[Reblog]Monday: What’s Lurking Beneath Your Sofa in Your (Otherwise) Healthy Home | Drexel School of Public Health
By Anneclaire De Roos, MPH, PhD, Associate Professor
When I think about this National Public Health Week’s topic – ‘Healthy Homes’ – what immediately comes to mind are themes like injury, fire safety, lead, radon, mold, and secondhand smoke. Most people’s thoughts about healthy homes probably don’t include dust. How harmful can dust bunnies be? Actually, we’ve long known that people with asthma and allergies are sensitive to dust mites. And now there is ever-increasing documentation of a different type of health hazard from house dust – exposure to a diverse mix of pollutants including metals, pesticides, dioxins, flame retardants such as polybrominated diphenyl ethers (PBDEs), polycyclic aromatic hydrocarbons, and phthalates.
These chemicals adhere to dust particles and blow into your household after being stirred up by traffic, are released from your sofa or appliances as they degrade over time, are deposited from disintegrating home building materials, and are introduced from cigarette smoking or pesticide applications indoors. Some of the pollutants are known to cause adverse health effects, such as lead and dioxins. Others, including PBDE and phthalates, are not as well understood, although there is emerging evidence that these chemicals cause hormonal changes and may be particularly damaging when exposure happens during pregnancy or childhood.
The trouble arises because people inadvertently swallow small amounts of dust during their normal daily activities like eating, drinking, and breathing. For example, it’s well known that exposure to organochlorines, such as dioxins, comes from the diet – from fatty foods including fish, meat, and dairy. However, we are now learning that a major source of our exposure also comes from ingestion of dust, in amounts that rival dietary exposures. This is an especially important pathway of exposure for small children, who crawl on the floor and explore their environment using hand-to-mouth behavior. House cats also ingest very high amounts of house dust through self-grooming. In fact, studies in the US and Europe have found that house cats had 50 times higher blood levels of PBDEs than people.
Aside from not breathing or swallowing, or fruitlessly trying to change the behaviors of your toddler or pet, what can be done to reduce exposure to pollutants from household dust? The answers are somewhat obvious, but do require vigilance.
1) Avoid introduction of pollutants inside the home where possible, by banning smoking in the home and seeking alternatives to pesticide applications
2) Wipe your feet on a high-quality doormat before entering the home
3) Eliminate wall-to-wall carpeting and shag rugs, which trap dust
4) Vacuum frequently, ideally using a high-powered vacuum cleaner with a dirt finder
5) Wet-mop non-carpeted floor surfaces on a regular basis
6) Wipe down toys and other items your toddler contacts, using a wet cloth
In my review of the literature, I even saw a recommendation to wipe down your cat with a wet cloth on a daily basis (good luck with that!). Nevertheless, it makes good health sense to follow these recommendations, particularly during pregnancy or with toddlers in the home. At the very least, you will have a cleaner home to show for it.
- Wipe the Cat with a Damp Cloth and other Healthy Home Tips (newsblog.drexel.edu)
- Exposure to TDCPP Appears Widespread (ehp.niehs.nih.gov)
- Human Exposure Assessment of Indoor Dust: Importance of Particle Size and Spatial Position (ehp.niehs.nih.gov)
- Flame retardants, found in many consumer products, ignite health concerns (bangordailynews.com)
- Diesel Exhaust Particles Induce Cysteine Oxidation and S-Glutathionylation in House Dust Mite Induced Murine Asthma (plosone.org)
- You Are a Guinea Pig: Americans Exposed to Biohazards in Great Uncontrolled Experiment (nakedcapitalism.com)
- The Dark Side of New Car Smell (healthyhomemagazine.com)
- Workplace Wellness (newsblog.drexel.edu)
- Public Health Wednesdays: Racism as a Public Health Issue. (mkhanaintransit.wordpress.com)
- National Public Health Week! (fimrcblog.com)
With the school system failing them, many children are turning to drugs. Heard this one before, right? Well, how about the part where the pusher is your pediatrician, and the fed is subsidizing?
“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
A recent NYT article spot lighted increasing psych diagnoses in children for the purpose of acquiring “brain boosting” pharma creations to increase academic performance. The purpose is to make a child more competitive on a college application, and increase funding for a school district as test scores rise. Children are being force-fed drugs instead of given the attention they need or the freedom to be creative and learn discipline on their own as pharmaceutical “solutions” are abused as steroids for the brain. Worse yet, the behavior is sanctioned by those in authority, who are supposed to advocate for their well-being–their parents, doctors and the federal government…
Education is a highly competitive arena, whether it’s a student vying for a scholarship or admission to their college of choice, or a district teaching to standardized test scores and praying for funding. The Obama administration’s lauded “Race to the Top” initiative even goes so far as making funding an actual competition–schools submit innovative proposals for education reform in an effort to win federal money.
An anonymous California superintendent pontificated that “diagnosis rates of A.D.H.D. have risen as sharply as school funding has declined.” Poor children are being prescribed stimulants at increasing rates, and Medicare is paying the bill. If we are not directly funding public education in this country, we are indirectly doing so in efforts to respond to the problem….
- Athletes and Drug Abuse (ajochum23.wordpress.com)
- Prescription Drug Misuse and Abuse by Teens Up 33 Percent, According… (prweb.com)
- Prescription Drug Abuse: Top 10 Things CDC Says You Should Know (pbs.org)
From the 4 March 2013 article
NEW YORK – The palliative care team at Mount Sinai Hospital gathers on a Thursday morning to exchange the latest information on the patients in their ward. It is a raw, unforgiving day outside, but the weather, the news, most everything beyond these walls are concerns that patients on this ward do not have the luxury to worry about. Theirs is a shrunken world measured in degrees of pain, blood pressure, heart rate, and a set of poor options – none of which any healthy person would welcome.
The simplest definition for palliative care is that it is treatment designed to reduce the pain, discomfort and stress associated with a serious disease. But it also entails eliciting from patients and families in dire circumstances their priorities and wishes to make sure the treatment conforms to those desires.
New York State felt so strongly about the importance of palliative care that last year it enacted pioneering legislation to make certain all those with advanced illnesses had access to this sort of treatment. Now other states are considering following New York’s lead.
Around the oval conference table sit two palliative care doctors, three palliative care nurses, a social worker, an art therapist and a chaplain, who, in this case, is a rabbi. Other nurses enter the room one-by-one to give updates on the patients they are tending to.
The unit is much quieter than most acute-care wards, with far less clattering and beeping medical machinery in order to keep the unit as serene as possible. Occupying one of the 13 beds in the unit today is a 28-year old Brooklyn man with liver failure. Death is imminent, one of the doctors, Stephen Berns, says. Days if not hours. Although the man’s pain can be addressed, his elderly grandparents worry that he will die before their parish priest arrives to perform a baptism. The rabbi, Edie Meyerson, tells the group that she has researched the issue and learned that any Christian can perform a baptism, if it should come to that.
A few doors down lies a 77-year old woman, a one-time deputy superintendent in the state’s corrections system. Her breast cancer has metastasized throughout her body and now all her organs are blinking off. Her closest relatives — two cousins and a niece, the latter her health proxy, have asked that she be removed from the ventilator that appears to be all that is keeping her alive. “We know this is not what she would want,” her cousin says later that day. “She would not want to be on all these machines.”
Then there is a 48-year old man from Puerto Rico with an inoperable tumor in his throat. His face is swollen to such an extent that he can’t open his eyes and his lips have ballooned into protuberances. He has found that even with painkillers, the only tolerable position is to sit cross-legged on his bed, leaning forward with his head cushioned on a pile of pillows. The team wants to start him on steroids to reduce the swelling, but the patient is already hinting that he has had enough.
Advanced Life Limiting Conditions
Not Enough Doctors
- One palliative care doctor for every 1,300 patients with a serious illness in the U.S.
- One oncologist for every 145 patients with a new cancer diagnosis
- One cardiologist for every 71 heart attack victims
- The American Academy of Hospice and Palliative Medicine Workforce Task Force estimates that there is shortage of as many as 18,000 palliative care doctors in the U.S.
Source: Center to Advance Palliative Care.
The cast of characters on the ward today is not atypical. Statistically, most patients on the ward will die here; a minority will improve enough to enable them to depart, usually to their homes, a nursing home or other health care facility. For all of them, the goal of the staff is to provide care that best accords with their wishes, whether that be an end to life-prolonging efforts, relief from the symptoms that are afflicting them, or some combination of the two.
The New York law passed last year ensures that everyone in the state with “advanced life limiting conditions or illnesses who might benefit from palliative care” not only be informed of these services by their healthcare provider but that the provider facilitate access to that care if they desire it. Violations are subject to fines of up to $10,000 and a prison term of up to a year. (According to the state health department, no one has yet been charged or prosecuted under the law.)
“That was a major step,” says Amber Jones, a consultant on palliative care in New York. “It shone a light on the need patients and families have for information.”
This year, legislatures in several other states are considering their own palliative care legislation at least partly modeled after the New York law. Those states include Rhode Island, New Hampshire, Connecticut, Vermont, Massachusetts, Arkansas and Michigan.
Even as legislation advances, there remains widespread confusion about what palliative care is. “There is a misunderstanding among the public that palliative care means end of life care,” says Jay Horton, director of the Palliative Care Consult Service at the Lilian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai. “Many clinicians have the same view.” But the view is not accurate.
Palliative care provides an added layer of support for seriously ill persons and their families. It is delivered alongside all other disease treatments, in an effort to ease the suffering caused by both the disease and its treatment. Palliative care is always part of the treatment for someone in hospice care, that is, someone with a short prognosis who wants to forego further disease intervention.
But palliative care is also appropriate for many others with serious or chronic illnesses, such as leukemia, lymphoma (which is cured in a significant number of patients), heart failure, emphysema, renal failure, and dementia (with which people can live for years.) One common misconception about palliative care is that it is mutually exclusive with treatment for the underlying disease, that it only comes into play when all hope of cure is gone. That is not the case. “Just because you are undergoing palliative care doesn’t mean you are giving up on other treatment,” Horton says.
Practitioners are quick to point out that palliative care, as it is practiced today, entails far more than the relieving of symptoms….
- New York takes the lead on palliative care (sacbee.com)
- Doctors on Call: Prognosis doesn’t matter with palliative care (jacksonville.com)
- National Hospice and Palliative Care Organization Promotes Recommendations Released by Choosing Wisely Campaign (paramuspost.com)
- Nursing: Palliative Care Of AIDS Patients (expertscolumn.com)
- Involving other providers in palliative care may help meet growing demand (eurekalert.org)
- The Growing Demand For Palliative Care Could Be Met By Involving Other Providers (medicalnewstoday.com)
- Palliative Care and the Patient Experience (thielst.typepad.com)
- Palliative care in all wards in Thiruvananthapuram by March (thehindu.com)
Trivia is awesome, especially when the questions are "a little out there." Today's trivia quiz is based on ridiculous dental facts. If you answer all of these correctly, you're a dental genius!
1) In what setting was the first commercial toothbrush (similar to what we use today) invented?
2) What is the number one cause of tooth loss in people under the age of 35?
- Tooth Loss Due To Periodontal Disease More Likely In Postmenopausal Women Who Smoked (medicalnewstoday.com)
- Global Study Suggests Dental Health Could Someday Be A Useful Risk Marker For Heart Disease (medicalnewstoday.com)
- Tooth Decay and Periodontal Disease (expertscolumn.com)
- Dental disease linked to halitosis (sfgate.com)
- Periodontal Disease Treatment (dentalimplantsmexico.wordpress.com)
- Study Confirms Link Between Periodontitis and Diabetes (ultimatesmileftl.com)
A very interesting use of crowdsourcing for medical research.
Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.
Using automated software tools to examine queries by six million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholesterol lowering drug, pravastatin.
- Unreported Side Effects of Drugs Are Found Using Internet Search Data (secretsofthefed.com)
- Unreported Drug Side Effects Discovered by Analysis of Google Big Data (labsoftnews.typepad.com)
- Google Search As A Tool To Identify Unreported Drug Side Effects (drx.typepad.com)
- Web searches uncover hidden drug dangers (newscientist.com)
- Ramblings: Big Data or Clinical Trials or both? (binaryhealthcare.wordpress.com)
- Search Engines May Be More Able To Do The FDA's Job Than The FDA (huffingtonpost.com)
- Should You Mix Those Two Drugs? Ask Dr. Google (news.sciencemag.org)
When a person is approaching the end of life, we can find no easy answers, no solution that fits every person's or family's situation, even when they know a lot about the options available to them.
- Reports Show Hospice Saves Medicare Dollars (krextv.com)
- payment cuts and hospice (hospicesupport.wordpress.com)
- $300,000 for Hospice NZ to help improve care (national.org.nz)
- GUEST OPINION: Get acquainted with the value of hospice (tauntongazette.com)
- Hallmark, Where Are The Hospice Cards? (forbes.com)
Doing yoga is way more than just an excuse to buy expensive leggings. Aside from improving fitness and flexibility, yoga has been used to treat many ailments including depression, arthritis, anxiety, asthma, type II diabetes, fatigue, chronic pain, IBS, and sleep disruptions. Recent research suggests that hatha yoga can also play a role in reducing risk for diabetes and cardiovascular disease. So how might twisting yourself into a pretzel lower your risk for two prominent chronic diseases?
You are probably familiar with acute inflammation if you have ever had an infection or sprained ankle. Swelling and pain are an effective way for our bodies to let us know that something is wrong. Chronic systemic inflammation, however, is not so apparent. It can persist undetected at a low level for years as it slowly damages body tissue while elevating risk for type II diabetes, atherosclerosis, cardiovascular disease, and age-related diseases.
Systemic inflammation is mediated by numerous chemicals inside the body. Two such chemicals are Leptin and adiponectin. These hormones are made in the adipose tissue and have recently been recognized to have a ….
Yoga’s Effect on Inflammation
In 2012, Kiecolt-Glaser et. al. present in their paper Adiponectin, leptin, and yoga practice that “expert” hatha yoga practitioners have significantly different levels of leptin and adiponectin when compared to “novice” practitioners. Specifically, experts are shown to have 28% higher blood level adiponectin and a leptin concentration 26% lower than that of novices. Furthermore, the experts’ average adiponectin to leptin ratios were nearly twice that of the novices. Given that leptin and adiponectin are correlated with C-reactive protein, a potent marker of inflammation, this means that those who do more yoga seem to have lower systemic inflammation….
A 2008 study by the Yoga Journal found that 6.9% of U.S. adults, or 15.8 million people, practice yoga and that 4.1% of non-practitioners, or about 9.4 million people, say they are hoping to try yoga within the next year. On this scale, if regular yoga practice can reduce systemic inflammation in healthy adult women, this is definitely an area worth further research!
- Chronic Inflammation: Could it be making you sad? (mindbodymovement.org)
- ‘Healthier hormones’ through diet and exercise (eurekalert.org)
- Hatha Yoga (dominicspoweryoga.com)
- Therapeutic Targets Found To Alter Inflammation, Type 2 Diabetes (medicalnewstoday.com)
- Mechanisms regulating inflammation associated with type 2 diabetes, cancer identified (medicalxpress.com)
- The Science That Proves You Are What You Eat (talesfromthelou.wordpress.com)
- Systemic Inflammation in Progressive Multiple Sclerosis Involves Follicular T-Helper, Th17- and Activated B-Cells and Correlates with Progression (plosone.org)
From the 20 March 2013 post at Science Roll
I was very glad to see the new book authored by e-Patient Dave deBronkart, whose thoughts I describe to medical students as a part of the official curriculum at Semmelweis Medical School, just became available.
Medical professionals must let patients help and become equal partners in the treatment! A must-read book!
Concise reasons, tips & methods for making patient engagement effective.
Third book by e-Patient Dave, cancer beater, blogger, internationally known keynote speaker and advocate for patient engagement; co-founder and past co-chair of the Society for Participatory Medicine. Profile:
- Let Patients Help: A New Book Authored by e-Patient Dave deBronkart (scienceroll.com)
- Project HealthDesign’s new video series: Conversations with e-PatientDave (projecthealthdesign.typepad.com)
- Part 1: Value of social media in healthcare is already outlined – just not realized (himss.org)
- The Multidimensional Role of Social Media in Healthcare (gumption.typepad.com)
- First Post: A Video About Patients Involvement in Their Own Healthcare (healthitoutlook.wordpress.com)
- The 7 Habits of Highly Patient Centric Providers (forbes.com)
- I’m an e-patient: equipped, enabled, empowered, engaged (worldofdtcmarketing.com)
New Database Reveals Thousands of Hospital Violation Reports New Database Reveals Thousands of Hospital Violation Reports
Hospitals make mistakes, sometimes deadly mistakes. A patient may get the wrong medication or even undergo surgery intended for another person. When errors like these are reported, state and federal officials inspect the hospital in question and file a detailed report.
Now, for the first time, this vital information on the quality and safety of the nation’s hospitals has been made available to the public online.
A new website, www.hospitalinspections.org, includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word. Previously, these reports were filed with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid (CMS), and released only through a Freedom of Information Act request, an arduous, time-consuming process. Even then, the reports were provided in paper format only, making them cumbersome to analyze.
Release of this critical electronic information by CMS is the result of years of advocacy by the Association of Health Care Journalists, with funding from the Ethics and Excellence in Journalism Foundation. The new database makes full inspection reports for acute care hospitals and rural critical access hospitals instantly available to journalists and consumers interested in the quality of their local hospitals.
The database also reveals national trends in hospital errors. For example, key word searches yield the incidence of certain violations across all hospitals. A search on the word “abuse,” for example, yields 862 violations at 204 hospitals since 2011. …
- Series on N.C. hospitals wins national award (charlotteobserver.com)
- Medical execs dispute hospital study (krqe.com)
- Govt. To Publish Data On What Drug & Device Makers Pay To Individual Doctors & Hospitals (consumerist.com)
- Time Magazine Study Reveals Hospitals Hiking up Medical Bills (counselheal.com)