Halloween Vaccine Sampler

October 30, 2009

For all you parents of trick-or-treaters worried about creepy neighbor Jerry popping a roofie into your kid’s “fun-sized”  glucose glob, I’d be more concerned about Junior’s little costumed friends and the sticky, slobbery, flu-infested mucosal secretions all over their chubby hands. Why? Because swine flu doesn’t seem to understand that it’s supposed to kill off old, sick people languishing in nursing homes instead of healthy little children and glowing pregnant women. That’s right. 95% of hospitalizations have occurred in those under 65 years old, with 45% occurring in children under 18. Believe it or not, the situation isn’t all just media hype and scare tactics. It’s ugly out there. True, not everyone dies or ends up in the hospital, but even an uncomplicated course of swine flu will park your ass in bed for a week or longer. So these days, I’m more worried about kids catching H1N1 than swallowing a razor blade hidden in a popcorn ball.

So there’s the usual “I don’t trust the government/science/western medicine/drug companies” grumbling over the H1N1 vaccine. Yeah, I get it. Sure, sure. Whatever. You’re not going to blow my freakin’ mind with the argument that the pharmaceutical industry WANTS us to be scared and WANTS us to get the vaccine because that means lotsa cash for them. I understand that profit is a motivating factor. That doesn’t really change the risk/benefits analysis all that much, nor does it change the fact that both the H1N1 shot and nasal spray are safe and effective, even for pregnant women (Tamma, Ault, del Rio, Steinhoff, Halsey, & Omer, Sept. 2009). So, if you’re able to, I’d toss a dose of H1N1 vaccine into your Halloween treat bag this weekend. Here’s info on how to pay for it. Here’s info on who should get vaccinated first. If you live in New Mexico, you can try these clinics, or contact your regular health care provider (if you’re lucky enough to have one). While you’re there, consider getting a seasonal flu vaccine as well (seasonal flu is different from H1N1 swine flu, and you’ll need a separate vaccine for each one.)

Hey, you also might want to throw a pneumococcal vaccine into your goody bag as well, since many viral flu deaths occur in people who develop bacterial pneumonia in addition to the flu.

And while you rot your enamel with sweet sugary Halloween candy, ponder the fact that we’ll soon have a vaccine against cavities (Li et al., 2009; Nui et al., 2009; Lui et al., 2009; etc., etc. Apparently Asia is all over this one.)

Sugar ain’t your thang? Perhaps the upcoming anti-nicotine and the anti-cocaine vaccines are more your style.

Too old to need anti-party vaccines? Keep holdin’ out for that vaccine against Alzheimer’s!

But whatever you do, don’t toss the condoms just yet. The new HIV vaccine was only 30% effective (which is still a major breakthrough).

There’s a whole exciting world of novel vaccines out there. From anthrax to cancer, the boring ol’ CDC vaccine schedules are about to get a whole lot more interesting. For now, though, I’ll be happy if I’m able to get immunized against the dreaded swine flu before I catch it from one of my germy little patients. Secretly, though, I’ll keep my fingers crossed for an anti-cellulite vaccine…


WICked

October 25, 2009

There were three men in my class during nursing school. One was very handsome and had a master’s in public health, one was a good-lookin’ musician who witnessed the long, painful death of a beloved family member when he was young, and the third guy… well, he ate a lot of cheese. Lots of cheese. Everyday. Like, a pound of cheese in his lunch, alongside a weird variety of other foods.

I asked him what the deal was with all the cheese one day. He looked at me, a little shyly, beneath long eyelashes (why is it that men always get the long, thick lashes?) “Well, my wife applied for WIC awhile back, and one of the few quality things you can buy with WIC is cheese.”

WIC, or the Special Supplemental Nutrition for Women, Infants and Children program, is  a program funded by the U.S. Department of Agriculture intended to supplement the diets of low-income moms and kids. A few years ago, people realized that the food packages available through WIC were devoid of key nutrients such as whole grains and fresh produce, so the USDA has recently changed the guidelines for WIC food packages to include healthier options. Through regulation of food packages, WIC aims to affect the dietary quality and habits of participants. WIC is not intended to be the primary source of food or simply general food assistance for participants. “Rather, WIC food benefits are scientifically based and intended to address the supplemental nutritional needs of a specific population–low-income pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age who are at risk”  (USDA, 2007). Food package guidelines are intended to give state’s considerable flexibility in designing food packages to meet their population’s specific needs. In addition to food supplementation, WIC also provides nutritional assessments, counselling, referral, and other services.

The issue of WIC resurfaced recently in my life when a classmate and I discussed a project she’s working on to increase access to locally grown produce and locally produced foods via WIC. This prompted one of those “I know, right?” conversations in which I shared an anecdote of recently noticing that the only WIC-approved cereals at my local grocery stores were chocolate-blasted corn crushers or whatever. After vigorously applauding her efforts, I addressed my mounting curiosity on the subject of WIC-approved foods by consulting a trusted Internet colleague, Dr. Google. A list of currently approved foods for New Mexican WIC participants can be found here, while comparison of old WIC food packages to new WIC food packages is here. And though I’m not claiming that putting cocoa-covered sugared corn bombs into the hands of toddlers is the absolute best use of public money, I did learn that those cereals (which now have to have a whole grain content of at least 51%) are an extremely important source of iron for WIC participants, and so the whole whole-grain-or-not debate is really secondary to the nutritional goal of iron supplementation. Most remarkably, my classmate’s goal of increasing access to healthy, local foods has already begun to surface here in New Mexico with WIC’s farmers market program. I couldn’t find any information on whether or not the farmer’s market program has increased the currently inadequate fresh fruit and vegetable consumption (Ponza et al., 2004) among participants, though.

Now, I am grateful that WIC exists. But, like my classmate, I believe if WIC exists, it should exist in the most effective form possible for participants and for the community. Which means there’s still work to be done. For example, WIC moms are less likely to breastfeed than eligible non-participants (Jacknowitz, Novillo & Tiehen, 2007; Ponza et al., 2004). Whether this is because moms who enroll in WIC are less likely to breastfeed in the first place (perhaps they are more likely to work outside the home than their eligible non-participant counterparts?) or because WIC makes infant formula available is unclear. Much of WIC’s interventional energy is aimed at promoting breastfeeding through support (for instance, moms who breastfeed exclusively receive a heftier food-package benefit than non-breastfeeding moms) and education, so this finding is worrisome. Of course, this begs the question, what is really the best way to promote breastfeeding in this population? Does it have more to do with the available food packages or education/support services or with perhaps with other factors that we can’t hope to address with a program like WIC?

Joyce, Racine & Yunzal-Butler (2008) wrote an illuminating article on the matter of how effective WIC programs actually are in terms of reducing adverse birth events and improving health of women and children. They essentially conclude that, although the success of WIC has been overstated, modest effects on fetal growth and emphasis on positive lifelong habits justify continued funding of the program. They say that more emphasis should be placed on reducing smoking among WIC moms, promoting breastfeeding, establishing positive life-long habits, and providing support— in essence, the educational and social support services are just as important as the food packages provided by WIC.  Which simply illustrates how nutrition doesn’t exist in a vacuum, and seemingly cut-and-dry programs designed to increase the amount of protein available to pregnant or breastfeeding women or calories to growing children must address numerous not-so-cut-and-dry factors like culture preferences/practices, education, and the tendency to select cheese over swiss chard at the grocery store..


Barely Legal

October 16, 2009

Being a nurse can be really fun. You get to watch babies being born. You get to dry a seconds-old human off with a stack of soft receiving blankets fresh from the warmer. You check the first set of post-uterine vitals, clear gunk from the airway, count fingers and toes, adorn the kiddo with her first bling (a hospital I.D. band), and place that slightly smushed pink bundle of joy against her 13-year-old mother’s chest for first the first time.

As you try to help the new mother breastfeed her baby, you can’t help but notice that mom seems confused and distracted. “Let’s put the cell phone away for a few minutes so you can hold your baby with both hands,” you gently instruct this lucky young lady. “Hold on, I’m in the middle of a text,” she replies. You wait patiently. Baby yawns. Suddenly a gaggle of middle-school girls barge into the room and flock towards the baby. “Oh, she’s so cute!” they exclaim. “Is it too soon to pierce her ears?” one asks.

Baby’s hungry and starting to fuss. You tell mom that her baby needs to eat. “Can we do it later? My friends are here!” she says.

Now, I’m not relating this anecdote, which I’ve experienced with nearly every young teen mother I’ve taken care of, in order to laugh at the frivolities of teen girls. Nor is this to say that all young moms and dads are too immature to function as parents. Just most of them. Which is why I welcomed Obama’s strategy to prevent teen pregnancy back in May, which put an end to abstinence-only funding and instead focused on evidence-based interventions. Sadly, the fun didn’t last, and I aspirated chunks of my own partially digested freedom fry when I read this a few weeks ago, which says that those rascals over in the Senate Financing Committee voted to reinstate funding for Jesus only abstinence-only education.

For practical purposes, the most important part of the abstinence-only versus comprehensive sex education debate is the evidence demonstrating how woefully ineffective abstinence-only education is (Kohler et al., 2008; Roosa & Christopher, 1990; Underhill, 2008; etc. etc. etc.) and how effective comprehensive sex-education programs can be (Oringanje et al., 2009). Unfortunately, the paucity of well-designed studies from either camp means that there isn’t really strong support for a definitive statement on the matter. Furthermore, pinning the phenomenon of teen pregnancy solely on the shortcomings of sex education is dangerously short-sighted and allows us to conveniently ignore larger cultural, sociopolitical and economic factors that contribute to teen pregnancy. So why am I choking on my own vomit at the thought of funneling $50 million of federal money into abstinence-only education? I don’t know. Maybe it’s because of the subtle and not-so-subtle messages of sexism, racism and classism embedded in most abstinence-only curricula (Froyum, 2009). Maybe it’s because the teen pregnancy rate is rising at the same time that contraceptive use amongst teens is declining (Contraceptive Technology Update, 2008). Maybe it’s because I was socialized to think poorly of early childbearing and think highly of education and financial independence. Maybe it’s because I didn’t learn Jesus and so I believe that teens will do what their healthy, fertile, baby-friendly little bodies tell them to do. I don’t know. Maybe it’s just because one of my little 13-year-old mamas told me she hadn’t heard of condoms before she started having sex. Had she been privy to the forbidden secret of wrappin’ it up, she might not have to face the emotional trauma and economic instability that naturally arises when one attempts to text message and breastfeed at the same time.