If we had a power outage for a really, really long time, how would you fare? Really…could you go a really, really long time with out your computer, TV, cell phone over, say, your refrigerator? If you had access to a super powered generator what would you turn on? In other words, what would you find “essential” – things like refrigerators, the stove and perhaps a light or two…or technology.
A recent article in USA Today is quite illuminating. It turns out that many people, adult people, are so hooked on technology that in the case of a massive power outage they would actually put their lives and those of their kids at huge risk by turning on things like video games over truly essential items like lights and a refrigerator by running the games in a closed garage.
The USA Today article points out the highlights of a new study in this month’s Pediatrics about the dangers of gas-powered generators. The study notes that after Hurricane Ike, an ER in Houston treated 37 people from gas-generator-related carbon monoxide poisoning. Of those people, 54% were under the age of 18 and 75% of this group were playing video games.
This study highlights that our sense of “what is essential” has become skewed towards all that is plugged in. If our kids can not deal without technology for a bit, if we can not deal without technology for a bit, it’s time we took a collective big step back and realized that we actually can. It will feel strange and foreign for a day or so but life will go on because our “essentials”…food, shelter, oxygen, family…are met.
*This blog post was originally published at Dr. Gwenn Is In*
Hodge’s start-up Personal Pediatrics aims to equip a fleet of self-starter pediatricians in major metro areas with iPhones, cloud-based practice software and the marketing know-how to court new parents, families and corporate health programs alike. The company’s plan points to a growing trend of doctors returning to what was once a mainstay of the profession: the house call.
Hodge has already established that the iPhone doctor model works — after more than a decade working in a pediatrics office in St. Louis, Missouri, where she saw up to 35 patients a day for about 10 minutes each, Hodge traded in the patient assembly line to launch Personal Pediatrics. That was three years ago. Back then she had her laptop and Palm Treo in tow.
I have to mention one thing first. The whole health 2.0 movement is not about transforming the healthcare system into an online service, but there are more and more people who want to reach healthcare services through online or mobile applications.
If there are no patients who want to be online, no doctors will build such services. That’s how it works.
*This blog post was originally published at ScienceRoll*
The Centers for Disease Control (CDC) currently recommends that children 6 month to 18 years old receive an annual flu vaccine. There are two types of flu vaccines used in the US: a live attenuated virus (LAIV) and a trivalent inactivated virus (TIV) vaccine. Both are safe and effective – while efficacy varies from year to year, they are 70-90% effective in healthy adults. Efficacy is young children appears to be slightly less, about 66%.
There remains, however, many sub-questions about the flu vaccines and by the time researchers have thoroughly explored them vaccine technology is likely to have progressed, and therefore any new vaccines will have to be tested all over again.
One of those sub-questions about vaccine safety and efficacy is the net effect of the flu vaccine in children with asthma. Some have raised concerns that the vaccine may exacerbate asthma, a 1-2% increased wheezing and 3% increased hospitalizations have been reported, although so far the bulk of the data suggests that both types of flu vaccines are safe in children with asthma. There is evidence to suggest that the LAIV may be superior to the TIV in children, particularly with asthma.
A new study, presented but not published, further explores the safety and efficacy of the TIV in children. Study author, Avni Joshi, M.D., of the Mayo Clinic, reports:
“The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine’s effectiveness has not been well-established. This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization.”
The study is a retrospective study of 263 children who presented to the Mayo clinic with laboratory confirmed influenza. They found that children who had recieved the TIV vaccine had a 3 times greater risk of hospitalization than those who were not vaccinated. These results raise concerns about the safety and effectiveness of the TIV in children with asthma.
Dr. Joshi concludes:
“While these findings do raise questions about the efficacy of the vaccine, they do not in fact implicate it as a cause of hospitalizations. More studies are needed to assess not only the immunogenicity, but also the efficacy of different influenza vaccines in asthmatic subjects.”
That may seem like a curious conclusion given the results of this study, but it is accurate. The key to understanding the implications of this study is that it is retrospective. That means it looks at children who have the flu and then looks back to see who was vaccinated and who wasn’t. This in turn means that children were not randomized to either be vaccinated or not, and this opens the door to any number of variables that cannot be controlled for in the study.
The authors did look as obvious factors, such as severity of asthma and insurance status, and found that they did not correlate with risk of being hospitalized. But what other factors might there be? The flu vaccine is optional, which means that parents decide whether or not to vaccinate their children, perhaps with advice from their pediatrician. It is likely that sicker or more frail children are more likely to get vaccinated. It is also likely that children who had a bad reaction to the flu in the past are more likely to get vaccinated. The flu vaccine is recommended especially for those who are at high risk for complications if they get the flu.
Therefore while this study raises important questions, it is not designed to answer them definitively. A prospective trial is required for that, and that is what Joshi means by “more studies are needed.” In general, retrospective studies are useful to find correlations and generate hypothesis, but are not capable of determining causation – there are simply too many variables that are not controlled for.
As expected, the anti-vaccinationists have already jumped on this study and misinterpreted its significance. They did not recognize its retrospective nature nor put it into the context of existing research on the safety and efficacy of the flu vaccines.
Clinical trials are complex, and there are many types that each have their own strengths and weaknesses. Often, many independent lines of basic science and clinical evidence need to be brought together to form a reliable conclusion about a specific intervention. That is the essence of science-based medicine. Individual studies typically only provide a tiny slice of information, but are often presented to the public as if they are definitive. This creates a constant background noise of misinformation about medical questions.
It also provides a rich source of data from which to cherry pick, allowing proponents to support almost any notion by shopping from the vast store of often conflicting medical research. This reinforces the need to look thoroughly at the totality of scientific evidence on any claim or question.
When that is done on the question of the flu vaccines, it is clear that both types of vaccines are safe and effective. However, there is also much room for improvement in the vaccine technology itself, as well as evidence-based recommendations for who, exactly, should get which type of vaccine.
This current study adds incrementally to our knowledge on this question, and suggests questions for future research. It is not the kind of evidence, however, that should lead to changes in the current recommendations.
As if we needed any more indications that the sexuality education we teach in schools might not be working, the latest place for teens to find answers to their questions is via cell phone.
In spite of web sites that allow teens to ask anonymous questions like We’re Talking Teen Health and Go Ask Alice!, teens are still looking for answers to immediate sexuality-related questions, and texting them is the newest way to get answers.
In California, teens can text their sexuality questions to ISIS by texting the word ‘hookup’ to the phone number 365247 which will allow them to sign up for weekly health tips. Each tip contains a prompt to text the word ‘clinic’ plus a zip code to get contact information for two local clinics.
In North Carolina, they can text questions to The Birds and Bees Text Line. Both services provide non-judgmental and medically accurate information within 24 hours to teens with questions.
Neither site provides medical advice, only information from an adult and encouragement to seek medical care. The important part is that these services are another place teens can reach out to adults for information and support.
I worry a little bit about what happens when teens admit they were raped, or are being sexually abused – what do the adults receiving this information do – and are they responsible for reporting what they learn to the authorities, but I guess that is a abridge we cross when we come to it.
For now, I am happy there are more adults willing to provide the information teens need to make good decisions, get medical care, and protect themselves. As always, parents would be the best source of sexuality information, but they might need their own texting site for their questions!
Heading out for a family walk over the weekend, we barely got beyond the end of the driveway before we quickly turned back…sunblock. We forgot to goop! A quick retreat back to the garage, we all lathered up and were on our way.
Over kill for such a mild sun day? Not in our experience. We’ve not only been caught off guard before and had “low intensity” sun days create rather intense burns behind necks, knees and arms, but have a family history of melanoma that haunts us ever time we step outside. My husband’s dad lost his life to melanoma. He was in the Navy and sunblock wasn’t what it is today, nor was the treatment for melanoma. He didn’t have the control we do today and would be really upset with us for tossing caution to the wind with our skin and our kids.
As reported by ABC news, there are 1 million cases of skin cancer a year and counting, melanoma, a year with 90% of those related to sun-exposure. We are truly playing with fire every time we step outside without sunblock on.
There’s nothing wrong with getting a tan if you some common sense and use sunblock – SPF 15 or higher with UVA and UVB protection. The key is to avoid becoming a french fry and to remember to reapply the sunblock liberally and often (each hour is the expert recommendation). As Dr. Doris Day, a NYC dermatologist interviewed by ABC noted: “You need to go through sunscreen…One bottle should not last a summer.”
Kids, too, need sun protection and it’s a myth that babies can not have sunblock applied to their skin. Infants older than 6 months of age can have the sunscreen applied to the entire skin and infants under 6 months of age can have sunscreen applied to very exposed area such as the hands and face in just the amount needed to cover those areas.
By the way, sun protection isn’t just for our weekend warrior moments. Think of it as part of your every day skin care. If your kids walk to and from school, they need sun protection. If you walk outside during your work day, you need sun protection. Many daily moisturizers now include SPF 15 and are great for that daily purpose where you need a bit of protection but not the intense protection as you do on weekends when outdoors more.
So, go ahead and get outside and get some sun…just do it safely and take the few extra minutes to apply sun protection. It’s fine to get a tan but no tan is worth dying for and that’s the point we all have to remember.
For more tips on sun safety for infants and kids, click here and here.
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