Golf Carts' Use Is Spreading, As Is Danger to Kids

Study of more than 100 kids treated at trauma centers reveals serious injuries

From: http://www.webmd.com/children/news/20170915/golf-carts-use-is-spreading-as-is-danger-to-kids?src=RSS_PUBLIC

Joining Your Kid on Playground Slides? Think Again

It seems like fun but can be a quick trip to a broken limb, study authors warn

From: http://www.webmd.com/children/news/20170915/joining-your-kid-on-playground-slides-think-again?src=RSS_PUBLIC

Young Kids With Cellphones Face Cyberbullying

Study finds elementary school children with phones are more likely to be cyberbullied

From: http://www.webmd.com/children/news/20170915/young-kids-with-cellphones-face-cyberbullying?src=RSS_PUBLIC

When Hurricanes Strike, People Aren't the Only Victims

The safety of pets can force some wrenching decisions for their owners

From: http://pets.webmd.com/news/20170915/when-hurricanes-strike-pets-are-victims-too?src=RSS_PUBLIC

State Laws Have Big Impact on Kids' Gun Injuries

Locale matters, too, with firearm violence affecting urban, rural teens differently, studies find

From: http://www.webmd.com/children/news/20170915/state-laws-have-big-impact-on-kids-gun-injuries?src=RSS_PUBLIC

More U.S. Kids Landing in ER With Opioid Addiction

Researcher calls findings an emerging public health issue

From: http://www.webmd.com/mental-health/addiction/news/20170915/more-us-kids-landing-in-er-with-opioid-addiction?src=RSS_PUBLIC

A blog post on blog posts: Fact, fiction, and friction

A blog by definition is a regularly updated website or web page, typically one run by an individual or group, and is written in an informal or conversational style. As with any conversation, there is usually a blend of fact and opinion. In the case of a blog on medical topics, frequently the opinions are those of experts, and it is not uncommon for such opinions to lead to healthy debate.

Fake news or skewed views?

We make many decisions on the basis of research studies, and this is particularly the case in medicine. The non-medical media often does a good job of sensationalizing research in ways that are at times excessive. A new drug or device is labeled a breakthrough treatment on the front page of the newspaper, when in fact the supporting evidence of effectiveness was modest at best and only relevant for a small subset of patients with the least prominent form of the disease. A commonly consumed food is labeled a risk factor for cancer in humans, when in fact the study involved only rats with two million times the exposure a human would have in a lifetime. As you can tell, it can be a rat race in more ways than one.

When not caring for patients, physicians spend countless hours reading journals to learn about new therapeutic options and trends in medicine. Physicians in particular must read with a critical eye. It is often not difficult to manipulate study parameters or statistics in order to demonstrate a particular finding in a study. For example, let’s say there is a study evaluating a medication to prevent headaches, and the results suggest no significant reduction in the number of headache days per month. If you modify the units to reduced number of headache hours per month, it could look like there was a noticeable improvement. There are many factors that actually weaken the link between the medication and this perceived improvement. For example, if subjects in the study started taking prescription pain medication to stop the headache after it started, and experienced shorter duration headaches, this could make it appear that the study drug was effective at reducing the hours of headache per month. As such, it is very important to really understand the nuances of a study before jumping to conclusions about conclusions. It is in this regard that I often think of the store Syms and their old slogan, “An educated consumer is our best customer.”

Physicians’ opinions are shaped by research (what is written in textbooks and scientific journals) and by clinical experience. Clinical experience is the sum total of everything that patients tell their physician over the years and decades of experience and practice. Years of caring for patients yields rich information about treatments that work well and for whom they might work well. In taking care of headache patients, I have learned over the years that a key to headache relief includes paying careful attention to addressing non-pain symptoms (vomiting can be more of a problem than the pain of the headache), triggers (no patient leaves my office without spending some time talking about sleep problems because they are so common), and the non-medication treatments they’ve tried. Although a recent blog post I wrote on acupuncture may have seemed a bit skewed, I do not regularly advise patients not to try acupuncture. Different patients respond differently to different therapies.

Clinical experience: That’s what she said…

In my clinical experience, the overwhelming majority of my patients have indicated no long-term migraine benefit from acupuncture treatment. Yet some of those very same patients have indicated that acupuncture was effective for treating other conditions. I am glad that my acupuncture piece sparked some healthy debate. My intention was not to slander acupuncture, but rather to share the feedback from thousands of patients I’ve worked with over the years, as well as discuss some of the weaknesses in a study that looked at the long-term benefit of acupuncture for the treatment of migraine. That being said, I hope my acupuncture colleagues can accept this olive branch if they found my piece offensive, and understand that behind the subheadings (referred to as “snarky”), clinical experience was driving the content, not a personal vendetta for a treatment that may be effective for some patients with certain diagnoses. I would also point out that the inconsistent effectiveness of many treatments I employ has been written about extensively in the medical literature.

When considering what constitutes an “effective” therapy, I fondly recall one patient who came to see me for treatment of her headaches. She had seen numerous neurologists and pain specialists with limited benefit, as many treatments with significant research backing their efficacy just didn’t work for her. After introducing myself, she said, “Dr. Mathew, I know you are the doctor who is finally going to fix me.” In reply, I said, “Young lady, I am not a veterinarian, and as such, I do not fix people.” After a chuckle, a discussion of her history, and a physical examination, we outlined a treatment plan that involved lifestyle modifications and some complementary/alternative treatments, which she found beneficial. Although not a veterinarian, I was able to effectively treat her dog-gone headaches, and she was no longer barking up the wrong tree.

The post A blog post on blog posts: Fact, fiction, and friction appeared first on Harvard Health Blog.

From: Paul G. Mathew, MD, FAAN, FAHS https://www.health.harvard.edu/blog/a-blog-post-on-blog-posts-fact-fiction-and-friction-2017091512415

One Behavior Best Prevents High Blood Pressure

One critical trait emerged when researchers reviewed smoking and drinking habits, weight, diet and exercise

From: http://www.webmd.com/hypertension-high-blood-pressure/news/20170914/one-behavior-best-prevents-high-blood-pressure?src=RSS_PUBLIC

Can Coffee or Tea Extend Survival With Diabetes?

The answer may depend on whether you're a man or a woman

From: http://www.webmd.com/diabetes/news/20170914/can-coffee-or-tea-extend-survival-with-diabetes?src=RSS_PUBLIC

U.S. Cancer Death Rate Continues to Fall

But more cases are expected as baby boomers age, report says

From: http://www.webmd.com/cancer/news/20170914/us-cancer-death-rate-continues-to-fall?src=RSS_PUBLIC

Feeling okay about feeling bad is good for your mental health

When you have a negative emotion, are you upset or disappointed in yourself? Do you feel “bad” or “guilty” about this emotion? If so, you may be at risk for poorer longer-term psychological health.

A study in the July 2017 Journal of Personality and Social Psychology looked at the psychological health of people who accept, rather than negatively judge, their emotional experiences. Researchers found that accepting these experiences led to fewer negative emotions when confronted with daily stressors.

The article reported on three separate, but related, studies that explored how accepting negative emotions, rather than reacting to them, affects a person’s psychological health.

The first study aimed to see whether accepting emotions was associated with greater psychological health, and if this association was moderated by several demographic variables. Undergraduate students at the University of California at Berkley completed evaluations to assess acceptance, stress level, and psychological health. The researchers found that accepting mental health experiences was associated with greater psychological health across a range of demographic variables including gender, ethnicity, and socioeconomic status. Further, results indicated that the benefits to psychological health were associated with accepting the emotions associated with a negative event, rather than the situation that triggered those emotions.

In the second study, the authors examined a potential explanation for how the tendency to accept negative emotions is related to psychological health. They explored whether accepting one’s mental experiences helps to decrease negative emotions when experiencing stressors. A consistent reduction in negative emotions should, in time, improve overall psychological health.

Again, a group of undergraduates completed questionnaires related to acceptance and to their emotional responses to a stressful task completed in the lab. Results indicated that by habitually accepting emotions and thoughts, people experienced a lower degree of negative emotion when in stressful situations.

Finally, the authors wanted to see if these results held up for people other than college students. They followed people in a Denver community for a six-month period. These study volunteers completed measures of acceptance, psychological health, and stress, and kept nightly diaries for two weeks identifying the degree of negative emotion felt when experiencing stressors that day.

Results indicated that people who habitually accept their emotional experiences were more likely to report greater psychological health six months later. This was true regardless of gender, ethnicity, or socioeconomic status. Further, people who accepted these emotions were less likely to respond negatively to stressors. That is, people who routinely accept their emotions and thoughts when under stress, experience less daily negative emotion during these times. This in turn is associated with increased psychological health six months later.

Taken together, these three studies highlight the benefits of accepting emotions and thoughts, rather than judging them, on psychological health. It seems like common sense. When a stressful situation causes negative emotions, accepting feelings of frustration or upset — rather than trying to pretend you’re not upset, or beating yourself up for feeling this way — reduces guilt and negative self-image. Over time, this will in turn lead to increased psychological health.

The post Feeling okay about feeling bad is good for your mental health appeared first on Harvard Health Blog.

From: David R. Topor, PhD, MS-HPEd https://www.health.harvard.edu/blog/feeling-okay-about-feeling-bad-is-good-for-your-mental-health-2017091412398

Nerve 'Zap' Could Replace CPAP for Sleep Apnea

Device reduces breathing disruptions long-term, study says

From: http://www.webmd.com/sleep-disorders/sleep-apnea/news/20170914/nerve-zap-could-replace-cpap-for-sleep-apnea?src=RSS_PUBLIC

Disability backlog tops 1 million; thousands die on waitlist

Last year there were 7,400 people on waitlists who were dead, according to a report by Social Security's inspector general

From: http://www.cbsnews.com/news/social-security-disability-backlog-tops-1-million-thousands-die-on-waitlist/

Houston braces for mosquito explosion

Three weeks ago, Hurricane Harvey made landfall and the resulting floods caused more than 70 deaths. It damaged or destroyed more than a quarter of a million homes. Now, as Houston and its surrounding areas begin to recover, people are taking steps to head off a potential health threat. Omar Villafranca reports.

From: http://www.cbsnews.com/videos/houston-braces-for-mosquito-explosion/

Hospital cited after staffers take photos of patient’s genital injury

Hospital employees used their personal phones to take photos and videos while the patient was under anesthesia

From: http://www.cbsnews.com/news/hospital-cited-after-staffers-take-photos-of-patients-genital-injury/

Hysterectomy – Mayo Clinic

From: Mayo Clinic https://www.youtube.com/watch?v=aQ6sgMC7VFo

Golf Carts' Use Is Spreading, As Is Danger to Kids

Study of more than 100 kids treated at trauma centers reveals serious injuries

From: http://www.webmd.com/children/news/20170915/golf-carts-use-is-spreading-as-is-danger-to-kids?src=RSS_PUBLIC

Joining Your Kid on Playground Slides? Think Again

It seems like fun but can be a quick trip to a broken limb, study authors warn

From: http://www.webmd.com/children/news/20170915/joining-your-kid-on-playground-slides-think-again?src=RSS_PUBLIC

Bernie Sanders' Medicare for All: How would it work?

His "single-payer" health care plan aims to redirect -- and reduce -- trillions of U.S. health care spending

From: http://www.cbsnews.com/news/sanders-medicare-for-all-bill-how-would-it-work/

Young Kids With Cellphones Face Cyberbullying

Study finds elementary school children with phones are more likely to be cyberbullied

From: http://www.webmd.com/children/news/20170915/young-kids-with-cellphones-face-cyberbullying?src=RSS_PUBLIC

When Hurricanes Strike, People Aren't the Only Victims

The safety of pets can force some wrenching decisions for their owners

From: http://pets.webmd.com/news/20170915/when-hurricanes-strike-pets-are-victims-too?src=RSS_PUBLIC

State Laws Have Big Impact on Kids' Gun Injuries

Locale matters, too, with firearm violence affecting urban, rural teens differently, studies find

From: http://www.webmd.com/children/news/20170915/state-laws-have-big-impact-on-kids-gun-injuries?src=RSS_PUBLIC

More U.S. Kids Landing in ER With Opioid Addiction

Researcher calls findings an emerging public health issue

From: http://www.webmd.com/mental-health/addiction/news/20170915/more-us-kids-landing-in-er-with-opioid-addiction?src=RSS_PUBLIC

Fibromyalgia: What to know about Lady Gaga's chronic condition

Fibromyalgia affects about 4 million U.S. adults, or about 2 percent of the adult population

From: http://www.cbsnews.com/news/fibromyalgia-lady-gaga-chronic-pain-condition/

In Irma's wake, food safety a growing concern

Florida health officials are urging residents to take precautions to prevent food poisoning

From: http://www.cbsnews.com/news/hurricane-irma-power-outages-florida-food-safety/

One Behavior Best Prevents High Blood Pressure

One critical trait emerged when researchers reviewed smoking and drinking habits, weight, diet and exercise

From: http://www.webmd.com/hypertension-high-blood-pressure/news/20170914/one-behavior-best-prevents-high-blood-pressure?src=RSS_PUBLIC

Study prompts call to examine flu vaccine, miscarriage

Officials still recommend all pregnant women be vaccinated, as he flu itself is a much greater danger to women and their fetuses

From: http://www.cbsnews.com/news/study-prompts-call-to-examine-flu-vaccine-and-miscarriage/

Texas enlists Air Force to spray for mosquitoes

Officials say the rain and flooding from Harvey created large areas where mosquitoes can lay their eggs

From: http://www.cbsnews.com/news/texas-enlists-u-s-air-force-to-spray-for-mosquitoes-after-harvey/

Mayo Clinic Minute: Emergency room doctor’s storm cleanup reminders

From: Mayo Clinic https://www.youtube.com/watch?v=zzdBeyeW8ak

Selena Gomez reveals kidney transplant

Gomez said she needed a new kidney because of her lupus diagnosis and that her longtime friend Francia Raisa was the donor

From: http://www.cbsnews.com/news/selena-gomez-reveals-kidney-transplant/

Harper's hope: How Mayo made breathing easier

From: Mayo Clinic https://www.youtube.com/watch?v=lFXglapbxQg

Infectious Diseases A-Z: Why the HPV vaccine is important

From: Mayo Clinic https://www.youtube.com/watch?v=Jh6U1KUD2tU

San Diego washing streets with bleach to fight Hep A

An outbreak among the city's homeless population has killed 15 people and hospitalized 300 more

From: http://www.cbsnews.com/news/san-diego-power-washing-streets-with-bleach-to-fight-hepatitis-a/

Selena Gomez reveals she had a kidney transplant

Actress and singer Selena Gomez revealed she received a kidney transplant due to lupus. Her friend, Francia Raisa, was the donor. Vladimir Duthiers reports.

From: http://www.cbsnews.com/videos/selena-gomez-reveals-she-had-a-kidney-transplant/

Medicare for all: Does America really want it?

Sen. Bernie Sanders, I-Vermont, rolled out his Medicare-for-all plan Wednesday

From: http://www.cbsnews.com/news/medicare-for-all-does-america-really-want-it/

Can Coffee or Tea Extend Survival With Diabetes?

The answer may depend on whether you're a man or a woman

From: http://www.webmd.com/diabetes/news/20170914/can-coffee-or-tea-extend-survival-with-diabetes?src=RSS_PUBLIC

U.S. Cancer Death Rate Continues to Fall

But more cases are expected as baby boomers age, report says

From: http://www.webmd.com/cancer/news/20170914/us-cancer-death-rate-continues-to-fall?src=RSS_PUBLIC

Centene's stock rises after Fidelis acquisition

The St. Louis-based health insurance provider is expanding into the New York market with the $3.75 billion deal

From: http://www.cbsnews.com/news/centenes-fidelis-acquisition-sends-stock-up-sharply/

Nerve 'Zap' Could Replace CPAP for Sleep Apnea

Device reduces breathing disruptions long-term, study says

From: http://www.webmd.com/sleep-disorders/sleep-apnea/news/20170914/nerve-zap-could-replace-cpap-for-sleep-apnea?src=RSS_PUBLIC

How smart are you about car seats?

Follow me on Twitter @drClaire

If you’re a parent — or anyone else who has driven a child somewhere — you likely know quite a bit about car seats.

Or do you?

As both a pediatrician and a parent, I know that lots of people don’t know everything they should about car seats and booster seats. It’s understandable, as the information can be confusing, and while resources are available, many parents don’t know about them. But it’s a problem, because making a mistake when it comes to car seats can literally be life-threatening. Of the children 12 years and younger who died in motor vehicle crashes in 2015, more than a third weren’t buckled up.

Let’s test your smarts. Can you answer these questions?

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See all the answers here:

When should parents change from a rear-facing seat to a forward-facing one?

a)  12 months
b)  24 months
c)  When they outgrow the rear-facing seat (assuming they are at least 24 months old)

Answer: C. Turning children around too early is one of the most common car seat mistakes people make. In part, that’s because the recommendation used to be to turn children forward-facing at a year (that was the recommendation when my eldest children were babies), and some grandparents and others don’t realize it has changed. It’s also tempting to turn children around early because it’s easier to see them from the front seat.

But here’s the thing: children are safer if they are rear-facing. It’s just the physics of crashes and little bodies. So if a child turns two and is within the weight and height recommendations of the seat, leave them facing backward.

Remember, never put a car seat in a seat with an airbag — and the safest place in the car for the car seat is the middle of the back seat.

What is the youngest age you can move a child from a car seat to a booster seat?

a)  2
b)  3
c)  5

Answer: C. This is another common mistake. Just because your child has started preschool doesn’t mean they can get out of their car seat. And just because they are in kindergarten or first grade doesn’t mean they still don’t need to be in one. It is recommended that children be in a car seat, not a booster seat, until they are 5 years old, but they can, and should, stay in it if they are still within the weight and height recommendations of the seat.

How long does a child need to be in a booster seat?

a)  Until the car seat belt fits properly
b)  Until they are 57 inches tall
c)  Until they are 8 years old

Answer: The real answer is A. It’s kind of the point of booster seats. Children should be in a booster seat until the lap portion of the seat belt goes across the upper thigh, not the belly, and the shoulder portion goes across the chest, not the neck. That’s generally at a height of 57 inches (4 feet 9 inches).

Every state is a little different when it comes to the laws about children and car restraints. Here in Massachusetts, the law says that a child must be in a car seat or booster until they are 8 years old or 57 inches tall. Other states say seatbelts alone are okay at 6 or 7 — and others use weight guidelines. You should know the laws in your state. But even if the law says it’s okay to ditch the booster seat for your child, don’t do it if he or she is shorter than 57 inches or the seat belt doesn’t fit right for some other reason. Booster seats can cut the risk of serious injury by half.

Remember, too, that with booster seats, car seats, and seat belts, no ride is too short to buckle up!

At what age can a child ride in the front seat?

a)  8
b)  10
c)  12
d)  13

Answer: D. Yup, 13. Children 12 and under should be in the back seat. They are safer there. Part of it has to do with the airbag, and the size a person should be to be safe with one. I know that this sounds arbitrary — there are lots of 11 and 12 year-olds who are adult size — but it’s the recommendation. We’d all be safer in the back seat, honestly. So even if it makes your sixth or seventh grader mad, just say no to the front seat. Better your kid be mad at you than be seriously injured — or dead.

What percentage of car and booster seats are installed or used incorrectly?

a)  11%
b)  24%
c)  46%
d)  75%

Answer: C. Almost half (thank goodness it’s not D!). There are lots of ways people mess up, including:

• turning it around too soon
• not installing it tightly enough, or at the wrong angle
• using both the seatbelt and the LATCH system
• leaving the straps too loose
• putting clips in the wrong place.

Having installed car seats myself, I know how tough it can be. Luckily, there’s help available. The National Highway Traffic Safety Administration has all sorts of information and resources to help parents keep their children safe in the car, including buying and installation help for car seats and booster seats and information on how to get your seat inspected. Safe Kids has information on how to find technicians who can help you with installation problems and questions.

There are also lots of great resources on healthychildren.org, the parent education website of the American Academy of Pediatrics — check out their car seat information for families.

The post How smart are you about car seats? appeared first on Harvard Health Blog.

From: Claire McCarthy, MD https://www.health.harvard.edu/blog/how-smart-are-you-about-car-seats-2017091212389

Too many pain pills after surgery: When good intentions go awry

As a physician with an interest in reducing opioid-related problems, I frequently hear stories from colleagues and friends about their loved ones who either struggle with opioid addiction or have even died from opioid-related overdose. My follow-up question to them is usually: “How did it begin?” Almost every time the answer is the same: the individual experienced acute pain either from a trauma or surgery, was started on opioids by a doctor, and then couldn’t quit.

My son’s baseball coach, who is not in the medical field, described it perfectly. He went in for a minor back surgery and was discharged with 60 tablets of oxycodone (the opioid medicine in Percocet and Oxycontin). For the first couple of days, he had significant pain and used the pain pills. After the pain began to subside and acetaminophen and ibuprofen were sufficient, he stopped using the oxycodone. But after discontinuing the medication, he began feeling terrible, experiencing body aches, restlessness, and insomnia. He took another oxycodone and felt better. Fortunately, he had the insight to recognize what was going on: he was withdrawing from the opioid, even after taking it for only a few days. Had he continued treating his withdrawal with oxycodone, he may have become hooked. “I dodged a bullet,” he told me.

The problem of adverse effects and unused opioids

This story, repeated time and again, is interesting in light of a recent study published in JAMA Surgery. The paper was a meta-analysis that combined the results of six previous studies investigating use of opioids by patients after seven different surgical procedures. In the era of the opioid epidemic, where we know that the vast majority of pills taken for non-medical reasons (e.g., abuse) are obtained from friends or family members, the results are staggering: 42% to 71% of the prescribed opioids went unused. Furthermore, 16% to 29% of patients experienced adverse effects directly attributed to the opioids.

Multiple government and public health agencies recommend discarding unused opioids. It’s not safe to flush them down the toilet as they can contaminate our water supply, but most police stations and now commercial pharmacies have bins where unused medications can be safely disposed. Despite this, the study discovered that only 4% to 30% planned to dispose of the medications and only 4% to 9% planned to use a safe disposal method.

Why are opioids prescribed often and in larger amounts?

A key question is why overprescribing after surgery is occurring. I believe there are two likely explanations. The first is that surgeons, appropriately, do not want their patients to suffer from pain after an operation. The second is that, in many states, it is impossible to phone in a prescription for a controlled substance (e.g. an opioid pain medication). Therefore, a patient actually has to come back to clinic to pick up a prescription, which causes inconvenience to both the patient and the prescriber. Providing a prescription for 60 or 90 pills makes sense considering this barrier. Several states are implementing ways to provide electronic prescriptions that would make the doctor’s office visit unnecessary if a refill is needed, but it will take time before most doctors can do this.

However, as the study in JAMA shows, these large amounts may be far more pills than is required. As an example, consider another intriguing study of patients being treated for an acute extremity fracture. The researchers provided patients with special pills that contained both oxycodone and a small radio transmitter that became activated in the stomach. The researchers were able to detect exactly when the opioid was taken. Patients were instructed to use up to one week of oxycodone. At follow up, the average number of pills used was eight. Most of the severe pain was gone in just three days. There was no more need for opioids than a few pills, certainly less than 15.

Here’s what you can do to protect yourself and your community

How can the public protect itself? Physicians have a duty to educate about the risks and benefits of all treatments rendered, including when prescribing opioids. That unfortunately doesn’t always occur. So here’s my advice: if you are prescribed an opioid for acute pain, including after surgery, take all of the non-opioid pain medications permitted by your doctor as instructed (e.g. acetaminophen and ibuprofen, if not contraindicated). Add the opioid if, and only if, the pain is not bearable with the other medications. And once the pain is tolerable, stop the opioid and safely dispose of it by bringing it back to your pharmacy, if they have a disposal bin, or any DEA-recommended collection site. Finally, consider having a discussion with your doctor about the number of pills you are likely to need in the first place before the prescription is written. Being informed about safely using opioids could prevent dependence, and, ultimately, save your life.

The post Too many pain pills after surgery: When good intentions go awry appeared first on Harvard Health Blog.

From: Scott Weiner, MD https://www.health.harvard.edu/blog/too-many-pain-pills-after-surgery-when-good-intentions-go-awry-2017091112381

Disability backlog tops 1 million; thousands die on waitlist

Last year there were 7,400 people on waitlists who were dead, according to a report by Social Security's inspector general

From: http://www.cbsnews.com/news/social-security-disability-backlog-tops-1-million-thousands-die-on-waitlist/