I believe that if you speak to people who have crossed the magic mark of 45 or 50 and have aging parents and grandparents, they will tell you that they do worry or have seen changes that indicate a loved one is “not as sharp as they once were”. Well, there is research that shows there are ways to slow or reduce the decline in cognitive functioning.

Cognitive functioning simply refers to our ability to think, reason, concentrate, formulate ideas, and remember. In many ways, it defines who we are as individuals. When we can’t remember important events in our lives or recognize people we have known for years, we lose our individuality.

New data from the population-based Mayo Clinic Study of Aging (MCSA) has shown that older adults who actively use their mind and body may be less apt to develop mild cognitive impairment (MCI). Dr. Yonas Geda reports, “We have observed that engaging in computer use and moderate physical exercise is associated with decreased odds of MCI…”. Previous studies by Dr. Geda’s team has shown that moderate exercise done during middle or even later in life reduces the risk of MCI in men and women with normal cognitive function at baseline.

The data also support that participating in mentally-stimulating activities can reduce the odds of developing MCI. These would include using a computer, reading, playing games and doing crafts—anything that requires exercising cognitive ability. Beneficial computer use was considered as playing brain games, learning, or browsing—not simply checking e-mail.

The new data indicate that there is an additive impact when mentally-stimulating activities are paired with physical exercise. Researchers believe it is possible that the combination may have a beneficial effect on the manner in which the brain functions.

So, maybe all the games that we play on our computers are not so bad after all—that is, if we couple that with walking/pilates/yoga/crossfit or whatever your choice of getting your body moving as well.

http://www.medscape.com/viewarticle/763062?sssdmh=dm1.781041&src=nldne

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That being said, I was very surprised when I ran across an article which stated that dog waste was an environmental pollutant and placed in the same category by the Environmental Protection Agency (EPA) as oil and toxic chemicals. According to the EPA, “when pet waste is improperly disposed of, it can be picked up by stormwater runoff and washed into stormdrains or nearby waterbodies.” The runoff can than end up in lakes and streams causing significant water pollution.

Pet waste carries bacteria, viruses, and parasites that can threaten people’s health. It also contains nutrients that foster the growth of weed and algae that make swimming and recreational use of lakes, rivers and ponds unappealing or even unhealthy.

Most pet waste is attributable to dogs—about 90%. Seattle considers waste from dogs as a major pollutant to Puget Sound. Other cities such as Clearwater, FL, Arlington, VA, Dover, NH, and Boise, ID, have also identified dog waste as a major source of water contamination.

An article in USA Today reported that 40% of dog owners do not pick up their dog’s waste at all.
So if you are a dog owner, what should you do?

1. Make sure you do not allow your dog to leave a deposit near a water way, curb, or even your yard.
2. Wrap the waste in a biodegradable plastic bag and put it in the trash (if your city allows this).
3. Flush it down the toilet. Waste treatment plants can handle dog waste. However, do not flush cat waste down the toilet—treatment plants cannot handle the parasite Toxoplasma gondii which is commonly found in cat waste.
4. Install an underground pet waste digester. You can find these on the internet.
5. Bury the waste in your yard—at least 5” deep but away from gardens or water.
6. Use a poop collection service. Yes, they do exist.
7. Check to see if your city has a doggie waste digester (similar to the one in Cambridge, MA).

You can also join efforts to encourage all pet owners to dispose of their pet’s waste in a responsible way. Many cities are now engaged in developing pet waste management programs in an effort to improve aesthetics and better water quality.

I hope that all pet owners will realize that disposing of waste is a major health issue to all of us and help ensure that we maintain a clean, appealing environment. On behalf of all non-pet owners, I thank you.

http://cfpub.epa.gov/npdes/stormwater/menuofbmps/index.cfm?action=factsheet_results&view=specific&bmp=4

http://www.care2.com/causes/u-s-waters-polluted-by-10-million-tons-of-dog-poop.htmlpoop.html#ixzz1stHBW1mQ

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As I was going through my e-mails, I ran across an interesting presentation entitled, “What Women Should Eat”. It consisted of several slides that addressed many issues pertinent to women’s health and diet. It really repeated information given in several other articles I have seen, but condensed it in such a way that was easy to understand while maintaining a scientific tone.

The presentation made several recommendations for women of all ages that relate to a wide variety of health issues—heart disease, cancer, pregnancy, etc. Again, nothing that is not generally found in a number of other sources, but given in a concise way. The following are some of the data related to what women should eat.

Fish (or more specifically, omega-3 fatty acids) – Weekly intake of fish decreased the risk of heart disease in both young and older women. Moderate fish intake may cut risk of preterm birth. Regular consumption of omega-3 fatty acids reduce the risk of macular degeneration (a disease of the eye that causes blindness).

Coffee – Drinking 1-5 cups of coffee a day cuts the risk of stroke by 25%. It also reduces the risk of depression.

Diet during pregnancy – A high intake of margarine, vegetable oils, citrus fruits, raw sweet peppers and celery during pregnancy increases the risk of eczema and allergen sensitivity in the baby. Women who eat lots of fish while pregnant are less likely to have babies with asthma. Lack of folic acid during the first 1-2 months of pregnancy can increase the risk of language delays in the baby.

Baby’s diet – Breast milk is best. Babies have a lower risk for allergies if they are started on solid food between 4 and 6 months.

Vitamin D – Increased vitamin D consumption, either by food or supplement, decreases the risk of age-related macular degeneration.

Nuts – Adding a few nuts to a high carbohydrate mean can lower post-meal glucose and insulin levels. Consumption should consist of only a small handful since nuts are calorie-dense foods.

Antioxidants – Eating fruits, vegetables, whole grains, tea, and small amounts of chocolate (the darker the better) lowers the risk of stroke and heart disease. Risk is lower by getting antioxidants from food rather than through supplements.

It seems the best diet is one that is colorful—red strawberries, blueberries, blackberries, broccoli, eggplant, etc. This type of diet helps in lowering blood pressure and giving us the nutrient we need to stay healthy. And, it looks great, too.

http://www.medscape.com/features/slideshow/whs-nutrition?src=ptalk

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Congress passed the Consumer Protection Act of 2008 to prohibit delivery, distribution or dispensing controlled substances over the internet without a prescription. However, there are thousands of websites that continue to sell prescription drugs without requiring a prescription.

As the list of drugs for which there is a shortage continues to grow, the pressure to obtain these drugs also grows. Pharmacists look for suppliers that can provide the drugs. The pharmaceutical industry has provided guidelines for managing shortages through inventory management, use of therapeutic alternatives and precautions against stockpiling. The industry is also calling for approval of new suppliers after certain quality criteria are met.

Efforts to reduce the use of counterfeit medications has focused on packaging and dosage form authentication systems. Anti-counterfeit measures include unit-dose packaging, tamper-evident seals, embedded codes, scanning technology and raised printing on labels. These measures, unfortunately, do not ensure the integrity of the drug inside the packaging.

Pharmacists can report suspicious medications through Medwatch. They are instructed to remove any suspected counterfeit drugs from shelves and then test for authenticity. Education of the public regarding counterfeit medications is important to protect consumers from using drugs that are ineffective or even harmful.

It is important that anyone purchasing medications online be very diligent in checking the company from which the drug is being ordered. If there is no physical address or there is any concern regarding the source of the manufacturer, it is best to err on the side of caution and seek other sources for the drug.

Also, if a medication is purchased in a local pharmacy and any irregularity or damage to the packaging is noted, the issue should be reported to the pharmacist and discarded. Drugs do help us maintain health—as long as they are legitimate and not counterfeit.

Howard D. A silent epidemic: protecting the safety and security of drugs. Pharmaceutical Outsourcing. 2010;Jul/Aug:16–8.

http://www.medscape.com/viewarticle/759122_3

World Health Organization. IMPACT! International Medical Products Anti-counterfeiting Taskforce. Accessed at www.who.int/impact/news/beaware/en/index.html, December 16, 2010.

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The Advisory Committee on Immunization Practices (ACIP) has recently adopted guidelines for adult as well as pediatric immunization schedules. Immunization for influenza is needed yearly. Tetanus, diphtheria and pertussis immunization is recommended every ten years. Immunity can be maintained for other illnesses with one or two doses of the vaccine. For people over 60, there are specific recommendations for Zoster, Pneumococcal pneumonia, and Tdap immunizations.

Adults with certain illnesses and conditions such as pregnancy, HIV, diabetes, chronic liver disease, kidney failure requiring dialysis, and immunosuppression should follow more specific guidelines. While varicella, zoster, and Tdap immunizations are contraindicated during pregnancy, vaccination should be administered during the immediate post-partum period.

Human papillomavirus vaccination is recommended for girls age 11 or 12 and catch-up vaccination for women age 13 through 26. The vaccine is most effective in females prior to becoming sexually active. Once the woman has been infected, the vaccine is less effective. Men age 22 to 26 should also receive the HPV4 vaccine.
More information regarding immunizations is available on the CDC website at:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6004a10.htm. as well as http://www.medscape.org/viewarticle/758089?src=cmemp.

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Moving forward in time—if you were born 75 years ago (1936-7), you could expect to live to around age 60 if you were white and 50 if you were black. The most common cause of death was diseases of the heart and, secondly, pneumonia and influenza. Cancer had made its way to the third leading cause of mortality. The death rate was 1,125.9 deaths per 100,000. In 1937, we still had not found ways of overcoming bacterial diseases such as pneumonia. Antibiotics were not common until the late 40’s and early 50’s.

For those born in the 21st Century, the life expectancy has risen to mid-70’s to early-80’s. Diseases of the heart and cancer lead the most common causes of death. However, stroke, accidents, diabetes, and Alzheimer’s have entered the picture of deadly conditions. Pneumonia and influenza still appear in the top ten causes of death, but these are usually fatal for the elderly or immunosuppressed. The death rate has decreased to 746.2.

All of the data presented here are for the population in general. Different age groups have different common causes of death and death rates. In the younger population, accidents account for more deaths than does heart disease, although heart disease is still present in younger age groups. Also, HIV is a factor in those aged 24 – 44.

Of major interest to healthcare providers is the implication these data have in providing care for the general population. At one time, we had to be much more concerned regarding infectious diseases such as pneumonia and influenza (although septicemia is still a major concern these days).

Lowered death rates mean people are living longer but will probably have chronic conditions such as heart failure and diabetes. These require a different care approach than the treatment of acute illnesses. The rise in home care and increased therapy treatment are only two changes that have resulted from a decreasing death rate and change in causes of death.

While it may seem morbid to report and analyze these statistics, understanding the impact of living longer and with more chronic disease may allow us to make decisions that will enable us to have a better quality of life for a longer period of time.

http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf

http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_09.pdf

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According to the Agency for Healthcare Research and Quality, more than 770,000 people are injured or die each year in hospitals from adverse drug events (ADEs) or adverse drug reactions (ADRs) each year. Many are in people over 65 since about 25% of them take five or more medications. Changes that occur due to aging can alter the way in a drug is absorbed, metabolized and excreted. Criteria have been developed that list certain drugs that should be given to older adults only after careful considerations. These include bensodiazapines, sliding scale insulin and certain anti-histamines. The list can be found on the American Geriataric Association website.or https://www.dcri.org/trial-participation/the-beers-list/.

The FDA has approved a new low-dose hormone combination drug for the relief of menopausal symptoms called Angeliq. The drug is composed of drospirenone 0.25mg and estradiol 0.5 mg. Drug trials supported findings that postmenopausal women at least 40 years old who experienced at least 7 to 8 moderate to severe hot flashes daily or 50 to 60 moderate to severe hot flashes per week had a significant reduction in frequency and severity of hot flashes while taking the drug.

Starting March 1, 2012, new nutrition labels will appear on raw meat and poultry. Labels will now appear on most ground meat and ground poultry. In the past, labels appeared only on meat and poultry products with added ingredients (those with marinades or stuffing). The labels will report the percentage of lean and fat as well as calories and grams of total fat. Nutritional information for 40 popular cuts of meat and poultry will appear either on individual packages or on charts posted near the point of sale.

Pregnant women who smoke or who use nicotine replacement therapy (in lieu of smoking) during pregnancy increase the incidence that their babies will have colic during the first three months of life. Babies who are not exposed to nicotine in any form have less chance of having colic. The findings were reported by a study conducted in Denmark looking at over 60,000 mother/baby dyads.

http://www.medscape.com/viewarticle/759598?sssdmh=dm1.764049&src=nldne

http://www.medscape.org/viewarticle/759070?src=cmemp.

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A-fib is defined as a disruption in the normal sequencing of the electrical activity of the heart. The regular pulse wave does not occur in the upper chambers of the heart. The electrical activity moves about in a random fashion resulting in uncoordinated contraction of the heart muscle. The upper chambers “fibrillate” in a way that has been described as a “ball of worms”. Blood flow from the upper chambers (atria) to the lower chambers (ventricles) is slowed and can cause clots to form. Once formed, the clots can move to the brain and cause a stroke.

The most common symptom of A-fib is a rapid heart rate—often irregular. Individuals experiencing A-fib initially may not be aware there is a problem. The rapid and irregular heart beat may be perceived as palpitations or exercise intolerance. As the arrhythmia persists, the person may become short of breath, feel faint, have chest pain or tightness and believe he/she is having a heart attack. Others may not even notice the rapid heart rate and experience no discomfort at all.

The cause of A-fib is idiopathic or, put another way, we have no idea why people get it. It is associated with several conditions, but none can be identified as actually causing the condition. A-fib is associated with aging, mitral valve disorders, sleep apnea, enlarged atria, blocked arteries, pneumonia and lung disease, and high blood pressure. There is also a genetic link for some people.

The accurate diagnosis of A-fib is through an electrocardiogram (EKG). The person may be fitted with a halter monitor that records the heart function for a 24 hour period. A echocardiogram is done in almost all cases to determine how well the heart is pumping and to reveal if there is some associated heart disease present. Electrolyte levels and thyroid function are also tested.

In many cases, A-fib is treated with the use of blood thinners or anticoagulation therapy to reduce the possibility of blood clot formation. Drugs that affect heart rhythm are also used. These drugs act to slow the heart rate and/or convert the rhythm to normal. Other alternatives for treating A-fib include ablation (a catheter is inserted into the heart and a small amount of tissue is destroyed), atrial defibrillators (similar to a pace maker), and surgery.

In some individuals with a condition identified as paroxysmal A-fib, the rapid, irregular heart beat comes and goes. Certain substances can trigger A-fib in some people. These include caffeine, chocolate (in large amounts), tobacco, and cold beverages. Heavy exercise and sleeping on the left side may also trigger a bout of A-fib.

More aggressive treatment is needed for those with persistent A-fib. The rapid, irregular heart rate is continual. Defibrillation and ablation may be done to convert the person to normal heart rhythm.

A-Fib is not usually considered life threatening itself, but it is a serious medical condition that requires monitoring and treatment. While the condition and its treatment may seem complicated, effective methods of controlling and curing A-fib are currently available. And, there is lots of information about A-fib easily found in the local library and on the internet.

http://en.wikipedia.org/wiki/Atrial_fibrillation

http://www.a-fib.com/Overview.htm

http://www.heartpoint.com/afib-tellme.html

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A recent study reported in Medscape Nurses looked at issues related to working nights. Interestingly enough, it is entitled, “Help Me Make it Through the Night”. Historically, nurses choose to work nights for a variety of reasons—preference, family responsibilities, increased pay, quieter and slower pace, more relaxed atmosphere, and fewer interruptions to name a few.

The night-working population has been the focus of several studies. One of the recurring findings is that working nights is associated with increased health risks. These include: increased risk of breast and colorectal cancer; increase risk for stroke; increase wrist and hip fractures; increase in type 2 diabetes; irregular menstrual cycles and reduced fertility; increased cardiovascular disease and mental health disorders; and, increased blood pressure. The studies are quick to point out that there is association—not causation.

Researchers believe that working nights results in a disruption in circadian rhythms. Circadian rhythm is synchronized through exposure to patterns of light and dark. The patterns control biological cycles that repeat roughly every 24 hours. When rest-activity cycles match the light-dark cycles, a person is said to be “in phase”. Circadian rhythm can be disturbed if a person is exposed to inadequate or irregular amounts of light at certain times of the day.

According to the study, night workers are deprived of restful sleep and the sleep loss builds over successive shifts. Their sleep is more fragmented and sleep times are shorter. This results in “sleep debt” and feelings of chronic fatigue that is not easily erased with “catch-up” sleep. Night-shift nurses report struggling to stay awake during shifts and may fall asleep for brief periods during the night or in the car on the way home from work.

Some nurses do prefer the night shift and work nights for much of their careers. These may be people who are “night people”. By natural inclination they prefer to sleep late, work best later in the day, and stay up late into the night. Their characteristic or chronotype is that of an “owl” as opposed to a “lark” (morning person) or “hummingbird” (what most of us are).

Some nurses are never able to adapt to working nights. But, there are ways to mitigate the effects of working the night shift.

• Stay awake at night and sleep during the day even on day’s off.
• Darken the room, use a sleep mask and ear plugs when sleeping.
• Disconnect the door bell and turn off the cell and other phones.
• Put sleep at the head of the “To-Do List”.
• Stay away from caffeine close to sleep time—drink warm milk instead.
• Follow a routine when getting ready for sleep.
• While working, spend as much time as possible in brightly lit rooms.
• Wear sunglasses when driving home in the morning.
• Don’t schedule appointments or activities during routine sleeping hours.
• Avoid eating large meals within 4 hours before sleeping.
• If working rotating shifts, rotate clockwise (days, evenings, nights).
• Seek exposure to light upon waking.

Some hospitals now allow nurses to take naps on their breaks during the night. Some research has demonstrated that taking a nap during the night may be counterproductive. It may impede the ability to have restful sleep once the shift is over. Others cite the occurrence of “sleep inertia” characterized by a momentary disorientation or grogginess that is experienced immediately upon awakening. However, others cite that taking a short, 20-minute nap can combat sleepiness and increase the ability to perform more effectively.

So, after all is said and done, nursing remains a 24/7 endeavor. And, since it is, it is imperative that research continue to provide the best data on which to base the most effective policies to ensure the best care for patients and their families.

http://www.ehow.com/how_2043506_work-night-shift.html

http://www.medscape.com/viewarticle/757050?src=mp&spon=24

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Blood pressure is the pressure that blood creates as it travels throughout the body and pushes against artery walls. It is reported in two numbers—usually expressed as a higher number over a lower number. The higher number is the pressure that is exerted on the arteries when the heart beats and the arteries are filled with blood. The lower number is the pressure in the arteries when the heart is between beats.

It is important to remember that blood pressure is not a static reading. As activity or emotional states change, so does the blood pressure. If the pressure did not increase for a person running a race or for someone experiencing a highly emotional situation, sufficient oxygen would not be supplied to the body and fainting would occur.

The problem arises when the blood pressure remains at a high level when the person is resting. Hypertension is diagnosed when an individual has readings of 140/90 or higher on two separate occasions. Immediate treatment should be sought for an individual who has a blood pressure reading of 200/120. Diabetics require treatment for readings of 130/80 because of a diabetic’s increased risk of stroke and heart attacks.

Many people with hypertension are not aware they are at risk because frequently there are no symptoms there is a problem. For that reason, it is important to have blood pressure checks. Getting a blood pressure taken has become fairly easy. Most drug stores have blood pressure machines that people can use without charge. Also, people can go to a fire station and ask for someone to take their blood pressure.

Mayo Clinic physicians recommend that a person have a blood pressure reading at least every two years beginning at age 20. Children 3 and older should have their pressures checked as part of their yearly checkups.

So who is at risk? People who: have a family history of hypertension, heart disease or diabetes; are black; are older than 55; are overweight; are not physically active; drink excessively; smoke; eat foods high in saturated fats or salt; or use medications such as anti-inflammatories, decongestants, and illicit drugs such as cocaine.

The cause of hypertension in 95% of cases cannot be determined. This condition is called essential hypertension. It is believed to be sensitive to diet and life style. It is associated with high salt intake, obesity, stress, insufficient intake of potassium, calcium and magnesium, lack of exercise, and long-term alcohol consumption.

The most common cause of secondary hypertension is kidney disease but it can be a result of adrenal gland tumors. Birth control pills containing estrogen can increase blood pressure as well as medications that constrict the blood vessels. Weight loss drugs are also able to cause blood pressure to rise.

The first step in treatment usually involves changes in life style—lowering salt and fat intake, losing weight, increasing activity, and learning to manage stress. If life style changes are not sufficient to control hypertension, it may be necessary to add a medication regimen. There are a number of drug classifications that are used to treat high blood pressure. For some people diagnosed with hypertension, more than one type of medication may be ordered. The important issue is to make sure medications are taken as ordered every day.

According to medical research, the probability is that if a person lives long enough, he/she will experience hypertension. It is strongly associated with aging. But, it is treatable and people live long and productive lives even after a diagnosis of high blood pressure.

http://www.bing.com/health/article/mayo-MADS00100/High-blood-pressure-hypertension?q=hypertension+prevention

http://hypertension-facts.org/hypertension-treatment.html

http://www.webmd.com/hypertension-high-blood-pressure/guide/understanding-high-blood-pressure-basics

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