Health | Winter 2015 by HEALTH Magazine

SOUTHWEST

UTAH

PUBLIC

HEALTH

FOUNDATION

GOA L S

STAY HEALTHY

COLD AND FLU O&A

Advice on setting your worko ut goals

by S11sa11 Peck, RN

by Eric Houle

IN GOOD HANDS

WINTER WONDERLANDS

GET THE BUGS OUT Tips from a health inspector by Slwlle11 Sterner

F A MIL Y E X ER C I S E

PAST LESSONS

WINNING THROUGH CONSISTENCY

Winter is coming... protect yourself

BED BUGS

DROWSY DRIVING

THE ATHROUGH ill.71.S

The history of hand washing by William Clayto11 Petty, MD

Staying active during cold weather

Confessions of a sleepy driver

by David Heaton

by Jorda11 Merrill

FLU HISTORY

SA FE E A TIN G

PREPARE

THE FLU PANDEMIC OF 1918

DON'T FEEL GRINCHY Holiday Food Safety Tips by Robert Beers

A Utah retrospective by Twila Va11 Leer

WINTER ON THE ROAD How to pack your car for winter emergencies

by Paulette Vale11ti11e

E A TIN G RI G HT

VACCINATE

GIVE IT ASHOT

A journalist's perspective by M. Sue Bergi11

EBOLA

Balancing your intake of sweets

QUESTIONS OR COMMENTS?

by Sara Fausett, RD, CD

Email dheaton@swuhealth .org

HE A LTH LITER ACY

VIRUS

'TIS THE SEASON FOR ADDED SUGAR

The sto1y behind the hype by Li11da Rider, RN, BSN, CIC

HIDDEN BIAS Health screening mis-conceptions

by David Blodgett, MD, MPH

- - - - ON THE COVER - - - WINTER WONDERLANDS:

Special thanks to Erin, Mark and baby Lincoln Taylor for snowshoeing duough a winter sunrise. Sto1y on page 16

FOLLOW @SWUHEALTH

Stereogram on page 22 : sse1grno11 cmutesy of easystereogrambuilde1:com

PUBLISHER

MANAGING EDITOR

DESIGNER

FOUNDATION BOARD

Jeff Shumway

David Heaton

Kindal Erickson

David Blodgett, MD Chris White Jeff Shumway

Todd Stirling

§OlJTHWE§T

UTAH PUBLIC

HEALTH

IFOlJNDATliON

Jeff, David, Chri>, Dr. Blodgett, Todd, & Kinda/

pleased to introduce the ninth issue of Health to the residents of the five counties served by the Southwest Utah Public Health Department (SWUPHD). Those of us involved in public health realize that the better we do our job, the less you'll probably hear about it. Insuring the safety of air, water, and food, along with the prevention of contagious or chronic diseases, is often a behind-the-scenes business. This publication is part of our ongoing effort to get health-promoting information into the hands of our community members, to assist you in making the best health decisions for you and your family. We can do our best to present meaningful, evidence-based information, but it's up to you to take action. It's our goal to help you do that. Sincerely,

David W. Blodgett, MD, MPH SWUPHD Health Officer & Director

The entire contents of this publication are Copyright© 2014-2015 Health (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of advertizements, claims, and or representations made in this publication.

SUSAN PECK, RN SWUPHD SURVEILLANCE NURSE

WHT YH NHD TO KNOW very year we see our share of colds and flu in southwest Utah. It's difficult to predict how severe cold and flu season will be or which illnesses will circulate, but here is some basic information that should help keep you and your family healthier this year:

NEEDARUSHOT?

Visit your nearest health department office and get immunized against the flu! $18 or NO CHARGE with the following insurances: Altus, Arches, CHIP, DMBA, Medicaid, Medicare, PEHP, SelectHealth, Tall Tree, or United Healthcare

Locations & Hours (see page 30 for addresses) :

ST. GEORGE: Walk-In! Monday, Wednesday, & Thursday (7:30 AM - 5:00 PM), Tuesday (1:00 PM - 5:00 PM), Friday (8:00 AM - 4:30 PM) CEDAR CITY: Walk-In! Monday, Wednesday, & Thursday (7:30 AM - 5:00 PM), Tuesday (1:00 PM - 5:00 PM), Friday (8:00 AM - 4:30 PM) KANAB:call 435-644-2537 for nurse availability I BEAVER:call 435-438-2482 for nurse availability I PANGUITCH:call 435-676-8800 for nurse availability

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WINTER 2015

PREVENT When exactly is cold and nu season? We start seeing an increase in cases after the weather gets cooler in the fall. People usually start spending more time indoors in closer proximity to others, making it easier to spread germs. Flu season typically starts in the fall, peaks in February, then drops off in the spring.

How are these illnesses spread? Usually through droplets from coughing and sneezing, and germs left on hard surfaces like toys, countertops and door handles. You can get sick if you get caught in the line of fire of a sneeze or touch your eyes, nose, or mouth after touching an infected surface.

What's the difference between a cold and the nu? Both are viruses, but typically the flu (or influenza) is worse; with rapid onset of symptoms that include fever, body aches, headache, sore throat, fatigue, and dry cough. The flu can keep you bedridden for several days to a couple of weeks. The common cold is usually milder with congestion, runny nose and wet cough, and it's unlikely to cause more serious complications like the flu can.

What is "EV-068"? EV-D68 is one of over 100 enteroviruses (which include the common cold, pinkeye, and meningitis). It got a lot of attention this past summer and fall because, although it had been rare in the past, EVD68 caused a nationwide outbreak of respiratory illness which affected mostly children, especially those

with asthma. Prevention and treatment of EV-D68 is the same as those for colds and flu.

What is the stomach nu? There really is no "stomach flu". These are gastrointestinal illnesses that can be caused by viruses, bacteria, or parasites. Often it's a case of food poisoning and it's not uncommon to see an increase in cases during the holidays when people gather to eat.

How can colds and nu be prevented? Get the annual flu vaccine. Practice frequent and thorough hand washing. Keep your hands away from your face and avoid contact with sick people. If you do get sick, stay home from work or school and cover your coughs and sneezes with your arm.

Can I still get a nu shot? Yes. The health department still has a supply of flu vaccine, including the High-Dose vaccine for people 65 and older, which offers them better immunity. Many health care providers and pharmacies also offer the vaccine.

What can I do if I get a cold or the nu? It's the tried and true method of getting plenty of rest, fluids, and proper nutrition that help you get better sooner. You can also treat symptoms with over-the-counter remedies. You don't need to go to the doctor unless symptoms are severe. Influenza can be treated with anti-viral medication at a doctor's discretion, but most people recover at home. Antibiotics are useless against a cold or the flu. "-

WHY YH NHD TO DO...

DRINK plenty of fluids

COYER

when coughing & sneezing

WASH your hands

STAY

at home and recover

for the flu

.. JO PR(Y(NT COlD &fl~ SWUHEALTH.ORG

WILLIAM CLAYTON PÂŁTTY, MD APPOINTED BOARD MEMBER, SWUPHD

TH( HISTORY Of HAND WASHIN~ Ignaz Semmel weis (1818-1865)

en, women, and children have always washed their hands when covered with mud, dirt, or other undesirable solids. But it was not until 1847 that the link between hand washing and disease was documented.

In 1199, the renowned Arabic physician, Moses ben Maimon, wrote that one should "never forget to wash your hands after touching a sick person." There was no scientific evidence for his recommendation, but this did not deter him from teaching that cleanliness was the physician's best friend. In his own practice he even went one step further: "I dismount from my animal, wash my hands, go forth to my patients." The link proving that hand washing could deter disease begins with the story of "childbed", or puerperal fever, a bacterial infection contracted by women during childbirth. The first known documented evidence of childbed fever was reported in Paris in 1646. Hospitals throughout Europe

HEALTH

and America in those days were reporting between 20 to 25% death rates among women giving birth in hospitals. Occasionally there were fatality reports of up to 100%! Dr. Alexander Gordon of Scotland said in 1785, "I myself was the means of carrying the infection to a great number of women." Fevers were thought to be the result of an "infectious process," even though bacteria had not yet been discovered. Some physicians of the era felt that childbed fever might be associated with contagion and poor hygiene.

should wash their hands with a chlorine solution and require obstetrical attendants to change clothes. One year later, in 1843, Dr. Oliver Wendell Holmes of Boston concluded that childbed fever was carried from patient to patient by physicians and nurses. He suggested that doctors should avoid performing autopsies before attending births and that all medical staff should wear clean clothing.

In 1822, a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the odors of human corpses. He postulated that physicians attending patients with contagious diseases would benefit by using a liquid chlorinated solution on their hands.

Author Richard Gordon (Great Medical Disasters) describes conventional physician hygiene at the time: "Cleanliness was next to prudishness ...there was no object in being clean ... indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head." Surgeons "operated in blood-stiffened frock coats - the stiffer the coat, the prouder the busy surgeon."

In London, Dr. Thomas Watson recommended that practitioners who attended birthings

Dr. Holmes was a crusader for his beliefs and asserted that if a physician had two cases of

WINTER 2015

childbed fever in his practice within a short time he should remove himself from obstetrical duty for a month. Such outrageous recommendations were not accepted by his peers. Without scientific studies to back up his views, he suffered vicious criticism and mockery by other doctors. Dr. Charles Meigs, a leading obstetrician in Philadelphia, chided him in a letter: "Doctors are gentlemen, and gentlemen's hands are clean." The link between hand washing (now referred to as hand hygiene) and disease was finally provided by the work of Dr. Ignaz Philipp Semmelweis. In 1847, while Dr. Semmelweis was working as the Assistant Chairman of Obstetrics at the Vienna General Hospital, his good friend Professor Jakob Kolleschka cut himself while doing an autopsy. After he died, his autopsy showed the same changes as victims of childbed fever. Dr. Semmelweis linked this observation to the difference he noted in the death rates of mothers in the

two obstetrical wards of the hospital.

ing ward work and before each vaginal examination.

In one ward, the mothers were delivered and attended to by student midwives, while in the other ward the mothers were delivered and attended to by medical students. The death rate in the midwife ward was 2.85% but on the medical student ward it was a dismal 11.25%. The medical students were performing autopsies in the early morning and then going to the obstetrical ward; delivering babies and doing vaginal examinations on post-delivery mothers. No hand washing was done at any time by the midwives, the medical students, or the attending physicians. Dr. Semmelweis postulated that "cadaverous particles" were being transmitted on the hands of the medical students from the autopsied corpses to the mothers. After experimenting with various solutions to cleanse the hands, he required medical students wash their hands with chlorine water/chlorinated lime solution before start-

The first month after hand washing was instigated, the mortality rate in the medical student ward dropped to less than 3% and remained there for the next seven months. Yet Dr. Semmelweis received only criticism from his colleagues for his efforts. The contention became so intense that he left for Pest, Hungary in 1850 where he accepted the Chair of Obstetrics at the St. Roch us Hospital. The death rate in the obstetrical wards he oversaw dropped to 0.82%. In 1861 he wrote a classic paper entitled The Etiology, the Concept and the Prophylaxis of Childbed Fever. Dr. Semmelweis' adamant and outspoken defense of proper hand washing in preventing childbed fever may have played a role in his death. He became outraged at the indifference of his fellow physicians and began writing letters to prominent European obstetricians, denouncing some as irresponsible murderers. In 1865 his

wife and contemporaries felt he was losing his mind and admitted him to an insane asylum where he died 14 days later from either being severely beaten by hospital personnel or from a wound to his hand. Dr. Semmelweis has since become known as the "Savior of Mothers." Although bacteria, originally called "animalcules", were discovered in 1683, these microorganisms had not yet been linked to disease. In 1880, Louis Pasteur, a French microbiologist and chemist, reported his observations on a series of mothers who had died from childbed fever. He took blood and pus samples from the deceased and cultured them. He then observed the cultures under a microscope and noted that "parasites ... in long chains ... appear as little tangled packets like tangled strings of pearls." These "long chains" were bacteria, later called streptococcus. The link between bacteria and disease had been established.

Pasteur and his German contemporary, Dr. Robert Koch, are regarded as the fathers of germ theory and bacteriology. Evidence was now available to convince doctors and nurses that they were responsible for transmitting streptococcus from patient to patient in the hospital. The solution? Simple hand washing. Medical science and hygiene have come a long way since then, but the basic practice of routine hand washing remains. Dr. Oliver Wendell Holmes could well have replied to his snobbish acquaintance, "Doctors may be gentlemen, but their hands harbor bacteria.""Dr. Petty pmcticed a11esthesiology for 15 years a11d ta11ght at fo11r US. 1111iversities for 12 years. He served over 20 years i11 the US. Navy a11d was promoted to the m11k of captia11. Dr. Petty fins a11thored three books, 1111111ero11s articles, mid has lect11red extensively i11 40 co1111tries. His wife Zoe joi11ed hi111 for seveml years of vo/1111teer h1111w11itaria11 work developi11g 11eo11atal resuscitatio11 programs i11 the Middle East a11d Africa, i11 additio11 to a Visiti11g Professorship at the Ki11g H11ssei11 Ca11cer Center i11 A111111a11, Jorda11. Dr. Petty is wrrently retired a11d resides i11 Cedar City, Utah.

SWUHEALTH . ORG

This article was originally published in the Deseret News (Tuesday, March 28, 1995) under the title "Flu Epidemic Hit Utah Hard in 1918, 1919"

TWILA VAN LEER DESERET NEWS COLUMNIST

AUTAH HTRISP(~TIY( "Many towns are closed by order of health board; Theaters, churches and all public gatherings under ban for present; Spanish influenza rapidly spreading." -Deseret News, Oct. 10, 1918

orld War I was ending, but another scourge, influenza, stood in the wings as if waiting specifically to stymie the world's search for long-awaited peace. Spanish influenza, so called because 8 million people in that countly suffered its ravages, was spreading its tentacles into most of the nations of the globe.

In September 1918, with the Allies nearing vict01y over the Central Powers, the virus spread to China, Africa, Brazil and the South Pacific, infecting millions. Soldiers returning from the front brought it to the U.S. Midwest. Then from Boston, Philadelphia and New York, the disease spread until all of the countly, including Utali, was in the grip of the worst pandemic since the Black Death (bubonic plague) of the 1400s. Over the next year, a fifth of the world's population suffered. More than 21 million died, including 675,000 Americans - 10 times as many as died in the world war. More than half of the U.S. soldiers who died in Europe succumbed to the virus and not to enemy action. Tens of thousands of milita1y deaths resulted from a virus so small that 30 million could fit on the head of a pin.

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WINTER 2015

In Salt Lake City, LDS faithful were gathered for regular semiannual conference meetings when the first signs of the outbreak were rep01ted on Oct. 3. Within four weeks, more than 1,500 cases had been documented, with 117 deaths, and the numbers continued to grow, spreading from the urban centers to vi1tually eve1y community in the state. Health officials marshaled their forces for the battle. In Ogden, with both local hospitals full, the LDS 3rd Ward amusement hall became a tempora1y care center. My1tle Swainston, a recent graduate of LDS Hospital School of Nursing in Salt Lake City, took charge. Her sala1y and the costs of the emergency hospital were shared by the American Red Cross, Ogden City, and Weber County. Miss Swainston had her work cut out for her. The day after her arrival, Ogden had 40 new cases. With a few hospital beds from Fmt Douglas and donated sheets, blankets, and other items, she coped. Over the course of the outbreak, several hospitals expanded or set up se1vices in public buildings, including churches. TI1e Judge Memorial Hospital in Salt Lake City, which had been closed a short time earlier, reopened to make room for the ill.

PREVENT Not all health officials were agreed as to how the epidemic should be handled. The state health depattment order to close all public places was "absolutely ridiculous and absurd. Such an action can be merely due to hysteria" for a disease no more threatening than the measles, said Salt Lake Health Director Samuel G. Paul. But by the time the flu had run its course, thousands of Utahns were dead - about 4 percent of all those who contracted the disease. Utah was third, behind Colorado and Pennsylvania, in the rate of deaths. Twila Peck, now 89, recalls the outbreak in the Tintic Mining District. Her father was stricken and her mother nursed him back to health. Other family members escaped, but she remembers looking through a neighbor's window to see a young mother with her infant, both "laid out" in the living room awaiting burial. "We had to play by ourselves, and if we went anywhere, we wore inasks," Peck said. As it became apparent the epidemic was going to leave no Utal1 community untouched, local officials set down stringent rules. Stricken homes had to display large quarantine signs. Gauze masks, provided by the health depattment, were to be worn in the sick room and when in public. Streetcar conductors were instructed to limit the number of riders. Stores couldn't hold sales, and funeral services were limited to a half hour, later reduced to 15 minutes, and no more than three vehicles could accompany the hearse to a burial place. LDS Church President Joseph Fielding Smith died in November 1918, and his funeral also was restricted to a handful of family members. As conditions worsened, the rules were more vigorously enforced. A barber who refused to wear a mask was fined $10. Police arrested the proprietor of a Salt Lake City soft drink establishment, along with seven card-playing customers. A farewell patty for one Salt Laker was raided, and all 16 present would have been nabbed if five had not bolted out a back door. TI1e city put on 100 extra officers to enforce the flu rules.

A local newspaper repmter commented on the eerie sense of desettion on downtown Salt Lake streets. Along eight blocks of Main Street he spotted one human wearing a mask - a guard checking business doors - and two black cats. But the ban on public assemblies was hard to enforce when news of the Nov. 11 armistice ending the war was announced. People "went mad" in the streets of Utah's communities, restrictions or no. Health officials tried to cancel parades, but city officials insisted. Influenza cases were on the decline anyway, they argued.

After the "happy chaos" of Armistice Day, flu took hold again, and the dispensations that had been allowed as the disease declined were replaced with even tougher guidelines.

The epidemic played hob with the 1918 fall elections as would-be officials were stymied by their inability to meet with voters. Many simply quit campaigning.

The nursing shmtage was so acute that the Red Cross asked local businesses to allow employees to have a day off if they would volunteer at hospitals during the night.

Patticularly hard hit were Indian reservations. An estimated 2,000 Navajo Indians in southern Utah and nmthern Arizona died, and 62 deaths were recorded on the Uintah Resetvation, including Ute Chief Atchee. In the four-corner states; Utah, Colorado, Arizona and New Mexico, 3,293 American Indians died. Their natural outdoor lives that exposed them to the elements, along with failure to understand health precautions, contributed to the rate.

Whiskey, considered one of the more effective remedies, was hard to come by. The states were then in the process of ratifying the 18th Amendment to the U.S. Constitution, outlawing alcohol. Liquor was contraband. But some officials released whiskey to medical personnel for use as medicine. One Ogden man who went to comt inebriated tried to convince the judge he was only trying to fend off the "influenzy." But the judge decided the dosage was overlarge and sentenced the man to a $50 fine or 30 days in jail. Liquor aside, the usual treatment was bed rest in a cool room, plenty of liquids and hot packs to break up chest congestion. Vicks VapoRub was in such demand across the country that it became hard to find. Dr. Kilmer's Swamp Root was offered as a curative for the kidneys after an attack of "the grip," and Eatonic could help millions suffering the aftereffects of flu by removing acidity and poisons, its makers advettised. Panguitch, the last Utah town to be struck, held out until a returning soldier brought the virus home with him and shared it with others at a homecoming patty. Even the small community of Escalante repmted 200 cases at one point.

A solar eclipse earlier that summer was blamed by many Indians, who saw it as an omen of a challenging time to come. Some white people, on the other hand, tended to blame the epidemic on the "smoke and fumes" generated by the war. Christmas 1918 gave the epidemic a fresh statt as groups gathered to celebrate the holiday. In Salt Lake City, 106 new cases were repmted, with 46 in Ogden. In January, the return of the 145th Light Field Artillery Regiment, composed primarily of Utah boys, was another temptation for people to gather. The regiment had seen no action, although it had been in France. Its only casualties were 14 flu-related deaths. But Utahns were caught up in the post-war fever and despite discouragement from health officials, they again lined streets in Ogden, Logan and Salt Lake City to greet the returning warriors. A new outbreak of the flu followed within a few days. In the spring of 1919, the epidemic began to wind down, although there was another, less lethal, surge of the disease that winter. From September 1918 to June 1919, Utal1 registered 2,343 deaths from flu. In 1919, the state had the second highest death rate from the disease in the country, with 180.2 deaths per 100,000 population. TI1e only state that, _ exceeded that rate was South Carolina with 189.3. I'-

Ml~~ Y. lAMB~ON W(NT TO TH( DOtTOR:

In Blanding, the local store owner was stricken and his family made the key available to needy shoppers, who promised to take only what they needed and pay for it when he was up and about again. Everywhere, church members and community groups all rallied to help one another through the height of the epidemic.

"I want to know if influenza. can be transmitted by kissing" "Beyond a doubt. Miss Lambson." "Well, a boy with a pronounced case of 'flu' kissed me. 11

"So? How long ago was this?" Ogden and Park City tried to confine the disease by requiring that anyone entering their towns have a cettificate signed by a doctor assuring that they showed no sign of flu. Railroads were warned not to accept passengers who had no such cettificate, and masks were to be worn by those who were allowed in. State health director T.B. Beatty huffed off to Ogden to plead for a more rational approach, but after a meeting with government and health officials he returned to Salt Lake with nothing accomplished.

"Well, let's see . ago."

I think it was about two months

"Why, Miss Lambson, no hann can come fran the exposure . It is quite too late . " "I knew it," she sighed, "But I just love to talk about it." -Published 1920 in "Agricula" (Branch Agricultural College, now Southem Utah University)

SWUHEALTH . ORG

This article was originally featured in BYU Magazine (Fall 2014, pp. 24-25) under the title "Immunization Misconceptions". A wealth of well-researched information on vaccines can be found at more.byu.edu/vaccines.

M.SUE BERGIN Writer and hospice chaplain. Sue lives in Orem. Utah and has written for BYU Magazine. the Ensign. the San Francisco Chronicle. The Wall Street Journal. and Psychology Today

the truth about vaccines is amatter of life and death eth Luthy's first child was born with a rare bile duct disorder that destroyed his liver by the time he was a year old. He was able to get a liver transplant, but the battle was just beginning. Because little Michael had to take immune-suppressing medications to prevent his body from rejecting his new liver, he could not be immunized, and he could not fight off infections.

Luthy had hoped that her vulnerable infant would be protected by the "herd effect"-if a high enough percentage of

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WINTER 2015

people around Michael were vaccinated, contagious diseases would be unlikely to spread to him. Instead, he caught eve1ything. "He got chicken pox, and it landed him in the ICU," she says. "He caught whooping cough, and he was sick for six months-in the hospital for about half of that.... It went on and on." As Michael Luthy, now a healthy 26-yearold, grew up, his mother became a school nurse. Now a nurse-practitioner and associate professor in the BYU College of Nursing, she works to spread the word that

PREVENT childhood vaccines are safe. She understands the concerns many parents have but wants them to know that the science behind immunizations is solid and the truth about vaccines is a matter of life and death.

Myth 1: Vaccines Cause Autism Only one study linking one immunization (the MMR vaccine-measles, mumps, rubella) to autism has even been published in a respected scientific journal, The Lancet, and that article was retracted in 2010 after editors discovered the study was not simply flawed but fraudulent. In contrast, multiple studies involving several hundred thousand children conclude that the rate of autism in immunized children is the same as it is in unimmunized children. So why does the belief that vaccines cause autism persist? Luthy believes it is partly because correlation-observing that one event follows another-is powe1ful. "You get your first MMR vaccine at about 12 months, and that's also right around the same time that the first signs of autism show up. So it would be natural to connect the two," she says. Correlation, however, is not the same as causation. Personal experience, too, can sometimes trump science. Ben Moulton didn't question vaccines with his first child, but as time went on and both his first and second child began showing developmental problems and behaviors on the autism spectrum, he began to wonder about vaccines. "Not knowing where to point the blame, I started looking toward all the immunizations the children got at once as a potential culprit." There is no connection, Luthy says, but parents want so much to protect their children. If they can find the cause for illness in one child, they reason, perhaps they can prevent it in their next child. "I understand the fear. I was a mother with a child with an illness and nobody knew why," she says. "So I looked for reasons on my own." Another factor in the endurance of this myth is distrust of the pharmaceutical industry. "Some people call it 'Big Pharma'-the idea that drug companies fund the vaccine studies and skew them because they want to make money off of our children. But that's just not true. Pharmaceutical companies make much less from vaccines because the research is so costly and the profits are sparse."

Myth 2: Young Immune Systems Can't Handle So Many Vaccines Giving an hours-old infant its first vaccine (against hepatitis B) and a 2-month-old baby six vaccines seems like a lot to ask of a brand new immune system (see web link at end). But Luthy says that babies entering into a germ-laden

world are immediately bombarded by far more antigens in their environment than they are through vaccinations. "Their immune systems can handle it," she says. Though babies catch lots of colds and other minor bugs, they needn't catch more seriousand sometimes deadly-illnesses like whooping cough (pertussis), diphtheria, tetanus, mumps, measles, rubella, and rotavirus if they are immunized, she says. "Children need protection the most during the first year of life," says Luthy, "because they are so much more vulnerable when they are small. If an adult gets whooping cough, they will have an annoying cough for a few months. A baby who gets whooping cough, though, has an airway the size of a straw, and their tiny bodies can much more easily be overwhelmed. Infants are often hospitalized for whooping cough, and sometimes we can't save them." To address parents' worries about overloading their children's immune systems, researchers have studied what it would take to overload an immune system, and learned it would take about 100,000 vaccines all given at the same time. "When we talk about four or six vaccines at once, we're nowhere near the threshold. An ear infection challenges a child's immune system more than a vaccine," says Luthy. "Hesitators," or parents who believe the overload myth, seek to control how much immune material their child gets and how frequently. They come up with their own vaccination schedule, believing they're protecting their child. In Luthy's work in a Utah County clinic, parents often bring in a book by a pediatrician who recommends an alternative schedule with fewer vaccinations spread out over more time. This approach, says Luthy, has no peer-reviewed science behind it and puts children at risk. While it's true that vaccines can cause side effects such as rash, fever, swelling, and soreness, the illnesses they protect against have far greater consequences, including blindness, deafness, heart defects, paralysis, and death. Luthy is grateful that hesitators do usually complete their children's vaccinations by kindergarten age, but it's better to protect them earlier. "By the time you're 4 years old, if you catch something you're probably not going to die," she says, "When you're an infant is when you're more likely to die."

Myth 3: Vaccines Contain Toxic Mercury In Luthy's clinical work, she regularly encounters parents who decline the MMR vaccine-and sometimes all vaccines-because they're concerned about mercu1y. MMR, however, does not and never has contained any form of mercu1y, says Luthy.

In the past, many vaccines contained a preservative called thimerosal, which breaks down in the body into ethylmercury. This chemical compound clears from the body quickly, as opposed to methylmercmy, the more familiar form of mercu1y that is not easily cleared and can build up in the body and become toxic. Still, because of public concern, thimerosal has been eliminated or reduced to trace amounts in vaccines. Today, no vaccine for children age 6 and under contains thimerosal except the flu vaccine. Luthy wants to be clear that it is possible to have a reaction to a vaccine. Each vaccine has different possible side effects, which are outlined on the U.S. Centers for Disease Control and Prevention (CDC) website. Reactions are overwhelmingly mild (sh01t-lived soreness, swelling, or fever). Severe reactions (seizures, death) are extremely rare. Luthy believes the benefits of vaccines far outweigh the risks: "Every medication on the planet has a potential side effect-eve1y single one, even a Tylenol."

Choosing Facts over Fear Cory Aitchison, the father of three daughters, including one with autism, says when his first daughter was born 14 years ago, he knew that the benefits of vaccines outweighed the slight possibility of complications, "but when it is your own daughter, a l-in-100,000 chance seems much more daunting." He remembers his thoughts as this first daughter was born: "I was overwhelmed with joy, terror, love, and uncertainty. After we had a couple of minutes with her, the nurses took our perfect daughter and sta1ted to poke, stick, and smear her with all kinds of stuff. At that moment I wondered if this was all really necessary." But Hannah got her first vaccine in those first hours, and Aitchison and his wife, Colleen, went forward with immunizing all three of their children on schedule. They do not connect their middle daughter's autism to vaccines and recommend that other parents follow where the science leads. "I truly understand that the decision to vaccinate can be difficult," Aitchison says. "But my advice is to trust your doctor. Give her all the relevant facts regarding family hist01y and make an informed decision." Luthy, too, empathizes with parents who agonize over immunizations. It's their sacred responsibility to protect their children, and they feel torn. Luthy believes that if parents follow the science, they need not agonize: "The science continues to build that vaccines don't cause autism and that infant immune systems can safely handle many vaccines at once. We just need to keep working to get the word out." "

SWUHEALTH . ORG

LINDA RIDER, RN, BSN, CIC APPOINTED BOARD MEMBER, SWUPHD/ CERTIFIED INFECTION PREVENTIONIST AT DIXIE REGIONAL MEDICAL CENTER

(PID(MIC IS TH( lARG(ST IN HISTORY Although West Africa has seen over 14,400 cases and over 5,170 deaths, it remains highly unlikely that Ebola will spread significantly in the developed world (as of 11/14/14).

bola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the identified Ebola virus strains. There are five Ebola virus strains, four of which are associated with disease in humans. A fifth strain (Reston) has only caused disease in non-human primates.

Ebola viruses are found in several African countries. The disease was first identified in 1976 near the Ebola River in Zaire (now known as the Democratic Republic of the Congo). Since then, outbreaks have occurred sporadically in Africa. The natural reservoir host for Ebola virus remains a mystery. However, based on evidence and the nature of similar viruses, researchers believe the virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in animal hosts native to Africa. The outbreak in West Africa started in March of 2014. Widespread transmission has occurred in three countries - Liberia, Sierra Leone and Guinea. Localized transmission has occurred in Nigeria, Senegal, Mali, Spain and the United States.

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PREVENT L

inda Rider returned to the United States on November 14th after volunteering as an Infection Control Practitioner for an Ebola Treatment Unit in West Africa. She then voluntarily quarantined herself at home for 21 days while checking in with the health department. She recounts:

"My team was trained in Monrovia, Liberia, then stationed in the city of Buchanan. We got accustomed to wearing the PPE (Personal Protective Equipment), which can be worn up to two hours before becoming unbearable. There are only about 60 doctors in the entire country and many people live without electricity and running water. We were able to talk to Ebola survivors who were healthcare workers before much was known about the outbreak. Liberians seem to have a healthy respect for the disease now but are not fearful or panicked. Efforts to educate the public about Ebola and its prevention are evident everywhere in the form of billboards, posters, and popular music. There is evidence that the outbreak may be winding down, at least in Liberia."

Ebola is spread through direct contact (via broken skin or mucous membrane linings of body openings) with: • Blood or body fluids (including, vomit, feces, urine, breast milk, semen, saliva, and sweat) of a person who is sick with Ebola disease • Objects and surfaces that have been contaminated with the virus

Healthcare workers, family and friends who are in close contact with Ebola patients are at the greatest risk of getting sick because they come into contact with infected blood or body fluids of sick patients. During outbreaks, the disease can spread quickly within healthcare settings (such as a hospital or medical clinic). Exposure can occur in healthcare settings where staff are not wearing appropriate protective equipment such as masks, eye protection, gowns and gloves. Exposure can also occur when the protective equipment is not removed safely.

• Infected animals Ebola is not spread through air, water or in general, by food. However, in Africa, Ebola may be spread as a result of handling bush meat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitoes or other insects transmit Ebola virus. Only mammals (humans, monkeys, apes and bats) have shown the ability to become infected with and transmit Ebola virus.

Currently, the mortality rate of Ebola virus disease is about 50%. Aside from supportive care in the hospital (giving fluids and nutritional support), there is no specific treatment for Ebola. No vaccine is currently available. Several experimental treatments are being investigated. Vaccine manufacturers are also evaluating potential vaccine strategies. The risk of an Ebola outbreak m the

United States is very low. Sporadic cases can be expected in travelers coming to the United States from the affected West Humanitarian aid African countries. workers returning from affected countries may also develop disease. Most of these individuals will have instructions regarding monitoring their health status. In general, the risk among travelers of Ebola disease is very low unless they are spending time inside a hospital having direct contact with infected individuals. The CDC has been working closely with US Customs and Border Protection, airlines, and cargo ships to help ensure that the chance of Ebola virus introduction in the United States remains very low. According to the CDC, the current outbreak does not pose a major risk to the United States. For the latest updates on Ebola, check with the CDC Ebola site at www.cdc. gov or the World Health Organization at www.who.org. 6'

SWUHEALTH . ORG

ERIC HOULE HEAD CROSS COUNTRY AND TRACK &FIELD COACH SOUTHERN UTAH UNIVERSITY

INNING BY TAYING CONSIST(Nl Want to im~rove your ~~ysical fitness in io151 Here's some ~a lance~, realistic a~vice from atract coac~ t~at ~el~e~ arunner ~ecome an Olym~ic at~lete

sustainable, long-term training program is a great way to improve your physical and mental health, while at the same time achieving realistic goals. No matter what your age or experience, the primary focus of any well-thought-out training program should be on your overall physical maintenance and ongoing consistency. A long-lasting training program, which increases the load and intensity over time, helps to control interruptions, such as injuries, that ultimately affect your enthusiasm and training regularity. Consistency lies in getting into the habit of doing something. The phrase "use it or lose it" couldn't be more true when it comes to a person's physical health. A few of the obvious benefits of starting a training program are an increase of energy levels throughout the day (which increases motivation to accomplish your daily goals), muscle tone and improved appearance (which increases confidence), and strengthening your immune system (which helps to prevent sickness), to name a few. The reasons for getting started are plentiful, but sticking to it is not so easy. However, it is the consistency in all that we do that allows us to reap the benefits. If you can stay consistent in most

Cam Levins took first in the 5k and 10k

during the 2012 NCAA Nationals

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things, you will experience success throughout life. So, too, it is with our physical well-being. Take the first step by starting; whether you choose walking, hiking, running, biking, swimming, or a combination, then stay consistent. Follow up by incorporating realistic goals with periodic challenges, and the rewards will help you stick with your training regimen. This will keep you from falling off the proverbial wagon. The biggest detriments to sticking with a training program are doing too much, too fast, not purchasing or replacing appropriate equipment, and setting unrealistic goals that don't allow for systematic development. Increasing mileage and intensity too quickly will almost always lead to injuries, setbacks, and loss of motivation. When designing a training program, take time to do some research and seek advice from someone with experience. Remember, all of us are unique with strengths and weaknesses that need to be considered when designing a program. When I hear the phrase, "I've fallen off the wagon," I know the training program was too difficult from the very beginning, or that the set goals were out of reach. When setting goals, the foundation should always be to become active and take control of physical health. After a while, more advanced goals should follow. Even experienced runners, who have taken time off, run for just five minutes a day before increasing the load and intensity when restarting their training. When it comes to your conditioning and confidence in sticking with a training program, remember that everyone's starting line is different and consistency is the key. On your mark, get set... Happy Running!" November 14, 2014: the SUU cross country team, coached by Eric Houle, qualifies for the NCAA Nationals

SWUHEALTH . ORG

DAVID HEATON MANAGING EDITOR/ SWUPHD PUBLIC INFORMATION OFFICER

Don't let the cold weather bother you, anyway;)

he warmer regions in our corner of the state allow for outdoor exercise year-round; walking, running, hiking, biking, climbing, golf, tennis, and pickleball, to name a few. When temperatures drop, there are still lots of indoor options; from home exercise equipment to gyms and community centers that offer weight lifting, racquetball, aerobics, swimming, yoga, or Zumba. You can even join a team and participate in a league sport.

When the snow flies, many southern Utahns stay active with winter sports. Here are some of our local offerings:

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PROMOTE Downhill Skiing, Snowboarding, & Tubing Brian Head Resort: Ski, snowboard, and tube at Utah's highest base elevation (9,600 ft), where the annual snowfall is 300 inches. Enjoy 71 runs served by 8 lifts. The 2014-1015 season is scheduled from November 21 through April 12. Visit brianhead.com Eagle Point: Utah's newest ski resort, located on Tushar Mountain, 18 miles east of Beaver. Eagle Point boasts 450 inches of snow annually and some steep slopes among 40 runs. Back country and snowshoe trails are also offered. season expected to start December 20. Visit skieaglepoint.com

Snowshoeing Each Saturday in January and February, rangers at Cedar Breaks National Monument provide free guided snowshoe hikes to the public. The route is two miles, round trip, with a break in a cozy yurt. Snowshoes are provided! Call 435-5869451 (ext. 4425) to make a reservation.

Or, strike out on your own after renting snowshoes and poles at SUU's Outdoor Center. Call 435-865-8704 for more information

Cross-Country (Nordic) Skiing Southwest Utah offers some of the best terrain in the west for those who enjoy the challenge and solitude of cross-country skiing. There are rentals and groomed trails at Brian Head, Ruby's Inn/ Bryce Canyon, Duck Creek, and Cedar Breaks. If you want to get serious about this activity and find out where the best trails are, visit the website for the Cedar Mountain Nordic Ski Club: cmnsc.org

Ice Skating There are two ice skating rinks operational during the winter months in southwest Utah, both with affordable rentals: Cedar City: The Glacier, next to the aquatic center, Facebook.com/yetiskates.org Bryce Canyon City: Ruby's Inn, 435-8345341

Indoor Swimming Miss the water and want to get out of the cold? Take a plunge at one of these aquatic centers, offering one-time and extended passes: Sand Hollow Aquatic Center (St. George) 1144 N. Lava Flow Drive 435-627-4585 or visit stgcity.org/ departments/ recreation/ swimming Washington City Aquatic Center 350 N. Community Center Drive 435-656-6360 or visit washingtoncity.org/ communitycenter Cedar City Aquatic Center 2090 W. Royal Hunte Drive 435-865-9223 or visit cedarcity.org/ 445

Don't let the winter keep you down! Try to balance time spent in front of the fire (or screen) with the exercise your body needs. It's even more enjoyable when you invite family and friends to join you. k.

SWUHEALTH . ORG

ROBERT BEERS SWUPHD ENVIRONMENTAL HEALTH DIVISION DIRECTOR

POULTRY

>165 째

FISH, PORK, RED MEAT

>155 째

HOT FOOD STORAGE

COLD FOOD STORAGE

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>135 째

<40 째

he holiday season is a special time of the year. As families, loved-ones, friends, and neighbors gather to celebrate special events and express best wishes for the coming year, food will likely play a major role. A bout of food-borne illness could easily ruin festivities and travel plans. The following suggestions will help keep the upcoming holidays memorable for all the right reasons.

PROMOTE /

"Their mouths will hana open a moment or two ... " Many diseases can be spread through the foods we eat. Do not prepare foods if you are experiencing symptoms such as fever, nausea, vomiting, or diarrhea! Disease-causing bacteria can also be spread from contaminated foods to safe foods. Wash fresh fruits and vegetables thoroughly before preparation. Always wash your hands before preparing foods and after handling raw meats, fish or poultry!

the Last thing he took was the Log for their fire!" The bacteria that cause food-borne illness are all around us. Occasionally they get into the foods we eat and can cause disease. Generally, these bacteria can be killed by adequate cooking. Fish, ground meats, and pork should be cooked to at least 155° Fahrenheit. Poultry (chicken and turkey) should be cooked to at least 165°F. Using an accurate thermometer is the only way to verify temperatures!

"He slunk to the icebox ... " Bacteria can reproduce rapidly when foods are left at room temperature. Foods should be kept either hot or cold. Hot foods should be kept at or above 135°F on a stove or in an oven. Cold foods should be stored at or below 40°F in a refrigerator or freezer. Bulk foods such as turkeys, roasts, hams, or pots of stew, chili, and soup can take several hours to cool - even in a refrigerator. Break these items into small sections, slices, or containers to allow for faster cooling. Store foods in the refrigerator in a way that keeps liquid from raw products from dripping onto other foods. Avoid keeping leftover foods at room temperature on tables or counters for "grazing'' throughout the afternoon or evening!

"... and he, HE HIMSELF, the Grinch, carved the roast beast." Bacteria can spread to foods from contaminated utensils or work suifaces. Keep food preparation and storage areas clean. Wash dishes and utensils thoroughly after use and keep storage areas clean. While sanitizing wipes have gained popularity, suifaces should be cleaned first with soap and water since wipes are designed for sanitization only. Wash cutting boards and counters using soap and hot water immediately after spills or cutting meats or poultry! Use these tips to help protect yourself and others from illness at your next gathering involving food. Happy holiday eating!

images and text in quotes

& © Dr. Seuss Enterprises, used with permission

SWUHEALTH . ORG

SARA FAUSETT RD, CD CLINICAL AND OUTPATIENT DIETITIAN FOR INTERMOUNTAIN HEALTHCARE AT VALLEY VIEW MEDICAL CENTER

BAlANC( YO~R INTAK( Of SW((lS

here is increasing concern that Americans eat too much added sugar, which increases the risk for certain health problems. Studies and awareness efforts such as Fed Up, a documentary produced by Katie Courie, link sugar to our nation's obesity epidemic. As the debate continues among producers, government, and health groups, recommendations are emerging for the use and intake of sweeteners. Food labels in the United States will soon show "added sugars". Sugar has become the next big deal in

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the food industry, and can also be another health topic to feel confused about. Here are some basics on sugar, which may be especially timely during the holidays, when extra food consumption often includes sweet treats.

The Scoop On Sugar As a side-effect of the diet era of low-fat foods, industry leaders started adding more sugar to products to preserve taste and customer loyalty to food products that were deemed "healthier." Now, even

PROMOTE the United States Department of Agriculture has referred to sugar as the number one food additive because of its sweet taste, texture, and preserving properties. Some of the names by which sugar can be found on the ingredients list are: sugar, molasses, syrup, corn sweetener, fruit juice concentrate, and any word ending in -ose (fructose, sucrose, etc.). These added sugars are demonized as having absolutely no nutritive value and are often labeled as "empty calories". Some may argue that sugars from natural sources are more nutritious. However, natural sugar is still considered added sugar. Natural sugar comes from sources like honey, brown sugar, and molasses. Adding some honey to your tea, a spoonful of sugar to your coffee, and molasses in your oatmeal are all considered added sugars. The difference lies in the nutritive value. Natural sugar generally comes with some small amount of vitamins and minerals. However, these vitamin and mineral sources are minimal compared to the obvious ones we all know. With the rising obesity epidemic, sugar has claimed a top spot for the blame. The intake of added sugars has increased to 500 extra calories per day, or 52 pounds per year, on average. The Centers for Disease Control (CDC) have found that sugar consumption is highest among the younger generation, including teens and adults in their twenties, although all age groups have seen a rise in sugar intake.

We Know the Culprits While the blame for sources of added sugar are often placed on fast food, restaurants, junk food and beverage industries, about half of our sugary foods and beverages are consumed inside the home and include the usual suspects: candy, cookies, cakes, fruit drinks, ice cream, and especially soda. Most of us know what sugary foods we could limit in our diet. Don't waste time focusing on ketchup, barbeque sauce, and peanut butter while still drinking

your favorite soda. In a year, the average American will consume 53 gallons of soda and sugary drinks.

How Much Is Recommended? The World Health Organization recommends consuming fewer than 100 calories (six teaspoons) of added sugar per day. One twelve ounce can of your favorite soda contains about 160 calories (ten teaspoons). Check out food labels to get a better idea of how much added sugar you are consuming in one day. Four grams of sugar is equal to about one teaspoon.

Easy Ways To Watch Sugar During the Holidays Most Americans consume more than double the recommended amount of added sugars on an average day. During the holiday season, added sugar intake climbs even higher. Try these tips to reduce your sugar consumption during the holidays (or any day):

Want some festive color and a touch of flavor? Replace fizzy drinks with fruit water!

er, lemon n~ ~ime

rmelon time

1. Watch what you drink. Sugary beverages are usually readily available at holiday and social events. Drink water instead and you may find you are more alert, satisfied, and full. When at a party, if you must have a sugary drink, alternate it with water.

2. Use spices or extracts instead of sugar to add flavor, such as ginger, cinnamon, nutmeg, almond, lemon, vanilla, or orange. 3. When baking, try an equal amount of unsweetened applesauce as a sugar replacement. 4. Focus on the produce. Try to make your fruits and vegetables beautiful and tasty during the holiday season so that you can fuel up and feel full. 5. Be picky with your sweets. Choose your favorite holiday sweets to make and serve. Don't gorge on all that come your way, but focus on the ones you really like. Plan for them and consume in moderation. k.

SWUHEALTH . ORG

TI1e pmctice of public hen/th is 111uch 111ore effective when i11dividunls tnke respo11sibility for their ow11 hen/th n11d snfety. However, 11nvignti11g the sheer volu111e of henlth-relnted i11fon11ntio11 11ow nvnilnble to the nvemge perso11 rn11 be n dnu11ti11g tnsk. Reco111111e1ulntio11s rn11 be c01ifusi11g or co11tmdictory. Severn/ pnst nrticles i11 this publicntio11 hnve covered evnluntiug the relinbility of sources, stntistics, risk n11nlysis, n11d resenrc/1 ter111s i11 hopes tlint you will beco111e n 111ore iiifor111ed co11s11111er of 111edicnl services before spe11di11g your ti111e n11d 111011ey.

DAVID BLODGETT, MD, MPH SWUPHD DIRECTOR AND HEALTH OFFICER

How results from health screenings are often not what they seem ealth screening tests, including elective ones, have grown in popularity and availability, leading to some misunderstandings about how effective and advisable they actually are. In reality, screenings that seem like a good idea may not be as beneficial as we might imagine.

Misconception #1 "I will always fare better if the disease is detected earlier." It makes sense on the sutface that a disease found as early as possible will be much easier to treat, and you will then be healthier and happier as a result. For some diseases, including some cancers, this can be the case. For example, it is clearly better to find high blood pressure as quickly as possible in order to prevent fmther complications associated with this disease.

Do you remember these? Find the hidden image. See page 2 for a hint .

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It is easy to allow things that seem self-evident to cloud our perception. It may make sense to say that a patient who is found to have very early-stage cancer is likely to have a longer life span after diagnosis than one presenting in the very late stages of the disease. Or that patients whose disease is found as a result of screening are also likely to do better than patients presenting with symptoms. However, both of these observations can result from what is called a sampling bias. A bias is something that seems to suggest an outcome, but actually is not true. In the medical field, we talk about this phenomenon in terms of

PROMOTE lead-time bias and length-time bias. These biases in how we perceive the occurrence of disease can prevent us from getting an accurate understanding regarding the value of catching an illness and intervening at an early stage.

Lead-time bias Lead-time bias is based on the fact that there is a delay in how long it takes a person who is screened for a disease to develop symptoms when compared with someone who is diagnosed when symptoms are noticed. Screening leads to an earlier diagnosis, so the patient lives longer with the diagnosis, but may not live longer overall. It is easy to see that the person who was screened lived longer than the one who wasn't, but the actual time that the two people had the disease is the same. TI1is is pa1ticularly true for diseases that take a very long time to develop, like prostate cancer. Here's an example: you have two neighbors; both of them develop prostate cancer at the same time. Your first neighbor (A) visits the doctor, gets screened for prostate cancer and is found to have cancer two years after the cancer developed. Your second neighbor (B) is not screened, so while neighbor A now knows he has cancer, neighbor B continues his life as though everything is fine. So, who is better off between the two? The answer largely depends on the nature of the disease and the effectiveness of interventions which treat the disease. Neighbor A now goes to multiple doctors, has multiple surgeries and deals with the side effects of treatment along with the emotional and financial burdens associated with knowing he has cancer. Neighbor B remains blissfully unaware of his condition until he begins having symptoms ten years later (twelve years from when the cancer actually sta1ted). He goes to the doctor who finds the cancer and he gets the diagnosis. Neighbor A, meanwhile, has been struggling with cancer treatments for twelve years, but still has cancer and its symptoms. Two years later, unf01tunately, both neighbors A and B die from complications due to prostate cancer. I hope you can see the problem. Neighbor A seems like he was able to live longer with his cancer because it was discovered earlier. After all, he had it for twelve years before he died from it. Poor neighbor B died only two years after his diagnosis; if only he had been screened! In this case, we have been fooled by lead-time bias. We think the screening worked when it did not. In reality, they both had cancer for 14 years. Screening and years of knowing he had cancer didn't help neighbor A. In fact, it could be argued that it made life much worse for him

Length-time bias Many diseases do not present the same way in different people. Some people have a version of a given disease that progresses ve1y slowly without symptoms. Their disease can be discovered by screening tests for a ve1y long period of time. Others many have the same disease, but it might progress rapidly and be detectable by screening only for a sh01t

period of time. Hence, screening is more likely to detect slowly progressing cases, making it seem like those who have been screened are more likely to be cured or do better than those that don't. In order to understand what's really happening, you have to be able to consider larger numbers of people than just the one person you know. This population-based approach to disease activity is what we call epidemiology. To illustrate this concept, take a neighborhood with 200 women. 0 ne side of the street (100 women, side A) decides to get screened for ovarian cancer, while the other side (100 women, side B) decides not to. Over the next ten years, you watch these women to see how many of them get ovarian cancer. Side A faithfully gets screened once a year. Side B never gets screened. During the ten years, 20 of the women on side A screened positive for ovarian cancer and 18 of them are still alive. Two other women from side A also died from ovarian cancer which was not detected by the screening, bringing the total deaths to four. During the same time period, four women from side B were diagnosed with ovarian cancer after having symptoms and all four of them died of the disease. In this example, it is easy to see that the same number of women on both sides died of ovarian cancer. However, without considering the whole population, it would be tempting to believe that screenings had a great benefit to the women of side A because 18 of the 20 women found to have cancer survived. What actually happened here is that most of them had a non-fatal form of cancer that was too slow-growing to impact their life. TI1ere are probably still 18 side B women who would have tested positive as well, if they had been screened. The real issue to consider here is the impact of all of the testing and treatment endured by 18 non-fatal cancer patients from side A.

Misconception #2: "If get screened, I'll live longer." Lead-time and length-time biases have a big impact on how we perceive screening tests, but there are other influences, as well. People who readily adopt new, supposedly healthy behaviors tend to be healthier than those who do not. Observational studies, which allow people to volunteer to pa1ticipate, generally show that people who have opted for screening have better outcomes than those who did not. For instance, women who have Pap smears are less likely to die from ce1vical cancer. However, they tend to be better-educated and wealthier, which also lowers the baseline risk of ce1vical cancer death. It becomes difficult to determine how much the favorable outcome in women who have Pap smears is due to the test and treatment, and how much is due to their other favorable health behaviors.

Misconception #3 "I wouldn't be here today if my disease had not been found early." One of the most compelling pro-screening arguments points to the personal testimonies of patients who, having been screened, were diagnosed and

treated. These patients often attribute their continued smvival to the fact that they were screened and sometimes become advocates for it. However, for an individual case, it is impossible to tell if screening has made a difference. As an example, 97% of those found to have an Abdominal A01tic Aneu1ysm (AAA) from a screening will not die from that condition, which likely would have been discovered by a good physical exam if it became more threatening anyway. On the opposite side of this argument, 5% of those who get surge1y for AAA will die from the procedure itself.

Misconception #4 "If I get a negative screening result, there is no chance I have the disease" 0 ne danger is the belief that screening is 100% effective. People who are undergoing health screenings tend to believe that theirs is the life that will be saved. Often, the decision about whether a screening is effective or not is based on population statistics. For example, screening and treatment for colorectal cancer reduces m01tality by about 15%, but people whose cancers were detected by screening can still die from them. Studies show that, at best, breast cancer screening (mammogram) reduces m01tality by 30%, not 100%. Many other screening tests are much less effective. The benefits of screening are often communicated in terms of population risks. For example, breast cancer screening can lower the population's death rate from breast cancer by 30%, which may lead to the assumption that an individual's risk must also be reduced by 30% from screening as well. But this is a measure of risk as obse1ved in a population of people, called relative risk. The risk for you as an individual is called absolute risk, and is a different st01y. A SO-year-old woman who gets screened eve1y two years" for the next twenty years only lowers her risk of dying from breast cancer from around 4% to around 3%. Although the benefit for the population as a whole is considerable (30%), the benefit for the individual can be fairly small (1%).

Conclusion As you can see, there is often a sto1y behind the

st01y when it comes to screening for diseases. Becoming aware of these subtle realities is imp01tant in helping you make fully informed decisions about your health and quality of life. Today's health market offers an increasing array of screenings and products, some of which over-promise or over-simplify on what they deliver. Seek out reliable resources, such as the United States Preventive Se1vices Task Force (USPSTF)"", and consult with a trusted prima1y care physician who knows your medical histo1y and can help determine which screenings are right for you.""The US. Preventive Tnsk Force rnrrently reco111111e111ls bie1111inl brenst cn11cer scree11i11gs (typicnlly 111n11111wgrn111s) for wo111e11 stnrti11g nt nge 50 1111/ess other riskfnctors nre present. ""Click the "Reco111111e111lntio11s" tnb nt USPreventiveServicesTnskForce.org

SWUHEALTH . ORG

SHALLEN STERNER SWUPHD ENVIRONMENTAL HEALTH SCIENTIST

ADYlt( AIO~T 1(0 l~GS fROM A ff(AlTHINSP(tTOR

ed bugs! Do I need to say anything more to make your skin crawl? I know every time I deal with these creatures, my skin starts to itch. My mind starts telling me that I am being bitten the very minute I know I am in a room with bed bugs. While they're not dangerous and don't transmit disease, dealing with bed bugs can be very frustrating, so here's some guidance to help with current or future infestations.

Bed bugs have been living and thriving with humans for thousands of years. Bed bugs were nearly eradicated in the United States through the use of DDT, but in recent years they have made a strong resurgence. The reason for this has been debated, with the most common theories being an increase in international travel and resistance to available pesticides. The Utah Department of Health's website describes these creatures as follows: "Bed bugs are small insects (adults are about 1/4 inch long) that feed on the blood of humans and animals. Adults are reddish-brown in color and larvae are a clear-yellowish color." They are about the size of an apple seed or smaller, depending on what stage of life they are in. The eggs are hard to see and are about the size of the head of a pin. Bed bugs usually feed at night, which is partly why they are so hard to find and remove. After feeding, they will nest in close proximity to their host. They can be found nesting in and on mattresses, box springs, headboards, night stands, chairs, baseboards, and cracks in the walls and ceiling. In fact they will nest in almost any small crevice that keeps them close to their food source. Bed bugs will feed on their host about once each week.

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Bed bugs know a host is present because they are attracted to the carbon dioxide exhaled when you breathe. Their bites leave small itchy spots that are very similar to a mosquito bite. An individual who has been living with bed bugs can have dozens of bites. This is part of the frustration with bed bugs; you can receive many bites and not even know where they are coming from. Fortunately, bed bugs will usually leave clues of their presence. You will start to see blood smears on your sheets and blankets. You may also notice small black fecal spots or molted skins near where they are nesting. The fecal spots will often turn red when water is added to them. If you are getting mysterious bites on a regular basis, then I would recommend you look closely for these signs. If you've got bites but can't find any of these signs, then you might want to obtain a monitoring device. The one I prefer is a trap, available online, that you put under the leg of the bed after adding some dry ice. The carbon dioxide from the dry ice will attract the bed bugs and they get caught in the trap. The best way to protect against bedbugs is to never get them in the first place. Since bed bugs can be transferred from one location to another very easily, people who travel frequently should inspect their hotel or motel rooms at each stop. This inspection needs to take place before you make yourself at home. You don't want to find them in the middle of the night after they have had a chance to get into your belongings. First, always carry a flashlight, which will help spot them or any of their signs. Second, I would inspect the mattress, because this is where you are most likely to find them. Gently remove the sheets and look at the seams of the mattress and box spring. Use the flashlight to check out the luggage rack and any small crevices near the bed. Be very careful when purchasing used mattresses or furniture. You should inspect them carefully before taking them home. Avoid

taking furniture or mattresses from dumpsters, because they could be infested with bed bugs.

If you do get bed bugs, it can be difficult to get rid of them, but it's not impossible. Find a professional pest control specialist to take care of the problem as soon as possible. They have most likely dealt with bed bugs before and know how to do so appropriately. The specialist may need to conduct more than one treatment before the bed bugs are eradicated. Unfortunately, you can't just leave your home to kill them off. Bed bugs can live several weeks or even months without feeding. Sleeping on the couch, another room, or at a friend's house, could spread the bed bugs and make matters worse. For those who want to try to solve the problem on their own, start by getting rid of posters, clutter, and any other unnecessary items where bed bugs can hide. Throwing the mattress away is usually not recommended, because it may be just one of the many hiding places used by the bugs. Your money would be better spent on hiring a professional or buying a mattress encasement. One.,.,路,_.,,.,,,.,,....-. method to physically remove be bugs from a mattress is to wrap tape around your hand, sticky side out, and run it along the mattress seams and any other potentia hiding place. There are several bed bug contr products available at your lo hardware store. Please re ber to follow the manufa recommendations when mg any type of chemical. Otherwise, you could be inviting another hazard into your home. Having bed bugs in your home or hotel room is not a sign of dirtiness. These little parasites have become widespread in the past twenty years and can be found in immaculate rooms as well as filthy ones. If you are diligent during your travels, you will most likely keep them out of your home. If you do get bed bugs you will need to be diligent in your efforts to get rid of them. "-

SWUHEALTH . ORG

This article is third in a series spotlighting "Zero Fatalities", a united effort to save lives by preventing the five deadliest behaviors that occur on Utah's roads. Not buckling up and distracted driving were covered in the last two issues of Health magazine. Aggressive and impaired driving will follow.

JORDAN MERRILL SWUPHD HEALTH EDUCATOR

Of DROWSY DRIYIN~ Fatigued drivers going without sleep for 24 hours or more are equivalent to a drunk driver with a .10 blood alcohol level.

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oday's society often has a 24/7 mentality, where people feel they have to "get there fast and get there now!" Getting sufficient sleep before hitting the road can take a backseat to travel plans that include cutting into normal sleep time or driving through the night. The notion of saving time and "got to keep on going" are unwise justifications for driving drowsy. Over 30 million Americans struggle to get an adequate amount of sleep each night. With over 200 million licensed drivers in the country and 30 million of them lacking sleep on a daily basis, the safety of our roads could be questionable. How many times have you driven while fatigued and drowsy?

A recent study conducted by the AAA Foundation for Traffic Safe-

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ty showed that drowsy drivers are responsible for over one in five (20%) of fatal car accidents that occur on our roads and highways. Drivers age 24 and under are twice as likely to get in a drowsy driving-related accident as drivers ages 40-59. There are multiple studies reported by the Centers for Disease Control (CDC) which show that fatigued drivers going without sleep for 24 hours or more are equivalent to a drunk driver with a .10 blood alcohol level, which is above the legal limit in any state. It may not be illegal to drive drowsy, but just like drugs or alcohol, drowsiness slows reaction time, decreases awareness, and drastically impairs judgment. Drowsy driving is impaired driving.

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ne evening, about ten years ago, I was living in St. George and drove to Cedar City after work to hang out with friends. After dinner, a movie, and hours of catching up, I realized it was 5:30 in the morning and I needed to be to work by 7 am. I jumped in my car, threw my seatbelt on, and started for home in the dark with absolutely no sleep for the past 24 hours. I had driven drowsy plenty of times before and always managed to stay awake, so I wasn't worried when the tiredness began to set in. I found myself doing everything imaginable

to keep alert; I rolled down the windows, sang to myself, and turned up the radio. The moment that I felt I had my drowsiness under control is when I relaxed, thinking to myself, "I've got this". Seconds later, I opened my eyes and realized I had dozed off. I had set my cruise control to 80 mph and was apparently traveling much faster than the red car which was now about three feet in front of me. With only a split second to react, I grabbed the wheel and hit the brakes, which sent me immediately sliding sideways down the freeway at an extreme-

ly high rate of speed. At that point I no longer had control of my car, which began rolling down the road before flipping end over end until it slid to a stop, upside down, only feet from oncoming traffic. Had I not been buckled up I would have undoubtedly died. Even more frightening was the realization that I had almost hit the car in front of me, which could have taken the lives of those passengers and weighed on my conscience forever, had I survived. My vehicle was completely totaled, having been smashed flat and folded almost in half.

Being on time for work was no longer a concern. My transportation back to town was via ambulance with IV's and straps everywhere, followed by many hours of tests and scans. All of this because I told myself that drowsy driving was something I could handle for a short forty-minute drive. I no longer think "I've got this". Never again will I drive when drowsy, not even slightly. I know the signs to look for as well as the consequences of poor decision-making, and hopefully others will reconsider their driving habits after hearing about my mistake.

The remains of Jordan's car

The National Highway Safety Administration has estimated that each year in the United States there are 1,550 deaths, 71,000 injuries, and more than 100,000 accidents caused by drowsy driving. Utah's efforts to curb drowsy driving are now more noticeable on most highways prone to drowsy drivers. The Utah Department of Transportation has placed roads signs warning against drowsy driving, as well as providing information directing drivers where they can pull off and rest. A poll by the Utah Department of Public Safety found that 71% of drivers who admitted to drowsy driving had less than eight hours of sleep and 41 % of those drivers had been driving for less than an hour when they started having signs of drowsiness. The Southwest offers many beautiful drives that deserve to be enjoyed with both eyes open. Here are some suggestions for recognizing fatigue as well as combating those heavy eyelids:

Recognize the symptoms of fatigue • Eyes closing or going out of focus • Persistent yawning • Irritability, restlessness, and impatience • Wandering or disconnected thoughts • Inability to remember driving the last few miles • Drifting lanes, swerving, tailgating, or hitting rumble strips • Head bobbing • Abnormal speed or failure to obey traffic signs • Back tension, burning eyes, shallow breathing or inattentiveness

Safety Tips • Maintain a regular sleep schedule that allows adequate rest. • When the signs of fatigue begin to show, pull over to a safe location. Take a short nap in a well-lit area or

jog around. • Avoid driving between 12am and 6am (Death rates increase 3.2 times by driv ing at night) • Share driving responsibilities with a companion (Reduces accident risk by 50%) • Begin long trips early in the day. • Keep the temperature cool in the car. • Stop every 100 miles or two hours to get out of the car and walk around; exercise helps to combat fatigue. • Stop for light meals and snacks. • Drive with your head up, shoulders back and legs flexed at about a 45 degree angle. The best remedy to avoid drowsy driving is to get adequate sleep at night, with 7-8 hours as the recommended amount. No destination is ever more important than a life. Stay awake, stay alert, and stay alive!"-

SWUHEALTH . ORG

PAULETTE VALENTINE SWUPHD EMERGENCY PREPAREDNESS DIVISON DIRECTOR

Planning a~ea~ can mate t~e ~iff erence ~etween an inconvenience or atrue emergency.

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

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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 a snowstorm or on slick roads. Some car owner's manuals suggest not having your car on

PROTECT cruise control during any storm event, since reaction time is quicker when you have manual control of your vehicle. While tapping the brake pedal may work for controlling skids in some cars, pumping anti-lock (ABS) brakes can be dangerous. Of course, ABS brakes and hightech features like traction control are no substitute for safe stopping distances and reasonable speeds.

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.

Watch the weather.

Get your vehicles ready for winter.

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).

Slowdown. A little caution can make a lot of difference when roads are slick. Slowing

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. Be-

fore 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."-

n the night of December 7, 2013, a record-breaking snowstorm hit the Washington County region. Traffic ground to a halt along 1-15 in the Virgin River Gorge after numerous cars slid out of control and semi-trailer trucks jack-knifed; blocking the freeway. Hundreds of vehicles were stranded overnight for up to twelve hours with no cell phone service. While many kept their engines running for heat, others shivered through the night in freezing temperatures. Travellers with blankets, coats, food, water, and plenty of fuel could remain fairly comfortable during the ordeal, and some even shared what they had with other motorists. While emergency response personnel made efforts to help where they could, many were on their own. Fortunately, everyone survived the incident, but a few extra provisions or some basic supplies in the trunk made the difference between an inconvenient wait and a miserable nightmare.

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