Oral Hygiene Prevents Health Problems

Most of us know that oral hygiene is critical to healthy teeth, white smiles and first impressions. But not nearly as many are familiar with the extreme consequences of what can happen if you don't take care of your mouth.
Most individuals have some inflammation of the gums -- i.e. gingivitis -- that goes unchecked. A study published in the National Library of Medicine reports that 10 to 15 percent of adults will develop severe periodontitis, which is an advanced form of gum disease that begins to deteriorate bone, too.
"Gingivitis has always been a major concern for the public," explains Dr. Harold Katz, a bona fide dentist to the stars, who founded the California Breath Clinic in Beverly Hills. Katz, also a bacteriologist, has a legacy of oral care research, including creating the high-quality line of TheraBreath products (therabreath.com).
"But more studies are emerging that support the idea that dental health can reflect your overall health, too. Gum disease can contribute to an increased risk for heart disease, and it can worsen diabetes. Bad oral hygiene may even be a risk factor for dementia," Katz added.
According to Katz -- as well as mounting medical research -- poor oral hygiene can lead to many physical problems. The Journal of the American Geriatric Society just released a study showing that elderly people who brushed their teeth less than once a day were up to 65 percent more likely to develop dementia, compared to seniors who brushed daily.
Dental check-ups can also point out other areas of concern among pregnant women. A professor at the European Society of Human Reproduction and Embryology's annual meeting suggested that gum disease can affect healthy conception much like obesity. Plus, pregnant women have a 65 to 70 percent chance of experiencing pregnancy gingivitis, where gums develop exaggerated inflammation and plaque buildup due to fluctuating hormones.
Expectant mothers with gum disease even suffer a higher risk of a premature birth. But oral hygiene can work toward prevention, too. Reuters Health just released findings that indicate pregnant women with gingivitis who use mouthwash have more of a chance of carrying their baby to full term.
Another study recently presented to the American Heart Association revealed that patients who received routine teeth cleanings had a 24 percent lower risk of heart attack than those who didn't maintain regular dental care.

Fruit for People with Diabetes

Mrs.Sheela Paul &Ms.Rohini, - DietitiansDiet Department.



 

























People with diabetes should avoid fruits as they contain “a lot of sugar”.This is not true. 

Fruit has been enjoyed by mankind from the very earliest of time. In terms of nutrition, fruits form one of the food groups in the daily diet and are very good sources of several vitamins, minerals, electrolytes and

Kudos to The New York Times Magazine for Examining the "Feel-Good War" on Breast Cancer!

In last week's The New York Times Magazine, Peggy Orenstein wrote an article called "Our Feel-Good War on Breast Cancer".  The piece is lengthy but well researched, insightful, and well worth the reading time.

Peggy, a breast cancer survivor herself, hits every key public health issue- cancer screenings, treatment options, "awareness" raising, message framing, funding, and research.  As someone who has been critical of "awareness" raising, I was happy to see the issue discussed front and center.  For me, her interview with Dr. Gayle Sulik (Sociologist and Founder of the Breast Cancer Consortium) was the most striking.  A key quote from Dr. Sulik (I added the bolding):

“You have to look at the agenda for each program involved.  If the goal is eradication of breast cancer, how close are we to that? Not very close at all. If the agenda is awareness, what is it making us aware of? That breast cancer exists? That it’s important? ‘Awareness’ has become narrowed until it just means ‘visibility.’ And that’s where the movement has failed. That’s where it’s lost its momentum to move further.”

Peggy also tackles the issue that is an ongoing challenge in public health and medicine:  screening.  Screenings are tests that look for diseases before you have symptoms.  Ideally, screening will identify diseases early when they are easier to treat and have better outcomes.  For breast cancer, the key screening test is a mammogram (x-ray of the breasts).  However (as Peggy points out), we seldom hear about the research that demonstrates limited effectiveness of mammograms for reducing cancer death.  This is not the research cited in the communication materials from advocacy organizations.  We also tend not to hear about the negative side effects of screening large segments of the population.  There can be false positive tests: which subject the patient to unnecessary medical intervention and emotional distress.  There can also be over-treatment for the detected cancer, even if it turns out to be a non-aggressive tumor.

When I was working in suicide prevention, one of the best articles I read was "Screening as an Approach for Adolescent Suicide Prevention" by Dr. Juan Pena and Dr. Eric Caine.  The authors dedicate a section of the paper to key decisions and tasks to resolve before implementing a screening program.  While the public health issue and screening tests are different, I believe many of their decision points are generalizable to almost any health issue.  The table presenting these decisions and tasks is a great reminder to public health professionals and clinicians that recommending and undertaking a screening program should be strategic and the decision should be re-visited regularly.  For example, the authors highlight:

• Key Decision:  Population and Setting- Is the screening program consistent with the target population's community or cultural values?
• Key Decision:  Screening Instrument- What will be the false positives and false negatives rates in the population to be screened?  Are these rates acceptable?
• Key Decision:  Staffing and Referral Network- Are there effective treatments available for the types of conditions being screened for?
• Key Decision:  Quality Assurance- How will the screening program be monitored to ensure that protocols are followed?
• Key Decision:  Legal and Ethical Issues- Has sufficient informed consent been given to parents and youth about risks, benefits, and limits of screening?

Going back to the "Feel-Good War" article:  I like that Peggy did not just point out all the flaws in our current breast cancer screening and treatment systems.  Instead, she invited her interviewees to recommend potential improvements.  Some ideas were noted in two key areas:

• Message Re-Framing:  Rather than offering blanket assurances that “mammograms save lives,” advocacy groups might try a more realistic campaign tag line. The researcher Gilbert Welch has suggested this message, “Mammography has both benefits and harms — that’s why it’s a personal decision.”

• Funding Re-Distribution:  Peggy asked scientists and advocates how some of that "awareness" money could be spent differently. She highlights the February recommendations of a Congressional panel (made up of advocates, scientists and government officials) that called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities. 

Tell Me What You Think:

• What do you think about the "pink culture" or awareness raising around breast cancer?  Will it effectively lead us to our goal of prevention?
• In addition to message re-framing and funding re-distribution, what else would you recommend to help improve the approach to breast cancer prevention, screening, and treatment?

"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

• Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.

Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.

• Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.

Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.

• Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".

Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:

• What have been your favorite episodes of "Call the Midwife"?
• What other public health issues are portrayed in the 1950s that still challenge us today?

Social Media: Providing Connections, Voices, Adventures to Many with Chronic Illness

I am in awe of social media.  

I am in awe of it in my professional life.  I have connected with colleagues all over the world who share my passion for public health, health communication, blogging, pop culture- you name it.

I am also in awe of it in my personal life.  As someone who lives with a chronic illness, I have connected with others who suffer from similar symptoms, offer support, advocate for patient rights, and recommend creative solutions to balancing work and life.

In the past month, I have been struck by several examples of how social media is transforming the lives of people with chronic illness.  Without the networks available within social media, many of these people may have been very isolated due to their conditions.

On March 11, 2013 NBC Nightly News with Brian Williams ran a story about Virtual Photo Walks.  The project's tagline is "Walk the walk for those who can't".  Using the social media platform Google+, Virtual Photo Walks enables people to become "interactive citizens" again.  They connect with smart phone enabled photographers to "travel" and see places and people that they used to see...or always wished that they could.  The news story profiled a woman with Lupus who could not travel due to her serious health condition.  She always wanted to go to Italy and with Google+ she did.  We watched World War II veterans no longer able to travel, "visit" the USS Arizona Memorial through the collaboration of photographers and Google +.  It was incredible to watch.    

On April 5, 2013 CNN Tech ran a story called "On Twitter, Roger Ebert Found a New Voice".  The story describes how Roger became an avid twitter user in 2010, years after cancer had silenced his voice.  He wrote, 

"Twitter for me performs the function of a running conversation. For someone who cannot speak, it allows a way to unload my zingers and one-liners".

As someone growing up in the 80's, I regularly watched "Siskel and Ebert and the Movies".  Keeping up with Roger through twitter and his blog "Roger Ebert's Journal" in recent years has been a seamless transition.  I felt like the show never ended.  I kept up with his running commentary and of course- his movie reviews.

Sustaining your presence in the world is important with a chronic illness.  I felt that point strongly when reading his final blog post, "A Leave of Presence".  

"What in the world is a leave of presence?  It means I am not going away".  

Please Share:

• What creative ways do you see social media being used to support those with chronic (or acute) illnesses?
• Why do you think these communication channels are so effective in "sustaining your presence"?

Writing Public Health Blogs: Do We Get Back What We Put In?

Last week I attended a great webinar hosted by AcademyHealth called: “Traditional and New Methods for Disseminating What Works”.  One of the speakers was Dr. David Kindig and he touched on the evaluation component of writing a public health blog- do we get back what we put in?  As the tweet below indicates, this is an important question for all of our blogs.

My exploration of this question nicely coincides with the theme for this week’s National Public Health Week- “Return on Investment”.  I was initially going to write just my own thoughts, but then decided it would be a much richer piece if I could incorporate input from other public health bloggers.  The following colleagues were kind enough to send me their thoughts:

Jim Garrow: The Face of the Matter, Public Health Memes

Elana Premack Sandler: Promoting Hope, Preventing Suicide for Psychology Today

Jonathan Purtle: The Public's Health for the Philadelphia Inquirer

Michael Siegel: The Rest of the Story: Tobacco News Analysis and Commentary

Thomy Tonia: International Journal of Public Health-Blog 

1. How much time do you dedicate to your blog per day/week/month?

Jim: I wish I could post more blogs per week; right now I'm averaging about a post a week (sometimes it'll be 3-4 posts in a week, sometimes no posts for a few weeks in a row). Each post takes about an hour between research, linking and writing. And I've got to be constantly on the lookout for new and time-relevant material.

Elana: When I was writing weekly, I spent 3-5 hours a week researching, writing, editing, and posting (using the content management software, sometimes the hardest part!). I have a background in journalism, so I'm able to write and self-edit relatively quickly. Now that I'm posting only once a month, I probably spend 5-7 hours a month between culling through stories of interest, thinking about the relevance of various topics, writing, editing, and posting. It's actually more challenging to post only once a month, as I get out of practice and have more material to comb through to see what rises to the top.

Jonathan: On average, a 500-750 word post takes me 4-5 hours. I currently post twice a month. I used to post weekly, but the time burden was too much. 

Michael: Approximately one hour per day, mostly devoted to writing my daily posts.

Thomy: I blog as part of my job as an Editorial Assistant/ Social Media Editor for the International Journal of Public Health. When I was focused only on the blog, I dedicated about 4 hours per week (divided between blogging and visiting other blogs/public health sites- to get ideas, keep informed and interact). Since I now also manage the twitter and Facebook accounts, I have reduced my blog time to 2-3 hours per week. 

Leah: I spend about 5 hours on each blog post- between finding the story, writing, and marketing the posts on social media. Since I try to address topics that are hot in the news that week or that day (like Jim says above), I'm constantly on the lookout for relevant stories.  Throughout the week I save all my possible stories/links/ideas on a spreadsheet and pick the best one.  While my posting frequency has varied over the past three years of writing Pop Health, my goal is to post at least once per week.

2. Who is the audience for your blog?

Jim: The blogs that I write are written for professionals in the fields of public health and emergency management. My thought is that I can affect more change by finding and teaching best practices to the people on the ground actually working with the public.

Elana: My blog is read by mental health and public health professionals as well as laypeople interested in psychology, mental health, pop culture, and suicide prevention. Since I blog on a site that does a lot of promotion for itself, I have a relatively wide readership. Each post can generate 500-2000 hits; I haven't done any real numbers-running, but 100-300 hits on the day the post is published is probably average, and then each post accrues hits over time.

Jonathan: The general public in Philadelphia and surrounding areas. Given the size of the health care sector in the region, I like to think health professionals read it as well. I also dream that policy makers read it—although I’m not sure if either health professionals or policy makers read Philly.com.

Michael: Incredibly diverse audience of anti-smoking advocates, groups, and researchers, smokers’ rights advocates, government agencies, tobacco companies, newspaper reporters, stock market analysts, consumers, trade groups, and policy makers.

Thomy: Originally, our intended audience was mainly public health students, as we are affiliated with the Swiss School of Public Health. However, especially through social media, our audience seems to be not only public health students and professionals but also people who just have an interest in public health. Nevertheless, it is not easy to know exactly who our audience is, as we do not get a lot of comments and it is difficult to know who actually reads the blog. We try to engage people to write guest posts for us. This generally works quite well.

Leah: I write for a broad public audience with an interest in public health, pop culture, or both. Therefore, I use it as a platform to breakdown and explain public health/communication concepts (e.g., "teachable moments"; "cue to action"). From the analytics, emails, and comments that I receive, I know that I have a large following among public health professionals, students, and teachers.  I have heard from more than one faculty member to say that they use my blog with their students to demonstrate the connection between public health and their everyday lives (e.g., movies, magazines, advertising).

3. What is the ideal “return/s on investment” for your blogging efforts? 

Jim: I've been writing blogs relevant to public health and emergencies for more than six years. I've found it to be one of the best investments I've made in my career, even with the huge investment in time and effort required for success.  I've found that the best return I've realized is my network of contacts and friends across the country and around the world; none of whom I would've met without being available and "out there" online.

Elana: For me, the ideal return on investment is reader engagement. I really get a lot out of seeing reader comments (the good and the not-so-good) and corresponding with readers via the comments section, or with friends and more personal connections on Facebook when I promote my posts there.

Jonathan: The ideal return is three-fold: (1) A public which understands that health is about more than just individual choices. A public which begins to see the reverberating impacts of social/economic policies, beyond the health care sector, on people’s health. A public which is knowledgeable about trauma theory and research on trauma/stress. (2) Networking. (3) Increased readership. While this is the most measurable, I’m not convinced it means all that much. Who’s reading? How are they reading? How is the information changing their perceptions? Is it at all? We have no idea.

Michael: The ideal “return on investment” is the blog having an actual impact on public policy.

Thomy: Increasing readership and dissemination of ideas is always a good return. We would ideally like to have more engagement in the form of interaction (e.g., comments). Networking is also quite satisfying and really helps broaden our blogging horizons. As a public health journal, we are also interested in disseminating our research articles.  I personally would like to see more and more public health students, researchers and professionals having blogs and engaging in social media to learn new things, disseminate their knowledge, “meet” interesting people and also –why not- for the fun of it!

Leah: Pop Health began as a hobby that just happened to incorporate my field of public health.  Now it has become a key part of my professional portfolio.  Therefore, the key returns are now different than three years ago.  Now, I'm looking for increased readership and referrals to my site.  I'm looking for increased dialogue with readers and colleagues.  I'm also looking for new and exciting professional opportunities (e.g., guest blogging, writing, and teaching) that can emerge by branding my expertise in this niche of public health.

4. Do you measure these “returns”?  If so- how?

Jim: I've seen a tremendous benefit professionally. As a direct result of my online identity and interactions, I've been invited to more than a dozen international, national and regional conferences to speak on those topics I blog about.  But even beyond those personal returns, I've seen a tremendous benefit professionally. Not only am I able to call on friends I've made around the globe to help with ideas for work, but I've grown as a result of being forced to flesh out my ideas. When I write about something, I want it to be well thought-out and considered. By writing these ideas out, I am forced to consider not only my idea, but how it affects other, larger problems...Without writing it out, I would just have a nugget of an idea, no more than that.

Elana: I measure this ROI very unscientifically. I notice which topics generate more interest (both in terms of hits, which are tracked by Psychology Today, and comments) either on the Psychology Today site or on Facebook. I've wanted to get more sophisticated with Google Analytics, but can't do that as I don't actually manage the website that hosts my blog. I've also enjoyed meeting people at professional conferences who recognized my name because of my blog. That really blew me away - it meant that I was really reaching people (not just my Mom!).

Jonathan: Philly.com tracks usage statistics and sends them to us on a weekly basis. Posts on animals, kids, and pop culture typically do the best.

Michael: Yes, but not formally. I assess the actions of public health agencies and organizations to determine whether the blog seems to be changing their thinking about these issues. I also assess the state of public opinion in the field regarding these issues.

Thomy: We keep track of visitors, time spent on blog (etc.) via Google Analytics and StatCounter. We also monitor the most popular posts and try to have some ongoing themes corresponding to these popular posts.  Regarding the “return on investment” to the Journal, we are trying to monitor whether articles that have been featured in the blog are downloaded more often from our website.

Leah: I have used Google Analytics and Blogger Statistics for measurements like page views, referring sites, and key words used to find Pop Health. I also take note of the posts that stimulate more engagement with readers- I would note that more dialogue seems to take place directly on social media where I market the posts (i.e., Facebook & Twitter) vs. the comment section on the blog itself.  As a result of the blog, I have also been invited to guest write on other sites like The Public's Health- so tracking those opportunities helps me to measure return on investment as well.

Evaluation and Return on Investment are key concepts in public health

With public health professionals constantly being asked to do more with less, it is imperative that we show how our investments are paying off. It is important to think of "investments" broadly- they are not just money...they are our time too.  As you can see from the responses to question #1, creating and maintaining a blog is a huge commitment.  And although we write for a variety of audiences with different goals (ranging from promoting research to trying to impact policy), we share the challenge of trying to evaluate those goals.

Therefore, we need to lead ongoing dialogue about the goals and evaluation of public health blogs. CDC's National Prevention Information Network (NPIN) is continuing its "In the Know: Social Media for Public Health" webcasts this spring and the June 4, 2013 event will focus on Measurement & Evaluation.  I look forward to continuing this discussion there and elsewhere.

Thank you again to Jim, Elana, Jonathan, Michael, and Thomy for your contributions!  I appreciate you making the time and sharing your experiences.

I would like to invite other public health bloggers to weigh in on these questions:  

• How much time do you dedicate to your blog per day/week/month?
• Who is the audience for your blog?
• What is the ideal “return/s on investment” for your blogging efforts? 
• Do you measure these “returns”?  If so- how?

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder