Flu Shots

I just got a flu shot. My arm hurts.

Getting a Shot:

Check your local health department. This is often the lowest cost way to go.

Search the American Lung Association's Flu Clinic Locator

In Nashville, flu shots will be given by the Health Dept starting Nov 6. $10. If you're one of the many who work at Vanderbilt, go get yours for free at Occupational Health today.

Info:

CDC flu homepage

CDC: Key Facts about Influenza (Flu) Vaccine (note that women who are or will be pregnant during flu season are among the list of those who should be vaccinated)

CDC: Questions & Answers: Flu Shot

(Don't forget the flu map!).

Technorati Tags: flu shots; influenza
MeSH Tags: Influenza Vaccines

Changing Your Mind = Not Allowed in Maryland

via Feministing, a Maryland appellate court decided that it's not rape if you consent to sex and decide or need to withdraw that consent during intercourse. The specific court decision [PDF] focuses on what a jury should have been told regarding this matter:

"JURY INSTRUCTIONS; COURT’S RESPONSE TO JURY QUESTION REGARDING WHETHER PRIOR CONSENT VITIATES CRIMINAL CHARACTER OF POST PENETRATION WITHDRAWAL OF CONSENT; BATTLE V. STATE, 287 MD. 675 (1980); QUESTION POSED BY JURY, “IF A FEMALE CONSENTS TO SEX INITIALLY AND, DURING THE COURSE OF THE SEX ACT TO WHICH SHE CONSENTED, FOR WHATEVER REASON, SHE CHANGES HER MIND AND THE . . . MAN CONTINUES UNTIL CLIMAX, DOES THE RESULT CONSTITUTE RAPE?” WAS NOT AMBIGUOUS AND THUS REQUIRED A SPECIFIC ANSWER AND, NOTWITHSTANDING WEIGHT OF AUTHORITY TO THE CONTRARY, SHOULD HAVE BEEN ANSWERED IN THE NEGATIVE UNDER THE MOST CURRENT MARYLAND LAW TO ADDRESS THE ISSUE."

The actual case itself is detailed in the PDF linked above, and is somewhat complicated, so you may want to read it for yourself. Much of the case for why this situation should be rape as outlined in the previous trial is also described.

Technorati Tags: consent; Maryland; Maryland
MeSH Tags: Maryland; Rape

Assorted Interesting Things

Just in Time for Halloween:

The FDA reminds you of the risks associated with decorative contact lenses.

via Unbounded Medicine, bread formed into body parts.

Ballistic Gelatin Cadavers Hit the Theatre

Done with your body? Consider donating it to the Anthropological Research Facility (that's the Body Farm for the locals).

Other Things:
via Medgadget, a special bra for women after heart surgery.

From Morbidity and Mortality Weekly Report, an update on mumps in the U.S. - "During January 1--October 7, 2006, a total of 45 states* and the District of Columbia reported 5,783 confirmed or probable mumps cases to CDC."
Regarding the patients' vaccination status: "Data regarding vaccination status are incomplete. In Iowa, one of the states with the most complete data, preliminary vaccination data have been reported through September 30. Among 1,798 patients with completed follow-up reports, 123 (7%) were unvaccinated; 245 (14%) had received 1 dose of measles, mumps, and rubella (MMR) vaccine, and 884 (49%) had received >2 doses of MMR vaccine. The vaccination status of 546 (30%) patients, the majority of whom were adults, was unknown (3)."

Hmm. I'm kind of glad now that I was given another MMR earlier this year, although that appears to be not at all foolproof...

In other vaccine news, the CDC recommends shingles vaccination. The CDC also has an updated free, online self-study course on public health available, Principles of Epidemiology in Public Health Practice, Third Edition.

Kevin MD is an interesting blog. However, I hope I never get some of his readers as my doctor, or nurse, or even next-door neighbor. In response to a post about ER admissions for chest pain that are really anxiety attacks, some reader comments:
"Hopefully she gets a nuclear perfusion scan during admission with equivical results leading to a cardiac catheterization. In addition to the CT, those will greatly increase her odds of getting a radiation induced cancer in 20 years."
"No. Hopefully she'll get a CT scan with contrast to rule out PE, will have an allergic reaction to the IV Dye. The radiologist, freaking out because she is an Attorney, Will give her IV Epinephrine by mistake, causing her to go into V-Tach."
Yes, definitely make rude comments about paying back the patient for bothering you, rather than being concerned about how said anxiety is obviously disrupting the patient's life (as evidenced by the trip to the ER) and the follow-up care in this situation. Aren't you hilarious?

Technorati Tags: ballistic gelatin; body donation; cadavers; contact lenses; immunization; medical ethics; mumps; shingles; vaccines
MeSH Tags: Contact Lenses; Forensic Ballistics; Herpes Zoster; Immunization; Mumps; Tissue and Organ Procurement

How I met my hubby...

In honor of our anniversary, which is today, and the fact we made it 5 years now and grown our family by 2.3 children, I thought I would regale you all in how I met my hubby...and how we became husband and wife.

How it all began: In the year of 1997, I decided that there was no way that I could return to my parents house for the summer after living by myself and on my own for the year at Michigan State University. So I attended a job fair, thinking I'd get myself a really cool job, make lots of money and live on my own. Well, some of that was true. What I found was a YMCA Camp close to my hometown and parents but where I could work, make money and LIVE for free. I visited the camp in May for a weekend to start running trail rides, as I was hired for a ranch counselor. Pretty fitting, considering my degree is in Equine Management. The first person I was introduced to was Chuck. I ate lunch with the staff and he was loud, rambunctious and funny. Oh, and did I mention perverted? That's when I thought..."cool, I'm gonna fit in here". We talked some more over a bummed cigarette with Charlie the horse down at the ranch and he seemed super cool.

Then we had staff training. He was obnoxious, conceited and annoying. I remember thinking "dude, just shut up. No one wants to hear you ramble." But he was one of 3 original smokers on camp. I was one of the other ones, and Jason (coincidentally the best man in our wedding) was the third. I got to know Chuck pretty well and my original thought of him came back.

However, I was not romantically interested in him in the least. I wanted CJ. The young Irishman who was an exchange counselor. *sigh* Apparently he spent a lot of time talking to Chuck about me, and Chuck told him to just make the move. CJ never did...and although Chuck informed me I should...I never did either. CJ ended up hooked up with the black widow.

CJ, Chuck, Matt and Jason....the original crew. Men who changed my life.

Then comes my 4th of July party, 1997. At my parents house. My first *real* party ever. And we had a few friends spending the night, some because they were too trashed, some for convenience. Chuck was one of them. Everybody had a bed but him. We were good friends. I offered him to sleep with me. He had other things in mind. Don't worry...I didn't give it up to him. I cried. Sobbed really because I was still a virgin. Chuck quieted me and held me and told me it was all ok and nothing would happen if I didn't want it to. Then we went to sleep...and he was still there in the morning. Waking me up with kisses.

After that we were kinda inseperable. He had his own room at camp, instead of sleeping with the kids, like I did. I spent A LOT of time there...hanging out, smoking, talking, making out. About one week after our initial "hook-up", I had a LONG week. It was the 2 week campers and we were with them non-stop...no breaks at all. I came back from the barn at about 9:30 pm one night and in the middle of our cabin was a dozen beautiful roses in a vase and a 3 wick blueberry candle (now my absolute favorite scent) burning. The girls of course were all abuzz about who it was for....it's so romantic you know! I started to cry and let my other counselor know I needed to run for a minute. I went and found Chuck with tears running down my cheeks. He informed me that he had already talked to Matt (who was my supervisor) and had gotten me some time off so that we could have an appropriate first date. He had it all set up.

We went to Don Pablos and a movie matinee (as I had to be back to camp after dinner). It was wonderful! For some reason, I was sooo nervous during that date. We'd been friends for some time, and we'd been making out, but this was so official. We learned a lot about each other during that date...like he learned that I was not yet 21!!! He seemed VERY nervous when I couldn't drink alcohol. I think he was concerned I wasn't of legal age yet (18, here in the States). Especially since he was 28!

Fast forward 8 months: We moved in together so I could finish my last year at MSU and he began school at the local college.

Fast forward 2 years: He proposed. May 20, 2000.

Fast forward 1 1/2 years: We were married. October 27, 2001. It was beautiful!! It rained a light mist during the ceremony but was nice after that. It was such a busy day but all so worth it when I saw him looking at me with such loving and endearing eyes as I walked down the aisle. I loved that man so much and here were all our friends and family watching us commit ourselves entirely to each other.

We were married in a VERY small historical chapel in a local park. It really did look like something from Little House on the Prarie. It was perfect for us and afterwards we had our pictures taken at the park and on the playground. I've been told by several different people that we had the most loving, caring and beautiful wedding they'd ever seen. We danced our first dance as husband and wife to "When you say it best, you say nothing at all" by Allison Krause and it fit us to a T. I have so many wonderful memories of that day but the one that sticks out the most is happiness!

We took our honeymoon in London 9 weeks after the wedding. We left right after Christmas and then enjoyed ringing in the New Year in London. It was fabulous! I cannot wait to go back again and share more rich culture with my husband. I guess that's what I love about him...our ability to balance each other. He's introduced me to museums and art galleries and fine dining and I introduced him to the Royal Mews (which was closed while we were there *poo*) and clubs and just strolling through the park. Even today we balance each other....when he seems to be down, I'm up and when I'm down, he brings me up. I love him for that. I love him for what he does to me. I love him for how he makes me a better person. Now, that's not to say that we don't have our struggles and our fights, but I think overall we are a pretty happy, balanced, and loving couple. 5 years of marriage later...don't you think we still look happy?

Assorted Things, Old and New

Via Feministing, Emergency Kindness is a network to get emergency contraception from those who can get it to those who need it. The site includes info on Plan B, how the network works, how to volunteer, and a blog.

Via the Kaiser Network, HHS Should Ensure Abstinence Education Material Used by Federal Grantees Contains Accurate Information on Condoms, STIs, GAO Legal Opinion Says. Here's the related GAO Decision

New York Times: New Devices and Effective Options in Contraception - says, "A shocking 60 percent of unplanned pregnancies occur in women using contraception"

The Well-Timed Period points out some lying liars.

Via Medgadget, eyelash transplants. This involves incisions and frequent trimming. People, can you please get a grip?

Technorati Tags: abstinence; contraception; emergency contraception; Emergency Kindness; sex education
MeSH Tags: Condoms; Contraception; Contraception, Postcoital; Sexual Abstinence

Pregnancy dreams

I have had some of the weirdest dreams, but this one really made me a little scared.

I was only 18 weeks along and started having contractions. So I go into the ER. By myself. I guess Chuck must have been home with the boys.

I was in one of the ER rooms but people had forgotten about me. I started feeling the need to push and I was screaming for someone and pushing the nurses' button every second to try to get them in there....but no one was coming.

I pushed the baby out and he was still in the placenta and everything. All was still intact. I was seriously screaming bloody murder at this point...scared out of my mind and so afraid of what was going to happen to my baby.

After about an hour, a nurse came in and assured me that 18 weeks was an acceptable cooking time for the little peanut and his chance of survival was good. She came back in soon after to tell me that my peanut was dead. He had breathed in the amniotic fluid outside of my body and had suffocated.

I don't like dreams like that. Not in the least.

Preview: American Experience – Test Tube Babies

Tomorrow, October 23rd, PBS stations will air "Test Tube Babies," an episode of the program American Experience, which describes the history of in vitro fertilization (IVF). The documentary includes historical and current footage and interviews with many participants in the development of this breakthrough technology, including researchers, fertility experts, bioethicists, and notable couples who received the treatment in the early stages of its development. It begins with experiments with IVF in rabbits that took place as early as the 1930s, and follows the technology through the birth of the first "test tube baby" in England in 1978 and beyond.

"Test Tube Babies" illustrates the controversy generated by IVF, including public fear of babies who would be born abnormal or as "monsters," the possibility of a slippery slope that would lead to eugenic trait selection, concerns from pro-life advocates about the destruction of embryos, the absence of federal funding for IVF research. This history is particularly relevant today, as similar debates arise on the issue of stem cell research and destruction of fertilized eggs.

The piece includes coverage of the story of John and Doris Del-Zio, who had been helped in creating an embryo by Dr. Landrum Shettles. At the time, the procedure was very controversial and led to the ultimate destruction of the couple's embryo and the firing of Dr. Shettles from Columbia Presbyterian Hospital due to the administration's fears of public scrutiny. The Del-Zios ultimately filed a lawsuit for emotional distress, considering the action the destruction of their baby, and mindful of the potential impact of this public event on the future of IVF.

"Test Tube Babies" also follows the successes in IVF that resulted almost concurrently with the well-publicized Del-Zio case, and the shift in public opinion that followed the births of normal, healthy babies from IVF technology. In fact, the individual who halted the Shettles experiment ultimately went on to open the first IVF clinic in New York. The evolving world of IVF is detailed, including commentary on the questions that faced early researchers with little published evidence to rely upon and the growing public acceptance of the practice. According to the piece, 400,000 IVF babies have been born in America since the nation’s first successful IVF birth in 1981, and there are currently 2 million "test tube babies" in the world.

Overall, "Test Tube Babies" provides an intriguing introduction to IVF and its history. The American Experience "Test Tube Babies" website provides additional related materials, including a timeline of IVF and reproductive technology, profiles of relevant people and events, families' stories, and commentary on ethical issues. Check your local listings for airtimes in your area; online viewing will be available after the documentary airs, as will a transcript.

Thanks to WGBH, producers of American Experience, for provision of an advance copy of this documentary.

Technorati Tags: American Experience; IVF; In vitro fertilization; test tube babies
MeSH Tags: Fertilization In Vitro

Update, and Total Hip Replacement Resources

I had forgotten how excruciating dial-up internet access is to use, so posts will indeed be spotty for another couple of days. My mom's surgery went well - they had her walking (with her walker) by 2pm the day of the operation, and she came home yesterday. Thus far, I haven't totally bungled the shots.

For a good list of patient-friendly websites with total hip replacement information, see MedlinePlus: Hip Replacement.

This is gonna be a long pregnancy!

I'm 10 weeks.

And I feel like I'm about 37 weeks.

Seriously.

I don't know whether it's because this is our third child or whether it's because I'm overweight (but only about 20 lbs over where I was when I got preggo with Lucas) but this bebe already feels like s/he wants to fall out of my hoo-ha. No lie.

Walking around at work at night I feel sooo much pressure I'm dreading what it's going to be like at 40 weeks. I feel like I'm already doing the pregnancy waddle and I'm not even wearing maternity clothing!!

I also already have the ligament stretching. My midwife has recommended the prenatal cradle and I have to say I really honestly think I'm buying one this time around.

Already this pregnancy has been so different from the last two. It's weird. The cravings. The sleeplessness. The uncomfortableness. The pain. The moodyness. *sigh* Like I said....it's gonna be a long 30 more weeks.

On Monday (10-16-06) I went to my second midwife appt. Things went well! I'm down 9...yes, NINE...pounds. I think their scale is wrong, but Chuck says to take it for what it's worth! My blood pressure was a little high for me but still totally normal (132/82). We discussed my penchance for pickles and she said it's perfectly normal...and to eat what I can keep down during this point in time.

I also discussed caffeine with her. With the boys, I quit the stuff cold turkey. This time it's been sooo much harder. I'm not craving it per se...I'm just used to the Mt. Dew. The crack of all pops. However, there was a study done last year that linked caffeine (even at the 1-2 cups per day) with early miscarriage and preterm labor. I'm not willing to take that chance...so good-bye crack! Next appt..4 weeks!

Okay, Okay...

So, I've been not blogging about something very important in my life. I have my reasons. But it's also kept me from blogging much at all because a big part of my life I couldn't share yet. There are still people in my life that do not know that yes, I amHaha!!! I've been leaving little hints here and there, but I wanted to tell my family first since my mom does occassionally read the blog and I really didn't want her to find out that way!

I'm currently 10 weeks along and I'm feeling pretty okay now. For the most part. Poopy diapers and well for that matter even mine make me want to throw up, but I think I'm starting to get past the morning sickness all day long thing. I am completely and utterly exhausted though. Hell, I feel asleep during my break tonight sitting at my pc. I'm sure I was quite the site! I am having all kinds of weirdo cravings that I never had with the boys. For example, pickles and bacon, pickles and ice cream, and most recently saurkraut and ice cream. I don't eat them TOGETHER but with each other...ya know...like both for one meal. Grosses Chuck out!

The questions before people ask:

#1 Yes, we are hoping for a little girl this time. We didn't want a girl when we were pregnant with the boys but now we are thinking a girl would round out our family nicely.

#2 No, this was not planned. Well, not totally. We weren't actively trying, but we weren't actively preventing either. This isn't a bad thing...just means a more crowded 3 bedroom home and a lot more baby toys.

So there. Now I'll be blogging all about my bloated belly, how my pants won't fit and how my hormones have me crying at work.

Amanda~I know you've known all along :) I'll be telling people at work next week, so HUSH HUSH till then!

Wednesdays.

Huh. I just noticed that like my last 4 posts or so have all been on Wednesdays!

I wonder why?

Maybe because I'm trying to get over the "hump" day at work?

Maybe because that's when I'm feeling slumpy...coming down from the weekend and not quite to the next weekend?

I don't know...but I'm gonna try to blog more often. I find it helps me get my feelings out. And I know that my hubby happens to read the blog even though he never posts. So maybe, just maybe, he can understand me just a *little* bit better considering we work opposite shifts and never see each other :(

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

On another note, Lucas was DRY all day long at school today! I'm freaking ecstatic. Then he went 3 more times at home after that. Albeit he did have 2 accidents...but still! He's 2 1/2 and well on his way now to being diaper free. And considering last Saturday he told me "NO MORE DIAPERS MOMMA!" he'll be happy to hear that too!

Tag...you're it!

1.Things that scare me:
- something happening to my boys (or them being taken from me)
- housefires
- someone breaking in and killing us all

2. People who make me laugh:
- Zachary
- Lucas
- Chuck

3. Things I hate the most:
- stupid/ignorant people
- people who say "that's not part of my job"
- how I lose my temper with Zachary

4. Things I don't understand:
- how ANYONE can find Paris Hilton attractive
- Politics. I don't even try to understand
- Why people bad mouth the US but then try desperately to get their green card.

5. Things I'm doing right now:
- working (shhh...:D)
- blogging
- freezing

6. Things I want to do before I die:
- see my boys be wonderful dads to their children
- travel the world with my husband
- lose my baby weight so I'm comfortable

7. Things I can do:
- BJ's (at least I think I'm pretty good)
- Make people laugh
- Bake

8. Ways to describe my personality:
- Stubborn (yes, it's #1)
- Outgoing
- Easy to get along with

9. Things I can't do:
- Do a cartwheel
- spend hours on the pc just "surfing"
- play RPG video games

10. Things I think you should listen to:
- Your children. They are small PEOPLE
- Your mother (mine usually has good advice)
- Your husband (his needs are important too!)

11. Things you should never listen to:
- IN-LAWS!
- Gossip (but it's so much fun!)
- Crappy music

12. Things I'd like to learn:
- Watercolors
- How to deal with Zachary more effectively
- How to be a contortionist. My hubby would love it!

13. Favorite foods:
- Mexican
- Pickles (well at least right now)
- Ben & Jerry's mint chocolate cookie ice cream

14. Beverages I drink regularly:
- Water
- Hot tea
- Mt. Dew (well, I'm trying not to)

15. Shows I watched as a kid:
- Growing Pains
- Cosby Show
- Family Ties

16. Persons I'm tagging:
- LO
Anybody else who wants to do it!

Spotty Posting. Or Maybe Not.

I'll be out of town over the next couple of weeks, helping my mom following her total hip replacement. I may post infrequently during that time. On the other hand, she might be asleep a lot of the time, in which case, never mind. Your friendly medical librarian is going to be in charge of both cooking (ah ha ha!) and providing daily abdominal injections of anticoagulant (which they did not teach me in grad school). Stay tuned for details.

The husband will be holding down the fort here*, medicating a kitty, recording some music, and pulling some pork. Keep your fingers crossed that he's not having Sonic and 40s for dinner every night.

* I realized later that I should clarify that by "here" I mean meatspace, not this spot in the blogosphere.

Once a Librarian, Always a Librarian

To the person who got here searching for "nursing journal articles on human trafficking,"

Email me, I can help you find them.

Men With Cramps Redux

In a previous post, I mentioned that I thought this site might be a joke, but that it fairly perfectly illustrates the absence of all signs of being reputable you would expect when looking for clinical trials. That original site has not changed, but given this companion site, it is definitely a joke. What I can't figure out, given the silliness (and not really superior humor), is why the creators would pay to take out ads for the "Institute" in alt-weeklies all over the country. At least LonelyGirl was mildly intriguing, with a hint of a plot.

Technorati Tags: clinical research; MacInnes and Porritt Institute
MeSH Tags: Clinical Trials; Dysmenorrhea; Ethics, Research; Pelvic Pain

Blog: The Assertive Cancer Patient

The Assertive Cancer Patient is a relatively new blog, started in August '06 and written by cancer patient Jeanne Sather. Jeanne writes of the importance of being an assertive patient rather than a "good" patient in obtaining the best medical care. A couple of Jeanne's most striking posts:

Medical Mistakes—They Will Happen - Jeanne describes her own experience on the receiving end of medical errors, as well as her tips for avoiding them. She soundly advises readers to double-check things (such as whether you received the right prescription), and - above all - ask questions.

No More Campbell's Soup for Me - find out how much of your dough really goes to breast cancer research when you buy that pink soup can.

It's October--Time to Gag Me With Those Pink Ribbons - "Retailers right, left, and center are offering pink-themed merchandise, then donating a tiny share of the profits to cancer research. The reason the pink marketing campaign makes me so angry is that it encourages women to indulge in retail therapy while trivializing a very serious disease. This is not about raising money for cancer research; this is about companies trying to sell us stuff we don't need, just to make a profit." On a related note, Breast Cancer Action runs the Think Before You Pink campaign, which provides information on just this very topic. Time also covered this on Oct 11, as did Twisty.

Campaign for Real Beauty Before and After

Dove's campaign named above has posted a video demonstrating the work and artifice that goes into producing images of women for promotion and mass media. Although Dove is not the first to provide this type of demonstration, it's illustrative nonetheless. And people wonder why I call all the work that goes into making women look like "women" a form of drag.

Technorati Tags: advertising; beauty; body image; campaign for real beauty; dove; media
MeSH Tags: Advertising; Body Image; Cosmetics; Self Concept; Social Desireability

Menstruation Round-Up

I've had several visitors to Women's Health News recently who were looking for information on menstruation and whether what they were experiencing is considered normal. Here is a collection of links on menstruation for adults and kids. These resources explain the normal menstrual cycle, help prepare and inform younger women, explain certain problems you may experience, and generally serve as a good basic reference on the topic.

MedlinePlus: Menstruation

KidsHealth: All About Menstruation

TeensHealth: All About Menstruation

MayoClinic: Menstruation: Preparing Your Pre-Teen

National Women's Health Information Center: Menstruation and the Menstrual Cycle

Cleveland Clinic: Normal Menstruation

FamilyDoctor: Menstrual Cycle Problems (a flow chart!)

MayoClinic: Menorrhagia (heavy menstrual bleeding)

MayoClinic: Vaginal Bleeding: What's Normal, What's Not?

American Collge of Obstetricians and Gynecologists: Menstruation

Our Bodies, Ourselves: Sexual Anatomy, Reproduction, and the Menstrual Cycle

Feminist Women's Health Center: Menstrual Cycles: What Really Happens in Those 28 Days?

Scarleteen: On The Rag

American Pregnancy Association: Menstruation

Technorati Tags: menstruation
MeSH Tags: Menstruation

It's Flu Map Time!

Beginning in October, the Centers for Disease Control and Prevention begins updating U.S. flu activity information on its Influenza web section. These updates include the much-loved weekly U.S. flu map, which graphically tracks the spread of flu across the nation. Those of us who are data and epidemiology geeks will be anxiously awaiting updates each week for months, holding our breaths waiting to exclaim, "One of 'em turned red!"

Key Facts About the Flu Vaccine

Technorati Tags: CDC; epidemiology; flu; Influenza
MeSH Tags: Centers for Disease Control and Prevention (U.S.); Influenza, Human [note to the indexers - I think it's good that you split the tags into Human Influenza and Avian Influenza, but I think it's a little misleading, because I'm still getting Avian in my Human search results. And chocolate in my peanut butter. Most people, at a glance, are going to think you did this so Influenza, Human excludes bird flu strains, which it doesn't.]

OBOB Friday Extra

The Our Bodies, Ourselves blog has some good stuff up in their Friday Extra post, including video of Stephen Colbert with Gloria Steinem, and a series on sex trafficking. Check it out.

PS: Just found The Ambien Cookbook, thanks to BoingBoing. Do not read if you are currently manning your library's reference desk, or don't say I didn't warn you. "Grab one cartoon bluebird in midair and devour it raw, feathers and all."

Off-Topic: Baby Librarians!

Okay, I don't know when I became the grandmotherly type who looks at course-required blogs by medical librarians-in-training and thinks, "Oh, so cute! Baby librarians blogging!" but such a transformation has indeed occurred. Thanks to David, I found the list of blogs by students in the LIBR-534 (Health Information Sources and Services) class taught by Dean Giustini at the University of British Columbia. Despite my ovarian reaction, these students have some interesting things to say as fresh voices just entering the field. Check them out, and if you're more experienced, maybe you can answer some of their questions while you're at it.

I hope the little guys make it to the ocean! Uh, I mean, graduation and gainful employment.


[Photo by jonvaughan and used under the provisions of the Creative Commons Attribution-NonCommercial-ShareAlike license.]

Quick Links

Found via Kevin, MD:

Buying pink: How much of your purchase goes to breast-cancer research? - Seattle Times

"Research shows that doctors interrupt patients, on average, after 23 seconds - and only 2 percent of patients get a chance to finish their opening statements." - Bottom Line: Get Better Care From Your Doctor

On the absurdity of not having health insurance - OnThePharm blog. $100 for a liter of saline? Seriously?

Via the Kaiser Network:

FDA Attorneys Seek Dismissal of Plan B Lawsuit; CRR Lawyers Seek Subpoenas for White House Documents, Testimony

Violence Against Women 'Severe, Pervasive' Worldwide, U.N. Report

Women Have Right To Make Personal Decisions, Receive Reliable Information About Plan B, Opinion Piece Says

CONGRATULATIONS!!

To Matt and Angela!!

They had a baby girl today named Emily Dian!! They already have two GORGEOUS boys and I'm so excited to hear that they have a healthy, happy little girl to counteract the boys' antics :)

Another friend of mine also found out they are having a little girl, after two boys.

I hope that trend can continue.

How Childbirth Went Industrial

This piece in the New Yorker provides an interesting history of childbirth in America. It begins and ends with the story of Elizabeth Rourke, a mother-to-be who endured 40 hours of labor, and transitioned during that period from being determined to have as little intervention as possible to asking for the epidural and ultimately having a C-section. The article describes the amazing biomechanics and process of uncomplicated birth, and provides a history of of interventions, focusing specifically on forceps and C-sections, how "better" sometimes loses out to "easiest to do or teach," what used to go wrong that usually doesn't now, and the medicalization of birth. The development and influence of the Apgar score is described, as are numerous maneuvers that can be used to extract infants in precarious positions. The author also tells of the conflict between the evidence for practice and what actually happens, from early 20th century doctors with higher maternal mortality rates than that of midwives due to their poor hygiene to 21st century doctors who perform surgeries when forceps might do the job more safely. This piece is an interesting read; thanks to my colleague Julie for passing it along.

Technorati Tags: childbirth; New Yorker; obstetrics
MeSH Tags: Apgar Score; Cesarean Section; Labor, Obstetric; Obstetrical Forceps; Parturition

Does Breastfeeding Boost Children's Intelligence?

A recent study published in BMJ (Der et al 2006) asserts that maternal intelligence accounts for any IQ boost a breastfed baby may get, rather than the breastfeeding itself, as it was the more intelligent women who tended to breastfeed. You may have seen coverage of this study in news outlets, with headlines such as Link Between Breast-Feeding and Child's IQ Debunked (from the National Women's Health Information Center, no less). However, several "rapid responses" point out methodological problems that may influence the authors' conclusions. First among these is that the authors define breastfeeding status by whether the child was ever breastfed, without distinguishing, for example, between those who were breastfed once or for a year. Among US women (in recent studies - this paper's data is rather older), 70.3% ever breastfeed; the percentage is down to 38.5% by the time the child is 3 months old. There is a fairly dramatic dropping out of breastfeeding mothers, and the study's authors don't seem to account for this, viewing the issue as a "yes" or "no."

Among the comments:
"...it is not unreasonable to infer that this study misclassified a number of infants as 'breastfed' who would have been predominantly artificially fed. It is likely that many of these infants did not receive a clinically significant dose of breastmilk or breastfeeding. It is not surprising, then, that it found that “breastfeeding” did not significantly impact on the cognitive development of artificially fed infants."
"Presumably, the same could be "proven" statistically for drinking alcohol in pregnancy…that fetal alcohol effects aren't due to how much alcohol the mother drinks, but due to her intelligence. If overwhelming numbers of low-IQ women drink during pregnancy, the biological effects on the fetus of drinking alcohol might be said to be explained "more by intelligence" than by drinking alcohol."
"Most of the so-called breastfed children in this data set were likely partially breastfed for a time period measurable in weeks, not even months."

The conclusions the authors draw do seem questionable given their definitions of "breastfed." The main point I want to make, though, is that alarming, conclusive-sounding headlines on health topics may not always present the full or true picture of a study's findings or its limitations.

Technorati Tags: BMJ; breastfeeding; intelligence
MeSH Tags: Breast Feeding; Intelligence

Sooooo tiiirreeeddd!

I'm exhausted. End of story.

The boys are on a new daycare/preschool schedule so they only go M/W/F but they go longer during the day. But this means I have them Tuesday and Thursday from the moment they wake up. Which is early.

Like 7:15 early.

I know, I know...some of you reading this are thinking "THAT's EARLY?" Well when you work nights that's dang early! Granted I'm getting out of work at 1 am now so that helps, but by time I get home and around and settle down enough to go to bed it's at least 2 am if not 2:30. *sigh* At least, so far (knock on wood), the boys have been chill in the morning...cuddling in bed with me, content to watch their PBS cartoons and let mommy sleep just a little bit more.

It amazes me at how much they've changed and grown in their short years. It wasn't too long ago that I had to do EVERYTHING for them and now, just this morning, Lucas got up into the cupboard (big no-no, but he does it anyway, little bugger) and got down a can of chicken noodle soup. Zachary then proceeded to use the manual can opener to open said can of soup, pour it into a pan-which he got out himself, pour in a can of water, and then put it on the stove. He then came to me and told me he was ready for me to turn the stove on.

I'm just marvel at the things my 4 year old can do. We give him a lot of leeway to do these things too...I think it's good for him to know how to do things like cook, bake, wash dishes, vacuum. :) Makes my job easier!

Tomorrow is gonna be a rough day at work. I'm dreading coming in and dealing with the backlash of the previous' posts issues. *sigh* At least I get to sleep in tomorrow!

Assorted Updates

From Belly Tales: It was National Midwifery Week, and I missed it.

Via Feministing: An interview with Melanie Martinez, who was booted from "The Good Night Show" due to a years-old parody of abstinence-only sex ed, and women with disabilities more likely to be abused.

Reproductive Rights Blog has an entry on state rules for judicial bypass for abortion.

From Our Bodies, Our Blog, pink ribbon overload and a new book on menopause [Our Bodies, Ourselves: Menopause]

Women's Bioethics Project: Marijuana May Stave Off Alzheimers

Via the Kaiser Network:
Panel of Experts, Lancet Papers Examine Maternal Mortality in Developing Countries
Many California Women Exposed to Rocket Fuel Chemical Perchlorate Have Suppressed Thyroid Function, Study Says
Indonesian Government Imposes Ban Against Female Genital Cutting
Health Department for Four Michigan Counties Overcharged Low-Income Women for Contraceptives, Report Says
One-Third of U.S. Infant Deaths Result of Premature Birth, Study Says

NYTimes: Women face the greatest threat of violence at home

How did I not know about this $%@# in the Northern Marianas Islands?!?

A Little Breastfeeding Humor from The Onion

Breastfed Babies No Smarter
(you have to love anything that includes the word "puerility")

Happy National Medical Librarians Month!

October is National Medical Librarians Month, and in honor of that observation, I'd like to share some information about my work and the work of medical librarians in general.

From the Medical Library Association's brochure, Medical Librarianship: A Career Beyond the Cutting Edge" (PDF):
What is a medical librarian?
"Medical librarians provide health information about new medical treatments, clinical trials and standard trials procedures, tests, and equipment to physicians, allied health professionals, patients, consumers, and corporations. They help physicians provide quality care to patients, help patients find information, answer consumers’ questions, and provide information to the health care industries.

Medical librarians become Web managers, medical informatics experts, and chief information officers as well as catalogers, instructors, and reference librarians. A medical librarian needs a graduate degree in library or information science." [As well as additional subject knowledge in the health sciences and specialized training on medical information resources. For more information on the skills librarians need and where the work, see the brochure]

So what does your medical librarian blogger do all day?
My role has evolved over time, as I have gained new skills and progressed in my training. I've done circulation and reference, managing digital resources, producing data and materials for the budget, web updates, weeding collections, proposal-writing, and a whole host of other activities, depending on what was needed. Right now, I'm spending a lot of time working on clinical questions in support of our physicians and other healthcare providers. This involves carefully searching the medical literature for well-designed clinical research in order to provide evidence related to drugs, procedures, treatments, and conditions. I (and other librarians) locate relevant research, summarize the findings, and report back to the clinicians to inform their patient care.

For example, here are a few questions I have worked on over the past couple of months:

What medications can cause tetany in the emergency or critical care setting?

Is etomidate associated with tetany or severe tonic symptoms?

What is the evidence for therapies to address aspiration pneumonia or aspiration pneumonitis?

Does anxiety increase risk of myocardial infarction in middle aged women?

Are selective serotonin reuptake inhibitors (SSRIs) the most effective treatment for anxiety?

This patient has hyperpigmented macules on his irises since birth. Can you find any disease associations with this (in an otherwise generally healthy adult patient)?

Is there any evidence for the efficacy of orally applied chlorhexidine in reducing ventilator-associated pneumonia (VAP)? If so, what is the most effective dose?

What is the evidence for an association between dexamethasone (Decadron) and reduced leukopenia in septic patients?

Ethical issues in decision-making for patient with traumatic brain injury who cannot provide consent to treatment continuation or withdrawal and has no identifiable family or other surrogate decision-maker

Is there any evidence supporting the use of Rocephin (cephtriaxone), Flagyl (metronidazole) and Vancomycin for open skull fractures?

You might think all of this information would be in textbooks, but it isn't, and if it is, it's likely out of date and omits the most current research. To find resources to answer these questions requires searching of online medical citation databases, hand-searching of references, reading and understanding the articles, assessing methodological rigor, and winnowing to the best, strongest, and most relevant research, which is then summarized to highlight the key findings for our busy clinicians. Medical librarians are a keystone in evidence-based medicine, because clinicians suffer from busy schedules, information overload, and simply do not have the finding expertise librarians possess. Do you hope your doctor is keeping up with literature on diabetes (or whatever condition is relevant to you)? A PubMed search for articles on diabetes published in just the last year turns up more than 4,000 results. An Institute of Medicine report states that, "Substantial investments have been made in clinical research and development over the last 30 years, resulting in an enormous increase in the medical knowledge base and the availability of many more drugs and devices. Unfortunately, Americans are not reaping the full benefit of these investments. The lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of about 15 to 20 years (Balas and Boren, 2000). Even then, adherence of clinical practice to the evidence is highly uneven." You can see how the help of an expert searcher and evaluator could come in handy for finding the right information at the right time. With the help of medical librarians, clinicians can get access to just the right resources to inform their patient care.

For a list of other medical librarian bloggers, see this LIS Wiki. A couple of my favorites, in no particular order: David Rothman; Clinical Evidence, Searching Tidbits, and Other Minutiae; The Krafty Librarian; Medlibrarian.net.

Technorati Tags: librarians; medical librarians; National Medical Librarians Month
MeSH Tags: Librarians

Senate Dems Block Vote on Child Interstate Abortion Notification Act

On Saturday, Senate Democrats effectively blocked a final vote in this legislative session on S.403, which would "prohibit taking minors across State lines in circumvention of laws requiring the involvement of parents in abortion decisions" by voting down a cloture motion to end debate on the legislation, brought forth by Senator Bennett of Utah on behalf of Bill Frist, John Ensign, Tom Coburn, Craig Thomas, Jim DeMint, Wayne Allard, Mitch McConnell, Trent Lott, Jim Bunning, Conrad Burns, Ted Stevens, Johnny Isakson, John Cornyn, Jeff Sessions, Larry Craig, Mike Crapo, and John Thune. The House passed their version last week, but had added provisions.

(found via the Kaiser Network)

Technorati Tags: abortion; child custody protection act; Congress; interstate abortion notification
MeSH Tags: Abortion, Induced

How A Bill To Reduce Abortion Lost Pregnancy Prevention Initatives

William Saletan authored an interesting piece in Sunday's Washington Post, "Where the Rubber Meets the Roe," which addresses how the proposal that became the Pregnant Women Support Act lost the aspects that might have helped prevent unwanted pregnancies, despite the backers' goal of reducing abortions by 95% over the next 10 years. A few excerpts (keep in mind that I have not yet fact-checked Saletan's numbers):

Meanwhile, Democrats for Life of America , which has eight members of Congress on its advisory board and works with 30 others, has devised a plan to reduce the abortion rate by 95 percent " by helping and supporting pregnant women ." Rep. Timothy J. Ryan (D-Ohio) was set to lead the charge. Then Ryan looked at the data and realized that to get anywhere near that target, he and his colleagues would have to provide more birth control. That's when the squirming began.

Some of Ryan's antiabortion allies worried that "morning-after" pills might prevent embryos from implanting, so he omitted such pills from his bill. They opposed requiring private insurers to cover contraception, so he took that out, too. They complained that other pregnancy-prevention bills hadn't emphasized abortion reduction, so he put abortion reduction in the title. They wanted sex education programs to emphasize abstinence; they got it. The only troublesome thing left in the bill was birth control.

It broke the deal. Democrats for Life abandoned Ryan and began a contraceptive-free alternative.

...

The objectors make several arguments. They point out that birth control pills, like morning-after pills, can block implantation of an embryo. But there's no evidence that this has ever happened. The chance is theoretical, and breastfeeding poses the same chance, so you'd have to stamp that out, too. Critics also note that many birth control methods can fail. That's true, but it's an argument for using two methods, not zero.

Third, they protest that federal family planning money supports Planned Parenthood, which performs abortions. But only 14 percent of this money goes to the organization, and fewer than 9 percent of Planned Parenthood clients go there to have an abortion.

...

Does the increased risk from more sex outweigh the decreased risk from more protection? Do the math. On average, contraception lowers the odds of pregnancy by a factor of seven. If you're capable of having seven times as much sex, congratulations. The rest of us will get pregnant less often, not more.

[Note: if you have trouble accessing the article, try BugMeNot, or the condensed piece in Slate.]

Technorati Tags: abortion; contraception; Democrats for Life; pregnancy prevention; Pregnant Women Support Act
MeSH Tags: Abortion, Induced; Contraception; Pregnancy/prevention and control