Protect the skin you're in

It’s summer in Louisiana and the heat is on.

Did you know daytime weather from June through August averages around 90 degrees Fahrenheit? On top of that, humidity hovers in the 90 percent range most days. Between the heat and the humidity, it’s no surprise that we feel hot and sweaty on a daily basis.

June, July and August are also among the sunniest months Louisiana sees all year, which makes it so important to protect yourself from harmful sun exposure. Skin cancer was the ninth most commonly diagnosed cancer in Louisiana between 2010 and 2014, according to the Louisiana Tumor Registry, which collects information about all cancers diagnosed and/or treated in Louisiana.

Ultraviolet (UV) radiation, which comes from the sun, reaches us whether the weather is sunny, cloudy or hazy. The most hazardous hours for UV exposure in the lower 48 states are from 10 a.m. to 4 p.m. CST.

What is skin cancer?

Cancer is a catch-all term for a disease in which abnormal cells in the body divide uncontrollably and invade other tissues, spreading throughout the body through the blood and lymph systems.

Skin cancer, the fourth most common form of cancer in the U.S., is usually caused by overexposure to UV light. It is commonly classified into three types.

• Basal cell carcinoma begins in the basal cell layer of the skin. The bad news is it can be disfiguring and expensive to treat, but the good news is that it’s highly curable.
• Squamous cell carcinoma begins in the squamous layer of the skin. Like basal cell carcinoma, it’s highly curable though it can be expensive to treat and cause disfigurement.
• Melanoma begins in the melanocytes, the cells that produce the pigment that gives skin its color. It is the third most common skin cancer, but it’s the most dangerous and the most deadly.

Skin cancer doesn’t discriminate against anybody, but it’s more likely to develop in people with these characteristics, according to the Centers for Disease Control and Prevention (CDC):

• A lighter natural skin color
• Skin that burns, freckles, reddens easily or becomes painful in the sun
• Blue or green eyes
• Blond or red hair
• Certain types and a large number of moles
• A family history of skin cancer
• A personal history of skin cancer

If you have any of these characteristics — and even if you have none — it’s vital that you protect yourself when being exposed to the sun.

Safety in the sun

The CDC recommends these simple steps to protect yourself from UV radiation:

• Stay in the shade, especially during midday hours. If you’re outdoors, sit beneath an umbrella, a shady tree or other shelter.
• Wear clothing that covers your arms and legs. Choose tightly woven fabrics for the best protection. Keep in mind that a typical T-shirt has a sun protection factor (SPF) lower than 15, so use other types of protection as well.
• Wear a hat with a wide brim to shade your face, head, ears and neck. Hats made of tightly woven fabric, such as canvas, are preferable. Avoid straw hats with holes that let sunlight through. If you wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using sunscreen with an SPF of 15 or higher or by staying in the shade.
• Wear sunglasses that wrap around and block both UVA and UVB rays. Most sunglasses sold in the U.S. block both UVA and UVB rays.
• Use sunscreen with an SPF of 15 or higher, and both UVA and UVB (broad spectrum) protection. Apply a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back. Reapply sunscreen if you stay out in the sun for more than two hours and after swimming, sweating or toweling off.

Sunscreen safety concerns

Sunscreen has been making headlines recently after a pilot study found it takes just one day of sunscreen use for several common ingredients to enter a person’s bloodstream at worrisome levels and for some to continue to build in the blood as daily use continued.

The Center for Drug Evaluation and Research, an arm of the United States Food and Drug Administration (FDA), conducted the study, published in the medical journal JAMA. The study concluded four common sunscreen chemicals — avobenzone, oxybenzone, ecamsule and octocrylene — are among 12 chemicals in need of further research by manufacturers before they can be considered “generally regarded as safe and effective.”

That doesn’t mean you should stop using sunscreen, because we don’t yet know whether these ingredients have any harmful effects after they are absorbed. We do know, though, that overexposure to the sun is harmful, so continue to protect your skin.

Let’s talk indoor tanning

If you think indoor tanning is a safe alternative, think again. The CDC says indoor tanning — whether it’s a tanning bed, booth, sunbed or sunlamp — should be avoided. All of these methods expose users to high levels of UV radiation, which may result in skin cancer. Just because it’s from a mechanical source doesn’t make it any safer than the UV radiation you’re exposed to when out in the sun.

Screening saves lives

The importance of getting screened for cancer cannot be overstated. Through screening, doctors can help find and treat a number of cancers at an early state, before symptoms show up. Cancer that is detected after symptoms appear may have begun to spread and therefore be harder to treat.

Talk to your doctor if you’re concerned about skin cancer — or any other type of cancer, for that matter.

Tackling cancer in Louisiana

The Louisiana Department of Health’s Taking Aim at Cancer in Louisiana (TACL) initiative launched last year and is working toward improving cancer outcomes in the state. TACL’s goals are increasing access to care, improving the quality of care and reducing the costs of care.

To learn more from the Department of Health about cancer in Louisiana, click here.

The bottom line

So, what’s the bottom line when it comes to sun exposure and tanning, according to the CDC? Every time you tan, you increase your risk of getting skin cancer. Take steps to avoid those harmful UV rays. And remember, skin safety isn’t just for the summer months. Protect the skin you’re in — every day.

Say cheese! Well-Ahead Louisiana aims for healthy smiles across the state

By MeCHAUNE BUTLER, MPA | Oral Health Promotion Manager, Well-Ahead Louisiana;  GEORGENA DESROSIER, MPH | Oral Health Promotion Coordinator, Well-Ahead Louisiana; and ANGELA VANVECKHOVEN | Health Education Manager, Well-Ahead Louisiana 

Oral disease is almost completely preventable, but it still affects children and adults throughout Louisiana every day. Oral health has a direct impact on many other diseases and conditions, including diabetes, heart disease and stroke. Additionally, gum disease in pregnant women is associated with premature births and low birth weight.

Along with those risks, 83% of the state’s parishes have a shortage of dental care providers. That is why Well-Ahead Louisiana, an initiative of the Louisiana Department of Health, focuses on promoting oral health through expanded access to preventive dental services, specifically through school dental sealant programs.

Dental sealants

Dental sealants prevent 80% of cavities on the back teeth, where 9 out of 10 cavities occur. These thin plastic coatings are applied to the chewing surfaces of the first and second molars, where food and bacteria are not easily removed, acting as a barrier to protect the teeth from plaque and acids that cause tooth decay. When correctly applied, dental sealants last several years before reapplication is needed.

School dental sealant programs

Tooth decay causes pain, and children suffering from dental pain cannot focus or be productive, particularly during school. School dental sealant programs are an evidence-based best practice for preventing tooth decay among children who are less likely to see dentists in a private practice. Schools are an ideal place to reach children, and they play a pivotal role in affecting children’s health. In Louisiana, a dentist must first perform an oral health screening; a dentist, dental hygienist or other qualified dental professional can then apply sealants.

These programs are either school-based or school-linked. School-based are conducted completely within the school setting using portable dental equipment. School-linked can include transporting the children to a linked federally qualified health center, having a mobile bus or van at the school, or holding the program in a school-based health center.

Louisiana Seals Smiles

Well-Ahead Louisiana is excited to continue its Louisiana Seals Smiles program, which is a replicable program that provides free oral health screenings and dental sealants to eligible students ages 6 to 14.  Recently, the Louisiana Seals Smiles Toolkit was added to Well-Ahead’s website to provide guidance and resources for any provider who wants to implement a school dental sealant program in his or her community. It includes step-by-step instructions for implementation and printable, ready-to-use downloads like parent flyers, a clinic charting form, a dental report card and more.

Children who have good oral health are better able to learn, grow and play. Be a leader in ensuring youth in your community have healthy smiles by using the toolkit to start a school sealant program. Together, we can move Louisiana’s health forward.

For more information

To learn more about oral health, visit Well-Ahead Louisiana or email wellahead@la.gov.

Mental health affects everyone, not just those with a mental illness

By DR. REBEKAH GEE | Louisiana Department of Health Secretary

Last fall, NOLA.com | The Times-Picayune's series “A Fragile State” placed a spotlight on one of our most vulnerable populations. Full of heartbreak and sometimes hope, these courageous stories reminded us of the tragic impact of mental illness on families and individuals in our state. Because May is National Mental Health Month, I turn to these stories once more as a call to awareness and action.

“A Fragile State” vividly portrayed the enduring impact of years of financial cuts and psychiatric hospital closures that occurred under the Jindal administration, actions that left thousands of people without some vital services. Now, however, the ball is in our court, and Louisiana can and must do better. 

These individual stories are heartbreaking and the solutions are complex. More inpatient beds are needed as well as adequate numbers of doctors who can treat patients who have mental health and substance use illnesses. True solutions start with addressing poverty, health disparities, early childhood trauma and violence – issues beyond the walls of a doctor’s office or hospital. The seeds of mental illness and addiction are sown in the pain of trauma and neglect. Louisiana must also invest new funds and renewed dedication to ensuring quality care options in the community – more crisis services and greater access to these services – are available for people when they need them most.

A lifetime of care

We need to demand care that occurs throughout the life course. This means a pregnant mom with mental illness is treated and there is help available as she parents her child. When and if a school-age child suffers from mental illness, she is diagnosed and treated instead of failing and dropping out.

It means that a family with a son in a sudden crisis is treated for mental illness instead of ending up in the criminal justice system, leaving a trail of pain in his wake. It means that individuals and families always know who to call and what to expect when help is needed.

Care throughout a person’s life, with a strong focus on immediately helping those who are facing a crisis, is the mental health system Louisiana must commit to building. This system will require more providers, more resources and greater investments from our communities.

An ideal system includes easily accessible mental health services in the community. Inpatient beds will be a component of this continuum, but not its foundation. We must address crises via mobile crisis response or specialized drop-in centers, for example, and the system should address homelessness and lack of transportation that can get in the way of recovery.

The Louisiana Department of Health is focusing on four critical areas: ensuring there is a full continuum of care, implementing effective crisis services, improving the access to and quality of care, and making the mental care system easier to navigate.

First and foremost, under Gov. John Bel Edwards’ leadership, we led the charge for coverage under Medicaid expansion. Prior to expansion, most low-income adults in Louisiana had no health insurance and no access to treatment for mental health. Rather than treating mental illness, it fell to the correctional system to remove mentally ill individuals from society, rather than treating people and preventing harm to others.

Since Medicaid expansion, more than 485,000 adults are now covered, of whom more than 65,000 have received specialized outpatient mental health services and more than 15,000 have received inpatient mental health care at a psychiatric facility. Tens of thousands of people have received treatment for addiction. We have sought and received millions of new federal dollars for addiction treatment and are rebuilding our system of mental health care in partnership with local human service districts that serve as the safety net for mental health care.

The way forward

The journey for families with a loved one with mental illness can be excruciating, even for our citizens with high incomes and the means to pay for care. The Louisiana Department of Health is charged with taking care of those in the shadows, individuals who are sometimes forgotten, neglected, the most vulnerable and complex. We are failing in that charge.

“A Fragile State” is a raw and honest account of a system that needs to change. That change will be led by the Department of Health, but it is bigger than a single state agency. Change will come only when we work in tandem with the community, with law enforcement, with the judicial system and any other stakeholders in mental health.

We commit that as a Department we will continue to fight this battle on all available fronts — to rebuild and strengthen a system of care that too often fails those who are desperately in need of help. This will not be easy, but we commit to fight for the systems of care and the resources needed to win the struggle against mental illness and addiction so that people can thrive. Only then will our communities reach their full potential.

Breastfeeding culture in Louisiana hospitals continues to improve

By BETSY DANCISAK, MPH | Breastfeeding Program Coordinator, LDH Bureau of Family Health

More and more Louisiana babies are born in hospitals that have policies and practices in place to support breastfeeding. For the past 12 years, the Louisiana Department of Health’s The Gift program has helped hospitals prepare families for breastfeeding and support them once their babies are born.

The Gift, a program of the Louisiana Department of Health’s Bureau of Family Health, helps hospitals along the pathway to international designation as a Baby-Friendly hospital. Baby-Friendly designation is provided through the World Health Organization and UNICEF’s (United Nations International Children’s Emergency Fund) Baby-Friendly Hospital Initiative.

When hospitals put the Baby-Friendly Initiative’s Ten Steps to Successful Breastfeeding practices in place, they are setting families up for success in breastfeeding and infant care. The hospital stay is a critical time for moms and babies to get the hang of breastfeeding while they have on-site coaches (a.k.a. lactation consultants) and other nursing staff to support them at the push of a call-button.

Baby-Friendly designation recognizes hospitals that give mothers the information, confidence and skills necessary to successfully initiate and continue breastfeeding their babies or safely feed with formula. Helping women achieve their breastfeeding goals is not only beneficial to individual mothers and babies, but it may help reduce health disparities on a statewide level. Breastfeeding can improve many short- and long-term health outcomes for mothers and children, regardless of social or economic status, and allows all infants access to the same quality of nutrition and immune protection.

Aside from the benefits of breast milk, the Ten Steps to Successful Breastfeeding help new moms and families connect with and understand their babies, regardless of whether the baby breastfeeds or receives formula. Responsive caregivers are fundamental to trusted and secure relationships, which are key to establishing a strong foundation for lifelong well-being.

In 2013, none of Louisiana’s 52 birthing facilities were designated as Baby-Friendly. Now, 49% of all Louisiana births take place across 16 Baby-Friendly hospitals. Thirty-seven of Louisiana’s eligible birthing centers are also Gift designated (including the 16 Baby-Friendly hospitals). Gift designation means that a hospital has implemented or is making progress toward implementing the Ten Steps.

Marci Brewer, The Gift’s program manager, said, “Louisiana hospitals are working hard to create a more positive breastfeeding culture and provide high quality, patient-centered care. Change isn’t easy, but we are gradually seeing improvements across the state. I applaud hospital administrations and staff members for their dedication to continually improving the care they provide; it has resulted in an unprecedented number of Gift and Baby-Friendly designations.”

The Gift program recognizes that support must extend beyond the hospital setting — increasing breastfeeding rates takes a village. The Ten Steps addresses the importance of establishing breastfeeding support groups and increasing awareness of such resources so mothers have the continued support they need to achieve their breastfeeding goals. When prenatal providers, communities and hospitals use consistent, evidence-based information, it is easier to provide practices that support optimal infant feeding and improve the quality of the birth experience for mother and baby.

To learn more about The Gift and other breastfeeding initiatives in Louisiana, visit thegiftla.org.

It's time to set the record straight regarding vaccination myths

By DR. FRANK WELCH | LDH Immunization Program Medical Director

Once again, misconceptions about the safety of vaccines are making headlines. These fallacies, or “fake news” as Louisiana Sen. Bill Cassidy referred to them, come during the worst measles outbreak in the last 25 years — an outbreak mostly spread by unvaccinated individuals.

As of April 29, more than 700 measles cases have been confirmed across the United States, with the largest clusters in New York and Washington/Oregon. Fortunately, Louisiana has remained free of measles. However, measles cases are also rising globally, prompting the Centers for Disease Control and Prevention to urge Americans traveling abroad to make sure they are vaccinated.

It’s not just measles on the rise, though. Other vaccine-preventable diseases, such as whooping cough (pertussis) and mumps, have experienced a resurgence in recent years because of anti-vaccination myths that promote falsehoods about vaccines’ safety and their contents.

Vaccination myths

One of the vaccination myths making headlines claims that vaccines contain tissue from aborted fetuses. 

Sen. Cassidy himself debunked this claim recently while speaking to news media, saying, “The connection to aborted children, there is tissue from 1963, the early Sixties in which some fetal material was used to create vaccines, but that’s, what, 56 years ago. And, the Catholic Church has said that the benefits of immunization so outweigh this concern that the Catholic Church strongly recommends immunizing children.” 

No current fetal tissue is used to create vaccines. You can learn more about this topic here.

As for dispelling other myths, PublicHealth.org provides a wonderful, informative guide that aims to educate the public about vaccination and debunk the myths that have arisen. Here are the guide’s top eight myths about vaccination and why they’re false.

Myth #1: Vaccines cause autism.

The widespread fear that vaccines increase risk of autism originated with a 1997 study published by Andrew Wakefield, a British surgeon. The article was published in The Lancet, a prestigious medical journal, suggesting that the measles, mumps, rubella (MMR) vaccine was increasing autism in British children.

The paper has since been completely discredited due to serious procedural errors, undisclosed financial conflicts of interest, and ethical violations. Andrew Wakefield lost his medical license and the paper was retracted from The Lancet.

Nonetheless, the hypothesis was taken seriously, and several other major studies were conducted. None of them found a link between any vaccine and the likelihood of developing autism.

Today, the true causes of autism remain a mystery, but to discredit the autism-vaccination link theory, several studies have now identified symptoms of autism in children well before they receive the MMR vaccine. And even more recent research provides evidence that autism develops in utero, well before a baby is born or receives vaccinations.

Myth #2: Infant immune systems can’t handle so many vaccines.

Infant immune systems are stronger than you might think. Based on the number of antibodies present in the blood, a baby would theoretically have the ability to respond to around 10,000 vaccines at one time. Even if all 14 scheduled vaccines were given at once, it would only use up slightly more than 0.1% of a baby’s immune capacity. And scientists believe this capacity is purely theoretical. The immune system could never truly be overwhelmed because the cells in the system are constantly being replenished. In reality, babies are exposed to countless bacteria and viruses every day, and immunizations are negligible in comparison.

Though there are more vaccinations than ever before, today’s vaccines are far more efficient. Small children are actually exposed to fewer immunologic components overall than children in past decades.

Myth #3: Natural immunity is better than vaccine-acquired immunity.

In some cases, natural immunity — meaning actually catching a disease and getting sick– results in a stronger immunity to the disease than a vaccination. However, the dangers of this approach far outweigh the relative benefits. If you wanted to gain immunity to measles, for example, by contracting the disease, you would face a 1 in 500 chance of death from your symptoms. In contrast, the number of people who have had severe allergic reactions from an MMR vaccine, is less than one-in-one million.

Myth #4: Vaccines contain unsafe toxins.

People have concerns over the use of formaldehyde, mercury or aluminum in vaccines. It’s true that these chemicals are toxic to the human body in certain levels, but only trace amounts of these chemicals are used in FDA approved vaccines. In fact, according to the FDA and the CDC, formaldehyde is produced at higher rates by our own metabolic systems and there is no scientific evidence that the low levels of this chemical, mercury or aluminum in vaccines can be harmful. See section III of this guide to review safety information about these chemicals and how they are used in vaccines.

(Note: Mercury, or thimerosal, was removed from all childhood vaccines in 2001 and was never a component of the MMR vaccine.)

Myth #5: Better hygiene and sanitation are actually responsible for decreased infections, not vaccines.

Vaccines don’t deserve all the credit for reducing or eliminating rates of infectious disease. Better sanitation, nutrition, and the development of antibiotics helped a lot too. But when these factors are isolated and rates of infectious disease are scrutinized, the role of vaccines cannot be denied.

One example is measles in the United States. When the first measles vaccine was introduced in 1963, rates of infection had been holding steady at around 400,000 cases a year. And while hygienic habits and sanitation didn’t change much over the following decade, the rate of measles infections dropped precipitously following the introduction of the vaccine, with only around 25,000 cases by 1970. Another example is Hib disease. According to CDC data, the incidence rate for this malady plummeted from 20,000 in 1990 to around 1,500 in 1993, following the introduction of the vaccine.

Myth #6: Vaccines aren’t worth the risk.

Despite parent concerns, children have been successfully vaccinated for decades. In fact, there has never been a single credible study linking vaccines to long term health conditions.

As for immediate danger from vaccines, in the form of allergic reactions or severe side effects, the incidence of death are so rare they can’t even truly be calculated. For example, only one death was reported to the CDC between 1990 and 1992 that was attributable to a vaccine. The overall incidence rate of severe allergic reaction to vaccines is usually placed around one case for every one or two million injections.

Myth #7: Vaccines can infect my child with the disease it’s trying to prevent.

Vaccines can cause mild symptoms resembling those of the disease they are protecting against. A common misconception is that these symptoms signal infection. In fact, in the small percentage (less than 1 in one million cases) where symptoms do occur, the vaccine recipients are experiencing a body’s immune response to the vaccine, not the disease itself. There is only one recorded instance in which a vaccine was shown to cause disease. This was the Oral Polio Vaccine (OPV) which is no longer used in the U.S. Since then, vaccines have been in safe use for decades and follow strict Food and Drug Administration (FDA) regulations.

Myth #8: We don’t need to vaccinate because infection rates are already so low in the United States.

Thanks to “herd immunity,” so long as a large majority of people are immunized in any population, even the unimmunized minority will be protected. With so many people resistant, an infectious disease will never get a chance to establish itself and spread. This is important because there will always be a portion of the population – infants, pregnant women, elderly, and those with weakened immune systems – that can’t receive vaccines.

But if too many people don’t vaccinate themselves or their children, they contribute to a collective danger, opening up opportunities for viruses and bacteria to establish themselves and spread.

Not to mention, as the Centers for Disease Control and Prevention (CDC) warns, international travel is growing quickly, so even if a disease is not a threat in your country, it may be common elsewhere. If someone were to carry in a disease from abroad, an unvaccinated individual will be at far greater risk of getting sick if he or she is exposed.

Seek reliable resources

My colleague Dr. Joseph Kanter, the assistant state health officer for the Louisiana Department of Health, in a recent interview said he advises parents to seek reliable sources of information regarding vaccines, such as the CDC and the World Health Organization (WHO), and in particular their children’s pediatrician.

“There’s just a lot of lies and misinformation out there and I really hate to see more parents fall victim to it,” Dr. Kanter said. I couldn’t agree more.

The bottom line is this: Vaccines are safe. Vaccines are effective. Don’t fall victim to the falsehoods.