I think employing the precautionary principle with cellphones is a reasonable idea depending on the circumstances. If it starts to impair your quality of life, I would argue the current safety profile of cellphones justifies a fairly liberal approach to their usage.
For example, as a pediatrician I get a lot of calls and I try to use my cellphone to return calls during downtime moments of my life so that when I get home I can maximize my time with my kids. I use my cellphone a lot (rather than waiting to arrive home and use my landline) and would not change this facet of my life as the risk of a brain tumor to me seems so remote and the time with my kids is tangible and valuable.
However with my kids, I will likely employ a stricter application of the precautionary principle. My children's skull bones are thinner secondary to physical immaturity and their brains are more plastic and still developing. Furthermore, their lifestyles will not dictate a heavy need for constant connectivity (at least not early on in life). Perhaps a cellphone that will only connect to my phone and my wife's phone? I doubt that this would be over-utilized!
I realize that this sounds contradictory to my previous blog where I concluded that I felt comfortable sending my kids to a school where a new cell phone tower is being built. My wife and I remain comfortable with that decision. As written previously, we are happy with our neighborhood elementary school and the good certainly outweighs any risk I might ascribe to radiaton from a cell phone tower (risk that I still believe is very low as further supported by a NYT article from April 13, 2011 - snippets of which I have posted below).
However, when it comes to the weighing of pros and cons in regards to my child carrying a cell phone and using it habitually, not many pros come to mind. Of course safety and better communication are a few positives, but I hope to achieve that with other means and I would not be opposed to a cell phone programmed to only communicate with a set directory. Of course, as my child matures - both physically and emotionally - I will likely liberalize their phone usage.
Even if there were no health concerns, there are other issues at stake - sexting, distractions at school, driving and dialing, and over-usage to name a few. The bottom line is that the health risks seem small and possibly zero. However, there are many reasons to limit the habitual use of a cell phone in a young child and the precautionary principle adds one more reason to the list, but it likely is just that - a precaution.
From the April 13, 2011 NYT. . . here are some excerpts from an excellent article titled "Do Cellphones Cause Brain Cancer" written by Siddhartha Mukherjee who is an assistant professor of medicine in the division of medical oncology at Columbia University. He is the author of “Emperor of All Maladies: A Biography of Cancer.”
The most exquisite — and arguably the most sensitive — means to identify a carcinogen is to study the effects of the substance not on humans or animals but on cells. In the 1970s, a Berkeley biochemist named Bruce Ames devised a cellular test to do just that. Ames’s test is based on a series of simple principles. Normal cells in the body grow through cell division, or mitosis, which is carefully regulated by genes. Certain genes accelerate growth, while other genes dampen or stop it. Cancer originates when the “accelerator” genes are permanently activated or when the “brake” genes are permanently damaged. Since genes are encoded by DNA, chemicals that mutate DNA — mutagens — can alter the growth-controlling genes and thereby cause cancer. Ames devised a special strain of bacterial cells that act as a “sensor” for mutations and therefore can also detect mutagenic chemicals. Chemical mutagens are so commonly carcinogenic that versions of the Ames test represent the gold standard by which most carcinogens are found.
Cellphone radiation is not a chemical, of course, but the rules about mutagenicity still apply (X-rays, for instance, are known to cause cancer and are detectable by Ames’s test). Laboratory experiments that link phone radiation to DNA mutation using a version of the Ames test have been largely contradictory. In 2005, a panel of experts, including a biomedical engineer, an epidemiologist, a genetic toxicologist and a radiation biologist, published a review of nearly 1,700 scientific papers on the cellular effects of radiation emitted by phones. In the review of more than 50 experiments linking phone radiation to DNA damage in animal or bacterial cells, evidence of damage has been negative in more than two-thirds of the studies. Since nonionizing radiation cannot directly affect the structure of DNA, experiments linking phone radiation to DNA damage are generally unconvincing. The most striking study linking cellular phone radiation to DNA damage, published in 2005 by researchers from the Medical University of Vienna, has recently been embroiled in even deeper scientific controversy: researchers studying the data intensively have argued that the original study is fraudulent.
But it is possible for something to be a carcinogen without directly damaging DNA. Some chemicals might activate growth pathways or survival pathways in cancer cells (eventually damaging DNA and mutating genes — but indirectly). Exogenous estrogen, for instance, activates growth pathways in breast cells and can cause breast cancer but doesn’t damage DNA. Others may provoke inflammation, creating a physiological milieu in the body that allows malignant cells to grow and survive. Yet others — the class of substances that we know least about — might not damage DNA directly but chemically modify genes so that their regulation is changed. These substances are like the dark matter of the carcinogenic world: they are barely visible to our current tests for carcinogens and thus lie at the boundaries of the knowable universe. Cellphones and their radiation have been tested for many of these properties — for instance, their ability to chemically modify DNA without causing mutations — but evidence linking this form of radiation to such cellular changes remains largely negative.
This section is about animal studies. . .
Nonetheless, biologists have exposed mice and rats to chronic nonionizing radiation (comparable to that emitted by phones) to determine whether it causes cancer. In rats prone to developing breast cancer, there was no acceleration of breast cancer. In another experiment, rats were treated with a chemical carcinogen in utero (to “prime” them to develop brain tumors) and then exposed to radiant energy comparable to cellphone radiation for two hours per day, four days a week, for 22 months. The experiment revealed no increased incidence of brain tumors in rats. Nor was there any accelerated growth in previously established brain tumors. From 1997 to 2004, six independent experiments on mice and rats studied the effects of chronic radiation on brain cancer. No experiment revealed an increased risk of brain cancer.
An excellent article and if you would like to read it in full here is the link.
Friday, April 15, 2011
Wednesday, March 23, 2011
Post #23 Assessing the Risk of Cell Phones to Children's Health
Recently, our local elementary school allowed a cellular company to hoist a cell phone tower next to the cafeteria. Apparently, the school district will receive some monetary subsidy in exchange for allowing the tower to be built. I am unaware of the politics, legislation and deal-making that allowed this to happen; however, as a local pediatrician (with one child and many patients who attend this school) I felt compelled to do some cursory research into the potential health hazards (if any) regarding long term exposure to a cell tower.
As I am not an expert in epidemiology, radiation, cellular technology or cancer, I have posted snippets of the most relevant research I have found. And although I have my personal misgivings about the actual process that led to the cell tower being erected, I have tried to stick to the facts in regards to the health risks (the editorializing comes mostly at the end).
The main bias may be in the selection of websites that I chose to research - mostly government agencies - which I realize may be a problem for some.
Like most debates, evidence for both sides can be found on the web. The evidence in general seems to favor that there is no appreciable risk from cell phone radiation. Most organizations that I trust (CDC, WHO, FDA, NIH) all post evidence on their websites that generally conclude that cell phone usage has not shown a statistically relevant risk in developing cancer.
1. National Cancer Institute
This link is a nice primer on the health risks of cell phone use and a good summary of the reputable information available. The general conclusion is that "there is currently no conclusive evidence that non-ionizing radiation emitted by cell phones is associated with cancer risk."
The National Cancer Institute also reports that a "Nordic study is expected to provide some results on children in the next few years. Plans are also under way for a study called MOBI-KIDS, which would evaluate risk from new communications technologies, including cell phones, and other environmental factors in people between age 10 and 24."
2. National Institutes of Health
This link is to a subsection of the NIH website which summarizes an interview with Toxicologist, Dr. Michael Wyde, who is overseeing the National Toxicology Program (NTP) cell phone studies.
In the interview Dr. Wyde states, "Currently, there’s little or no evidence to suggest that cell phone usage is associated with brain tumors or any other adverse health effects in humans."
3. World Health Organization
Key facts listed in this link show:
• Mobile phone use is ubiquitous with an estimated 4.6 billion subscriptions globally.
• To date, no adverse health effects have been established for mobile phone use.
• Studies are ongoing to assess potential long-term effects of mobile phone use.
• There is an increased risk of road traffic injuries when drivers use mobile phones (either handheld or "hands-free") while driving.
4. Center for Disease Control
This blog commented on a large epidemiologic study called INTERPHONE which was funded by the European Union and health agencies in 13 countries. From 2000 to 2005, INTERPHONE interviewed 14,000 adults about their cell phone use, other exposures to RF radiation, and other factors conceivably related to brain cancer.
The study concluded that, "overall, no increase in risk of [brain cancer] was observed with use of mobile phones. There were suggestions of an increased risk... at the highest exposure levels... However, biases and errors limit the strength of the conclusions we can draw from these analyses and prevent a causal interpretation... The possible effects of long-term heavy use of mobile phones require further investigation."
5. Food and Drug Administration
This webpage focuses on the risks of cell phone radiation to children. "The scientific evidence does not show a danger to any users of cell phones from RF exposure, including children and teenagers."
6. Wikipedia
Under the cancer subheading in this Wikipedia entry there are is a list of studies both for and against the risks of cell phone radiation.
7. British Medical Journal
BMJ 2010; 340:c3077 doi: 10.1136/bmj.c3077 (Published 22 June 2010)
This case-control study looks at mobile phone base stations and early childhood cancer risk in children born to mothers who lived near cell phone towers during pregnancy.
Paul Elliott, professor of epidemiology and public health medicine, head of department, director, MRC-HPA centre for environment and health, concludes that "there is no association between risk of early childhood cancers and estimates of the mother’s exposure to mobile phone base stations during pregnancy."
Overall the current body of evidence gives me solid relief about cell phones and the lack of health risk they pose.
However, one thing that frustrated me in my research was that I could not find a significant amount of information on health risk secondary to cell phone towers. Understandably, most of the research is concentrated on cell phone usage.
Several articles did comment that cell phone usage exposed the body (and more specifically the brain) to higher radiofrequency energy then a cell phone tower did; however none of the articles really went into detail about distance from the tower, hours near the tower, etc.
One could then extrapolate that if studies are showing that cell phone usage is safe, then exposure to a cell phone tower must also be. But as a parent, I would obviously feel safer and less anxious if there were clear studies in regards to cell phone towers.
The BMJ article cited above discusses cell phone towers and finds no risk to the children of woman who lived near the towers during pregnancy. However there were some debatable flaws to the study and although the conclusion is assuaging, the more studies the merrier.
Interestingly, several websites cautioned that the risks of driving while using a mobile phone were greater than the risks from the radiation exposure itself. Guilty as charged!
In the end my research made me feel better about my child's (and patients') exposure to a cell phone tower, but not completely at ease. It's the unknown that gnaws at me – but I suppose there will always be some level of unknowing.
Would I rather the cell phone tower not be built? Yes. But this may be more NIMBYism than true health concern.
Would I vote to stop it? Yes.
Am I going to fight a long battle to stop it? There are probably better and more productive ways my time could be spent for my child (unless of course the risk of cell phone towers becomes more real in future research).
Am I going to move schools because of this? I doubt it. Our family as a whole is very happy with the school and this potential but unlikely risk doesn't seem to warrant a move.
As in life, every decision carries some risk. We take some risk every time we send our child to school, but as parents we have to decide if the good outweighs the bad. And while my wife and I would rather not see a cell phone tower erected, ultimately, as of this writing, the research leads me to believe very little has changed with the bad.
As I am not an expert in epidemiology, radiation, cellular technology or cancer, I have posted snippets of the most relevant research I have found. And although I have my personal misgivings about the actual process that led to the cell tower being erected, I have tried to stick to the facts in regards to the health risks (the editorializing comes mostly at the end).
The main bias may be in the selection of websites that I chose to research - mostly government agencies - which I realize may be a problem for some.
Like most debates, evidence for both sides can be found on the web. The evidence in general seems to favor that there is no appreciable risk from cell phone radiation. Most organizations that I trust (CDC, WHO, FDA, NIH) all post evidence on their websites that generally conclude that cell phone usage has not shown a statistically relevant risk in developing cancer.
1. National Cancer Institute
This link is a nice primer on the health risks of cell phone use and a good summary of the reputable information available. The general conclusion is that "there is currently no conclusive evidence that non-ionizing radiation emitted by cell phones is associated with cancer risk."
The National Cancer Institute also reports that a "Nordic study is expected to provide some results on children in the next few years. Plans are also under way for a study called MOBI-KIDS, which would evaluate risk from new communications technologies, including cell phones, and other environmental factors in people between age 10 and 24."
2. National Institutes of Health
This link is to a subsection of the NIH website which summarizes an interview with Toxicologist, Dr. Michael Wyde, who is overseeing the National Toxicology Program (NTP) cell phone studies.
In the interview Dr. Wyde states, "Currently, there’s little or no evidence to suggest that cell phone usage is associated with brain tumors or any other adverse health effects in humans."
3. World Health Organization
Key facts listed in this link show:
• Mobile phone use is ubiquitous with an estimated 4.6 billion subscriptions globally.
• To date, no adverse health effects have been established for mobile phone use.
• Studies are ongoing to assess potential long-term effects of mobile phone use.
• There is an increased risk of road traffic injuries when drivers use mobile phones (either handheld or "hands-free") while driving.
4. Center for Disease Control
This blog commented on a large epidemiologic study called INTERPHONE which was funded by the European Union and health agencies in 13 countries. From 2000 to 2005, INTERPHONE interviewed 14,000 adults about their cell phone use, other exposures to RF radiation, and other factors conceivably related to brain cancer.
The study concluded that, "overall, no increase in risk of [brain cancer] was observed with use of mobile phones. There were suggestions of an increased risk... at the highest exposure levels... However, biases and errors limit the strength of the conclusions we can draw from these analyses and prevent a causal interpretation... The possible effects of long-term heavy use of mobile phones require further investigation."
5. Food and Drug Administration
This webpage focuses on the risks of cell phone radiation to children. "The scientific evidence does not show a danger to any users of cell phones from RF exposure, including children and teenagers."
6. Wikipedia
Under the cancer subheading in this Wikipedia entry there are is a list of studies both for and against the risks of cell phone radiation.
7. British Medical Journal
BMJ 2010; 340:c3077 doi: 10.1136/bmj.c3077 (Published 22 June 2010)
This case-control study looks at mobile phone base stations and early childhood cancer risk in children born to mothers who lived near cell phone towers during pregnancy.
Paul Elliott, professor of epidemiology and public health medicine, head of department, director, MRC-HPA centre for environment and health, concludes that "there is no association between risk of early childhood cancers and estimates of the mother’s exposure to mobile phone base stations during pregnancy."
Overall the current body of evidence gives me solid relief about cell phones and the lack of health risk they pose.
However, one thing that frustrated me in my research was that I could not find a significant amount of information on health risk secondary to cell phone towers. Understandably, most of the research is concentrated on cell phone usage.
Several articles did comment that cell phone usage exposed the body (and more specifically the brain) to higher radiofrequency energy then a cell phone tower did; however none of the articles really went into detail about distance from the tower, hours near the tower, etc.
One could then extrapolate that if studies are showing that cell phone usage is safe, then exposure to a cell phone tower must also be. But as a parent, I would obviously feel safer and less anxious if there were clear studies in regards to cell phone towers.
The BMJ article cited above discusses cell phone towers and finds no risk to the children of woman who lived near the towers during pregnancy. However there were some debatable flaws to the study and although the conclusion is assuaging, the more studies the merrier.
Interestingly, several websites cautioned that the risks of driving while using a mobile phone were greater than the risks from the radiation exposure itself. Guilty as charged!
In the end my research made me feel better about my child's (and patients') exposure to a cell phone tower, but not completely at ease. It's the unknown that gnaws at me – but I suppose there will always be some level of unknowing.
Would I rather the cell phone tower not be built? Yes. But this may be more NIMBYism than true health concern.
Would I vote to stop it? Yes.
Am I going to fight a long battle to stop it? There are probably better and more productive ways my time could be spent for my child (unless of course the risk of cell phone towers becomes more real in future research).
Am I going to move schools because of this? I doubt it. Our family as a whole is very happy with the school and this potential but unlikely risk doesn't seem to warrant a move.
As in life, every decision carries some risk. We take some risk every time we send our child to school, but as parents we have to decide if the good outweighs the bad. And while my wife and I would rather not see a cell phone tower erected, ultimately, as of this writing, the research leads me to believe very little has changed with the bad.
Wednesday, March 9, 2011
Post #22 Fever Phobia Deconstructed
An excellent article detailing how parents and pediatricians should approach fever. I absolutely agree that the comfort of the child supersedes the fear-driven need to bring the number of the fever down.
My motto in the office is "treat the child, not the fever". In fact this motto can be extended to almost any other symptom, i.e. "treat the child, not the cough". As with all symptoms, it is far more important to elucidate the source of the fever rather than to focus on the fever itself.
The same goes with cough, runny nose, rashes, etc. If the source is benign then one need not worry about the symptom itself. Which does not mean you shouldn't treat the symptom - if there is discomfort it should be addressed.
On the otherhand, if a pediatrician suspects that the source may be of concern, i.e. pneumonia, meningitis, kidney infections - a more extensive evaluation, closer monitoring and treatment will be called for.
Sweating Out a Fever
Focus on Symptoms, Not Just the Number on the Thermometer, Doctors Advise
Wall Street Journal March 1, 2011
By MELINDA BECK
When a child's temperature begins to rise, worried parents often spring into action, marshaling cool washcloths and pain relievers, making frantic calls to the doctor or even visiting an emergency room.
Now, the American Academy of Pediatrics is telling parents that the number the thermometer displays is just a number—and that making a feverish child comfortable is far more important than bringing his temperature to 98.6 on the dot.
Fevers are the main reason for one-third of calls and visits to pediatricians.
"The signs and symptoms provide much more information than just the fever itself," says Janice E. Sullivan, a professor of pediatric critical care at the University of Louisville School of Medicine in Kentucky and co-author of an AAP report on fevers, released Monday.
The report, aimed at calming what it calls "fever phobia," also says there is no evidence that lowering a fever will help a child get well faster, or that leaving a fever untreated could cause seizures, brain damage or death, as some caregivers fear.
Many pediatricians have given parents a similar message for decades, but it hasn't sunken in. There's widespread confusion over what fevers in both children and adults signify, when to treat them—even what constitutes an official "fever" (100 degrees Fahrenheit? 100.4?) Many parents also rely on the thermometer to tell them how sick a child is when he's too young to talk. To some, it's an objective measure, which can't be faked, of whether an older child should be packed off to school or sent back to bed.
Fevers are the main reason for one-third of calls and visits to pediatricians, the report notes. Yet many beliefs about them are based more on culture, tradition and playground chatter than scientific evidence. Ads showing parents fretting over thermometers confuse things further.
Drugstore Dangers
These days, navigating the world of children's pain relievers is almost as tricky as interpreting a child's temperature.
Johnson & Johnson's McNeil Consumer Healthcare unit recalled 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl for infants and children last year after federal investigators found bacterial contamination and other problems at a plant in Pennsylvania. Subsequent recalls included Children's Tylenol Meltaway strips in bubblegum flavor, Junior Strength Motrin caplets and Children's Benadryl Allergy Fast Melt tablets in cherry and grape.
Problems ranged from moldy smells to floating metal particles to the possibility of excess concentrations of an ingredient. In a legal filing last week, Johnson & Johnson said alternative supplies are expected to be available in the second half of this year.
In their absence, many parents have turned to generics and drugstore brands, children's Advil or Triaminic, another liquid acetaminophen for children.
Experts are still concerned about combination cough-and-cold syrups. Manufacturers voluntarily withdrew those labeled for children under age 2 in 2007 after pediatricians complained that they didn't work well and posed a risk of accidental overdose. But this week's American Academy of Pediatrics report warns that parents should not give cough-and-cold products containing acetaminophen even to older children, given the risk that they might unknowingly take other products with acetaminophen, which can cause fatal liver damage at high doses.
Many liquid medications for children still on the market have confusing dosing information, according to a study in the Journal of the American Medical Association in December. For example: a label calling for a one-teaspoon dose packaged with a cup marked in milliliters. Since the study was conducted, the Food and Drug Administration issued voluntary guidelines for making children's medication labels easier to understand. The researchers, from New York University, plan to repeat the study to see if the guidelines have made a difference.
In the meantime, experts say, parents should pay very careful attention to dosing information since even small errors can have big consequences in children.
Melinda Beck ."There's a huge desire to do the right thing, but when we think we're healing the child, we may be really treating ourselves" by taking action, says Glen Stream, president-elect of the American Association of Family Physicians.
Experts stress that a fever isn't an illness, it's a response, probably an evolutionary adaptation to help fight infection. Setting the body's thermostat (the hypothalamus gland in the brain) a few degrees higher slows the reproduction of bacteria and viruses and boosts white blood cells.
There's some evidence that illnesses may resolve faster when fevers are left untreated, the report notes. At the same time, elevated temperatures themselves can cause discomfort in children by interfering with sleep, appetite and activities.
"If your child looks uncomfortable, then treat the discomfort with acetaminophen or ibuprofen," says Dr. Sullivan. But she says a fever alone with no other symptoms doesn't need treating. "The fever itself doesn't tell us how ill the child is. There isn't a good correlation."
The report, which is aimed at pediatricians, not parents, doesn't specify other ways to make a sick child more comfortable. But Dr. Sullivan says parents should be on the lookout for rashes, irritability and altered mental status.
"Anytime you have a significant change in behavior, you need to talk to your doctor," says Henry Farrar, who practices pediatric emergency medicine at Arkansas Children's Hospital and co-authored the report. It also stresses the need for rest and proper fluid intake.
If a fever-reducing medicine is warranted to make a sick child more comfortable, the report says there is no substantial difference between acetaminophen and ibuprofen in safety or effectiveness. But it warns against combining them or alternating them—which some doctors recommend—because it compounds the risk of errors.
COMMON AILMENTS ASSOCIATED WITH FEVERS
Some temperatures are cause for concern all by themselves. But going strictly by the numbers on a thermometer can be misleading, since people can react differently to the same infections.
The report also stresses the importance of checking package labels for the correct dosages, which are based on weight and age in children. As many as half of all U.S. parents give children incorrect doses, according to the report.
And if a child is asleep, he shouldn't be awakened just for medication, the report notes. In one study, 85% of parents said they had done so.
There are some cases where a fever alone can be worrisome. Parents should contact a doctor immediately if an infant under 3-months old has a fever of 100.4 or higher, which could signal a serious infection. Children with underlying conditions, such as weak heart muscles, may not be able to tolerate a fever and should get medical attention if one appears.
Children and adults can spike fevers as high as 106 due to hyperthermia, or "heat stroke," a malfunction in the body's ability to cool itself, often after physical exertion in hot weather. Drinking fluids and being immersed in cool water can help; fever-reducing drugs don't.
Fevers can occur in children and adults for many other reasons, including auto-immune diseases like lupus, cancers like leukemia and lymphoma and just normal teething. Some people routinely run fevers even with minor illnesses, and some people seldom get them. (Rare fevers that last for weeks with no apparent reason are known as FUOs—fevers of undetermined origin.)
Even the classic 98.6 isn't so much "normal" as "average," experts note. A healthy person's temperature varies much as a full degree during the day, reaching highest in the evening and lowest between about 6 a.m. and 9 a.m. (just when tough school-or-bed decisions are being made.)
Given all that variability, does it make sense to check the thermometer at all?
Yes, doctors say. Since most fevers accompany viral infections, experts agree that children with temperatures above 100.4 should stay home until they are fever free, without medication, for at least 24 hours, whether they have symptoms or not.
The same goes for adults—and they shouldn't be under the illusion that lowering a fever with medication also lowers their chance of infecting coworkers, experts say. "We really don't want people with fevers to be in the workplace," says Robert Hopkins, a University of Arkansas professor of internal medicine who serves on the American College of Physician's clinical guidelines committee.
The illnesses with little or no fever pose more of a dilemma. Some viruses are most contagious in the early stages, before a fever has developed. Others, like last year's H1N1 virus, made many people miserable but seldom caused fevers.
That can make for tough calls for parents and school nurses when it comes to deciding whether a child who complains of illness, but doesn't have a fever, should be in school.
"Sorting out the difference between a math-anxiety headache and an illness that could be contagious or prevent a child from learning is a judgment call," says Amy Garcia, executive director of the National Association of School Nurses. It helps to know the child very well, she says. "I had three boys myself, so I know the drill pretty well."
My motto in the office is "treat the child, not the fever". In fact this motto can be extended to almost any other symptom, i.e. "treat the child, not the cough". As with all symptoms, it is far more important to elucidate the source of the fever rather than to focus on the fever itself.
The same goes with cough, runny nose, rashes, etc. If the source is benign then one need not worry about the symptom itself. Which does not mean you shouldn't treat the symptom - if there is discomfort it should be addressed.
On the otherhand, if a pediatrician suspects that the source may be of concern, i.e. pneumonia, meningitis, kidney infections - a more extensive evaluation, closer monitoring and treatment will be called for.
Sweating Out a Fever
Focus on Symptoms, Not Just the Number on the Thermometer, Doctors Advise
Wall Street Journal March 1, 2011
By MELINDA BECK
When a child's temperature begins to rise, worried parents often spring into action, marshaling cool washcloths and pain relievers, making frantic calls to the doctor or even visiting an emergency room.
Now, the American Academy of Pediatrics is telling parents that the number the thermometer displays is just a number—and that making a feverish child comfortable is far more important than bringing his temperature to 98.6 on the dot.
Fevers are the main reason for one-third of calls and visits to pediatricians.
"The signs and symptoms provide much more information than just the fever itself," says Janice E. Sullivan, a professor of pediatric critical care at the University of Louisville School of Medicine in Kentucky and co-author of an AAP report on fevers, released Monday.
The report, aimed at calming what it calls "fever phobia," also says there is no evidence that lowering a fever will help a child get well faster, or that leaving a fever untreated could cause seizures, brain damage or death, as some caregivers fear.
Many pediatricians have given parents a similar message for decades, but it hasn't sunken in. There's widespread confusion over what fevers in both children and adults signify, when to treat them—even what constitutes an official "fever" (100 degrees Fahrenheit? 100.4?) Many parents also rely on the thermometer to tell them how sick a child is when he's too young to talk. To some, it's an objective measure, which can't be faked, of whether an older child should be packed off to school or sent back to bed.
Fevers are the main reason for one-third of calls and visits to pediatricians, the report notes. Yet many beliefs about them are based more on culture, tradition and playground chatter than scientific evidence. Ads showing parents fretting over thermometers confuse things further.
Drugstore Dangers
These days, navigating the world of children's pain relievers is almost as tricky as interpreting a child's temperature.
Johnson & Johnson's McNeil Consumer Healthcare unit recalled 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl for infants and children last year after federal investigators found bacterial contamination and other problems at a plant in Pennsylvania. Subsequent recalls included Children's Tylenol Meltaway strips in bubblegum flavor, Junior Strength Motrin caplets and Children's Benadryl Allergy Fast Melt tablets in cherry and grape.
Problems ranged from moldy smells to floating metal particles to the possibility of excess concentrations of an ingredient. In a legal filing last week, Johnson & Johnson said alternative supplies are expected to be available in the second half of this year.
In their absence, many parents have turned to generics and drugstore brands, children's Advil or Triaminic, another liquid acetaminophen for children.
Experts are still concerned about combination cough-and-cold syrups. Manufacturers voluntarily withdrew those labeled for children under age 2 in 2007 after pediatricians complained that they didn't work well and posed a risk of accidental overdose. But this week's American Academy of Pediatrics report warns that parents should not give cough-and-cold products containing acetaminophen even to older children, given the risk that they might unknowingly take other products with acetaminophen, which can cause fatal liver damage at high doses.
Many liquid medications for children still on the market have confusing dosing information, according to a study in the Journal of the American Medical Association in December. For example: a label calling for a one-teaspoon dose packaged with a cup marked in milliliters. Since the study was conducted, the Food and Drug Administration issued voluntary guidelines for making children's medication labels easier to understand. The researchers, from New York University, plan to repeat the study to see if the guidelines have made a difference.
In the meantime, experts say, parents should pay very careful attention to dosing information since even small errors can have big consequences in children.
Melinda Beck ."There's a huge desire to do the right thing, but when we think we're healing the child, we may be really treating ourselves" by taking action, says Glen Stream, president-elect of the American Association of Family Physicians.
Experts stress that a fever isn't an illness, it's a response, probably an evolutionary adaptation to help fight infection. Setting the body's thermostat (the hypothalamus gland in the brain) a few degrees higher slows the reproduction of bacteria and viruses and boosts white blood cells.
There's some evidence that illnesses may resolve faster when fevers are left untreated, the report notes. At the same time, elevated temperatures themselves can cause discomfort in children by interfering with sleep, appetite and activities.
"If your child looks uncomfortable, then treat the discomfort with acetaminophen or ibuprofen," says Dr. Sullivan. But she says a fever alone with no other symptoms doesn't need treating. "The fever itself doesn't tell us how ill the child is. There isn't a good correlation."
The report, which is aimed at pediatricians, not parents, doesn't specify other ways to make a sick child more comfortable. But Dr. Sullivan says parents should be on the lookout for rashes, irritability and altered mental status.
"Anytime you have a significant change in behavior, you need to talk to your doctor," says Henry Farrar, who practices pediatric emergency medicine at Arkansas Children's Hospital and co-authored the report. It also stresses the need for rest and proper fluid intake.
If a fever-reducing medicine is warranted to make a sick child more comfortable, the report says there is no substantial difference between acetaminophen and ibuprofen in safety or effectiveness. But it warns against combining them or alternating them—which some doctors recommend—because it compounds the risk of errors.
COMMON AILMENTS ASSOCIATED WITH FEVERS
Some temperatures are cause for concern all by themselves. But going strictly by the numbers on a thermometer can be misleading, since people can react differently to the same infections.
The report also stresses the importance of checking package labels for the correct dosages, which are based on weight and age in children. As many as half of all U.S. parents give children incorrect doses, according to the report.
And if a child is asleep, he shouldn't be awakened just for medication, the report notes. In one study, 85% of parents said they had done so.
There are some cases where a fever alone can be worrisome. Parents should contact a doctor immediately if an infant under 3-months old has a fever of 100.4 or higher, which could signal a serious infection. Children with underlying conditions, such as weak heart muscles, may not be able to tolerate a fever and should get medical attention if one appears.
Children and adults can spike fevers as high as 106 due to hyperthermia, or "heat stroke," a malfunction in the body's ability to cool itself, often after physical exertion in hot weather. Drinking fluids and being immersed in cool water can help; fever-reducing drugs don't.
Fevers can occur in children and adults for many other reasons, including auto-immune diseases like lupus, cancers like leukemia and lymphoma and just normal teething. Some people routinely run fevers even with minor illnesses, and some people seldom get them. (Rare fevers that last for weeks with no apparent reason are known as FUOs—fevers of undetermined origin.)
Even the classic 98.6 isn't so much "normal" as "average," experts note. A healthy person's temperature varies much as a full degree during the day, reaching highest in the evening and lowest between about 6 a.m. and 9 a.m. (just when tough school-or-bed decisions are being made.)
Given all that variability, does it make sense to check the thermometer at all?
Yes, doctors say. Since most fevers accompany viral infections, experts agree that children with temperatures above 100.4 should stay home until they are fever free, without medication, for at least 24 hours, whether they have symptoms or not.
The same goes for adults—and they shouldn't be under the illusion that lowering a fever with medication also lowers their chance of infecting coworkers, experts say. "We really don't want people with fevers to be in the workplace," says Robert Hopkins, a University of Arkansas professor of internal medicine who serves on the American College of Physician's clinical guidelines committee.
The illnesses with little or no fever pose more of a dilemma. Some viruses are most contagious in the early stages, before a fever has developed. Others, like last year's H1N1 virus, made many people miserable but seldom caused fevers.
That can make for tough calls for parents and school nurses when it comes to deciding whether a child who complains of illness, but doesn't have a fever, should be in school.
"Sorting out the difference between a math-anxiety headache and an illness that could be contagious or prevent a child from learning is a judgment call," says Amy Garcia, executive director of the National Association of School Nurses. It helps to know the child very well, she says. "I had three boys myself, so I know the drill pretty well."
Friday, July 30, 2010
Post #21 When Should I Send My Sick Kid Back To School?
School and daycare criteria are often overly restrictive in their back to school policy for sick kids. This can unnecessarily hamper the education of your child without benefitting the health of the other kids in his/her classroom.
Below is an excellent article highlighting policy from the American Academy of Pediatrics that helps parents (and doctors) understand when exclusion does and does not make sense.
AAP Updates Guidelines for Infectious Disease Exclusions
Pediatric News Volume 44 Issue 2 February 2009
DIANA MAHONEY (New England Bureau)
Conjunctivitis: It's red, it's itchy, it's crusty, but it is not—repeat NOT—cause for automatic exclusion from day care or school, according to the latest edition of the American Academy of Pediatrics' “Managing Infectious Diseases in Child Care and Schools.”
The rationale behind this seemingly revolutionary recommendation is the fact that neither treatment nor exclusion of children with conjunctivitis from group settings reduces the spread of infection, Dr. Laura A. Jana discussed at the annual meeting of the American Academy of Pediatrics.
The same goes for many of the common childhood infections that incite knee-jerk reactions among schools, day care providers, and parents.
“Multiple studies have shown that most viruses are spread by children who seem well, which means that exposure happens before the school or day care facility can make the first phone call for the child to be picked up,” said Dr. Jana, a pediatrician and owner of a child care facility in Omaha, Neb.
So while conventional wisdom says that automatically excluding kids with conjunctivitis, fever, and stomachaches will prevent the spread of these infections, “the evidence doesn't back this up,” she said, noting that “hand and surface hygiene continue to be the best way to reduce infections in group care.”
The confusion regarding exclusion is understandable, said Dr. Jana. Unlike the best-practice guidelines issued in 2002 by the AAP, American Public Health Association, and others, state guidelines for exclusion from child care or school lack detail, are not based on medical evidence, and vary considerably by state.
“Most states do not require center and school policies to follow national guidelines, and individual exclusion policies must only comply with state licensing, which means children are often excluded for harmless conditions,” she said. The consequences of inappropriate exclusion policies and practices, she added, include excess health care visits, antibiotic-seeking behavior, and lost work and school time.
The one exclusion criterion from the national guidelines that is excluded most frequently, according to Dr. Jana, is the directive that a child should be excluded if the illness prevents him or her from participating comfortably in activities. “This child should really be at home,” she said. “Additionally, a child should be excluded from school or day care if the illness results in greater care than the staff can provide,” she noted, or if the illness poses a risk of spreading a harmful disease to others. (See box below.)
The common cold, for example, does not warrant exclusion, “unless the child is too uncomfortable to participate in routine daily activities,” Dr. Jana said. “The virus itself can be spread before, during, and well after the time of symptoms, so preventing a child's attendance won't significantly reduce the chance of spread.”
The updated “Managing Infectious Diseases in Child Care and Schools” (Elk Grove Village, Ill.: American Academy of Pediatrics, 2008), also recommends against exclusion for the following conditions that often incite red flags, according to Dr. Jana:
▸ Hand, foot, and mouth disease. “Children should not be excluded unless they have sores in their mouth with drooling or if the rash is associated with fever or behavior change,” Dr. Jana explained. “Good hygiene is the best way to minimize the opportunity for the spread of this common virus.”
▸ Fifth disease. Because there is little virus present when the telltale rash appears, exclusion has no preventive benefit.
▸ Draining skin infection, including methicillin-resistant Staphylococcus aureus (MRSA) infection. “Because of the media attention surrounding MRSA, there's a lot of anxiety about this, but the reality is, these children should be excluded only if the infection is accompanied by fever, pain, or behavior change,” said Dr. Jana. “There is no need for the caregiver to request a culture, because it won't affect how the infection will be handled. Some kids without symptoms have MRSA, and there is no good way to eradicate the germ yet from individuals, families, or classrooms.”
▸ Diarrhea. According to the revised guidelines, diapered children with diarrhea may remain in care if the diarrhea is contained in the diaper and the child has no more than two stools above normal baseline. “This is a departure from the previous recommendation that all diapered children be excluded until the diarrhea resolves or is deemed noninfectious,” said Dr. Jana. Children who are able to use the toilet may remain in care with good hand washing, as long as they don't have accidents. “Exclusion is appropriate for children with blood in their stool not explained by medication, hard stool, or diet,” she said.
▸ Vomiting. Exclusion is recommended for a child who has had two or more episodes of vomiting in the previous 24 hours and continuing exclusion until the vomiting resolves or a health care provider determines the cause is not contagious.
▸ Fever. “Children with fever should not be excluded automatically, unless the fever is accompanied by behavior change or other signs or symptoms of illness,” explained Dr. Jana. The exception to this is children younger than 4 months old with unexplained fever.
▸ Respiratory illness. Most respiratory illnesses do not require exclusion; however, a child with persistent coughing or trouble breathing should be evaluated for pneumonia, asthma, or serious respiratory infection, such as whooping cough.
▸ Earache, no fever. “This child should be excluded if he or she requires more care than the staff can reasonably provide,” said Dr. Jana. “Often, these kids are in a lot of pain and cannot participate in routine activities.”
▸ Lice. “Lice are a nuisance, but they're not a health hazard,” said Dr. Jana. “Children with lice should be excluded, but they don't have to be sent home right away. It can wait until the end of the day, and they can return once treatment occurs,” she said.
“Of course, all of these are recommendations, and while they are based in evidence, they are not binding,” Dr. Jana concluded.
Revised ‘When to Exclude’ Criteria
With the exception of the noted updates, most of the exclusion criteria outlined in the revised “Managing Infectious Diseases in Child Care and Schools” are consistent with the national illness exclusion guidelines published jointly in 2002 by the AAP, APHA, the Maternal and Child Health Bureau, and the National Resource Center for Health and Safety in Child Care. These include:
▸ Tuberculosis, until an appropriate health care provider or health official certifies that the child is in appropriate therapy and can attend care.
▸ Impetigo, until 24 hours after treatment has been initiated.
▸ Chickenpox until all sores have dried and crusted (usually 6 days).
▸ Mumps, until 9 days after an onset of parotid gland swelling.
▸ Hepatitis A virus, until 1 week after an onset of illness or jaundice or as directed by the health department.
▸ Measles, until 4 days after an onset of rash.
▸ Rubella, until 6 days after an onset of rash.
▸ Fever, when accompanied by behavior changes or other symptoms such as a sore throat, rash, vomiting, diarrhea, earache, etc.
▸ Diarrhea (frequent, runny, watery stools).
▸ Blood in the stool not explained by dietary change, medication, or hard stool.
▸ Vomiting two or more times in a 24-hour period.
▸ Body rash with fever.
▸ Sore throat with fever and swollen glands or mouth sores with drooling.
▸ Severe coughing with the child getting red or blue in the face or making a high-pitched whooping sound after coughing.
▸ Persistent abdominal pain (more than 2 hours) or intermittent pain with other signs and symptoms.
▸ Signs of possible severe illness such as irritability, unusual tiredness, or neediness that compromises caregivers' ability to care for others.
▸ Uncontrolled coughing or wheezing, continuous crying, or difficulty breathing.
Below is an excellent article highlighting policy from the American Academy of Pediatrics that helps parents (and doctors) understand when exclusion does and does not make sense.
AAP Updates Guidelines for Infectious Disease Exclusions
Pediatric News Volume 44 Issue 2 February 2009
DIANA MAHONEY (New England Bureau)
Conjunctivitis: It's red, it's itchy, it's crusty, but it is not—repeat NOT—cause for automatic exclusion from day care or school, according to the latest edition of the American Academy of Pediatrics' “Managing Infectious Diseases in Child Care and Schools.”
The rationale behind this seemingly revolutionary recommendation is the fact that neither treatment nor exclusion of children with conjunctivitis from group settings reduces the spread of infection, Dr. Laura A. Jana discussed at the annual meeting of the American Academy of Pediatrics.
The same goes for many of the common childhood infections that incite knee-jerk reactions among schools, day care providers, and parents.
“Multiple studies have shown that most viruses are spread by children who seem well, which means that exposure happens before the school or day care facility can make the first phone call for the child to be picked up,” said Dr. Jana, a pediatrician and owner of a child care facility in Omaha, Neb.
So while conventional wisdom says that automatically excluding kids with conjunctivitis, fever, and stomachaches will prevent the spread of these infections, “the evidence doesn't back this up,” she said, noting that “hand and surface hygiene continue to be the best way to reduce infections in group care.”
The confusion regarding exclusion is understandable, said Dr. Jana. Unlike the best-practice guidelines issued in 2002 by the AAP, American Public Health Association, and others, state guidelines for exclusion from child care or school lack detail, are not based on medical evidence, and vary considerably by state.
“Most states do not require center and school policies to follow national guidelines, and individual exclusion policies must only comply with state licensing, which means children are often excluded for harmless conditions,” she said. The consequences of inappropriate exclusion policies and practices, she added, include excess health care visits, antibiotic-seeking behavior, and lost work and school time.
The one exclusion criterion from the national guidelines that is excluded most frequently, according to Dr. Jana, is the directive that a child should be excluded if the illness prevents him or her from participating comfortably in activities. “This child should really be at home,” she said. “Additionally, a child should be excluded from school or day care if the illness results in greater care than the staff can provide,” she noted, or if the illness poses a risk of spreading a harmful disease to others. (See box below.)
The common cold, for example, does not warrant exclusion, “unless the child is too uncomfortable to participate in routine daily activities,” Dr. Jana said. “The virus itself can be spread before, during, and well after the time of symptoms, so preventing a child's attendance won't significantly reduce the chance of spread.”
The updated “Managing Infectious Diseases in Child Care and Schools” (Elk Grove Village, Ill.: American Academy of Pediatrics, 2008), also recommends against exclusion for the following conditions that often incite red flags, according to Dr. Jana:
▸ Hand, foot, and mouth disease. “Children should not be excluded unless they have sores in their mouth with drooling or if the rash is associated with fever or behavior change,” Dr. Jana explained. “Good hygiene is the best way to minimize the opportunity for the spread of this common virus.”
▸ Fifth disease. Because there is little virus present when the telltale rash appears, exclusion has no preventive benefit.
▸ Draining skin infection, including methicillin-resistant Staphylococcus aureus (MRSA) infection. “Because of the media attention surrounding MRSA, there's a lot of anxiety about this, but the reality is, these children should be excluded only if the infection is accompanied by fever, pain, or behavior change,” said Dr. Jana. “There is no need for the caregiver to request a culture, because it won't affect how the infection will be handled. Some kids without symptoms have MRSA, and there is no good way to eradicate the germ yet from individuals, families, or classrooms.”
▸ Diarrhea. According to the revised guidelines, diapered children with diarrhea may remain in care if the diarrhea is contained in the diaper and the child has no more than two stools above normal baseline. “This is a departure from the previous recommendation that all diapered children be excluded until the diarrhea resolves or is deemed noninfectious,” said Dr. Jana. Children who are able to use the toilet may remain in care with good hand washing, as long as they don't have accidents. “Exclusion is appropriate for children with blood in their stool not explained by medication, hard stool, or diet,” she said.
▸ Vomiting. Exclusion is recommended for a child who has had two or more episodes of vomiting in the previous 24 hours and continuing exclusion until the vomiting resolves or a health care provider determines the cause is not contagious.
▸ Fever. “Children with fever should not be excluded automatically, unless the fever is accompanied by behavior change or other signs or symptoms of illness,” explained Dr. Jana. The exception to this is children younger than 4 months old with unexplained fever.
▸ Respiratory illness. Most respiratory illnesses do not require exclusion; however, a child with persistent coughing or trouble breathing should be evaluated for pneumonia, asthma, or serious respiratory infection, such as whooping cough.
▸ Earache, no fever. “This child should be excluded if he or she requires more care than the staff can reasonably provide,” said Dr. Jana. “Often, these kids are in a lot of pain and cannot participate in routine activities.”
▸ Lice. “Lice are a nuisance, but they're not a health hazard,” said Dr. Jana. “Children with lice should be excluded, but they don't have to be sent home right away. It can wait until the end of the day, and they can return once treatment occurs,” she said.
“Of course, all of these are recommendations, and while they are based in evidence, they are not binding,” Dr. Jana concluded.
Revised ‘When to Exclude’ Criteria
With the exception of the noted updates, most of the exclusion criteria outlined in the revised “Managing Infectious Diseases in Child Care and Schools” are consistent with the national illness exclusion guidelines published jointly in 2002 by the AAP, APHA, the Maternal and Child Health Bureau, and the National Resource Center for Health and Safety in Child Care. These include:
▸ Tuberculosis, until an appropriate health care provider or health official certifies that the child is in appropriate therapy and can attend care.
▸ Impetigo, until 24 hours after treatment has been initiated.
▸ Chickenpox until all sores have dried and crusted (usually 6 days).
▸ Mumps, until 9 days after an onset of parotid gland swelling.
▸ Hepatitis A virus, until 1 week after an onset of illness or jaundice or as directed by the health department.
▸ Measles, until 4 days after an onset of rash.
▸ Rubella, until 6 days after an onset of rash.
▸ Fever, when accompanied by behavior changes or other symptoms such as a sore throat, rash, vomiting, diarrhea, earache, etc.
▸ Diarrhea (frequent, runny, watery stools).
▸ Blood in the stool not explained by dietary change, medication, or hard stool.
▸ Vomiting two or more times in a 24-hour period.
▸ Body rash with fever.
▸ Sore throat with fever and swollen glands or mouth sores with drooling.
▸ Severe coughing with the child getting red or blue in the face or making a high-pitched whooping sound after coughing.
▸ Persistent abdominal pain (more than 2 hours) or intermittent pain with other signs and symptoms.
▸ Signs of possible severe illness such as irritability, unusual tiredness, or neediness that compromises caregivers' ability to care for others.
▸ Uncontrolled coughing or wheezing, continuous crying, or difficulty breathing.
Wednesday, June 24, 2009
Post #19 Sunscreen Advice
A sure sign that spring and summer are upon us is the location of your local retailer's sunscreen shelves, which are now front and center - not to mention the dazed look of frazzled folks overwhelmed by so many options.
SPF, UVA, UVB, what does it all mean? IMO, all those TLA's are enough to make a person crazy.
Let's start at the beginning.
Sunscreen 101:
UVA/UVB – both of these are ultraviolet rays. Basically, UVA are the aging rays, and UVB are the burning rays. You don't want too much of either of these, which is why a "broad spectrum" sunscreen is the best option. Sunscreens contain chemicals that absorb or reflect UV rays.
SPF means Sunburn Protection Factor. Basically, SPF tells you the protection offered against UVB rays but not against UVA rays. If it's SPF 15, that means you can be in the sun 15 times longer than someone without sunscreen before beginning to burn. The higher the SPF, the greater the protection against UVB rays; however a high number can give a false sense of security. Furthermore, the effectiveness of the sunscreen is affected by a number of things including how often it is applied, how much is absorbed into the skin, the activity engaged in, and the skin type of the user.
Currently, there is no benchmark rating used for UVA rays. For good UVA protection look for products containing zinc oxide, avobenzone, and ecamsule.
And then, there are the water resistant and waterproof sunscreens. According to FDA regulations, "water resistant" means the product maintains its level of protection after 40 minutes of water immersion. The FDA doesn't like to see any label stating "waterproof," because no sunscreen truly is. However, manufacturers will label it "waterproof" if protection levels are maintained after 80 minutes.
Applying:
The general rule of thumb is that it should take a handful of sunscreen to properly cover the body. For you, that would be an adult-size handful. For your child, it's a child-size handful. As they grow, their hands get bigger, and you'll automatically be putting enough on.
Sunscreen comes in a lot of different forms. Sprays, lotions, gels, fun colors, there's plenty to choose from. When possible, find a broad spectrum UVA/UVB sunscreen that contains either zinc oxide, avobenzone, or ecamsule.
Babies under 6 months of age should be kept out of the sun as much as possible, and try to use a wide brimmed hat and loose fitting clothing to shield them. For all children over 6 months I recommend to use at least SPF 30.
Reapplying:
In one word – frequently. For best results, follow instructions on the sunscreen container. And while you're doing that, check the expiration date. Sunscreen loses its effectiveness beyond the expiration date or if it’s over 2 years old.
Sticking with it:
Make sunscreen application a part of the established "going out" routine, similar to how a bedtime routine includes brushing teeth.
You can say "Okay Jane, we're going to the swimming pool, but you know the drill. First, get undressed and let me put on your sunscreen. Jimmy, you can set the timer on the microwave for 30 minutes. Then go get your swimsuits on. When the timer goes off, we're off."
Hopefully, by the time Jane and Jimmy are teenagers – when they will be more inclined to think whatever you tell them is wrong - you will have established a habit of sun safety to where they won't think twice about going out without sunscreen.
If they hesitate, tell them to get on the computer and Google "skin cancer." If they find a site with photos, that's even better. Tell your daughter to Google "aging" so she can see how a suntan today means wrinkles tomorrow.
Vitamin D or sunscreen?
Lately, there's been a debate in the medical community. The AAP (American Academy of Pediatrics) has come out with a very strong statement about the need for Vitamin D, which comes from food and exposure to the sun (UVB rays).
They are tying low levels of Vitamin D to poor bone health, a higher risk of certain cancers, and diseases such as diabetes and multiple sclerosis.
Until we get more information and data, my take on this is that it's a work in progress. An appropriate level of Vitamin D is necessary for good health, but so is an appropriate level of sun protection.
One thing we do know to be fact is that too much sunlight increases the risk of melanomas and other skin cancers.
On that note, here's a question for you. Are you, or your child, the type that "tans, never burns?" If so, you're still at risk of developing skin cancer. It's a myth that only those who sunburn get melanoma. It's exposure, which adds up throughout your life, particularly too much exposure in early life.
Summer sun:
I suggest Houstonians plan outdoor activities before 10 a.m. or after 4 p.m., when the sun is not at its peak. I highly recommend full body swimwear for both girls and boys. Cover up with clothing – T-shirts can be worn over the top of bathing suits – the darker the better. A wet white T-shirt offers little protection against the sun. Wear wide-brimmed hats at the park. Sunglasses will protect your eyes – kids love wearing "cool" sunglasses. Use a lip balm with SPF on your lips, and sunscreen of at least SPF 30 on your skin.
Remember, sunscreen is only as good as where you put it. Don't forget to apply it to the tips of the ears, backs of the knees, between the toes…and anywhere else the sun does indeed shine.
SIDE BAR:
The ABC's of safe sun:
A is for Away: stay away from the sun in the middle of the day, when rays are most damaging, even on cloudy days. In Houston, this means from 10 a.m. – 4 p.m.
B is for Block: Block the sun's rays by using a sunscreen with a minimum SPF of 30. Apply it 30 minutes before going out, and reapply often throughout the day.
C is for Cover up: use protective clothing such as long-sleeve shirts, hats, or clothing with a tight weave to keep out as much sunlight as possible. Use lip balm for your lips, and sunglasses for your eyes. Babies under six months of age should be kept out of direct sunlight.
SPF, UVA, UVB, what does it all mean? IMO, all those TLA's are enough to make a person crazy.
Let's start at the beginning.
Sunscreen 101:
UVA/UVB – both of these are ultraviolet rays. Basically, UVA are the aging rays, and UVB are the burning rays. You don't want too much of either of these, which is why a "broad spectrum" sunscreen is the best option. Sunscreens contain chemicals that absorb or reflect UV rays.
SPF means Sunburn Protection Factor. Basically, SPF tells you the protection offered against UVB rays but not against UVA rays. If it's SPF 15, that means you can be in the sun 15 times longer than someone without sunscreen before beginning to burn. The higher the SPF, the greater the protection against UVB rays; however a high number can give a false sense of security. Furthermore, the effectiveness of the sunscreen is affected by a number of things including how often it is applied, how much is absorbed into the skin, the activity engaged in, and the skin type of the user.
Currently, there is no benchmark rating used for UVA rays. For good UVA protection look for products containing zinc oxide, avobenzone, and ecamsule.
And then, there are the water resistant and waterproof sunscreens. According to FDA regulations, "water resistant" means the product maintains its level of protection after 40 minutes of water immersion. The FDA doesn't like to see any label stating "waterproof," because no sunscreen truly is. However, manufacturers will label it "waterproof" if protection levels are maintained after 80 minutes.
Applying:
The general rule of thumb is that it should take a handful of sunscreen to properly cover the body. For you, that would be an adult-size handful. For your child, it's a child-size handful. As they grow, their hands get bigger, and you'll automatically be putting enough on.
Sunscreen comes in a lot of different forms. Sprays, lotions, gels, fun colors, there's plenty to choose from. When possible, find a broad spectrum UVA/UVB sunscreen that contains either zinc oxide, avobenzone, or ecamsule.
Babies under 6 months of age should be kept out of the sun as much as possible, and try to use a wide brimmed hat and loose fitting clothing to shield them. For all children over 6 months I recommend to use at least SPF 30.
Reapplying:
In one word – frequently. For best results, follow instructions on the sunscreen container. And while you're doing that, check the expiration date. Sunscreen loses its effectiveness beyond the expiration date or if it’s over 2 years old.
Sticking with it:
Make sunscreen application a part of the established "going out" routine, similar to how a bedtime routine includes brushing teeth.
You can say "Okay Jane, we're going to the swimming pool, but you know the drill. First, get undressed and let me put on your sunscreen. Jimmy, you can set the timer on the microwave for 30 minutes. Then go get your swimsuits on. When the timer goes off, we're off."
Hopefully, by the time Jane and Jimmy are teenagers – when they will be more inclined to think whatever you tell them is wrong - you will have established a habit of sun safety to where they won't think twice about going out without sunscreen.
If they hesitate, tell them to get on the computer and Google "skin cancer." If they find a site with photos, that's even better. Tell your daughter to Google "aging" so she can see how a suntan today means wrinkles tomorrow.
Vitamin D or sunscreen?
Lately, there's been a debate in the medical community. The AAP (American Academy of Pediatrics) has come out with a very strong statement about the need for Vitamin D, which comes from food and exposure to the sun (UVB rays).
They are tying low levels of Vitamin D to poor bone health, a higher risk of certain cancers, and diseases such as diabetes and multiple sclerosis.
Until we get more information and data, my take on this is that it's a work in progress. An appropriate level of Vitamin D is necessary for good health, but so is an appropriate level of sun protection.
One thing we do know to be fact is that too much sunlight increases the risk of melanomas and other skin cancers.
On that note, here's a question for you. Are you, or your child, the type that "tans, never burns?" If so, you're still at risk of developing skin cancer. It's a myth that only those who sunburn get melanoma. It's exposure, which adds up throughout your life, particularly too much exposure in early life.
Summer sun:
I suggest Houstonians plan outdoor activities before 10 a.m. or after 4 p.m., when the sun is not at its peak. I highly recommend full body swimwear for both girls and boys. Cover up with clothing – T-shirts can be worn over the top of bathing suits – the darker the better. A wet white T-shirt offers little protection against the sun. Wear wide-brimmed hats at the park. Sunglasses will protect your eyes – kids love wearing "cool" sunglasses. Use a lip balm with SPF on your lips, and sunscreen of at least SPF 30 on your skin.
Remember, sunscreen is only as good as where you put it. Don't forget to apply it to the tips of the ears, backs of the knees, between the toes…and anywhere else the sun does indeed shine.
SIDE BAR:
The ABC's of safe sun:
A is for Away: stay away from the sun in the middle of the day, when rays are most damaging, even on cloudy days. In Houston, this means from 10 a.m. – 4 p.m.
B is for Block: Block the sun's rays by using a sunscreen with a minimum SPF of 30. Apply it 30 minutes before going out, and reapply often throughout the day.
C is for Cover up: use protective clothing such as long-sleeve shirts, hats, or clothing with a tight weave to keep out as much sunlight as possible. Use lip balm for your lips, and sunglasses for your eyes. Babies under six months of age should be kept out of direct sunlight.
Friday, May 1, 2009
Post #18 Swine (H1N1) Flu: Cautiously Optimistic
When the first reports of the swine flu (now renamed the H1N1 flu) reached my desk at the end of last week, I was curious. . . however my weekend plans were about to swing into full gear. So other then a quick glance at the fax, pigs did not cross my mind again the entire weekend (BTW, to avoid misappropriated fear about pigs/pork being a potential source of the flu, the formerly known swine flu has been renamed. . . I use thoughts about pigs for literary purposes only).
By Tuesday (4/28/09) of this week, the media was on an information blitz, inundating the public and medical community with factoids, articles and history on past flu epidemics and the potential dangers of this new swine flu. I thought of pigs a bit more.
Generally, my friends and patients know that I am not an alarmist. When their children are sick, they turn to me to offer a voice of reason, and generally I am able to assuage their anxiety. However, being a mild connoisseur of flu history, I began to get a queasy feeling in my stomach as I read each additional article on the evolving potential swine flu pandemic. All the hallmarks were there for a possible incendiary public health threat. Any time my mind idled, it turned to thinking about pigs.
Dr. Sandro Galea, director of the Center for Global Health at the University of Michigan and a professor of Epidemiology at the University's School of Public Health, says that generally speaking, at the beginning of events such as the swine flu outbreak there is confusion, which quickly gives way to rational behavior.
And this makes sense. After all, it is often the lack of information and the fear of the unknown that drives many of us to initially overreact. With more information, we can make greater and greater rational decisions.
Early in this week, many of my patients asked my advice on the breaking swine flu. Other then a few tidbits of information from CDC.GOV I had little to offer. However, each passing day has brought forth crucial information which is being used to formulate public policy.
Over this weekend the CDC and WHO will gather more information on the virus itself, the pattern of the outbreak/spread and research the known cases/deaths. Already facts are coming in suggesting a milder threat than initially perceived. I believe by Monday they will have a much better feel of the scope and magnitude of this problem.
A few things that we already know about this virus:
1. This strain of H1N1 does not seem nearly as virulent as the deadly 1918 H1N1 flu strain.
2. As of the writing of this blog there has only been 1 known death in the U.S. and it was to a child who had underlying medical issues prior to contracting the flu. Additionally, this child came from Mexico via Brownsville to Houston, Texas for the purposes of receiving greater medical expertise/care.
3. The number of deaths in Mexico are unclear. As of the writing of this blog there were only 12 confirmed deaths, which contrasts to the >150 deaths speculated by certain media sources.
4. A possible theory as to why a greater number of deaths have occurred in Mexico is that there is a cultural tendency to seek medical care later in the course of illnesses. Which may mean that this virus is not as deadly for those who are appropriately treated. See NYT Article for more details.
5. Northwestern University researchers have a computer model they say is doing a good job predicting the spread of swine flu and it is predicting the entire United States will have between 1,600 and 2,000 cases one month from now.
6. This strain of flu is a mixture of pig, bird, and human flu (although some people believe all flu strains originated from birds at some point).
7. They expect a vaccine against this strain to be ready in 4-6 months in time for the winter flu season.
An often-used analogy during this outbreak has been preparing for a hurricane. Having resided in Houston since 1982, I have lived through many evacuations, news blitzes and the hurricanes themselves. Recently, in 2005, following the fallout of Hurricane Katrina, Hurricane Rita was set to strike the Gulf Coast. In an effort to protect its constituents, Houston was advised to evacuate. Many people did. What ensued was hours of gridlock leading to cars running out of gas with people languishing under the brutal Texas sun with no AC.
Ultimately, although Rita was the fourth-most intense Atlantic hurricane ever recorded, Houston as a whole remained safe during the storm. Our family chose to stay, and after hearing the stories of friends trapped on the highway, we were glad that we had avoided the gridlock.
On the flip side, had we lived and stayed in New Orleans during Hurricane Katrina or in Galveston during Hurricane Ike, my wife and I would have regretted our decision to not evacuate as the consequences would have been quite severe.
Whether this pandemic ends in a whimper or a bang has yet to be determined. The more we know, the more it seems a whimper is the more likely of the two. However, even if things do not end in a bang, we should be prepared to expect more cases and more deaths.
In fact, every winter the United States suffers approximately 36,000 deaths from the seasonal flu, albeit mostly in the elderly and ~100 deaths in young children. And thus, as with any seasonal flu outbreak, there will be expected deaths. However, this fact alone should not create fear.
The initial fear was that many of us have never encountered this new strain of flu either by actually catching it or by being vaccinated against it. Coupled with the fact that middle aged people were dying from the flu in Mexico, the media and public were led into a frenzy. However, as stated above, it seems the flu is milder than initially thought and that the original statistics out of Mexico may need to be revised.
If things do end in a whimper, one thing to be wary of is that the virus may mutate and come back with a vengeance this winter. This is not a certainty but a distinct possibility (as this is what happened to some extent with the 1918 outbreak).
Balancing the well being of the public is not for the faint of heart. It is often a damned if you do, damned if you don't position that I do not envy.
My point in writing about hurricanes is that like weather, pandemics (and epidemics) are difficult to predict and as such public guidance is a difficult task. Like medicine, public health is as much an art as it is a science, which involves the delicate juggling of statistics, public perception, fear, medical facts and politics (yes, unfortunately politics).
And as in medicine, when decisions are made, the potential benefits must be weighed with the potential risks as well as the potential costs to form a cost-beneficial plan that minimizes risk and maximizes the well-being of the public at large.
Unlike a hurricane threat, the great thing about a potential pandemic is that for the most part, conservative measures carry little risk or cost from an individual standpoint. Currently, the safest thing for a family to do is to stay put and avoid unnecessary interaction with others. At the very least avoiding large crowds - especially places where children spread a lot of germs - will decrease the risk of acquiring the H1N1 flu. Additionally, if your child is sick, there should be greater vigilance in keeping them at home.
Time.com, May 1, 2009
But when it comes to slowing the overall spread of a pandemic flu, the best thing we can do is keep sick people away from everyone else. It's called "social distancing," and studies of the deadly 1918 Spanish flu showed that cities that instituted distancing measures quickly suffered lower death tolls than cities that did nothing or reacted slowly.
Employing these measures, while somewhat constrictive socially, are easy to do and carry little risk or cost other than the potential for cabin fever!
Some mothers have asked me if they should keep their kids home from school. Until more is known (which may be as soon as this Monday - I would see how this unfolds over this weekend), for children in mother's day out programs and other elective-type school settings it might be a good idea. As for regular grade school, I believe that over the weekend the government will make that decision for us. They seem to be relatively conservative thus far in shutting school downs.
Other easy-to-employ protective measures include basic hygiene, which everyone should have a firm handle on by now.
An additional measure that may also be prudent will be to get the flu vaccine in the fall. Whether they add the swine flu H1N1 strain or not remains to be seen. One potential cost to receiving this vaccine is that during a different swine flu outbreak in 1976, a vaccine was mandated by the Ford administration. Within weeks, reports surfaced of people developing Guillain-Barré syndrome, a paralyzing nerve disease that can be caused by the vaccine. By April, more than 30 people had died of the condition, in contrast to the one soldier that actually died from the virus. Note: this is NOT an issue with the current flu vaccine.
Extensive testing will need to be done to prepare a vaccine which avoids the pitfalls of the 1976 vaccine. And like everything else in medicine, the risks of this particular flu virus will need to be weighed against the potential harms of the vaccine. Speaking personally, I will almost certainly be getting the vaccine for myself and my family like I do every fall.
Besides the measures detailed above, here are a few other smart pointers from Time.com:
1. Don't Rush to the ER
With the cable news networks reporting nonstop on swine flu, it feels like the disease is lurking everywhere, and that your slightest sniffle is a sign that you've contracted the virus. That would explain why people with no outward symptoms of illness are flooding emergency rooms in swine flu–affected states, afraid that they might be sick. That's a really bad idea.
First of all, having to examine people who aren't really sick only stresses the already strained resources of hospitals that are trying to prepare for a pandemic. Plus, going to an emergency room unnecessarily may even pose a slight risk to you. In past outbreaks, including SARS in 2003, hospitals were actually loci of infections — all those sick people in close proximity — and the same could be true of swine flu.
If you actually have flu-like symptoms — a fever above 100° F, headache, sore throat, body aches, chills or fatigue — and you live in an area where there have been confirmed swine flu cases, by all means report to your doctor. Otherwise, leave the hospital to the sick people.
2. Don't Be Afraid to Eat Pork
On April 29, the CDC announced that swine flu would no longer be referred to as swine flu, but as the "2009 H1N1 flu." It's less catchy, but more accurate. For one thing, there is no evidence that this virus makes pigs really sick. And the H1N1 virus actually contains genes from swine, avian and human flus. The virus also cannot be spread through pork products — you can't contract swine flu by eating bacon, hot dogs or anything else that was once a pig. Nor will culling pigs, as authorities did in Egypt, do anything to stem the spread of the disease. H1N1 has jumped to humans and is passing easily from person to person, so it's now a human flu that needs to be controlled in us, not the pigs.
3. Don't Hoard Antivirals
The H1N1 virus has so far proven vulnerable to the antiviral drugs Tamiflu and Relenza, which is good news. A cornerstone of the government's pandemic preparations was the stockpiling of 50 million doses of those drugs over the past few years, enough to ensure that doctors would be able to respond sufficiently to new outbreaks. But that capacity could be compromised if people begin stockpiling antivirals for their own use. Already there are reports of pharmacies running short of Tamiflu, and many hospitals in the U.S. have begun restricting the power to prescribe antivirals to just a few doctors. Also, the misuse or overuse of Tamiflu or Relenza by patients can promote resistance in the flu virus — effectively removing the only bullets from our gun.
Hopefully, after reading this (lengthy, I know!) blog you have a clearer understanding of the current H1N1 flu situation. However, please be advised that things may change rapidly in the very near future.
One final note: I have read a slightly alarmist email circulating that subtly recommends purchasing nutritional supplements from a Wimberley Pharmacy at the end of its message. I am not sure as to the validity of the facts in this email, but I am personally sticking to the guidance and facts put forth by the CDC and will not be purchasing any nutritional supplements to combat this flu virus.
By Tuesday (4/28/09) of this week, the media was on an information blitz, inundating the public and medical community with factoids, articles and history on past flu epidemics and the potential dangers of this new swine flu. I thought of pigs a bit more.
Generally, my friends and patients know that I am not an alarmist. When their children are sick, they turn to me to offer a voice of reason, and generally I am able to assuage their anxiety. However, being a mild connoisseur of flu history, I began to get a queasy feeling in my stomach as I read each additional article on the evolving potential swine flu pandemic. All the hallmarks were there for a possible incendiary public health threat. Any time my mind idled, it turned to thinking about pigs.
Dr. Sandro Galea, director of the Center for Global Health at the University of Michigan and a professor of Epidemiology at the University's School of Public Health, says that generally speaking, at the beginning of events such as the swine flu outbreak there is confusion, which quickly gives way to rational behavior.
And this makes sense. After all, it is often the lack of information and the fear of the unknown that drives many of us to initially overreact. With more information, we can make greater and greater rational decisions.
Early in this week, many of my patients asked my advice on the breaking swine flu. Other then a few tidbits of information from CDC.GOV I had little to offer. However, each passing day has brought forth crucial information which is being used to formulate public policy.
Over this weekend the CDC and WHO will gather more information on the virus itself, the pattern of the outbreak/spread and research the known cases/deaths. Already facts are coming in suggesting a milder threat than initially perceived. I believe by Monday they will have a much better feel of the scope and magnitude of this problem.
A few things that we already know about this virus:
1. This strain of H1N1 does not seem nearly as virulent as the deadly 1918 H1N1 flu strain.
2. As of the writing of this blog there has only been 1 known death in the U.S. and it was to a child who had underlying medical issues prior to contracting the flu. Additionally, this child came from Mexico via Brownsville to Houston, Texas for the purposes of receiving greater medical expertise/care.
3. The number of deaths in Mexico are unclear. As of the writing of this blog there were only 12 confirmed deaths, which contrasts to the >150 deaths speculated by certain media sources.
4. A possible theory as to why a greater number of deaths have occurred in Mexico is that there is a cultural tendency to seek medical care later in the course of illnesses. Which may mean that this virus is not as deadly for those who are appropriately treated. See NYT Article for more details.
5. Northwestern University researchers have a computer model they say is doing a good job predicting the spread of swine flu and it is predicting the entire United States will have between 1,600 and 2,000 cases one month from now.
6. This strain of flu is a mixture of pig, bird, and human flu (although some people believe all flu strains originated from birds at some point).
7. They expect a vaccine against this strain to be ready in 4-6 months in time for the winter flu season.
An often-used analogy during this outbreak has been preparing for a hurricane. Having resided in Houston since 1982, I have lived through many evacuations, news blitzes and the hurricanes themselves. Recently, in 2005, following the fallout of Hurricane Katrina, Hurricane Rita was set to strike the Gulf Coast. In an effort to protect its constituents, Houston was advised to evacuate. Many people did. What ensued was hours of gridlock leading to cars running out of gas with people languishing under the brutal Texas sun with no AC.
Ultimately, although Rita was the fourth-most intense Atlantic hurricane ever recorded, Houston as a whole remained safe during the storm. Our family chose to stay, and after hearing the stories of friends trapped on the highway, we were glad that we had avoided the gridlock.
On the flip side, had we lived and stayed in New Orleans during Hurricane Katrina or in Galveston during Hurricane Ike, my wife and I would have regretted our decision to not evacuate as the consequences would have been quite severe.
Whether this pandemic ends in a whimper or a bang has yet to be determined. The more we know, the more it seems a whimper is the more likely of the two. However, even if things do not end in a bang, we should be prepared to expect more cases and more deaths.
In fact, every winter the United States suffers approximately 36,000 deaths from the seasonal flu, albeit mostly in the elderly and ~100 deaths in young children. And thus, as with any seasonal flu outbreak, there will be expected deaths. However, this fact alone should not create fear.
The initial fear was that many of us have never encountered this new strain of flu either by actually catching it or by being vaccinated against it. Coupled with the fact that middle aged people were dying from the flu in Mexico, the media and public were led into a frenzy. However, as stated above, it seems the flu is milder than initially thought and that the original statistics out of Mexico may need to be revised.
If things do end in a whimper, one thing to be wary of is that the virus may mutate and come back with a vengeance this winter. This is not a certainty but a distinct possibility (as this is what happened to some extent with the 1918 outbreak).
Balancing the well being of the public is not for the faint of heart. It is often a damned if you do, damned if you don't position that I do not envy.
My point in writing about hurricanes is that like weather, pandemics (and epidemics) are difficult to predict and as such public guidance is a difficult task. Like medicine, public health is as much an art as it is a science, which involves the delicate juggling of statistics, public perception, fear, medical facts and politics (yes, unfortunately politics).
And as in medicine, when decisions are made, the potential benefits must be weighed with the potential risks as well as the potential costs to form a cost-beneficial plan that minimizes risk and maximizes the well-being of the public at large.
Unlike a hurricane threat, the great thing about a potential pandemic is that for the most part, conservative measures carry little risk or cost from an individual standpoint. Currently, the safest thing for a family to do is to stay put and avoid unnecessary interaction with others. At the very least avoiding large crowds - especially places where children spread a lot of germs - will decrease the risk of acquiring the H1N1 flu. Additionally, if your child is sick, there should be greater vigilance in keeping them at home.
Time.com, May 1, 2009
But when it comes to slowing the overall spread of a pandemic flu, the best thing we can do is keep sick people away from everyone else. It's called "social distancing," and studies of the deadly 1918 Spanish flu showed that cities that instituted distancing measures quickly suffered lower death tolls than cities that did nothing or reacted slowly.
Employing these measures, while somewhat constrictive socially, are easy to do and carry little risk or cost other than the potential for cabin fever!
Some mothers have asked me if they should keep their kids home from school. Until more is known (which may be as soon as this Monday - I would see how this unfolds over this weekend), for children in mother's day out programs and other elective-type school settings it might be a good idea. As for regular grade school, I believe that over the weekend the government will make that decision for us. They seem to be relatively conservative thus far in shutting school downs.
Other easy-to-employ protective measures include basic hygiene, which everyone should have a firm handle on by now.
An additional measure that may also be prudent will be to get the flu vaccine in the fall. Whether they add the swine flu H1N1 strain or not remains to be seen. One potential cost to receiving this vaccine is that during a different swine flu outbreak in 1976, a vaccine was mandated by the Ford administration. Within weeks, reports surfaced of people developing Guillain-Barré syndrome, a paralyzing nerve disease that can be caused by the vaccine. By April, more than 30 people had died of the condition, in contrast to the one soldier that actually died from the virus. Note: this is NOT an issue with the current flu vaccine.
Extensive testing will need to be done to prepare a vaccine which avoids the pitfalls of the 1976 vaccine. And like everything else in medicine, the risks of this particular flu virus will need to be weighed against the potential harms of the vaccine. Speaking personally, I will almost certainly be getting the vaccine for myself and my family like I do every fall.
Besides the measures detailed above, here are a few other smart pointers from Time.com:
1. Don't Rush to the ER
With the cable news networks reporting nonstop on swine flu, it feels like the disease is lurking everywhere, and that your slightest sniffle is a sign that you've contracted the virus. That would explain why people with no outward symptoms of illness are flooding emergency rooms in swine flu–affected states, afraid that they might be sick. That's a really bad idea.
First of all, having to examine people who aren't really sick only stresses the already strained resources of hospitals that are trying to prepare for a pandemic. Plus, going to an emergency room unnecessarily may even pose a slight risk to you. In past outbreaks, including SARS in 2003, hospitals were actually loci of infections — all those sick people in close proximity — and the same could be true of swine flu.
If you actually have flu-like symptoms — a fever above 100° F, headache, sore throat, body aches, chills or fatigue — and you live in an area where there have been confirmed swine flu cases, by all means report to your doctor. Otherwise, leave the hospital to the sick people.
2. Don't Be Afraid to Eat Pork
On April 29, the CDC announced that swine flu would no longer be referred to as swine flu, but as the "2009 H1N1 flu." It's less catchy, but more accurate. For one thing, there is no evidence that this virus makes pigs really sick. And the H1N1 virus actually contains genes from swine, avian and human flus. The virus also cannot be spread through pork products — you can't contract swine flu by eating bacon, hot dogs or anything else that was once a pig. Nor will culling pigs, as authorities did in Egypt, do anything to stem the spread of the disease. H1N1 has jumped to humans and is passing easily from person to person, so it's now a human flu that needs to be controlled in us, not the pigs.
3. Don't Hoard Antivirals
The H1N1 virus has so far proven vulnerable to the antiviral drugs Tamiflu and Relenza, which is good news. A cornerstone of the government's pandemic preparations was the stockpiling of 50 million doses of those drugs over the past few years, enough to ensure that doctors would be able to respond sufficiently to new outbreaks. But that capacity could be compromised if people begin stockpiling antivirals for their own use. Already there are reports of pharmacies running short of Tamiflu, and many hospitals in the U.S. have begun restricting the power to prescribe antivirals to just a few doctors. Also, the misuse or overuse of Tamiflu or Relenza by patients can promote resistance in the flu virus — effectively removing the only bullets from our gun.
Hopefully, after reading this (lengthy, I know!) blog you have a clearer understanding of the current H1N1 flu situation. However, please be advised that things may change rapidly in the very near future.
One final note: I have read a slightly alarmist email circulating that subtly recommends purchasing nutritional supplements from a Wimberley Pharmacy at the end of its message. I am not sure as to the validity of the facts in this email, but I am personally sticking to the guidance and facts put forth by the CDC and will not be purchasing any nutritional supplements to combat this flu virus.
Wednesday, March 25, 2009
Post #16 Malpractice: Wash Your Hands or Risk a Lawsuit
I was cleaning out some of the interesting articles that I have collected over the past year and came across one of my favorites from the Wall Street Journal 2008. The essential premise of the article is that certain nosocomial (hospital-acquired) infections can be 100% averted if proper hygiene regimens are followed - beginning with, of course, hand washing.
Certain facts in the article jump out at me:
1. Nearly all hospital infections are avoidable when doctors and staff clean their hands and rigorously practice proper hygiene and other preventive measures.
2. Since October of 2008 (according to the article) Medicare no longer reimburses hospitals for nosocomial infections following orthopedic or heart surgeries.
3. Beth Israel Medical Center in New York City hasn't had a central line (a large IV placed in a major blood vessel) bloodstream infection in the cardiac intensive care unit in nearly 3 years!
4. If you don't wash your hands and you pass on a nosocomial infection, you risk being sued.
Bottom line: Infections can be avoided with good hygiene beginning with hand washing. This is important not just in the O.R. but in every aspect of healthcare.
A great additional read is an entire chapter dedicated to hand washing in Atul Gawande's book Better.
Certain facts in the article jump out at me:
1. Nearly all hospital infections are avoidable when doctors and staff clean their hands and rigorously practice proper hygiene and other preventive measures.
2. Since October of 2008 (according to the article) Medicare no longer reimburses hospitals for nosocomial infections following orthopedic or heart surgeries.
3. Beth Israel Medical Center in New York City hasn't had a central line (a large IV placed in a major blood vessel) bloodstream infection in the cardiac intensive care unit in nearly 3 years!
4. If you don't wash your hands and you pass on a nosocomial infection, you risk being sued.
Bottom line: Infections can be avoided with good hygiene beginning with hand washing. This is important not just in the O.R. but in every aspect of healthcare.
A great additional read is an entire chapter dedicated to hand washing in Atul Gawande's book Better.
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