Northern California Society of Public Health Educators

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Scholar Corner

National Diabetes Education Program Release

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A newly published set of 10 guiding principles highlights areas of agreement for diabetes care that could be clinically useful in diabetes management and prevention. Presented by the National Diabetes Education Program (NDEP), Guiding Principles for the Care of People With or at Risk for Diabetes <> is aimed at assisting with identification and management of the disease, self-management support for patients, physical activity and blood glucose control, among other topics. More than a dozen federal agencies and professional organizations support the document.

"There are a lot of diabetes guidelines out there, and practitioners and patients can get confused about which they should follow," said Judith Fradkin, M.D., director of the Division of Diabetes, Endocrinology and Metabolic Diseases in the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. "With these Guiding Principles, we aren't creating new guidelines, but clarifying where there is general agreement across myriad diabetes guidelines. Guiding Principles represents a set of sound practices. Our goal in developing this resource is to help clinicians help their patients with diabetes."

"Guiding Principles is the result of a major collaborative effort from a varied group of experts who are committed to improving the care for people with or at risk for diabetes," said NIDDK Director Griffin P. Rodgers, M.D. "These principles represent the cornerstone of diabetes management and prevention."

Diabetes has placed a health care and financial burden on Americans. More than 29 million Americans have diabetes and another 86 million --  over one in three adults --  have prediabetes. Diabetes costs the country $245 billion annually, estimates the American Diabetes Association.

NDEP is a partnership between the NIH and the Centers for Disease Control and Prevention. The following organizations and U.S. agencies support Guiding Principles:

-- Academy of Nutrition and Dietetics
-- Agency for Healthcare Research and Quality
-- American Academy of Ophthalmology
-- American Academy of Physician Assistants
-- American Association of Clinical Endocrinologists
-- American Association of Diabetes Educators
-- American Association of Nurse Practitioners
-- American College of Obstetricians and Gynecologists
-- American Diabetes Association
-- American Heart Association
-- American Optometric Association
-- American Podiatric Medical Association
-- Department of Defense
-- Endocrine Society
-- Health Resources and Services Administration
-- Indian Health Service
-- National Council of Asian Pacific Islander Physicians and AANPHI Diabetes Coalition
-- Office of Minority Health

The NDEP works with more than 200 partners and offers materials and resources to the public, people diagnosed with diabetes, health care professionals and business professionals. To view or download NDEP resources, visit <>.

The NIDDK, a component of the National Institutes of Health (NIH), conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see <>.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit <>.


Combat Patient's Chronic Stress

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Tips for Helping Patients Combat Chronic Stress

Originated by: Patricia Hernandez

Submitted: 29 Oct 2014

Last updated on: 29 Oct 2014

Related Health Topics:


We used to live in an age where immediate stress occurred due to wars, immense animals looking at us for dinner, and having to move from our home due to natural disasters. Nowadays stress is felt by everyone of any age due to various factors from work, school, relationships, living conditions, food insecurity, financial situations, and much more.

Stress is normal and can prove helpful as acute stress has numerous benefits such as releasing hormones, specifically cortisol. Cortisol is like a general calling all the troops to the battlefield in order to protect its most valued treasure, the body. The body responds with either flight, fight, or freeze mode. Once the threat is over the body returns to normal and all the systems relax and the person moves on. Relaxation techniques to reduce stress are also helpful in reaching the relaxation phase sooner.

Stress: A Public Health Concern

The American Institute of Stress (AIS) acknowledges stress now to be a chronic and emotional issue as the body remains in constant fight or flight mode, which can then increase chronic health conditions, if the body does not transition into the relaxation phase. Dr. Paul Rosch, President of AIS, explains an overview of research simplifies a cause of stress to the feeling of not able to be in control of situations.

The American Psychological Association (APA) has been issuing a survey on stress to the American public since 2007. The most recent survey, conducted in 2013, surveyed that most respondents felt stress was at more than half of what is considered healthy and most reported their stress levels have intensified. Most Americans experience chronic stress, due to numerous stressors and are unable or unaware of how to improve their situations or to relax. This is supported by the survey as it found“fewer than four in 10 adults report doing an excellent or very good job at managing stress”

Many people are not able to decrease their stress levels, either due to lack of education, time, or inconsistency, which then impacts their lifestyle and leads to unhealthy choices, such as addictions, lack of sleep, little to no exercise, and detrimental food options. This can lead to increase chronic diseases due to the immune system under constant fear of attack and improper care of the body.

Tips for Practice

  • There is no one-size-fits-all protocol. Public health professionals offering and practicing strategic tips to help reduce stress can assist patients individually or in group settings, as well as oneself.

  • Offer patients a confidential place to release frustrations and feelings of being out of control. By understanding the situations and circumstances of the patient, public health educators can identify and even relate to the feelings, and can offer strategically stress-reduction tips that can best assist the patient if he/she is committed to releasing the stress. The AIS offers on their website self-assessments such as The Workplace Stress Survey and the Holmes-Rahe Stress Inventory which can be offered to patients or taken oneself.

  • Encourage patients to take a 5-minute time out—it’s enough to enter the relaxation stage. Continued research in various scientific and psychological journals are finding the best practices are deep breathing, meditation, Cognitive-Based Therapy, massage, yoga, and aroma therapy to name a few.

Discussed in a following article are these specific techniques, which can be shared with patients and even practiced together in the office. Stay tuned!


American Psychological Association (2014). Stress in America 2013.

Rosch, P. (N.D.) Stress and Cancer. The American Institute of Stress (N.D.). Self-Assessment.



Dental Care for Persons with Alzheimer's

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As Alzheimer's progresses, the person with dementia may forget how to brush his or her teeth or forget why it's important. As a caregiver, you may have to assist or take a more hands-on approach. Proper oral care is necessary to prevent eating difficulties, digestive problems and infections.

Daily oral care

In the early stages of Alzheimer's, dental care focuses on prevention. Getting check-ups and cleaning and flossing teeth regularly can prevent the need for extensive procedures later on, when the person with dementia may be less able to tolerate them.

During the middle and late stages of Alzheimer's, oral health may become more challenging. The person may forget what to do with toothpaste or how to rinse, or may be resistant to assistance from others. Try these tips:

  • Loss of appetite may be a sign of mouth pain or ill fitting-dentures.

    Provide short, simple instructions.
    Explain dental care by breaking directions into steps. "Brush your teeth" by itself may be too vague. Instead, walk the person through the process. Say: "Hold your toothbrush." "Put paste on the brush." Then, "Brush your teeth."
  • Use a "watch me" technique.
    Hold a toothbrush and show the person how to brush his or her teeth. Or, put your hand over the person's hand, gently guiding the brush. If the person seems agitated or uncooperative, postpone brushing until later in the day.
  • Keep the teeth and mouth clean.
    Brush the person's teeth at least twice a day, with the last brushing after the evening meal and any nighttime liquid medication. Allow plenty of time and find a comfortable position if you must do the brushing yourself. Gently place the toothbrush in the person's mouth at a 45 degree angle so you massage gum tissue as you clean the teeth.

If the person wears dentures, rinse them with plain water after meals and brush them daily to remove food particles. Each night, remove them and soak in a cleanser or mouthwash. Then, use a soft toothbrush or moistened gauze pad to clean the gums, tongue and other soft mouth tissues.

  • Try different types of toothbrushes.
    You may find that a soft bristled children's toothbrush works better than a hard bristled adult's brush. Or that a long handled or angled brush is easier to use than a standard toothbrush. Experiment until you find the best choice. Be aware that electric dental appliances may confuse a person with Alzheimer's.
  • Floss regularly.
    Most dentists recommend flossing daily. If using floss is distressing to the person with Alzheimer's, try using a "proxabrush" to clean between teeth instead.
  • Be aware of potential mouth pain.
    Investigate any signs of mouth discomfort during mealtime. Refusing to eat or strained facial expressions while eating may indicate mouth pain or dentures that don't fit properly.

Read more:


Indication of Alzheimer's Risk

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Early Memory Slips May Indicate Alzheimer’s Risk

Brain ResearchHealthy older individuals experiencing memory lapses are significantly more likely to develop dementia, according to new research. In a study of more than 500 seniors, researchers found those with self-reported memory complaints (SMCs) were nearly three times as likely to develop mild cognitive impairment. Additionally, of those who developed dementia, nearly 80 percent had earlier reported SMCs.

The study followed participants for an average of 10 years and asked them annually about noticeable changes in memory. Over half of participants reported memory complaints during this time and, on average, progression from SMCs to mild cognitive impairment took nine years while progression to dementia took twelve years. The authors concluded that with this potential early indicator of future dementia, “physicians should query and monitor SMCs from their older patients.”

Public Health Roadmap Action Item M01

Growing evidence linking self-reported cognitive decline to future dementia underscores the need for public health officials to have a better understanding of the extent of the problem in their states. An Optional Module for the Behavioral Risk Factor Surveillance System(BFRSS) allows states to measure the percentage of the population with self-reported increased confusion or memory loss – those at potentially higher risk of developing dementia and creating a burden on the health care system. Through the Healthy Aging Program at the Centers for Disease Control and Prevention (CDC), the Alzheimer’s Association has funding available to help pay for using the Cognitive Module in your state. For more information, contact Alison Sinton ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).


Public Health Extras: Tobacco, Teen Birth Rates, Nutrition, Transportation

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Public health extras: News on tobacco marketing, teen birth rates, nutrition, agriculture workers, transportation

Study: Direct mail marketing has effect on young smokers

Tobacco direct mail marketing promotes and sustains smoking behaviors, according to a study of Midwestern adults published online in September by APHA’s American Journal of Public Health.

Studying information from more than 2,600 young adults — defined as having a mean age of 24 — in the Midwest in 2010 to 2012, researchers found that 13 percent of those surveyed received tobacco direct mail materials over the previous six months. The materials included coupons for cigarettes and other tobacco products. Among nonsmokers and ex-smokers, receiving coupons was associated with becoming a current smoker by the time researchers followed up with survey participants. Among smokers, receiving promotional materials was associated with a lower likelihood of quitting smoking when researchers followed up.

The researchers, who were affiliated with the National Institute on Minority Health and Health Disparities Division of Intramural Research and University of Minnesota’s Division of Epidemiology and Community Health, suggested that because of their findings, direct mail marketing of tobacco-related materials should be regulated, as it might reduce prevalence of smoking among young adults.

US teen birth rate drops by more than half

The U.S. teen birth rate fell 57 percent between 1991 and 2013, according to new data from the National Center for Health Statistics.

The data, which were published in August in National Vital Statistics Reports, mean the current teen birth rate is less than one-third of what it was in 1957, when teen births reached their peak. Between 1991 and 2012, teen births declined among all racial and ethnic groups, with the largest declines among black teens, and decreased in every state as well. Overall, the decline translates to about 4 million fewer teen births. The study attributed the significant decline to a number of behavioral changes, such as increases in contraception use and less sexual activity among young people.

The study also found that the birth rate among the youngest girls — those ages 10-14 — fell to its lowest level ever in 2013. Since 1991, birth rates among teens ages 15-17 declined by 68 percent, while the birth rate among those ages 18-19 deceased 50 percent. Teen births come with considerable costs as well, estimated at $9.4 billion in 2010 alone. However, the recent declines are estimated to have saved the U.S. $12 billion that same year.

The study notes that despite significant progress, the U.S. teen birthrate still remains higher than rates in most developed countries.

For more information, visit

Higher income linked to healthier eating

The U.S. income-related nutrition gap grew between 1999 and 2010, according to new research that examines the economic challenge of sustaining a healthy diet.

Published in September in JAMA Internal Medicine, the study found that people with higher socioeconomic status had healthier diets than people with lower socioeconomic status. The income-related differences were likely associated with healthier foods costing more as well as limited access to stores that sell nutritious foods in low-income neighborhoods.

The study reported that among racial and ethnic groups, Mexican-Americans had the healthiest diets, while blacks had the least healthy diets. Overall, women generally had better diets than men. Researchers hypothesized that the healthier eating among Mexican-Americans may be due to food tradition and culture, while poorer diets among blacks was linked to lower income and education. The study also found that dietary quality was the poorest and improved the slowest among people who had 12 years or less of formal education.

However, the study, which was based on data from more than 29,000 adults participating in the 1999-2010 National Health and Nutrition Examination Surveys, also found that Americans’ dietary quality has improved overall, with much of the gains associated with reduced consumption of trans fat.

“The overall improvement in diet quality is encouraging, but the widening gap related to income and education presents a serious challenge to our society as a whole,” said study author Walter Willett, MD, chair of the Department of Nutrition at Harvard School of Public Health.

APHA offers comments on transportation issues

APHA has called on two national transportation authorities to offer better policy to improve the health and lives of millions of Americans.

In a Sept. 3 letter spearheaded by the Partnership for Active Transportation, APHA offered the U.S. Department of Transportation and Federal Highway Administration both praise and suggestions for improvements on the Statewide and Nonmetropolitan Transportation Planning and Metropolitan Transportation Planning regulations currently under review.

APHA highlighted the importance of creating infrastructure that makes it safe and convenient to walk or bicycle as part of daily behavior, and noted that increased motorized transportation can increase air pollution, which has negative health effects on children.

“Health also should be integrated into the planning process,” the letter suggested.

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