October 2014 Health Bulletins

	Ask the Doc Dr. Pierre-Paul Tellier is Associate Professor of Family Medicine and Director of Student Health Services at McGill University in Quebec.

“What self-exams should we do?”
— Catherine W., Simon Fraser University, Burnaby, British Columbia

There are no self-examinations currently proven to be an adequate screening test for detecting a disease before it becomes serious—whether for breast cancer, testicular cancer in males, moles for malignant melanoma, or genital warts.

What’s a screening test?
A screening test is used to detect diseases early. To be considered useful, a screening test must meet several criteria. These include:

• The test must be valid: i.e., it can accurately detect a disease at an early stage. 
• The potential benefit of the test must outweigh the potential harm.

What’s wrong with self-exams?
Research has demonstrated that people frequently make mistakes while performing self-exams of the breasts, testicles, and skin. Consequently, they tend to over-diagnose or under-diagnose the disease they are looking for.

Such exams can make individuals anxious and drive them towards expensive medical tests and treatments. When their tissue samples are analyzed, some of those tests and treatments prove to have been unnecessary.
This translates into:

• Unnecessary risk to the patients
• A waste of medical resources
• A threat to patients’ emotional health without extending their lives.

This is not good!

But stay tuned
It’s nonetheless important to stay attentive to evolving recommendations. Researchers are always looking for easy and inexpensive ways of diagnosing serious diseases early. 

Secondary and tertiary prevention
Self-exams of the breasts, testicles, and moles on the skin are aimed at secondary prevention, which means detecting a disease before it is serious and causing symptoms.  

The detection of genital warts is an example of tertiary prevention, because when a genital wart is present it indicates the disease at its most serious stage. (Actually, genital warts are annoying, but not seriously threatening.)  

	Ask the Trainer Frankie Romeo is a certified personal trainer, small group training coach, and graduate student at Lipscomb University in Nashville, Tennessee

“What are some easy workouts that could be done at work?”
— Bahareh J., Johns Hopkins University in Baltimore, Maryland

Many people work in a sedentary environment. Just contemplating ways to get adequate physical activity is a great first step! Below are five work-friendly exercises that cover each plane of movement to make for an efficient workout. Equipment and athletic attire are not required.

1   Knee & hip flexion

• Bend one knee so that the heel comes towards the buttocks.
• Maintain this bend as you raise the knee as high as possible, shortening the angle between the thigh and stomach.
• Relax the leg and return the foot to the ground before the next repetition.
• Isolate each leg and keep an upright posture throughout the movement.
• Hold a stable surface to assist with balance.
• Perform 10-20 total repetitions, alternating each leg.

2   Resisted head extension

• Waffle the hands and place them behind the head towards the top.
• Provide gentle resistance by pulling the head forward.
• Use the posterior neck muscles to lower and raise the head in a controlled manner. This will look like an exaggerated nod.
• Perform 20 slow repetitions.

3   Waffled chest pull

• Again, waffle the hands. Bring them in front of the chest with straight arms. Palms should be facing towards you.
• Try to pull the hands apart without actually doing so—maintaining a waffled grip. This engages the shoulders’ external rotators and back muscles which assist posture.
• Bend the arms to bring the hands towards your chest as if you’re pulling something towards you, then extend the arms back out in front of you. Maintain a constant outward pull with the hands.
• Perform 20-30 repetitions.

4   Gluteal squeeze & crunch

• Squeeze the buttocks by tilting your hips forward.
• Tighten your stomach and crunch slightly forward at the same time. This activates both the gluteal and abdominal muscles for a stronger postural foundation.
• Perform 20-30 repetitions. 

5   Engaged T-twists

• With arms straight and extended to form a T, tighten your stomach and twist side-to-side as far as possible without moving the feet.
• Maintain a tightened stomach throughout to activate the abdominal muscles.
• Perform 25-50 total rotations.

For a greater inventory of exercises and workout possibilities, try using an exercise band. These are appropriate for use in most workplaces during break hours. See the next issue of Student Health 101 (November 2014) for video demonstrations.

	Ask the Relationship Educator Joleen M. Nevers, MAEd., CHES, AASECT, is a certified sexuality educator and the health education coordinator at the University of Connecticut

“Which STI/STD is most common among college students?”
— Tracey D.*, Binghamton University, New York
*Name changed for privacy

This is a question I often hear from students. They are surprised to hear that one of the most common sexually transmitted infection (STI) among students, and in the general Canadian population, is Human Papilloma Virus (HPV). About 70 percent of adults  become infected with HPV at some point in their lives, according to the Public Health Agency of Canada.

How you can become infected
HPV infects people through skin-to-skin sexual contact of the infected area. Oral, vaginal, or anal sex is not required for transmission.

The health impact of HPV
HPV has about 40 strains. Many are benign and don’t cause harm. Other strains can cause:

• Genital warts, which are treatable
• Cancers of the cervix, vagina, penis, and anus
• Cancers of the throat, tongue, and tonsils

Do you have HPV?
Most people who acquire the infection may not ever know they have it, as they won’t develop warts or cancer. Nevertheless, they can pass it on to others. There is no HPV screening test. Visible genital warts can facilitate diagnosis by a health care provider.

Get vaccinated against HPV
Students, both men and women, can get a vaccine that can protect against some strains of HPV, up to age 26. In Canada, there are two vaccines that are approved for use in females, and one that is approved for use in males. Both vaccines are given in a series of three shots over six months.

The Cervarix® vaccine protects against two of the most common HPV strains that cause cancer. It has only been approved for use in females in Canada.

The Gardasil® vaccine protects against two of the most common HPV strains that cause cancer and also two of the most common strains that cause genital warts. It is approved for use in both males and females.

Safer sex strategies provides some protection
Condoms and dental dams made from latex, polyurethane, or polyisoprine offer some protection from HPV. Since neither the condom nor dental dam covers the full genital area, it is still possible to contract HPV through skin-to-skin contact. For example, if a male has HPV on his scrotum and that area comes into contact with the skin of his partner (male or female), he might transmit the virus.  Plastic wrap used as a dental dam might provide more coverage of the genital area but should not be used as condom. Lubrication can be used with condoms and dental dams to increase sensation and pleasure.

FIND OUT MORE
Contact your health centre on campus or locally.

Health Canada's fact sheet on HPV

Sex Information and Education Council of Canada's fact sheet on HPV

	Ask the Counselor Peter Welch, MA, teaches at the University of New Hampshire, and is a wellness educator and counselor

“How can one control anger within a college or work environment?”
— Name and college withheld   

Your question is important. Anger is a normal human emotion with a wide range of expressions, from feeling irritated to outright rage. Anger can be a motivator to help you stand up for yourself or fight an injustice. Mismanaged or inappropriate anger, however, can lead to problems with your health, work, and relationships.

Strategies to help you manage anger

Recognize Acknowledge your anger as a likely reaction to a perceived threat or some underlying feeling—e.g., hurt, vulnerability, embarrassment, or shame.  Recognize, too, that sometimes anger is unreasonable, regardless of its trigger.

Time out Stop for ten seconds. Cool down, gain some perspective, and rethink your response.

Relax Learn techniques to settle yourself down, like deep breathing or meditation. Come up with a calming word or phrase, e.g., “This moment will pass.”

Know your triggers Understand what pushes your buttons, and work toward averting those situations. If your triggers are unreasonable—e.g., you unfairly blame others for your anger—seek professional help immediately (see below).

Exercise Slow exercise, like stretching or yoga, might help you develop a quiet mindset so your typical anger triggers are less unsettling.

Rethink Change the way you think about your angry feelings. Walk yourself through an alternative scenario for your anger. Does road rage really help you feel better?

Do something else Think about a funny moment. Help someone. Pet an animal. Give someone a hug. Doing something incompatible with anger will help you redirect.

Patience and forgiveness Give yourself time to learn new strategies for managing your anger. Learn to forgive others who have hurt you.

Seek professional help If your anger is intense, unreasonable, or involves you treating others harshly, it is your responsibility to work actively on your emotional and behavioral self-regulation. Many professional counselors and therapists are trained to help clients manage anger and typically use cognitive behavior approaches (helping you change the way you think about a particular issue). Find a local therapist.

Anger management techniques from the Canadian Mental Health Association

How would you react to a cow in your parking spot? A Zen approach to overcoming anger.

How do you get your fix of creativity?
What's your fix, and why do you need it?

We asked you how you get your creative fix. And you told us: Creative writing, making music, dancing, cake decorating, fixing electronic devices, learning to play the ukulele, “making interesting functional junk out of things I find,” falconry, and “the craft of living creatively”—among much more.

In case you ever need to justify your creative endeavors
Research is showing how important it is to stay creative through adulthood. Participation in the arts and crafts is associated with inventiveness as adults and entrepreneurial and career success, according to a study published last year in Economic Development Quarterly.

“The most interesting finding was the importance of sustained participation in those activities,” said researcher Dr. Rex LaMore, Director of the Center for Community and Economic Development at Michigan State University in the US (quoted on an MSU website). “If you started as a young child and continued into your adult years, you’re more likely to be an inventor as measured by the number of patents generated, businesses formed, or articles published.”

The neuroscience of creativity
The old idea that creativity and imagination are rooted in the right brain alone has been challenged. Instead, our cognitive flexibility and playfulness emerges from a broad neural network—the brain’s “mental workspace”—according to a study published last year in the Proceedings of the National Academy of Sciences.

What you do for fun
In a recent Student Health 101 survey, over 500 students ranked eight creative activities by popularity. Then you told us what we’d missed.

1. Drawing or painting
2. Dressing creatively/fashion
3. Creative writing
4. Making music
5. Making objects or sculpture
6. Making video or film
7. Making clothes
8. Theatre production 

A sampling of your other creative pursuits

“My Baba (grandmother) has a plethora of information [about] cooking. She shares all of her Ukrainian cooking secrets with me. Once I master a recipe, I can start exploring different ways and styles of making things. [It] gives me an outlet for my creativity.”
—Krystina W., a third-year student at Concordia University College of Alberta in Edmonton
 
“I’m active on Twitter and regularly engage with individuals and companies. I find new ways to be creative while chatting, such as making posters, taking pictures of myself, or posting pictures of recipes. I enjoy interacting with people through Twitter because I don’t feel judged. I let my creativity flow.”
—Katie C., a fifth-year student at Durham College in Oshawa, Ontario

For more on creativity in all its forms, see The Creativity Post, a nonprofit website exploring “all the varieties of the human experience that creativity brings to life.”

The new dietary supplement: food

By Amber Harding with Chris Stuck-Girard

Are you one of the 40 percent of Canadians who take a vitamin or mineral supplement? Maybe your parents raised you on Flintstones-shaped vitamins to get you excited about the habit. But should you keep popping those pills? According to an increasingly robust body of research, the answer is no.

Young adults most commonly cite health improvement or health maintenance as their reason for taking supplementary vitamins, according to a 2013 study in JAMA Internal Medicine. Their faith is misplaced. “We believe that the case is closed—supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful,” concluded an editorial in the Annals of Internal Medicine last year. “These vitamins should not be used for chronic disease prevention. Enough is enough.”

Vitamins linked to earlier deaths
Certain vitamins taken with the goal of preventing intestinal cancers actually increased mortality, according to a 2004 review of studies by the Cochrane Collaboration. Three years later, a study of 11,000 men by the National Cancer Institute found that those who took multivitamins were twice as likely to die from advanced prostate cancer as those who did not. In 2012, another research review by Cochrane found that beta-carotene and vitamin E supplements “seem to increase” the risk of earlier death.

Dietary supplements aren’t necessary
“Most people who eat a reasonable diet will get everything they need in the food that they eat,” Dr. Paul Offit, chief of the division of infectious diseases at Children’s Hospital of Philadelphia in the US, told The Guardian newspaper last year. (The exceptions might be people on certain special diets, like vegans or people who live in climates that are never sunny, he added.)

Where did the supplement myth come from?
Claims to the contrary are likely founded in flaky research methodology and misunderstandings. “Supplement users tend to be wealthier and healthier than non-users,” wrote pharmacist Scott Gavura in a post for Science-Based Medicine last year. “It’s the ‘healthy user’ effect which shows up throughout epidemiological studies, confounding evaluations of outcomes. That is, we shouldn’t assume supplement use make you healthier, any more than assuming that supplement use makes you wealthier.”

How then to get your vitamins?
It seems we must resort to food. Eat produce of all colors in the rainbow. Each hue represents a different blend of nutrients, and if you cover the spectrum you’re well on your way to complete nutrition.

It’s always useful to remember food writer Michael Pollan’s nutrition maxim: “Eat [unprocessed] food, mostly plants, not too much.” That’s a message even a caveman can understand.