </a>for its citizens to follow. And the USA has <a href="http://www.mypyramid.gov/">this one</a>. I promote Dr. Walter Willett and Dr. Barabara Rolls, as well as the Cooper Institute. I am perfectly comfortable with both the DHHS Nutrition and Physical Activity Guidelines. Oh and the website for <a href="http://www.nutritionaustralia.org/">Australians </a>is especially colorful. You get the idea. There is a lot of evidenced based information out there that you can access and apply to your own life. And as I like to say in my own classes - this stuff only works if YOU WORK IT! Do set goals - reasonable, achievable, smart - do engage in physical activity and do get support from friends. Health challenges are GREAT - nationally broadcast competitions, not so smart.

The Biggest Loser is Often Not the Smartest Loser

I scanned over some negative press last night regarding the TV show, The Biggest Loser. The arguments made against the program were ones tha...

4:17 PM

Making Group Think Your Think

I have increasingly less patience with magazines that like to quote research. One reason is that the stories seldom delve beyond the headlines and thus don't really tell you what, if anything, the research should mean to you and the other is that the research is often old news or worse, disproved old news. In a magazine I read through today there was mention of several studies, all small and all by the same researcher, regarding the influence of persons with high levels of self control. The study author, Michelle vanDellen, PhD, contends that people who witness others exhibiting self control or think about persons they know who have high levels of self control, will then exhibit this same self control during testing. For this study, my thought was, AND THEN??? What about when the other person is not around or you are no longer thinking about them? Dr. vanDellen's study reminds me of other studies that came out last year. These studies indicated that people seemed to model the behavior of their friends and coworkers in regards to maintaining healthy weights, exercising regularly, quitting smoking and eating less junk food. This sort of group behavior works the opposite way as well. I do not need a research study to convince me that people who work together can become healthy together - my coworkers are proof. The study I would like to see regards what it might take to get people to INTERNALIZE the self control they witness. How does one go from doing something because their coworker does it, to doing it because it is what they truly want to do? There are plenty of behavior theories that could explain the process. The ones that make the most sense have to do with whether or not the behavior witnessed is one that the other person feels capable of doing, if that behavior is seen as capable (effective) of providing the desired result(change), if that result is indeed desirable to the person who is trying it, the perception of reward, benefit or satisfaction the doer gets from the new behavior and the response of others when the person does it. Health educators try to provide role models who are like the target audience so that people see people JUST LIKE THEM doing the desired activity. Health educators also try to show behaviors that are easy, possible, and repeatable. The behavior should also have some immediate positive association. It is hard to make exercise addictive because the pay off doesn't come immediately, but a payoff can be a sense of accomplishment or the verbal praise someone receives from completing an activity. My coworkers do a really good job of adopting health promoting behaviors, some of them are more consistent than others. The consistent ones, those are the ones we need to study and emulate - not me, I am beyond consistent, a little less driven is better but some drive IS needed. So yes, group influence is great, but only if it's positive and only if it can be internalized. Sadly, it seems like we are more likely to internalize the "all you can eat" mentality than the " I need to exercise every day" one. :(

Making Group Think Your Think

I have increasingly less patience with magazines that like to quote research. One reason is that the stories seldom delve beyond the headli...

5:34 PM

Is that a good fit for you, honey??

Oh, how I do love research. And it just doesn't get any better than this - condom studies. Okay, it is serious in that condoms can protect us from many, but not all, sexually transmitted disease and to some extent, but not all, they can prevent pregnancy. So how a condom feels to the wearer and the partner, and whether or not it is snug or irritating, or breaks - well, that is serious business. Of course, if it doesn't FIT right, then it won't FEEL right and if it doesn't feel RIGHT then it probably won't feel GOOD. And a lot of people have sex because it gives them pleasure.... if a condom limits pleasure, that doesn't necessarily mean people will stop having sex, more likely they will stop using condoms, and in many cases, that would be health risk. According to a midsized study of over 400 men between ages 18 and 67, we have a problem. Almost 50% of those men reported issues that sometimes led to the removal of the condom. (I read about this on Yahoo News before looking up the study) The <a href="http://www.kinseyinstitute.org/research/condom_barriers.html">Kinsey Institute </a>does research on sex, gender and reproduction. They have several current studies and one involves condoms. One part has been completed and I refer to this study in the opening paragraph of today's blog. The full article is available if you have a subscription to a journal or university library, the abstract can be read <a href="http://sti.bmj.com/content/86/1/36.abstract">here.</a> I did not access the full article, the only reason=s I would is to see where the researchers advertised their project in order to get men to take the online survey. I understand that they advertised in some newspapers, but they also had a link to the survey in a blog from a condom sales website. Which condom company might that be? Trojan is the one we all know... does it have a blog? Too funny. And the conclusion the researchers make is equally amusing and yet understandable. They suggest that people like ME<>quality, which will in turn promote greater satisfaction, thus use, thus protection. Let me just end with - Safe Sex is Good Sex............ :)

Is that a good fit for you, honey??

Oh, how I do love research. And it just doesn't get any better than this - condom studies. Okay, it is serious in that condoms can prote...

5:13 PM

Buckfast

I cannot even think of what that title might mean to anyone living outside of the UK. Well, yes I can. In America, it could make you think of what broncos do in a rodeo. They jump and buck and try to rid themselves of that inconvenient rider. But in Scotland, England and Northern Ireland it is a wine that was originally created and sold by the monks of Buckfast Abbey. The monks no longer sell it themselves and it is no longer known as a tonic nor advertised as having health benefits (it once was!). I only heard about it yesterday when listening to the BBC Scotland and as I researched it today, I saw that the controversy did not begin yesterday but has been going for years. I think that the new attention is due to a documentary being aired in the UK that speaks to the significant number of crimes in Scotland that have some association with Buckfast. Buckfast is also called Buckie and some other names ("wreck the hoose juice" is my favorite). In fact, it sort of reminds me of the cheap, sweet wine that teenagers drank in my coming up years, Boone's Farms. The difference is that Buckfast has double the alcohol content of Boone's Farms and also contains a significant amount of caffeine. Buckie is sold in a green and a brown bottle with a bit of a variation in alcohol content and caffeine. The caffeine is 35-55 mg per 3 ounces and the alcohol is near 15% for the same. In the USA a wine serving is supposed to be 4 ounces and is usually served as 6-8 . (also, coffee has on average 60 mg of caffeine) The controversy involves where to pin the blame for the high crime association. The news regards a report that a particular precinct in Scotland had over 5000 incidents which included mention of Buckfast, that nearly half the people involved in them were drinking it before hand and that the bottle itself was used as a weapon over one hundred times. The numbers are for a recent three year period. The arguments made include that the alcohol itself is the problem and should be banned, that the people drinking it are the problem, that the area where the report has come from is the problem and that caffeinated alcohol is the issue. We have had that last concern come up in America and the USA was noted in that regard in at least one article. Others say that it isn't fair to pick on Buckfast and that comparison statistics for other beverages should also be put in the press. Scottish politicians are concerned over proliferation of the drunken Scot stereotype. This reminds me of one of my favorite lines from one of my favorite authors in my all time favorite books, Diana Gabaldon and the Outlander Series. Now I must say, the reason I listen to BBC Scotland is partly because of these books, but more so because it is my heritage. My ancestry is Scotch, Dutch and Italian. If you've taken a look at my profile picture it is likely no surprise to you that I did not list them in order of amount! Anyways, I am going to add to the stereotype with absence of malice and in honor of my Scotch/Dutch father. " The only time you'll find a Scot not drinking is at a funeral - and that's only if he's the one in the coffin. "

Buckfast

I cannot even think of what that title might mean to anyone living outside of the UK. Well, yes I can. In America, it could make you think...

4:43 PM

New Zealand Nutrition Conference

I thought if I just wrote obesity conference as the title, you might skip this read due to obesity burnout. I will keep it short for you. Tomorrow in New Zealand - Wellington to be exact, nutrition experts from across the country are meeting with tobacco control experts in an attempt to revitalize the campaign against obesity. The rates of overweight and obese are similar in New Zealand to USA and other western countries. About 33% of adults are overweight and 25% are obese. They may have more obese adults than the USA. In a press release about the up coming conference the Cancer Society Health Promotion Manager, Dr. J. Pearson shared some of her thoughts or concerns and here I will share those that resonated with me. She said that they (the country) needed to tackle this problem the way New Zealand and other countries have dealt with tobacco. Many countries have successfully reduced their national smoking rates, some, like the USA have cut them in half. You know how it was done - ongoing campaigns about the dangers, increase in cost, limited access and promotion, esp. to children, and medications or programs to assist in quitting. When Dr. Pearson mentioned the advertising of unhealthy and fast foods I had a thought. Remember when tobacco ads were more prominent? Do you ever remember seeing a person who looked sick (or dry skinned and wrinkly) smoking a cigarette? No. Do you see many obese people doing commercials for Twinkies, Fritos, sodas and McDonald's? I understand that eating is pleasureful but for some it is a pleasure substitute or a lack of understanding. Even if food makes you happy I am near certain that being overweight does not bring you contentment. When we first started to crack down on smoking people - addicts, became upset that the government was trying to control them and tell them what to do. That is mostly because the tobacco companies were minimizing the health effects and glamorizing smoking. Now that the majority of the population DOES believe that tobacco kills, having limited access to tobacco and being protected from tobacco smoke is seen as a GOOD thing. So think of a person who is hearing that obesity, even moderate overweight(ness) , can lead to heart disease, diabetes, and arthritis but seeing healthy, slim, active people eating high fat high calorie foods? Or the person wants to eat the lower calorie plant based or Mediterranean diet but cannot find those foods or afford them? As Dr. Pearson said, "It is like telling a smoker not to smoke, then putting them in a room full of smokers and handing them a cartoon of cigarettes!" On a final note, there is also concern in New Zealand that many of the schools healthy lunch programs have lost funding and that the Government seems to think that increasing physical activity is going to solve the problem. As I have learned and Dr. Pearson notes "strong international evidence" is telling us that this problem cannot be solved if people do not start eating LESS calories. Physical Activity is a must for good health and disease prevention but it is NOT a first line weight loss strategy, calorie control, is. Now stay tuned tomorrow for news on the problem of obesity in our PETS :)

New Zealand Nutrition Conference

I thought if I just wrote obesity conference as the title, you might skip this read due to obesity burnout. I will keep it short for you. T...

4:53 PM

Hold Everything..

Okay, maybe not everything, but you could hold the stuffing or at least hold your weight - steady, until the New Year. Hold the Stuffing is a contest that is played in some form or another at many businesses at this time of year. The point of the "challenge" is to support people who have made strides in obtaining a healthy weight, even if they are not at their goal weight yet. Health Promotions staff encourage people to just keep things even and enjoy the holidays. This means that the person is not to try to lose weight over the next six or seven weeks, but it ALSO means that they are not to gain any either. The threshold is 2 pounds. The "contestants" cannot go up OR down more than two pounds from their start weight. The weight needs to be taken before Thursday November 26th. You can play with teams and go by a group weight or you can do it individually. We are doing it individually at my small office and I created a tracking tool for each person to use. I will link it here and you will be able to play too if you like. Just <a href="http://docs.google.com/Doc?docid=0AVpUruYXPyXJZGNycXRnMzRfMTIyZzhwcXRocnQ&hl=en">print the form</a>, get your weight and be mindful of your eating. That being said and Thanksgiving a mere few days away - let me share some things my sister has learned from her Weight Watchers class. (everyone knows that if they tell me something they risk seeing it in a future blog post) One thing that the program has its members do is think of all the things they would like to eat on the day and to portion them out on a paper plate. Actually take a plate and write in the things you are going to eat. Hopefully, you will make the lower calorie items take up more space than the high calorie ones. My sister shared something else which I REALLY like and that I include on the tracking sheet. That is to "control what you eat, how much you eat and when you eat." I have been doing this for years and years and I highly recommend it. Do taste lots of things on your holiday, just don't eat so much of them! Also, be careful because some items have more calories than you can possibly imagine!

Hold Everything..

Okay, maybe not everything, but you could hold the stuffing or at least hold your weight - steady, until the New Year. Hold the Stuffing i...

5:04 PM

Health Care Attitudes Raise Costs

I attended a conference this week and during that conference I was able to hear a physician speak about health care reform. He spoke about the costs of health care, about Medicaid and Medicare, the bills in the house and senate, when issues stood the best chance of being addressed by policy, other countries health care systems, resources and attitudes and how it all impacted this "broken" system. The speaker was Robert Brooks, MD, MPH, MBA. He is an Associate Vice President for Health Care Leaders at USF. In other words, he was neither a politician or a slouch. He spoke for over an hour, but the points that resonated with me and stayed with me, were these two. The first is that for something to change everyone has to see that there is a problem. Those same people have to see that there is a solution(s) to that problem and then there has to be a window of opportunity to address it. We have all three right now he said, but that last one, it is going to change as politicians start to worry about other things, like elections. Unfortunately, we will still have a problem even if they stop talking about. The second issue that made sense to me is that we have great expectations and demands in this country and they are VERY expensive. We do not have the resources to maintain this level of health care but it is also very unlikely that we will change our way of thinking about this. For that reason, rationing may HAVE to take place. ( He didn't say that part) He is referring to the idea that we need to have the most expensive drug or the newest drug even if it doesn't work better than the older drug. We want CTs and MRIs and PET scans even when the results won't change the treatment course. We want medical devices and other diagnostic tests and we want pills for everything. When we talk about comparative research the public, often stirred up by politicians, thinks it means that people will not get choices and the government is going to take away the better treatments. Comparative research is really the opposite of that. You have a right to know that the brand name drug ISN'T better sometimes. Or that yes, taking one pill a day may be easier than taking two, but if the long acting pill is quadruple the cost and no more effective, then we really can't afford that pill merely for convenience. A perfect example is the research out this week that says women may be able to wait ten years (to age 50) before starting mammogram tests and then only need them every other year. Doctors, organizations, people in general are all aghast at this and before ANYONE said a word about the report, I thought, okay well, that makes sense. If the testing isn't changing the outcome then why are we doing it? And for everyone to scream about it now is just nuts. Yes, we always did it before, but maybe we don't have to now. I, for one, as a woman, was thinking, OH THANK YOU boob god... however, I may not get the reprieve some get because of my family history, darn it! We do research to find out what is best for us. What prevents disease, like use of condoms, and vaccines - what prevents conditions from becoming diseases, like pap smears, PSA tests (sometimes) and blood work. What keeps a disease from killing us, like some medications, chemotherapy and surgery. We should then apply the research and if someone disproves it, then we have to act on that too. Really, is anyone griping because we don't do blood letting or leeching anymore? Lastly, sometimes the treatment doesn't cost a thing, but you have to do it. Perhaps you have pain from arthritis or some form of insomnia and the recommendation for both is to increase physical activity or lose weight or lift weights. Maybe the person with a sleep disorder has to commit to a routine. Perhaps to prevent cancer the person has to stop smoking or tanning or drinking too much. Too hard you say, doc you say, just give me that pill I heard about on TV... well, if we keep it up, there will be no medicine and no doctors to dispense it. Which is another point. Specialists. We have too many specialists, ordering too many tests and doing too little communication with each other. Again, $$$$$$$$$$$$$$$$$$$$$ Um, so , yeah. Lost my train of thought really, guess this turned into a rant. Okay, then... have a good night/day. :)

Health Care Attitudes Raise Costs

I attended a conference this week and during that conference I was able to hear a physician speak about health care reform. He spoke about ...

4:50 PM

Sugar By Any Name

Every time I saw the commercial I wanted to throw a shoe or something at the TV. I kept telling myself that I was going to have to do a quick review of the product to see if it was as bad as it sounded. It is. I tried, I really tried to hold out faith in the food industry. Maybe, I thought, maybe they will respond to the obesity epidemic and make low cost health food available to the people that need it the most. I was wrong. And not only do the make bad food cheap, they make bad food fancy and expensive. It is like they want to make sure whichever financial situation the parent is in, they will be pulled to the processed and or unhealthy food. [a perfect "affluent" example is chunk white albacore tuna and a less affluent is Sunny D or another cheap fruit juice meant to take the place of soda and thus be better for your kid] This is about about fruit juice. You have read here and in several other places that children need their fruits and vegetables. You should also be hearing that they need them on a plate. (this is true for adults as well) You may recall this blog post <a href="http://yourhealtheducator.blogspot.com/2009/08/perils-of-fructose.html">http://yourhealtheducator.blogspot.com/2009/08/perils-of-fructose.html</a> inspired from a training I attended. The scientist was expressing concern about fructose. He is not the only scientist or obesity specialist that I have heard refer to this. The problem is not sugar in fruits and vegetables but those sugars being taken out of context, so to speak. When sugar comes in an apple, along with the skin - water and fiber included, it is treated differently by the body then if it comes in juice. Also, in juice it is a concentrated sugar. It takes several apples to make a glass of juice. You can end up with 160 calories of juice in a small glass when an apple only has 80 calories. So who do you suppose the company Adam & Eve are targeting with their Fruitables line? They have several different flavors including several Sesame Street options. Kids will probably ask for them. The advertisements remind us that children need fruits and vegetables. In another bullet, the ad notes that many beverages are full of sugar. Let us look at the Bert and Ernie's Berry. It is 100% juice. This one comes in an 8 ounce serving but some of the others I looked at say that the serving size is 4 ounces, and that is indeed better. But this particular one has 120 calories and 25 mg of sodium and 25g of sugar. There is a little symbol next to the sugar content to let you know that this is naturally occurring from the fruit juice. The drink has no fiber. It has no protein. It has sugar and salt. In fruits you do get protein and fiber and less calories. Fruitables are NOT a health food. And remember, just because something occurs naturally does not mean it is safe. Doesn't radon gas occur naturally in our environment?

Sugar By Any Name

Every time I saw the commercial I wanted to throw a shoe or something at the TV. I kept telling myself that I was going to have to do a qui...

4:52 PM

Health Education