SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION WINTER 2018-2019
HEALTH REVOLUTIONS
PG. 6
FAMILY MEALTIME
PG. 16
FIGHT THE FLU
PG. 22
LETTER FROM THE HEALTH OFFICER
It is a pleasure to welcome you to the latest edition of HEALTH Magazine. I am grateful for the kind words of encouragement and appreciation we continue to receive about this publication; it makes the work it requires worthwhile, and helps us know if we are hitting the mark. As a state and as a nation, we have been making some crucial decisions about the future we’re creating for our children. Even though Utah, as a state, voted for Proposition 2 - a step toward legalizing marijuana - I was grateful that our region voted against the proposition; thank you. We will be dealing with the consequences of this decision as a state for many years to come.
We are fortunate to live where we do, with the opportunities we all enjoy.
This issue of HEALTH magazine includes articles about eating together as a family, travel safety, preparedness, diabetes, pneumonia, and other topics designed to help you enjoy the kind life we are all seeking. We are fortunate to live where we do, with the opportunities we all enjoy. Thank you for the honor of serving as your Health Officer. Here’s to your health in the New Year and for years to come! Sincerely,
David W. Blodgett, MD, MPH SWUPHD Health Officer & Director
HEALTH MAGAZINE | WINTER 2018-2019
ON THE COVER The Saturday Evening Post "Freedom from Want" Norman Rockwell
This famous painting by Norman Rockwell is the third in a series called The Four Freedoms. They were inspired by a speech of the same name given by President Franklin D. Roosevelt for his State of the Union Address in 1941. After speaking on the freedoms of speech and worship, and before freedom from fear was addressed, President Roosevelt stated: “The third is freedom from want—which, translated into world terms, means economic understandings which will secure to every nation a healthy peacetime life for its inhabitants—everywhere in the world.” The paintings were published in the Saturday Evening Post in 1943, accompanied by essays written on each of the Four Freedoms. Freedom from Want illustration © SEPS licensed by Curtis Licensing
INSIDE PREVENT 4. REVOLUTIONS IN PUBLIC HEALTH
By David W. Blodgett, MD, MPH
6. WINTER FEVER
By Lori McGuire, RN
8. PREPAREDNESS IS FOR EVERYONE
By Kirsten Miner
10. OVER THE RIVER & THROUGH THE WOODS
PROMOTE 12. CARSEAT SAFETY 14. HOLIDAY FOOD SAFETY 16. FAMILY MEALTIME
Interview with 'The Food Nanny"
18. MYPLATE 20. EDIBLE QUOTES
PROTECT 22. WHAT TO DO WITH THE FLU
By Victor R. Worth, DO
24. I SURVIVED MALARIA
Interview with Melissa Sevy
26. THE PUBLIC HEALTH NURSE
By Shana Chavez
28. PREDIABETES SWUHEALTH.ORG | PAGE 3
By David W. Blodgett, MD, MPH SWUPHD Director & Health Officer
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n an earlier edition of HEALTH Magazine, we profiled one of my public health heroes, John Snow. He is an example of an 18th century polymath - or someone who made singular contributions to several fields of study before dying young at the age of 45. We told the story of how he painstakingly made a map of the victims of cholera during an 1854 epidemic in London. There is a wonderful book that details the story, called The Ghost Map by Steven Johnson. It is worth reading just for his description of what life in 1850’s London would have been like alone. London had been experiencing cholera epidemics for most of the 1800s, and life expectancy for those who lived in London was low, especially if you were in the lower classes. The average gentleman died at age for-
ty-five, while the average “tradesman” (or typical working-class man) died in his mid-twenties. In other parts of England, the average working-class man died around the age of sixteen. This was due largely to the high infant mortality rate; the majority of all recorded deaths were of children under five. John Snow wanted to test his theory that cholera was caused by infectious particles, which stood in direct opposition to the accepted medical doctrine of the day. The medical establishment believed in the theory - handed down from Greek and Roman thought - that disease was caused by bad air; called the miasma theory. The theory seemed to fit; often there were bad smells associated with places that also seemed to be associated with disease. Sometimes the hardest untruths to dislodge are
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the ones that seem plausible on the surface, particularly if someone is willing to forcefully argue for the theory. At the time John Snow was investigating the cholera outbreak, the forceful proponent for the miasma theory was John Chadwick, who is remembered for being among the first to set up a public entity to protect the community’s health. He argued that some health-related problems couldn’t be solved by individuals, but needed the resources of the entire community for solutions. The problem was, he based it all on the wrong theory. He championed widespread sanitation activities such as scrubbing and disinfecting streets to eliminate the bad smells, and building sewers. I am sure the citizens appreciated such efforts, but it didn’t help eliminate the diseases he was fighting. The sewers were constructed to dump into the Thames River, which became so badly polluted that the following years became known as “the big stink.” Unfortunately, the river was also the source of the city’s drinking water. The outbreaks of cholera only intensified. John Snow and Chadwick battled it out during their day, with Snow dying before the germ theory of disease could be vindicated. It took another 40 years before the germ theory would finally replace the miasma theory as the accepted model of how diseases spread. Better sanitary practices were an immediate result, leading to decreases
in infectious diseases that would have been unthinkable a century ago. A local example helps highlight the struggle between the two theories: July 17, 1905
(Minutes of the County Court of Iron County at Parowan, Utah Book No. 2, Page 331) Archivist Note: Herbert Adams was appointed Justice of the Peace in and for Cedar Precinct., and following is one of Justice Adams' notable cases: Dr. George W. Middleton, City Physician and Health Officer (as well as Mayor) instituted proceedings against certain sheep men who ranged their herds in Coal Creek Canyon for pollution of Cedar City's water supply. The whole case rested upon the germ theory of sanitary pollution, and the Doctor's expert evidence was wholly on this point.
Suddenly Judge Adams broke in with a question: Judge: Doc, what is a germ? Doctor: Germs are minute living organisms of animal or insect life of microscopic size. Judge: Doctor, have you ever seen a germ with your own eyes? Doctor: Yes, through a microscope, I have. Judge: Why haven't you put some of those animals here before the Court as an exhibit in this case? Doctor: Your Honor, they are too small to be seen with the naked eye and the Court has no microscope. If your honor desires, I can bring my microscope and slides from my office. Judge: You mean, Doc, that they can't be seen by the naked eyes or with common reading glasses? Doctor: Yes, your honor, they are too small for that. Judge: Anything that is too small to be seen by the naked eye is too small for this Court to waste its time on. Doc, you show me a germ and I will eat it. Case Dismissed.
Why is it that we sometimes have a hard time giving up on a theory that has been disproven? Medicine has many stories like this one, where incorrect theories persisted long after they should have been discarded. I don’t think this phenomenon is unique to medicine. We live in a world where voices argue strongly for their side, and we sometimes seem to think the loudest voice must also be the correct one. Often, the stakes are very high, involving lives, health, and happiness. So, unfortunately, adopting an inaccurate theory can spell disaster for you as an individual, or for a community. We try to help you sift through the mountain of health claims being made today in hopes that we can be a reliable source of information for you in your quest for better health.
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By Lori McGuire, RN SWUPHD Nurse
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ymptoms of pneumonia were first described over 2000 years ago by the Greek physician Hippocrates. Pneumonia, derived from the Greek word “pneumon” (meaning lung), is an infection of one or both lungs in which the air sacs the alveoli - fill up with fluid. Although pneumonia can be caused by viruses or fungi, the most common type is pneumococcal pneumonia, which results from infection by Streptococcus pneumoniae bacteria. These bacteria were first observed under a microscope by German pathologist Edwin Klebs
in 1875. Ninety-two different types of S. pneumoniae have been identified so far. Pneumococcal pneumonia (referred to hereafter simply as pneumonia) mainly occurs in young children and the elderly. It can infect the upper respiratory tract and spread to the blood, lungs, middle ear, or nervous system. Pneumonia was known historically as “winter fever” and typically occurred following infection with influenza or the common cold. Before the advent of antibiotics, it was a leading cause of death in the United States. Indeed, scientists believe
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that many of the millions who There was an acute interest in perished in the 1918 influen- creating a pneumococcal vacza pandemic died of bacterial cine in 1911 when gold mines in pneumonia. Although we now South Africa faced potential clohave vaccines to prevent pneu- sure due to pneumonia illness monia and effective antibiotic amongst the miners. The Brittreatment, it is still the cause ish mining industry was instruof about 1 million mental in initiating hospitalizations vaccine research but in the U.S. annu- Flu and was unable to creally, and flu and pneumonia ate an effective vacpneumonia comcine. The great flu bined rank as the combined pandemic during 8th leading cause rank as the World War I inof death in the nacreased the urgency 8th leadfor vaccine develoption. ment. Fortunately, ing cause Along with havit was around this ing a respiratory of death in time that antibiotillness like the flu, the nation. ics emerged and other factors that pneumonia became increase the risk of a treatable disease. getting pneumonia include age Unfortunately, antibiotic resis(under 2 and over 65 years old), tance eventually evolved and in cigarette smoking, and chronic the 1970s vaccine research fired health conditions such as asth- back up. The first pneumococma, heart disease, and diabetes. cal vaccine was approved by the Pneumonia typically has a FDA in 1978. short incubation period of 1-3 There are currently two vacdays. Signs and symptoms in- cines available that specificalclude fever, chills, a non-im- ly protect against pneumonia: proving, phlegm-producing the pneumococcal polysaccough, shortness of breath with charide vaccine (PPSV-23) and normal activity, and feeling the pneumococcal conjugate suddenly worse after having vaccine (PCV-13). PPSV-23 was had the flu or an upper respira- first licensed in the U.S. in 1983 tory infection. Pneumonia can and it helps to protect against 23 vary greatly in severity – some strains of S. pneumoniae. Adults people may have it and not 65 and older should even know it (sometimes called receive 1 dose of this “walking pneumonia”). Severe vaccine; if the vaccine cases can lead to bacteremia was given before age 65, (bacteria in the blood), shock, get a second dose after and respiratory failure. Pneu- age 65, at least 5 years after monia can be treated with anti- the first dose. biotics but it can take a month or longer before symptoms dis- The PCV-13 vaccine was first licensed appear.
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in 2010 in the U.S. It is given to young children as a series and is also recommended as a one-time dose to adults 50 years of age or older. Ideally, an adult over 65 who has never had a pneumococcal vaccine would get a dose of PCV-13 and then receive a dose of PPSV-23 twelve months later. The two vaccines should not be given simultaneously. Getting the annual influenza vaccine can also offer protection by preventing the flu, which is a major risk factor for pneumonia infection. These immunizations can be obtained at your nearest health department office (see page 30) or your healthcare provider.
By Kirsten Miner
SWUPHD Access and Functional Needs Advocate
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ixteen years ago, in response to the deadly events of September 11, 2001 and the anthrax attacks that followed, Congress created a new program to help health departments across the nation prepare for emergencies. Since then, the Southwest Utah Public Health Department has been involved in helping our local communities prepare, respond to, and recover from emergencies and disasters. These events could come in the form of flooding, fires, storms, earthquakes, landslides, chemical spills, pandemics, active shooters, or terrorist activity. The Health Department maintains a close working relationship with the other local first-response agencies in order to answer the needs of the community when the
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unexpected occurs. As efficient and helpful as that may be, resources are limited and may be inadequate when a large scale catastrophe occurs. “We really want people to realize that they may be on their own for an extended period of time when disaster strikes,” says Joe Dougherty, spokesperson for the Utah Department of Emergency Management. “It could be a couple of weeks or more before help arrives in any specific neighborhood.” Because there is no guarantee of outside help being available immediately after a disaster, it is imperative that individuals take personal responsibility to plan and prepare themselves (and those in their care) for emergencies.
for this population are called “access and functional needs”, or AFN. Examples of AFNs would include transportation, medical care, emergency alerts, prescription drugs, and medical devices or equipment. If you think about it, all of us know someone - if not ourselves - who has an AFN. Children are certainly dependent on others for AFNs. People with chronic illness, developmental disabilities, and the deaf and blind all have unique AFNs. We also develop AFNs as we age, sometimes requiring the assistance of canes, wheelchairs, hearing aids, or drivers. We might have AFNs we don’t even think about. What if your one pair of prescription eyeglasses gets lost or broken during an accident or disaster?
nities, AFN Coalition members can get help with: • Creating emergency plans using best practices. • Exercising and refining plans, making sure AFNs are covered. • Encouraging their employees and clients to create their own personal plans. An important tool promoted by the Coalition is the “Preparedness Buddy” concept, in which a vulnerable person finds a trusted friend or neighbor who would come to his or her aid during an emergency and would be familiar with AFNs like medications and other health needs. The information is shared between buddies using a simple pamphlet that can be referred to when needed.
Have you ever considered how Last year, the Health Depart- While preparedness starts with your aging parent would han- ment invited representatives us as individuals, most of us dle a disaster? If you don’t live from a variety of community would want to include our famclose by, who ilies, neighbors, could provide Experience has shown that people and friends in assistance? If our plans, espeyou were sepa- who are vulnerable or disabled are cially those who rated from your more severely impacted by disasters. would struggle children during on their own. an emergency, The next level would they have a communica- organizations to join a new Ac- of readiness includes neighbortion plan or pre-arranged meet- cess and Functional Needs Co- hoods, churches, schools, and ing place? Do you know anyone alition, with the focus of ensur- businesses. Then, communities who is dependent on oxygen or ing that the AFNs of vulnerable become resilient in the face of other medical assistance, and and disabled people are being challenges and can hold their do they have a back up plan in addressed in their emergency own until help arrives from state case the power went out for an plans. Participation in the coa- or national agencies. extended period? Experience lition has grown steadily to inhas shown that people who clude schools, medical clinics, are vulnerable or disabled are rehabilitation centers, and busi- If you would like to participate in more severely impacted by di- nesses. the AFN Coalition or want copies sasters and require extra considof the Preparedness Buddy pameration when preparing for the Besides networking and pre- phlet, please email Kirsten at: unexpected. The gaps that exist paredness education opportu- kminer@swuhealth.org.
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By Paulette Valentine
SWUPHD Emergency Preparedness & Response Division Director
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outhwest Utah’s weather is as diverse as its scenery. Winter storms come on quickly. Travellers heading north on Interstate 15 from Washington County under sunny skies can soon find themselves encountering slick, treacherous roads as they ascend the Black Ridge and enter Iron County. With cold weather comes the hazards of winter driving, including icy roads and
reduced visibility from fog, wind, rain, and snow. Preparing and planning can make the difference between an inconvenience and a true emergency.
Know your vehicle.
Not everyone is a “car person”, but you can take the time to learn about any special features your vehicle may have to help while driving in
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a snowstorm or on slick roads. Some car owner’s manuals suggest not having your car on cruise control during any storm event, since reaction time is quicker when you have manual control of your vehicle. Anti-lock (ABS) brakes and high-tech features like traction control are no substitute for safe stopping distances and reasonable speeds.
Watch the weather.
One way to reduce risk in winter is to plan trips in relatively good weather. Be alert and stay up- to-date on changing weather and traffic reports in order to anticipate and avoid hazardous conditions. Smartphones make monitoring the weather even easier with real-time updates (just be sure not to check while driving).
Slow down.
A little caution can make a lot of difference when roads are slick. Slowing down by at least five miles per hour below the normal speed and keeping more car lengths between vehicles will give everyone more time for any sudden stops. There’s no obligation to keep up with high speed limits on freeways when road conditions are bad. Be patient with other drivers; even take time out when frustrated. Getting anywhere safer is better than faster.
Get your vehicles ready for winter.
It’s a good idea to keep your tires at proper inflation. During winter months in Utah, some roads will have rules posted which require additional traction, including four-wheel drive, snow tires, or chains. Make sure your vehicle has been properly serviced and fluid levels are full, especially antifreeze and windshield washer fluid. It’s a good idea to secure an extra jug of washer fluid in your trunk, since you’ll likely use more while driving on wet, dirty roads. Before driving, remove any troublesome ice from the windshield and windows, along with piled snow from the hood and cabin top, in order to prevent problems with visibility. Always keep your gas tank at least half full.
Have a winter emergency kit in your car.
In the event you have to pull over or find yourself broken down during winter weather, be prepared with a winter emergency kit. Recommended items include an ice scraper, flashlight and batteries (stored separately), hand-warmers, blankets, drinking water, high-calorie food bars, shovel, jumper cables, whistle, first aid kit, and stand-alone emergency lights or flares. You can add sanitary supplies and extra clothes (including cold-weather outdoor wear), and makes sure to consider extra supplies for others travelling with you.
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Utah’s top causes of motor vehicle traffic crash deaths in 2017*: • Speed (40%)
• Unrestrained occupants (30%)
• Bad Weather (14%)
• Drunk driving (13%) • Failing to yield (11%) • Distracted driving (7%)
*Some crashes had multiple causes
I
n Utah, all passengers in a vehicle must wear a seatbelt and children up to age 8 must be properly restrained in an approved child safety seat. Most parents are conscientious about making sure their infants and children are buckled into car seats, but did you know 3 out of 4 car seats are not used or installed correctly? The most common mistakes made when using car seats are: • Using the wrong seat for the child’s age, weight, and height • Putting them in the front seat too soon • Putting them in a forward-facing car seat too early • Not using the correct lower anchors or top tethers for their seat and vehicle • Not tightening the harness straps enough The Southwest Utah Public Health Department offers free individual car seat installation instruction. Call your nearest office (see below) to set an appointment with a car seat technician. Bring your child’s car seat (or purchase one at the office) and learn how to correctly install it! • St. George: (435) 652-4064 • Cedar City (435) 865-5151 Basic guidelines for safe car seat use: • Infants should be restrained in rear-facing child safety seats for as long as possible (until at least 2 years of age or 30 pounds). • Children can ride forward facing with a harness until a least 4 years of age and 40 pounds. • Children who are at least 4 years of age and 40 pounds can ride in a booster seat, which can be used until the seat belt fits correctly. • All children under age 13 should ride in the back seat.
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Basic Car Seat Safety Car seat has all of its parts, labels and instructions and has never been in a crash.
Child always rides in a back seat, never in front of an air bag.
The shoulder strap is tight enough that access strapping can't be pinched.
The chest buckle is in line with the armpit, positioned on the chest.
Child always rides in a car seat for appropriate size and age. Car seat is buckled tightly in the car and doesn’t move more than one inch, to the right or left. For more information regarding car seats, booster seats, and seat belts please visit www.safekids.org
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(165° is for cooking poultry, casseroles & leftovers) (160° is for cooking ground meats) (145° is for cooking roasts, ham, steaks, chops, pork) (≥140° is for keeping food warm) (≤40° is for refrigeration)
“Then the Whos, young and old, would sit down to a feast. And they’d feast! And they’d feast! And they’d FEAST! FEAST! FEAST! FEAST!”
Holiday season has arrived! As families, loved-ones, friends, and neighbors gather to celebrate these special events, food will likely play a major role. There is also an increased risk of catching a foodborne illness, which could leave you feeling “Grinchy”. So, whether you “feast on Who-pudding” or “rare Who-roast beast”, the following suggestions will help keep the upcoming holidays memorable for all the right reasons.
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“Their mouths will hang open a moment or two…”
Many diseases can be spread through the foods we eat. Every year, it is estimated that over 37 million Americans get sick with a foodborne illness, often causing fever, nausea, vomiting, or diarrhea. Keep meats and eggs separate from other food, from the shopping cart to the fridge to preparation. Wash fresh produce thoroughly before preparation. Always wash your hands thoroughly before eating and preparing foods, and after handling raw meat. Do not handle or prepare food if you are sick!
“He slunk to the icebox…”
Germs can reproduce rapidly when foods are left at room temperature. Foods should be kept either hot (at least 140°) or cold (40° or below). Avoid keeping perishable food out on tables or counters for “grazing” for longer than two hours. Store it in the refrigerator or freezer at that point.
“...the last thing he took was the log for their fire!”
Generally, bacteria in food can be killed by adequate cooking. Roasts, hams, steaks, shops, and whole pork should be cooked to an temperature of 145°. Ground meats, especially beef, should be cooked to 160°. Turkey, chicken, casseroles, and leftovers should be cooked to 165°. Using an accurate meat thermometer is the only way to ensure these foods have been cooked to the safe minimum internal temperature! Insert the thermometer into the center of the meat to get a reading, and clean between uses.
“...and he, HE HIMSELF, the Grinch, carved the roast beast.”
If you buy a frozen turkey for your holiday feast, remember that it will need to thaw. The safest way is in the refrigerator: 24 hours for every 5 pounds, up to six days before cooking, so plan ahead! The alternative is to submerge in cold water 30 minutes for every pound, changing the water every half hour. Keep all utensils and surfaces used to prepare raw foods washed and separate from other food. Use these tips to help keep you, your family, and guests safe and healthy at your next holiday gathering. Happy feasting! Adapted from an article published in the Winter 2015 issue of HEALTH Magazine (“Don’t Feel Grinchy”). Quotes and images from “How the Grinch Stole Christmas” by Theodor “Dr. Seuss” Geisel, ™ & © Dr. Seuss Enterprises. Used with permission.
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The Benefits of Eating Together
An interview with Liz Edmunds - author, cook, and star of "The Food Nanny" reality show - is passionate about encouraging families to sit down and enjoy dinner together on a regular basis. Having raised seven children in a busy household, she knows what she's doing.
"Y
ou often hear about the American family falling apart," Liz says. "The most powerful and natural time in the whole day to gather the family together is at dinner time, and nobody is doing dinner anymore. All kinds of activities are being scheduled through dinnertime. People are eating in their cars on the go and not taking the time to sit down to eat a nutritious meal every night and taking the opportunity to talk face to face with their loved ones. The communication and relationship is even more important than the nutrition." So, if a family wants to get back on track, where do they start? "Every family needs to set a regular dinner hour," says Liz. "Hopefully between 5:00 and 7:30 p.m. The days of having a big noon meal together are long gone and breakfast is too rushed. A regular dinner time provides stability. It's something to look
forward to after a long day at school or work, where family members are in a safe place with people who love them. They get to talk about the day and values are taught. It's therapy." What about conflicting activities? "Don't punish the whole family because a couple of members aren't there," Liz advises. "Set the dinner hour and stick with it. That consistency will result in kids not filling up on junk when they get home, because they're looking forward to a home-cooked meal. Set aside a plate for those who come in later and enjoy some interaction with them as well, while they're eating." Now comes the hardest part: trying to figure out what to eat every night. The solution? Liz recommends a method she has used for over 25 years. "Seven years into my marriage I created a meal plan to make it easy to put dinner
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on the table on an ongoing basis. It's called Theme Night. Monday is for comfort food, Tuesday is Italian night; fish, meatless, or breakfast on Wednesday, Thursday is Mexican night, Friday is pizza, Saturday is grilling, and Sunday is tradition night.�
your family in what meals they want or are craving. Then create your shopping list and go to the store. You'll start to find you need fewer ingredients when you cook on a consistent basis because you'll have a lot on hand. You can make smaller trips in between for fresh produce. Most everything "I realized later that my family was else you can refrigerate or freeze." getting a great variety of food because I had at least eight recipes to Liz asserts that families who stick choose from under each theme," to a simple plan and make regular Liz says. "I also made sure to offer mealtime a part of their schedule two to three vegetables with each will enjoy a greater quality of life. meal; a combination of fresh, fro- "If you eat dinner as a family at zen, or canned , along with fruit." least three nights a week, you're Liz's meal plan takes about ten going to stick together. Get up to minutes to update. "I do it every five nights if you can. When your two weeks. One week is too short, family is bonding over good food, and a month is too long. Include life is good!"
If the notion of cooking at home with your family most nights seems daunting, take courage from Liz: "When you make your kitchen the heart of your home, you create an experience where you know what's going into your meals. You're chopping, handling, smelling the food. There's a connection between body and soul. It's the true life! Your family will be healthier, both physically and emotionally." Liz Edmunds and her daughter Lizi are passionate about helping families understand the importance of family dinnertime and cooking great food. You can find their delicious recipes and weekly meal plans at thefoodnanny.com and on Instagram (@thefoodnanny).
Other words of wisdom from The Food Nanny:
Dessert: "Kids who don't get the chance to eat sweets in moderation often binge on it when they leave
home. Prepare dessert once a week in small portions. I also make cookies or brownies in between." Meat: "I believe it's important to include it in our diet but we could all use less, especially red meat. That's why I have a meatless night and many of my other recipes are meatless as well." Bread: "I cut out bread three times a day. Choose one meal to eat your bread, maybe two on occasion. Try whole grains." Fruits and Veggies: "Most people don't get enough. Serve two to three veggies every meal. Try new ones often and eventually your family will end up liking them. Try fruit for desserts." Fast Food: "It has it's time and place, just don't eat out all the time. When you go to a restaurant, share your meal or bring home half to eat the next day." Dieting: "Don't eliminate any foods. Most diets don't work long term. What do you love and crave? Make it healthy and practice portion control. Eat a large variety of foods along with plenty of vegetables and fruits. Eat until you're satisfied, not full, then push your plate away. Then you can enjoy a little treat. Soon you won't crave sweets as much."
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Michael Pollan, author of “In Defense of Food” HEALTH MAGAZINE |WINTER 2018-2019
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Is MyPlate Your Plate? In 2011, the USDA replaced the Food Pyramid with a updated guide to healthy eating: a simple plate. “MyPlate” is a visual reminder to balance your meals, emphasizing vegetables and whole grains. Eating with a focus on variety, amount, and nutritional value will lead to weight loss, improved health, and extra years of life!
Eat mostly whole grains. Refined grains, like white bread and white rice, have less nutrition. Whole grains have more fiber, iron, and B vitamins.
Eat fruits of all colors. Go for fruit instead of fruit juice, which has more fiber and fewer calories. The more colors and types that you eat, the better! Aim to get mostly non-starchy veggies.
It’s not just about the food.
A palm-sized amount at lunch and dinner is all you need. Beans, nuts, fish, and chicken are good, lean choices.
According to the American Academy of Pediatrics, there are proven benefits for children and teens who frequently eat together with their families:
• Better grades • Enhanced language development • Higher intake of fruits and vegetables • Fewer eating disorders • Decreased risk of alcohol, tobacco, and drug use • Lower stress • Fewer behavior and emotional problems • Better relationships with parents and siblings
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esearcher & Journalist Michael Pollan coined the phrase “eat food, not too much, mostly plants” (see page 18) as an ultra-simple guide to nutrition. Here are a few samples from his book Food Rules (An Eater’s Manual): Rule 2: Rule 5: Rule 8: Rule 23: Rule 25: Rule 39: Rule 46: Rule 49: Rule 52: Rule 53: Rule 58: Rule 60: Rule 64:
Don’t eat anything your great-great-grandmother wouldn’t recognize as food. Avoid foods that have some form of sugar (or sweetener) listed among the top three ingredients. Avoid food products that make health claims. Treat meat as a flavoring or special occasion food. Eat your colors. Eat all the junk food you want as long as you cook it yourself. Stop eating before you're full. Eat slowly. Buy smaller plates and glasses. Serve a proper portion and don't go back for seconds. Do all your eating at a table. Treat treats as treats. Break the rules once in awhile.
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“Food is an important part of a balanced diet.” Fran Lebowitz
“We all eat, and it would be a sad waste of opportunity to eat badly.” Anna Thomas
“Even in this high-tech age, the low-tech plant continues to be the key to nutrition and health.” Jack Weatherford
“Eating crappy food isn't a reward — it's a punishment.” Drew Carey
“Don’t dig your own grave with your knife and fork.” English Proverb
“In my food world, there is no fear or guilt, just joy and balance” Ellie Krieger
“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have the safest way to health.” Hippocrates
“If more of us valued food and cheer and song above hoarded gold, it would be a merrier world.” J.R.R. Tolkien
“Take care of your body. It’s the only place you have to live.” Jim Rohn
“Life expectancy would grow by leaps and bounds if green vegetables smelled as good as bacon. ” Doug Larson
“After a good dinner one can forgive anybody, even one’s own relatives.” Oscar Wilde
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It’s been one hundred years since the devastating influenza pandemic of 1918. We’ve come a long way, but we still have far to go.
By Victor R. Worth, DO Guest Columnist
The 1918 Influenza Pandemic
three cars could follow a hearse to the graveyard. Unsurprisingly, hundreds of In the fall of 1918, World War I, known additional policemen had to be hired to then as the “Great War”, was drawing enforce these public safety orders. to a close. But the world would face an even deadlier tragedy that winter – influ- Despite these measures, the pandemic enza. At least 50 million people around accelerated. Desperate families tried a the globe would lose their lives to this variety of ineffective tonics and herbal illness. Nearly 700,000 people died in remedies. Even alcohol was touted as the United States. The disruption of being able to prevent the infection, and normal life caused by this pandemic though Utah was a dry state, health ofis hard to imagine today. Here in Utah, ficials allowed doctors to administer it. schools, churches, theaters, and oth- But in an age when influenza was poorer public gathering places were closed ly understood, there was little more that down. Stricken homes had to display physicians and families could do besides large quarantine signs. Rules required try to alleviate the symptoms, maintain face masks in public, forbade spitting nutrition and hydration, and let the paon sidewalks, and limited the number of tient rest. By the end of the pandemic, at passengers on streetcars. The city of Og- least 2,500 Utahns had lost their lives. den even required a certificate of good health issued by a physician within the Fighting the flu last twenty-four hours for anyone want- Other influenza pandemics would aping to enter the town. Funerals were pear over the next hundred years, but limited to 15 minutes and no more than none even nearly as severe. Perhaps
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that’s why awareness of the flu’s deadly potential seems to have slipped to the back of our collective consciousness. Yet influenza remains a real threat. Every year, between 20,000 and 60,000 Americans die from the flu and its complications. Compare that, for example, to 11,000 reported fatalities in the entire world from the Ebola virus over the last full decade. The threat of an exotic illness grabs headlines and provokes fear, while year after year, influenza takes its deadly toll. My own experience as a physician sadly includes such cases: lives claimed, and bodies – even young ones - forever crippled by the flu. Yet much of this suffering could be prevented. How? Fortunately, we know a great deal more today than we did in 1918, and immunization has become our most powerful weapon against influenza. The fact is that flu shots work. They decrease the chances of getting the flu and can reduce the severity of illness in those who still get sick despite being vaccinated . Interestingly, flu shots decrease the chances of being hospitalized and dying not just from the flu, but from heart disease, stroke, and other problems that the flu can aggravate.
Who should get immunized?
Everyone over six months of age should get a flu shot. People over 65 and those with lung, heart, kidney, and other medical problems, are at especially high risk of severe complications of the flu. So are pregnant women. Family members can help protect people at higher risk by getting vaccinated themselves. Health care workers should get a flu shot annually.
The importance of annual vaccination
Every year, the CDC’s recommendation for which strains of flu to include in the annual vaccine changes based on what strains seem likely to reach us in the fall and winter. Since it takes about six months to produce a vaccine, those predictions are not always spot-on, and the flu vaccine
can vary in effectiveness from year to year. Even so, it is unwise to simply pick and choose which year to get a flu shot. One study, for example, showed that a single flu shot reduced the risk of death by about 10%, while the practice of getting annual flu shots reduced the risk by an impressive 75%.
Hygiene and prevention of exposure
Preventing the spread of influenza begins with simple measures. It has been shown that even someone living in the same home as a person with the flu can prevent transmission with careful handwashing and the use of a mask if they start early enough. Cleaning of frequently touched surfaces and objects can also help. If you do get sick, stay home from work and keep sick children home from school. Cover your cough, wash your hands frequently, and avoid sharing personal items. Travelers may even want to check the CDC website at cdc.gov/travel, since influenza in many parts of the world follows different seasonal patterns than here.
Treatment
If you have typical signs of the flu (fever, chills, body aches, cough, sore throat, headache, fatigue, and sometimes vomiting and diarrhea), or if you know that you have been exposed to someone with influenza, consult your doctor. Treatment with antiviral medications like oseltamivir, also known as Tamiflu, may be appropriate. Antivirals can shorten the length of the illness and significantly reduce its severity. However, these medications don’t seem to work well unless they are started within 48 hours after the onset of symptoms. And, of course, antivirals are no substitute for vaccination against the flu.
On the horizon
In addition to vaccines and antivirals, the last hundred years have brought us many other important SWUHEALTH.ORG | PAGE 23
tools for fighting influenza. While antibiotics don’t stop the flu directly, they are important in fighting the bacterial lung infections that so often result. Other innovations, from mechanical ventilation machines to simple improvements like the routine use of protective gloves, gowns, and masks by medical professionals, are all helping to lessen the loss of life and the burden of suffering from this common but deadly disease. Researchers are also working hard to develop a universal flu vaccine that would protect against all flu strains and not have to be modified every year. No one knows when another severe influenza pandemic will strike, though it certainly will. Public health agencies are constantly improving methods of surveillance to detect potentially lethal strains of flu and develop vaccines quicker. Hospitals and governments are continuously refining plans to deal more effectively with an eventual pandemic. The best thing we as individuals and families can do is to take the flu seriously each and every year. Dr. Victor Worth and his family live in Cedar City. He practices family medicine at the Intermountain Canyon View clinic in Parowan.
An interview with Melissa Sevy Co-Founder of FairKind
M
elissa Sevy is no stranger to world travel. She is co-founder of FairKind, a company dedicated to providing fair trade work for artisans in developing countries. Earlier this year, they received an order for 100,000 handmade Ugandan bracelets. Melissa flew to Uganda in May and spent two weeks setting up a supply chain. She had previously established a core group of 60 women who were accomplished jewelry makers, but such a large order would require at least 300 artisans. “My work there was connecting with other artisan groups,” says Melissa. “They had the skills, but no market to sell their products through. We were able to bring them into this project, giving them work for several months.” Once the project was underway, she returned home to Utah. A week after her trip, Melissa
began experiencing flu-like symptoms: head and body aches, fatigue, loss of appetite, and alternating fever and chills. “Four days later I was in the hospital with renal failure and my liver was shutting down,” she recalls.
your entire trip, then for a couple weeks after you get home, but I neglected that. I’ve always slept under a mosquito net but hadn't been using repellent, mainly because I’ve hardly ever been bitten by mosquitoes.” Melissa’s luck ran out during her Uganda Melissa had been to Ugan- trip this past spring. da several times since 2009, and has usually enjoyed good “I never saw a bite,” she rehealth in her travels (with the members. “I felt fine when I exception of an eight month got home, but it usually takes stay In 2012, during which a couple of weeks to manifest she was suffered with round- symptoms." Once Melissa worms, E.coli, and a bro- became ill, her fever would ken foot, all within the same reach 104 degrees. “Then week). I would crash in a pool of sweat for a few hours. That’s Having a background in the only time I would feel public health, Melissa was better, then the fever would familiar with malaria, a mos- spike back up.” These cycling quito-borne blood disease symptoms (typical of malaria) caused by a parasite. “I’d delayed medical treatment. “I known a few people who had went to an instacare, but the malaria,” says Melissa. “but fever had broken, so I went I had become very lax in my home without any tests.” years of traveling. There’s a preventive medication you’re “The day after that I went in supposed to take for a few when my fever was high, and days before you leave, during I was showing signs of shock. HEALTH MAGAZINE | WINTER 2018-2019
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I also mentioned being in Uganda so they sent me to and flare up later.” After four days, she left the hosthe emergency room to get tested for malaria. pital for the last time; the danger had passed. The test came back negative, but it turns out you’re supposed to test the next day as well with malaria, so that put them on the wrong trail. I was sent home with medication for a urinary tract infection.”
Soon afterward, the hospital put a malaria protocol in place to be better prepared to handle future cases, however unlikely they might be. Ironically, if Melissa had gone to a clinic in Uganda with her initial symptoms, she would have been treated for malaria After two days of no improvement, Melissa returned immediately, since it’s so common there. to the hospital and got a second malaria test; this time it was positive, so she was discharged with an- “It took me about two months to recover. I was weak ti-malarial medications. and nauseated for a few weeks. It was hard to focus and It took everything I had to muster up the energy The following morning, a laboratory worker - who for two or three hours of work per day from home.” happened to be a friend - took a look at her lab results. “She noticed a viral load of 10%. The standard Melissa’s ordeal didn’t slow her down for very long. for hospital admission is 5%, so she alerted the hos- She returned to Uganda for a month in August to pital.” Meanwhile, Melissa’s brother had come to continue her work with FairKind. “I did take all the her home to check on her. “He noticed me wincing precautions this time,” she says with the voice of every few seconds as we talked,” she says. “ It was the someone who has learned the hard way. “And I am weirdest thing; I felt like I was getting electric shocks happy to say I did not return with malaria!” in my brain, alternating between the right and left sides. My brother took me back to the emergency Melissa Sevy continues her work with FairKind in countries room, and they said ‘It’s a good thing you’re here!’” around the world, including India, China, Morocco, Peru, Mexico, and Rwanda, to name a few. She gave the interview By this time she was dehydrated and her kidneys for this article over Skype from Budapest. and liver were compromised, but she was able to get stabilized with the right treatment. “Around 2:00 am FairKind advocates for artisans in developing countries the second night the “brain zaps” disappeared, so I traditionally an exploited group - to arrange fair trade work asked the nurse for a popsicle,” Melissa recollects. through large orders that provide consistent work and mar“It turns out I had P. falciparum malaria. It’s the ket demand. Benefits provided to FairKind artisans include most life-threatening, but it doesn’t stay in your sys- health insurance, help in accessing healthcare, and health tem like other species which can remain dormant classes. Find out more about the company at FairKind.com.
Malaria transmission occurs limited Malaria risk no Malaria
SWUHEALTH.ORG | PAGE 25
Written by Shana Chavez SWUPHD Clinical Assistant
T
he origin of formal public health nursing dates back to mid-1800s England and began as an experiment in home nursing. To offer health services to those who could not afford it, a single hospital-trained nurse was sent out to provide in-home care to the sick poor in a small area of Liverpool. This successful idea led to the division of Liverpool into 18 separate geographical areas or districts, each of which was supplied its own nurse who would be responsible for the health of those living in their assigned area. Prior to beginning their assignments, each of these district nurses received additional training in the areas of maternal and infant care, sanitary reforms, and infectious diseases. A major focus was
improving hygiene and cleanliness in homes by teaching sanitary principles. The nurses were also tasked with documenting caseloads, time spent, and care provided. They often dealt with conditions that are rare of unheard of today, like postpartum infections and diseases such as typhoid fever, scarlet fever, and diphtheria. This type of geographical nursing quickly spread throughout England. In the late 1800s, as America became inundated with millions of immigrants arriving on disease infested ships, the concept of district nursing was adopted in the United States with the establishment of several visiting nurse institutions. One such institution, The Henry Street Settlement in New York, was es-
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tablished in 1893 by Lillian Wald, a graduate of the New York Hospital School of Nursing. The Henry Street Settlement was initially staffed with Wald and one of her nursing school classmates, but quickly expanded to include several more nurses, activist lawyers, and social reformers, all living together and sharing expenses. Much of their efforts were directed toward sanitation, employment, recreation, and education. Wald actually coined the term “public health nurse�, wanting to emphasize the community value in their work; recognizing that much of the illness they encountered in homes was the result of larger societal issues. The Henry Street Settlement served residents of the Lower East Side, which was populated by poor immigrants. Eventually, however, the Settlement treated thousands of people across New York City. By 1901, there were 60 nursing associations consisting of 130 visiting nurses in the United States. Within fifteen years, the number of organizations had grown to more than 1900, including more than 5000 nurses serving 1500 cities and towns. Public health nursing was becoming recognized as a vital part of the larger public health movement that had been ongoing since the mid 1800s. As the field of public health nursing grew, Lillian Wald and other leading nurses saw the need to standardize practices, so the National Organization for Public Health Nursing (NOPHN) was created in 1912 with Wald being named as its first president. By 1920, many entering the public health nursing field began specializing in specific areas such as tuberculosis - which at that time was a leading cause of death - as well as infant, child, and maternal health, venereal diseases, and school and industrial nursing.
However, serving the needs of the poor remained a priority, which led Wald, in her efforts to serve even more vulnerable people, to enlist the help of the Red Cross. Qualified nurses, working under the direction of local Red Cross chapters, worked to offer bedside care and preventive services in rural areas. During the 1920s, more than two thousand Red Cross rural nursing services were active across the country. By the late 1920s there were thousands of separate public health nursing agencies. 65% of them were actually small entities employing a single nurse. Others were operated by volunteers or local government. Most acted independently of each other, which sometimes caused confusion and duplication of services. Debate began regarding the functions of volunteer versus government agencies, and conflict between health departments and the medical profession arose. Many leaders in the field began to consider the separation of curative and preventive services, which would significantly alter the role of community nurses. The circumstances that created the need for public health nursing in the first place had changed, as well. Community health needs were no longer as urgent. The teaching of personal hygiene and improved sanitation had helped to decrease the rate of illness. Antibiotics became available in the early to mid 1940s which were instrumental in treating many infectious diseases. Death rates declined sharply as chronic disease began replacing infectious disease as the leading cause of death. At the same time, many people began seeking hospital-based care for medical services, reducing the need for skilled inhome nursing.
and became more preventive in nature. The roles and responsibilities of public health nurses have continued to evolve as new public health issues emerge. Today, public health nursing can be found in a variety of settings, some of which include:
Health Departments
At federal, state, and local levels, public health nurses assist in developing policies and methods to improve the health of entire populations by monitoring current health trends. Nurses in this setting implement and administer health-related interventions that will provide the greatest benefit to the most people.
Schools
In addition to assessing and monitoring individual health issues, school nurses promote public health through prevention with early health teaching of good personal practices such as hygiene, nutrition and exercise. They are also involved in emergency preparedness and response and other community programs.
Volunteer Organizations
Among their many duties, nurses in agencies such as the Red Cross and the Peace Corps have a strong focus on providing disaster relief as well as educating communities on disease outbreak prevention.
Faith Communities
Faith nursing, also known as parish nursing, focuses on the health and wellbeing of the population within a specific faith community. A parish nurse is a registered nurse who integrates spiritual care in the process of promoting health and preventing illness. Regardless of their ever-changing responsibilities, public health nurses will always share a common vital By the mid-20th century, many role: To improve the health of compublic health services shifted from munities through the application of homes into clinic-based settings current public health principles.
SWUHEALTH.ORG | PAGE 27
I
n the last 20 years, the number of American adults diagnosed with type 2 diabetes has more than tripled. Type 2 diabetes occurs when your body doesn’t use insulin well and is unable to keep blood sugar at normal levels. About 95% of people with diabetes have type 2 diabetes. It develops over many years and is usually diagnosed in adults (though increasingly in children, teens, and young adults). You may not notice any symptoms, so it’s important to get your blood sugar tested if you’re at risk.
and depression. Diabetes is the 7th leading cause of death in the United States, but type 2 diabetes and its long-term complications can be prevented or delayed with healthy lifestyle changes, such as losing weight if you’re overweight, healthy eating, and getting regular physical activity.
WHAT IS PREDIABETES?
“Prediabetes” means your blood glucose (sugar) is higher than normal, but not enough to be classified as type 2 diabetic. Type 2 diabetes can be delayed or prevented in peoComplications from diabetes usu- ple with prediabetes who develop ally develop over a long time with- and maintain a healthy lifestyle. out any symptoms and include heart disease, stroke, vision loss, It’s estimated that over 50,000 adults nerve damage, kidney disease, and in Southwest Utah have prediabeamputations. In addition, diabetes tes, yet 90% of them don’t know it. puts you at risk for gum disease, Take the first step by finding out hearing loss, Alzheimer’s disease, your risk with this screening:
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your test
At-Risk Weight Chart
Do you match any of these risk factors? Are you a woman who has had a baby weighing more than 9 pounds at birth?
Circle if True
1 1
Do you have a sister or brother with diabetes? Do you have a parent with diabetes? Find your height on the chart (see chart at right →→→). Do you weigh as much as or more than the weight listed for your height? Are you younger than 65 years of age and get little or no exercise in a typical day? Are you between 45 and 64 years of age?
1 5 5 5 9
Are you 65 years of age or older?
Height Weight 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4"
129 133 138 143 147 152 157 162 167 172 177 182 188 193 199 204 210 216 221
SCORE (add your circled numbers): IF YOUR SCORE IS 3 TO 8 POINTS
This means your risk is probably low for having prediabetes now. Keep your risk low. If you’re overweight, lose weight. Be active most days, and don’t use tobacco. Eat low-fat meals with fruits, vegetables, and whole-grain foods. If you have high cholesterol or high blood pressure, talk to your health care provider about your risk for type 2 diabetes.
IF YOUR SCORE IS 9 OR MORE POINTS
This means your risk is high for having prediabetes now. Please contact your health care provider to get tested for prediabetes (usually covered by insurance). You can also get tested at the Southwest Utah Public Health Department for $25 (see page 30 for locations). A prediabetes test is usually an A1C: a simple finger prick that can give results in a few minutes.
Where can I get more information?
Visit swuhealth.org/diabetes for an online version of the prediabetes screening and resources for preventing and managing diabetes.
SWUHEALTH.ORG | PAGE 29
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Ask your doctor if Eating Vegetables is right for you. Here’s some real news about fake food. Did you know that over 60% of the food we buy is highly processed? That means more fat, sugar, salt, and additives. That’s a lot of low-quality fuel being poured into a high-performance engine. Are you fed up with not feeling your best? Introducing: Eating Vegetables. Vegetables are a natural alternative to the “food products” many of us are surviving on. Actually eating them produces amazing results. Vegetables contain nutrients, vitamins, minerals, and enzymes that will keep you healthy and help you lose weight in addition to fending off diseases. Restore your energy and vitality by Eating Vegetables! Now available in a variety of shapes, colors, and flavors. All varieties may not be available in all locations. Check your local market for options. Some patients may actually be able to grow their own. Supplementing with Assorted Fruits is recommended for optimal results.
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