The Zika Virus – Are You Next?

By: CDC Global

As the Zika virus, also known as Zika or ZIKV, and its effects have been a main topic in the news during the summer of 2016, many wonder how this disease may affect them. However, this disease has not been studied for a long period of time and there are still some unknowns regarding its effects on humans. According to Lupton (2016), the disease is transmitted through mosquito bites from the aedes aegypti mosquito, but the exact number of days for the incubation of ZIKV is inconclusive. Based on various sources, the incubation period may range anywhere from 3 to 12 days. Also, the disease is asymptomatic in a majority of cases as “approximately 1 in 5 people infected with ZIKV show symptoms, these include acute onset fever, maculopapular rash, arthralgia, conjunctivitis, headache and eye pain” (Lupton, 2016, p. 200). Lupton (2016) also stated that the countries that currently have the largest number of cases of ZIKV also have cases of chikungunya and dengue fever, which can look similar to the symptoms of ZIKV. As a result, it is important to “conduct laboratory testing to avoid a misdiagnosis” (p. 201) as using non-steroidal anti-inflammatory drugs to relieve the symptoms can cause hemorrhaging, especially if dengue is the condition one has. It is important to note that Lupton (2016) also stated that women at any stage of pregnancy should avoid travelling to countries affected with ZIKV as this may increase the possibility of giving birth to babies with neonatal abnormalities should they become infected. This article supports many of the claims of the video clips on the Zika virus, such as how it is transmitted, the symptoms, and the fact that women at any stage of pregnancy, not just the third trimester, should be careful about travelling to the affected countries. None of the media clips spoke about Zika being possibly mistaken for another disease and that testing should be done to rule those out.

The research conducted by Marques Salge, Corrêa Castral, Cordeiro de Sousa, Godoi Souza, Minamisava, & Brunini de Souza (2016), stated that “only 18% of human infections with the Zika virus result in clinical manifestations. Among them, the most common are maculopapular rash, low fever, arthralgia, myalgia, and headache” (p. 9). When pregnancy is accompanied by a rash it may be a sign that microcephaly will manifest in the newborn, although this is not in all cases and a rash does not indicate the Zika virus. The transmission of the disease, aside from a bite from the aedes aegypti mosquito, may also occur sexually or other body fluids such as saliva and urine. Marques Salgue et al (2016) also stated that to date, no other conditions in utero is associated with the Zika virus other than microcephaly. However, microcephaly and Zika only have an association, it is not conclusive that this virus causes microcephaly in newborns when the mother is infected. This article also speaks about the same topics such as the clinical manifestation of the disease and how it is transmitted. The media clips I chose were conclusive in saying that Zika caused microcephaly, but this article states that there is an association of the virus with microcephaly, but it is not conclusive that this is the cause.

In Sutton and Hudson’s (2016) article, they stated that the Zika Virus (ZIKV) is associated with congenital birth defects and infection is caused by the aedes mosquito. The World Health Organization (WHO) has been following up on ZIKV and its spread into 46 countries and territories. The signs and symptoms associated are “low grade fever, swelling in joints of the hands and feet, a transient rash that spreads from the face to the body, conjunctivitis resembling pink eye, including general symptoms such as myalgia, and head- aches” (Sutton & Hudson, 2016, p. 36). In an effort to prevent contracting this disease, people are advised to have protected sex, apply “insect repellents containing DEET, wear clothes that cover ex- posed skin, stay in screened areas and sleep under mosquito nets” (Sutton & Hudson, 2016, p.38). Based on the video clips, one may not know that Zika has been monitored since 2007 by the WHO and viewers may think that this is a fairly new disease. Nevertheless, it is in agreement with the clips that mosquitoes and sex are the most common ways that this disease is transmitted.

Below are video clips that discuss the Zika virus, how it manifests itself and how to prevent it.

References

Lupton, K. (2016). Zika virus disease: a public health emergency of international concern. British Journal Of Nursing, 25(4), 198-202.

Marques Salge, A. K., Corrêa Castral, T., Cordeiro de Sousa, M., Godoi Souza, R. R., Minamisava, R., & Brunini de Souza, S. M. (2016). Zika virus infection during pregnancy and microcephaly in newborns: an integrative literature review. Revista Eletronica De Enfermagem, 181-14. doi:10.5216/ree.v18.39888

Sutton, K. L., & Hudson, M. P. (2016). ZIKA: A Mosquito-borne Emerging Virus. Journal Of Continuing Education Topics & Issues, 18(2), 36-40.

Opiate and Heroin Epidemic

Over the recent years just about every area in the country has been affected by the recent increase in overdoses related to opiate and heroin addiction. Through research there has been discovered that there is a common relationship between opiate and heroin abuse.  It was found that the abuse of nonmedical prescription opioid abuse typically leads to the transition to heroin. It was found that “the incidence of heroin uses among people who reported prior nonmedical use of prescription opioids was 19 times as high as the incidence among persons who reported no previous nonmedical use” (Comptom, 2016). There are several reasons that contribute to why a person would switch from opioids to heroin. One is that there was an increase in polices at the federal and state level that are aimed at eliminating inappropriate prescribing of opioid medication and implementing prescription drug monitoring programs, taking enforcement and regulatory actions to address outrageous prescribing and eliminating the “pill mills”(Compton, 2016). With new policies in place that make it difficult for a person to doctor shop, the person will then switch to heroin because it more available. It is also believed that when manufactures of the prescription OxyContin started using a formula that deters abuse, making the drug not as potent to the people who abuse it, they then switch to heroin (Compton, 2016). The most prominent reason why people switch from abusing opioid pain medication to heroin is the recent increase in availability of heroin, the increased purity and the decrease in price. The reasons have fueled the increase in abuse, and overdose rates in the country.

drug addiction

The reason why so many people make the switch from opiates to heroin is because heroin is more available then prescriptions and once a person starts to detox it can be too much to handle. Here is a video explaining the process of withdrawal.

 

The best way to help your loved ones is to educate on the dangers of addiction.

Prevention

Talk to your children and loved ones about the dangers of abusing pain medications and drugs. There is an increase in the abuse of heroin due to the fact that it is cheaper than pain medication. Most people who start abusing heroin started with pain medication.

Instead of leaving unused opiate prescription medication around the house, you can bring your used medications to be safely disposed of to your local police station.

Signs of addiction

Physical signs

  • Noticeable elation/euphoria
  • Marked sedation/drowsiness
  • Confusion
  • Constricted pupils
  • Slowed breathing
  • Intermittent nodding off, or loss of consciousness
  • Constipation

Other signs of opiate abuse include:

  • Doctor shopping
  • Shifting or dramatically changing moods
  • Extra pill bottles turning up in the trash
  • Social withdrawal/isolation
  • Sudden financial problems

Withdrawal symptoms can mimic flu symptoms and include:

  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Sweating
  • Fatigue
  • Anxiety
  • Inability to sleep (Patterson, 2015).

Where to get help

If you think a loved one is addicted to opiates it is important to talk with them and try and get them to get help. It is important to have Narcan (Naloxone) available in the house in case there is an overdose. You can now have your local pharmacist prescribe you with Narcan and teach you on how to use it (Benson, 2016).

A person needs professional help when detoxing from opiates or heroin there are many detox centers around the country that use medications that help decrease the physical symptoms of detox, they include

Suboxone – Suboxone is an opiod agonist-antagonist that is commonly used for heroin abuse because it consists of 2 drugs. One (buprenorphine) which mimics the effects of heroin and two (naloxone) helps reduce the chance of overdose.

Methadone – Methadone or buprenorphine are opiod agonists. They have the same effects as heroin, but to a smaller, safer degree.

Naloxone – Naloxone is an opiod antagonist which blocks the effects of heroin. It is generally used for heroin overdose.

National Hotlines for help with addiction

UNITED STATES – ALCOHOL AND DRUG HELPLINE:
National Toll-free number: 1-800-821-4357. Available 24 hours a day.

Narconon
DRUG REHAB HELPline
1-800-468-6933

Narcotics Anonymous
1-800-992-0401

 

References

Addiction pill image. (2015). https://www.stepstorecovery.com/turn-to-help-for-opioid-addiction/

Benson, J.(2016 February 1) As heroin overdoses continue, pharmacists urge more awareness of Narcan. The Day. Retrieved from http://www.theday.com/local/20160201/as-heroin-overdoses-continue-pharmacists-urge-more-awareness-of-narcan-availability

Compton, W., Jones, C., Baldwin, G. (2016. January, 14) Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. New England Journal of Medicine. Retrieved January 22, 2016 from http://www.nejm.org/doi/full/10.1056/NEJMra1508490

Drug abuse image. (2016). https://www.detoxcentersnearme.com/heroin-detox/

Patterson, E. (2015) Opiate Abuse. DrugAbuse.com. Retrieved February 27, 2016 from http://drugabuse.com/library/opiate-abuse/#signs-and-symptoms

 

 

Naloxone: Bringing a New Hope for Addicts

Death from opioid overdose in the United Stated has greatly increased in the past 20 years. Focus on addiction has changed from imprisonment to treatment. Changing the focus and increasing the availability of Naloxone, a drug used to reverse the effects of an overdose, to EMTs, law enforcement, families and friends of addicts has greatly decreased the risk of death from overdose. These deaths have opened up the discussion of pharmacies providing Naloxone without a prescription and more insurance coverage to maintain the cost-effectiveness of programs. Multiple programs, both local and federal, have been started to provide lower rates for treatment and Naloxone use to decrease deaths.

Overdose is the leading cause of accidental deaths in the United States. In 2014 47,055 deaths were reported. 18,893 of those deaths were due to prescription painkillers and 10,574 were due to heroin overdose (ASAM, 2016). Many of these deaths could be prevented if Naloxone was available to family and friends.

Some questions about Naloxone:

How does Naloxone work? How is it given?

When a person overdoses they stop breathing. Naloxone is most effective when used with CPR. If the first dose of Naloxone doesn’t work another can be given with no adverse effects. (Engleman, n.d.). Basically Naloxone works to reverse an overdose. It is a drug that has been designed to block the opioid from entering into the brain and reversing the effect of the drug. It can be given as a nasal spray, or as a shot. The nasal spray works within 3-4 minutes and the shot works within 2-3 minutes. The effects of Naloxone can last 60-90 minutes which is usually plenty of time for EMTs to arrive. Naloxone is also more effective if the person who overdosed is given CPR. (Engleman, 2016)

I understand why EMTs have it, but why police, family and friends? What kind of training is needed/provided?

 

It is important for families and friends to be provided with Naloxone because they are usually the first to find the person who overdosed. The same goes to police, often they are the first to arrive at the scene, before the ambulance arrives. Training for safe use of Naloxone in Rhode Island is provided by the Naloxone Overdose Prevention and Education Program of Rhode Island (NOPE-RI) (Engleman, n.d.). The nasal spray is easiest to use, it is placed into a nostril and sprayed. The shot requires more training but it is injected into a large muscle, usually the thigh or the upper arm.

What happens after they go to the hospital?

Many addicts go to treatment after the hospital. There have also been local programs set up to decrease deaths from overdose. In Gloucester Massachusetts a program called the Angel Program was developed as a way for addicts to come and get into treatment faster. Treatment is expensive and insurance doesn’t always cover it. (Mankiewitcz, 2016).

Sources

Harm Reduction Coalition, (n.d.) Administer

Naloxone overdose response. Retrieved

from http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/administer-naloxone/

 

Engleman, A., (n.d) Naloxone and overdose

prevention education program of Rhode Island. Retrieved from http://www.NOPERI.org

Mankiewicz, J., Harapax, I., Nguyen, T., &

Schuppe, J. (2016, June 5). How a

heroin crisis started a police revolution. Retrieved from http://www.nbcnews.com/storyline/americas-heroin-epidemic/how-heroin-crisis-sparked-police-revolution-n571551

SAMHSA, (2015, March). Federal guidelines

for opioid treatment programs.

Is depresstion all in your head?

Fact vs. fiction
We have all felt own at some points in our life but are we all depressed? Do we need treatment or can we just snap out of it? What causes depression? And what are the long term effects?
Currently, there is some debate over whether depression is an illness or a mindset. And we have some powerful almost inspirational videos saying that depression can be cured with a change in attitude.

 


This is a nice motivational but what isn’t true is that depression comes and goes. One of the biggest misconceptions when speaking about depression is the difference between the medical definition and how it is used in everyday langue. It isn’t unusually to say that something “makes you depressed”; for example you have been dieting all week, and you are going to treat yourself with a snack from the vending machine and once you arrive only to find out that the last one is stuck inside of the …. that isn’t depressing isn’t it? Actually no it isn’t. Minor setbacks like this are no doubt a disappointment but a true depression has not just emotional but also causes biological differences in the brain. In fact, one of the most damaging things you can do is tell somebody to “cheer up” or “get over it” Because in some cases it isn’t possible.
Can depression a good thing?
Depression is not necessarily a good thing, but it is a human thing, normal at appropriate times. If something tragic happens like loss of a loved one or something else tragic it is normal for someone to feel depressed, however feeling depressed is not being depressed.

The video above explains the science of a “heartbreak.” These kinds of depression are normal.
The difference between Major depressive disorders and feeling blue.
There are many types of depression, but the DSM-V (or the Diagnostic and Statistical Manual of Mental Disorders is the handbook used as the authoritative guide to the diagnosis of mental disorders) currently recognizes Depressive Episodes and Major Depressive Disorder (MDD). Thou they are linked there are some stark differences between the two. However, depressive episodes are typically isolated and temporary incidents. The criteria for a MDD can include a depressive episode of multiple episodes but it has many more symptoms listed below.

More than a mindset
Well if someone is just sad to get a pint of Ben and Jerrys a bottle of wine and watch a Ryan Gosling movie on Netflix have a good cry, sleep and get over it. Right? Not according to Stanford professors.

Robert Sapolsky. Below is a clip from one of Sapolsky lectures

(ever wanted a Stamford education? Now is your chance Many of Sapolksy’s full lectures can be seen free on YouTube)
According to Robert Sapolsky’s study called Depression, antidepressants, and the shrinking hippocampus Sapolsky is a neuroendocrinologist, professor of biology, neuroscience, and neurosurgery at Stanford University, and his paper study speaks to the changes in the biology and the structure of the brain. His studies on rats proved that extreme emotions could alter the structure of the brain. Below is a video of a man overcoming fridged cold temperatures he attributes this seemly superhuman power to a breathing technique. However at around three mins into the video we find that he had an extremely emotional experience, perhaps changing has brain functions leading to an abnormal response.

Can the cold heal all wounds? Probably not, in the article Fixable or Fate? Perceptions of the Biology of Depression by\Lebowitz discusses the way the brain changes after experiencing intense emotion. It is important to think of the brain as liquid ever changing and reacting to whatever happens. Lebowitz highlighted how malleable the brain is and how even if the brain is damaged in some cases it can repair itself. However, people who have had more depressive symptoms also had different brains. Their brains were less malleable and less likely to change even with therapeutic intervention. Now not only will your brain change but it may take longer to change back if it changes at all. Some of the symptoms might “get better, ” but it is as if a major depressive episode literally scares the brain.

For a long time, the cause of depression was thought to be in the production of serotonin. In a study titled Interaction of brain 5-HT synthesis deficiency, chronic stress, and sex differentially impacts emotional behavior in Tph2 knockout mice, Essentially this article confirms that serotonin is a powerful influence on depression when it comes to the brains of mice. In this case variations in the production of serotonin (one of the 3-part chemical cocktail) caused adverse effects. They found that variation in genes moderating 5-HT (serotonin) system function, with other common variants of the genetics, as well as outside factors, can contribute “to negative emotionality and aggression-related behavior emerging from compromised brain development and highly efficient neuroadaptive processes across the life cycle.”
So if it is a chemical imbalance why not correct the imbalance such as giving insulin to somebody with diabetes? It isn’t that simple as explained by Dr. Terry Lynch is an Irish medical doctor and psychotherapist. The over the use of antidepressants which are typically flooding the system with serotonin (or other brain chemicals) have shown to begin to atrophy the areas of the brain that produce it naturally. Once you have a surplus, your body no longer needs to create these chemicals thus shut down production.

Good advice for some people could be deadly for others. People suffering from MDD appear lethargic and almost comatose, but that is on the outside. Inside the body is under attack by constant stress. Draining the person’s energy. Sapolsky goes on to say that when someone is that low, they are to depress to attempt suicide however it is when they begin to recover and start to gain more energy that they are most likely to attempt suicide. Which is alarming and exemplifies how damaging the first video titled YOU ARE NOT DEPRESSED, STOP IT! can be.
People who have depression disorders are not looking for sympathy they have an illness here are some things to say and some things not to say.

What to say:
You’re not alone in this.
You are important to me.
Do you want a hug?
When all this is over, I’ll still be here and so will you.
I can’t understand what you are feeling, but I can offer my compassion.
I’m not going to leave you or abandon you.

What NOT to say:
There’s always someone worse off than you are.
No one ever said that life was fair
Stop feeling sorry for yourself.
It’s your fault.
Believe me; I know how you feel. I was depressed once for several days.
I think your depression is a way of punishing us.

Gutknecht, L., Popp, S., Waider, J., Sommerlandt, F. M., Göppner, C., Post, A., . . . Lesch, K. (2015). Interaction of brain 5-HT synthesis deficiency, chronic stress and sex differentially impact emotional behavior in Tph2 knockout mice. Psychopharmacology, 232(14), 2429-2441. doi:10.1007/s00213-015-3879-0
Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98(22), 12320-12322. doi:10.1073/pnas.231475998
Lebowitz, Supplemental Material for Fixable or Fate? Perceptions of the Biology of Depression. (2013). Journal of Consulting and Clinical Psychology. doi:10.1037/a0031730.supp

Depresstion

Fact vs. fiction

We have all felt own at some points in our life but are we all depressed? Do we need treatment or can we just snap out of it?  What causes depression? And what are the long term affects?

Currently, there is some debate over whether depression is an illness or a mindset.  And we have some powerful almost inspirational videos saying that depression can be cured with a change in attitude.

This is a nice motivational but what isn’t true is that depression comes and goes. One of the biggest misconceptions when speaking about depression is the difference between the medical definition and how it is used in everyday langue.  It isn’t unusually to say that something “makes you depressed”; for example you have been dieting all week, and you are going to treat yourself with a snack from the vending machine and once you arrive only to find out that the last one is stuck inside of the …. that isn’t depressing isn’t it? Actually no it isn’t.  Minor setbacks like this are no doubt a disappointment but a true depression has not just emotional but also causes biological differences in the brain.  In fact, one of the most damaging things you can do is tell somebody to “cheer up” or “get over it” Because in some cases it isn’t possible.

Can depression a good thing?

Depression is not necessarily a good thing, but it is a human thing, normal at appropriate times.  If something tragic happens like loss of a loved one or something else tragic it is normal for someone to feel depressed, however feeling depressed is not being depressed.

The video above explains the science of a “heartbreak.”  These kinds of depression are normal.

The difference between Major depressive disorders and feeling blue.

There are many types of depression, but the DSM-V (or the Diagnostic and Statistical Manual of Mental Disorders is the handbook used as the authoritative guide to the diagnosis of mental disorders) currently recognizes Depressive Episodes and Major Depressive Disorder (MDD).  Thou they are linked there are some stark differences between the two.  However, depressive episodes are typically isolated and temporary incidents.   The criteria for a MDD can include a depressive episode of multiple episodes but it has many more symptoms listed below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

More than a mindset

Well if someone is just sad to get a pint of Ben and Jerrys a bottle of wine and watch a Ryan Gosling movie on Netflix have a good cry, sleep and get over it. Right?  Not according to Stanford professors.

 

Robert Sapolsky.  Below is a clip from one of Sapolsky lectures

 

https://www.youtube.com/watch?v=yXnGzOcVNWo

 

(ever wanted a Stamford education? Now is your chance Many of Sapolksy’s full lectures can be seen free on YouTube)

According to Robert Sapolsky’s study called Depression, antidepressants, and the shrinking hippocampus Sapolsky is a neuroendocrinologist, professor of biology, neuroscience, and neurosurgery at Stanford University, and his paper study speaks to the changes in the biology and the structure of the brain.  His studies on rats proved that extreme emotions could alter the structure of the brain.  Below is a video of a man overcoming fridged cold temperatures he attributes this seemly superhuman power to a breathing technique.  However at around three mins into the video we find that he had an extremely emotional experience, perhaps changing has brain functions leading to an abnormal response.

 

 

Can the cold heal all wounds? Probably not, in the article Fixable or Fate? Perceptions of the Biology of Depression by\Lebowitz discusses the way the brain changes after experiencing intense emotion.  It is important to think of the brain as liquid ever changing and reacting to whatever happens.  Lebowitz highlighted how malleable the brain is and how even if the brain is damaged in some cases it can repair itself.   However, people who have had more depressive symptoms also had different brains.  Their brains were less malleable and less likely to change even with therapeutic intervention.  Now not only will your brain change but it may take longer to change back if it changes at all.  Some of the symptoms might “get better, ” but it is as if a major depressive episode literally scares the brain.

 

For a long time, the cause of depression was thought to be in the production of serotonin. In a study titled Interaction of brain 5-HT synthesis deficiency, chronic stress, and sex differentially impacts emotional behavior in Tph2 knockout mice, Essentially this article confirms that serotonin is a powerful influence on depression when it comes to the brains of mice.  In this case variations in the production of serotonin (one of the 3-part chemical cocktail) caused adverse effects. They found that variation in genes moderating 5-HT (serotonin) system function, with other common variants of the genetics, as well as outside factors, can contribute “to negative emotionality and aggression-related behavior emerging from compromised brain development and highly efficient neuroadaptive processes across the life cycle.”

So if it is a chemical imbalance why not correct the imbalance such as giving insulin to somebody with diabetes? It isn’t that simple as explained by Dr. Terry Lynch is an Irish medical doctor and psychotherapist. The over the use of antidepressants which are typically flooding the system with serotonin (or other brain chemicals) have shown to begin to atrophy the areas of the brain that produce it naturally. Once you have a surplus, your body no longer needs to create these chemicals thus shut down production.

 

 

Good advice for some people could be deadly for others. People suffering from MDD appear lethargic and almost comatose, but that is on the outside.  Inside the body is under attack by constant stress.  Draining the person’s energy.  Sapolsky goes on to say that when someone is that low, they are to depress to attempt suicide however it is when they begin to recover and start to gain more energy that they are most likely to attempt suicide.  Which is alarming and exemplifies how damaging the first video titled  YOU ARE NOT DEPRESSED, STOP IT! can be.

People who have depression disorders are not looking for sympathy they have an illness here are some things to say and some things not to say.

 

What to say:

You’re not alone in this.

You are important to me.

Do you want a hug?

When all this is over, I’ll still be here and so will you.

I can’t understand what you are feeling, but I can offer my compassion.

I’m not going to leave you or abandon you.

 

What NOT to say:

There’s always someone worse off than you are.

No one ever said that life was fair

Stop feeling sorry for yourself.

It’s your fault.

Believe me; I know how you feel. I was depressed once for several days.

I think your depression is a way of punishing us.

 

 

Gutknecht, L., Popp, S., Waider, J., Sommerlandt, F. M., Göppner, C., Post, A., . . . Lesch, K. (2015). Interaction of brain 5-HT synthesis deficiency, chronic stress and sex differentially impact emotional behavior in Tph2 knockout mice. Psychopharmacology, 232(14), 2429-2441. doi:10.1007/s00213-015-3879-0

Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98(22), 12320-12322. doi:10.1073/pnas.231475998

Lebowitz, Supplemental Material for Fixable or Fate? Perceptions of the Biology of Depression. (2013). Journal of Consulting and Clinical Psychology. doi:10.1037/a0031730.supp

 

What We Really Know About Obesity

 

In the United States, more than 2 in every 3 adults are classified as overweight or obese as well as more than 1 in every 3 children. With so much media attention directed towards the obesity epidemic occurring throughout much of the world, it can often be difficult to determine what information is fact, fiction or an over-simplification. The goal of this article to look at various claims made in the media regarding the causes of obesity and compare them with peer reviewed evidence.

Clip #1:

This initial clip takes aim at the efforts to place a junk food tax on items containing high levels of sugar and saturated fat that contribute substantially the problem of obesity. The types of items most prominently targeted include soda and fast food. The narration of the video uses a relatively neutral tone about the issue, but the individuals interviewed here are strongly in favor of this kind of policy that would in turn use the new tax revenues to provide subsidies for fresh produce and other healthy options. It’s suggested that this new cost dynamic will modify people’s behavior in a way that makes them more likely to buy healthier options, thus improving the health of the population overall. Evidence suggests however that solely changing the cost of different kinds of food has minimal effect on overall health. (Silva, Leng, Rawof & Vilakazi, 2016)

Despite higher taxes on junk food showing some decreases in consumption, there is a lack of evidence for any connection to improved rates for obesity. People eating less junk food is certainly a good place to start, but as a self contained method for decreasing obesity it’s lacking. There are also ethical issues raised that go unaddressed in this news piece. Such a tax would undoubtedly be regressive in how it prohibits low income individuals the autonomy to eat what they chose to at its actual market value. (Silva et al., 2016) While those involved in public health policy are decidedly against obesity, for many this issue boils down to a political debate of whether or not government should intervene in such a punitive way on these products.

Clip #2:

This next topic explores the role that proximity to supermarkets plays in the prevalence of obesity, produce consumption and intake of sugary drinks throughout various communities. This video clip from a PBS news hours segment places significant blame for the obesity crisis on lack of easy access to supermarkets for families who live in these “food deserts”. The video explains how for individuals without means of transportation and who live in areas with only convenience stores or fast food easy available, that obesity rates will be higher.

Research does support that people targeted for an obesity intervention, focusing on nutritional education, who lived closer to large supermarkets had better outcomes. (Fiechtner, Kleinman, Melly, Sharifi, Marshall, Block & Taveres, 2016) This leaves a much more nuanced conclusion that supermarket proximity can positively influence reduction in BMI for those actively working towards improved nutrition, but shouldn’t be considered an isolated modification that can significantly alter obesity rates on its own.

Clip #3:

The final source examined is a TED Talk given by a chef named Jamie Oliver called “Teaching Children about Food.” In his presentation he advocates a number of interventions aimed reducing childhood obesity. Among the concepts talked about were early childhood education in school about the importance of eating fresh, whole foods as well as the removal of sugary drinks from the cafeteria. Oliver makes positive claims about the effectiveness of this approach as he’s already begun to see results in his own community.

Our peer reviewed source uses a systematic review of intervention programs targeting obesity in elementary school children. Requirements for inclusion in this study were methods revolving around increased consumption of fruits and vegetables, as well decreases in sugar sweetened beverages. In addition, the students were educated about nutrition as well given increased opportunity for physical activity. A majority of these studies found a positive connection between intervention and a reduction in BMI. (Brown, Buchan, Baker, Wyatt, Bocalini & Kilgore, 2016)

 

References:

  Brown, E. C., Buchan, D. S., Baker, J. S., Wyatt, F. B., Bocalini, D. S., & Kilgore, L. (2016). A Systematised Review of Primary School Whole Class Child Obesity Interventions: Effectiveness, Characteristics, and Strategies. Biomed Research International, 20161-15. doi:10.1155/2016/4902714

  Diniz Silva, A. C., Hiang Leng, T., Rawof, N., & Vilakazi, B. (2016). Implementation of a “food tax” to prevent obesity: A critical appraisal. Diabetes & Primary Care, 18(3), 126-130.

Fiechtner, L., Kleinman, K., Melly, S. J., Sharifi, M., Marshall, R., Block, J., & … Taveras, E. M. (2016). Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity. American Journal Of Public Health, 106(3), 557-562. doi:10.2105/AJPH.2015.302986

There are 58 Million Diabetic Feet in America – How do We Protect Them?

FeetAccording to the Centers for Disease Control, diagnosed and undiagnosed diabetes in the United States has increased over 500% (from 5.5 million to 29.10 million) in the past 25 years. Yet, lower limb amputations among diabetics due to peripheral neuropathy (diabetic nerve damage) and peripheral vascular disease (poor circulation) have decreased by approximately 60% in the last decade. Doctors attribute the decrease in lower limb amputations to diabetic management programs consisting of strict blood glucose control and foot care plan.

Blood glucose is the naturally occurring sugar that provides energy to your cells. Diabetes disrupts this natural exchange causing damage to your body’s cells, making it necessary for you to adhere to medication and lifestyle changes. Control over blood glucose levels decreases damage to your organs and systems – heart, blood vessels, nerves, kidneys, bone and skin – vital to the health of your feet. Strict blood glucose control means minimizing hypoglycemic (low blood glucose) or hyperglycemic (high blood glucose) levels – striving for a normal blood glucose range (determined by your health team) minimizes risks of diabetic complications such as amputation. A diabetic management program incorporating a foot care plan will decrease your risk of foot wounds and possible amputation.

Diabetic Management Program

Meet Your Diabetic Health Team. Composed of your primary doctor, diabetic nurse educator, nutritionist, podiatrist and, most especially, you. Your team will determine your blood glucose goal for success, and will educate and monitor your progress to achieving this goal. They will show you how to care for your feet and monitor for signs of wounds. They are your “go to” people, use them to protect the health of your feet.

Eat Well. Your diabetes educator or nutritionist will collaborate with you to create a healthy diet plan including fresh vegetables, lean proteins, fish and fruit. Eat smaller portions and try not to go in for seconds. A good diet protects the health of your blood vessels by lowering cholesterol and blood pressure. Healthy blood vessels transport the nutrients to your feet.

Exercise. Your diabetic health team will encourage you to start exercising gradually and increase to at least 30 minutes a day, 7 days a week. Always check your blood glucose levels before exercising to avoid a hypoglycemic or hyperglycemic event. Low impact exercises such as swimming, walking, yoga and dancing are wonderful alternatives for diabetics who already experience some degree of peripheral neuropathy or for diabetics just beginning an exercise program. There are so many activity choices – if you get bored, don’t stop, just try something new. Exercising not only strengthens your heart and lung health, it also improves your circulation allowing nutrients to flow into your body’s cells and wastes to be eliminated.

Lose Weight. Eating well and exercising may result in weight loss. Losing just 5% of your body weight may lower your blood glucose level, decrease your blood pressure and cholesterol rates, and increase your energy level.

Follow Your Doctor’s Prescription. Proper medication administration is vital for maintenance of controlled blood glucose levels. You need to understand when and how to administer your medication, as well as consequences of possible drug interactions if you are taking multiple medications. Even something as simple as over-the-counter cold medicines may interfere with your blood glucose levels. If you have questions, speak with your diabetic health team.

Monitoring

Monitor Your Blood Sugar Levels. Check your blood glucose levels before each meal, before bedtime, and before exercising. Your daily monitoring provides a gauge on how well you’re maintaining control over blood glucose levels. Look at it as an historical record of how your food intake, exercise routine and lifestyle modifications affect your blood glucose level, and “adjust” accordingly.

Your diabetic health team with administer a blood test called a HbA1c test at least twice a year which will indicate the average amount of blood glucose during the previous three months. High test results (above 7%) mean that your diabetes is not well controlled and there is an increased risk of complications. Meet with your diabetic team to “tweak” your diabetic management program.

Quit Smoking. The results are in, nicotine increases blood glucose levels. Research in 2011, led by Xiao-Chuan Liu of California State Polytechnic University, concluded that nicotine raised levels of hemoglobin A1c (HbA1c) by as much as 34%. High blood glucose levels caused by smoking not only damage your heart, lungs and kidney, but contribute to blood vessel compromise and poor circulation. Consequently, the risks of peripheral neuropathy and vascular disease, and subsequent amputation markedly increase. So, if you smoke, speak with your diabetes team and let them find the right smoking cessation program.

Develop a Daily Foot Care Routine. Bathe your feet in warm water, pat dry and check the bottoms of your feet and between your toes for any wound problems. Signs and symptoms such as redness, pain, corns, bunions open wounds, and changes in foot shape need to be addressed by your diabetic team. The risk of wounds increases if you walk barefoot – always wear low-heeled shoes or boots outside the home, and slippers inside the home. Speak with your diabetic educator regarding a foot care routine.

Take advantage of your diabetic health team’s knowledge. Adhering to a diabetic management program will decrease the risk of peripheral neuropathy and vascular disease, as well as amputation.

For further information, call a member of your diabetic health team, and you can find information at the following sites:

American Association of Diabetic Educators
American Diabetes Association
Joslin Diabetes Center

References

American Chemical Society. (2011, March 29). First identification of nicotine as main culprit in diabetes complications among smokers. ScienceDaily. Retrieved November 15, 2016 from www.sciencedaily.com/releases/2011/03/110327191036.htm

Barshes, N.K., Sigireddi, M., Wrobel, J.S., Mahankali, A., Robbins, J.R., Kougias, P., and
Armstrong, D.G. (2013) The System of Care for the Diabetic Foot: Objectives,
Outcomes, and Opportunities, Diabetic Foot & Ankle. 4: 21847. Retrieved from
http://dx.doi.org/10.3402/dfa.v4i0.21847

Nemcová, J., & Hlinková, E. (2014). The efficacy of diabetic foot care education. Journal Of
Clinical Nursing, 23(5/6), 877-882. Retrieved from
doi:10.1111/jocn.12290

Shrivastava S.R., Shrivastava P.S., and Ramasamy J. (2013) Role of self-care in management
of diabetes mellitus. Journal of Diabetes & Metabolic Disorders. 12:14. Retrieved from
DOI: 10.1186/2251-6581-12-14

The Lunar Effect: Does a full moon really have an impact on human behavior?

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Monday’s November 14, 2016 super moon as captured by photographer Greg Kretschmar.

On Monday, millions of people around the globe went outside to observe the super moon. Armed with their smartphones and camera equipment, the super moon quickly became a trending topic as people shared their captured photos of this phenomenon. A super moon is the occurrence of a full moon during a time when it’s orbit is close to the earth’s atmosphere. During this most recent time, the moon was just 221,525 miles from earth making this the closest the moon has been to earth since 1948.

Monday’s brightly lit moon reminds us of an age-old superstition, does the super moon affect human behavior? This superstition has been around for thousands of years and is known as the lunar effect. Today, much of the superstition lies in the medical field. Some speculations are that a full moon may increase hospital admissions, emergency room visits, psychotic behaviors, trauma & blood loss. Others theorize that the lunar effect may induce pregnancy labor or have an impact on the rate of death in hospitals. It is not only the common population who believes in this theory, but medical professionals.

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Social media meme that may be shared among nurses who believe in the lunar effect.

The Today Show discusses this trend among medical professionals. Social media has also proven that this is a common thought process. For those working in the medical profession, or know of others, you may see Facebook or Twitter comments regarding the phenomenon. The question still begs, with so many people believing in the lunar effect, is there any truth to it?

A study in 2014 out of ISRN Emergency Medicine magazine looked at the effects of the full moon on psychiatric emergency departments. It found that while the opinions that emergency department personnel felt that a full moon results in an increased demand in patient services that very little research is available to confirm this. Two doctors of medicine, Templer & Veleber are often cited as finding links between full moon and suicides, homicides, crime rate and hospital stays. However, this study was conducted in 1980 which today leaves it as being 36 years old and since then, flaws have been discovered in the research methods. Although this study is commonly cited as confirming that the full moon has these effects, the M.D.’s concluded that there is no correlation and that the lunar effect is mostly folklore.

Popular social media news source, Buzzfeed, shares some theories on the lunar effect exploring fact and fiction.

The video confirms that doctors believe that nights of a full moon cause more activity in the hospital setting. It speculates that the reason that this might happen is because the brain is wired to remember “events” over “non-events”; just as one may remember your 16th birthday over any average day. The thought is that if strange behaviors occur during a full moon, you are more likely to remember them.

The Buzzfeed video also looks at the opinions that a full moon has ties to mental health. This is an opinion that has been going on since the Middle Ages. During these times we did not have artificial light. The folklore may have developed because sleep deprivation can effect a person’s mental functions. A recent study was conducted in 2013 in India looked at this aspect of the lunar cycle. It found that of the participants, the average amount of sleep lost during a full moon was 21 minutes. Many thoughts are on the fact that this may be related to the added light that the full moon provides.

This video explores the full moon’s effect on sleep loss. They speculate that there is an extra effect from the full moon beyond the added light. They reference a Switz study where individuals were found to sleep better during new moons (where the moon is not present in the sky), and full moons. This study was conducted in 2003 and was not originally conducted to look at the link between the moon and human sleep patterns. Despite this, another study was conducted last year following the sleep patterns of 201 individuals. Although there were slight results in the REM Cycle (Rapid Eye Movement or Deep Sleep stage of sleep), the study showed inconclusive results that the lunar cycle had any effect on the human sleep cycle.

The moon has always been one of our biggest mysteries. We raced to the moon in 1969. We have looked to it for it’s wonder since the beginning of human history. It is no wonder that it has driven us to study in great depth. Despite all of this, it is difficult to draw conclusions. Is it the moon, or is it what we believe the moon brings us? This is our unsolved question, and it proves to be an unsolvable one yet. Our best bet is to be aware that the full moon, although mysterious, does not have enough proven evidence when it comes to practical medicine.

 

 

References

8 Facts about tonight’s ‘biggest and brightest supermoon’ (2016, November 14). Retrieved November 16, 2016, from http://www.itv.com/news/central/2016-11-14/8-facts-about-the-biggest-and-brightest-supermoon/

Chakraborty, U. (2013). Effects of different phases of the lunar month on humans. Biological Rhythm Research, 45(3), 383-396. doi:10.1080/09291016.2013.830508

Effects of lunar phase on sleep in men and women in Surrey. (n.d.). Retrieved November 16, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/26096730

Parmar, V. S., Talikowska-Szymczak, E., Downs, E., Szymczak, P., Meiklejohn, E., & Groll, D. (2014). Effects of Full-Moon Definition on Psychiatric Emergency Department Presentations. ISRN Emergency Medicine, 2014, 1-6. doi:10.1155/2014/398791

Templer, D.I. and Veleber, D.M. (1980) The moon and madness: A comprehensive perspective. Journal of Clinical Psychopharmacology, 36, 865-868.