wellmd dc-wellness-dr maryam makowski phd-shared
TRANSCRIPT
3/1/21
1
Wellness
Maryam S. Makowski, PhD, FACNClinical Assistant Professor, Department of Psychiatry and Behavioral Sciences
Associate Director of Scholarship and Health Promotion, WellMD & WellPhD Center
March 2021
1
Examples of Behaviors Affecting Wellness
Self-awarenessSelf-monitoring
Self-care
Wellness Role Models
Work/Rest/Relaxation/Fun
Sleep
Hydration Nutrition Physical ActivityPreventive/Indicated
Medical Care
Caffeine/Alcohol Intake
Other Lifestyle Behaviors
Mayo Clin Proc. 2019 Nov;94(11):2171-2177
2
Five Key Daily Habits
Move Get Adequate Sleep Eat 1 Serving of Green Leafy Vegetables
Keep HydratedCaffeine/
Alcohol Intake
3
3/1/21
2
Physical Activity
4
Kane L. Medscape National Physician Burnout, Depression & Suicide Report 2019
5
Strategies to Increase Daily Physical Activity
Personal: Engaging in 5-10 minutes of any physical activity few times a day
Organizational: Creating exercise facilities, biking or walking paths close to patient care areas
Curr Probl Pediatr Adolesc Health Care. 2019 Dec;49(12):100664
6
3/1/21
3
Sleep
7
Sleep-deprived Individuals Unaware of Their Sleepiness
Van Dongen, Maislin et al. 2003
8
Sleep-deprivation à Inaccurate Emotional Processing
9
3/1/21
4
Fatigue Risk Management :https://www.residentfatigue.ca/mssites/frm/index.html
10
Personal Strategies to Improve Sleep
• Insomnia: Cognitive behavior therapy effective without use of sleep medications (Trauer JM, Qian MY, Doyle JS et al 2015)
• Go to sleep within 1 hour of a consistent time.• Wake up within 1 hour of a consistent time.• Keep early afternoon naps to < 1 hour.• Avoid late afternoon/ evening naps.• Eliminate or reduce alcohol consumption prior to sleep time• Avoid eating 3-4 hours before going to bed• Keep the room dark, quiet, relaxing and at a comfortable temperature• Use eye masks, ear plugs, white noise machines
11
Organizational Strategies to Improve Sleep
• Providing private nap rooms or sleep pods• Improving efficiency of practice to reduce workload
Curr Probl Pediatr Adolesc Health Care. 2019 Dec;49(12):100664
12
3/1/21
5
Strategic Use of Caffeine
13
Caffeine• Increases alertness, attention, memory & reduces reaction time in sleep deprived
individuals
• Effective dose : 40- 400 mg
• Alerting effects peak about 75-90 min after ingestion
• Alerting effects last about 5 hrs
• Impairs sleep quality up to 12 hours after ingestion
• Increases sleep latency
Neurosci Biobehav Rev. 2016 Dec;71:294-312.
14
Half Life of Caffeine: 6 to 8 hours
8 am150 mg
2 pm75 mg
8 pm37.5 mg
2 am18.75 mg
9.38 mg
15
3/1/21
6
Strategic Use of Caffeine
•Have smaller amounts•Use to reduce sleep inertia (Van Dongen, Price et al.
2001, Hilditch, Dorrian et al. 2016)
• Before a nap (Caff-Nap) (Schweitzer, Randazzo et al. 2006)
• Waking up before your natural waking up time
•Use to reduce sleepiness after high carbohydrate meals (Kassis, Katz et al. 2013)
16
Alcohol Intake
17
Alcohol
ttp://w w w .niaaa.nih.gov/alcohol-health/overview -alcohol-consum ption/w hat-standard-drinkAdam Sherk et al. Canadian Journal of D ietetic Practice and Research, 2019, 80:111-115
120 calories150 calories 130 calories 100 calories
If you do choose to drink, do so in moderation: Up to 1 drink a day for women or 2 for men.
18
3/1/21
7
Excessive Drinking
• Heavy drinking: • Women: 8 or more drinks/week• Men: 15 or more drinks/week
• Binge drinking: • Women: 4 or more drinks during a single occasion in about 2-3 hours.• Men: 5 or more drinks during a single occasion in about 2-3 hours.
• Alcohol screening and brief counseling (5–14 minutes) can reduce how much alcohol a person drinks on an occasion by 25%
https://www.cdc.gov/vitalsigns/alcohol-screening-counseling/index.html ; Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services
19
Consequence of Excessive Drinking• Detrimental effects can last 14 hours• Impairs sleep quality • Interferes with the absorption of vitamin B group• Increases impulsivity and the risk of a suicide attempt • Increases risk of cancer• Overall absolute increase in cancer risk for one bottle of wine/week: 10 and 5
cigarettes/week for women and men respectively• May contribute to 5% to 11% of all breast cancer cases, with higher risks seen
among heavy drinkers. • 51% of healthcare providers don’t know alcohol is a risk factor for breast cancer
Alcohol and the M ale Reproductive System , Em anuele M A, Alcohol Research and Health, 2001; Alcohol C lin Exp Res. 2004 M ay;28(5):780-; BM C public health. 2019;19(1):316; Hydes TJ et al. BM C Public Health. 2019 M ar 28;19(1):316; Sinclair J, et al. BM J O pen 2019;9:e027371
20
Nutrition
21
3/1/21
8
Challenges in The 1st Year of Practicing as a Physician
50% 55% 60% 65% 70% 75% 80%
Heavy workloads
Irregular meal times
Long hours
BMJ 2013;347:f5095
22
Nutritional Status Can Affect Patient Care• Irritability and frustration (Lemaire, Wallace et al. 2011; Bushman, Dewall et al. 2014)
• Alertness (Lemaire, Wallace et al. 2011; Neely, Landstrom et al. 2004)
•Motivation (Neely, Landstrom et al. 2004)
• Episodic memory, concentration and executive function (Lemaire, Wallace et al. 2011; El-Sharkawy, Bragg et al. 2016 )
• Risk tolerance and decision making (de Ridder, Kroese et al. 2014;Singh and Launer 2018;
habat-Simon, Shuster et al. 2018;DanzigerS, Levav et al. 2011;habat-Simon, Shuster et al. 2018)
23
Eat One Serving of Green Leafy Vegetables Everyday
• Contain nutrients essential to mental health (LaChance LR, Ramsey D. 2018)
• May imporve cognitive performance and slow down the rate of age-related cognitive decline (Morris, Wang et al. 2017; Kang, Ascherio et al. 2005;Morris, Evans et al. 2006)
24
3/1/21
9
Smoothies
• Protein: Plain Greek yogurt, kefir, almonds, pistachios, cashews, pumpkin, sunflower or hemp seeds, natural peanut or other nut butters, tofu or protein powders
• Omega 3 fatty acids: Walnuts, chia or flax seeds• Antioxidants, vitamin C and fiber: Berries• Green leafy vegetables: Spinach, kale
25
Organizational Strategies to Improve Nutrition
Improve access to
• Affordable healthy food and snack options at workplaces
• Food storage and eating areas
• Areas to eat food with colleagues
Postgrad Med J. 2016 Aug;92(1090):478-81.
26
Hydration
27
3/1/21
10
Hydration Status Affects Cognitive Performance
• Vigilance• Attention span• Visual focus and acuity• Decision making• Sleep quality• Perception of task difficulty• Frequency of errors• Lapses in memory• Mood
Watson, Whale et al. 2015; Benton, Jenkins et al. 2016; Ganio, Armstrong et al. 2011;Armstrong, Ganio et al. 2012;Stachenfeld, Leone et al. 2018, Aristotelous, P., G. et al 2018
28
Time-release Fluids
29
Organizational Strategies to Improve Nutrition
• Improve access to
• Water fountains
• Toilets
Postgrad Med J. 2016 Aug;92(1090):478-81.
30
3/1/21
11
Five Key Daily Habits
Move Get Adequate Sleep Eat 1 Serving of Green Leafy Vegetables
Keep HydratedCaffeine/
Alcohol Intake
31
References• Menon NK, Trockel MT, Hamidi MS, Shanafelt TD. Developing a Portfolio to Support Physicians' Efforts to Promote Well-
being: One Piece of the Puzzle. Mayo Clin Proc. 2019 Nov;94(11):2171-2177. • Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, Rowe S, McCool JM, O'Donovan CA, Micek MA,
Stewart MT. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care. 2019 Dec;49(12):100664.
• Hamidi MS, Boggild MK, Cheung AM. Running on empty: a review of nutrition and physicians' well-being. Postgrad Med J. 2016 Aug;92(1090):478-81Gupta, S. Brain food: Clever eating. Nature 531, S12–S13 (2016).
• Krause, A., Simon, E., Mander, B. et al. The sleep-deprived human brain. Nat Rev Neurosci 18, 404–418 (2017).• McLellan TM, Caldwell JA, Lieberman HR. A review of caffeine's effects on cognitive, physical and occupational
performance. Neurosci Biobehav Rev. 2016 Dec;71:294-312.• Hsu DP, Hansen SL, Roberts TA, Murray CK, Mysliwiec V. Predictors of Wellness Behaviors in U.S. Army Physicians. Mil
Med. 2018 Nov 1;183(11-12):e641-e648.• Bazargan M, Makar M, Bazargan-Hejazi S, Ani C, Wolf KE. Preventive, lifestyle, and personal health behaviors among
physicians. Acad Psychiatry. 2009 Jul-Aug;33(4):289-95. • Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive Behavioral Therapy for Chronic Insomnia: A
Systematic Review and Meta-analysis. Annals of internal medicine. 2015;163(3):191-204.• https://www.residentfatigue.ca/mssites/frm/index.html - Fatigue Risk Management toolkit http://bit.ly/2RqhIN8
32
Resources
• How much alcohol is really in your drink? How many calories? What's the cost to you per week, month, or year?
https://www.rethinkingdrinking.niaaa.nih.gov/Tools/Calculators/Default.aspx• Dietary Reference Intakes (DRIs) Calculator for Healthcare Professionals:
https://www.nal.usda.gov/fnic/dri-calculator/• Healthy Eating Plate: https://www.hsph.harvard.edu/nutritionsource/healthy-
eating-plate/• Evidence-based information and recommendations related to Sleep Health:
https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health/ebrs• Physical Activity Guidelines: https://health.gov/sites/default/files/2019-
10/PAG_ExecutiveSummary.pdf• Hydration: https://www.gssiweb.org/en/sports-science-
exchange/Article/hydration-and-cognition-in-the-general-population
33
3/1/21
12
Thank You!
34