What does the evidence say about risk communication?

The U.S. Food and Drug Administration has published a new report that’s right up our alley. It’s called Communicating Risks and Benefits: An Evidence-Based User’s Guide.

The introduction offers an explanation of evidence-based health communications that we believe should be the standard for all organizations, from corporations to government agencies to universities.

“…Sound communications must be evidence-based in two related ways. One is that communications should be consistent with the science — and not do things known not to work nor ignore known problems. The second is communications should be evaluated — because even the best science cannot guarantee results. Rather, the best science produces the best-informed best guesses about how well communications will work. However, even these best guesses can miss the mark, meaning that they must be evaluated to determine how good they are and how they can be improved.”

The report goes onto address the concept of communicating risks and benefits across a wide range of fields – in health provider settings, news coverage and corporate communications to name a few – and offer practical tips about using evidence in all sorts of communications.

Cornell’s own Valerie Reyna, whom we’ve written about before, authored Chapter 12 about communicating risks and benefits to people of all ages, and her work is extensively quoted in other chapters of the report.

The report is chock-full of useful recommendations.  Among them are:

  • Health professionals should receive specific training on how to communicate the risks and benefits of medical procedures and medicines.
  • Provide information along with explaining meaning to help consumers make good decisions.
  • Test the readability of health care messages to ensure they use plain language.

If you work in the field of health care, this report is a must-read!

Bed bugs: A bigger problem than you think

The news reports were horrifying. Major retailers like Nike, Abercrombie & Fitch and Victoria’s Secret had to close their flagship stores in Manhattan last summer due to bed bugs infestations. While a lot of the hype has died down, bed bugs are still a growing problem in the U.S., according to Cornell bug experts.

Earlier this summer, Cornell entomologist Judy Gangloff-Kaufmann briefed legislators in Washington D.C. on the latest research into this troublesome insect, which is spreading discomfort at alarming rates.

The resurgence of bedbugs in the last decade occurred after the pests virtually disappeared in the United States from 1960 to about 2000. This is likely due to home-use bans on such insecticides as lindane, chlordane, diazinon and dursban and an increase in global travel in the last decade, Gangloff-Kaufmann said.

Gangloff-Kaufmann works with Cornell Cooperative Extension’s Integrated Pest Management Program. They’ve put together guidelines for preventing and eliminating bed bug infestations.  The publication is aimed at addressing the problem in group living facilities, but its advice can apply to problems in individual homes as well.

Among the tips are:

  • Wash donated clothing before wearing.
  • Do not take furniture or items from the street,
  • There are currently no insect repellents that are labeled for bed bugs.  If you inspect an infestation, contact your local Cooperative Extension office for a referral to a professional exterminator.

The best way to address the bed bug problem is to share the facts about how to cope with them, Gangloff-Kaufmann says. So spread the word about the evidence on bed bugs.

Wash your hands! And other ways to ward off food poisoning

Following last week’s recall of 36 million pounds of ground turkey, we thought it’d be a good time to review the evidence on Salmonella poisoning.

According to the U.S. Centers for Disease Control, the bacteria Salmonella live in the intestinal tracts of humans and other animals, including birds. People usually contract the bacteria by eating foods contaminated with animal feces, which typically look and smell normal even though they are carrying the bacteria. Salmonella is also be found in the feces of pets, especially, reptiles and young birds.

An estimated 1.4 million people contract Samonella poisoning every year in the U.S.  A total of 107 cases in 31 states have been identified in the most recent outbreak spread by the ground turkey meat. Infection typically results in diarrhea, fever, and abdominal cramps 12 to 72 hours contact with the bacteria. The illness usually runs its course in 4 to 7 days, and most people don’t require treatment.  But severe cases require hospitalization for dehydration.

So what’s the best way to prevent the spread of Samonella?  The evidence shows there are some simple steps you can take to reduce your risk of Samonella poisoning.

  • Cook poultry, ground beef, and eggs thoroughly.
  • Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
  • Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.
  • Avoid direct or even indirect contact between reptiles and infants or immunocompromised persons.

Beyond these common-sense measures, researchers at Cornell are trying to do more. Two Cornell faculty members recently received a grant from the U.S. Department of Agriculture to study how tomato plants interact with the Samonella bacteria, with the hopes of eventually breeding new varieties of produce that suppress Samonella. 

Until then, keep up the hand-washing!

New insights into the teenage brain

We have all heard the frightening statistics before.  Teens ages 15 to 19 are age group most likely to die due to injury – about six times more likely than 10- to 14-year-olds. Crime rates are highest among young males. Teens are also more likely to abuse alcohol and engage in risky sexual behavior compared with people of other ages.

Now a new paper published by the National Institute of Mental Health sums up the body of research on the vulnerability of teenagers. Much of the problem, it turns out, has to do with their brain development.

The paper explains that brain scans have revealed that the brain doesn’t resemble that of an adult until most people are in their early 20s. And the parts of the brain responsible for behaviors such as controlling impulses and planning ahead are among the last to mature.

Research also shows that the parts of the brain involved in emotional responses are more active in teenagers compared with adults, which may help explain teenagers tendencies to act impulsively and take on more risks.

So what’s a parent to do?  Cornell Professor Valerie Reyna studies risky behavior among teenagers. (In fact, we’ve written about her research before.)   She’s created a web page of resources on Risky Decision-Making in Adolescence to help teachers and parents guide kids.   She offers a long list of strategies to keep young people safe, such as using positive role models and role playing to simulate risky situations.

If there are teenagers in your life, it’s worth understanding how their brains and developing and what you can do to help them make good decisions.

The evidence on U.S. debt

As the federal government struggles this week to raise the federal debt limit, we thought it’d be a good time to review the evidence on household debt over here at EBL. 

A business columnist at the Detroit News made the point this week that American families actually hold more debt than the federal government, with households owing more than $2.4 trillion of credit card debt alone. (That compares to approximately $1.4 trillion in the total debt for the U.S. government in 2011.)

What else do we know about Americans and debt?   Family Economics and Resource Management, a project by Cornell Cooperative Extension to people achieve more  secure financial situations, compiled an interesting list of facts about Americans and debt management.  Among them:

  • 40 percent of U.S. households live beyond their means.
  • the net worth of the average middle-class American household after accounting for debt is less than $10,000.
  • and 48 percent of American credit card holders only pay the minimum payment amount each month.

Essentially, the evidence shows that Americans are no more responsible with their borrowing habits than the federal government.

But there is a way out.  Rutgers Cooperative Extension has compiled 20 tips for smart borrowing, such as:

  • Borrow as little as possible by making the largest down payment you can afford.  This will help you to avoid becoming “upside down” or owing more than your purchase is worth.
  • Shop for credit, just like other purchases. Compare at least three different banks for the lowest interest rates and fees.
  • Always pay more than the minimum monthly payment. For example, send 6 percent of a $5,000 outstanding balance on an 18 percent APR credit card, instead of 3 percent, and you’ll save 9 years of payments and $2,975 in interest.

Be sure to understand the facts about any money you borrow or credit cards you hold.  Smart borrowing will help you achieve financial success over the long run.

How to promote creativity among kids

Did you know there’s an evidence-based way to measure creativity? 

In the 1950s, a psychologist named Ellis Paul Torrance developed a series of tasks to measure creativity and gave them to 400 Minneapolis children. 

Scholars have followed the children since then and recorded all of their creative accomplishments – patents, research papers, art exhibits, business innovations, books, musical scores, and so on. Sure enough, the children who scored high on the tests showed the more creativity as adults as well. If fact, the correlation of test scores to lifetime creative accomplishment was more than three times stronger for childhood creativity than childhood IQ.

To date, the Torrance test has been taken by millions of people worldwide in 50 languages.  But recently, one researcher identified a disappointing trend. Kyung Hee Kim, a professor of Educational Psychology at the College of William and Mary, analyzed nearly Torrance scores of nearly 300,000 children and adults.  She found the scores had been steadily rising until 1990. Since then, creativity scores have consistently fallen every year. (Her work was famously documented in an article in Newsweek magazine in 2009.)

When Kim says creativity is declining, she’s not just talking about artistic ability, but a range of skills such as the ability to produce original ideas, see things from a different angle, elaborate upon ideas  and synthesize information.  (She explained all of the measures to Encyclopedia Brittanica.)

What does this mean?  Kim is the first to point out there’s more research needed.  But , based on her body of research on creativity, she does suggest some steps that parents and teachers can take to foster creativity among children.

  • Take the time to try to find the answer children’s questions and teach how to find their own answers.
  • Don’t always emphasize getting the “right” answers, but instead encourage inventiveness.
  • Encourage spontaneous and even silly play.
  • Foster independence.
  • Introduce children to different experiences including different places, cultures, food, languages, and people.

Leadership stereotypes: Men still dominate

Over our most recent decade, women in the U.S. have made great strides in taking on new leadership roles. We’ve had our first female presidential candidate and our first female Speaker of the House. In 2011, 13 Fortune 500 companies were run by women and – get this! – those companies outperformed the overall stock market by 28 percent, according to an analysis by Forbes magazine.

But, alas, a new meta-analysis shows that our society still views leadership as a male trait.

The study, out of Northwestern University, found that women are hampered with two forms of prejudice when it comes to taking on leadership roles:  They are viewed as less qualified in general. And when they assume traits we associate with leadership, such as assertiveness or decisiveness, their behavior is viewed as inappropriate. (One Huffington Post columnist uses a less appropriate but more colorful word.)

But there is a silver lining. The analysis found that masculine views of leadership are less extreme today compared to when researchers began studying the culture of leadership traits in the early 1970s.

So what’s a woman to do?  Personally, I agree with Huffington Post columnist Laura Hibbard. The best thing we can do is to take on more leadership roles more often. The culture shift has already begun. Now we just need to make sure it continues.

Serious business: The evidence on heat waves

A massive heat wave is drifting across the United States, extending all of the way from Texas to the Canadian border.  So far in July, nearly 1,000 daily high temperature records were tied or broken in cities across the nation, including 12 all-time highest temperature records.

What does this mean for all of us?  Yes, it’s time to crank up the air conditioner and hit the swimming pool. But more importantly, it means we need to be on the look-out for heat-related illnesses.

Keith Tidball is a senior extension associate in the Department of Natural Resources at Cornell and the coordinator for the New York State Extension Disaster Education Network.  

These days, it’s his job to educate people about how to stay safe in the heat. But he also learned a heck of a lot on the topic as an infantry officer in the U.S. Army. “I saw my share of strapping young guys become injured – sometimes permanently – from heat-related illness,” he said.

Keith offered three facts to help everyone stay safe during a heat wave:

  1. Heat illnesses can quickly become life-threatening. In fact, according to the National Weather Service, heat is the number-one weather-related killer in the United States.
  2.  Your body is 50 to 70 percent water, and heat causes that water to evaporate. So staying hydrated is the most important thing you can do for your body during heat waves. Water is best, but anything without alcohol or caffeine helps. The best way to know if you’re hydrated is to check the color of your urine. If it’s clear or light-colored, you’re in good shape.  If it’s bright or dark yellow, you need to drink a lot more water.
  3. Prevention is key. Once you’ve had a heat-related injury, you’re more susceptible to the next one. “In the military, you would have to wear a red tape around your uniform to indicate you’d had a heat-related illness in the past,” Keith explained.

He also offered a host of resources from universities and federal agencies about ways to cope with the heat.

The bottom line: If you’re urine is not clear when it’s hot out, you’re in danger. So, go ahead, take a break right now and drink some water.

Evidence-based pain relief

An estimated 116 million Americans suffer from chronic pain – a condition that deteriorates quality of life by hampering physical activity, as well as taking a cognitive and emotional toll. 

Beyond understanding the scope and magnitude of chronic pain, this is a personal issue for me. My mother suffers from arthritis that has, over the years, led her to suffer from pain 24 hours a day. She is scheduled to have knee replacements this summer, and we’re hoping that will help. But her continuing experience has definitely underscored for me what a life-changer chronic pain can be.

So I was anxious to read the Institute of Medicine report released last month about chronic pain. Relieving Pain in America:  A Blueprint for Transforming Prevention, Care, Education, and Research was written by a committee of 19 experts – the nation’s leading experts on reaching out to and treating people living with chronic pain – who reviewed all of the evidence available on the topic.

Unfortunately, their findings aren’t incredibly optimistic. The committee concluded that health care providers and the general public need to rethink the way we view chronic pain – treating it not as just a symptom, but its own condition that requires treatment.

Among their recommendations are to collect better data on chronic pain – who suffers from it and what are the consequences.  The medical system needs to encourage more collaboration between primary care physicians and pain specialists, provide better pain assessments and eliminate the barriers to getting treatment for chronic pain. And researchers need to conduct more longitudinal research on pain treatment and translate findings into effective therapies.

On the positive side, the report does offer a road map about how to improve life for patients suffering from chronic pain. Here’s hoping it leads to more evidence-based methods for treating it.

Building the evidence for meditation

For centuries, cultures and religions across the globe have practiced meditation as a form of worship.  In more recent times, researchers have hypothesized that the practice brings health benefits along with it – reducing stress, lowering blood pressure, even alleviating the symptoms of epilepsy.

While more than 1,000 studies have been conducted on the benefits of meditation, several systematic reviews in recent years have all drawn the same conclusion: Scientific research on meditation practices lacks a common theoretical perspective and tends to suffer from poor research methods. 

While there doesn’t seem to be any adverse effects to practicing meditation, more vigorous studies are needed to prove that it can actually improve health.

Across the globe, many researchers are doing just that – conducting new, methodically-sound studies on the benefits of meditation.

One new paper published in the Journal of Neuroscience this spring used magnetic resonance imaging, or MRI, to demonstrate the meditation can reduce the experience of pain, as well as pain-related brain activation.

“This is the first study to show that only a little over an hour of meditation training can dramatically reduce both the experience of pain and pain-related brain activation,” Fadel Zeidan, lead author of the study and post-doctoral research fellow at Wake Forest Baptist Medical Center, explained in an article published in ScienceDaily.

The study was small, with only 15 healthy volunteers participating. But they saw about a 40 percent reduction in pain intensity and a 57 percent reduction in pain unpleasantness. (In contrast, pain-relieving drugs typically reduce pain levels by about 25 percent.)

More work is still needed. But these initial results are promising – not only for the health benefits they document, but also because they’re paving the way toward a higher-quality body of evidence on the benefits of meditation.

Considering all of the evidence on sunscreen

While our family is spending a week at the beach – as I’m sure many others are this summer, too – I thought it would be appropriate to share my pre-vacation research on sunscreen.

There are all sorts of sunscreens on the market these days, with SPFs ranging from 15 to 50+. There are chemical sunscreens, which soak into the skin and absorb UV light, and mineral sunscreens that sit on top of the skin and block UV light. 

With all of the options out there, I wanted to know what’s the best way to avoid and sunburn and help prevent skin cancer?

After sifting through dozens of fact sheets and studies, I found a good summary of the evidence at the Environmental Working Group’s web site.  The group weighs the pros and cons of using sunblock and explains how various ingredients work.

Among the highlights, I learned that most people don’t apply enough sunscreen to achieve the maximum amount of sun protection.   In fact, the best time to apply it is 15-30 minutes before heading outside.

Both chemical and mineral sunscreens work well.  The important factor to look for is a “broad spectrum” sunscreen, which blocks both UVA and UVB rays.

If you’re interested in looking up a specific product, the Environmental Working Group has a database of sunscreens that evaluates the ingredients in more than 1,700 sunscreens.  The group suggests avoiding ingredients with unknown side effects.

Whew!  Now that I’ve got that figured out, we’re off to the beach.

Botox and empathy: The missing link

 Botox – an injection that temporarily prevents formation of wrinkles by paralyzing facial muscles – is the most common cosmetic procedure in the United States.  According to the American Society of Plastic Surgeons, some 4.6 million people receive the treatment annually.

Today, there is new evidence that the wrinkle-reducer is hampers the ability to understand what others are feeling.

A new study has found that people who have had Botox injections are physically unable to mimic the emotions of others, ultimately preventing them from understanding what others are feeling. The New York Times summed up the research in a recent article. 

In the study, women who had been injected with Botox looked at a set of photographs of human eyes and were asked to match them with human emotions. They were compared to a control group, who received a facial injection that does not paralyze facial muscles.

Those who received Botox were significantly less accurate at identifying emotions compared to the control group.

While this is just one study, it’s good evidence that you can never know the full impact of a medical treatment until you investigate all of the possibilities.

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