+ All Categories
Home > Documents > WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

Date post: 22-Feb-2022
Category:
Upload: others
View: 2 times
Download: 0 times
Share this document with a friend
12
3/1/21 1 Wellness Maryam S. Makowski, PhD, FACN Clinical 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-awareness Self-monitoring Self-care Wellness Role Models Work/Rest/ Relaxation/Fun Sleep Hydration Nutrition Physical Activity Preventive/ 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 Hydrated Caffeine/ Alcohol Intake 3
Transcript
Page 1: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 2: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 3: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 4: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 5: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 6: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 7: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 8: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 9: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 10: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 11: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

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

Page 12: WellMD DC-Wellness-Dr Maryam Makowski PhD-shared

3/1/21

12

Thank You!

34


Recommended