During the month of October, Health Literacy Month encourages everyone working to provide easy access to understandable health information. For more than 20 years, October has been recognized as Health Literacy Month. Health Literacy Month is a time of international observance when hospitals, health centers, literacy programs, libraries, social service agencies, businesses, professional associations, govern­ment agencies, consumer alliances, and many other groups work collaboratively to integrate and expand the mission of health literacy.

Low health literacy is more prevalent among:

• Older adults
• Minority populations
• Those who have low socioeconomic status
• Medically underserved people”

What Are the Consequences of Low Health Literacy? – The two major areas that are impacted by low health literacy are “economic costs to society and the health-care system, and costs in terms of the human burden of disease” (Institute of Medicine, 2004). There is also considerable psychological suffering created by low health suffering. Within those overarching categories, the results of low health literacy (as measured by reading and numeracy skills) can include:

• Shame and stigma, which can create barriers to health and behavioral health care and to improving low health literacy;
• Reduced knowledge and understanding of a person’s own medical conditions and treatment;
• Reduced knowledge and understanding of health-promoting behaviors and preventive care and services;
• Increased rates of hospitalization and use of emergency services;
• Increased rates of poor health status;
• Entry of sicker patients into healthcare systems;
• Increased health care costs and spending (Institute of Medicine, 2004).

During this time, organizations and individuals promote the importance of understandable health information along with bringing awareness to breaking down the barriers of understanding. According to health experts, there is a large gap between the way health care issues are communicated by professionals, and the ability of the average person to understand them. Most people have limited health literacy… Not just those with limited reading or writing skills. If someone struggles to understand health literacy, statistically, they are more likely to skip important medical tests, have a harder time living with conditions, and visit the emergency room more often. This is why understanding health literacy is so important for everyone.

The good news is, that many health care facilities are trying to improve the way they communicate with patients to make sure everything is clear before the patient leaves. They are doing things like simplifying their written materials, using video and photos to teach patients, and more to help doctors clearly get their message across.

There are a few things you can do to improve your own health literacy individually or as a organization:

1. Improve your communication with health professionals. Make a list of your symptoms before you go in, have questions written down, and take a few notes when your doctor is explaining things to you.

2. Make sure you know who to call with any questions when you leave.

3. Attend health education programs at a library, community center, or anywhere you can find them in your community.

4. Talk to local schools and request that kids are taught about health literacy and education so they are prepared as they get older.

5. Hold a staff training to teach staff to use simple language, short sentences, and explain medical terms.   Some useful tools for measuring individual.

6. Update materials for your organization to include similar resources in the primary language for Limited English Proficiency.

“Lung health remains a major concern within the Veteran community, as many Veterans face heightened risks due to service-related tobacco use, occupational hazards, and environmental exposures. Respiratory diseases are a prominent health issue for veterans, with the Department of Veterans Affairs diagnosing approximately 7,700 cases of lung cancer annually among Veterans and an estimated 900,000 at risk due to factors like age, smoking, and environmental conditions. In 2023, 55% of Veterans had ever smoked, compared to 32% of civilians, underscoring the need for increased lung health awareness and preventive care.

“Lung health has historically been impacted by high smoking rates among Veterans,” says Joel Nations, MD, Volunteer Spokesperson for the American Lung Association; Pulmonologist, Washington DC VA Medical Center. “This is especially true for military personnel during deployment, though many Veterans reduce smoking or quit altogether after leaving the service. However, their history of smoking keeps them at elevated risk for lung cancer. The most important steps are to avoid smoking, quit if you do smoke, and get screened if you’re at high risk.”

American Lung Association (Press Releases | American Lung Association | American Lung Association)

“Lung disease affects a staggering number of Americans. About 10 million adults are diagnosed with chronic bronchitis each year, and about 4.7 million others have ever been diagnosed with emphysema.

Chronic bronchitis and emphysema constitute the diseases that make up Chronic Obstructive Pulmonary Disease (COPD). About 25 million people live with asthma as well.

Occupational lung diseases, which include asbestosis and mesothelioma, also affect many Americans. Occupational illnesses are estimated to cost $150 billion annually.

Chronic Obstructive Pulmonary Disease (COPD), typically caused by long-term exposure to lung irritants that damage the lungs and airways, is attributed to occupational exposure 19.2% of the time.”

Lung Institute (Healthy Lung Month – Lung Institute)

October is a month set aside for lung awareness. It’s National Healthy Lung Month, and Lung Health Day is October 28. National Respiratory Care Week is October 25-30. It may seem arbitrary to set aside a particular month for health awareness, but it’s useful to remind ourselves of the things in our environment that can harm us and to act with compassion toward those who have already been harmed.

Lung disease affects a staggering number of Americans. About 10 million adults are diagnosed with chronic bronchitis each year, and about 4.7 million others have ever been diagnosed with emphysema. Chronic bronchitis and emphysema constitute the diseases that make up Chronic Obstructive Pulmonary Disease (COPD). About 25 million people live with asthma as well.

Occupational lung diseases, which include asbestosis and mesothelioma, also affect many Americans. Occupational illnesses are estimated to cost $150 billion annually. Chronic Obstructive Pulmonary Disease (COPD), typically caused by long-term exposure to lung irritants that damage the lungs and airways, is attributed to occupational exposure 19.2% of the time.

In support of Healthy Lung Month, let’s raise awareness about the rapid escalation of lung disease in the United States.

The notion that harmful air pollutants exist only outdoors is false. Some pollutants occurring in the home can be more harmful than those commonly encountered outdoors. Modern homes harbor many sources of respiratory irritation, but it’s not terribly difficult to lung-proof your home. Some common lung irritants found indoors are lead, formaldehyde, radon, cleaning agent vapors, and fire-retardants. Natural pollutants also make their way into the home, including pet dander, dust mites, and mold. Here are a few simple ways the people, especially those with lung disease, can avoid these lung damaging agents.

• Clean the Air:Buy a vacuum with a HEPA filter to reduce lead, chemical build-up, and allergens such as pet dander in the home. Follow this step by mopping with a microfiber mop to soak up any leftover particles.
• Avoid exposure to indoor pollutants that can damage your lungs.
• Minimize exposure to outdoor air pollution.
• Green Your Space:Fill your place with plants! Indoor plants help purify the air, removing toxins such as formaldehyde, benzene, toluene, and xylene. Spider plants and aloe vera plants are good choices for the home.
• Go Natural: Fragrances in cleaning products, laundry detergents, and air fresheners can all damage the lungs opt for fragrance-free whenever possible.
• Test for Radon: Make sure your home has a radon detector. This colorless, odorless gas is the second leading cause of lung cancer in the United States today.
• Don’t Vape or Smoke

Your entire body depends on your lungs to keep breathing and distributing oxygen-rich blood throughout your body and to get rid of the body’s gaseous waste, carbon dioxide. Our bodies do have a natural defense system designed to protect the lungs, keeping dirt, germs and other irritants at bay. But there are some important things you can do on a regular basis to keep your lungs healthy and reduce the risk of disease.

Sometimes we take our health for granted. Lungs keep us alive and well and for the most part, we don’t need to think about them.  Remember without lungs we couldn’t survive.  Love your lungs this October and work to make any necessary changes to keep yours healthy!

“CDC defines bullying as any unwanted aggressive behavior(s) by another youth or group of youths, who are not siblings or current dating partners. It involves an observed or perceived power imbalance, and is repeated multiple times or is highly likely to be repeated.

Bullying may inflict harm or distress on the victim including physical, psychological, social, or educational harm.1 Common types of bullying include:

• Physical such as hitting, kicking, and tripping.
• Verbal including name-calling and teasing.
• Relational or social such as spreading rumors and leaving out of the group.
• Damage to victim’s property.

Bullying is an adverse childhood experience that is widespread in the United States. Bullying harms all youth involved including those who are bullied, those who bully others, and bystanders who witness it.

Bullying is common. About one in five high school students reported being bullied on school property in the past year. More than one in six high school students reported being bullied electronically in the past year including through texting and social media.

Some youth experience bullying more than others. Female students were more likely than male students to experience bullying, both on school property and electronically.”

Center for Disease Control and Prevention – CDC (Bullying | Youth Violence Prevention | CDC)

Unless you were homeschooled in the wild or have some type of supernatural luck, you’ve probably tangled with a mean girl or bully at some point in your life. Unfortunately, bullies grow up and get jobs, so you might just run into them again in the workplace, on social media or even in your close-knit neighborhood community. Bullying is not just succumbed to childhood but it is also very prevalent in adulthood as well. Unfortunately, adult bullying behavior identically reflects childhood bully behavior: it methodically targets a person with the intention to intimidate, undermine, or degrade. The same tactics get used, too: gossip, sabotage, exclusion, public shaming, and many other conscious behaviors. Many adult victims feel as though they cannot take any action against bullying out of fear they may cause trouble, lose their job or be viewed as weak; however, there are many steps adults can take to discourage bullying and stand up to their perpetrator.

Take the issue seriously and present it in an objective manner

Yes, bullying can be a huge hit to your ego and it can lead to feelings of depression and anxiety however you must report this behavior from an objective standpoint. Whether you are reporting this behavior to school officials, your managers at work or to legal authorities; make sure you have all the facts documented in detail and try not to bring your subjective feelings into the matter. If you feel as though your boss or teacher will not take these complaints seriously then go two or three level higher up the ladder; talk to the school principal or your manager’s boss. Keep it straightforward and low on emotion. Rehearsing your story beforehand with friends, family, or your therapist will help you stay calm and collected. Use words such as “harassment”, or “abuse” as these terms have higher connotations in the legal system and oftentimes the term “bullying” may be displayed to others as juvenile.

Take care of your mental health

Bullying can be damaging to your mental health. Bullying can lead many adults to drink excessively, self-medicate, overeat and disengage from friends and family. Other adults will choose to fight back in a negative manner, which can result in self-destruction. Avoid succumbing to bad behaviors and make sure you are leaning on support from family and friends during this time.

“October is Spina Bifida Awareness Month—a time to celebrate the hundreds of thousands of people living with Spina Bifida.  Spina Bifida occurs in the first 28 days of pregnancy.  Spina Bifida is the most common permanently disabling birth defect compatible with life.  Often referred to as the “snow flake” condition.  Each year over 1,600 babies are born with this condition in the United States.  By 18 years old all those diagnosed with Spina Bifida will have had at least 8 surgeries.  There is no cure with Spina Bifida.”

Spina Bifida Association (https://www.spinabifidaassociation.org/awareness-month/facts/)

How is Spina Bifida Diagnosed:

In most cases, spina bifida is diagnosed before birth (prenatal). However, some mild cases may go unnoticed until after birth (postnatal). Very mild forms of spinal bifida are found when doing tests for other conditions or may never be detected.

PRENATAL DIAGNOSED:

The most common screening methods used to look for spina bifida during pregnancy are maternal serum alpha fetoprotein (MSAFP) screening and fetal ultrasound.  A doctor can also perform an amniocentesis test.

• Maternal serum alpha fetoprotein (MSAFP) screen.  At 16 to 18 weeks of pregnancy, a sample of the mother’s blood is taken to measure the level of a protein called alpha-fetoprotein (AFP), which is made naturally by the fetus and placenta.  During pregnancy, a small amount of AFP normally crosses the placenta and enters the mother’s bloodstream.  Abnormally high levels of AFP may indicate that the fetus has spina bifida or other neural tube defect.  This test is not specific for spina bifida and cannot definitively determine that there is a problem with the fetus.  This means that a high AFP level alone is not enough to be sure the fetus has a neural tube defect.  If a high level of AFP is detected, the doctor may request additional testing, such as an ultrasound or amniocentesis.

The second trimester MSAFP screen may be performed alone or as part of a larger, multiple-marker screen.  Multiple-marker screens can look for neural tube defects and other birth defects, including Down syndrome and other chromosomal abnormalities.  First trimester screens for chromosomal abnormalities also exist but signs of spina bifida are not evident until the second trimester when the MSAFP screening is performed.

• Ultrasound.  A fetal ultrasound uses high-frequency sound waves to create a picture of the developing baby inside the womb.  It is highly accurate in diagnosing some birth defects during pregnancy, including spina bifida.  Fetal ultrasound can be performed during the first trimester (usually between 11-14 weeks) and the second trimester (usually at 18-22 weeks), and diagnosis is more accurate during the second trimester.
• Amniocentesis.  In this test, a doctor removes a sample of the amniotic fluid that surrounds the fetus and tests it for protein levels that may indicate a neural tube defect and genetic disorders.

POSTNATAL DIAGNOSED:

Closed neural tube defects are often recognized at birth due to an abnormal fatty mass, tuft or clump of hair, or a small dimple or birthmark on the skin at the site of the spinal malformation.  Spina bifida occulta is usually found when x-rays are done for another reason.

In rare cases, myelomeningocele and meningocele are not diagnosed during routine prenatal tests.  The baby will be diagnosed when they are born with a bubble on their back.  Babies with myelomeningocele and closed neural tube defects may have muscle weakness in their feet, hips, and legs that result in joint deformities first noticed at birth.  Mild cases of spina bifida (occulta, closed neural tube defects) not diagnosed during prenatal testing may be detected postnatally using ultrasound or X-ray imaging to look at the spine.

Doctors may use magnetic resonance imaging (MRI) or a computed tomography (CT) scan to get a clearer view of the spinal cord and vertebrae.  To evaluate for hydrocephalus, the doctor will request a head ultrasound, CT or MRI to look for extra cerebrospinal fluid inside the brain.

HOW SPINA BIFIDA CAN BE PREVENTED, THE BEST TREATMENT TO GIVE YOUR BABY; being FOLIC ACID!

Women of childbearing age can reduce their risk of having a child with spina bifida by taking 400 micrograms (mcg) of folic acid every day pre-conception. Because it is water soluble, folic acid does not stay in the body for very long and needs to be taken every day to be effective against neural defects. Since half of all pregnancies in the United States are unplanned, folic acid must be taken whether a woman is planning a pregnancy or not. Research has shown that if all women of childbearing age took a multivitamin with the B-vitamin folic acid, the risk of neural tube defects could be reduced by up to 70%.  If you can prevent this the quality life is sure to be the best!

TREATMENTS FOR SPINA BIFIDA:

Some children with myelomeningocele and closed neural tube defects will need surgery to improve the alignment of their feet, legs, or spine.  Children with myelomeningocele usually have hydrocephalus and may require surgery to help drain fluid in the brain, such as the placement of a shunt or ETV.  Multiple surgeries may be required to replace the shunt, which may become clogged, infected, or disconnected.

Some individuals with myelomeningocele or closed neural tube defects require assistive devices for mobility such as braces, walkers, crutches, or wheelchairs.  The location of the defect on the spine often determines the type of assistive devices needed.  Children with a defect high on the spine will have little movement of the legs and will use a wheelchair for mobility.  Children with a defect lower on the spine usually have more strength in the legs.  They may be able to walk independently, or they may use crutches, leg braces, walkers, and wheelchairs depending on the activity.  Children with myelomeningocele usually have some degree of delayed mobility, so they are referred to physical therapists early on to maximize their strength and function.

Treatment for bladder and bowel dysfunction typically begins soon after birth.  Children with myelomeningocele and some closed neural tube defects have damage to the lowest spinal nerves which control typical bowel and bladder function.  Some children may be able to urinate typically, but most will need to drain their bladders with a catheter or thin tube 4-6 times a day to remain dry in between and to prevent kidney damage.  Kidneys are monitored closely so that medications or surgeries can be performed to prevent renal failure.  To prevent bowel accidents many people with myelomeningocele and closed neural type defects will use rectal medications or large volume enemas to have planned bowel movements.  Close follow-up with a spina bifida specialty clinic is recommended to develop a safe bowel and bladder program.

Treatment for progressive tethering of the spinal cord (called tethered cord syndrome) can be treated with surgery to help prevent further neurological deterioration.

“The cause of spina bifida is still unknown. Researchers believe it may be a combination of genetics and the environment that causes the condition. There are some things women who are pregnant or could get pregnant can do to help prevent spina bifida, including:

• Take at least 400 micrograms of folic acid each day. Spina bifida happens early in a pregnancy, often before a woman even knows she is pregnant. All women who are sexually active should take folic acid supplements. While taking folic acid and getting the best prenatal care cannot completely prevent spina bifida, it can reduce the risk.
• Talk with your primary care physician or pharmacist. If you’re planning to get pregnant or are sexually active, understanding how any prescriptions, over-the-counter medicines or supplements could affect a potential pregnancy can help you make decisions about your care.
• Work with your provider to monitor and manage your medical conditions. If you have a condition such as Type 1 or Type 2 diabetes or are overweight, you will want to work with your OB/GYN or primary care provider before getting pregnant. Once you are pregnant, your OB/GYN may refer you to a maternal-fetal medicine specialist to get extra care during your pregnancy.
• Avoid overheating your body (such as in a sauna or hot tub), and treat any fever you may have.”

NORTON Children’s (https://nortonchildrens.com/news/news-what-is-spina-bifida/)

  SPINA BIFIDA

TETHERED SPINALCORD (shown above)

FETUS WITH HYDROCEPHALUS (shown above)

  HYDROCEPHALUS

Spina Bifida is one of the causes of Tethered Spinal Cord and Hydrocephalus.

Tethered Spinal Cord is a stretch-induced functional disorder associated with the fixation (tethering) effect of inelastic tissue on the caudal spinal cord, limiting its movement. This abnormal attachment is associated with progressive stretching and increased tension of the spinal cord as a child ages, potentially resulting in a variety of neurological and other symptoms.

Hydrocephalus is caused by either increased production of CSF or impaired circulation and absorption

Spina bifida is a birth defect that affects the spine. Here are the latest national statistics on spina bifida in the United States:

1.)Each year, about 1,400 babies are born with spina bifida, or 1 in every 2,758 births, according to the U.S. Centers for Disease Control and Prevention. The exact cause of spina bifida is unknown. There is no cure but most people with spina bifida lead long and productive lives.

2.)Who it effects the most: Hispanic women have the highest rate of having a child affected by spina bifida, when compared with non-Hispanic white and non-Hispanic black women. Data from 12 state-based birth defects tracking programs were used to estimate the total number of pregnancies affected by spina bifida compared to the total number of live births (also called the prevalence of spina bifida) for each racial/ethnic group:

• Hispanic: 3.80 per 10,000 live births
• Non-Hispanic black or African-American: 2.73 per 10,000 live births
• Non-Hispanic white: 3.09 per 10,000 live births

The symptoms listed below are some of the ways in which tethered spinal cord syndrome may be exhibited in children:

• Lesion on the lower back
• Fatty tumor or deep dimple on the lower back
• Skin discoloration on the lower back
• Hairy patch on the lower back
• Back pain, worsened by activity and relieved with rest
• Leg pain, especially in the back of legs
• Leg numbness or tingling
• Changes in leg strength
• Progressive or repeated muscle contractions
• Bowel and bladder problems

Spina bifida consequences that may occur, know the type of the spina bifida gives an idea of how many problems the patient will have:

• Abnormal sensation or paralysis, which mostly occurs with closed neural tube defects and myelomeningocele.  People with these conditions typically have some degree of leg and core muscle weakness and loss of feeling in the groin and feet or legs.  The sensation can be more significant on one side of the body.
• You may see deterioration of the gait in the patient’s walking.  Typically, the lower in the spine where the condition occurs results in less weakness and loss of feeling.  The strength and feeling do not improve with age due to nerve damage.  People with these types of spina bifida may lose strength and sensation as they grow and mobility can become more difficult with age.  People with these conditions may walk independently or use some combination of leg braces, walkers, crutches, or wheelchairs.  As they age, they may require more of these supports.
• Chiari II malformation, in which parts of the brain called the brain stem and the cerebellum (hindbrain) protrude downward into the spinal canal or neck area.  It is almost always seen on advanced imagining of the brain in people with myelomeningocele, but it rarely causes symptoms.  When it does, this condition can press on the spinal cord and cause a variety of symptoms including difficulty breathing, swallowing, and arm weakness.  Surgery is sometimes required to reduce pressure in this area.
• Blockage of cerebrospinal fluid, causing a condition called hydrocephalus.  Hydrocephalus is the abnormal buildup of the fluid that surrounds the brain.  Most people with myelomeningocele have this condition, which is not seen in the other types of spina bifida.  This buildup can put damaging pressure on the brain.  Hydrocephalus is commonly treated by surgically implanting a shunt—a hollow tube—in the brain which allows drainage of the excess fluid into the abdomen where it is absorbed by the body.  The tube is tunneled under the skin and not very noticeable to others.  Another treatment option is an endoscopic third ventriculostomy or ETV, a procedure that creates a new path for the fluid to flow.
• Meningitis, an infection in the meninges covering the brain.  It can sometimes be associated with shunts.  Meningitis may cause brain injury and can be life-threatening.
• Tethered cord syndrome can occur with all forms of spina bifida, although it is very rare in individuals with spina bifida occulta.  Usually the spinal cord and nerves float freely.  A tethered cord means that there is some type of tissue attached to and pulling the cord down.  This can cause damage to the nerves and decrease feeling and strength, as well as problems with bowel and bladder control.  It is surgically treated if a person has symptoms.
• Bowel and bladder incontinence affect most individuals with myelomeningocele and closed neural tube defects.  The nerves at the very bottom of the spine control bowel and bladder function and don’t usually work properly in people with these types of spina bifida.  Most people with myelomeningocele and some types of closed neural tube defects need a regimen or other assistance to drain their bladders periodically or to have regularly scheduled bowel movements.
• Learning disabilities, including difficulty paying attention, understanding concepts, impaired motor skills, impaired memory, and difficulty with organization and problem solving are commonly seen in children with myelomeningocele.  People with strength lower down in their legs tend to have less difficulty than those with more leg weakness.  Evaluation for an individualized education plan is recommended for all children with myelomeningocele.
• Other complications such as skin ulcers, low bone mineral density, impaired male fertility, obesity, and kidney failure can be seen in people with myelomeningocele and neural tube defects as they age.  Additionally, people with myelomeningocele are at risk for precocious puberty (when changes to that of an adult occur too soon), sleep apnea, and depression.

The estimated lifetime cost of care for a person with spina bifida, with caregiving costs, is $791,900.

Learn tomorrow how you can prevent Spina Bifida with much more!

“October is Spina Bifida Awareness Month—a time to celebrate the hundreds of thousands of people living with Spina Bifida. Every October, we highlight community stories that challenge us to raise more awareness and support for those living with Spina Bifida.  As a community, we can do this by raising awareness about Spina Bifida either in our own circles or larger networks. It’s also a great time for us to challenge ourselves to find new ways to get involved in raising awareness and advocacy activities.

Spina Bifida is a birth defect that is something you are born with, its not something you develop over time.  There is no cure to Spina Bifida. ”

Spina Bifida Association (https://www.spinabifidaassociation.org/awareness-month/)