AAP Updates Polio Vaccine Recommendations

I’m so glad that the number of cases of polio has decreased significantly, from 350,000 cases in 1988 to 1600 cases in 2009. However, wild polioviruses is still common in 4 countries: Afghanistan, India, Nigeria, and Pakistan. For those who travel there, it’s recommended to get an additional dose if they have already received when they were young, or to get the 3 doses at the minimum age.

September 26, 2011 — The American Academy of Pediatrics AAP has updated its recommendation for the administration of poliovirus vaccines, clarifying the standard schedule for immunization, as well as the minimal ages and minimal intervals between doses, according to a policy statement published online September 26 in Pediatrics.

Although the use of oral poliovirus vaccine OPV beginning in the early 1960s led to the elimination of polio in the United States, with the last reported outbreak seen in 1979, wild polioviruses still occur naturally in 4 countries: Afghanistan, India, Nigeria, and Pakistan. The fact that these 4 countries exported the virus to other countries that reported polio cases in 2009 points to the potential for the virus to be brought into the United States, the AAP policy statement says.

Twenty countries reported 1349 cases of polio in 2010, and 14 countries have reported 333 polio cases through August 23 of this year.

Inactivated poliovirus vaccine IPV replaced OPV as the vaccine of choice in the United States in 2000 in an effort to prevent rare but serious vaccine-associated paralytic polio. The current vaccination schedule, designed to produce immunity early in life, calls for 3 doses of IPV at 2, 4, and 6 through 18 months of age, and a fourth dose at 4 through 6 years of age. The AAP recommends that if risk for exposure is imminent, such as when a person travels to 1 of the 4 countries with wild polioviruses, then the doses should be administered at the minimum ages and intervals.

Within the United States, pockets of underimmunized children could lead to an outbreak if the wild viruses migrate to where those children are living, the AAP says.

The AAP statement says that after an individual receives the IPV series of doses, immunity is “long-term, possibly lifelong.” However, another recommendation in its statement is that even adults who completed immunization with OPV or IPV early in life get a single dose of IPV if they are at increased risk for exposure to wild poliovirus in 1 of the countries.

Three combination vaccines and 1 stand-alone vaccine are licensed in the United States. Diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B DtaP-HepB-IPV; Pediarix, GlaxoSmithKline, is licensed for the first 3 doses and through 6 years of age. DtaP, IPV, and Haemophilus influenza type b DtaP-IPV/Hib; Pentacel, Sanofi Pasteur is licensed for all 4 doses through 4 years of age. DtaP-IPV Kinrix, GlaxoSmithKline is licensed for the last dose at ages 4 through 6. IPV Poliovax, Sanofi Pasteur, the stand-alone vaccine, is licensed for all doses in infants, children, and adults.

The World Health Assembly set a goal in 1988 of eradicating polio worldwide. At that time, an estimated 350,000 cases of polio existed in 125 countries. That number decreased to 1604 cases in 2009.

Pediatrics. Published online September 26, 2011.

via AAP Updates Polio Vaccine Recommendations.

What do you do when you see someone litter on the subway or smoke in the park?

Today I was sitting on the subway, holding onto my backpack. Through my peripherals, I saw white, mashed up a ball drop onto the subway floor. I looked up at the man who dropped it: he looked to his right with his hands held in front of his lap. He pretended as if nothing happened!

Should I have told him, “Sir, you dropped your trash on the floor. You should pick it up.”? Though he didn’t look like someone who would beat me up if I said anything, I didn’t want to cause any trouble.

For example, one professor of mine told a man in Central Park to not smoke (because since May 23, 2011, it has been illegal to smoke in NYC parks). The man told him to “f you, and his dog.” Yeah… not exactly the most friendly thing you’ll see.

So who should enforce these public rules? Should laypeople like us, or should there be specific people who enforce these rules?

Clean Up – Physically and Emotionally

Today begins Day 1 of Week 2 for my 3rd semester of nursing school (1 more semester left to go!).

Normally, I would have clinical right now — in the nursery, with a postpartum mother, or in the labor & delivery (L&D) room. Instead, a maternity simulation is scheduled for my group from 6pm-9pm so I had all morning and afternoon to clean up.

So I turned up the music on Grooveshark, brought out the trash can, and started dumping. And vacuuming. And wiping down surfaces. And emptying the recycling bins and trash cans. And putting things back to where they belong…

That’s probably the worst part about living without mom and dad. I have to clean on my own… and it doesn’t help that my sister isn’t always helpful. She leaves stuff there and here. Since I’ve been back though, she has been a little bit better about cleaning up though. Just a little.

In terms of cleaning up mentally, I got to think about what I wanted to do down the road.

One thing that I want to do is to get involved with the Asian American community more — even though my Chinese isn’t the greatest. I started reading a book called Asian American Communities and Health so I can’t wait to get more into it.

Another thing is I want to get really good at doing assessments, especially since that plays such a huge role as a nurse. That helps sets what a nurse does versus a lay person. And then I got to think, what do I do with this information? And then I got to make those things happen.

Where I went to in China


 

This is the route I took to visit some major cities in China.

Shanghai (2 nights) > High-Speed Rail (1:07)

> Nanjing (2 nights) > Flight (3:00)

> Guangzhou (1 night) > High-Speed Rail (1:20)

> Shenzhen (1 night)> Subway (0:30)

> Hong Kong (5 nights) > Ferry (1:00)

> Macau (1 day)> Ferry (1:00) 

> Hong Kong > Flight (4:30)

> Beijing (3 nights) > High-Speed Rail (0:30) 

> Tianjin (2 nights) > High-Speed Rail (5:00)

> Shanghai (1 night) > Flight > HOME in USA

Apple Orchards Near NYC – Apple Picking Without a Car! | offManhattan

It’s fall again! It’s my favorite season — less insects, cool weather requiring just a sweater and perhaps an umbrella, and apple cider! For the last two years, I’ve done the Amazing Maize Maze at the Queens County Farm but I hadn’t gone apple picking. This year, instead of heading out to Pathmark for a 1/2 gallon bag of apples, I’ll spend a day at a orchard. After typing apple picking nyc into google, I found a website with the following information. Maybe you will want to go too. Have fun!

If you’re going to bite into a ripe juicy apple on a crisp autumn afternoon, you’d do well to be standing under the tree from which it came. This harvest season, head away from the produce aisle and north of Manhattan to the source, where you can breathe in the fresh countryside air, feel blessed by all the bounty, and stock up for those cobblers, appletinis, and pies your friends and family will be expecting.

We’ve selected six places for your next apple picking adventure, and all you need is a healthy sweet tooth and a train (or bus) ticket to get there.

1. Maskers Orchard | Warwick, NY | maskers.com

Why crop up here: In addition to a breathtaking 200-acre setting (with plenty of romantic corners), horned goats and cute-as-Wilbur pigs, Maskers Country Store has shelves filled with apple butter and fresh jams, and the perfect picnic basket to take all your goods home in.

The Apples: Macintosh, Cortlands, Mutsu Empire, Red & Golden Delicious

When to chew: Saturdays, 9:30a.m.-4:30p.m.

How to get there: Take the New Jersey Transit’s #196 or #197 bus from Port Authority to Willowbrook Station in Warwick. The orchard is 1/2 mile down the road. Take a walk or call Josie’s taxi at 845.986.8073. (45 Ball Road, 845.986.1058)

2. Outhouse Orchards | North Salem, NY | oM Review

Why crop up here: Local families come just for the apple cider doughnuts. Walk past the goats and clucking roosters and into the large market for some fresh produce, Pennsylvania Dutch candies, jugs of apple cider, or jams. You can pick your own pumpkins too. Oh, and those doughnuts.

The Apples: Ten varieties, including Red Delicious, Granny Smith, and McIntosh

When to chew: Open daily April through December, 8:30a.m.-6:00p.m.. Apple picking is 10:00a.m.-5:00p.m.

How to get there: Take Metro North Railroad from Grand Central to Croton Falls station stop. Cabs wait at the station to take city folks to the Orchards, three miles up the road. (Outhouse Orchards, 130 Hardscrabble Road., 914.277.3188.)

3. Fishkill Farms | Fishkill, NY | fishkillfarms.com

Why crop up here: You can also pick your own cherries, berries, peaches, nectarines. Plus, fall means hayrides, live music, and barbecues.

The Apples: There are 15 varieties to chose from, including Idared, Red Delicious, Macoun, Granny Smith, and McIntosh

When to chew: 9:00a.m. to 5:00p.m., 7 days a week

How to get there: Take the Metro North’s Hudson Line to Beacon station. Then take about a 20 minute taxi ride. (9 Fishkill Farm Road, 845.897.4377)

4. Jenkins & Luekin Orchards | New Paltz, NY | jlorchards.com

Why crop up here: This 50-year-old family orchard has delicious apple cider from their own cider mill, local honey, and freshly made treats in the bakery. Pick your own pumpkins for $.35/pound, enjoy a hayride for $2, or do the free corn maze.

The Apples: If you visit the during the last week of September and the first two weeks of October, all 12 varieties—that includes Macoun, McIntosh, Rome Beauty, Red Delicious—will be available.

When to chew: Weekdays and Weekends, 9:00a.m.-6:00p.m.

How to get there: Take the Trailways bus from Port Authority to New Paltz bus (and taxi) station in downtown. Hop a 10 minute cab to the farm. (Jenkins & Leukins Orchards, 69 Yankee Folly Road, 845.255.0999)

5. Wilkens Fruit & Fir Farm | Yorktown Heights, NY | wilkensfarm.com

Why crop up here: Close to FDR’s home, here you can pick peaches, purchase honey, maple syrup, fresh baked fruit pies, apple strudel sticks, and cider doughnuts.

The Apples: 14 varieties, including Gala, McIntosh, Granny Smith, Fuji, Baldwin

When to chew: Friday, Saturday, Sunday, 10:00a.m.-4:30p.m.

How to get there: Take Metro North to Croton Harmon. Call a cab in advance. (1335 White Hill Road, 914.245.5111)

6. Meadowbrook Farm | Wappinger, NY

Why crop up here: Also near the FDR estate and Vanderbilt Mansion, the giant orchard opens this weekend. Feed the goats and chickens, pick pumpkins, and munch on cider doughnuts at the picnic tables.

The Apples: Cortlands, McIntosh, Empires, Red & Golden Delicious

When to chew: Saturday and Sunday, 9:00a.m.-6:00p.m.

How to get there: Take Metro North to New Hamburg. Call 845.297.8294 for A-1 taxi and ride less than 10 minutes. (Meadowbrook Farm, 29 Old Myers Corners Road, 845.297.3002)

via Apple Orchards Near NYC – Apple Picking Without a Car! | offManhattan.

2 out of 3 maternal deaths were due to maternal obesity :(

This is a sad article on obesity, moms and babies. Now it’s time to talk to people about how they can maintain a healthy weight.

http://www.nytimes.com/2010/06/06/health/06obese.html

As Americans have grown fatter over the last generation, inviting more heart disease, diabetes and premature deaths, all that extra weight has also become a burden in the maternity ward, where babies take their first breath of life.

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests thatobesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

Hospitals, especially in poor neighborhoods, have been forced to adjust. They are buying longer surgical instruments, more sophisticated fetal testing machines and bigger beds. They are holding sensitivity training for staff members and counseling women about losing weight, or even having bariatric surgery, before they become pregnant.

At Maimonides Medical Center in Brooklyn, where 38 percent of women giving birth are obese, Patricia Garcia had to be admitted after she had a stroke, part of a constellation of illnesses related to her weight, including diabetes and weak kidneys.

At seven months pregnant, she should have been feeling the thump of tiny feet against her belly. But as she lay flat in her hospital bed, doctors buzzing about, trying to stretch out her pregnancy day by precious day, Ms. Garcia, who had recently weighed in at 261 pounds, said she was too numb from water retention to feel anything.

On May 5, 11 weeks shy of her due date, a sonogram showed that the baby’s growth was lagging, and an emergency Caesarean was ordered.

She was given general anesthesia because her bulk made it hard to feel her spine to place a local anesthetic. Dr. Betsy Lantner, the obstetrician on call, stood on a stool so she could reach over Ms. Garcia’s belly. A flap of fat covered her bikini line, so the doctor had to make a higher incision. In an operation where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth.

About two out of three maternal deaths in New York State from 2003 to 2005 were associated with maternal obesity, according to the state-sponsored Safe Motherhood Initiative, which is analyzing more recent data.

Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows.

The problem has become so acute that five New York City hospitals — Beth Israel Medical Center and Mount Sinai Medical Center in Manhattan, Maimonides in Brooklyn andMontefiore Medical Center and Bronx-Lebanon Hospital Center in the Bronx — have formed a consortium to figure out how to handle it. They are supported by their malpractice insurer and the United Hospital Fund, a research group.

One possibility is to create specialized centers for obese women. The centers would counsel them on nutrition and weight loss, and would be staffed to provide emergency Caesarean sections and intensive care for newborns, said Dr. Adam P. Buckley, an obstetrician and patient safety expert at Beth Israel Hospital North who is leading the group.

Very obese women, or those with a B.M.I. of 35 or higher, are three to four times as likely to deliver their first baby by Caesarean section as first-time mothers of normal weight, according to a study by the Consortium on Safe Labor of the National Institutes of Health.

While doctors are often on the defensive about whether Caesarean sections, which carry all the risks of surgery, are justified, Dr. Howard L. Minkoff, the chairman of obstetrics at Maimonides, said doctors must weigh those concerns against the potential complications from vaginal delivery in obese women. Typically, these include failing to progress in labor; diabetes in the mother, which can lead to birth complications; and difficulty monitoring fetal distress. “With obese women we are stuck between Scylla and Charybdis,” Dr. Minkoff said.

But even routine care, like finding a vein to take blood, can be harder through layers of fatty tissue.

And equipment can be a problem. Dr. Janice Henderson, an obstetrician for high-risk pregnancies at Johns Hopkins in Baltimore, described a recent meeting where doctors worried that the delivery room table might collapse under the weight of an obese patient.

At Maimonides, the perinatal unit threw away its old examining tables and replaced them with wider, sturdier ones. It bought ultrasound machines that make lifelike three-dimensional images early in pregnancy, when the fetus is still low in the uterus and less obscured by fat, but also less developed and thus harder to diagnose clearly. “You really need to use the best equipment, which is more expensive,” said Dr. Shoshana Haberman, the director of perinatal services.

Many experienced obstetricians complain that as Americans have grown larger, the perception of what constitutes obesity has shifted, leading to some complacency among doctors. At UMass Memorial Medical Center in Worcester, Mass., Dr. Tiffany A. Moore Simas, the associate director of the residency program in obstetrics, demands that residents calculate B.M.I. as a routine part of prenatal treatment. “It’s one of my siren songs,” Dr. Moore Simas said, “because we are very bad at eyeballing people.”

Dr. Haberman said there was obesity in her own family, and she had seen how hurtful even professionals could be. “We as a society have issues with the perception of obesity; anatomically, you get turned off,” she said.

So she was sympathetic to Ms. Garcia, making sure she got a room with a window, and calling to check on her after hours.

Ms. Garcia, 38, a former school bus dispatcher, is 5 feet tall. She said she had tried diets, weight-watching groups and joining a gym. She was 195 pounds before her pregnancy (B.M.I., 38) and ballooned to 261 pounds, which she attributed to water weight and inactivity.

“I’m the smallest one in my family,” she said. Her older brother weighed more than 700 pounds before having gastric bypass surgery.

She wiped tears away as she confessed that she worried that she might die and leave her baby without a mother.

At Ms. Garcia’s stage of pregnancy, every day in the womb was good for the baby but bad for the mother, Dr. Minkoff said. “She’s making a heroic decision to put her own self in peril for the sake of the child,” he said.

She survived, but was dismayed by the size of her son, Josiah Patrick, who had to be put on a breathing machine. At first she could see him only by remote video. But after a month, Josiah was off the ventilator, taking 15 milliliters of formula and had smiled at his mother, and doctors said he was where he should be developmentally for a preemie his age.

The hospital estimated that the cost of caring for the mother and baby would be more than $200,000, compared with $13,000 for a normal delivery.

Ms. Garcia promised Dr. Minkoff that she would lose weight and see her baby graduate from college. “I’m going on a strict, strict, strict diet,” she said. “I’m not going through this again.”

Shanghai

China in the airport and Shanghai!

Breakfast on Delta

Delayed flight over 24 hours

At the airport day 2 waiting to get on the airplane. We had $12 in Delta voucher for breakfast and considering we had already eaten breakfast at the hotel for free, we decided to just get something else to eat. So for two fruit cups and a bottle of water at Starbucks, it costed $11.40 on Delta. Whoohoo!!

The Bund in Shanghai

The Bund in Shanghai

We arrived in Shanghai on Sunday, August 28 around 6:40pm and got onto the Line 2 subway by 7:18pm. It took 1 hour (8:18pm) to get to Nanjing East Rd subway stop. The best part was it took about 2 minutes to walk to the Nanjing Hotel!!!We then took some time to relax and change into something more comfortable to look around Shanghai.At 9pm, we walked east toward the Bund, and looked at the city life. First, we got the ‘pan fried’ bun – 4 for 8 yuan. And Yes, I saw the thing that Sunny got for me. I don’t know if I’ll be able to roll like them but it has inspired me a little bit — especially since it lights up!

The Bund 2

The Bund 2

We walked really slowly so we didn’t arrive at the Bund until 9:40ish. In a way, I was surprised by the number of people there!! Many Chinese tourists and foreign tourists alike. Of course, there were some smokers there but since I read about it, I was more indifferent to them. Also, there isn’t such thing as ‘personal space’ either. And staring is ok! haha.The Bund is really nicely lit up at night.

Xintiandi -- “New Paradise”

Xintiandi -- “New Paradise”

We then decided to taxi it over to Xintiandi — “New Paradise” (16 yuan before 11pm). It’s full of foreigners and many young people dressed up! There were many cafes that were so full of energy on this Sunday evening.

East Nanjing Pedestrian Street

East Nanjing Pedestrian Street

At 11pm, we got tired and headed back to the East Nanjing Pedestrian Street but starting from the west side (where the People’s Square is) walking west. The lights were still on (as shown in the picture) and much less people were around. The homeless were settling in onto their benches.
We headed over to the McDonald’s nearby to try out the internet. It didn’t work! And my phone didn’t work either. Anyway, we tried to order food the ‘proper’ way and was immediately called out as a “old outsider” or foreigner. Haha, just because I used the proper name for the food… and even though I ordered a cheeseburger and a 10 piece chicken nugget, none were available. Only a tiny two piece chicken wing (the size of your pinky!!) and a 5 piece chicken nugget were available. Too bad it didn’t taste that great.
At night, we plugged everything in and hopped on the internet.

Xiao Long Bao - Soup Buns

Xiao Long Bao - Soup Buns

NEXT DAY on Monday, August 29, 2011, we both woke up at 5:45am, despite going to sleep at 2am. We didn’t get up until 7:20am and got ready and left by 8am. At first, we were going to go eat at a ‘little eat’ place two blocks away but…Instead, we were stopped by good soup bun prices! 8 for 12 yuan. And yes, we only took about 4 steps out of the hotel and stopped right in front of the restaurant in front of us. Yes, it is a little bit sad but we did it anyway. And the soup in the picture was 8 yuan – and just as yummy! I like how the food in Shanghai is not as oily as they make it in the US so good food, good prices — hooray!

Mei Long Zhen Restaurant

Mei Long Zhen Restaurant

On the right is a picture of an expensive but historic restaurant: Mei Long Zhen Restaurant (1038 Nanjing Rd W). Simple and tasty, we ordered a specialty dish with just shrimp, Ma Po tofu (best one I’ve had!), vegetables (sad to say that we found HAIR but they quickly replaced it… still scary to see though), and hot and sour soup with sea cucumber, roast pork and other expensive ingredients.Apparently we ‘bought’ the hair towels too and the tea was 12 yuan. At least the bathrooms were western with toilet paper and the decor of the place was amazing!It came out to be 302 yuan — not cheap but we probably won’t go to these really nice places often haha. Honestly, I prefer the cheap but good tasting food!! Better for stomach and ‘piece of mind’.

Past People’s Square

Past People’s Square

We did make stop at Shen Da Cheng (636 Nanjing Rd E) and bought this warm red bean and other bean cup of food (3.5 yuan) and a meat mooncake. YUMMYAnd we went to McDonalds and got free wifi for 30 minutes! YAY Unfortunately, I also got bite 10 times! BUT at least we went to the drug store to buy anti-itch for 5.6 yuan.We walked past People’s Square, ate a 85 degree (mango thing), and went to ICBC to exchange the travellers’ cheque. NEVER AGAIN. It took over 30 minutes and they charged $11.25 US.

Also, since the phone card was bought in Beijing, Shanghai people can’t get access to info there. Retarded.

We also shopped around and I got a nice blue and white dress for 139 yuan. Thanks mom!!

Reel Kitchen

Reel Kitchen

On the way over to the Jiag’an Temple, the Reel Kitchen ad stopped us in our feet! So many tasty desserts appeared on this ad. Look at mom — she looks happy. Hehehe. Especially about the Taiwanese ice!

Jing'an Temple

Jing'an Temple

We are inside the Jing’an Temple in this picture. People are praying with incests in a ‘north, south, east, and west’ direction. Many statues are made of gold and we walked into the temple to see Buddha of the past, present, and future. It’s neat how the temple has survived from World War I and II and the drum tower and clock (bell) tower really do have a drum and a bell inside!The girl standing in front — well, I was surprised that even women dressed in high heels, and old and young men, and of course more, all come to say their prayers.And if you throw money into the pot, you shall be protected. But I’m not sure if I believe that.

Meetfresh

Meetfresh - Ice

So we headed back to the B2 Reel Kitchen to get the specialty dessert “Meetfresh.” Black grass jelly and that kind of ice (yes, the ice was black), and taro jelly. With condensed milk on top. YUMMMMMY

Fruit on Chopsticks

Fruit on Chopsticks

Thankfully, by this time, we were tired and the B2 was connected to the Line 2 subway. We paid 3 yuan each for a stop only 3 stops away and headed back to the hotel. We saw a couple eating fruit so we couldn’t resist and had to get some too! The melon and watermelon on a chopstick were 2 yuan each. How fun!!!We then took a nap from 4:30pm to 9pm. Oopss. By the time we got ready and left our room, it was 3 minutes to 10pm so we ate at the place we ate for breakfast. More siao long bao!! Eggplant over rice and small shrimp wonton soup. Total cost 30 yuan.We then went to get a message about 1 block away for 88 yuan 1.5 hours foot and body message. Mom kept asking them questions while I closed my eyes and just relaxed. Once mom told them that she will tip them more, they stopped trying to sell us products, haha.

It ended at 12:10am and we headed home and got on the internet. And now it’s almost 3am so time to go sleep and go to Nanjing tomorrow!!!

Addiction

My mom is addicted to YouTube. After coming back from Hong Kong to China, she said the worst part about China is that they banned YouTube. Yes, I suggested to her that she should try YouKu, China’s version of YouTube. She said she did but couldn’t find the show that she wanted to watch.

Now that she’s back home, she glued to her iPad. Even as of right now.

My dad is addicted to the stock market. He watches it go up and down. He watches YouTube videos of ‘experts’ predicting the next day’s outcome at 10pm and in the morning before the market opens. He keeps reading about what will happen. He then goes on to StockCharts.com and reads the charts hourly to determine what he will do next with his stocks. He gets the most excited when he makes $$.

Maybe the only thing that will take him away from the computer is Miki – a Japanese Restaurant that my parents enjoy eating at.

Yesterday, he said that my mom and I should go out for lunch alone because he still had taxes to do (he had them delayed, I guess). I went over to tell my mom and when my dad came by, she said that we were going to Miki. When he heard that, he instantly changed his mind and said he’ll go eat with us.