Veteran's and Military Health

Since it is the Memorial Day weekend, I wanted to say a big thank you to all our military--veterans and those currently in the active military or reserves. Thank you for all the sacrifices you have made to protect our country.

Since there are many health issues related to military service, I wanted to provide a link to some great information from the National Library of Medicine. There is a MedlinePlus Veterans and Military Health page that has links to great information on topics such as agent orange, post-traumatic stress disorder, traumatic brain injuries and much more. If you know anyone who is or was in the military and is having health issues, please pass the link on to them.

Thank you again to our wonderful military!

Heart failure risk lower in women who often eat baked/broiled fish

The American Heart Association just released the results of a study that looked at women who eat baked/broiled fish on a regular basis.

Here are some of the Study Highlights:

• The risk of developing heart failure was lower for postmenopausal women who frequently ate baked or broiled fish, but higher for those who ate more fried fish.
• Dark fish such as salmon was healthier for the heart than tuna or white fish such as sole.
• Eating fried fish one or more times per week was associated with a 48 percent higher risk of heart failure in postmenopausal women compared to those who ate it infrequently.

If you want to read the whole news release from the American Heart Association, here's the link: http://www.newsroom.heart.org/index.php?s=43&item=1344

Here are a couple links to more information on the health benefits of eating fish:

JAMA Patient Page: Eating Fish: Health Benefits and Risks (American Medical Association) – PDF

Nutrition Facts for Cooked Seafood (Food and Drug Administration) - PDF

Kids of Deployed Parents May Face Mental Health Risks

I just read a news story about a recent study that found that children whose parents are deployed in Afghanistan or Iraq face a higher risk of psychiatric problems requiring hospitalization, a new study indicates.

Researchers from the Uniformed Services University of the Health Sciences tracked over 375,000 children, aged 9 to 17, whose parents were on active duty between 2007 and 2009.

"There was a 10 percent increased risk of hospitalization among children 9 to 17 whose parents were deployed," said Dr. Jeffrey Millegan, disaster and preventive psychiatry fellow at the Uniformed Services University of the Health Sciences.

I found some really great links that provide all kinds of useful information for kids and adults as well.

Coloring Book Pages for Kids(National Center for PTSD) – PDF

Military Kids: Responding to Their Grief(American Hospice Foundation)

Talk, Listen, Connect: Helping Families During Military Deployment(Sesame Workshop)

When Loved Ones Go to War(Nemours Foundation)

What Military Families Should Know About Depression(Center for the Study of Traumatic Stress) - PDF

Families in the Military (American Academy of Child and Adolescent Psychiatry) – PDF

U.S. Army HOOAH4HEALTH: Family Matters(U.S. Army Medical Dept.)

The Emotional Cycles of Deployment

Deployment Guide

Having Trouble Affording Your Prescription Drugs?

Are you without prescription drug coverage and having trouble affording the drugs you need? If so, there are organizations that can help you find free or low-cost medications.

One of the organizations is a drug company trade group called Partnership for Prescription Assistance (http://www.pparx.org). Here is what their web site says:

“The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free.

“Our mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. We offer a single point of access to more than 475 public and private programs, including nearly 200 offered by pharmaceutical companies. We have already helped millions of Americans get free or reduced-cost prescription medicines.”

Industry and government patient assistance programs offer an estimated 1,000 medicines to treat a variety of diseases and conditions, including cancer, high cholesterol, diabetes, high blood pressure, stroke, depression, schizophrenia, and Alzheimer’s.

This is a free service so if you ever come across a web site that asks for money to help you find free or low-cost prescriptions, beware. It is a scam.

Additionally, www.accesstobenefits.org is a website with information on many programs to help seniors and people with disabilities reduce their prescription drug costs. The site is sponsored by a coalition of organizations serving Medicare beneficiaries. These programs offer the most help if you don’t have other prescription drug coverage and if your income is limited. Apply now for the Extra Help available through the Medicare Prescription Drug Coverage for people with limited incomes and resources. If you qualify, you can join a Medicare drug plan, and Medicare will pay 85 to 100 percent of your prescription drug costs.

Spring Cleaning: Tips for Doing it Safely

Keep safety in mind during the springtime cleaning spree. So says the American Academy of Orthopaedic Surgeons (AAOS) in a recent press release. Many people take advantage of the weather to clean both the inside and outside of their home, but there are many hazards associated with this springtime ritual.

Statistics show that thousands of people injure themselves during their annual clean, whether it be using a step ladder, a lawn mower or moving furniture. The American Academy of Orthopaedic Surgeons (AAOS) urges people to take the proper safety precautions to reduce the number of spring cleaning-related accidents

STATISTICS:
According to the U.S. Consumer Product Safety Commission:
- In 2010, more than 35,500 people injured themselves using a stepladder;
- Over 41,000 Americans injured themselves while gardening or using gardening equipment;
- More than 127,000 were injured while operating a lawn mower.

AAOS SAFETY TIPS:-
- Proper techniques for lifting, carrying and bending should be part of any spring cleaning project to avoid back injuries:
- Separate your feet, shoulder-width apart and keep your back upright and bend at the knees while tightening the stomach muscles.
- Lift with your leg muscles as you stand up; don’t try to lift any object by yourself if it is too heavy or an awkward shape.

- When gardening, avoid prolonged repetitive motions during activities such as digging, planting, trimming and pruning and take frequent breaks.

- Use a sturdy step stool instead of a counter or furniture – such as a chair or the couch – when dusting high hard to reach areas.

- Ladders used for chores – such as washing windows, painting, cleaning gutters and trimming trees – should be placed on a firm, level surface. Never place a ladder on ground or flooring that is uneven, soft or wet.

- Use care with extension cords: be sure they are properly grounded. To avoid tripping or falling, do not drape extension cords across spans of crossing walkways.

- When working on a ladder, over-reaching or leaning too far to one side can make you lose your balance and fall. Your bellybutton should not go beyond the sides of the ladder. Never climb a ladder without a spotter.

- When mowing the lawn, be sure to wear proper footwear and eyewear for protection:

- Use a mower with a control that stops it from moving forward if the handle is released. Never pull backward or mow in reverse unless absolutely necessary – carefully look for others behind you when you do.

- Children should be at least 12-years-old before they operate any lawn mower, and at least 16- years-old for a ride-on mower.

- Read product labels for proper use and wear protective clothing and gloves when using chemicals for gardening or cleaning. Store all chemicals at the appropriate temperature, which is usually indicated on the package – in a place that is out of reach of both children and pets and never place chemicals into unmarked containers or containers labeled for a different substance.

- Take frequent breaks and replenish fluids to prevent dehydration and keep a cell phone within reach in case of accident or injury.

Protect Yourself from the Sun: UV Index

Since I posted some information last week on melanoma/skin cancer awareness and prevention, I thought a good follow-up would be to post some information on the ultraviolet (UV) index. This index is used to describe the intensity of ultraviolet rays on any given day. The higher the number, the quicker you will get sunburn if you don't take precautions.

The United States Environmental Protection Agency (EPA) has a great description of what each level of the UV index means. Here is the information from their UV index scale page:

2 or less: Low
A UV Index reading of 2 or less means low danger from the sun's UV rays for the average person:
• Wear sunglasses on bright days. In winter, reflection off snow can nearly double UV strength.
• If you burn easily, cover up and use sunscreen.

Look Out Below
Snow and water can reflect the sun's rays. Skiers and swimmers should take special care. Wear sunglasses or goggles, and apply sunscreen with an SPF of at least 15. Remember to protect areas that could be exposed to UV rays by the sun's reflection, including under the chin and nose.

3 - 5: Moderate
A UV Index reading of 3 to 5 means moderate risk of harm from unprotected sun exposure.
• Take precautions, such as covering up, if you will be outside.
• Stay in shade near midday when the sun is strongest.

Me and My Shadow
An easy way to tell how much UV exposure you are getting is to look for your shadow:
• If your shadow is taller than you are (in the early morning and late afternoon), your UV exposure is likely to be low.
• If your shadow is shorter than you are (around midday), you are being exposed to high levels of UV radiation. Seek shade and protect your skin and eyes.

6 - 7: High
A UV Index reading of 6 to 7 means high risk of harm from unprotected sun exposure. Apply a sunscreen with a SPF of at least 15. Wear a wide-brim hat and sunglasses to protect your eyes.
• Protection against sunburn is needed.
• Reduce time in the sun between 10 a.m. and 4 p.m.
• Cover up, wear a hat and sunglasses, and use sunscreen.

Made in the Shades
Wearing sunglasses protects the lids of your eyes as well as the lens.

8 - 10: Very High
A UV Index reading of 8 to 10 means very high risk of harm from unprotected sun exposure. Minimize sun exposure during midday hours, from 10 a.m. to 4 p.m. Protect yourself by liberally applying a sunscreen with an SPF of at least 15. Wear protective clothing and sunglasses to protect the eyes.
• Take extra precautions. Unprotected skin will be damaged and can burn quickly.
• Minimize sun exposure between 10 a.m. and 4 p.m. Otherwise, seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

Stay in the Game
Be careful during routine outdoor activities such as gardening or playing sports. Remember that UV exposure is especially strong if you are working or playing between the peak hours of 10 a.m. and 4 p.m. Don't forget that spectators, as well as participants, need to wear sunscreen and eye protection to avoid too much sun.

11+: Extreme
A UV Index reading of 11 or higher means extreme risk of harm from unprotected sun exposure. Try to avoid sun exposure during midday hours, from 10 a.m. to 4 p.m. Apply sunscreen with an SPF of at least 15 liberally every 2 hours.
• Take all precautions. Unprotected skin can burn in minutes. Beachgoers should know that white sand and other bright surfaces reflect UV and will increase UV exposure.
• Try to avoid sun exposure between 10 a.m. and 4 p.m.
• Seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

Beat the Heat
It is possible to go outside when the UV Index is 11 or higher. Make sure you always seek shade, wear a hat, cover up, wear 99-100% UV-blocking sunglasses, and use sunscreen. Or you can opt to stay indoors and take the opportunity to relax with a good book rather than risk dangerous levels of sun exposure.

If you want to check out the UV index in your area, the EPA has a web page where you can enter your city or Zip Code to find out the UV index. Check it out at UV Index Forecast.

After Heart Attack, Certain Painkillers May Raise Risk for Recurrence

Results of a Danish study found that people with a history of heart attack are at an increased risk of suffering another heart attack or death if they use certain types of prescription or over-the-counter pain medicines for even as little as one week. These drugs include Advil, Motrin or Voltaren. The study found that those taking certain non-steroidal anti-inflammatory drugs (NSAID) for one week have a 45 percent heightened risk of suffering another heart attack. For those on the drugs for 3 months, the risk increases to 55 percent.

The most common NSAIDs prescribed to study participants were ibuprofen (Advil, Motrin) and diclofenac (Cataflam, Voltaren). Diclofenac carried the highest cardiovascular risk, even greater than rofecoxib (Vioxx), an NSAID banned in the United States in 2004 because of a higher rate of heart attacks and strokes among those taking it.

Dr. Elliott Antman, professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston, says that if a heart patient also suffers from rheumatoid arthritis or Lupus, they should try non-drug pain relief methods, such as physical therapy, heat and splints, or other types of pain relievers before resorting to NSAIDs. It is important to talk to your doctor about all your medications so they know exactly what you are taking.

Check out these links for more information:

Chronic Pain Medications (American Academy of Family Physicians)

Medication Guide for Non-steroidal Anti-inflammatory Drugs (NSAIDs) (Food and Drug Administration)

Prescription Nonsteroidal Anti-inflammatory Medications (American Academy of Family Physicians)

Pain Relievers Linked to Higher Risks of Heart-Related Deaths Among Healthy People (American Heart Association)

May is Melanoma/Skin Cancer Detection & Prevention Month

Since warmer weather is on its way and people will be outside more, I thought I’d post some information on skin cancer. There are links below to more detailed information on the various kinds of skin cancer.

There are three main types of skin cancer that get their names from the types of cells involved: Melanoma, basal cell and squamous cell.

Here are more detailed descriptions from the National Cancer Institute:

Melanoma: Melanoma begins in melanocytes (pigment cells). Most melanocytes are in the skin. See the picture of a melanocyte and other skin cells. Melanoma can occur on any skin surface. In men, it’s often found on the skin on the head, on the neck, or between the shoulders and the hips. In women, it’s often found on the skin on the lower legs or between the shoulders and the hips.Melanoma is rare in people with dark skin. When it does develop in people with dark skin, it’s usually found under the fingernails, under the toenails, on the palms of the hands, or on the soles of the feet.

Basal cell skin cancer: Basal cell skin cancer begins in the basal cell layer of the skin. It usually occurs in places that have been in the sun. For example, the face is the most common place to find basal cell skin cancer.

In people with fair skin, basal cell skin cancer is the most common type of skin cancer.

Squamous cell skin cancer: Squamous cell skin cancer begins in squamous cells. In people with dark skin, squamous cell skin cancer is the most common type of skin cancer, and it’s usually found in places that are not in the sun, such as the legs or feet.However, in people with fair skin, squamous cell skin cancer usually occurs on parts of the skin that have been in the sun, such as the head, face, ears, and neck.

PREVENTION

The best way to prevent skin cancer is to protect yourself from the sun’s rays when you are outside. Here are some suggestions:

Since the sun’s rays are strongest during the middle part of the day, avoid being outdoors between 10:00 a.m. and 4:00 p.m. If you have to be outside, stay in the shade as much as possible.

Wear protective clothing: long-sleeve shirts and long pants, wide-brimmed hats that go all the way around so they protect your neck as well as your face.

Watch out for reflected rays that bounce off water, sand, snow and ice. The harmful rays can also penetrate windshields and windows in cars.

Apply sunscreen with an SPF of at least 15 a half hour before going outside or after swimming. Reapply it every 2 hours while outside.

DETECTION

You should regularly exam your skin for suspicious moles and other lesions. This can lead to early detection and successful treatment of skin cancer. The American Academy of Dermatology has an excellent description of how to perform skin self-examination. Check out this wonderful resource: Skin Examinations

Here are some other links to more detailed information about the different kinds of skin cancer:

What You Need to Know about Melanoma and Other Skin Cancers (National Cancer Institute)

Anyone Can Get Skin Cancer (National Cancer Institute)

Basic Information about Skin Cancer (Centers for Disease Control and Prevention)

Skin Cancer (American Academy of Dermatology)

Child Car Seat Safety

A recent study found that many children in car seats manage to unbuckle the seatbelt on their own and they do so at very young ages.

A team of researchers led by Dr. Lilia B. Reyes, a clinical fellow in the department of pediatrics at Yale School of Medicine, surveyed 378 parents and found that just over half reported that at least one of their children had managed to unbuckle a seatbelt in a car seat at some point.

Of the children who unbuckled their seatbelts, 75 percent were aged 3 or younger; some were as old as six years. Some unbuckled their seatbelts as young as 12 months. Boys were more likely to do so than girls (59 percent vs. 42 percent).

More than 40 percent of the children who unbuckled their seatbelts did so while the car was moving, increasing the risk of serious injury by 3.5-fold. Most parents responded that they pulled the car over and reprimanded the child and rebuckled the car seat.

Very young children haven't developed enough yet to realize the dangers of unbuckling their car seat. If you want more information on car seat safety, check out these links:

AAP Updates Recommendations on Car Seats (American Academy of Pediatrics)

Car Safety for You and Your Baby (American College of Obstetricians and Gynecologists)

Car Seat Safety: Avoid 10 Common Mistakes (Mayo Foundation for Medical Education and Research)

Child Passenger Safety: A Parent's Primer (National Highway Traffic Safety Administration) - PDF

Food Allergies

A food allergy occurs when your body's immune system responds to harmless food as if it were a threat to your body. It is actually a 2-step process. When you have your first exposure to a food that your body is allergic to, your immune system produces immunoglobulin E (IgE) antibodies to that allergen. The next time you are exposed to that allergen, you will have an allergic reaction to that food.

Symptoms of food allergy

If you are allergic to a particular food, you may experience some or all of the following symptoms:

- Itching in your mouth or swelling
- GI symptoms, such as vomiting, diarrhea, or abdominal cramps and pain
- Hives or eczema
- Tightening of the throat and trouble breathing
- Drop in blood pressure

If you have any of these symptoms, it is important to seek medical help immediately, especially if you have trouble breathing. Severe allergic reactions (anaphylaxis) can lead to death.

You may need to see an allergist to figure out which food(s) you are allergic to. Once you know the foods that cause on allergic reaction, it is important to avoid them. Some foods are obvious and are easy to avoid, but if you are allergic to something like peanuts, for example, it is important to read food labels which now have warnings on them about allergies.

If you have food allergies, you should wear a medical alert bracelet that identifies your allergies in case you have a severe reaction and are unable to communicate.

Here are some links to more detailed information about food allergies:

Food Allergy (National Institute of Allergy and Infectious Diseases)

Tips to Remember: Food Allergy (American Academy of Allergy, Asthma, and Immunology)

Allergy Blood Testing (American Association for Clinical Chemistry)

Allergy Skin Tests (Mayo Foundation for Medical Education and Research)

Food Allergies: Reducing the Risks (Food and Drug Administration) - PDF

Egg, Milk or Wheat Allergies: What to Avoid (InteliHealth, Harvard Medical School)

Exercise for your Health

I figured since there will be many folks who overindulge on candy and regular food around the Easter holiday, I'd post some information on exercise to help you work off those extra calories! Before starting any exercise program, check with your doctor first.

Exercise is a must for everyone. It will help many aspects of your health. If you don't get enough exercise, you are at an increase chance of:

Heart disease
Type 2 diabetes
High blood pressure
High blood cholesterol
Having a stroke

The ideal goal is to have at least 2 1/2 hours of moderate aerobic exercise a week (1/2 hour of exercise five days a week). You should also do strengthening exercises at least 2 days a week (push-ups, sit-ups, lifting weights).

Some examples of moderate exercise are:

Biking slowly
Canoeing
Dancing
General gardening (raking, trimming shrubs)
Tennis (doubles)
Using your manual wheelchair
Using hand cyclers— also called arm ergometers
Walking briskly Water aerobics

After you have adjusted to the moderate exercises, you may want to turn it up a notch and increase your exercises to a more vigorous level. Again, make sure you check with your doctor first. Some examples of vigorous exercise are:

Aerobic dance
Basketball
Fast dancing
Jumping rope
Martial arts (such as karate)
Race walking, jogging, or running
Riding a bike on hills or riding faster
Soccer
Swimming fast or swimming laps Tennis (singles)

If you want more detailed information on exercise, check out these links:

Be Active Your Way: A Guide for Adults (Dept. of Health and Human Services) - PDF

Physical Activity for Everyone Centers for Disease Control and Prevention)

Fitness Fundamentals: Guidelines for Personal Exercise Programs (President's Council on Fitness, Sports and Nutrition)

Tips to Help You Get Active National Institute of Diabetes and Digestive and Kidney Diseases)

Guide to Physical Activity (National Heart, Lung, and Blood Institute)

Alzheimer's Disease

You may have seen on the news that Alzheimer's diagnostic guidelines have been updated for first time in decades. The NIH-supported revision also proposes staging of disease, potential use of biomarkers.

I have some information about those changes and at the end of this post are some links to general information on Alzheimer's disease as well as important information for caregivers.

To reflect what has been learned, the National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer’s Disease cover three distinct stages of Alzheimer's disease:

Preclinical — The preclinical stage, for which the guidelines only apply in a research setting, describes a phase in which brain changes, including amyloid buildup and other early nerve cell changes, may already be in process. At this point, significant clinical symptoms are not yet evident. In some people, amyloid buildup can be detected with positron emission tomography (PET) scans and cerebrospinal fluid (CSF) analysis, but it is unknown what the risk for progression to Alzheimer’s dementia is for these individuals. However, use of these imaging and biomarker tests at this stage are recommended only for research. These biomarkers are still being developed and standardized and are not ready for use by clinicians in general practice.

Mild Cognitive Impairment (MCI) — The guidelines for the MCI stage are also largely for research, although they clarify existing guidelines for MCI for use in a clinical setting. The MCI stage is marked by symptoms of memory problems, enough to be noticed and measured, but not compromising a person’s independence. People with MCI may or may not progress to Alzheimer's dementia. Researchers will particularly focus on standardizing biomarkers for amyloid and for other possible signs of injury to the brain. Currently, biomarkers include elevated levels of tau or decreased levels of beta-amyloid in the CSF, reduced glucose uptake in the brain as determined by PET, and atrophy of certain areas of the brain as seen with structural magnetic resonance imaging (MRI). These tests will be used primarily by researchers, but may be applied in specialized clinical settings to supplement standard clinical tests to help determine possible causes of MCI symptoms.

Alzheimer's Dementia — These criteria apply to the final stage of the disease, and are most relevant for doctors and patients. They outline ways clinicians should approach evaluating causes and progression of cognitive decline. The guidelines also expand the concept of Alzheimer's dementia beyond memory loss as its most central characteristic. A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may be the first symptom to be noticed. At this stage, biomarker test results may be used in some cases to increase or decrease the level of certainty about a diagnosis of Alzheimer's dementia and to distinguish Alzheimer's dementia from other dementias, even as the validity of such tests is still under study for application and value in everyday clinical practice.

Here are some other links to check out:

Alzheimer’s Association Report: 2011 Alzheimer’s disease facts and figures

National Institute on Aging: Alzheimer’s Disease Fact Sheet

Understanding Alzheimer's Disease (National Institute on Aging)

Caregiver Guide (National Institute on Aging)

Caregiver Stress (Alzheimer's Association)

National Stress Awareness Day

To recognize National Stress Awareness Day (April 18th) I decided to post some information on stress that includes some links to more detailed information.

Since everyone has experienced stress at some point in their lives it’s important to learn how to cope with it. There are different kinds of stress that have different symptoms and treatment approaches and it is important to be able to distinguish them so you know how to deal with them.

Acute Stress:

Acute stress is the most common form of stress. It lasts only for a relatively short period of time: getting your taxes paid on time, a fender bender traffic accident, or a project deadline are examples of things that can cause acute stress. The most common symptoms are:

- emotional distress, including anger or irritability, anxiety, and depression
- muscular problems including tension headache, back pain, jaw pain,
- stomach and bowel problems such as heartburn, acid stomach, diarrhea, and irritable bowel syndrome;
- short term stress can lead to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath, and chest pain.

Episodic Acute Stress:

Episodic acute stress is when you experience frequent occurrences of acute stress—you’re always in a rush but you’re always late; you can never seem to get organized; you’re always worrying about something.

The symptoms are:

elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath, and chest pain.

Chronic Stress:

Chronic stress grinds at people day after day and causes wear and tear on the body. Chronic stress includes experiences like dysfunctional families, poverty, or unhappiness with one’s job.

Chronic stress can lead to suicide, violence, heart attacks and other problems. Depression may set in and lives are destroyed. Treatment often involves both medical and behavioral interventions.

DEALING WITH STRESS:

You can prevent or reduce stress by:

- Planning ahead
- Preparing for stressful events

Some stress is hard to avoid. You can find ways to manage stress by:

- Noticing when you feel stressed
- Taking time to relax
- Getting active and eating healthy
- Talking to friends and family

For more information on managing stress, visit Stress Management from the American Heart Association.

Links to more information:
Stress: Constant Stress Puts Your Health at Risk (Mayo Foundation for Medical Education and Research)

Listening to the Warning Signs of Stress (American Psychological Association)

Stress Symptoms: Effects on Your Body, Feelings and Behavior (Mayo Foundation for Medical Education and Research)

New Study about Teens Involved in Traffic Accidents

I came across this press release from State Farm about a study involving teen drivers and I thought it was worth sharing:

Philadelphia, April 11, 2011 - A recent study by The Children's Hospital of Philadelphia (CHOP) and State Farm Insurance Companies® hones in on the most common errors teen drivers make that lead to a serious crash. Teen drivers are involved in fatal crashes at four times the rate of adults. The findings were published in the journal Accident Analysis and Prevention.

Researchers analyzed a nationally-representative federal database of more than 800 crashes involving teen drivers and identified a few common "critical errors" that are often one of the last in a chain of events leading up to a crash. Seventy-five percent of these crashes were due a critical teen driver error, with three common errors accounting for nearly half of all serious crashes. Among crashes with a teen driver error:

- Twenty-one percent occurred due to lack of scanning that is needed to detect and respond to hazards.
- Twenty-one percent occurred due to going too fast for road conditions, (for example, driving too fast to respond to others, or to successfully navigate a curve)
- Twenty percent occurred due to being distracted by something inside or outside the vehicle.

The researchers note that environmental conditions, such as poor weather, vehicle malfunction, aggressive driving, or physical impairments such as drowsy driving were not primary factors in most crashes. "This study helps dispel the myth that most teen crashes are due to aggressive driving or thrill-seeking," said Allison Curry, Ph.D., lead author and a researcher at CHOP's Center for Injury Research and Prevention (CIRP). “Promoting safe driving skills is as important as preventing problem behaviors."

By getting very specific about the types of teen driver errors that are most likely to precede a crash, this study makes it possible to target policies, programs, driver education and other strategies to reduce those critical errors and prevent crashes from happening.

"Laws and policies that address distractions by limiting the number of peer passengers and prohibiting cell phone use among novice drivers will help reduce crash rates, but will only address part of the problem," says study co-author Dennis Durbin, MD, MSCE, who co-directs CIRP. "Many crashes will still occur due to the inability of teen drivers to detect and respond to a hazard in time. Formal teen driver training and parent-teen practice drives should focus on building scanning and hazard awareness skills."

Scanning involves observing the surroundings far ahead of the vehicle and side-to-side, not just immediately in front of the hood. It is a higher-level skill that experienced drivers develop over time. The study authors note that developing effective ways to teach this skill sooner in the learning-to-drive process could reduce teen crash risk. Pilot tests of this type of training have shown promise in increasing hazard detection and response skills among novice drivers.

"This research gets us one step closer to understanding why teens crash and what we can do to help prevent future crashes," says Cindy Garretson, Director of Auto Technology Research. "Strong graduated driver licensing laws, along with educational programs that are focused on common teen driver errors, will help keep our roads safer for everyone."

Germs and hygiene

Germs can be spread in many ways, including through the air and on surfaces. That’s why it’s important to take measures to stop the spread of germs. Some tips to stop the spread of germs are:

- Covering your mouth and nose when you sneeze or cough
- Cleaning your hands often
- always before you eat or prepare food, and after you use the bathroom or change a diaper
- Avoiding touching your eyes, nose or mouth

Frequent handwashing is one of the most effective ways to prevent the spread of germs. Wash your hands with soap and water for at least 20 seconds. (If you sing Happy Birthday through twice, that takes about 20 seconds.) If you don’t have access to soap and water, alcohol-based hand sanitizers or disposable wipes work well.

Kitchen safety:

When preparing food, it is important to use proper sanitizing techniques to avoid the spread of germs. Here are some tips to help keep things safe:

- Wash your hand frequently when handling food
- Wash cutting boards and utensils thoroughly before using and when switching between foods
- Wash all fruits and vegetables under cold running tap water
- Do not cross-contaminate foods:
- use separate cutting boards for meat and vegetables
- use separate utensils when handling meats and vegetables or wash them thoroughly between foods,
- wash your hands thoroughly after touching meat

Cook foods to the proper temperature:

Beef, Veal, Lamb Steaks and Roasts
145 °F

Fish
145 °F

Pork
160 °F

Beef, Veal, Lamb Ground
160 °F

Egg Dishes
160 °F

Turkey, Chicken and Duck
Whole, Pieces & Ground
165 °F

Links to helpful information on Germs:

Ounce of Prevention Keeps the Germs Away: Seven Keys to a Safer Healthier Home (Centers for Disease Control and Prevention) - PDF

Germs: Understand and Protect against Bacteria, Viruses and Infection (Mayo Foundation for Medical Education and Research)

Stopping Germs at Home, Work and School (Centers for Disease Control and Prevention)

Hand Washing: Do's and Dont's (Mayo Foundation for Medical Education and Research)