According to Dr.Kumar, an Endocrinology, Diabetes & Metabolism specialist from NewYork-Presbyterian says that 17 teaspoons of added sugars a day can turn into 57 pounds of added sugar in a year. But what is added sugar, and how can people consume enough to gain so much? There are natural sugars that we consume from fruits and milk, but added sugar is added into foods we consume that are processed without realizing it. These can be harder for our bodies to process and overtime it can take a toll on our bodies.
What can get affected?
There are many ways consuming too much sugar can affect us, from heart issues to gaining weight, the list is endless. Dr.Hu mentioned from the Harvard Publishing Group (2022) that the liver processes sugars the same way it processes alcohol which is how it can be so damaging. Added sugar in large amounts overtime can cause people to have a fatty liver, and gain an excess amount of weight as well. According to WebMD (2022) Teeth can rot with so much exposure from sugar that it creates bacteria that breaks down our teeth. Surprisingly enough people can also age faster since excess add-on sugar can create AGEs which are harmful molecules that take place in the bloodstream. Lastly, a very serious medical condition someone can contract would be diabetes, and that would require much attention and lifestyle change from that diagnosis. Dr.Kumar from NewYork-Presbyterian mentions that his research shows that people who consume too much added sugar, especially high fructose corn syrup can lead to insulin resistance that can lead to type 2 diabetes. Not only that, but the body can also experience inflammation which can be painful, especially towards the joints.
What can we do ?
The easiest way to prevent ourselves from getting consumed from the excess of added sugars would be to track, and be aware of where of allfoods we eat that contain processed sugars. The American Heart Association (2022) suggests that “women consume no more than 100 calories and men no more than 150 calories”. With that being said, it is easy to see how fast someone could over consume sugar without even realizing it. The infographic below shows just how much and what common things people eat on the daily basis that have add-on sugars.
The Bottom Line
Taking the time now to look into and read the labels of all the foods you consume can make all the difference. Having cheat days and having fun eating is great, but when people are eating without knowing there is sugar in that food that is the problem. Like the Infograph shows above, store bought salad dressing, white bread, even granola can contain more sugar than one might think. If you add that up that is 15 grams of sugar which is more than half of the total amount a women should consume in a day and a little less than half for men. With the average amount of grams a person can consume daily sitting at 82 grams which turns into that 66 pounds mentioned earlier from NorthWestern Medicine.
References:
Harvard Publishing Group. Heart Health: The sweet danger of sugar. Harvard Medical School. .2022
YouTube. (2018). Natural Sugar vs Added Sugar – What’s The Difference? YouTube. Retrieved August 31, 2022, from https://www.youtube.com/watch?v=TrvNvujKKW8.
Hospice care is a specialized type of care that aims to focus on the quality of life for individuals who experience a life-limiting terminal illness of six months or less. The goal of hospice is to allow comfort during the last phase of the incurable disease to let the patient live as comforable as the disease process allows (Hospice Foundation of America). Hospice care can be provided in; long-term care facilities, an acute medical facility, homes, or an inpatient hospice facility. Hospice will provide the following to patient’s and families; spiritual care, family meetings, coordination of care, and bereavement services.
Hospice Philosophy:
“Hospice philosophy accepts death as the final stage of life – It affirms life, but does not hasten or postpone death. A hospice team will treat the person and symptoms of the disease, rather than treating the disease itself. The interdisciplinary team of professionals work together to manage symptoms that way a person’s last days may be spent with dignity and quality, surrounded by their loved ones” (American Cancer Society).
As your loved one gets sicker:
As the disease progresses, loved ones will endorse, increased weakness, assistance, and symptom management. As this process continues, hospice is able to keep your loved one in their comfort environment with adding supplies, medications, DME, and emotional support as requested by the family or patient (Mayo Foundation 2021).
Nursing staff will increase their visits to 7x/week.
Social workers will be available to the family and patient for support.
Chaplains will be available to the family and patient for life review and emotional support.
Certified nursing assistants will increase their visits to 7x/week to aid patients with personal hygiene.
If a crisis occurs:
Going through this end-of-life journey without life having different plans can a challange and can have conflicts with the hospice plan of care. The hope is that having a hospice care team available 24/7 allows patients to get effective help quickly without needing to escalate the type of care they are receiving (Phongtankuel, 2019). If the patient decides to pursue going to the hospital this is allowed just ensure hospice is notified as this is considered a change in status, hospice does have the ability to promote comfort over the phone with the use of medications in the home; Morphine, Lorazepam or Atropine. Hospice is able to provide urgent nursing visits and the ability to do an urgent medication delivery if the patient needs it through their own pharmacy.
How to know death is near:
A patient who is actively dying will experience a series of things;
Decreased level of conciousness
Bed-bound
Non-verbal cues of pain/discomfort
Changes in the rate and depth of breathing
Decreased ability to eat and drink
At this point in the EOL process, medication dosages, frequency, and route of administration will be monitored by the hospice team and make changes as necessary to keep the patient comfortable.
After the final breath was taken:
Once death has occurred, hospice will be notified either by the family or another healthcare professional caring for the patient. The hospice nurse will come out to do the death pronouncement and will call to notify the funeral home. Patient’s can remain in the home until the family is ready to release the body. Hospice’s bereavement team will remain available for family support. Bereavement services are available to family members for 13 months following the death (Cake & Lambert, 2022).
References:
Cake, & Amanda Lambert, M. S. (2022, June 2). What happens when someone dies at home with hospice? Cake Blog. Retrieved August 31, 2022, from https://www.joincake.com/blog/what-happens-when-someone-dies-at-home-with-hospice/
Mayo Foundation for Medical Education and Research. (2021, March 2). Hospice care: Comforting the terminally ill. Mayo Clinic. Retrieved August 31, 2022, from https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050
Phongtankuel, V., Burchett, C. O., Shalev, A., Adelman, R. D., Prigerson, H. G., Czaja, S. J., Dignam, R., Baughn, R., & Reid, M. C. (2019). Perceptions of a Home Hospice Crisis: An Exploratory Study of Family Caregivers. Journal of palliative medicine, 22(9), 1046–1051. https://doi.org/10.1089/jpm.2018.0511
What is Hospice? Hospice Foundation of America. (n.d.). Retrieved August 31, 2022, from https://hospicefoundation.org/Hospice-Care/Hospice-Services
Have you ever felt so anxious that you started shaking or bouncing your legs, or biting your nails? Have you ever gotten up from studying to walk around a couple of minutes to focus better? Do you feel that you are unusually jumpy, nervous, or jittery for no identifiable reason, which forces you to twirl your hair or pick at your skin?
If you can answer yes, then you have stimmed.
Self-stimulatory behaviors or stimming are motor, verbal, visual, tactile, or olfactory repetitive behaviors that individuals use as sensory stimuli to regulate emotions or to more comfortably communicate with others. Some examples of stimming are:
Rocking the body back and forth
Rubbing the skin
Biting nails
Spinning in circles
Clapping hands
Repeating sounds
Tapping your foot or your fingers in the desk
Smelling objects repetitively
Why Autistic Individuals Stim?
Stimming is a topic that has been controversial for years in the autism world. Many clinicians, teachers, and parents have seen stimming behaviors as a problem in autistic individuals. However, currently, reliable studies and many scholars and professionals, support stimming behaviors as beneficial for the autistic population and have identified similar behaviors in the non-autistic population, as well.
In this video, the Director of Child Development at Mount Sinai Beth Israel, Alma Sadiq, M.D. explains that stimming is a common behavior in autistic children. She states that children with autism can present with stimming behaviors due to anxiety, overstimulation or to communicate their feelings. She states that children can often engage in stim behaviors to calm themselves, or when they are overexcited and cannot self-regulate. Sadiq also explains that autistic children engage in both verbal and nonverbal stimming. However, a lot of stimming behaviors are body movements like shaking a toy repeatedly or spinning in circles. Also, Sadiq explains the difference between stimming and motor tics. She states that “A child can be blinking or have facial grimacing, or can be smacking their lips or making sounds. These are tics. They could be motor or vocal tics and these are different from stimulating behaviors.”
Sadiq finishes by stating that it is important to analyze when the child engages in stimming behaviors and to understand the reasons for engaging in those behaviors. For example; children are stimming because they feel overloaded with the stimuli in their surroundings or maybe because they ate something they did not like and are trying to communicate that to you. Sadiq concludes by saying stimming is a method that helps autistic children to communicate or to simply calm themselves down when overexcited. Stimming is a self-stimulatory behavior that is common in people with autism spectrum disorder (ASD).
In this video clip, Philip Fizur, M.D. underscores that stimming is a behavior that is used by autistic individuals to manage stimuli levels in the environment to help soothe. The video clip also states that stimming is part of the diagnostic criteria for ASD. However, autistic individuals do this in a way that can be socially disruptive. The video clip also mentions the reasons why autistic and non-autistic people stim, such as regulating stress and emotions and helping with sensory processing or social communication.
Fizur also states that individuals use stimulatory behaviors like hand flapping to shut out external stimuli that can be caused by overwhelming environments and are more commonly used by autistic individuals. When autistic individuals receive too much information from their surroundings, they may not know how to react, so they use stimming to relieve the overstimulation and emotional excitation caused by stress and anxiety. According to Fizur, verbal communication can be challenging in autistic individuals, so stimming helps them communicate their feelings and needs. For example, when autistic kids are extremely happy, they show you by repeatedly clapping their hands or repeatedly jumping up and down. Similarly, autistic individuals use types of stimming to let you know the food that they cannot tolerate because of flavor or texture.
According to the video clip, there is not a specific reason why stimming makes people feel good but the behavior helps activate the chemicals in the brain that regulate our emotions. The video also mentions that in the past clinicians believed that autistic stimming behaviors needed to be stopped or “fixed.” However, recent studies state that if the stim is unharmful, individuals should be allowed to do it because it can be highly beneficial.
What do Autistic Individuals Think About Stimming?
“Stimming is like breathing… Just as natural, just as important.”
(The mighty, 2016)
In this video clip, various autistic individuals share their thoughts about how they feel when stimming. They reveal that stimming refreshes their minds, helps them deal with negative emotions, relieves tension and stress, and provides them with calmness. Stimming also allows them to focus and provides them with joy and excitement, making them feel incredibly happy and enthusiastic about the outer world they are exploring. In the video, one of the participants explains that trying to stop stimming behaviors feels unpleasant for autistic individuals, such as themselves.
We all Should Stim!
As an occupational therapy assistant with a background in early childhood education, I have seen stimming behaviors not only in individuals with neurodevelopmental conditions but also in neurotypical individuals.
In all the video clips, stimming can be seen as beneficial to autistic and non-autistic individuals. The various authors believe we all should stim! The authors asserted that non-autistic persons also stim, but it only seems disruptive to others when autistic persons do it. Stimming releases emotions and energy, helps regulate sensory stimuli in the surrounding and as a way to communicate feelings. I have stimming behaviors! I do it to focus better when I am studying. I have come to realize that I cannot stay sitting for too long, so I got a desk that I can move up and down so that I can study sitting or standing up. I added wheels to the desk, so I can move around my apartment in case I feel overwhelmed, and I want to change my environment. And you? Do you stim?
Consider that something as simple as the fidgeting we may see in non-autistic people has a lot in common with stimming in autism. Therefore, we should collectively promote a greater understanding of these kinds of repetitive behaviors, not just for the ASD population but for the rest of us who also share various types of self-soothing habits.
Kapp, S. K., Steward, R., Crane, L., Elliott, D., Elphick, C., Pellicano, E., & Russell, G. (2019). “People should be allowed to do what they like”: Autistic adults’ views and experiences of stimming. Autism: The International Journal of Research & Practice, 23(7), 1782–1792. https://doi.org/10.1177/1362361319829628.
Mays, N. M., Beal-Alvarez, J., & Jolivette, K. (2011). Using movement-based sensory interventions to address self-stimulatory behaviors in students with autism. Teaching Exceptional Children, 43(6),46–52. https://doi.org/10.1177/004005991104300605.
McCormack, L., Wong, S. W., & Campbell, L. E. (2022). ‘If I don’t do it, I’m out of rhythm and I can’t focus as well’: Positive and negative adult interpretations of therapies aimed at ‘fixing’ their restricted and repetitive behaviours in childhood. Journal of Autism & Developmental Disorders, 1–14. https://doi.org/10.1007/s10803-022-05644-6.
Have Healthcare Workers Received the Mental Health Support They Needed During the COVID-19 Pandemic?
The Impact of the COVID-19 Pandemic
Mental health is an important factor for employers to consider to ensure a productive and stable work environment particularly in the healthcare setting. The COVID-19 pandemic has had a negative effect on the mental health of employees and the work setting (Villarreal-Zegarra et al., 2022). Increased levels of anxiety, depression, and PTSD were reported by healthcare workers. Have mental health resources improved for healthcare workers as a result of the COVID-19 pandemic? Are the resources that are currently available sufficient? Can we rely on the media to provide us with accurate information on this topic or should we turn to research studies? The news can be a quick fix for information and research can be time consuming and exhausting. However, it is important to recognize fact vs. fiction in the media.
What the Media is Saying
A media report from April 14, 2020 gives a brief overview of the level of stress the pandemic was causing healthcare workers. The country was only about one month into the pandemic when there was still so much uncertainty and unknown. The clip below offers a glimpse into what the country and the healthcare field was experiencing.
This clip reported on the concern that the COVID-19 pandemic could lead to PTSD in healthcare workers. The reporter stressed the importance of mental health resources offered to healthcare workers in response to the pandemic. This media report mentions the proactive movements put into place to decrease the stress level of healthcare workers. Although this media clip provides some hope there isn’t any factual based information provided. A more reliable source would offer research study statistics. However, it is important to note that this media clip was created at the very beginning of the pandemic when there was almost no research data available on whether mental health resources were increased and how effective they were.
Another media report from May 26, 2021 similarly reported the stress healthcare workers experienced due to COVID-19. The short clip posted below gives a brief overview of what mental health resources for healthcare workers look like one year into the pandemic.
This clip reported on a recent study performed at Marquette University that found that anxiety and depression during the pandemic is higher in nurses than the general public. The hospital system was reported to have put an emphasis on offering more resources to help healthcare workers. The information provided was reassuring. However, there was no data provided to support this statement.
A third media report created by The Denver Channel reported that 2 years into the pandemic employers were, “rolling back” on their efforts to provide mental health resources to employees. The clip below cultivates a sense of concern.
The news reporter emphasizes a global survey from Head Space Health that found only 25% of employees said their work still focused on mental health. Could this really be true? How many individuals participated in the survey? Would this news report cause you to feel alarmed about your own work setting? It is easy to watch a 1 minute 30 second video from a seemingly credible news source and take it for factual information.
The Research
A recent research study performed at St. Luke’s Hospital assessed an existing well-being program available for all employees. A total of 212 employees completed anonymous surveys determining levels of depression, post-traumatic stress disorder, awareness of mental health resources, and their opinion of effectiveness of those resources (Bucca et al., 2022). It was found that 54% of staff suffered from mild anxiety, over 50% suffered from mild depression and 37% suffered from PTSD due to the COVID-19 pandemics impact on the workplace (Bucca et al., 2022). The results of the survey motivated the hospital to increase the wellness resources they offered for their employees. This is an example of how mental health resources improved in response to the COVID-19 pandemic for healthcare workers.
Another research study performed by Schoultz et al., had a strong focus on how the COVID-19 pandemic effected healthcare workers in nursing homes. Healthcare workers in this setting were negatively impacted by the pandemic due to staff shortages, increased workloads and high percentage of deaths among residents (Schoultz et al., 2022). A training course created by the World Health Organization called Psychological First Aid (PFA) was discussed and how it can be incorporated in these healthcare settings. The PFA program, “aims to reduce initial distress, meet current needs (psychological and physical), promote flexible coping, and encourage adjustment while establishing feelings of safety” (Schoultz et al., 2022, p. 2). A systematic review found that health care workers demonstrated with high anxiety (23.3%), depression (22.8%), and insomnia (38.8%) indicating a need for improved support in the field (Schoultz et al., 2022). A systemic review noted that there was not enough research to prove the efficacy of the PFA program and encouraged more research to be done.
A research study performed by Villarreal-Zegarra et al., aimed to assess policies on mental health in the workplace during the COVID-19 pandemic. The COVID-19 pandemic has had a negative effect on the mental health and the work setting (Villarreal-Zegarra et al., 2022). A scoping review of articles that analyze mental health policies during the pandemic in the work setting was performed. Out of 6522 articles analyzed only 4 studies were included in the review (Villarreal-Zegarra et al., 2022). Overall, the research available on improved or increased mental health policies in the work setting as a result of the pandemic are limited (Villarreal-Zegarra et al., 2022).
A fourth research study performed by Brooks et al., analyzed the effects of Employee Assistance Programs and if employees used them. The purpose of EAP programs is to support employee mental health while also supporting the employer with results of improved productivity (Brooks et al., 2020). Both national and regional survey data collected from employee surveys was analyzed in order to determine if employees were using EAP benefits to assist with their mental health (Brooks et al., 2020). Brooks et al., collected data from secondary sources of public and private organizations consisting of employee surveys. The findings of the study determined that there was a low percentage of employees using the EAP services provided. However, it was discovered that health care professionals were more likely to use EAP services than other professions (Brooks et al., 2020). Brooks et al., reported that employers have enhanced EAP benefit options due to the growing need for mental health care as a result of the COVID-19 pandemic. Overall, the study findings suggested that more research on employer EAP programs is necessary to better determine if they are effectively being used.
What do all of these research studies have in common? They were all written by healthcare professionals who supported their findings with research data. The articles they have written are peer reviewed and were retrieved from EBSCOhost database. Overall, the research is lacking when it comes to the availability and effectiveness of mental health resources for healthcare workers. The COVID-19 pandemic has been a learning curve for both employers and healthcare workers. Continued research on well-being programs and how they impact healthcare workers is important and necessary.
The Facts
In conclusion, there is a common understanding by both the media and the researchers that the COVID-19 pandemic had a negative impact on healthcare workers mental health. Initially the media reported on the increased efforts by employers to support the mental health of healthcare workers. Two years into the pandemic the media depicted a doomed future for the mental health of healthcare workers by stating resources would decrease. According to the information obtained from the research articles there was no indication that there would be a reduction in employer efforts to sustain the mental health of healthcare workers. What remains unclear is whether well-being programs offered are recognized and used by employees and the impact they have on their mental health. The bottom line is that more research needs to be performed. It is up to employers and employees to advocate for mental health resources and participate in research studies to better understand if they are helping. It is important to recognize that the media often twists information to make for a better story. When looking for reliable information stick to peer reviewed, scientific research articles.
References
Brooks, C. Darren, and Jeff Ling. “Are we doing enough”: An evaluation of the utilization of employee assistance programs to support the mental health needs of employees during the COVID-19 pandemic.” Journal of Insurance Regulation, vol. 39, no. 8, 2020, pp. 1–34., https://doi.org/10.52227/23478.2020.
Bucca, Anthony, et al. “Unmasking the Truth of Health Care Workers’ Well-Being during the COVID-19 Pandemic.” Critical Care Nurse, vol. 42, no. 4, 2022, pp. 20–26., https://doi.org/10.4037/ccn2022769.
Schoultz, Mariyana, et al. “Psychological First Aid for Workers in Care and Nursing Homes: Systematic Review.” BMC Nursing, vol. 21, no. 1, 26 Apr. 2022, pp. 1–6., https://doi.org/10.1186/s12912-022-00866-6.
Villarreal-Zegarra, D., Reategui-Rivera, C. M., Sabastizagal-Vela, I., Burgos-Flores, M. A., Cama-Ttito, N. A., & Rosales-Rimache, J. (n.d.). Policies on mental health in the workplace during the COVID-19 pandemic: A scoping review. PLOS ONE, 17(7). https://doi.org/https://doi.org/10.1371/journal.pone.0272296
Type 1 diabetes mellitus is described as an autoimmune disease, meaning there is no way to prevent it from affecting a person. Type 1 diabetes is a genetic disorder that is usually diagnosed while the patient is a child; this form of diabetes is caused by the immune system attacking the cells in the pancreas that create insulin. Type 2 diabetes is usually developed later in life and is caused when a persons body does not create enough insulin; this is usually diet-related. Unlike type 2 diabetes, type 1 diabetes cannot be caused due to an unhealthy lifestyle or excess sugar consumption; which can be a common misconception. Only about 5% of people living with diabetes have type 1, according to the CDC (2022). Although type 1 and type 2 diabetes are not the same, they both still can lead to medical complications in the future.
What causes type 1 diabetes?
The American Diabetes Association (2022) has theorized that early diet can have some affect on whether a person will develop type 1 diabetes and reports that infants who are breast fed often have a lower incidence rate of type 1 diabetes. Although they report this to be a “fact,” it is not a widely accepted theory; so for now it remains just that, a theory. According to the CDC, there is no official cause or reason a person gets of type 1 diabetes.
I was diagnosed with type 1 diabetes, does this mean I cannot have sugar?
The incidence of type 1 diabetes typically peaks in adolescents and young adult years. Because of this, many parents of children with type 1 diabetics believe that this diagnosis means that their child can no longer have sugar or sweet treats; this is very far from the truth. People living with type 1 diabetes can still consume whatever foods they choose; they just have to be conscious of their carbohydrate and sugar intake. This is important to be able to administer the correct amount of insulin to correct the potential high blood sugars. Blood sugars can be monitored by using continuous glucose monitoring devices or CGMs.
As mentioned before, type 1 diabetes can go undiagnosed for months or even years and because of this hypoglycemia can account for around 8% of diabetes related deaths (Kelly, 2021). Although it is important to be mindful or sugar “highs” it is also important to monitor for low sugars. While insulin will correct a high blood sugar, it is not the solution for a low blood sugar. Low blood sugars should be corrected by consuming a protein or sugary snack.
What are the treatments for type 1 diabetes?
Currently there is no cure for type 1 diabetes, but there are effective treatment options for patients who have been diagnosed. Treatments for type 1 diabetes include insulin management, blood sugar monitoring, consuming a balanced diet, and exercising. It may be necessary to consume a diabetic diet; which consists of limited or counted carbohydrates. By counting the carbohydrates, it makes it easier for the patient to determine the correct dose of insulin.
Lifestyle Changes
For those diagnosed with type 1 diabetes, it is often assumed that it is going to be necessary to go through an entire lifestyle change and while this may be true is some aspects, it is not for all. Lifestyle changes can seem daunting to someone who has just had their life turned around with a diagnosis of type 1 diabetes. But people living with diabetes are still able to live a normal every day life. Some daily routine changes can include:
Frequent blood sugar checks
Counting carbohydrates
Maintaining a healthy diet
Adequate amounts of exercise/physical activity
Daily skin checks to monitor for wounds on the feet or lower extremities
Patients with diabetes are more susceptible to nerve damage, especially in the lower extremities, therefore it is important to monitor for cuts or wounds on the feet and legs. Due to the nerve damage, if a patient isn’t continuously monitoring their skin integrity, a wound can go undiscovered for long periods of time and cause infections. These potential infections can lead to hospitalizations and then in turn cause other health issues. Taking care of your body and promoting your health is an important aspect of daily living.
Reference
Ahmed, A. S., Alotaibi, W. S., Aldubayan, M. A., Alhowail, A. H., Al-Najjar, A. H., Chigurupati, S., & Elgharabawy, R. M. (2021). Factors Affecting the Incidence, Progression, and Severity of COVID-19 in Type 1 Diabetes Mellitus. BioMed Research International, 1–9. https://doi.org/10.1155/2021/1676914.
Center for Disease Control and Prevention. (2022, November 3). What is type 1 diabetes. Retrieved August 18, 2022, from https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html.
Genetics of diabetes | ADA. (2022). American Diabetes Association. Retrieved August 18, 2022, from https://diabetes.org/diabetes/genetics-diabetes.
Kelly, B. (2021). Nursing interventions for people with type 1 diabetes and frequent hypoglycemia. British Journal of Community Nursing, 26(11), 544–552. https://doi.org/10.12968/bjcn.2021.26.11.544.
