Friday, September 13, 2019

Be a food safety superhero

Many people have daydreamed about being a superhero. Who wouldn’t want to have the power of flight or super strength? Well, those kinds of powers may be out of our reach, but there’s one that isn’t: being a food safety superhero. With September being Food Safety Education Month, it’s a great time to learn about preventing foodborne illnesses and how to keep food safe.

Much like Batman and his familiar rogues’ gallery of villains — the Joker, Catwoman and the Penguin, just to name a few — the kitchen also has its common culprits when it comes to food poisoning and foodborne illnesses. When contaminated and consumed, these foods can make a person very sick. Let’s take a closer look at the usual suspects.

First, a little sanitation: Always wash your hands with soap and warm water before handling food and immediately after handling any raw food. Wash your counter tops, cutting boards, dishes and utensils with soap and hot water between the preparation of raw foods and cooked or ready-to-eat foods.

Chicken, beef, pork and poultry
  • The bad guys: campylobacter, salmonella, Clostridium perfringens, E. coli, yersinia and other bacteria
  • How to fight back: Never wash raw poultry or meat, since this increases the chances of spreading bacteria to other foods and surfaces. Cook your poultry and meat thoroughly to a safe internal temperature using a cooking thermometer and these charts. Don’t rely on the meat’s color or juices to tell you if it’s fully cooked. Refrigerate any leftovers within two hours of preparation at a temperature of 40 degrees Fahrenheit or colder. Divide larger cuts into small quantities for refrigeration, as this helps the meat cool quickly and prevent bacteria from growing.

Seafood and raw shellfish
  • The bad guys: Vibrio, salmonella, listeria, norovirus and other bacteria
  • How to fight back: Cook raw seafood to proper temperatures, usually an internal temperature of 145 degrees. Other ways to tell if seafood is done are if fish flesh is opaque and separates easily with a fork; shrimp, scallop, crab and lobster flesh become firm and opaque; and the shells of clams, mussels and oysters open during cooking (unopened ones should go in the trash). Don’t eat seafood if it smells sour, rancid or like ammonia. Cooked seafood should be refrigerated if it’s been out for more than two hours or for more than an hour when temperatures are 90 degrees or higher. Refrigerate at 40 degrees or colder.

Fruits and vegetables
  • The bad guys: salmonella, E. coli and listeria
  • How to fight back: Wash your hands and all utensils and food prep surfaces before and after preparation. Under running water, wash or scrub your produce and cut away any damaged or bruised areas, then dry with a clean paper towel. Keep produce separate from raw meat, poultry and seafood. Refrigerate your prepared fruits and veggies within two hours, or one hour if it’s 90 degrees or hotter outside. Store in a clean container in a refrigerator at 40 degrees or colder.

  • The bad guys: salmonella, E. coli and listeria
  • How to fight back: Cook sprouts such as alfalfa or bean thoroughly to kill off any germs.

Raw milk, raw milk soft cheeses and other raw milk products
  • The bad guys: campylobacter, cryptosporidium, E. coli, listeria and salmonella
  • How to fight back: Choose products that have been pasteurized — if the label says “pasteurized,” it’s safe to consume. These products include milk, yogurt, ice cream and soft cheeses like queso fresco, queso blanco, brie, Camembert and feta. Pasteurization is a process that heats raw milk to a specific temperature just long enough to kill off germs. This process doesn’t destroy enough of the nutritional benefits of raw milk to make raw milk worth the risk. Refrigerate milk products at 40 degrees or colder. Keep your eye on the expiration date. If a product is past this date, throw it out to reduce your chances of getting sick.

  • The bad guy: salmonella
  • How to fight back: Buy and use pasteurized eggs and egg products from stores and suppliers, and never buy cracked or dirty eggs. Cook your eggs thoroughly, until the whites and yolks are firm. If your recipe calls for raw or undercooked eggs, such as Caesar salad dressing or eggnog, make sure you only use pasteurized eggs and egg products. No matter how tempting it may be, do not taste or eat raw batter or dough that contains eggs. Eggs and any foods containing eggs should be refrigerated shortly after cooking. Refrigerate eggs at 40 degrees or colder.

Raw flour

  • The bad guys: E. coli and other bacteria
  • How to fight back: Most flour is a raw agricultural product, which means it hasn’t been treated to kill bacteria. When you cook with flour, the heat from cooking kills off the bacteria. That’s why you shouldn’t eat raw dough or batter. It’s delicious, but it’s not worth the risk. Just don’t do it.

Now that you’re armed with information, you can take the fight to foodborne illnesses. It’s in your power to protect yourself and your loved ones from sickness.

Wednesday, September 11, 2019

Generation Rx part of the prescription to treat the opioid crisis

Prescription misuse among teenagers and young adults was the topic of a workshop during the Louisiana Opioid Action Summit held Sept. 4-6. Summit attendees learned about Generation Rx, a free program created to help raise awareness about misuse of prescription pain relievers. Such misuse has been viewed as a key driver of the opioid epidemic, and the Louisiana Department of Health has led efforts to educate physicians about the dangers of overprescribing opioid pain medication.

However, more can be done to educate people from all age groups about the dangers of prescription misuse. That's where Generation Rx comes in. The program has specially designed educational materials targeting five age groups (elementary, teen, college, adult and older adult), with materials for young people that can be used in K-12 education and in higher education.

Nicole Cartwright Kwieck, a clinical professor of pharmacology at The Ohio State University, where Generation Rx was developed, presented during the summit session on teens and young adults. Kwieck said that a team of researchers and professors created Generation Rx after realizing there was a need for better education around prescription drug use — particularly in school settings.

“We do a terrible job in this country teaching people how to use medications,” Kwieck said. “If you think back on your own experience ... you were probably weren't taught in school. You were probably taught by a parent or a loved one, maybe a professional.”

Reaching younger audiences

The core messages communicated through Generation Rx are:
  • Only use prescription medications as directed by a health professional.
  • Never share your prescription medications with others or use someone else’s medications.
  • Always store your medications securely to prevent others from taking them, and properly dispose of medications that you no longer need.
  • Be a good example to those around you by modeling these safe medication-taking practices and discussing the dangers of misusing prescription drugs with your family, friends, colleagues, students or patients.
In developing the teen and higher education-focused section of the program, Kwieck said, program authors considered the idea that teens and young adults are often seeking new experiences and may see the risk of any type of drug misuse as compelling. They also tend to overestimate the risky behaviors of their peers, leading to conclusions such as “Everyone else is doing it so I can, too.”

The materials were also developed with the idea that teens often don't respond well to lectures and have short attention spans, so the activities are designed to get “them out of their seats” and highlight the dangers that prescription misuse poses. Activities include a Family Feud-style game, an interactive discussion designed around a PowerPoint presentation and skits that allow participants to act out various scenarios.

Rusty Fornea, who spoke during the session for the Washington Parish-based ADAPT Inc., said the organization deployed Generation Rx in parish schools in the spring and received positive responses. Some of those schools, Fornea said, have asked when Generation Rx will return.

“Once we were able to get it rolling, the facilitators and the youth really enjoyed it because it's interactive,” Fornea said.

Widespread misuse

More than 5,700 Americans misuse a prescription pain reliever each day, according to the National Survey on Drug Use and Health.

While 83% of those prescriptions came from a single doctor, more than half of those misused were obtained through a friend or relative, according to data from SAMSHA. That means that misused prescription pain relievers are often not prescribed to the person taking them, which is helping fuel the opioid crisis and leading to addiction and overdose deaths.

You can learn more about Generation Rx here.

Friday, September 6, 2019

We can all play a role in preventing suicide

By DANITA LEBLANC | LCSW-BACS, LDH Office of Behavioral Health

Each death by suicide has a ripple effect throughout families and communities. Over the last 30 years, the suicide rate in the United States has continued to rise. In this country, 47,173 individuals died by suicide in 2017; that is 129 people per day. That same year, 720 individuals died by suicide in Louisiana.

Suicide is generally not on your radar until it affects you personally. Even when a family member or friend is showing warning signs, it can be difficult to talk about. Oftentimes small gestures can make a big difference.

Family, friends and co-workers often see that someone is in distress before professionals become aware of them. We can learn to be alert to the signs that someone might be thinking of suicide, we can learn how to ask about suicide, we can help keep someone safe, we can be there for them and we can learn how to connect them to help.

Some warning signs that someone may be having thoughts of suicide include:
  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings
  • Sudden improvement after having been depressed

Five action steps
We can all have a role in preventing suicide. The #BeThe1To campaign encourages these five action steps to prevent suicide.

  1. ASK: Ask directly about suicide in a way that sounds like you want to know the answer. Studies show that asking at-risk individuals if they are suicidal does not increase suicide or suicidal thoughts. Direct questions like “Are you thinking about suicide?” or “Are you thinking about killing yourself?” communicate in a supportive and non-judgmental way that you are open to talking about suicide. You could also let them know what you see, hear, sense or learn about them that provides you with clues that something isn’t right.

    Example: Mary, I’ve noticed you seem distressed and have been keeping to yourself since your house flooded. Sometimes when people have had a traumatic experience like that, they think about suicide. Are you thinking about suicide?

    Take them seriously. Listen while they talk about the situation causing them emotional pain. Also listen for any potential reasons they want to stay alive. Both are important. Do not impose your reasons for why they should want to live; help them focus on their reasons.
  2. KEEP THEM SAFE: Once we agree that suicide is the focus, we need to know a few things about how to keep them safe. To figure out how to keep them safe, we need to know more about the situation and their plan. Have they already done anything to try and kill themselves? Have they thought about how they would kill themselves? Is the plan detailed as to what, when and where? The more detailed the plan is, the higher the severity of risk.

    Reducing a person’s access to highly lethal means that they plan to use to kill themselves is an important part of suicide prevention. Keep the person safe by putting time and distance between the person and their chosen method. Over 40% of the time, the decision to act on thoughts of suicide and the act of suicide is less than 10 minutes.
  3. BE THERE: Support the person at risk of suicide. Stay with them or help connect them to other support. Is there someone else in the person’s life who is available, willing and able to help if needed? Being there could mean being physically present or speaking with them on the phone, or any other way that shows support. Actively listen to what they say and let them know you hear them. Make sure you follow through on whatever you say you will do. Do not commit to anything you are not willing to do.
  4. HELP THEM CONNECT: Help the person with thoughts of suicide connect with ongoing supports that can help them establish a safety net for those moments they find themselves in a crisis. The National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) will connect you to the crisis call center closest to you based on your area code. If texting is preferred, text to 741741; the website has information on what happens when the text is used. If it is an emergency, contact 911 or go to the nearest emergency room.

    Explore some possible supports with the person in crisis. Are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can help? Is there an Employee Assistance Program at the person’s workplace? In Louisiana, local governing entities responsible for behavioral health and developmental disability services may be able to help.
  5. FOLLOW UP: After your initial contact with the person experiencing thoughts of suicide and after you have connected them with the immediate support systems they need, follow up with them to see how they are doing. Leave a message, send a text or give them a call. The follow up step lets you check in with them to see if additional support is needed and conveys caring and concern to the person thinking about suicide. This contact can also contribute to increased feelings of connectedness.

If someone you know is struggling, don’t be afraid to reach out to them. Each of us can be the one to help.

Friday, August 30, 2019

Living a life in recovery

By BRENT AMBACHER | STR and LaSOR State Peer Recovery Support Specialist, LDH

(Note: Brent Ambacher is sharing his recovery story in honor of National Recovery Month, observed every September as a time to increase awareness and understanding of mental and substance use disorders and to celebrate the people who recover. Learn about recovery resources in Louisiana here.)

The last time I had a drink — April 29, 2012 — I didn’t even want one. After about 10 days of AA meetings, I’d heard enough to make me decide I was done, and had given up for good (I thought) about 72 hours earlier. The problem was, after 27 years of consistent and ever-increasing drug and alcohol use, my body wasn’t down with this plan. I was unable to hold down food or water, and had started vomiting blood.

Alcohol is one of the few substances that can actually kill you if you stop abruptly. I sort of knew this. I was fully aware that I was a hopeless alcoholic who hadn’t gone a single day without drinking myself to “sleep” in probably 10 years. But I wasn’t able to connect the dots. I was told I needed to go to the emergency department, but the prospect of waiting for hours in that condition was too horrifying to contemplate.

Brent Ambacher
So, instead of my usual vodka intake of more than a liter, I was sitting on my back porch, crying, sweating, shaking uncontrollably and trying to choke down a glass with a mixture of two-thirds beer and one-third honey.

I could not for the life of me understand how this was helpful, but I knew enough to know that I was in serious physical trouble and that a guy with 20 years of sobriety probably knew more than I did about quitting. The drink was his recipe. It took me two hours to get it down, but it worked. How does somebody end up the way I did — 46, jobless, divorced, broke, homeless and staying with my eldest sister?

Struggling to cope

I was a missionary kid who grew up in Hong Kong and moved back there after college. I’d been a successful photographer, journalist, advertising executive and spin doctor. I’d lived on three continents, married a beautiful, smart and talented English woman, spent nine years in London, moved to New York, traveled the world. I was SOMEBODY. But that was just on the surface.

Inside, I was desperately frightened that one of these days, everyone would figure out that I was a fake, with no talent, and that I didn’t deserve anything I had. I had also been struggling with anxiety and depression for as long as I could remember. Drugs and alcohol were my way of trying to cope with feeling like a failure and prop myself up so I could keep impressing everybody else.

I guess I thought if other people loved me enough, I’d be OK.

I wasn’t. I was a pathetic drunk and I was close to death.

Climbing back from the bottom

That was seven years — and an entire lifetime — ago. I had to start over, from the bottom. I delivered auto parts for a while, and then someone suggested I might look into becoming a Peer Recovery Support Specialist. I’d never heard of one, but I gave it a shot. Besides getting sober, it was the most important thing I’d ever done for myself.

I went to work at a treatment center and spent a little over two years helping people like me. Another person suggested I apply for a job that I never would have dared to try for, but they hired me — as the Statewide Peer for the STR Grant, here at the Louisiana Department of Health’s Office of Behavioral Health. Then they asked me if I wanted to try my hand at facilitating Peer Employment Trainings, so I said yes to that, too. I’ve learned that I don’t often know best what it is that I’m supposed to do next, but saying yes is usually the right idea.

I make about a quarter of what I used to. I don’t jet off for the weekend because I feel like it. But in return, I have so much more than money could buy me. I was able to be present and help nurse my father through the last four years of his decline from Parkinson’s and dementia, and I was at his bed when he died. I have a job where I’m allowed to be useful, and where the pain of my past can light a pathway forward for people who are looking for a way out of substance use and mental health challenges. 

And, for the last 2,600-and-something days, I haven’t needed a drink or a drug to be OK with myself. It sure seems like a good trade to me.

Friday, August 23, 2019

Candida auris: A new fungus among us

By DR. DAVID J. HOLCOMBE | Medical Director, LDH Region 6

Fungi, like bacteria, surround us.

These organisms — which include yeast and mushrooms —come in many forms, including Candida species, a fungus that is common and ubiquitous. Candida albicans, for example, is the causative agent of thrush, vaginal yeast and other skin infections, and can be easily treated. However, this is not true of a “new” fungus on the block, Candida auris.

A highly magnified view of Candida auris.
“Auris” means ear in Latin and is an appropriate name for this organism, which was discovered in the ear of a Japanese woman in 2009. Considered an oddity at the time, Candida auris quickly spread around the world, appearing a year earlier in Pakistan (2008), then subsequently in India (2009), Venezuela (2012), the United States and South Africa (2013), and Europe and Australia (2015).

Candida auris actually exists in at least four distinct genetic variants, leading researchers to believe that it has arisen independently in several different locations around the world.

Candida auris, a relatively new fungus, is a highly efficient killer.

Candida auris is not, however, just another fungus. It has proven to be highly resistant to many antifungal drugs. It spreads rapidly through hospitals, nursing homes and long-term care facilities where it proves difficult, if not almost impossible to eradicate. More common in weakened and susceptible patients, it kills nearly half of those infected within 90 days
Evolution and control

Where did this horror come from (besides from the ear of a Japanese woman) and what can be done to control or eliminate it?

Fungal specialists believe that our widespread use of antifungal agents has gradually resulted in the evolution of this previously harmless fungus. Much like the widespread use of antibiotics has caused the evolution of multiple drug-resistant bacteria, antifungal agents have created an environment favorable to the development of fungi that are immune to most antibiotics.

With antifungal agents so widely used in agriculture, resistant fungi will reproduce and flourish. It is not exactly survival of the fittest, but more precisely survival of the most adaptable. Candida auris appears to be one of these highly adaptable organisms.

We cannot easily produce new antifungal agents, nor can we eliminate the use of fungicides (or antibiotics) for agricultural purposes. It may come down to the same principle of highly selective use which has already been applied to antibiotics. Fungicides can be restricted or outlawed, even though the consequences on agricultural production may be dramatic.

For example, the fungus that destroyed the potato harvests in Ireland in the 1840s led to widespread crop failures, disease and famine. The same could occur with a new resistant fungus in our time that could wipe out wheat or rice harvests. Possible reductions in agricultural productivity must be weighed against the dangers posed by these new organisms.
Source: CDC

What comes next?

We can restrict our use of both antifungal and antibiotic agents to circumstances when they are truly required. Hospital infectious disease practitioners must add Candida auris to their already long list of resistant organisms they need to identify, track and eliminate in the hospital, long-term care and nursing home settings.

We are all engaged in this intense battle between humankind and the world's microorganisms, whether they be fungal or bacterial. Common sense must prevail or we will become victims of these horrific microscopic organisms that may kill with impunity because there is nothing available to use against them.

Learn more about Candida auris here.