COVID shots for tots; summer burn hazards; online gambling addiction risks; aging parents and car keys: Upstate Medical University's HealthLink on Air for Sunday, July 3, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a pediatric infectious disease doctor tells what you need to know about the COVID vaccine for children under 5.

Jana Shaw, MD: ... There are numerous benefits to vaccination -- reduction of risk for infection, reduced risk for spread, and highly reduced risk for severe disease and death ...

Host Amber Smith: We'll get some safety reminders to help prevent burn injuries this summer.

Tamara Roberts: ... Just like we do when we talk about in the kitchen, having that safe area, at least three feet around a stove, we would like to have you teach your children the same thing about when you're cooking with a grill ...

Host Amber Smith: A psychiatrist tells how to place sports bets without developing a gambling addiction. And a geriatrics expert explains when and how to take the car keys from an aging parent.

All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll go over some reminders about how to be safe around fireworks and campfires. But first, a pediatric infectious disease expert explains how the COVID-19 vaccine was tested and OK'd for children younger than 5. And she tells why it's important for this age group to be vaccinated.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Parents have a lot of questions about COVID vaccinations for their children who are under the age of 5. Here with me with some answers is Dr. Jana Shaw. She's a professor of pediatrics at Upstate specializing in infectious disease. Welcome back to "HealthLink on Air," Dr. Shaw.

Jana Shaw, MD: Thank you for having me, Amber. Great to be here with you.

Host Amber Smith: Now, probably the most important question is, how do we know these vaccines are safe?

Jana Shaw, MD: Very important question. Safety is one of the most important concerns parents have, and understandably. They want to make sure that whatever they put in their children's bodies is safe. We do know vaccines are safe in general and specifically for COVID vaccines because we have a very robust vaccine safety monitoring system in the United States.

The vaccines are tested during clinical trials, and the testing itself and monitoring is very rigorous. In addition, the vaccines continue to be monitored for safety once they are authorized or licensed. So vaccine safety monitoring does not end once we use vaccines in the general public. Same process we follow for vaccine authorization or licensure in children. During the clinical trials, vaccine safety data is collected, carefully monitored and documented. And even after vaccines are authorized, children continue to be monitored to ensure that the vaccines they've received, including COVID vaccines, that they remain safe.

So in short, the answer is, how do we know? We know because we look and measure and document safety. And if we identify any concerning signals, we pause. We quickly evaluate, and we use scientific epidemiological methods to establish causality, right? Because, something happens after vaccination doesn't mean it happened because of vaccination. So association does not imply causation. Hence, if there are any serious concerns or signals that come up, we pause, use scientific methods to investigate, and if we find out that there is a problem, we stop using vaccines. And we have lots of good examples from the past where there were some safety concerns, the rotavirus vaccine, for example, where vaccination was paused and production was stopped. And we stopped using the vaccine because there was an issue. But similarly, there might be concerns that arise, and we establish the concerns are not related to vaccination, we lift pause and we continue to vaccinate.

Host Amber Smith: So by the time the FDA has approved this vaccine, it's already been used in numerous children. It's been tested out and made sure that it's safe. It's not coming straight from a lab to a person. It's already been tested in people, right?

Jana Shaw, MD: Oh, absolutely. So the difference between the safety we know from clinical trials and the safety we know from population-level monitoring is that for the COVID vaccines for children -- and we are talking about the little ones, the 6 months to 5 years of age or so -- there were over 8,000 children enrolled in those clinical trials. So we do have vaccine safety information for those children, and a vaccine safety focus on the same areas that it did for adults. So, for example, we always look at what we call systemic reactions, essentially after vaccination. How many children did get fever? How many children did feel tired? How many children had headaches and so on, so forth. And we also look at local reactions. How many children had pain at a site? How many had swelling? And we ask them every day, we call them, we document, we measure. This is a very rigorous, robust process to ensure that the vaccines are well tolerated and they are safe.

Host Amber Smith: Now, it was more than a year ago that vaccines were approved for adults. Why did it take so much longer for the under-5-year-olds?

Jana Shaw, MD: Well, it's because we always start with the populations who are at the highest needs for vaccination, right? So with COVID in the beginning of the pandemic, we thought that the elderly and adults with underlying medical conditions such as hypertension, diabetes and so on and so forth were at the greatest risk of dying. So the vaccine development and testing was focused on adults. But over time and especially with Omicron, we recognized that COVID is a big deal for children too. So as we have slowly lowered the age of clinical testing to the younger age groups and children. It took us a while to get there because the approach was cautious was deliberate and was based on the epidemiology of the disease and the urgency with which Omicron spread throughout the U.S. And by epidemiology, I mean monitoring for frequency of this infection in the population.

Host Amber Smith: So why should kids get vaccinated?

Jana Shaw, MD: It's really important to remind ourselves that COVID can be serious even in young children. Historically, we thought of COVID as a disease of elderly and people with underlying medical conditions, but as we learned more and as Omicron swept through the country, we recognized that children were particularly vulnerable to Omicron. A number of them ended up in the hospital, and a number of them ended up with some serious complications of the infection known as MIS-C, which stands multi-inflammatory syndrome in children. So we know Omicron can be serious for children, and the infection can have very unpredictable manifestations. Therefore it's of paramount importance that all children are protected against severe disease. And vaccination is the only way to do it. We have, since the pandemic started, we have since removed masking, social distancing. People now gather in public spaces. So the risk of exposure to the virus is much greater than it was during times where we were either working remotely, children were at school remotely or had to wear a mask. That level of protection is now removed. So vaccination is the single most important intervention that parents can do to protect their children.

Host Amber Smith: Is this vaccine, for the children under 5, is it the same vaccine that adults are taking, just less of it?

Jana Shaw, MD: Absolutely. Yes. So it is the same vaccine. Both Moderna and Pfizer were authorized. For Pfizer, the dose of the vaccine is tiny. It's only 3 micrograms, which is a very small amount of what we call antigen, that information that goes into our bodies to instruct the immune system to build protection. With Moderna, again, it's the same vaccine as well, just with a reduced dose.

Host Amber Smith: Upstate’s “HealthLink on Air” has to take a short break, but please stay tuned for more information about the COVID vaccine for children under 5 with Dr. Jana Shaw.

This is Upstate’s “HealthLink on Air,” with your host, Amber Smith. I’m talking with Dr. Jana Shaw. She’s a pediatric infectious disease expert at Upstate, and we’re talking about the new COVID vaccination recommendations for children under age 5.

You mentioned Pfizer and Moderna. Both of those are mRNA vaccines. Adults also originally had an alternative vaccine option. Is that available for children as well?

Jana Shaw, MD: So I believe you're referring to the Johnson & Johnson vaccine. That is not available for children. And just for the listeners, mRNA vaccines, Pfizer and Moderna, are the preferred vaccines, mostly because there were concerns about severe serious reaction following vaccination with Johnson & Johnson vaccine and clotting disorder. Particular women were at higher risk for this severe complication, and because we monitor vaccine safety carefully, we picked up the signal. We established it was related to vaccination, and we therefore prefer that people use mRNA vaccine, and not Johnson & Johnson. For children that option is not available.

Host Amber Smith: So how should a parent choose, or do they get to choose between Pfizer and Moderna?

Jana Shaw, MD: Very difficult question. Sometimes having choices can be challenging, right? With Pfizer, it is a three-dose vaccine, so it will take a while for the child to be fully protected because it really, you have to sort of maintain the intervals between the doses. Moderna is a two-dose vaccine. So if parents who are eager to get their children protected faster, they may choose to use Moderna, where only two doses are required. If they would prefer maybe a higher level of protection, and wait a little longer for the full protection, they could choose Pfizer.

Host Amber Smith: Is one better than the other for a child with a chronic health condition?

Jana Shaw, MD: There are no differential recommendations for Moderna or Pfizer. The vaccines were tested in children with underlying conditions and also in children with different ethnic and racial backgrounds. So we know the vaccines do perform really well, regardless of whether the child is otherwise healthy or may have asthma or other medical issues. And the vaccines were tested in different races, as well.

Host Amber Smith: Now these are shots that we're talking about. Is there another option for inhaling through the nose, or is it only available as a shot?

Jana Shaw, MD: It is only available as a shot. We don't have nasal vaccine. As you noted, you know, influenza, for example, we have a flu nasal vaccine, but that option is not available for COVID, not only not for children, but not for adults as well.

Host Amber Smith: Can these vaccines be given when the child comes for other childhood vaccinations?

Jana Shaw, MD: Yes. Co-administration is approved. They can be safely given with other vaccines.Parents should just check with their pediatrician to make sure the vaccines are available on site. Sometimes pediatricians' offices may choose to schedule COVID vaccine clinic because we are trying not to waste COVID 19 vaccines. The vaccines are packed in numbers of 10. So if you open one, and you only use one, then you would waste nine doses. So pediatricians and providers try to be really careful and thoughtful about usage, and they may choose to schedule vaccine clinics where multiple children will come, so we don't waste any vaccine. So please check with your pediatrician's office what practice is available.

Host Amber Smith: I think some parents feel like, you know, the pandemic's over, so maybe they don't need to vaccinate their child, or maybe the child's already been exposed and they're safe. Do they still need to be vaccinated?

Jana Shaw, MD: Yes. The answer is yes. And you are right, a lot of children, especially during the Omicron wave, got infected. In fact, some of the data suggests that three out of four children were infected during Omicron. The challenge with natural infection is that the protection doesn't last long, and we know people can get reinfected upon exposure, especially as the COVID variants escape natural immunity. So because natural immunity doesn't last long, and breakthrough infections continue to occur, it's really important that children are vaccinated, because vaccines provide a reliable level of protection.

Host Amber Smith: Should a child get vaccinated if they already had COVID?

Jana Shaw, MD: The answer is yes. We know that COVID infection provides you with certain degree of protection, but the protection is limited. We know probably three months after your infection, you are again at risk of being reinfected, and you may develop a severe disease. So, and in fact, I know personally several people who had repeatedly been infected with COVID. So we know that immune protection from natural infection wanes over time. It wanes very quickly. And therefore vaccination is probably the best next strategy for you rather than being exposed to the virus, because the vaccine protection lasts longer.

And in fact, in people who had natural infection and got vaccinated, they had even higher level of antibodies, which are the molecules that protect you from severe disease. So we know that vaccination following natural infection is safe because the clinical trials, including the childhood trials, the Pfizer, has shown and shared data with us about safety and immunity following vaccination in children who had COVID.

Host Amber Smith: So I wanted to ask you more about what the COVID vaccine does for children under the age of 5. We're not really sure for how long it will protect them after they are vaccinated, right?

Jana Shaw, MD: Correct. Yes. So we have to wait long enough to measure the level of protection, the length of protection. We can probably extrapolate from adult studies because the level of protection for children, the antibody levels, is very similar to adults. So assuming that the pharmacodynamics and the antibody decline over time will be similar for children, it's quite likely that children will be protected for at least six months and probably longer, following vaccination, against a severe disease, hospitalization and death. And that is with Omicron, because we should remind ourselves that vaccines for the little ones -- 6 months through 5 years of age -- were tested during the Omicron phase. So the antibody levels we measured, or the manufacturers measured, really are antibody levels that are comparable to adults. They're high, to protect those children against severe disease for months to come.

Host Amber Smith: So the vaccine should protect them from getting seriously ill or hospitalized, if they do become infected. Does it do anything to prevent them from spreading the coronavirus If they're infected?

Jana Shaw, MD: Yes, it does. I will use adult data here because I don't have children's data, but in adults we know that adults who are vaccinated, they are not only less likely to get infected, but once they are, if they have breakthrough infection, which typically is mild, they are less likely to transmit the infection to those around them, and they're less likely to become seriously ill. So there are numerous benefits to vaccination -- reduction of risk for infection, reduced risk for spread, and highly reduced risk for severe disease and death.

Host Amber Smith: When I hear you describe that it should protect for at least six months it makes me wonder if this is going to be like a flu shot that you need to get every year. Does that look like what is going to happen?

Jana Shaw, MD: It's quite likely, Amber. I think those are important questions, and people really want to know how often will we have to get vaccinated. Honestly, the true answer is we don't know today. But what I can tell you with certainty, that scientists and researchers, they continue to monitor antibody levels in people who were vaccinated, so we can safely determine how frequently people will need to be vaccinated. The antibody level itself is only one arm of that decision tree, because we also will have to monitor the emergence of variants. And, as you know, and I'm sure listeners have heard, Omicron has managed to escape natural immunity from prior variants and also has been escaping the vaccine-induced immunity, so we are seeing more people getting breakthrough infection. But thankfully the vaccines continue to perform extremely well and protect people against severe disease.

Host Amber Smith: Do you recommend that parents get their children vaccinated now, or should they wait until the fall before they go back to school?

Jana Shaw, MD: You know, it really depends on your level of risk. I'm so risk-averse as a parent. And I have three children who are fully vaccinated, not only with all childhood vaccines, but also with COVID vaccines, including boosters. So for me, I couldn't wait to get my children vaccinated because I did not want them to be infected. You know, COVID is one of the viruses that, especially for children, it can be very unpredictable. We have healthy children who end up in the hospital with MIS-C, which is a very serious inflammatory condition in children. So it's really challenging to predict which child will just have a cold or no disease with COVID and a child that will end up in a hospital. So for me, being able to vaccinate as soon as I can is really the approach I take. And I would recommend that parents consider that as a strategy to keep their children safe because we know COVID vaccines are extremely safe. So not vaccinating might be a dangerous choice.

Host Amber Smith: Do you have general advice for what parents can expect? Are their children likely to be tired after they get vaccinated, or will there be soreness at the injection site?

Jana Shaw, MD: We know what reactions one can expect, and I would also note here that parents are most welcome to actually look at the data themselves. ACIP, which is (spelled) A C I P, abbreviation for the Advisory Committee for Immunization Practices -- it's the body that advises CDC (Centers for Disease Control and Prevention) on vaccines -- has a recording that's publicly available from their June 17th meeting where the information about reactions is carefully summarized and shared. So if you want detailed information, please log in and watch the video from the public meeting.

But to answer your question, there are, yes, there are reactions, both local and systemic, that parents can expect in children. And depending on the child's age, they differ. So let's look at, let's say, children 6 months to 23 months of age. Those children were more likely to have irritability and be sleepy. Children older, 2 to 5 years of age, complain of headache and fatigue. A small proportion of children had fevers. None of those fevers needed a doctor's visit or hospitalization, but those children had low-grade fevers and needed maybe Tylenol or Motrin to help them with that. The important thing to mention is that those reactions are short-lived, a couple days, one to two days. They respond to Tylenol or Motrin. They go away, and they don't come back. And, they are comparable to reactions that parents have experienced with their children after other childhood vaccines. So they are no different, compared to the reactions their children had after vaccination with other childhood vaccines.

Host Amber Smith: Is there anything else to know about this vaccine?

Jana Shaw, MD: Yes, I think to remember thatin the past there was concern about myocarditis, which is an inflammation following vaccination that has been documented as a signal for young adults, young males, particularly. We continue to monitor this reaction. With younger age groups, for those 5 to 11, there really has not been increased riskfor myocarditis. So again, the vaccines continued to work really well. The clinical trials were not powered enough to detect this risk for children 6 months to 5 years of age, but the vaccine will continue to be monitored. But the expectation is that the risk is going to be even lower than observed in young adults because the doses are so small, compared to the adult doses.

Host Amber Smith: Well, Dr. Shaw, I really appreciate you making time for this interview. Thank you.

Jana Shaw, MD: Thank you for having me.

Host Amber Smith: My guest has been pediatric infectious disease specialist Dr. Jana Shaw. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from psychiatrist Sunny Aslam, MD, from Upstate Medical University.

How can someone enjoy mobile sports betting without developing a gambling addiction?

Sunny Aslam, MD: One of the ways I think about gambling is analogous to alcohol, that many people can have a glass of wine or go out to a bar, and it doesn't cause them any distress at all. They do this in groups, or as a couple, with friends. It's a social event. They set limits around their drinking, and they do it responsibly with no harms at all. But there are a small group of people with alcohol, just like with gambling, who will be harmed by their repeated use.

Unfortunately, the difficulty is, the industry is built against you. The industry knows where its profit centers are, and those are in people with other addiction and mood disorders. People who are more vulnerable, people who already have an addiction, who already have a psychiatric disorder; they're particularly vulnerable. And they're targeted by these companies.

Gambling use disorder was moved under the category from impulsive disorders to be treated with substance use disorders, with other addictions, essentially, because there's increasing recognition of the chemistry in the brain, the wiring in the brain, is virtually identical to what happens with, for example, you inhale a cigarette, it activates the seeking system in the brain, and it seems to be virtually indistinguishable for those with gambling use disorder.

There's a wide range of problems associated with gambling use disorder. Fifty percent of people with gambling use disorder have a mood disorder, such as major depression, 40% can have an anxiety disorder, 32% have suicidal thinking, and half of those will actually attempt suicide. Once you have become addicted to gambling, there's repeated harm. That part of the brain appears to be changed for people. And it is something that will be with them forever.

About half of people with gambling use disorder have an alcohol or a tobacco addiction as well, or both. We know those are risk factors. Being young and male is a risk factor, as well, for gambling disorder. So there's a number of these risk factors that people should keep in mind before they enter into online betting or head to the casino.

The two different paths we hear about from patients and that have been studied, particularly around what happens in the brain, is gambling for a rush or gambling for an escape. And online, it can be both. It taps into both those areas. Our concern with online betting is that there's virtual anonymity, and the accessibility is around the clock.

But there are ways to have an accountability partner. Don't do this alone. Set a limit around how much time and how much money you'd like to spend. And then if you notice you're going over those limits, maybe it's time to ask for help. And there's a number of ways of getting help. That can mean coming to the addiction medicine clinic for a consultation or going to a 12-step group -- Gamblers Anonymous is very popular -- and there's good evidence that 12-steps work.

It's important to recognize your risks. Be aware. Know that simply being honest with those around you, or maybe even bringing someone along with you -- a family member, a friend -- can help be a protective layer to an industry that is set up to prey on vulnerabilities you might have toward developing gambling disorder.

Host Amber Smith: You've been listening to Dr. Sunny Aslam from Upstate Medical University.

Summer burn safety -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

As Central New Yorkers begin to enjoy summer weather, I'm with Tamara Roberts from the Clark Burn Center at Upstate with some reminders about safety. Ms. Roberts is the burn program manager. Welcome back to "HealthLink on Air," Ms. Roberts.

Tamara Roberts: Thank you for having me here.

Host Amber Smith: Now, because some people like to celebrate with fireworks for the 4th of July and other summertime gatherings, I'd like to first ask you about how frequently you see patients at the burn center who were injured by fireworks.

Tamara Roberts: We don't see a lot of patients that are admitted inpatient. They're more often seen in our outpatient setting because they're not as major a burn injury. What we see are a lot more of the injuries that are associated with the activities that go around the firework events and everything that kind of happens. So those are all different types of injuries that are occurring during the 4th of July weekend and things like that.

Host Amber Smith: Are they burn related?

Tamara Roberts: Yes, they are burn-related injuries. It can be things such as injuries related to falling into bonfires, applying fuel or other combustible things into a fire and then having it explode, and people are getting injured that way. Unfortunately, sometimes people will drink alcohol and trip and fall into a fire. So we really are seeing a lot of the injuries that are associated around the holidays, not only with fireworks, but also all the other activities that kind of go along with it. Lots of sparkler injuries we do see on our kiddos.

Host Amber Smith: Sparklers -- those are very appealing, because those people hold in their hand, right? And you light the tip?

Tamara Roberts: Yeah. Yeah. The sparklers are the ones that typically the kids will hold it, and it has all the nice little, pretty sparkles that goes, and they can whip them around. People think that they're safe for kids, but those can get up to 2000 degrees Fahrenheit. So they are really hot, and if the child were to touch where it was lit, it can give a very deep, deep burn to these children. And if they're dropped on the ground and they step on it, they can get burns that way as well. So we suggest keeping a bucket of water. If parents are allowing the kids to use the sparklers, have a bucket of water out there so that when they're done utilizing the sparklers that they're putting them into that bucket of water.

Host Amber Smith: In general, the fireworks that people like to do at their homes, do you think those have become safer over the years? Because years ago they were, they seemed to be the source of some really significant injury.

Tamara Roberts: No, I don't believe they've become safer. We still strongly urge people to leave fireworks to the pros. They have made some that are legal to purchase in the state of New York, but they're still very dangerous, and they can have complications. We're not the only burn center in the state of New York. And so maybe in our area, we're not seeing those injuries, but definitely in some of the other burn centers, they've seen real significant injuries. Things that you can buy are bottle rockets and fountains, and those types of things, you have shooting flames coming out, and they're extremely dangerous. They can catch clothes on fire. They can cause a lot of damage. There are "kid-friendly fireworks," is what they call them, and people will buy them because they think they're safe. They're like the snakes and the little smoke bombs. And because they're popular with the younger kids, and kids aren't really familiar with how to handle them, there's a lot of injuries that happen every year. About 5% of all your firework injuries are actually from ones that are designed for children. So, they're not really that safe.

Host Amber Smith: Are there instructions that people need to follow to make them safer?

Tamara Roberts: There are instructions, and most of them say that once something is lit, you're not supposed to hold onto it. You're supposed to set it down and move away. There shouldn't be only one person there lighting it, and everybody else should be a safe distance away from it. And you definitely need to make sure that children are not around when you're lighting it, and they should never be faced toward anybody. You should be in an area that is not heavily populated with homes and burnable debris and things like that, because stuff can catch on fire.

Host Amber Smith: In terms of other potential burn injuries, this is the time of year people are having, maybe, campfires. What mistakes have you seen people make that could be avoided around campfires?

Tamara Roberts: I think, educating their kids on how to stay away from a campfire, or if they're cooking on the campfire -- maybe toasting marshmallows or things like that -- how to be a safe distance away. Making sure that you are not consuming alcoholic beverages when around a campfire, because accidents happen really quickly. And, they can be very detrimental, not only to adults, but also to children. So we want to make sure that we're being safe. And when we're putting the fires out, we need to make sure that they're applying water and putting that out. And the other thing is never put gasoline or any other igniter onto a campfire, because it causes severe injuries. You get that explosive fire, and it will cause a flash burn.

Host Amber Smith: If someone suffers a burn from the open flames or a flash burn at a campfire, what is the first aid that you would advise?

Tamara Roberts: Immediately stop that burning process. If they're on fire, they need to stop, drop and roll to get that fire out. And then they need to cool it with lukewarm water. So if they have that ability, they need to, for at least five minutes, be cooling it with lukewarm water. Never use ice because ice actually can cause further injury to the tissues of the skin and make your burn worse. So we strongly discourage that. And then depending on how severe it is, they may need to go get treatment.

Host Amber Smith: How would they know if they need to go to the hospital?

Tamara Roberts: If they have open tissue, or blistering, and it's a pretty big area, I would say if it's covering their entire forearm or even a hand that may be like a whitish color, it could be very severe. It's better to go get checked out than to not get checked out. Err on the side of safety.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Tamara Roberts from the Clark Burn Center at Upstate.

Now, grills and smokers are popular in the summer. Do you ever see people who have severe burns from touching the grates or the charcoal?

Tamara Roberts: We've seen where we've had some of the kids who will grab the grates on some of the grills, as well as just bumping up against the grill. So we always try to provide education, making sure that we teach about safe space and just like we do when we talk about in the kitchen, having that safe area, at least three feet around a stove, we would like to have you teach your children the same thing about when you're cooking with a grill. And also with grills, we see -- you know, propane grills are terrible because you go to light them, and you've got that fuel on, and you've got the cover closed, so you have to think about those gases that are in there. And people get down in there, and you can get a flash burn from that. And also, thinking about where your grill is. We've seen structure fires, their houses catch on fire because they're doing it on a porch and leaving it unattended, and that can be really unsafe. So, it's better to take it down in the yard, away from your house. And always make sure you are watching the grill because you never know if grease is going to drip down and cause some type of a fire. And you always want to make sure that if you're opening it, because you think there's a fire, be very careful with opening it. And, if it's not something that you can put out, call the fire department. Don't be a hero.

Host Amber Smith: Now what about sunburns? Does the burn unit ever get patients with sunburns that are so severe that they need hospitalization?

Tamara Roberts: In my 12 years here, I have had just two -- one was a child, and one was an adult. A lot of times it's with photosensitivity medications. That's those medicines that we take and it says right on there, don't be out in the sun. And your skin gets burned so badly that it actually causes a deep, what we call a second-degree, burn. So there's blisters, and the skin is coming off. So people really need to remember that you apply sunscreen, and it's not just once. You have to apply it liberally multiple times throughout the day, because the sun really does wreak havoc on our skin, and it can cause burns really easily. And that's adults, that's kids, and we just have to really make sure that we're protecting ourselves.

Host Amber Smith: If someone neglects to use sunscreen or adequate sunscreen, and they end up with a severe sunburn, what advice do you have for how to treat it at home?

Tamara Roberts: If it's a severe sunburn and they have open skin, I would recommend that they probably be seen, at least, in the burn clinic to assess the situation and determine if it's very severe. They can wash with soap and water as they normally would. But not being a doctor, I can't say just apply something. It's better for them to go to the burn clinic here at Upstate, or just come to the emergency room to be seen by one of our physicians who can adequately say, "This is what you should do."

Host Amber Smith: So how does one get into the burn clinic, or what do they do? Where do they go?

Tamara Roberts: We have a number that they can call right here at Upstate. It's 315-464-1800. And, push the button that they say for burn clinic. And they can call and get an appointment scheduled right into the clinic. We have clinics four days a week so that people can get in and be seen.

Host Amber Smith: And if someone went to the emergency department, would they eventually, would they put them to the burn clinic or would they take care of them there first, I guess?

Tamara Roberts: If they were to go to the emergency department, they would be assessed by our burn team right there in the emergency department, or one of the physicians trained in burns down there, and they would assess if they need to be admitted into the hospital, if they need further treatment, or if they can just follow up in the burn clinic. And they'll help them make that appointment.

Host Amber Smith: I'd like to ask you about an alert from the American Burn Association, kind of looking ahead to fall and winter. What is this group's new concern?

Tamara Roberts: Well, with the colder temperatures coming, there's a big concern that because of the rising cost in fuel that people are going to use alternative methods for heating their homes. And that is very alarming because we know that space heaters andusing our stoves to try to warm up our homes is just so risky. Many times people will have fires in their homes because of space heaters tipping over or clothes getting knocked onto a space heater. And sometimes people have ended up with carbon monoxide poisoning, which is a gas that's colorless and odorless, and we can't see it, smell it, hear it, that we can have overcome us, and we die from it. But people use their stoves to warm their home when they can't afford to put fuel or propane in a tank to heat their home.

Host Amber Smith: Related to that, let's talk about smoke detectors. How many smoke detectors do you need in a house?

Tamara Roberts: Well, the law says that you should have one, at least, in your kitchen, outside your living room. There should be one down in your basement, by the attic. There's supposed to be one outside of every bedroom.

Host Amber Smith: So that's a lot of smoke detectors, perhaps.

Tamara Roberts: It is.

Host Amber Smith: How can people obtain smoke detectors and learn about how to install them properly?

Tamara Roberts: The Clark Burn Center is collaborating with different entities within communities, and we're doing our first what we call "Install the Device and Save a Life" program, and our first one will be at Brady Market (307 Gifford St.) in Syracuse. And what we're doing is, we'll be providing at least one smoke detector to each home. And it's also going to provide you information with how you can get more smoke alarms if you need more smoke alarms for your home. It's going to provide a video link on how to install these. We'll have videos on how to install smoke alarms appropriately. We're also going to have education on fire and burn prevention as well as education on poison control. So we'll be talking about carbon monoxide poisoning, those odorless, tasteless gases that can overcome us in our homes, and many other activities for kids to also learn about -- safety and making an escape plan if there were a fire in the home and things. So that'll be happening in July of this year.

Host Amber Smith: And then for future events that the burn center will have representatives at, people can go to Facebook, to the Upstate Health Facebook page, and that's where you're sharing information about the locations that, where you'll be, right?

Tamara Roberts: Yes. Yep. That'll be posted up there, the dates, times, locations that we will be there. Yes.

Host Amber Smith: Well, thank you so much for making time for this interview.

Tamara Roberts: Thank you for having me and letting me educate people.

Host Amber Smith: My guest has been Tamara Roberts. She's the burn program manager at Upstate's Clark Burn Center. I'm Amber Smith for Upstate's "HealthLink on Air." Here's some expert advice from Dr. Sharon Brangman, chief of geriatrics at Upstate Medical University.

How do you advise adult children when it's time to take the car keys away from a parent?

Sharon Brangman, MD: Well, this is one of the toughest things that we deal with in geriatrics. There is no set age when somebody should stop driving. This is a very individual thing. We should not have a one-size-fits-all. The aging process, in and of itself, can make driving more risky. For example, someone could have arthritis in their neck, and they can't turn their head to look over their shoulder when they're changing lanes, or they may have a weakness in their legs that could keep them from pressing down hard on the brakes. There are also vision problems that occur, or hearing problems that can make it difficult to drive. And of course, if you have any kind of memory problem that impacts your ability to make decisions or have appropriate reactions when you're driving, that could be another red flag.

So what we usually tell adult children is that they have to have a plan. You can't just do this overnight. You have to look and see how you are going to supplement the driving needs of their parents, for example, when they have to stop driving. And we live in a society, and especially in our city, we don't have a very walkable city, and most of our services are out in the suburbs. So when you stop someone from driving, you can cut them off from everything from groceries to the pharmacy, to going to church and socializing. So you have to have a plan. You have to have a process so that you can figure out who's going to fill in those gaps. A lot of adult children feel ambivalent because they can't do it, but we now have lots of driving services, and there are actually people who do this now as a living, who can come and help drive. And yes, you may have to give up some of your spontaneous ability to come and go, but you can still be able to get the things you need appropriately, if you don't have a car yourself.

And we always want to stop before there's a terrible accident. And I don't have a crystal ball to predict when that might happen for any one person, but we don't want to wait for someone to get hurt before we make that decision. And that's the part that gets tricky because again, that's a very individual thing.

There are driving evaluation programs that can be helpful, where an older adult can go and get a driving test by someone objective to just see how they are behind the wheel, and if there's any adaptations that might be helpful or anything that can be done to help them stay on the road safely. We have some patients who stopped driving at night, or they don't drive during the busiest times of the day when the roads are quieter, and that's sometimes is an adaptation that works. But unfortunately, there does come a time when it is time to hang up the car keys to keep you safe and to keep others safe, as well.

Host Amber Smith: You've been listening to Dr. Sharon Brangman, chief of geriatrics at Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Is there anything better than a love poem? Especially in these times? Vincent Casaregola, who teaches at St. Louis University, sent us a gorgeous and yet bittersweet testament of a love now gone. Here is "This Poem Is Just About You":

This poem is just about you, not you,

not some substitute to hold you

out of time's reach and cost --

this poem cannot touch you, cannot

feel the softness of your skin beneath

a fleeting brush of fingers,

cannot reclaim the sight of you

reclining on a chaise or standing

in the window's morning light,

cannot be the light reflected

in your glance across the table

or be the gentle tilt of your head

when listening, or speak your thoughts

with your voice, tender or alarmed,

angry or soft, as moods propel.

No, this is a thing of words, poor

currency that barely pays the price

of simple goods on ordinary days,

passing words, mortal and fleeting,

with no eternity in store, no marble

meaning etched in history.

And when your rebel cells collude

again, rise in secret, then strike,

bringing insurrection to the lung

or brain, these words, bring no relief

from any throbbing pain, no salve

for the sting of doubt and fear

as you, sleepless, outstare

the darkened midnight ceiling, nor

can they ease the ache that grows

stronger with each morning, or feel

the tangled tightness in your grip

as you reach for help to cross a room.

These words bring me no comfort,

not even cold comfort, but lie

dry as old paper in the musty attic,

less comfort, even, than a cold,

post-mortem final kiss that seals

the moment in the dim, grey room.

These words themselves have little or no

life, no breath for me to hear as from you

when you'd lain asleep beside me,

and they will fade, as ink on paper fades

in heat and angry sun, or as screens will

fade when the grid itself will die --

carve them on our stones, if you will,

the stones themselves erode to dust,

and even while they last, the sharp carving

smooths with age, making words clefts

for blown sand, for spores of lower plants,

for fibers of what, once, had flowered.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air": a new national suicide hotline number and a caution about dangerous, purple-colored heroin.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.