Medlnk october 12 page

Celebrating 16 Years

Taking care of you!

I find myself making excuses to avoid a visit with my gynecologist. Any advice on getting me to make – and keep – appointments?

Can the shoes I wear be causing my back pain?

October 2015

Mental health care is vital, but often tough to get

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By ROBERT PREID HealthDay

lthough most Americans think mental health care is important, they often believe it’s expensive and hard to get, a new survey shows.

In questioning more than 2,000 adults, nearly 90 percent said they place equal value on mental and physical health.

But one-third said mental health care is inaccessible. And 40 percent said cost is a barrier to treatment for many people, the survey found.

Forty-seven percent of respondents thought they have had a mental health condition, but only 38 percent of them had received treatment. Of those who were treated, most thought it was helpful, including 82 percent who got psychotherapy and 78 percent who received medications.

The survey also found that 86 percent of participants knew that mental health disorders such as depression are risk factors for suicide. Only 47 percent knew that anxiety disorders also increase suicide risk, according to the survey.

The survey findings were released in September by the Anxiety and Depression Association of America, the American Foundation for Suicide

Prevention and the National Action Alliance for Suicide Prevention.

Other findings: 55 percent of respondents said they had been affected by suicide in some way; 94 percent believe suicide is preventable; 93 percent said they would take action if someone close to them were considering suicide;

“People see the connection between mental health and overall well-being, our ability to function at work and at home, and how we view the world around us,” Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention

and 67 percent said they would tell someone if they were having suicidal thoughts, with women being more likely than men to do so.

“There’s a significant body of research that demonstrates that individuals suffering from anxiety disorders and depression face an increased risk for suicidal thoughts and attempts,” Dr. Mark Pollack, president of the Anxiety and Depression Association of America (ADAA), said in an ADAA news release.

Pollack, who is also a professor and chairman of the psychiatry department at Rush University Medical Center in Chicago, added that effectively diagnosing and treating anxiety disorders and depression, especially when a person has both, are key to reducing suicide crises.

Survey respondents aged 54 and younger were more likely to have received treatment for a mental health condition than those who were older. Those between 18 and 34 were more likely than older people to consider it a sign of strength to see a mental health professional. Women were more likely than men to have received treatment, and to say they had suffered anxiety and depression.

Men were more likely to admit to substance abuse, the survey found.

Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, said the findings were encouraging.

“Progress is being made in how Americans view mental health and the important role it plays in our everyday lives,” she said in the news release.

“People see the connection between mental health and overall well-being, our ability to function at work and at home, and how we view the world around us.

Respondents want to help a loved one by connecting them to the right mental health treatment and support.”

MORE INFORMATION The U.S. National Library of Medicine has more about mental health at nlm.nih.gov.

Good news for Medicaid patients Patent expirations on several leading antipsychotic drugs could save Medicaid billions of dollars a year as the medications become available in cheaper generic versions, a new study finds.

Patients covered by Medicaid — the publicly funded insurance program for the poor — account for 70 to 80 percent of all antipsychotic prescriptions in the United States, the researchers said.

The lower costs of ‘second-generation’ antipsychotics, such as Abilify and Seroquel, could prompt Medicaid to lift restrictions on access to the drugs, the study authors predicted.

The drugs are used to treat mental illnesses such as schizophrenia and bipolar disorder.

“Mental health medications are among the most prescribed drugs in Medicaid, and many of these medications have recently become available as generics or soon will be,” said Eric Slade, an economist and associate professor in the psychiatry department at the

University of Maryland School of Medicine.

“Our predictions suggest that this change will result in a substantial financial windfall to states and to the federal government,” he added.

In 2011, Medicaid spent more than $3.6 billion on so-called second-generation antipsychotic drugs, a category of drugs introduced in the 1990s. Five brand-name drugs — Abilify (aripiprazole), Seroquel (quetiapine), Zyprexa (olanzapine), Geodon (ziprasidone), and Invega (paliperidone) — accounted for 90 percent, or $3.3 billion, of that spending, the study found.

Using forecasting models, the research team estimated that Medicaid’s annual spending on antipsychotic drugs will fall by nearly 50 percent, or $1.8 billion, by 2016.

Spending should drop another $2.8 billion by 2019, they predicted.

The study was recently published in the journal Psychiatric Services.

Source: HealthDay

MORE INFORMATION The U.S. National Institute of Mental Health has more about mental health medication at nimh.nih.gov.

Rowan Medicine MedicaLink Ask Rowan Medicine

Taking care of you!

Dr. Meagan Vermeulen, a Rowan Medicine Fanily Physician, responds: “What are you doing to take care of you?”

That’s a question I frequently ask my patients. At times, patients will seem genuinely perplexed by the question. Then, they will start to talk about taking their medications or watching what they eat, trying to guess exactly how they should

be answering.

But, how closely they are adhering to their diet or medication schedule is information I will have already picked up during their routine examination. Instead, “What are you doing to take care of you?” is a holistic question, one that will help me to understand how their life may be influencing their health.

As a physician, I’m interested in more than my patients’ lab results or blood pressure readings. For me, a patient’s emotional and mental health are closely tied to physical health and I believe it is my responsibility to be sure that I do everything possible to promote all three aspects of health and wellness.

A great example of this is the person who finds herself caught between two generations, caring for an aging parent while still working, managing a household and raising at-home children. In my career, I have often seen patients who, finding themselves in a caregiver role, have become overwhelmed and over-extended, and have then allowed their own health needs to slip through the cracks. Caregiving can generate a tremendous amount of emotional stress that interferes with sleep patterns, increases blood pressure, leads to poor diet choices and even impacts personal relationships.

"Caregiving can generate a tremendous amount of emotional stress that interferes with sleep patterns, increases blood pressure, leads to poor diet choices and even impacts personal relationships."

Taking care of yourself emotionally will always benefit your physical health. Think of it like putting gas in your car. You don’t have to spend a lot of time doing it, but if you don’t, your engine will eventually stop running.

You can take time for ‘self-care’ simply by setting aside 30 minutes each day to do something that helps you recharge. It could be watching a favorite show, reading

a book or listening or playing music. When patients will tell me they have too many responsibilities, too many people depending on them to take 30 minutes each day, I don’t doubt their dilemma. I’m also willing to negotiate, asking them to find at least 10 minutes each day and to build on that.

If you are like most people and often find yourself overwhelmed by all the things you ‘absolutely have to do,’ here are a few suggestions to help you find time to take care of you:

• • • •

Learn how to say “no.” Remember, there is a huge difference between “I choose not to do this” and “I can’t do this.”

Allow yourself to be less than perfect. Most of us hold ourselves to unreasonable standards.

Avoid an ‘all or nothing’ mentality. It’s OK – in fact, it’s admirable – to simply give your best effort.

Don’t multi-task. Why do we tend to celebrate being busy? It isn’t necessarily a good thing. We all think we can multi-task, but our brains just aren’t wired to enable that.

The end result of multi-tasking is usually added stress.

Finally, remember that if you are trying to be all things to all people, you are probably not taking care of you. Guilt is a powerful, but useless emotion. You should never feel guilty about taking care of yourself, because that will only make you better equipped to help your loved ones in their lives.

Dr. Meagan Vermeulen is a Rowan Medicine family physician and a member of the faculty at the Rowan University School of Osteopathic Medicine. To schedule an appointment in her Washington Township office, please call 856-218-0300.

Rowan Medicine MedicaLink

Ob/Gyn & Midwifery Clinical Services

Expect The Best The best choice for your maternity and gynecological care. We also offer midwifery services, as well as maternal/fetal medicine.

For access to the most advanced Ob/Gyn and Midwifery specialists, call 856-566-7090 to make an appointment today. rowanmedicine.com facebook.com/rowanmedicine twitter.com/rowanmed

Stratford 856-566-7090

Mullica Hill 856-256-5800

Turning sniffles into smiles Primary and preventive care from infancy through adolescence

• Well baby and child visits • School, camp and sports physicals

• Immunizations • Check-ups

Convenient hours include walk-in morning hours, Saturday morning and evening appointments.

Most insurances accepted.

Sewell 856-589-1414

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Rowan Medicine MedicaLink Ask Rowan Medicine

I find myself making excuses to avoid a visit with my gynecologist. Any advice on getting me to make – and keep – appointments?

Dr. Maria Nguyen, a Rowan Medicine obstetrician and gynecologist, responds: First, let me assure you that you are not alone.

It’s no secret that many (maybe even most) women do not like going to the gynecologist.

In fact, a quick Google search for the phrase “why women hate the gynecologist” returns more than 480,000 results.

So, what are your best excuses? ‘Too busy’ is probably the most common reason that women skip many types of routine health examinations.

Although women tend to make most of the health care decisions in their families, they sometimes focus on making sure that everyone else gets the health care they need, putting themselves at the bottom of the priority list. There is nothing wrong – and maybe something admirable – about that. If you end up neglecting your own wellness visits, ask yourself what would happen to those family members if you became seriously ill because of some preventable illness?

Admittedly, some women have reasons – such as a history of sexual abuse or previously having had uncomfortable exams – that make it difficult for them to feel comfortable with a gynecological exam. Other women who may be suffering from a condition like depression or who are victims of domestic violence may be fearful that, during the course of an examination, their physician will find out.

To those women, I can only say, “I understand.” And part of that understanding is assuring them that, while their personal history may make them hesitant, they still need to take the right steps to stay healthy. One of those steps is having a candid conversation with their doctor about their concerns. And if your gynecologist seems disinterested in discussing your reservations, then it is time to find another physician.

Not all women hate their gynecologists. And, although some will actually say they love their gynecologist, very few will ever feel that way about the actual examination. This comes back to the relationship you have with your doctor. If you feel encouraged to voice concerns as well as ask your gynecologist questions, then the exam itself will seem a lot more bearable.

If nothing else, remind yourself that a visit to the gynecologist can save your life. Many individuals – both men and women – avoid seeing a physician because they worry about getting 'bad news.' For women, routine screenings for breast and gynecological cancer, including cervical cancer (called 'the most preventable female cancer' by the CDC) can detect these diseases at the earliest, most treatable stage.

For the vast majority of women, routine wellness screenings by a gynecologist will result in a reassurance that they are healthy.

"For women, routine screenings for breast and gynecological cancer, including cervical cancer (called 'the most preventable female cancer' by the CDC) can detect these diseases at the earliest, most treatable stage."

Now you may be thinking that I only advocate for women to see their physician because I’m a doctor. But I know how hard it is for women to put themselves first, to have a ‘taking care of me’ attitude. But remember, ‘taking care of me’ isn’t selfish. It means you are also setting a good example for your daughters and sisters. By taking care of your own health, you are making sure you will be there to take care of your family members when they need you.

Dr. Maria Nguyen is a Rowan Medicine obstetrician and gynecologist and a faculty member at the Rowan University School of Osteopathic Medicine. To schedule an appointment with her in her Washington Township or Stratford offices, please call (856) 589-1414.

Rowan Medicine MedicaLink Ask Rowan Medicine

Can the shoes I wear be causing my back pain?

Dr. Knic Rabara, a Rowan Medicine physician in the NeuroMusculoskeletal Institute, responds: Our feet may be the most tortured parts of our bodies.

We jump on them, run on them, and cram them into overly tight shoes that sometimes tilt our feet at impossible angles. Given what we ask of the 26 bones, 33 joints and more than 100 muscles, tendons and ligaments in each one, Leonardo da Vinci wasn’t exaggerating when he described the human foot as “a masterpiece of engineering and a work of art.”

Every step you take hits the ground with a force of about one and one-half times your body weight.

To put that in perspective, a 200-pound person who takes 5,000 steps per day (about half of the 10,000 steps recommended for good health), will subject his feet to more than 1.5 million pounds of pressure every day.

causing stress and uneven wear on the discs that separate the vertebrae of the spine. At the same time, high heels also change the way a person normally walks. Walking in an unnatural way can, over time, lead to a number of painful conditions, including sciatica and degeneration of the spine.

Flip flops, shoes that are totally flat and similar attire are at the opposite end of the shoe spectrum, but wearing them can frequently lead to knee and hip pain. When shoes do not provide arch support or cushioning against the impact of those thousands of pounds of pressure as you walk, that impact is absorbed by the joints of “Every step you take vibrates throughout your skeletal the ankle, knee and hip. The system, and if your shoes don’t provide adequate support repeated stress on the joints or absorb those vibrations, the cumulative effect could be can contribute to the onset of osteoarthritis. a painful injury to your knees, hips or back.”

“Every step you take hits the ground with a force of about one and one-half times your body weight.”

At one time or another, you have likely experienced the shock wave that generates through your back from accidentally stepping into a hole. You may have even ended up with back pain after such a misstep.

Every step you take vibrates throughout your skeletal system, and if your shoes don’t provide adequate support or absorb those vibrations, the cumulative effect could be a painful injury to your knees, hips or back.

The type of shoes a person wears is often overlooked as a cause of joint or back pain. If you consider that your feet are the foundation for your entire body, it is easy to understand how slight changes to that foundation could affect the alignment of the rest of your body.

As you might suspect, high-heeled shoes are a frequent contributor to joint and back pain. When people wear high heels, their hip angle changes and their body’s center of gravity shifts forward. That shift works against the natural curvature of the spine, Rowan Medicine MedicaLink is an Advertorial Supplement published by Rowan University School of Osteopathic Medicine (RowanSOM). RowanSOM staff: Mary Louise Bianco-Smith (editor), Julia Swope, Gerald Carey, Lynne Yarnell, Lucy McGorry, Bernardine Jones. Please send inquiries via email to: sominfo@rowan.edu or RowanSOM Marketing Department, Suite 1600, 42 East Laurel Road, Stratford, NJ 08084, 856-566-6191.

Rowan Medicine MedicaLink

Our specialists not only treat your pain, but work to optimize your quality of life. Our services target diseases of the neuromuscular system, including acute or chronic pain, multiple sclerosis, muscular dystrophy, traumatic brain injury, gait dysfunction, headaches/migraines, balance disorders, post-stroke syndrome, spinal cord injury, neck and back pain and nerve injuries.

While this isn’t to say that you should avoid wearing fashionable shoes, you should do so sparingly. For example, it’s fine to wear high heels at work. But, if you do, consider wearing a pair of good sneakers during your commute and switch to heels once you arrive.

Although any damage to your joints and spine that is being caused by the shoes you wear will occur over time, keep in mind that occasional joint or back aches could be a warning sign of a painful and perhaps permanent condition.

Remember to consult with your physician if you experience any back pain that continues beyond two days, if any pain or numbness radiates from the lower back into the legs, or if your back pain worsens when standing or walking.

Dr. Knic Rabara specializes in Physical Medicine and Rehabilitation at Rowan Medicine’s NeuroMusculoskeletal Institute at the Rowan University School of Osteopathic Medicine in Stratford. To schedule an appointment, please call 856-566-7010.

NeuroMusculoskeletal Institute Call for an appointment 856-566-7010 42 East Laurel Road Suite 1700 Stratford, NJ 08084 rowanmedicine.com

Smoking linked to greater risk for type 2 diabetes

By MARY ELIZABETH DALLAS HealthDay Smokers have a much greater risk for type 2 diabetes than those who never smoked, and the same is true for those routinely exposed to secondhand smoke, a new study suggests.

But the Harvard researchers said this increased risk gradually drops over time once smokers kick the habit.

“Cigarette smoking should be considered as a key modifiable risk factor for diabetes,” study co-author Frank Hu, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health in Boston, said in a university news release.

“Public health efforts to reduce smoking will have a substantial impact on the global burden of type 2 diabetes,” Hu added.

Countless studies have linked smoking to serious health issues, including cancer, lung disease and heart disease. In conducting the study, the researchers investigated the link between smoking and diabetes. The study was only designed to find an association, and not a causeand-effect relationship.

The new analysis included 88 previous studies involving nearly 6 million people. The studies specifically examined the effects of smoking on the risk for type 2 diabetes.

a 22 percent higher risk for the blood sugar disease, the findings showed.

But the investigators also found that smokers who quit reduced their risk for type 2 diabetes.

The increased risk was up to 57 percent (depending on how much one smoked) before quitting, 54 percent within five years of quitting and 18 percent after five years of quitting. Once a decade had passed, former smokers’ increased risk for type 2 diabetes dropped to 11 percent, the study found.

The study authors estimated that nearly 12 percent of all cases of type 2 diabetes in men and over two percent of all cases in women (almost 28 million cases worldwide) may be linked to active smoking.

“Despite the global efforts to combat the Compared with never smoking, current tobacco epidemic, cigarette use remains the smoking increased the risk for the disease by leading cause of mortality and morbidity 37 percent, according to the report published worldwide,” study first author An Pan, a professor September in The Lancet Diabetes & Endocrinology. of epidemiology at the School of Public Health Former smokers were also at 14 percent at Tongji Medical College, Huazhong University greater risk for type 2 diabetes than those of Science and Technology, in China, said in a who never smoked, and people exposed to university news release. secondhand smoke on a regular basis had

MORE INFORMATION The U.S. Centers for Disease Control and Prevention has more on the health effects of smoking at cdc.gov

Need for long nap could signal type 2 diabetes The need for a long daytime nap or being tired throughout the day may be linked to an increased risk of type 2 diabetes, new research suggests.

A review of more than 260,000 people found that those who were very sleepy during the day had a 56 percent higher risk of diabetes compared to those who weren’t tired. People who took long naps — 60 minutes or more — had a 46 percent higher risk of diabetes, according to a report in the Wall Street Journal.

STUDY ALSO FOUND CONTINUAL EXPOSURE TO SECONDHAND SMOKE RAISED CHANCES OF DEVELOPING DISEASE

These findings don’t show a cause-and-effect relationship between napping and type 2 diabetes.

It’s also possible that the need for a nap and excess daytime fatigue are warning signs of type 2 diabetes.

One of the study’s authors, Dr. Tomohide Yamada, a researcher at the University of Tokyo, said people who need to take long naps or who are very tired during the day should see their doctor.

The study is scheduled to be presented this month at the European Association for the Study of Diabetes conference in Stockholm, Sweden.

Source: HealthDay

1 in 4 senior women in U.S. has osteoporosis: CDC

By E.J. MUNDELL HeathDay The weakening bones of osteoporosis greatly raise a person’s odds for dangerous fractures, and a new report finds that onequarter of all American women aged 65 or older suffer from the condition.

Close to six percent of men in this age group also have osteoporosis, according to the report from the U.S. Centers for Disease Control and Prevention.

Experts weren’t surprised, and said more must be done to test for and treat the loss of bone density that often comes with age.

Osteoporosis and its precursor condition — osteopenia (low bone mass) — “is not just a problem for the 80-year-old individual, but starts to become an issue for many adults in their 50s and 60s,” said Dr. Saad Chaudhary, a spine surgeon at

Benefit of targeted workouts Certain types of exercise improve bone health in middle-aged men with low bone mass and may lower their risk for osteoporosis, according to a small new study.

Men naturally lose bone mass as they age, which can put them at risk for osteoporosis, a condition that weakens bones and makes them more likely to break. About 16 million American men have low bone mass, and nearly two million have osteoporosis.

The new study included 38 healthy, physically active middleaged men with low bone mass who followed a weight-lifting or jumping program for a year. In both exercise regimens, the men did 60 to 120 minutes of targeted workouts a week.

The men also took calcium and vitamin D supplements. Their bone health was assessed at the start of the study and again at six and 12 months.

Both groups had significant increases in the bone mass of the whole body and lumbar spine at six months, and this increase was maintained at 12 months. Only those who did weight-lifting had increases in hip-bone density, the study found.

“Weight-lifting programs exist to increase muscular strength, but less research has examined what happens to bones during these types of exercises,” Pam Hinton, director of nutritional sciences graduate studies in the department of nutrition and exercise physiology at the University of Missouri-Columbia,

said in a university news release.

“Our study is the first to show that exercise-based interventions work to increase bone density in middle-aged men with low bone mass who are otherwise healthy. These exercises could be prescribed to reverse bone loss associated with aging,” she added.

However, Hinton pointed out that the findings do not prove that all kinds of weight-lifting will boost bone mass.

“Only the bone experiencing the mechanical load is going to get stronger, so we specifically chose exercises that would load the hip and the spine, which is why we had participants do squats, deadlifts, lunges and the overhead press,” Hinton said.

“Also, the intensity of the loading needs to increase over time to build strength. Both of the training programs gradually increased in intensity, and our participants also had rest weeks. Bones need to rest to continue to maximize the response,” she added.

“The interventions we studied are effective, safe and take 60 to 120 minutes per week to complete, which is feasible for most people.

Also, the exercises can be done at home and require minimal exercise equipment, which adds to the ease of implementing and continuing these interventions,” she explained.

The study was published recently in the journal Bone.

MORE INFORMATION The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about exercise and bone health at niams.nih.gov

Mount Sinai Beth Israel Hospital in New York City.

In the study, released last month by the CDC’s National Center for Health Statistics, Anne Looker and Steven Frenk, of the CDC’s Division of Health and Nutrition Examination Statistics, examined 2005-2010 data from a major federal government health survey.

The investigators reported that more than 16 percent of all seniors — about 25 percent of women and nearly six percent of men — have full-blown osteoporosis as evidenced on bone density tests of the spine and hip.

The numbers rise even higher when the data involves osteopenia, where bone loss is already apparent but hasn’t reached the stage of osteoporosis.

In that case, almost half (48 percent) of seniors — more than 52 percent of women and 44 percent of men — had osteopenia, the data showed.

Of course, rates of osteoporosis rose with age — about 26 percent of adults aged 80 or older had the condition. But the CDC team also noted that almost 13 percent of all adults between 65 and 79 years of age had osteoporotic bones.

In terms of demographics, MexicanAmerican seniors had the highest rate of osteoporosis (almost 25 percent), while blacks had the lowest rate (a little more than 10 percent), the report found.

Chaudhary stressed that much of this bone loss could be prevented.

“We reach our peak bone mineral density in adolescence and then must work conscientiously to maintain that through activity, a balanced diet, and consultation with health care providers,” he said.

Neglect your bone health in youth, and the consequences to quality of life could be significant, Chaudhary added.

“Osteoporosis is the more severe stage and can often result in one or more fractures of the spine and cause pain and disability,” he said.

“Bone mineral density screening is recommended for postmenopausal women, and men aged 50 and above based on their risk factor profiles, or for all

women age 70 and above and men aged 80 and above,” Chaudhary said. He believes that diet is also important — especially intake of calcium and vitamin D, which work together to help strengthen bones.

Dr. Caroline Messer directs the Center for Pituitary and Neuro-Endocrine Disorders at Lenox Hill Hospital in New York City. She noted the “unexpectedly high percentage of men over age 65 with osteopenia.”

While current guidelines don’t recommend routine bone density testing for men younger than 80, “based on this new data, perhaps males aged 65 or over should also be considered for routine testing,” Messer said.

Find out more about bone loss at the National Osteoporosis Foundation at nof.org.

Apples are american kids' favorite fruit

Fall’s other bounty is full of nutrition

By RANDY DOTINGA HealthDay

Kale:

Apples are the favorite fruit of U.S. kids and young people, accounting for almost 20 percent of all fruit consumed, a new study finds.

This childhood fave takes an even bigger slice of the fruit pie when apple juice is added to the tally, the researchers said.

“Apples and apple juice alone account for 30 percent of total fruit intake,” said study author Kirsten Herrick, a senior service fellow with the U.S. National Center for Health Statistics.

The study doesn’t say whether this is good news or not. “They’re a good fruit option, but there are a rainbow of fruits to consider that offer a variety of different minerals and vitamins,” she said.

Also, “substituting whole fruits for 100-percent fruit juices is always a good choice,” Herrick said.

A diet rich in fruits and vegetables is associated with a healthy weight and decreased risk of diabetes, stroke, cancers and other deadly conditions, the researchers pointed out.

But estimates from 20072010 showed that only 40 percent of U.S. children met Department of Agriculture recommendations for one to two cups of fruit a day, Herrick said.

“In general, kids are not eating enough fruit,” she said.

Until now, information has been lacking about the specific types of fruit kids eat, she added.

That’s where the new study comes in.

The researchers examined the results of 2011-2012 surveys on the food habits of more than 3,100 children and young people aged 2 to

19 years. The investigators found that whole fruits made up 53 percent of fruit consumption overall, and 100-percent fruit juices made up 34 percent. The rest consisted of mixed-fruit products and beverages that aren’t 100-percent fruit.

OCTOBER IS NATIONAL APPLE MONTH! Apples made up 19 percent of fruit intake, followed by citrus juice (14 percent), apple juice (10 percent) and other fruit juices (nine percent). Next in popularity were bananas and melons, the survey found. Avocados, which are actually berries, weren’t included because a database considered them to be vegetables, Herrick said.

The research didn’t find any differences in fruit consumption between males and females or kids from rich or poor families.

Black kids are less likely to eat whole fruit and more likely to drink fruit juice than

kids of other races, and those of Asian heritage consume the most whole fruits and the least fruit juice, the findings showed.

“The study can’t speak to why these differences exist,” Herrick said, but other research suggests that ethnic culture and fruit availability are major factors.

Bonnie Braun, a nutrition specialist and professor emerita at the University of Maryland School of Public Health, welcomed the study.

The findings are helpful to researchers, policymakers, parents and nutrition educators, she said.

What should parents do?

“Scientists and nutritionists seem to have consensus around one key message: Eat a variety of fruits in multiple colors,” she said. “Their second key message is: The more whole fruits, the better.”

Braun said that it’s also wise to adjust portion size by age and size of the child or young adult. Also, she added, parents should watch what they eat themselves since they influence kids, and they should expose children to a variety of fruits and vegetables.

MORE INFORMATION For more about kids and proper diets, see the American Heart Association at heart.org

This super food is in its prime right now and offers vegetable protein, fiber, folate and the minerals phosphorous, potassium, calcium and zinc. Kale is a source of alpha-linolenic acid, an omega-3 fatty acid. Omega-3s are well known for an array of benefits to the joints and skin in addition to boosting your mood.

Pears: Enjoy fresh for the most benefits as the skins are nutrient rich! Pear skin is thought to be highly concentrated with phenolic phytonutrients that have anti-inflammatory benefits.

Recent research even suggests they reduce type 2 diabetes risk because the flavonoids they contain keep your insulin levels in check. Pears are also a great source of fiber and copper, which is associated with increased cardiac and thyroid health.

Beets: These gorgeous red vegetables are packed full of health benefits, plus an earthy flavor that goes wonderfully with goat cheese and walnuts in our fall salad recipe!

Before passing on that bowl of borscht, consider the health benefits of its main ingredient: beets. This often unloved veggie contains fiber and potassium and is an excellent source of folate — just a half cup of cooked beets provides 17 percent of the recommended daily folate intake — and, like all vegetables, has no saturated fats or cholesterol.

Researchers believe the red pigment (called betacyanin) in beets could protect against development of cancerous cells and might play a role in reducing the inflammation associated with heart disease.

Sources: The Apple Products Research & Education Council (APREC), USA Pears.org, FitDay.com, American Kale Association, National Gardening Association

October 31 is Halloween

Halloween health and safety tips Fall celebrations like Halloween and Harvest Day are fun times for children, who can dress up in costumes, enjoy parties, and eat yummy treats. However, Halloween injuries send many children (and some adults) to emergency rooms in the United States every year, experts say.

Nearly one in five Halloween injuries involved the head, noted the American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America. Lacerations were also common, the groups noted. The study showed that onequarter of all hand and finger injuries were lacerations from pumpkin carving accidents.

Children younger than five and kids between 10 and 14 sustained the greatest proportion of injuries.

“Costumes, candy and scary monsters tend to be top-of-mind for kids during Halloween, not falls and fractures,” said Dr. John Gaffney, pediatric orthopedic surgeon and academy spokesman. “It’s important for parents to establish clear boundaries with their kids and teach them safety tips to ensure they have a positive experience, rather than having to visit the emergency room.”

Experts from both associations provided the following safety tips to parents and their children during Halloween:

➤ Hold a flashlight while trick-or-treating to help you see and others see you.

Always WALK and don’t run from house to house. ➤ Always test make-up in a small area first. Remove it before bedtime to prevent possible skin and eye irritation. ➤ Look both ways before crossing the street. Use established crosswalks wherever possible. ➤ Lower your risk for serious eye injury by not wearing decorative contact lenses. ➤ Only walk on sidewalks whenever possible, or on the far edge of the road facing traffic to stay safe. ➤ Wear well-fitting masks, costumes, and shoes to avoid blocked vision, trips, and falls. ➤ Eat only factory-wrapped treats.

Avoid eating homemade treats made by strangers. ➤ Enter homes only if you’re with a trusted adult. ➤ Only visit well-lit houses. ➤ Never accept rides from strangers. ➤ Never walk near lit candles or luminaries. ➤ Be sure to wear flame-resistant costumes.

Expecting trick-or-treaters or party guests?

Follow these tips to help make the festivities fun and safe for everyone: ➤ Provide healthier treats for trick-or-treaters such as low-calorie treats and drinks.

For party guests, offer a variety of fruits, vegetables, and cheeses. ➤ Use party games and trick-or-treat time as an opportunity for kids to get their daily dose of 60 minutes of physical activity. ➤ Be sure walking areas and stairs are well lit and free of obstacles that could result in falls. ➤ Keep candle-lit jack o’lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended. ➤ Remind drivers to watch out for trick-or-treaters and to drive safely.

For pumpkin carvers Are you going trick-or-treating? ➤ Use a pumpkin carving kit, or knives designed for carving. ving.

➤ Swords, knives, and other costume accessories should be short, soft, and flexible. ➤ Avoid trick-or-treating alone. Walk in groups or with a trusted adult. ➤ Fasten reflective tape to costumes and bags to help drivers see you. ➤ Examine all treats for choking hazards and tampering before eating them.

Limit the amount of treats you eat.

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These tools are less likely to get stuck in a pumpkin while carving.

In the event of a pumpkin carving injury, elevate the injured body part above the heart and apply direct pressure to the wound with a clean towel. If bleeding doesn’t stop after 15 minutes, or if the cut is very deep, p, go to the emergency room.

Pumpkin carving always requires adult supervision.

Rather than using a knife to carve, children can scoop out pumpkin seeds or decorate the pumpkin.

Don’t carve a pumpkin if you are under the influence of alcohol or another substance.

Source: Centers for Disease Control and Prevention

Non-Candy Alternatives Young trick-or-treaters typically are overloaded with candy, but you don’t have to jump on the candy bandwagon.

The Academy of Nutrition and Dietetics suggests these healthier Halloween options: ➤ Vitamin C-packed, 100 percent-fruit chews. ➤ Trans fat-free animal crackers or some sugar-free gum ➤ Small juice boxes with 100 percent fruit juice ➤ Small cups of low-fat pudding ➤ Halloween stickers, temporary tattoos, pencils or other non-food goodies Source: The Academy of Nutrition and Dietetics

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