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What medical tests do I really need? Is there a way to protect kids from the flu without the vaccine? Do I really need to be screened for colon cancer?
February 2015
U.S. measles outbreak still rising
By TARA HAELLE HealthDay The number of people infected with measles linked to the outbreak at Disney amusement parks in southern California now stands at 121, health officials recently reported. The overwhelming majority of cases — 68 — have been in California. Most of those people hadn’t gotten the measles-mumpsrubella, or MMR, vaccine, the Associated Press reported. Health officials said that about one of every four California patients has had to be hospitalized, the Los Angeles Times reported. Public health officials are urging people who haven’t been vaccinated against measles to avoid the Disney parks where the outbreak originated. California state epidemiologist Gil Chavez also urged the unvaccinated to avoid places with lots of international travelers, such as airports. ‘Patient zero’ — or the source of the initial infections — was probably either a resident of a country where measles is widespread or a Californian who traveled abroad and brought the virus back to the United States, the AP reported. The outbreak is occurring 15 years after measles was declared eliminated in the United States. But the new outbreak illustrates how quickly a resurgence of the disease can occur. And health experts explain the California outbreak simply. “This outbreak is occurring because a critical number of people are choosing not to vaccinate their children,” said Dr. Paul Offit, director of the Vaccine Education Center and an attending physician at The Children’s Hospital of Philadelphia’s
“Delaying vaccination leaves children vulnerable to measles when it is most dangerous to their development, and it also affects the entire community.” – Dr. Yvonne Maldonado American Academy of Pediatrics
Division of Infectious Diseases. “Parents are not scared of the disease” because they’ve never seen it, Offit said. “And, to a lesser extent, they have these unfounded concerns about vaccines. But the big reason is they don’t fear the disease.” Last week, the American Academy of Pediatrics (AAP) recommended that all parents vaccinate their children against measles. “Vaccines are one of the most important ways parents can protect their children from very real diseases that exist in our world,” Dr. Errol Alden, the academy’s executive director and CEO, said in a news release. “The measles vaccine is safe and effective.” Dr. Yvonne Maldonado, vice chair of the academy’s Committee on Infectious Diseases, said: “Delaying vaccination leaves children vulnerable to measles when it is most dangerous to their development, and it also affects the entire community. We see measles spreading most rapidly in communities with higher rates of delayed or missed vaccinations. Declining vaccination for your child puts other children at risk, including infants who are too young to be vaccinated, and children who are especially
vulnerable due to certain medications they’re taking.” The United States declared measles eliminated from the country in 2000. This meant the disease was no longer native to the United States. The country was able to eliminate measles because of effective vaccination programs and a strong public health system for detecting and responding to measles cases and outbreaks, according to the U.S. Centers for Disease Control and Prevention. But in the intervening years, a small but growing number of parents have chosen not to have their children vaccinated, due largely to what infectious-disease experts call mistaken fears about childhood vaccines. Researchers have found that past outbreaks of vaccine-preventable diseases are more likely in places where there are clusters of parents who refuse to have their children vaccinated, said Saad Omer, an associate professor of global health, epidemiology and pediatrics at Emory University School of Public Health and Emory Vaccine Center, in Atlanta. These so-called ‘vaccine refusals’ refer to exemptions to school immunization requirements that parents can obtain on the basis of their personal or religious beliefs. “California is one of the states with some of the highest rates in the country in terms of exemptions, and also there’s a substantial clustering of refusals there,” Omer said. “Perceptions regarding vaccine safety have a slightly higher contribution to vaccine refusal, but they are not the only reason parents don’t vaccinate.” Other reasons include the belief that their children will not catch the disease, the disease is not very severe and the vaccine is not effective, Omer noted. A big contributing factor to the parents’ continuing concerns about vaccine safety was a 1998 fraudulent paper published and later retracted in the medical journal The Lancet. The study falsely suggested a link between the measles-mumps-rubella vaccine and autism. The lead author of that paper, Andrew Wakefield, has since lost his medical license for having falsified his data. Several dozen studies and a report from the Institute of Medicine have since found no link between autism and any vaccines, including the MMR vaccine. Researchers say that those who refuse vaccines tend to share similarities. “In general, they’re upper-middle to upper class, well-educated — often graduate school-educated — and in jobs in which they exercise some level of control,” Offit
Serious complications from measles can include pneumonia and encephalitis, which can lead to long-term deafness or brain damage. said. “They believe that they can google the word vaccine and know as much, if not more, as anyone who’s giving them advice.” Omer added that recent data has shown that measles cases tend to disproportionately involve people who are not vaccinated. “The higher the vaccination rates, the lower the frequency and size of outbreaks,” he noted. The American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention and the American Academy of Family Physicians all recommend that children receive the MMR vaccine at age 12 to 15 months, and again at 4 to 6 years. The most common side effects of the MMR vaccine are a fever and occasionally a mild rash. Some children may experience seizures from the fever, but experts say these seizures have no long-term negative effects. The majority of recent outbreaks have been traced back to unvaccinated U.S. residents. Last year, 644 measles cases were reported to the CDC, the highest number of cases recorded since the disease was declared eliminated. Measles is one of the most contagious of human diseases. The airborne virus can linger in an area up to two hours after an infected person leaves, and approximately 90 percent of people without immunity will become sick if exposed to the virus. Serious complications from measles can include pneumonia and encephalitis, which can lead to long-term deafness or brain damage. An estimated one in 5,000 cases will result in death, according to Offit. “If a child died of measles in southern California, I think people would start vaccinating,” Offit said. “I think it will take more suffering and more hospitalizations and more deaths to not see these outbreaks. We’re compelled by fear, and we don’t fear this disease enough.”
More information Visit the U.S. Centers for Disease Control and Prevention for more on the measles and www.cdc.gov. Source: HealthDay
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Is there a way to protect kids from the flu without the vaccine? Dr. Jacqueline Kaari, a pediatrician with The University Doctors, responds: or nose unless they have just washed their hands. This has been one of the most difficult flu. Some children with flu will also experience Because the flu virus can live for several hours on flu seasons in recent years, and we vomiting and diarrhea. Your pediatrician can surfaces such as doorknobs and handrails, a person still have a long ways to go. Flu season advise you on the best ways to care for your infected with the flu can leave the virus on one of usually begins in the late fall or early child, including prescribing Tamiflu, an antiviral those surfaces where it awaits the next person who winter, peaks in January or February, and medication that – if given within 48 hours of the can pick up the virus simply by touching the can still be with us into the first part onset of symptoms – can decrease the severity same spot. of May. and length of your child’s illness and reduce the Keep an ample supply of tissues available and This flu season is a challenging one risk of flu-related complications. teach your children to use them when they sneeze because the annual flu vaccine doesn’t To schedule an appointment with Dr. Kaari, and to discard used tissues immediately. If no match with the strain of the virus that has initially been please call 856.566.7040 for the Stratford tissues are available, make sure your children use prominent this season. Office located at 42 East Laurel Road, Suite the ‘vampire cover’ by sneezing or coughing into the The annual vaccine is designed to work against strains 2545. Or, please call 856.582.0033 for the crook of their elbows instead of into their hands. of the virus that researchers have determined are most Washington Township office, 405 HurffvilleIf your child becomes sick with the flu, keep likely to circulate during flu season. Unfortunately, a Cross Keys Road, Suite 203. the child at home to avoid the chance of infecting different strain of the virus appeared in the United others at school or in a daycare setting. One reason States last fall, limiting the effectiveness of the vaccine. the flu spreads easily is because an individual will Despite this, there are still steps you can take to become contagious protect your children and others from the flu, and the about 24 hours before first line of defense remains the annual flu vaccine. experiencing any Although we are already in February, it’s not too symptoms. After late to vaccinate your children. Once they receive the becoming ill, that vaccine, it will take about two weeks for their bodies person can continue to to manufacture enough antibodies to give them full spread the virus for up protection from the flu during the remainder of to seven days. the season. Children and the Even though the vaccine isn’t a good match for the elderly are the virus that has circulated early, the vaccine should limit most susceptible to the ill effects of any strain of the flu. And, as we move pneumonia and other into the latter half of the season, researchers believe serious complications there is a good chance that the strains covered under from the flu. In a this year’s vaccine will become the ones to circulate severe flu season, there most commonly. can be as many as 170 Encouraging “This flu season is a Primary and preventive care from infancy through adolescence flu-related fatalities good hygiene challenging one because the among children. As of habits will also • Well baby and child visits • Immunizations last month, government help protect your annual flu vaccine doesn’t • School, camp and sports physicals • Check-ups reports showed that children against match with the strain of the nearly 60 children the flu. Take a few virus that has initially Convenient hours include walk-in morning hours, Saturday morning had already died from minutes to show and evening appointments. Most insurance plans accepted. been prominent…” flu complications your children Call for an appointment this season. how to correctly wash their hands for maximum Call your pediatrician effectiveness. That includes lathering soap on their 856.566.7040 856.582.0033 if your child shows signs palms, backs of their hands and between their fingers 42 East Laurel Road 405 Hurffville-Cross Keys Road – body aches, headache, for 20 seconds (about the time it takes them to sing the Suite 2545 Healthtrax Suite 203 fever, sore throat and ‘ABC song’) before rinsing. Remind them to wash their Stratford, NJ Sewell, NJ running nose – of the hands often and to avoid touching their eyes, mouth
Turning sniffles into smiles
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“Do I really need to be screened for colon cancer?” Dr. Drew Chiesa, a gastroenterologist with The University Doctors, responds: Despite the fact that colorectal colorectal cancer by 41 percent and those who had cancer is curable and that a number of colonoscopies reduced their risk by 68 percent. high profile public In the second study, figures – such as another research team Sharon Osborne looked at results over a and Supreme Court 30-year period of fecal Justice Ruth Bader occult blood testing Ginsberg – have among a group of more survived the disease, than 46,500 participants. colorectal cancer The participants who had remains the second leading cause an annual fecal occult of cancer deaths among Americans. blood test, reduced This year, it is likely that colorectal their risk of death from cancer will cause more than 50,000 colorectal cancer by 32 deaths in America. percent, while those who Two large, long-term studies in were tested every two the New England Journal of Medicine point out that it years had a 22 percent lower risk. doesn’t have to be that way. Along with the fact that testing will save lives, In the first study, researchers examined data from these studies point out that there are several nearly 89,000 individuals over a 22-year period. They different tests, including colonopscopy, fecal occult found that those individuals who received screening blood test, fecal immunochemical test and flexible sigmoidoscopy reduced their risk of dying from sigmoidoscopy, that can find this disease in its early, most curable stage. Unfortunately, too many people attach a significant ‘ick’ factor to the tests used to screen for colorectal cancer. The fecal occult blood test and the fecal immunochemical test both test stool samples for the presence of blood. This annual test is done in the home, requiring the patient Let us help treat your digestive health issues! to place samples from two or three bowel movements John C. Chiesa, DO, FACOI onto special cards that are Drew Chiesa, DO then mailed or taken to a Donald McMahon, DO medical laboratory Richard Walters, DO for analysis. Colonoscopy and flexible Call for an appointment: 856.566.6853 or 856.218.0300 (Option 6) sigmoidoscopy require test preparation that involves We offer GI Services at these locations: consuming only clear Marlton • Mt. Laurel • Stratford • Washington Twp. • West Deptford liquids the day before the test and taking laxatives to theuniversitydoctors.com completely clear the colon.
We Trust our Gut Instinct
The belief that the test preparation is – at best – uncomfortable has kept many people from being screened. While causing some discomfort, the test prep really isn’t as horrible as you may have heard. Colonoscopy is done while the patient is under monitored anesthesia and allows the physician to clearly see the inside of the entire colon and to biopsy or remove any suspicious looking polyps, the grapelike growths that can be the precursor to cancer. If no suspicious areas or polyps are found, repeat colonoscopies are scheduled once every 10 years. A flexible sigmoidoscopy does not require anesthesia, but sedation for patient comfort can be used. With this test, the physician can examine less than half of the colon. The flexible sigmoidoscopy should be repeated every five years. There is no doubt that early detection saves lives. More than 90 percent of people who are diagnosed with early stage colorectal cancer will continue to live for at least five more years. Routine screening generally begins at age 50, although some individuals have risk factors that indicate they should begin screening several years earlier. One recent troubling statistic has indicated a significant increase of colorectal cancer among younger individuals, including those as young as 20 to 34 years old. Because the reasons for this are not yet clear, routine screenings for people in this age group is not recommended. If you are over – or approaching 50 years – talk to your doctor about which colorectal cancer screening is best for you. While some of these tests are more effective than others for cancer prevention, the best test will always be the one that gets done. To schedule an appointment with Dr. Chiesa, please call 856.218.0300. The office is located in Washington Township at Harbor Pavlions, 570 Egg Harbor Road, Suite C-2, Sewell, NJ 08080.
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Donald A. Barone, DO, Chief, Division of Neurology 42 East Laurel Road, Suite 3500, PO Box 1011, Stratford, NJ 08084
The University Doctors MedicaLink Ask The University Doctors
Ask The University Doctors
Dr. Joshua Coren, a family physician with The University Doctors, responds
Dr. Tanya Kadrmas-Iannuzzi, a pediatrician with The University Doctors, responds: It may seem like your children are Regarding necessity, vaccines are essential to safeguard older children and teenagers. Meningitis, for constantly getting vaccinations, but example, is a terrifying illness. The initial symptoms are often confused with influenza, but meningitis vaccines provide vital protection for progresses rapidly. Most who contract it survive, but between 10 and 15 percent do not, and a significant children when they are most vulnerable number of those who survive do so with permanent disabilities that can include brain damage, hearing loss to crippling and, in some cases, or recurrent seizures. fatal diseases. The human papillomavirus (HPV) immunization is recommended – for both girls and boys – in the Before they are two years old, most preteen years. Given as a series of three shots over a six month period, the HPV vaccine is safe – more children will have received a series of than 62 million doses have been distributed since its introduction – and it prevents genital warts and vaccinations that protect against more several types of cancer. than a dozen diseases, including diphtheria, tetanus The HPV virus spreads by direct contact, usually during sexual activity. The U.S. Centers for Disease and pertussis (DTaP vaccine), measles, mumps and Control and Prevention (CDC) estimates that nearly all sexually active men and women become infected rubella (MMR vaccine), polio and chicken pox. By with the virus at some point in their lives. Although the virus usually does not cause any health problems, the time children are old enough to begin kindergarten, there are more than 26,000 cases each year of HPV-related cancers that could be prevented they will need booster vaccinations against all of through vaccination. these conditions. Finally, there is one other vaccine that everyone who is older than six months needs to get every year. Around the time children enter 6th grade (11- 12 years) Like all the other immunizations mentioned here, an annual flu shot helps protect you, your family and they will need two more vaccines. The first is a booster every person you come in contact with. (Tdap) against tetanus, diphtheria and pertussis. The Dr. Kadrmas-Iannuzzi is a pediatrician with The University Doctors at the Rowan University School second protects against meningitis (a potentially fatal of Osteopathic Medicine. To schedule an appointment at the Stratford office located at 42 East Laurel infection of the fluid surrounding the brain and spinal Road, Suite 2545, please call 856.566.7040. To schedule an appointment at the Washington Township cord) and septicemia (an infection of the bloodstream). office located at Healthtrax, 405 Hurffville-Cross Keys Road, Suite 203, please call 856.582.0033. A second meningitis vaccine is recommended at age 16. With exceptions for medical or religious reasons, New Jersey law requires college students to have received this vaccine if they will be living in campus dormitories at colleges or universities in the state. When it comes to vaccinations for their children, parents will often ask two questions: “Is that vaccine really necessary?” and “Will the vaccine cause autism or other side effects?” Although the virus The second usually does not cause question is easy. In most cases, the any health problems, only side effect there are more than from a vaccination 26,000 cases each year is some residual soreness at the site of HPV-related cancers of the vaccination. that could be prevented There is no credible through vaccination. evidence that When it comes to vaccinations for their children, parents will often ask childhood vaccines cause autism or any other disease. In my practice, I two questions: “Is that vaccine really necessary?” and “Will the vaccine see just as many autistic children who have never been cause autism or other side effects?” vaccinated as those who are up-to-date on their shots.
What medical tests do I really need? Many diseases – prescribe this blood test beginning at such as hypertension, age 20. If you are without those risk factors diabetes and heart you should begin testing at age 35. disease – have become Diabetes Screening Everyone who has so commonplace in our sustained high blood pressure (greater than discussions about health 135/80) should also be screened for diabetes that they no longer at least once every three years, regardless seem urgent. of whether they are receiving treatment But chronic diseases for their high blood pressure. Talk to your are often ‘silent killers’ and ignoring the physician to determine if other factors routine diagnostic tests that can spot – such as your lifestyle, weight or family these conditions in their earliest stages history – increase your personal risk factors could increase your risk of permanent for this serious, but preventable disease. disability or even premature death. Hepatitis C virus The U.S. Preventive Can routine medical tests be a bit Services Task Force (USPSTF) currently burdensome? Absolutely. Especially if recommends that all adults born between you aren’t feeling sick or you have to 1945 and 1964 – essentially all of the ‘baby rearrange work or boom’ generation “.. chronic diseases are often family schedules to – be tested for the ‘silent killers’ and ignoring the have the tests done. presence of this But, on balance, those routine diagnostic tests that can virus. Hepatitis are small prices to C virus can live spot these conditions in their pay for the peace for decades earliest stages could increase of mind that comes in your body from knowing you are your risk of permanent disability without causing or even premature death.” disease-free or have symptoms. When caught a potentially symptoms do serious health problem when it can be occur, they are often signs of advanced eliminated or easily managed. liver disease. While there are other age- or genderHIV At one time recommended only specific diagnostic tests, here are some for high risk individuals, the USPSTF now that everyone should consider: recommends this test for all adolescents Blood Pressure Test Have this and adults between the ages of 15 and checked by your health care provider 65 years and for all pregnant women. The every two years if your pressure is USPSTF expanded this screening to all normally below 120/80, or annually if individuals in the ages shown because many it is higher than that but still below people are unaware of their sexual partners’ 139/90. Treatment for high blood risk factors for HIV infection. pressure can include lifestyle changes, Eye exam If you are older than 40 years medications, or both. Left untreated, or already wear eyeglasses, schedule an eye high blood pressure can cause exam every two years. Besides measuring permanent and life-threatening damage your eyesight, your health care provider to your arteries, heart, eyes, kidneys will look for signs of diseases like glaucoma and brain. or the ill effects of high blood pressure on Cholesterol Test If you have high your eyes. blood pressure, are overweight or Dental exam Routine dental exams have a family history of heart disease are an important part of preventive or diabetes, your physician should health. Besides checking for cavities, your
Do older children and teenagers need vaccinations too?
dentist will look for signs of gingivitis, an infection of the gums that is associated with an increased risk of diabetes, heart disease and stroke. Colorectal Cancer A leading cause of cancer deaths, colorectal cancer is preventable through routine screening and highly curable when detected early. Your physician can help you decide which of several tests is best for you. Routine screening normally begins at age 50, although some higher-risk individuals
should begin screening at a younger age. Routine preventive screenings will allow you to focus on maintaining good health and avoiding chronic disease. If you haven’t kept up to date on your routine screenings, make it a point to talk with your physician to see which tests are right for you. To schedule an appointment with Dr. Coren, please call 856.380.2400 for the Mt. Laurel Office located at 100 Century Parkway, Suite 140.
Need a family physician? As your primary care office, we will manage and coordinate all of your medical care, including: • Routine preventive care • Acute care • Specialist referrals
• Annual wellness physicals • Chronic disease management • Follow-up vists
Most insurances accepted • Convenient hours Stratford 856.566.7020
Mount Laurel 856.380.2400
Hammonton 609.704.0185
Sewell 856.218.0300
The University Doctors 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, University Doctors Pavilion, Suite 1300, 42 East Laurel Road, Stratford, NJ 08084, 856.566.6191.
The University Doctors MedicaLink Ask The University Doctors
Ask The University Doctors
Dr. Joshua Coren, a family physician with The University Doctors, responds
Dr. Tanya Kadrmas-Iannuzzi, a pediatrician with The University Doctors, responds: It may seem like your children are Regarding necessity, vaccines are essential to safeguard older children and teenagers. Meningitis, for constantly getting vaccinations, but example, is a terrifying illness. The initial symptoms are often confused with influenza, but meningitis vaccines provide vital protection for progresses rapidly. Most who contract it survive, but between 10 and 15 percent do not, and a significant children when they are most vulnerable number of those who survive do so with permanent disabilities that can include brain damage, hearing loss to crippling and, in some cases, or recurrent seizures. fatal diseases. The human papillomavirus (HPV) immunization is recommended – for both girls and boys – in the Before they are two years old, most preteen years. Given as a series of three shots over a six month period, the HPV vaccine is safe – more children will have received a series of than 62 million doses have been distributed since its introduction – and it prevents genital warts and vaccinations that protect against more several types of cancer. than a dozen diseases, including diphtheria, tetanus The HPV virus spreads by direct contact, usually during sexual activity. The U.S. Centers for Disease and pertussis (DTaP vaccine), measles, mumps and Control and Prevention (CDC) estimates that nearly all sexually active men and women become infected rubella (MMR vaccine), polio and chicken pox. By with the virus at some point in their lives. Although the virus usually does not cause any health problems, the time children are old enough to begin kindergarten, there are more than 26,000 cases each year of HPV-related cancers that could be prevented they will need booster vaccinations against all of through vaccination. these conditions. Finally, there is one other vaccine that everyone who is older than six months needs to get every year. Around the time children enter 6th grade (11- 12 years) Like all the other immunizations mentioned here, an annual flu shot helps protect you, your family and they will need two more vaccines. The first is a booster every person you come in contact with. (Tdap) against tetanus, diphtheria and pertussis. The Dr. Kadrmas-Iannuzzi is a pediatrician with The University Doctors at the Rowan University School second protects against meningitis (a potentially fatal of Osteopathic Medicine. To schedule an appointment at the Stratford office located at 42 East Laurel infection of the fluid surrounding the brain and spinal Road, Suite 2545, please call 856.566.7040. To schedule an appointment at the Washington Township cord) and septicemia (an infection of the bloodstream). office located at Healthtrax, 405 Hurffville-Cross Keys Road, Suite 203, please call 856.582.0033. A second meningitis vaccine is recommended at age 16. With exceptions for medical or religious reasons, New Jersey law requires college students to have received this vaccine if they will be living in campus dormitories at colleges or universities in the state. When it comes to vaccinations for their children, parents will often ask two questions: “Is that vaccine really necessary?” and “Will the vaccine cause autism or other side effects?” Although the virus The second usually does not cause question is easy. In most cases, the any health problems, only side effect there are more than from a vaccination 26,000 cases each year is some residual soreness at the site of HPV-related cancers of the vaccination. that could be prevented There is no credible through vaccination. evidence that When it comes to vaccinations for their children, parents will often ask childhood vaccines cause autism or any other disease. In my practice, I two questions: “Is that vaccine really necessary?” and “Will the vaccine see just as many autistic children who have never been cause autism or other side effects?” vaccinated as those who are up-to-date on their shots.
What medical tests do I really need? Many diseases – prescribe this blood test beginning at such as hypertension, age 20. If you are without those risk factors diabetes and heart you should begin testing at age 35. disease – have become Diabetes Screening Everyone who has so commonplace in our sustained high blood pressure (greater than discussions about health 135/80) should also be screened for diabetes that they no longer at least once every three years, regardless seem urgent. of whether they are receiving treatment But chronic diseases for their high blood pressure. Talk to your are often ‘silent killers’ and ignoring the physician to determine if other factors routine diagnostic tests that can spot – such as your lifestyle, weight or family these conditions in their earliest stages history – increase your personal risk factors could increase your risk of permanent for this serious, but preventable disease. disability or even premature death. Hepatitis C virus The U.S. Preventive Can routine medical tests be a bit Services Task Force (USPSTF) currently burdensome? Absolutely. Especially if recommends that all adults born between you aren’t feeling sick or you have to 1945 and 1964 – essentially all of the ‘baby rearrange work or boom’ generation “.. chronic diseases are often family schedules to – be tested for the ‘silent killers’ and ignoring the have the tests done. presence of this But, on balance, those routine diagnostic tests that can virus. Hepatitis are small prices to C virus can live spot these conditions in their pay for the peace for decades earliest stages could increase of mind that comes in your body from knowing you are your risk of permanent disability without causing or even premature death.” disease-free or have symptoms. When caught a potentially symptoms do serious health problem when it can be occur, they are often signs of advanced eliminated or easily managed. liver disease. While there are other age- or genderHIV At one time recommended only specific diagnostic tests, here are some for high risk individuals, the USPSTF now that everyone should consider: recommends this test for all adolescents Blood Pressure Test Have this and adults between the ages of 15 and checked by your health care provider 65 years and for all pregnant women. The every two years if your pressure is USPSTF expanded this screening to all normally below 120/80, or annually if individuals in the ages shown because many it is higher than that but still below people are unaware of their sexual partners’ 139/90. Treatment for high blood risk factors for HIV infection. pressure can include lifestyle changes, Eye exam If you are older than 40 years medications, or both. Left untreated, or already wear eyeglasses, schedule an eye high blood pressure can cause exam every two years. Besides measuring permanent and life-threatening damage your eyesight, your health care provider to your arteries, heart, eyes, kidneys will look for signs of diseases like glaucoma and brain. or the ill effects of high blood pressure on Cholesterol Test If you have high your eyes. blood pressure, are overweight or Dental exam Routine dental exams have a family history of heart disease are an important part of preventive or diabetes, your physician should health. Besides checking for cavities, your
Do older children and teenagers need vaccinations too?
dentist will look for signs of gingivitis, an infection of the gums that is associated with an increased risk of diabetes, heart disease and stroke. Colorectal Cancer A leading cause of cancer deaths, colorectal cancer is preventable through routine screening and highly curable when detected early. Your physician can help you decide which of several tests is best for you. Routine screening normally begins at age 50, although some higher-risk individuals
should begin screening at a younger age. Routine preventive screenings will allow you to focus on maintaining good health and avoiding chronic disease. If you haven’t kept up to date on your routine screenings, make it a point to talk with your physician to see which tests are right for you. To schedule an appointment with Dr. Coren, please call 856.380.2400 for the Mt. Laurel Office located at 100 Century Parkway, Suite 140.
Need a family physician? As your primary care office, we will manage and coordinate all of your medical care, including: • Routine preventive care • Acute care • Specialist referrals
• Annual wellness physicals • Chronic disease management • Follow-up vists
Most insurances accepted • Convenient hours Stratford 856.566.7020
Mount Laurel 856.380.2400
Hammonton 609.704.0185
Sewell 856.218.0300
The University Doctors 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, University Doctors Pavilion, Suite 1300, 42 East Laurel Road, Stratford, NJ 08084, 856.566.6191.
Electronics keeping you up at night? By DENNIS THOMPSON HealthDay
People who use a tablet or e-book reader might wind up spending some sleepless nights because of their new gadget. That’s because the light emitted by a tablet like an iPad can disrupt sleep if the device is used in the hours before bedtime, according to a new Harvard study. People who read before bed using an iPad or similar “e-reader” device felt less sleepy and took longer to fall asleep than when they read a regular printed book, researchers found. The morning after reading an e-book, people found it harder to wake up and become fully alert than after reading a regular book — even though they got the same amount of sleep. The bright light from these devices appears to suppress melatonin, a sleep-promoting hormone that normally increases during the evening and reaches its highest levels as you sleep, said lead researcher Anne-Marie Chang. She’s an associate neuroscientist in the Division of Sleep and Circadian Disorders at Harvard’s Brigham and Women’s Hospital in Boston. “This light has serious consequences on our sleep and on our alertness, not only while we’re using these electronic devices but the following morning as well, even after eight hours of sleep,” Chang said. The study’s findings were published last December in the Proceedings of the National Academy of Sciences. In the study, 12 young adults read for about four hours before bedtime on five consecutive evenings, in a very dimly lit room at the hospital. Half read e-books and the rest read printed books. After that, they spent another five evenings reading at the hospital, only they traded their e-books for printed books and vice versa.
The bright light from these devices appears to suppress melatonin, a sleep-promoting hormone that normally increases during the evening and reaches its highest levels as you sleep.
Participants reading an e-book took longer — about 10 minutes longer — to fall asleep than when they read a printed book. They rated themselves as feeling less sleepy. When they did nod off, they spent less time in REM sleep, the phase of sleep associated with dreaming and deep, restorative sleep, the researchers observed. Blood drawn from the participants revealed that using an e-book reader delayed the natural nightly increase in their melatonin levels by more than an hour and a half, compared to when they read a printed book. The following day, participants who read an e-book said they woke up feeling sleepier and took longer to fully wake up and become alert, according to the researchers. Measurements taken by the research team found that iPads emitted heavy doses of blue-wavelength light, which has been shown in previous research to suppress melatonin and increase alertness. Other light-emitting e-readers also display large amounts of blue light, as do laptops, cell phones, LED
monitors and other electronic devices, the researchers said. “Bright light tends to make your brain think the sun is up. When you click it [an e-reader] off to go to sleep, you will have trouble getting to sleep,” said Dr. W. Christopher Winter, medical director of the Martha Jefferson Hospital Sleep Medicine Center and president of Charlottesville Neurology and Sleep Medicine, in Charlottesville, Va. “Light is not conducive to sleep, just as running on a treadmill right before bed isn’t a good idea either.” A 2014 National Sleep Foundation poll found 89 percent of adults and 75 percent of children have at least one electronic device in their bedroom, said Kristen Knutson, an assistant professor of sleep medicine at the University of Chicago and a research fellow with the foundation. For about 45 percent of adults and 30 percent of kids, that device is a tablet or smartphone, the poll found. “There could be serious effects if you use these devices night after night,” Knutson said.
A 2014 National Sleep Foundation poll found 89 percent of adults and 75 percent of children have at least one electronic device in their bedroom.
“People need to be more mindful. Think about when you’re using them. You could think of electronics as similar to junk food. Eating junk food is fine from time to time, but you have to do it in moderation.” People who want to read before bed should use a printed book, Chang said. They also could use an e-book reader that does not emit light. Researchers found that unlighted e-book readers gave off reflected light similar to that produced by printed books. “Presumably, the reflected light from the room is not enough to have these changes in their sleep,” Chang said.
More information For more on sleep, visit the U.S. National Institutes of Health at www.nih.gov.
Source: HealthDay
Kindness, compassion is the Rx By KATHLENN DOHENY HealthDay
Want to give health care a boost? Try a little kindness, experts say. Various studies suggest that when health care workers approach patients with compassion, patients often heal faster, have less pain and anxiety, and even bounce back faster from common colds. “When health care is delivered with kindness and compassion, it has a significantly greater effect than when it is given in a dispassionate fashion that assumes that the human connection has no benefit,” said Dr. James Doty, founder and director of Stanford University School of Medicine’s Center for Compassion and Altruism Research and Education.
“Staff can also help a patient feel cared for when they avoid the impression that they are rushed.” – Dr. James Doty, Stanford University Medical School
While medicine holds the power to cure, he said, how it is delivered can make a huge difference — not just for patients but for health care providers, too. Doty based his comments on a review of the published research on kindness and compassion in medical care. He presented the findings in November at the Compassion and Healthcare Conference in San Francisco. According to Doty, human evolution may be key to explaining why kindness matters in health care. That’s because humans evolved to include the nurturing of offspring. So, when someone nurtures someone in need, Doty said, the ‘feel-good’ hormone, oxytocin, is released in the patient’s brain. That may help patients feel less anxious and tense, translating to lowered perceptions of pain. Displaying compassionate care is simple, Doty said. For example, “those who practice this [know to] lean toward the patient,” he said, sending the patient the message that their doctor or other provider is interested. “We know you can express concern by simple touch,” said Doty, who is also a professor of neurosurgery at Stanford. Staff can also help a patient feel cared for when they avoid the impression that they are
rushed, Doty said. In the literature review, Doty found research showing that compassionate treatment helped “not only to reduce pain and anxiety but it was also tied to lower blood pressure, shorter hospital stays and even reduced the severity and length of the common cold. Improved cooperation may be one reason: The research showed that when patients viewed a health care provider as compassionate, that boosted the odds that the patient would follow a doctor’s recommendations. Doty said health care workers also tended to feel more engaged and useful in this type of caring environment. But who’s tracking ‘kindness’ in today’s health care industry? Doty said that while some national surveys monitor health care settings and how they are serving patients, they don’t drill down to levels of compassion. Through his work with the center at Stanford, Doty said he’s begun to meet with insurers to explain how offering care in a kind way can boost outcomes. Another expert in the field agreed that caring delivery is crucial to better patient outcomes. Emiliana Simon-Thomas is science director of the Greater Good Science Center based at
The research showed that when patients viewed a health care provider as compassionate, that boosted the odds that the patient would follow a doctor’s recommendations. the University of California, Berkeley. She said a key message from the collected research on kindness is that compassion in health care is a two-way street. That means that patients who are looking for more compassion in their care should be more compassionate themselves — seeking to understand the stresses health care workers are under. “That may mean taking the time to listen to your doctor, even if you’re getting unwelcome news,” Simon-Thomas said. And what if the relationship between a patient and his or her health care provider isn’t working? According to Simon-Thomas, patients who find themselves with a provider who is not compassionate should feel free to request another one, but not in a combative way. “Too often people get angry and combative, to their own disservice, when it is much more effective to gently ask for what you need, and express how an interpersonal dynamic is making you feel,” she said. For instance, a woman who is overweight and told by her doctor she’ll have a heart attack if she doesn’t get serious about weight loss might feel hurt and depressed. According to Simon-Thomas, she could first thank the doctor for his advice, then tell him how his manner makes her feel, and then ask for another doctor with whom she might connect more easily.
More information There’s more on compassion at Berkeley’s Greater Good Science Center at www.greatergood.berkeley.edu.
Source: HealthDay
Eczema may cause more health issues By STEVEN REINBERG HealthDay Adults with eczema — a chronic, itchy skin disease that often starts in childhood — may also have an increased risk of heart disease and stroke, according to a new study. This increased risk may be the result of bad lifestyle habits or the disease itself. “Eczema is not just skin deep,” said lead researcher Dr. Jonathan Silverberg, an assistant professor of dermatology at the Northwestern University Feinberg School of Medicine in Chicago. “It impacts all aspects of patients’ lives and may worsen their heart-health,” he said. The researchers found that people with eczema smoke and drink more, are more likely to be obese and are less likely to exercise than adults who don’t have the disease. The findings also suggest that eczema itself may increase the risk for heart disease and stroke, possibly from the effects of chronic inflammation, he said. “It was intriguing that eczema was associated with these disorders even after controlling for smoking, alcohol consumption and physical activity,” Silverberg added. It’s important to note, however, that this study only found an association between eczema and a higher risk of other health conditions. The study wasn’t designed to tease out whether or not having eczema can actually cause other health problems. Having eczema may take a psychological toll, too, Silverberg pointed out. Since eczema often starts in early childhood, it can affect self-esteem and identity, he said. And those factors may influence lifestyle habits. The skin condition can also make it harder
“It was intriguing that eczema was associated with these disorders even after controlling for smoking, alcohol consumption and physical activity.”
– Dr. Jonathan Silverberg Northwestern University Feinberg School of Medicine
Eczema was strongly linked with sleep troubles, according to the study. People with eczema were also more likely to have pre-diabetes or diabetes than people without skin problems, the study authors said. to exercise, because heat and sweat make the itching worse, Silverberg said. The study was published in a recent issue of the Journal of Allergy and Clinical Immunology. For the study, Silverberg’s team collected data on more than 61,000 adults ages 18 to 85. These adults were part of the 2010 and 2012 U.S. National Health Interview Surveys. The researchers found that people with eczema were 54 percent more likely to be severely obese than those without the skin condition. People with eczema were also 48 percent more likely to have high blood pressure. They were also about one-third more likely to have high cholesterol than those without eczema, the study noted. Eczema was strongly linked with sleep troubles, according to the study. People
with eczema were also more likely to have pre-diabetes or diabetes than people without skin problems, the study authors said. Silverberg noted that the lifestyle factors linked to eczema and other health conditions — such as smoking, drinking and obesity — can be changed. “Patients and doctors can work together to eliminate these bad behaviors and reduce the risk for heart disease and stroke,” Silverberg said. Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City, said the stress caused by eczema may play a role in increasing the risk for heart disease and stroke. “Eczema can have a major impact on the self-esteem and overall well-being of the patient,” she said. Stress is often a trigger, leading to a worsening of the itch and rash
that follows, she said. “It’s important to address the issue from the onset of the condition, even in children, to help them understand how to best handle the symptoms, both physical and emotional. Cognitive therapy along with skin care can have a major benefit in reducing symptoms and flare-ups from the stress component of the condition,” Day said.
More information For more about eczema, visit the U.S. National Library of Medicine at www.nlm.nih.gov
Source: HealthDay
Community boosted heart health By STEVEN REINBERG HealthDay
With heart health, sometimes it takes a village. That may be the take-home message from a new study. It found that one Maine community’s long-term focus on screening for heart risk factors, as well as helping people quit smoking, saved both money and lives. Over four decades (1970 to 2010), a community-wide program in rural Franklin County dramatically cut hospitalizations and deaths from heart disease and stroke, researchers reported January 13th in the Journal of the American Medical Association. Between 1970 and 1989 the death rate in the county was 60.4 per 100,000 people — already the lowest in Maine. But between 1990 and 2010, that rate dropped even lower, to 41.6 per 100,000 people. According to the research team, the health benefits were largely due to getting citizens to control their blood pressure, lower their cholesterol and quit smoking. “Improving access to health care, providing insurance and concentrating on risk factors for heart disease and stroke made a substantial difference in the health of the overall population,” said co-author Dr. Roderick Prior, from Franklin Memorial Hospital in Farmington, Maine. Prior believes that the Franklin County experience can be a model for other communities in the country. “If communities begin to take hold of their health problems, they can increase longevity and decrease the cost of health care,” he said. Begun in 1974, the Franklin Cardiovascular Health Program aimed at reducing heart disease and stroke among the roughly 22,000 people living in the county at the time. During the first four years of the program, about 50 percent of the adults in the county were screened for heart health. Outreach was key. According to the study authors, organizers sent “nurses and trained community volunteers into town halls, church basements, schools and work sites,” to help get residents motivated for screening. Screening helped alert people to potential health issues, and after screening, the proportion of residents whose blood pressure was controlled jumped from about 18 percent to 43 percent, Prior’s team said.
Outreach was key. According to the study authors, organizers sent “nurses and trained community volunteers into town halls, church basements, schools and work sites,” to help get residents motivated for screening. “Improving access to health care, providing insurance and concentrating on risk factors for heart disease and stroke made a substantial difference in the health of the overall population.” – Dr. Roderick Prior, Franklin Memorial Hospital
Regular cholesterol screening was added in 1986, and over five years reached 40 percent of the county’s adults, 50 percent of whom had high cholesterol, the researchers said. Between 1986 and 2010, the proportion of people who saw improvements in their cholesterol numbers rose from 0.4 percent to about 29 percent, respectively. Likewise, after a quit-smoking program
began, the rate of nonsmokers in Franklin County jumped from 48.5 percent to 69.5 percent. This increase was significantly higher than changes in nonsmoking rates elsewhere in Maine, the team said. Lives were saved or extended, as well. In the 1960s, the death rate in Franklin County was at or above the overall death rate in the state, but from 1970 to 2010 the county’s death rate fell to below the state’s average, including deaths from heart disease and stroke. Not only did the program reduce the death rate, but it saved the county money. From 1994 to 2006, hospitalizations were less than expected, which saved nearly $5.5 million in total in- and out-of-area hospital costs for county residents each year, the researchers said. “This important study demonstrates that community-based interventions are feasible and can be sustained over a prolonged period,” said Dr. Gregg Fonarow, a professor of cardiology
at the University of California, Los Angeles, and a spokesman for the American Heart Association. He believes the Maine example also “highlights the potential impact of targeted, multidimensional community-based interventions for improving heart health and outcomes.” Dr. Darwin Labarthe is a professor of preventive medicine and epidemiology at the Feinberg School of Medicine at Northwestern University in Chicago, and co-author of an accompanying journal editorial. He believes that “the communities in which we live have the capability to do what was done in Franklin [County], Maine.”
More information Find out more about heart disease in your community at the U.S. Centers for Disease Control and Prevention at www.cdc.gov. Source: HealthDay
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