Category Archives: Advice

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Why get flu vaccine: from Huffington Post

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From Huffington Post: With summer decidedly behind us, it’s time to start thinking about where to get this year’s flu shot.

Yes, it’s flu season again. And yes, the best way to protect yourself from coming down with the virus is still a vaccine.

Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, made that message loud and clear Thursday at the annual National Foundation for Infectious Diseases press conference on flu vaccines.

“If we could increase vaccination coverage in this country by just five percent more, that would prevent about 800,000 illnesses and nearly 10,000 hospitalizations,” said Frieden. “Flu vaccine is one of the best buys in public health.”

How 2016’s vaccine is different than last year

This year, there are two basic types of flu vaccines: one that protects against three strains of flu, and one that protects against four.

Both flu vaccines protect against the strains seen early in the season in the U.S., including the commonly known H1N1 (swine flu), H3N3 and a Type B strain. The only difference between the two is that the “quadrivalent” vaccine also protects against a second Type B strain.

While it seems logical that more coverage is better, the CDC doesn’t have a recommendation for which one to get ― just that you scoop up whichever shot is available.

“The problem is that a vaccination deferred is often a vaccination forgotten,” Frieden explained. In other words, it’s most important that you get a shot soon rather than holding out for one you might prefer.

There is one big change to the CDC’s flu shot recommendations: People who were counting on the nasal spray form of the vaccine will have to settle for a shot. The CDC recommends only the injection for preventing the flu for the 2016-17 season after concerns arose last year about the effectiveness of the spray.

Of the 144 million Americans who got vaccinated against the flu last year, about 20 million opted for the nasal spray.

Don’t wait until the last minute to get your shot

Last year’s flu season was moderate; there were fewer doctor’s visits, hospitalizations and deaths linked to flu and pneumonia compared to the preceding three seasons. The 2015-16 season started picking up in late December and continued to swell through early March, but don’t wait until the beginning of this December to get inoculated.

For one reason, it takes time to build the antibodies to fight the flu. In adults, the shot takes effect after about two weeks. For kids under eight who may need two shots to be fully vaccinated, injections have to be spaced more than four weeks apart, so the earlier they get the first shot, the better.

Secondly, there’s no way to predict when you’re going to come into contact with someone who has the flu and could spread it to you. It’s best to be vaccinated before the virus starts sweeping through your community.

Ideally, the CDC says, everyone should get their flu vaccine by the end of October, although shots received later in the year will still be beneficial.

Flu shots save lives

Unlike the common cold, the flu can progress from congestion and fatigue to more serious symptoms, like fever, chills and muscle aches that can knock you out for several days.

Medical complications caused by the flu include pneumonia, blood infections, diarrhea and seizures. In worst case scenarios, the flu can lead to death, especially for the very young or the very old.

While the CDC does not directly count deaths related to influenza, their analyses estimate that they can range from 3,000 to about 49,000 people per year. Vaccines can prevent this: During the 2012-13 season, over 100 children died of the flu or flu-related complications, but 90 percent of those children did not receive the flu vaccine.

The vaccine is also extremely important for pregnant women, who are at an increased risk of hospitalization and death from flu. In addition to protecting them from the flu, the vaccine is also linked to the prevention of preterm delivery and gives young infants immunity during the first six months of their life, when they are too young to get the vaccine themselves.

There’s also evidence to show that vaccines can prevent flu-related complications, like heart attack and stroke in older populations, said Dr. Wilbur Chen, chief of adult clinical studies within the Center for Vaccine Development.

People ages 65 and older should also make sure they’re up to date with their pneumococcal vaccine too, which can prevent pneumococcal pneumonia, a serious flu-related complication.

Of course, there’s no guarantee that the vaccine will 100 percent protect you from the virus. However, people who get the vaccine are less likely to get ill and are less likely to spread the disease to others. If you get vaccinated and still end up with the flu, it’ll probably be less serious than it would have been had you not gotten the shot.

Nearly everyone should get a flu shot

Anyone over the ages of six months old who doesn’t have medical conditions that would cause them to react badly to the shot should get one.

The CDC lists special populations for whom a severe bout of flu could cause serious medical complications, saying these groups should be prioritized in the event that there’s a shortage of vaccines. In no particular order, they are children ages six months to five years old; people 50 years old and over; immunosuppressed people (including those who are immunosuppressed because of medicine or HIV); pregnant women; children and teens on long-term aspirin therapy; nursing home residents; people with asthma, diabetes or other chronic diseases; the extremely obese; and Native Americans/Alaska Natives.

People who have severe, life-threatening allergies to the vaccine, or anyone who has ever had Guillain-Barre syndrome, will have to skip their shot and rely on theherd immunity of those around them to be protected.

During the 2015-16 flu season, about 46 percent of Americans over the age of six months got vaccinated, a slight decrease from the year before.

“It’s not perfect; we wish it were better,” said Frieden about the vaccine. “But it will cut your risk of flu, if the match is good, by at least a half. And that’s far better than anything else you can do to protect yourself against the flu.”


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When Teenagers Bristle at ‘How Was School?’ From NY Times

Asking teenagers more specific questions about their day is just one strategy to help them open up. Credit Getty Images

“How was school today?”

If your house is like mine, the conversation will go something like this:

“Fine.”

“What did you do?”

“Nothing.”

In reality, few days are entirely fine, and none are entirely empty. So how do we improve on this perennial flop of an exchange?

As adults we can often forget how stressful middle and high school can be. While some students are energized by school, most find their days taxing, even under the best conditions.

Adolescents may have fun at school with their friends, but they are also in close quarters with scores of peers they didn’t choose. The rough adult equivalent would be to spend nine months of the year in all-day meetings with 20 or more random age-mates — and be expected to bounce home and share enthusiastic updates.

Elementary has historically been more fun and less pressured than the later grades, but this is no longer true in many communities. We should bear that in mind on the days that our younger children seem worn down by school and when our teenagers seem altogether fed up with it.

Many kids, having brooked a demanding day, are ready to leave it in the rearview mirror. They may receive the greeting “How was school?” as we would a cheerful: “Describe all the tedious things you did today!”

In truth, “How was school?” is often short for, “I love you and miss you and would like to touch base.” Throwing the door wide open by inviting teenagers to talk about any part of the day may seem like we are meeting them more than halfway in our conversational efforts. But seeing it from the teenager’s perspective, our broad question may cover more ground than a weary teen can consider.

Posing more specific questions usually helps. Asking, “How is that group project going?” or “Did you guys do sprints again in practice?” can move things in the right direction, especially when our tone conveys that we have no agenda or angle to pursue.

Even better, drop your line of inquiry if your teenager puts a topic on the table. Should an adolescent say, “English was stupid today,” a warm “How come?” can keep the conversation going. At my practice, I am often charged with engaging fragile adolescents on delicate subjects. Asking, “How come?” with genuine curiosity and without judgment has long been my most reliable ally in the effort to help teenagers open up.

Sometimes “How was school?” gets a detailed answer, but not one the parent had in mind. Though teenagers will often share good or interesting news, they’re just as likely to respond with a complaint, or an entire rant. Having held it together throughout the day, they may be primed to blow off steam when we unwittingly invite them to do so.

When the griping begins, parents often step in with well-meaning suggestions. “Did you tell the office about your jammed locker?” or “Have you let your teacher know that you didn’t understand the assignment?” From here, the conversation almost invariably takes the same unhappy path: Parents try to convince the teenager of the wisdom of their guidance, and the teenager tries to convince the parents that they just don’t get it.

And the adolescent is often right. Teenagers, like adults, typically grouse to seek relief, not advice. If we can keep that in mind, asking “Do you want my help, or do you just need to vent?” lets us offer the kind of support our children are hoping for. Allowing teenagers to complain is not the same as endorsing their complaints. Healthy venting sessions usually let adolescents return to school (and adults return to work) less burdened the following day.

At the literal end of the day, most parents simply want to connect with their teenagers. More than it may seem on the surface, our adolescents often want to connect with us, too. To help make this happen, we might set aside our terms and consider meeting them on theirs.

Several months ago at a school I was visiting, I met with a group of ninth-grade students. As I often do, I asked them, “When I meet with your parents tonight, is there anything that you want me to pass along?” A hand shot up, followed by its owner, an earnest girl who stood to say, “Please tell them that when I complain about my school day, the only thing I want them to say back is, ‘Oh my God, that stinks.’ ” Her classmates nodded, and some even quietly applauded.


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Tips to Help Your Child Have a Successful School Year, From NY Times


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Concussion recovery time study, from New York Times

New research shows that athletes who leave the game immediately after a concussion recover twice as fast as athletes who keep playing. Credit Fabrizio Costantini for The New York Times

High school athletes who kept playing in the minutes after a concussion took nearly twice as long to recover as those who left the game immediately after the head trauma, a new study shows.

The finding, published in the journal Pediatrics, is believed to be the first to focus on one of the most difficult social challenges of treating concussions: a pervasive sports culture that encourages young athletes to keep playing through pain. Medical guidelines call for benching the athlete immediately after the head injury to prevent long-term complications and the potentially devastating consequences of a second hit.

“Kids are often reluctant to acknowledge a concussion,” said Dawon Dicks, a youth football coach with CoachUp in Andover, Mass. “The kid may want a scholarship and want to go to college, or it could be that ‘Dad or Coach wants me to play.’ That’s when they’re going to start to be a little dishonest in what they’re truly feeling.”

The latest study tracked the neurological symptoms of 69 athletes who visited the University of Pittsburgh Medical Center Sports Medicine Concussion Program after suffering head trauma during a contact sport. The athletes, who ranged from 12 to 19 years old, came from football, soccer, ice hockey, volleyball, field hockey, basketball, wrestling and rugby.

The sample included 35 athletes who were removed from games right after getting a concussion and compared their symptoms and recovery to 34 athletes who kept playing in the game or match after taking a hit. The study found that players who stayed in the game after head trauma took an average of 44 days to recover. By comparison, athletes who left a game immediately after signs of concussion took only an average of 22 days to recover.

While there were no meaningful differences in recovery time among girls or boys, and no differences by sport, that may be because of the size of the study. Researchers say that while the sample size was small and involved just one clinic, the results clearly highlight the importance of physical and cognitive rest promptly following concussion.

The findings may help doctors promote the message that taking immediate precautions after concussion will actually allow the athlete more opportunities to keep playing, not fewer. Resting immediately in the 24 to 48 hours following a concussion (and then slowly returning to normal activities under the supervision of a physician) reduces the possibility of further stress on the system and allows brain cells to heal faster so that athletes can get back to their sport more quickly. “It’s something that we consistently preach to coaches, parents and kids,” said R.J. Elbin, who led the study while at the University of Pittsburgh but who now is director of the Office for Sport Concussion Research at the University of Arkansas. “However, until now, there really has not been any data that supports this idea.”

Estimates show that each year in the United States, there are up to 3.8 million sports-related concussions, which can happen when there is a blow or jolt to the head that causes the brain to bounce within the skull, stretching and damaging brain cells. Symptoms of concussion may include dizziness, confusion, nausea and sensitivity to light.

Young athletes are particularly prone to prolonged recovery and complications from concussion. “The developing brain has been shown to be more vulnerable to the physiological effects of the injury,” said Tad Seifert, a neurologist and director of the Sports Concussion Program for Norton Healthcare, in Louisville, Ky.

Despite increased awareness of the dangers of concussions and efforts to educate those in the sports community on how to recognize and treat the head injury, an estimated 50 to 70 percent of concussions go unreported. While some athletes and coaches may not always recognize the signs of concussion, the larger concern is a sports mind-set that frowns on leaving the game.

“The idea of being a football player is that we’re tough. We get back up. We don’t cry. We don’t make a big deal out of it,” Mr. Dicks said. “There is the idea that you must sacrifice your body and your brain for the overall greater good of the team.”

Mr. Dicks said he tries to counter that notion and teaches his athletes about the severity of concussions, which can not only sideline players from sports for a few weeks but can also cause pain, trouble sleeping and difficulty in school for months or longer. But awareness varies depending on the economic resources of the school.

At the private high school where Mr. Dicks used to coach, “they go above and beyond to make a big deal out of concussions,” Mr. Dicks said, and noted that there was a certified athletic trainer at every practice and game looking after the health of the athletes. “At the urban high school where I coached, a kid might get a handout about concussion.”

The study authors acknowledged that their data did not show whether the athletes who kept playing following concussion suffered additional head impacts or simply continued physical exertion. Further research is needed to determine exactly why staying in the game post concussion can slow recovery times.

Hearing that leaving the game speeds recovery may finally motivate young athletes to stop playing as soon as they’re hit, said Dr. Jeff Bazarian, professor of emergency medicine and physical medicine and rehabilitation at the University of Rochester. “Now, armed with this study, I think I’m going to be able to say to athletes who did not come out of the game right away that, ‘your recovery might take longer than average because of that,’ ” he said. “I can tell my athletes that this is one thing you can do something about, maybe not this time, but next time.”

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The Underused HPV Vaccine, from the New York Times

Category : Advice , Vaccine

The Underused HPV Vaccine

You’d think that when parents are told of a vaccine that could prevent future cancers in their children, they’d leap at the chance to protect them. Alas, that is hardly the case for a vaccine that prevents infections with cancer-causing human papillomavirus, or HPV. The vaccine, best given at age 11 to 12, is currently the most underutilized immunization available for children.

HPV is by far the most common sexually transmitted infection in the United States, and nearly every sexually active person becomes infected at some time in life. The virus in one or another of its variants causes more than 90 percent of cervical cancers, as well as most cancers of the vulva, vagina, anus, penis and oropharynx, which includes the back of the throat, base of the tongue and tonsils. It also causes genital warts.

Every year, the Centers for Disease Control and Prevention reports, about 14 million Americans become infected with HPV, most of them teenagers or young adults, and a cancer caused by HPV is diagnosed in an estimated 17,600 women and 9,300 men.

Yet, when one of my sons was urged to get the HPV vaccine for his boys, ages 11 and 14, he replied, “Why? They’re not yet sexually active.” I reminded him that not all sex is consensual, and exposure to the virus does not require sexual penetration. However, his response reflects a common misunderstanding among millions of parents, and often their children’s doctors, of the value of the vaccine and the fact that it is most effective if given to preteenagers when the immune response is strongest and before they are exposed to an offending form of the virus.

But as of 2014, only 40 percent of girls and 21 percent of boys ages 13 to 17 had received all three doses of the HPV vaccine, whereas 88 percent of boys and girls had been vaccinated against tetanus-diphtheria-pertussis and 79 percent had gotten the meningococcal vaccine.

There are several explanations for the low rate of HPV immunization among young teens. One is that the vaccine is relatively new — it was first approved in 2006 — and expensive. At about $300 a dose, the three-dose series can approach $1,000 a child, although now, as with other government-recommended vaccines, it is covered by insurance with no co-pay, and the federal Vaccines for Children program provides free vaccination for children who are uninsured or underinsured, according to the American Cancer Society.

The society last month updated its immunization guideline for the HPV vaccine, bringing it in line with the advice issued two years ago by the federal Advisory Committee on Immunization Practices. While the committee considered evidence primarily from company-sponsored studies, the cancer society looked at additional studies conducted by independent researchers.

The society also more carefully defined the effect of age at the time of immunization, finding decreased effectiveness with age that underscores the importance of early vaccination.

“If the vaccine is to be given to people 22 to 26, doctors should inform patients that it is less effective,” said Debbie Saslow, the director of cancer control intervention for the cancer society. Still, it is not too late to immunize college students who did not get the vaccine when they were younger, she said.

A second obstacle to wider HPV immunization is the erroneous belief that it would promote teenage promiscuity, an argument more commonly used to counter birth control advice for teenagers. There is no direct connection between the vaccine and sexual activity and no reason to suggest one, said Dr. Saslow, the lead author of the cancer society’s updated guidelines. If asked, a parent or doctor could simply say the vaccine prevents infection by a very common virus that can cause cancer.

Although some early publicity for the vaccine focused on preventing sexually transmitted disease, Dr. Saslow said, “first and foremost, this is a cancer-prevention vaccine. Multiple studies have shown no negative impact on any measure of sexual activity among girls given the HPV vaccine. You don’t tell teenagers learning to drive not to wear a seatbelt because it may encourage them to run red lights.”

Parental support for having 11 and 12 year old children vaccinated against HPV has been very weak, with only one in five thinking it should be required for school entry. Several states have proposed mandatory vaccination for school entry, and a national sampling of 1,501 parents of children ages 11 to 17 showed that including an “opt out” provision would almost triple parental support for such a requirement, according to researchers at the University of North Carolina Gillings School of Global Public Health.

The most pernicious argument against HPV immunization involves postings on the web of undocumented horror stories that some parents attribute to the vaccine, not unlike the misattribution of autism to the vaccine for measles-mumps-rubella. None of the accounts of severe adverse effects parents have linked to the HPV vaccine have been borne out by sound research.

Three HPV vaccines have been developed, although only one, which protects against nine variants of the virus, now remains on the market. The C.D.C. has stated unequivocally that clinical trials have shown them all to be “very safe.”

Before being licensed in 2009, the vaccine called Cervarix, which protects against the two variants of HPV linked to cervical cancer, was studied in more than 30,000 females. The four-variant vaccine called Gardasil, licensed in 2006 for females and in 2009 for males, was studied in more than 29,000 recipients, and the newest nine-variant vaccine, called Gardasil 9, licensed in December 2014 and the only one now sold, was studied in more than 15,000 males and females.

“Each HPV vaccine was found to be safe and effective,” the agency has declared.

The most common side effects are local pain, redness or swelling at the site of the intramuscular injection. As with other vaccines given to teenagers, fainting sometimes occurs, and patients should be advised to sit or lie down for 15 minutes after getting the vaccine.

The three-dose vaccines should be given to boys and girls as follows: The first dose should ideally be given at age 11 or 12, but can be given to children as young as 9 or to young adults through age 26. The second dose is administered one or two months after the first. And the third dose is given six months after the first. Protection is not complete until all three doses are received. However, there is no maximum interval; if any dose is delayed, it should be given at the next opportunity. There is no need to restart the series.

The vaccine can be safely administered at the same time as other vaccines are given, like the Tdap, meningococcal or influenza vaccine. Although HPV vaccine should not be given during pregnancy, no fetal harm has yet been shown when pregnancy was discovered after one or more doses of the vaccine were administered.

Thus far, there is also no indication that vaccine protection diminishes with time. Individuals followed for up to 10 years post-immunization have shown no sign of decreased protection, and booster doses are not required.

About HPV and the Vaccine to protect against it (From the CDC)

HPV vaccine for males (from the CDC)


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