Tis the Season

Between Easter, Earth Day and Mother's Day there are so many things to look forward to in April and May! Spring is my absolute favorite time of year. The warm weather and longer days make the freezing temperatures and relentless snow seem like distant memories. More time is spent outside simply running around, hanging out with friends, hiking and enjoying a lazy Sunday afternoon under the sun. Spring means taking a second to stop and smell the flowers and trips to your local pharmacy for a high dose of Claritin-D 24 hour. You audaciously pack away your wool sweaters and warm scarves as soon as your Yahoo weather app says the temperature is over 50 degrees, completely forgetting that the wind chill in Harrisonburg makes it feel a solid 10 degrees colder... Oh it's because we live in the valley? I don't care, make it stop. 

With Spring comes the end of a semester. With the end of the semester comes final exams, projects and presentations. With finals comes stress, lack of sleep and a compromised immune system. In my health research methods class last semester, I had the chance to research the correlation between stress and sleep. We had the opportunity to carry out the entire process of research including literature review, identifying peer-reviewed instruments to collect information, submitting an IRB form, analyzing the data and drawing conclusions. As tedious and time-consuming as the process was it gave me a better understanding for the research process and a new found appreciation for sleep. I mean, who doesn't enjoy a good nights rest but now I understand the impact it can have on your health.

Our study found that individuals who were more stressed had an overall lower sleep quality and experienced more sleep disturbances. Here are 5 real life examples of how sleep deprived JMU's student population is during finals: 

1. I witnessed a kid snoring in the quiet study room in Carrier yesterday.

2. There is someone in my direct line of vision who is taking a nap on one of the couches in HHS. 

3. I saw a couple making out before they parted ways for class. Direct indication that they are sleep deprived and not thinking straight. 

4. I took a nap on the 10 minute bus ride form ISAT to Varner the other day. 

5. The closer we get to finals, the more tweets I see after 2am. 

Stress goes hand in hand with finals. Papers must be finished, deadlines must be met and exams must be taken. It is imporant for college students and professors to recognize the impact that stress can have on sleeping patterns and your overall health. Poor sleep quality leads to illness which adds more stress. Your body needs sleep to recover and process information. 

So here is my public committment to just say no to procrastination, to stay on top of things and to sleep for 8+ hours once a day..maybe twice if it's Monday or something. As Liz Lemon would say "Yes to life. Yes to love. Yes to staying in more." 

Asbestos at JMU

Asbestos is a group of minerals composed of tiny fibers that if inhaled can lead to asbestosis, lung cancer and other lung disease that may not appear until many years after exposure. Asbestos is found naturally in soil and ultramafic rock formations which can expose a population if the soil or rocks are disturbed. Manufacturing companies began including asbestos in over 3,000 different building materials including floor tile, linoleum, cement siding, roofing material/sealants, pipe insulation and adhesives after witnessing its resistance to fire and heat.

            Several countries reported early on that exposure to asbestos can be a major health risk. France was responsible for the first study of mortality among asbestos workers and suggested that asbestos was responsible for the death of fifty employees who worked closely with asbestos related products.  

            James Madison University was built in 1908 before there was much evidence that linked asbestos to cancer therefore several of the original buildings at JMU were built with materials that contained asbestos. A 1981 Breeze article reports on the renovations of different JMU buildings because of the presence of asbestos including Garber and Gibbons Hall. The article outlined the procedure for removing asbestos and how they continued operations of dining hall during asbestos removal. https://mdid.cit.jmu.edu/media/get/162282/r-2394950/254669/the-breeze-1981-07-21-volume-58-issue-57/

           I have lived in the AST sorority house on campus in the treehouses for the past three years. Recently, the house went through minor renovations to replace the carpeted floor. During the renovation, it was brought to my attention that there may be intact asbestos containing material in the foundation of the house indicating that major renovations to the structure of the house would expose the asbestos and present a major health concern. Intact asbestos-containing material is not likely to pose a health risk. However, if the material is damaged, asbestos fibers can be released in to the air. It is recommended that  major repair or removal of asbestos containing material only be performed by trained asbestos professionals. JMU should consult trained professionals in the removal and repair of buildings on campus that contain asbestos related products.

           

Roe v Wade, Crime and Confounding Factors

Roe v Wade, Crime and Confounding Factors

A confounding variable is an extraneous variable in a statistical model that correlates with both the dependent and independent variables. We discussed the correlation between pancreatic cancer, smoking and coffee intake. Does smoking and drinking coffee cause cancer independently of one another? Or is there a relationship between smoking and drinking coffee that can lead to pancreatic cancer? There is evidence that argues for either hypothesis. Confounding factors encourage epidemiologists to evaluate and understand all sides of disease transmission and analyze the relationship between necessary and sufficient cause of disease. 

The relationship between breast feeding and health benefits exemplifies confounding factors. Most educated women believe breast feeding is associated with healthy outcomes in both the child and mother but there is minimal scientific evidence that supports this claim leading me to believe that there is a confounding factor that plays a role. Breast feeding is typically associated with higher socioeconomic status and education level. Without adjusting for SES and education level, we cannot understand the impact that genetics, a safer household environment, a more conducive learning environment and increased access to books and vocabulary has on a child IQ level. There are many benefits to breast feeding including; increased nutrients and antibodies in milk, easier to digest than formula, protects against disease, more convenient than bottle formula and leads to a more secure, comforting relationship between mother and newborn. There is definitely an association between breast feeding and health outcomes but it might not necessarily be a causal link. 

Understanding the relationship between crime rates and police efforts involves an investigation into possible confounding factors. We need to consider city demographics, the type and severity of crime and policy changes. All of these variables can play a significant role in the rate of crime. If the demographics of a community are changing, we can expect to see a difference in crime rates. Additionally rates may fluctuate if there are changes made in the class and schedule of certain crimes. Policy also plays a roles in crime rates. Roe vs Wade is landmark decision by the United States Supreme Court in 1973 to legalize abortion. In the 15 years following Roe vs Wade states with high abortion rates and low abortion rates had nearly identical crime patterns but it is important to note that this is a period before generations exposed to legalized abortion are old enough to do much crime. But between the years of 1985-1977 when individuals born after Roe v Wade would be in peak crime ages, high abortion states experience a decline in crime rate of 30% relative to low abortion states.  When comparing arrest rates for individuals born in the same state, we also witness a decline in crime rates for those born after legalization. The legalization of abortion minimized the number of children born into broken, unloving homes. There was a greater percentage of children born into nurturing homes with conducive learning environments. Parents were more invested into teaching their children right from wrong. There is a lot of evidence that can lead an individual to believe that Roe v. Wade was a direct cause of declining crime rates. However, it is important to consider confounding factors such as increased policing efforts in major cities and community initiatives such as the war on drugs. Drug use is often associated with crime and programs such as DARE were introduced in elementary schools across the nation to teach children to say no to drugs. The impact that the war on drugs and DARE had on declining crime rates is debatable but there is reason to believe that it could have impacted the decline crime rates in 1985-1997. 

Confounding factors call in to question the correlation between Roe v Wade  and declining crime rates. This exemplifies the importance of adjusting for confounding variables and identifying direct causality between disease rate and transmission. 

Substance Abuse Among Anesthesiologists

In 1956 the American Medical Association declared alcoholism to be an illness and, in 1987, extended the definition to include dependence on all drugs. Alcoholism and other forms of impairment impact anesthesiologists at similar rates to other professions. However, addiction to opioid remains the most common for anesthesia personnel. The question at hand is do individuals seek careers in anesthesiology for increased access to drugs or do the develop an addiction during their residency or in practice?

Between  1991–2001, 80% of U.S. anesthesiology residency programs reported experience with impaired residents, and 19% reported at least one pretreatment fatality. There have been many theories concerning the etiology of chemical dependence including biochemical, genetic, psychiatric, and, more recently, exposure-related theories. Factors that have been proposed to explain the high incidence of drug abuse among anesthesiologists include the proximity to large quantities of highly addictive drugs, the relative ease of diverting particularly small quantities for personal use, the high stress environment in which anesthesiologists work.

This past summer I had the opportunity to shadow a Cardiothoracic Physician Assistant for a few days. She had done several clinical rotations during Physician Assistant school, one being anesthesiology. She shared horror stories of anesthesiologists getting high during a surgery, or ODing in the call room. What I found interesting is that Nurse Anesthesiologists were more likely to steal drugs and use them outside of the hospital while Anesthesiologist residents and practicing physicians were more likely to use during their shift. Dr. Ott-Walter shared a similar story - Opium, especially morphine only lasts for 6-8 hours and often times surgical procedures will last more than 8 hours. One anesthesiologist was coming off a high during a procedure and was starting to go through withdraw. He made a decision to shoot up behind the curtain but instead of injecting an opioid, he injected a stimulant that is medically used to wake people up after surgery. Minutes later the anesthesiologist went into cardiac arrest and the surgeons had to stop the procedure to assist the anesthesiologist. Opioid use among anesthesia personnel is typically not suspected by friends and relatives and signs often go unnoticed. 

So is addiction related to genetics or is opioid use an exposure-related phenomenon? 

"Considerable research has been done in mice suggesting a genetic basis for addiction. Mutant mice with α4 nicotinic subunits that contained a single point mutation resulting in hypersensitive nicotinic acetylcholine receptors. The majority of individuals who experiment with psychoactive substances do not become dependent but there is a small subset of individuals taht do. These individuals typically exhibit pre-existing co-morbid traits such as novelty-seeking and antisocial behavior. Genetic susceptibility plays a role in the transition from substance use to dependence and from chronic use to addiction. 

 It has been suggested that emotional stress and access to agents may play much less of a role in the development of addiction than was previously thought. However some researchers hypothesize that increased risk of addiction in certain occupational setting is related to exposures that sensitize the reward pathways in the brain to promote substance abuse. Anesthesiologists who become addicted through such sensitization may continue to use the opiods to alleviate the withdrawal they feel when away from the exposure."

At first I expected opioid use was exposure related among anesthesiologists because they have the highest rate of opioid treatment compared to other practicing physician specialties. Anesthesiologists have the most access to fentanyl and sufentanil, making them more susceptible to use and abuse. Although research hasn't exactly pinpointed genetic mark-ups of addiction and dependence, there is a strong association between genetic make-up and addiction. Some individuals argue that addiction and dependence is more common among thrill-seeking individuals. I don't believe that plays a role in this particular situation. A typical opioid user is a white, middle-aged female with a family that had a valid prescription for morphine or another type of painkiller and once that prescription ran out, they turned to heroin use. I believe this is the case among anesthesiologists as well, indicating that both our genetic make-up and exposure play a role in addiction.







Information found at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766183/

Natural Disasters

Natural disasters such as a tsunami, earthquake, hurricane or mudslide can trigger a cascade of social and health problems. Before the advancement of injury prevention, injuries were viewed as random, unavoidable accidents. Where a natural disaster is unavoidable, the injuries associated with them can be reduced through pre-event, event and post-event intervention. Injury intervention involves prevention/limitation of energy build-up, controlling circumstance of energy use to prevent release, modifying energy transfer to limit damage and improving emergency response, treatment, rehabilitative care to limit disability and promote recovery. 

Hurricane Katrina triggered a re-evaluation of the United States emergency response to natural disasters. The lives lost, homes destroyed and displacement of communities has had a huge impact on New Orleans and the surrounding area. Our nation is still responding to the aftermath of the hurricane. For instance, a deadly amoeba was found in St. Bernard that when inhaled through the nose causes a deadly meningitis. The free-living, Naegleria fowleri, amebic infection has claimed the lives of several individuals. The Lousiana Department of Health and Hospitals argue that the presence of amoeba found in chlorine treated water is a result of population decline after the hurricane. St. Bernard was a thriving 67,000 person community before the hurricane but the population has declined to almost 15,000 after Hurrican Katrina. The underuse of the public water system has allowed the chlorine to dissipate, allowing the pathogen to colonize and grow. An outbreak such as this can be hard to predict but disease and injury prevention methods that would require surveillance of the public water system may have prevented such an outbreak. 

Injury prevention in regards to a natural disaster include reduction in environmental impact, advancement in emergency response and limitation of disease occurence. Environmental protection including dams, reservoirs, wind protectors can reduce the structural damage often associated with a hurricane or tsunami. Increased adherence to emergency response pre-event can limit the number of people directly exposed to a hurricane or tsunami by evacuating the area. Pre-event emergency response also includes an evacuation plan and roads that can meet the needs of the community. Post-event emergency reponse includes better response time to emergency situations and quick transport time to a hospital. 

The recent mudslide in Washington state emphasizes the importance of occupational and environmental safety. Landslides and floods are unfortunatlely common and present a major public health concern. A total of 24 people have died from the mudslide and several are still unaccounted for. More than a square mile of a residential area along the bank of a river has been affected by the mudslide. Injury prevention would include evaluation of the soil and observation of rain levels to predict and prevent the impact of a mudslide. 

ADHD

The DSM-V defines Attention Deficit Hyperactive Disorder (ADHD) as having 5 or more of the listed symptoms including; difficulty with organization, losing or misplacing items, frequently forgetting information, distracted and failure to pay close attention to details. According to this definition myself
and the majority of the population should be diagnosed and treated for ADHD. 

It is well-known that the United States is the most medicated country in the world. Direct-to-Consumer advertising allows Big Pharma to push drugs into the marketplace. As pharmaceutical advertisements list the symptoms that this drug can treat, consumers begin to think that they have that disease and need that drug right away. No sooner than when the commericial ends, consumers are scheduling doctor appointments in hopes of a new prescription. Drugs are viewed as a quick fix and the demand continues to rise. 

I have seen ADHD medication misused and abused more than any other prescription drug. Individuals who are prescribed it will sell it to their peers during midterm and finals week. I have seen parents use it during the holiday season to cross off everything on their to-do list. Most alarmingly, I have witnessed individuals take it at parties claiming that it makes them more alert and sociable. 

In my opinion, there are two types of individuals who are diagnosed with ADHD: those who have a normal level of distraction or impulsiveness and those that have an underlying disorder. There are several conditions or disorders that can lead to symptoms that parallel ADHD symptoms including; sleep disorders, undiagnosed vision or hearing disorders, substance abuse, iron deficiency, bipolor or major depressive disorder, Obsessive Compulsive Disorder and learning disabilties such as dyslexia. 

The stimulants that are prescribed to ADHD patients are highly addictive, have negative side effects and only work short term. ADHD medication isn't a treatment option, it is a band-aid at best, simply masking the underlying effect of the disease. I cannot minimize the fact that some individuals are more distracted than others and have a hard time paying attention but in most cases there is another cause.  

Some of the side effects of stimulants include; increased anxiety, irritable, depressesion, severe weight loss due to appetite suppression and suicide. In a recent study, children treated with stimulants for ADHD experienced slower BMI growth followed by a rapid rebound that could continue to obesity. The rapid rebound occured in late adolescene after discontinuation. The study emphasized it was the stimulant that was associated with rapid rebound and not the disease as the stimulant can cause growth delays. 

Public health professionals should pay attention to the effect that stimulants can have on childhood obesity and should aim at restructuring the diagnosis and treatment of ADHD.  

Alzheimer Disease

Alzheimer Disease 

Magnolia's of Lancaster is a Senior Living Center for residents diagnosed with varying degrees of dementia. They offer a Memory Care Program for individuals with Alzheimer's Disease (AD) and dementia caused by blunt head trauma. I have the privilege of working there as a Resident Care Assistant assisting with ADL's and facilitating activities for the residents. It has been one of the most rewarding experiences I have ever had. These inspiring individuals who worked as teachers, nurses, and computer engineers have accomplished so many feats throughout their life but cannot remember their own success. My favorite part of my job is remembering it for them. Certain cues will help the residents remember parts of their life and it is so rewarding to see their faces light up as they relive one of their favorite moments. During our Christmas party this past year a resident who can barely speak was singing along perfectly with Jingle Bells. 

Of course there are many challenges associated with Alzheimer's Disease, one of them being the impact that the disease has on family members. It is heartbreaking to watch a resident have a conversation with their son or daughter without knowing who they are or how they know them. The devastating effects of the disease take a huge toll on family members. I found it inspiring that many of the managers and supervisors at Magnolia's of Lancaster had no previous professional experience with dementia or AD before they applied for the position but rather had personal experience with a parent or other family member who was diagnosed with AD. Individuals in the early stage of the disease are aware of what is happening to them and it terrifies them to witness other individuals suffering through the later stages. 

Similar to other mental illnesses, there was minimal amount of research done on AD until recently. Medication has been developed to slow the progression of the disease but there is a lack of scientific evidence for any preventive measures. As scientists develop a deeper understanding of the disease, they have started to make correlations between behaviors and have begun to identify protective factors and risk factors. 

The global prevalence of AD is estimated to be around 24 million and will continue to rise as the worldwide population continues to age. AD seems to be more prevalent in the United States compared to Africa, Asia and Europe which may have to do with methods of diagnosis. Some factors that are highly associated with AD include diabetes, smoking, hypertension and obesity. Education, increased leisure activity, a Mediterranean diet and more physical activity have been correlated with a decreased risk for AD. I find it incredible interesting that cognitive reserve can reduce an individuals risk for AD. Studies of "normal aging" indicate that higher educational or occupational attainment slow the progression of cognitive and functional decline. Although the etiology of AD remains unclear, Epidemiologists and Public Health professionals should be concerned with the genetic and environmental risk factors that may be associated with the disease.