It dawned on me the other day – after a specific incident I’ll mention in a moment – that despite all the joy and exhilaration of this season, it’s also one that can be loaded with danger if we’re not careful. And that’s exactly what we’re NOT during this month because there’s too much to do and because we’re rushing to get it all done.  

Let me backtrack. I’m terrified of falling. You already know that if you’ve read our book or have seen prior blogs (http://www.smartwomanshealth.com/horn_miller_blog/?p=282). Because of this, I am extra cautious about watching where and how I walk when doing stairs, and of course, when there’s been rain or snow or ice. We had a huge snowstorm over the weekend; in fact, it set a record for December snowfalls in Baltimore (a bit over 20 inches).Despite thinking I was being careful yesterday on the first day out after the snowstorm, I missed seeing a patch of ice as I was coming out of the grocery store, and the next thing I knew, I was flat on the ground with the hot tea from my cup spilled all over me. The only thing good about it was that it happened so fast that I didn’t have time to get that awful feeling you get AS you are falling.

That fall started me thinking that perhaps I had NOT been as cautious as I usually am, or that I had been in such a hurry because of all the things I had to do, that I was distracted. And this led me to the realization that distraction – due to rushing and being more overprogrammed than usual – can cause many unforeseen dangers during this busy and harried season.  

So, I made a list of these potential hazards that may occur because we are too busy, rushing too much, or overtired.

·        Falling or having an accident (car or other)

·        Overeating

·        Eating too much sugar

·        Drinking too much alcohol

·        Smoking too much or starting to smoke again

·        Spending too much money

·        Not getting enough sleep

·        Not getting enough exercise

·        Being emotionally raw and losing your temper unnecessarily

·        Getting depressed and not realizing it

·        Completely missing the joy of the season

Now, doing any of the above for a short period of time may not be harmful, but the Holiday Season generally lasts at least one month or more for all of us. And so does the rushing around and the lack of attention to our routine daily lives. Doing any or all of the above for a month or so can be devastating to our health, especially since it can lead us to break all our good habits from the prior ten or eleven months.

The simple remedy? SLOW DOWN and FOCUS.  Be aware that rushing and being distracted and trying to do too many things can put you at risk for an accident or worse.  Tell yourself that it’s ok if: 1) you don’t get your Holiday cards out until after Christmas or 2) you’re late to a holiday party or 3) you give someone on your list a gift card to Amazon instead of picking out the perfect present or 4) you send store-bought cookies to the school party instead of baking them yourself , and so forth. You get the picture.  Remember that all the perfectly-chosen gifts and home baked cookies in the world are not worth anything if they cost you your good health habit,  and thus, your good health.

Wishing you and yours a joyful and slow upcoming holiday weekend – Merry Christmas and Happy Kwanzaa! And hope your Chanukah was wonderful.

If you’re feeling blue right about now, and wondering why, you’re not alone. The holiday season is well known for bringing on sadness, or for worsening a depression that was present previously.  There are many reasons for this, but the most obvious is that holiday time is usually family time – at least it is as portrayed in the advertisements in all forms of media. And whether you’re missing family members who are no longer here, or remembering past Decembers that were happier than this one, this time of year can be one of sadness.

There is also another important reason that the December holidays can make you feel down, and that is the time of year itself. These are the shortest days of the year, which obviously means that our exposure to sunlight at the lowest of the year. What’s the connection? You’ve probably heard of “seasonal affective disorder” (also referred to as “SAD”).  This is a type of  depression that occurs in some people at the same time(s) every year, and that is related to the seasons – more specifically it is related to the lessening amount of daylight.

What are the symptoms? They can be identical to other forms of depression and can include everything from increased fatigue to extreme moodiness to irritability to social withdrawal to full blown anxiety and hopelessness. And like other types of depression, you can actually get physical symptoms including sleeping too much, a change in appetite, decreased ability to concentrate, and even weight gain.

What makes SAD different from other depressions is that the symptoms can come out of the blue, with no real reason. What I mean by that is that usually with SAD, you cannot figure out why you feel so blue since it seems that everything else in your life is ok for the moment. In addition, if you were already suffering with depression, you can still get SAD. This can translate into worsening of your symptoms, even if you are on antidepressants. Although this can happen with other forms of depression, with SAD, it is more common that there is no precipitating cause of your feeling down.

People with SAD are thought to produce too much melatonin in their bodies which then causes a disruption in our internal clocks. In addition, whether or not you will get SAD is related to genetics and to age. The most common time of the year for people to suffer with SAD is right now – during the shortest days of the year. But it is not uncommon for people to get SAD and its symptoms at other times of the year when the seasons, and thus the amount of daylight, change; these include late August- early September, and March-April.

How is it treated? Some experts feel that antidepressant medications (or increasing the dosage if you are already taking them) is enough to treat SAD. But many others feel that the best way to treat it is by what is called “light therapy.” Now this is not, as it sounds, just turning on all the lights or staring into your lamps.  Light therapy for SAD must include a very specific type of light, from which you sit at a very specific distance for a prescribed amount of time daily.  For instance, the light must be of adequate intensity; if you use a light of 10,000 lux, you must be exposed to it for 30 minutes daily. If your light is of 5000 lux, then you have to use it for a full 60 minutes daily. The prescribed distance you should sit from the light is 12-18 inches. It is usually recommended that you use it in the mornings.

Yes, you can get your own light and use it without a prescription. BUT, it is always a good idea to let your clinician know you are doing it, especially because the therapy can have side effects such as eyestrain and headaches. And, your clinician should also know about your symptoms, as you may need medication in addition. Lastly, since some insurance companies will pay for the light itself, you should let your clinician know so that he/she can give you a prescription so that the light will be covered by insurance.

SO, if everything is going well in your life – except for the crazy schedules of the season-  and you suddenly are feeling like you don’t want to go to those holiday parties or even get out of bed,or, if you’ve been mildly blue, but it has increased recently, then consider that you may have SAD.  The good news is that SAD can be treated and in some cases, light therapy brings about improvement even more quickly than do antidepressant medications.  Talk to your clinician about your symptoms, and don’t just assume that you’ve become a Holiday Grinch.

For further information on light therapy, go to: http://www.mayoclinic.com/print/seasonal-affective-disorder-treatment/DN00013/METHOD=print

There are many foods we hear about that are considered junk food and often on the “forbidden” list, but they really aren’t bad for you. Here are a few that may surprise you – just in time for the holidays!

Sour Cream

It is true that sour cream is 90% fat. However, it is usually only eaten in small quantities. A serving of sour cream is two tablespoons and is only 52 calories. This is less saturated fat than is in a 12-ounce glass of 2% milk.

Coconut

Coconut is packed with saturated fat. However half the fat is lauric acid. A recent review has found that lauric acid can increase the LDL or “bad” cholesterol levels, but it boosts the HDL or “good” cholesterol more. The rest of the fat is made up of medium chain fatty acids, which are neutral. A pinch of unsweetened shredded coconut can make a nice snack, or at least can add some flavor to another snack. Just don’t overdo it as it is high in calories.

Chocolate

Chocolate has been given a bad rap in the past. However, dark chocolate is rich in flavonoids. These compounds (also found in green tea and red wine) have been found to reduce inflammation and relax blood vessels, improve blood flow, and even improve your mood. Three ounces a day can decrease blood pressure. Once again, moderation is the key when it comes to eating chocolate. The recommended amount is the equivalent of 2 Hershey kisses a day.

Pork Rinds

Pork rinds are made from fried pigskin. Sounds fatty?! However, a one-ounce serving contains 9 grams of fat, 17 grams of protein and NO carbohydrates. Almost half the fat is unsaturated and in the form of oleic acid (the same healthy fat found in olive oil); the rest is saturated fat that is in the form of stearic acid and considered harmless. The key, if you like these, is not to go overboard.

Beef Jerky

Beef jerky is often thought to be high in preservatives and not particularly healthy. However, it doesn’t have to be unhealthy if you get the right brands. It is a great high protein snack that won’t raise your insulin levels. The key is to find it with all natural ingredients (without MSG, sodium nitrate and chemicals). For variety and omega-3 fatty acids, make sure to get grass-fed beef or give salmon jerky a try!

Taking a folic acid supplement has long been recommended to pregnant women to lower the risk of low birth weight, preterm delivery, and defects in the development of the baby’s neurologic system.  In fact, in 1998, the U.S. required that flour and other whole grains be fortified with folic acid for this very reason.

 Taking it as a supplement is also recommended to adults in midlife and older for specific medical problems in which folic acid deficiency is playing a role. Some of these include: 1) a certain type of anemia (low red blood cell count)  related to Vitamin B12 deficiency;  2) liver disease; 3) alcohol abuse or overuse;  4) kidney dialysis;  5) problems with absorption in the gastrointestinal tract; and 6) in people on certain drugs such as antiseizure medications, among others.

In recent years, folic acid supplementation for older adults has been in vogue for prevention of heart disease, though no studies have shown such a benefit, and more recently, for stroke prevention. In fact, a study showing that folic acid was effective in preventing strokes was released just as we were writing our book, although appropriate dosages were unknown.

 Now comes research from Norway (Ebbing M et al. JAMA 2009 Nov 18.)* in which the results of two separate trials of folic acid supplementation were combined, and included nearly 7000 people.  (Of note, Norway does not mandate folic acid fortification of foods.) Study participants received either folic acid plus Vitamins B12 and B6; folic acid plus B12 only; B6 alone ; or placebo.

After following the patients for an average of 6 years, it was found that those who took folic acid had a 21% greater risk for developing cancer than those who did not take folic acid.  Interestingly in another study in 2009, it was shown that folic acid supplementation increased the risk of prostate cancer.  Since it is known that folic acid can impair the immune system’s surveillance of cancer cells, and may even stimulate growth of already established cancer cells,  these findings are not all that surprising from a biologic point of view.

So, where does that leave us adults in midlife and older with respect to folic acid supplementation? Do we take it and possibly prevent heart disease or strokes, but risk an increased chance of cancer? The answer is not simple; as with all good medicine, it involves taking a personal approach and weighing the risks vs. the benefits in terms of  your particular case given your health profile.  The best answer is definitely not the same one for everyone.

Since we now know that there may be a risk in taking folic acid in amounts over what we get in our diets, and the benefits of it in terms of cardiovascular disease and strokes are not definite, the safest approach – based on our CURRENT knowledge – is NOT to take extra, or supplements of, folic acid unless you have a specific medical reason, or a folic acid deficiency. Unless you have one of the conditions that lead to folic acid deficiency mentioned above, you should be able to get all you need in your diet. 

What foods naturally contain folic acid? Leafy green vegetables (like spinach and turnips), citrus fruits, and dried beans and peas. Should you avoid whole grains and foods containing flour since they are fortified with folic acid – so that you can avoid getting too much? Most experts believe that even with the fortification in these foods, the American population is still within safe limits in terms of the amount of folic acid in the diet.

There’s a good lesson in all this. Trends in nutrition and vitamin supplementation come and go. New information and scientific studies are constantly coming out. Speak to your clinician before you take supplements of folic acid, or anything else for that matter.  Remember: vitamin and herbal supplements can have negative effects too. Don’t go buying lot of vitamins and herbs in hopes of staying healthy or living forever. You will probably do better in the long run to simply eat a healthy diet.

*(Ebbing M et al. Cancer incidence and mortality after treatment with folic acid and vitamin B₁₂. JAMA 2009 Nov 18; 302:2119)

You know how every month of the year has been designated as “National Awareness Month” for a specific condition or disease? Just recently, The American Foundation for Paying Attention to Things (AFPAT) has declared this December as “National Awareness Month” in an effort to combat what they see as “the current epidemic of complete and utter obliviousness” in America.  They further say that not only are Americans suffering from an epidemic of general unawareness, but that Americans are even unaware that they are unaware!

As with all other awareness campaigns, especially those related to health, the National Awareness Month campaign includes a recommendation for screening, or self-exam, for the disorder. The suggestion is that at least once a year, you:  while making eye contact with yourself in the mirror, take 3-5 minutes to think about the fact that you are a human being. 

The AFPAT of course has many activities planned for this month, including  a charity walk, advertising campaigns, and the wearing of a 9 inch highly-reflective yellow ribbon.

So, what do you think? Do you have time for one more self-exam and one more thing to be aware of?!

Here’s a link for more info: http://www.theonion.com/content/news/december_named_national_awareness

Insomnia is becoming a cultural problem. In 1999 a survey found that 30% of American men and 20% of women used medication to help them sleep in the course of a year.

There are a variety of medications available. They may help for the short term, but it is really important to get to the root cause of the sleep problem. For some, it may be sleep apnea. For others, it may be anxiety or depression. There may be medical conditions that are causing sleep problems. If you have a problem sleeping, see your doctor. That said, I will run through the medical options for sleep. There are a variety of options.

Over The Counter Medications

Most of the over the counter medications contain antihistamines that cause drowsiness. These are medications such as Tylenol PM, Sominex, Unison, and Benedryl. These medications can cause dizziness, daytime sleepiness and dry mouth.

Natural Remedies

Melatonin is one of the more popular natural remedies. In studies, it has been found to help people fall asleep but may not increase the total sleep time or reduce daytime fatigue. It has been found to benefit the elderly who have low melatonin levels. It has helped people who are blind to maintain their circadian rhythm. It has been found to have benefit to some who are jet lagged. There is no set dose. Some recommend as little as 0.3 mg at bedtime for insomnia. High doses may actually keep people awake. Rozerem isn’t really natural, but it acts on the melatonin receptors and has a similar effect on sleep. It has the side effect of potential dizziness and daytime drowsiness. Valerian is an herb that can be helpful for sleep. It takes one to two weeks of continued use to work. The usual dose is between 300 and 600 mgs. It is relatively safe but can cause vivid dreams, and has been reported to cause abnormal heart rhythms in high doses. Chamomile tea is safe and relaxing and can be very helpful for those who have mild sleeping problems.

Prescription Drugs

Long acting drugs include Klonopin , Restoril, and Dalmane. These drugs are in the benzodiazepine family. They can cause depression, depressed breathing, memory loss (sleep walking), and overdoses can be fatal. These drugs should not be mixed with alcohol. They can become habit forming. Short acting non-benzodiazepines include Sonata, Ambien, and Lunesta. Sonata is very short acting and can be taken if you can’t fall back to sleep in the middle of the night. Ambien and Lunesta are better if you take them at bedtime as they are longer acting than Sonata. Ambien and Lunesta are particularly useful for people with jet lag. Side effects include dizziness, nausea, amnesia with sleepwalking and headache.

Other Prescription Drugs Chloral Hydrate is rarely used due to the risk of addiction. As we know from Anna Nicole Smith, when chugged from the bottle and mixed with other drugs it can be fatal. These medications and supplements are not meant to be used long term. Many can result in rebound insomnia when they are stopped. Some can interfere with the sleep cycle so that the sleep isn’t as restful a natural sleep.

If you have a sleep problem, it is important to consult your doctor and find ways to sleep without medication

There are many ways that you can improve your immune system and ward off colds and viruses. It can be as simple as eating the right foods and exercising!

Foods that Boost your Immunity

Omega 3 fatty acids that are found in fish, flaxseed, and walnuts reduce inflammation and help strengthen the immune system. You might want to shoot for at least two servings a week.

Protein

Zinc is important for white blood cells to function properly. The white blood cells are the cells that fight infection. Zinc is found in protein such as lean meats, chicken, eggs, and tofu. It is also found in fortified foods. It is important to eat adequate amounts of these zinc containing proteins.

Fruits and Vegetables

Brightly colored fruits and vegetables are loaded with phytonutrients. Phytonutrients improve the immune system and can help to fight cancers as well. Not to mention, they are just plain good for you!

Citrus

Citrus fruits contain vitamin C. This vitamin can help ward off colds. Although you can find it in supplements, it is probably more effective if you can get it in food such as oranges and grapefruit.

Nuts

Nuts contain vitamin E. Vitamin E is an antioxidant vitamin that helps to fight colds and upper respiratory infections. The best nuts for vitamin E are sunflower seeds (1/4 cup), almonds (1/4 cup) and 2-3 brazil nuts (they also contain selenium).

Garlic

Garlic has immune boosting properties that fights bacteria and viruses. If you have a cold, the best way to use garlic is to chop it up and swallow it. You can use it as a paste on bread or mixed in applesauce. Don’t chew it if you don’t want your breath to smell!

Chicken Soup

The hot liquid of chicken soup clears the nasal passages. However, something about most chicken soup helps boost the immune system and helps to fight colds. Whether it is the soup or the love with which it is cooked, chicken soup works!

Mushrooms

Mitake, shitake, and reishi mushrooms are among the mushrooms that help boost the immune system. You can stir fry them or get them in capsules (fungi.com). Better yet, put them in your chicken soup!

Exercise

Regular, moderate exercise allows the cells that fight viruses and bacteria to circulate more quickly throughout the body. While they are getting an energy boost, they give your immunity a big boost. The more you exercise, the longer lasting the immune effect. That is another reason why exercise is so important.

In Summary

By eating well and exercising, you can increase your odds of having a healthy cold-free winter!

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month. Our final blog from the past is about an issue we should be aware of all the time, but especially in the summer with much of our eating taking place outdoors which can lead to barbecuing (and undercooking) and no refrigeration.  

Monday 23 Nov 2009

Now that Thanksgiving is right upon us, and the rest of the Holidays are around the corner – all of which have a feeding frenzy associated with them – a warning about food-borne illnesses is timely. My husband could quickly give you an example of a food-borne illness because he’s been upset with me ever since I told him to be careful about eating hamburger meat due to the recent outbreaks of E. Coli infection associated with that particular food.

So, why should you worry if you don’t eat hamburger? Because the Centers for Disease Control and Prevention (CDC) estimates that 76 million Americans get sick from food-borne illnesses each year. And that’s just the tip of the iceberg because not all food-borne illnesses are even reported to public authorities.

A recent study done by the Center for Science in the Public Interest (CSPI), reported on October 9, 2009, found that even some of the healthiest foods can carry food-borne infections. The CSPI group analyzed information on food-borne illnesses from the most recent all the way back to 1990; the information was based on the CDC’s data.  The authors found that the most common organisms causing the illnesses included norovirus, and E. Coli and Salmonella bacteria.

What specific foods were most likely to carry an organism that caused a food-borne infection and illness? The authors found that leafy green vegetables were the food type that was responsible for the highest number of outbreaks, causing approximately 13,600 illnesses during the time period studied.

Here is a listing of the rest of the top ten foods responsible for food-borne illnesses during this period.

• Eggs, involved in 352 outbreaks and 11,163 reported cases of illness.
• Tuna, involved in 268 outbreaks and 2,341 reported cases of illness.
• Oysters, involved in 132 outbreaks and 3,409 reported cases of illness.
• Potatoes, involved in 108 outbreaks and 3,659 reported cases of illness.
• Cheese, involved in 83 outbreaks and 2,761 reported cases of illness.
• Ice cream, involved in 74 outbreaks and 2,594 reported cases of illness.
• Tomatoes, involved in 31 outbreaks and 3,292 reported cases of illness.
• Sprouts, involved in 31 outbreaks and 2,022 reported cases of illness.
• Berries, involved in 25 outbreaks and 3,397 reported cases of illness.

An important issue about the above listing of specific foods is that the CDC’s database cannot discriminate whether the specific food caused the illness, or whether it was other foods mixed with that food; for instance whether tomatoes alone caused an illness, or if tomatoes were in a salad, whether it was the other ingredients of the salad. The authors of the study also caution that since potatoes are almost always eaten cooked, it was probably a food eaten along with the potato that caused the illness.

Having said all that, the above list is pretty scary, right? Especially when you remember that this is an underestimate of the actual number of illnesses caused by food borne infections.

Is there anything you can do to prevent a food-borne infection from ruining your happy and healthy holidays? Absolutely. 

·        Always keep fresh (and frozen) food products cold.

·        Always be sure to thoroughly cook your food.

·        Always keep your food preparation area clean and sanitary.

·        Avoid eating raw eggs or using them in recipes, including ice cream.

·        Keep foods, like oysters, chilled. Avoid eating them raw.

·        If you do eat raw oysters or sushi, be aware that they can carry organisms that can cause illness.

·        Wash your hands frequently!  Janet Horn

NEXT MONTH (which begins tomorrow) WE’LL RETURN TO ALL-NEW BLOGS – PLEASE STAY WITH US!!

Watch Out for Food-Borne Illnesses During the Holidays (and all the time)!

We felt that this needed to be posted again!

You may have heard that the U.S. Preventive Services Task Force (USPSTF) issued new recommendations for breast cancer screening this week, which include many changes from prior recommendations. There has been an outpouring of responses and media attention since the announcement was made. The American College of Radiology released a statement saying that these changed recommendations will result in “countless unnecessary breast cancer deaths each year.”  The American Cancer Society as well as the American College of Obstetrics and Gynecology also disagree with the recommendations, and believe that women should continue to follow the  prior recommendations. In fact, the Secretary of Health and Human Services issued a statement telling women to keep getting mammograms as they’ve been doing in spite of the USPSTF recommendations.

What are these new recommendations that have created such confusion among patients and controversy among physicians? The two major changes include:

·        not routinely screening (with mammograms) women ages 40-49, biennially screening women ages 50-74, and screening ages 75 and beyond based on general health;

·        discouraging teaching breast self-exams

What is the controversy? Previously, it was recommended that all women begin getting routine mammograms at age 40, and yearly thereafter. No age group  has been considered too old to get mammograms.  In addition, the teaching of breast self exam (BSE) has been for years a major part of the campaign for early detection of breast cancer.

This is confusing, but here’s what you need to know.

The recommendations were based on two reports, commissioned for this Task Force, that combined and synthesized research data from the past seven years, which was when the USPSTF made its last recommendations.  Several important results, which affected their recommendations. were found in these reports:

1) the largest number of mammograms that were false positive (ie, showed an abnormality that was not cancer when biopsied) occurred in women ages 40-49 – thus, mammograms in this age group led to many unnecessary biopsies;

 2) mammograms done every year do not significantly reduce the death rate from breast cancer, whereas mammograms done every two years do reduce the death rate significantly – this says that mammograms done every two years minimizes the risks while maximizing the benefits of mammography in the largest number of women;

3)teaching breast self-exam does not reduce the number of deaths from breast cancer, and can cause harm in that more unnecessary imaging and biopsies done in women who find abnormalities by BSE;

4) there was not enough information about the number of deaths from breast cancer in women ages 75 and older because the data showed that more deaths are due to heart disease and strokes in this group – therefore no recommendations could be made about mammograms for women of this age.

You can probably see from the above findings that the USPSTF based its recommendations on large groups of women in the general population, and not those with risk factors for breast cancer. In addition, their recommendations were made based on death rates caused by breast cancer; in studies that looked to see if mammograms affect the chance of living longer in a significant number of women, the answer was yes – early detection of breast cancer improves survival and saves lives. It almost seems that the recommendations were also based on what was cost-effective for the general population.

The most important point I want to make here is the same one we make in our book. Each woman has a unique medical history and lifestyle; because of this, decisions on your healthcare should be made based on your individual genetic make-up, medical history and lifestyle, not on generic recommendations made to all women. If you’re concerned about the frequency of your routine mammograms,  talk to your clinician about the best screening schedule for you, especially if you have a family history of breast cancer. If you don’t know your risk for breast cancer, ask your clinician to discuss this with you.  If you’re comfortable with BSE and wish to continue, then go ahead and do so. And DEFINITELY, if you find a lump in your breast, don’t ignore it.  See your clinician immediately about it.

The worst thing would be to become so confused or upset by these recommendations that you don’t do any preventive health maintenance. Remember, these are only recommendations and could (and probably will) change again at any time. Even the experts don’t agree on them. You should do what’s best for you and your health.  

The Holidays and upcoming winter are a popular time to go on a cruise. Especially since there’s nothing to worry about when you’re on a cruise. There are NO: meals to fix; house to clean; repairs to make; work to obsess over. The only concerns may be an outbreak of stomach flu (viral gastroenteritis) or a Titanic-like occurrence – both very low risk, right? Yes, for the Titanic-like happening; but for the outbreak – think again.

A recent study was published in Clinical Infectious Diseases (2009 Nov 1; 49:1312) in which a team of 46 medical professionals evaluated the cleanliness of  the public restrooms in 52 cruise ships over a three year period. Obviously, this was a covert operation.  The clever way that they were able to check for cleanliness included the application of a gel to objects in several restrooms at the start of each cruise by a team member; the gel was colorless and fluorescent (visible under ultraviolet light) and was easily removable by the light application of water. The restrooms were examined daily by the team member, and the gel was reapplied if it had been washed away.

Cleanliness varied widely from ship to ship, with scores from 100% to less than 5%! Although toilet seats were the best-cleaned objects overall, they were cleaned only 50% of the time. The handholding rails next to the toilets were often overlooked.  Baby-changing tables were the least cleaned objects, being cleaned less than 30% of the time.

In the event of an outbreak of gastroenteritis on a ship, the team member present on that ship was able to compare the cleanliness in the bathrooms before and after the outbreak.  Not surprisingly, those ships that had an outbreak had significantly lower cleanliness scores (measured before the outbreak) than did the ships with no outbreaks. However, the ships with the outbreaks had better cleanliness scores after the outbreak than they did before.

Moral of the story: don’t be complacent in thinking that your cruise ship is very clean as a matter of course. Better yet, consider booking a cruise on a ship that has just had an outbreak as the staff will be much more attuned to the importance of regular cleaning and sanitation! And – always wash your hands frequently.