J. R. White – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Sat, 30 Dec 2017 16:30:10 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.1 Diagnosing Child Abuse http://brainblogger.com/2008/11/07/diagnosing-child-abuse/ http://brainblogger.com/2008/11/07/diagnosing-child-abuse/#comments Fri, 07 Nov 2008 14:32:11 +0000 http://brainblogger.com/?p=1786 Unquestionably, child abuse is one of the most devastating and horrendous issues faced by health practitioners. Not only because of the vulnerability of the victim and the implications for their future health but also because of the senselessness of this violence.

In a BMJ editorial, Naomi Sugar explains current research and makes a case for putting money towards the research needed to refine the medical field’s understanding of child abuse.

Sugar first notes that the importance of diagnosing child abuse is a solemn affair. Making a diagnosis of this sort can break up families, put people in jail, and is, of course, a black mark on personal reputations. Unfortunately though, diagnosing child abuse is not a cut and dry affair.

Currently several factors are examined when child abuse is considered:

  • A physical examination
  • A radiological survey
  • Caregiver’s report of the accident
  • Reports of the scene from those present soon after the injury occurred
  • History from other observers

Even with these considerations, determining abuse can still be difficult although there are several red flags that practitioners pay attention to. One such case is when caregiver’s change the event details from retelling to retelling. Another is when the present injury is not connected to the events being described.

Sugar reviews a Welsh study on child abuse. This study notes that most times abuse is diagnosed when the abuse is out-and-out admitted or when the abuse is confirmed through a variety of means such as case meetings or court proceedings.

This Welsh group has studied numerous types of child abuse injuries including scald burns, human bites, oral injuries, bruises, and, in this current study, fractures. This group and others who study child abuse use a number of techniques such as computer modeling, documented case studies, autopsy studies, and retrospective case reviews to develop a more precise understanding of these injuries. Researchers use a variety of tools to represent actual humans. Cadaveric rabbit models and test dummies are two such tools.

Sugar notes that uniformity of observational studies of infant and toddler fractures will help further understanding of child abuse injuries. She suggests that these studies need “age categories, uniformly applied diagnostic procedures, such as skeletal surveys, and a priori diagnostic criteria for abuse and non-abuse.”

Increasing the accurate diagnosis of child abuse is necessary in order to ensure both the safety of children and the integrity of the family unit. New techniques and improved methodology will lead the way towards making this a reality.

Reference

N. F Sugar (2008). Diagnosing child abuse BMJ, 337 (oct02 1) DOI: 10.1136/bmj.a1398

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McCain’s Health Issues Reflect His Character http://brainblogger.com/2008/11/03/mccains-health-issues-reflect-his-character/ http://brainblogger.com/2008/11/03/mccains-health-issues-reflect-his-character/#comments Mon, 03 Nov 2008 16:45:21 +0000 http://brainblogger.com/?p=1788 You can’t have skeletons in the closet if you want to be the Commander in Chief of the U.S. Armed Forces.

As Election Day draws near, I imagine that both McCain and Obama are exhausted; both have been run through the ringer. After all, they must endure non-stop campaigning schedules, high pressure debates, and the constant scrutiny of the press. Along with this, every aspect of their lives are being examined under the most powerful of microscopes. From tax records to religious affiliations to personal friendships, both men are left bare, no secrets uncovered.

This openness extends to their health histories as well. Both candidates issued records or statements detailing major health issues. Not surprisingly, Obama, 25 years younger than McCain, has a clean bill of health; the only exception is his difficulty kicking the smoking habit.

John McCainMcCain’s record is fairly impressive as well even though he is 72. Along with his past problems with melanoma he may need joint replacement therapy down the road, a result of his time spent as a Prisoner of War (POW). Along with this, his records note that he tried to hang himself, eight months into his 5+ years spent as a POW. He was found to be mentally stable after being examined for mental disorders and we can assume that his suicide attempt was a rational decision considering the circumstances he was in.

Initially I was surprised upon reading this. After all, McCain’s strength of character, proven by his perseverance during his POW days as well as through other reports from those who know him well, seems to be contrary to this act of desperation. Don’t get me wrong, I don’t fault McCain because of this; he is a human susceptible to human weaknesses and certainly he was in the midst of more devastation and pain than many of us can imagine. This image just didn’t concur with the fiery candidate that I see on TV.

But eventually my surprise over his health details gave way to curiosity. Today he still suffers from ailments related to his time spent representing our country. This coincides with the reports that McCain’s patriotism and dedication to his country is intense. And it seems as if this would go a long way towards drawing voters. After all, for a future president, what speaks louder than loving your country so much that you are willing to suffer intensely?

Well, quite a bit it seems.

Most polls show McCain trailing Obama by a substantial margin. It seems that there is something more important to people than patriotism, the good old-fashioned War World II Generation-goodness. Don’t get me wrong, I do not doubt Obama’s patriotism but McCain’s past is textbook-flag-waving-country-first-stuff.

What is it that Americans value more highly than what McCain offers? Obama’s calmer and steadier demeanor? Liberal views? A change in ranks? Do our changing values represent progress? I don’t know.

But what I do know is that McCain’s type of patriotism may be dying. Excluding the military, you seldom hear young people talk about their country in endearing terms. And you certainly don’t see many who feel so strongly for their country that they are willing to put country above all else.

Obama may be the face of the future but for the sake of our country, I hope that McCain’s brand of patriotism isn’t a thing of the past.

Reference

F. Charatan (2008). Records of presidential candidates show McCain has had melanoma and Obama is using nicotine replacement therapy BMJ, 337 (oct27 2) DOI: 10.1136/bmj.a2260

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Obama and McCain – Friend or Foe of Science? http://brainblogger.com/2008/11/02/obama-and-mccain-friend-or-foe-of-science/ http://brainblogger.com/2008/11/02/obama-and-mccain-friend-or-foe-of-science/#comments Sun, 02 Nov 2008 14:09:38 +0000 http://brainblogger.com/?p=1783 In the last presidential debate there were only a few zingers. One came from John McCain who, after Barack Obama compared him to G. W. Bush, emphatically stated, “If you wanted to run against President Bush, you should have run four years ago.”

Since the debate Obama’s running mate, Joe Biden, responded to McCain’s implications with, “If it walks like a duck, if it looks like a duck and it quacks like a duck, it’s a duck!”

But regardless of the promises or perceived merits of either candidate, no one really knows what a McCain or an Obama country would look like. We listen to their words, review their records, and seek out the truth but as to the reality of their campaign promises, it’s anybody’s guess. And as to Biden’s duck analogy… well, it’s a possibility but not a guarantee.

John McCainStill though, McCain’s ties to the conservative voter base rattles me somewhat. Not that I’m against his views particularly but I worry about the attitude that seems to be prevalent among some republican supporters. In extreme cases, there seems to be an undercurrent of intolerance, sometimes to the point of crazed hatred. When your supporters yell, “Kill him,” that’s taking campaigning too far. It makes me wonder if the Republican base is healthy? Are common sensibilities and the ability to be un-objective when necessary less prevalent among this group?

I direct this question to republicans instead of democrats for two reasons. One, mentioned above, has to do with the dangerously frenzied sort of atmosphere that has been reported at republican rallies. And my second reason has to do with Bush, the current republican president. It seems that the Bush administration hasn’t exercised common sensibilities regarding health issues. In a BMJ article, Douglas Kamerow points out that over the last eight years this administration has made choices in regards to health issues and policies that seems to shrug off scientific knowledge in favor of personal views and interests. It seems that many times Bush was “an army of one” when dealing with hot-button and high-profile issues — refusing to use science as a basis for decisions and doing… well, what he (or his administration) just wanted to do. The Union of Concerned Scientist has documented many of these instances including:

  • Insisting on and publicizing the effectiveness of abstinence only sex education, despite a lack of evidence for it.
  • Censoring testimony before Congress by the Centers for Disease Control and Prevention (CDC) on the health hazards of climate change.
  • Posting erroneous data linking abortion and breast cancer on CDC’s website.
  • Distorting evidence on the effectiveness of condoms in preventing HIV transmission and prevention
  • “Stacking” a federal advisory committee on prevention of lead poisoning to prevent more stringent standards.
  • Adding non-scientific proponents of positions favored by the administration to sessions at scientific meetings in the guise of providing “balance.”

Along with these actions, this administration directly influenced other key issues by refusing to publish evidence, allowing invalid data to influence decisions, and changing test results. Even more disturbing is that this administration, “…prevented its own surgeon general from speaking out on topics in the areas of mental health, global health, and secondhand smoking.” In other words our health policies have been based, at least partly, on a very biased and self-serving administration.

Is this pattern related to the republican’s large evangelical christian voter base? Possibly knowing that many of your constituents agree with the outcome, if not the means, may have allowed Bush to endorse these methods. But I am going to venture to say that most members of this subgroup would not sanction these unethical methods. Most rational opponents of say, sex education or abortion would not want misinformation to lead the argument for policy changes. Logical arguments that are not based in science exist for every issue so there is no need to distort scientific results; this only leads to more governmental distrust and is misguided.

Both ideologies, support bases, and candidates have taken on a life of their own by this point in the race. Will McCain’s views cause him to do the same as his party’s predecessor? Could Obama push his views or his constituent’s views via this same avenue? I hope not. An intolerance to science is dangerous for everyone — regardless of party ties.

Reference

D. Kamerow (2008). Politics and science: a cautionary tale for the presidential candidates BMJ, 337 (oct14 4) DOI: 10.1136/bmj.a2093

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ADHD – A Very Incomplete Puzzle http://brainblogger.com/2008/10/13/adhd-a-very-incomplete-puzzle/ http://brainblogger.com/2008/10/13/adhd-a-very-incomplete-puzzle/#comments Mon, 13 Oct 2008 15:39:28 +0000 http://brainblogger.com/?p=1587 Teaching students with ADHD was always challenging for me. My usual methods of managing behavior, explaining assignments, and reviewing routines weren’t very effective for many of these kids. I’ve been lucky enough to know a handful of teachers who were knowledgeable about techniques that helped their ADHD students achieve. And although I often picked their brains in an attempt to beef up my arsenal of teaching wonders, the techniques weren’t always easy to execute amid a classroom of children needing various modifications.

Oftentimes I felt frustration. I knew that these students needed some minor adjustments to be as successful as they so desperately wanted to be. Usually their parents cried out for help too; they didn’t want school work and organization skills to be a daily, nightly struggle. Like many things in education, I wasn’t quite sure why more advanced training wasn’t provided, why ADHD children didn’t receive more outside support, why these children and their parents weren’t better educated about this condition.

GirlA recent BMJ article shed light on some of my frustrations. In Diagnosis and management of attention-deficit/hyperactivity disorder in children, young people, and adults: summary of NICE guidance, the authors summarized key findings and recommended strategies for dealing with both conditions. Considering that the number of children diagnosed with ADHD has substantially increased in both the US and UK, this article sought to clarify some issues surrounding the disorder.

There were many recommendations regarding the treatment and management of ADHD/ADD, but the section that grabbed my attention was suggestions for future research. It turns out there are basic (or at least what I consider to be basic) questions about these conditions that researchers still don’t have definitive answers to. See for yourself:

  • The criteria for diagnosis of ADHD in adult life? (There are no clear conclusions about the level of ADHD symptoms in adults that should be considered as grounds for intervention.)
  • The optimal duration of drug treatment? (Methylphenidate is often prescribed for years without good evidence on whether prolonged therapy is effective or safe.)
  • The effectiveness of group based parent training and education programs compared with medication in children of school age? (The evidence they do have is primarily based on studies of younger children.)
  • The effectiveness of non-pharmacological approaches for adults with ADHD? (There is insufficient evidence regarding this.)
  • The effect of providing training in behavioral management of ADHD for teachers?

These are the exact recommendations suggested by NICE. I took for granted that conclusions had been drawn regarding many of these issues. I was wrong.

I imagine researchers lack significant evidence for most mental illnesses. Being aware of this can eliminate some frustrations related to living with, or directly being involved with someone who has, a mental illness. This can also help you make better decisions. After all, if the optimal duration of drug treatment is unknown, you may want to talk to your doctor about other options. If someone dismisses the idea that ADHD can be treated without medication, you can refute that based on a lack of substantial evidence. Keeping abreast of the latest information is a key component to managing any mental illness. After all, knowing what you don’t know is always half the battle.

Reference

T. Kendall, E. Taylor, A. Perez, C. Taylor (2008). Diagnosis and management of attention-deficit/hyperactivity disorder in children, young people, and adults: summary of NICE guidance BMJ, 337 (sep24 1) DOI: 10.1136/bmj.a1239

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China’s Tainted Reputation http://brainblogger.com/2008/10/07/chinas-tainted-reputation/ http://brainblogger.com/2008/10/07/chinas-tainted-reputation/#respond Tue, 07 Oct 2008 23:57:24 +0000 http://brainblogger.com/?p=1591 Call me paranoid but I am careful about what I allow in my house. When I buy toys for my son I actually look to see where they are made. The same with clothing. And ditto for food items. Although I consider these actions quite sound, there is a kink when it comes to execution.

You see, I try to buy safe items. The lead paint toy scare made me steer clear of toys from China. This was something I tried to do anyhow preferring USA manufactured items. The same for clothing items considering the ridiculously low wages I knew that many companies paid their workers. As for food, well, I try to buy produce that is grown close-by so that it’s more nutrient rich. Of course I think that my success rate in all of these endeavors is somewhere in the single digits; it feels as if every item on the store shelf is imported. Heck, trying to find a toy not made in China is like trying to find the leprechaun at the end of the rainbow.

ChinaWhen the lead paint issue became, well, an issue, it was a clear signal that some piece of our regulation process wasn’t working. When it comes to safety, regardless of who blows the whistle, China or America, the whistle needs to be blown before people are harmed.

Recently China has been involved in another safety faux pas. In the BMJ article, China’s tainted infant formula sickens nearly 13,000 babies, the details are spelled out. 104 children are seriously ill and four children have died because melamine was in the formula. A WHO adviser for food safety recently stated:

…for infant formula, given the heavy reliance on this as a food by small infants, it would be particularly prudent for competent authorities to closely monitor the product for contamination…

You think?

Am I ridiculous to worry about the safety of Chinese imports considering these two recent instances of negligence? Especially considering the fact that both of these cases involved items that are used by children.

If so, call me ridiculous.

I know that tainted food and dangerous products can originate from anywhere. And I realize that the tainted formula doesn’t affect consumers in the U.S. But considering the fact that we import so much from China and other countries; considering the fact that twice in the last year items made in China were found to be so unsafe; I think my hesitance is founded.

So yes, I am careful about what I let into my house. Government systems and regulation departments do not ensure the safety of imported, or domestic for that matter, products.

References

J. Parry (2008). China’s tainted infant formula sickens nearly 13 000 babies BMJ, 337 (sep24 1) DOI: 10.1136/bmj.a1802

J. H. Tanne (2008). Efforts to reduce US trainees’ hours were ineffective, study says BMJ, 337 (aug05 2) DOI: 10.1136/bmj.a1140

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Writing Away Your Worries http://brainblogger.com/2008/10/03/writing-away-your-worries/ http://brainblogger.com/2008/10/03/writing-away-your-worries/#comments Fri, 03 Oct 2008 17:11:51 +0000 http://brainblogger.com/?p=1589 I have always been a fan of the written word. Even before I started my professional writing career I wrote. In school yes, but I wrote beyond what was required for classes. I wrote fiction stories and a little poetry but I mainly spent my time filling up diaries and journals. Even though I sometimes recalled day-to-day interactions most of my entries were about my feelings, trying to sort out the racing thoughts in my mind.

I have a box full of these journals that I don’t want to get rid of and yet they are painful (and boring) to look through. I don’t care to get bogged down in the muck and mire of bygone emotions. It seems the journals and diaries served their purpose; they allowed me to share my feelings and thoughts so that I could move on. I didn’t realize it at the time but I was engaged in therapeutic writing.

An in-depth article regarding the effects of this type of writing was recently published in Medical Humanities. The article clarifies the definition of therapeutic writing and sheds light on how this form of therapy helps people with cancer. Although the research is mainly qualitative instead of quantitative, the information presented is a substantial nod to the powerful healing properties of writing.

Therapeutic writing, unlike many forms of writing, is not necessarily written for others. The main purpose is for the writer to create something that is beneficial for them. In this study the participants were in total control of their writing. They choose the form of the writing as well as the content. The benefits to this type of writing are many. It allows the writer to express emotions and thoughts that they couldn’t express in other ways. It allows the writer to “get stuff off their chest.” And it allows the writer to say anything they want, without concerning themselves with audience response.

Past research shows many benefits to therapeutic writing. In the case of the terminally ill, writing was the medium that allowed individuals to address “existential and relational concerns.” It seems that without this opportunity, these important issues weren’t always processed. Once the patients had the opportunity to face these issues they were oftentimes more able to handle their upcoming death better as well as gain a sense of closure to their lives.

It’s no surprise to me that writing can have profound effects on people. Sometimes just the act of getting thoughts out of your head and onto paper can help you to feel more grounded, more clear-headed. This type of writing, therapeutic writing, is like a conversation you have with yourself. And unlike a conversation you have with somebody else, you are free to express yourself totally, completely, until you are empty. And instead of turning to others for wise words or comforting suggestions, your inner wisdom has a chance to voice itself. You are both the burdened and the comforter.

Without realizing it, I’ve engaged in therapeutic writing for years. Not only for the terminally ill, journaling can soothe troubled minds and strong emotions.

Reference

G Bolton (2008). “Writing is a way of saying things I can’t say”–therapeutic creative writing: a qualitative study of its value to people with cancer cared for in cancer and palliative healthcare Medical Humanities, 34 (1), 40-46 DOI: 10.1136/jmh.2007.000255

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Are Doctors Super Human? http://brainblogger.com/2008/09/22/are-doctors-super-human/ http://brainblogger.com/2008/09/22/are-doctors-super-human/#comments Mon, 22 Sep 2008 14:48:21 +0000 http://brainblogger.com/?p=1405 It’s common knowledge that an example is more powerful than words. After all, aren’t parents routinely admonished for telling their children to do one thing while clearly breaking that same rule themselves? For parents and non-parents alike, saying one thing while doing something else greatly diminishes the influence of the words. Maybe that explains why most people don’t get enough zzzzzzz’s. Let me explain.

The number of people who suffer from sleep-deprivation are substantial. Data from the National Sleep Foundation’s 2007 Sleep Study shows that 67% of women experience sleep problems more than once a week. And beyond the statistics, it is obvious that sleep-issues plague many. Just take a look at the covers of magazines or check out your local paper; you don’t have to look far to find a story about how to sleep better.

Ironically, medical professionals routinely assert that getting a proper night’s rest is vital, is necessary, to being healthy and feeling good. Adequate, quality sleep is touted to help a number of medical problems from clinical depression to the common cold. And anyone who has worked or works with children knows first-hand how important a good-night’s sleep is for promoting a balanced mood and emotional resilience. Point is, sleep is one of the most important things we can do to keep our bodies and minds healthy. At least that’s what the medical professionals tell us.

This is precisely why it has always amazed me that this same profession has routinely ignored their own advice. The recent BMJ article, Efforts to reduce US trainees’ hours were ineffective, study says, is recent evidence that interns and doctors are still expected to work ridiculously long hours in hospitals.

The consequences of tired doctors on-call are obvious and so to remedy this problem the US Accreditation Council for Graduate Medical Education enforced new limits of no more than 30 consecutive hours for residents whose long shifts were more likely to cause mistakes or patient risks. Interns participating in this particular study kept journals noting the basics such as hours spent working or sleeping. They also noted things such as car crashes or possible risky medical situations such as errors they made.

Unfortunately, the study was unable to prove that a more rational system that allowed interns to get the rest they needed prevented most of the mistakes that lack-of-sleep were previously blamed for! The reason? Interns, regardless of the new limits, were still required to work ridiculously long-hours so the results could not be measured.

Now I know that it takes a lot to make it through medical school and through the rotations that are mandatory before becoming a certified MD. But come on, doctors are not superhuman. They are not immune to the effects, sometimes deadly effects, of sleep-deprivation. The human body requires sleep, as the medical profession is so fond of telling us. Why is it then that those whose business is the human body aren’t allowed to take care of their own?

Reference

J. H. Tanne (2008). Efforts to reduce US trainees’ hours were ineffective, study says BMJ, 337 (aug05 2) DOI: 10.1136/bmj.a1140

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Planning for Postnatal Depression http://brainblogger.com/2008/09/08/planning-for-postnatal-depression/ http://brainblogger.com/2008/09/08/planning-for-postnatal-depression/#respond Tue, 09 Sep 2008 03:30:08 +0000 http://brainblogger.com/?p=1410 Depression is a subtle thing. It can easily take on the disguise of other illnesses or temporary conditions.

Tired? Who isn’t? Sad? Well, the world can be depressing. Worried? Yeah, that’s why we all have grey hairs. Can’t sleep well? Join the club. Aren’t hungry? You’re just too busy. Unfocused? You just need to simplify. Irritable? It’s that time of the month. Don’t want to socialize? You’ve been at work all day.

Even for those who have lived with depression for years, it can be easy to dismiss another serious episode because so many of the symptoms mirror what most of the general population suffers from. It’s only when the symptoms have escalated and you are at the point where your functioning just isn’t normal that you may then snap your fingers and say, oh yeah, this again. But it’s only when you call depression by its name that you can adequately deal with it. And this is the case with postnatal depression as well.

DepressionBMJ recently published a letter in response to a previous article titled, Management of postnatal depression. In the letter, the author, Ruth V. Reed, warned people about the effects postnatal depression can have on children. Effects such as:

… reduced cognitive development, violence, and disturbances in behavior and patterns of play.

Reed goes on to note that treating postnatal depression can be difficult because the waiting time to receive cognitive therapy is usually quite lengthy and taking drugs for depression is more complicated when a new mother is breastfeeding her child.

Since the effects of postnatal depression can be serious and since the number of women who suffer from this condition are quite substantial, I think that better ways of identifying and treating postnatal depression need to be developed. As noted earlier, depression doesn’t always appear to be depression and getting help for this in the midst of caring for a new child can seem overwhelming. I believe that one way of treating this condition more effectively is by clear communication between the patient and her gynecologist before birth.

Ideally, frank discussions about postnatal depression between patient and doctor would happen briefly throughout the pregnancy. This would lessen the stigmatization surrounding depression as well as send a signal to the patient that the doctor takes this condition seriously.

Although education about depression, including postnatal depression, is readily available, the doctor is oftentimes not involved. Just knowing that your doctor is aware of this condition and is going to be asking you about your state of mind after you give birth can make it easier to be honest if you do experience postnatal depression.

Included in these discussions should be a conversation about medicine options, including the issues that are inherent with breastfeeding. A simple checklist for the patient to use in the weeks and months after delivering can help her and her doctor become aware of any sneaky postnatal depression that may be present.

Since the birth of a child is a wonderful yet busy and stressful time, a plan for possible postnatal depression would help everyone involved. The patient can make decisions before the indecision of depression and the tiredness that comes with an infant brings. The family can experience peace of mind knowing that, if depression were to occur, they have a viable plan in place. The doctor knows that most of the decisions were made by the patient and has opened a dialogue that can lead to faster treatment. All in all, a few minutes of openness can lead to better management of postnatal depression.

Reference

R. V Reed (2008). Don’t forget children and fathers BMJ, 337 (aug27 1) DOI: 10.1136/bmj.a1414

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The Dark Side of Antibiotics http://brainblogger.com/2008/09/03/the-dark-side-of-antibiotics/ http://brainblogger.com/2008/09/03/the-dark-side-of-antibiotics/#comments Thu, 04 Sep 2008 02:52:42 +0000 http://brainblogger.com/?p=1407 I have many memories of being sick as a child. I remember lying on the couch watching movies with our rented VCR and putting sympathy stickers given to me by my older sisters in my sticker book. I remember stopping by the meat market to buy a BBQ burger and bag of Cheetos before heading home to my sickbed, a spot on the living room couch. I have some vivid memories of being cooped up for days at a time. Once my teacher even called to invite me to the movies since I missed the last few weeks of school because of one of my latest spells.

From pneumonia to the shingles to the flu, I wasn’t one to win the perfect attendance awards handed out at the end of the year. In contrast, my best friend M, seldom missed school. When she came down with something, strep throat was the usual culprit, she was whisked off to the doctor, started on a round of antibiotics, and then returned to school later that day or the next at the latest. Even today, when M or her children get sick she follows her usual protocol, a quick visit to the doctor, the appropriate medicine and all is well.

The difference in our getting-well-routines no doubt had something to do with the fact that M’s mother worked outside the home whereas my mother was a stay-at-home mom. Of course, I now understand how difficult it is to take off days, not to mention weeks, at a time to take care of a sick child. My mother had the luxury of letting my body heal itself, when it would comply, because she wasn’t having to use up precious sick days.

Because of my childhood I’ve always hesitated to use medicine. Not always a blessing, this has caused me some problems when medicine has truly been the best course of action for one ailment or another. But besides from my belief that in many cases the body can heal itself is my weariness at the possible negative effects of taking this or that drug. Once again I blame my childhood because I was known for having reactions to numerous drugs: hives, bruises, etc.

So when articles such as, Antibiotics account for 19% of emergency department visits in US for adverse events and Antibiotics may be linked to risk of cancer, are released my anxiety increases dramatically. Whereas many people would shrug off articles like these, I examine the facts trying to make heads or tails of the significance of the findings.

And in these cases, both articles provide good information about antibiotic usage. The first article discusses the fact that about 19% of ER visits are related to adverse events related to antibiotics. Many of these cases, about 80%, have to do with allergic reactions while some are caused by overdoses or errors.

In the second article, researchers have found some evidence that antibiotics may increase the risk of certain types of cancer. The results are far from concrete though and researchers note that:

… the observational design of the study means that they cannot say whether antibiotic use causes cancer or whether other factors, such as infectious agents or behavioral factors, explain the findings.

The most useful information is related to the use of antibiotics for respiratory tract infections. John Bartlett, a specialist in infectious diseases at Johns Hopkins University, Baltimore notes that many respiratory tract infections are not due to bacterial infections and therefore are not going to respond to antibiotics. In those cases of course, using antibiotics would not be the smart choice.

Both studies seem to add fuel to the already current idea that prescribing antibiotics should not be done recklessly. But even though this overriding attitude has been standard for a few years now, many people still think of antibiotics as the answer to their aches and pains. And, like my friend M, there are reasons for this that are far-removed from any medical implications. Allowing your body to heal itself is not necessarily a quick process. And in today’s fast paced world, that is an unpopular notion.

References

R. Dobson (2008). Antibiotics may be linked to risk of cancer BMJ, 337 (aug21 3) DOI: 10.1136/bmj.a1381

B. Roehr (2008). Antibiotics account for 19% of emergency department visits in US for adverse events BMJ, 337 (aug15 2) DOI: 10.1136/bmj.a1324

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When It Comes to Health, Adults Shortchange Kids http://brainblogger.com/2008/08/22/when-it-comes-to-health-adults-shortchange-kids/ http://brainblogger.com/2008/08/22/when-it-comes-to-health-adults-shortchange-kids/#comments Fri, 22 Aug 2008 16:09:35 +0000 http://brainblogger.com/?p=1200 The problems of childhood obesity are not exclusive to American soil. Both the U.S. and many European countries face this crisis. Various solutions have been proposed and executed. Everything from promoting exercise to teaching children about the origin of their food to banning candy or sweets on school campuses.

Now the European Commission has put forth a new initiative. A recent BMJ article, European Commission plans free fruit and vegetable scheme in schools, highlights the commission’s desire to get kids off to a strong start regarding healthy eating habits. Although various countries have enacted similar plans, the commission’s concern is that these plans have holes in them including:

  • They only cover a small regional area
  • They only provide healthy food on a short-term basis or every once in a while
  • There are no guarantees that the program will continue

The commission wants to fix this by providing money to countries that voluntarily participate. The catch: each participating country must match the money provided by the commission with the exception of some needy areas.

Although I think that efforts to promote healthy habits among children is worthy, I think that this program, and others like it, are really band-aids for the real problem: us adults.

As most of us have humbly learned, children learn from example. And so the logical explanation for obesity and unhealthy eating habits among our children is nothing less than our own example. Because of our misguided actions and decisions, governments around the world are having to shell out money to fix our screwed up results.

Not only have we picked up shudder-inducing eating habits (and hey, I definitely include myself in the “we” I blame) but we have allowed the marketing industry to become corrupt-a-kid renegades. The combination of our desire for a quick drive-through burger, endless commercials, and colorful “fruit” roll-up boxes depicting one beloved cartoon character or another has proven too much for our impressionable children.

If we really want to curb the obesity issue and teach our kids how to eat we have to shun convenience and instant gratification for something else: good food. We have to pull out the cutting board and cut the orange instead of handing over a packet of sugary fruit chews. We have to plan meals instead of watching TV. We have to pass up the quick candy bar we crave so that our kids don’t get into the habit of thinking that it’s okay to fill our bodies with sugar.

I cringe at these words. Alas, I am a sugar-addict and I too know how easy it is to order a basket of fries or reason that a few sips of soda won’t hurt. But I know that each time I hear about another government program aimed at preventing what I’ve helped start I’m going to cringe even more.

Reference

Watson, R. (2008). European Commission plans free fruit and vegetable scheme in schools. BMJ, 337(jul15 1), a829-a829. DOI: 10.1136/bmj.a829

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Will Money Improve NYC’s Health? http://brainblogger.com/2008/08/14/will-money-improve-nycs-health/ http://brainblogger.com/2008/08/14/will-money-improve-nycs-health/#respond Thu, 14 Aug 2008 14:27:31 +0000 http://brainblogger.com/?p=1198 You know, there’s a reason why famous sayings are, well, famous sayings. It’s because they’re true and they usually sum up this truth is just a few words so as to package their neat truism in a tidy little box.

BMJ’s article, New York’s road to health, quickly brought to mind one of those sayings in just two simple words:

Money Talks

If you’ll allow me to though, I’m going to add three words to this saying to make it even more apropos for this topic:

Across the Board Money Talks

NYCIn Karen McColl’s feature story, New York’s daring health initiatives are summarized with an emphasis on the role that current New York City mayor, Michael Bloomberg, plays in these events.

New York City has plenty to boast about when it comes to health mandates that have successfully been put in place: the Smoke Free Air Act, the phasing out of trans fatty acids from many restaurants, and requiring certain restaurant menu items to list calorie information. But the most recent health initiative is the one that I found surprising.

As part of a pilot project, selected low-income families can earn money for taking care of themselves and their families. How much money?

  • Maintaining subsidized health insurance — $20 per parent group, $20 for all children
  • Keeping up private or employer insurance for the entire family — $50/month
  • Attending an annual medical check-up — $200 per family member
  • Attending suggested follow-up visits within the correct timeframe — $100 per family member
  • Attending regular preventive dental check-ups — $100 per family member

It is suggested that Mayor Bloomberg’s unique leadership and personal qualities are largely responsible for enabling New York City to make such huge and powerful public health gains. Not only is he highly dedicated to public health in general, he has money.

Bloomberg is a private philanthropist who donates vast amounts of money to health causes. Plus, his connections and personal monetary strength means that he has a wide breadth of influence.

I’m not suggesting that the city’s success hinges upon Bloomberg’s wealth. In fact, Dr. Frieden, the health commissioner doesn’t mince words. He states:

None of these things would have been possible without [Mayor Bloomberg’s] leadership. It took a lot of political effort to get these things through, and it involved taking a lot of political heat to do the right thing. They are all now very popular, but getting them through meant standing up to vested interests and doing things that lead to a fairly brutal critique in the tabloid newspapers. And Mayor Bloomberg was willing to do that because he knew that it would save lives.

The barriers that prevent disadvantaged families from taking care of their health are beyond the scoop of this article but I am optimistic that this plan will work because money is behind the initiatives. From both the man who is the “face” of the program to the money provided to the families who follow the requirements, money is involved. And money talks.

Reference

McColl, K. (2008). New York’s road to health. BMJ, 337(jul08 3), a673-a673. DOI: 10.1136/bmj.a673

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How To Talk To Kids About Sex http://brainblogger.com/2008/08/11/how-to-talk-to-kids-about-sex/ http://brainblogger.com/2008/08/11/how-to-talk-to-kids-about-sex/#comments Mon, 11 Aug 2008 19:09:00 +0000 http://brainblogger.com/?p=1204 Do you remember the dreaded sex talk given to you by your parents? Most likely you fall into one of two camps. You belong in the first camp if your only memory of this talk is the recollection of a flushed, burning face staring at the carpet hoping-no, praying-that this moment would mercifully end… like two seconds ago. You belong in the second camp if you have absolutely no recollection of THE TALK. And the reason for this? This would be because it never happened.

Now, those of us who endured those uncomfortable few minutes (really, was it that much longer?) may wish that we had been one of the “lucky” ones who were able to avoid the issue altogether. But according to BMJ’s editorial, Increasing communication between parents and their children about sex, there’s reason to hope that these uncomfortable discussions become commonplace.

Why? According to this article, some studies have shown a correlation between parent/child communications about sex and delayed age of sexual activity. Another study showed that children who were “talked with” used condoms at a higher rate. Regardless of the small amount of data showing positive results regarding teenage sexual activity, most professionals… most people really… would agree that better communication can only be a good thing.

This is partially the reason that numerous programs designed to increase parent/child communication about this sensitive topic have been developed and implemented. After all, I remember feeling awkward when my parents talked to me about sex but I doubt that they looked forward to the conversation either. Since it’s an all-around difficult subject matter, both kids and parents avoid broaching the topic.

Since sex talks are A) important and B) an easy task to avoid, innovative programs that encourage communication are essential. The program highlighted in the article, Talking Parents, Healthy Teens, is one such program. Identifying the fact that many parents can’t or won’t travel long distances or dedicate after-hours to educating themselves about effective ways to discuss sex with their children, the program goes to parents.

Sex ed has entered the workplace.

Although it’s not unusual for companies to offer personal development seminars such as investing basics or preventative health measures during lunch hours, it’s uncommon to find workers brown-bagging it so they can attend their sexual communication class. But this might change.

This particular program was successful on many grounds: a proper number of participants completed 7 or 8 sessions. Participants continued to discuss sexual issues with their adolescents months after completing the program. And both teenagers and parents reported that the program resulted in “consistent significant effects on communication.”

The positive effects of good communication skills should never be undervalued. And yet too often we forget that, like any skill, proper communication takes practice and effort. Refresher courses and learning new ways of communicating might help us in many areas of our lives, including helping to keep our adolescents sexually safer. And while communication isn’t always easy, it’s accessible to everyone. So maybe, just maybe, the dreaded sex talks don’t have to be quite as awkward after all.

Reference

Kirby, D. (2008). Increasing communication between parents and their children about sex. BMJ, 337(jul10 2), a206-a206. DOI: 10.1136/bmj.a206

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What Makes A Good Doctor? – A Patient’s Perspective http://brainblogger.com/2008/08/06/what-makes-a-good-doctor-a-patients-perspective/ http://brainblogger.com/2008/08/06/what-makes-a-good-doctor-a-patients-perspective/#comments Wed, 06 Aug 2008 13:23:27 +0000 http://brainblogger.com/?p=973 Health and Healthcare CategoryWhy am I writing this article? I admit, even to myself it seems a little random. But a combination of recent events and articles I’ve read lately lead me to write this, my pleading to doctors if you will. Let me brief you.

Recently I wrote Acknowledging Vaccine Concerns. The main point of the article was to note that doctors who acknowledge their patient’s vaccine concerns would help increase the vaccination compliance number more than any other method.

Castlerigg Stone CircleNext, I read an article in BMJ titled, Obsessive compulsive disorder with associated hypochondriasis, which gave a brief account of one woman’s struggle with both of these disorders. She describes her first visit with her current doctor who exhibited so much understanding, concern, and patience that it made me want to move to England just so I could have the same doctor!

And then finally someone close to me, a friend we’ll call Judy, recounted an experience she had with her (former) endocrinologist. Judy was recently diagnosed with hypothyroidism and after taking medicine to correct the imbalance she started having some unusual (for her) problems such as painful knees and stiff muscles. Along with this, she felt worse then before she started the medicine and her thyroid levels were still not on track. When she tried to gain a clearer understanding of her condition by asking questions about her diagnosis and prognosis, her doctor got angry at her. Judy felt so frustrated because her everyday life was being affected greatly by these issues and her thyroid problem was still not resolved.

All of these “events” led me to really think long and hard about what I need in a doctor, and what I believe most laypeople want. So I’ve made a list. And it is my sincere hope that if others out there disagree with my list or have things to add, that they put in their two-cents worth.

Before I get to my list I want to say something up front. I have had many wonderful doctors. And a good doctor is somewhat like a good vet or a great teacher… they impact you for life and you never, ever forget them. And no one expects a great doctor to be perfect; they have “off” days and bad moods and personal problems. But even in the midst of this, they respect you. And that is number one on my list:

1. Respect: A good doctor respects you. They show you this by listening and responding in a kind manner.

2. Time: A good doctor doesn’t make you feel as if you are one of 20 people she needs to see within the next 2 hours…even though you may be. This doesn’t mean that she sits with you for as long as you want. No, this means that she is present and takes time to address your concerns.

3. Acknowledgment: A good doctor acknowledges your thoughts, opinions and viewpoints. This doesn’t mean that she agrees with them or likes them; instead it means that she respects your point of view enough to seriously address these issues.

4. Understanding: A good doctor realizes that most people are really scared of anything related to doctors and medicine. They are fearful of getting bad news, fearful of not understanding the language used or the tests being run.

5. Knowledge: This one is such as basic necessity that I almost didn’t include it. I think everyone agrees that a doctor needs to be knowledgeable in their field; a good doctor knows their stuff.

I’d like to end with my corny but honest plea to doctors everywhere. I think that this was the basic sentiment — although certainly not the exact words — I was thinking when being prepped for emergency surgery a few years ago:

Please understand that this body you are treating is the only body I have. Please realize that this medical world is yours, not mine. I am a foreigner to all of this so I need you to explain things to me and I need you to help me feel comfortable because it feels vulnerable for my life to be in someone else’s hands.

Reference

Harrington, P. (2008). Obsessive compulsive disorder with associated hypochondriasis. BMJ, 336(7652), 1070-1071. DOI: 10.1136/bmj.39555.608252.AD

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Finding New Ways to Treat Depression http://brainblogger.com/2008/07/28/finding-new-ways-to-treat-depression/ http://brainblogger.com/2008/07/28/finding-new-ways-to-treat-depression/#comments Mon, 28 Jul 2008 14:02:25 +0000 http://brainblogger.com/?p=1072 Psychiatry and Psychology CategoryI think it’s good to think outside the box. Especially when it comes to finding solutions to some pretty major problems. Let’s take depression for example.

Starting in May 2007, the FDA started requiring that a warning be posted on antidepressant drugs. The warning was about the increased risk of suicide for patients in the 18-24 age range. This warning was the result of a FDA analysis of patient data.

So it seems to me that depressed young people need more options besides medication. Of course, all people who suffer from depression need options but for this age group, in light of this study, it seems necessary. So, let’s look at other possible options.

DepressionTherapy: This is a standard treatment and it can be a good one. But unfortunately this method of treatment requires a good therapist and this isn’t always easy to find. Not because there’s a shortage of capable therapist out there but because it can get complicated. Sometimes the therapist doesn’t practice the type of therapy that is best for your condition. Maybe you live in a very small town with only 1 or 2 practicing therapists. Many times therapists don’t accept insurance or don’t accept your insurance.

In the case of depression, Cognitive Behavioral Therapy is one of the better therapy choices. But it can be hard to find a therapist that specializes in this type of therapy. Many may offer some form of it but there’s something to be said for someone who knows the intricacies of treating depression using only this therapy.

Classes: This isn’t a usual treatment option but I think it’s a good one. It’s my outside the box contribution, if you will. Many people who are depressed suffer from various thinking patterns that make depression more likely to occur or enable the depression to stay around. Bringing these patterns to patients’ attention and then teaching them other ways to think can go a long way towards helping a depressed individual become healthier.

Other Support Systems: There are a myriad of options available for supporting those with depression. Whether it is some type of group therapy, support group, or study group. One option that I find alluring is telephone treatment. This type of treatment was offered to over 604 employees aged 18 years and over in various U.S. companies. The treatment involved telephone assessment and facilitation to inpatient treatment, a psycho-educational workbook, support and monitoring of treatment. The results were very positive.

Although medication is usually the first or second line of defense against depression, there are more options available. Since medication may not the best treatment choice for many, and since traditional therapy isn’t always accessible, I think it’s necessary to search for other ways to offer support and help so that those who need to treat their depression have a number of viable, encouraging choices at their disposal.

References

Barbui, C., Cipriani, A., Geddes, J.R. (2008). Antidepressants and suicide symptoms: compelling new insights from the FDA’s analysis of individual patient level data. Evidence-Based Mental Health, 11(2), 34-35. DOI: 10.1136/ebmh.11.2.34

Gilbody, S. (2008). Telephone treatment support improves outcomes for depressed employees. Evidence-Based Mental Health, 11(2), 47-47. DOI: 10.1136/ebmh.11.2.47

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A Bad Mix – Cell Phones and Children? http://brainblogger.com/2008/07/25/a-bad-mix-cell-phones-and-children/ http://brainblogger.com/2008/07/25/a-bad-mix-cell-phones-and-children/#comments Fri, 25 Jul 2008 15:14:03 +0000 http://brainblogger.com/?p=1073 Do you remember a time when most people on the roads just drove their car? Let me be more explicit. Do you remember a time when the main activities drivers engaged in were talking to a passenger, singing, and eating or drinking something?

Today it’s not often that I simply see someone driving; a good third or so of the people are talking on their cell phones. Now I realize that my percentage is far from accurate data but the fact that a large number of people talk (via cell) and drive is common knowledge.

Of course the prominence of cell phones goes beyond the streets. You can find cell phones attached to ears everywhere. Little is sacred now; once that little phone rings a quick “excuse me” is the standard protocol. Sometimes I wonder if society is addicted; after all, people seem to take their phones everywhere, even when they are in the company of others. I see it when I walk my son around the neighborhood, other walkers and their cell phones. I’ve been out to eat with acquaintances that interrupt our dinner for their daily touch-base with their aunt. I’ve even accidentally responded to strangers in the grocery store who were looking my way, saying something, yet talking on those headset devices.

The good news for our cell-crazed culture is that a German study recently announced that their decade’s long study found that cell phones were safe for adults. Of course there were caveats: they cannot make conclusions based on more than 10 years of cell phone usage and some cellular activity did change while being “under the influence” of mobile/cell phone radiation. (According to the article, even this information did not dissuade the survey from concluding that cell phones were safe.)

So, the good news is that, as of now, we can continue being a country obsessed with cell phones.

I think it’s important to note though that the study could not make any safety statements regarding children and cell phone usage. Therefore, since there is not evidence one way or another they suggest that children do not use mobile phones.

Although most kids probably aren’t concerned about how healthy it is to use cell phones, as their parents, we have to be. And since having a cell phone is starting to become “the thing” at earlier and earlier ages, we need to pay extra attention to future studies that focus on this population and cell phone exposure. It may just be that we have to tone down our usage of cell phones in order to keep our kids from becoming too eager to start acting like adults at the expense of their health. The question is: could we do it?

Reference

Tuffs, A. (2008). Mobile phones do not pose health risk, German survey shows. BMJ, 336(7659), 1461-1461. DOI: 10.1136/bmj.a545

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