Flu was a slow starter this season, but it’s finally here. Those who track such things say it’s going to be a doozy of a season. It’s time to get vaccinated, and to make sure everyone in your family is protected!
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Tags: Flu, influenza, vaccination, vaccine
Categories : Flu, Uncategorized
This Seattle mom shares the story of her infection, and consequently, that of her newborn son.
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Tags: immunization, immunize, Pertussis, vaccine, Whooping Cough
Categories : Pertussis, Uncategorized
Pseudoscience is the shaky foundation of practices–often medically related–that lack a basis in evidence. It’s “fake” science dressed up, sometimes quite carefully, to look like the real thing. If you’re alive, you’ve encountered it, whether it was the guy at the mall trying to sell you Power Balance bracelets, the shampoo commercial promising you that “amino acids” will make your hair shiny, or the peddlers of “ natural remedies” or fad diet plans, who in a classic expansion of a basic tenet of advertising, make you think you have a problem so they can sell you something to solve it.
Pseudosciences are usually pretty easily identified by their emphasis on confirmation over refutation, on physically impossible claims, and on terms charged with emotion or false “sciencey-ness,” which is kind of like “truthiness” minus Stephen Colbert. Sometimes, what peddlers of pseudoscience say may have a kernel of real truth that makes it seem plausible. But even that kernel is typically at most a half truth, and often, it’s that other half they’re leaving out that makes what they’re selling pointless and ineffectual. But some are just nonsense out of the gate. I’d love to have some magic cream that would melt away fat or make wrinkles disappear, but how likely is it that such a thing would be available only via late-night commercials?
What science consumers need is a cheat sheet for people of sound mind to use when considering a product, book, therapy, or remedy. Below are the top-10 questions you should always ask yourself–and answer–before shelling out the benjamins for anything, whether it’s anti-aging cream, a diet fad program, books purporting to tell you secrets your doctor won’t, or jewelry items containing magnets:
- What is the source? Is the person or entity making the claims someone with genuine expertise in what they’re claiming? Are they hawking on behalf of someone else? Are they part of a distributed marketing scam? Do they use, for example, a Website or magazine or newspaper ad that’s made to look sciencey or newsy when it’s really one giant advertisement meant to make you think it’s journalism?
- What is the agenda? You must know this to consider any information in context. In a scientific paper, look at the funding sources. If you’re reading a non-scientific anything, remain extremely skeptical. What does the person or entity making the claim get out of it? Does it look like they’re telling you you have something wrong with you that you didn’t even realize existed…and then offering to sell you something to fix it? I’m reminded of the douche solution commercials of my youth in which a young woman confides in her mother that sometimes, she “just doesn’t feel fresh.” Suddenly, millions of women watching that commercial were mentally analyzing their level of freshness “down there” and pondering whether or not to purchase Summer’s Eve.
- What kind of language does it use? Does it use emotion words or a lot of exclamation points or language that sounds highly technical (amino acids! enzymes! nucleic acids!) or jargon-y but that is really meaningless in the therapeutic or scientific sense? If you’re not sure, take a term and google it, or ask a scientist if you can find one. Sometimes, an amino acid is just an amino acid. Be on the lookout for sciencey-ness. As Albert Einstein once pointed out, if you can’t explain something simply, you don’t understand it well. If peddlers feel that they have to toss in a bunch of jargony science terms to make you think they’re the real thing, they probably don’t know what they’re talking about, either.
- Does it involve testimonials? If all the person or entity making the claims has to offer is testimonials without any real evidence of effectiveness or need, be very, very suspicious. Anyone–anyone–can write a testimonial and put it on a Website. Example: ”I felt that I knew nothing about science until The Science Consumer blog came along! Now, my brain is packed with science facts, and I’m earning my PhD in aerospace engineering this year! If it could do it for me, The Science Consumer blog can do it for you, too! THANKS, SCIENCE CONSUMER BLOG! –xoxo, Julie C., North Carolina.”
- Are there claims of exclusivity? People have been practicing science and medicine for thousands of years. Millions of people are currently doing it. Typically, new findings arise out of existing knowledge and involve the contributions of many, many people. It’s quite rare–in fact, I can’t think of an example–that a new therapy or intervention is something completely novel without a solid existing scientific background to explain how it works, or that only one person figures it out. It certainly wouldn’t just suddenly appear one night on an infomercial. Also, watch for words like “proprietary” and “secret.” These terms signal that the intervention on offer has likely not been exposed to the light of scientific critique.
- Is there mention of a conspiracy of any kind? Claims such as, “Doctors don’t want you to know” or “the government has been hiding this information for years,” are extremely dubious. Why wouldn’t the millions of doctors in the world want you to know about something that might improve your health? Doctors aren’t a monolithic entity in an enormous white coat making collective decisions about you any more than the government is some detached nonliving institution making robotic collective decisions. They’re all individuals, and in general, they do want you to know.
- Does the claim involve multiple unassociated disorders? Does it involve assertions of widespread damage to many body systems (in the case of things like vaccines) or assertions of widespread therapeutic benefit to many body systems or a spectrum of unrelated disorders? Claims, for example, that a specific intervention will cure cancer, allergies, ADHD, and autism (and I am not making that up) are frankly irrational.
- Is there a money trail or a passionate belief involved? The least likely candidates to benefit fiscally from conclusions about any health issue or intervention are the researchers in the trenches working on the underpinnings of disease (genes, environmental triggers, etc.), doing the basic science. The likeliest candidates to benefit are those who (1) have something patentable on their hands; (2) market “cures” or “therapies”; (3) write books or give paid talks or “consult”; or (4) work as “consultants” who “cure.” That’s not to say that people who benefit fiscally from research or drug development aren’t trustworthy. Should they do it for free? No. But it’s always, always important to follow the money. Another issue that’s arisen around pseudoscience is whether or not a bias of passionate belief is as powerful as fiscal motivation. If you have a bias detector, turn it on to full power when evaluating any scientific claim. If yours is faulty–which you might not realize because of bias–perhaps you can find someone in real life or online with a hypersensitive bias detector. Journalists, by nature of training and their work, often seem to operate theirs on full power.
- Were real scientific processes involved? Evidence-based interventions generally go through many steps of a scientific process before they come into common use. Going through these steps includes performing basic research using tests in cells and in animals, clinical research with patients/volunteers in several heavily regulated phases, peer-review at each step of the way, and a trail of published research papers. Is there evidence that the product or intervention on offer has been tested scientifically, with results published in scientific journals? Or is it just sciencey-ness espoused by people without benefit of expert review of any kind?
- Is there expertise? Finally, no matter how much you dislike “experts” or disbelieve the “establishment,” the fact remains that people who have an MD or a science PhD or both after their names have gone to school for 24 years or longer, receiving an in-depth, daily, hourly education in the issues they’re discussing. If they’re specialists in their fields, tack on about five more years. If they’re researchers in their fields, tack on more. They’re not universally blind or stupid or venal or uncaring or in it for the money; in fact, many of them are exactly the opposite. If they’re doing research, usually they’re not Rockefellers. Note that having “PhD” or even “MD” after a name or “Dr” before it doesn’t automatically mean that the degree or the honorific relates to expertise in the subject at hand. I have a PhD in biology. If I wrote a book about chemical engineering and slapped the term PhD on there, that still doesn’t make me an expert in chemical engineering. And I’m just one person with one expert voice in the things I do know well. I recommend listening to more than one expert voice.
There is nothing wrong with healthy skepticism, but there is also nothing wrong in acknowledging that a little knowledge can be a very dangerous thing, that there are really people out there whose in-depth educations and experience better qualify them to address certain issues. However, caveat emptor, as always. Given that even MDs and PhDs can be disposed to acquisitiveness just like those snake-oil salesmen, never forget to look for the money. Always, always follow the money.
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Tags: fake, pseudoscience, real science, science
Categories : Ask Emily, Uncategorized
Flu season has begun. It’s been nasty in other parts of the world, and could turn that way here—it’s impossible to say how it’s going to play out.
Few of us think of flu as being a serious disease, but in the US, deaths each year range from 3,000 to an astonishing 49,000. About 200,000 people are hospitalized each year for influenza-related illnesses.
It’s not worth the risk. Everyone over the age of six months needs to get vaccinated each year unless a healthcare provider believes there’s a medical reason not to do so.
Symptoms of flu can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea.
If you’re not yet vaccinated, you can find a flu vaccination clinic near you with the flu vaccine finder at http://flushot.healthmap.org
For more information on flu, visit http://www.cdc.gov/flu
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Categories : Flu, Influenza (flu), Uncategorized
Our dinner conversations are usually launched by my 8th grader, a girl of many opinions. She’ll start out by asking each of us how our day went, or sometimes what we did that day. Depending on the answers, or with no relation to the answers, we move on to other topics.
Last night, Paloma (the 8th grader) was telling us about the fruit they had that day in the school lunch. She talked about how grossed out the kids were, and she went on from there, just generally trash-talking the fruit.
I wondered why she was expending negative energy on the school fruit, because she brown bags it for lunch and she loves fruit. When I bring fresh fruit into the house, I have to stash some in a far corner or I’ll never get any. Same with canned fruit. She. Loves. Fruit.
So, I asked her why having fruit with the school lunch was a bad thing, and she told me it’s not the fact that it’s “fruit” (she did the air quotes), but that it was disgusting, slimy, limp, and gross fruit.
I replied that the schools were trying to bring healthier choices to kids, and that providing fruit was a good option. Didn’t she, my fruit-loving girl, agree?
Yes, she did agree, but “you gotta have the good stuff. No kid is gonna eat it if it looks like that. And, it tastes gross.”
This change that kids are seeing in school lunches comes about because of the Healthy Hunger-Free Kids Act of 2010. It’s legislation that has good intentions and will, I believe, make a difference in the end.
But the trial-and-error phase is painful.
Kids around the country are complaining about the quantity and quality of the food offered each day, and some parents and others are complaining that the allotted calories per lunch don’t take into account the active lifestyle that many kids have at school.
Some kids get their primary nutrition for the day from the school breakfast and lunch, and some kids need help in judging their nutritional requirements because they, like so many adult Americans, are packing on unhealthy body weight.
The fact is, a healthy diet helps one’s body stay healthy. But, as a reasonable adult who knows the importance of good nutrition, would you eat “disgusting, slimy, limp, and gross fruit?” Neither would I, and apparently, neither will many of my daughter’s classmates.
It’s not enough to say our kids should eat healthier, we have to show them what that means and provide for them food that looks and tastes good. We eat with our eyes first, to quote about a thousand chefs.
We need solutions like the Farm to School programs popping up around the country.
What programs are working for your school? Or do you have ideas for programs that might get our kids excited about healthy food and help our schools serve food that the kids actually want to eat?
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Tags: Farm to School, Nutrition, school lunch
Categories : Uncategorized
Few symptoms cause as much confusion and concern as fevers do. Dr. Katherine Vaughn, PKIDs’ medical director, answers questions about this worrisome symptom (check with your child’s doctor to determine what course of action is best for your child):
Why do Fevers Occur?
A fever is a resetting of the body’s thermostat to a higher temperature. This usually occurs in response to an infection, although other conditions can cause fever as well. Fever is an indicator that the immune system is working.
What is a Fever?
We all tend to think of 98.6 as a “normal” temperature, and anything above as a fever. In fact, temperature varies from person to person, and will also fluctuate by about a degree in any given person over the course of a day. We typically run about a degree lower in the morning compared to the evening. A temperature of over 100.4 is considered a fever.
How should a Temperature Be Taken?
Rectal temperature is considered the “gold standard”, and it’s most important to obtain in this way in an infant under 3 months of age. An axillary or ear (tympanic) temperature can be obtained in older infants and children. Forehead and pacifier thermometers are not as reliable a measure of temperature.
When Do I Worry About a Fever?
Always notify your doctor if an infant 3 months of age or younger has a rectal temp of over 100.4. The fever itself isn’t harmful, but babies this age can be quite ill without showing other signs, and will likely need to be seen.
For children over 3 months of age, it’s less likely they will be seriously ill and not have other signs and symptoms. A child’s behavior and activity level are more important clues to the severity of illness. A 6 month old who is playing and happy with a temperature of 103 would be less concerning than a 9 month old with a 101 temp who is listless and lethargic. A fever has to be quite high (generally felt to be greater than 106) for the fever itself to be harmful.
Other symptoms, such as rash, trouble breathing, lethargy, or other indications of a sick-looking child should prompt a call to your physician or visit to the ER. Fevers over 104 degrees, or any fever lasting more than 3 days should prompt a call to your physician to help assess for the need for a visit.
When Should a Fever Be Treated?
The main reason to treat a fever is for comfort. A happy child with a fever does not have to be treated. However, as temperatures rise over 101, many children become uncomfortable, with headache, body aches, increased heart rate, etc.
Treatment can be with acetominophen or ibuprofen at the appropriate doses. Never give your child aspirin for fever. It has been linked to a condition called Reyes’ syndrome.
Lukewarm sponge baths can also be used, as well as offering plenty of fluids. Don’t worry if your child doesn’t want to eat much for a few days, as long as they’re drinking.
Avoid alcohol sponging (it will raise the temperature) or cold water baths (increases discomfort).
- “The temperature came down a few degrees and my child feels better, but the temperature still isn’t normal. My child must be really sick.” A child’s response to acetominophen or ibuprofen (in terms of degrees a fever decreases) is not an indicator of severity of illness. We don’t expect the temperature to come down to normal. Remember, treating the fever is done mainly for the child’s comfort, but it doesn’t make the illness get better any sooner.
- “Fever can cause brain damage.” A temperature probably has to be over 106 to cause problems like this, and in a normally healthy person, that doesn’t happen.
- “What about febrile (fever) seizures? They can occur at temperatures less than 106.” True. Febrile seizures are frightening. They occur in 3-4 percent of children, usually between 6 months and 5 years of age. They are typically brief and don’t cause any lasting problems. Always notify your child’s doctor if they have a febrile seizure.
Take Home Message
Fevers are rarely harmful. In a child under 3 months of age, call your doctor for any temperature over 100.4 . In older children, you can feel more comfortable evaluating the child, giving medicine to bring the fever down if they are uncomfortable, and calling the doctor if you’re concerned about how they are looking or acting.
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Tags: babies, children, fever, katherine vaughn, Kids, pediatrics
Categories : Fever, Uncategorized
In early April, we wrote a blog post about the END7 Campaign’s work to raise awareness and donations in order to eliminate seven neglected tropical disease (NTDs) by 2020.
We are dedicated to fighting these devastating diseases because they infect more than one billion people around the world. That’s one out of every six people who is likely to suffer from blindness, malnutrition or disfigurement due to these totally preventable diseases.
But in addition to minimizing suffering from these effects, controlling NTDs is also important for success in fighting other diseases notably HIV/AIDS. In many parts of the world, there is quite a bit of geographic overlap between NTDs and HIV/AIDS. In fact, research demonstrates that there are increased odds of having HIV when an individual is co-infected with an NTD. For instance, women with female genital schistosomiasis (FGS) have a three-fold increased risk of contracting HIV/AIDS compared to those not burdened by the disease. Moreover, soil-transmitted helminths (or intestinal worms) can actually worsen the progression of HIV toward AIDS by increasing viral loads.
These high rates of co-infection mean there are a number of opportunities for the NTD and HIV/AIDS communities to join forces to coordinate and collaborate on further research and treatment programs for these diseases.
We’re hosting a workshop at AIDS 2012: XIX International AIDS Conference to begin these discussions. If you’re attending, we hope you’ll join us!
To learn more about NTDs and the links between these diseases and HIV/AIDS, visit END7 on Facebook and tell your friends and family to do the same.
Sabin Vaccine Institute
Image courtesy of Esther Havens
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Tags: End7, hiv, NTDs, Sabin
Categories : NTDs, Uncategorized
(Pertussis outbreaks are occurring in the U.S. and elsewhere, yet many healthcare professionals seem reluctant to test for it. We asked Dr. James D. Cherry to explain when testing should be done and we extend our thanks to him for this post on diagnosing whooping cough. Dr. Cherry is a member of the Global Pertussis Initiative (GPI) and author of previous papers on pertussis Dx. Please feel free to share this post with your healthcare provider.)
In pertussis the site of infections is on ciliated epithelial cells in the nasopharynx (NP). In primary infections (infants and young child not previously vaccinated) the bacterial load is high and is present in the nasopharynx from the onset of illness (coryza) the second week of the paroxysmal stage and often longer. In children who are vaccine failures the bacterial load in the NP is less than in primary infections and the bacteria are present for a shorter period of time (ie onset of coryza through the second week of cough).
In adults (all of whom have had previous infections unknown to them) the bacterial load is less than in previously vaccinated children and the duration of presence of bacteria is also less. Also, adolescents and adults rarely seek care for their pertussis cough illness until the third or fourth week from illness onset. Nevertheless adults with unrecognized pertussis are the most common source of infection in infants who are unimmunized or only partially immunized.
Culture is 100% specific whereas all other tests are not. Culture in children is a much more sensitive test than generally believed. However, today in the U.S., for the most part, culture is a lost art in most diagnostic laboratories because of lack of fresh media and technicians with little experience. With a good laboratory the main reason for failure to isolate Bordetella pertussis is that the specimen was not collected properly or that it was collected too late in the illness.
To obtain an adequate sample the ciliated cells in the NP must be touched by the dacron tip of the NP swab or the catheter used in a NP aspirate must touch the ciliated cells. Nasal wash is frequently done but this is much less sensitive than either NP swab or NP aspirate. For PCR the same facts apply regarding specimen collection.
For children (during the first 3 weeks of illness) and adults (during the first week of illness) PCR is the method of choice because it is much more sensitive than culture. Unfortunately, there has been much misinformation disseminated about PCR results. PCR is readily available in the U.S. in hospital labs and several commercial labs.
The test that is universally available in the U.S. uses primers that identify insertion sequence (IS) 481 for B. pertussis and IS1001 for B. parapertussis. Because B. pertussis contains ~238 copies of IS481 this test is exceedingly sensitive. It is so sensitive that it can pick up examination room contamination because of a previous patient with pertussis or the immunization with DTaP of a previous patient in the room. Therefore NP specimens should not be collected in rooms where DTaP immunization is being carried out or in rooms that have been occupied by previous patients with pertussis.
Today in the U.S. real time PCR is the method most often used and the number of cycles necessary to obtain a positive result reflects the concentration of B. pertussis in the sample. The lower the cycle the greater the number of bacteria. With high cycle detection the possibility of contamination at the collection site is a likely possibility. However positives are positives regardless of the cycle. It has been suggested that labs not report high cycle positives as positive results. This is wrong; these results represent infections or contamination and the physician who obtained the specimen must decide if the findings are consistent with the patient’s illness. The lab should not call high cycle positives as negative or indeterminate because this relays false information to the physician.
In situations in which both IS481 and IS1001 are positive this may be due to infection with B. holmesii (also a cause of clinical pertussis) or a mixed infection with B. pertussis and B. parapertussis.
PCR should only be performed on patients with cough illnesses. During pertussis outbreaks asymptomatic infections are very common in previous vaccinees so that you will get positive PCR results from people who are well and these results just confuse the picture (except in planned surveillance studies).
All persons who have been previously vaccinated or who have had previous infection will have a rapid rise in antibody to various B. pertussis antigens so that pertussis illness can be diagnosed by single serum serology. The most useful antibody to determine if a cough illness is pertussis is that to pertussis toxin (PT) because this antigen is exclusive of B. pertussis. Some tests also determine antibody to filamentous hemagglutinin (FHA) but since this antigen is not exclusive to B. pertussis high titers could be due to B. pertussis infection, other Bordetella spp and M. pneumoniae and perhaps other microorganisms.
Single serum serologic Dx has been used successfully in Massachusetts for over 20 years. Commercial laboratories also perform single serum serology but unfortunately many of these tests are poor. Specifically any test that uses the whole B. pertussis bacterium is virtually useless as are tests that don’t express results in units. Tests that say they are measuring IgM antibody are also useless. To my knowledge the only commercial test available in the U.S. that is acceptable is that offered by Focus Laboratories. This test has specificity of ~95%.
Serologic diagnosis will be affected by recent immunization with either DTaP and Tdap so it should not be attempted if the patient has been vaccinated within the previous year. In general single serum serology should be used for the diagnosis of pertussis in adolescents and adults who have not been recently vaccinated.
White Blood Cell (WBC) Count
Primary infections of pertussis universally have high WBC counts with absolute lymphocytosis. This is seen in all infants who have not been immunized and who have not received antibody to PT from the mother transplacentally. Therefore in young infants with afebrile cough illnesses the WBC count with differential can be diagnostic. Because the WBC count has prognostic implications it should be performed on all infants who might have pertussis at the time of first physician encounter. A WBC count of > 20,000 cells/mm3 with a lymphocyte count of > 10,000 cells/mm3 should be diagnosed as pertussis and immediately treated with azithromycin.
- The onset of cough illnesses in afebrile or minimal febrile persons of all ages should be suspected of having pertussis.
- Lab confirmation tests should be performed and specific tests employed relate to patient age, vaccine history and duration of cough.
- For infants and children PCR is the most sensitive and specific test.
- Whenever possible cultures should also be performed so that epidemic trends can be followed (ie antibiotic resistance, genetic changes in the organism)
- For adolescents and adults single serum serology to determine antibody to PT is the most sensitive and specific test (unless the patient is seen during the first week of cough).
- For young infants the WBC count with differential is often diagnostic.
James D. Cherry, MD, MSc
Distinguished Professor of Pediatrics
David Geffen School of Medicine at UCLA
Pediatric Infectious Diseases
Mattel Children’s Hospital UCLA
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Tags: diagnosis, Global Pertussis Initiative, James D. Cherry, Pertussis
Categories : Pertussis, Uncategorized
It’s no secret that clean hands are one of our most effective weapons against infections. At PKIDs, we’re big on handwashing. One of our first projects as an organization was the development of a handwashing video for young kids. It still gets used today:
Several years later, PKIDs and students from the Art Institute of Portland developed a handwashing cartoon that’s perfect for middle school or high school students. It’s a flash program and can be played from a computer.
We also have a handwashing poster that can be downloaded from our site. There are two versions—one with PKIDs’ brand on it and one that’s unbranded, should you want to put your own contact info on it.
Yep, we think clean hands are a big deal in the fight against infections. If you know of any resources health educators can use, just put them in the comments section. Thanks!
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Tags: clean hands, educational, Handwashing, resources
Categories : Handwashing, Uncategorized