{
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      "amount": "0.001 STEEM",
      "from": "steemegg",
      "memo": "Free Upvotes Await!!!, Vote @se-witness for one of your 30 witness votes. Once you do so, you will start accumulating free upvotes every 6 hours automatically.  Please check my latests posts for more info.  Thanks!",
      "to": "dnagrimes"
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      "amount": "0.001 STEEM",
      "from": "emrebeyler",
      "memo": "Hi @dnagrimes. @smooth.witness is not an active witness anymore. It's important for every stake holder to vote for active witnesses. Please update your votes accordingly. That being said, I am a hard-working witness with stable block production. You can see my witness related work at https://emrebeyler.me. I would be happy if you consider me once you reshuffle your votes. Here is a quick link to vote for my witness: https://app.steemconnect.com/sign/account-witness-vote?witness=emrebeyler&approve=1",
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      "author": "steemitboard",
      "body": "Congratulations @dnagrimes! You received a personal award!\n\n<table><tr><td>https://steemitimages.com/70x70/http://steemitboard.com/@dnagrimes/community.png</td><td>Thank you for the witness votes you made to support your Steem community and for keeping the Steem blockchain decentralized</td></tr></table>\n\n<sub>_You can view [your badges on your Steem Board](https://steemitboard.com/@dnagrimes) and compare to others on the [Steem Ranking](https://steemitboard.com/ranking/index.php?name=dnagrimes)_</sub>\n\n\n**Do not miss the last post from @steemitboard:**\n<table><tr><td><a href=\"https://steemit.com/steemitboard/@steemitboard/use-your-witness-votes-and-get-the-community-badge\"><img src=\"https://steemitimages.com/64x128/https://cdn.steemitimages.com/DQmTugCUsoXX762vg1CuHRrpnPbfnjPogp8iCGv7F2kSVuj/image.png\"></a></td><td><a href=\"https://steemit.com/steemitboard/@steemitboard/use-your-witness-votes-and-get-the-community-badge\">Use your witness votes and get the Community Badge</a></td></tr></table>\n\n###### [Vote for @Steemitboard as a witness](https://v2.steemconnect.com/sign/account-witness-vote?witness=steemitboard&approve=1) to get one more award and increased upvotes!",
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      "memo": "Please REMOVE your witness vote from the downvote freek @themarkymark, he doesn't deserve to be in the top 20 witnesses! You have 24 HOURS from now to act, otherwise you will be DOWNVOTED! (Just let you know how you feel when you received downvotes) Link to remove the witness vote: https://beta.steemconnect.com/sign/account-witness-vote?witness=themarkymark&approve=0 For reasons to remove the vote, please check out this post: https://busy.org/@fuk.themarkymark/fuck-themarkymark",
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      "body": "Congratulations @dnagrimes! You received a personal award!\n\n<table><tr><td>https://steemitimages.com/70x70/http://steemitboard.com/@dnagrimes/birthday1.png</td><td>Happy Birthday! - You are on the Steem blockchain for 1 year!</td></tr></table>\n\n<sub>_You can view [your badges on your Steem Board](https://steemitboard.com/@dnagrimes) and compare to others on the [Steem Ranking](http://steemitboard.com/ranking/index.php?name=dnagrimes)_</sub>\n\n\n**Do not miss the last post from @steemitboard:**\n<table><tr><td><a href=\"https://steemit.com/japanese/@steemitboard/new-japanese-speaking-community-steem-meetup-badge\"><img src=\"https://steemitimages.com/64x128/https://cdn.steemitimages.com/DQmRWbAjbeETEaqSPLcpwYX1JN5pZhdPffv4q6DaBs6xvZm/image.png\"></a></td><td><a href=\"https://steemit.com/japanese/@steemitboard/new-japanese-speaking-community-steem-meetup-badge\">New  japanese speaking community Steem Meetup badge</a></td></tr></table>\n\n###### [Vote for @Steemitboard as a witness](https://v2.steemconnect.com/sign/account-witness-vote?witness=steemitboard&approve=1) to get one more award and increased upvotes!",
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      "author": "steemsheep",
      "body": "You might also want to check out this article about SIDS: https://steemit.com/health/@steemsheep/the-real-reasons-for-sids-sudden-infant-death-syndrome-and-how-to-prevent-it",
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      "body": "What is a living will and why should it be important to you? Do you want to be in control of what is done to you if you go into the hospital unconscious? Merriam-Webster (1) defines living will as “ : a document in which the signer indicates preferences or directions for the administration and especially the withdrawal or withholding of life-sustaining medical treatment in the event of terminal illness or permanent unconsciousness”. It tells the doctors what you want them to do for you if you must go to a hospital and you are unconscious and unable to communicate (e.g. you were in a bad car wreck or had a bad stroke). It is important not to confuse this with a regular will (whom you leave your property/possessions/minor children to when you die). Lawyers often charge a lot of money for living wills and medical power of attorney, but you can do them yourself free.\n\nThe simplest way is to just “google” “living will” on your home computer (or have your children/friends do it for you). Many sites will let you download the blank forms free. It is usually 10-15 pages that are self-explanatory and easy to fill out (20-30 minutes). The papers then need to be witnessed (a notary is not required for the living will but is for the medical power of attorney). If circumstances change, you can change your instructions. After it is witnessed, take it to your local hospital and have them scan it into your medical record. This is better than your primary care doctor because if you are in a motor vehicle accident on a Friday night their office will not be open until Monday morning. The hospital is open 24/7.\n\nMake at least two additional copies. You can also scan it into your \"smart phone\". Place one in an envelope in the glove compartment of your vehicle and the other in a “zip-lock” bag and place it in your refrigerator freezer. If an ambulance comes to your home and you are unconscious and the only one there, they will check your freezer for your medical history and living will. Discuss your wishes with your family but remember your “living will” overrides their wishes. Sometimes adult children can not make themselves “unplug the machine” even though they know that’s what their parent wanted done. Your living will allows you stay in control of what is or isn’t done to you when you are in the hospital\n\nRef\n1.\thttps://www.merriam-webster.com/dictionary/living%20will",
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      "body": "What is a living will and why should it be important to you? Do you want to be in control of what is done to you if you go into the hospital unconscious? Merriam-Webster (1) defines living will as “ : a document in which the signer indicates preferences or directions for the administration and especially the withdrawal or withholding of life-sustaining medical treatment in the event of terminal illness or permanent unconsciousness”. It tells the doctors what you want them to do for you if you must go to a hospital and you are unconscious and unable to communicate (e.g. you were in a bad car wreck or had a bad stroke). It is important not to confuse this with a regular will (whom you leave your property/possessions/minor children to when you die). Lawyers often charge a lot of money for living wills and medical power of attorney, but you can do them yourself free.\n\nThe simplest way is to just “google” “living will” on your home computer (or have your children/friends do it for you). Many sites will let you download the blank forms free. It is usually 10-15 pages that are self-explanatory and easy to fill out (20-30 minutes). The papers then need to be witnessed (a notary is not required for the living will but is for the medical power of attorney). If circumstances change, you can change your instructions. After it is witnessed, take it to your local hospital and have them scan it into your medical record. This is better than your primary care doctor because if you are in a motor vehicle accident on a Friday night their office will not be open until Monday morning. The hospital is open 24/7.\n\nMake at least two additional copies. You can also scan it into your \"smart phone\". Place one in an envelope in the glove compartment of your vehicle and the other in a “zip-lock” bag and place it in your refrigerator freezer. If an ambulance comes to your home and you are unconscious and the only one there, they will check your freezer for your medical history and living will. Discuss your wishes with your family but remember your “living will” overrides their wishes. Sometimes adult children can not make themselves “unplug the machine” even though they know that’s what their parent wanted done. Your living will allows you stay in control of what is or isn’t done to you when you are in the hospital\n\nRef\n1.\thttps://www.merriam-webster.com/dictionary/living%20will",
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      "author": "tomask-de",
      "body": "Nice read. I leave an upvote for this article *thumbsup*",
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      "title": "fossbot voter comment"
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{
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  "op": [
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    {
      "author": "dnagrimes",
      "body": "Lung cancer is the leading cause of cancer death. 95% of lung cancer is in smokers. Doctors can get people off heroin easier than getting smokers off cigarettes. Nicotine addiction is the leading cause of preventable death. Secondary smoke in non-smokers increases the risk of lung cancer. Feel free to enjoy your addiction---just not in my air space",
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{
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      "author": "dnagrimes",
      "body": "Not all birth defects are currently preventable. Some are preventable but require “moms to be” to understand what causes these birth defects and take the necessary steps to prevent them. Some women were not planning to get pregnant and therefore were not taking the necessary steps (50% of US pregnancies are unplanned). Because of this fact, all reproductive age women need to take these steps. See my previous blog and follow me, for how to prevent neural tube defects (NTD). This blog will discuss how to prevent birth defects from diabetes (high blood sugar).\n\nDiabetes is divided into two main types. The most severe is type 1. This is juvenile onset, insulin dependent, diabetes mellitus (type 1 IDDM). This usually occurs in young children with a pancreas that is unable to make insulin. Insulin is a hormone that acts as the “key” to unlock the “door” to the cell that lets glucose (sugar) enter the cell to act as fuel for the cell. Without insulin the cell starves and dies. Sugar stays in the blood (high blood sugar) but is unable to be used. The problem is not “too much sugar” in the blood but not being able to get it into the cell to act as fuel for the cell. Before the isolation and availability of insulin from pork pancreas, these children and young adults all died. This group only accounts for 3 % of diabetics. With the availability of insulin these children were able to lead a full and productive life. With control of their A1c to normal levels before pregnancy, these women were able to have babies with no increased risk of birth defects compared to a mom without diabetes.\n\nType 2 DM is a milder form with reduced insulin production and/or “insulin resistance” that usually does not start until the person is an adult. Their bodies can make some insulin, but not enough. It can also be caused by insulin “resistance”. The “key” does not fit “well” so it takes more insulin. Type 1 causes early and severe symptoms. Type 2 is mostly asymptomatic in its early stages and in the past some type 2 DM went 10-15 years without being diagnosed and treated. Being undiagnosed allowed irreversible, preventable damage to occur to their bodies. This form of diabetes makes up 97% of diabetes (DM). Uncontrolled DM is the leading cause of blindness, kidney dialysis and kidney transplants, and leg amputations in the US.\n\nDoctors have recently become very aggressive in diagnosing, treating and preventing type 2 DM (1). The US is currently in the middle of a diabetic epidemic. The two leading causes of type 2 DM are getting older (that is a good thing) and obesity (that is a bad thing). Two out of every 3 adults in the US are now either overweight (BMI [body mass index] 25-29.9) or obese (BMI over 30). A BMI of 20 to 25 is the best, and associated with the longest life expectancy. Obesity (and lack of exercise) has caused our current diabetes epidemic. People undergoing gastric bypass for morbid obesity can often stop all their diabetes medicine once they have lost weight.\n\nA “third” form is gestational diabetes mellitus (GDM). This is probably a variation of type 2 triggered by the extra stress of pregnancy on a women’s body. GDM occurs in the second half of pregnancy and “reverts” back to normal (or borderline diabetes) after delivery. An important point to understand is that without preconception testing (A1c) you may be misdiagnosed as GDM instead of preconception type 2. This is critical because GDM is not associated with an increase in birth defects because the A1c is normal at conception and only becomes abnormal in the second half of pregnancy. Birth defects are caused by an abnormal A1c at the time of conception. High blood sugars (high A1c) at the time of conception cause birth defects, GDM (high blood sugar in the last half of pregnancy) does not cause birth defects but can cause the baby to be large and need a caesarian section (C/S). All women should get a yearly A1c, so any abnormal result can be treated before you get pregnant. Diabetics that get their A1c back down to normal with medication, exercise, and weight loss have the same birth defect rates as normal women (no increase).  Any mom that has a large baby (9 or more pounds) should be tested for diabetes at her 6-week post-partum visit. Most women with GDM will become type 2 DM within 10 years of delivery unless they start exercising, eat healthy, and lose weight. Twenty-seven percent can avoid type 2 DM and the necessary medications and medical complications if they are smart.\n\nIf your A1c is 5.5 or less (normal) your risk of a birth defect is about 2% (2 out of a hundred babies). If your A1c is 6.5 at conception your birth defect rate increases to 3 out of 100 babies (3%). If your A1c is 14 or over then your birth defect rate is 1out of 5 babies (20%). This high rate could have been prevented if you had a preconception test (A1c) and were treated for DM before getting pregnant. Protect your future baby by getting tested (A1c) once a year after you start having periods. Also start taking over the counter (OTC) folic acid to prevent NTD (open spine birth defect). If you are thinking about being sexually active get started on LARC (see my blog on the best “forgettable” contraception).\n\nFifty percent (50%) of US pregnancies are unplanned. Once you have the infamous “missed period” it is already too late to prevent these increased birth defects. If you are not already taking folic acid and have a normal A1c you will have caused your baby to be at increased risk for birth defects. It is very simple to protect your baby from these increased risks. Use the best current contraception (LARC) to prevent an unplanned pregnancy.\n\nOne out of every two adults in the US today now have DM or borderline DM. If your annual A1c at your doctor’s office is 5.5-6.4 then you are a “borderline DM”. You will not need any medicine but need to exercise at least 30 minutes each day, eat healthy (more fruits and vegetables), and lose weight. The DPP/DPPOS study (2) showed that this resulted in a 27% decrease in progression to type 2 DM when compared to not doing this. The people that progress to type 2 DM will require medication (usually pills) to control their A1c below 7.0. If not controlled with oral medication, then insulin shots may need to be added. If your A1c is 6.5 or higher you have diabetes (DM), you will need oral medication and possible insulin shots.\n\n\nReferences\n1.\twww.acog.org/-/media/For-Patients/faq176.pdf?dmc=1&ts=20180623T1633372775\n2.\tLancet Diabetes Endocrinol. 2015 Nov;3(11):866-75. doi: 10.1016/S2213-8587(15)00291-0. Epub 2015 Sep 13.",
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      "body": "The unforgettable Long Acting Reversible Contraception (LARC) Implant (Nexplanon), and 2 IUDs (progesterone and copper) are currently the world’s best form of birth control. No single form of birth is right for everyone. Large studies, like the St. Louis CHOICE Study (1), have shown that when women are given their choice of all common contraceptives, LARC turns out to be the best. \n\nMany women came into my office saying they were “here for the pill” when in fact what they needed was a full discussion of the risks and benefits of all common methods of contraceptives, so they could make an informed and educated choice for the best method for them. See the BEDSIDER web site for a more detailed discussion of the common modern methods of contraception (2). If you are not in a long term, monogamous sexual relationship, condoms, in addition, should be used to prevent sexually transmitted diseases (STDs), even when using the best contraceptive. LARC and the pill will not prevent STDs. \n\nThe implant is like a birth control pill under the skin for 3 or 4 years that you do not have to remember to take. IUDs can be inserted and then “forgotten”. About 10% of women get pregnant on the pill, mainly because they forget to take them, and 40% discontinue the pill during the first year (1). They may not start another method but remain sexually active and have an unplanned pregnancy. The failure rate on LARC was less than 1% (only 0.27%). The pill has a 15 times higher failure rate (4.55). Satisfaction was over 80% with LARC (still using after 1 year) and only 50-60% of other methods are still using them one year later. Most women notice lighter periods and less cramps with the progesterone IUD, the implant, and the pill; which is another benefit that prevents missing work or school.\n\nThe long acting shot (every 3 months), depot medroxyprogesterone acetate [DMPA] has a low failure rate (0.22) but also has a high discontinuation rate of 40-50% at one year (1). Two of the main reasons for discontinuation of DMPA are weight gain and irregular bleeding.\n\n\nReferences\n1.\tN Engl J Med 2012; 366:1998-2007\nDOI: 10.1056/NEJMoa1110855\n2.\twww.bedsider.org",
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      "body": "<html>\n\n<p><br></p>\n<p><br></p>\n<p><p>< class = \"pull-right\" ><img src=\"https://imgsafe.org/image/9057d232e7\"/>https://imgsafe.org/image/9057d232e7</p></>&nbsp;&nbsp;· Almost 7500 sexually active women in St. Louis could have their choice of free contraception for up to 3 years (1)&nbsp;</p>\n<p>· They only had to not want to get pregnant for at least one year and be willing to listen to all the risk and benefits of all available common contraceptives&nbsp;</p>\n<p>· They could then have their choice of all the methods and switch if they were unhappy with their choice</p>\n<p>&nbsp;· This was the first prospective large US multi-year study that compared the outcomes of the pregnancy rates and satisfaction with the most popular contraceptive methods currently available with no cost consideration</p>\n<p>&nbsp;· The main author was Dr Jeff Peipert and was paid for by the Susan Buffett Foundation</p>\n<p>&nbsp;· The average US teen has sex for the first time when they are 18 years old (2)&nbsp;</p>\n<p>· This is no different than Europe, Canada, and Mexico</p>\n<p>&nbsp;· The only difference is that US teens have a much higher unplanned pregnancy and abortion rate (3,4)</p>\n<p>&nbsp;· Lack of adequate sex education in US schools is one of the major differences</p>\n<p>· Failure rates of long-acting reversible contraception [LARC] (intrauterine devices [IUDs] and implants) were compared to the most commonly used contraceptive, “the pill”&nbsp;</p>\n<p>· One half of failures causing unplanned pregnancies is the incorrect or inconsistent use of the method (5)</p>\n<p>&nbsp;· “Forgettable contraception” like LARK takes these failures “off the table”</p>\n<p>&nbsp;· The implant (Nexplanon) and IUDs do not require you to remember anything</p>\n<p>&nbsp;· The failure rate for the pill, patch, or ring was 20 times higher than LARC (1)&nbsp;</p>\n<p>· LARK users had over 80% continuous use at 12 months compared to 50% for the pill (6)</p>\n<p>&nbsp;· Satisfaction with the two groups was also similar (IUDs 80%; the pill 54%) (6)</p>\n<p>&nbsp;· For a more detailed description of individual methods please see Bedsider (7)&nbsp;</p>\n<p><strong>References</strong>&nbsp;</p>\n<p>1. Effectiveness of Long-Acting Reversible Contraception BrookeWinner,M.D., JeffreyF.Peipert, M.D., Ph.D., Qiuhong Zhao, <a href=\"https://www.nejm.org/toc/nejm/366/21?query=article_issue_link\">May 24, 2012</a><br>\nN Engl J Med 2012; 366:1998-2007 DOI: 10.1056/NEJMoa1110855</p>\n<p>&nbsp;2. <a href=\"http://chartsbin.com/view/xxj\">http://chartsbin.com/view/xxj</a>&nbsp;</p>\n<p>3. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011;84:478-485&nbsp;</p>\n<p>4. Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Estimated pregnancy rates for the United States, 1990-2005: an update. Natl Vital Stat Rep 2009;58:1-14&nbsp;</p>\n<p>5. Kost K, Singh S, Vaughan B, Trussell J, Bankole A. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception 2008;77:10-21&nbsp;</p>\n<p>6. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21508749\">Obstet Gynecol.</a> 2011 May;117(5):1105-13. doi: 10.1097/AOG.0b013e31821188ad.&nbsp;</p>\n<p>7. www.bedsider.org &nbsp;</p>\n</html>",
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      "author": "dnagrimes",
      "body": "If enough of us put pressure on our legislators we can get the sale of cigarettes made illegal. It will take a large majority of people because of all the tax money (and bribes) they  will lose. Tobacco growing (and marijuana) can still remain legal so they can't complain of \"loss of freedom\". Cigarettes are the only product that when \"used as directed\"  kills its consumer. If teens have to grow their own tobacco and roll their own cigarettes the addiction/deaths will disappear. Prohibition proved that people want legal (and safe) alcohol. So let them make, tax, and sell it. The addiction of nicotine is stronger than heroin. Getting teens addicted to nicotine is the only thing that lets tobacco companies continue to make billions of dollars dollars while killing millions of people prematurely with lung cancer, heart attacks, strokes and other cancer.",
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      "body": "<html>\n<p>&nbsp;· Always call 911 first (tell them someone may be having a heart attack or a stroke)&nbsp;</p>\n<p>· Put 2 full strength aspirin under the person’s tongue (acts as a blood thinner and prevents the clot causing the heart attack or stroke from progressing)</p>\n<p>&nbsp;· The patient will be taken to the closest hospital that can give the new “clot buster” drugs (not a small community hospital)</p>\n<p>&nbsp;· You (or your loved one) may be given heparin in the ambulance on the way to the hospital (strong blood thinner)&nbsp;</p>\n<p>· The longer your brain (stroke) or heart muscle (heart attack) is without oxygen the higher the risk of permanent serious damage&nbsp;</p>\n<p>· You will not have time to change to the “right” hospital&nbsp;</p>\n<p>· Most states have designated “heart attack and stroke” hospitals that can do the necessary tests and then administer the life saving clot buster drugs which the emergency responders will be aware of when they come to transport you&nbsp;</p>\n<p>· Take Advanced Cardiac Life Support (ACLS) from your local Red Cross or hospital, especially if someone in your family has already had a previous heart attack or stroke</p>\n<p>&nbsp;· Always start ACLS and start the AED (if available) while awaiting the emergency responders if someone is unconscious or not breathing&nbsp;</p>\n<p>&nbsp;· If someone in your family has had a previous heart attack, consider purchasing an automated external defibrillator (<strong>AED</strong>) and taking the ACLS course from the Red Cross&nbsp;</p>\n<p>· &nbsp;AEDs can be lifesaving while awaiting the arrival of emergency responders and give “automatic” instructions on whether a “shock” is needed or not</p>\n<p>&nbsp;· Training in the use of AEDs are given in ACLS courses and AEDs are available in most large public places (airports, malls, banks) and in emergencies can be used without ACLS training</p>\n<p>&nbsp;· Twenty-five percent of heart attack victims die before the arrival of emergency responders&nbsp;</p>\n<p>· See Red Cross AED video (1) &nbsp;</p>\n<p>&nbsp;Reference</p>\n<p>1. <a href=\"https://www.youtube.com/watch?v=BAWGjNAj_vA\">https://www.youtube.com/watch?v=BAWGjNAj_vA</a>&nbsp;</p>\n</html>",
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      "author": "arrliinn",
      "body": "Very true @dnagrimes. If governments really want to eradicate or at least limit smoking it should be banned or treated as illegal. However as you said they only impose taxes and give warnings, for what... \n\nThank you for adding this information. 😊",
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      "body": "@@ -1515,8 +1515,713 @@\n t to do.\n+%0A%0ASmoking takes an average of 10 years off of your life expectancy.%0A%0AReferences%0AU.S. Department of Health and Human Services. The Health Consequences of Smoking%E2%80%9450 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 %5Baccessed 2015 Aug 17%5D.%0AJha P, Ramasundarahettige C, Landsman V, Rostrom B, Thun M, Anderson RN, McAfee T, Peto R. 21st Century Hazards of Smoking and Benefits of Cessation in the United States    %5BPDF%E2%80%93738 KB%5D. New England Journal of Medicine, 2013;368(4):341%E2%80%9350 %5Baccessed 2015 Aug 17%5D.\n",
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      "body": "Lung cancer is the leading cause of cancer death. Governments say they want to prevent smoking and lung cancer but their actions  show otherwise. Governments get rich from taxes on cigarettes. It would be easy for governments to make all cigarette sales illegal. People could still have the \"freedom\" to \"grow tobacco and roll\" their own if they want this \"freedom\". Putting the cigarette companies out of business would eliminate over 95% of smokers.  Teens are too lazy to get addicted by having to grow and roll their own cigarettes. Big tobacco companies will continue to bribe politicians to keep this from happening. They get teens addicted when they are young and stupid and trying to fit in and prove they are \"adults\" by smoking with their friends. Smoking for as little as 2 years gets most teens addicted for life.\n\nNinety to ninety-five percent of lung cancer is from smoking or second-hand smoke. Every premature death from smoking (cancer, heart attacks, and strokes) is one less person  the government has to pay social security benefits for the rest of their lives. Smoking addiction is a win-win situation for government  (taxes and premature death with less social security payments). Governments can truly say smokers get addicted \"of their own free will\". How many teens do you know that would go to the trouble of growing and rolling their own cigarettes? Governments \"facilitate\" teens getting addicted by allowing legal production of cigarettes. Teens don't want \"grown-ups\" telling them what to do.",
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      "body": "Thanks \nHow strange that 2 of us picked the same topic on the same day Amazing that 20% of parents still but their babies to sleep on their tummies",
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      "body": "Recent article in Lancet (www.thelancet.com/action/showFullTextImages?pii=S0140-6736%2816%2930175-1) of 10 million people worldwide still shows the \"sweet spot\" (lowest mortality) of Body Mass Index (BMI) is 20-25. The Nurses Health Study showed that exercise (150 MET/wk {brisk walking for 1 min is 1 MET} was the second most important factor for longevity (second only to not smoking). So never smoking (or stopping) is the most important factor for living longer. Regular exercise (150 MET/wk) is the second most important. See  Primary prevention of coronary heart disease in women through diet and lifestyle. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. N Engl J Med. 2000 Jul 6;343(1):16-22. PMID:10882764",
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      "body": "@@ -742,24 +742,27 @@\n were 58,000 \n+US \n cases of pol\n@@ -774,16 +774,19 @@\n d 3,000 \n+US \n deaths f\n@@ -929,16 +929,19 @@\n ases of \n+US \n measles \n@@ -962,16 +962,29 @@\n S deaths\n+ from measles\n . In 201\n",
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      "body": "Because some vaccines are given at the same peak age of SIDS (1-6 months) we were concerned if the vaccines might be increasing the risk of SIDS. Studies have shown that not only was there no increase but vaccines actually decreased the SIDS rate. Is the person standing outside the bank being robbed a \"lookout\" or an innocent bystander that does not even know the bank is being robbed? That is the question science has to answer. \nhttp://www.nationalacademies.org/hmd/Reports/2003/Immunization-Safety-Review-Vaccinations-and-Sudden-Unexpected-Death-in-Infancy.aspx",
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      "body": "Good common sense evidence based  suggestions for decreasing SIDS. The only reason millions of people worldwide are not still dying from smallpox and being in iron lungs is because our parents and grandparents made sure we received these vaccines. The world is now free from smallpox and the vaccine is no longer necessary because the disease was eliminated by the vaccine. My friend in second grade was in an iron lung from polio. Luckily I received the vaccine and did not get polio. The only two remaining countries with polio are India and Pakistan. Once they are clear we can stop giving anyone the polio vaccine. Rare deaths from adverse reactions to vaccines need to be weighed against the thousands of lives they save. In 1952 there were 58,000 cases of polio and 3,000 deaths from polio.Since 2000 we have had no cases of polio except those brought in from other countries (and no deaths). In 1952 there 700,000 cases of measles and over 600 US deaths. In 2016 (after the MMR vaccine) there were only 85 cases of US measles and no deaths. Risk vs. benefit is strongly in favor of vaccines.",
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      "body": "Hey @dnagrimes, great post! I enjoyed your content. Keep up the good work! It's always nice to see good content here on Steemit! Cheers :)",
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      "body": "<html>\n<p><img src=\"https://i.imgsafe.org/01/t/013ea5f45e.jpeg\" width=\"400\" height=\"300\"/>&nbsp;</p>\n<p>The three leading causes of infant mortality (congenital malformations, disorders related to short gestation and low birth weight, and sudden infant death syndrome [SIDS]) accounted for approximately 43% of all infant deaths in the United States (1). Neural tube defects (NTD) can be prevented by starting folic acid 3-12 months before a planned pregnancy or daily folic acid for all reproductive age women to avoid the complications caused by the 50% unplanned pregnancy rate in the US (see my previous blog on NTD @dnagrimes). A future blog will discuss how to prevent birth defects from maternal diabetes. &nbsp;</p>\n<p>&nbsp;Sudden Infant Death Syndrome (SIDS) is the sudden, unexplained death of a baby younger than 1 year of age that doesn’t have a known cause even after a complete investigation. This investigation includes performing a complete autopsy, examining the death scene, and reviewing the clinical history. Most SIDS deaths occur between 1 and 4 months of age. Ninety percent (90%) of SIDS occur before 6 months of age. What are the known factors that can prevent some of these SIDS deaths? &nbsp;</p>\n<p>&nbsp;Prone or “tummy” sleeping used to be the recommended position for infant sleeping. Following several studies showing this to be dangerous for infants less than one year old, the American Academy of Pediatrics (AAP) in 1992 began recommending that all infants less than a year old always be put to sleep on their backs, on a firm mattress, with a fitted sheet, in a separate and safe crib/bed in their parent’s bedroom, with a blanket or sleeper, not covering the babies head, and no bumper pads or toys. See the picture from Safe to Sleep (2). Since these recommendations went into effect we have seen a steady decrease in tummy sleeping and a decrease in SIDS (3). It is especially important that parents make sure that baby sitters, day care centers, and grandparents follow these recommendations. Many grandmothers will say that they “put their previous twenty grandchildren to sleep on their tummies with no problems”, they were lucky, not safe. Share this slide with them (3). &nbsp;</p>\n<p><img src=\"https://i.imgsafe.org/01/t/01a7a70b72.png\" width=\"400\" height=\"300\"/></p>\n<p>&nbsp;The highest risk of SIDS to your baby is putting your baby on their tummy on a soft surface (head sinks more than an inch into the mattress or blanket) for sleeping. This combination multiples the risk of SIDS by a factor of 21 times your baby being on their back on a firm mattress. Your baby using a pacifier decreases SIDS by 70% when compared to no pacifier. Breast feeding also decreases the risk of SIDS. Smoking during and after pregnancy increases the risk of SIDS.&nbsp;</p>\n<p>Some immunizations are given during the peak time for SIDS. This raised the question of whether these immunizations should be delayed until after the high-risk months for SIDS (1-6 months after birth). Studies confirmed that immunizations did not increase the risk of SIDS but lowered the risk (4) when given at their usual time.Breastfeeding and use of a pacifier also decrease SIDS. &nbsp;&nbsp;For more information please see the “Thirteen ways to keep your baby from dying from SIDS”(5) on the “Safe to Sleep” website. &nbsp;&nbsp;&nbsp;&nbsp;</p>\n<p><strong>References</strong>&nbsp;</p>\n<p>1. www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm</p>\n<p>&nbsp;2. www1.nichd.nih.gov/sts/about/environment/Pages/look.aspx&nbsp;</p>\n<p>3. www1.nichd.nih.gov/sts/about/SIDS/Pages/progress.aspx&nbsp;</p>\n<p>4. <a href=\"http://www.cdc.gov/vaccinesafety/concerns/sids\">www.cdc.gov/vaccinesafety/concerns/sids</a>&nbsp;</p>\n<p>5. <a href=\"https://www1.nichd.nih.gov/sts/about/risk/Pages/reduce.aspx\">www1.nichd.nih.gov/sts/about/risk/Pages/reduce.aspx</a> &nbsp;&nbsp;</p>\n<p><br></p>\n<p><br></p>\n</html>",
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      "body": "In 1984 Taiwan began the first universal vaccine of hepatitis B in newborns. Hepatitis B is a viral infection that attacks the liver. Chronic infections often lead to the development of liver cancer. In the past, many babies born to mothers with chronic hepatitis B developed exposure to the hepatitis B virus coming through the birth canal. Many of these women had no symptoms and did not know they could pass this deadly disease on to their newborn. Chronic infections in these infants with this hepatitis B are often asymptomatic but over many years will progress into liver cancer. Cases of hepatocellular carcinoma (HCC) in 6 to 9-year-old children born in Taiwan between 1984 and 1986 declined by 75% (1) after the start of the vaccine program. Six to nineteen-year-old children and teens still showed a 70% decrease in HCC twenty years later (2).\n\nThe AMERICAN ACADEMY OF PEDIATRICS (AAP) now recommends that all newborns weighing at least 2,000 grams be given the first Hepatitis B vaccine within 24 hours of birth (3). Despite an effective available vaccine, 1000 US babies still acquire Hepatitis B at birth. They have a 90% of developing chronic Hepatitis B and up to a 25% chance of dying from liver cancer or liver failure when they get older (3). These unnecessary deaths are entirely preventable. There is no cure for Hepatitis B but it can be easily prevented with the vaccine. We have effective vaccines for Hepatitis A and B but no current vaccine for Hepatitis C. Hepatitis B and C are the leading cause of liver cancer. Hepatitis B was the leading cause of liver cancer in the past. Because we have been giving almost all newborns and high-risk adults the Hepatitis B vaccine since the 80’s, we have greatly reduced the number of cases caused by Hepatitis B. So now Hepatitis C has become the leading cause of liver cancer in the US. Just as polio and smallpox have disappeared so can Hepatitis B.\n\nIf mom has the active hepatitis B virus in her body when her baby is born, then the baby will also need hepatitis B immune globulin (HBIG) within 12 hours of delivery. These “passive” antibodies will help the baby fight the virus and make the vaccine more effective (4). Most people that get the hepatitis vaccine have no adverse reactions. Over 100 million people have received the hepatitis B vaccine in the US and there have been no reported serious side effects. Most side effects are minor (sore arm or low grade temp) (4). To learn more about hepatitis B, talk with your child’s doctor or visit the CDC hepatitis B disease page.\n\nReferences \n1.) Hepatitis B vaccination in children: the Taiwan experience. Pathol Biol (Paris). 2010 Aug;58(4):296-300. doi: 10.1016/j.patbio.2009.11.002. Epub 2010 Jan 29.\n2.) Decreased Incidence of Hepatocellular Carcinoma in Hepatitis B Vaccines: A 20-Year Follow-up Study J Natl Cancer Inst 2009; 101:1348–1355\n3.) www.aappublications.org/news/2017/08/28/HepB082817\n4.) www.cdc.gov/features/hepatitis-b-vaccine/index. \n\nSee my other blogs @dnagrimes",
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      "body": "![c2773d83d8.jpg](https://cdn.steemitimages.com/DQmTAzssquQkhgwPRTDjAbCAoufpa7SVQS4iDpLDySigdTq/c2773d83d8.jpg)\n![c2777d7c86.jpg](https://cdn.steemitimages.com/DQmYm9ioUDwPmdt8H39pqcsoNdCoHCRcJpcV8YiFhnZVVN4/c2777d7c86.jpg)\n\nWhen I was in first grade my parents took us to visit their friends and my brother, sister, and I played with their children. While we were there the mother’s doctor gave her a pain shot. We knew she was sick, but people usually got better. A few months later she died. The children and father were crying. I later learned from my mother that she died from cervical cancer (female cancer of the opening to the womb). This used to be the leading cause of cancer death in young women. Most cancers attack seniors. The older you get the higher your risk of cancer (1). This cancer devastated young families because children were without their mothers and husbands were without their wives.\n\nSince the 1950’s cervical cancer has been reduced by 70% in rich countries like the US but remains a devastating killer in underdeveloped countries. It accounts for one out of every 10 cancer deaths in women worldwide (2). The breakthrough was from a Greek doctor and scientist, George Papanicolaou (3). In 1913 he emigrated to the US to work at the Department of Pathology at New York Hospital. Testing the vaginal fluid of female guinea pigs, he discovered malignant and premalignant cells that could easily be seen. He published his research in 1928. This was the birth of the Pap smear. He then applied this knowledge to humans, but it did not become widely accepted until the 60’s (4). \n\nThe key to the reduction in deaths was being able to detect and eliminate precancerous cells (dysplasia). The detection and elimination of dysplasia allowed us to prevent the development of cervical cancer and its deadly consequences. By getting a yearly Pap smear, women were able to prevent this cancer (and the need for radiation, radical surgery, and chemotherapy). Many women think that they have and are being treated for cervical cancer when they have an abnormal Pap smear and dysplasia. Dysplasia is easily treatable and can prevent the development of cancer. Dysplasia is a disease of the surface layer of the cervix and can only be seen looking at cells under the microscope. No one has ever died from dysplasia, but left untreated or undetected it can progress into deadly cancer. Cancer is when these cells start invading down into the tissue beneath the surface layer. The process from dysplasia to cancer usually takes several years so there is ample time to catch and treat this abnormal change before it becomes the deadly cancer. Dysplastic cells can be easily frozen, cauterized, or surgically removed (simple outpatient procedure). Freezing or cautery will not cure cancer. Radical surgery and/or radiation is necessary to cure cervical cancer if it is detected early enough. Early cervical cancer can now be cured 90+% of the time. It is always best to detect and eliminate dysplasia before it has a chance to progress into cancer.\n\nDr.  Papanicolaou’s discovery of the Pap smear was even more incredible when you understand we were able to detect, treat, and eliminate dysplastic cells before they had a chance to progress into cancer, without even knowing the cause. In the late 1990’s we received scientific proof that cervical cancer was caused by the human papillomavirus (HPV) (5,6). About 15 different types account for most of the cases of cervical cancer worldwide. Type 16 alone is responsible for 50% of cervical cancer cases and deaths. Type 18 is responsible for another 20%. The new HPV vaccine, GARDASIL®9 (Human Papillomavirus 9-valent Vaccine, Recombinant) prevents 90% of the worldwide cases of cervical and penile cancer and 90% of genital condyloma (warts)(7). Eighty percent (80%) of men and women will get an HPV infection during their lifetime. The vaccine only works if given before exposure to these viruses. It does not do any good to give the polio or smallpox vaccine to someone that already has polio or smallpox. A two-shot series 6-12 month apart is recommended between ages 9-14. Just as our parents and grandparents prevented us from getting smallpox and polio by getting us vaccinated as children, we need to protect our children from cervical and penile cancer when they are older. Only 60% of teens received this vaccine in 2016 (8). This means that 40% of parents have left their children at risk of dying from these cancers that are preventable (cervical and penile cancer). A vaccine is a small price to pay for not dying from smallpox, polio, and preventable cancer. Only two cancers are currently preventable using vaccines. We will discuss prevention of liver cancer in another story about the Hepatitis B vaccine.\n\n\n\n\n\nReference\n1.)\tNational Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14(1):1–38.\n2.)\tParkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74– 108. [PubMed: 15761078]\n3.)\thttps://en.wikipedia.org/wiki/Georgios_Papanikolaou\n4.)\tPapanicolaou GN, Traut HF. \"The diagnostic value of vaginal smears in carcinoma of the uterus\". American Journal of Obstetrics and Gynecology. 1941;42:193.\n5.)\t Bosch FX, Manos MM, Munoz N, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995;87:796–802. [PubMed]\n6.)\t Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–19. [PubMed]\n7.)\thttps://www.cdc.gov/hpv/parents/vaccine.html\n8.)\thttps://www.cdc.gov/hpv/hcp/vacc-coverage/index.html",
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