Tag Archives: Centers for Disease Control

University of Exeter study: Asthma attacks reduced in tree-lined urban neighborhoods

19 Nov

The Centers for Disease Control and Prevention describe how to tell if you have asthma:

How Can You Tell if You Have Asthma?
It can be hard to tell if someone has asthma, especially in children under age 5. Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma.
During a checkup, the doctor will ask if you cough a lot, especially at night, and whether your breathing problems are worse after physical activity or at certain times of year. The doctor will also ask about chest tightness, wheezing, and colds lasting more than 10 days. They will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems, and they will ask questions about your home. The doctor will also ask if you have missed school or work and about any trouble you may have doing certain things.
The doctor will also do a breathing test, called spirometry, to find out how well your lungs are working. The doctor will use a computer with a mouthpiece to test how much air you can breathe out after taking a very deep breath. The spirometer can measure airflow before and after you use asthma medicine.
What Is an Asthma Attack?
An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body’s airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways even more.
You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following your doctor’s advice. When you control your asthma:
• you won’t have symptoms such as wheezing or coughing,
• you’ll sleep better,
• you won’t miss work or school,
• you can take part in all physical activities, and
• you won’t have to go to the hospital.
What Causes an Asthma Attack?
An asthma attack can happen when you are exposed to “asthma triggers”. Your triggers can be very different from those of someone else with asthma. Know your triggers and learn how to avoid them. Watch out for an attack when you can’t avoid the triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, and smoke from burning wood or grass…. http://www.cdc.gov/asthma/faqs.htm

Urban trees can affect the quality of life and health.

The Nature Conservancy published How Urban Trees Can Save Lives:

The Planting Healthy Air report documents which cities stand to benefit most from tree plantings, in terms of both heat and PM reduction, and how much investment would be required to achieve meaningful benefits.
The analysis found that investing just US$4 per resident in each of these cities in tree planting efforts could improve the health of millions of people, and that trees are as cost-effective as many other common solutions.
Most of the cooling and filtering effects created by trees are fairly localized, so densely populated cities—as well as those with higher overall pollution levels—tend to see the highest overall return on investment (ROI) from tree plantings…. https://global.nature.org/content/healthyair

Exeter University reported that asthma attacks were reduced in tree-lined urban areas.

Science Daily reported in Asthma attacks reduced in tree-lined urban neighborhoods:

People living in polluted urban areas are far less likely to be admitted to hospital with asthma when there are lots of trees in their neighbourhood, a study by the University of Exeter’s medical school has found.
The study into the impact of urban greenery on asthma suggests that respiratory health can be improved by the expansion of tree cover in very polluted urban neighbourhoods.
The study, published in the journal Environment International, looked at more than 650,000 serious asthma attacks over a 15 year period. Emergency hospitalisations were compared across 26,000 urban neighbourhoods in England.
In the most polluted urban areas, trees had a particularly strong association with fewer emergency asthma cases. In relatively unpolluted urban neighbourhoods trees did not have the same impact.
In a typical urban area with a high level of background air pollution — for example, around 15 micrograms of fine particulate matter (PM2.5) per cubic metre, or a nitrogen dioxide concentration around 33 micrograms per cubic metre — an extra 300 trees per square kilometre was associated with around 50 fewer emergency asthma cases per 100,000 residents over the 15 year study period.
The findings could have important implications for planning and public health policy, and suggest that tree planting could play a role in reducing the effects of air pollution from cars.
Over 5.4 million people receive treatment for asthma in the UK with an annual cost to the NHS of around £1 billion. 18 per cent of adults report asthma in the previous 12 months, and a quarter of 13-14 year olds report symptoms. Asthma causes over a thousand deaths a year.
The study led by Dr Ian Alcock, research fellow at the University of Exeter’s Medical School, found that trees and green space were both related to a decrease in people admitted to hospital with asthma…. https://www.sciencedaily.com/releases/2017/11/171117103814.htm

Citation:

Asthma attacks reduced in tree-lined urban neighborhoods
Date: November 17, 2017
Source: University of Exeter
Summary:
People living in polluted urban areas are far less likely to be admitted to hospital with asthma when there are lots of trees in their neighborhood, a new study has found.
Journal Reference:
1. Ian Alcock, Mathew White, Mark Cherrie, Benedict Wheeler, Jonathon Taylor, Rachel McInnes, Eveline Otte im Kampe, Sotiris Vardoulakis, Christophe Sarran, Ireneous Soyiri, Lora Fleming. Land cover and air pollution are associated with asthma hospitalisations: A cross-sectional study. Environment International, 2017; 109: 29 DOI: 10.1016/j.envint.2017.08.009

Here is the press release from the University of Exeter:

Asthma attacks reduced in tree-lined urban neighbourhoods
People living in polluted urban areas are far less likely to be admitted to hospital with asthma when there are lots of trees in their neighbourhood, a study by the University of Exeter’s medical school has found.
The study into the impact of urban greenery on asthma suggests that respiratory health can be improved by the expansion of tree cover in very polluted urban neighbourhoods.
The study, published in the journal Environment International, looked at more than 650,000 serious asthma attacks over a 15 year period. Emergency hospitalisations were compared across 26,000 urban neighbourhoods in England.
In the most polluted urban areas, trees had a particularly strong association with fewer emergency asthma cases. In relatively unpolluted urban neighbourhoods trees did not have the same impact.
In a typical urban area with a high level of background air pollution – for example, around 15 micrograms of fine particulate matter (PM2.5) per cubic metre, or a nitrogen dioxide concentration around 33 micrograms per cubic metre – an extra 300 trees per square kilometre was associated with around 50 fewer emergency asthma cases per 100,000 residents over the 15 year study period.
The findings could have important implications for planning and public health policy, and suggest that tree planting could play a role in reducing the effects of air pollution from cars.
Over 5.4 million people receive treatment for asthma in the UK with an annual cost to the NHS of around £1 billion. 18 per cent of adults report asthma in the previous 12 months, and a quarter of 13-14 year olds report symptoms. Asthma causes over a thousand deaths a year.
The study led by Dr Ian Alcock, research fellow at the University of Exeter’s Medical School, found that trees and green space were both related to a decrease in people admitted to hospital with asthma.
Dr Alcock said:
“We wanted to clarify how urban vegetation may be related to respiratory health. We know that trees remove the air pollutants which can bring on asthma attacks, but in some situations they can also cause localised build-ups of particulates by preventing their dispersion by wind. And vegetation can also produce allergenic pollen which exacerbates asthma.
We found that on balance, urban vegetation appears to do significantly more good than harm. However, effects were not equal everywhere. Greenspace and gardens were associated with reductions in asthma hospitalisation at lower pollutant levels, but not in the most polluted urban areas. With trees it was the other way round. It may be that grass pollens become more allergenic when combined with air pollutants so that the benefits of greenspace diminish as pollution increases. In contrast, trees can effectively remove pollutants from the air, and this may explain why they appear to be most beneficial where concentrations are high.”
Co-author Dr Rachel McInnes, Senior Climate Impacts Scientist at the Met Office, added: “This finding that the effects of different types of vegetation – green space and gardens, and tree cover – differ at both very high and very low air pollution levels is particularly relevant for public health and urban planning policies. We also know that the interaction between pollen and air pollution, and the effect on health and asthma is highly complex and this study confirms that more research is required in this area. Large collaborative research projects, like this from the NIHR Health Protection Research Unit in Environmental Change and Health are a very effective way to carry out this type of cross-disciplinary work.”
Date: 17 November 2017 http://www.exeter.ac.uk/news/university/title_622600_en.html

Pascal Mittermaier wrote in Why Plant Trees in Cities? Because They Protect Our Most Vulnerable Residents:

So how do we make cities cooler and healthier? Urban planners and public health officials are grappling with the best way to approach this issue. But there’s one solution we can implement now: plant more trees. Trees and other vegetation naturally cool the air around them by shading surfaces and releasing water vapor. While the effects are local—most of the improvement is within 100 meters—they can still be meaningful, reducing temperatures by up to 2°C.
Trees also provide another significant public health benefit: they reduce fine particulate matter air pollution, a problem that contributes to 5 percent of all deaths worldwide each year. Our organization, The Nature Conservancy, has carried out a study of 245 cities around the world that stand to benefit from tree-planting initiatives, assessing their efficiency and return on investment. Compared to other ways to cool outdoor air temperatures and reduce fine particle matter, trees deliver similar benefits per dollar spent—and, planting trees is the only intervention that addresses both air pollution and heat…. https://newcities.org/perspectives-why-plant-trees-in-cities-because-they-protect-our-most-vulnerable-residents/

One program which all residents of urban areas can participate is the planting of urban trees and encouraging public officials to expand and protect tree canopy.

Resources:

Asthma.com
http://www.asthma.com/additional-resources.html

Asthma Health Center
http://www.webmd.com/asthma/guide/asthma-support-resources

Asthma Resources
http://www.webmd.com/asthma/asthma-resources

Where information leads to Hope. © Dr. Wilda.com

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Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

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http://drwildareviews.wordpress.com/

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Journal of the American Medical Association special report: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

15 Mar

HELPGUIDE.ORG defines substance abuse and also describes some of the traits of a substance abuser.

Drug abuse, also known as substance abuse, involves the repeated and excessive use of chemical substances to achieve a certain effect. These substances may be “street” or “illicit” drugs, illegal due to their high potential for addiction and abuse. They also may be drugs obtained with a prescription, used for pleasure rather than for medical reasons.
Different drugs have different effects. Some, such as cocaine or methamphetamine, may produce an intense “rush” and initial feelings of boundless energy. Others, such as heroin, benzodiazepines or the prescription oxycontin, may produce excessive feelings of relaxation and calm. What most drugs have in common, though, is overstimulation of the pleasure center of the brain. With time, the brain’s chemistry is actually altered to the point where not having the drug becomes extremely uncomfortable and even painful. This compelling urge to use, addiction, becomes more and more powerful, disrupting work, relationships, and health. http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

In a 2014 article the National Institute on Drug Abuse took a cautious approach in linking pain killers and drug abuse.

The National Institute on Drug Abuse wrote in Abuse of Prescription Pain Medications Risks Heroin Use:

Text Description of Infographic

In 2010 almost 1 in 20 adolescents and adults – 12 million people – used prescription pain medication when it was not prescribed for them or only for the feeling it caused.  While many believe these drugs are not dangerous because they can be prescribed by a doctor, abuse often leads to dependence.  And eventually, for some, pain medication abuse leads to heroin.

Top Figure: 1 in 15 people who take non medical prescription pain relievers will try heroin within 10 years.

Left  Graph: Number of people who abused or were dependent on pain medications and percentage of them that use heroin.  Pie charts show in 2004 1.4 million people abused or were dependent on pain medications and 5% used heroin. In 2010, 1.9 million people abused or were dependent on pain medications and 14% used heroin.

Right Top Graph:  Heroin users are 3 times as likely to be dependent.  14% of non medical prescription pain reliever users are dependent. Yet, 54% of heroin users are dependent.

Right Bottom Graph:  Heroin emergency room admissions are increasing.  In 2005 there were less than 200,000 emergency room visits related to heroin. By 2011 this number had increased to almost 260,000….https://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use

The CDC issued new recommendations regarding prescribing pain medication.

Kimberly Leonard of U.S. News wrote in Getting a Painkiller from a Doctor Is About to Get Harder:

Government health officials on Tuesday provided strategies for primary care doctors who treat patients suffering from chronic pain. Among the recommendations: to use urine drug testing before prescribing highly addictive painkillers like oxycontin, codeine and morphine.

The guidance, put forth by the Centers for Disease Control and Prevention, is part of the government’s response to the epidemic of people dying from opioid overdoses, which include prescription painkillers but also the drug’s cheaper alternative, heroin. Data from the CDC show that in 2014 these deaths surpassed car accidents as the No. 1 cause of injury-related death.

For the most part, the CDC recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. Primary care doctors have been in part responsible for the surge in addiction: Since 1999, the prescribing and sales of opioids has quadrupled, and primary care doctors account for nearly half of these prescriptions….                                                                                                           http://www.usnews.com/news/articles/2016-03-15/cdc-issues-guidance-on-prescription-painkillers

Citation:

Special Communication | March 15, 2016

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 FREE ONLINE FIRST

Deborah Dowell, MD, MPH1; Tamara M. Haegerich, PhD1; Roger Chou, MD1

[+] Author Affiliations

JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.1464

Text Size: A A A

Article

Tables

Supplemental Content

References

ABSTRACT

ABSTRACT | INTRODUCTION | GUIDELINE DEVELOPMENT PROCESS | RECOMMENDATIONS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.

Objective  To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Process  The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.

Evidence Synthesis  Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.

Recommendations  There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.

Conclusions and Relevance  The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Here is the recommendation for patients from LeShaundra Cordier Scott, MPH, CHES; Sarah Lewis, MPH, CHES:

RECOMMENDATIONS FOR SAFER AND MORE EFFECTIVE PAIN MANAGEMENT

A JAMA article was published online on March 15, 2016, describing a new Centers for Disease Control and Prevention opioid prescribing guideline for chronic pain. The guideline provides recommendations based on available science for safer, more effective treatment of chronic pain outside of active cancer, palliative care, and end-of-life care.

The recommendations ask health care practitioners to

  • Use nonopioid medications and other therapies such as physical therapy instead of or in combination with opioids.
  • Prescribe the lowest effective dosage of opioids to reduce risks of opioid use disorder and overdose.
  • Discuss potential benefits and harms of opioids with patients.
  • Assess improvements in pain and function regularly.
  • Use tools such as urine drug tests and prescription drug monitoring programs to inform themselves about patients’ other medications that increase risk.
  • Monitor patients for signs of whether opioid use disorder might be developing and arrange treatment if needed

 

WHAT YOU CAN DO

 

If you have chronic pain, be sure to

  • Consider ways to manage your pain that do not include opioids, such as physical therapy, exercise, nonopioid medications, and cognitive behavioral therapy.
  • Make the most informed decision with your doctor.
  • Never take opioids in greater amounts or more often than prescribed.
  • Avoid taking opioids with alcohol and other substances or medications you have not discussed with your doctor.

If you or someone close to you has an addiction to pain medication, talk to your doctor or contact the Substance Abuse and Mental Health Services Administration’s treatment help line at (800) 662-HELP.

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Published Online: March 15, 2016. doi:10.1001/jama.2016.3224.

Here is the press release from the American Medical Association:

March 15, 2016

AMA Responds to CDC Guidelines on Opioids

For immediate release:
March 15, 2016

CHICAGO – In response to the Centers for Disease Control and Prevention (CDC) guidelines issued today, the American Medical Association (AMA) noted its shared goal of reducing harm from opioid abuse and seeking solutions to end this public health epidemic and applauds the agency for making the issue a high priority. As with any guideline development of this magnitude, we appreciated the opportunity to add the voice of patients and physicians.

“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care,” said Patrice A. Harris, MD, the AMA board chair-elect and chair of the AMA Task Force to Reduce Opioid Abuse.

“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”

###

Media Contact:
Jack Deutsch
AMA Media & Editorial
202-789-7442
Jack.Deutsch@ama-assn.org

If you or a member of your family is prescribed pain medication, the course of treatment should follow CDC recommendations.

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

 

Baylor University study: ‘Violence Free Zone’ program can be effective

25 Mar

The Centers for Disease Control (CDC) collects statistics about school violence. According to School Violence: Data & Statistics, the CDC reports:

The first step in preventing school violence is to understand the extent and nature of the problem. The Centers for Disease Control and Prevention (CDC), the U.S. Department of Education, and the U.S. Department of Justice gather and analyze data from a variety of sources to gain a more complete understanding of school violence.
According to the CDC’s School Associated Violent Death Study, between 1% and 2% of all homicides among school-age children happen on school grounds or on the way to and from school or during a school sponsored event. So the vast majority of students will never experience lethal violence at school.1
Fact Sheets
• Understanding School Violence Fact Sheet[PDF 254 KB]
This fact sheet provides an overview of school violence. http://www.cdc.gov/violenceprevention/pdf/school_violence_fact_sheet-a.pdf
• Behaviors that Contribute to Violence on School Property[PDF 92k]
This fact sheet illustrates the trends in violence-related behaviors among youth as assessed by CDC’s Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors health risk behaviors that contribute to the leading causes of death and disability among young people in the United States, including violence. http://www.cdc.gov/HealthyYouth/yrbs/pdf/us_violenceschool_trend_yrbs.pdf
• Understanding Youth Violence [PDF 313KB]
This fact sheet provides an overview of youth violence.
• Youth Violence: Facts at a Glance[PDF 128KB]
This fact sheet provides up-to-date data and statistics on youth violence…. http://www.cdc.gov/violenceprevention/pdf/yv-datasheet-a.pdf http://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/data_stats.html

A Baylor University study examined an intervention strategy which might be effective in reducing school violence.

Science Daily reports in ‘Violence-free’ zones improve behavior, performance in middle, high school students:

A youth violence-reduction mentoring program for trouble-plagued schools in urban centers has contributed to improved student behavior and performance at high-risk middle and high schools in Wisconsin and Virginia, according to a new Baylor University case study.

The “Violence-Free Zone” is the national model of mentoring students in areas with high levels of crime and violence. The mentoring program is designed to address behaviors that result in truancies, suspensions, violent incidents, involvement in drugs and gangs and poor academic performance in public middle and high schools.

Four evaluations of VFZ programs conducted between 2007 and 2013 show positive impact, including a unique return-on-investment (ROI) analysis of a VFZ high school in Milwaukee, according to study leaders Byron Johnson, Ph.D., director of the Program on Prosocial Behavior in Baylor’s Institute for Studies of Religion, and William Wubbenhorst, non-resident fellow at Baylor and scholar in faith-based and community initiatives.

The case study evaluates improvements at two VFZ high schools in Richmond, as well as the impact of the Milwaukee VFZ program on youths mentored by adults who work full time in the schools as hall and cafeteria monitors and role models. They work closely with safety officers, teachers and counselors.
Among the key findings:

1. A four-year study (academic years 2007 to 2010) of the VFZ Program in Milwaukee’s School for Career and Technical Education showed a: • 44 percent reduction in the average number of behavioral incidents per VFZ student per month • 79 percent reduction in average number of suspension days per VFZ student per month • 23 percent reduction in truancy incidents per VFZ student per month • 9.3 percent increase in GPA per VFZ student • 24 percent higher rate of graduation from high school than non-VFZ students • 8 percent higher college enrollment rate (as compared to the Wisconsin state level) • 64 percent increase in the number of students reporting a more positive school climate (as compared to the year prior to the VFZ program start)

2. A Return-On Investment Analysis of the Milwaukee school’s program showed an estimated lifetime savings of $8.32 for every $1 invested in the VFZ program, based on reduced administrative costs from fewer suspensions; reduced police costs from service calls; reduced juvenile detention costs; lower truancy rates; savings from reduced number of auto thefts within 1,000 feet of the school; savings from reductions of such high-risk behaviors as drinking, violence against intimate partners or violence against oneself; and projected increases in lifetime earning associated with higher high school graduation and college enrollment rates.

3. A four-year study (from academic years 2009-2012) of overall school-level trends of the VFZ program in Richmond showed a: • 44 percent reduction in the average number of suspensions per student • 27 percent reduction in the average number of suspension days per student • 18 percent increase in the average grade point average

4. A one-year study (academic year 2013-14) of VFZ students in three middle schools and eight high schools in Milwaukee showed a: • 7 percent decrease in the average number of non-violent incidents per VFZ student per month • 31 percent decrease in the average number of violent incidents per VFZ student per month.
The Milwaukee Violence-Free Zone program was created and is directed by the Washington, D.C.-based Center for Neighborhood Enterprise and implemented in Milwaukee schools by CNE’s community partners, Running Rebels Community Organization and the Milwaukee Christian Center. The Richmond program was operated in partnership with the Richmond Outreach Church.

“The VFZ initiative not only is measurably effective in reducing violence, it is cost-effective,” said CNE President Robert L. Woodson. “It produces saving to the community by avoiding court and incarceration costs and by promoting attendance and academic achievement. It makes it possible for teachers to teach and students to learn.” For more information about the Multi-State Mentoring Research study, visit http://www.cneonline.org/
http://www.sciencedaily.com/releases/2015/03/150323111642.htm

Here is an excerpt describing the Violence Free Zone concept:

Reducing Youth Violence: The Violence-Free Zone Violence-Free Zone Initiative:
A Proven Model for Stopping Violence in the Schools and Creating Peace in the Community
The Violence-Free Zone is the national model of a youth violence reduction and high-risk- student mentoring program created by the Center for Neighborhood Enterprise. Designed to operate in the most trouble-plagued schools in urban centers with high levels of crime and violence, the VFZ has produced measurable decreases in violent and non-violent incidents and suspensions in more than 30 schools across the country. The principles developed in the Violence-Free Zone model have also proved applicable to suburban and rural communities.
Three studies by evaluators from Baylor University reported that the VFZ had measurable impact in improved safety, reduction in suspensions and truancies, and increased academic performance. Educators and law enforcement officers from sites around the country have praised the VFZ for changing the culture of previously violent schools and reducing crimes in surrounding neighborhoods.
How It Works
The goal of the Violence-Free Zone initiative is to reduce violence and disruptions in the schools and prepare students for learning. The Center provides overall management and direction to the Violence-Free Zone initiative sites, and selects established youth-serving organizations to be CNE’s community partners and implement the VFZ program in the schools. These organizations have the goal of stopping violence in their neighborhoods and have demonstrated that they have the trust and confidence of young people. The Center provides training in the Violence-Free Zone national model as well as technical assistance, administrative and financial oversight, and linkages to sources of support.
Central to the program are the Youth Advisors, mature young adults who are from the same neighborhoods as the students in the schools they serve. The Youth Advisors command respect because they have faced and overcome the same challenges as the students. Carefully screened, hired, and managed by the local community-partner organization, the Youth Advisors work in the schools as hall monitors, mediators, and character coaches, and they mentor the high risk students that often are responsible for disruptions…. http://www.cneonline.org/reducing-youth-violence-the-violence-free-zone/

Citation:

Violence-free’ zones improve behavior, performance in middle, high school students

Date: March 23, 2015

Source: Baylor University

Summary:
A youth violence-reduction mentoring program for trouble-plagued schools in urban centers has contributed to improved student behavior and performance at high-risk middle and high schools in Milwaukee, Wisconsin, and Richmond, Virginia, according to findings of a new case study.

Here is the press release from Baylor University:

‘Violence-Free’ Zones Improve Behavior and Performance in Middle and High School Students, Baylor University Study Finds
March 20, 2015
WACO, Texas (March 23, 2015) — A youth violence-reduction mentoring program for trouble-plagued schools in urban centers has contributed to improved student behavior and performance at high-risk middle and high schools in Milwaukee, Wisconsin, and Richmond, Virginia, according to findings of a new Baylor University case study.
The “Violence-Free Zone” (VFZ) is the national model of mentoring students in areas with high levels of crime and violence. The VFZ mentoring program is designed to address behaviors that result in truancies, suspensions, violent incidents, involvement in drugs and gangs and poor academic performance in public middle and high schools.
Four evaluations of VFZ programs conducted between 2007 and 2013 show positive impact, including a unique return-on-investment (ROI) analysis of a VFZ high school in Milwaukee, according to study leaders Byron Johnson, Ph.D., director of the Program on Prosocial Behavior in Baylor’s Institute for Studies of Religion, and William Wubbenhorst, non-resident fellow at Baylor, scholar in faith-based and community initiatives and co-president of Social Capital Valuations, LLC.
The case study also includes an evaluation of school-level improvements at two VFZ high schools in Richmond, as well as the impact of the Milwaukee VFZ program specifically on youths directly receiving mentoring services from the VFZ “Youth Advisers” — adults who work full time in the schools as hall and cafeteria monitors, role models and mentors. They work closely with school safety officers, teachers and counselors to provide a support system for students.
Among the key findings:
1. A four-year study (academic years 2007 to 2010) of the VFZ Program in Milwaukee’s School for Career and Technical Education showed a:
44 percent reduction in the average number of behavioral incidents per VFZ student per month
79 percent reduction in average number of suspension days per VFZ student per month
23 percent reduction in truancy incidents per VFZ student per month
9.3 percent increase in GPA per VFZ student
24 percent higher rate of graduation from high school than non-VFZ students
8 percent higher college enrollment rate (as compared to the Wisconsin state level)
64 percent increase in the number of students reporting a more positive school climate (as compared to the year prior to the VFZ program start)
2. A Return-On Investment Analysis of the Milwaukee school’s program showed an estimated lifetime savings of $8.32 for every $1 invested in the VFZ program, based on reduced administrative costs from fewer suspensions; reduced police costs from service calls; reduced juvenile detention costs; lower truancy rates; savings from reduced number of auto thefts within 1,000 feet of the school; savings from reductions of such high-risk behaviors as drinking, violence against intimate partners or violence against oneself; and projected increases in lifetime earning associated with higher high school graduation and college enrollment rates.
3. A four-year study (from academic years 2009-2012) of overall school-level trends of the VFZ program in Richmond showed a:
44 percent reduction in the average number of suspensions per student
27 percent reduction in the average number of suspension days per student
18 percent increase in the average grade point average
4. A one-year study (academic year 2013-14) of VFZ students in three middle schools and eight high schools in Milwaukee showed a:
7 percent decrease in the average number of non-violent incidents per VFZ student per month
31 percent decrease in the average number of violent incidents per VFZ student per month
The Milwaukee Violence-Free Zone program was created and is directed by the Washington, D.C.-based Center for Neighborhood Enterprise (CNE) and implemented in Milwaukee schools by CNE’s community partners, Running Rebels Community Organization and the Milwaukee Christian Center. The Richmond program was operated in partnership with the Richmond Outreach Church.
“The VFZ initiative not only is measurably effective in reducing violence, it is cost-effective,” said CNE President Robert L. Woodson. “It produces saving to the community by avoiding court and incarceration costs and by promoting attendance and academic achievement. It makes it possible for teachers to teach and students to learn.”
For more information about the Multi-State Mentoring Research study, visit the Center for Neighborhood Enterprise’s website at http://www.cneonline.org
ABOUT BAYLOR UNIVERSITY
Baylor University is a private Christian University and a nationally ranked research institution, characterized as having “high research activity” by the Carnegie Foundation for the Advancement of Teaching. The University provides a vibrant campus community for approximately 16,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 80 countries to study a broad range of degrees among its 12 nationally recognized academic divisions. Baylor sponsors 19 varsity athletic teams and is a founding member of the Big 12 Conference.
ABOUT THE INSTITUTE FOR STUDIES OF RELIGION
Launched in August 2004, the Baylor Institute for Studies of Religion (ISR) exists to initiate, support and conduct research on religion, involving scholars and projects spanning the intellectual spectrum: history, psychology, sociology, economics, anthropology, political science, epidemiology, theology and religious studies. The institute’s mandate extends to all religions, everywhere, and throughout history, and embraces the study of religious effects on prosocial behavior, family life, population health, economic development and social conflict. While always striving for appropriate scientific objectivity, ISR scholars treat religion with the respect that sacred matters require and deserve.
School violence is a complex set of issues and there is no one solution. The school violence issue mirrors the issue of violence in the larger society. Trying to decrease violence requires a long-term and sustained focus from parents, schools, law enforcement, and social service agencies.

Resources:

A Dozen Things Students Can Do to Stop School Violence                                                  http://www.sacsheriff.com/crime_prevention/documents/school_safety_04.cfm

A Dozen Things. Teachers Can Do To Stop School Violence.                                                        http://www.ncpc.org/cms-upload/ncpc/File/teacher12.pdf

Preventing School Violence: A Practical Guide                                                                          http://www.indiana.edu/~safeschl/psv.pdf

Related:

Violence against teachers is becoming a bigger issue                                                                        https://drwilda.com/2013/11/29/violence-against-teachers-is-becoming-a-bigger-issue/

Hazing remains a part of school culture                                                                                            https://drwilda.com/2013/10/09/hazing-remains-a-part-of-school-culture/

FEMA issues Guide for Developing High-Quality School Emergency Operations Plans  https://drwilda.com/2013/07/08/fema-issues-guide-for-developing-high-quality-school-emergency-operations-plans/

Study: 1 in 3 teens are victims of dating violence                                                                           https://drwilda.com/2013/08/05/study-1-in-3-teens-are-victims-of-dating-violence/

Pediatrics article: Sexual abuse prevalent in teen population                                                        https://drwilda.com/2013/10/10/pediatrics-article-sexual-abuse-prevalent-in-teen-population/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Centers for Disease Control report: Nearly 8 in 10 children miss developmental screenings

17 Sep

The goal of this society should be to raise healthy and happy children who will grow into concerned and involved adults who care about their fellow citizens and environment. A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination http://www.peds.arizona.edu/medstudents/Physicalexamination.asp

PHYSICAL EXAMINATION
Every child should receive a complete systematic examination at regular intervals. One should not restrict the examination to those portions of the body considered to be involved on the basis of the presenting complaint.
Approaching the Child
Adequate time should be spent in becoming acquainted with the child and allowing him/her to become acquainted with the examiner. The child should be treated as an individual whose feelings and sensibilities are well developed, and the examiner’s conduct should be appropriate to the age of the child. A friendly manner, quiet voice, and a slow and easy approach will help to facilitate the examination.
Observation of the Patient
Although the very young child may not be able to speak, one still may receive much information from him/her by being observant and receptive. The total evaluation of the child should include impressions obtained from the time the child first enters until s/he leaves; it should not be based solely on the period during which the patient is on the examining table. In general, more information is obtained by careful inspection than from any of the other methods of examination.
Sequence of Examination
Skill, tact and patience are required to gather an optimal amount of information when examining a child. There is no routine one can use and each examination should be individualized. Ham it up and regress. Get down to the child’s level and try to gain his trust. The order of the exam should conform to the age and temperament of the child. For example, many infants under 6 months are easily managed on the examining table, but from 8 months to 3 years you will usually have more success substituting the mother’s lap. Certain parts of the exam can sometimes be done more easily with the child in the prone position or held against the mother. After 4 years, they are often cooperative enough for you to perform the exam on the table again.
Wash your hands with warm water before the examination begins. You will impress your patient’s mother and not begin with an adverse reaction to cold hands in your patients. With the younger child, get to the heart, lungs and abdomen before crying starts. Save looking at the throat and ears for last. If part of the examination is uncomfortable or painful, tell the child in a warm, honest, but determined tone that this is necessary. Looking for animals in their ears or listening to birdies in their chests is often another useful approach to the younger child.
If your bag of tricks is empty and you’ve become hoarse from singing and your lips can no longer bring forth a whistle, you may have to turn to muscle. Various techniques are used to restrain children and experience will be your best ally in each type of situation.
Remember that you must respect modesty in your patients, especially as they approach pubescence. Some time during the examination, however, every part of the child must have been undressed. It usually works out best to start with those areas which would least likely make your patient anxious and interfere with his developing confidence in you.

The article goes on to describe how the physical examination is conducted and what observations and tests are part of the examination. The Cincinnati Children’s Hospital describes the Process of the Physical Examination http://www.cincinnatichildrens.org/health/p/exam/

Christina Samuels reported in the Education Week article, CDC: Nearly Eight in 10 Children Miss Developmental Screenings:

Only about 21 percent of parents in 2007 reported that they were asked to fill out a questionnaire from their health-care provider asking about their child’s developmental, communication, or social behaviors—an essential step in steering children to early-intervention services, according to the Centers for Diseases Control and Prevention in Atlanta.
The CDC released the information Sept. 10 as part of an analysis on the use of several preventive services for infants, children and adolescents. In general, children are not receiving enough preventive care, the agency concluded. CDC recommendations are that young children be screened for developmental delays at 9, 18, and either 24 or 30 months, and for autism spectrum disorder at 18 months and at either 24 or 30 months.
For its analysis, the CDC turned to the 2007 National Survey of Children’s Health and focused on children from 10 to 47 months olds. Children were not more or less likely to be screened based on gender, race or ethnicity, family structure, parental education, household income, or location. However, parents were the least likely to report an official screening if the child had not had insurance in the past year; only 9 percent of parents reported that request.
The study did note that a majority of parents, about 52 percent, reported that a health-care advisor asked them informally if they had any concerns about their child’s learning, development, or behavior. However, indications of a parental concern or risk for a developmental delay did not result in additional screening for those children, and informal inquiries are less likely to pick up on the children who need help, the report said. Health-care providers may be overrelying on their own judgment or distrustful of parent reports, the researchers hypothesized.
The CDC noted other gaps in the preventive screening that connect to potential disabilities. Using surveys collected in 2009 and 2010, the CDC found that 50 percent of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss.
Also, 67 percent of children ages 1 to 2 years were not tested for blood lead or results were not reported to CDC in 2010; lead exposure can lead to serious negative consequences for a child’s developing brain. http://blogs.edweek.org/edweek/early_years/2014/09/cdc_nearly_eight_in_10_children_miss_developmental
_screenings.html

Here are the key findings from the CDC report:

Key Findings
Morbidity and Mortality Weekly Report published a supplement that examined the use of selected clinical preventive services among infants, children, and adolescents in the United States. This supplement indicates that millions of U.S. infants, children, and adolescents did not receive key clinical preventive services. Increased use of clinical preventive services could improve the health of infants, children, and adolescents and promote healthy lifestyles that will enable them to achieve their full potential.
Read the full article: Use of Selected Clinical Preventive Services to Improve Health of Infants, Children, and Adolescents¬¬ – United States, 1999-2011
Main Findings from this Report
Use of clinical preventive services among U.S. infants, children, and adolescents is not optimal. There are large disparities by demographics, geography, and healthcare coverage and access in the use of these services. This report provides a baseline snapshot of use of selected clinical preventive services for U.S. infants, children, and adolescents prior to 2012, before or shortly after implementation of the Affordable Care Act.
Report findings include:
• Breastfeeding: One in six (17%) pregnant women did not receive breastfeeding counseling during prenatal care visits in 2010.1
• Hearing: Half (50%) of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss during 2009–2010.2
• Child Development: In 2007, parents of almost eight in ten (79%) children aged 10–47 months were not asked by healthcare providers to complete a formal screen for developmental delays in the past year.3
• Lead Poisoning: Two-thirds (67%) of children aged 1–2 years were not tested for blood lead or results were not reported to CDC in 2010.4
• Vision: According to their parents, approximately one in five (22%) children aged 5 years never had their vision checked by a healthcare provider during 2009–2010. Approximately one in four children did not have their blood pressure measurement documented at clinic visits during 2009–2010.5
• Hypertension: Approximately one in four (24%) outpatient clinic visits for preventive care made by 3–17 year-olds during 2009–2010 had no documentation of blood pressure measurement.6
• Dental: In 2009, more than half (56%) of children and adolescents did not visit the dentist in the past year, and nearly nine of ten (86%) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.7
• Human Papillomavirus (HPV) Vaccination: Nearly half (47%) of female adolescents aged 13–17 years had not received their recommended first dose of HPV vaccine in 2011, and almost two-thirds (65%) had not received all three recommended vaccine doses.8
• Tobacco: Approximately one in three (31%) outpatient clinic visits made by 11–21 year-olds during 2004–2010 had no documentation of tobacco use status, and eight of ten (80%) of those who screened positive for tobacco use did not receive any cessation assistance.9
• Chlamydia: During 2006–2010, almost two-thirds (60%) of sexually active females aged 15–21 years did not receive chlamydia screening in the past year.10
• Reproductive Health: During 2006–2010, approximately one in four (24%) sexually experienced females aged 15–19 years and more than one in three (38%) sexually experienced males aged 15–19 years did not receive a reproductive health service from a healthcare provider in the past year.11
These findings come from the second of a series of periodic reports from CDC to monitor and report on progress made in increasing the use of clinical preventive services to improve population health. There are many important clinical preventive services for infants, children, and adolescents. Healthcare providers, parents, and guardians can find out more about the preventive care children need by visiting http://www.cdc.gov/prevention.
About this Study collapsed
Clinical Preventive Services collapsed
The Affordable Care Act collapsed
CDC’s Activities http://www.cdc.gov/childpreventiveservices/key-findings.html

See, Developmental Monitoring and Screening http://www.cdc.gov/ncbddd/childdevelopment/screening.html

The increased rate of poverty has profound implications if this society believes that ALL children have the right to a good basic education. Moi blogs about education issues so the reader could be perplexed sometimes because moi often writes about other things like nutrition, families, and personal responsibility issues. Why? The reader might ask? Because children will have the most success in school, if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of societies’ problems would be lessened if the goal was a healthy child in a healthy family. There is a lot of economic stress in the country now because of unemployment and underemployment. Children feel the stress of their parents and they worry about how stable their family and living situation is.

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Related:

People MUST talk: AIDS epidemic in Black community
https://drwilda.wordpress.com/2012/08/02/people-must-talk-aids-epidemic-in-black-community/

Study: When teachers overcompensate for prejudice
https://drwilda.wordpress.com/2012/05/10/study-when-teachers-overcompensate-for-prejudice/

Location, location, location: Brookings study of education disparity based upon neighborhood https://drwilda.wordpress.com/2012/04/18/location-location-location-brookings-study-of-education-disparity-based-upon-neighborhood/

Jonathan Cohn’s ‘The Two Year Window’
https://drwilda.wordpress.com/2011/12/18/jonathan-cohns-the-two-year-window/

Hard times are disrupting families https://drwilda.com/2011/12/11/hard-times-are-disrupting-families/

3rd world America: The link between poverty and education
https://drwilda.com/2011/11/20/3rd-world-america-the-link-between-poverty-and-education/

3rd world America: Money changes everything https://drwilda.com/2012/02/11/3rd-world-america-money-changes-everything/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/
Dr. Wilda © https://drwilda.com/

University of St. Thomas study: Sleep problems equal to marijuana use and drinking in predicting poor academic performance in college

4 Jun

Moi has posted quite a bit about the effect of sleep deprivation on children and teens. A study of older men published in the Journal Sleep details the effect of sleep deprivation on older men. The bottom line is that no matter one’s age, in order to fully function, people need adequate rest. See, Study: Poor sleep quality can lead to cognitive problems in older men https://drwilda.com/2014/04/02/study-poor-sleep-quality-can-lead-to-cognitive-problems-in-older-men/

Sarah Klein reported in the Huffington Post article, Sleep Problems Equal To Binge Drinking, Marijuana Use In Predicting Poor Academic Performance:

While the temptations to stay up late are many, a small new study suggests a very good reason for college students to hit the hay. Those who are poor sleepers are more likely to get worse grades and to withdraw from a course, according to a new study. In fact, the effects of poor sleep were about as strong as binge drinking and marijuana use on a student’s academic performance.
The researchers analyzed data from over 43,000 students included in the spring 2009 American College Health Association’s National College Health Assessment (NCHA). After controlling for potentially confounding factors that might predict how a college student fares academically, like clinical depression, feelings of isolation or chronic health problems, the researchers found that getting poor sleep was a strong predictor of problems at school.
While few students are likely to have a clinical sleep disorder, Roxanne Prichard, Ph.D., associate professor of psychology at the University of St. Thomas in St. Paul, Minnesota tells The Huffington Post, about 60 percent say they have some kind of problem sleeping. But for all the effort colleges put into anti-drinking and de-stressing campaigns, little time or money is spent to promote better sleep — and doing so could help both students and the colleges themselves, she says…. http://www.huffingtonpost.com/2014/06/03/sleep-drinking-marijuana_n_5433148.html?utm_hp_ref=education&ir=Education

Citation:

Poor sleep equal to binge drinking, marijuana use in predicting academic problems

Date: June 2, 2014
Source: American Academy of Sleep Medicine
Summary:
College students who are poor sleepers are much more likely to earn worse grades and withdraw from a course than healthy sleeping peers, new research shows. Results show that sleep timing and maintenance problems in college students are a strong predictor of academic problems. The study also found that sleep problems have about the same impact on grade point average (GPA) as binge drinking and marijuana use.
See, Poor sleep equal to binge drinking, marijuana use in predicting academic problems http://www.sciencedaily.com/releases/2014/06/140602102011.htm

Here is the press release from the American Academy of Sleep Medicine:

FOR IMMEDIATE RELEASE
American Academy of Sleep Medicine
Sunday, June 1, 2014

CONTACT: Lynn Celmer, 630-737-9700, ext. 9364, lcelmer@aasmnet.org

Poor sleep equal to binge drinking, marijuana use in predicting academic problems
DARIEN, IL – A new study shows that college students who are poor sleepers are much more likely to earn worse grades and withdraw from a course than healthy sleeping peers.
Results show that sleep timing and maintenance problems in college students are a strong predictor of academic problems even after controlling for other factors that contribute to academic success, such as clinical depression, feeling isolated, and diagnosis with a learning disability or chronic health issue. The study also found that sleep problems have about the same impact on grade point average (GPA) as binge drinking and marijuana use. Its negative impact on academic success is more pronounced for freshmen. Among first-year students, poor sleep— but not binge drinking, marijuana use or learning disabilities diagnosis—independently predicted dropping or withdrawing from a course. Results were adjusted for potentially confounding factors such as race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
“Well-rested students perform better academically and are healthier physically and psychologically,” said investigators Roxanne Prichard, PhD, associate professor of psychology and Monica Hartmann, professor of economics at the University of St. Thomas in St. Paul, Minnesota.
The research abstract was published recently in an online supplement of the journal Sleep and will be presented Tuesday, June 3, in Minneapolis, Minnesota, at SLEEP 2014, the 28th annual meeting of the Associated Professional Sleep Societies LLC.
Data from the Spring 2009 American College Health Association National College Health Assessment (NCHA) were analyzed to evaluate factors that predict undergraduate academic problems including dropping a course, earning a lower course grade and having a lower cumulative GPA. Responses from over 43,000 participants were included in the analysis.
According to Prichard, student health information about the importance of sleep is lacking on most university campuses.
“Sleep problems are not systematically addressed in the same way that substance abuse problems are,” she said. “For colleges and universities, addressing sleep problems early in a student’s academic career can have a major economic benefit through increased retention.”
For a copy of the abstract, “What Is The Cost Of Poor Sleep For College Students? Calculating The Contribution to Academic Failures Using A Large National Sample,” or to arrange an interview with Roxanne Prichard or an AASM spokesperson, please contact AASM Communications Coordinator Lynn Celmer at 630-737-9700, ext. 9364, or lcelmer@aasmnet.org.
Established in 1975, the American Academy of Sleep Medicine (AASM) improves sleep health and promotes high quality patient centered care through advocacy, education, strategic research, and practice standards. With about 9,000 members, the AASM is the largest professional membership society for physicians, scientists and other health care providers dedicated to sleep medicine. For more information, visit http://www.aasmnet.org.

According to the Centers for Disease Control (CDC), insufficient sleep is a public health epidemic.

In the article, Insufficient Sleep Is a Public Health Epidemic, the CDC reports:

How Much Sleep Do We Need? And How Much Sleep Are We Getting?
How much sleep we need varies between individuals but generally changes as we age. The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need 9-105 hours, and adults need 7-8 hours. According to data from the National Health Interview Survey, nearly 30% of adults reported an average of ≤6 hours of sleep per day in 2005-2007.3 In 2009, only 31% of high school students reported getting at least 8 hours of sleep on an average school night.4
Sleep Hygiene Tips
The promotion of good sleep habits and regular sleep is known as sleep hygiene. The following sleep hygiene tips can be used to improve sleep.
• Go to bed at the same time each night and rise at the same time each morning.
• Avoid large meals before bedtime.
• Avoid caffeine and alcohol close to bedtime.
• Avoid nicotine.
(Sleep Hygiene Tips adapted from the National Sleep Foundation ) http://www.cdc.gov/features/dssleep/

More Americans of all ages need to begin getting a good night’s sleep.

Resources:

National Sleep Foundation’s Teens and Sleep
http://www.sleepfoundation.org/article/sleep-topics/teens-and-sleep

Teen Health’s Common Sleep Problems
http://kidshealth.org/teen/your_body/take_care/sleep.html

CBS Morning News’ Sleep Deprived Kids and Their Disturbing Thoughts http://www.cbsnews.com/2100-500165_162-6052150.html

Psychology Today’s Sleepless in America http://www.psychologytoday.com/blog/sleepless-in-america

National Association of State Board’s of Education Fit, Healthy and Ready to Learn http://eric.ed.gov/?id=ED465734

U.S. Department of Education’s Tools for Success
http://www2.ed.gov/parents/academic/help/tools-for-success/index.html

Related:

Another study: Sleep problems can lead to behavior problems in children https://drwilda.com/2013/03/30/another-study-sleep-problems-can-lead-to-behavior-problems-in-children/

Stony Brook Medicine study: Teens need sleep to function properly and make healthy food choices https://drwilda.com/2013/06/21/stony-brook-medicine-study-teens-need-sleep-to-function-properly-and-make-healthy-food-choices/

University of Massachusetts Amherst study: Preschoolers need naps Does school start too early? https://drwilda.com/tag/too-little-sleep-raises-obesity-risk-in-children/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

States getting tough about requiring childhood vaccinations

19 May

Michaeleen Doucleff reported in the NPR story, How Vaccine Fears Fueled The Resurgence Of Preventable Diseases:

For most of us, measles and whooping cough are diseases of the past. You get a few shots as a kid and then hardly think about them again.
But that’s not the case in all parts of the world — not even parts of the U.S.
As an interactive maphttp://www.cfr.org/interactives/GH_Vaccine_Map/index.html#mapfrom the Council on Foreign Relations illustrates, several diseases that are easily prevented with vaccines have made a comeback in the past few years. Their resurgence coincides with changes in perceptions about vaccine safety….
http://www.npr.org/blogs/health/2014/01/25/265750719/how-vaccine-fears-fueled-the-resurgence-of-preventable-diseases?utm_medium=Email&utm_campaign=20140202&utm_source=mostemailed

There are many myths regarding vaccination of children.

Evie Blad reported in the Education Week article, States Tightening Loopholes in School Vaccine Laws:

As outbreaks of preventable diseases have spread around the country in recent years, some states have been re-evaluating how and why they allow parents to opt their children out of vaccines required for school attendance.
Requiring vaccines before school admission has been a key component of a decades-long campaign that had nearly rid the United States of some of its most severe illnesses, from the measles to whooping cough, public-health experts say. But they also warn that broad “personal belief” exemptions that don’t relate to a child’s medical condition or a family’s religious beliefs have made it too easy to bypass vaccines, poking a sizable hole in the public-health safety net.
While some parents act out of a sense of personal conviction, others do so simply because they don’t have time to schedule an appointment, said Stephanie L. Wasserman, the executive director of the Colorado Children’s Immunization Coalition, an Aurora, Colo.-based group that seeks to increase vaccine coverage in the state.
“We want to close that convenience loophole,” she said. “When you choose not to immunize, there are consequences not only to your child and your family; there are consequences to your community as well.”
Since 2011, Washington, Oregon, California, and Vermont have revised their personal exemption processes.
In Colorado—a state with one of the highest opt-out rates in the country and the most recent one to examine its vaccine-exemption policies—a bill passed this month would draw schools into the public health fight….
Laws at a Glance
While all states have school vaccination laws on the books, states vary on how much leeway parents have to opt their children out of required vaccinations.
50 states require specified vaccines for students, but allow exemptions for medical reasons.
48 states grant exemptions for people who have religious beliefs against immunizations. (Mississippi and West Virginia do not allow this exemption.)
19 states allow exemptions for those who object to immunizations for personal or moral beliefs.
SOURCE: National Conference of State Legislatures
http://www.edweek.org/ew/articles/2014/05/14/31vaccines.h33.html

Dina Fine Maron wrote in the Daily Beast article, 6 Top Vaccine Myths:

To sort through the onslaught of information and misinformation about childhood immunizations, we asked Austin, Texas-based pediatrician Ari Brown, coauthor of “Baby 411: Clear Answers and Smart Advice for your Baby’s First Year,” to debunk some of the most common vaccination myths.

Myth 1: It’s not necessary to vaccinate kids against diseases that have been largely eradicated in the United States.
Reality: Although some diseases like polio and diphtheria aren’t often seen in America (in large part because of the success of the vaccination efforts), they can be quite common in other parts of the world. The Centers for Disease Control and Prevention warns that travelers can unknowingly bring these diseases into the United States, and if we were not protected by vaccinations, these diseases could quickly spread throughout the population….

Myth 2: Mercury is still in kids’ vaccines.
Reality: At the center of this issue is a preservative called thimerosal (a compound containing mercury) that once was a common component in many vaccines because it allowed manufacturers to make drugs more cheaply and in multidose formulations. But public concern, new innovations and FDA recommendations led to its removal from almost all children’s vaccines manufactured after 2001. (More thimerosal background can be found at the FDA’s Web site) Since flu vaccines are not just for children, manufacturers still put thimerosal in some flu-shot formulations. You can ask your pediatrician for the thimerosal-free version, says Brown.
If your child does not have asthma and is at least 2 years old, Brown recommends the FluMist nasal-spray vaccination over the flu shot. “It seems to have better immune protection and it could help your child avoid another shot,” she says. (Caveat: the spray does contain a live version of the virus, which can result in a slight increase in flulike symptoms).

Myth 3: Childhood vaccines cause autism.
Reality: There is no scientific evidence that this link exists. Groups of experts, including the American Academy of Pediatrics and the Institute of Medicine (IOM), agree that vaccines are not responsible for the growing number of children now recognized to have autism…..

Myth 4: Getting too many vaccines can overwhelm the immune system and cause adverse reactions or even serious illness.
Reality: Children’s immune systems are capable of combating far more antigens (weak or killed viruses) than they encounter via immunizations. In fact, the jury is still out on if there’s an actual limit on how many the body can handle—though one study puts the number around a theoretical 10,000 vaccines in one day.(Visit the American Academy of Pediatrics’ site or the Network for Immunization Information for more information)
Currently, “There is even less of a burden on the immune system [via vaccines] today than 40 years ago,” says Edgar Marcuse, a professor of pediatrics at the University of Washington who works on immunization policy and vaccines…..

Myth 5: It’s better to let my kid get chickenpox “naturally.”
Reality: Before the chickenpox vaccine was licensed in 1995, parents sometimes brought their child to a party or playground hoping that their child might brush up against a pox-laden kid to get their dose of chickenpox over since cases were usually less severe for children than adults. But pediatricians say severe complications are possible with chickenpox—including bacterial infections that could result in a child’s hospitalization or death….

Myth 6: The flu shot causes the flu.
Reality: The flu shot does not contain a live virus, so your child can’t get the flu from this shot. But, after the shot, it’s not uncommon to feel a bit achy while the immune system mounts its response. Remember that for two weeks following the shot, your child can still get the flu, so be sure to help your child avoid that feverish kid next door.http://www.thedailybeast.com/newsweek/2009/02/22/six-top-vaccine-myths.html

A question in the current climate is what can be done to make parents responsible for putting other children at risk.

Jed Lipinksi wrote in the Slate article, Endangering the Herd: The case for suing:

As you’d expect, the growing anti-vaccination movement responded in fury. After Caplan wrote a related post for the Harvard Law Blog, angry comments poured in. “This article is industry propaganda at its worst,” one commenter declared. Another wrote: “Caplan would have familiar company in fascist Germany.” The blog eventually shut down the comments for violations of the site’s policies against “abusive and defamatory language” and the sharing of personal information.
Here’s why the anti-vaxxers are wrong and Caplan and his co-authors are right to raise the idea of suing or criminally charging them: Parents who choose not to vaccinate their kids for reasons of personal belief pose a serious danger to the public.
Measles vaccines are about 95 percent effective when given to children. That leaves a 5 percent chance that kids who are vaccinated will contract measles. This means that no matter what, the disease still poses a public health risk, but we rely on others to get vaccinated to hugely reduce the likelihood of outbreaks. That’s the process known as herd immunity.
Unvaccinated children threaten the herd. Take the San Diego measles outbreak of 2008. After unknowingly contracting the disease on a trip to Switzerland, an unvaccinated 7-year-old boy infected 11 other unvaccinated kids, according to the Centers for Disease Control and Prevention. The majority of the cases occurred in kids whose parents had requested personal belief exemptions (or PBEs) through the state of California, one of 17 states to allow them. But three of the infected were either too young or medically unable to be vaccinated. And overall, 48 children too young to be vaccinated were quarantined, at an average cost to the family of $775 per child. The CDC noted that all 11 cases were “linked epidemiologically” to the 7-year-old boy and that the outbreak response cost the public sector $10,376 per case.
Today, several states blame a rise in preventable diseases on the declining child vaccination rates. In Michigan, less than 72 percent of children have received their state-mandated measles, mumps, and rubella (MMR) vaccines. In New York, as Caplan noted in his blog post, pockets of Brooklyn’s Hasidic Jewish community are experiencing a mini measles epidemic. Thirty cases have been confirmed so far. According to Dr. Yu Shia Lin of Maimonides Medical Center, some members of the community avoid the measles vaccine because they think it causes autism. The most visible proponent of this idea, former Playboy Playmate Jenny McCarthy, will receive a giant new platform for her viewpoints when she joins the daytime gossipfest The View on Sept. 9.
The belief that the MMR vaccine causes autism goes back to a 1998 study published in the Lancet by a British gastroenterologist named Andrew Wakefield. In 2010, after years of criticism, the journal finally retracted Wakefield’s study, announcing that it was “utterly clear, without any ambiguity at all, that the statements in the paper were utterly false.” Britain’s General Medical Council later revoked Wakefield’s medical license, noting that he’d failed to disclose his role as a paid consultant to lawyers representing parents who thought vaccines had harmed their kids. The CDC makes clear there is no connection between vaccines and autism.
Yet this dangerous idea persists. Often, it persists among people who are simply doing what they think is best for their kids. Which is why it’s necessary to take extra measures to ensure nonvaccinators understand the risk they pose to other people’s children….
There are legal obstacles to penalizing parents who don’t vaccinate their kids. Courts are generally less likely to impose liability on someone who fails to act than they are on someone who acts recklessly. Also, proving cause and effect will sometimes be difficult. Then again, to win damages, a plaintiff would only have to prove that it’s “more likely than not” that a nonvaccinated child infected another person.parents who don’t vaccinate their kids—or criminally charging them….http://www.slate.com/articles/news_and_politics/jurisprudence/2013

It is just a matter of time before there will be lawsuits regarding whether a parent owed a duty to the public to vaccinate their child.

Here is information from the 6 Top Vaccine Myths regarding vaccination schedules:
For Health Care Professionals
Birth-18 Years and Catch-up
• View combined schedules (birth-18 years and catch-up)
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a2.htm
• Print combined schedules (including intro, summary of changes, references…) [355 KB, 7 pages]
http://www.cdc.gov/vaccines/schedules/downloads/child/mmwr-0-18yrs-catchup-schedule.pdf
• Print combined schedules in color (chart in landscape format) [202 KB, 5 pages] also in black & white [348 KB, 5 pages]
http://www.cdc.gov/vaccines/schedules/downloads/child/mmwr-0-18yrs-catchup-schedule.pdf
• Print full MMWR supplement (birth-18 years, catch-up, adult, adult medical and other indications, adult contraindications and precautions) [1MB, 21 pages]
http://www.cdc.gov/mmwr/pdf/wk/mm62e0128.pdf
• Order free copies from CDC
http://wwwn.cdc.gov/pubs/ncird.aspx#schedules
For Everyone
Easy-to-read Schedules for All Ages
Easy-to-read formats to print, tools to download, and ways to prepare for your office visit.
• Infants and Children (birth through 6 years old)Find easy-to-read formats to print, create an instant schedule for your child, determine missed or skipped vaccines, and prepare for your office visit…
http://www.cdc.gov/vaccines/schedules/easy-to-read/child.html
• Preteens & Teens (7 through 18 years old)Print this friendly schedule, take a quick quiz, fill out the screening form before your child’s doctor visit, or download a tool to determine vaccines needed…
http://www.cdc.gov/vaccines/schedules/easy-to-read/preteen-teen.html
• Adults (19 years and older)Print the easy-to-read adult schedule, take the quiz, or download a tool to
• determine vaccines needed…
http://www.cdc.gov/vaccines/schedules/easy-to-read/adult.html
http://www.cdc.gov/vaccines/schedules/

Here is information from the American Academy of Pediatrics regarding vaccination.
http://www2.aap.org/immunization/ Parents must consult their doctors about vaccinations.

Related:

3rd World America: Tropical diseases in poor neighborhoods
https://drwilda.com/2012/08/20/3rd-world-america-tropical-diseases-in-poor-neighborhoods/

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http://drwildareviews.wordpress.com/

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Study: Poor sleep quality can lead to cognitive problems in older men

2 Apr

Moi has posted quite a bit about the effect of sleep deprivation on children and teens. A study of older men published in the Journal Sleep details the effect of sleep deprivation on older men. The bottom line is that no matter one’s age, in order to fully function, people need adequate rest.

Science Daily reported in the article, Poor sleep quality linked to cognitive decline in older men:

A new study of older men found a link between poor sleep quality and the development of cognitive decline over three to four years. Results show that higher levels of fragmented sleep and lower sleep efficiency were associated with a 40 to 50 percent increase in the odds of clinically significant decline in executive function, which was similar in magnitude to the effect of a five-year increase in age. In contrast, sleep duration was not related to subsequent cognitive decline.
“It was the quality of sleep that predicted future cognitive decline in this study, not the quantity,” said lead author Terri Blackwell, MA, senior statistician at the California Pacific Medical Center Research Institute (CPMCRI) in San Francisco, Calif. “With the rate of cognitive impairment increasing and the high prevalence of sleep problems in the elderly, it is important to determine prospective associations with sleep and cognitive decline.”
The study involved 2,822 community-dwelling older men at six clinical centers in the U.S. Participants had a mean age of 76 years. The study is published in the April 1 issue of the journal Sleep.
“This study provides an important reminder that healthy sleep involves both the quantity and quality of sleep,” said American Academy of Sleep Medicine President Dr. M. Safwan Badr. “As one of the pillars of a healthy lifestyle, sleep is essential for optimal cognitive functioning.”
The population-based, longitudinal study was conducted by a research team led by Dr. Katie Stone, senior scientist at CPMCRI in San Francisco, Calif. Institutions represented by study collaborators include the University of California, San Francisco; University of California, San Diego; Harvard Medical School; University of Minnesota; and several Veterans Affairs medical centers….
http://www.sciencedaily.com/releases/2014/03/140331170557.htm

Citation:

VOLUME 37, ISSUE 04

ASSOCIATION OF SLEEP QUALITY WITH SUBSEQUENT COGNITIVE DECLINE IN OLDER MEN
Associations of Objectively and Subjectively Measured Sleep Quality with Subsequent Cognitive Decline in Older Community-Dwelling Men: The MrOS Sleep Study
http://dx.doi.org/10.5665/sleep.3562
Terri Blackwell, MA1; Kristine Yaffe, MD2; Alison Laffan, PhD1; Sonia Ancoli-Israel, PhD3; Susan Redline, MD, MPH4; Kristine E. Ensrud, MD, MPH5; Yeonsu Song, PhD1; Katie L. Stone, PhD1
1Research Institute, California Pacific Medical Center, San Francisco, CA; 2Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA; 3Department of Psychiatry and Medicine, University of California, San Diego, La Jolla, CA and the Veterans Affairs San Diego Center of Excellence for Stress and Mental Health, San Diego, CA; 4Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 5Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN; Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
Study Objectives:
To examine associations of objectively and subjectively measured sleep with subsequent cognitive decline.
Design:
A population-based longitudinal study.
Setting:
Six centers in the United States.
Participants:
Participants were 2,822 cognitively intact community-dwelling older men (mean age 76.0 ± 5.3 y) followed over 3.4 ± 0.5 y.
Interventions:
None.
Measurements and Results:
Objectively measured sleep predictors from wrist actigraphy: total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of long wake episodes (LWEP). Self-reported sleep predictors: sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), TST. Clinically significant cognitive decline: five-point decline on the Modified Mini-Mental State examination (3MS), change score for the Trails B test time in the worse decile. Associations of sleep predictors and cognitive decline were examined with logistic regression and linear mixed models. After multivariable adjustment, higher levels of WASO and LWEP and lower SE were associated with an 1.4 to 1.5-fold increase in odds of clinically significant decline (odds ratio 95% confidence interval) Trails B test: SE < 70% versus SE ≥ 70%: 1.53 (1.07, 2.18); WASO ≥ 90 min versus WASO < 90 min: 1.47 (1.09, 1.98); eight or more LWEP versus fewer than eight: 1.38 (1.02, 1.86). 3MS: eight or more LWEP versus fewer than eight: 1.36 (1.09, 1.71), with modest relationships to linear change in cognition over time. PSQI was related to decline in Trails B performance (3 sec/y per standard deviation increase).
Conclusions:
Among older community-dwelling men, reduced sleep efficiency, greater nighttime wakefulness, greater number of long wake episodes, and poor self-reported sleep quality were associated with subsequent cognitive decline.
Citation:
Blackwell T; Yaffe K; Laffan A; Ancoli-Israel S; Redline S; Ensrud KE; Song Y; Stone KL. Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. SLEEP 2014;37(4):655-663.

Here is the press release from the American Academy of Sleep Medicine:

Poor sleep quality linked to cognitive decline in older men
American Academy of Sleep Medicine
Monday, March 31, 2014
FOR IMMEDIATE RELEASE
CONTACT: Lynn Celmer, 630-737-9700, ext. 9364, lcelmer@aasmnet.org
DARIEN, IL – A new study of older men found a link between poor sleep quality and the development of cognitive decline over three to four years.
Results show that higher levels of fragmented sleep and lower sleep efficiency were associated with a 40 to 50 percent increase in the odds of clinically significant decline in executive function, which was similar in magnitude to the effect of a five-year increase in age. In contrast, sleep duration was not related to subsequent cognitive decline.
“It was the quality of sleep that predicted future cognitive decline in this study, not the quantity,” said lead author Terri Blackwell, MA, senior statistician at the California Pacific Medical Center Research Institute (CPMCRI) in San Francisco, Calif. “With the rate of cognitive impairment increasing and the high prevalence of sleep problems in the elderly, it is important to determine prospective associations with sleep and cognitive decline.”
The study involved 2,822 community-dwelling older men at six clinical centers in the U.S. Participants had a mean age of 76 years. The study is published in the April 1 issue of the journal Sleep.
“This study provides an important reminder that healthy sleep involves both the quantity and quality of sleep,” said American Academy of Sleep Medicine President Dr. M. Safwan Badr. “As one of the pillars of a healthy lifestyle, sleep is essential for optimal cognitive functioning.”
The population-based, longitudinal study was conducted by a research team led by Dr. Katie Stone, senior scientist at CPMCRI in San Francisco, Calif. Institutions represented by study collaborators include the University of California, San Francisco; University of California, San Diego; Harvard Medical School; University of Minnesota; and several Veterans Affairs medical centers.
An average of five nights of objective sleep data were collected from each participant using a wrist actigraph. Cognitive function assessment included evaluation of attention and executive function using the Trails B test. According to the authors, executive function is the ability for planning or decision making, error correction or trouble shooting, and abstract thinking. Results were adjusted for potential confounding factors such as depressive symptoms, comorbidities and medication use.
The underlying mechanisms relating disturbed sleep to cognitive decline remain unknown, the authors noted. They added that additional research is needed to determine if these associations hold after a longer follow-up period.
Funding was provided by the National Heart, Lung, and Blood Institute (NHLBI) for the Outcomes of Sleep Disorders in Men Study, an ancillary study of the parent Osteoporotic Fractures in Men (MrOS) Study, which was supported by the National Institutes of Health (NIH).
To request a copy of the study,“Associations of Objectively and Subjectively Measured Sleep Quality with Subsequent Cognitive Decline in Older Community-Dwelling Men: The MrOS Sleep Study,” or to arrange an interview with the study author or an AASM spokesperson, please contact Communications Coordinator Lynn Celmer at 630-737-9700, ext. 9364, or lcelmer@aasmnet.org.
The monthly, peer-reviewed, scientific journal Sleep is published online by the Associated Professional Sleep Societies LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The AASM is a professional membership society that improves sleep health and promotes high quality patient centered care through advocacy, education, strategic research, and practice standards (www.aasmnet.org). A searchable directory of AASM accredited sleep centers is available at http://www.sleepeducation.com.

According to the Centers for Disease Control (CDC), insufficient sleep is a public health epidemic.

In the article, Insufficient Sleep Is a Public Health Epidemic, the CDC reports:

How Much Sleep Do We Need? And How Much Sleep Are We Getting?
How much sleep we need varies between individuals but generally changes as we age. The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need 9-105 hours, and adults need 7-8 hours. According to data from the National Health Interview Survey, nearly 30% of adults reported an average of ≤6 hours of sleep per day in 2005-2007.3 In 2009, only 31% of high school students reported getting at least 8 hours of sleep on an average school night.4
Sleep Hygiene Tips
The promotion of good sleep habits and regular sleep is known as sleep hygiene. The following sleep hygiene tips can be used to improve sleep.
• Go to bed at the same time each night and rise at the same time each morning.
• Avoid large meals before bedtime.
• Avoid caffeine and alcohol close to bedtime.
• Avoid nicotine.
(Sleep Hygiene Tips adapted from the National Sleep Foundation ) http://www.cdc.gov/features/dssleep/

More Americans of all ages need to begin getting a good night’s sleep.

Resources:

National Sleep Foundation’s Teens and Sleep http://www.sleepfoundation.org/article/sleep-topics/teens-and-sleep

Teen Health’s Common Sleep Problems http://kidshealth.org/teen/your_body/take_care/sleep.html

CBS Morning News’ Sleep Deprived Kids and Their Disturbing Thoughts
http://www.cbsnews.com/2100-500165_162-6052150.html

Psychology Today’s Sleepless in America
http://www.psychologytoday.com/blog/sleepless-in-america

National Association of State Board’s of Education Fit, Healthy and Ready to Learn
http://eric.ed.gov/?id=ED465734

U.S. Department of Education’s Tools for Success http://www2.ed.gov/parents/academic/help/tools-for-success/index.html

Related:

Another study: Sleep problems can lead to behavior problems in children
https://drwilda.com/2013/03/30/another-study-sleep-problems-can-lead-to-behavior-problems-in-children/

Stony Brook Medicine study: Teens need sleep to function properly and make healthy food choices https://drwilda.com/2013/06/21/stony-brook-medicine-study-teens-need-sleep-to-function-properly-and-make-healthy-food-choices/

University of Massachusetts Amherst study: Preschoolers need naps Does school start too early? https://drwilda.com/tag/too-little-sleep-raises-obesity-risk-in-children/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/