NMCSD POPULATION HEALTH PROGRAM NEWSLETTER

Suicide Prevention Suicide is one of the leading causes of death in the U.S., and has increased 24 percent from years 1999 to 2014, the Centers for Disease Control and Prevention (CDC) reports. In 2014, an average of 20 veterans a day died from suicide, says the U.S. Department of Veteran Affairs. While not all suicides are pre-ventable, getting patients the help they need is a crucial step in the prevention process.

Know Suicide Risk FactorsKnowing suicide risk factors will help you counsel patients or refer them to get the help they need before it’s too late.

Risk factors include:

• Family or personal history of suicide attempts• Family history of child maltreatment• History of mental disorders, especially depression• History of drug or alcohol abuse• Impulsive or aggressive tendencies• Feeling hopeless• Feeling isolated or cut off from people• Financial, social, or relationship losses• Physical illness• Barriers to accessing mental health treatment• Unbearable pain• Talking about committing suicide

Suicide Protective Factors The following factors may help protect patients against sui-cide, says the CDC:

• Family or other social support systems• Easy access to effective clinical interventions and support• Problem solving and conflict resolution skills

What Practitioners Can DoReferring military service members to the support and inter-ventions they need to thrive is an important suicide prevention strategy. A 2016 study published in Frontiers in Psychiatry found that antidepressant therapy protects against suicide attempts. Click here for military-specific suicide prevention programs and provider resources.

An Internal Behavioral Health Consultant (IBHC) is a member of the primary care team who spe-cializes in helping patients with conditions like depression, anxiety, anger, grief and relationship

problems. This important healthcare professional assists with health behavioral changes like lowering stress, boosting exer-cise, quitting smoking, healthy weight management, managing diabetes, improving sleep, modifying alcohol use, managing chronic pain, and lowering blood pressure and cholesterol. Click here to learn more about your IBHC and how they can help pa-

tients at risk for suicide.

Military Crisis HotlineA good resource for military service member in urgent need of someone to talk to (any time of day or night) is the mili-tary crisis line, online chat, and text messaging service:

• 1-800-273-TALK (8255) press 1 for military members --OR text 838255

• Visit the Military Crisis Htoline online here

Click here for a patient suicide prevention handout.

MONTHLY HEALTH THEME: MENTAL HEALTH

https://go.usa.gov/xX3bHMAY 2017 • Your Health Is Our Mission!

Post-traumatic stress disorder shouldn’t be taken light-

ly, which is why the military and department of defense

strongly support efforts to get patients suffering from PTSD

the help they need. The U.S. Department of Veterans Affairs

reports that 7 to 8 percent of the U.S. population will ex-

perience PTSD at some point in their lives, and about 30

percent of Vietnam vets have had PTSD. Identifying signs

and symptoms of PTSD is the `first step in treating patients

with PTSD.

PTSD Warning Signs

Four types of PTSD symptoms to watch out for include:

1. Re-experiencing symptoms

PTSD patients may relive a traumatic event, and experi-

ence the same horror or fear they did during the event

(even physical symptoms like sweating or a racing heart).

They might have nightmares, flashbacks, or frightening

thoughts about the event.

2. Avoidance symptoms

Patients with PTSD may avoid situations, places, people,

events, objects or certain feelings that remind them of

a traumatic event. They might avoid crowds, watching

certain movies, or driving if those things trigger traumatic

memories.

3. Cognition and mood symptoms

PTSD patients might avoid relationships, or lose loving

feelings toward family and friends. They may feel detached

or alienated from people, not trust anybody, or believe the

world is dangerous. These patients might lose interest in

enjoyable activities, have feelings of blame or guilt, or have

negative feelings about the world or themselves. They

might not remember certain portions of a traumatic event.

4. Arousal symptoms

Patients who feel always on alert, jittery, and on the

lookout for danger might be experiencing hyperarousal.

They may have difficulty sleeping, eating or concentrat-

ing, startle easily, or take extra safety precautions at all

times. They might also feel tense, on edge, or have angry

outbursts.

Diagnosing PTSD

To be diagnosed with PTSD, The National Institute of Mental

Health says adults must have all of the following symptoms

for at least one month:

• At least two cognition and mood symptoms

• At least two arousal symptoms

• At least one avoidance symptom

• At least one re-experiencing symptom

When Should Patients Seek Help?

Stress reactions to traumatic events can improve over time.

However, patients with PTSD symptoms that last more than

three months, cause great distress, or disrupt home and work

life should seek help, suggests the National Center for PTSD.

Medications and psychotherapy (“talk therapy”) are the main

treatments for PTSD.

Military and DOD Support

The U.S. Department of Defense and U.S. Department of Vet-

erans Affairs strongly support PTSD awareness and treatment

programs for service members, and have gone to great lengths

to increase access to PTSD treatment. Counseling is available

through military members’ primary care doctors and behavioral

health specialists. The National Center for PTSD offers treat-

ment programs for U.S. veterans, and provides a program loca-

ter link. Other outpatient PTSD counseling resources include

Military OneSource and the VA’s readjustment counseling ser-

vice (877-WAR-VETS).

The OASIS program is an 8-week, more intensive PTSD re-

covery program offered by NMCSD. The program is available to

active-duty service members with combat PTSD who haven’t

improved with outpatient PTSD treatment. The military crisis

line, text messaging and online chat service (1-800-273-8255

or text 838255) are free to all service members, and useful for

those feeling acutely distressed.

The VA/DOD clinical practice guidelines for management

of post-traumatic stress and the clinicians guide to medica-

tions for PTSD are resources for providers.

MILITARY SUPPORT OF POST-TRAUMATIC STRESS DISORDER

New Provider Resource PageLooking for ways to have up-to-date, standardized patient and provider resources at your fingertips at all times? Now you can with our new NMCSD provider resource page.

Visit this page regularly to have access to:

• Quarterly population health program newsletters• Monthly health themes• Upcoming patient class offerings• Up-to-date, evidence-based and NMCSD PAO approved

patient education materials (such as healthy eating, weight loss, exercise, and stress reduction handouts)

• Up-to-date NMCSD provider resources• Links to credible external sources

Why is Standardization Important?Using our new NMCSD provider resource page helps im-plement standardization, which provides numerous patient and provider benefits:

• Increased patient processing fluency• Improved patient trust• Faster patient brand recognition

• Improved organization credibility• Increased patient engagement and loyalty• Better use of up-to-date information by providers• Increased patient satisfaction (patients prefer standardiza-

tion over new stimuli)

Using the NMCSD Provider Resource PageSimply click here to access the NMCSD provider resource page, utilize up-to-date patient handouts, and keep up with the latest NMCSD news and resources.

NEW PROVIDER RESOURCES

Heart-Healthy Sum-mer Recipe: Tuna & White Bean SaladLooking for delicious summer recipes bursting with flavor, but healthy enough to recommend to your patients? Try this mouth-watering (and heart-healthy) tuna & white bean salad recipe.

Ingredients• 3 small cans (15 ounces total) white tuna in packed water,

drained (choose low sodium tuna if needed)• 2 cups canned white navy beans, drained (choose low-

sodium beans if needed)• 1 cup cherry tomatoes, quartered• 1 cup cucumbers, cut into bite-sized pieces• ½ cup red onion, sliced• 1 avocado, peeled, pitted, and cut into bite-sized pieces • 3 tablespoons olive oil• 2 tablespoons lemon juice• 2 tablespoons balsamic vinegar• 2 cloves garlic, minced• ¼ cup cilantro, chopped • Salt and pepper to taste

Directions

1. In a large bowl, mix together olive oil, lemon juice and balsamic vinegar.

2. Add all other ingredients and mix well.

3. Chill before serving, if desired.Servings: 6 to 8

Nutrition AnalysisThe table below shows nutrition content of the recipe (using the U.S. Department of Agriculture’s Food Tracker)

Why It’s HealthyThis recipe is beneficial for your diabetic, hypertensive or obese patient because it’s loaded with lean protein, fiber, healthy fats (including omega-3 fatty acids), and complex carbohydrates from veggies. Patients can prepare it as a side or main dish as it pro-vides the perfect balance of macronutrients, vitamins, and min-erals, helps keep blood sugar in check, boosts satiety, and is low in sugar and saturated fat. Encourage hypertensive patients to choose low-sodium tuna (or grilled chicken instead), low-sodium beans, and omit extra salt.

Per Serving Entire Recipe

Calories 219 calories 1,534 calories

Fat 9 grams 66 grams

Protein 19 grams 123 grams

Carbohydrates 17 grams 122 grams

Fiber 5 grams 35 grams

HEALTHY RECIPE

LATEST SLEEP RESEARCH

New Study Finds Prebiotics Help Improve SleepOne in three American adults don’t get recommended amounts of sleep regularly (at least seven hours nightly), the Centers for Disease Control and Prevention (CDC) reports. While skimping on sleep because of busy day-to-day life-styles is often the culprit, stressful life events and poor sleep quality are other causes of chronic sleep deprivation. A new study says prebiotics may improve poor-quality sleep related to stress.

What are Prebiotics?Prebiotics are non-digestible, natural components in foods linked with promoting helpful bacterial growth in the gut. Ex-amples of prebiotics include inulin, galactooligosaccharides and fructooligosaccharides, which are found in plant foods -- and available in supplements. Many fiber-rich foods are nat-urally rich in prebiotics; examples include garlic, leeks, on-ions, chicory, asparagus, artichokes, bananas, yams, sweet potatoes and whole wheat.

New Research FindingsStress disrupts healthy sleep patterns, according to a study published in 2017 in Frontiers in Behavioral Neuroscience. Researchers who conducted this study examined effects of prebiotics, lactoferrin, and milk fat globule membrane on sleep -- and found prebiotics taken for four weeks enhanced sleep quality in mice exposed to stress. Researchers say because getting sufficient sleep impacts brain development and function, eating a prebiotics-rich diet beginning early in life may promote optimal psychological and brain health.

Another study published in 2017 in the Journal of Clinical Sleep Medicine found that high fiber intakes (and lower satu-rated fat and sugar consumption) are associated with deeper, more restorative sleep in humans. Not all high-fiber foods are rich in prebiotics, but encouraging patients to boost fiber is important since many Americans get too little of this essen-tial nutrient.

A third related study examined effects of prebiotics on stress and depression, which can alter sleep patterns. This 2017 study published in Biological Psychiatry found that fructooli-gosaccharides and galactooligosaccharides reduced markers of stress, anxiety and depression in mice.

How It WorksPrebiotics appear to reduce stress-related sleep disturbanc-es because these food components attenuate gut changes associated with stress. The 2017 study in Frontiers in Behav-ioral Neuroscience found that rats consuming prebiotics had higher numbers of lactobacillus rhamnosus (probiotics) in fecal material. Good bacterial balance in the digestive tract plays a role in gut and central nervous system interactions, brain chemistry regulation, and the human body’s response

to stress, anxiety and memory function, says a review pub-lished in 2015 in Annals of Gastroenterology.

Practical Patient AdviceEarly research indicates beneficial effects of prebiotics on stress and sleep, but more research is needed (especially human trials) in this realm.

When speaking with patients who are have trouble sleep-ing, encourage them to:• Eat a healthy diet rich in prebiotics and fiber (fruits, veg-

etables and whole grains)• Get regular exercise (but avoid night time workouts)• Stick with a regular sleep schedule• Get at least seven hours of sleep nightly• Avoid late afternoon naps• Avoid alcohol, caffeine and nicotine late in the day• Manage stress when possible• Avoid going to bed hungry or very full• Keep sleeping areas cool and quiet (consider using a

white noise machine or fan)

Bottom LineIt’s too soon to recommend prebiotic supplements as sleep aids, as more research is needed. However, early research shows promising results.

If you know a patient who is having trouble sleeping and would like help,

direct them to the NMCSD Nurse Navigator to enroll in an upcoming Sleep Management

Class at a clinic near them.

619-524-0113

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Meet the members of your Care Team who take their healthcare beyond the walls of NMCSD. These practitioners inspire by leading a healthy & active lifestyle.

We recently interviewed Pedriatric RN Jen Cassel about working at NMCSD and leading a healthy lifestyle. Here is what she had to say:

Why do you love working at NMCSD?As a civilian, I love that I’m being of service to the Navy com-munity. And as a Nurse, I’ve found such a sense of com-munity working at the hospital, there is a real family-like atmosphere here at NMCSD that is different from working in a private sector hospital. Providers and staff are genuine-ly friendly and courteous and everyone takes pride in their work. There is a real collaborative effort to improve patient outcomes.

I also love that I’ve been encouraged to further my education and skill set by my mentors here at NMCSD. This is truly a teaching hospital.

Why did you choose to go into Pediatrics?Pediatrics gives me the platform to be fun with the kids. I love being playful, interactive and creative at work and peds allows me to do that. Working with kids keeps me young, as I’m learning about new games, cartoons, and toys through them. I also get to work with the parents as well, so I’m for-tunate to use my full capacity as a provider when it comes to patient interaction.

In the Pediatrics Department at the hospital, you can feel the child-like spirit and we aim to keep everyone smiling and happy. On Easter, I wore bunny ears and put mindful quotes

in the eggs for the kids easter-egg hunt. That doesn’t really get to happen in other wings of the hospital.

When kids are at the hospital for longer stays, we work hard to accommodate and support the family. We want them to feel like family here.

How do you stay healthy yourself?I surf, run and do yoga regularly and those three activities provide a great balance for body, mind & spirit. I’m adven-turous and love being outdoors, so I hike whenever I have time too.

I make time for social connections with friends. Every Mon-day, I meet up with a friend and we cook a healthy meal together and watch our favorite TV show. I also brew my own kombucha to keep my gut happy!

I travel often also. I enjoy ex-ploring other cul-tures and seeing how others are living their lives. It helps me to appreciate my life. I also love meeting new people and gain-ing new perspective whenever possible and travel allows that. I think it’s important to keep growing and exploring through life.

Photo below: NMCSD Pediatric RN Jen Cassel and ENS Kaitlyn Kelley, RN at Wanderlust 108 5k Run & Yoga Event in San Diego on April 15th.

MODEL THE WAY

“I’ve found such a sense of

community working at the

hospital, there is a real family-

like atmosphere here at

NMCSD...”

- PEDIATRIC RN JEN CASSEL

BECOME A CONTRIBUTOR

We want to share your patient success stories, health tips and expertise with both patients and providers at NMCSD. We can utilize your content in a future newsletter, on social media or videos shown in our clinics.

We are looking for contributors to share the experience of care at NMCSD and to help patients learn more about healthy living practices. Please reach out to Alyssa.a.brown.ctr@mail.mil to learn more.

WAYS TO LOWER PROSTATE CANCER RISKS

Among U.S. men, prostate cancer is the most common can-cer (aside from skin cancer) and a leading causes of death, says the Centers for Disease Control and Prevention (CDC). That’s why knowing about ways to keep prostate cancer risks low is important.

1. Consume Lycopene-Rich Fruits and Veggies

A fruit- and veggie-rich diet is one way to keep cancer risks at bay. More specifically, lycopene (an antioxidant found in red and pink fruits and veggies) may play an important role. According to reviews published in 2015 in Medicine and Plos One, higher lycopene consumption is associated with lower prostate cancer risks. Good sources of lycopene include to-mato products (raw tomatoes, tomato juice, tomato sauce, tomato soup, and tomato paste), pink grapefruit, apricots, pink guavas and watermelon.

Patients who want to reduce prostate cancer risks can be encouraged to incorporate these foods (and a variety of oth-er fruits and veggies) into their daily meal plans. The Dietary Guidelines for Americans 2015 - 2020 suggest getting 2 1/2 to 3 1/2 cups of vegetables and 2 cups of fruits in daily when eating 2,000 to 2,600 calories per day.

2. Enjoy Green Tea

It’s true that more research is needed studying effects of green tea on prostate cancer prevention, but so far results appear promising. According to a review published in 2017 in Nutrition and Cancer and the National Cancer Institute, green tea seems to lower prostate cancer risks -- especially among high-risk patients with high-grade prostate intraepithelial neoplasia. Because green tea pro-vides a host of other po-tential health benefits, you can’t go wrong rec-ommending it (in moder-ate amounts) to patients.

3. Ejaculate Regularly

It appears frequent ejaculation may play a key role in prostate cancer prevention, according to a study published in 2016 in European Urology. Researchers who conducted the study say men who reported higher ejaculation frequencies (at least 21 times monthly) in adulthood were less likely to be diagnosed with prostate cancer than men who ejaculated four to seven times per month. A 2015 review published in Archives of Ital-ian Urology and Andrology confirms that more frequent ejacu-lations seem to protect against prostate cancer.

4. Reduce Belly Fat

Central obesity (excess belly fat) is a risk fac-tor for prostate cancer, according to a study published in 2016 in Prostate International. Researchers who con-ducted another study published in 2015 in Urologic Oncology say higher prostate cancer risks are associated with waist circumferences greater than 40 inches in men, and waist-hip ratios greater than 1.

To help reduce abdominal obesity, encourage patients to boost fruit and vegetable intake, eat plenty of lean protein foods, and reduce animal fat, added sugar, and refined carbo-hydrates (like white bread, white rice, and commercial baked goods). Participating in cardiovascular and resistance-training exercises regularly and getting plenty of sleep can also help reduce belly fat.

5. Keep an Eye on Aspirin Research

New research indicates taking low doses of aspirin regularly may affect prostate cancer risks. One study published in 2016 in the International Journal of Cancer found that patients tak-ing low-dose aspirin at least two times weekly had a lower inci-dence of prostate cancer. And, a review published in European Urology in 2017 says patients who take aspirin regularly (more than three tablets weekly) have lower risks for lethal prostate cancer and overall mortality compared to patients who don’t use aspirin. Researchers who conducted this study say taking aspirin after being diagnosed with prostate cancer may inhibit cancer progression and improve survival rates.

How to Advise PatientsThe best patient advice for lowering prostate cancer risks is to exercise regularly, eat a nutritious diet rich in fruits and vegeta-bles, maintain a healthy weight, keep off excess belly fat, and get plenty of rest (adults should aim for at least seven hours nightly). Keep an eye on new research examining effects of as-pirin on prostate cancer.

Believe it or not, the sun can damage skin in just 15 min-utes. A 2017 PubMed Health report says skin cancer is the most common cancer in the U.S., and 2 million people are diagnosed with this condition annually. Fortunately, patient education can help prevent and catch skin cancer before it becomes life-threatening.

Types of Skin CancerTwo main types of skin cancer are nonmelanoma (squamous and basal cell) and melanoma cancers. • Nonmelanoma skin cancer forms in skin cells that don’t

make pigment, and rarely spreads to other parts of the body.

• Melanoma skin cancer forms in skin cells that make pigment, is less common, and is more likely to spread to other parts of the body. PubMed Health says that while melanoma represents less than 5 percent of skin cancers, it’s the most deadly.

Sun Protection TipsYou can still encourage your patients to have fun in the sun, but need to emphasize sun safety.

The following tips are useful cancer-prevention strategies for patients:

• Avoid indoor tanning beds• Wear protective clothing, such as long sleeves and hats

that cover your ears, face, and back of the neck• Use umbrellas to shade yourself from the sun’s rays• Don’t forget eye protection (choose sunglasses that

protect against UVA and UVB rays)• Use sunscreen with sun protection factor (SPF) of at least

15, and reapply every two hours (and after sweating, swimming, or toweling off)

• Use caution during the hours of 9:00 am to 4:00 pm when the sun’s rays is strong, especially in late spring and sum-mer months

Benefits of Vitamin B3 SupplementsA study published in 2015 in The New England Journal of Med-icine found that giving high-risk study subjects 500 milligrams of oral nicotinomide (a vitamin B3 supplement) twice daily cut basal-cell and squamous-cell skin cancers by 23 percent after a period of 12 months. While this result is significant, the study didn’t examine effects on melanoma skin cancer (the most dan-gerous type).

Skin Cancer Risk Factors The following factors increase patient skin cancer risks:

• Fair skin• Blue or green eyes• Red or blond hair• Having freckles or numerous (more than 50) moles• Skin that burns easily• Frequent sunburns• Unprotected UV radiation exposure• Regular sun exposure• Family or personal history of skin cancer• A weakened immune system• Arsenic exposure (click here to learn more)

SKIN CANCER PREVENTION

Skin Cancer Screening RecommendationsFor patients without a history of skin cancer who don’t have suspicious skin spots or moles, the Centers for Disease Con-trol and Prevention (CDC) says there isn’t enough evidence to recommend for or against routine skin cancer screenings. But patients should be encouraged to report unusual skin or mole changes to their healthcare provider, and chat with a doctor if they’re at risk for skin cancer (have a family history of skin can-cer, etc.).

Identifying MelanomasKnowing what to look for helps identify and treat melanomas before cancer spreads to other parts of the body.

Patients should be aware that melanomas often have the following characteristics:• Are wider than 6 millimeters (1/4 inch) in diameter, which

is the size of a new pencil eraser• Are dark black or contain more than one color (might be

different shades of black, tan, brown, gray, white, pink, red or blue)

• Might be lumpy or hard, ooze or bleed, or break down and look scraped

• Are asymmetrical or irregular in shape with uneven, scal-loped, ragged, blurred, or notched edges

• Evolve over time (may change shape, size, color or eleva-tion -- or start to itch, ooze, bleed, or become crusty)

Important Patient Advice Sun protection and early detection are important skin cancer prevention strategies to stress to patients. Because skin cancer is treatable, especially when caught early, patients should see a provider right away if they notice any suspicious or changing moles (or other skin spots).

FOLLOW US!

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ALL ABOARD!Check out these stops on our new Medical Home Port (MHP) Website!

Learn about your MHP Care Team & clinic support services.

Find out about Health Education classes available to you and your family – at no cost!

Quick access to community resources, like RelayHealth, Mind Body Medicine, Fleet & Family Services and more...

Connect with your Nurse Navigator for help navigating the MHP & other NMCSD resources!

SKIN CANCER PREVENTION