Stress in Teenagers: Patterns Rival Adult Stress
Health Watch – March 11, 2014
Dr. David Prescott – Eastern Maine Medical Center Behavioral Medicine
Teenagers in the Stress In America Survey: Each year, the American Psychological Association conducts a national survey to examine Americans’ perceived level of stress, sources of stress, and how we are coping. This year’s survey continues to suggest that most Americans find their stress level to be higher than they would like. But, this year’s survey revealed that the stress outlook for teenagers mirrors that of adults, and that stress negatively impacts the lives of many of our teens.
The Negative Impact of Stress Begins Before Adulthood: In 2013, American teenagers rated their level of stress higher than adults for the month prior to being surveyed. Like adults, most teenagers believe that their stress level is higher than it ought to be. Not surprisingly, teenagers report that their stress level is higher during school months than when school is not in session. And, about one-third of teenagers believe that their stress will get worse in the coming year.
Stress is Part of Life – But How Well Do Teens Cope? Most health experts agree that some level of stress is unavoidable. A more relevant question than whether or not people feel high levels of stress, is how they address it. In this area, it appears that teenagers, like adults, are more likely to use sedentary or passive coping techniques, rather than techniques which promote physical and emotional wellness. For example, frequent coping responses that teenagers use to cope with stress include:
· Playing video games (46% of teens report this as stress coping technique)
· Going online or surfing the Internet (43% of teens report this as stress coping technique)
· Watch TV or movies (36% of teens report this as stress coping technique)
· Reducing Sleep (teens with less than 8 hours of sleep per night rate their personal stress higher than teens who sleep at least 8 hours)
How well to Teens Understand the Impact of Stress on Their Health? Like adults, teenagers appear to downplay the impact of stress on their physical and emotional health. However, it appears that teenagers are less likely than adults to acknowledge that stress can have negative health consequences. For example:
· 54% of teens say that stress has little or no impact on their physical health;
· 52% say stress has little or no impact on their emotional health.
Yet, when questions are phrased in terms of specific behaviors, teenagers readily acknowledge that stress makes them more nervous, angry, and tired.
Teaching Teenagers More Effective Stress Management: Helping teenagers develop effective stress coping strategies can have lifelong benefits. Some ideas for places to start include:
1. Move your body. Physical activity is one of the most effective stress busters. That doesn’t mean you have to go for a jog if you hate running. Find activities you enjoy and build them into your routine such as yoga, hiking, biking, skateboarding or walking. The best types of physical activities are those that have a social component. Whether you’re into team sports, or prefer kayaking or rollerblading with a friend or two, you’re more likely to have fun – and keep at it – if you’re being active with friends.
2. Get enough shut-eye. Between homework, activities and hanging with friends, it can be hard to get enough sleep, especially during the school week. Ideally, adolescents should get nine hours a night. Most teens, though, are getting less. According to APA’s Stress in America Survey, teens say they sleep an average of just 7.4 hours on a school night. That’s unfortunate, since sleep is key for both physical and emotional well-being. To maximize your chance of sleeping soundly, cut back on watching TV or engaging in a lot of screen time in the late evening hours. Don’t drink caffeine late in the day and try not to do stimulating activities too close to bedtime.
3. Let yourself shine. Spend some time really thinking about the things you’re good at, and find ways to do more of those things. If you’re a math ace, you might tutor a younger neighbor who’s having trouble with the subject. If you are a spiritual person, you might volunteer at your church. If you’re artistic, take a photography class. Focusing on your strengths will help you keep your stresses in perspective.
Get help signing up for health insurance on the Federal Marketplace. Sponsored by Penobscot Community Health Care and Bangor Housing.
Tuesday, March 4th
Bangor Housing Community Center, 161 Davis Road
6:00 pm – 7:30 pm
Telemedicine – – what is it?
(And why should we care?)
By: Dr. Jonathan Wood
Telemedicine means different things to different people. We now share x-ray pictures and EEG tracings over long distances, lab values can routinely be reviewed from afar, and for many of us, our patients entire medical record is now “in the cloud”, securely available digitally to caretakers who need to see it. From anywhere! For some people, this is telemedicine. But for me, telemedicine is something much more than that.
Healthy Living – February 4, 2014
Dr. David Prescott – Eastern Maine Medical Center Behavioral Medicine
Auditory hallucinations – hearing sounds or voices that appear to come from within the mind – have been to focus of inquiry for centuries. While auditory hallucinations may represent symptoms of a significant mental illness, they also occur for reasons not suggestive of a mental illness.
How Common Are Auditory Hallucinations? Surveys of both college students and adults concerning how many people experience hearing some type of voice are surprising. For example:
· Almost 30-40% of college students report that they have heard voices while awake, and almost half of those report hearing them at least once a month.
· Between 8-12% of adults report having had at least one hallucinatory experience.
· Experiencing a hallucination does not necessarily mean that a person will develop a significant mental health problem.
Thus, hearing a voice or sound that isn’t really there can mean many different things. In his recent book “Hallucinations,” neurologist Oliver Sacks describes some of the neurological bases for hallucinations, and argues that hallucinations are simply part of the human experience. He describes stories of people in both common and extreme situations (for example, people severely injured who were miles from help) who clearly hear voices. Nevertheless, there are certain patterns of auditory hallucinations which indicate the need for mental health treatment.
Common Mental Health Problems that Involve Hallucinations: Sometimes, hearing voices or sounds is a symptom of a significant psychiatric problem. Examples include:
· Schizophrenia: In addition to auditory, visual, or tactile hallucinations, people with schizophrenia often become highly disorganized in their behavior. Typically their level of functioning at school or work declines significantly. Auditory hallucinations are the most common type of hallucination associated with schizophrenia.
· Bipolar Disorder: Bipolar disorder involves intense mood swings beyond the normal “ups and downs” of everyday life. Hallucinations may be part of the manic or depressed cycle of bipolar disorder.
· Organic Illnesses: Hallucinations may be a symptom of classis brain pathology, such as a tumor, dementia, or seizures.
· Substance Induce Psychosis: Use of alcohol or other drugs, either short or long term, can cause hallucinations.
A discovery during surgery at Eastern Maine Medical Center in Bangor has led to a nationwide recall of a device that helps prevent blood clots.
It’s called the Cordis Opt-ease Vena Cava Filter…and it’s inserted into a vein that returns blood to the heart from the legs.
Please do not get up on your roof to shovel snow if you can avoid it
Two weekends ago was a snowy time and there were public service announcements urging homeowners to clear the snow off of their roofs. Every year as it gets snowier we see these ads and every year we at Eastern Maine Medical Center treat many people with fall injuries. This particular weekend we saw 20 people in the Emergency Room who fell off their roofs and 6 were admitted with serious injuries.
By- Dr. Jonathan Wood
When is someone dead? It seems simple, but clearly it is not.
This is the question circulating the country right now around the case of an unfortunate young girl in California who was declared “brain dead”, but whose family insists that she is not dead. This case is sad and unfortunate, perhaps made more tragic by the girl’s age and by the fact that her brain injury resulted from complications of a seemingly “routine” operation. Unfortunately, the situation has become even more tragic because of the confusion around understanding her death. This confusion is very important to discuss because this type of misunderstanding is more common than many people realize.
Amy Badger, was in for this months Fit Friday. She talked with Wayne about tips on eating and hydration tips for working out.
Amy Badger, was in for this months Fit Friday. She showed Wayne and Joy how to do push ups, and how to modify them to your fitness level.
By- Dr. Amy Movius
Frostbite is something everyone is Maine should know a thing or two about. With single digit temperatures expected this week, it’s a good time to review some frostbite facts. Frostbite is when body tissues literally freeze, and ice crystals form inside cells. If the skin is the only tissue frozen it is “superficial” frostbite. Deep frostbite occurs when all tissue layers are involved. Ironically, frostbite is classified by degrees, similar to burns.
By: Dr. William Sturrock
Osteoporosis is a disease that affects over 45 million Americans, and is found in 55% of the population over age 50. It is found more frequently in women however has been recently recognized as also occurring in men as well particularly over age 65. There has been good research which shows that there are many conditions predisposing to unhealthy bones which can result in osteoporotic fractures to include cigarette smoking and postmenopausal status, long-term COPD or inflammatory bowel disease, heavy alcohol consumption, decreased physical activity, seizure disorders and certain cancers particularly prostate cancer. Recently with the recognition that many men also demonstrate low testosterone levels as they age, it has been shown that a good percentage of these individuals will also have osteoporosis unless treated. There are also studies suggesting that high consumption of carbonated soft drinks and other problems associated with nutrition will increase risk for unhealthy bones.
Because prevention is much smarter than waiting for problem to develop, many experts have recommended increased calcium intake as well as vitamin D, which is essential for bone metabolism.
Experts recommend that at least 1200 mg of calcium with 600 units of vitamin D for adults under 65 and 800 units for older adults should be taken by patients at risk. There is an interesting fact of human physiology that exposure of our skin to sunlight will actually allow us to manufacture vitamin D, and some individuals have tried to increase the vitamin D levels by getting more sun. Unfortunately the American Dermatology Association does not recommend increasing our sun exposure, due to the risk of skin cancer.
Recently our ability to measure vitamin D levels and has added some additional confusion because many individuals living in northern climates can have an abnormally low levels due to the fact they are having much less sun exposure. In addition there have been a lot of suggestive connections between low vitamin D levels and conditions such as fatigue and depression. This has led some clinicians to recommend patients try to take vitamin D for these conditions as well, and there has been much increased vitamin D testing without clear guidelines for treatment. There is a well-known endocrinologist from Bangor, Clifford Rosen MD who has been working with the National Institutes of Health on the issue of what levels of vitamin D are ideal, and whether clinicians should be using it to treat conditions other than osteoporosis. I agree with his previous recommendations that at this point we should not have any false expectations that vitamin D is a primary therapy for conditions such as fatigue or depression. He also has questioned the wisdom of high-dose vitamin D treatment for patients whose levels are close to normal.
By: Dr. David Prescott, Ph.D.
Seasonal Depression Impacts Many People: People who live in areas where daylight hours in winter are extremely short are more likely to be impacted by seasonal affective disorder, or seasonal depression. According to the American Psychiatric Association, 10-20% of people in America feel more depressed with the onset of winter. A true diagnosis of seasonal affective disorder is less common, with estimates ranging from around 1% to 10% of the population during the winter, partly depending on the latitude at which you live.
By- Dr. Amy Movius
Halloween costumes aren’t just for trick-or-treaters. Whether young – or just young at heart – dressing up at Halloween is fun! Cosmetic contact lenses of different colors and designs are a costume accessary that is growing in popularity. These lenses do look pretty cool and the selection seems endless. A Google search of “Halloween contact lenses cheap” returned almost 4 million results! Besides on-line, these lenses may be found in beauty supply stores, costume or specialty stores, and even at convenience stores and flea markets. They can also be quite inexpensive. Great, right?
By: Dr. David Prescott
What is ADHD? Attention Deficit Hyperactivity Disorder, or ADHD, is one of the most common mental health problems diagnosed in children, with lower prevalence among adults. Estimates of its prevalence in children and teenagers typically range from a low of 5% to a high of 10%.
Sudden Infant Death Syndrome (SIDS) is the leading cause of infant death in the United States. The Safe to Sleep campaign aims to change that. TV5 Health Advisor Dr. Jonathan Wood joined Jim Morris on TV5 News at 5 to talk about it.
LONG-TERM USE OF PROTON PUMP INHIBITORS
By- Dr. Joan Marie Pellegrini
PPI’s (Proton Pump Inhibitors) is a class of popular drugs used to treat GERD (Gastro esophageal Reflux Disease). Some trade names for these drugs are Nexium, Protonix, Prevacid, and Prilosec. These drugs have been on the market for decades and considered quite safe. They are used to reduce the acid in the stomach. In general, their use is indicated for 2-8 weeks to treat esophagitis, gastritis and other acid-related conditions. However, many patients are on these drugs for years and even decades. PPI’s are the 3rd most commonly prescribed medication at over 100 million prescriptions per year. There does not appear to be any problem with short term use. However, there is rising concern for long-term use.
Data has suggested that long term use can impair absorption of nutrients from the stomach. In particular, calcium and iron are better absorbed in an acidic environment. With long term absorption problems, a patient can develop anemia (low blood counts) and be at increased risk of fractures. Other problems associated with PPI use are increased flatulence, possibly an increase in the risk of some infections such as C difficile colitis and pneumonia, a decrease in effectiveness of some drugs (Plavix is one of these drugs but the data on this is confusing and controversial).
PPI’s have not been shown to reduce the risk of esophageal cancer as was once thought. The PPI helps to relieve the symptoms of reflux but does not actually cure reflux.
Many experts feel that if every patient were to adhere to guidelines to modify their diet, exercise, and manage to lose weight that up to 90% of patients on PPI’s would not actually need the medication.
Clearly there is a role for PPI’s. Since their introduction they have been considered a fantastic drug. PPI’s have dramatically reduced the rate of complications from acid-related disease such as ulcers and gastritis.
Therefore, if you have been on one of these drugs for a long time, it is my recommendation that you have a discussion with your physician about its use. Are you suffering any of the adverse side effects? Is the drug effective for you? Is there another alternative? Do you actually need a PPI? Would now be the time to start a diet and exercise regimen that may help with some of your symptoms (many overall benefits!)?
By: Dr. Anthony Ng
With the recent news of shooting and violence in the news, such as nationally of the young child shot in Chicago, and the mass shooting in Washington, DC, as well as local acts of violence within our local Maine communities, many have been wondering if there is a way that we can tell or predict who will be such likely perpetrator of violence. The hope is that we can prevent such violence from happening, short of the ongoing debate on gun control. The answer is both yes and no.
By- Dr. Joan Marie Pellegrini
Several years ago the National Cancer Institute funded a large trial looking at screening for lung cancer in high-risk patients and the results have been recently released. High risk was defined as amount and length of time of tobacco exposure (1). Patients (2) were randomized to a chest x-ray versus a low dose CT scan annually for three years. The results showed that CT scanning could lead to a 20% decrease in lung cancer deaths. This is mostly because screening patients with CT found many more early stage cancers which could be treated with a cure.
There may be more you may realize to the term “Man’s Best Friend”…By: Dr. Jonathan WoodThe benefits of pet ownership sometimes seem obvious to those of us who have them: pets are loyal, they’re non-judgmental, they reduce our stress, they sense our mood and respond appropriately, and they’re generally just wonderful to have around. But research over the past several years is starting to elucidate distinct medical benefits beyond our qualitative sense that “pets make us feel good”. Research is starting to solidify the notion that our pets actually do make us healthier. For example:A recent report out of UCLA studied 76 heart failure patients and assessed their anxiety levels before and after 3 interventions. One group received a visit from a volunteer, one group received a visit from a volunteer with a dog (with which the patient was allowed to interact), and a control group received no visit at all and remained at rest. Vital signs, stress hormone levels and anxiety questionnaires were evaluated for each patient before and after the interventions.While the blood pressures and hormone levels decreased in both interventions, the apparent positive effect of the dog on anxiety was most dramatic: a 24 percent drop in anxiety levels in the dog group versus a 10 percent drop in the volunteer-alone group and no change in the control group! This study is consistent with a number of studies of the effects of animals and pets on health and disease over the past 15-20 years. This phenomenon has even spawned a new type of therapeutic approach with specific goals and guidelines, known as “animal-assisted therapy” or “pet-facilitated therapy”. What are some of the health benefits of pet ownership or of animal-assisted therapy? Below are a few examples:· Two studies suggest strongly that pet ownership improves 1-year survival after heart attacks.· ACE inhibitors lower blood pressure quite effectively in patients with hypertension, but they have little effect on the increases that occur with mental stress. However, in patients who own pets and take ACE inhibitors, these stress-induced increases are significantly blunted.· Male pet owners have significantly lower systolic blood pressures, triglyceride levels, and cholesterol levels than non-pet owners.· Psychiatric patients with a variety of disorders have been shown to have significantly decreased levels of anxiety following animal-assisted therapy sessions when compared with controls.· Some studies suggest that medication use and cost can be significantly reduced in settings where pets are actively involved in therapy. · Several studies show that pet owners make fewer medical appointments and have fewer minor illnesses. In addition, people who acquire pets show significant improvements in measures of psychological well-being and these effects are maintained over time.· Several aspects of child health are also improved by animal and pet contact on a number of different levels:o The presence of a dog during a child’s physical exam decreases stresso The cognitive development of children appears to be enhanced by pet ownership.o Measures of children’s self-esteem is enhanced by pet ownershipo Children who own pets show more capacity to empathize than those who do not.o Children with autism who have pets seem to exhibit more pro-social behaviors than those who do not.And the list goes on and on. Although these are very difficult studies to perform and invariably there are many factors involved in health maintenance, it seems clear that there are many physiologic and psychosocial benefits of pet ownership and of animal use in therapeutic settings. Many of the effects appear to be the result of decreased stress. As the underlying neurochemical basis for stress-related illness becomes clearer, it will become easier to quantify these effects and allow us to better advocate for using our furry friends to improve health.In the meantime – – enjoy your pets as you always have and revel in the fact that you are probably healthier because of them!For more information on the health benefits of pets, visit some of these web sites:· The CDC’s website on the heath benefits of pets:http://www.cdc.gov/healthypets/health_benefits.htm· The Delta Society – a non-profit group whose mission is “improving human health through service and therapy animals”:http://www.deltasociety.org· The 1987 consensus statement from the National Institutes of Health on this subject:http://consensus.nih.gov/1987/1987HealthBenefitsPetsta003html.htm
By: Dr. Amy MoviusThis week, many schools are starting preseason training for fall sports and the weather has been hot and humid. With these conditions, it is very important to be aware of the potential for climatic heat stress, especially as some of these kids will be abruptly increasing their activity after a leisurely summer break.Heat-related illness happens when the body has increased heat production (as with exercise) and/or a decreased ability to transfer heat to the environment (think uniforms/ sports equipment). It can be fatal and treatment to decrease body temperature should begin as soon as any symptom(s) are recognized. So what are the symptoms? An early one is cramping. Heat exhaustion, which happens when the body has lost too much water and salt, can occur next. Persons with heat exhaustion sweat profusely and have cold, pale, and clammy skin. Heat stroke is the most extreme type of heat-related illness and happens because the body temperature is so high that cells are damaged. Persons with heat stroke are red and hot with dry skin, and confusion. Though heat and humidity are beyond human control, there are lots of other ways to prevent heat illness in child athletes. A summary of recommendations from the AAP (American Academy of Pediatrics) is as follows:1. Everyone in leadership positions for youth sports should emphasize awareness, education, and implementation of heat illness risk-reduction strategies to all staff that oversee/ assist with these sports.2. Capable staff and treatment facilities readily should be readily available.3. Young athletes should be educated on proper sports preparation, prehydration/hydration, honest reporting of any symptoms, and other issues such as getting enough recovery time and rest to reduce their risk of heat stress.4. Athletes should be given an opportunity to acclimatize to preseason practice and conditioning in the heat, typically over a 2 week period. There are specific guidelines for American youth football available.5. Appropriate fluids should be readily accessible to athletes and consumed at regular intervals before, during and after exercising.6. Activity should be modified based on the degree of heat. This can include lowering intensity, shortening duration, and/or increasing breaks during practice sessions. 7. Athletes should avoid or limit participation when ill or recovering from illness.8. Athletic staff needs to receive training in how to monitor athletes for signs and symptoms of heat illness. They should be directed to immediately stop sport participation and start treatment of any individual they suspect may have any of these signs or symptoms. 9. Any athlete with symptoms of heat illness should not resume activity that day.10. An emergency action plan should be clearly in place.11. There should be at least 2 hours of rest between separate events occurring on the same day.12. In extremely hot conditions, sessions should be canceled or rescheduled.For more information on heat related illnesses, please consider the references below.1. Climatic Heat Stress and Exercising Children and Adolescents. Council On Sports Medicine and Fitness and Council on School Health Pediatrics 2011: 128:e741, Luke et al.2. Heat Injury Prevention Practices in High School Football. Clin J Sport Med. 2007:17(6):488-493, Jardine. 3. Heat Illness and Heat Stroke. Pediatrics in Review 2007:28:249-2584. HealthyChildren.org – Heat Related Illness