A healthy dose of preventative medicine is the best way to keep your family functioning at peak form, both now and in the years ahead. But staying current with what you should be doing to ensure your children’s health can be daunting. To help you, we’ve outlined some of the latest and most important health information at each stage in your child’s development. As with any health issue, nothing can replace an on-going relationship with your physician.
INFANTS
Early Screening for Autism
The statistics are staggering: One in 150 children is diagnosed with autism. Consequently, the American Academy of Pediatrics is now urging a routine autism screening at 18 months.
Autism spectral disorders (ASDs) are neurobiological disorders that impair a person’s ability to communicate and interact with others. Although there is no known cure, early detection and intervention can dramatically improve communication skills and anti-social behavior.
Parents should contact their physician if their child exhibits any of these “red flag” behaviors:
• no smiling, babbling, pointing, or back-and-forth gesturing by 12 months,
• no words by 16 months, or
• loss of language or interactive behavior at any time.
The following organizations can provide more information: The American Society of Autism (www.autism-society.org), Autism Speaks (www.autismspeaks.org), and the Center for Disease Control (www.cdc.gov/ncbddd/autism).
SIDS Breakthrough: Can a hearing test protect your baby?
Recent research by Dr. Daniel D. Rubens has found a link between the hairs of the inner ear and Sudden Infant Death Syndrome. These hairs send information to the brain to monitor CO2 levels in the blood. Rubens documented that conducting a simple and inexpensive hearing test after a baby’s birth can detect if these hairs are functioning properly. This research marks an exciting breakthrough that may help explain this disease that kills 1 in 1,000 babies worldwide each year.
Parents can help to prevent the accidental suffocation of their baby. The American Academy of Pediatrics recommends that babies under the age of 6 months sleep on their backs as the best way to reduce the risk of SIDS. Parents should remove extra blankets, pillows, or stuffed animals from the baby’s crib, and crib mattresses should be firm. The AAP also recommends that parents exercise caution if co-sleeping with their infant to prevent unknowingly rolling onto the baby or to prevent the baby from becoming trapped between the gaps of a headboard. Studies have linked a higher incidence of SIDS with cigarette smoke, so a baby’s room should be smoke-free.
TODDLERS/PRE-SCHOOLERS
Update: Lead in Toys
Despite the promises for increased toy safety this past Christmas season, you may continue to wonder if toys or children’s products are free of lead paint.
Why is lead dangerous? If a child places lead-paint-based toys in his or her mouth, saliva can break down the paint, and the child can ingest the lead. Even low levels of lead in a child’s blood can impair intelligence and cause learning disabilities. Children who have been exposed to lead usually will not exhibit immediate symptoms, so if parents suspect lead poisoning, they should contact their physician for a blood test.
What if I own a toy that contains lead? The Toy Industry Association (www.toyinfo.org) explains that if a child has had limited contact with the toy, most likely the child will not suffer adverse effects. However, parents should get rid of the toy and contact their physician as a safety measure.
How to avoid dangerous lead-tainted toys: The Consumer and Product Safety Commission (CPSC) encourages parents to check for toy recalls at its website (www.cpsc.gov) or by calling the CPSC hotline at 800-638-2772. Sign up for e-mail updates at www.cpsc.gov/cpsclist.aspx.
In addition, fill out registration information so the manufacturer can notify you if there is a recall of that product. Also, contact the company if you experience any safety issues.
Exercise Caution: Painted toys and furniture manufactured before 1978 often contain lead-based paint. Be cautious of hand-me-down cribs and second-hand toys.
For detailed information, download the pamphlet, “Lead in Your Home: A Parent’s Reference Guide” at www.epa.gov/lead (click on “Additional Resources”).
Feed a Cold, Starve a Fever and Withhold Cough Medicines
Winter weather guarantees that children will seek comfort indoors. But continuously running furnaces that dry out the air and tight-knit quarters where germs are most easily spread lead to coughs, colds, and congestion. A well-meaning parent may reach for a cough suppressant, such as Dimetapp, Robitussin, or Triaminic, to bring relief to a young child. However, according to a recent policy statement released by the American Academy of Pediatrics, administering such medications to children under the age of 6 can be harmful. Side effects of dextromethorphan, an active ingredient in cough suppressants, range from irritability and restlessness or lethargy to hallucinations and hypertension. In addition, codeine can lead to vomiting, facial swelling, and even respiratory depression.
Pediatricians maintain that most childhood coughs are productive because they release phlegm and keep the airway clear; suppressing a cough, then, is counterproductive. Pediatricians also assure parents that most coughs are short-lived, lasting only a few days. They suggest safe alternatives to cough medicines, such as using a humidifier and offering fluids to drink. If the cough persists, parents should consult their pediatrician to rule out allergies or a serious respiratory illness.
If concerned about medication overdose, call poison control: 1-800-222-1222.
PRE-TEENS
New Immunization Requirements for Pre-teens
Tdap:
Adolescents aged 11-13 are encouraged to receive another dose of the Tdap vaccine if it has been at least five years since the previous dosage. Tdap protects against tetanus, diphtheria, and pertussis (whooping cough). Additional boosters are necessary about every 10 years to ensure protection.
MCV4
Meningoccocal disease (meningitis) is spread through nose or mouth secretions. Symptoms, such as high fever and neck stiffness, can occur within hours of contact. Severe cases can result in coma or death, and survivors often suffer permanent hearing loss or brain damage. University students living in dormitories have recently been required to receive this vaccine. Many secondary schools are now requiring the immunization as a precaution for younger age groups. Contact your school about immunization requirements.
HPV
A recent vaccine is the HPV vaccine, which protects against human papillomavirus, the most common sexually transmitted disease in the U.S. HPV is often present within the body, but symptoms are mild or nonexistent; however, in some instances, HPV can lead to cervical cancer. The target group for this new vaccine is pre-adolescent girls (ages 11-12) since the vaccine becomes less effective once a woman becomes sexually active. The vaccine consists of 3 dosages spread over a 6-month period.
To download a current immunization schedule, visit www.cispimmunize.org. Contact your pediatrician or the Tulsa Health department (582-9355) for more information.
Educate Early About Alcohol
Did you know a recent survey found that 34 percent of 8th graders have tried alcohol in the last year, and 64 percent of 8th graders believe alcohol is easily accessible? You may also be surprised to know that kids who drink are more likely to engage in sexual activity and to have problems in school.
These statistics should encourage parents to start early in discussing the dangers of alcohol with their children. Many parents may feel uncomfortable about discussing difficult subjects such as alcohol and drug abuse, and sex; however, research also suggests that children who have good relationships with their parents are less likely to use alcohol or engage in other risky behavior.
A pamphlet published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), “Make a Difference: Talk to Your Child about Alcohol,” helps parents establish open communication with their children and includes helpful tips to discourage underage drinking. This pamphlet can be obtained online at http://pubs.niaaa.nih.gov/publications/children.pdf. Visit with your child NIAAA’s website at www.thecoolspot.gov.
TEENS
Tips to Help Teens Adopt Healthy Lifestyles
During the National Summit on Obesity in October 2004, troubling statistics for childhood obesity were shared: From 1999-2002, about 15 pecent of children ages 6-19 were considered obese. Obesity is linked to a sedentary lifestyle, which is also revealed by statistics: Almost half of teens ages 12-21 admit that they do not engage in daily exercise. Health problems linked to obesity include heightened blood pressure, cholesterol levels, and instances of Type 2 diabetes, which become life-long health challenges.
The Summit stressed the importance of reaching teens before it is too late. Nearly 80 percent of obese teens become obese adults. Teens are encouraged to exercise regularly and adopt healthy eating habits. Teens are discouraged from dieting since their growing bodies need up to 3,000 calories per day. A wise alternative is choosing healthy foods to supply these calories.
Sidebar:
Heart Checkmark Check-Up
For a quick way to spot heart-healthy products, look for the American Heart Association’s red heart with the white check mark on product packages. Products displaying the heart checkmark must be low in saturated fat, cholesterol and sodium and contain at least 10 percent of the Daily Value of one or more of protein, vitamin A, vitamin C, calcium, iron or fiber. Still, keep tabs on calories by paying attention to portion sizes. “The heart-check logo doesn’t mean you can overeat the product or think it’s the magic bullet,” cautions Wahida Karmally, RD, director of Nutrition at the Irving Center for Clinical Research at Columbia University Medical Center in New York City.
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The Truth About Heart-Healthy Foods
by Sandra Gordon
When it comes to beating heart disease—public enemy number one—diet is your first line of defense. That’s because what you and your family eat can strongly affect blood pressure and blood cholesterol positively or negatively, paving the way for artery-clogging plaque. A ‘heart-healthy’ diet is low in saturated and trans fat and rich in fruits, vegetables, whole-grains and low-fat dairy products. Within that basic framework, however, some items may provide additional protection. Or can they? Here’s food for thought on what’s heart smart and what’s not.
Eggs Enriched with Omega-3s
Secret Weapon: Docosahexaenoic acid (DHA) and EPA (eicosapentenoic acid)—omega-3 fatty acids that may help reduce the risk of heart disease by reducing inflammation, a risk factor for heart attack, lower blood pressure slightly and the growth rate of the “bad” LDL cholesterol. One omega-3 enriched egg typically contains 50 to 150 mg of DHA and 2 mg of EPA. For that added bonus, expect to pay as much as $1.50 more per dozen, compared to regular eggs, which contain 60 percent fewer omega-3s, on average.
Try it/Buy it? “Omega-3-enriched eggs aren’t necessary for heart health,” says Melissa Ohlson, R.D., nutrition project coordinator for preventive cardiology at the Cleveland Clinic in Cincinnati. Why? They contain little DHA and EPA, providing less than 1 percent of the American Heart Association’s suggested intake of .5 to 1.8 grams of per day (500 to 1800 milligrams). And like regular eggs, they’re also a significant source of cholesterol. One Egg Lands Best enriched egg, for example, provides 180 milligrams, which is more than half of the recommended daily dietary cholesterol limit of 300 milligrams.
Smart Switches: If you’re an egg lover, consider egg whites and commercially-prepared egg substitutes to keep your cholesterol intake low. For heart-healthy mega doses of omega-3s, consume at least two 3-ounce fish meals a week, such as salmon and albacore tuna.
Soy
Secret Weapon: Soy protein (think tofu, edemame, soy milk, soy smoothies) contains alpha-linolenic acid (ALA), an omega-3 fatty acid that converts to DHA and EPA in the body, and isoflavones, antioxidants that have been linked to a reduced risk of heart disease. “But soy’s biggest benefit is that it displaces saturated fat in the diet,” says Mikelle McCoin, R.D., senior nutrition director at the Gladstone Institute of Cardiovascular Disease in San Francisco. “If you’re eating soy, you’re probably not eating red meat.”
Try it/Buy it? Definitely seek out soy. Because soy protein contains little to no artery-clogging saturated fat and cholesterol, increasing your intake while usurping high sat-fat foods, such as whole milk and red meat, can help lower LDL cholesterol in the blood. To get at least 25 grams of soy protein a day (recommended), go with whole soy foods, such as soy milk (7 grams of soy protein per cup), edemame (11 grams of soy protein per half cup), 1/4 cup of roasted soy nuts (17 grams per one-fourth cup) or tofu (10 grams per half cup). Although there are products with isolated isoflavones on the market, McCoin doesn’t recommend them since the degree to which isoflavones are cardio-protective solo isn’t yet clear.
Smart Switches: Don’t like soy? No problem. To downsize dietary saturated fat and cholesterol, eat vegetarian meals regularly. Aim for one meatless meal per day if you have high cholesterol or a family history of heart disease.
Dark Chocolate
Secret Weapon: Proanthocyanidins—antioxidants in the flavonoid family that may help keep arteries clear, reduce the stickiness of blood platelets to reduce the risk of heart attack and lower blood pressure by improving blood vessel elasticity. In fact, a recent study in the Journal of the American College of Nutrition found that those who consumed 1.6 ounces of dark chocolate daily for two weeks experienced an eight-fold increase in the ability of their arteries to dilate, which improves blood flow to the heart, compared to those in the low-flavonoid chocolate group.
Try it/Buy it? Despite the promising research, “I wouldn’t recommend eating chocolate regularly for heart health,” says McCoin. Ounce per ounce, dark chocolate is calorie dense, which can contribute to weight gain if you consume it often, a major risk factor for heart disease.
Smart Switches: When you go the chocolate route occasionally (you’re human, after all), “look for dark chocolate that has at least 70 percent cocoa,” advises Mary B. Engler, Ph.D., a cardiovascular researcher at the University of California in San Francisco, such as Lindt Excellence. (Check the label.) More cocoa signals higher flavonoid content.
Red Wine
Secret Weapon: Like dark chocolate, red wine is rich in proanthocyanidins. And, the alcohol (ethanol) in red wine—or any alcoholic beverage—is also good for your heart. Studies have shown that consuming one to two drinks a day reduces the risk of heart disease by as much as 50 percent. Alcohol raises HDL (the “good”) cholesterol, which removes LDL cholesterol from artery walls.
Try it/Buy it? For heart health, there’s no need to limit yourself to red wine. Still, if you imbibe, cut yourself off at one glass per day. (One drink equals 12-ounces of beer, a 4-ounce glass of wine, or a 1 1/2-ounce of 80-proof spirits.) Beyond that daily dose, alcohol can raise blood pressure to increase your risk of heart disease—and a host of other health problems.
Smart Switches: Don’t drink? No problem. Studies suggest that drinking one to two 8-ounce glasses of purple grape juice daily has similar heart-healthy benefits. “It enhances the body’s production of nitric oxide, which relaxes and opens arteries, and helps prevent arteriosclerosis from forming,” says David Bell, M.D., a cardiovascular researcher at the Indiana School of Medicine, in Fort Wayne.
Tea
Secret Weapon: Like dark chocolate and red wine, green and black tea are a potent source of flavonoids, especially quercetin and Epigallocatechingallate (EGCG), which may relax blood vessels, prevent blood from clotting and prevent LDL cholesterol for oxidizing, a process that paves the way for artery-clogging plaque. One study showed that drinking three cups of tea a day reduced the risk of heart disease by 11 percent.
Try it/Buy it? Definitely consider adding tea to your repertoire if you don’t drink it already. Studies have shown that tea drinkers generally have lower death rates regardless of age, gender, smoking status, obesity, hypertension, diabetes or previous heart attack. “The more you drink, the lower your risk of heart disease,” says McCoin.
Smart Switches: For the most benefit, opt for brewed green or black tea, which contains five to 10 times the flavonoids of instant tea.
Grapeseed Oil
Secret Weapon: A byproduct of wine production, this mild flavored oil is a decent source of antioxidant vitamins E and C and beta-carotene. One study showed that grapeseed oil may increase HDL cholesterol and lower LDL cholesterol by 13 percent and 7 percent, respectively. But research on this oil is scanty.
Try it/Buy it? Steer clear. “Grapeseed oil is a major source of omega-6 fatty acids, which may increase arterial inflammation, a risk factor for heart attack,” says Fred Pescatore, M.D., author of The Hamptons Diet.
Smart Switches: Stick with canola oil and flaxseed oil, which contain heart-healthy ALA.
Sandra Gordon is a frequent contributor to many national magazines, including FAMILY CIRCLE, PREVENTION, WOMAN’S DAY, PARENTS, AMERICAN BABY and CHILD, and also the author of Consumer Reports Best Baby Products, 2007.
Sidebar:
10 Tips for a Healthier Lifestyle were offered at the National Summit on Obesity:
1. Limit fast food and soft drinks in the home
2. Limit TV, movies, and videogames to 2 hours a day
3. Have children do household chores
4. Walk to destinations whenever safe and possible
5. Advocate for school physical education and nutrition programs
6. Encourage and observe children playing sports
7. Encourage an active outside break after school, before homework
8. Investigate city recreational opportunities
9. Choose fitness oriented gifts (such as a jump rope)
10. Plan active family outings and vacations
Setting Good Eating Habits Early:
An easy way for children to get a dose of vitamin C is by drinking juice. However, the American Academy of Pediatrics encourages parents to regulate juice intake since even 100 % fruit juices are often high in sugar. Children who fill up on juice may refuse healthy foods at meal times. Too much juice can also lead to tooth decay, especially if given to a baby in a bottle at bed time.
The AAP suggests the following juice serving sizes:
• Infants 6 mo. to 12 mo.: up to 4 ounces a day
• Children 1 year to 6 years: up to 6 ounces a day
• Children older than 6 years: up to 12 ounces a day
Parents should limit or avoid fruit juice cocktails, sweetened drinks, or soda, which contain high amounts of sugar and provide little or no nutritional value. Parents should also offer fresh fruit to boost a child’s fiber intake.
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Reduce Fat & Calories, Keep the Flavor
Healthy Substitutions for Any Recipe
We all understand the importance of a healthy diet, yet it seems we’re always faced with a choice: flavor or nutrition. Not anymore.
Below, Duke Integrative Medicine offers tips for substituting healthier alternatives in your favorite recipes.
APPLESAUCE
Substitute: Use applesauce in place of butter, margarine, oil or shortening in all your favorite baking recipes.
Why: Replacing butter and oil with applesauce makes baked goods extra moist, while cutting calories and saturated fat.
Note: As a general rule of thumb, one cup of applesauce replaces one cup of butter, margarine, oil or shortening. However, there isn’t a standard formula for substituting applesauce, so you may have to experiment a few times before getting it just right.
NON-FAT YOGURT
Substitute: Non-fat yogurt, as well as non-fat sour cream or mayonnaise, can be used as an alternate for the regular or full fat versions in dressings or dips.
Why: Regular sour cream and mayonnaise contain a lot of fat, so by replacing them with non- or low-fat alternatives, the fat content of your recipes will be significantly decreased.
Note: If the recipe calls for high heat, be sure to use non-fat sour cream rather than yogurt, as it cannot be boiled. For all replacements, it is a simple one-to-one ratio.
HONEY
Substitute: Honey can be used instead of refined sugar as a sweetener in almost any recipe.
Why: As a natural sweetener, honey is easier to digest, helping with blood sugar levels. This is especially helpful if you are diabetic, as it prevents insulin levels from sharply increasing after eating something sweet.
Note: Use about half the amount of honey as you would refined sugar.
LOW-SODIUM TAMARI
Substitute: Low-sodium tamari is a wheat-free soy sauce which can be used in the place of salt.
Why: Because of its full flavor, you only need to use about half the amount that you would of salt, which reduces the overall sodium level in your recipe.
Note: The tamari has a naturally occurring dark color that may not be ideal for certain recipes.
WHOLE WHEAT FLOUR
Substitute: Whole wheat flour can be used in place of white flour in any baking recipe. It is especially delicious in chocolate chip cookies.
Why: It’s important to incorporate whole grains into your diet and baking with whole wheat flour is a good way to start.
Note: Using whole wheat flour instead of white will make your baked goods a little denser.
VEGETABLE STOCK
Substitute: When making salad dressings, particularly vinaigrettes, replace half the amount of oil with vegetable stock.
Why: By using only half the oil, the dressings are lower in fat, but still full of flavor. Plus, you can use olive oil, which is both rich in vitamin E and aids in weight loss and vitamin absorption.
Note: You will notice a lighter, more watery consistency.
EGG WHITES
Substitute: When baking, use three egg whites and one yolk to replace two whole eggs.
Why: Using fewer egg yolks reduces the cholesterol and saturated fat content in baked goods.
Note: For recipes calling for one egg, use two egg whites or 1⁄4 cup of egg substitute.
To learn more, go to www.dukeintegrativemedicine.com
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Fast Facts:
5 to Save Lives
These five simple preventative practices could save nearly 100,000 Americans each year.
Five to follow are:
1. Daily aspirin therapy. This healthy habit helps prevent heart disease.
2. Smoking cessation assistance. An additional 42,000 lives would be saved each year by increasing to 90 percent the portion of smokers who are advised by a health care professional to quit and are offered assistance. Currently, only 28 percent of smokers receive such services.
3. Colorectal cancer screening. Another 14,000 additional lives would be saved each year by increasing to 90 percent the portion of adults age 50 and older who are up to date with recommended colorectal cancer screening. Today, fewer than 50 percent of adults are current.
4. Flu vaccination. An additional 12,000 lives would be saved each year if the number of adults age 50 and older who get an annual flu vaccination grew to 90 percent. Only 37 percent of adults currently get the shot every year.
5. Breast cancer screening. An additional 3,700 lives would be saved each year by increasing to 90 percent the portion of women age 40 and older who have been screened for breast cancer in the past two years. Today, 67 percent of women have been screened in the past two years.
Source: National Commission on Prevention Priorities
Hormone Fluctuations and Mood Disturbances
According to a report released by the Society for Women’s Health Research in November, 2007, women seem to be more vulnerable to mood disorders and depression “during times of hormonal fluctuations such as the menstrual period, pregnancy and perimenopause.”
For some women the study shows that a normal hormonal transition can trigger mild to severe mood disorders including depression and bipolar disorder; however, more research needs to be done on how and why this occurs. “Women need to be critically aware of changes in their moods during key life cycle events,” said Sherry Marts, Ph.D., and vice president of scientific affairs for the Society.
To learn more, go to www.womenshealthresearch.org
What Are Your Kids Watching?
In a study done by the University of Michigan, scientists found a strong link between aggressive behavior and violent television and video games. In fact, researcher Brad Bushman, a professor of psychology and communications studies, discovered that repeated exposure to violent television and video games is a stronger influence on aggressive behavior than is living in poverty, engaging in substance abuse or having abusive parents.
Information from the University of Michigan states, “The correlation between media violence and aggression is stronger than the link between condom use and reduced risk of HIV, or between second-hand smoke and lung cancer.”
“Playing video games, particularly first-person shooter games, may be much more dangerous than watching violent television shows or movies,” says Bushman. “Playing games is highly active, and it requires players to identify with violent characters. It also rewards aggression, and the amount of violence is almost continuous.”
Bushman also reported that playing violent video games actually changes brain function, desensitizing chronic players to real-life violence.
Another researcher in the study, social psychologist L. Rowell Huesmann said that watching violence also “primes” aggressive scripts and beliefs, creating a heightened level of neural excitation that spreads to other thoughts stored in nearby areas of the brain. Paradoxically, then, exposure to violent media violence both decreases emotional response to violence and increases neurological arousal – a one-two punch that can be lethal.
“A high and steady diet of TV violence in early childhood increases the risk that both females and males from all social backgrounds will become violent, aggressive adults,” Huesmann says, without any of the typical academic qualifications. “Media violence can affect any child from any family, not just children who are already violence-prone.”
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Screening Tests for Women:
What You Need to Know and When
Screening tests can find diseases early when they are easier to treat. Health experts from the U.S. Preventive Services Task Force have made recommendations, based on scientific evidence, about testing for the conditions below. Talk to your doctor about which ones apply to you and when and how often you should be tested.
Obesity: Have your body mass index (BMI) calculated to screen for obesity. (BMI is a measure of body fat based on height and weight.) You can also find your own BMI with the BMI calculator from the National Heart, Lung, and Blood Institute at: www.nhlbisupport.com/bmi/.
Breast Cancer: Have a mammogram every 1 to 2 years starting at age 40.
Cervical Cancer: Have a Pap smear every 1 to 3 years if you:
Have ever been sexually active.
Are between the ages of 21 and 65.
High Cholesterol: Have your cholesterol checked regularly starting at age 45. If you are younger than 45, talk to your doctor about whether to have your cholesterol checked if:
o You have diabetes.
o You have high blood pressure.
o Heart disease runs in your family.
o You smoke.
High Blood Pressure: Have your blood pressure checked at least every 2 years. High blood pressure is 140/90 or higher.
Colorectal Cancer: Have a test for colorectal cancer starting at age 50. Your doctor can help you decide which test is right for you. If you have a family history of colorectal cancer, you may need to be screened earlier.
Diabetes: Have a test for diabetes if you have high blood pressure or high cholesterol.
Depression: Your emotional health is as important as your physical health. If you have felt “down,” sad, or hopeless over the last 2 weeks or have felt little interest or pleasure in doing things, you may be depressed. Talk to your doctor about being screened for depression.
Osteoporosis (Thinning of the Bones): Have a bone density test beginning at age 65 to screen for osteoporosis. If you are between the ages of 60 and 64 and weigh 154 lbs. or less, talk to your doctor about being tested.
Chlamydia and Other Sexually Transmitted Infections: Have a test for chlamydia if you are 25 or younger and sexually active. If you are older, talk to your doctor about being tested. Also ask whether you should be tested for other sexually transmitted diseases.
HIV: Have a test to screen for HIV infection if you:
o Have had unprotected sex with multiple partners.
o Are pregnant.
o Have used or now use injection drugs.
o Exchange sex for money or drugs or have sex partners who do.
o Have past or present sex partners who are HIV-infected, are bisexual, or use injection drugs.
o Are being treated for sexually transmitted diseases.
o Had a blood transfusion between 1978 and 1985.
Should You Take Medicines to Prevent Disease?
Hormones: Do not take hormones to prevent disease. Talk to your doctor if you need relief from the symptoms of menopause.
Breast Cancer Drugs: If your mother, sister, or daughter has had breast cancer, talk to your doctor about the risks and benefits of taking medicines to prevent breast cancer.
Aspirin: Ask your doctor about taking aspirin to prevent heart disease if you are:
• Older than 45.
• Younger than 45 and:
+ Have high blood pressure.
+ Have high cholesterol.
+ Have diabetes.
+ Smoke.
Immunizations: Stay up-to-date with your immunizations:
• Have a flu shot every year starting at age 50. If you are younger than 50, ask your doctor whether you need a flu shot.
• Have a pneumonia shot once after you turn 65. If you are younger, ask your doctor whether you need a pneumonia shot.
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Screening Tests for Men:
What You Need to Know and When
Obesity: Have your body mass index (BMI) calculated to screen for obesity. (BMI is a measure of body fat based on height and weight.) You can also find your own BMI with the BMI calculator from the National Heart, Lung, and Blood Institute at: www.nhlbisupport.com/bmi/.
High Cholesterol: Have your cholesterol checked regularly starting at age 35. If you are younger than 35, talk to your doctor about whether to have your cholesterol checked if:
• You have diabetes.
• You have high blood pressure.
• Heart disease runs in your family.
• You smoke.
High Blood Pressure: Have your blood pressure checked at least every 2 years. High blood pressure is 140/90 or higher.
Colorectal Cancer: Have a test for colorectal cancer starting at age 50. Your doctor can help you decide which test is right for you. If you have a family history of colorectal cancer, you may need to be tested earlier.
Diabetes: Have a test for diabetes if you have high blood pressure or high cholesterol.
Depression: Your emotional health is as important as your physical health. If you have felt “down,” sad, or hopeless over the last 2 weeks or have felt little interest or pleasure in doing things, you may be depressed. Talk to your doctor about being screened for depression.
Sexually Transmitted Infections: Talk to your doctor to see whether you should be tested for gonorrhea, syphilis, Chlamydia, or other sexually transmitted infections.
HIV: Talk to your doctor about HIV screening if you:
o Have had sex with men since 1975.
o Have had unprotected sex with multiple partners.
o Have used or now use injection drugs.
o Exchange sex for money or drugs or have sex partners who do.
o Have past or present sex partners who are HIV-infected, are bisexual, or use injection drugs.
o Are being treated for sexually transmitted diseases.
o Had a blood transfusion between 1978 and 1985.
Abdominal Aortic Aneurysm: If you are between the ages of 65 and 75 and have ever smoked (100 or more cigarettes during your lifetime), you need to be screened once for abdominal aortic aneurysm, which is an abnormally large or swollen blood vessel in your abdomen.
More Information
For more information on staying healthy, order the following free publications from the Agency for Healthcare Research and Quality. Call the AHRQ Publications Clearinghouse at 1-800-358-9295, or send an E-mail to: ahrqpubs@ahrq.hhs.gov.
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All in the Family:
Family-Centered Health Care
by Jamie Blevins R.N., B.S.N., M.S., Ed.D
It began early one Friday evening in May. While eating dinner out, my youngest son, Jack, who had just turned 2 the day before, decided to sit on my lap and lay his head on my chest. He refused to eat anything, but drank some of his milk and my water. By the time we got home, Jack had thrown up all over his dad, John, my husband, and then began running a slight fever. Before Jack went to bed that night, still warm, he threw up again. When given Ibuprofen every 6 hours, he would perk up a little and play for short periods of time, but when the Ibuprofen wore off, he would go back to feeling bad and running a fever. We cycled through these symptoms all weekend.
Late Sunday morning, Jack’s temperature climbed to 103 degrees Fahrenheit and stayed there. With the high fever, he began breathing very quickly (tachypnea), had an unproductive cough, was audibly congested, had clammy skin, and was weak—he could hardly hold his head up. He was very agitated and irritable if touched, but frequently latched on to John or me to be held; he was restless because he could not get comfortable, and extremely lethargic.
My instinct as a mother and also a nurse, as well as a pediatric educator, was that his illness was serious. I thought, “We cannot seem to get his fever down and it keeps climbing—we need to see the doctor.”
Because it was the weekend, John and I got Jack and our other two sons, Bo, 9, and Will, 5, ready to go to the Pediatric After Hours Clinic at St. Francis Hospital. When we arrived, we saw the doctor right away. We explained Jack’s symptoms, and the doctor took Jack’s vital signs, listened to his heart and lungs, ran a blood culture because of his high fever, and took a chest X-ray.
After all of the procedures had been completed, the doctor confirmed that Jack had RUL (Right Upper Lobe) pneumonia and needed to be hospitalized for a few days to receive antibiotics and respiratory treatment therapy.
I was shocked that Jack needed to be hospitalized! We have always prided ourselves on taking good care of our boys and keeping them healthy, and (fortunately) never having had any of our children hospitalized. It was so unexpected. Never did I think that I would be faced with the hospitalization of my own child.
After the shock of hearing that Jack had to be hospitalized, my experience as a clinical nurse and nurse educator kicked in. I knew that we needed to take a “family-centered” approach. “Family-centered care,” as defined by the pediatric community, identifies the family as the constant in the child’s life, and the family as a whole is considered the patient. This significant concept should be applied in the care of children and their families, and the Pediatric Unit at St. Francis Hospital adheres to this philosophy.
The family-centered approach started at the beginning of this situation. Our entire family took Jack to the After Hours Clinic. The older boys brought their Game Boys, a few snacks, and paper and pencils for drawing. Dad sat with them while I was in the exam room with Jack. As the situation with Jack evolved, the two older boys were included in everything, from what was wrong with Jack and why he needed an IV (intravenous tube), to other treatments he might need.
Throughout the stressful situation, John and I took a calm and reassuring approach with the boys. We answered any questions the boys had and let them stay near Jack while he was being treated. Even though Jack did not feel well, he was comforted because his brothers were in the room with him. Will, my inquisitive and observant child, asked about the needle in Jack’s arm and why there was tubing and a bag of water hanging from it. He also learned that Jack had a butterfly needle in his forearm and kept telling everyone he saw that his brother had a butterfly needle in his arm — how children retain information!
After a few hours, we were admitted to the pediatric floor at St. Francis. My husband called his parents, who live in town, to come and get the two older boys for a few hours while we settled Jack into his room. After John’s parents took the two older boys, John stayed with Jack while I ran home and packed up some clothes, toiletries, and a few presents for Jack for the few days’ stay, while Jack received his medicine and respiratory therapy.
Over the next few days, John and the boys came to visit us after work and school. Jack was so excited to see his brothers. John and I had decided that I would be responsible for Jack while he would be responsible for the two older boys. Grandparents, friends and our church community helped us as well. With everyone pitching in, the stress level during Jack’s hospitalization was kept to a minimum.
Sidebar:
TIPS For PARENTS
Taking a family-centered approach during a stressful situation strengthens the family unit: it helps every member cope with unexpected events and encourages such important qualities as honesty, trust, consistency, flexibility, compassion, closeness, respect, teamwork, and open communication among family members.
1. Involve and include the entire family. Involving the family prevents anyone from feeling left out and helps make everyone feel important.
2. Ask for help. Remember to involve grandparents, friends, your church, and support groups to help with other siblings, make food, or just listen.
3. Allow children to express their feelings. Encouraging your children share concerns and questions helps open the lines of communication and identifies areas that need to be addressed with each child.
4. Explain what is going on to your children. Open communication helps them understand the situation and allows you to clarify any misunderstandings.
5. Treat each child fairly and according to age. Doing so keeps fighting, regression, and competition among siblings to a minimum.
6. Provide an atmosphere that is non-threatening, warm, and accepting. Creating such an atmosphere opens communication with your children and helps you understand what is going on with them, thereby preventing confusion, frustration, and anger.
7. Maintain a calm, relaxed, and reassuring approach with your children.
8. Maintain normalcy, as much as possible. Sticking to a familiar routine helps keep children from getting out of sorts and acting out.
9. Make sure nurses and doctors treat the patient as the family. In order to ensure a family-centered approach, while hospitalized, be assertive by asking questions and addressing concerns.
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MRSA Madness
The CDC Answers Common Questions
With so much publicity about the “super bug” Methicillin-resistant Staphylococcus aureus (MRSA), often called “staph,” we wanted to get answers to some commonly asked questions.
According to the Mayo Clinic Web site, “Staph bacteria are normally found on the skin or in the nose of about one-third of the population. If you have staph on your skin or in your nose but aren’t sick, you are said to be ‘colonized’ but not infected with MRSA. Healthy people can be colonized with MRSA and have no ill effects. However, they can pass the germ to others.
Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. But in older adults and people who are ill or have weakened immune systems, ordinary staph infections can cause serious illness.
In the 1990s, a type of MRSA began showing up in the wider community. Today, that form of staph, known as community-associated MRSA, or CA-MRSA, is responsible for many serious skin and soft tissue infections and for a serious form of pneumonia.”
The following are some commonly asked questions about MRSA with answers from the Centers for Disease Control (CDC). Go to www.cdc.gov to learn more.
What type of infections does MRSA cause?
• In the community most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, beard area of men).
• Almost all MRSA skin infections can be effectively treated by drainage of pus with or without antibiotics. More serious infections, such as pneumonia, bloodstream infections, or bone infections, are very rare in healthy people who get MRSA skin infections.
How is MRSA transmitted?
• MRSA is usually transmitted by direct skin-to-skin contact or contact with shared items or surfaces that have come into contact with someone else’s infection (e.g., towels, used bandages).
In what settings do MRSA skin infections occur?
• MRSA skin infections can occur anywhere.
• Some settings have factors that make it easier for MRSA to be transmitted.
• These factors, referred to as the 5 C’s, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness.
• Locations where the 5 C’s are common include schools, dormitories, military barracks, households, correctional facilities, and daycare centers.
How do I protect myself from getting MRSA?
• You can protect yourself by:
• practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand sanitizer and showering immediately after participating in exercise);
• covering skin trauma such as abrasions or cuts with a clean dry bandage until healed;
• avoiding sharing personal items (e.g., towels, razors) that come into contact with your bare skin; and using a barrier (e.g., clothing or a towel) between your skin and shared equipment such as weight-training benches;
• maintaining a clean environment by establishing cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with people’s skin.
Should schools close because of an MRSA infection?
• The decision to close a school for any communicable disease should be made by school officials in consultation with local and/or state public health officials. However, in most cases, it is not necessary to close schools because of an MRSA infection in a student. It is important to note that MRSA transmission can be prevented by simple measures such as hand hygiene and covering infections.
Should the school be closed to be cleaned or disinfected when an MRSA infection occurs?
• Covering infections will greatly reduce the risks of surfaces becoming contaminated with MRSA. In general, it is not necessary to close schools to “disinfect” them when MRSA infections occur. MRSA skin infections are transmitted primarily by skin-to-skin contact and contact with surfaces that have come into contact with someone else’s infection.
• When MRSA skin infections occur, cleaning and disinfection should be performed on surfaces that are likely to contact uncovered or poorly covered infections.
• Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the environment.
• It is important to read the instruction labels on all cleaners to make sure they are used safely and appropriately.
• Environmental cleaners and disinfectants should not be used to treat infections.
• The EPA provides a list of EPA-registered products effective against MRSA: http://epa.gov/oppad001/chemregindex.htm
Should the entire school community be notified of every MRSA infection?
• Usually, it should not be necessary to inform the entire school community about a single MRSA infection. When an MRSA infection occurs within the school population, the school nurse and school physician should determine, based on their medical judgment, whether some or all students, parents and staff should be notified. Consultation with the local public health authorities should be used to guide this decision.
• Remember that staphylococcus (staph) bacteria, including MRSA, have been and remain a common cause of skin infections.
Should the school be notified that my child has an MRSA infection?
• Consult with your school about its policy for notification of skin infections.
Should students with MRSA skin infections be excluded from attending school?
• Unless directed by a physician, students with MRSA infections should not be excluded from attending school.
• Exclusion from school and sports activities should be reserved for those with wound drainage (“pus”) that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good personal hygiene.
I have an MRSA skin infection. How do I prevent spreading it to others?
• Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages until healed. Follow your healthcare provider’s instructions on proper care of the wound. Pus from infected wounds can contain staph, including MRSA, so keeping the infection covered will help prevent the spread to others. Bandages and tape can be discarded with the regular trash.
• Clean your hands frequently. You, your family, and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
• Do not share personal items. Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms, that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.
Practical Advice for Teachers
• If you observe children with open draining wounds or infections, refer the child to the school nurse.
• Enforce hand hygiene with soap and water or alcohol-based hand sanitizers (if available) before eating and after using the bathroom. |
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