Saturday, September 17, 2011

Drug Poisoning in Children on the Rise

A recent study published in the Journal of Pediatrics blames greater availability of prescription medications in the household for a rise of accidental drug poisonings in children. The large majority of these accidents which lead to serious poisonings, hospitalizations and even death are from young children finding and ingesting drugs by themselves. Failure to poison-proof a household may play a role. The larger problem is simply the increased use and availability of prescription medications including pain medications, narcotics, sedatives for sleep, muscle relaxants for injury and cardiovascular prescriptions. Dosing mistakes for pediatric patients account for only a very small portion of the problem. Past emphasis by FDA and other professionals has minimized therapeutic mistakes and does not account for the rise of serious drug poisoning in children. The offending medications are often not even drugs that are commonly used for children.

The most recent surveys show that 55% of adults have taken a prescription medication within the last week and 11% have taken five or more prescription drugs within the preceding week. The use of over-the-counter medications such as common anti-inflammatory products and acetaminophen has increased and created more prevalence in the home. However the largest increase in poisonings remains from prescription medications. Therefore there are more adult medications around that are toxic to toddlers and young children. Medications of seniors or grandparents were estimated to be involved in these accidents only 10 to 20% of the time. These products are often stored in containers or pill reminders that are not child resistant. The rise of more serious admissions for accidental poisonings and the types of drugs ingested, point to the greater availability of medications in the child’s environment, without adequate precautions for protected access.  

Some experts believe there are limitations to education about prevention and poison-proofing the home for toddlers and young children. The consensus among experts in behavior is that the best efforts in childproofing will result in prevention 90% of the time. Even that would be improvement over the status quo. The typical pattern for accidental ingestion is during the period of time that the medications are in use by an adult. They are probably left out for convenience without recognizing the hazard they present to a curious young child. Medication in locked cabinets is generally considered inconvenient which limits the accessibility especially when needed two or three times a day. The recent information sheds light on the prevalence of prescription medications in a household and the serious risks of self ingestion by children. Some experts have suggested new types of packaging that would restrict the access to medication by limiting the amount. This means flow restrictors for liquid medications and containers that would dispense only one tablet at a time. Such changes would have to be applied to both adult and pediatric products to have any beneficial effect.

Renewed education for all consumers about where the risks are that may be overlooked is an important first step. More thoughtful storage and access to prescription medications is necessary to restrict access to young children. In general the situation gives one reason to pause and consider society’s overall increased use of powerful medications such as opiates and sedatives which have clearly been on the rise. In turn, it has indirectly increased the risks to our children. Preventive measures need to take steps to decrease the immediate risks while evaluating the larger picture of a society that emphasizes appropriate use of therapeutic prescription drugs.

Wednesday, September 7, 2011

Food Storage Tips

Seventy to eighty million people a year in the United States get food poisoning resulting in over 100,000 hospitalizations and numerous deaths. Only 20% are attributed to restaurants and food workers. Many cases are somewhat self-inflicted by poor handling and storage of food in the home. Whether it is summer picnics, cookouts or holiday dinner season, proper food handling and storage is critical to keeping your family safe and enjoying your celebrations with food.

Handling your food properly as soon as purchased means prompt and proper storage until it is ready for consumption. Raw meat products are a common source where it is important to avoid cross contamination with other products. Separate clean packaging in plastic until it can be promptly refrigerated or frozen is important in avoiding the spread and proliferation of harmful bacteria. Effective refrigerator temperature is 40 degrees Fahrenheit and freezers at 0 degrees to ensure safe storage. Carefully store meats in clean leak-proof bag, double wrapped tightly with suitable freezer wrap or plastic. Storing on the bottom shelf of the refrigerator will avoid possible dripping on other foods. Fresh meats or fish should be consumed within 1-3 days. Five days can still be satisfactory for some whole products such as a roast or chops. On average, frozen meat products should be consumed within six months, sooner for products like ground beef. Some whole roasts can be safely frozen for up to 10-12 months. Even if safe, this pushes the limits of food product integrity. Monitor the temperatures in your refrigerator and freezer to ensure no temperature fluctuations are occurring due to mechanical malfunctions or weather conditions.

Check use-by or sell-by dates on food packages. Remember, these dates do not apply once the package is open even if restored properly. Best-if-used-by dates provide the most reliable information. They take into account normal handling and use of the product. Any package new or leftover can get lost in the refrigerator. You cannot safely judge a food product by the appearance, smell or taste. If in doubt, please throw it out! It is not worth the risk of consuming tainted food. Condiments often remain open in the refrigerator for long periods and are easily forgotten. Storage of condiments on the door is a suitable location in the refrigerator by design. Even the few acidic condiments that may be safe for longer will lose integrity of quality and taste; they still should be replaced after two months. Fresh eggs should always be stored in a protective carton in a more consistently cool area. Do not store on the door where they are subject to temperature fluctuations and breakage. Fresh produce should be stored in perforated bags that allow air circulation and evaporation of moisture. Do not wash them before storage. The moisture will speed decay and decrease shelf life dramatically. Except for selected items like a hard aged salami or cheese that contain natural mold that can be trimmed or even safely consumed, moldy or questionably appearing products should be discarded.

Cleaning the refrigerator/freezer more regularly is important to avoid excess build up of bacteria. Clean spills as soon as they occur with a weak cleaning solution that will sanitize. Bananas, potatoes and onions should be stored in a cool dry place, not refrigerated. Store leftovers of any kind, in a clean airtight container. Food you prepare should be refrigerated within 2 hours after cooking to avoid spoilage and development of excess bacteria.


Enjoy cooking and family celebrations but stay safe. Remember when in doubt throw it out!

Sunday, August 14, 2011

How to Tame Stress in the Workplace

For years incivility in the workplace has grown to worrisome proportions. The large majority of workers have fallen victim to rudeness and increased stress on the job. The impact on the business and individuals is measurable with potentially devastating economic and personal loss. It is widely accepted that it is linked to broader changes in our culture. The source of the rudeness was more commonly coworkers rather than clients. There are ways to encourage trust and respect in professional relationships at every level.

The definition of incivility is rude behavior lacking respect or politeness. We have long understood that cooperation is necessary in any relationship whether personal, professional, or family. All these relationships are built on trust and respect. Civility is simply how people work and live together cooperatively. Some would say that it has been key to the strength of our culture cutting across social class, economics and other forms of bias. Research shows that incivility occurs very frequently in the workplace. Low level negative behavior can be childish requests or accusations about lack of knowledge. More intense actions such as being left out of a key meeting, having your credibility undermined in front of others or extra work assigned because of inaction by others, even yelling or shouting are not uncommon. Unfortunately these behaviors are much more common than any violence in the workplace, yet can be very devastating.

How does this affect workers? The stress created in the workplace profoundly affects the overall productivity of any business and the health of individual workers. Increasing demands of the economy and technology have created increased productivity with less people. However the stress on the individual worker has increased. Most companies have overlooked the value and importance of professional civility. Much of the negative behavior occurs without organizational awareness. Some companies may even feel they don't have time "to be nice". The reality is they cannot afford to ignore effective communication cultivating professional relationships among their staff. The effects of stress on personal health have been widely accepted for over 50 years. The more stress a person experiences the more likely they are to get sick. The vulnerability to illness can last for a couple years after the stress has past. The unhealthy effects pertain to infectious diseases, chronic illness including mental and emotional side effects.

A model of workers who are valued for their effort and information yields greater productivity. When there is proper training in the specifics of the job, effective respectful communication, and encouraging value of all team members, the workplace is more comfortable and accomplishes more. Although people need to be compensated fairly the most common reason people leave a job is because of lack of respect and inappropriate treatment. With a better working atmosphere there is less turnover of staff and greater loyalty to the organization and its mission. Cultivating a professional atmosphere means trust that your coworkers are doing their best. Look for the strengths in each other and compliment those traits. Have and expect a clear process for communication and feedback available to everyone that is done in a manner with respect for all team members. No one person can accomplish the mission without the contributions of all the team members. Recognize someone for their help and support. Appreciation and validating the individual remains a very strong motivator at home or work. With a little help from our friends, we can lead healthy, happy, more productive lives.

Monday, August 1, 2011

Paid Sick Leave

Four in every ten workers have no paid sick leave. This single phenomenon has a major impact on public health. The Center for Disease Control (CDC) has identified paid sick leave as one of the three most important ways to reduce the spread of illness in the community along with hand washing and proper food handling. Paid time off from work allows an individual to seek medical attention, recover from injury or illness faster, and tend to a sick child or adult family member without threatening family economic security.

Paid sick leave promotes better public health by eliminating the spread of illness when sick workers are on the job. They are clearly less productive, make more mistakes and are incapable of sustaining high quality services. Research shows that illness is frequently spread by contact in the workplace from worker to worker throughout all industries. This is particularly poignant in service industries in particular food services where both workers and customers are at risk. One in six Americans get food related illnesses resulting in 125,000 hospitalizations and 3,000 deaths each year. At least 20% of these cases are traced back to a sick food worker.

Most people who do not have paid sick leave are in lower paid or part-time jobs where no benefits are provided. The short-term economic impact of time-loss from the job makes people come to work when they are sick. They cannot afford to take care of a sick child or get them to a health care provider. Children are more likely go to school sick creating additional negative health impacts in the community. There is an economic and social impact on family income, child's education and school performance. The CDC recommends keeping children home for 24 hours after a fever subsides in order to limit the spread of disease and allow adequate time for recovery. Research confirms that sick children improve faster with a parent present. Adults recover faster when they are able to get access to health care and adequate rest. Return to work in less time and lives that are more productive are the dividends.

Paid sick leave changes the dynamic in important ways. It promotes public health decreasing the spread of illness keeping workers and businesses healthy. The return on investment by any metric is a positive economic and social benefit that far outweighs the alternative. Three municipalities have passed mandatory sick leave standards including San Francisco, Milwaukee, and District of Columbia. After several years experience with minimum sick leave standards in place, two thirds of employers support them and tens of thousands of workers have benefited. Job growth has been enhanced in these same markets by having these benefit standards in place. National data shows workers who do have a sick leave benefit accrue on average 9 days a year, but only use 2 to 3 days a year. Fear that abuse of a sick leave benefit is simply unfounded. Companies that provide paid sick leave report higher morale, greater productivity and fewer employees who actually come to work sick.

The lack of paid sick leave is a serious public health problem with many economic and social implications. There are many existing models for sick leave and its associated benefits. Policies that promote a better balance between work and personal health result in better employee morale, less turnover and improved public health.

Update: Head Injuries Revisited

Head injuries in athletes resulting in concussions occur more frequently than previously thought.  We are learning more about the problem and the important consequences. Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury (TBI).  High school athletes comprise 60,000 of these injuries. The consequences vary a great deal but can be physical, emotional and intellectual.

TBI can result in short term symptoms as well as problems that are more serious which may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual and personality traits of the injured person. The more blows to the head that occur, even small ones, increase the risk of for mental deficits. Significant head trauma to a football player occurs hundreds of times a week during practice and game experience. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A 2000 study surveyed 1,090 former N.F.L. players and found more than 60 percent had suffered at least one concussion in their careers and 26 percent had three or more. Those who had concussions reported more problems with memory, concentration, speech impediments, headaches and other neurological problems than those who had not, the survey found. Considering these professional players spent many years coming up through the ranks as amateurs, the frequency of head trauma is likely under-reported. Other common problems are being discovered as we examine this challenge more closely. Depression, insomnia, attention deficit, personality changes occur more frequently among those who had even a single episode of head trauma. Long-term problems may take eight years or more to develop and become evident.

Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits on exam regardless of how quickly they subside on the sidelines. It is widely accepted that symptoms of a concussion can reappear hours or days after the injury, indicating that the player had not healed from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur. This is challenging and unclear how much time is enough. A health care provider should be involved in examining and investigating these head injuries to insure the best outcome. Even one episode of head trauma makes the athlete at risk for serious consequences and more vulnerable for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. Reducing the numerous head blows by enforcing more practices where there is no contact. Research has shown the number of head blows during a college football season totals in the thousands to an individual player.  Many of these have forces comparable to driving a car into a concrete wall at 40 miles per hour. Teaching better techniques to reduce the head leading contact and providing better equipment can reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to preserve and protect athletes of all ages. A concussion is a complicated problem that needs thorough initial evaluation. Seek medical attention for head injures even if they seem mild and no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early and be the reassuring basis for ongoing treatment.

Monday, July 18, 2011

Extreme Heat Injury Prevention

When sustained heat waves hit a region, heat related injury and health ramifications can be serious, including sunstroke and even major organ damage due to heat.
According to the Center for Disease Control, extreme heat is blamed for 700 deaths each year in the U.S. They tend to happen in small epidemics when we are confronted with heat waves as we are experiencing this time of year. Some experts predict this may be more commonplace due to overall global climate changes. Heat exhaustion is a relatively common reaction to severe heat and includes symptoms such as dizziness, headache and fainting. If left untreated, it can progress to Heat stroke. When severe, it requires medical attention. The severe form manifests when someone can no longer cool their body after profuse sweating leading to dry skin, a body temperature above 103 degrees Fahrenheit, heat rash, muscle cramps, confusion and sometimes unconsciousness. Profoundly dangerous effects to the central nervous system and circulation can happen quickly when warning signs are ignored.

Humans cope with heat by expelling some heat through their breath and perspiring. The evaporation of moisture off the surface of our skin dissipates the internal heat. High humidity makes this very difficult. The cooling effect is seriously impaired. The published Heat Index estimates how it feels and how much the humidity can increase the effect of a given temperature, which can be 15 degrees or more when humidity is high. Urban areas are known to be “islands of heat”. The vast amount of concrete and asphalt absorbs and radiates the heat to a great extent. The increase density of people and heat producing machinery put urban dwellers at much greater risk than their rural counterparts. This is particularly dangerous when a heat wave lasts more than two days. The nights do not cool down due to the stored heat and people do not get a break from the prolonged heat. More urban heat related deaths occur at night.

Who is affected most? Elderly, the very young, people with chronic illness are most vulnerable. Some medications may make people more sensitive to the heat (diuretics, beta blockers, mental health meds) Discuss your concerns with your physician to see if any special precautions are recommended. But even healthy people who have to work or exercise in extreme heat are subject to dangerous effects.

The single most helpful thing you can do in extreme heat is spend several hours a day in air conditioning. If you do not have air conditioning, plan to spend time with someone who does. Many public buildings are available that have climate control such as libraries, schools, shopping malls, coffee shops. Fans do help with the evaporation/cooling process. They can also be more detrimental when simply blowing more hot air around. It can be comparable to a convection oven, magnifying the bad effects of the heat. During periods of extreme heat stay indoors and avoid direct sun. Slow down and avoid strenuous activities.

Even healthy well conditioned athletes are vulnerable to dangerous effects of heat. If you have to work outside you need a plan. Wear loose fitting, lightweight, light colored clothing. Use a wide brimmed hat to protect the head and face. Drink plenty of fluids. Water is the best. Alcohol and caffeinated beverages should be avoided as they can make things worse. Eat light food in smaller amounts but more often. Take frequent breaks to get out of the direct sun and catch up on fluids. A buddy system is a great idea. If you work alone you may not notice the beginning effects that can cloud your judgment. Partners can help keep an eye on each other. A buddy system is also a great idea for elderly or those who live alone and may need assistance. Water consumption is top of the list. Two liters a day is a good start for a normal healthy person. In extreme heat the need goes up dramatically. Use of salt tablets is discouraged and potentially dangerous. Some sports drinks without caffeine can be suitable but should not be the sole source of fluid replacement. Water is the best.

Never leave children or pets in a closed vehicle. Temperatures can increase rapidly to 140 degrees which is seriously dangerous after only a few minutes.

With only a small bit of planning and common sense you can survive the heat wave comfortably and safely without becoming a statistic.

Friday, July 8, 2011

Sibling Rivalry or Support?


We usually spend more time with our siblings than any other family member. We potentially spend more time on earth with them than any other human. If you think of it that way, you probably want to be nicer to your brother or sister. Seriously, the relationship with our siblings along with the interaction of parents is the basis for all relationships and how we make our way in the world. The social skills learned here provide a foundation for all other relationships.

Sibling rivalry has been the subject of a great deal of research. It happens and is normal. How the parents handle those interactions dictates a lot of the future. Children are testing and exploring the limits of social behavior. They are learning what to do when confronted with certain challenges and frustrating situations. Each child needs to be acknowledged as a valued individual and not compared to another. Try to reward or acknowledge appropriate behavior. When a child is quiet and occupied, it may be hard to take time out of a hectic schedule to provide praise for the child's quiet behavior. If a child shows initiative by being considerate, let them know how much that is appreciated. Modeling good behavior for children is important, particularly how parents handle the difficult moments. It is still normal for some disagreement when sharing; feeling slighted by the attention or advantages provided to another sibling. Never tolerate physical harm, verbal abuse or intimidation. This can and should be interrupted. Time outs are very useful. They are not punitive, but serve as an immediate way to interrupt the bad behavior and provide a couple minutes of cooling off. Then appropriate behavior and an alternative can be discussed. Do not be concerned about assigning blame. Learning how to compromise, negotiate, and control aggressive impulses are important lessons. It is how these simple moments are resolved that will determine how they resolve conflicts and disagreements in the future and as adults. They will begin to gain perspective of another person and learn how to compromise. They acquire important life long skills when realizing consideration is actually easier and more beneficial. Family meetings serve as a reminder, when review of issues and rules takes place. Encourage the children's input for rules, expectations and consequences if expectations are not met. Validating their opinion encourages self-esteem and cooperation. If possible, give the kids opportunity to settle their differences in a reasonable fashion without a parent always intervening or defending one of the combatants. On the other hand, inappropriate behavior should be interrupted by a time out, followed by discussion when cooler heads can prevail.

Children need to be safe, know their basic needs will be met, understood as individuals, and loved. This sounds simple but is a bit of a challenge to do consistently in some families. Good communication based on mutual trust and respect for each family member is mission critical. Studies in the last few years in Britain and the U.S. have indicated that families were happier if there was at least one girl. The suggestion was that there was more discussion of feelings, expression of affection and perhaps caretaking done by a sister of other siblings. Certainly, there is a cultural pattern repeated here but it is not gender specific. A pattern of sisters in a family promotes this favorable communication. Studies indicated growing up with at least one girl or more in the family lowered the chance of depression, violent behavior, or feelings of guilt. However, the fundamental difference is part cultural when females are considered more emotional and nurturing. Experts agree that emotional expression is fundamental to good psychological health. That is not to say both genders with proper modeling of behavior and communication skills can learn the importance of respectful meaningful communication skills. Research has also found that single children who found strong social support inside or outside the family did just as well. Therefore, the important element is quality of communication within the family that addresses truly important issues. Parental behavior that models loving expression and nurturing behavior resulted in children who were more confident and effective adults.

Bruce Kaler M.D. is a practicing physician for over thirty years and has authored the medical mystery novel Turnabout as well as the non-fiction Owners Manual for Injury Prevention. Visit his website at http://www.seattledoc.com/ . Health related articles at Ezine expert articles

Saturday, June 25, 2011

Role Models


The wholesale produce business was started by my immigrant grandfather and his brother during the 1936 depression. When I was a child my father, his brother and a cousin ran the business under the continued tutelage of my grandfather. He was the emeritus head of the family business while operations were really managed by my dad and uncle. For as long as I can remember the produce warehouse was my playground. A diversity of unique activities, niches and motley playmates the world has ever seen.  People of all walks of life and social status would rub shoulders and at least temporarily befriend each other for the sake of daily business. The level of tolerance and camaraderie was palpable and unlike most public places. The other spin to the ambience was that it all occurred in the very early morning hours of darkness between midnight and dawn’s first light, partly outdoors in the elements and under the partial shelter of a warehouse that included massive walk-in coolers. The entire area had a mostly damp, humid aroma of decaying fruit and vegetables. The perfume of fresh and fermenting produce is a unique blend that is recognizable regardless of location. The many colors of the local and exotic fruits were a perfect counterpoint to the variety of human beings laboring and customers just passing through. Loud gregarious calls were the order of the day. Intermingled with jokes and technical jargon describing an order being processed from the warehouse, glaring lights pierced the darkness illuminating artistic displays of fresh fruit and vegetables. The energetic pace was infectious, seductive and bordered on carnival.   

Growing up in a family business I was not treated as the owner’s son but as just one of the employees. If anything I felt a self imposed higher standard to show the rest of the crew I was capable and deserving of their respect as any co-worker. I wanted to be liked by the other co-workers because it made me feel more adult. Of course my family’s recognition and approval meant a lot as well. I worked with people of poverty and privilege. I learned growing up among my motley workmates of heartbreak, disaster, passion, redemption, trust, loyalty, honesty, tolerance and compassion. I was able to see first hand how difficult the human condition can get, how fortunate I was and how frail and vulnerable a life can be. I counted some of the most sorted characters among my many role models for I was a student to all of them.

All of these people and places became my extended family. Milestones of my youth and education were shared and celebrated with all of them as they often were an integral part of the experience. I once told my father during a busy morning while loading a truck with 50 lb sacks of potatoes how much I enjoyed working there. I said that I could work with him and my uncle forever. At age 15 and the only young person in this environment, my years of experience gave me a sense of accomplishment and confidence working along side adults. I was stooped over shifting the heavy sacks into position when I heard the low stern voice of my father in my ear, “I don’t ever want to hear you say that again.” He moved so quietly close to me that his voice sounded as if it was reverberating inside my head. By the time I stood up and turned he was already striding ten paces away with his back to me. I said nothing. We never spoke of that rare moment. When I shared the anecdote with him some 35 years later he did not recall it. For me it cemented something that I had always known: my parents wanted more for me. Although there were never any demands to do any specific thing other than always do my best. Clearly they wanted me to have and do more than they had. Their dream was for me to be a dreamer who could reach his goals. I learned how to love and be loved as well as respect, trust, dignity, honesty and tolerance. The value of experience that comes with age was also a common but unspoken theme. I am the result of many moments both memorable and mundane that taught me how a life can be lived and fulfilled. My role models and inspiration were everywhere. For that I am very fortunate and grateful.

Bruce Kaler M.D. is a practicing physician for over thirty years and has authored the medical mystery novel Turnabout as well as the non-fiction Owners Manual for Injury Prevention. Visit his website at http://www.seattledoc.com/ . Health related articles at Ezine expert articles