A recent study found that stressful days increase the risk of fatal (and non-fatal) car accidents.  Excerpted from the Canadian Health Network website.

The study, led by Dr. Donald Redelmeier, an internal medicine specialist at Sunnybrook Health Sciences Centre in Toronto, and reported by the Canadian Press on April 11, 2012, shows that particular dates are associated with an increase in traffic deaths.  The study is published in this week’s issue of the Journal of the American Medical Association.

Dr. Redelmeier’s group looked at a 30-year study of traffic accident in the United States.  It found that the country’s mid-April tax deadline day is associated with an elevated risk of fatal crashes.  The study found that Americans have a six per cent increased risk of dying on tax day—and a similar risk likely occurs on Canada’s tax deadline day, April 30, researchers say.

They found the same increase in risk both during the morning hours, the afternoon hours and the evening hours, prevailing for the whole day, and not just before midnight.  That differs from Super Bowl Sunday where there’s a 41 per cent increased risk in the average number of road fatalities primarily within three hours following the game’s completion.   Driver error contributes to about 93 per cent of such events.

“Stress is often speculated as a contributing factor in driver error, and yet stress is almost impossible to study in a scientific manner,” Redelmeier said. “Here, we were trying to pull out one particular form of stress.”  Researchers aren’t clear on what factors are behind the bump-up in the chance of dying in a road accident on the final day for filing taxes.  While one explanation is that stressful deadlines can lead to driver distraction and human error.  Sleep deprivation and drinking alcohol could also play a role.

Redelmeier believes a similar level of risk applies to the spectrum of outcomes that can arise from collisions on roadways – from brain and spinal cord injuries to other kinds of physical trauma and property damage.  And everyone, not just drivers, but passengers and pedestrians are also at risk.

“What that means is even if you as an individual have filed early, it doesn’t mean you’re immunized against the situation, because you live in a community of all sorts of other drivers out there,” he said.  “The increase in risk on tax day included the passengers and pedestrians, which is a common theme of all of road trauma—bad driving imposes risks on other people.”

Redelmeier said no matter how much stress is being experienced, it’s critical that drivers remember to wear their seatbelts, obey the speed limit, restrict alcohol consumption and minimize distractions while behind the wheel.  Almost every one of these fatal crashes could have been entirely avoided by a small change in driver behaviour. Basic safety practices should not be forgotten at times of stress.”

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What do musicians and athletes have in common? They may overuse muscles in the course of their work and require medical attention. When the therapy is needed for a musician or other type of performer, it falls under the broad category of “music therapy.” In this, the last in the series of three articles on music therapy, we look at not how music can be therapy, but how those performing the music may need therapy.

Music therapy can take many routes, and it can involve many types of therapists, including those who deal with musicians and dancers. Those practitioners may be part of the Performing Arts Medicine Association (PAMA,) , which describes itself as “an international member organization comprised of dedicated physicians, therapists, trainers, educators and administrators, as well as performers and students with the common goal of improving the well-being of performing artists.”  Many PAMA members have written extensively to help educate other performers, as well as health professionals, about this important work.

Studies and publications deal with such issues as postural problems, music therapy for developing self-confidence in performers, voice care, the importance of physical fitness to performance, injury prevention, and stress and anxiety as it applies to performers. Many of these apply to all performers while others are specific to a discipline, or an instrument. You can learn more about these PAMA member publications here.

Many musicians themselves may not be aware of the connections between their art and their health, so it is up to the health professional to be aware of the complexities that may affect the performer’s work—both physically and mentally. Often it is the front line [office] staff who will flag something the health care professional needs to be aware of. This is where educational conferences and symposiums can be of great benefit to the practitioner, and to those who work with them. These educational events are held in various locations throughout the world.

One event that may be of particular interest is the 30^th Annual PAMA Symposium on “Medical Problems of Performing Artists:  Performing Arts Medicine, Past, Present, and Future.” This is being held July 26-29, 2012 in Snowmass, Colorado.  The symposium is in conjunction with the Aspen Music Festival and School.

It is very fitting to have this symposium in conjunction with a music festival. Just as music therapists can bring new understanding as to how music can be used as therapy or medicine for particular illnesses, therapy for the musician or performer is equally important, and cannot be overlooked. PAMA understands this, and hopes that other health professionals do as well.

While some people say they need absolute silence when they’re working a recent study published by the American Pain Association states that listening to music may actually bring relief, especially to those who suffer from anxiety and easily become absorbed in cognitive activities.

According to an article posted on Newswise, researchers at the University of Utah found that music provided “meaningful intellectual and emotional engagement to help reduce pain.” The article goes on to say “The findings suggest that engaging activities like music listening can be effective for reducing pain in high anxiety persons who can easily become absorbed in activities. They [the researchers] noted that interaction of anxiety and absorption is a new finding and implies that these personality characteristics should be considered when recommending engagement strategies for pain relief.” So listening to some music while you’re working may actually reduce any anxiety you’re feeling about that work.

It may not be just listening to music that is helpful, but also listening to specific sounds.
Dr. Lee Bartel, who we introduced in our last article on this subject of music as therapy says there are already many applications where sound therapy is effective including being used in Neonatal Intensive Care Units and operating rooms in hospitals to using targeted melodic-based therapy in stroke rehabilitation. “However, in my opinion, the most powerful effects already being demonstrated and new ones to be determined will all have their basis in discoveries of brain processes within the gamma zone,” he says, “and the role of sound through a process of brain-wave rhythmic driving (entrainment) to stimulate this brain activity.” Bartel thinks this could lead to some real breakthroughs in using music as therapy.

“I anticipate that our research will show scientifically that specific parameters of sound, rather than the holistic “magic” or “power” of music, result in predictable effects on body and brain and consequently this sound can be targeted for specific medical effects.” Those effects may be easier to achieve than you think.

Play some music in your office and see if your anxiety level or the anxiety level of your patients is relieved. You may have to experiment with different types of music to see what suits best. Or you may just want to stick with something from the radio. You just may find you are concentrating a bit more on the melody or lyrics of whatever song is playing, and a little less on the stress you might be feeling in the office.

Heart disease is the number one killer of women over the age of 55 according to this report from the Public Health Agency of Canada. Yet many women may not even recognize the signs that they are having, or have had, a heart attack.  They, and perhaps even their doctors, may attribute the signs of heart disease to life situations, other illnesses, or drug side-effects. Therefore, women may wait until it’s too late to prevent complications, or worse, death.  Here’s what to watch for:

• Unusual fatigue that gets worse with activity
• Shortness of breath; difficulty breathing
• Heartburn that is not relieved by antacids
• Sudden nausea or vomiting that is not relieved by antacids
• Anxiety
• Tightening and pain in the chest that may extend to the jaws, neck or shoulders
• General feelings of weakness
• Paleness
• Sweating

Any of these symptoms alone may not be cause for concern, but if they are occurring in combination, medical attention should be sought quickly.  Women, and their medical practitioners, should also be aware that these symptoms may appear and disappear, and may occur up to a month before the actual “attack.”  That’s what happened to Jacqueline Laraquette (not her real name).

“I’d been feeling this heaviness on my chest, almost like a bad heartburn, off and on for more than two weeks last August, and it seemed to disappear, but then was  back one day, and kept getting worse, so I thought we should stop at the hospital on the way to our cottage,” Laraquette says.  “Early tests showed that I’d had a minor heart attack, but then, more extensive tests at another hospital a few days later showed it had been a major heart attack, and that there’d been some damage as much as one month earlier. I was shocked to find all of this out—after what I thought might be a minor problem.”

Looking back, Laraquette said she did experience many of the other symptoms she’s since learned were related to heart attacks, but put them down as anxiety related to the trauma of both her father and brother dying earlier in the summer. “They’d died of heart attacks, so I guess it was in my mind that this could be heart-related, which is why I decided to go to the hospital.  I’d forgotten that there were some women in our family who had heart problems—I just thought it was a problem on the men’s side—and these symptoms were very different than what I’d seen with my brother and my dad.”

Laraquette was lucky she followed her instincts to get the chest heaviness checked out. According to the Heart and Stroke Foundation in Ontario, one in three Canadians will die before their time from either heart disease or strokes, and they echo the findings of the Public Health Agency that heart attacks kill more women than all other diseases combined.  The 2012 campaign “Make Death Wait” is in full swing and you can get more information on how to get involved here. The campaign is not just directed at the general public. The more that health professionals know about heart disease, particularly as it relates to women, the better it will be for their patients.

“I consider myself lucky that even though I had a major heart attack, I survived to tell the tale, and to warn my family and friends, especially the women in my life, to get checked, and to not ignore any of those symptoms. They should talk to their doctors too, and make sure that they are doing all they can to prevent what I went through.”

Other Helpful links:

Risk Assessment Questionnaire (from Heart and Stroke Canada website):
https://ehealth.heartandstroke.ca/heartstroke/hsra/EnterSurvey.aspx

Healthy Weight Action Plan (linked from Risk Assessment questionnaire website):
https://ehealth.heartandstroke.ca/heartstroke/HWAP2/signup.asp?UID=1807965

Music therapy is the skilful use of music and musical elements by an accredited music therapist to promote, maintain, and restore mental, physical, emotional, and spiritual health. Music has nonverbal, creative, structural, and emotional qualities. These are used in the therapeutic relationship to facilitate contact, interaction, self-awareness, learning, self-expression, communication, and personal development.

This is how music therapy was described by the Canadian Association of Music Therapy (CAMT) at its Annual General Meeting in May 1994, and is still used today to describe this form of therapy that has wide-ranging uses and benefits. Music therapy is used in a variety of settings in the public and private sector. The clients range in age, and musical backgrounds, including not having any background at all, but just an appreciation for music, and a willingness to try this therapy.

Music therapy has been successfully used in all types of care including pre and post-natal, neonatal, oncology, and geriatric. Victims of violence and abuse, and those with substance abuse and mental health issues have also had positive outcomes. CAMT researchers say that music as therapy can be beneficial with many patients including, but not limited to those with:

• Acquired Brain Injury
• AIDS
• Autism
• Developmental Disabilities
• Emotional Traumas
• Hearing Impairments
• Parkinson’s Disease
• Physical Disabilities
• Speech and Language Impairments
• Visual Impairments

In a recent interview on TVOntario, Lee Bartel, Professor and Associate Dean of Research at the University of Toronto’s Faculty of Music was asked about the difference between music as medicine and music as therapy. In classic music therapy, Bartel explained, the benefits are psychosocial—and are between the therapist and the client continuing to use music to accomplish certain things in the therapy sessions. “Music as medicine, on the other hand, would be something we might better describe as a prescription…Take two songs and call me in the morning kind of thing,” Bartel said.

Heidi Ahonen, Senior Music Therapist and Professor at Wilfred Laurier University in Waterloo, ON, worked with patients who had Parkinson’s disease and she found that listening to low-frequency sounds for a period of 30 minutes helped to decrease symptoms. The prescription was the low-dose sound, and the dose was 30 minutes. “That was not about the patient’s relationship with Heidi at all,” Bartel said, “It was about the patient coming in and being given a dose of sound. That is music medicine in its purest form.”

More research is being done, and is being done collaboratively among universities and hospitals in Ontario, including the University of Toronto, Wilfred Laurier University, Mount Sinai Hospital, and the Baycrest Centre for Geriatric Care, Toronto. This may lead to even more breakthroughs and is leading to the development of more research facilities, which are expected to open in the next few years.

In subsequent articles, we’ll delve more into the research being done, and more of the benefits and impacts of music as therapy, and music as medicine.

This year’s crop of healthcare buzzwords and catchphrases includes a handful of terms that are really oxymorons. An oxymoron is when one of the words or phrases in the expression contradicts the rest.  However, lingo must adapt to where we are today.  Here are eight of the most popular.

1. Palliative intensive care. Palliative care is generally perceived as comfort care with morphine or other diligent pain relief regimens to ease the dying process, along with more counseling for loved ones to understand what’s happening and accept it. But intensive or critical care means pulling out all the stops, doing everything possible, to keep patients alive.  Now, providers are combining the two. It is said that 30% of all hospital in-patient deaths occur in the intensive care unit, so why not introduce palliative care systems much earlier?  The idea increasingly being implemented within hospitals is to bring the patient and family together with palliative care professionals, when the patient’s condition is appropriate, in a much more concerted and structured way than has been the ICU routine.

2. Cultural DNA. Again the contradiction. DNA is something we’re born with, it can’t be changed with a shift in culture.  But changing an organization’s cultural DNA is an expression that increasingly resonates among quality leaders. With this phrase, they’re trying to convey the idea that if leaders of a healthcare organization walk the walk and talk the talk, their behavior will gradually work its way into everyday practice.

3. Change fatigue. People get tired mainly when routines stay the same, day in and day out, right? Not necessarily. We’ve been hearing healthcare providers talk about a new kind of fatigue, one brought on by too much change too fast.  There’s change in leadership, areas of responsibility, accelerated workload and expectations, and requirements for new skills and training in people who may not be prepared for it or want it.  Now managers are trying to find productive ways to make transitions so there is enough stability and constancy mixed in to prevent change fatigue.

4. Positive deviance or disruptive innovation. In healthcare settings, these two phrases, which have different origins and meanings, can be used to express the same idea. They implies a strategy in which providers look at peers—be they controversial individuals or entire institutions—that function differently, but still achieve excellent results.  One example of positive deviance comes from Michael Edmond, MD, chairman of infectious diseases at Virginia Commonwealth University, who eschews conventional wisdom that hospitals should perform active surveillance with testing to prevent hospital-acquired MRSA infections. Instead, he bucked that trend in favor of hand-washing and other universal precautions such as catheter insertion bundles. He got his infection rates down without using expensive testing and without having to put colonized patients into isolation.  Disruptive innovation is a similar idea. A concept originally proffered by Harvard professor Clayton Christensen, disruptive innovation can mean advancing healthcare quality through a wide range of new ideas: the use of payment incentives, transparency, retail clinics, comparative effectiveness research, and the use of social networks.

5. Getting to genba (or gemba). Okay, not exactly a new phrase but we predict much more frequent use of this Lean-derived expression in virtually all aspects of healthcare.  Genba is a Japanese word meaning the place where crucial work takes place.  It may mean that a nurse will go to a patient’s home to see how preventive care is provided there.  The idea is that by going to where the work (where the patient is) actually happens, patient care might very well improve.

6. Gamification. This is one possible way to ensure patient compliance and improve health literacy.  ‘Gamification’ (a word to describe health-related web sites that have game-like interfaces and qualities) is a way to get people to learn about their health and use their healthcare data to improve it.  Think of an iPhone app that lets one notify, or even compete with, friends on Twitter or Facebook how far and fast everyone ran today on the treadmill. There might be games in glucose checks for diabetics. Calorie counters may not just log in the day’s tally, but also show with a pinball machine interface whether those meals hit all the food groups.  Game on!

7. Engagement. In essence, engagement means getting everyone on the team to understand the reasons for a policy or practice and incorporate those goals into everyday procedures.  For patients, being engaged means that providers have tried to cultivate their trust, making sure on repeated occasions that they understand their diagnosis and the importance of adhering to the prescribed care regimen, and of course, doing adequate follow-up.

8. Getting to zero. Look for increased controversy in the use of this phrase to describe the goal to reduce adverse events, surgical errors, hospital-acquired infections, ventilator-associated pneumonia, and anything else bad that happens to patients in healthcare settings.  There’s a sense among providers that the use of this phrase only provokes frustration, because realistically, zero can never be fully achieved forever. And some events are just not preventable. Simple as that.  Another take in this controversy is that if an organization does achieve the elusive zero one day, it may provoke a subtle complacency.

Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.com. Follow Cheryl Clark on Twitter.

The full article can be read here.

Researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ) in Stratford, NJ recently released their findings that led them to develop 10 New Year’s resolutions to help you age successfully. Dr. Terri Ginsberg of the New Jersey Institute for Successful Aging at the UMDNJ-School of Osteopathic Medicine, says that there are some pretty simple ways to age successfully, and offers these tips as New Year’s Resolutions for ageing gracefully, and staying healthy in 2012.

1. Get better sleep at night by avoiding naps during the day, or watching TV in bed—regardless of how tired you are.
2. Eat well, including lots of coloured vegetables. Those green, yellow, and red fruits and veggies have lots of nutrients that your body needs—especially as you get older.
3. Make an appointment with your doctor and dentist soon to start the year off right with a good check-up. Then, follow their advice and get whatever tests you need to stay healthy.
4. Stop worrying. You really can make yourself sick worrying a lot—especially about things over which you have no control. Let it go. Worry lines on your face make you look older too.
5. Stay in touch with family and friends. Keeping busy and social keeps you healthy, and active, which makes you at least feel younger.
6. Exercise your body and your mind by moving more, and reading more. Take a walk to the library, and improve your mental and physical health.
7. See #6.
8. Have some fun by laughing and singing more. This helps with #4 too.
9. Take more control over your health. See #3.
10. Get involved with others by volunteering in your community. No matter how busy you are, helping someone else is good for your health, and your lifestyle. Older folks helping younger folks is always good for everyone!

Source: http://www.newswise.com/articles/ten-new-year-s-resolutions-to-help-you-age-successfully

The University at Buffalo (UB) recently got into the discussion about New Year’s resolutions by offering its annual list for having a healthy and prosperous 2012.

UB faculty based their recommendations on work done at the university and from what they saw happening in other communities. Here are five of their suggestions.

1. Help a returning soldier. There are lots of ways to help our returning soldiers and their families. UB faculty noted that many returning soldiers were helped with projects around their homes. [Note to Canadians: Check with a Military Family Resource Centre to find out what’s needed. If you don’t live near a MFRC, go online to see how you can help long distance. Don’t forget our troops still in Afghanistan. Check with the local post office. They will help you send mail. ]
2. Improve your oral health, and improve lung and heart health. Researchers found there is a direct link between better dental care and improved cardiovascular health. Source: http://ubfacultyexperts.buffalo.edu/floss-to-protect-against-pneumonia-and-heart-disease
3. Combat feelings of loneliness by reading more fantasy, says UB associate professor of psychology Shira Gabriel, PhD. She and graduate student Ariana Young found that people reported feeling more satisfied with their life, and less lonely reading stories from “Harry Potter”, “Twilight” or other fantasy narrative fiction.
4. Be nice to nurses. They are on the front lines in any health care situation, especially emergency rooms, and are under a lot of pressure from both doctors and patients, and are most likely the first to spot medical errors. Source: http://www.buffalo.edu/news/12641
5. Talk to your child about bullying. After well-publicized, and sometimes very tragic, cases of bullying, there were anti-bullying campaigns in schools and communities, but a heartfelt chat with a parent may be the best way for children to understand the ramifications of bullying—and it may open up some lines of communication if they are being bullied, or know someone who is. Source: http://www.buffalo.edu/news/13013

Source: http://www.newswise.com/articles/view/584174/?sc=lwhn

Regardless of whether you make New Year’s resolutions have a happy, healthy 2012.

I’ve wondered about the meaning of the word wellness.  It’s not in my dictionary so I looked online and found “wellness” equated with “health”.  I’ve talked about some of this in one of my previous posts “Choices in Healthcare”.

To explore the idea further I spoke with two people who use the word wellness. Mora File, owner of the Wild Orchid Health and Wellness Centre on Centre Street in Napanee had this to say about wellness:  “It’s the integration of all aspects of the things that have an impact on our life including the work we do, the food we eat, and the things we do to keep things in balance. It’s also knowing when you need to take better care of a certain aspect of your life and how to access what you need to do that.”

Joanne Maclean, owner of Wellness in the Woods on Highway 2 east of Napanee said that she thinks of wellness as something that is “achieved from the inside out,” and “is a way of making yourself feel better.” She said her clients tell her they always feel better and more relaxed when they leave her salon, in its  lovely wooded setting, so it was easy coming up with its name.

Does wellness just mean health? It’s fortunate that while none of my health problems have been life-threatening, they have affected my quality of life, and they have led me to search outside the norm for answers to my problems. I have a family doctor who supports my belief that she is just one of many health professionals I can consult. I also have complementary care available including chiropractic, massage therapy, yoga, naturopathy, holistic nutritional counselling, and Traditional Chinese Medicine. Thanks in part to this team of practitioners I maintain my wellness. I’ve referred to this in The Best of Both Worlds.

We have a hospital in my community and a number of doctors to care for us when we are not well. We also have a growing number of complementary and alternative care providers.

Wellness is a state of being: having a healthy mind, body and spirit. It’s more than just being free of disease. Achieving wellness requires active promotion of health and prevention of illness. While it’s good to have a team of people who can help us achieve optimum health, ultimately, it is up to us. We need to make the best choices we can and not always rely on someone else to take care of us. We need to work to achieve whatever wellness means to us. Heredity or just bad luck may give us some health challenges to deal with but if we keep wellness as the goal, and we have a range of choices, then meeting those challenges will become easier.

Christine Peets is a freelance writer, writing instructor, and business communications trainer, all part of her company Captions Communications. She is an avid believer in preventative, complementary, and alternative medicines, in addition to western medicine, and uses them all to maintain her health and wellness. Learn more about Christine’s work on her website, www.CaptionsCommunications.ca, and read more of her writing on her blog, “With Humour and Hope: The Only Way to Live.”