Author: Courtney Luecking

There’s a health app for that

Raise your hand if you have ever downloaded a fitness or nutrition tracker app. What about an app to track your fertility or blood sugar levels? While one source states nearly 2 out of 3 medical/health apps focus on general health topics like diet, stress, or fitness, other apps focus on specific health conditions like pregnancy, diabetes, mental health, or medication information and reminders.

The number of health and medical apps available for smartphones is growing exponentially (as of 2015, upwards of 165,000). A cross-sectional survey of mobile phone users indicates that those who have downloaded apps trust the accuracy of apps and that their data is safe (Krebs, 2015). But is anyone or anything monitoring or regulating these apps for their legitimacy?

The Food and Drug Administration (FDA) and Federal Trade Commission (FTC) are the two agencies tasked with overseeing the development and marketing of medical apps. However, they oversee a fairly small proportion of the available apps. This is because the FDA limits their oversight to those apps that are considered a medical device, meaning anything intended to diagnose, cure, or prevent disease or to affect the structure or function of the body. The FTC only looks in to apps that make unsubstantiated health claims.

At this time, there isn’t enough evidence to identify which apps work better than others. So, if you find yourself in the market for an app for health or wellness reasons, keep the following in mind:

  • What is the risk of using the product? If the app is intended to diagnose or help treat a medical condition, it will likely need to have FDA approval and you want to be careful with your selection.
  • What is the evidence behind the app? Does the app’s website provide any links to legitimate evidence that the app supports or leads to the intended effect?

Technology has provided a wonderful opportunity for monitoring our health, promoting and supporting behavior change, and sharing information with our health providers. But with all the available options and potentially for positive, or negative effects, we need to be informed consumers.

 

Sources:                     

Federal Trade Commission. Developing a mobile health app? Find out which federal laws you need to follow. https://www.ftc.gov/tips-advice/business-center/guidance/mobile-health-apps-interactive-tool

Krebs P & Duncan DT. Health app use among US mobile phone owners: A national survey. JMIR Mhealth Uhealth. 2015 Oct-Dec; 3(4): e101.

Mirsa, S. New report finds more than 165,000 mobile health apps now available, takes close look at characteristics and use. iMedical Apps + MedPage Today. September 17, 2015. https://www.imedicalapps.com/2015/09/ims-health-apps-report/

Molenti, M. Wellness apps evade the FDA, only to land in court. Wired. April 3, 2017. https://www.wired.com/2017/04/wellness-apps-evade-fda-land-court/

Radcliffe S. Who regulates all these health-related apps? Healthline. September 14, 2017. https://www.healthline.com/health-news/who-regulates-all-these-health-related-apps#4

US Food & Drug Administration. Is the product a medical device? https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/ClassifyYourDevice/ucm051512.htm

Do meta-analyses really offer a bottom line?

For any particular health behavior or condition, the number of research studies is ever-growing. The expansive literature makes it nearly impossible for health practitioners, and even researchers, to stay up-to-date.

Meta-analyses are a type of systematic review that allow for the combination of findings from individual studies in a way that increases statistical power and may thus generate evidence-based ‘bottom lines’ for practice. However, a recent viewpoint in the Journal of the American Medical Association, The Misuse of Meta-Analysis in Nutrition Research, leaves us wondering whether meta-analyses do more harm than good.

Some of the most common flaws discussed in this viewpoint include:

  • The people. Individual studies may include a range in demographic characteristics, like age, sex, race, and ethnicity. While it is typically a good thing to include a variety of people in a single study, trying to compare different study populations can make it more challenging to identify real effects. Think: comparing a study that looked at egg consumption and cholesterol levels in men aged 65 and older to a study looking at women aged 20 – 40 years – there are many other factors that could explain the observed effects.
  • The study design. Although studies may be looking at the relationship between saturated fat and heart disease, they may have used different tools to measure saturated fat intake over varying periods or time or different measures related to heart disease. In addition, some trials may have randomly assigned participants to a group while others followed their natural behaviors over time. This is like trying to compare apples and oranges, although they are both fruit, they are in fact different and it may not be appropriate to try and interpret them together.

Results of meta-analyses matter because they can influence health care policy – either by providing an evidence base for decision-making and/or media headlines prompting public conversation that elevates the priority of a specific condition or behavior. Barnard and colleagues suggest the peer-review process should and could be improved by:

  1. Having content expert editors as well as editors with expertise in meta-analysis techniques
  2. Having authors of the review confirm the appropriateness of the representation of the data with authors of the original report
  3. Having transparent methods and data so that others may reproduce the analysis
  4. Pooling original primary data and not published summary data

 

Sources:                     

Meta-Analysis. Study Design 101. https://himmelfarb.gwu.edu/tutorials/studydesign101/metaanalyses.html

Barnard ND, Willett WC, Ding EL. The Misuse of Meta-analysis in Nutrition Research. JAMA. Published online September 18, 2017. doi:10.1001/jama.2017.12083

The Nutrition Source, Harvard T.H. Chan School of Public Health. Meta-analyses in nutrition research: sources of insight or confusion?

Teal Pumpkin Project: Promoting fun and safe Halloween treats for all

As my little one tries new foods, I pay close attention for any strange reactions that might indicate a food allergy. Food allergies are the result of an immune response to proteins found in food. The immune response can cause mild symptoms such as redness on the skin or an itchy mouth. Or it can cause more serious, life threatening symptoms, known as anaphylaxis, like trouble swallowing, shortness of breath, or loss of consciousness.

While more than 170 foods have been identified to cause allergic reactions, eight allergens are responsible for the majority, and the most severe, reactions in the United States. The ‘big’ eight include: egg, milk, peanut, tree nut, wheat, soy, fish, and shellfish.

It is estimated that upwards of 15 million people in the United States have food allergies, and that number is on the rise. A Centers for Disease Control & Prevention report states there is increasing prevalence of food allergies among children, and a recent media headline shared that insurance claims for anaphylactic (severe) food reactions are going up in adults too.

Although the reason(s) or cause(s) for these increases is unknown, what is known is that food allergies impact quality of life. Holidays can be a particularly challenging time for people with food allergies, but Food Allergy Research & Education (FARE) has initiated a worldwide movement to create a safer, happier Halloween for all. To support the movement, all you have to do is offer non-food treats, like bubbles or stickers, and place a teal pumpkin on your doorstep as a way to let families know you are safe for children with food allergies or other health concerns.

If Halloween is one of your favorite celebrations during the year, think about how a small change in what you hand out can allow others to experience the fun and tradition of trick-or-treating.

The TEAL PUMPKIN PROJECT and the Teal Pumpkin Image are trademarks of Food Allergy Research & Education (FARE)

 

Sources:                     

NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010; 126(6):S1-58

Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS data brief, no 121. Hyattsville, MD: National Center for Health Statistics. 2013. Retrieved from http://www.cdc.gov/nchs/products/databriefs/db121.htm.

National Institute of Allergy and Infectious Diseases, National Institutes of Health. Report of the NIH Expert Panel on Food Allergy Research. 2006. Retrieved from www.niaid.nih.gov/topics/foodallergy/research/pages/reportfoodallergy.aspx

United States Census Bureau Quick Facts (2015 estimates).

Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M, Chuang K, Sicherer M, Sicherer S. Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics 2013; 131:e10-e17.

Herbert L, Shemesh E, Bender B. Clinical management of psychosocial concerns related to food allergy. J Allergy Clin Immunol Pract. 2016; 4(2):205-213.

Bollinger ME; Dahlquist LM, Mudd K; Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006; 96:415-421.

Food Allergy Research & Education. Teal Pumpkin Project. https://www.foodallergy.org/education-awareness/teal-pumpkin-project

Improving the Nutrition Profile of Food Donations

Hunger impacts one in seven people in the United States. Children, older adults, and those who are homeless are particularly susceptible to the impact of stress and inadequate nutrition for healthy growth and development and/or disease management that accompanies hunger.

The Feeding America Network includes 200 food banks and 60,000 food pantries and meal programs that aim to get nourishing food to people in need. In fact, they serve more than 46 million people each year. To serve all of these individuals, Feeding America relies on donations from individuals and corporations. The great news is that donating food is easy. In fact, more people donate to food drives each year than watch the Super Bowl.

The less than great news is that many of the items donated are high in sodium and/or sugar, which could be particularly harmful for growing children and adults managing chronic diseases like diabetes or heart disease. Fortunately, this trend is starting to change. NPR’s WNYC provides a positive example of how Washington D.C.’s Capital Area Food Bank has significantly reduced (by 84%) the amount of junk food it supplies by being more clear in their requests for the types of foods they want to be able to offer.

The #GiveHealthy Movement is also changing how and what people donate. The #GiveHealthy movement uses technology to allow hunger relief organizations to specify the types of healthy food items they desire. For example, this may include fresh fruit, vegetables, or other healthy food items. Food drive organizers can then connect with and share specific hunger organizations’ wish lists. Donors can purchase identified items and everything will be delivered, at no cost, to the organization.

What we eat matters. What we donate matters. And there is finally support to change the nutrition profile of what we offer to support those in need. I challenge you to #GiveHealthy and to support others to as well.

 

Sources:             

Feeding America. http://www.feedingamerica.org/research/hunger-in-america/facts-and-faces/

#GiveHealthy. Hunger is a Health Issue. http://givehealthy.org/index.php/givehealthy-food-drive-2017/hunger-is-a-health-issue/

WNYC. NPR. One of America’s Biggest Food Banks Just Cut Junk Food By 84 Percent in a Year. http://www.wnyc.org/story/one-of-americas-biggest-food-banks-just-cut-junk-food-by-84-percent-in-a-year/

Hello from the other side

Hola! This post comes to you from Barcelona, Spain. The juxtaposition of history and modern day is stunning. Although this visit is short, I can’t help but notice some stark cultural and environmental differences, and similarities, between this urban environment and those I have lived in state side.

Similarly, the streets are filled with bicyclists, pedestrians, taxis, and various forms of pubic transportation. However, bicyclists and pedestrians have more dedicated space on the road than most places in the US. A recent initiative with the US Department of Transportation, Safer People, Safer Streets, hopes to change that.

You may already know that walking and bicycling are good for one’s own health, but they are also good for the health of the environment and financial health of a community. Alarmingly, while walking and bicycling are on the rise in the US, so are fatalities associated with these modes of transportation.

Safer People, Safer Streets, an initiative launched in early 2015, involves research and resources to help communities create safer, better connected walking and bicycling networks. The Initiative involved road safety assessments in every state as well as a Mayors’ Challenge to do at least one of several things: take a complete streets approach (enable safe access for all), identify and address barriers to safe streets, collect data about walking and biking, use practical designs for existing streets, create and complete transportation networks, improve laws and regulations, and educate and enforce proper road behavior. You can find out if your local community has been recognized for its efforts to improve safety here.

I look forward to witnessing positive changes in the transportation networks of the communities in the US. What are the streets and laws like in your area?

Sources:

U.S. Department of Transportation. Safer People, Safer Streets: A Pedestrian and Bicycle Safety Initiative. https://www.transportation.gov/safer-people-safer-streets

Helping Out After Natural Disasters

In recent weeks, there have been several catastrophic natural disasters. Arshya recently wrote about the public health aftermath of such disasters. Recovery from natural disasters must be comprehensive in that the safety, sanitation, and welfare of the people, animals, infrastructure, and environment of the affected communities must be addressed.

It is likely that you or someone you know has been impacted by the hurricanes or earthquake, which might leave you wondering how you can help. If you cannot provide time, many local, national, international, and online organizations will accept your donations. Before committing your resources, take a few minutes to do a little research to check whether a charity is legit. Charity Navigator is a trusted source for identifying organizations responding to natural disasters.

The Federal Trade Commission (FTC) offers additional tips for wise giving after natural disasters:

  • Be wary of charities that seem to have appeared overnight.
  • Stick to charities that have a proven track record for dealing with disasters.
  • Designate the disaster so that your funds will be used directly instead of going in to a general fund.
  • When texting to donate, confirm the number with the source. Charges will show up on your phone bill but donations may not be immediate.

The FTC also offers tips for those affected by natural disasters:

  • Be skeptical of people or groups promising immediate clean-up or debris removal. Some may offer overly priced quotes for work, demand payment before ever doing work, or lack the necessary licenses or skills to complete the work.
  • Be on the lookout for rental listing scams that ask for sending money before actually visiting the property.
  • You may need to share personal information to gain access to resources, so make sure you know exactly who you are dealing with before sharing your social security number or financial information.

 

Sources:             

Federal Trade Commission. FTC Advise for Helping Hurricane Harvey Victims. August 28, 2017. https://www.ftc.gov/news-events/press-releases/2017/08/ftc-advice-helping-hurricane-harvey-victims

The Voice of Public Health

People get in to public health because they want to help others. They want to share their wealth of knowledge in a way that makes a difference.

So then why don’t people hear public health messages?

Jim Garrow offers a fun, yet thoughtful read about why public health is boring.

One reason, messages go unnoticed is that public health has relied heavily on data and presenting rational arguments in an effort to persuade people to change behavior. Facts are important, I’m not denying that. But what really speaks to people?

Matthews and colleagues offer up the notion of speaking to deeper, moral values that connect us. Some practical, if not obvious, suggestions include:

  • Avoiding that intrinsic tendency of self-righteousness
  • Find common ground or at least empathy
  • Foster personal relationships, particularly with those who have different values than you
  • Tell stories that incorporate 6 moral foundational values (Care, Liberty, Fairness, Loyalty, Authority, and Sanctity)
  • Understand your target community

People are more than numbers, and life is constantly going on around them. A wise teacher once told me we need to see people, know people, and care about people. We need to communicate, and then try again in different ways, over and over.

Dr. Anoop Kumar has a provocative post claiming “…this historic time is when your (public health) voice is most needed…You are being called to a higher purpose – to say what you know, to speak up for the good of our communities and our country…”

How will your voice be heard?

 

Sources:             

Garrow, Jim. Public Health is Boring. May 13, 2015. https://medium.com/rebel-public-health/public-health-is-boring-d7c9b9792787

Kumar, Anoop. A Clarion Call to Publich Health Mavens. May 19, 2014. https://medium.com/healthcare-and-public-health/a-clarion-call-to-public-health-mavens-c9775456ea7

Matthews G, Burris S, Ledford SL, Baker E. Advocacy for leaders: crafting richer stories for public health. J Public Health Manag Pract. 2016;22(3):311-315.

 

Fake Health News

Fake news has been dominating headlines over the past year. Although much of the publicity has been related to politics, fake news about health may be more widespread and difficult to identify.

But what exactly is fake news?

By definition, fake news is the deliberate spread of misinformation with the intention of making political or financial gain. Ultimately it may cause individuals to make health decisions that lead to harm or suffering.

How do you identify fake news?

HealthNewsReview.org is a health news watchdog at the University of Minnesota School of Public Health that offers 10 benchmarks to evaluate the truthfulness of health care reporting.

Before taking any article at face value, ask yourself the following questions. Answering no indicates a red flag for truthfulness or accuracy.

Does the story…

  1. sufficiently discuss the costs of the health intervention?
  2. adequately quantify the benefits of the intervention?
  3. avoid exaggerating potential benefits or ignoring potential harms?
  4. acknowledge the quality of evidence?
  5. avoid over-selling or exaggerating the findings?
  6. include comment from independent sources and identify potential conflicts of interest?
  7. compare the new intervention with those already available?
  8. clearly state how available the intervention is for consumers?
  9. show what is truly new or different about the intervention?
  10. mostly repeat a news release?

Kelly McBride, vice president of the Poynter Institute, acknowledged in an article in the Atlantic – “In science, good information is really boring. Science doesn’t leap ahead the way journalists like to cover it.”

Bottom Line: If it sounds too good to be true, it probably is.

 

Tracking Food Recalls

By: Courtney Luecking, MPH, MS, RD Doctoral Candidate: Nutrition

Back around Labor Day, I blogged about ways to prevent foodborne illness. Another way to keep your loved ones safe is to pay attention to food recalls. According to Foodsafety.gov, food recalls and alerts are made when “there is reason to believe that a food may cause consumers to become ill”. This could be the result of a bacteria or virus being present in a food, a potential allergen, or the mislabeling or misbranding of food.

In preparing for the Thanksgiving holiday, two headlines jumped out to me – “Heinz Recalls Hundreds of Cases of Gravy Just Ahead of Thanksgiving” and “Sabra recalls hummus amid listeria contamination fears”. These were particularly concerning because I knew foods like this were on the menu. What if I had missed those news stories?

Here are some tips to proactively get information about potentially contaminated food products and what to do if you have one of these products in your home.

Checking for Product Recalls

  • Visit the Foodsafety.gov website to see information about recent recalls
  • For packaged products, compare your labels to the recalled product for: brand name, sell by date, and the package code
  • For fresh produce concerns, call your grocery store and ask to speak with a manager

Staying Aware of Food Recalls

What to Do When You Have a Recalled Product

  • Do not eat the food product
  • Check the FDA or USDA website for instructions on what to do
  • Check with your grocery store to see if they are issuing refunds or replacement products
  • Clean your kitchen to ensure the contaminated food hasn’t affected other parts of your kitchen

Resources:

Foodsafety.gov – Recalls & Alerts. https://www.foodsafety.gov/recalls/

How to Check Food Recalls. http://www.wikihow.com/Check-Food-Recalls

Let us give thanks

By: Courtney Luecking, MPH, MS, RD Doctoral Candidate: Nutrition

Thanksgiving is my favorite holiday. It is an opportunity to take time away from routines, gather with family and friends, and literally give thanks. The history buffs can check their knowledge about the origin of Thanksgiving, but I would like to concentrate on the science behind the power of gratitude.

Check out this beautiful infographic for a more in depth summary, but the short of the long is that expressing gratitude has numerous physical and mental health benefits. Studies have linked gratitude with improved sleep, increased energy levels, and increased self-esteem. One trial also found those who kept a gratitude journal for 10 weeks were 25% happier than the group who did not keep a journal.

Read more about the benefits of expressing gratitude here and here.

With all these benefits, why limit it to one day a year? Instead, why not find some space for gratitude all year long?

be-thankful

Here are some ideas to intentionally acknowledge what or who you are grateful for throughout the year:

  • Snap a daily photo. Get inspiration from 365grateful, a stunning display of all the wonderful – big and small – things in the world
  • Keep a journal or list – paper, word document, or note on a phone or tablet
  • Try an app
  • Write a thank you note – for a purpose or just because
  • Jar of happiness
  • Meditate
  • Pray
  • Count your blessings

Let us give thanks not only this Thanksgiving holiday but more frequently in the upcoming year. After all, don’t we have much to be thankful for?