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Just Sip It: More Than Half Of U.S. Kids Not Properly Hydrated

(sara_girl22/Flickr)

(sara_girl22/Flickr)

One statistic jumped out at me from this study by researchers at the Harvard School of Public Health about whether U.S. kids are drinking enough water: “Nearly a quarter of the children and adolescents in the study reported drinking no plain water at all.”

When you think about the kinds of serious health problems your kids might have, not drinking quite enough water may not top your list.

But it’s serious: beyond the physical problems related to insufficient water-drinking, there are cognitive implications as well, researchers report:

Inadequate hydration has implications for children’s health and school performance. Drinking water can improve children’s performance on cognitive tests. Two studies have found that children’s cognitive performance improved as their urine osmolality [a measure of urine concentration] decreased. Increasing drinking water access in schools may be a key strategy for reducing inadequate hydration and improving student health, because schools reach so many children and adolescents and that they typically provide free drinking water to students.

The study was published online in the American Journal of Public Health.

I asked Erica Kenney, a postdoctoral researcher and one of the study authors, a few questions about the work. Here, lightly edited, is what she said, via email.

RZ: What’s the takeaway here?

EK: We often take for granted that kids will keep themselves hydrated automatically and will drink when they’re thirsty, or that their schools, summer camps, afterschool programs, child care centers, etc. will be providing them with enough opportunities to drink water during the day. But our study indicates that this may not be the case — over half of all children and adolescents in the U.S. are estimated to be inadequately hydrated. We need to do a better job of getting safe, clean, appealing drinking water to kids (and by “we” I don’t just mean parents and families — I also mean the places where kids learn and play during the day) and keeping them hydrated so that they have the opportunity to be at their best in terms of well-being, cognitive functioning, and mood.

Where do we go from here? Continue reading

After A Death, Crackdown On Drowsy Teen Drivers Led To Fewer Crashes, Study Finds

(KaritoGlam/Flickr)

(KaritoGlam/Flickr)

By Marina Renton
CommonHealth Intern

It was to be Maj. Robert Raneri’s last day of work before his wedding the following week. On June 26, 2002, Raneri, a member of Army Reserves, left his home in Nashua, New Hampshire for the Devens Reserve Forces Training Area in Ayer, Massachusetts. But he never arrived.

Raneri was killed by a 19-year-old drowsy driver who admitted to having stayed up through the night playing video games. Shortly after Raneri’s death, his fiancée, Maj. Amy Huther, learned she was pregnant with his child.

In accordance with Massachusetts law at the time, the teen driver faced misdemeanor charges, leading to five years probation, a 10-year license suspension and 140 hours of mandated community service, The Boston Globe reported in 2004.

Drowsy Driving

But the tragedy brought attention to the problem of drowsy driving and, in 2007, led to new rules that govern the way young drivers grow into their adult licenses: the graduated driver-licensing program.

Those rules (amendments to already existing law) included stiffer nighttime driving penalties, driver’s education on drowsy driving and tougher penalties for negligent or reckless driving. And it seems the strict new rules have worked, dramatically decreasing the number of drowsy driving accidents involving teenagers, according to a new study out this month in the journal Health Affairs.

Indeed, the results are striking: Among junior operators (ages 16-17), the overall rate of car accidents fell by 18.6 percent, the rate of night crashes decreased by almost 29 percent, and there was an almost 40 percent decrease in car crashes resulting in a fatal or incapacitating injury, researchers report. The study focused on data from one year before and five years after the implementation of the new amendments.

Legal Crackdown

This is the first study of its kind to look at the effects of individual components of a driver licensing law, such as more exacting penalties, the authors state.

Dr. Charles Czeisler, chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital in Boston and co-author of the study, said in an interview that researchers are “confident that these features of the law were critical in the decline in the teen fatal and incapacitating injuries as well as the overall crash rate that we observed.”

Like young drivers everywhere, Massachusetts teens don’t have the same privileges as adult drivers. They aren’t allowed to drive at certain times of night; they can’t have friends in the car right away; and they have to drive with a parent or other adult in the car when they’re first starting out. Continue reading

Why To Exercise Today: Because It’s Not Sitting

If you’re like me, this bout of November weather in June provides yet another excuse to ratchet back your exercise regime. And that means more sitting. Do not give in. Here, two more reports underscore the perils of sitting, one from the U.K. and one out of New York City.

In the U.K., sedentary behavior “now occupies around 60% of people’s total waking hours in the general population, and over 70% in those with a high risk of chronic disease. For those working in offices, 65–75% of their working hours are spent sitting,” according a new study published online in the British Journal of Sports Medicine.

cell105/flickr

cell105/flickr

To try to get workers off their bums, public health experts issued a consensus statement urging periodic stand-up breaks during the day.

According to the panel backing the new recommendations:

…for those occupations which are predominantly desk-based, workers should aim to initially progress towards accumulating 2 hours a day of standing and light activity (light walking) during working hours, eventually progressing to a total accumulation of 4 hours a day… To achieve this, seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks.

Along with other health promotion goals (improved nutrition, reducing alcohol, smoking and stress), companies should also promote among their staff that prolonged sitting, aggregated from work and in leisure time, may significantly and independently increase the risk of cardiometabolic diseases and premature mortality.

Even New Yorkers, who live in one of the best walking cities on the planet, are sitting far longer than what’s considered healthy, according to a new study by the U.S. Centers for Disease Control and Prevention and researchers at New York University, published in the journal Preventing Chronic Disease.

Researchers found great differences among various demographics — surprisingly, higher income folks spent more time sitting compared to those with lower incomes. Continue reading

Asthma, Lyme Disease, Salmonella: How Climate Change May Worsen Your Health

EPA Administrator Gina McCarthy speaks  in Washington in 2014. (Manuel Balce Ceneta/AP/File)

EPA Administrator Gina McCarthy speaks in Washington in 2014. (Manuel Balce Ceneta/AP/File)

The link between climate change and extreme weather is widely known. But as the planet warms, what about the risks to your own personal health?

I asked U.S. Environmental Protection Agency Administrator Gina McCarthy, a Boston native in town to deliver the commencement address at UMass Boston (her alma mater), to give some specific examples of how climate change can impact human health. Here, edited, is our conversation.

RZ: So, feel free to get scary here, what should people know about climate change and their own health?

GM: As temperatures rise, smog gets worse and allergy seasons get longer, which makes it harder for our kids to breathe. We know that increasing the ozone, the ground level smog, makes it difficult for kids — and also the elderly — to breathe, it impacts their lung function. So, you’re going to see a dramatic rise in the number of kids with asthma who experience bad air days.

So, the allergy season gets longer, and this is related to the warmer temperatures as well as the later fall frosts, which means plants produce pollen later in the year. The length of the ragweed pollen season has increased in 10 of 11 locations studied in the Central U.S. and Canada.

This season is awful: I have a little allergy this year for the first time. I found myself sneezing, my eyes watering. Even the dog went on some kind of antihistamine. I felt sorry for her.

You also mentioned ticks, what will happen in their world?

Warmer temperatures also bring increases in vector-borne diseases — Lyme disease, mosquito and tick-borne diseases, and expanded seasons. What we see is that the Lyme disease areas are expanding and the number of cases is increasing. Among the states where Lyme disease is most common [New Hampshire, Delaware, Maine, Vermont, and Massachusetts], on average, these five states now report 50 to 90 more cases per 100,000 people than they did in 1991.

You can clearly see the geographic region expand. Also, West Nile Virus is expanding. Our climate assessment tracks geography and seasons getting longer, expanding. As temperatures get higher, the entire ecosystem changes. I was in Aspen, the winters are getting shorter.

Screen shot 2015-05-28 at 1.11.33 PM

Are there any other diseases we should brace for?

There are also water and food borne diseases: salmonella, that relates to food potentially sitting out, the higher the temperature the more salmonella outbreaks. The same with water — anything that’s a bacteria — it’s going to increase in warmer weather. Continue reading

What You Really Need To Know About Dense Breasts

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

By Michael Misialek, M.D.
Guest Contributor

Reading the pathology request on my next patient, I saw she was a 55-year-old with an abnormality on her mammogram. Upon further investigation I discovered she had dense breasts and a concerning “radiographic opacity.” The suspicion of cancer was high based on these findings and so, a breast biopsy had been recommended. As I placed the slide on my microscope and brought the tissues into focus, I immediately recognized the patterns of an invasive cancer. Unfortunately the suspicion had proven correct.

Just a few patients earlier, an almost identical history had prompted another breast biopsy. This time the results were far different, a benign finding and obviously a sense of relief for the woman. Every day these stories unfold; the never ending workup of abnormal mammogram findings. Both radiographically and microscopically, it can be challenging at times sorting out these diagnoses, particularly in the face of dense breasts.

But what, exactly, are dense breasts and why are they suddenly in the news?

Breast Tissue 101

Breast tissue is actually made up of three tissue types when viewed under the microscope. The percentage of each varies between patients. There is fat, fibrous tissue (the supporting framework) and glandular tissue (the functional component). This is what I actually see under the microscope. Cancer can occur in fatty or dense breasts. It can be toughest to assess when the background is dense.

Biopsy, considered the gold standard in diagnosis, may even prove difficult to interpret when in the background of dense breasts. Dense breasts can hide a cancer, making it more difficult to detect both by mammogram and under the microscope.

Breast density has taken a lot of heat recently. A new study published in the Annals of Internal Medicine found that not all women with dense breasts and a normal mammogram warranted additional screening, as was previously thought. Understandably this report has received much attention. The authors found nearly half of all women had dense breasts. This alone should not be the sole criterion by which additional imaging tests are ordered since these women do not all go on to have a cancer. Clearly other risk factors are at play.

Confusion All Around

This is confusing for patients and doctors alike, especially when it seems as if screening guidelines are a moving target. Recently, the American College of Physicians issued new cancer screening guidelines: among these was mammograms, being recommended every two years. This too is getting a lot of press.

The American College of Radiology, American Cancer Society, Society of Breast Imaging and American College of Obstetricians and Gynecologists recommend yearly mammograms beginning at age 40. Continue reading

Report: Judge Approves $200M Settlement Plan For New England Compounding Center Victims

A Massachusetts bankruptcy judge gave verbal approval for a $200 million settlement plan for victims of a national meningitis outbreak linked to the New England Compounding Center, the Boston Business Journal reports. Continue reading

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Study: Even After Depression Lifts, Sufferers Face Higher Stroke Risk

(mac keer/Flickr)

(mac keer/Flickr)

In case you missed this piece on NPR today, it’s worth a listen: Harvard researchers have found that long after the dark symptoms of depression have lifted, those of us who suffered from the disorder have an increased risk of stroke later in life.

Patti Neighmond reports on the new study, published in the Journal of the American Heart Association:

Medical researchers have known for several years that there is some sort of link between long-term depression and an increased risk of stroke. But now scientists are finding that even after such depression eases, the risk of stroke can remain high.

“We thought that once people’s depressive symptoms got better their stroke risk would go back down to the same as somebody who’d never been depressed,” says epidemiologist Maria Glymour, who led the study when she was at Harvard’s T.H. Chan School of Public Health. But that’s not what her team found.

Even two years after their chronic depression lifted, Glymour says, a person’s risk for stroke was 66 percent higher than it was for someone who had not experienced depression.

The study authors conclude that to mitigate this risk of stroke, depression should be identified and treated early:

This study, in conjunction with other work confirming that depressive symptoms are causally related to stroke risk, suggests that clinicians should seek to identify and treat depressive symptoms as early as possible relative to their onset, before adverse consequences begin to accumulate.

Continue reading

50 Years Of American Health Choices: Smoking Gains Offset By Getting Fatter

(Lucia Sofo via Wikimedia Commons)

(Lucia Sofo via Wikimedia Commons)

Feeling optimistic? Then you may see the moral of this story as, “Yay, public health efforts! They can wield amazing power and save many lives.”

In more of a glass-half-empty mood? Then your takeaway may be, “If it’s not one thing, it’s another.” Or perhaps, that public health must play an eternal game of Whack-a-Mole.

The story itself: The National Bureau of Economic Research just sent over word of a new working paper that looks at American health behaviors and their effects over 50 years, from 1960 to 2010. It examined six behaviors: obesity, smoking, heavy drinking, unsafe driving, firearms, and poison or overdoses. What most struck me: Though we’re generally living longer, our health gains from shunning cigarettes and safer driving are all but erased by the rise in obesity and drug overdoses. Sigh. From the summary:

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

…The authors find that the gains associated with declines in smoking, motor vehicle fatalities, and heavy drinking are essentially offset by the losses arising from rising obesity and misuse of firearms and poisonous substances. Valued in dollar terms, there is a near zero net gain in health from public health and behavioral changes over the past fifty years. However, the analysis includes a mix of some risk factors that have been aggressively addressed through public health and behavioral changes over a long period (smoking, unsafe driving), and others that are in the earlier stages of being addressed and have proven challenging (obesity, prescription drug addiction).

The authors conclude “our study demonstrates the enormous benefits of public health and behavioral change in improving population health, underscoring the importance of continued advances in these areas of research and practice.”

I asked Harvard health economist David Cutler, who co-authored the report, what he’d want the public’s takeaway to be (and included a plea to help me beat down my own cynicism.) His e-mailed response:

There are some who see this as ‘glass mostly empty’ – i.e., if it’s not one thing, it’s another. But remember how hard these changes are. Quitting smoking is very difficult, and yet millions of people have done it. Reducing caloric intake is very difficult, though weights finally seem to be stabilizing. The difficulty of these interventions makes the successes particularly notable.

Readers, your own thoughts? Read the full paper here and the summary here.

Elmo’s New Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines

 

Vivek H. Murthy, video star and Friend of Elmo. Who’d have thought, back when Dr. Murthy’s appointment to be the U.S. surgeon general was facing political fire, that this would be the sequel? But there he is in a popular new video, cavorting with Elmo. Okay, not cavorting, but rather working nicely together with Elmo to help promote vaccinations while the recent Disneyland measles outbreak is still fresh in memory.

And Dr. Murthy’s big-city colleagues are also going visual to promote vaccinations: Public health chiefs from Los Angeles County to Boston are just out with a series of videos in which they personally urge their residents to get their kids immunized. See the full collection here, including Boston’s Huy Nguyen (below). The videos, part of the Big Cities Health Coalition, are aimed at health districts with a combined population of 14 million.

Recent history: When President Obama proposed Dr. Murthy, then at Brigham and Women’s Hospital, as surgeon general in late 2013, colleagues showered him with praise and said they expected him to be a progressive and visible leader. Then, last year, opposition from gun groups — Murthy had expressed support for gun control in the wake of the Newtown shootings — held up and threatened to scuttle his confirmation. But in December, in a squeaker vote, he got the nod.

And now here he is, living up to predictions that he would be “visible” — and on “Sesame Street,” no less. After Elmo gets his vaccination in the video above, he (it?) says, “That was so easy! Why doesn’t everyone get a vaccination?” Dr. Murthy strokes his chin: “That’s a good question, Elmo, that’s a good question…”

Harvard Study: Better Police Reports On Bike Crashes Could Save Lives

A "ghost bike" is placed in memory of Marcia Deihl, who was killed in a crash in Cambridge, Massachusetts, on March 11. (Rachel Zimmerman/WBUR)

A “ghost bike” is placed in memory of Marcia Deihl, who was killed in a crash in Cambridge, Massachusetts, on March 11. (Rachel Zimmerman/WBUR)

Last month, Marcia Deihl, a songwriter and community activist out for a bike ride on the first warm day after a brutal winter, was struck and killed by a dump truck outside a Whole Foods in Cambridge, Massachusetts. A white “ghost bike” now memorializes her death.

Aspiring photojournalist Christopher Weigl, just 23, was also killed in a bike accident: Wearing a helmet, and traveling in the bike lane near Boston University, Weigl collided with a 16-wheel tractor trailer when the truck made a wide right turn in the winter of 2012.

And less than a year before that, MIT graduate student Phyo N. Kyaw sustained fatal injuries when his bike collided with a truck in a busy Cambridge intersection.

These deaths happened close to home: where I work, shop, ride with my kids. And they underscore two truths: There are more cyclists on the road, and more of them are getting hurt in accidents, some fatal. The number of commuters who bike to and from work rose about 62 percent nationwide from 2000 to 2013, one report found. With those numbers comes added risk: 726 bicyclists were killed and 49,000 bicyclists injured in 2012, according to the National Highway Traffic Safety Administration.

As a driver, you don’t need a research study to tell you that bikes are everywhere, whether you’re in Boston, New York or Seattle. But you do need research, and data, to help fix the problem — that is, reduce the number of accidents and deaths.

(Source: National Highway Traffic Safety Administration)

(Source: National Highway Traffic Safety Administration)

Cities, towns, planners and private businesses can’t move forward building safer cars and safer bike environments until they learn more precisely how bike accidents happen. Is a truck’s wide turn to blame? A taxi door opening at the wrong time? These seemingly small details of crashes are critical, says Anne Lusk, a research scientist in the Department of Nutrition at the Harvard School of Public Health.

That’s why Lusk and her colleagues have issued a blueprint of sorts for improving bike-vehicle crash reports produced by the police; their findings are published this week in the journal Injury Prevention.

After studying hundreds of hopelessly low-tech police reports used to record bike accidents, Lusk and her colleagues are making a nationwide plea: They’re calling on police in all states to step into the modern era and improve reports on crashes involving vehicles and bicycles. Currently, Lusk said in an interview, the details on crashes are handwritten and drawn by police on paper, with few bicycle-specific codes or diagrams.

Lusk offered one example: Currently, a crash report from Massachusetts shows “two vehicles” drawn. One of the “vehicles” is then coded as a “pedal cyclist” but there is no drawing on the template of a bicycle to show which side of the bike was hit.

Police have been recording bike crashes since the introduction of the bicycle in 1890, researchers note.

Now it’s time for a major upgrade. Lusk says police should “use electronic tablets with dropdown menus that have specific vehicle/bicycle codes, for instance, whether the bicyclist was riding inside a painted bike lane when hit, or whether the cyclist crashed into a driver’s open car door. The dropdown menu would also include other specific data like a coded vehicle picture and a coded bicycle picture. This information could then be automatically loaded onto spreadsheets for later analysis, Lusk said. Continue reading

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