tag:blogger.com,1999:blog-64309556502951659202024-02-18T19:30:04.757-08:00Excellence, Evidence, and the Everyday {musings of an evidence based mom}Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.comBlogger28125tag:blogger.com,1999:blog-6430955650295165920.post-41303685189276172622013-08-31T13:29:00.001-07:002013-08-31T13:41:42.027-07:00Have you ever washed your reusable bags?Up until recently I hadn't ever washed my reusable grocery bags, not because I didn't think it was necessary or a good idea, but to be honest, the idea just hadn't crossed my mind. Since Alameda County now charges for bags, and word on the street is that Contra Costa county will also soon be charging, it seems I will be using more and more reusable bags in the near future.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZlB8jvpNzUacJEeyOufrfv9of9R_en1_Me9LNF0BIxh-ske9OGAhdOo7jQ792Vq-3penSKGHddL6GoXSOrT71Y1KvGtZo7nWzmzeh8bRlgQuy4Rcn0esClHJyXVWMtkLHScG2IpWrHHm_/s1600/reusableBags.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZlB8jvpNzUacJEeyOufrfv9of9R_en1_Me9LNF0BIxh-ske9OGAhdOo7jQ792Vq-3penSKGHddL6GoXSOrT71Y1KvGtZo7nWzmzeh8bRlgQuy4Rcn0esClHJyXVWMtkLHScG2IpWrHHm_/s320/reusableBags.JPG" width="320" /></a>Awhile ago Mr. L sent <a href="http://foodpoisoningbulletin.com/2013/e-coli-infections-spike-after-plastic-bag-ban-in-california" target="_blank">this</a> article to me about the need to wash reusable bags. I promptly washed our bags, and bookmarked the article for further thought and study. Larson cites a study published by law professors at the University of Pennsylvania and George Mason University. This study claims to have found a 46% spike in San Francisco deaths during the 3 months immediately following the county wide plastic bag ban in October 2007 (2). Yikes! That seems pretty terrible. However, either I'm being incredibly dense, the numbers in this study are a little sketch, or lawyers have a very different way of reporting numbers, but regardless, after looking at this study a few times this week I wasn't able to grasp what was actually going on. I'm a little uncomfortable with the way the authors compared the before and afters, and since I'm not actually positive of anything, I'll simply be setting this study aside and looking at two published articles that are applicable to this discussion.<br />
<br />
Perhaps many of you have been washing your bags for years-- if you think about it, it really is common sense. However, one study randomly interviewed shoppers and sampled reusable bags in California and Arizona (3). They found that reusable bags are seldom, if ever, washed, and that most bags had large amounts of bacteria, about half had some coliform bacteria on them, and 8% had e. Coli on them. The good news is, is that these authors report a >99.9% reduction in bacteria after washing the reusable bags (3).<br />
<br />
Another article of note concerns a "point-source" <a href="http://www.cdc.gov/norovirus/" target="_blank">norovirus</a> outbreak on a soccer team (4). After interviewing, constructing a graph of exposures, and calculating risks associated with different exposures for those who were sick and those who were not sick, it was determined that the likely cause of the norvirus outbreak among this team was a reusable grocery bag containing sealed snacks which were stored in the bathroom of the original team member who was sick. As the authors point out, this exposes one good reason not to store food, or bags containing food, in the bathroom and the need to disinfect bathroom surfaces-- especially after someone has a stomach and intestinal bug. However, they also point out that this, "illustrates one of the less obvious hazards of reusable grocery bags" (4).<br />
<br />
I like reusable grocery bags for multiple reasons--they're often easier to carry, they're less likely to break, and they're less wasteful. However, it now seems obviously important to me to wash these bags frequently and to practice good segregation by not putting meat in the bag one day and fresh produce in it the same bag the next day. <br />
<br />
I'm curious though, have you ever thought about the importance of washing your reusable bags?<br />
<span style="font-size: x-small;"><br /></span><span style="font-size: x-small;">(1) Larson, L. E. coli Infections Spike After Plastic Bag Ban in California. Food Poisoning Bulletin. February 10, 2013.<a href="http://foodpoisoningbulletin.com/2013/e-coli-infections-spike-after-plastic-bag-ban-in-california/" target="_blank">http://foodpoisoningbulletin.com/2013/e-coli-infections-spike-after-plastic-bag-ban-in-california/</a>. Accessed 8/30/13.</span><br />
<span style="font-size: x-small;"><br /></span><span style="font-size: x-small;">(2) Klick, J., and Wright, J. Grocery Bag Bans and Foodborne Illness. August 15, 2012. <a href="http://foodpoisoningbulletin.com/wp-content/uploads/Grocery-Bag-Bans-and-Foodborne-Illness-1.pdf" target="_blank">http://foodpoisoningbulletin.com/wp-content/uploads/Grocery-Bag-Bans-and-Foodborne-Illness-1.pdf</a>. Accessed 8/31/13. </span><br />
<span style="font-size: x-small;"><br /></span><span style="font-size: x-small;">(3) Williams, D., Gerba, C., Maxwell, S., and Sinclair, R. Assessment of the Potential for Cross-contamination of Food Products by Reusable Shopping Bags. Food Protection Trends, (2011) 31(8): 508-513. <a href="http://www.foodprotection.org/publications/food-protection-trends/article-archive/2011-08assessment-of-the-potential-for-cross-contamination-of-food-products-by-reusable-shopping-bag" target="_blank">http://www.foodprotection.org/publications/food-protection-trends/article-archive/2011-08assessment-of-the-potential-for-cross-contamination-of-food-products-by-reusable-shopping-bag</a>/. Accessed 8/30/13.</span><br />
<span style="font-size: x-small;"><br /></span><span style="font-size: x-small;">(4) Repp, K., and Keene, W. A Point-Source Norovirus Outbreak Caused by Exposure to Fomites. J Infect Dis. (2012) 205 (11): 1639-1641. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415849/" target="_blank">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415849/</a>. Accessed 8/30/13.</span>Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com3tag:blogger.com,1999:blog-6430955650295165920.post-79963852399463493702013-08-16T17:57:00.001-07:002013-08-16T17:59:19.206-07:00thankful <div class="separator" style="clear: both; text-align: left;">
This last month has been a bit of a whirlwind for my family what with a camping trip, Baby's first birthday party (I guess I'll have to come up with a new alias for him since he's not a "baby" anymore), a quick trip to Los Alamos to visit family, and then more family visiting us. But looking back, I'm thankful for each individual trip/event-- God has been so gracious and good to us to bless us with so much family who love us and want to be involved in our lives, wonderful friends to share a birthday with, and gorgeous scenery and the great outdoors to enjoy. Despite short periods when I wished we weren't doing one or another of our trips, I know we will have fond memories for many, many, years to come.</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBzkTjMAUrPPQk0keQFkDF1WpU5nNDDLW08IeKQ4ES1xrRgncM8Gn6-_TwMlbKWCjzgYJQxeWaoZJoALrioHAf8zoYMoIkCSJiGp9yrSszZDcnZmbhlnwgJTCV7JB8aQhp1cor57WT-RtA/s1600/IMG_3649.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBzkTjMAUrPPQk0keQFkDF1WpU5nNDDLW08IeKQ4ES1xrRgncM8Gn6-_TwMlbKWCjzgYJQxeWaoZJoALrioHAf8zoYMoIkCSJiGp9yrSszZDcnZmbhlnwgJTCV7JB8aQhp1cor57WT-RtA/s320/IMG_3649.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Trinity Alps, California</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2ORmOOP9b2BnRoql-0QJzk-T8Q8iRnqaGEjUL6LrsZzwUhOZoqBuLWSOsPCLONoRH6p_2cVojCBPV8tHonYpVU0y665QBOnPCz4OIK5CU4v2RqXRTWFJmDZXadkAaem79rODn7wUJMi1V/s1600/IMG_3638.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2ORmOOP9b2BnRoql-0QJzk-T8Q8iRnqaGEjUL6LrsZzwUhOZoqBuLWSOsPCLONoRH6p_2cVojCBPV8tHonYpVU0y665QBOnPCz4OIK5CU4v2RqXRTWFJmDZXadkAaem79rODn7wUJMi1V/s320/IMG_3638.JPG" width="212" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Certainly one of the dirtiest camping trip I've been on!</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHlcLBkB-h8LQ3bIzx_7wwqEbDJFhyphenhyphenTa9aIkrrAcSoruy0CbD4g_GHpoyIUu29iPoTaJHpqm7Dk4ldMljj7vyTKp4eidDqqX3vizrr-TasOWCoo0NQ1N96BW67Jb3dzOn4ImlTQ_h1LVOy/s1600/IMG_3799.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHlcLBkB-h8LQ3bIzx_7wwqEbDJFhyphenhyphenTa9aIkrrAcSoruy0CbD4g_GHpoyIUu29iPoTaJHpqm7Dk4ldMljj7vyTKp4eidDqqX3vizrr-TasOWCoo0NQ1N96BW67Jb3dzOn4ImlTQ_h1LVOy/s320/IMG_3799.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px;">A joint birthday party for three little friends, all turning one.<br />
What are little boys made of? why, Frogs, and Snails, and Puppy Dog tails, of course!</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxg8W25peUa7yVkI10nckmGKDfBtAISa-favldsybGSX3DCmcla34MwMFgWKKLPBmkrJsBwel_fPhznvwa6WQVF1uNf-2Mk2HZlaAf9OFEeFj1IcdIHyqJeFXPZw5EkGB6nTGrSDbu2MMB/s1600/IMG_3864.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxg8W25peUa7yVkI10nckmGKDfBtAISa-favldsybGSX3DCmcla34MwMFgWKKLPBmkrJsBwel_fPhznvwa6WQVF1uNf-2Mk2HZlaAf9OFEeFj1IcdIHyqJeFXPZw5EkGB6nTGrSDbu2MMB/s320/IMG_3864.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px;">The cake was certainly squishy and fun...</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ-iN8YCj2P_cLJJOszJLOp70-2xiOrxLIlLQ0iLGxF5FiXyvqu1I95BNf1aacvomj526m9uxqEkHKJtwljk3rnRkpeeKdCKO0IugeVaKH1vCOoElYNz3PtKfaG8mSuVBPS6Z85YwzRheW/s1600/IMG_3873.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto; text-align: center;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ-iN8YCj2P_cLJJOszJLOp70-2xiOrxLIlLQ0iLGxF5FiXyvqu1I95BNf1aacvomj526m9uxqEkHKJtwljk3rnRkpeeKdCKO0IugeVaKH1vCOoElYNz3PtKfaG8mSuVBPS6Z85YwzRheW/s320/IMG_3873.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">...but it makes more sense that you're supposed to eat it if you have a fork!</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzLP4cLE6h5XN7pXAVa_6Xig5ecWbRmDkEl5SWgUK6jtCW2Ka1mn0ZG9oWCMfNqbkzJnTtpTwy743Owp_l0Smvkb89Oc3PszsFXtgoAy_-7udrbsov9u3TV8ljX-3lfgCbZGSybWb0tl2H/s1600/2013-08_1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzLP4cLE6h5XN7pXAVa_6Xig5ecWbRmDkEl5SWgUK6jtCW2Ka1mn0ZG9oWCMfNqbkzJnTtpTwy743Owp_l0Smvkb89Oc3PszsFXtgoAy_-7udrbsov9u3TV8ljX-3lfgCbZGSybWb0tl2H/s320/2013-08_1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fun times with aunts! So sad the times are few and far between</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA6esxFUT2HPFOho-SltraAQ-vmlPRhZJKlXSFUulVU6e8CKTlEf07WYpEGzZEcvYNTz9lGN9LB06a4q3665c4wZI8R81kWAYRuNtjg9-wpRpPQP83k-fHShoUKD4AlDkKSUOm3mQ-KDjd/s1600/IMG_3960.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA6esxFUT2HPFOho-SltraAQ-vmlPRhZJKlXSFUulVU6e8CKTlEf07WYpEGzZEcvYNTz9lGN9LB06a4q3665c4wZI8R81kWAYRuNtjg9-wpRpPQP83k-fHShoUKD4AlDkKSUOm3mQ-KDjd/s320/IMG_3960.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My parents' tree was knocked down by a hailstorm, so Mr. L got to use a chain saw and help remove it.</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNDvHhpYuBsYTvCpDMlPeRnoeTPoydqy0Pj43oGGpgJICCy4s8O_ngJ_BrcY8d8nMCQXxrAcB92q_BC3j4uaWZQW6mABd9iN-rNo72hWKqK-wnpjqVU8c-4Ufculx_DbvYeWN7CB8oXZIu/s1600/IMG_4019.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNDvHhpYuBsYTvCpDMlPeRnoeTPoydqy0Pj43oGGpgJICCy4s8O_ngJ_BrcY8d8nMCQXxrAcB92q_BC3j4uaWZQW6mABd9iN-rNo72hWKqK-wnpjqVU8c-4Ufculx_DbvYeWN7CB8oXZIu/s320/IMG_4019.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Beautiful Los Alamos ski area.</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://sphotos-a-sjc.xx.fbcdn.net/hphotos-ash4/1003034_10151585780193616_385412529_n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://sphotos-a-sjc.xx.fbcdn.net/hphotos-ash4/1003034_10151585780193616_385412529_n.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px;">And last, but not least, a birthday visit from Baby's paternal grandparents.</td></tr>
</tbody></table>
Truly, we are blessed with so many things to keep us busy, and I am thankful! I'm also thankful for, and looking forward to, having nothing major planned over the next several months. I'm sure there will be plenty of ordinary everyday things to occupy our time and to be thankful for.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-2793327111797832642013-07-22T11:12:00.000-07:002013-07-22T11:12:08.940-07:00Sunscreen {and the tension with cancer prevention}<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZzhPnoRslngkF6BxKyKEEMd4O4VuAj9zty0dWIm_I8JRueABc8JqRcTCeMJJMyKocPWqT1k2UrJ0mkhE1AdRBO2PPnjdmuRxvLcR3vXZXkjLuTmCR3-RldxHpVYHSp4Gx0IwY9t_Wb3GB/s1600/IMG_2921.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZzhPnoRslngkF6BxKyKEEMd4O4VuAj9zty0dWIm_I8JRueABc8JqRcTCeMJJMyKocPWqT1k2UrJ0mkhE1AdRBO2PPnjdmuRxvLcR3vXZXkjLuTmCR3-RldxHpVYHSp4Gx0IwY9t_Wb3GB/s320/IMG_2921.JPG" width="213" /></a>I know everyone is probably sick of hearing about sunscreen by now, so I promise this is the last post about it. There were just so many different aspects to cover-- many more than I had originally thought of.<br />
<br />
The more I'm reading, the more I'm learning that skin cancer really is a concern, and I ought not to brush it off as something that doesn't affect me. Melanoma rates are rising every year in the United States, and overexposure to sun, especially in youth, appears to be linked to an increased risk of developing cancer later in life (1).<br />
<br />
If the the melanoma rates really are related to sun exposure, I'm curious what has changed. For example, common sense would tell me that, in general, the population spends less time in the sun today than 100 years ago, not more. But yet, the population certainly did not liberally apply commercial sunscreen 100 years ago (2).<br />
<br />
I found a few interesting speculations for why sun exposure might be more dangerous today then it was in past decades, and I think this could contribute to the rising rates of skin cancer. In <i>The Five Paradoxes of Vitamin D </i>(2)<i>, </i>Chesney states that between 1600 and 1960 the skies in general where simply darker because of the amount of coal in the air. Coal and coke were the primary fuel used to heat both homes and industry, and this contributed greatly to hazy skies, especially over cities. However, between 1950-65 the types of fuels the world used diversified--populations starting using nuclear energy, hydroelectricity, and other non-coal hydrocarbons (2). In the last several decades there has also been aggressive campaigns to reduce many kinds of emissions from industrialized countries and to promote "clean air".<br />
<br />
Another environmental factor that might contribute to the change of intensity from the sun is atmospheric dimming due to volcanic ash. Four catastrophic volcanoes erupted between 1815 and 1902: Tambora, Krakatoa, Santa Maria, and Mount Pelée. Tambora, which is in Indonisia, erupted in 1815 and was the most explosive eruption in 1300 years (170 times stronger than the Mt. St. Helens eruption in 1980). The atmospheric dimming was so noticeable that the following year, 1816 ,is known as "the year without a summer". Apparently, volcanoes in the 20th century have been less intense and the ash has been more localized which could be one reason dimming has fallen since 1990 (2). <br />
<br />
One last environmental factor to consider when thinking about environmental changes is the presence of CFC's in the stratosphere. When CFC's reach the stratosphere certain chemical reactions cause the depletion of the ozone layer. With the depletion of the ozone layer, a higher number of UVB rays hit the earth (2) and this could contribute to an increased need for protection from the sun.<br />
<br />
To be honest, I'm nowhere near an expert at environmental science. One question I have about atmospheric dimming is that if it didn't start declining until 1990 (and I believe it's been a pretty gradual decline), then would that really contribute to the increase in skin cancer we see today? As Mr. L pointed out, that would depend on how long it takes for skin cancer to develop. Are the effects that noticeable within a 23 year window? I just don't know enough about the etiology of skin cancer to answer this question.<br />
<br />
So, to conclude this series on sunscreen and vitamin D, it appears that it probably <i>is</i> important to protect ourselves from the sun, but this doesn't diminish the importance of vitamin D. Some studies have associated a deficiency in vitamin D with autoimmune disease, fractures, cancer, and cardiovascular disease (1). A prior NHANES suggested that low vitamin D levels were even associated with all-cause mortality (1). When thinking about how I should ensure that my family receives enough vitamin D this is a big tension for me, since I prefer not to rely on supplements for essential parts of our diet, but I also don't want to significantly increase our risk of skin cancer (yes, there are dietary sources of vitamin D, but I think it's unlikely that we would get enough from our diet).<br />
<br />
I do plan on being more consistent with sunscreen (since at least in <a href="http://excellenceetc.blogspot.com/2013/07/sunscreen-protection-methods.html" target="_blank">one large study</a> it didn't appear to be associated with vitamin D deficiency), but until I'm more convinced that moderate, non-sunburning sun exposure is a significant risk factor for developing skin cancer, I'm still not planning on slathering it on every day.<br />
<br />
<span style="font-size: x-small;">(1) Dart H, Wolin KY, Colditz GA. Commentary: eight ways to prevent cancer: a framework for effective prevention messages for the public. Cancer Causes Control. 2012 Apr;23(4):601-8. doi: 10.1007/s10552-012-9924-y. Epub 2012 Feb 26. </span><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685578/?report=reader">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685578/?report=reader</a>. <span style="font-size: x-small;"> Accessed 7/11/2013.</span><br />
<span style="font-size: x-small;">(2)Chesney, RW. The five paradoxes of vitamin D and the importance of sunscreen protection. Clin Pediatr (Phila). 2012 Sep;51(9):819-27. doi: 10.1177/0009922811431161. Epub 2011 Dec 12. http://www.ncbi.nlm.nih.gov/pubmed/22166748. Accessed on 6/3/13.</span><br />
<span style="background-color: white; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: xx-small; line-height: 14px;">(3)Linos E., et al.. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003-2006. Cancer Causes Control. 2012 Jan;23(1):133-40. doi: 10.1007/s10552-011-9862-0. Epub 2011 Nov 2.</span><a href="http://www.ncbi.nlm.nih.gov/pubmed/22045154" style="background-color: white; color: #a17c82; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: x-small; line-height: 14px; text-decoration: none;">http://www.ncbi.nlm.nih.gov/pubmed/22045154</a><span style="background-color: white; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: xx-small; line-height: 14px;">. Accessed on 7/9/13. </span>Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-80823195013151539952013-07-19T12:47:00.000-07:002013-07-19T12:47:14.428-07:00quick link, and happy weekend!Happy Friday, dear readers! I'm looking forward to a fairly low-key weekend before a very busy next month or so starts for us. I hope you have a lovely weekend ahead of you too.<br />
<br />
But anyways, I just found an article on the New York Times,<a href="http://parenting.blogs.nytimes.com/2013/07/19/dear-parents-please-ignore-the-latest-research/?smid=tw-NYTMotherlode&seid=auto" target="_blank"> Dear Parents: Please Ignore the Latest Research</a>, and thought the message was timely and that you might enjoy the read.<br />
<br />
Nicholas Day does a good job of highlighting the ridiculousness of letting our parenting decisions be too heavily influenced by what new research finds and what the media reports:<br />
<blockquote class="tr_bq">
"Science works in small, boring ways. Findings have to accumulate, and they take their time to do so. They rarely arrive in a baby-manual-ready bundle, already replicated, with a massive data set backing up the conclusions. <i>Unless you are a scientist doing infancy research yourself, a single study means very little. It has meaning inside the discipline; it has far less meaning inside the home</i>."</blockquote>
One of the examples he uses is a recent psychology study that suggested that baby boys who used pacifiers were likely to have difficultly expressing emotion later in life. Regarding this, Day says:<br />
<blockquote class="tr_bq">
"This sort of study is almost always <i>tentative and highly contingent. It’s a single data point in a very complicated matrix</i>. Parents rarely recognize this. And you don’t have to wonder why. Here’s how <a href="http://www.jsonline.com/features/health/pacifiers-may-stunt-boys-emotional-growth-uw-study-says-2a6t7ss-170123616.html">the pacifier study was covered</a>: “Parents who don’t want their baby boys to grow up emotionally stunted may want to pocket their pacifiers during the daytime.” Your call! If you want your boy to be emotionally stunted, feel free to keep using it! "</blockquote>
Basically, Day concludes that science is important and useful, but that we shouldn't let new sensational studies influence our day-to-day parenting (you should just read the article though, it's not that long).<br />
<br />
To me, this article perfectly highlights the great need for God's wisdom and the Bible in parenting and decision making. Science will continuously publish and discover new things about babies and children; however, in years to come, some of this research will be forgotten, some likely reversed, and some confirmed as true. However, God's wisdom is timeless-- it's not new or sensational, but it is true. Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-57442647810495456672013-07-14T14:28:00.000-07:002013-07-14T14:28:15.001-07:00Sunscreen {protection methods}<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidvrlrI-EA8Yreqk60AufXXgN9sfNXwZ1mkzra1YbLJqf788p7YdYyHdslk_dnk-YqlYOdUNdv5o8PZkkRrvwUQxOa4HHAejxm64iPbTfE848r5ghgK-sIOQDcKSEY3eMK9TTKWgacZNv_/s1600/IMG_1597+%25282%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidvrlrI-EA8Yreqk60AufXXgN9sfNXwZ1mkzra1YbLJqf788p7YdYyHdslk_dnk-YqlYOdUNdv5o8PZkkRrvwUQxOa4HHAejxm64iPbTfE848r5ghgK-sIOQDcKSEY3eMK9TTKWgacZNv_/s320/IMG_1597+%25282%2529.jpg" width="320" /></a></div>
Sunscreen is one of many ways we can protect ourselves from the sun, but it's not the only way. Shade, long sleeves, and hats also work well in protecting us. I was surprised to learn that people who tend to seek shade and wear long sleeves where more likely to be vitamin D deficient than people who reported regularly using sunscreen (1). Part of the reason this surprised me is that for years I've thought in the back of my head that sunscreen was greatly contributing to the epidemic of vitamin D deficiency, but inasmuch as my reading has shown me, this is probably not the case. <br />
<br />
The CDC started The National Health and Nutrition Examination Survey (NHANES) in the early 1960's to conduct nation-wide surveys to gather statistics of various population groups and health topics. In 1999 the program became an ongoing survey that examines about 5,000 people each year regarding emerging health and nutrition topics. The data NHANES collects is available for researchers to analyse and use, or for agencies to utilize in evaluating and implementing health policy. One example of NHANES data in use is the growth charts that doctors use to see how well babies and children are growing (2). <br />
<br />
Between 2003-2006 NHANES collected data regarding sun protection habits and the levels of vitamin D in participants' blood. Linos, et al., analysed this data and published a paper examining what they found (1). Below is a graph from their paper that illustrates part of what they found-- that for all races combined, two factors, staying in the shade and wearing long sleeves, were significantly associated with lower vitamin D levels, while frequency of wearing hats or using sunscreen were not associated with lower vitamin D levels.<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnx__tlNyN4S_N-w7GlT0CMPyCnpQWdtqUD9iUQvLBb1Q0FsIO0kV-YLQKdbRugieObJPVo2mnetn1IECRlO-uPlOt-W4OPMuGvQIh8HmaSusNeXHUQ9f9FUapLTGh_EgzQgjYPmZhCPEt/s1600/graphTypesOfSunProtection.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="293" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnx__tlNyN4S_N-w7GlT0CMPyCnpQWdtqUD9iUQvLBb1Q0FsIO0kV-YLQKdbRugieObJPVo2mnetn1IECRlO-uPlOt-W4OPMuGvQIh8HmaSusNeXHUQ9f9FUapLTGh_EgzQgjYPmZhCPEt/s320/graphTypesOfSunProtection.JPG" width="320" /></a></div>
The NHANES data is a survey intended to gather information about the population at a specific point in time--this study design is called a cross-sectional study. Cross-sectional studies are the simplest of all study designs, but also one of the weakest(3). This type of study is often used to asses prevalence; for example, in this paper the authors measured the prevalence of vitamin D deficiency in different subsets of the population. The major weakness of this design, however, is that because of the lack of any time dimension (all data is gathered at the same time) it is extremely difficult to establish any semblance of causality (3). Because of this major design limitation we need to be careful not to make too strong of a conclusion from this study.<br />
<br />
I think what they found is interesting-- I wouldn't have guessed that sunscreen was not associated with vitamin D deficiency, but that shade and long sleeves were associated. Although we certainly can not say that shade and long sleeves <i>cause</i> deficiency it is instructive to consider this association when thinking about our sun protection options. We should realize that it's possible that protective clothing may be much more effective at protecting us from the sun than sunscreen-- this may be good or bad depending on what your goals are.<br />
<br />
Although causality can't be established by this study, I still think it makes a fairly strong case that sunscreen is not single-handedly causing the epidemic of vitamin D deficiency. For me, I think this means that I'll worry less about using sunscreen, but also that in certain situations I'll be more likely to seek shade, since that is apparently one good way to protect myself from overexposure to the sun. <br />
<span style="font-size: x-small;"><br />
</span> <span style="font-size: x-small;">Photo Credit: Sanny Hauck</span><br />
<span style="font-size: x-small;"><br />
References:</span><br />
<span style="font-size: x-small;">(1)Linos E., et al.. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003-2006. Cancer Causes Control. 2012 Jan;23(1):133-40. doi: 10.1007/s10552-011-9862-0. Epub 2011 Nov 2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22045154">http://www.ncbi.nlm.nih.gov/pubmed/22045154</a>. Accessed on 7/9/13. </span><br />
<span style="font-size: x-small;">(2) National Center for Health Statistics. National Health and Nutrition Examination Survey 2013-2014 Overview: Let's Improve Our Health. <a href="http://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/2013-14_overview_brochure.pdf">http://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/2013-14_overview_brochure.pdf</a>. Accessed on 7/11/2013</span><br />
<span style="font-size: x-small;">(3) Elwood, M. <i>Critical Appraisal of Epidemiological Studies and Clinical Trials: Third Edition. </i>Oxford: Oxford University Press, 2008. p. 25-6, 46. </span>Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-58843707773080231892013-07-08T11:06:00.000-07:002013-07-08T11:26:41.835-07:00"bundling" vs. sipping and snackingEarly in June I remembered that I had a dental radiology license that needed renewing by the end of the month, and in order to renew it, I needed 30 hours of continuing education (yikes!). Thankfully, acquiring the hours wasn't as bad as I anticipated since I was able to finish them online during nap times and in the evening. <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2RBwcPx8YJ0STK_9YPbx4rD4pVU6Y_LZUSWzQrJ6gvphZ7GxhzaXWZLngVZwpuj7Sees9dEOC_GjZdrx7_QPIGAscUM-Brm7T05vD0KtXyG9MRelkSgSNWwyR_JxKlh22kGbMIdeh2dPq/s1600/100_1433.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="264" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2RBwcPx8YJ0STK_9YPbx4rD4pVU6Y_LZUSWzQrJ6gvphZ7GxhzaXWZLngVZwpuj7Sees9dEOC_GjZdrx7_QPIGAscUM-Brm7T05vD0KtXyG9MRelkSgSNWwyR_JxKlh22kGbMIdeh2dPq/s320/100_1433.jpg" width="320" /></a></div>
<br />
One of the courses I took, <a href="http://www.adaceonline.org/index.aspx?sec=olce&sub=ce&pag=cmain&ce_id=1261" target="_blank">Interviews with the Experts, Key Topics in Dentistry Today</a>, spent a few minutes talking about parenting and children's dental health. Although nothing that Dr. Lott shared was ground breaking, I think some of it is worth sharing.<br />
<br />
As a side note, unlike most of my other posts where I spend time examining published research, this post is different since I will only be summarizing "expert opinion". Expert opinion is an important way that we know things, but it is not as reliable as certain other ways of knowing. (Sometime I'll have to write a post about the hierarchy of evidence.) For this reason, you won't find a list of references at the bottom--I'm simply reporting on one pediatric dentist's opinion.<br />
<br />
With that disclaimer, one habit that greatly contributes to the demise of oral health is sipping and snacking. I'm not particularly great at controlling this in my life (to be honest, I have quite a sweet tooth), but it truly is important. As a mom, I certainly see the appeal of feeding kids food throughout the day to keep them happy and quiet (especially when under social pressure!) but as a former dental professional I cringe inside when I consistently observe it. <br />
<br />
The concept that Dr. Lott talked about to combat sipping and snacking was the idea of "bundling". If your child drinks juice or eats dessert, bundle it with the meal. Don't eat lunch, let your child play for an hour, and then offer dessert, but let them eat it all at the same time. Don't let your child sip on juice throughout the day, but instead, treat it as a part of their meal. One reason this is so important is that your teeth don't care that much about how <i>many</i> fermentable carbohydrates (e.g. sugars, starches, fruits) they are exposed to at one sitting, but rather <i>how often</i> they are exposed. Perhaps think of it like a cut that you get on your hand, if you wash it and then leave it alone it will get better much quicker than if you don't wash it but instead irritate it every half hour and rub dirt on it multiple times during the afternoon. Obviously the illustration only goes so far, but the point is that certain foods weaken your teeth, and prolonged exposure only exacerbates the problem. (<a href="http://www.mayoclinic.com/health/cavities/DS00896/DSECTION=causes" target="_blank">Mayo Clinic</a> has a reasonable explanation of how tooth decay forms.)<br />
<br />
Like most habits that we want to discourage in our children, it's important to take a look at what our habits are. Take the sippy cup, for example. Do you have an adult version of the sippy cup? We know that it's best for the toddler to not carry a cup with juice in it around all day, but do I do this in my adult way? I prefer to sip on coffee throughout the morning, but really, I ought to bundle it with my breakfast, or at least drink it in one prolonged sitting when I'm doing my morning devotions.<br />
<br />
When thinking about sipping and snacking, for me, it's not just the immediate disadvantages that bother me, but it's the habit that you're fostering, a habit that your child may struggle with for his entire life.<br />
<br />
<br />Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-32656557310209785612013-06-06T21:45:00.000-07:002013-07-14T14:27:25.277-07:00Sunscreen {a historical perspective}I've always thought that sunscreen smells bad, feels bad, and is just generally inconvenient. Since I also know that vitamin D is important for many reasons, and your body synthesizes it from the sun, I generally use the excuse of “getting my vitamin D” for not applying sunscreen as often or as liberally as recommended. <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvsc9Ga4-J2RFcipjMgL7OcfMWnAdBEsApvsDXuY9mfAeZ-uoc_7GkKJ-Q2qGCtJ8aAykdkSgat7g0B-ZkRL1UQFWNapcCYoaV-duuOGRd-TKBGejr9jMrHH7v1yXrj5RCVRsYDTQz1_FJ/s1600/IMG_1857.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvsc9Ga4-J2RFcipjMgL7OcfMWnAdBEsApvsDXuY9mfAeZ-uoc_7GkKJ-Q2qGCtJ8aAykdkSgat7g0B-ZkRL1UQFWNapcCYoaV-duuOGRd-TKBGejr9jMrHH7v1yXrj5RCVRsYDTQz1_FJ/s320/IMG_1857.JPG" width="212" /></a></div>
<br />
Since sunscreen season is fully upon us, I thought a post (or perhaps a series of posts) <br />
looking at what the evidence has to say about sunscreen would be timely. Today we’ll start with a historical perspective.<br />
<br />
In <i>The Five Paradoxes of Vitamin D and the Importance of Sunscreen Protection</i>, Russell Chesney takes time to look at the history and relationship between vitamin D and sunshine. Below is a short summary and review of his journal article published in Clinical Pediatrics.<br />
<br />
<a href="http://en.wikipedia.org/wiki/Rickets" target="_blank">Rickets</a>, a vitamin D deficiency disorder, first emerged in England around the start of the industrial revolution and reached epidemic proportions by 1650. At first, it was puzzling that rickets was much less prevalent in the tropics and in rural areas, but as the link between vitamin D and rickets and the sources of vitamin D became known, this observation made sense. By 1930, it was well understood that vitamin D deficiency caused rickets and that there were 2 “sources” of vitamin D, a substance found in cod liver oil, and sunshine. Due to the nature of extreme latitudes, the coal in the air above cities to filter the sunlight, and the habits of city dwellers, it made sense that those who lived in cities would receive less sunlight, and therefore be more susceptible to vitamin D deficiency and rickets.<br />
<br />
In 1931, The <a href="http://www.acf.hhs.gov/programs/cb/about/history" target="_blank">Children’s Bureau</a> strongly advised parents to suntan infants and give them cod liver oil. At this time in history, the value of sunlight exposure was highly stressed, while there was little thought given to potential skin damage. (How far we have swung to the other side, when we now recommend little to no sun exposure for the first 6 months!)<br />
<br />
Around 1985 it was observed that skin cancer rates were increasing. With this observation came the real fear of developing skin cancer from exposure to sunlight. Sun exposure recommendations therefore changed, and today the AAP and the American Academy of Dermatology recommend shelter form sun and liberal sunscreen use. However, adhering to these recommendations necessitates vitamin D supplementation by mouth in order to prevent deficiency. <br />
<br />
It is interesting to me, but not surprising, that opinions of whether vitamin D should be absorbed from the sun or ingested through diet/supplements are highly influenced by the current opinion concerning the potential harmfulness of the sun. <br />
<br />
It’s estimated that a large percentage of the United States is vitamin D deficient, and I’m curious if this could be related to our sun protection behaviors. Also, is there any reason that the sun might be stronger today and consequently require more “protection” from than in the past? Or is this obsession with sun protection just a result of our safety obsessed society? Next week, I hope to address some of these questions.<br />
<br />
But enough of me talking, what is your relationship to sunscreen? Do you practically hate it too?<br />
<br />
<span style="font-size: x-small;">References:</span><br />
<span style="font-size: x-small;">Chesney, RW. The five paradoxes of vitamin D and the importance of sunscreen protection. Clin Pediatr (Phila). 2012 Sep;51(9):819-27. doi: 10.1177/0009922811431161. Epub 2011 Dec 12. http://www.ncbi.nlm.nih.gov/pubmed/22166748. Accessed on 6/3/13.</span>Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-67796952100282764292013-05-07T07:30:00.000-07:002013-05-07T07:30:00.933-07:00Pursuing Christ-glorifying priorities<br />
At the beginning of the year about the time I (re)started blogging, I was thinking about priorities and how they contribute to excellence. Funny how certain things continually resurface. After a few hiccups, I think things are finally starting to fall in order again here at our little home, but it's crazy how easy it is for things to get out of hand (sin and the second law of thermodynamics in action, I guess). <br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbnAGNXc1OFtFHE1pRou3KgVoEau3VIyuE2qbQjW118WO-BWB1B3ourGJeBwVIOs_DFM4-JthbU-sSg0UAm9HD7fZvaa6d1gqhQtS0gFO5D57Th2AqzcIICwKjMOBi1TF18U9XVYRuzR7d/s1600/IMG_1519.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbnAGNXc1OFtFHE1pRou3KgVoEau3VIyuE2qbQjW118WO-BWB1B3ourGJeBwVIOs_DFM4-JthbU-sSg0UAm9HD7fZvaa6d1gqhQtS0gFO5D57Th2AqzcIICwKjMOBi1TF18U9XVYRuzR7d/s320/IMG_1519.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
When it comes to priorities and managing my home wisely, I think the difficulty lies in the fact that too often, what ought to be done at a given moment is really not what I<i> want</i> to do at that moment. But yet, if I want to keep things moving in the right direction I need to keep my priorities in line with what God would have for me, and consistently choose the right "next thing" to do. Persevering in choosing the right "next thing" can be hard for me, especially if that "next thing" is to clean the tub, or to start dinner when I'd really rather have some computer time. <br />
<br />
I originally had high hopes for multiple posts a week here at Excellence, Etc., but I'm afraid if dinner won't be ready on time, or my home is not orderly, or my son needs attention I can't really glorify God by sitting down to write. It's just a hobby for me, so it falls pretty low on the priorities list.<br />
<br />
In their proper place, I believe that some hobbies can be Christ-glorifying, refreshing, and edifying, but how do you fit hobbies and things you enjoy into your already full day?<br />
<br />
I've been trying to be more efficient at keeping my house clean (which is the biggest time sink/area of avoidance for me) as well as planning further ahead by starting dinner early in the afternoon. This way, when Baby sleeps longer, or I somehow have some "extra" time, I'm caught up on the essentials and can sit down at the computer and have some time to write without having neglected my higher priorities.<br />
<br />
Have you found any ways to be more efficient so you can have time to do some "optional" but enjoyable activities? I'd love to hear any other ideas about how you keep your priorities in order!Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-84222643504145555022013-05-01T15:06:00.001-07:002013-07-08T11:07:47.492-07:00The weekly dose: xylitol-- a good augment to fluoride?<i style="background-color: white; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;"><span style="font-size: xx-small;">{About once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}</span></i><br />
<i style="background-color: white; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;"><span style="font-size: xx-small;"><br /></span></i>
When I was reading and writing about <a href="http://excellenceetc.blogspot.com/2013/04/the-weekly-dose-baby-has-teeth-and-how.html" target="_blank">oral hygiene for children under two</a>, I came across an interesting recommendation from the American Academy of Pediatric Dentists regarding maternal oral hygiene. In their recommendations on <a href="http://www.aapd.org/media/Policies_Guidelines/G_infantOralHealthCare.pdf" target="_blank">Infant Oral Health Care</a>, they say that, "Evidence suggests that the use of xylitol chewing gum (at least 2-3 times a day by the mother) has a significant impact on mother-child transmission of MS [<i>mutans Streptococci</i>] and decreasing the child’s caries rate.” It seems likely to me (or at least biologically plausible) that if chewing xylitol gum can reduce the transmission of bacteria it could also reduce the mother's susceptibility to get cavities herself. I wanted to see what the evidence had to say about xylitol and gum chewing.<br />
<br />
The question I'm interested in today is, is xylitol chewing gum effective at preventing dental cavities?<br />
<br />
It turns out that xylitol has been talked about and studied for some time in relation to dental cavities. The oldest applicable reference on <a href="http://www.ncbi.nlm.nih.gov/pubmed" target="_blank">Pubmed</a> is from 1970-- "<a href="http://www.ncbi.nlm.nih.gov/pubmed/5438802" target="_blank">The effect on rat fissure caries of xylitol and sorbitol</a>." Despite the fact that study was published 43 years ago, and that there have been multiple published trials in the last decade there is still no firm consensus about xylitol, especially when it comes to the adult population (1). The American Dental Association published a report on Non-fluoride Caries Preventative agents in 2011 and addressed many different preventative treatments to supplement fluoride use (2).<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXxFFPZZLX10rYP8_kUs5nkwpoGN75CGdNM46F6dLw_YCdpqtFqNzecWVh8eg71dSn6vx24e1JLGYngvBVxgqmP2ZsJljErcRBTV5jE-FfAlfidDs7qRu5k6YnYttcHH_sdhmc-qQaPMnv/s1600/ADATable5.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="335" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXxFFPZZLX10rYP8_kUs5nkwpoGN75CGdNM46F6dLw_YCdpqtFqNzecWVh8eg71dSn6vx24e1JLGYngvBVxgqmP2ZsJljErcRBTV5jE-FfAlfidDs7qRu5k6YnYttcHH_sdhmc-qQaPMnv/s400/ADATable5.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">ADA recommendations (2)</td></tr>
</tbody></table>
In the report published by the ADA, the panel concluded that the evidence supporting adults chewing xylitol gum was relatively non-existent, and so this recommendation only earned a strength of "expert opinion". In the figure I attached you can see that the strength of the recommendation for chewing xylitol (or another polyol gum) is actually "stronger" for children. This is because most of the research that has been done surrounding xylitol and chewing gum as an anti-caries agents have focused on children.<br />
<br />
When studying xylitol chewing gum it can be difficult to distinguish between the gum and the xylitol, since it is biologically plausible that gum chewing in itself could reduce the incidence of cavities. This is because the act of chewing might both increase the rate at which any left over food is removed from the mouth, and increasing salivation(2). Because of this, it is unfortunate that there has not been a study that compared xylitol gum to other sugar free gums. This fact significantly contributes to the "weak," or "expert opinion" ratings that you see in the figure for the recommendations to use xylitol gum(2).<br />
<br />
Earlier this year, a fascinating 3-year trial was published that looked at the effects of xylitol on the incidence of cavities in adults (1) (Medscape has a pretty good summary <a href="http://www.medscape.com/viewarticle/777731" target="_blank">here</a>, if you're interested but don't want to read the original). This study did not look at chewing gum, but instead used xylitol lozenges. Even though this study doesn't directly relate to my question, I think it is a well designed study (well, at least the study lasted longer than a year and was a randomized controlled trial) and can contribute to our understanding of xylitol. The authors concluded that in adults, xylitol lozenges have little or no effect on caries. Although they did see a small reduction in the incidence of cavities in the experimental group, it was not large enough to be significant. One interesting observation the authors make is that because of the small magnitude of reduction in cavities (~10%), previously published trials could have either missed or magnified this relationship due to unintentional incorporation of bias. <br />
<br />
So, where does all this leave us? After nearly two weeks of thinking off and on about xylitol gum, do I have an answer for my question? Is chewing xylitol gum an effective measure against dental cavities? I think I can conclude that there is no strong, evidence-based support for this, but that there is a possibility that chewing (sugar free) gum may mildly help to reduce the incidence of dental cavities. And, since the gum I buy contains xylitol, I will be chewing xylitol gum. But, since the recommendations are so weak, I won't be seriously working on changing my gum chewing habits. (Although, to be honest I'm chewing gum right now, and I think I've chewed a little more than previously since starting the post. ;) )<br />
<br />
How about you? What are your gum-chewing habits?<br />
<br />
<br />
<span style="font-size: x-small;">(1) Bader, JD, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J Am Dent Assoc. 2013 Jan;144(1):21-30. Accessed from <a href="http://www.ncbi.nlm.nih.gov/pubmed/23283923" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/23283923</a> on 4/30/2013.</span><br />
<span style="font-size: x-small;"><br /></span>
<span style="font-size: x-small;">(2) Rethman, MP, et al. Non-fluoride Caries Preventative Agents: Full report of a systematic review and evidence-based recommendations. ADA Center for Evidence Based Dentistry, 3/24/2011. Accessed from <a href="http://ebd.ada.org/contentdocs/clinical_recommendations_non_fluoride_caries_preventive_agents_full_report.pdf" target="_blank">http://ebd.ada.org/contentdocs/clinical_recommendations_non_fluoride_caries_preventive_agents_full_report.pdf</a> on 4/30/2013</span>Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-37606238800583476532013-04-19T18:49:00.002-07:002013-04-19T18:50:12.527-07:00motherhood, a lesson in thanksgiving<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4zNRCSYu_hQ2kJ_0_IxLjogwVAqIE-nt618EQmuz4frN3f26Z4qzf7LWNIXgA6z_750z2FkivygterzKoMP5njGWQgA9nCifCNfofv1ZC5lYizdbZG9TulBZb1EvSIguxybqmnbU5burA/s1600/IMG_1459.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4zNRCSYu_hQ2kJ_0_IxLjogwVAqIE-nt618EQmuz4frN3f26Z4qzf7LWNIXgA6z_750z2FkivygterzKoMP5njGWQgA9nCifCNfofv1ZC5lYizdbZG9TulBZb1EvSIguxybqmnbU5burA/s400/IMG_1459.JPG" width="400" /></a></div>
More than anything else I've experienced in my life, motherhood has shown me the need to start the day (and night!) with an attitude of humility, knowing that I don't deserve anything good, and that all good things I do receive (and there are many!) are a gracious gift from my Heavenly Father. <br />
<br />
I think the reason motherhood highlights this for me is the frequency and intensity with which my desires are thwarted. Babies are just so needy and, at times, unpredictable.<br />
<br />
Baby has finally started sleeping through the night again, but there was a period over the last few months where we were travelling on and off, he was teething, and then we were sick, so he was definitely not consistently sleeping through the night. When I was needed, I'd get out of bed, assess his needs, attempt to meet his needs, comfort him back to sleep, and then crawl back to bed myself. This got old rather quickly, and my heart would start to grumble, telling me that I deserved sleep, or wondering why it was always my "turn" to take care of Baby.<br />
<br />
One morning after my heart had been particularly grumbly, I took the time to sit down and study and remind myself of what God had to say in the Bible about grumbly hearts. It struck me that this attitude really all comes back to the idea of what I deserve. <br />
<br />
The reality is, as much as I'd like to think otherwise, I don't deserve anything good, since I am by nature a child of wrath (<a href="http://nasb.literalword.com/?q=Ephesians+2" target="_blank">Ephesians 2</a>). (This attitude sure fosters humility, doesn't it?!) Yet, God gives me many good things (life! a son! rest!) (<a href="http://nasb.literalword.com/?q=James+1%3A17" target="_blank">James 1:17</a>). God is always good, even when life interferes with my personal desires, and my attitude ought to reflect this magnificent goodness.<br />
<br />
When we cultivate this attitude of humility--because the good things we receive are gifts, and not something we deserve, it becomes oh so much easier to be thankful in all things and to replace our grumbly hearts with happy hearts!Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-80961364077510008082013-04-11T15:03:00.000-07:002013-07-08T11:07:58.543-07:00The weekly dose: Baby has teeth! (and how shall I care for them?)<i style="background-color: white; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;"><span style="font-size: xx-small;">{<span style="font-size: xx-small;">About o</span>nce a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}</span></i><br />
<br />
Last week I spilled the beans that Baby has two little teeth. They're so cute! (Or at least I think they are.) Even though it's recommended that you wipe your baby's gums with a wet washcloth from the time he's born, I really haven't been that consistent at caring for his gums, but the advent of actual teeth is certainly motivation enough for me to become consistent and establish a good oral care routine for Baby. <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1OnAEi9CB9fdRcXc8HdlxTPChMCcbcczMLOmLrdPqWOoUL2UJQcWgwqw245m_kMLjCIQozzL60zW3B2j2VRZdppOF6DlGb7F3w8l7K-Oi3YNBoRDGqCDxY7m4w-IwLo-0H6GoGGrd2po2/s1600/IMG_1333.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1OnAEi9CB9fdRcXc8HdlxTPChMCcbcczMLOmLrdPqWOoUL2UJQcWgwqw245m_kMLjCIQozzL60zW3B2j2VRZdppOF6DlGb7F3w8l7K-Oi3YNBoRDGqCDxY7m4w-IwLo-0H6GoGGrd2po2/s1600/IMG_1333.JPG" height="320" width="319" /></a></div>
<br />
I have a fairly high risk for cavities, or caries, so unfortunately that puts Baby at a high risk too. Because of this, it's especially important to me to establish good habits for Baby to minimize (hopefully prevent!) cavities both with his baby teeth now, and then later with adult teeth. <br />
<br />
It is known that diet plays a huge role in oral health, and that certain feeding habits are strongly associated with early childhood caries(1), but today, I will be focusing only on the actual oral care routine and not the other factors that may contribute to early childhood caries (ECC). I just want you to remember and know that simply using the right toothbrush and toothpaste, even if used consistently, is probably not enough to ward off all early childhood caries. In technical terms, caries are an infectious disease with a multifaceted etiology (2).<br />
<br />
Before we go any further, the question I seek to answer today is, what is the best way to care for a baby's (< 2 years old) teeth?<br />
<br />
After a quick Google search, it became evident that there are many different opinions about what is the best way to care for a baby's teeth, the main differences being whether to use a fluoride-containing toothpaste, or "training" toothpaste, and whether to use a baby washcloth, or a baby toothbrush. To highlight this disparity, the American Dental Association (ADA) <a href="http://www.ada.org/4052.aspx#shouldchildrenuse" target="_blank">recommends against fluoride toothpaste</a> for children under two unless told otherwise by a dentist, while the American Academy of Pediatric Dentistry (AAPD) says a qualified yes for fluoride for children under two(2).<br />
<br />
The best resources I found this time where the policy reviews by the <a href="http://www.aapd.org/" target="_blank">AAPD</a>. Fortunately, the policy reviews are well notated and not based solely on expert opinion. I tried a few <a href="http://www.ncbi.nlm.nih.gov/pubmed" target="_blank">PubMed</a> searches, but was sadly fairly unsuccessful on that front. <br />
<br />
In regards to infant oral hygiene, the AAPD's policy is that:<br />
<blockquote class="tr_bq">
<blockquote class="tr_bq">
"Toothbrushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size. In children considered at moderate or high caries risk under the age of 2, a ‘smear’ of fluoridated toothpaste should be used. In all children ages 2 to 5, a ‘pea-size’ amount should be used." (2)</blockquote>
</blockquote>
They even included a picture of what a "smear" versus "pea-size" amount of toothpaste is.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1v0oGGKhzKKFCzVoeZEVxtl0D9L0WZLjpIZPqnMD9ht6wtewLH3IGbgAW3isgggtEVbFONegFa5d5bQLxqYBWsdYMNV-nP-2q2afpF44l-ZSxSMuWyPe3Pm4PwqX4fe8k2Jq0qSSlvgOi/s1600/smearVsPeaSize.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1v0oGGKhzKKFCzVoeZEVxtl0D9L0WZLjpIZPqnMD9ht6wtewLH3IGbgAW3isgggtEVbFONegFa5d5bQLxqYBWsdYMNV-nP-2q2afpF44l-ZSxSMuWyPe3Pm4PwqX4fe8k2Jq0qSSlvgOi/s400/smearVsPeaSize.JPG" height="221" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
It makes me happy to see recommendations that allow for flexibility to be tailored to an individual's needs, since truly, one size rarely fits all. I suppose also that this flexibility could explain the difference between the AAPD's policy and the ADA's policy-- maybe the ADA is assuming a low risk for people reading their webpage(?).</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Well, the suggestion to use a smear of fluoride toothpaste is in line with what my dentist recommended when I asked him about it a few weeks ago. As far as toothbrushes versus baby washcloths go, my dentist suggested the washcloth until baby has more teeth since it's probably a little easier to get into Baby's mouth and actually clean the teeth than it would be with a toothbrush. Once Baby has molars, if not before, I'll certainly plan on switching over to a baby toothbrush though. </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
We can't forget about flossing though! Well, maybe we can since without teeth that touch, there's no need to floss.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Happy toothbrushing!</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<span style="font-size: x-small;">(1) American Academy of Pediatric Dentistry. (2012). Policy on the Dietary Recommendations for Infants, Children and Adolescents. Reference Manual V 34/No 6. pages 56-58. </span><br />
<span style="font-size: x-small;">(2) American Academy of Pediatric Dentistry. (2011). Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Reference Manual V 34/No 6. pages 50-52. </span><br />
<span style="font-size: x-small;"><a href="http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf">http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf</a>. Accessed 4/11/13.</span><br />
<br />
<br />Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com2tag:blogger.com,1999:blog-6430955650295165920.post-36531856631619965212013-04-05T11:57:00.002-07:002013-04-05T11:57:51.734-07:00living life at homeThis week has been full of many little things, getting back from our visit to New Mexico, fighting colds, switching to two-naps-a-day for the little one, and starting a spring cleaning challenge, to name a few. Oh right, and then there was Easter too. It's been a good week, I just haven't had time to prepare the post I was hoping to.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVtcqhqEgg_bWc7QB1Cfnjw1QV2QMf5BYkHc3HK7JgJzJN5PCldI7EJnKsZ70thQ-9QUThNb5nd_JABMVRu5Y0CoFp9yZaPiv3Wj5ELpRlXDJx4PZtd1mjCJeW1R3IDjmdrcfkBxdy7hsI/s1600/IMG_1277.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVtcqhqEgg_bWc7QB1Cfnjw1QV2QMf5BYkHc3HK7JgJzJN5PCldI7EJnKsZ70thQ-9QUThNb5nd_JABMVRu5Y0CoFp9yZaPiv3Wj5ELpRlXDJx4PZtd1mjCJeW1R3IDjmdrcfkBxdy7hsI/s1600/IMG_1277.JPG" height="319" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">time at the zoo with Nana and Papa!</td></tr>
</tbody></table>
<br />
My friend Tifo and I have been planing on doing a cleaning challenge for some time, and we finally <a href="http://tiffomelon.wordpress.com/2013/04/01/spring-cleaning/" target="_blank">started this week</a>. So instead of gaining more head knowledge and blogging about it, I am (hopefully) gaining a cleaner home. It's been a real challenge for me to try and fit in the extra cleaning projects-- our home needs them done so bad, but it seems like I'm doing well most weeks if all the laundry is put away and the floors vacuumed. After yesterday, the fridge looks much better though!<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNbbkhLYW8DTQq0BPSbqPgMXmFFl_k568FCI7VnHpZRgVNkohuXtTSC3RuGrdYtnYyP4aErEcfoSKUGjGvip1IdX53QJqU7c2chDoCaZFnZm95wB00fwxmE6iRw-B5KvC-LWRP8_wia1L3/s1600/IMG_1506_2.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNbbkhLYW8DTQq0BPSbqPgMXmFFl_k568FCI7VnHpZRgVNkohuXtTSC3RuGrdYtnYyP4aErEcfoSKUGjGvip1IdX53QJqU7c2chDoCaZFnZm95wB00fwxmE6iRw-B5KvC-LWRP8_wia1L3/s1600/IMG_1506_2.JPG" height="320" width="319" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">look! I have teeth!</td></tr>
</tbody></table>
As you can see, Baby now has teeth! When we were in New Mexico, he got to meet our favorite dentist, and dare I say it, he even liked the office. Maybe he'll be a dentist when he grows up ;). <br />
<br />
Next week I hope to write a post about caring for baby teeth... there are so many varying and different opinions on the web, but like usual, we will look at what the available evidence has to say. <br />
<br />
Have a happy weekend!Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com2tag:blogger.com,1999:blog-6430955650295165920.post-27816394365162070232013-03-28T10:51:00.000-07:002013-03-28T11:16:56.153-07:00is the HPV vaccine fundamentally different?A few weeks ago <a href="http://www.babycenter.com/204_parents-worries-about-hpv-vaccine-on-the-rise-study-says_10379654.bc" target="_blank">BabyCenter News</a> posted an article from HealthDay News, <i>Parents' worries about the safety of HPV vaccine on the rise, study says</i> (March 15, 2013). Years ago I spent a semester studying HPV and its relationship to oral cancer, so I'm naturally a bit interested in the HPV vaccine discussions.<br />
<br />
Before I say too much, I want you to know that I am not an expert on vaccines, and am not either recommending, or not recommending that you or your children get the HPV vaccine. I do think it's interesting to critically think through this article and the recommendations that accompany it. <br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZY4BAcesa_WGIx9iwjyCjjo7KJk2LjiHICEa28BgHUQLeGJ_WQUI0D7JkcuUwzSmuNL56-ysDAT7dPsOGGeyF8Zy-Nt-1lzK3wH7iYOTl8DiOS59FGRfwu7jr-hjll0Qr5rNFKwtJZam0/s1600/P1030429.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZY4BAcesa_WGIx9iwjyCjjo7KJk2LjiHICEa28BgHUQLeGJ_WQUI0D7JkcuUwzSmuNL56-ysDAT7dPsOGGeyF8Zy-Nt-1lzK3wH7iYOTl8DiOS59FGRfwu7jr-hjll0Qr5rNFKwtJZam0/s1600/P1030429.JPG" height="232" width="320" /></a>According to this article, the safety concerns of parents in regards to the HPV vaccine nearly quadrupled between 2008 and 2010. HealthDay News doesn't tell us which study actually found this out, merely using using the catch words of "experts" and "study." I'd be curious to know how the study actually measured these concerns, since there could certainly be room for error here. Did the concerns really quadruple?<br />
<br />
The article also states that, "There are more than 100 strains of HPV....". It's true that there are many different strains of HPV, but to emphasize this when focusing on the HPV vaccine seems a little over dramatic since the HPV vaccine is only effective against 4 strains of HPV(1). <br />
<br />
But what really jumps out the most to me is that the article states that,<br />
<blockquote class="tr_bq">
"...the worries [about safety] seem specific to the HPV vaccine. Parents in the study
were also asked about two other vaccines recommended for teenagers: the
"Tdap" vaccine against tetanus, diphtheria and whooping cough; and the
"MCV4" vaccine against bacterial meningitis -- a potentially fatal
inflammation around the brain and spinal cord. Across the study period, less than 1 percent of parents cited safety concerns over those two vaccines."</blockquote>
This makes sense to me-- think about the different modes of transmission. Tetanus, diphtheria, whooping cough, and meningitis are all highly contagious and can be transmitted in an everyday<br />
setting. HPV is different. HPV is a sexually transmitted disease. I believe that's at least part of the reason why it was reported that just over 17% of parents said that the HPV vaccine was "not necessary." <br />
<br />
The ways of acquiring HPV are directly related to a specific lifestyle, whereas the other diseases can be acquired simply by going to the grocery store or stepping on a rusty nail. And that is a difference that ought to be considered when thinking about this vaccine.<br />
<br />
No matter how safe a medical intervention is, there will always be associated risks and costs (at least to someone). In critically thinking about this, we must weigh these risks and benefits. The article may be right that there are very few risks associated with the vaccine, but we should also be careful to think about the potential benefits since this disease is a result of a lifestyle that is chosen. <br />
<br />
But anyways, just some musing on how the HPV vaccine is a little different ideologically than other vaccines.<br />
<br />
What do you think though? Is a different mode of transmission for the disease a big enough difference to put this vaccine in a different sort of category? Or, does it all just seem the same to you?<br />
<br />
<br />
<span style="font-size: x-small;">(1) CDC. (2012). Human Papillomavirus (HPV) Vaccine. <a href="http://www.cdc.gov/vaccinesafety/Vaccines/HPV/index.html" target="_blank">http://www.cdc.gov/vaccinesafety/Vaccines/HPV/index.html</a>. Accessed 3/27/2013</span> Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com2tag:blogger.com,1999:blog-6430955650295165920.post-79917430538718018272013-03-19T13:00:00.000-07:002013-03-19T13:00:04.832-07:00baby wearingYesterday I bought a <a href="https://www.quirkybaby.com/boba-carrier-3g-bobaair.html" target="_blank">new baby carrier</a>! I've been researching and trying different models out for a few months now. I can't wait until my new carrier gets here, hopefully later this week! <br />
<br />
Since Baby was born, I've been borrowing a friend's <a href="http://www.amazon.com/Ergo-Carrier-Black-Camel-Lining/dp/B0010PW3A4/ref=sr_1_1?ie=UTF8&qid=1363628463&sr=8-1&keywords=ergo" target="_blank">Ergo Baby Carrier</a> and have also tried and used a smattering of other carrying options. I've found that unless I'm planning on running, I really would rather wear Baby in the carrier than put him in a stroller or a grocery cart. Carrying him is just so much easier for me. I always know where he is, I don't have to push a stroller around (or carry the stroller downstairs, put it in the car, get it out of the car...), I don't have to find stroller friendly routes, and I always have my hands free. With the proper carrier, it's also really comfortable for me.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgV2Qb0CeuimaoegZ7auGDqR-C-DSqLAfe2eSlwVI0eR3giSQn7YIqo6hzyPEJ8vGYII_mozH46kNqWm1tfpiXpNkHSg3VaT7w8WgaK7ZFjiBQSS1-Keuk3gbesM2DCao9dWcmWbTskhdKR/s1600/IMG_0515_2.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgV2Qb0CeuimaoegZ7auGDqR-C-DSqLAfe2eSlwVI0eR3giSQn7YIqo6hzyPEJ8vGYII_mozH46kNqWm1tfpiXpNkHSg3VaT7w8WgaK7ZFjiBQSS1-Keuk3gbesM2DCao9dWcmWbTskhdKR/s1600/IMG_0515_2.JPG" height="240" width="320" /></a></div>
This discovery is slightly surprising to me since "baby wearing", as it is often called, is closely associated with the Attachment Parenting movement. As a general philosophy I don't really agree with much of the Attachment Parenting movement, but I'm starting to see that even if I don't agree with the entire philosophy, that doesn't mean that everything they endorse is necessarily void of value.<br />
<br />
I feel like that has been the story of my adult life, learning that not everything is black and white like I wanted it to be when I was in high school. This is a perfect example to me of the importance of not being dogmatic in overgeneralizing my feelings towards a specific set of beliefs. Yes, certainly if I disagree with a philosophy I should take time and think it through before I adopt one of their practices, but it's also foolish to simply write off everything that falls under the broader umbrella of a philosophy I disagree with. <br />
<br />
Have you every written something off because of it's associations? Or I suppose the opposite could be true too-- being too accepting of other ideas before examining them to see how they'd fit into your philosophy of life. Do you lean towards one or the other?<br />
<br />
I'm glad I didn't ignore the idea of baby wearing since it turns out it fits our needs and lifestyle quite nicely.Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com5tag:blogger.com,1999:blog-6430955650295165920.post-77333744259596200542013-03-14T15:14:00.000-07:002013-03-14T15:14:37.658-07:00The weekly dose: is vinegar an effective household disinfectant?<i><span style="font-size: xx-small;">{Once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}</span></i><br />
<br />
The question of whether vinegar is an effective household disinfectant is an important question by itself, but it is also closely linked to the question of how important it is to actually have disinfected homes. But perhaps that’s a question for a different day.<br />
<br />
So, the question for this week: is vinegar an effective household disinfectant?<br />
<br />
Australia's ABC Health and Wellbeing posted a reasonable <a href="http://www.abc.net.au/health/talkinghealth/factbuster/stories/2012/02/02/3407024.htm#.UT0mroVHvHG" target="_blank">article</a> answering the question, "Does vinegar really kill household germs?". They concluded that it does, but not as well as commercial products. However, in classic fashion, I wanted to know what the original research had to say about this.<br />
<br />
Most of the research that I found centered around disinfecting produce or chicken, but this still seems relevant since they compared the vinegar to other disinfectants, which usually included bleach.<br />
<br />
Searching <a href="http://www.ncbi.nlm.nih.gov/pubmed/" target="_blank">PubMed</a> for "vinegar disinfect*" I came up with 878 results. Limiting the studies to humans and studies published in the last 5 years reduced that number to 64, but to be honest this probably wasn’t the best search. One interesting result that did show up was a study about Salmonella on Chicken breasts (1). This would at least be applicable in the kitchen. This study found that 0.2 mg/mL thymol (which is found in Thyme oil) plus 2 mg/mL of acetic acid (vinegar) was just as effective in reducing the Salmonella as a chlorine-based washing solution on contaminated chicken breast meat. However, the huge draw back to this study is that they didn’t compare the acetic acid and thymol mixture to a simple acetic acid solution, so it’s unclear to me how much of a difference the thymol actually makes.<br />
<br />
On an unrelated note, Amazon apparently sells thyme oil, but I’m not sure what the actual concentration of thymol inside the thyme oil would be. I wonder if the thyme oil would make vinegar smell better though. Hmm. Maybe I’ll have to try it. <br />
<br />
Changing the search terms to “domestic surfaces disinfect*” seemed to pull up more relevant results. Unfortunately, most of the results still seemed to center around food. One study looked at knifes and bell peppers inoculated with Salmonella and e. coli(2). They compared 3% hydrogen peroxide, 2.5% acetic acid, 70% ethyl alcohol (wine is usually <a href="http://toxipedia.org/display/toxipedia/Ethyl+Alcohol" target="_blank">12-15% ethyl alcohol</a>), and sterile distilled water for decontamination of the bell peppers. The study concluded that ethyl alcohol and hydrogen peroxide may be effective antimicrobials for in-home decontamination of peppers, and that use of detergent and warm water is effective for decontamination of knifes used during meal preparation. The authors of this study explain that it is important to pay attention to disinfecting food in the home since it is possible for food outbreaks to occur even in the home. In 2008 15% of food outbreaks with a known origin came from a home. This was a good reminder to me, that this really does matter for me in my home. <br />
<br />
Perez, et al. included a insightful figure (see below) looking at the length of exposure a disinfectant and the corresponding efficacy of the different disinfectants that clearly shows that the length of time the bell pepper was exposed to the disinfectant greatly influenced the efficacy of the disinfectant. Even though alcohol appears to be the best disinfectant in the shortest amount of time, the authors recognize that many people might not be comfortable with such an elevated concentration of alcohol, and because of this they suggest the use of hydrogen peroxide with an application time of 5 minutes. <br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7xz5Bx4Nmk5El1tIpWQnThN2ncJfBkhCD_ezugyitJ6hLAw7d5yGC8jjTsMKq6w5-Kiv-zk-P-EpUuUE7ocEr8oq98rJQWmYfrPJa4LAFfdC7W_nMcQ-1yzW6NEXUlFN52epIxLpSn1e2/s1600/bellPeppersDisinfection.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7xz5Bx4Nmk5El1tIpWQnThN2ncJfBkhCD_ezugyitJ6hLAw7d5yGC8jjTsMKq6w5-Kiv-zk-P-EpUuUE7ocEr8oq98rJQWmYfrPJa4LAFfdC7W_nMcQ-1yzW6NEXUlFN52epIxLpSn1e2/s1600/bellPeppersDisinfection.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Perez et al., Figure 1</td></tr>
</tbody></table>
<br />
So, where does all this leave me? Is vinegar an effective household disinfectant? It does appear to be effective against Salmonella and e. coli. Since all the studies I found focused in the kitchen, I’m not comfortable generalizing these conclusions to the bathroom (I’m guessing there’s a different set of organisms in there), but as far as the kitchen goes, vinegar appears to be at least mildly effective. I’ll probably start using it occasionally. However, since I’m not interested in using alcohol, as Perez et al. suggested, I think I’ll start disinfecting the kitchen and my produce with hydrogen peroxide-- it smells better than vinegar anyway. <br />
<br />
(1) Lu Y, Wu C. 2012. Reductions of Salmonella enterica on chicken breast by thymol, acetic acid, sodium dodecyl sulfate or hydrogen peroxide combinations as compared to chlorine wash. Int J Food Microbiol. 152(1-2):31-4. doi: 10.1016/j.ijfoodmicro. Accessed from: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22030209" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/22030209</a>.<br />
(2) Perez KL, Lucia LM, Cisneros-Zevallos L, Castillo A, Taylor TM. 2012. Efficacy of antimicrobials for the disinfection of pathogen contaminated green bell pepper and of consumer cleaning methods for the decontamination of knives.Int J Food Microbiol. 2012 May 1;156(1):76-82. doi: 10.1016/j.ijfoodmicro.2012.03.012. Accessed from: <a href="http://www.ncbi.nlm.nih.gov/pubmed/22476008" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/22476008</a>.Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-25729441029780253052013-02-27T13:26:00.000-08:002013-02-27T13:26:34.435-08:00wisdom and the limitations of scienceIn perusing my blogroll I came across two different posts that, when combined with my experience of being a mother, make an interesting illustration for the importance of wisdom when applying and interpreting evidence.<br />
<br />
Alice Callahane, at <a href="http://scienceofmom.com/2013/02/18/book-talk-sleep-choices/" target="_blank">Science of Mom</a> wrote about researching and trying to understand sleep choices for infants. I'm far from an expert on this subject, but I believe this is a fairly well researched, but highly polarized subject. In regards to this, she says,<br />
<blockquote class="tr_bq">
<i>"In the real world, lots of factors determine how different families
handle sleep</i>. Infant temperament is one of them. Safety is another.
There are also cultural expectations, family dynamics, work schedules,
parenting styles, and feeding methods to factor in. Where baby sleeps is
a complex parenting decision, <i>one that is exceedingly difficult to
study in a quantitative manner</i>. ..I also recognize that this parenting decision – and most
of them for that matter – <i>can never be reduced to science and
statistics</i>..." (emphasis mine)</blockquote>
I too often fall into this trap of believing that decisions can be reduced to science and statistics. It's easy to read a study and then conclude that this study must necessarily apply to everyone I know. If the study design was good, and the statistics were also pretty clear, why shouldn't I be able to generalize the results to everyone? I believe there are both extrinsic and intrinsic reasons against being too liberal in my study generalizations.<br />
<br />
The intrinsic reason against applying a study too generally is that population-based studies are, just that, population based. Because of this, they show what is best for the population, and not necessarily for a particular individual. If I make too many particular conclusions from a population based study I commit the whole to part fallacy, what is true of the whole (population) is not necessarily true for every part (an individual). Population based studies don't, and can't, look at every factor that effects every person, like in the sleep example above.<br />
<br />
The extrinsic reason against over-generalization is closely related to the intrinsic reason, but instead of focusing on the limitations due to the actual science, the extrinsic reason focuses more on your personal experiences and preferences. <br />
<br />
The importance of considering personal experience in decision making was driven home to me when I read a post from <a href="http://llironies.blogspot.com/2013/02/i-need-some-sleep.html" target="_blank">Kyte</a>, a friend from high school, where she candidly wrote about some of her experiences of being a new mom. My experience has been very different, but it's not that hers is the "right" experience and mine the "wrong", or vice versa. They're simply different experiences. And, I'm sure, at least partly because of these different experiences, we'd make different decisions for our families, even if we had the same exact evidence available to us. That's just the way decision are, even evidence-based ones.<br />
<br />
These are some of the reasons I've been thinking about the limitations of science and how this effects evidence-based decisions. Next time I'm tempted to judge someone for making a different decision than I would have, I'll try a little harder to remember that decisions cannot be reduced to science and statistics and that wisdom dictates that I factor in individual experience.<br />
<br />
<br />Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-3964239169395386632013-02-22T09:45:00.000-08:002013-02-22T09:47:44.851-08:00in the kitchen...is my produce clean?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgk5GDwQLo8WZ2ethUj1ZKyWSEUeOn8Us1XRbmmZWKz7eV6-pyZ7ek1PfqqsDOuaXe50Q7AD435Y9g5_r3b6y8Cs1yXpwojveZZAXqmKRuPW92yPeBywS1-QtIRlm0I8uK1U8-WTWF3ygf-/s1600/SGC.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgk5GDwQLo8WZ2ethUj1ZKyWSEUeOn8Us1XRbmmZWKz7eV6-pyZ7ek1PfqqsDOuaXe50Q7AD435Y9g5_r3b6y8Cs1yXpwojveZZAXqmKRuPW92yPeBywS1-QtIRlm0I8uK1U8-WTWF3ygf-/s1600/SGC.jpg" /></a><br />
I was thumbing through my new cookbook, <a href="http://www.amazon.com/Science-Cooking-Cooks-Illustrated-Cookbooks/dp/1933615982/ref=sr_1_1?ie=UTF8&qid=1361551938&sr=8-1&keywords=the+science+of+good+cooking" target="_blank">The Science of Good Cooking</a>, looking for some dessert to make for a get together at a friend's house and came across an interesting side article about cleaning apples and pears (it's on page 377, if you really wanted to know).<br />
<br />
I've always just cleaned fruit with cold running water, probably because that's what my mom did and I've never felt the need to do anything different.<br />
<br />
Apparently, American Test Kitchens found that spraying produce with vinegar was the best way to remove surface wax and pesticides (not sure how they know this, but that's what it says). They were curious if spraying fruit with vinegar would also destroy bacteria. To test this, they performed an experiment with apples and pears dividing them into five groups; unwashed, rinsed under cold running water, scrubbed in water with a brush, washed in a vinegar solution, and scrubbed with antibacterial soap. They took surface samples of the fruit and cultured the samples in petri dishes for four days. Rinsing in cold water removed 25% of bacteria, scrubbing removed 85%, and the vinegar removed 98% (they didn't mention how the calculated these numbers, or what the antibacterial soap culture looked like). <br />
<br />
American Test Kitchen references the journal <i>Microbiology</i> with the reason why vinegar works well-- the acetic acid found in vinegar lowers the internal pH of bacterial cells which causes several key biomechanical mechanism in the cell to stop working which in turn kills the bacterium.<br />
<br />
Because of the effectiveness of vinegar, <u>The Science of Good Cooking</u> recommended washing produce in a solution of 3 parts water to 1 part vinegar applied from a spray bottle. Obviously this isn't that best science or experiment that's ever been performed, but I still found it quite interesting.<br />
<br />
Washing fruit in vinegar couldn't hurt, right? Maybe I should go buy a new spray bottle to keep in the kitchen. I'm curious, though. How do you wash produce?Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com4tag:blogger.com,1999:blog-6430955650295165920.post-5232198597707179462013-02-19T17:05:00.001-08:002013-02-19T17:07:39.158-08:00The weekly dose: are there measurable risks associated with Clorox bleach?<i><span style="font-size: x-small;">{Once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}</span></i><br /><br />After discovering the other week that it really is better to avoid food coloring, I’ve been curious about other “natural” claims that I often run into, but usually ignore. As a former dental assistant, infection control is something that is close to my heart, so I thought I’d start thinking about cleaning products. <br /><br />
Clorox bleach happens to be my favorite home disinfectant for the bathroom and kitchen-- there’s just something about it that smells so clean, and it does such a good job making sinks look sparkling clean, and making mold and mildew disappear. Not surprisingly though, the greener/more natural crowd does not look kindly upon Clorox bleach. A quick google search about “household use of bleach as a disinfectant” brings up quite a range of hits, from an article from Reader’s Digest listing the <a href="http://www.rd.com/home/cleaning-organizing/12-smart-ways-to-use-bleach/" target="_blank">amazing things you can do with bleach</a>, to an article from National Geographic about <a href="http://greenliving.nationalgeographic.com/natural-alternatives-bleach-disinfecting-2724.html" target="_blank">natural alternatives to bleach</a>. <br /><br />
With each question I try to formulate and research, I feel like I find a million more questions that need answering. There are so many facets to the issue of household use of Clorox bleach, from the chemistry and toxicity of bleach, to the ideas/theories behind our standards of a cleanly home, to the efficacy of natural alternatives. In short, I feel like I need a background in chemistry to fully understand, and then probably the length of a book to explain.<br />
<br />But, with no further excuse, the question I wish to address today is: are there measurable risks associated with household use of Clorox bleach?<br />
<br />Clorox bleach (from here on I’ll simply call it bleach) contains 5-10% sodium hypochlorite (NaClO) and is extremely basic with a pH value around 12(1)(the pH scale ranges from 0 to 14, with a pH of 7 being neutral). According to the MSDS, bleach is corrosive, and may cause severe irritation or damage to skin and eyes. It is also harmful if swallowed(1). None of this sounds good, but MSDS’s never sound good since they give you a worse-case scenario and, I feel, do not really represent the potential risks from reasonable household use. To understand what the more realistic risks are I spent time searching PubMed for an appropriate study to read and summarize.<br />
<br />In 2009, Zock, et al., published a study looking at the domestic use of bleach in 10 European countries and allergic sensitization and respiratory symptoms in adults (2). The authors had a significant number of participants since their study was part of a larger study designed to identify risk factors for asthma and allergies which had 7,263 participants. The participants were interviewed and asked a variety of questions regarding their household use of bleach. Other lab tests, including spirometry (to measure lung function) and blood work (to measure certain antibodies to quantify allergies) were performed. The study also collected dust samples from some homes. The authors then analyzed the collected data to see if there was any association between bleach use, allergies, and respiratory symptoms. <br /><br />
In short, the study concluded that the health effects of bleach are paradoxical. It appears that bleach use in the home is associated with fewer allergies, but it is also associated with an increase in non-allergic lower respiratory symptoms. <br /><br />
One observation that the study made was that their results are specific for the use of bleach, and not simply the overall cleanliness of a home. The authors considered many possible confounders (a third factor which, in this case would independently effect both those who use bleach and those who don’t) and adjusted for a variety of characteristics without observing a difference in the observed associations. If cleanliness was a confounder and they did not adequately adjust for it their results, any potential associations could be distorted, but this was not the case.<br />
<br />Although I found this to be an interesting study to analyze, after pulling out some notes form a class years ago, I confirmed that these observed associations, although statistically significant were weak to moderate at best. Because of this, and a few other factors, I don’t feel like this study is strong enough to suggest that bleach actually causes either a decrease in allergies or an increase in respiratory symptoms. But then again, I really was just looking for good associations.<br />
<br />
To properly answer my question though, yes I believe this study showed that there are measurable risks associated with household use of bleach. However, it gets trickier since this study also showed measurable benefits associated with the use of bleach-- the paradoxical nature of this study.<br />
<br />
This study has given me much food for thought in my quest to understand bleach and the possible pros and cons in regularly using it in my home. Perhaps some of the puzzle is starting to come together. <br />
<br />
But that said, as far as my recommendations go, and what I will be doing in my home, I’m afraid all I have to say is, “more research is needed.” <br /><br />
<span style="font-size: x-small;">(1)The Clorox Company. (2009). Material Safety Sheet: Clorox Regular Bleach. Retrieved from <a href="http://www.thecloroxcompany.com/downloads/msds/bleach/cloroxregularbleach0809_.pdf" target="_blank">www.thecloroxcompany.com/downloads/msds/bleach/cloroxregularbleach0809_.pdf</a>.<br />(2) Zock JP, Plana E, Antó JM, Benke G, Blanc PD, Carosso A, Dahlman-Höglund A, Heinrich J, Jarvis D, Kromhout H, Lillienberg L, Mirabelli MC, Norbäck D, Olivieri M, Ponzio M, Radon K, Soon A, van Sprundel M, Sunyer J, Svanes C, Torén K, Verlato G, Villani S, Kogevinas M. (2009 Oct.). Domestic use of hypochlorite bleach, atopic sensitization, and respiratory symptoms in adults. J Allergy Clin Immunol.,124(4):731-8.e1. doi: 10.1016/j.jaci.2009.06.007. Epub 2009 Aug 8. Retrieved from<a href="http://www.ncbi.nlm.nih.gov/pubmed/19665775" target="_blank"> http://www.ncbi.nlm.nih.gov/pubmed/19665775</a></span><br />Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-74102565750038455832013-02-12T08:36:00.001-08:002013-02-19T17:07:26.927-08:00stumpedI've been studying household bleach for the past week (plus some), and it's turned out to be more complicated than I had originally thought. As I imagined, using bleach to disinfect is common practice; however, the "greener" crowd sees bleach as a fairly toxic chemical (in excess and when mixed with certain other common substances it certainly is!) that doesn't really belong in our homes. I haven't found any conclusive scientific studies that look at household use of bleach, and so I'm still thinking and will hopefully have a more thorough discussion up soon.<br />
<br />
<div style="text-align: left;">
One interesting line of thought that I've been entertaining is, how important is it to have our homes disinfected? Clearly the goal of cleaning a home is different than cleaning a hospital or dental office, and perhaps, just maybe, "clean" but not disinfected is best for a home setting. The Hygiene Hypothesis might support this thought too. I ran across this over at <a href="http://mytwohats.com/2012/04/15/digging-in-the-dirt-a-few-reasons-why-getting-dirty-is-healthy-for-kids/" target="_blank">My Two Hats</a> the other day: </div>
<blockquote class="tr_bq">
<div style="text-align: left;">
<span style="font-size: small;">"...digging in the dirt may be healthy is
the hygiene hypothesis. This theory, bandied about for a number of
years now, states that as our environment gets cleaner and cleaner, the
way in which our immune system interacts with the environment changes.
Because the immune system isn’t challenged in the same way, it may not
develop in the same way. The theory suggests that kids who have far
fewer exposures to microbes may have higher risk of some diseases, such
as asthma and eczema. Of course, this is still a “theory”, and we must
approach it with a balanced perspective."</span></div>
</blockquote>
<div style="text-align: left;">
<span style="font-size: small;"><span style="font-size: xx-small;"> <span style="font-size: small;">This is not the first time I've come across this line of thought, and it mostly makes sense to me, but again, I haven't fully looked in<span style="font-size: small;">to it either.</span></span></span></span></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<span style="font-size: small;"><span style="font-size: xx-small;"><span style="font-size: small;"><span style="font-size: small;">What are your thought<span style="font-size: small;">s </span>about <span style="font-size: small;">using bleach in your home<span style="font-size: small;">? <span style="font-size: small;">What <span style="font-size: small;">is important to you</span> to disinfect? T<span style="font-size: small;">he bathroom? <span style="font-size: small;">Kit<span style="font-size: small;">ch<span style="font-size: small;">en sink?</span></span></span></span></span></span></span></span></span></span></span> </div>
Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-53656831799822257222013-02-04T08:00:00.000-08:002013-07-09T16:07:20.136-07:00Vitamin D and BabyThe other day I finally did it, I bough a vitamin D supplement for Baby. I still feel slightly guilty both for buying it, and for the fact that I hadn't bought it sooner (he'll be 6 months this week).<br />
<br />
You see, I've known for some time that the both the <a href="http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Vitamin-D-And-Your-Baby.aspx" target="_blank">American Academy of Pediatrics</a> and the <a href="http://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm" target="_blank">Center for Disease Control</a> recommend a 400 IU vitamin D supplement for exclusively breastfed infants. We were also sent home from our stay in the NICU with multivitamin drops I was theoretically supposed to mix with formula or milk and then feed to Baby. Well, I wasn't going to give Baby formula, and it just seemed so inconvenient to pump just to turn around and immediately give a bottle-- it seems like so many extra, and unnecessary steps. I know our wonderful pediatrician mentioned the need for vitamin D at one point as well. So, yes, if my son has a vitamin D deficiency it is solely my responsibility. And therefore, as you could guess, this is why I feel guilty for not having bought it sooner.<br />
<br />
But, I'm stubborn. I don't like supplements-- you could say it's a pet peeve of mine. I feel like I ought to be able to get all the vitamins I need from my diet and a healthy lifestyle (spent anytime outside lately for your vitamin D?). The only time I've even semi-consistently taken vitamins or other supplements is during pregnancy. I suppose all of the hype surrounding neural tube defects and folic acid influenced me and I decided the potential benefits outweighed the risks.<br />
<br />
To take the time and thoroughly research vitamin D supplementation has been on my mental to-do list since shortly before Baby was born, but to be honest I still haven't really gotten around to it. By purchasing the supplement I feel like I caved in to pressure and am conforming to the norm without knowing if this is really best. I know this is silly, but this is how my mind works...I want to know <i>why</i>, and just knowing that it's recommended isn't enough.<br />
<br />
On an unrelated note, the supplement contains <a href="http://excellenceetc.blogspot.com/2013/01/the-weekly-dose-is-there-real-harm-to.html" target="_blank">artificial coloring</a>. I asked the pharmacist if it were possible to find one without artificial coloring, and she seemed skeptical. Even the supplements she had behind the counter contained artificial color. Perhaps there is some available somewhere -- I'd love a link if you know of a place that sells some.<br />
<br />
That said tough, after considering what I know of the benefits and risks, I've decided to swallow my pride and add the vitamin D supplement to Baby's diet, even without actually doing the research myself. Perhaps this is keeping with my evidence based theme, or perhaps not. I could see it both ways. At least I've 'fessed up to it.<br />
<br />
Here's hoping Baby will swallow the drops!Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-60069034227799645682013-02-01T08:00:00.000-08:002013-02-01T08:00:05.940-08:00Handwashing, a continuationSince I’ve been studying triclosan and hand soaps for the past week (The weekly dose: are antimicrobial hand washes beneficial?), you could say handwashing has been weighing heavily on my mind. Again, nothing new and crazy here, but just some reflections from everything that I’ve read.<br />
<br />
The Harvard Health Letter(1) reminded me that the amount of time I take to wash my hands matters<span style="font-size: x-small;">. </span>This letter said that washing your hands for 15 seconds, which is about the time it takes to sing “Happy Birthday” (really?! I would have guessed that took longer than 15 seconds...), reduces bacterial counts by about 90%, but if you spend 30 seconds washing your hands the bacterial counts drop close to 99.9%. <br />
<br />
Perhaps one way to make sure you spend a long enough time washing your hands would be to recite a memory verse-- or post one next to your sink and wok on memorizing it. If you wash your hands 10 times a day, for 30 seconds each, that would be 5 minutes. Could we more purposefully use this time than just letting our minds wander?<br />
<br />
In some ways, this next fact doesn’t fit with what the Harvard Health letter stated at all. I’m not quite sure how to perfectly harmonize these statements, but, I don’t think this fact annuls the importance of taking your time when you wash your hands. <br />
<br />
The double-blind study that compared soap uses in inner-city households found that about one-third of participants had higher microbial counts on their hands after washing them then before washing their hands(2). When I first read this in the abstract, I thought I didn’t understand what the authors were looking at, or misunderstanding what they were actually saying. But yes, they did find that sometimes microbial counts go up after washing your hands. The authors accounted this to increased skin shedding during washing, which is caused by the mechanical friction of rubbing your hands together. However, even though they measured this increase, it would be wrong to conclude that washing your hands is of not use. This study followed the participants for one year, and there were significant reductions in all microbial counts after a year. This indicated that sustained and consistent hand hygiene practices do significantly reduce microbial counts over time, even if a single wash doesn’t make a huge difference. This is a fascinating study with some interesting discussion if you want a good read...<br />
<br />
A good take away would be to wash consistently and thoroughly, dry gently, and remember to use moisturizer to avoid skin flaking/extreme dryness. <br />
<br />
I know this isn’t anything mind-blowing, but I find it interesting to examine common practices to see if there’s actual evidence to back it up. And yes, I believe there is evidence to support the importance of hand washing. <br />
<br />
<span style="font-size: x-small;">(1) The Handiwork of Good Health. Harvard Health Letter. 2007 Jan;32(3):1-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17323497" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/17323497</a>. Accessed 1/28/2013.<br />(2) Larson E, Aiello A, Lee LV, Della-Latta P, Gomez-Duarte C, Lin S. Short- and long-term effects of handwashing with antimicrobial or plain soap in the community. J Community Health. 2003 Apr;28(2):139-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12705315" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/12705315</a>. Accessed 1/30/13.</span><br />
<br />Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-261293422833609692013-01-30T15:04:00.003-08:002013-01-31T17:24:43.289-08:00The weekly dose: are antimicrobial hand washes beneficial?<i><span style="font-size: x-small;">{Once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}</span></i><br />
<br />
It seems lately everyone has been ill with something or other, and as you know, I was no exception. The common (and simple!) anecdote to not spreading illness, that we have all been taught since we were small, of washing our hands, is still one of the best ways to avoid spreading illness. With flu season in full swing, it seems appropriate to examine what we wash our hands with. Hopefully I’m not beating a dead horse here, but here’s the promised discussion about triclosan and hand soap.<br />
<br />
The question I would like to answer is: in the home (or another community, non-healthcare setting) is it beneficial to use an antibacterial soap containing triclosan?<br />
<br />
It is estimated that in America, about half of the commercially available hand soaps contain an antibacterial additive(1). Most of the time this additive is Triclosan. According to Wikipedia, Triclosan has been used since the early 1970’s, and is a chemically synthesized antimicrobial. The FDA states that Triclosan is not known to be hazardous to humans, however there are some new studies that raise potential concerns so the FDA is now reevaluating the use of Triclosan in consumer products (2). <br />
<br />
Triclosan is often used in healthcare facilities, and because of this, many studies look at this application. I would like to point out though, that the needs of a household are much different than the needs of a healthcare facility, and therefor the decision on whether to use antimicrobial soap in one setting will not necessarily transfer to another setting. According to one study(3), the primary purpose of handwashing in the community, or home, is to prevent or reduce the acquisition of “transient organisms” which have a potential to cause disease. This can be contrasted to a healthcare setting where handwashing is designed to minimize the organisms naturally found on a provider’s hands, as well as to prevent cross contamination during patient care. It is also important to note that the products available to the consumer contain a much lower concentration of antimicrobial than products that are available in a health care setting, and so the efficacy of the soaps will differ. <br />
<br />
After looking at some miscellaneous articles about Triclosan on the web, I went to PubMed (<a href="http://www.ncbi.nlm.nih.gov/pubmed">http://www.ncbi.nlm.nih.gov/pubmed</a>) and searched “triclosan hand soap” which resulted in 58 hits with publication dates from August 1975 through May 2012. At least 18 of these hits were highly relevant, based on the title alone. <br />
<br />
Historically, there hasn’t been much research concerning the effects antimicrobial soap in a community setting (3). One double blind study in 2003 compared the use of triclosan (0.2%) handwash soap to plain handwash soap in 238 inner city households. The effects of handwashing after a year were significant, regardless of whether plain soap or antimicrobial soap was used, however there was not a significant difference between the two types of soap. Because there was no definitive evidence in favor of triclosan soap, the authors suggest against using antibicorbial soap as general household soap.<br />
<br />
One meta-analysis (a review-type article where they synthesis results from many published studies) did find that antimicrobial soap produced statistically significant reductions when compared with plain soap (4). However, I only have access to this abstract, and so don’t know whether they looked at hospitals or communities, and what concentrations of antimicrobials they considered. Since the abstract says they also considered chlorhexidine gluconate, iodophor, and povidone I’m guessing that they were not specifically considering household, or community use. <br />
<br />
In 2007 a systematic review was published which examined the efficacy of products containing triclosan in a community setting (5). The authors concluded that soaps containing triclosan at concentrations commonly used (0.1%-0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. The authors also noted that it is possible that triclosan contributes to the development of antibiotic-resistant bacteria. <br />
<br />
There are other studies suggesting that there are several harmful risks associated with triclosan, even at the low levels found in consumer products. These risks range from being harmful to the environment and aquatic organisms (6), to weakening muscles (8), to developing antibiotic resistant bacteria. However, I haven’t taken the time to fully examine these, or other potential risks.<br />
<br />
So, in the home is it beneficial to use an antibacterial soap containing triclosan? No, I believe the research shows there are no benefits to be gained by using a triclosan antibacterial soap in the home, and therefore, my family will continue to avoid buying these products. <br />
<br />
<span style="font-size: x-small;">(1)The Handiwork of Good Health. Harvard Health Letter. 2007 Jan;32(3):1-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17323497">http://www.ncbi.nlm.nih.gov/pubmed/17323497</a>. Accessed 1/28/2013.</span><br />
<span style="font-size: x-small;">(2) FDA: For Consumers. Triclosan: What Consumers Should Know. Aug. 29, 2012. <a href="http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm">http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm</a>. Accessed 1/29/2013.</span><br />
<span style="font-size: x-small;">(3) Larson E, Aiello A, Lee LV, Della-Latta P, Gomez-Duarte C, Lin S. Short- and long-term effects of handwashing with antimicrobial or plain soap in the community. J Community Health. 2003 Apr;28(2):139-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12705315">http://www.ncbi.nlm.nih.gov/pubmed/12705315</a>. Accessed 1/30/13.</span><br />
<span style="font-size: x-small;">(4) Montville R, Schaffner DW. A meta-analysis of the published literature on the effectiveness of antimicrobial soaps. J Food Prot. 2011 Nov;74(11):1875-82. doi: 10.4315/0362-028X.JFP-11-122. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22054188">http://www.ncbi.nlm.nih.gov/pubmed/22054188</a>. Accessed 1/30/13. </span><br />
<span style="font-size: x-small;">(5) Aiello AE, Larson EL, Levy SB. Consumer antibacterial soaps: effective or just risky? Clin Infect Dis. 2007 Sep 1;45 Suppl 2:S137-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17683018">http://www.ncbi.nlm.nih.gov/pubmed/17683018</a>. Accessed 1/30/13. </span><br />
<span style="font-size: x-small;">(6) Bedoux G, Roig B, Thomas O, Dupont V, Le Bot B. Occurrence and toxicity of antimicrobial triclosan and by-products in the environment. Environ Sci Pollut Res Int. 2012 May;19(4):1044-65. doi: 10.1007/s11356-011-0632-z. Epub 2011 Nov 5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17683018">http://www.ncbi.nlm.nih.gov/pubmed/17683018</a>. Accessed 1/30/2013. </span><br />
<span style="font-size: x-small;">(7) Fritsch EB, Connon RE, Werner I, Davies RE, Beggel S, Feng W, Pessah IN. Triclosan Impairs Swimming Behavior and Alters Expression of Excitation-Contraction Coupling Proteins in Fathead Minnow (Pimephales promelas). Environ Sci Technol. 2013 Jan 28. [Epub ahead of print]. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23305567">http://www.ncbi.nlm.nih.gov/pubmed/23305567</a>. Accessed 1/30/2013.</span>Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-61453805959951324052013-01-25T15:43:00.002-08:002013-01-25T15:43:13.689-08:00Sick week...Apologies for not having the "Weekly Dose" ready on time, I've been ill this week with a stomach bug so things have not gone quite as planned. Hopefully I'll stop back in before Monday, but if not, have a lovely weekend!<br />
<br />
Stay tuned for a review about triclosan and hand soaps in the home; I think the discussion should be pretty interesting after starting the research earlier today.<br />
<br />
My dishes need some soap-ing action themselves, so until later...Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-30099052400693363822013-01-23T08:00:00.000-08:002013-02-19T17:07:39.157-08:00Why do medical recommendations constantly change?At least monthly it seems like there is “new research” or “new guidelines” that are published and tell the reader that what was previously thought is now considered wrong. Butter is bad, but margarine is better--5 years later, no, margarine is bad, butter might be better. Or, running is better than walking, wait no, walking is usually better than running This flip-flopping can make decisions annoying at best and impossible at worst; I know it drives my mom nuts. However, I think this flip-flopping is just the nature of research and goes along with living an evidence-based life. Here are some reasons that I believe contribute to this flip-flopping.<br />
<br />
A big part of having an “evidence-based” attitude is making the best possible decision for a given situation using the best available evidence. When considering why it’s ok that recommendations change, it’s important to remember that decisions (and thus recommendations) are based on what’s available at that particular time. Because of this, as new research becomes available, the recommendations ought to change to reflect new knowledge.<br />
<br />
Even if there is no new research available, another reason for recommendations to change is if the originally available research has been reexamined and has been found lacking. No human is infallible, and scientists certainly aren’t excluded from this characteristic! There could be statistical mistakes, or even underlying study design mistakes that could significantly change a border-line conclusion.<br />
<br />
One more reason for the apparent flip-flop nature that I’d like to highlight is the news media and their love of sensationalism. It’s much more exciting to say something like, “sunscreen causes Rickets,” than “preliminary research suggests a correlation between prolonged sunscreen use and vitamin D deficiencies” (fictional example). Obviously, if I were trying to attract attention I would chose the first headline, but as a consumer I should realize that the news article probably doesn’t give me the whole picture. <br />
<br />
Despite these difficulties in having an “evidence-based” approach to life, I truly think it is worth the extra effort to think through decisions, and then to periodically rethink the same decisions, even if that means changing your position. It has taken me years to realize that it’s not a bad thing to change my mind, sometimes there’s new information available, or sometimes the situation could have changed. And sometimes, I hate to admit it, just sometimes, I was actually wrong in the first place.Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0tag:blogger.com,1999:blog-6430955650295165920.post-61602487262262722872013-01-21T08:00:00.000-08:002013-01-21T18:38:13.454-08:00 Priorities.... and the home In continuing to think about priorities, I’m reminded about the need for excellence. Without excellence, it would be all too easy to float through life thinking of priorities as a sort checklist to complete each day. I’m particularly convicted of the need for excellence when it comes to caring for my home. I can think of caring for my home as a duty that must get done (speaking of which, I must vacuum today, the floors are nasty!), or I can choose to think of caring for my home as a privilege and part of my vocation as a wife. If we adopt the later view, taking care of our homes can become a joy which will in turn bless others. <br /><br />When we view caring for our homes as a priority and we think of carrying out this duty as a joy and privilege it is easier to excel at taking care of the home. It is important to take care of the home whole-heartedly, as if we were taking care of our homes for Christ (<a href="http://nasb.literalword.com/?q=col+3%3A23" target="_blank">Col 3:23</a>). <br /><br />Perhaps one way to excel at taking care of the home is to not simply keep the home tidy and clean, but to pay attention to the little things that contribute to making a house a home. When we think of tending to our homes, do we think about what would make our home welcoming? Perhaps yummy scents? A light left on in a corner, or the porch? Of course, if we have toys strewn over the floor and laundry occupying most of the couch, tidying the home would take priority. But, if excellence is our goal, we must not settle for a home that is simply tidy. What are some ways you prioritize your home?Rebeccahttp://www.blogger.com/profile/05724785455970160104noreply@blogger.com0