Latest / Morning Medical with Dr. Chow / Tampon Safety Concerns, Blood Culture Bottle Shortage, and Healthy School Lunch Strategies

Transcript

Tampon Safety Concerns, Blood Culture Bottle Shortage, and Healthy School Lunch Strategies · Morning Medical with Dr. Chow

• 0:00
  Welcome back to another episode of Morning Medical with Dr.
• 0:03
  Chow.
• 0:04
  I'm your host, Dr.
• 0:05
  Chi-Ming Chow, and today we've got some important updates that you won't want to miss.
• 0:11
  We're diving into a critical health issue that's recently been making headlines: the
• 0:15
  presence of heavy metals in tampons.
• 0:19
  This shocking discovery has prompted an investigation by the United States Food and
• 0:23
  Drug Administration, and it's something that all women should be aware of.
• 0:31
  The United States Food and Drug Administration announced on Tuesday that it will examine the
• 0:35
  potential harm to women from heavy metals such as lead and arsenic found in tampons.
• 0:42
  This decision follows the publication of a small pilot study in July that found traces of
• 0:47
  these metals in both organic and nonorganic tampons.
• 0:51
  Although the levels of lead and arsenic were low, it’s essential to note that there is no
• 0:56
  safe level of exposure to lead, according to the United States Environmental Protection
• 1:01
  Agency.
• 1:02
  The July study discovered only the presence of the metals and did not test whether the metals
• 1:07
  are released from tampons when used.
• 1:11
  The United States Food and Drug Administration stated that it has commissioned an independent
• 1:16
  literature review and initiated an internal bench laboratory study to evaluate metals in
• 1:22
  tampons.
• 1:23
  The laboratory study will mimic normal use of tampons to see just how much, if any, metals
• 1:29
  may be released into the human body during their use.
• 1:34
  The literature review will examine all research in the area to shed light on the potential
• 1:38
  health impact of such exposure.
• 1:41
  The United States Food and Drug Administration wants the public to know that before tampons
• 1:46
  can be legally sold in the United States, they must meet Food and Drug Administration
• 1:50
  requirements for safety and effectiveness.
• 1:54
  Manufacturers must test the product and its component materials before, during, and after
• 1:59
  manufacturing.
• 2:01
  Before a product is allowed onto the market, biocompatibility testing is undertaken by the
• 2:06
  manufacturing company, which is part of safety testing, and is reviewed by the Food and Drug
• 2:11
  Administration prior to market authorization.
• 2:14
  The Consumer Healthcare Product Association, a trade group, also noted in a statement that its
• 2:20
  products are rigorously tested to meet strict regulatory standards.
• 2:25
  The group said it is supportive of continued research to help ensure the safe use of these
• 2:30
  products.
• 2:31
  The Center for Baby and Adult Hygiene Products, a trade association also known as BAHP, said it
• 2:38
  supports the Food and Drug Administration’s further research on the safety of tampons in
• 2:42
  real-world use and the agency’s ongoing commitment to public health.
• 2:47
  The July study tested 30 tampons from 14 brands purchased from major online retailers and
• 2:53
  stores in the United States, the United Kingdom, and Greece.
• 2:57
  The researchers conducted a blinded study, so they did not know the brands.
• 3:02
  They ran tests for 16 heavy metals: arsenic, barium, calcium, cadmium, cobalt, chromium,
• 3:10
  copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc,
• 3:19
  according to senior study author Kathrin Schilling, assistant professor of environmental
• 3:24
  health sciences at Columbia University’s Mailman School of Public Health in New York
• 3:29
  City.
• 3:30
  The study found an average of 100 nanograms per gram of lead and 2 nanograms per gram of
• 3:36
  arsenic in the tampons.
• 3:38
  There was no detectable level of chromium and no detectable level of mercury, which is very
• 3:44
  good.
• 3:46
  Interestingly, organic tampons contained higher levels of arsenic, while nonorganic tampons had
• 3:53
  higher levels of lead.
• 3:55
  The average lead concentration in tampons was about 10 times higher than the maximum levels
• 4:01
  currently allowed in drinking water, while arsenic levels were five times lower than
• 4:05
  current limits for drinking water.
• 4:08
  It is important to note that arsenic should not be present in tampons at all, and we do not yet
• 4:13
  understand the effects of vaginal exposure since it has not been studied.
• 4:18
  There is no safe level of lead exposure, and it has been shown to cause reproductive health
• 4:22
  issues in women.
• 4:24
  However, the mere presence of a chemical is not an indication of risk or adverse effect,
• 4:30
  according to the American Chemistry Council.
• 4:32
  The Centers for Disease Control and Prevention emphasizes that the measurement of an
• 4:37
  environmental chemical in a person’s blood or urine is a measure of exposure; it does not by
• 4:42
  itself mean that the chemical causes disease or an adverse effect.
• 4:48
  Vaginal tissue is more permeable than other parts of the body, so if studies were to find
• 4:53
  that heavy metals or worrisome chemicals do leach from menstrual products into the body, it
• 4:58
  could be a significant problem.
• 5:01
  Anna Pollack, associate professor of global and community health at George Mason University in
• 5:06
  Fairfax, Virginia, previously told CNN that she is most concerned with menstrual products that
• 5:12
  are used inside the body.
• 5:14
  She coauthored a review of 10 years of studies on contaminants in tampons, sanitary pads,
• 5:20
  menstrual cups, and other products.
• 5:23
  However, there is no reason for people to be afraid to use menstrual products at this time.
• 5:29
  Pollack added that people should just be aware of the issue and monitor any research that
• 5:34
  develops.
• 5:36
  Tampon makers and the United States Food and Drug Administration recommend that tampons not
• 5:41
  be used at night or for longer than eight hours due to a greater risk of toxic shock syndrome,
• 5:47
  a deadly bacterial infection that can cause organ failure and death if not treated.
• 5:54
  That advice also applies to anyone concerned about heavy metals or chemicals in their
• 5:59
  menstrual products.
• 6:02
  Other recommendations include washing your hands before and after inserting or removing a
• 6:07
  tampon to reduce bacterial spread, changing tampons every four to eight hours, and using
• 6:12
  the lowest absorbency possible.
• 6:15
  If you can wear one tampon up to eight hours without changing it, the absorbency may be too
• 6:20
  high.
• 6:21
  Signs of toxic shock, which include a sudden high fever, diarrhea, dizziness, vomiting, or a
• 6:27
  rash that looks like a sunburn, need immediate medical attention.
• 6:31
  In addition, if you have discomfort, pain, or other unexpected symptoms like unusual
• 6:36
  discharge when trying to insert or wear a tampon, or if you have an allergic reaction,
• 6:42
  stop using tampons and contact your provider.
• 6:46
  Next up, we have a pressing issue that has flown under the radar for many: the shortage of
• 6:51
  blood culture bottles.
• 6:53
  On July 10, the United States Food and Drug Administration issued an advisory to clinicians
• 6:59
  about a global shortage of Bactec blood culture bottles, which are essential for diagnosing
• 7:05
  bloodstream infections.
• 7:07
  This shortage, announced by Becton Dickinson, is expected to last for months, and hospitals
• 7:13
  using the Bactec system have already started to report receiving far fewer bottles than they
• 7:18
  need.
• 7:20
  Blood cultures are a critical tool for diagnosing bloodstream infections, identifying
• 7:25
  the specific bacteria causing the infection, and determining the optimal antibiotic
• 7:30
  treatment.
• 7:31
  Without sufficient blood culture bottles, serious infections can be missed, and patients
• 7:35
  may be overexposed to overly broad antibiotics.
• 7:39
  This increases the risk of antibiotic resistance and side effects.
• 7:44
  The shortage has had a highly variable impact on different facilities across the country,
• 7:49
  with some hospitals receiving only a fraction of the bottles they need, forcing them to
• 7:54
  implement rationing plans.
• 7:57
  Interestingly, not all hospitals are affected.
• 8:01
  There are two other manufacturers of blood culture systems—bioMerieux's BacT/ALERT and
• 8:07
  Thermo Fisher's SIGNAL systems—that are not experiencing shortages.
• 8:12
  However, their bottles are incompatible with the Bactec system, and switching to a new blood
• 8:17
  culture system on short notice is not feasible for many hospitals.
• 8:21
  This disparity has highlighted the urgent need for better care coordination and resource
• 8:25
  sharing to ensure equal access to essential diagnostic tools for all patients.
• 8:31
  During the COVID-19 pandemic, the concept of Crisis Standards of Care was widely discussed.
• 8:38
  These standards include three levels of strategies to address resource shortages:
• 8:43
  conventional, contingency, and crisis plans.
• 8:46
  Conventional plans involve steps to conserve resources and prepare for shortages without
• 8:52
  harming patients.
• 8:54
  Contingency plans may require significant changes to usual practices, like using
• 8:59
  alternative treatment strategies, and involve some risk but aim to avoid patient harm.
• 9:05
  Crisis plans, however, involve withholding resources from some patients, likely causing
• 9:09
  harm, to save others.
• 9:12
  The blood culture bottle shortage, while not a pandemic, still warrants some of the same
• 9:17
  strategies used during COVID-19.
• 9:21
  Our Mountain Plains Regional Disaster Health Response System convened a rapid response
• 9:27
  Medical Advisory Panel to compile and distribute region-wide guidance on minimizing
• 9:32
  the harms from this shortage.
• 9:36
  The panel's guidance emphasized conventional strategies for conserving blood culture
• 9:41
  bottles, such as implementing best practices to increase the yield of blood cultures, avoiding
• 9:47
  contamination, and not drawing blood cultures when they are not indicated.
• 9:52
  These steps alone can often reduce blood culture bottle use by 30 to 50 percent.
• 9:59
  Hospitals experiencing significant shortages should also use contingency strategies, like
• 10:04
  restricting blood cultures to higher-risk situations.
• 10:07
  If hospitals reach crisis conditions, they may need to ration blood cultures further, using
• 10:12
  them only for patients with compromised immune systems or critical illness.
• 10:17
  Before reaching this crisis point, hospitals should discuss transferring patients or blood
• 10:22
  cultures across systems to prevent the avoidable tragedy of some patients going
• 10:26
  without essential diagnostic tools while others do not.
• 10:30
  This ongoing shortage is expected to resolve by the new year, but it highlights an ethical
• 10:35
  vulnerability in how we manage shortages in healthcare.
• 10:40
  It is unfair and unethical for patients to be disproportionately affected by a shortage based
• 10:46
  on which hospital they use.
• 10:48
  During the COVID-19 pandemic, resource sharing and region-wide guidance helped mitigate such
• 10:53
  disparities.
• 10:54
  However, the blood culture bottle shortage affects only one supplier, leading to highly
• 11:00
  variable impacts.
• 11:02
  Without better coordination and cooperation among hospitals, this will lead to significant
• 11:06
  inequities in care and outcomes.
• 11:09
  As shortages in healthcare become increasingly common, local, state, and federal leaders
• 11:15
  should track those that might have differential impacts across health systems in a region.
• 11:21
  To ensure both optimal and equitable health outcomes, we need strategies to facilitate
• 11:27
  better regional coordination and resource sharing.
• 11:31
  Even amid a significant shortage, critically ill patients should be able to trust that they
• 11:37
  will receive similar care regardless of the hospital they go to.
• 11:42
  As the new school year kicks off, Canadian parents are once again faced with the challenge
• 11:47
  of preparing healthy lunches for their children.
• 11:50
  With grocery store aisles filled with sugary snacks and processed foods, it can be tough to
• 11:55
  find nutritious options that kids will actually eat.
• 11:59
  But according to dietitians, there are several strategies that can make lunchtime both
• 12:04
  enjoyable and healthy.
• 12:07
  Amanda Nash, a registered dietitian with the Heart and Stroke Foundation, emphasizes the
• 12:12
  importance of including fiber and protein in school lunches.
• 12:17
  "When we look at our kid’s school lunches, we want to make sure that we’re giving them all
• 12:21
  the nutrients that they need, which includes things like fiber and protein," she says.
• 12:26
  "By having that fiber and protein in their lunch, they’re going to feel more satisfied
• 12:31
  from their food for a longer period.
• 12:33
  And then by getting all of those key nutrients through a balanced lunch, we’re going to help
• 12:38
  them to learn to grow, to be more creative, and to keep their attention and their focus
• 12:44
  throughout the school day."
• 12:46
  Canada’s Food Guide plate offers an excellent starting point for deciding what to pack in
• 12:52
  your child’s lunch.
• 12:54
  The guide suggests filling half of the lunch with fruits and vegetables, a quarter with
• 12:59
  whole grains, and the final quarter with protein-rich foods.
• 13:04
  It also recommends steering clear or limiting ultra-processed foods.
• 13:09
  Ultra-processed foods, such as sugary drinks, potato chips, and ready meals, have been linked
• 13:15
  to various health problems in numerous studies, including obesity, heart disease, Type 2
• 13:22
  diabetes, and certain types of cancer.
• 13:25
  Even if you manage to craft the perfect healthy lunch for your child, it can sometimes come
• 13:30
  back home with just a few nibbles taken, leaving parents feeling frustrated and
• 13:34
  disappointed.
• 13:36
  Amanda Nash advises parents not to be discouraged.
• 13:39
  "We want to remember that when we’re looking at food and nutrients and fueling our children, we
• 13:45
  need to look at the full day.
• 13:47
  So lunch doesn’t have to be perfect," she says.
• 13:50
  "We also want to trust our children’s sense of satiety.
• 13:54
  So we know that when they’re hungry, they’re going to eat.
• 13:58
  And when they’re full, they’re going to stop.
• 14:01
  We can choose what we offer our children, and then the children get to choose those offerings
• 14:07
  and how much they’re going to eat."
• 14:09
  Angel Luk, a registered dietitian based in Richmond, British Columbia, suggests that the
• 14:14
  first step to improving school lunches is to involve your children in the process, no matter
• 14:20
  their age.
• 14:21
  Start by making a list of healthy foods they like, such as their favorite fruits, and get
• 14:26
  them to brainstorm ideas for snacks.
• 14:29
  "And once you have that list, take them on that grocery run and guide them through and let them
• 14:34
  choose things, let them help pay for it, and then also bringing it home and washing and all
• 14:40
  of those steps," she explains.
• 14:41
  "It seems so simple, but that is exactly how we get kids involved because the more involved
• 14:46
  they are and the more they’re part of that process in creation, they actually start to
• 14:50
  realize that, ‘I can create food.
• 14:52
  And food doesn’t have to come in a package’."
• 14:56
  Another tip is to plan lunches ahead of time, ideally weekly.
• 15:02
  Taking a few moments each weekend to brainstorm a variety of balanced meal options can help
• 15:07
  reduce stress during busy mornings and ensure that you have all the ingredients on hand.
• 15:13
  Preparing some items in advance, like chopping vegetables or cooking grains, can also save
• 15:19
  time and make it easier to pack healthy lunches throughout the week.
• 15:23
  "Planning ahead weekly can be really helpful.
• 15:27
  You can look for the sales in the grocery stores when they’re available.
• 15:31
  Stock up on some of the foods that are more shelf-friendly, freezer-friendly foods," Nash
• 15:36
  explains.
• 15:38
  "And then at the beginning of the week, sit down with your kids and talk about what kind of
• 15:42
  lunches they want for the week."
• 15:44
  When it comes to healthy school lunches, simplicity often works best.
• 15:48
  Instead of feeling pressured to come up with a brand-new meal every day, focus on small,
• 15:53
  manageable changes.
• 15:55
  For example, rotate different fruits, veggies, or sandwich fillings throughout the week, or
• 16:00
  keep the filling the same and just switch up the type of bread or wrap.
• 16:05
  "Sometimes parents and caregivers are blown away by this, but kids don’t mind eating the
• 16:10
  same thing again and again, because a child’s priority may just be a simple fast lunch so
• 16:16
  that they can quickly eat and then run to the playground with their friends," Luk says.
• 16:21
  "It’s not a balanced meal that looks like an Instagram-worthy post.
• 16:24
  They just want to get it in and go out and play."
• 16:27
  Canada’s Food Guide and the Heart and Stroke Foundation recommend limiting ultra-processed
• 16:32
  foods in kids’ lunches.
• 16:35
  In kids aged nine to 13 years old, ultra-processed foods make up nearly 60 percent
• 16:40
  of their diets.
• 16:42
  Diets high in ultra-processed foods, including sugary drinks, are linked to an increased risk
• 16:47
  of cardiovascular disease, stroke, diabetes, cancers, tooth decay, and mortality later in
• 16:54
  life.
• 16:55
  "Ultra-processed foods are going to be any food that is not necessarily identifiable as its
• 17:02
  original form.
• 17:03
  And so if we look at things like the lunch meats, some of those can be heavily processed.
• 17:11
  So an option would be that you can have you make your meats at home, maybe make a chicken
• 17:17
  or a roast, and then you can use those leftovers," Nash says.
• 17:21
  "However, we also recognize that that’s not always affordable and feasible for everybody.
• 17:27
  So we want to look again at how often and how much we’re including some of these processed
• 17:33
  foods, taking options and alternatives when we can."
• 17:37
  The World Health Organization also advises that children should limit their added sugar intake
• 17:42
  to less than six teaspoons per day, which is roughly twenty-five grams.
• 17:47
  Luk says it’s OK to occasionally include a treat in your child’s lunchbox, like gummy
• 17:52
  candies or another sugary snack, as long as it’s in moderation.
• 17:56
  However, if you’re packing a sugary treat for lunch, consider skipping dessert at dinner.
• 18:02
  Many informative websites offer great ideas for healthy lunch meals, such as Canada’s Food
• 18:07
  Guide, the Heart and Stroke Foundation, and UnlockFood.ca, a nutrition website by the
• 18:13
  Dietitians of Canada.
• 18:15
  Nash suggests a fun way to introduce new foods to your kids’ lunches: put a spin on their
• 18:20
  favorite dishes.
• 18:21
  For example, you could try a cold whole-grain quesadilla with sliced red peppers or tomatoes,
• 18:27
  or cold French toast cut into strips with yogurt and fruit.
• 18:30
  Pack a thermos of smoothie and a homemade whole-grain bun.
• 18:34
  Or, if your child loves pizza, try a whole-grain pita topped with hummus, cheese,
• 18:39
  and sliced cucumbers.
• 18:41
  That wraps up today’s episode of Morning Medical with Dr.
• 18:44
  Chow.
• 18:45
  I hope you found these updates and tips useful.
• 18:47
  Remember, staying informed is the first step to better health.
• 18:51
  Thanks for tuning in, and I'll see you next time.