Archive for the ‘Parenting’ Category

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Asthma News: Parents Underestimate Children’s Symptoms, Placebos Effective in Improving Patient’s Subjective Improvement but Not Objective Health

Monday, July 25th, 2011

image from consumerreports.org

A couple of months ago, one of my colleagues, Jon Stefanuca, wrote a post for Eye Opener entitled Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem. In that article, he explained the importance of patients proactively knowing and explaining their asthma symptoms to healthcare providers. He focused on some of the key features of asthma and the unique symptoms that each individual may experience. If you have not already read that article, I highly recommend it as a great way to become a better advocate for yourself or someone in your life that suffers from asthma.

Over the last few months, I have been thinking about Jon’s advice in relation to some work I have been doing. It makes good sense and hopefully will help people receive better care when they are having exacerbations of their asthma. However, I was disheartened to read a recent article from Reuters about how frequently parents underestimate their children’s asthma symptoms.

Parents Underestimate Their Children’s Asthma Symptoms

I am always a little leery of studies that are drugmaker-funded, particularly when the study suggests that perhaps more medications are needed to combat a problem. However, taken at face value, this is a pretty frightening idea given how many children now suffer from asthma and how serious a condition it can be for those children and families. The article points to a disconnect between the parents’ description of their child’s asthma and whether the asthma was actually being adequately treated:

While more than seven out of every 10 parents interviewed described their child’s asthma as “mild” or “intermittent,” the disease was adequately treated in only six in 10 kids.

A doctor who was not involved in the study explained it this way:

“Parents are only aware of asthma when the child is more severely ill,” Dr. Gordon Bloomberg…

“Physicians cannot just ask the parent ‘how is your child doing?’ The physician will get a global answer that doesn’t reflect the child’s quality of life,” said Bloomberg, of Washington University in St. Louis.

Poor treatment may influence asthmatic children’s quality of life, as well as that of their families.

In the survey, more than four in 10 parents reported missing work because of their child’s asthma, and similar numbers of parents regularly lost sleep for the same reason.

Children are Better Reporters Than Their Parents of Symptoms

Interestingly, “[t]he study also found children tended to be better than their parents at determining how well their asthma was being treated.” So, clearly, doctors must take the time to discuss the asthma symptoms and treatments not only with parents but also in a sensitive and appropriate way with the children patients themselves in order to receive a better indication of the disease status. The doctors interviewed for the Reuter’s article had different opinions on what this means for asthma treatment:

According to a new report, this suggests parents need more education about asthma medications.

But one expert said more medication is not the be-all and end-all for children.

“The idea of total control…is not where we should be putting our energy,” Dr. Barbara Yawn from Olmstead Medical Center in Rochester, Minnesota, told Reuters Health in an email.

Instead of just giving children with stubborn breathing problems more medication, she said better communication is needed to determine how children’s lives are affected, and what it will take to prevent their symptoms.

New Study Shows Receiving Treatment, Even with Placebo, Important for Asthma Patients – But Does not Improve Objective Health

image from 123rf.com

In another recent study, reported in the New England Journal of Medicine, researchers looked at how asthma patients responded to a medication (bronchodilator), two different types of placebos (fake inhaler or fake acupuncture), or no intervention at all. An objective measure was taken of the patient’s ability to exhale after each intervention (or lack of intervention) and the patient’s own rating of improvement was noted. What was so interesting about this study were the different outcomes between the objective (spirometry) and subjective (patient’s self-reporting) measurements of improvement.

The bronchodilator provided markedly better objective treatment over the placebos or no treatment – a 20% improvement rather than 7% for the placebos or no treatment. However, the subjective measure of improvement found that patients were almost the same, 45-50% improvement, whether the patients received the actual bronchodilator (50%), the placebo inhaler (45%) or the sham acupuncture (46%).  All of which were higher than the 21% improvement reported by those who did not receive intervention.

An article about the study in medicalnewstoday.com explains the outcome this way:

Now a study of asthma patients examining the impact of two different placebo treatments versus standard medical treatment with an albuterol bronchodilator has reached two important conclusions: while placebos had no effect on lung function (one of the key objective measures that physicians depend on in treating asthma patients) when it came to patient-reported outcomes, placebos were equally as effective as albuterol in helping to relieve patients’ discomfort and their self-described asthma symptoms.

The study’s senior author, Ted Kaptchuk, Director of the Program in Placebo Studies at Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School explained it this way in the article:

“It’s clear that for the patient, the ritual of treatment can be very powerful…This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”

However, I wonder if it cannot also be understood another way – which is that patients are likely to feel like their symptoms have been improved after a visit to a doctor, even if objectively their airway is still compromised.

How Should this Impact Asthma Treatment?

So what can be done with this new information? I think that Jon’s advice about patient’s knowing their own symptoms and expressing them clearly to their doctors is critical. I also agree completely with his advice that patients should ask for an objective measure of their respiratory improvement before leaving a health care facility. These two steps seem key to making sure that patients objective health is being improved – not just their subjective opinion of improvement. Finally, I think that it is critical that parents act as the best advocates possible for their children – which may include making sure that the children are heard on their own symptoms since parents are not the most reliable reporters.

What do you think? Are there other tips for asthma patients and their parents out there? How do respond to these new studies?

Related Videos:

Videos about Asthma

Related Articles:

Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

Service dogs in school — a fresh look

Friday, July 22nd, 2011
Service Dog and Boy

service dogs

A while back I wrote a piece on the topic of service dogs for kids and mentioned the use of service dogs in schools. A regular reader of our blog then wrote in with a number of comments and questions about the propriety of dogs in schools. To help answer her questions, I recently spoke with Nancy Fierer, who is the Director at Susquehanna Service Dogs in Harrisburg, Pennsylvania, which is an organization that trains and places service dogs. Susquehanna is the organization that placed two of the dogs mentioned in this NPR story.

The ADA and dogs in school

I also did a little more research on the Americans with Disabilities Act (“ADA”) and its impact on the issue. The ADA requires that all public facilities allow a disabled person and his or her service dog (not pets) to enter the premises just the same as a non-disabled person. So is a school considered a public facility? It’s an interesting question. On the one hand it is accessible to the public in the sense that parents and students can freely enter a school. However, if you’re not the parent of a child at the school, can you just walk into a school and roam the halls like you might roam around a mall? I think if you tried that, you would get stopped pretty quickly and asked to leave if you had no valid business there. However, the law appears to be settled that schools are considered public facilities at least for those areas that are open to the public such as administrative offices, gymnasiums during sporting events, and auditoriums during public events. Therefore, schools must be accessible to service dogs in these public areas. For class rooms, however, it’s not so clear. While the law appears to favor allowing service dogs in class rooms, it is being decided on a case-by-case basis because there are other considerations as well – the age of the child, the disability at issue, the ability to control the dog, etc.

How much school assistance is necessary?

I have to admit that when I first wrote on this topic, I had envisioned that the dog and child were a self-contained unit that required little in the way of adult assistance. Ms. Fierer indicated that that is usually not the case. Depending on the age of the child and the level of disability, the child may be able to care for the dog independently. However, in most instances an adult (teacher’s aide or nurse perhaps) is required to pitch in with help giving the dog water and taking it out for bathroom breaks. Ms. Fierer indicated that the dog does need water breaks during the day (feeding can be done at home before and after school). This is usually accomplished by keeping a water bowl in a nearby room – perhaps a nurse’s office or a counselor’s office. Several times a day, either the child (if he/she is old enough) or an adult can take the dog for a drink. The same is true for bathroom breaks (pee only; No. 2 is usually taken care of at home). Again, service dogs do require assistance from the school but from what Ms. Fierer told me, the disruption is fairly minimal and can be worked out with proper planning.

Controlling a service dog

A larger issue is the child’s ability to control the dog. Even though service dogs are highly trained, the owner (in this case a child) must still be able to control the dog before being permitted to take a dog into school. These include such basic commands as making the dog sit, stay, come, leave it, and walk on loose leash. These are some of the common commands that all service dogs must know. In addition, a service dog also receives additional training in a particular disability and learns specific commands unique to that disability, e.g., retrieving specific items, pulling a wheelchair, responding to seizures, search and rescue. These commands must be mastered as well. For example, if an autistic child is in need of the dog to put its head in the child’s lap to help calm him/her down, the child (or a trained adult) has to be able to give the dog that command. If the child cannot give that command to the dog, then it undermines the usefulness of the dog in school.

Because of the demands that service dogs place on the child, very young children usually do not take dogs to school unescorted. Ms. Fierer said she would be surprised to see a six-year-old, for example, taking a dog to school alone. Older children can, with proper training, be permitted to take a dog to school alone. To ensure that the child is capable of caring for the dog, Susquehanna utilizes the Assistance Dogs International Public Access Test. This test requires the owner and the dog to perform multiple tests in a variety of settings to ensure that the dog is well-trained and that the owner can properly control the dog. For children, Ms. Fierer indicated that the testing is usually administered with the parent and child because she uses the team approach – the parent, child and dog are a team. For a child taking the dog to school, however, the parent is usually not there so the child must be able to control the dog independently. Only when a child is adept at controlling the dog should the child be permitted to take the dog to school. Even then, parents have to work closely with the child’s teacher and other school staff to coordinate the details of how the dog will be cared for.

Other concerns

Our reader also asked questions about whether service dogs are a distraction in school and whether they can pose a danger to other children. After talking to Ms. Fierer, it’s my opinion that these are not major concerns. As for being a distraction, Ms. Fierer said that is usually not the case. Service dogs are generally introduced into the school gradually, starting with maybe a half-hour per day and building from there. The children get accustomed to the dog and the novelty soon wears off. Also, the other children need to be educated that this is a service dog and not a pet to be played with. Children can easily learn this lesson. As for being a danger to other children, Ms. Fierer said she has never heard of a dangerous incident happening at school such as a dog biting a child. These dogs are amazingly well-trained and the trainers allow zero tolerance for aggressive behavior. If a dog shows any aggression, that dog does not make the cut for being a service dog. Therefore, I don’t believe this concern is a valid reason for denying a child a service dog.

Training a service dog

In terms of the actual training given to the dogs, Ms. Fierer said that when a puppy is eight weeks old, it starts living with a dedicated puppy handler who is responsible for teaching the dog basic manners.  This time includes classes at Susquehanna twice per month.  This arrangement goes on till the dog is 18 months old, at which time the dog receives about six months of intense training.  About 50-60 percent of training is the same for all service dogs. The rest is devoted to the unique needs of each disability. Before a dog is placed, Susquehanna spends about 2 and ½ weeks training the family that is receiving the dog. Even after placement, Susquehanna continues to do follow-up training – at first on a weekly basis and then gradually declining over the next six months. It even does annual re-testing.

I hope this follow-up addresses our readers’ concerns. Ms. Fierer emphasized that service dogs are not the solution for every child. Susquehanna actually does therapy sessions with families before even agreeing to place a dog to ensure that the dog and the family are a good fit. She indicated that it is a big responsibility to own a service dog and it is not a decision that is made lightly by the dog trainers. However, for the right child and the right family, a service dog can be an amazing asset.

Related Nash and Associates Links:

Service Dogs for Kids

 

photo from servicedogtraining.wordpress.com

 

 

 

 

 

 

 

 

 

 

 

Week in Review: (July 2 – July 9, 2011) Eye Opener Health, Law and Medicine Blog

Saturday, July 9th, 2011

Eye Opener’s Week in Review

From the guest editor:         Good morning! I was hoping that you would take a break from making your “to do” list to stop by and check in with us. As usual, we have been busy blogging. And practicing law. And getting ready for trial. And in trial! Needless to say, we have been pushing it to the limits. In truth, we wouldn’t have it any other way. Before we get back to trial preparation, lets take a step back and look at the past week.

–Jason Penn, guest editor

Litigating for the Sake of Litigating: A Temptation to Be Resisted

By Jon Stefanuca

What do you do when your opposing counsel forgets that the practice of law is a profession and not a blood sport? What do you do when the phase “zealous representation” gets confused with “obnoxious obstructionist behavior?” When faced with similar frustrations, Jon Stefanuca broke out his keyboard and explained what we litigators deal with on a day to day basis. Being a lawyer is a very rewarding profession, but like any other, it has its share of frustrations. Don’t take my word for it, read more

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

By Sara Keogh

Germs are in your kitchen.  They are in your bathroom and your bedroom.  They are on your fingertips and even on your tongue.  And everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.  Sara Keogh reported on news that may make keeping hospitals and other health care environments less germy in the future. Two simple solutions, copper and duct tape, might have a major impact on infection control.  Read more

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.
  • And more!

Images courtesy of:

www.lifehack.org

www.mountainpulse.blogspot.org

 

Week in Review: (June 27 – July 1, 2011) Eye Opener Health, Law and Medicine Blog

Monday, July 4th, 2011

Eye Opener’s Week in Review

From the (guest) editor:  Good morning!  With the morning workout complete, I thought now would be a good time to take a look back.  We had a sneaking suspicion that with the excellent weather forecast you might spend some time outdoors.  Before you do, make sure you read our Summer Series.  This week we gave you what you need to know before you (and your little ones) head to that family BBQ.  Enjoy your Independence Day, drink a tall glass of fresh squeezed lemonade and enjoy!

–Jason Penn, guest editor

Cancer: HIV/AIDS Patients At Increased Risk

By Jon Stefanuca

As if life with HIV/AIDS is not difficult enough, researchers have also found that HIV/AIDS patients are also more prone to developing various malignancies when compared with the non-infected population. In fact, cancer is one of the leading causes ofmortality in the HIV/AIDS  population. It is estimated that 30%-40% of HIV patients will develop some type of cancer during their life time.  Read more

Skin Cancer: Types, Causes and How to Protect Yourself

By Sara Keogh

We can all agree that “skin cancer” is bad.  When we refer to skin cancer, what do we mean?  Most often we are referring to squamous cell, basilar cell or malignant melanoma.  On Tuesday, Sara described the different types of skin cancer and the  associated rates and survival statistics.  Read more

Skin Cancer Prevention: Will new FDA Rules Help?

By Sara Keogh

So Sara’s piece on Tuesday convinced you that sunscreen is necessary?  But how do you pick one?  Last week, the FDA announced new regulations of sunscreen. If sunscreens meet the new legal standards, they can use certain marketing phrases so that consumers know what level of protection will be provided by the product.  Read more

Diseases of Summer: Ticks and Lyme Disease

By Theresa Neumann

Summer is heating up, and there are lots of outdoor activities in which to participate. Along with the thermostat, however, there is also a rise in the deer tick population! This equates to an increase in Lyme disease, the most commonly reported vector-borne illness in America! Maryland, Virginia, Pennsylvania, Delaware and New Jersey all all“hotbeds” for this disease, comprising 5 of the top  12 states comprising 95% of all Lyme disease cases nationwide. Before you leave for the family picnic, you should read more

Skin Cancer Prevention: The Dangers of Tanning Beds

By Sara Keogh

It is popular to “pre-bake” before hitting the beach.  A tanning bed is often the The use of tanning beds or “indoor tanning” greatly increases a person’s risk of developing skin cancer. It is a completely voluntary exposure to UV radiation, and yet many people choose to expose themselves despite all of the risks.  Before you opt to “fake and bake,” you should read more

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.
  • And more!

 

Images courtesy of:

www.news.getaroom.com

www.topnews.net.nz

www.dsf.chesco.org

www.magazine.ayurvediccure.com

www.frenchtribune.com

 

 

Skin Cancer Prevention: The Dangers of Tanning Beds

Friday, July 1st, 2011

 

Image from hometanningbed.com

In my last two posts, I have examined the various types of skin cancer, their prevalence and survivability rates, and some prevention methods. Today, I will focus on another major risk factor for skin cancer. The use of tanning beds or “indoor tanning” greatly increases a person’s risk of developing skin cancer. It is a completely voluntary exposure to UV radiation, and yet many people choose to expose themselves despite all of the risks.

Known Dangers of Tanning Beds

Here are just a few statistics about indoor tanning from the Skin Cancer Foundation:

  • “Ultraviolet radiation (UVR) is a proven human carcinogen. Currently tanning beds are regulated by the FDA as Class I medical devices, the same designation given elastic bandages and tongue depressors.
  • The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances. Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.
  • Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.
  • Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.
  • Nearly 30 million people tan indoors in the U.S. every year; 2.3 million of them are teens.
  • On an average day, more than one million Americans use tanning salons.
  • Seventy-one percent of tanning salon patrons are girls and women aged 16-29.
  • Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.
  • People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.
  • The indoor tanning industry has an annual estimated revenue of $5 billion.”

Internal references omitted

 

Horrifically, it is mainly young people choosing to use these devices despite the greatly increased risk of melanoma and other skin cancers. Given the enormous financial incentive to service young people – the industry cannot be expected to regulate itself. If they can make $5 billion dollars a year in revenue with a largely young female population, why would they stop? (Aside from morality of course…)

How to Protect the Skin – Even if You Don’t Want To

From a social perspective, there need to be some changes to the value our society places on certain skin color and beauty. This is outside of the realm of this post – but what a shame that in this century, men and woman would still rather expose themselves to harmful radiation than live life with their natural coloring (or lack thereof).

From an education perspective, I think that public awareness and an increased focus on education must continue to be one prong to battle this problem. However, clearly warnings alone are not enough. This is exemplified by a recent news story about a now 23-year-old woman who visited tanning salons three to five times a week starting when she was 16 years old.  This young woman, who despite knowing the risks of tanning continued to use tanning beds until 2009, had to endure surgeries, drug therapies and over a year of painful treatment at the age of twenty-one for the advanced melanoma that had spread to her lymph nodes. Luckily, she is now cancer-free, but living with a greatly increased risk of developing another cancer. This is a cautionary tale, but it is also an example of the invincibility thinking of many young people that makes the risks seem lower than they really are to using tanning beds.

Legal Options – Regulation

So what remains? The tanning salon industry has a financial disincentive towards preventing skin cancers, the young patrons of these establishments may not understand the risks and consequences, yet the individuals and society are going to pay the price of devastating illness, high cost medical treatments and people’s lives if the current use of tanning beds continues. That is where the legal side of this post enters. There are a number of states that have started to regulate the use of these tanning beds – at least for minors. Most states do not regulate these very heavily. The National Conference of State Legislatures has compiled regulations from many states on their website. There are a combination of approaches which generally include either banning the use of tanning beds by very young children and teens (typically under 14 or 16 – but few states have an outright ban) and/or requiring parental consent for the use by children below a certain age (typically 18, occasionally 16). Some of these consent statutes require the parent to be present (in person) to provide consent. Others allow written consent or require the parent to be present only one time in the year. Do you think that these statutes are sufficient? Should the requirements involve vivid pictural warnings like the new requirements for cigarrettes?

In Maryland, Howard County is a leader in regulating this industry. In Howard County, minors under 18 years of age are not permitted to use tanning devices without a doctor’s note stating a medical reason and allowed frequency.  These rules are not subject to a parent’s consent. Many states legislators have proposed tougher legislation in the past few years to increase the regulations on this industry across the country, but few have been successful.

Your Thoughts?

What do you think should happen with the tanning industry? Do you think that there should be an outright ban for any minors using these devises? What about adults? There are still lots of tanning customers who are young adults who are over 18. What can be done to protect them from the increased risks of skin cancer? Is public education sufficient? Could it be done better?

Related Posts:

Skin Cancer: Types, Causes and How to Protect Yourself

Skin Cancer Prevention: Will New FDA Rules Help?

Skin Cancer Videos

 

Week in Review: (June 13 – June 17, 2001) Eye Opener Health, Law and Medicine Blog

Saturday, June 18th, 2011

Eye  Opener’s Week in Review

 

Jason Penn

From the Editor:  Today marks the end of week two as “guest” editor for the Eye Opener. I can tell you that the title “editor” is a misnomer. When it comes to the Eye Opener and its panel of bloggers, very little (if any) editing takes place. Consistently, our blawgers provide you with timely and topical posts. This week was no different. Let’s take a retrospective look at what the “Eye Opener” offered this week (and, of course, a sneak peek at the week ahead.)

– Jason Penn, Guest Editor

 

(Many thanks to Jason and all those back at the firm, who helped get the word out on some great topics this past week while I’ve been wrapping-up week #2 of the trial from hell…….Brian Nash)

July 1 – New Residents, New Rules……Again!

By: Theresa Neumann

While the loss of sleep is rarely a topic on Gray’s Anatomy (or any made-for-television medical drama), it is a genuine quandary for non-actor, medical residents. This past Monday, Theresa Neumann explored the ACGME’s limitations on the hours worked by medical residents in the United States. As Theresa explained, the overall maximum hours per week will not change; it remains at 80 hours.  One big change is the limit on the maximum continuous duty period for first year residents; this will be decreased from 24 to 16 hours.  It will remain 24 hours for residents after their first year, but recommendations include “strategic napping.” Curious about the other changes?  Read more

Newest Word on Crib Safety: Ban the Bumpers?

By: Sarah Keogh

Sleep isn’t only important for medical residents; it is also important for the smallest members of our families. As Sara Keogh explained on Tuesday, Maryland is considering regulations to ban the sale of crib bumpers. For many years, more and more emphasis has been placed on infants sleeping in safe cribs without any additional “stuff” in them. This has included the elimination of lots of former nursery staples. Baby blankets, stuffed animals, pillows and other loose items have been banned from the crib by safety experts for years. As requirements for cribs have required slats that are closer together, the utility of using a bumper to help a child from getting stuck between crib slats has been eliminated. More recently, the Consumer Product Safety Commission has developed even newer crib safety standards, including eliminating the use of drop-sides, and warned against the use of sleep positioners. Yet, despite the advice to put babies to sleep only on their backs in cribs empty of everything except a well fitting mattress and fitted sheet, many parents and caregivers persist in using other items in cribs. Now, with an increasing number of deaths associated with crib bumpers, Maryland is considering a stronger stance. Read more

Legal Boot Camp Class Four. Sean and Kristy’s Story: How a Jury Award is Conformed to the Cap

By: John Stefanuca

On Wednesday blogger Jon Stefanuca broke out his calculator:  bootcamp style.  In the state of Maryland, there is a cap on the damages that can be awarded.  But what happens when a jury returns a verdict in excess of the statutory amount?  Mathematics and law intersect.

To see the results, and a detailed explanation of how it all works, you can read more ….

 

Confusion with Advanced Directives: Palliative Care, End-of-Life and Hospice Care

By: Theresa Neumann

With the death of the always controversial Jack Kevorkian, we revisited a post by Theresa Neumann.  Breathing a little life into the post (pun intended), Theresa provides an excellent primer for readers that are facing end of life situations.  The differences are nuanced and can be difficult to understand at a most difficult time. Are you sure you know the difference between palliative, end-of-life and hospice care?  Read more

Acquired Brain Injuries: Subdural Hematomas

By: Theresa Neumann

When Humpty Dumpty fell, they were able to put him back together again.  Because our lives are nothing like a children’s nursery rhyme, when we fall, we get hurt.  A head injury is particularly serious. Have you ever bumped your head and developed a “goose-egg?” It’s truly amazing how fast that big bruise under the skin grows. That bruise, or hematoma, is from a broken blood vessel, usually a vein. The pressure from the swelling helps with clotting, along with the blood’s own clotting factors. This types of hematoma typically takes a week or more to go away. If it’s on the forehead, it’s often followed by one or two “black eyes.”  That’s because the blood tends to spread along  tissue planes, and gravity notoriously pulls everything downward causing it to pool in the eye sockets, where the blood cells degrade and their components are reabsorbed by the body. Unlike a fairy tale, however, this goose-egg can be serious.  Read more

Sneak Peak of the Week Ahead:

As I told you at the beginning, the Eye Opener’s writers continue in their efforts to provide you with timely and topical blogs for your reading pleasure. As evidenced by the above, this past week was no exception. The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Changes in Sunscreen:  will regulation prevent cancer?
  • HIV Patients:  Increased risk for developing cancer
  • Legal Boot Camp is back in session and Part III of our Cerebral Palsy tutorial.

Wishing You and Yours a Great Week Ahead!

Images courtesy of:

www.theepochtiems.com

www.sleepzine.com

www.nailsmag.com

www.aginglongevity

 

 


Newest Word on Crib Safety: Ban the Bumpers?

Tuesday, June 14th, 2011

Which crib bedding would you choose? Aesthetic or safe?

In the newest topic regarding crib safety, Maryland is considering regulations to ban the sale of crib bumpers. For many years, more and more emphasis has been placed on infants sleeping in safe cribs without any additional “stuff” in them. This has included the elimination of lots of former nursery staples. Baby blankets, stuffed animals, pillows and other loose items have been banned from the crib by safety experts for years. As requirements for cribs have required slats that are closer together, the utility of using a bumper to help a child from getting stuck between crib slats has been eliminated. More recently, the Consumer Product Safety Commission has developed even newer crib safety standards, including eliminating the use of drop-sides, and warned against the use of sleep positioners. Yet, despite the advice to put babies to sleep only on their backs in cribs empty of everything except a well fitting mattress and fitted sheet, many parents and caregivers persist in using other items in cribs. Now, with an increasing number of deaths associated with crib bumpers, Maryland is considering a stronger stance.

Danger of Crib Bumpers

The concern about crib bumpers is that there have been infant deaths associated with suffocation or strangulation and the use of crib bumpers. Some of the deaths are directly attributable to the bumpers (for instance a child found with their head wrapped in the ties of the bumper or their face pressed into the side of the bumper), while others are only potentially related to the bumper use but not definitively so (for instance, children whose death are classified as SIDS, but where bumpers were in use in the crib at the time of death and may have been a contributing factor in the death). This makes the discussion of the dangers muddy – with manufacturers claiming that bumpers are safe and advocates warning against their use to protect against suffocation.

Potential Ban on Sale of Bumpers

When the Baltimore Sun reported on the potential regulations, they mentioned something that gave me pause. They explained that if Dr. Sharfstein, secretary of the state Department of Health and Mental Hygiene, does decide to regulate this issue, the regulations will impact only the sale, not the use of the bumpers. While this makes sense from a policy perspective, the goal is not to punish parents who may not be aware of the safety risks, and from a enforceability perspective, the state cannot possibly enforce a regulation that requires knowledge of whether bumpers are being used in individual homes, the regulation of the sale of the item is going to have some drawbacks.

Will a State Ban Save Lives?

So here are my questions. Will regulations against the sale of these bumpers in Maryland make any difference in saving lives? In this day of internet shopping and wide availability of items through catalogues and easy interstate travel, are Maryland families going to forgo the crib bumper because they cannot be purchased in the local baby store, or are they still going to be buying the bumper with a set of nursery items on Amazon or through a national baby store? Will Internet or national companies without a store presence in Maryland be punished for selling a bumper to a person with a Maryland address? If so, then perhaps the word will get out that these items are dangerous and should not be used. If not, will parents even realize that the goal of the regulation is actually to curb the use of the bumpers. Either way, I guess that by decreasing the number of bumpers in Maryland homes, safety will be increased and perhaps over time, awareness will be increased and other states may follow suit.

Getting the Word Out

My other concern is that if there are parents who are still using bumpers, blankets or other items in their babies’ cribs, is the issue one of parent education? Perhaps the real emphasis needs to be on wider parental awareness of the safety issue. There are lots of great resources available to learn how to put infants to sleep safely:

httpv://www.youtube.com/watch?v=VNekf5P9_Yg&feature=youtu.be

Since the early 1990s, the emphasis has been on having infants sleep on their backs. This has lead to a dramatic decrease in SIDS deaths since that time. The “Back to Sleep” campaign began in 1994 and continues to this day.  However, when reading a 2005 paper from the AAP, I was surprised to read that SIDS deaths are more likely to occur when a baby who is used to sleeping on their back is placed to sleep on their stomach. This suggests that education needs to be of all potential caregivers since an occasional babysitter, grandparent or child care provider who is unfamiliar with the recommendations and the child’s normal sleep position may place the child to sleep on their stomach and cause real risk.

AAP has made many recommendations since 2005 including that children sleep in cribs with only a fitted sheet and without any additional soft bedding. These recommendations have varied somewhat over time on the use of bumpers and sleep positioners. However, the overall advice seems to remain the same – eliminate all soft bedding items. Despite these recommendations, there are still images in popular media of nurseries complete with cribs with soft bedding.

What changes are still needed?

What changes are needed to get the word out? Do you think that there needs to be a stronger effort to change the marketing images for infant products? Do you think that a ban on the sale of bumpers will have a significant impact on child safety? What about an education campaign focusing on caregivers, grandparents and day care providers?

Related Posts:

Over Two Million Cribs Recalled…What About Yours?

Infant Safety – drop-down crib hazard; CPSC issues recall

Generation 2 Worldwide and “ChildESIGNS” Drop Side Crib Brands Recalled; Three Infant Deaths Reported

Consumer Product Safety Commission vows to crack down on defective cribs – washingtonpost.com

 

Images from: sidscenter.org, potterybarnkids.com

How Much is Your Marriage Worth?

Friday, June 10th, 2011

When you’re injured as a result of someone else’s negligence, it’s easy to see why you have a legal claim. You are entitled to recover for the injuries that you suffered, including economic damages (lost wages, medical bills, etc.) and non-economic damages (pain and suffering). However, if you’re married, there is another category of damages that you may be able to recover – damage to your marriage. It’s called Loss of Consortium and is an important element of damages in the right circumstances. It is a legal recognition that the marital relationship itself – separate and apart from the injury to the individual – is a protected interest that is deserving of compensation if it has been harmed by the negligence of another person.

Loss of consortium has an interesting history. Under Common Law (which roughly translates to “the olden days” in this circumstance) a woman had no right to sue for loss of consortium. It was only the man who had the right. That was because the woman was essentially seen as the man’s property. If she was injured and unable to provide her usual domestic or bedroom duties as a result of someone else’s negligence, the man could recover for the loss of such services. He had basically lost some of the value of his property so he was entitled to compensation. Eventually, the courts (most courts, at least) recognized the unfairness of such a one-sided system and ruled that women could also make such a claim if their husband suffered an injury. However, there are still some states (Virginia, for example) that do not recognize loss of consortium at all, no matter who tries to bring it.

Back to the present day. A loss of consortium claim arises when one spouse suffers a serious injury that impairs the marital relationship. An easy example is if a husband suffers a traumatic brain injury as a result of a doctor’s negligence. In that circumstance, the man would be able to file a claim for his own damages, of course, but he and his wife could also allege loss of consortium because the brain injury impacts the marriage. The couple will now find it more difficult to do the things they use to do together as man and wife – going out together, caring for their children, taking vacations, intimacy, and the day-to-day marital difficulties that arise because the husband now has a brain injury. In Maryland, a jury can award monetary damages for the couples’ loss of companionship, affection, assistance and yes, sexual relations. It is notoriously difficult to put a dollar figure on such injuries, but the law recognizes the right of a husband and wife to recover financially if their marriage has been damaged. How much money to award for such injury is for the jury to decide. Like other damages, it is always the plaintiffs’ burden to prove that the marriage has been injured, which is usually done through the testimony of the husband and wife.

Speaking of intimacy, some pundits say that loss of consortium is just a code-word for damage to the couples’ sex life. This is not entirely true as the marital relationship entails far more than just sex, but these pundits have a point. A loss of consortium claim usually does include an allegation that the couples’ sex life has been impacted. If you are bringing a lawsuit, you have to understand that when you allege loss of consortium, you are opening up the door on the most intimate parts of your life. Defense attorneys will often ask highly personal questions – how often did you have sex before the injury, how often do you have sex now, how exactly does the injury make sex more difficult, have either of you ever strayed from the marriage, etc. Some couples are understandably reluctant to discuss such things. Thankfully, most defense attorneys are just as uncomfortable asking these questions as the plaintiffs are answering them, so the questions tend to be over with relatively quickly. Be aware, though, that if you do file a loss of consortium claim, your sex life may become an issue in open court.

In the District of Columbia, a loss of consortium claim is for similar damages, but with a slight difference. While in Maryland the claim belongs to both the husband and the wife and is brought by them jointly, in the District of Columbia the claim belongs solely to the non-injured spouse. Any money awarded by the jury for loss of consortium goes to the non-injured spouse rather than to the couple jointly.

Lastly, Maryland’s cap on non-economic damages applies to claims for loss of consortium. There is no separate cap for this claim. In other words, there is a single cap that applies to all allegations of injuries, whether it’s an injury to the individual or an injury to the marriage.  The Maryland Legislature does not allow a couple to receive more money for injury to the marriage above and beyond the cap, even if a jury decides that that money should be given. Just another example of how Maryland’s cap punishes plaintiffs.

Have you ever suffered an injury that impacted your marriage? Did you file a loss of consortium claim? What was the result?

Related Nash and Associates Links

Maryland’s alleged healthcare “crisis”

Insurance and Traumatic Brain Injury

Acquired Brain Injuries

 

 

Can a Simple Image Guide Good Nutrition?

Tuesday, June 7th, 2011

Image from www.choosemyplate.gov

Last week, the USDA unveiled the new MyPlate image to replace the outdated food pyramid. When I first saw the new image, I felt a welcome relief at the simplicity of this concept. The plate seemed like the iPhone of the nutrition world. Simply and intuitively designed – replacing a complex chart of recommendations with something that even a busy person could use in their every day lives.

As an individual and as a parent, I have worked hard for the last 5 or more years to dramatically change the buying and eating habits in our household. We buy most of our food, at least during the months from May until November, at the farmer’s markets around town. We try to buy most of our meat, eggs and dairy products from local farms. For the food that we purchase from the supermarket or from restaurants, I make a conscious effort to buy mostly real foods that are not full of preservatives, additives or other unidentifiable ingredients. Despite these efforts, it can still be a challenge to make sure that my meals are nutritionally well rounded.

My favorite feature of the new design MyPlate is that it is accessible even to the youngest children. Most people in this country eat their meals off plates, or at least are familiar with them. The idea of how much food to put on the plate and in what proportions resonates with me. Perhaps this image will also have the secondary effect of acting as a wake-up call to any Americans who are currently eating their meals primarily on the go, in their cars, or as undefined snacks constantly throughout the day (“grazing” as my father used to call it in our house).

Secondary Benefit of the Plate Image? Perhaps People will Focus on Sitting Down to Meals

To me, the take home message in the new image is that the healthiest option is to eat real meals, sitting down, preferably with others. These meals should be loaded with vegetables and fruits, with the addition of grains and protein. I suspect that the new USDA plate does not look like the plates of most Americans today at the average meal. Many, myself included most of the time, eat meals with more grains or proteins covering the plate than vegetables or fruits most of the time. However, this seems like a very achievable change to make. As long as we can help people get access to vegetables and fruits (outside the scope of this post – but there have been plenty of things written about how much easier it is in this country to get cheap meats and carbs than fresh fruits and veggies), then it seems simple with this guide to adjust your plate to be half covered in vegetables and fruits each meal.

Easy Enough for Kids and Busy Parents

Image from Zazzle.com

The other reason I like this image, besides its simplicity, is that it is easy. A child could easily use this as a template to fill their plate. Moreover, there are already a ton of children’s plates on the market that are easily divided…perhaps there should be similar plates for adults – I suspect someone is marketing this as I type. In case you were worried, someone has already developed the “Bacon My Plate” items. But, the point is that if you are a harried parent in today’s busy world, you may be searching for easy healthy foods for your kids. Well, perhaps the answer is here, just make sure that you fill the plate according to the guidelines and voila – dinner is ready.

Entire USDA MyPlate Website Devoted to Tips and Tools

What is less obvious from the media coverage in the last few days about the USDA MyPlate announcement is that the recommendations are not just in the image. The USDA has created a complete website and brochure that detail the recommendations much more thoroughly.  It also includes a number of interactive tools that help you evaluate the food group, calories and other details about particular foods. There are tools to help you plan meals, specific recommendations for toddlers and pregnant/nursing moms, advice for weight loss and other tips. A few of the other tips from the USDA brochure that I found especially important:

  • Make half your plate fruits and vegetables
  • Eat red, orange, and dark-green vegetables
  • Eat fruit, vegetables or unsalted nuts as snacks – they are nature’s original fast foods.
  • Switch to skim or 1% milk.
  • Make at least half your grains whole.
  • Vary your protein food choices.
  • Twice a week, make seafood the protein on your plate.
  • Use a smaller plate, bowl, and glass.
  • Stop eating when you are satisfied, not full.
  • Keep physically active.

These are just a few of the recommendations that accompany the new MyPlate image. There are lots more details available online. One of the recommendations that I was given when my son was a baby, just learning to eat finger foods, was to provide him with a rainbow of foods. Again, I think that the image works! If you feed your children (and yourself) a variety of different colored foods (and I am talking natural colors – think cherries, oranges, yellow peppers, spinach, blueberries, eggplant – not artificial colors…not fruit loops) throughout the day and week, you will provide a natural array of different vitamins and minerals without having to worry about reading labels.

Thoughts?

What are your tips for healthy eating? Do you like this new image? Do you think that it will make any impact on the obesity crisis?

Related Posts:

Does Nutrition Info on Fast-Food Menus Really Make a “Choice” Difference?

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Can Religion Make You Fat?