Saturday, April 27, 2013

How to Evaluate a Research Study

I was talking with a friend who was describing a research study about the brains of criminals. The researcher had concluded the brains were different, which prompted me to ask, “well did he have a matched control group?” My friends was quick to reply, “I’m sure he did what he was supposed to do because he was at the NIH [National Institutes of Health].” I didn’t have the heart to tell her that where the researchers work, or even what journal a research article appeared in, isn’t a 100% percent guarantee of findings.

When I was in college, for my final exam in experimental design, we were given articles from two well respected medical journals and asked to evaluate the studies. Needless to say, we found lots of room for improvement.

That being noted, there are times that researchers publish “quick and dirty” research findings because they want feedback before they invest in larger trials. With the advent of the internet, as well as other media outlets, these studies can be widely distributed. Therefore before you make a change in treatment plans, or make health decision based on a research study, here are some ways to evaluate the study:

• Where did you learn about the study?

• Was the study in animals or people? As interesting as findings can be in a rat, or other animals,  clinical trials in humans can yield very different findings.

• How many people were involved in the study? When it comes to chronic disease, studies need to have large populations and continue for an extended period of time. The goal is to ensure that observed differences are not the result of chance.

• Does the study include people like you? Ages, gender, stage of disease, ethnic groups and life style (e.g. active vs sedentary) of those studied can impact findings.

• Was it a randomized control group used?  Using a “control group”-which is matched in age and other characteristics to the group undergoing treatment-is the gold standard for research. However, it is expensive and so not always used.

• If a new medication was being tested, were there side effects reported?

• Who funded the study? Researchers are required to disclose where their funding comes from. If it’s a large study, with matched controls, from a reputable institution, chances are the findings are ones that you can trust.

• Have there been similar studies? If so, what were the results? Were they the same or different?

Before making changes, discuss it with your treating medical provider.

Further reading

Wednesday, April 24, 2013

Take a Break: Celebrate Earth Month Make your own art supplies/cosmetics/body care products

In keeping with April being Earth Month, and this Wednesday is in the middle of Earth week, today’s take a break is about making your own art supplies, cosmetics and body care products. If you missed last week, it covered making your own bread,Nutella and cleaning supplies. 

• Art supplies
-       Watercolors 
-       Modelingclay 
-       Crayons 
-       Fingerpaints
-       Chalk board paint: 1 T unsanded grout to 1/2 acrylic paint-mix until there are no lumps. Mix paint as needed, since it will harden. After it dries, lightly sand.
-       PuffyPaints 
-       ModelMagic 

• Cosmetics/Body Care
-       Natural body lotion 
-       Bubblebath 
-       Mouthwash 
-       BodyWash 
-       EyeCream 
-       Soap 
-       Sugar Scrub: Combine sugar and oil (safflouer, olive or whatever you have on hand) until it makes a good paste. I find that it definitely cuts down on the smell of cholrine after I’ve been swimming.
-       BathFizzies 
-       Lipstick 
-       Blush 
-       Mascara 

Saturday, April 20, 2013

Reducing Violence/Reducing Chronic Disease: The Solution is the Same

This past week has been filled with violence. The media is awash in the bombings at the Boston Marathon, poisoned letters sent to the President and a US Senator and the shooting and chase of the bombing suspects. As if that weren’t enough, incredible anger was voiced about the Senate not voting for stronger gun control measures.

While the media is having a field day over all the various choices for meaty stories, and Facebookers are posting over time their pro or con views on gun control, I find myself once again wondering why we’re not addressing the root issue of violence and what motivates people to use a weapon, be it a penis, knife, poison, black powder, car or gun.

Working with chronic conditions, as well as having spent years working in AIDS, the link between violence and chronic illness has been evident to me for a very long time. Many of the HIV+ women I worked with had incredible violence in their backgrounds, often at very young ages. It wasn’t uncommon to be holding a safer sex workshop and every participant had experienced rape, including some that were left for dead. Domestic violence was so much a part of some women’s lives, that it was standard to hear things like, “Well he wasn’t that bad. He only hit me with an open hand.”

The research now supports what I’ve known for some time, A growing body of science is consistently linking violence (the experience with and/or fear of) with risk for and incidence of a range of serious physical health problems. The effects of violence on health are a consequence of the physical, biological, environmental, social, behavioral, and emotional changes that violence imposes on all of us. While it has been long understood that violence has implications for emotional and physical injury, it is only relatively recently that we are beginning to recognize the longer-term effects that reap an extensive toll on the broader health status of individuals, families and communities. These health consequences include asthma, significant alteration of healthy eating and activity, heart disease and hypertension, ulcers and gastrointestinal disorders, diabetes, neurological and musculoskeletal diseases, and lung disease. … Adults reporting exposure to violence as children had increased likelihood of a number of chronic health conditions compared those without such exposures, especially if their experience involved multiple forms of violence exposures (ischemic heart disease 2.2x, cancer 1.9x, stroke 2.4x, chronic obstructive lung disease 3.9x, diabetes 1.6x, hepatitis 2.4x)

The two questions we need to be addressing, if we truly want to reduce violence (in all forms) and its consequences, are:
-       How do we create an environment and community where people are able to live a life of well-being, contentment and purpose?
-       How do we create a mental health system that helps to identify and effectively treat those in need?

It is important to note that in spite of all we do, there will still be incidences of violence, but significantly less, and because we are mortal, illness and accidents will still be part of our lives.

Tackling this problem is not easy. There is no pill, legislation or “one size fits all” quick fix approach. It is going to require work, cooperation and a belief that change is possible. It will need to come from the grass roots level and include as many different groups as possible, since we are a very diverse country. It needs to come the bottom up, which is the way most effective and sustained change occurs. It also means that we each must become “the change we want to see.”   It’s not okay to think you’ve done your part by sending e-mails to your congressman and reposting comments on Facebook. It means being an active, engaged and fully present part of your family and community.

With that in mind, consider the following:

• The Blue zones project,  which I’ve written about before in this blog, has studied five communities around the world where longevity is common among the majority of the population. They identified nine common denominators. When one looks at these Power Nine it is easy to see why these communities promote a sense of well-being and have less violence and chronic disease than their American counterparts. The Power Nine include:
- Move Naturally
- Know your sense of purpose
- De stress daily
- Eat a plant slant diet
- Don’t over eat
- Drink alcohol moderately
- Belong to a faith based or community group
- Put family (how you choose to define it) first
-       Associate with people who support healthy behaviors

So if you are thinking, “that’s fine if you live on an island, but it wouldn’t work in a city or my community,” think again. There is now a Blue Zones Project initiative to help cities and towns  become Blue Zones Communities. It provides an opportunity for citizens, schools, employers, restaurants, grocery stores and community leaders to work together on policies and programs that will make the most impact and move the community towards optimal health and well-being. Check out the following sites to see the impact it’s had on three communities:
-       Albert Lea, MN 
-       Ten communities in Iowa 

Prevention Institute has developed a series of tools communities, advocates, policymakers etc can use to reduce violence. 

• While improving communities will help to reduce some aspects of mental illness, there will still be a need for effective treatments.  While funding is key-a number of states have cut mental health funding, attitudes are a major barrier to people seeking care. NAMI (National Alliance on Mental Illness) is launching a new campaign to help shed light on mental illness and encourage understanding and conversation. Partnering with Lifetime, the film “Call Me Crazy: A Five Film” airs tonight, April 20 at 8 pm EST. Featured stars include: Jennifer Hudson, Melissa Leo, Octavia Spencer, Sarah Hyland, Sofia Vassilieva, Brittany Snow, Ernie Hudson, Jason Ritter, Jean Smart, Lea Thompson, Melanie Griffith, Chelsea Handler. To learn more about this film and watch the trailer, go to the NAMI website.

Wednesday, April 17, 2013

Take a Break: Celebrate Earth Month make Bread, Nut Butter, Cleaning Supplies

In honor of April being Earth Month (Monday April 22 is Earth Day), the next couple of “Take a Break” Wednesdays will be about making something you would normally buy.

Since it’s been snowing and sleeting where I live, I never thought I’d say this, but I’m fantasizing about “spring cleaning.”  So I’ll start this week with an easy way to make bread and a Nutella substitute followed by different types of natural cleaning supplies you can make.

• Make your own bread with the “no knead” method. By all means, make your own favorite bread recipe, but if you want one that’s supper easy, try this:
In a large bowl combine:
3 cups all-purpose or bread flour
1/4-teaspoon instant yeast (also called Rapid Rise highly active)
11⁄4 teaspoons salt

Add 1 5/8 cups water, and stir until blended; dough will be shaggy and sticky. I pour in 1 1/2 cups of water and then add a little extra. Cover bowl with plastic wrap. Let dough rest at least 12 hours, preferably about 18, at warm room temperature, about 70 degrees. An oven not in use is a good place for the bread.

About a half-hour before dough is ready, heat oven to 450 degrees. Put a 6- to 8-quart heavy covered pot (cast iron, enamel, Pyrex or ceramic) in oven as it heats. When dough is ready, carefully remove pot from oven. Sprinkle corn meal in the bottom. Using some corn meal on your hand, scoop out the bread mixture from the bowl and pour it into the prepared pot. Shake pan once or twice if dough is unevenly distributed; it will straighten out as it bakes. Cover with lid and bake 30 minutes, then remove lid and bake another 15 to 30 minutes, until loaf is beautifully browned. Cool on a rack.

Nutella. A friend of mine made me a version of this and it was so much better than the commercial chocolate hazelnut spread, I figured I had to try making it.  I made the almond variety yesterday and I think my husband will end up finishing it today. Using two cups of roasted lightly salted almonds, I ground them in the food processor until it was the consistency of peanut butter. Depending on your food processor, it can take as long as 10 minutes to reach this stage. I then melted 1/3 cup of dark chocolate chips in the microwave (1 minute) and pulsed that into the nuts. I added more melted chocolate because chocolate is a major food group for me. It is positively delicious on a cracker, apple or bread. The next time I make it, I’ll probably try a semi sweet chocolate, and to make it more like Nutella use milk chocolate.

• Cleaning supplies: This is a particularly useful idea for people affected by chronic conditions, as many of the commercial grade cleaning products are hazardous to your health. It will also save you a lot of money. Literally white vinegar, baking soda and liquid soap can take care of most things, as will Blue Dawn and white vinegar mixed in a spray bottle.
-       Goo Gone 
-   Oxy Clean (it’s nothing more than hydrogen peroxide and baking soda) 

Saturday, April 13, 2013

What is Google Telling Other People About You?

When was the last time you “googled” yourself? If you haven’t done this, you may be in for a surprise.

The Internet can be a tremendous gift to those affected by chronic conditions. From finding the latest information about a particular diagnosis, sharing medical data, to creating a Lotsa Helping Hands page for someone in need, it’s become the way many deal with their illness. Roger Ebert, the noted film critic, found that after he could no longer speak, his voice could still be heard through his on-line blog, as he noted,  “the internet creates a level playing field.”

For all this web “wonderfulness,” there is a dark side.  Seth Godin recently wrote an interesting piece Building Your Backlist (and living with it forever)  about the risk and assets of the information trail you leave on line.

The Internet has a very long memory. If you wish to remain anonymous about your chronic condition, yet you have an active blog, Facebook page and/or Twitter account regarding your experiences, anyone has access to it. Do you want your employer, or perspective employer, girl/boy friend or family to know this much about you?

Things to consider about how you appear on-line:
• If you want to protect your anonymity on-line but want to take part in on-line support groups and other social networking activities regarding your health, use a nickname and e-mail account that is different than what you normally use.

• Avoid posting pictures of yourself.

• Be careful about the information you share and where you post it.

• Social networking sites can be hacked. If you have a Facebook account, but don’t look at it that often, either close it out or get in the habit of checking it regularly to be sure that someone hasn’t done some posting for you.

• Before you post, tweet, blog, or even e-mail consider whether this is something you want the world to know. Even if you think you are deleting a page or an image online, it may not be gone. Keep in mind that e-mail can easily be forwarded.

Learn more ways about protecting your on-line identify

Wednesday, April 10, 2013

Take a Break: Enjoy, Remember and Celebrate Roger Ebert

Film critic Roger Ebert died last week after an incredible career and an amazing life. For a person who made his living by talking about the movies, losing his voice, as well as his ability to eat and speak, from cancer, caused him to create a second career on-line. People talk loudly and slowly to me. Sometimes they assume I am deaf. There are people who don't want to make eye contact. It is human nature to look away from illness. We don't enjoy a reminder of our own fragile mortality. That's why writing on the Internet has become a lifesaver for me. My ability to think and write have not been affected. And on the Web, my real voice finds expression. Remaking my voice 

 Among my favorite comments he wrote was “Kindness” covers all of my political beliefs. No need to spell them out. I believe that if, at the end, according to our abilities, we have done something to make others a little happier, and something to make ourselves a little happier, that is about the best we can do. To make others less happy is a crime. To make ourselves unhappy is where all crime starts. We must try to contribute joy to the world. That is true no matter what our problems, our health, our circumstances. We must try. I didn’t always know this and am happy I lived long enough to find it out.

Today’s take a break is all about making yourself and those around you a little happier by checking out the things Ebert enjoyed. Consider:

• Watching one of the “great movies” as selected by Ebert 

• Reading Ebert’s blog, particularly his last post “A Leave of Presence.” 

•  Read Ebert’s Remembering Gene, which was about his relationship with Siskel (the other half of the Siskel and Ebert television program). 

• Give people around you the famous “thumbs up.”

Saturday, April 6, 2013

At the Health Care Crossroads: Turn it over to the health experts, or re learn what we once knew?

We are at a cross roads, and the choices we make will be felt for many generations to come. As the largest segment of our society is aging, we can either continue on the same path of turning our health care over to the experts, or we can take responsibility for our own well-being. We can add all sorts of new jobs to the health care field or we can empower our communities, families and friends to act as they once did.

In the past several weeks, I've had interesting conversations with colleagues about the continuing belief that good health is equal to health care access, and how health care was being expanded to include a whole host of new "experts." The short response to this statement is that we should all know better. Good health is achieved by how we live our lives far more than having a doctor on every corner. The proliferation of "health experts" is a very slippery slope heavily protected by those who have a job at stake.

Recently, I read an article about the number of employment opportunities that would be available in the coming years as the "baby boomers" age. These included exercise specialists, personal care attendants, home designers, and the new field of "patient advocate." If you've followed this blog for any length of time, you will know I have frequently written about how to be a health advocate (Be a Friend with a Pen),  contacting condition specific organizations to arrange for an advocate and in general, the importance of using them. [Health Advocate Who, what, When and Where] However, does being a patient advocate require that you be certified?

If you want to make your living doing advocacy work, you are going to say yes and lobby as hard as you can to get this made a health benefit by the insurance company. However, take a few steps back.

When society left behind the community midwife, women, mothers and wives as healer, opting instead for doctors and hospitals (1800s in the USA), the cost of health care became a very serious issue for many, which has only gotten worse with each passing year. It also put us on the path of turning our medical needs over to an expert and away from listening to our bodies, and learning to heal ourselves.

I am not anti doctor or anti science by any stretch of the imagination, and am extremely pro public health, which is where the majority of life lengthening practices have come from (e.g. vaccines). As my fellow co-director of CCIN noted What I am opposed to is the continual turning over of aspects of our lives, particularly our well-being, to those who profess to know better than we do about what's best for us, and have the arrogance to dictate what our values should be.

To the relearn piece. For generations, families, friends and communities looked after each other as their survival depended on it. Whether it was a new baby, the death of a loved one, an accident, a significant illness, or what have you, people had a clear idea of how to respond. Mind you that weren't always able to do so, but they didn't spend time wondering what they should do.

When something happens, the natural urge for most people is to try and help in some way. However, with the proliferation of "experts" in all phases of life, people have become a lot more fearful of responding. They don't want to do the wrong thing, they think there is an "expert" that would be better at this, or they are concerned about invading someone's privacy. There are experts by the bucket load who will assure them they should be very cautious indeed. Better call them first. 

In short, by our dependence on experts, we are teaching people "learned helplessness." If there ever was a time in our history that we can’t continue on this path, it is now.

In order to weather the "gray" tidal wave of the aging boomers, I think it's financially and emotionally important that instead of encouraging the development of more "experts," we help communities, families and friends build on what they have that works, encourage them not to be afraid of reaching out to help and to relearn what was common practice in the society of their grandparents and great grandparents. Keep in mind that we have some incredible advantages in the internet age that were not available to our ancestors. In addition, the up and coming crop of seniors are going to be a lot healthier than their parents and grandparents, which means that many will make incredible volunteers.

For practical ways to go about this, in January, I wrote a series on Creating Positive Health Outcome for Patients. For an overview, read Do What You Can, With What You Have, Where you are. For more specifics try:
Creating Positive Health Outcomes for Patients: Five things hospitals can do 

Wednesday, April 3, 2013

Take a Break: Design a Fantasy Victorian Garden

With periodic snow squalls, Vermont is not exactly enjoying spring like weather, even though the calendar would suggest otherwise. Since I can’t go out and plant, I can still sketch a garden.

This week, it’s all about the era of the Victorian Garden. With their elaborate flowers and lawns, these types of gardens became popular as the English middle class had more leisure time.

There were eight elements of a Victorian garden:
• Lawn: All formal gardens had front and rear gardens
• Trees: Playing an important role in providing shade to key areas of the house, they also framed the approach to the house and helped with privacy.
• Shrubs: Marked paths and property lines and hid unsightly wooden fences
• Fencing: The more elaborate the home, the more elaborate the fencing. Cast iron was the most popular material used.
• Ornaments: From urns and sundials to man made fishponds, ornamentation was key to the Victorian garden.
• Seating: Gazebos, benches and pavilions spread out through the lawns and gardens. Porches favored wicker furniture.
• Flowers:  Carpet bedding, the use of same-height flora, was popular. Roses were extremely popular and climbing varieties were often trained over a trellis, bower or pergola.
• Vines: Used to hide fences, tree stumps and other unsightly features, vines were also used for shade.

With these basics in mind, design your fantasy Victorian garden that you would enjoy. Since it’s a fantasy, you’re not constrained by how much space you actually have. Need some ideas? Check out the following:

Not in the mood for sketching? Try the virtual garden or better yet grow a virtual garden. Just click anywhere on the black space and a flower will appear.