Monday, 4 February 2019

Using social media to help parents get vaccine questions answered

I recently wrote about how my oldest son learned how to ride a bike. His excitement got me to buy a used one, mostly because running after him down the street wasn’t going to be a solid long-range plan. Now, Milo and I get to explore on two wheels. We discovered a pond with ducks not far from the house and we’ve met a lot more people in the neighborhood, mostly ones who own dogs.

It’s also been a great way to show him what I want him to do on the bike — stay to the side of the road, wait until cars stop before you cross, and look behind you to see …

Maybe not that one. I once had that easy range of motion, but it’s gone, and I blame Milo and his younger brother Levi. I love them, but they’ve destroyed my neck. They’ve also destroyed my lower back, sleep rhythms, and knowledge of current events. But right now, it’s about the neck, and they’re not going to smile their way out of it. For six years, I’ve been constantly looking down, to read to them, to answer their questions, to hold them until I fall asleep in chairs with them.

Again, all their fault. Or maybe not completely.

Vijay Dayanani is a physical therapist at Harvard Medical School-affiliated Spaulding Outpatient Center and says the main culprit is technology. Laptops, iPads, and cell phones have created a looking-down culture, bringing the neck out of its ideal neutral position and perpetually stressing the muscles to where they eventually lock up. Parenting just compounds the problem by offering no break from the bad mechanics. More than that, Dayanani predicts that he’ll be treating a lot more neck arthritis in the future. Same goes for the fingers, particularly thumbs, from the incessant texting.

So what’s needed is some adapting, wherever it can be found. Here’s how, he says:

Awareness. It’s basic, but it’s easy to not think about how you’re holding your body. With parenting, it’s even easier to forget to simply look up every once in a while. Ultimately, the more that can be done at eye level, the better. Having any kind of screen at a comfortable height will help; adjusting your work computer will help even more. When you’re standing, check in to where your pelvis is. You want to make sure to slightly rotate it forward, which will maintain the curve in your lower spine and automatically bring up the top of your body.

Give your eyes a target. Put any picture that you love on the wall opposite your desk. It might be a little gimmicky, but anything that will cause you to look straight ahead for a few seconds will give the neck muscles a chance to rest and unwind. Along with that …

Keep a bottle of water on your desk. And drink it. It’s good to get up and move around once every hour. You could set a reminder on your phone, but you also have to remember to do that. Even if you did, deadlines can cause tunnel vision, but having to go to the bathroom is a hard one to ignore.

Check your pillow support. It should fill the space from your shoulder to your ear to keep your neck properly aligned. A simple test: while lying on your side, open your eyes. You should be looking straight ahead and your head should be level.

Work your mid-back. They’re key postural muscles. Do lat pulldowns or seated rows — a pull versus a push exercise will make it less likely to round your back.

Use hot and cold. Ice and heat are classics for a reason: they help. For anything acute and severe, ice every hour for 10 minutes for up to 72 hours. For anything else, it’s whichever temperature you prefer, once in the morning, at noon, and at night for 15 minutes each time. As men age, the simple act of urinating can get complicated. Prostate surgery often leaves men vulnerable to leakage when they cough, sneeze, or just rise from a chair. Or the bladder may become impatient, suddenly demanding that you find a bathroom right now. “Thousands of years ago, it was not as much of an issue,” observes Dr. Anurag Das, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center. “There were lots of trees, and you could just find one and go.”

But tricky bladders can be whipped into shape. The first step is a careful assessment of what triggers those difficult moments. Often your doctor can suggest helpful strategies and possibly medication to improve urinary control.
How urinary incontinence works in men

Urinary incontinence means the accidental or involuntary loss of urine from the bladder. Many cases involve slight “dribbling.” The most common types are urge incontinence and stress incontinence. The usual causes of urge incontinence in men are involuntary contractions of the bladder muscles (overactive bladder). This is sometimes related to long-term blockage from an enlarged prostate. “You feel the urge to go but you start leaking before you make it,” Dr. Das says. “It could be a few drips, or it could be a larger amount if you can’t find the bathroom in time.” Many men notice that certain triggers set off their urge incontinence, such as hearing running water, entering a cold room, rising after sitting, or even just inserting the key in your home’s door lock.

Stress incontinence refers to urine leakage that occurs when coughing, sneezing, lifting a heavy object, or other activity. In men, this is usually caused by problems in the rings of muscle, or sphincters, that squeeze closed to seal off the bladder.

“If they are weak or damaged, then coughing, sneezing, running, or jumping can cause leakage,” Dr. Das says. In men, the most common cause of stress incontinence is sphincter damage after prostate surgery. Radiation treatment for prostate cancer can also cause it. The doctor will ask questions to figure out what may be causing the problem and how severe it is. You may be asked to go home and keep a voiding diary, which is a careful record of how often you need to urinate and the circumstances or triggers that lead to leakage. The male hormone testosterone contributes to normal brain function, and some research links memory loss in older men to testosterone declines that occur naturally with aging. However, testosterone is also like jet fuel for prostate tumors, causing them to grow faster, so during cancer treatment doctors will often give hormonal therapies that suppress its activities in the body. But do those therapies increase risks for dementia and Alzheimer’s disease? Some recent reports suggest that they might, although researchers have so far been unable to prove the connection, and other studies have found no link at all.

In October, researchers published the largest study yet of hormonal therapy as a possible risk factor for dementia and Alzheimer’s disease. The researchers scoured Medicare beneficiary data for 1.2 million men aged 67 or older with prostate cancer who were treated between 2001 and 2014. Of those men, 35% were treated with hormonal therapy. Published in the prestigious Journal of Clinical Oncology, the investigation found no convincing evidence that hormonal therapy poses a meaningful risk for either dementia or Alzheimer’s disease.

Dr. Kevin Nead, a resident in radiation oncology at the University of Pennsylvania’s Perelman School of Medicine, wrote an accompanying editorial about the study. He claims it had some notable strengths, including that the Medicare data was so broad that investigators could consider other potential causes of cognitive decline apart from hormonal treatment. Nead himself published a research paper in March suggesting that hormonal therapy might be associated with increased dementia risk. On the basis of this new analysis, he now downplays those findings. Even if a relationship between hormonal therapy and cognitive decline does exist, he says, “The absolute risk is small when compared to the absolute benefit of hormonal therapy for men with prostate cancer.”
As a pediatrician, I know that many times when parents are hesitant about vaccines, it’s because of something they read on the Internet. Sadly, much of the anti-vaccine information that is out there is either misinformation or misconstrued information — but once parents have read it, it’s not always easy to convince them that it’s misinformation or misconstrued. I’ve often wished that we could find more ways to get good vaccine information on the Internet, and give parents a way to get their questions answered and concerns allayed there, rather than getting worried.

That’s exactly what researchers from Kaiser Permanente did, in a study recently published in the journal Pediatrics. They recruited women in their last trimester of pregnancy, and randomized them into three groups. One group was given access to a website with vaccine information that had a social media component that allowed them to comment and ask questions. Another group was given access to a website with vaccine information but no social media component. The third group was a “control” group, given the usual care and not given access to the website. They gave all the women a questionnaire to see how they felt about vaccines, and found that about 14% overall were “hesitant” about vaccines.

Of the women given access to a website (they used a login so that researchers could see if they used it), 35% visited it at least once. Interestingly, 44% of the vaccine-hesitant mothers visited, which is good news. We want vaccine-hesitant parents to look for information in good places. The mothers in the group that had a social media component generated 90 comments and questions. The majority of those comments and questions were directed toward the clinicians running the study, as opposed to between the women. They wanted to talk to the clinicians about their questions and concerns.

They followed the mothers until their babies were about 6 months (200 days) old to see if the babies got their vaccines, and if they got them on time. They found that 92.5% of the babies whose mothers had access to the website with social media were fully vaccinated, as opposed to 91.3% of the ones whose mothers just had website access, and 86.6% of those who got usual care.

The differences were small, it’s true, but having the ability to get information and ask questions had a statistically significant effect.

All parents want to do the right thing. They want their children to be healthy and safe. Parents who don’t vaccinate their children are worried that vaccines might hurt their child and might not work. The evidence shows abundantly that vaccines do work, that they do save lives, and that side effects are usually either minor or nonexistent. But that’s not always what parents hear or read.

Parents need and deserve good information, and they need and deserve the opportunity to talk about all of their concerns and ask all of their questions. In the setting of a busy pediatric practice, doctors don’t always have the time to sit, listen, answer questions, and discuss vaccines. We wish we always did, but the reality is that we don’t. But it’s not okay for doctors to simply say that we don’t have time. If we want to give parents what they need, and get more children vaccinated, we are going to have to come up with some creative solutions — like a website where parents can get information and share their worries and questions.

It’s also important that doctors fully realize just how much people rely on the Internet for health information, and take responsibility for either putting good information there themselves, or directing people to sites with good information.

Parents, and expectant parents, who have any questions or concerns about vaccines should let their doctor know. When we know before a visit, it’s easier for us to find ways to help. And as for sites with good information, here are my favorites:

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