With children, it’s never too early to start practicing good sun protection behaviors. In fact, exposure to ultraviolet radiation and a history of sunburns during childhood greatly increases your risk of developing skin cancer later in life.
Nanette Silverberg, MD, Director of Pediatric Dermatology, Mount Sinai Health System, shares some tips for protecting your child’s skin, which is especially important during the warmer months when they may spend so much more time outside in the sun.
Nanette Silverberg, MD, Director of Pediatric Dermatology
Here are five basic steps you should take:
Look for sunscreens that have a sun protection factor (SPF) of 30-50+ and that say they provide “broad spectrum” coverage, meaning they protect against both UVA and UVB radiation. UVA rays have less energy and are mostly linked to long-term skin damage, such as wrinkles, while UVB rays are the ones that cause sunburns, which are thought to cause most skin cancers, according to the American Cancer Society.
Sunscreens should be applied 30 minutes before going outside for the day and then reapplied every two hours.
Sunscreens should be reapplied after swimming or heavy sweating, as they are not waterproof.
In addition to sunscreen, children should wear a wide-brimmed hat and sun protective clothing (UPF 50) such as swim shirts or rash guard shirts. These shirts typically block 98 percent of ultraviolet radiation, according to the Centers for Disease Control and Prevention.
Stay in the shade as much as possible, and avoid the mid-day sun during its peak hours of intensity from 10 am to 2 pm.
Even if you apply sunscreen and practice good sun care, your child may still get a sunburn. What should a parent do to minimize the sting?
Dr. Silverberg, suggests applying a cold compress, or bathing your child in cool water. Over-the-counter hydrocortisone one percent cream can also be helpful to ease red, itchy, or tender skin and help with inflammation. Hypoallergenic moisturizers can soothe the skin.
If the sunburn is painful or widespread, talk with your pediatrician about whether taking ibuprofen is appropriate for older children. If you notice any blistering, you should consider consulting with a pediatric dermatologist. Follow up to check for sun damage and be extra careful with sun protection on healing skin.
Post-pool skincare is also extremely important, especially for young children. Dr. Silverberg says most children tolerate chlorinated water, but she recommends rinsing off after the pool and applying light emollients when coming indoors.
Skincare also includes applying therapies afterwards for children with eczema, and reapplying sunscreen for outdoor play. Additionally, shirts with UPF should be rinsed with water and left to air dry to help maintain their potency and soft feel.
Following a successful drive to get New Yorkers vaccinated against mpox—previously known as monkeypox—last summer, mpox cases in New York City waned just as quickly as they had spiked. The city declared an end to its outbreak in February this year.
However, an uptick of mpox cases in Chicago in May has health experts and officials concerned about a possible return of outbreaks nationwide. The Centers for Disease Control and Prevention issued a health alert in May, informing clinicians and public health agencies about the new clusters and calling on them to raise awareness about treatment, vaccination, and testing.
Between April 17 and May 5, 12 confirmed and one probable case of mpox were reported to the Chicago Department of Public Health. Nine (69 percent) of 13 cases were among men who had received two vaccine doses, and all cases were among symptomatic men. None of the patients was hospitalized.
The virus is most commonly spread through direct contact with a rash or sores of someone who has it. It can also be spread through contact with clothing, bedding, and other items used by someone with mpox.
Symptoms usually start in 3 to 17 days, and can last two to four weeks. Common symptoms include rash or sores that look like blisters—on the face, hands, feet, or inside the mouth, genitals, or anus. Flu-like symptoms such as sore throat, fever, swollen lymph nodes, or headaches are common too.
In this Q&A, Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square, discusses what people can do to protect themselves from mpox and the importance of being fully vaccinated.
What is mpox and should I be worried about it?
Mpox is an orthopox virus (a genus that includes smallpox and cowpox). In spring and summer of 2022, we saw a pretty large number of infections here in New York City, across the country, and even across the globe.
Because of a widespread vaccine campaign, we’re now seeing far fewer infections than we had been seeing in the summer of last year. However, we’ve recently seen a small increase in the number of infections in New York City.
Should I be concerned about it now?
We recently saw a fair number of cases—in fact, there were 13 recent cases in Chicago over a relatively short period of time. And even though the number of infections that we’ve seen across the country has been relatively low, this number has been an increase from what we’re used to seeing.
And that’s really causing us to pay more attention to what’s going on and to make sure that we’re being vigilant in case those numbers continue to rise.
Fast facts about mpox
3,821
Cumulative mpox cases in New York City in 2022
70
Number of daily cases at the peak of mpox outbreak
20
Number of cases in New York City from February to May 2023
45%
Percentage of fully vaccinated at-risk individuals in New York City
Top Three Most Vaccinated Regions
California (306,000 doses)
New York City (153,000 doses)
Florida (94,000 doses)
What can I do to prevent it?
The first, and probably most important, is to make sure that if you are concerned about mpox—if you believe you may have risk factors—you really need to get fully vaccinated. Fully vaccinated means that you received two doses of the JYNNEOS® vaccine, at least four weeks apart.
Two weeks after you’ve received that second dose of the vaccine, you are considered to be fully vaccinated. So if you’re not fully vaccinated, that is probably one of the most important steps that you can take to prevent getting mpox.
The next part is making sure that you’re having conversations with people like sexual partners. Anybody who may have symptoms at the time could potentially pose a risk for infection, and it’s important to have those conversations.
We don’t consider mpox to be a sexually transmitted disease, but we do know that it comes from close physical contact. So having those conversations is really important, and even asking sexual partners about their vaccination status is also an important step.
The third thing is, if you’re concerned that you may have symptoms that are consistent with an mpox infection—and that could be a rash, which is often very painful, as well as fever, body aches, and chills—then it’s really important that you seek medical care as soon as possible. Some studies have shown that that the vaccine can be helpful in preventing mpox infection even after you’ve been exposed. Or that it can make the infection less severe.
If I have only taken one dose of the vaccine and have not completed the series, do I only need to take one more dose? Or do I have to go through the whole series again?
Anybody who’s received one dose already of the JYNNEOS® vaccine only needs one additional dose. You want to make sure that at least four weeks have passed since you’ve got the first dose. You need to get that second dose of the JYNNEOS vaccine in order to be fully vaccinated.
If I had taken both doses last year, should I consider taking another dose?
At this time there is no recommendation for getting a “booster” shot for the JYNNEOS® vaccine, and possibly there may not even be any additional benefit. So at this time we’re not recommending any further doses: two doses are fully sufficient, and if you’ve gotten both of those doses, you’re considered to be fully vaccinated.
Am I adequately protected if I complete my vaccine series now? Am I still protected if I had completed my series last year?
Yes, you will absolutely be protected. You have to keep in mind that no vaccine is perfect; no vaccine will prevent 100 percent of infections. But this is about the best protection that you could potentially have. So if you’ve already gotten those two doses, and two weeks or longer have passed since then, you are fully protected.
Can I stay home if I have symptoms? Who should be seeking treatment?
If you are presenting with symptoms, you should absolutely be seeking treatment. One of the most important steps is getting tested and making sure that we’re confirming the diagnosis of mpox. One of the beneficial parts about this disease is that very few people will go on to have very severe symptoms.
It’s only a very small number of people who have died. The people who are most at risk are people who have some kind of advanced weakened immune system, people who are pregnant, and children.
Diabetes affects nearly 11 percent of the U.S. population. For people living with diabetes, they may be prescribed medication to help them manage their condition.
Reshmi Srinath, MD, Associate Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai and Director of the Mount Sinai Weight and Metabolism Management Program, discusses medications that are available for type 2 diabetes and what you need to know.
There are many different types of medications for type 2 diabetes, including pills and injections. What are the most common treatments, and what are the pros and cons?
There are numerous medications; however, our mainstay starting drug is metformin, a medication that works to relax the pancreas, which produces insulin and make the body more sensitive to insulin. It also reduces liver glucose production and lowers appetite. We start metformin for any patient who has prediabetes or type 2 diabetes that is uncontrolled. It also lowers inflammation and reduces cancer risk.
Newer diabetes medications work on the gut. These are daily or weekly injections that target a hormone that comes from your small intestine called glucagon-like peptide (GLP). These medications help the pancreas control blood sugar and produce insulin. They also have a significant benefit for weight loss as they slow the way food travels through your gut, which leads you to get full quicker and eat less, which helps control your glucose levels.
There is also another class of medications called SGLT2 inhibitors—pills that relax the kidneys and help them filter sugar. They also can help you improve your blood pressure and regulate your weight. Numerous studies have shown benefits from these medications in reducing the risk of heart disease and heart failure and reducing stroke risk. Lastly, there is insulin, our most potent medication that helps regulate blood sugar.
How well do these medications work?
Most medications on the market are quite effective. They help to lower your blood sugar and a marker called hemoglobin A1C, a diabetes risk marker where values over 6.5 percent correlate with type 2 diabetes. Values between 5.7 and 6.4 percent correlate with prediabetes, which is very important for our patients to know. We know that a majority of these medications do help to lower hemoglobin A1C, at least 1 to 2 percent.
What are some of the more significant side effects?
Injectables that work on GLP1 affect the gastrointestinal system, and the most common side effects include bloating, flatulence, and constipation. They also can activate gastric reflux, and potentially worsen constipation. The SGLT2 inhibitors work on the kidney. People on these describe feeling more thirsty, and that they are peeing more. Occasionally, patients may develop urinary tract or yeast infections.
Metformin is well tolerated. People do describe some gastrointestinal side effects in terms of some stomach upset bloating and nausea, but usually that goes away within the first week. The main risk with insulin is making sure patients aren’t developing low blood sugar due to too much insulin being administered.
Why is it important to take medications for type 2 diabetes?
It is very important you take medications. We know that diabetes is tightly linked to the risk of heart disease and stroke, which can be associated with greater mortality and morbidity. We know that diabetes, when uncontrolled, can lead to complications, including vision problems and potentially blindness. Diabetes can also lead to worsening kidney function and potentially kidney failure.
Diabetes itself can lead to symptoms of numbness, tingling in the hands and feet, which can eventually lead to a condition called neuropathy, where patients can actually lose sensation in their extremities, particularly the feet, which can lead to risk of injury, foot ulcers, and potential amputation. These are complications we want to avoid. I think the first step is really being vigilant and taking preventative measures, including taking your medications, being closely monitored by your physician, and monitoring your blood sugar.
Medications to treat type 2 diabetes have been in the news. What are they, and how do they work?
A lot of these medications have been in the news recently because they both help to manage type 2 diabetes and weight, which is a risk factor for type 2 diabetes. By helping patients lose weight, we can prevent them from developing type 2 diabetes. For example, you may have heard of drugs like Ozempic® and Mounjaro™, these are injectables that both work to help control diabetes but also have significant weight loss benefits.
We now have FDA approved versions of these, which are indicated for weight loss. Ozempic® has now what we consider a companion called Wegovy®, both known as semaglutide. These are both medications that work similarly. They’re the same drug, but Wegovy is approved for weight loss, and Ozempic® is approved for type 2 diabetes. Similarly, Mounjaro™, which is one of the newest drugs for type 2 diabetes, is being tested for obesity, and will likely get FDA approval for obesity.
In general, who are the most appropriate candidates for these drugs?
This is really a conversation to have with your primary care doctor or endocrinologist. As I mentioned earlier, obesity and weight gain are risk factors for type 2 diabetes. It’s important that you keep an eye on your blood test results and blood sugar.
We typically assess diabetes risk by looking at fasting blood sugar and at hemoglobin A1C, and sometimes patients even do a glucose tolerance test, which is another way of determining if patients have a risk for diabetes. For patients who definitely have diabetes risk, it is important to have a conversation about your weight and whether you might be candidate for some of these medications, which are FDA approved for obesity. Many medications approved for type 2 diabetes are being closely regulated by insurance companies, so it is now getting harder to get these structures purely off label.
Because falls put you at risk for severe injury and can limit your quality of life and ability to remain independent, older adults need to follow simple steps to drastically reduce your risk of falling, like reviewing medications with your provider or hazard-proofing your living space.
The fear of falling does not have to be a burden on your life and lifestyle. In this Q&A, Charla Sarabia, MPH, Injury Prevention and Community Outreach Coordinator at Mount Sinai Morningside, provides steps to follow to reduce your risk of falling, whether at home or in a care facility.
What are the most common risk factors for falling?
A combination of risk factors causes most falls. The more risk factors you have, the greater your chances of falling. Factors can include age-related changes, such as declines in vision, hearing, balance, and mobility, as well as chronic health conditions like Parkinson’s disease, arthritis, diabetes, and medication side effects. Additionally, environmental risk factors in your home, workplace, care facility, etc., include clutter, inadequate lighting, wet floors, unstable furniture, and improper footwear.
Are there any lifestyle changes I can make to prevent falls?
There are several lifestyle changes you can make to prevent falls, such as:
Increase regular physical activity to improve strength, balance, and flexibility
Review and modify your medications with your provider or pharmacist
Complete home modifications such as removing slippery rugs or clutter and improving lighting can also reduce the risk of falls
Schedule regular eye exams and maintain a healthy diet
Speak with your health care provider to review risks of falling and implement fall prevention strategies.
Are there any conditions that could make me more likely to have a fall?
There are several chronic conditions that can increase the risk of falls, including Parkinson’s disease, stroke, dementia, arthritis, and diabetes. These conditions can cause physical impairments, such as muscle weakness, balance problems, and coordination difficulties. In addition, some chronic conditions can cause cognitive impairment, confusion, or dizziness, increasing the likelihood of falling. Working with your health care provider to identify and manage any factors that may increase your risk of falling is essential.
Can certain medications increase my risk of falling?
Certain medications can increase the risk of falling, with some of the risks including dizziness, drowsiness, or instability. Examples of these medications are pills for anxiety and depression, sleeping pills, pain medications, and antipsychotics, which are used to treat schizophrenia and other mental health disorders. It is important to talk to your provider if you are taking any of these medications and are concerned about falling, as they can explain the side effects of your medications and suggest strategies to minimize the risk of falling.
What can happen after a fall?
Falls can have varying consequences depending on age, health status, and fall circumstances. For instance, falls can result in minor injuries, such as cuts and bruises, that can be treated with basic first aid. However, falls can also result in more severe injuries, such as fractures, especially in older adults. In addition, head injuries ranging from minor bumps to severe traumatic brain injuries can occur after a fall. Besides physical injuries, falls can also lead to psychological effects. For example, a fear of falling can lead to a decrease in mobility and physical activity and can lead to social isolation. Seeking medical attention after a fall, especially if you are an older adult or have underlying health conditions, is crucial to ensure that any injuries are properly evaluated and treated.
If I am concerned about falling, when should I see a doctor?
If you are concerned about falling, it is a good idea to talk to your doctor, especially if you are an older adult or have underlying health conditions. You should see a doctor if you have had a fall or near fall recently, feel unsteady on your feet, have difficulty walking, or fear falling. Your doctor can evaluate your overall health and assess your risk of falling. They may also recommend specific tests or refer you to a specialist, such as a physical therapist, to improve your balance and strength. It is important to seek medical attention early to prevent falls and avoid the potentially severe consequences that can result from them.
What are the best things I can do to prevent falls in my home?
To make your home safer from falls, the most important thing you can do is to take simple measures:
Remove hazards such as clutter, and install handrails
Improve lighting
Use non-slip mats/rugs
Wear appropriate, non-slip footwear
Have regular eye check-ups, and review your medications with your doctor to ensure they do not increase your risk of falling.
It’s not uncommon for people to put off seeking medical care. The process can be stressful, especially if you feel your health care provider doesn’t really understand you and your special concerns. That can be even more true for some patients, such as those in the LGBTQ+ community.
In this Q&A, Barbara Warren, PsyD, Senior Director for LGBT Programs and Policies, explains how to find a provider with specific experience in LGBTQ+ health issues, how that can help alleviate stress and improve health outcomes, and details Mount Sinai’s approach to offering compassionate care. Dr. Warren, who leads Mount Sinai’s implementation of lesbian, gay, bisexual, transgender and gender diverse (LGB/TGD) culturally and clinically competent health care, is also an Assistant Professor of Medical Education at the Icahn School of Medicine at Mount Sinai.
What are some of the biggest health challenges for the LGBTQ community?
One of the biggest challenges for LGB/TGD consumers is finding a provider and finding a health system that is both LGB/TGD clinically and culturally competent, and being able to go anywhere in that system, to any provider, to any setting, and feel safe, to feel that you are being treated both effectively and with compassion. This is something that we have taken lots of strides to make possible throughout the Mount Sinai Health System.
Why is it important to find a provider who has experience with LGB/TGD health issues? What can they offer?
One of the things that LGB and TGD patients should look for is a provider who understands their needs. Being lesbian, gay, bisexual, transgender and gender diverse isn’t a health problem in itself. But many LGB/TGD people have health issues that are related to something we call “minority stress.” Minority stress is any kind of stress that people can undergo that affects us both psychologically and physiologically—when we either have experienced or anticipate experiencing discrimination, bullying, or even violence. This is something that many people in the LGB/TGD community live with. Even if they themselves have had not had personal experiences, they know that there is a possibility of discrimination, and of misunderstanding by health care providers. This can create anxiety. When sustained over time, this anxiety can create health problems, not just psychological or health behavior issues.
“It is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects,” says Barbara Warren, PsyD.
Can You Give an Example?
Sometimes if we are experiencing many stressors, we may overeat, or drink more alcoholic beverages, or not get enough rest or sleep. Increased and sustained anxiety in response to stressors can interfere with decision-making, memory, and effective functioning. Sustained stressors create a physiological response that leads to increased levels of cortisol in our bodies. Cortisol is known as the body’s stress hormone. It governs key body functions but too much cortisol can lead to a number of health problems, for example increased cardiovascular risk. It is important to note that stressors may be personal or interpersonal in our lives in terms of our current life circumstances like the loss of a loved one, or loss of a job or housing.
Recent threats to LGB/TGD safety and equity across many states in the form of legislation to deny gender-affirming care, banning books and public education inclusive of both racial and LGB/TGD history and representation, banning drag or any other behaviors that don’t conform to rigid and outdated binary gender stereotypes, have all been recent sources of what we are calling “minority stressors.” They have had the effect of increasing rates of depression, anxiety, and suicidality, especially among LGB/TGD young people. So it is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects.
How do you find a provider who has this experience?
At the Mount Sinai Health System, we have a number of ways. First we have web pages that give you information and resources, including our LGBT web page. There are a number of other organizations that can help, including the Gay and Lesbian Medical Association and the World Professional Association for Transgender Health. You can email us at LGBTinfo@mountsinai.org, and we will answer your email and make a direct referral to providers around the Mount Sinai Health System that have special expertise.
In addition, we have a number of programs and a number of practitioners specializing in certain aspects of LGBT health. For example, our Institute for Advanced Medicine, which started as our HIV/AIDS program to serve the large gay and bisexual population, specializes in some of the health care issues that are facing LGB/TGD people. There are five locations throughout the city. Our Center for Transgender Medicine and Surgery is a national model for services to support undergoing a gender transition and TGD affirmative primary care. We take LGB/TGD health very seriously at Mount Sinai and offer ongoing training for all of our providers, our front-line workers—everybody from our security guards to our surgeons to create a safe and welcoming environment for our LGB/TGD patients, families, visitors, and employees.
Hearing loss is a common condition that affects millions of people worldwide. In the United States, one in eight people over age 12, and more than 65 percent of individuals over 60 years old, experience hearing loss, according to the National Institutes of Health.
The impact of hearing loss is not limited to difficulty hearing; it is also linked to other health issues such as cognition, dementia, social isolation, and depression. Maura K. Cosetti, MD, Director of the Ear Institute at New York Eye and Ear Infirmary of Mount Sinai, explains why taking steps to prevent hearing loss can be so important, and how hearing loss can lead to other complications, including a potential decline in your memory and thinking.
“Treatments for hearing loss are very effective at improving the clarity of speech, and recent data has also shown that they improve cognitive function as well,” she said.
Here are five important facts you may not know about hearing loss:
Individuals with hearing loss are at higher risk of dementia
Many studies have shown that hearing loss is associated with dementia. Adults with hearing loss are at a greater risk of dementia than those without hearing loss. Results from many studies, including one published in JAMA: The Journal of the American Medical Association, found that the risk was related to the amount of hearing loss. Specifically, adults with mild hearing loss were at twice the increased risk, while those with moderate and severe hearing loss were up to three to five times more likely to develop dementia. Overall, moderate to severe hearing loss has been associated with a 60 percent increased risk of developing dementia compared to those without hearing loss. This relationship is believed to be due to the brain’s increased effort to process sounds, which leads to cognitive overload and mental exhaustion.
To book an appointment with Maura K. Cosetti, MD, call 212-979-4200 or 212-241-9410.
Hearing loss can lead to depression and social isolation
Difficulty hearing can significantly impair communication, and those with hearing loss often limit their interactions and relationships with others, leading to isolation and loneliness. Many research studies have shown a close relationship between hearing loss, social isolation, and depression. Hearing loss is based on how loud sounds need to be for you to hear them, as measured in decibels. For every 10 decibel decrease in your ability to hear, the odds of social isolation increase by 52 percent. Many studies have shown that individuals with hearing loss are more likely to experience depression than those without hearing loss.
Hearing loss is not a normal part of aging and should be treated
Age-related hearing loss is common, often gradual, and may not be easily recognized. Signs of hearing loss include:
Struggling to understand conversations in noisy environments, such as restaurants, parties, or other crowded places.
Turning up the volume on your phone or television.
Ringing in the ears.
Asking people to repeat themselves or thinking others all speak quietly.
Misunderstanding words or phrases.
Some types of hearing loss can be associated with physical obstruction, such as ear wax or fluid in the ears, and can be easily treated. Other types, such as sensorineural hearing loss that occurs from damage to the inner ear, may benefit from amplification, such as hearing aids. Individuals who are experiencing these symptoms should speak to their doctor and seek evaluation for hearing loss.
If you are a hearing aid user but do not get much benefit from your hearing aids, speak to you doctor about other options that may be available, such as cochlear implants.
Treating hearing loss can improve cognition
Treatments for hearing loss are very effective at improving the clarity of speech, and recent data has also shown that they also improve cognitive function. Both hearing aids and cochlear implants are safe and highly effective treatments for hearing loss—and both have shown to improve cognition. Studies show that older adults who use hearing aids have better cognitive function than those with hearing loss who do not use hearing aids. Numerous studies on adults with more severe hearing loss show that cochlear implantation leads to improved cognitive function, and decreased risk of dementia over time. Data suggests that all treatments for hearing loss, including both hearing aids and cochlear implants, improve social engagement, reduce depression, and significantly improve quality of life.
There are many steps you can take to prevent hearing loss
Prevention is one of the most important things we can do to limit hearing loss. While some factors that contribute to hearing loss, such as genetics and aging, are beyond our control, there are many steps you can take to prevent or reduce the risk of hearing loss.
Protect your ears from loud noises. Avoid or limit exposure to loud noises, such as concerts, sporting events, and power tools. If you must be in a noisy environment, wear earplugs or noise-cancelling headphones to reduce the impact of loud noises on your ears.
Maintain good ear health. This includes avoiding the use of cotton swabs or other objects to clean your ears, as this can damage the delicate structures inside the ear.
Seek treatment for any ear infections or other conditions that could affect your hearing. Certain medications, such as some antibiotics and chemotherapy drugs, can cause hearing loss or damage. If you are taking any medications that could affect your hearing, be sure to discuss this with your doctor and take any necessary precautions to protect your ears.
Stop smoking. Exposure to cigarette smoke, either when you smoke or to second-hand smoke, significantly increases your risk of hearing loss.
Take care of your general health. Both uncontrolled diabetes and untreated high blood pressure are risk factors for hearing loss. Follow your doctor’s guidance for treatment of these conditions.