VOLUME 5
Friendly Food: Food
Safety tips that could keep your ship out of hot water …3 Buzz Kill: How some energy drinks could affect your overall health …5
ISSUE 3 September 2013
Can You Hear Me?
Techniques for conducting a proper Audiology analysis …6
Bug bytes
A publication of Navy Environmental and Preventive Medicine Unit TWO
W
elcome to the latest edition of Bug Bytes.
As the fall approaches, we look forward to the changing leaves, cool breezes, and kids going back to school. However, with the fall also comes new risks, new disease headlines, and new challenges in public health.
Helping You Promote Public Health This latest installment addresses important topics to keep you updated on the latest public health trends. Whether you have a caffeine addiction, need tips on baby safety or need general public health information, we hope that the articles within help you with your mission. As always, NEPMU-2 is ready to provide subject matter experts for your force health protection, anytime and anywhere. A.F. Vaughn CAPT, MC, USN OIC NEPMU-2
The Best Job in Navy Medicine As I prepare to transfer to my next assignment, I am already looking back over the past two years with a great deal of nostalgia. Being the Officer in Charge of what I consider to be the Navy’s premier public health unit has been a tremendous honor and a tremendously good time. The Unit is blessed to have a cadre of Preventive Medicine Technicians and General Corpsmen who, in my humble opinion, are among the best and brightest of Navy Medicine and the Navy as a whole. NEPMU-2 is also comprised of public health practioners from several disciplines within the
Is it Drinkable? HM2 Sanchez-Colon and HM2 Alonso Garcia test the drinking water at Hospital de Area Puerto Cortes in Honduras. See article on page 6 for more details about this mission!
CAPT Andrew Vaughn, Officer in Charge Medical Service Corps as well as preventive medicine officers from the Medical Corps. The common hallmarks of Officers and Enlisted personnel at NEPMU-2 are professionalism and a desire to provide outstanding service. In all of my years in the Navy, I have never come across a more tight knit crew of self-starters, always ready to help our customers and each other in getting the mission accomplished; always ready to go the extra distance to see the job done right and done on time. I am going to truly miss being in charge of this unique collection of outstanding “can do” professionals.
Did you know?
Doctor’s Orders: Should I be Screened? Edward S. Hurd, DO, MPH, MBA
Nerve impulses to and from the brain travel as fast as 170 miles per hour.
Q: What is medical screening? Why is it important?
Houseflies find sugar with their feet, which are 10 million times more sensitive than human tongues.
A: Medical screening is a long-standing practice designed to identify individuals who will benefit from early treatment. What constitutes “benefit” has been hotly contested in recent years, and therefore our screening practices for specific conditions have evolved. This has contributed to recent recognition of the concepts of “over-diagnosis” and “over-treatment.”
Fingernails grow nearly 4 times faster than toenails. Coca Cola originally contained cocaine Worker ants may live seven years and the queen may live as long as 15 years. Your nose can remember 50,000 different scents. Termites eat through wood 2 times faster when listening to rock music. Some lipstick contains lead acetate or sugar of lead. This toxic lead compound makes the lipstick taste sweet
Click here for full class schedule Food Safety Managers (B-322-2101):
23-24Sep; 28-29Oct; 25-26Nov Lab Identification of Malaria (B-322-2210):
25Sep 2013 Shipboard Pest Management (B-322-1075):
10-11Sep Shipboard Sanitation Certificate (B-322-1100):
TBA Operational Entomology
9-13Sep 2013 TRI-Service Food Code
17-18Sep 2013 For further info contact: NEPMU2NorfolkEducationandTraining@med.navy.mil
Newsletter Editor LT Sarah Goodman
Additionally, not all screenings are a simple blood test or questionnaire. Breast, colon, and cervical cancer screenings are highly invasive and uncomfortable. Moreover, inconclusive results can lead to even more tests and/or invasive procedures. As with all medical advice and recommendations, be sure to discuss them as well as any questions you may have with your Primary Care Manager (PCM). There are clearly instances, as with colon and cervical cancer, where the benefits of screening far outweigh the potential harms. Screening works best when targeted at specific high-risk groups, when there are lots of people with the disease, when the time between the start of the disease and the development of actual symptoms is long, and when current available treatment options have a high likelihood of success. A regular dialogue with your PCM is the best strategy for determining which recommendations and advice are best for you.
Pets.. And the Critters that Love Them LCDR Brian Prendergast, Entomologist
We love our pets. They are part of the family. Okay, I put up with our cat because I don’t want to know if my wife would choose me or it. Taking care of our pets is an important part of a well-maintained household. If you’ve had fleas in your home, you know the anxiety and frustration this can cause. Fortunately, flea control has greatly improved in recent years. Preventing a flea infestation is much easier than getting rid of an infestation. An ounce of prevention is worth a pound of cure! There are several products designed to be placed directly on an animal’s skin. In this case, an insecticide that kills fleas, and is harmless to your pet, is absorbed into the animal’s skin and spread through the body through the blood stream. When a flea feeds on the animal, a lethal dose of the pesticide will kill the flea or make it sterile and unable to reproduce. Essentially you are turning your pet into a lethal trap. The dog or cat is the major source of blood meals for fleas, and this ‘lethal trap’ will control a small infestation. It is necessary to reapply the insecticide every 30 days, or so. If the treatment wears off because you failed to reapply, it will be possible for fleas to successfully reproduce. Other products come in the form of a pill or a liquid that is designed to be ingested by the pet. Again, the poison is spread through the animal’s bloodstream. Pets should be on one of these regimens during times of flea activity, year round in most areas. Flea problems can be overwhelming if you move into a home that had an active infestation. Fleas have an incredible adaptation that prevents them from completing the process of maturing from an immature pupa into an adult until there are suitable hosts present. Once the pupa senses carbon dioxide and a source of a blood meal, it will break out of the cocoon. This way, fleas can survive for extended periods while a home is vacant. When a new occupant moves into an Infested home, fleas will sense their presence almost immediately and break out of the cocoons. The result will be extremely uncomfortable and surprising to the new occupants. If flea populations explode, either because they have thrived on your pet or because you moved into a home where fleas already existed, dealing with them can be more complicated and more costly. In many instances, paying a licensed pesticide applicator to control the problem is the most reasonable solution.
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 2 Website: http://www.med.navy.mil/sites/nepmu2
Are You Checking Out My Mussels??? LT Jeff Moody, EHO, BS Raw Oysters are known to be a natural aphrodisiac. However, could that feeling of butterflies in your stomach actually be the result of a waterborne pathogen?
they take precautions against contaminants that might be present.
It was once rumored that oysters were only safe to eat in months with the letter 'r' in their names. As it turns out, this myth is based in truth. In the Northern Hemisphere, oysters are much more likely to spoil in May, June, July, and August due to warmer waters and harvesting temperatures.
Oysters can contain harmful bacteria. Oysters are filter feeders, so will naturally concentrate anything present in the surrounding water. Oysters from the Gulf Coast of the United States, for example, contain high bacterial loads of human pathogens in the warm months, most notably Vibrio vulnificus and Vibrio parahaemolyticus. In these cases, the main danger is for immunocompromised individuals, who are unable to fight off infection and can succumb to septicemia, leading to death.
Three people became sick recently after eating raw oysters collected from private grounds. Fortunately for these individuals, the infection was the less potent of two Vibrio strains. However, the tougher kind can kill humans and typically hits unlucky consumers with vomiting, diarrhea and other stomach ailments. On public grounds, oystering is limited to the fall and winter, when Vibrio and other potentially dangerous pathogens are not active. But the state grants oyster farmers the right to harvest from their private beds any time they want: as long as
Food regulations require that all restaurants maintain shellstock tags of fresh oysters for sale for a minimum of 90 days, because some diseases (like Hepatitis A and Vibrio) that could come from shellfish can take a month or longer to show up. By saving the tags, the restaurant can show that they obtained the shellfish from approved waters. This will also help track the cause of any foodborne outbreak that might be related to shellfish.
Food Safety Awareness Month In honor of Food Safety Month, NEPMU-2 has compiled the most common violations seen by EHO’s and PMT’s while conducting galley inspections . These are significant issues that should be addressed and/or reported immediately if seen in any galley or restaurant facility. LT Sarah Goodman, LTJG Lee Bluitt, Environmental Health Meat Thawing at Room Temperature. There are many ways to defrost meat. Setting them on the counter at room temperature is not one of them! Make sure all meat is thawed in a thaw box, under cold running water, or in the microwave.
Poor Cleaning Habits. Most insect investigations are brought on by inadequate cleaning, especially the bakery and trash rooms. Make sure there is a good cleaning schedule in place as well as proper sanitizer levels to ensure proper sanitation.
Training Records Missing or Unavailable. Training records are supposed to be maintained on the premises, and each employee should have four hours of food safety training each year. If you didn’t write it down, it didn’t happen!
6 Most Common Food Service Violations
No Knowledge of Proper Cooking Temperatures. One of our favorite inspection questions is “What is the internal cooking temperature of chicken?” We usually get answers ranging from 120-365° F. Make sure the staff knows the proper cooking temp of all the main meat groups.
Prepping Ready to Eat Food with Bare Hands. Ready to Eat Food is any item that will be directly consumed after the employee prepares it. At NO time should an employee touch Ready to Eat Food without gloves!!
Cross Contamination with Potential Allergens. Be sure to prep foods that could potentially cause allergic reactions away from other food. The most common food allergies are wheat, peanuts, tree nuts, soy, milk, eggs, fish, and shellfish. 3
2013 TGI Fitness Challenge NEPMU-2 would like to congratulate all of it’s staff that participated in the challenge at Norfolk Naval Base.
GET YOUR ANSWERS HERE EMAIL NEPMU-2 click on the links below
LEGAL DEALERS ON EVERY CORNER….
Fleet/FMF
Finding your “wings” elsewhere...
-Entomology
LT Sarah Goodman, REHS/RS, Environmental Health Caffeine is a dietary staple in the Navy. It comes in many variations and varieties, and is the drug of choice for us, “not morning people”. There is a lot about caffeine, sodas, and energy drinks in the news, but what are the facts? According to the Mayo Clinic, about 200-300 milligrams of caffeine per day is safe (this is equivalent to two cups of coffee). However, depending on your age, gender, and other risk factors, this might not be an appropriate average. The best thing to do is to talk with your Primary Care Provider about what level is safe for you.
-Environmental Health -Industrial Health -Health Promotions Training Threat Assessment Deployable Platforms Department Senior Enlisted Leader
The additional (and perhaps bigger) issue is not necessarily the caffeine alone. Many energy, coffee, and carbonated drinks have extra sugar, sweeteners, and added additives that may impact your health. Yale University concluded the average American consumes 45 gallons of sugary drinks per year, contributing to the obesity academic. Also, most energy drinks have high levels of sodium, which can lead to poor heart health, and artificial sweeteners have been linked to various cancers, and also tooth decay.
RESOURCE LINKS
Another frightening trend is the mix of caffeine with alcohol. While the precise nature and degree of the relationship between caffeine and alcohol is not yet clear, it can at the very least mislead an individual about their state of intoxication. While the drink itself may not hurt you, the risky behaviors that may result from its affects could.
USAPHC U.S. Army Public Health Command
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PrevMed Topic Page NMCPHC (NEHC) supported page of Preventive Medicine topics and resources
WHO Fact Sheets World Health Organization publications and fact sheets
So, what is a Sailor to do when having to work long hours with little sleep? Try not to reach for that reach for that cup! Try taking a light exercise break, chew a piece of sugar free gum, listen to music, or have a healthy snack. If you’re like me, and have to have that caffeine boost (or just enjoy that freshly brewed cup of coffee in the morning), try to stick with just a few drinks a day and drinks with as few additives as possible.
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Instructions Navy Medicine Publications
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1. A cup of coffee may actually help protect against certain diseases 2. Energy drinks can have a variety of adverse side effects like: tremors, headache and heart palpitations 3. Drinking alcohol mixed with energy drinks is actually more dangerous than drinking alcohol alone.
AFPMB Armed Forces Pest Management Board online Bug Bytes Archive Back issues of the NEPMU -2 newsletter available online
Scan the QR code to link directly to NEPMU-2’s website! 4
Baby Safety Awareness Month HM1 Lelia Watton Baby Safety Month started in 1983 when Juvenile Products Manufacturer Association (JPMA) initiated “Expectant Mother’s Day.” In 1986, it was extended to a weeklong celebration, until 1991, when JPMA sponsored the first “Baby Safety Awareness Month.” Since then, every September has been designated as Baby Safety Month. The Juvenile Products Manufacturers Association is an organization of more than 250 companies in the United States, Canada and Mexico. JPMA advertises, networks, and ensures product performance certification and business development assistance is conducted, recognizing the needs of parents, children and retailers.
The JPMA Certification Seal on a product tells buyers a product has been sample tested to the highest standard set by ASTM (American Society for Testing and Materials), through annual testing. Standards organizations such as ASTM and the safety standards developed in cooperation with industry experts’, result in some of the best hazard-based regulations that ensures today's parents may be comforted in the safe use and selection of their children’s products. To find out more information about the JPMA certification program, the products certified and a complete listing of JPMA members, please visit www.jpma.org . Follow JPMA on Twitter @JPMA and connect with them on Facebook to learn about additional safety tips and JPMA initiatives.
Rock-a-bye Baby
LCDR Patrick McKenna, DO, MPH
In 1992 the American Academy of Pediatrics (AAP) recommended all babies be placed on their backs to sleep. Following this recommendation, deaths from Sudden Infant Death Syndrome (SIDS) declined dramatically. However, sleeprelated infant death, from SIDS and other causes, continues to contribute to a US infant mortality rate that is much higher than that of other developed countries. This prompted the AAP to expand its guidelines helping parents create a safe sleep environment for babies. The recommendations are as follows: Bumper pads should not be used in cribs as they provide no safety benefit and increase the risk of strangulation, suffocation and entrapment. In fact, the state of Maryland has recently banned the sale of crib bumpers. If you live in Maryland you can no longer purchase a crib bumper, including online or through the mail. Exclusive breastfeeding is recommended for at least the first six months. All infants should receive routine immunizations. Evidence suggests this reduces the risk of SIDS by 50 percent. Avoid all smoking and secondhand tobacco smoke exposure both during pregnancy and after birth. Always place baby on his/her back to sleep in a safetyapproved crib, bassinet, or playard with a firm mattress covered with a tight fitting sheet. Avoid any soft or loose
Bravo Zulu!!! NEPMU-2 takes pleasure in congratulating HM1 Jennifer Nolen and HM1 Daniel Estigoy on their promotion to the rank of Chief Petty Officer.
bedding such as pillows, blankets, and toys. Loose items in the crib increase the risk of suffocation and strangulation. Avoid sleeping in car seats, strollers, carriers, etc. Room-sharing with parents is recommended without bedsharing. Avoid sleep positioning devices, such as wedges, as these increase risk of entrapment. Pregnant women should receive regular prenatal care throughout pregnancy. Avoid alcohol and illicit substances during pregnancy and after birth. Pacifiers at naptime and bedtime are recommended and may be protective against sleep-related death. Avoid covering the baby’s head or overheating with excessive clothing. Do not use home cardiorespiratory monitors advertised to reduce the risk of SIDS. They have not been found to be effective and may provide a false sense of security. More information for parents can be found at www.healthychildren.org/safesleep. Let’s do our part this month and every month to help our sailors and marines keep the next generation safe while they sleep. Advise sailors and marines to follow these evidence-based recommendations from the AAP.
Sailors of the Quarter and Doc of the Month Senior Sailor of the Quarter: HM1 April Baisden Junior Sailor of the Quarter: HM3 Jason Ramirez Doc of the Month: HM2 Leslee Davidson
Bravo Zulu!!! NEPMU-2 is proud to announce the promotion of Third Petty Officer Olusola Adeyemo to the rank of HM2! Congratulations on your accomplishments!
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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Hearing Loss Counseling: How to Make Your Patients Think You’re a Wizard... LCDR Jason Jones, Audiologist Hearing Conservation has been a hot button issue for some time. Those who serve in the military will at some point be exposed to high-intensity noise. Two possible consequences of such exposures are the development of a hearing loss, most prominent for high-frequency sounds, and tinnitus, which is referred to as “a ringing in the ears.” Depending on a variety of factors, these effects may be either temporary or permanent consequences of such an exposure. Hearing loss and tinnitus are the most prevalent occupational injuries and subsequently holds the record for most claimed disability within the VA. All of the services have Hearing Conservation Programs (HCP) in place to mitigate the occurrence of occupational hearing loss. If you are testing or counseling patients in regards to anything medical in nature, you must guide your talk in a fashion that will capture their attention if you want to make an impression. The focus of Navy Audiology is to prevent occupational hearing loss, not to document it. With that said, if you understand how a sensorineural hearing loss affects a person, you are one step ahead. Without going through the acoustical to electrical synapses, just know that we all have hair cells in our cochlea that become damaged over time due to noise and other agents that cause hearing loss.
Helping Honduras
When talking to a patient, remember the four “P’s” of hearing loss. Hearing loss is Painless, so it occurs over time. It is also Progressive meaning that once it goes, it goes fast. Noise induced hearing loss is Permanent. Once a person has lost hair cell functioning, hearing aids may be the only help available. The good news is hearing loss is Preventable. If we protect ourselves on and off the job with proper fitting hearing protection, we will not lose any more hearing due to noise damage. The following statements will spark the interest of your patients and they will turn their attention to what you say. I can hear but I can’t understand. I hear fine but when there’s background noise, I’m lost. My wife says I don’t listen to her, but she mumbles. Once outer hair cell damage has occurred, one loses the ability to distinguish speech. They know that you’re talking to them, but they have to piece things together by reading lips and thinking about the context of the conversation. When background noise is introduced conversational speech is even more disadvantaged. As for the wife, noise induced hearing loss
speech frequencies. More than likely the wife’s voice frequency (pitch) falls exactly where the hearing loss exists. Men have more bass in their voice and bass is strong and will penetrate walls. Women do not have this luxury. Their voice will dissipate into the air and lose strength the further it travels. Of course, some women have deeper voices and of course, some men have perfected the art of selective hearing. The most important part of the Navy and Marine Corps Hearing Conservation Program is the person doing the testing, fitting the hearing protection and counseling. If this person doesn’t take hearing seriously, the patient won’t either…until it’s too late. Please contact LCDR Jones and the Audiology Division at NEPMU-2 for any issues or concerns with your HCP. LT Sarah Goodman
HM2 Sanchez-Colon and HM2 Garcia traveled to Puerto Cortes, Honduras in order to fulfill a need at the local government hospital. After conducting water testing, it was determined that the current infrastructure did not meet potable standards. HM2 Sanchez-Colon and HM2 Garcia coordinated with the hospital administration and maintenance team to install a water system for oral rehydration provided by the Waterstep Foundation. This system is typically used for disaster relief, but was modified to meet the primary needs of the hospital until the infrastructure could be repaired. “It was great to fill in the communication gaps between the city and hospital officials,” HM2 Sanchez-Colon said. “We were able to help HM2 Sanchez-Colon, HM2 Garcia, WaterStep Kurtis bring the right people together to help provide potable water to the Daniels, Vice Mayor Jan Carlo Rodriguez, WaterStep Kari Williams, Director Angel Flores patients in Puerto Cortes.” Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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NEPMU-2 Annual Picnic Pictures The staff of NEPMU-2 would like to thank the MWR Committee for a successful Command summer picnic.
Moving on is a Simple Thing… What it Leaves Behind is Hard... Letter from the Editor
LT Sarah Goodman, MPH, REHS/RS Confucius once said, “Choose a job you love, and you
thank-you’s. First, thanks to the staff of NEPMU-2 for
will never work a day in your life.” Well, I didn’t exactly
all your input and hard work. Bugbytes would not be
choose to be the Editor of Bugbytes (it was one of those
what it is without you! Thanks to the Navy and Marine
volun-told moments), but, I cannot tell you how much I
Corps Public Health Center and their support of our
have enjoyed this job since I inherited it over a year ago.
newsletter, and most of all, thanks to all the readers!!!
It has been wonderful to interact with all the intelligent
I leave Bugbytes in the very competent hands of my
people here at NEPMU-2, and share their knowledge with
colleague, LT Paula Volk. I know she will do a
readers all over the world. I sincerely hope that you have
wonderful job! My next stop is the Naval Branch Clinic
enjoyed past issues of Bugbytes. I know I have!
in Everett, Washington. I am excited for this next tour in
This farewell would not be complete without a few
career and in life. Thanks for reading!!!
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