Infants born to obese mothers risk developing liver disease, obesity

Infant gut microbes altered by their mother’s obesity can cause inflammation and other major changes within the baby, increasing the risk of obesity and non-alcoholic fatty liver disease later in life, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published Oct. 26 in the journal Nature Communications.

“Alteration of the gut microbiome early in life may precede development of obesity instead of being caused by established obesity,” said the study’s lead author Taylor Soderborg, an MD/Ph.D. candidate in the Integrative Physiology Program at the University of Colorado School of Medicine. “This is the first study to show a causative role of these microbes in priming development of obesity.”

Childhood obesity is a world-wide epidemic with recent predictions saying that 57 percent of today’s children will be obese by age 35. That parallels the rate of maternal obesity which is nearly 40 percent. Obesity increases the risk of non-alcoholic fatty liver disease (NAFLD) which impacts at least 30 percent of obese children. NAFLD can lead to liver failure, requiring a transplant.

In this study, researchers looked at two-week old infants born to normal weight mothers and obese mothers. They took stool samples from infants from both groups and colonized them inside germ-free mice.

They discovered that the gut microbes from babies born to obese mothers caused metabolic and inflammatory changes to the liver and bone marrow cells of the mice. Then, when fed a Western-style high fat diet, these mice were predisposed to more rapid weight gain and development of fattier livers.

“This is the first experimental evidence in support of the hypothesis that changes in the gut microbiome in infants born to obese mothers directly initiate these disease pathways,” Soderborg said.

For the study’s senior author, Jed Friedman, Ph.D., MS, professor of pediatrics and neonatology at the CU School of Medicine, the findings offer potential hope for understanding how early microbes might go awry in children born to obese mothers.

“About 35 percent of these kids have NAFLD and there is no known therapy for it,” he said. “But if we can alter the microbiome we can change the course of NAFLD.”

Friedman said the study shows that the microbiome can cause the disease rather than simply be associated with it. Newborns of obese mothers, he said, could be screened for potential changes in their gut that put them at risk for NAFLD.

“If we could modify the first two weeks of the infant microbiome, we could reduce the risk of this disease,” said Friedman.

That could be done through giving the infant probiotics or other supplements.

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Some pharmacies thwart efforts to improve access to the opioid overdose reversal drug

In response to the opioid crisis, all 50 states have changed their laws to make naloxone, the overdose reversal drug, easier to get and use.

Many states have issued standing medication orders so pharmacists can dispense the life-saving antidote without a prescription. Cities such as Philadelphia have campaigns encouraging family and friends of people at risk of overdose to carry naloxone.

Whether this is saving lives is just beginning to be evaluated, but one obstacle is clear: Many pharmacies haven’t gotten with the program.

In California, 3 out of 4 pharmacies still required a doctor’s prescription for naloxone early this year—two years after the law was changed, according to a new study by the University of California, San Francisco. Only half the stores had the easy-to-administer nasal spray in stock.

In Texas, where big chains such as CVS and Walgreens were surveyed, more than 80 percent dispensed naloxone without a prescription—but a quarter didn’t have it in stock, a study by the University of Texas found.

Why are pharmacies a weak link in this public-health effort? “Lack of knowledge of legislation, lack of required training, stigma about substance use disorder, and time,” the California researchers wrote this week in the Journal of the American Medical Association, where both studies appear.

Recognizing ongoing access issues, a Philadelphia City Council committee on Tuesday recommended a bill that would require pharmacies to have a least one naloxone pack (with two doses) in stock. Council is expected to vote on the measure next week.

“We did a survey and found 25 percent of pharmacies don’t have it,” city Health Commissioner Thomas Farley said. “We want 100 percent to have it on hand.”

Almost 50,000 people died of opioid overdoses last year, according to federal data. In Pennsylvania, the death toll was more than 5,400, including 1,200 in Philadelphia. The epidemic has turned drug overdose into the leading cause of death among Americans under 50.

Naloxone, used by medical professionals and emergency responders for more than 40 years, reverses the potentially lethal effects of opioids, which depress breathing and induce sleepiness.

Though the most popular brand, Narcan, is not cheap—about $150 for a two-dose pack of the nasal spray—public and private insurance covers the drug, and community groups supply it for free as part of prevention programs. Philadelphia has distributed 57,000 doses through such programs since June 2017, Farley said.

On Tuesday, New Jersey launched an “opioid data dashboard” to track drug-related overdose indicators. It shows that 19,809 people in the state were given naloxone by emergency responders or police between June 2017 and September 2018. That includes 600 who died.

Eventually, the dashboard may include naloxone dispensed without prescription under the state’s standing order, said New Jersey Health Commissioner Shereef Elnahal.

The finding that most California pharmacies are ignoring that state’s naloxone access law “speaks to the stigma that still exists around opioid addiction,” Elnahal said. “We want to change that with strong public messaging.”

After Pennsylvania’s standing order took effect three years ago, community health nurses raised awareness by going to pharmacies in each county.

The impact of the order “is anecdotal at this point,” said Ray Barishansky, a deputy secretary with the state Department of Health. “But we are seeing an increase in the amount of naloxone being distributed.”

Studies are beginning to measure the effect of access laws, as well as so-called Good Samaritan laws that legally protect lay people who administer naloxone in an emergency.

In states with access laws, pharmacies dispensed 79 percent more naloxone between 2007 and 2016 than those in states without such laws, one study found. Another study linked access and Good Samaritan laws to a 14 percent reduction in opioid overdose deaths.

“It’s not a magic bullet,” said Corey S. Davis, deputy director of the Network for Public Health Law and a co-author of those two impact studies. “It’s not going to single-handedly solve the overdose crisis. But all the data we have suggest the more naloxone dispensing we have, the fewer deaths there will be.”

Davis hopes the next wave of naloxone access laws will require doctors to provide a prescription for the antidote to any patient taking opioids chronically.

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FDA Moves to Restrict Flavored E-Cig Sales, Ban Menthol Cigarettes

THURSDAY, Nov. 15, 2018 — The U.S. Food and Drug Administration said Thursday it will take steps to limit or ban access to flavored e-cigarettes, menthol cigarettes and flavored cigars.

The move against flavored e-cigarettes stops short of the full ban that had been expected from the agency. Instead, sales of these products — thought to be especially alluring to teens — will only be allowed in stores within special closed-off areas made inaccessible to minors, The New York Times reported.

More unexpected was the FDA’s proposed ban on menthol cigarettes and flavored cigars, products which have long been thought to disproportionately harm the health of black Americans.

The menthol ban still has regulatory hurdles to overcome, so removal of those products from the market could take two years, the Times noted.

Still, the move would come as a huge blow to the tobacco industry, since menthols make up more than a third of the cigarette market.

All three moves are aimed at curbing uptake of vaped and smoked nicotine by the young. More than 3.6 million Americans under the age of 18 now vape, the agency noted.

The announcements come after the leading vape maker, Juul Labs, announced Tuesday that it would voluntarily withdraw most flavors of its hugely popular vaping product from the marketplace.

Juul, which controls 70 percent of the e-cigarette market, has come under increasing pressure to do something about the surging popularity of its vaping devices among youth.

In a statement released Tuesday, Juul CEO Kevin Burns said, “Our intent was never to have youth use Juul. But intent is not enough. The numbers are what matter, and the numbers tell us underage use of e-cigarettes is a problem.”

And in a statement released Thursday, FDA Commissioner Dr. Scott Gottlieb noted that “almost all adult smokers started smoking when they were kids. Today, we significantly advance our efforts to combat youth access and appeal with proposals that firmly and directly address the core of the epidemic: flavors.”

Nevertheless, the decision to restrict but not ban flavored e-cigarettes came as a surprise, since leaked documents had suggested a full FDA ban was imminent. In the end, the complex legalities of imposing a ban may have meant drawn-out court battles, something the FDA may have wanted to avoid, legal experts told the Times.

Instead, Gottlieb said that within the next three months, e-cigarette manufacturers should remove the products from “where kids can access them and from online sites that do not have sufficiently robust age-verification procedures.”

Anti-smoking advocates expressed some disappointment at the FDA’s announcement, however.

“We commend the FDA for recognizing the grave threat posed by electronic cigarettes on our children, and for imposing restrictions on manufacturers,” Nancy Brown, CEO of the American Heart Association, said in a statement.

“With e-cigarette use having jumped by 78 percent among high school students and 48 percent among middle school students, the need for action is urgent,” she added. “But limiting the sale of e-cigarettes is not enough — the FDA should also remove flavored e-cigarettes from the market and prohibit companies from marketing their products in ways that appeal to kids.”

And Matt Myers, president of Campaign for Tobacco-Free Kids, wondered to the Times, “Does this mean a simple curtain with a sign like we used to see at the entrance to the pornography section of video stores?”

Lyle Beckwith, a spokesman for the National Association of Convenience Stores, said his group “will be reviewing the regulation and advising our members accordingly” as to how to best implement the new rules.

He noted that, according to his teenaged son, most minors already get their flavor pods from older youth, not convenience stores.

The FDA first began its crackdown on flavored e-cigarettes earlier this year, as the number of teens using the products reached epidemic proportions, the Times reported. By far, the leading vaping product is made by Juul, whose e-cigarette devices resemble small computer flash drives. Use of Juul has skyrocketed among teens over the past year.

Flavored versions of e-cigarettes — including chicken and waffles, rocket Popsicle and “unicorn milk” — have boosted sales among the young even further, experts contend.

“The availability of flavors in e-cigarettes is one of the top reasons that middle and high school students cite as their motivation for using e-cigarettes,” said Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y. “Young people are more likely to try flavored e-cigarettes and consider them less harmful than tobacco-flavored e-cigarettes.”

The vaping industry has countered that flavored e-cigarettes actually provide a potential health benefit, helping to encourage tobacco smokers to quit.

“Flavors are important for switching,” Dr. Moira Gilchrist, a scientist with Philip Morris International, said during a visit to Washington in October for an FDA public meeting. Phillip Morris hopes to market its IQOS heat-not-burn device in the United States in tobacco and menthol flavors.

“The focus should be on what is the right thing to do for the 40 million men and women in the United States who would otherwise continue to smoke cigarettes,” she said.

As for the ban on menthol cigarettes and flavored cigars — both highly favored by black Americans — challenges lie ahead. The U.S. tobacco industry has long fought hard against such a ban. But health advocates were heartened by the news.

“Studies show that menthol cigarettes increase initiation, especially among youth,” Brown noted. “Menthol also has a disproportionate impact on minorities including African-Americans, who favor menthol cigarettes and find them more difficult to successfully quit.”

Delmonte Jefferson, executive director of the National African American Tobacco Prevention Network, told the Times, “While we’re saddened by the number of lives lost and new smokers addicted over the past decade, we’re pleased that the FDA is moving in this direction.”

The group also praised the agency for taking on flavored cigars.

“Little cigars like Black & Milds and Swisher Sweets are heavily marketed to African Americans and are often cheaper in our neighborhoods,” said LaTroya Hester, a spokesman for the network. “A lot of young, black kids don’t know that cigarillos are just as dangerous, so hopefully this will send that message. This is a huge step in protecting their health. It’s about time our young people are prioritized.”

More information

The U.S. National Institute on Drug Abuse has more about e-cigarettes.

Posted: November 2018

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Why early diagnosis of autism should lead to early intervention

Research suggests children can be reliably diagnosed with autism before the age of two. It also shows that many of the behavioural symptoms of autism are present before the age of one.

These behaviours include decreased interest in social interaction, delayed development of speech and intentional communication, a lack of age-appropriate sound development, and unusual visual fixations.

Preliminary results of a study in the Wellington region indicate most children are diagnosed when they are around three years old. However, there is arguably little point of providing early diagnosis if it does not lead to evidence-based early intervention.

Early start

The Early Start Denver Model (ESDM) is a promising therapy for very young children (between one and five years) with, or at risk for, autism. ESDM uses play and games to build positive relationships in which the children are encouraged to boost language, social and cognitive skills.

Where ESDM differs most from traditional intervention is that behavioural teaching techniques are embedded within this play. This includes providing clear cues for a behaviour, and rewarding that behaviour. Parents, therapists and teachers can use ESDM techniques within the children’s play and daily routines to help them reach developmentally appropriate milestones.

For example, a child who does not yet talk, may be learning to reach for preferred items. A child who has a lot of language may be learning to answer questions like “what is your name?”.

Initial research conducted in the United States, where the model was developed, suggests that ESDM is particularly effective when implemented for more than 15 hours a week by trained therapists in the home environment.

Improved cognition in early childhood

The model was adopted in Australia where the government funds autism specific early childhood centres. Research conducted in these centres indicates that children receiving ESDM intervention from trained therapists show greater improvements in understanding and cognitive skills than children who were not receiving treatment.

In New Zealand there is no government funding for such therapy. As a result, the cost of providing this intensive level of early intervention is beyond the budget of most families. There is also a lack of trained professionals with the technical expertise to implement such therapies.

For these reasons, we are working with the Autism Intervention Trust and Autism New Zealand to develop a New Zealand-specific low-intensity approach to delivering ESDM. The team is using the research of what is effective overseas and is applying it within a New Zealand context.

Mainstream schooling

New Zealand takes an inclusive approach to education. The main goal of the research programme therefore is for children with autism and their families to receive support earlier so that they can get a better start in their development and go on to mainstream schools.

One project involves training kindergarten teachers in ESDM. Inclusion of ESDM strategies in kindergartens is the biggest unknown because there is little teacher training in New Zealand around how to best support children with autism in mainstream settings.

A second project involves providing parent coaching and then adding on a small amount of one-on-one therapy. This will provide some preliminary evidence as to whether adding a minimal amount of one-on-one therapy is any more beneficial that just coaching parents.

Each project involves examining specific measures of communication, imitation (a key early learning skill children with autism typically struggle with) and social engagement with others.

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Exosomes ‘swarm’ to protect against bacteria inhaled through the nose

Bacteria are present in just about every breath of air we take in. How the airway protects itself from infection from these bacteria has largely remained a mystery—until now. When bacteria are inhaled, exosomes, or tiny fluid-filled sacs, are immediately secreted from cells which directly attack the bacteria and also shuttle protective antimicrobial proteins from the front of the nose to the back along the airway, protecting other cells against the bacteria before it gets too far into the body.

A research team from Massachusetts Eye and Ear describes this newly discovered mechanism in a report published online today in the Journal of Allergy and Clinical Immunology (JACI). The findings shed new light on our immune systems—and also pave the way for drug delivery techniques to be developed that harness this natural transportation process from one group of cells to another.

“Similar to kicking a hornets nest, the nose releases billions of exosomes into the mucus at the first sign bacteria, killing the bacteria and arming cells throughout the airway with a natural, potent defense” said senior author Benjamin Bleier, MD, a sinus surgeon at Massachusetts Eye and Ear and associate professor of otolaryngology at Harvard Medical School. “It’s almost like this swarm of exosomes vaccinates cells further down the airway against a microbe before they even have a chance to see it.”

The JACI study was motivated by a perplexing previous finding from Dr. Bleier’s lab a few years ago. In studies of sinus inflammation, researchers found that proteins in the cells of the nasal cavity were also present in patients’ nasal mucus. The team wanted to know why and how these proteins were moving from the cells into the nasal mucus, hypothesizing that exosomes had something to do with that process.

The new findings described in the JACI study shed light on this process. When cells at the front of the nose detect a bacterial molecule, they trigger a receptor called TLR4, which stimulates exosome release. When that happens, an innate immune response occurs within 5 minutes. First, it doubles the number of exosomes that are released into the nose. Second, within those exosomes, a protective enzyme, nitric oxide synthase, also doubles in amount. As a well-known antimicrobial molecule, nitric oxide potently arms each exosome to defend against bacteria.

The exosome “swarm” process gets an assist from another natural mechanism of the nose—mucocilliary clearance. Mucocilliary clearance sweeps the activated exosomes over to the back of the nose, along with information from cells that have already been alerted to the presence of bacteria. This process prepares the cells in the back of the nose to immediately fight off the bacteria, arming them with defensive molecules and proteins.

In their experiments described in the JACI report, Dr. Bleier’s team sampled patients’ mucus and grew up their own cells in culture. They then simulated an exposure to bacteria and measured both the number and composition of the released exosomes. They found a doubling of both the number of exosomes and of antibacterial molecules after stimulation. The team then confirmed this finding in live patients and further showed that these stimulated exosomes were as effective as antibiotics at killing the bacteria. Finally, the team showed that the exosomes were rapidly taken up by other epithelial cells, where they were able to “donate” their antimicrobial molecules.

Along with this new understanding of the innate immune system, the authors on the JACI paper suggest that their findings may have implications for new methods of delivering drugs through the airway to be developed. More specifically, as natural transporters, exosomes could be used to transfer inhaled packets of therapeutics to cells along the upper airway—and possibly even into the lower airways and lungs.

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Study finds alcohol advertising rules may fail to protect Australian kids

Regulations introduced to restrict the placement of alcohol advertising are unlikely to reduce young people’s exposure to alcohol marketing in Australia, new research led by Curtin University has found.

The research, published in the Drug and Alcohol Review journal, critically reviewed the placement rules added to the industry-run Alcohol Beverages Advertising Code (ABAC) Scheme in November 2017 and evaluated their ability to effectively regulate the placement of alcohol marketing in Australia.

Co-author Ms Julia Stafford, from the Alcohol Programs Team at the Public Health Advocacy Institute of WA (PHAIWA) based at Curtin University, said the placement rules do not meet the criteria for effective self-regulation and do not appear to have introduced any additional safeguards for young people.

“The placement rules were introduced to put some restrictions on where alcohol companies could market their products. The rules include requiring advertisers meet other industry codes that apply to the placement of alcohol advertising, market their products to audiences that are at least 75 per cent adults, and ensure alcohol advertising is not placed within programs aimed at minors,” Ms Stafford said.

“We found that they are unlikely to reduce young people’s exposure to alcohol marketing as they are very narrow in scope, exclude key forms of promotion, and place minimal restrictions on marketers. All but one of the 24 placement-related determinations published in the first six months of the placement rules were either dismissed or found to be ‘no fault’ breaches.

“The rules allow alcohol advertising to be broadcast during televised sport on weekends and public holidays, and do little to limit outdoor advertising. Alcohol ads placed in shopping centres, at sports stadiums, on public transport vehicles, and at bus stops or train stations outside of a 150m radius of a school are all consistent with the placement rules.”

First author Ms Hannah Pierce, also from the Alcohol Programs Team at PHAIWA, said the review also identified substantial flaws in the regulatory processes of the placement rules.

“The alcohol and advertising industries were heavily involved in the development of the rules, but there was no evidence of consultation with other stakeholders. There are also no penalties for marketers who breach the rules,” Ms Pierce said.

“Our findings support existing evidence that industry-managed systems fail to effectively regulate alcohol marketing and government intervention is needed if young people’s wellbeing is to be a priority.

“It has now been 12 months since the placement rules were introduced and our research shows that a comprehensive, independent review of the ABAC Scheme is needed.”

The research was also co-authored by researchers from the Public Health Advocacy Institute of WA and the School of Psychology at Curtin University and Cancer Council WA.

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First-ever prostate cancer treatment uses gold nanoparticles to destroy tumorous cells

A small clinical trial using gold nanoparticles that act as tumor-seeking missiles on a mission to remove prostate cancer has begun at The University of Texas Health Science Center at Houston (UTHealth). It is the first trial of its kind in the world.

The nanoparticles, or nanoshells, are made of small layers of silica glass formed into a sphere and wrapped in a thin layer of gold. The shells seek out and saturate cancerous cells, and their advanced vibrational properties are then harnessed to cause the tumorous tissue to pulse with extreme temperature when light is applied through a laser specifically designed to excite the particles. The oscillation kills the cancer cells while preserving the healthy tissue, avoiding the nerves and urinary sphincter. This procedure is the first in the world that is precise enough to potentially avoid negative ramifications like urinary incontinence or sexual impotency.

“This therapy could be life-changing for men diagnosed with prostate cancer and I’m honored to be among the first doctors the U.S. Food and Drug Administration approved to put it to the test,” said Steven Canfield, M.D., chair of the division of urology at McGovern Medical School at UTHealth, who recognized the possibility of the nanoparticles to treat prostate cancer and helped developed the trial to test the theory.

Prostate cancer begins when cells in a man’s prostate gland mutate and start to grow uncontrollably. Other than skin cancer, prostate is the most common cancer in American men, with an estimated 1 out of 9 men diagnosed. The American Cancer Society estimates 29,430 men died from the disease in 2018 alone.

Treatment options have traditionally included radical prostatectomy, which is the removal of the prostate gland and some of the tissue around it, radiation therapy and cryotherapy, among others. These methods carry the potential to have a negative impact on urinary function and sexual performance.

“The side effects of current prostate cancer treatments can be extremely traumatic. This new technology holds the potential to eliminate those life-altering effects, while still removing the cancer tissue and reducing hospital and recovery time,” Canfield said. “In fact, the first patient in the trial was actually riding a bike within a week of his treatment. The fusion of MRI and ultrasound imaging technology that we use to accurately identify and diagnose the cancer, combined with the extreme precision of the gold nanoshells in targeting the diseased cells, allows us to be incredibly accurate at obliterating them. I am excited as we continue tracking the progress of this groundbreaking improvement to prostate cancer care.”

Doug Flewellen, the first patient in Texas to receive the new method of care, says for him, the procedure was a no-brainer.

“No man wants to go through radical removal, and I knew active monitoring could have potentially aggravated the cancer,” Flewellen said. “The side effects of traditional treatment were not worth it to me, and I wasn’t afraid to try the most cutting-edge technology. Looking back, the experience was even better than I was expecting, and I hope to see nanoparticle therapy advance into an option for anyone diagnosed with prostate cancer in the future.”

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How to Teach Your Kids That Voting Matters — but So Does Compassion

Look, we know. We really know. It’s 2018, and you don’t know what to tell your kids about the actual state of the union anymore. Your Facebook feed is clogged with politics and nasty word wars about immigration and border control. You’re dreading Thanksgiving dinner because it’s pretty much a given Uncle Frank will get drunk and talk about arming preschool teachers and rabbis while your sister and her wife rage-cry into the mashed potatoes. Some mornings, you can’t remember why you thought it was a good idea to bring kids into this world. 

And that’s exactly why your vote matters today more than ever. Take your kids. Slap on an "I Voted" sticker. Just keep caring, OK? Caring is a revolutionary act when you’re slipping into a CNN or Fox News coma and all seems hopeless.

And no matter what your politics are, no matter what your religion is, you can choose to care — actively. Even if you’re feeling like your vote doesn’t count for much, your compassion still does. And there are many ways to help create a world for our children that is kinder and far better than this one. But it takes action — and one simple rule most of us were taught as children: Treat others as you would want to be treated. 

So on this voting day, put yourselves in the shoes of parents who are fleeing appalling, dangerous conditions in Central America. Whatever you feel about immigration, remember the caravan you’ve heard about is made up of families just like you and yours. Like you, these are parents who love their children more than anything. They are trekking hundreds and thousands of miles to try to keep their children safe and out of harm’s way. They are trying to escape poverty, violence, hunger and homelessness and find a better life for their families. 

Will the U.S. grant them asylum? It seems doubtful. But you can help these families. You can choose nonpartisan kindness today. Because kindness isn’t red or blue. 

Make compassion your platform. 

Here’s how:

Educate yourself & your kids 

Read about the caravan and reject xenophobia and fearmongering. Our country is better than that. Our kids deserve better than that.

Donate together 

Here are just a few nonprofit humanitarian organizations offering assistance and care on the frontlines. 

  • Save the Children’s Border Crisis Children’s Relief Fund: This fund provides emergency services and legal aid and works to reunite families.
  • UNICEFThis organization is working with the government of our neighbor Mexico to provide safe drinking and bathing water, hygiene essentials, sunscreen, access to support and much-needed training to authorities on child welfare, protection and nutrition.
  • Amnesty International Americas: Amnesty International is working overtime to document and monitor the situations and devastating conditions the families in the caravan are fighting against.
  • Pueblo Sin Fronteras: This immigrant rights group organized the caravan.

Help your kids call or email your congressperson or senator

If you’re not sure where to start, go to the U.S. House of Representatives website and enter your zip code. Looking for a senator? Just choose your state here. These sites will provide your elected officials’ names and contact information. 

Another route: Identify your reps at Democracy.io, and email with ease.

Voting matters. But compassion might matter even more these days. Make kindness your platform, and you’ll raise kids who care too. 

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Health Tip: Use Petroleum Jelly to Protect Your Skin

— The skin is the largest organ in the human body. And petroleum jelly is an inexpensive, readily available way to help protect it.

The American Academy of Dermatology suggests:

  • Apply petroleum jelly to damp skin, including lips and eyelids.
  • Apply it to minor cuts, scrapes and scratches to keep nearby skin from drying out.
  • Apply it to body areas prone to chafing.
  • Apply it after a diaper change if your child is prone to a rash.
  • Apply it to nails and cuticles between polishes. This will minimize brittleness and help prevent chipping.

Posted: November 2018

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What are this summer's shoe trends doing to your feet?

While we make so much fuss about children's school shoes, the footwear adult women spend most of their time in tends to be less heavily scrutinised. Your typical women's shoe is often flimsy, occasionally blister-inducing and, concerningly, can be capable of causing some serious damage to your foot.

So, with new season styles now in stores – and the weather too warm for your trusty ankle boots (alas) – which shoes are best for regular wear over the summer months? Sydney podiatrist Charlotte Bodell gives her verdict.

Mules are not a good option for daily wear.

Mules are not a good option for daily wear.Credit:Shutterstock

Mules

Mules in every style and hue are certainly this summer's default. Gucci's black Princetown mules (with the gold bar on the front – you know the ones) have trickled down from Zara, to Kmart, to the feet of every woman looking for a slightly casual corporate shoe.

But, what effect does wearing a shoe with no back support have on your feet? Quite a large and unpleasant one, says Bodell, who does not recommend mules as an everyday shoe.

"What you will definitely get is hammered toes from [your foot] clawing forward, corns on the apex of your toes [underneath the toes], and you will get corns on the tops of your toes, because the shoe is tapering down."

There is also a slightly more cosmetic problem which can result from the frequent wearing of mules, which Bodell says she has been observing in her clients since the '90s throwback shoes reached mainstream popularity last summer.

"Because there's no back to the shoe, the fat pad of the skin is hanging over the heel itself, and people are getting hard skin and cracks on the heel," she explains, adding there is an easy fix.

"Get a foot file and file the skin off, then put some heel balm cream on a nighttime with a pair of socks."

Slingbacks

Throw a strap around the back of a mule and you have the slingback. Often seen with a flat or a kitten heel, slingback styles are everywhere.

"It's good that there is a strap, because it's keeping the shoe on," Bodell says, although there is a catch.

The slingback is a slightly better option for daily wear, provided the fit is right.

The slingback is a slightly better option for daily wear, provided the fit is right.Credit:Shutterstock

"For [the strap] to stay on, you need to push your foot forward in the shoe. So, if the shoe is a little bit too small for you, your toes are going to be crunched up, and hammered, and curling under."

If that happens, you can end up clawing onto the front of the shoe with your toes, just like in a pair of mules. The key is to make sure your slingbacks are a nice fit.

Pointed-toe shoes

Shoe trends tend to oscillate between blunt and pointy (a helpful quirk to ensure we part with our money regularly and unnecessarily). A scan of the shops reveals it's currently pointy season. Unfortunately, this is not a season known for comfort.

"You're more likely to get the bunion formation on your big toe joint," Bodell warns of shoes which make your toes squish close together.

In more extreme cases, putting your non-triangular foot in a triangular shoe can lead to a painful condition called Morton's neuroma, which feels like you permanently have a rock stuck under the ball of your foot.

"You've got nerves on your metatarsal joints," Bodell explains. "And, when they're pushed together you get fibrous tissue that forms on the nerves. Then, when you squeeze the foot, it brings on a nerve pain."

Ouch.

Kitten heels

We might think that heels are worse than flats for our feet, but Bodell says a slight heel, like a kitten heel, can actually be better than a totally flat shoe.

"It helps the ankle joint get into position," she says. "If you have tight calves, it helps to take the pressure off your arch and off your calf."

However, the stiletto style of most kitten heels on the market is not ideal.

"They can be quite unstable; you're better off with a block heel. And, if you're prone to rolling your ankle, these will increase the likelihood of that."

Plastic shoes

"But, what about my favourite see-through plastic shoes?" I hear literally no one ask.

Probably popularised by Kim Kardashian (who wore high, transparent plastic boots from her husband Kanye West’s fashion line two years ago, prompting a number of knock-offs), shoes with transparent plastic uppers are around again this summer. And, as will probably not shock, they are neither comfortable nor sanitary.

"[The plastic] doesn't bend and it doesn't soften, so if you're using those shoes and it's hot in the afternoon, your feet will swell and you will get blisters," Bodell says, adding that "all the moisture and the sweat" can also create a nasty fungal situation.

The ideal summer workday shoe

So, which shoes should you be wearing this summer?

Bodell recommends a heel somewhere between 2-5cm high, ideally in the 2-3cm range.

"If you're wearing a flat shoe, the mid foot will roll through because you haven't got any cushioning or support on your arch," she says.

A strap across the front of the foot is also a good feature ("so you don't have to do any clawing"), while arch support and a little platform on the front should also help your feet wear a style for a long period.

"You want a little platform on the front to give you a bit of padding on the ball of your foot, which should prevent any sort of stress fractures if you're prone to pounding the streets."

But, if you are pounding the streets – either on your commute or your lunch break – Bodell says the best thing to do is to bring a pair of sneakers.

"There are lots of trendy ones out there now," she says. "You don't need to wear your boring trainers. But, if you're going to walk longer than 15-20 minutes in the morning, do not wear your regular strappy shoe you would wear to work: you will get problems."

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