Talking About Health; Why Health Communication Matters

Health communication online for supporting fitness–SparkPeople.com

September 21, 2012

Today is my daughter-in-law’s birthday. September is filled with birthdays in my family. And we celebrate them. Not so much with cake. More with talk and support. Reminding each other of all the good things from the past year and all that we have to look forward to in the year ahead. That support makes all the difference in the world for living a fulfilled life. That must be part of the idea behind SparkPeople.com. I read about the online site when I was going through a pile of old magazines this summer. I do that now and then, tearing out pages for items I want to follow-up on and throwing the rest of the magazine away or–if it is not too destroyed–donating it for others to read. At any rate, I read about SparkPeople being a site where members find support for reaching fitness goals. So today I visited the site.

My first impression in joining is that the site has a lot of capacity for customization. I could [tho I didn’t] create my own personal page. Even without creating the personal page, I entered some information in a very quick fashion and the screen rolled over to content relating to my interests. The site is filled with color and images and all kinds of links. There are communities to join, friendships to make [the site says], stories of success before and after joining.

I wonder how long members, on average, spend on the site and how many weeks, months, or years they remain active members. I noticed that the site has a lot of advertising support. As far as I have gone, that apparently supports the site so that it is free to subscribers. So far anyway. I do wonder if the site is doing so much for so many topics that it might prove to be less depth than some would want. I also wonder about the name and how people would find their way to the site if they didn’t read about it in a magazine. Perhaps others have experiences with the site and will let us know more.

Health communication, organizations, and health advocacy

September 14, 2012

Today is my daughter’s birthday. What a wonderful way to spend some time… reflecting on her years of growing up and the strong, healthy woman she is today. In the midst of thinking those lovely thoughts, I am clearing some desk clutter. I came across a glossy brochure from my health care organization. It says it is ‘exclusively’ for Health Advocate Members. I didn’t know that I was a member, but I guess I am. I opened it up and found five member wallet cards. A phone number is the highlight of the card, together with information about what HealthAdvocate does: healthcare help, EAP [employment assistance program], find the right doctors, and untangle insurance claims. Interesting. The brochure itself elaborates on each of these topics. For employee assistance, for example, the topics include stress and anxiety, work conflicts, anger and grief, as well as drug and alcohol abuse.

The brochure tells me that the way this all works is, I call the number which is toll free and I will get to talk to a counselor. Or, I can go online and access services. I’m not sure how well this all works. I’m not sure about a counselor communicating about so many health topics. Maybe the information is more general and the goal is to redirect a call to a more specific resource. It is interesting. I’ll check at the online resource and let you know what I think.

Health communication about eating sugar and wrinkles

August 29, 2012

Another one of those incomplete messages came my way. I was reading again while waiting for a meeting. And the headline was ‘Face facts about sugar.’ There it was. A statement, with no link to the published medical research and no mention of a journal it was published in. The magazine is a 2012 one. But when I went to search for research related to the idea that “Consuming sweets can damage skin’s collagen”–the article’s claim–I found research that was published in 1998 and conducted on male rats [see http://jn.nutrition.org/content/128/9/1442.short]. OK, interesting. But it seems worthy of at least a descriptive study in humans. And worthy of including female humans. While we might not want to volunteer for a randomized clinical trial in which we get assigned to a group that eats, let’s say, the amount of sugar that is ‘average’ or eats no sugar at all, it seems like there may be some ‘natural’ study groups out there to observe and survey. Folks who simply don’t eat sugar or eat very little sugar. Let them provide photos of their faces, or some lab work relating to collagen levels. Compare the results to a group that eats more ‘normal’ levels of sugar. Factor in whether they are male or female, how old they are, and a few of the other correlates related to collagen–such as lifetime sun exposure [see, for example, http://www.ncbi.nlm.nih.gov/pubmed/8642084]. It would be interesting to ‘see’ if there are differences in the appearance and would give us some actual ‘human’ face facts.

Health communication about BONIVA

August 25, 2012

“BONIVA has not been proven to stop and reverse bone loss in 9 out of 10 women and is not a cure for postmenopausal osteoporosis” [http://www.stategazetteftp.com/mags/parade/Pg_07.pdf]. This message has appeared in numerous magazines and newspapers. Have you seen or heard it?

I wonder how Sally Field feels about that. She appeared in ads to endorse the product and she read the script that said the research had shown that BONIVA reversed bone loss… I will track down the research and see if we can find what the published research really found. For now, I am reflecting on how many of us heard Sally’s ad versus how many of us have seen or read about the FDA’s retraction. And I am enjoying having the strength, including my bones, to pick up my 4 year old grandson and wrestle him into my lap for a family gathering at a restaurant after church on a warm Sunday afternoon.

Health communication and forest therapy…is this a case of country mouse vs. city mouse?

August 22, 2012

One of my sister’s brought to my attention some research about ‘forest therapy’. I read the article she sent me and was pleased to find that basking in the surroundings of a forest was reported to have positive benefits for human health. I would have to say that I didn’t need any justification for spending time in nature any opportunity that I get, but it was a nice thought to justify my own love of nature.

And then I decided to go on a hunt for the research. Alas, as is too often the case, there was no mention of the actual publication in the news report and so I had to go in search of the research. On PUBMED, I was able to find research on ‘forest therapy’. Sadly, the most recent article–published in the past several months in 2012, is a meta-analysis that examined all previously published articles and concludes that there is no evidence from which to draw conclusions about the effects of forest therapy [see http://www.ncbi.nlm.nih.gov/pubmed/22888281]. The authors conclude that, “Because there was insufficient evidence on forest therapy due to poor methodological and reporting quality and heterogeneity of RCTs, it was not possible to offer any conclusions about the effects of this intervention. However, it was possible to identify problems with current RCTs of forest therapy, and to propose a strategy for strengthening study quality and stressing the importance of study feasibility and original check items based on characteristics of forest therapy as a future research agenda.”

Alas, I remain steadfast in my belief that forest therapy, spending time walking and living and breathing in forest environments, sustains me. But I have at least one very good and close longtime friend who would not agree with me. She basks in the bright lights and fast pace of locations such as New York city in December. That, in fact, was one of the challenges associated with the research. There are unpleasant forest setings that no one would want to spend time in, so not all forests are created equal. And there has to be a great deal of individual variance related to preferences in this regard. Perhaps it is more important to communicate that each of us should take time to identify what environment and setting gives us the most calm and promotes our well-being. And then find time to bask in it.

Health communication and children’s backpacks: Should they carry a warning label?

August 12, 2012

Warning labels. We find them on so many things. And we too often ignore them. But parents are devoted to knowing what dangers face their children. So parents often read warning labels that have to do with products they might purchase for a son or daughter. Such warnings appear on bicycle safety helmets. The CDC notes that,

“Three organizations — ANSI, the Snell Memorial Foundation, and the American Society for Testing and Materials (ASTM) — have developed voluntary standards for bicycle helmets Table_1. Helmets are tested for the amount of impact protection they provide by dropping the upper torso and helmeted head of a crash-test dummy (i.e., a “helmeted headform”) onto a metal anvil and measuring the amount of force on the headform (22). Testing for strap-system strength is done by dropping a weight on the fastened strap; the weight causes weaker strap systems (i.e., straps or buckles) to break. Helmets that meet Snell standards provide better protection against bicycle- related head injury than do helmets that meet the less rigorous ANSI standards (18). The Consumer Product Safety Commission is developing federal standards for bicycle helmets. These standards will apply to all helmets sold in the United States and will most likely be similar to the existing standards.

All three existing standards require that manufacturers include warning labels that advise consumers that helmets are for bicycle use only (e.g., “not for motor-vehicle use” {23}) (24, 25). In addition, manufacturers are required to warn consumers (e.g., by including a warning label in the helmet) that a) a helmet that has sustained an impact should be returned to the manufacturer for inspection or be destroyed and replaced, and b) helmets need to be fitted and securely fastened to the bicyclist’s head to provide maximum protection”

Some research and experience begins to suggest that perhaps a warning label should appear on children’s backpacks. Some backpacks used for recreational backpacking have warning labels

Some children’s backpacks have warning labels because the material that the pack is made from includes content known to be a cause of cancer. See this review for example:

“This item just arrived, a gift for my 2 year-old son. He was thrilled when he saw it. It was therefore terribly upsetting to discover the following warning (in tiny print) on one of the product labels: “WARNING: This product contains chemicals known to the State of California to cause cancer and birth defects or other reproductive harm.” This warning follows the requirements of California Proposition 65 (ample material about it on the web). This warning is, of course, unacceptably vague. However, no caring parent would risk exposing their child to a toxic substance. This morning, my son woke up asking for his backpack. I am saddened, angered, and frustrated that he and I have been put in this position by inadequate regulation of toy safety (the backpack is made in China) and inadequate disclosure (both on the toy tag and on the Amazon website) identifying the specific potential risk” [http://www.cdc.gov/mmwr/preview/mmwrhtml/00036941.htm].

Consumer reports suggests that the size of the backpack, including how far down on a child’s back it falls and the width of straps, is important for the comfort of the pack for your child. For a full review of things to consider, see the report at: http://shopping.yahoo.com/news/how-to-pick-a-backpack-for-your-child-.html

Happy back to school shopping!

When is reading a mammogram like looking for a polar bear in a snowstorm?

August 9, 2012

When you have dense breast tissue… at least, that is what some physicians say [go here, for more: http://www.womentowomen.com/breasthealth/densebreasttissue-mammograms.aspx ].

It has been 15 years since my annual mammogram led to a callback from the doctor for more x-rays and then a needle biopsy and finally ‘the all clear’ — no sign of cancer pronouncement. But it happened again last week. I got my annual mammogram on my way out of town to go to Atlanta for a visit with my daughter and granddaughter and son-in-law. And the day after I had the screening, I got a message on my home machine to call for a return visit…

Things have changed in the last 15 years, of course. Now, digital mammography makes some things more likely to be seen on the x-ray compared to film. Go here for a comparison: http://www.umm.edu/breastcenter/digital_mammography.htm?gclid=CNbCiKu_27ECFUlnOgodsH4A_A

At any rate, I returned to the imagery center for more x-rays. Here is how the communication went. First, it was nearly impossible to understand the message on my answering machine. My husband and I listened to it a half dozen times. We looked up the phone numbers of the imagery center, and none of them matched what we thought we were hearing. Nonetheless, I wrote what we thought they were saying and tried the number. It rang out to a message saying that it was long distance. Not likely then to be what I needed to call. Next, I tried calling the number using the first 3 numbers that all the numbers online for the imagery center used. And the last 4 numbers we thought the caller was saying that appeared nowhere in the online listing. Success. I got a nurse who checked and said, “When can you come in?” And I made an appointment for the day after I would return from my visit, which was a week after the first mammogram.

I went to the imagery center, this time with my husband coming in. The volunteer greeted me with, “Oh. I am so sorry.” Yikes. Not what you want to hear. She remembered me from the week before because we had a long chat about my height. At any rate, I would venture to say–“so sorry” is not quite the right expression in this situation. Perhaps “sorry you have to come in for more tests” if ‘sorry’ is to be used at all. The expression and her empathy were, however, unsettling.

Once I was in the room with the x-ray technician, I encountered the other end of the spectrum. The communication was reactive rather than proactive regarding what she wanted me to do. “Put your arm up and grab the handle? I did. “No. Turn this way. Face the machine.” Her tone was irritated. Wow. It is 9:30 in the morning. Why is she so grumpy? I am the one getting my boob smashed again.

She sighed. Letting out a clear expression of annoyance, she said. “Stick your bum out.” Who talks like that? “No. Look at me– Like this–” she said as though talking to someone she regarded to be extremely stupid. Finally, she was satisfied.

Time for another image. She turns me a bit and I try to enact what I have learned. I stick my bum out. “No.” she says harshly. “Stand up straight.” My arm began to quiver. Unavoidably uncertain about what I was doing wrong. Several more images and abrupt commands later, we were done.

“Will the radiologist come in here to discuss these with me?”

“No. Wait in the waiting room. I will get you when he is ready for you.”

I asked the volunteer if she would get my husband when I got called to the radiologist meeting. She told me to ask the technician to do it. So, when the technician came to get me, I asked her. And she did. No attitude. Wow!

And then there was the radiologist. I don’t think he could have been nicer or clearer. He put two pictures up on a screen and pointed to a small round dark spot about the size of a pellet for a BB gun. “This is what we’re looking at that’s different,” he said. “All this is your muscle and dense breast tissue.” It all looked like a lot of snow to me but I could see the BB…

“We’re going to do an ultrasound to see what we can learn about that spot.”

“What will the ultrasound tell you?”

He launched into a helpful answer that I will summarize as, ‘if the sound waves go through the mass, it’s a cyst. If they don’t it may be something we need to take a look at.’

The sound waves showed no mass. He spent plenty of time making sure that it did not appear in any direction. And then he announced, “I believe it’s a cyst. I will call this ‘normal’ and you won’t need to return for a year. Unless, of course, you see or notice changes that should be checked. Any questions.”

Hip Hip Hooray…. But I wish someone would give me a satisfaction survey to fill out about the volunteer and x-ray technician. I have a few thoughts about how their communication could be improved.

Restless legs syndrome, summmer heat, and too little of an important thing–salt

July 28, 2012

It is summer time and the heat is overwhelming. Here I am with my niece and granddaughter at the Springfield, Missouri zoo. And we are…hot!

It was so hot going across the midwest to get to our family reunion that the rubber gasket that frames our windshield…melted!

Still, when I returned, it was cooler… 90s instead of 108. I got back to my garden trying to be sure that it would survive the heat and I would have tomatoes and peppers. So for three days in a row, I worked half a dozen hours in the morning and late afternoon. And then I ran out of steam. I drank a lot of water while working outdoors but it still felt like I was dehydrated. Alas, I was. Because I skimp on salt and had been sweating like crazy.

So, I bought a bag of my favorite only eat them at times like this snack chip–FRITOS. And I got some salt back in my system. It helped with muscle contractions, energy, and my restless legs at night.

”

Restless Leg Syndrome

Low levels of sodium are also linked to muscle contractions related to the medical disorder known as restless leg syndrome, according to Digitalnaturopath.com. One method of dealing with sodium’s role in this medical condition is making sure the ambient air temperature is comfortable enough to keep you from sweating during the night which causes you to lose sodium. Sodium supplements to treat muscle contractions causing restless leg syndrome should only be considered if your natural intake of sodium is low” [http://www.livestrong.com/article/487350-sodium-and-the-muscles/]. Phewwwwww.

The many uses of the word ‘evidence’: PREVENTION magazine

July 27, 2012

There are few things that frustrate me more than reading advice about health that says, “Based on the evidence…” but there is no reference to who conducted the research or where the research was published or when. I find this to often be the way that Prevention magazine writes about “evidence”. Sometimes, the report or story will include just enough information so that I can search online and find something that seems to be the basis for the claim being made. But I was catching up with some reading in Febrary, 2012 Prevention magazine, and p. 32, there begins a list recommendations for ‘heart health’ with each one including the capitalized subtitle in all caps: THE EVIDENCE. Reading about eating oranges, the article explains that “new research shows…citrus pectin helps neutralize a protein called galectin-3”. I searched PUBMED and googlescholar but could not find the ‘new evidence’. Several sentences later, it says “A 2009 study showed that a diet high in fruits and vegetables decreased the risk of heart failure by 37%”. There were a lot of studies published in 2009. Which one? Decreased risk by 37% for whom–people with high risk of heart failure, older adults, the general population, men, women? Help us out here. Tell us who did the research, where it was published, when, and something about the participants in the study. Communicate about health to increase health literacy…

Health communication about medical test sensitivity: The TSH and CA 125 blood tests example

July 23, 2012

Doctors often recommend blood tests to help them diagnose our condition or to check our health status. For example, I have an underactive thyroid condition. As discussed in my book ‘Talking about health’ — my ‘normal’ numbers fall outside the range of a healthy ‘normal’ [see for a discussion http://www.denvernaturopathic.com/news/TSH.html]. I was diagnosed with this condition in my 20s and have taken daily medication to address it since that time. My mother was diagnosed with the condition in her 20s as well. I go to see my internist annually, and he puts in an order for a TSH [thyroid stimulating hormone] test [http://www.endocrinology-online.com/Content/For%20Patients/TSH.htm] that I go to the lab for several weeks before my scheduled appointment. This test is considered to be very sensitive–but what does that mean? It is the probability that a person having a disease will be correctly identified by a clinical test. However, a careful reading of the article at the link shows that the results may depend on the time off day you were tested–a reason why the test is given in the morning after fasting.

But aren’t all medical tests highly sensitive? Otherwise, why do them?

The answer to the latter is ‘because that is the best that can be done’. The answer to former is ‘no’.

Take the CA 125 test, for example. The test was hoped to be a valid indicator of ovarian cancer. However, the test indicates the presence of other disease as well. So a positive CA 125 test validly indicates the presence of ovarian cancer sometimes but often does not:

“The result of a Ca-125 test is interpretable only by considering the context in which it was ordered. When you order a Ca-125 test you will have to estimate your patient’s risk for having ovarian cancer. If your patient can be put in a group in which the likelihood of cancer is high then a positive test is probably correct and a negative test wrong. If your patient can be placed in a low risk group then the positive test is probably wrong and the negative test meaningless. Furthermore, there is no way to evaluate a positive test. You can repeat the test and pick the best 2 out of 3; 3 out of 5; 4 out of 7, etc. Otherwise, she will be heading for surgery” [http://www.gynoncology.com/ca-125/].

So if your doctor orders a CA 125 test, remember that the results should be discussed. This is true of all medical tests.But when a test that has been ordered is not highly sensitive, it is really important to discuss the meaing of the test result. If the test comes back positive and is not highly sensitive, have a conversation and ask: ‘What’s next to rule in or rule out the condition you were testing for?’ AND ‘What other conditions could the positive test result suggest I may have? How will we rule out whether I do or do not have them?’