Health
Guide 2015
MORE CASES OF MEASELS A DAILY
HEALTH IMPLICATIONS OF VAPING
JOURNAL PUBLICATION
PRE-DIABETES IN CHILDREN
When you think
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2015 HEALTH GUIDE
3
Measles History According to the Centers for Disease Control and Prevention, measles first presented as a “nationally notifiable disease” in the United States in 1912. A little more than 50 years later, the Edmonston-Enders vaccine for measles was created and used for the first time in the U.S. in 1963. The measles vaccine is generally administered at the same time as that for the mumps and rubella, called an MMR vaccination. Measles was declared eliminated in the U.S. in 2000. However, due to an increase in the number of parents choosing not to vaccinate their children and an increase in international travel, there has been a resurgence of measles in the U.S. The highly contagious virus is transmitted through the air and has the potential to live in the air and on surfaces for up to two hours once it’s introduced to the environment.
What to look for Signs and symptoms of measles generally present within 7-14 days after exposure and include: ●
A bump in MEASELS cases
By Jenn Willhite Correspondent ecent headlines about the resurgence of measles in the U.S. have many Hoosiers worried, but local health officials say there’s no need to be overly concerned. The reason for the recent measles outbreak in the United States is twofold, said Amber Terhune, public health nurse with the Johnson County Health Department. “People are opting not to vaccinate their children,” she said. “And with travel on top of that, measles is being brought in from other countries where it is more prevalent.” Although health officials agree one case of the contagious virus is one too many, Indiana has had no reported cases of measles since 2012, according to the Indiana State Department of Health.
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However, one single case is enough to be considered an outbreak due to the highly contagious nature of the virus and its ability to rapidly spread, Terhune said. “Luckily, the outbreak is over, but look how quickly that exploded,” she said. “One case going to an amusement park and then we had well over 100 cases in a matter of weeks.” One unvaccinated person exposed to the measles virus acts as not only an incubator, but as a transmitter. The incubation period for measles is 21 days, she says. And you don’t have to be in the same room as the infected person to become infected, she says, you can walk in an hour later and be exposed after the person has gone. “There is always the potential it could come here,” she said. “It’s a plane ride see MEASELS on page 18
High fever
● Cough ● Runny ● Red,
nose
watery eyes
Within two to three days after symptoms present, white spots may appear inside the mouth. Up to five days following initial symptoms, rash develops along the hairline and upper part of the face. In subsequent days, the rash migrates downward to the neck, torso, arms, legs and feet. It is not uncommon for individuals with a rash to develop a fever as high as 104 degrees. It is important to remember the measles rash can take several days, sometimes up to two weeks, to go away.
Treatment Unfortunately, measles is a virus so there is not antibiotic treatment available. Over-thecounter medicines, such as Tylenol, may be used to help reduce fever. Essentially, the virus must run its course. Antibiotics may be administered if complications develop, but the type and dosage is dependent on the severity of infection.
Complications Frequent complications associated with the measles include ear infections and diarrhea. In some cases, severe complications can arise, including pneumonia, encephalitis, and death. Info: cdc.gov/measles; mayoclinic.org/diseases-conditions/measles
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2015 HEALTH GUIDE
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“The biggest thing with pre-diabetic patients is lifestyle, weight loss and healthy eating.” — Dr. Anne Clark, pediatrician
Childhood PRE-DIABETES on the rise Experts say the best way to combat it is to eat healthier, exercise
By Amy May Staff writer rea doctors say changes in diet and lifestyle are the biggest contributor to childhood obesity, which has become an alarming health care issue as nearly one-fifth of America’s kids are considered obese. “We eat a lot more junk, a lot more highly processed foods, fast foods,” said Dr. Danielle Broshears, a pediatrician with WindRose Health Network, Franklin clinic. “It’s not intentional. It’s just harder to sit down with your family and have a good, nutritious meal every night.” First lady Michelle Obama’s Let’s Move school lunch and childhood nutrition campaign, the NFL’s Play 60 and numerous other well-publicized programs have put a national spotlight on this issue. According to the Centers for Disease Control and Prevention, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. The percentage of American children ages 6-11 who are obese increased from 7 percent in 1980 to nearly 18 percent in
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2012. The percentage of adolescents ages 12-19 who are obese increased from 5 percent to nearly 21 percent over the same period. The CDC’s Risk Behavior Survey shows Indiana at the high end, with approximately 15 percent of its youths weighing in too heavy.
Short-term and long-term effects Childhood obesity has immediate and long-term effects on health and well-being. The CDC says that obese youths are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. Also, obese children and adolescents are at greater risk for bone and joint problems, sleep apnea and social and psychological problems such as stigmatization and poor self-esteem. Obese kids will likely be obese adults and at risk for adult health problems such as heart disease, stroke, osteoarthritis and cancer. Another dangerous, long-term and expensive health problem is diabetes. According to the CDC, diabetes was the seventh leading cause of death in the United States in 2013. Diabetes occurs when your body becomes
resistant to insulin, a hormone produced by the pancreas that enables the body to convert glucose (sugar) to energy. Without insulin, glucose is toxic. There are two kinds of diabetes: ● Type 1 was once called “juvenile diabetes” since it often affects young children. The disease progresses quickly. Symptoms include extreme thirst and weight loss. It is caused when the pancreas stops producing insulin. Patients must take insulin shots. ● Type II diabetes is when the body isn’t using its insulin properly or becomes resistant to it. It’s slower to develop and can be managed with diet and weight loss. But 40 percent of Type II patients use prescribed insulin (injections or pills), too. Since younger children are developing Type II, the term “juvenile diabetes” no longer applies to just Type I, Broshears said. “This was something that used to affect adults. (Childhood) obesity is moving it 20 years earlier. The quality and quantity of their lives is going to be decreased. They will live longer with the disease,” she said. “It’s more common in adults,” added Dr. see PRE-DIABETES on page 6
6 2015 HEALTH GUIDE PRE-DIABETES continued from page 5 Anne Clark, pediatrician with WindRose Health Network, Trafalgar clinic. “But with the rise in obesity, we are seeing it in teenagers. Obesity is the No. 1 risk factor for diabetes.” People who have a relative with diabetes are more likely to develop it. AfricanAmericans, Hispanics, Native-Americans and Pacific-Islanders also are more at risk. “With a younger person, they can run into more complications,” Clark said. Diabetes affects the entire body, but is especially damaging to the circulatory system. The heart and blood vessels are affected. Wounds won’t heal properly, especially on lower extremities. Some diabetics lose their feet or legs due to wounds or blood clots. Kidney function can be affected. It also affects the eyes, and many with diabetes lose visual acuity or even go blind. People don’t die from diabetes, per se, Broshears said, but from the complications it causes. Unlike with Type I, there is a warning period before Type II’s onset. This is called being “prediabetic” or “borderline diabetes,” Broshears said. A doctor can consult with an obese patient and determine if he is at risk. Some chil-
dren may show no symptoms at all. In others, symptoms may be similar to those of Type 1 diabetes, which include fatigue, thirst, nausea and frequent urination. Other symptoms may include weight loss, blurred vision, frequent infections and slow healing of wounds or sores. There may be a dark ring around the neck, called acanthosis nigricans. Girls may suffer from vaginal yeast infections or burning on urination, polycystic ovary syndrome with infrequent or absent periods, and excess hair and acne. A blood glucose test determines if a patient is prediabetic. “Pre-diabetes needs monitoring; 15 to 30 percent will develop Type II diabetes within five years. Most within 10 years,” Broshears said.
Management and prevention But it can be managed and prevented. “Even losing 5 to 10 percent of your body weight will make a significant difference,” she said. If your child has any of the risk factors, especially obesity, Broshears said it’s important to schedule a physical once a year so a doctor can monitor the situation. “The biggest thing with pre-diabetic patients is lifestyle, weight loss and healthy
eating,” Clark said. “We definitely see more obese kids as well as pre-diabetes. It’s one of the things we would screen for and talk to them about.” The rise in childhood obesity is likely due to Americans’ change in lifestyle. There is less time to shop and prepare fresh, healthy food; it’s just quicker and easier to order a pizza, microwave a packaged meal or grab some fast food, Broshears said. Unfortunately, those types of meals have a lot of calories. She added that you can’t just go on a diet and lose a few pounds to fend off diabetes, since you’ll likely gain the weight back once the diet is over. “It’s a lifestyle change. You have to change eating habits,” she said. This includes more lean meats, whole grains and vegetables and some fruits while reducing carbs, fats and sugar. Both doctors said diet is the biggest factor in childhood weight gain, but physical activity is important, too. Families should try to cut down on “screen time” and encourage physical activity. “It’s got to be a family change. You can’t just expect a 10-year-old to eat healthy, eat right and make good decisions on his own,” Broshears said. H
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8 2015 HEALTH GUIDE
Carbs don’t have to be your enemy By Erica Marcus Newsday nce it was fat. Now carbs are the nation’s principal nutritional bugaboo. And that puts pasta squarely in the culinary crosshairs. But vilifying one ingredient while lauding another just isn’t good science, according to Alice Lichtenstein, the Stanley N. Gershoff Professor of Nutrition Science and Policy at Tufts University and vice chair of the 2015 U.S. Dietary Guidelines Advisory Committee. “When you’re a scientist,” she said, “you don’t look at any food in isolation. It’s not about what’s a good food or what’s a bad food, there are just so many variables.” Lichtenstein said that the healthfulness of pasta depended on the size of the portion and what else was in the dish. “A lot of the calories come from the accompaniments,” she said. She’s a fan of bulking up a modest portion (2 to 4 ounces) of pasta with lots
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of vegetables and has a particular fondness for frozen broccoli. “For some reason,” she said, “if you toss the frozen florets into a tomato sauce, they hold up better than the fresh ones.” She added that frozen vegetables have every bit as much nutritional value as fresh — and more than “fresh” vegetables that have been sitting on the shelf for weeks. (Another surprise: cooking tomatoes “makes the nutrients more available than if they were raw.”) Lichtenstein is a fan of whole-grain pasta, but sees no reason to seek out pastas with higher protein content. “In the U.S., underconsumption of protein just is not a problem,” she said. “And it’s not that big a difference anyway.” In general, she counseled weight watchers to limit their calories. “If you take in fewer calories than you expend, you will lose weight.” But she also suggested that pasta lovers find a way to eat pasta. “Maintaining your weight is a lifelong process. You are going to have more success if you are enjoying what you eat.” H
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2015 HEALTH GUIDE
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10 2015 HEALTH GUIDE
E-cigs may be safer than toba
By Greg Seiter Correspondent
W
hile the percentage of American adult tobacco smokers has steadily declined during the last decade, a new-age version of the age-old practice has skyrocketed in recent times, particularly among middle school and high school students. Vaping and eJuice are relatively common modern-day terms associated with electronic cigarettes, which produce a type of noticeable mist or aerosol when inhaled that resembles, and even in some cases, tastes like tobacco smoke. E-cigarettes are promoted as a less dangerous and seemingly healthier alternative to traditional smoking practices and are even believed to be an effective tobacco smoking cessation aid. However, the U.S. Food and Drug Administration has yet to classify e-cigs and their associated products as actually being “safe” for consumers. When e-cigarettes first came out, water
vapor was used and manufacturers marketed them as an effective way for people to get off tobacco, said Nancy Voris, tobacco program coordinator for Johnson County. But as tobacco companies got involved, nicotine was added, she said. “So a person can now go into a vape shop and buy e-cig cartridges that contain a certain percentage of nicotine,” Voris said. “E-cig companies are owned by big cigarette companies and they want to stay in business, so they’re going to keep finding ways to make money.” Voris acknowledges that tobacco smoking rates are down, but is concerned that part of that reduction could have to do with the growing popularity of electronic cigarettes. “People don’t consider this as smoking,” she said. “but there have been no conclusive studies done yet that show vaping is any healthier.” As far as the presence of nicotine goes, Carl V. Phillips, chief scientific officer, Consumer Advocates for Smoke-Free Alternatives Association, said consumers should not be concerned. “The reality is that the relevant aspect of
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2015 HEALTH GUIDE
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obacco, but not entirely ‘safe’
“There’s definitely room to make these products even safer than they are, but even the worst assessments out there still put the risk factors at minimal compared to cigarettes. ... Even if imperfect, they’re still better than what they’re being substituted for.”
exposure has been studied,” he said. “E-cigarettes deliver nicotine. But nicotine, absent smoke, has not been shown to present measureable health hazards. It is delivered in rates that are simply too low to detect. “We know that because we have decades of research for smokeless tobacco.” Nicotine is a substance found in the nightshade family of plants and is a stimulant. Experts say that high amounts can be harmful to mammals. Voris said a big part of her concern is the lack of regulation to control the amount of nicotine being used or made available to customers. “Certainly, most of them (vape shops) get their products from a company, but there’s no regulation out there,” she said. “So in a worst-case scenario, tobacco companies could be telling distributors to give people as much nicotine as they can. “We can only trust that if a label says the product contains 5 percent nicotine, that’s actually the amount that’s in there.” And according to Voris, concerns over the presence of nicotine in e-cigarette juice isn’t limited to adult intake only. see VAPING on page 6
— Carl V. Phillips, Consumer Advocates for Smoke-Free Alternatives Association
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12 2015 HEALTH GUIDE
“Tobacco companies ... know that if they get kids started with e-cigarettes, it makes it a lot easier for them to go right to cigarette smoking later on.” — Nancy Voris, tobacco program coordinator for Johnson County quantify chemicals and contaminants that show up in tiny quantities when heating and compare what we know about the hazards of inhaling those contaminants, you can rule out the possibility that they cause a substantial amount of harm,” he said. “Of course, that doesn’t mean there are no risks at all. “Zero exposure to a potentially harmful chemical is safer than minimal exposure, but these risks are down in the range of every day hazards. Eating potato chips isn’t harmless. Driving isn’t harmless. But the risks are certainly not near the range associated with cigarette smoking.” Phillips does, however, agree that artificial flavoring for electronic cigarettes needs to be addressed. “There is a bit of genuine con-
cern that certain flavoring agents are sometimes present in quantities that might pose a hazard,” he said. “Responsible manufacturers use food flavorings and those are safe for eating. But that doesn’t necessarily mean they’re safe to inhale. “There are no standards for inhaling so we can’t say how much of a certain chemical is OK to put in something.” Voris is also troubled by the industry’s apparent direct marketing campaign aimed at teenagers. “Some (of the devices) look like a lip gloss case, for example. It’s something cool,” she said. “They can sneak it into a bathroom at school and do it with just a little vapor so that it’s hard to notice. “And kids aren’t just using these devices for nicotine delivery,” Voris continued. “They can be used for pot and other drugs, too.”
According to a CDC news release issued April 16, e-cigarette use among middle and high school students tripled from 2013 to 2014. Voris also believes that e-cig usage can lead to other habits among teenagers. “Tobacco companies ... know that if they get kids started with e-cigarettes, it makes it a lot easier for them to go right to cigarette smoking later on,” she said. Many questions regarding vaping remain unanswered, and industry experts disagree on levels of proposed nicotine limitations. “There’s definitely room to make these products even safer than they are, but even the worst assessments out there still put the risk factors at minimal compared to cigarettes,” Phillips said. “It’s absurd to say that if an item is only, let’s say, 97 percent safer than cigarettes, it should be completely banned. “Even if imperfect, they’re still better than what they’re being substituted for.” H
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“The flavors in some of these juices are specifically targeting kids,” she said. “At one count, there were something like 5,000 flavors, including gummy bear and cotton candy.” A toddler who comes upon these juices could get the lid off, drink it and poison himself, Voris said. This happened in New York in December, and the child died. “There are varying degrees of liquefied nicotine and there are other chemicals used to create these flavors, too.” Legislation that would require manufacturers to use specified safety equipment and childproof caps in conjunction with the production and sale of eJuice products was introduced as House Bill 1432 during Indiana’s most recent legislative session. But what about the potential for the presence of other chemicals in these liquids? Phillips said that consumers shouldn’t jump to any uneducated conclusions. “When you measure and
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2015 HEALTH GUIDE
Lung cancer top cancer killer of women in rich nations By Marilynn Marchione AP Chief Medical Writer or the first time, lung cancer has passed breast cancer as the leading cause of cancer deaths for women in rich countries. The reason is smoking, which peaked years later for women than it did for men. Lung cancer has been the top cancer killer for men for decades. “We’re seeing the deaths now” from lung cancer due to a rise in smoking by women three decades ago, said Lindsey Torre of the American Cancer Society. The society released a report in February based on new numbers from the International Agency for Research on Cancer. Some highlights:
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The cancer burden Globally, there were about 14 million new cancer cases and 8 mil-
lion cancer deaths in 2012, the most recent year for which numbers are available. “Developing countries account for 57 percent of cancer cases and 65 percent of cancer deaths,” Torre said.
Men vs. women; rich vs. poor countries For men, lung cancer has been the leading cause of cancer death globally for several decades. In poor countries, breast cancer remains the top cancer killer for women. Colon cancer has grown as a cause of death worldwide. As for the number of cases diagnosed, prostate and breast are the most common cancers in men and women, respectively, in rich countries.
The U.S. picture Lung cancer became the top can-
cer killer for men in the 1950s, and for women in the late 1980s, reflecting trends in smoking rates.
Looking ahead Smoking rates have leveled off or dropped in rich countries. In the United States, “we are already seeing lung cancer death rates decline,” Torre said.
How to lower risk The American Institute for Cancer Research says half of all cancers are preventable. Healthy diets and getting enough exercise cut risk. The hepatitis vaccine helps prevent liver cancer; the HPV vaccine lowers the risk of getting cervical cancer. The biggest factor: Stop smoking, or don’t start. Quitting by middle age can avoid 60 percent of the risk of dying of lung cancer, Torre said. “It’s never too late to quit.” H
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14 2015 HEALTH GUIDE
Migraine studies yield fresh approaches to ward off pain
By Lisa Mulcahy Los Angeles Times f you suffer from migraine headaches, you’ve got plenty of company. More than 10 percent of the population is hurting right along with you, including 18 percent of women. Migraines are most common from the ages of 25 to 55. The good news: New research can help change your approach to managing your migraines. Here are five strategies to try. Worry can cause a headache, but a recent study from Yeshiva University in New York found that the relief experienced after a stressful situation can also bring on the pain. The cause may be a drop in stress hormones including cortisol, according to study co-author Dawn Buse, director of behavioral medicine at Montefiore Headache Center in New York City. Calming yourself the right way can cut your risk. “If the stress has already passed, it’s wise to use all of the factors that may protect against migraine including sleep, proper nutrition,
Speaking of relaxation, meditation may just be the ticket when it comes to minimizing a migraine’s effect, according to researchers at Wake Forest Baptist Medical Center in Winston-Salem, S.C. “Those in our study who took a two-hour instructive class in mindful meditation for eight weeks and meditated on their own five days a week for 35 to 40 minutes experienced migraines that were less severe and shorter,” said lead study author Dr. Rebecca Erwin Wells. Chronic migraine sufferers also reported 1.4 fewer migraines per month on average.
I
Tweet pain away
physical activity and exercise, and relaxation practices, which balance the nervous system,” Buse said in an interview. Those practices could include cognitive behavioral therapy, guided visual imagery or simply closing your eyes for 30 seconds to focus on your breath.
University of Michigan researchers analyzed 21,741 tweets about migraine, 65 percent by people experiencing a headache at that time, and found that expressing feelings about the pain may provide symptom relief. “Neuroimaging studies have suggested that emotional and cognitive areas in the brain can modulate, in part, activity see MIGRAINES on page 18
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16 2015 HEALTH GUIDE
Early diagnosis and intervention key with autism improvement
By Terri Colby Chicago Tribune he prevalence of autism in the U.S. has soared in recent decades. There is no single verifiable cause and no magic pill for treatment. But new research suggests earlier diagnosis is possible and, with that, hope for a better outcome. “The earlier we start good targeted intervention, the better chance we have at molding some of the brain circuits that we know are important for language and social interaction and the things that are impaired in autism,” said Dr. Shafali Jeste, an autism expert at the University of California, Los Angeles. There is no blood test to quickly alert parents that their young children need help. Instead, diagnoses often don’t come before age 4 or 5 and are made when behaviors seem atypical or when childhood milestones are missed. Beyond regular developmental screenings by doctors, the U.S. Centers for Disease Control and Prevention encourages parents to contact their doctors if they suspect a problem with the way their child plays, learns, speaks, acts or moves. Last year, the CDC raised its autism prevalence estimate to 1
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in 68 American children from 1 in 150 in 2000. The advocacy group Autism Speaks says that the number of children in the U.S. with autism has increased tenfold in 40 years. As with many things in the world of autism, there is controversy about the reasons for the increase. Some of the increase likely can be attributed to changes in the way the disease is diagnosed. But that can’t account for all of the increase, experts say. Figures aside, the ability to make an early diagnosis is improving. While the CDC reports that the median age for autism diagnosis is after a child’s 4th birthday, there is evidence that use of a simple questionnaire for parents and pediatricians can reduce that age by about two years.
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Diana Robins, who heads a research program at the A.J. Drexel Autism Institute, has developed, with others, the M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised). Robins reported in a recent study in the journal Pediatrics that use of
the tool can reduce the diagnosis age to about 25 months. An earlier diagnosis means intervention can begin earlier, and that’s the good news. “Kids who start treatment earlier have a better chance of developing fluent language,” Robins said. “They have a better chance of being integrated into a typical classroom in elementary school, and they have a better chance of long-term success in terms of independence, the ability to go into higher education or be part of the work force.” But early intervention is no panacea, Robins added. “It’s complicated because some kids who get the very best early intervention are not able to be in a typical classroom and do not develop fluent language,” she said.
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Jeste, the UCLA behavioral child neurologist studying the biological and psychosocial basis of autism, noted that the disorder typically is diagnosed based on a list of symptoms that don’t show up until a child’s second or third year, sometimes later. But over the last decade, she said, it’s become more evident that doctors should be able to find
2015 HEALTH GUIDE
67 infants at risk for developing ASD and 50 low-risk infants. Compared with the control group, the at-risk infants later diagnosed with ASD looked less at the video and spent less time watching the woman’s face. “This study highlights the possibility of identifying certain features linked to visual
“It’s complicated because some kids who get the very best early intervention are not able to be in a typical classroom and do not develop fluent language.” — Diana Robins, A.J. Drexel Autism Institute some signs of autism, either through behavioral examination or through brain markers, before a formal diagnosis is made. “We know that brain development is very dynamic and is constantly changing in response to environment in the first few years of life,” Jeste said. “And we know that any kind of experience modulates brain development.” Researchers at Yale School of Medicine have reported spotting deficits in 6-monthold infants who later developed Autism Spectrum Disorder. Using video of a woman trying to engage a group of babies, researchers studied the infants’ eye movements, comparing
attention that can be used for pinpointing infants at greatest risk for ASD in the first year of life,” said Katarzyna Chawarska, associate professor at the Yale Child Study Center, in a press release. “This could make earlier interventions and treatments possible.” Some recent studies of small groups of children have shown successful results from interventions with children as young as 6 months. At the University of California, Davis, a treatment known as Infant Start was provided to seven infants aged 6 months to 15 months who had shown symptoms such as decreased eye contact, lack of social engagement or repetitive movement patterns.
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“Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3,” said Sally J. Rogers, professor of psychiatry and behavioral sciences and lead author of the study. “We have speeded up their developmental rates and profiles, not for every child in our sample but for six of the seven.” Published in September 2014 in the Journal of Autism and Developmental Disorders, the treatment was based on the Early Start Denver Model intervention, which coaches parents on best practices to optimize attention and engagement. Treatment began with 12 one-hour sessions with infant and parent, followed by six weeks of biweekly visits and follow-up assessments at 24 and 36 months. When compared with infants who had similar symptoms but did not get the therapy, the study group had significantly lower autism severity scores at 18 and 36 months. A small study published in February by researchers at the University of North Carolina at Chapel Hill found that simple strategies known as Adapted Responsive Teaching (ART) that are used by parents can be effective for 12-month-old infants at risk for ASD. H
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Don’t overtreat
MIGRAINES continued from page 14 related to the perception of physical pain,” said study author Alexandre DaSilva. “Social media may provide relief for migraineurs that goes beyond the emotional.”
other triggers, you might be just fine.” If a migraine does strike, try eating bread or crackers to raise your blood sugar and potentially ease symptoms. “Personally, I find eating starchy food helps when I’m having a migraine,” Cutrer said.
Before your doctor sends you off for expensive imaging tests like a CT scan or refers you to a specialist, ask to talk about your migraines. A study by Beth Israel Deaconess Hospital researchers in Boston found that 12 million Americans annually are overtreated for headaches. Instead, study author John N. Mafi said, “Clinical guidelines for headache recommend that physicians counsel their patients on lifestyle modifications. Leading an overall healthy lifestyle with a diet rich in fruits and vegetables as well as regular exercise can also help. Another important approach includes keeping a headache diary. “Once patients can identify each of their own migraine triggers, they can take active steps to prevent them, thereby lessening the need for medications or visits to the doctor.” H
communities and areas with large numbers of unvaccinated individuals. The best way to prevent a measles outbreak is to vaccinate, said Dr. Debra Holmes, pediatrician with Franklin Pediatrics. Contrary to popular belief, the vaccine is safe, she said. Reports about the vaccination being linked to autism simply aren’t true, she says, because the original study was flawed. You are at greater risk if you don’t vaccinate. “If you don’t get the vaccine, the measles is certainly more risky,” she said.
“I can recommend vaccinating and give them information,” she said “But sometimes when people are scared they don’t do anything.” Pryor encourages people to educate themselves about the measles virus by utilizing reputable sources that site evidence-based research, such as the CDC. Another option is to speak with your child’s pediatrician or local health department. If you are reluctant about giving your child all his vaccinations at once, speak with your pediatrician about taking it a step
Don’t obsess over red wine
Aged cheese. Chocolate. Wine. Caffeine. Most migraine sufferers are familiar with a long list of foods that may kick off a headache. “It’s key to remember, though, that migraines are caused in many people by compounding factors,” said Dr. Fred Cutrer, a neurologist at the Mayo Clinic in Rochester, Minn. “If you experience a strong smell like perfume, flickering or flashing lights, less sleep and you eat a cold-cut sub with nitrates all in one day, yes, you may get a migraine,” he added. “But if you ate that sub on a day when you didn’t experience those MEASELS continued from page 3 away.” If a measles case were to occur in Indiana, the individual’s travel history would be recorded, Terhune said. It would be important to know where the person had traveled so anyone they had come into contact with during their infectious period could be notified. Terhune believes part of what has stemmed the tide of measles outbreaks is education. “There has been more education and public service announcements about vaccination,” she said. “I know some states have philosophical exemptions and they’re looking at making that not an option.” Children are considered the most atrisk group for measles because they do not receive the measles vaccination, which is part of the mumps and rubella (MMR) vaccination, until they are a year old. Up to that point, a child still caries maternal antibodies, which generally do a good job of staving off infection. A segment of the adult population is unaware of its vaccination history, Terhune said. Those individuals, along with those who may have compromised immunity, should check with their doctor to see if they are at risk for the measles. According to the Centers for Disease Control and Prevention, there have been more than two dozen measles outbreaks in the United States since 2008; the most recent linked to an amusement park in California. The organization states most of the large outbreaks were directly linked to
“Luckily, the outbreak is over, but look how quickly that exploded. One case going to an amusement park and then we had well over 100 cases in a matter of weeks.” — Amber Terhune, public health nurse, Johnson County Health Department One of the most dangerous complications associated with measles is encephalitis, said Laura Pryor, chief quality officer with WindRose Health Network. Commonly caused by a viral infection, like the measles, encephalitis is an inflammation of the brain that can be fatal if left untreated. “If you’re going to have it from measles, it’s usually around six days after you’ve had the rash that it’ll show up,” said Pryor. “Symptoms of encephalitis include fever, headache, stiff neck, vomiting and seizures.” Pryor said she can’t tell people they have to vaccinate, but it doesn’t stop her from trying to steer them in the direction of education.
at a time. There is no real harm in taking it slow, even though it is best to vaccinate sooner rather than later, Pryor said. It just simply means they aren’t protected as early, she said. Pryor said vaccinations don’t always guarantee 100 percent immunity, but they certainly reduce the body’s reaction to the illness for the small percentage of individuals who present with the condition they were vaccinated against. “When kids are coming in for their baby shots, they’re getting a lot of shots at one time,” she said. “You can work with your doctor to give the child vaccinations one at a time. That way the parent can see their child is OK.” H
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