Wednesday, January 11, 2017

Talking to your children about school violence

By definition, school violence is youth violence that occurs on school property, on the way to or from school, or during a school sponsored event.  School violence can take on a number of different forms including weapon use, bullying, fighting, and electronic aggression.  Statistically, most youth violence has involved persons between the ages of 10 and 24, although the pattern is shifting to involve even younger individuals.
Although any death occurring in the school setting is unacceptable, deaths occurring in the school setting are rare.  Of all youth homicides, less than 3% of these occurred at school.

More common than deaths, however, are non-fatal victimizations that occur in the school setting. In 2014, the CDC reported 486,400 occurrences of non-fatal school violence. A 2015 national survey of youth in grades 9-12 found the following:
  • 7.8% reported being in a physical fight on school property during the 12 months prior to the survey
  • 5.6% reported that they did not go to school on one or more days in the 30 days prior to the survey because the felt unsafe at school or on their way to or from school
  •  4.1% reported carrying a weapon (gun, knife or club) on school property on one or more days in the 30 days before the survey
  • 6.0% reported being threatened or injured with a weapon on school property one or more times in the 12 months before the survey
  • 20.2% reported being bullied on school property and 15.5% reported being bullied electronically during the 12 months before the survey.
Sobering statistics such as these make it clear that there are legitimate concerns among students regarding school-related violence.  Many youths struggle to understand why anyone would do such a thing and question their safety at school. Even though there are no easy answers when addressing these concerns, it is important that parents be able to provide sound, rational advice when addressing their fears and anxieties.

Here are several suggestions offered by the non-profit organization, Mental Health America, to help guide parents through difficult discussions with their children about school violence:
  • Encourage children to talk about their concerns and to express their feelings. They may not understand the term "violence" but can talk to you about being afraid or a classmate who is mean to them.
  • Talk honestly about your own feelings regarding school violence. It is important for children to recognize they are not dealing with their fears alone.
  • Validate the child's feelings. Do not minimize a child's concerns. Let him/her know that serious school violence is not common, which is why incidents such as Columbine and Conyers, Georgia attract so much media attention. Stress that schools are safe places. In fact, recent studies have shown that schools are more secure now than ever before.
  • Empower children to take action regarding school safety. Encourage them to report specific incidents (such as bullying, threats or talk of suicide) and to develop problem solving and conflict resolution skills.
  • Discuss the safety procedures that are in place at your child's school.
  • Create safety plans with your child. Help identify which adults (a friendly secretary, trusted teacher or approachable administrator) your child can talk to if they feel threatened at school.
  • Ensure that your child knows how to reach you (or another family member or friend) in case of crisis during the school day. Remind your child that they can talk to you anytime they feel threatened.
  • Recognize behavior that may indicate your child is concerned about returning to school. Younger children may react to school violence by not wanting to attend school or participate in school-based activities. Teens and adolescents may minimize their concerns outwardly, but may become argumentative, withdrawn, or allow their school performance to decline.
  • Keep the dialogue going and make school safety a common topic in family discussions rather than just a response to an immediate crisis. Open dialogue will encourage children to share their concerns.
  • Seek help when necessary. If you are worried about a child's reaction or have ongoing concerns about his/her behavior or emotions, contact a mental health professional at school or at your community mental health center. Your local Mental Health Association or the National Mental Health Association's Information Center can direct you to resources in your community.
While there are no statistics to indicate that physical violence in the school setting is increasing, there is concern that electronic bullying, also known as cyberbullying, or online social cruelty may be on the rise.

With the widespread increase in electronic communication among today's youth, this is an issue that deserves ongoing attention.

Sources for article:
About School Violence from the Centers for Disease Control
Talking To Kids About School Safety from Mental Health America
Checklist to Help Prevent Violence in Schools from the National PTA

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Wednesday, January 4, 2017

Obstructive Sleep Apnea

The Greek word "apnea" means "without breath".  In sleep apnea, there is an involuntary cessation of breathing that occurs while sleeping.  These pauses in breathing can last anywhere from 10 seconds to as much as a minute.  Snoring is also a common feature of sleep apnea.  While snoring can just be a nuisance, snoring associated with sleep apnea can signal a serious medical condition. If left untreated, sleep apnea can lead to the development of high blood pressure, heart failure, memory problems, and can increase the chance of having driving accidents due to excessive fatigue.

How does OSA develop?  The most common type of sleep apnea is called Obstructive Sleep Apnea (OSA).  This occurs when soft tissue in the back of the throat collapses during sleep, blocking off the airway. OSA is usually seen in overweight individuals.  Other risk factors for the development of OSA include: a large neck, a recessed chin, smoking, and alcohol use.  A typical patient with OSA will snore loudly after falling asleep. The snoring is then interrupted by silent periods during which no breathing takes place (apnea).  These apneic episodes are then followed by sudden efforts to breathe. The result is disturbed sleep, leading to excessive daytime drowsiness.

How is OSA diagnosed?    Most people with OSA will be unaware of their snoring or episodes of apnea. The predominant symptom will be excessive daytime drowsiness.  The snoring and apnea episodes are usually reported by a family member. The American Sleep Apnea Association has published a questionnaire known as the Snore Score.  A positive response to any one of the following questions points to the possibility of someone having obstructive sleep apnea:
  1. Are you a loud and/or regular snorer?
  2. Have you ever been observed to gasp or stop breathing during sleep?
  3. Do you feel tired or groggy upon awakening, or do you awaken with a headache?
  4. Are you often tired or fatigued during the waking hours?
  5. Do you fall asleep sitting, reading, watching TV or driving?
  6. Do you often have problems with memory or concentration? 
Other symptoms that can be associated with OSA include morning headaches, weight gain, attention deficits and memory loss. The diagnosis is usually confirmed after monitoring for apneic episodes in a sleep laboratory.

How is OSA treated?     Fortunately, there are a number of treatments available for OSA, depending on the severity and underlying causes.  These treatment options include:
  • Avoidance of alcohol and medications that relax the airway and/or reduce respiratory drive.
  • Weight loss is highly effective in obese individuals by reducing excess fat around the neck which is constricting the airway.
  • Positional therapy, i.e., avoiding sleeping on the back (for adults)
  • Oral appliances designed to keep the airway open.
  • Surgery (the most common procedure is called uvulopalatopharyngoplasty which removes excess tissue that is blocking the airway). 
  • Continuous positive airway pressure (CPAP)
The American Academy of Sleep Medicine recommends the use of an oral appliance as a first line treatment for patients with mild to moderate OSA.  In many patients, however, CPAP is the most effective treatment method.  It works by blowing pressurized air into the person's airway at a high enough pressure to keep the airway from collapsing.  A relatively new surgical procedure known as the Pillar Procedure has been found to be helpful in mild-to-moderate OSA. This procedure involves the placement of flexible implants into the soft palate to keep it from relaxing and blocking the airway.  For more on Obstructive Sleep Apnea, visit the American Sleep Apnea Association.

Sources for article: 

What Is Sleep Apnea? from the National Heart, Lung, and Blood Institute
Test Yourself from the American Sleep Apnea Association
Pillar Procedure from the Mayo Foundation for Medical Education and Research

If you have any questions about Obstructive Sleep Apnea, please log into your account and send us your question. We are here to help.

Wednesday, December 28, 2016

'Get Smart' About Antibiotics

Most people know that antibiotics are used to fight infections. Millions of lives have been saved by their ability to combat bacterial infections.  Many people are unaware, however, that antibiotics are not effective for all types of infections, specifically those due to viruses.  Inappropriate use of antibiotics has led to the new problem of antibiotic resistance. One of the best known examples of antibiotic resistance involves bacteria known as MRSA, which stands for methicillin-resistant Staph aureus. Let's look at when it is appropriate to use antibiotics and learn about the "ugly side" of indiscriminate antibiotic use-----antibiotic resistance.

Antibiotic resistance is the ability of bacteria to resist the effects of drugs.  It is considered to be one of the world's most pressing public health problems. The number of bacteria resistant to antibiotics has increased in the last decade, in large part because of inappropriate antibiotic usage. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Drug-resistant bacteria do not respond to more common and less expensive antibiotics, and in some cases may not respond to any antibiotic currently available. This can lead to serious infections that require more powerful (and expensive) antibiotics, hospitalizations, and sometimes surgical procedures. There are also many instances in which resistant bacterial infections have caused deaths. There is the potential for antibiotic resistance to develop anytime an antibiotic is used, so it is important that they be given only when absolutely necessary.

In September, 2003, the Centers for Disease Control (CDC) launched their 'Get Smart' campaign to reduce the incidence of antimicrobial-resistant disease by "knowing when antibiotics work."  Along with the CDC, health care providers and patients also play an important role in improving the appropriateness of antibiotic use.

Recommendations for health care providers:
  • Only prescribe antibiotic therapy when likely to be beneficial to the patient
  • Use an agent that targets the specific organism responsible for the infection
  • Prescribe the antibiotic for the appropriate dose and duration
In a nutshell, this means that doctors should only prescribe antibiotics when a bacterial (rather than viral) infection is suspected, and should chose the antibiotic that is most likely to be effective for the specific bacteria responsible for that infection.  Colds, flu and most cases of sore throat or runny nose do not need antibiotics. They are caused by viruses and in most instances the body is able to combat the infection on its own.

Advice for patients:  The CDC has offered the following recommendations to encourage appropriate antibiotic usage and prevent the development of resistant bacteria.
  • Tell your healthcare professional you are concerned about antibiotic resistance.
  • Ask your healthcare professional if there are steps you can take to feel better and get symptomatic relief without using antibiotics.
  • Take the prescribed antibiotic exactly as your healthcare professional tells you.
  • Discard any leftover medication.
  • Ask your healthcare professional about vaccines recommended for you and your family to prevent infections that may require an antibiotic.
  • Never skip doses or stop taking an antibiotic early unless your healthcare professional tells you to do so.
  • Never take an antibiotic for a viral infection like a cold or the flu.
  • Never pressure your healthcare professional to prescribe an antibiotic.
  • Never save antibiotics for the next time you get sick.
  • Never take antibiotics prescribed for someone else.
For more information on appropriate antibiotic use see the "Get Smart" pages on the CDC's website.

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