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Primary Health
Care:
The Health Center Program
NEW Health is licensed by the
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of Public Health.
Dealing With Trauma
posted on: 4/29/2013 9:12:48 AM
Coping With Trauma
1. Identify the feelings that you may be experiencing. Understand that your feelings are a normal reaction to an
abnormal situation.
2. Remember that you have overcome adversity and trauma in the past. Try to remember what you did that helped you overcome the
fear and helplessness in that situation.
3. Talk to others about your fears. It's okay to ask for help.
4. Make efforts to maintain your usual routine.
5. Think positively. Realize that things will get better. Be realistic about the time it takes to feel better.
6. Recognize that the nature of terrorist attacks creates fear and uncertainty about the future. Continue to do the things in
your
life that you enjoy. Don't get preoccupied with the things you cannot control to the extent that they prevent you from living your
normal life.
7. Know the actions our government is taking to combat terrorism and restore safety and security. Recognize that trained
officials
throughout the country are mobilized to prevent, prepare for and respond to terrorist attacks.
8. Limit exposure to media coverage.
Tips for helping children cope:
1. Encourage children to say how they are feeling about the event.
2. Ask children what they have seen, heard or experienced.
3. Assure children that their parents are taking care of them and will continue to help them deal with anything that makes them
feel afraid.
4. Help children recognize when they have shown courage in meeting a new scary situation and accomplished a goal despite
hardship
or barriers.
5. Instill a sense of empowerment.
6. Let children know that institutions of democracy are still in place and our
government is intact. (It can also be helpful for adults to realize this.)
7. Know that it is possible for children to experience vicariously the traumatization from the terrorist attack (e.g. watching TV
coverage, overhearing adult conversations).
8. Limit exposure to media coverage.
More more information, visit the following resources:
Coping With Tragedy
posted on: 4/16/2013 4:03:02 PM
The North End, and the entire City of Boston, is shaken and distressed by Monday’s tragic events. Even if you did not personally
experience direct physical trauma from these events, they may present with emotional distress.
It is very common for people to experience emotional aftershocks when they have experienced a horrible event directly or
indirectly from media accounts. Sometimes this type of stress reaction appears immediately, but for others the feelings don’t
surface until a few days or weeks have passed. It is normal to experience a wide range of emotions, including shock, disbelief,
fear, anger, sadness, anxiety and hopelessness.
North End Waterfront Health’s Behavioral Health Department will hold a public drop-in session to discuss dealing with
the marathon tragedy on Tuesday, April 23 from 5-6 p.m. We encourage anyone who is having trouble during this difficult time to
stop by.
Here are some suggestions with ways to cope with the trauma:
- Identify the feelings that you may be experiencing. Understand that your feelings are a normal reaction to an abnormal situation.
- Remember that you have overcome adversity and trauma in the past. Try to remember what you did that helped you overcome the fear and helplessness in that situation.
- Talk to others about your fears. It's okay to ask for help.
- Make efforts to maintain your usual routine.
- Think positively. Realize that things will get better. Be realistic about the time it takes to feel better.
- Recognize that the nature of terrorist attacks creates fear and uncertainty about the future. Continue to do the things in your life that you enjoy. Don't get preoccupied with the things you cannot control to the extent that they prevent you from living your normal life.
- Know the actions our government is taking to combat terrorism and restore safety and security. Recognize that trained officials throughout the country are mobilized to prevent, prepare for and respond to terrorist attacks.
- Limit exposure to media coverage.
Children can experience emotional distress in response to these tragic events, too. Here are some tips for helping children cope:
- Encourage children to say how they are feeling about the event.
- Ask children what they have seen, heard or experienced.
- Assure children that their parents are taking care of them and will continue to help them deal with anything that makes them feel afraid.
- Help children recognize when they have shown courage in meeting a new scary situation and accomplished a goal despite hardship or barriers. Instill a sense of empowerment.
- Let children know that institutions of democracy are still in place and our government is intact. (It can also be helpful for adults to realize this.)
- Know that it is possible for children to experience vicariously the traumatization from the terrorist attack (e.g. watching TV coverage, overhearing adult conversations).
For more information, please call Mary Wright at 617-643-8064.
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Facts about Dementia
posted on: 3/12/2013 9:39:05 AM
Dementia is not a specific disease. It is a set of symptoms that affect a person’s ability to think, remember and reason
to such an extent that it interferes with activities of daily life. Alzheimer’s disease is the most common cause of progressive
dementia.
Dementia is considered a high priority health issue by “Healthy People 2020,” a government list of national objectives,
because Alzheimer’s disease is the sixth leading cause of death for adults age 18 and over. Dementia also affects the quality of
life and the ability to live independently for the individual with the disorder.
Dementia is not memory loss alone. It includes problems with at least two brain functions such as confusion, impaired
judgment, impaired language, difficulty communicating, as well as changes in personality and social behavior.
Symptoms of dementia include: memory loss, difficulty communicating, inability to learn or to remember new information,
difficulty with planning and organizing, difficulty with coordination, and inability to reason.
Dementia has many causes. There are progressive dementias that get worse over time. Alzheimer’s is the most common
dementia of this type. Other causes of dementia include infection, reaction to medications and some inherited disorders. Some of
these dementias can be reversible with treatment.
Diagnosis of dementia is important so that effective treatment and care may begin. It may require several doctor visits
and tests before a diagnosis of dementia can be made.
There is no standard treatment for dementia but some of the symptoms can be treated. There are several medications that
may be effective in helping patients with dementia. Also, the treatment of the cause of the dementia can slow or stop the progress
of the dementia.
Some of the risk factors for dementia include age, family history, alcohol use, smoking and high blood pressure or high
cholesterol levels.
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Substance Abuse in the Family Support Group
posted on: 2/19/2013 8:56:39 AM
North End Waterfront Health’s Behavioral Health Department is starting a Substance Abuse in the Family support group for those
with relatives suffering from drug and alcohol abuse.
The group will offer a private space for individuals to share their thoughts and experiences, to provide support to one
another, and to gain coping skills for dealing with stress and difficult family situations. Group members will benefit from
hearing from others whom are grappling with similar family issues. The group will be facilitated by staff from the Behavioral
Health Department at NEW Health and all discussions will be confidential.
What: Substance Abuse in the Family: A group for those coping with a loved one’s addiction
Where: The Nazarro Center
When: Tuesday evenings from 5:30 p.m. – 6:30 p.m.
March 12, 19, 26, April 2
Final session April 9 at NEW Health
This group is free and open to the public.
Individuals with questions are encouraged to contact the co-facilitators of the group:
Maura McDonald, mmcdonald15@partners.org, 617-643-8187
Gaby Avery-Peck, gavery-peck@partners.org, 617-643-8060
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Women's Heart Health Event on Valentine's Day
posted on: 2/13/2013 2:10:47 PM
North End Waterfront Health is hosting a “Circle of Red” women’s heart health event on Thursday, February 14 from 10 a.m. to 2
p.m.
The event, which is sponsored by the American Heart Association and Massachusetts General Hospital, will include heart
health screenings, games and prizes, heart healthy snacks, and a health information table – all for free.
Heart disease is the leading cause of death in women in the United States. In fact, more women than men die each year
from heart attacks. One in four women die from heart disease every year, while one in 30 women die from breast cancer. Women may
have different symptoms than men and are often not aware that they are having a heart attack.
Anyone is welcome to stop by the health center at 332 Hanover St. between 10 a.m. and 2 p.m. on Thursday. The table will
be set up on the first floor. See you there!
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Free Flu Clinic Thursday
posted on: 1/23/2013 2:24:53 PM
North End Waterfront Health, located at 332 Hanover St., is hosting a second free flu clinic on Thursday, January 24, from 3 p.m.
to 7 p.m.
During these times, the flu shot will be free for everyone over the age of 18. Children under the age of 18 are not
eligible to receive a free flu shot during the clinic on Thursday because children receive a more specialized dose of the vaccine.
If your child needs a flu shot, please contact your pediatrician.
For more information call our flu hotline at 617-643-8114.
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Winter Safety Tips
posted on: 1/22/2013 11:28:50 AM
Here are a few helpful tips to stay safe this winter.
- DRESS IN LAYERS.
- WEAR A HAT.
- WEAR NON-SKID BOOTS.
- FOR SAFETY AND VISIBILITY, WEAR A BRIGHTLY COLORED SCARF OR HAT.
- COVER EXPOSED SKIN WITH SUNSCREEN; YOU CAN BURN IN THE WINTER.
- DO NOT SHOVEL SNOW IF YOU ARE OUT OF SHAPE.
- USE ROCK SALT OR DE-ICING COMPOUNDS ON STEPS AND SIDEWALKS.
- DO NOT PUT YOUR HAND INTO THE SNOW BLOWER.
- AVOID DRIVING IN SNOW OR ICE STORMS.
- LIMIT TIME OUTDOORS IN FREEZING TEMPERATURES.
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Free Flu Clinic Saturday
posted on: 1/10/2013 9:43:08 AM
NEW Health is partnering with Mayor Menino and the Boston Public Health Commission to offer a free flu clinic on Saturday,
January 12 from 8:30 a.m. to 11:45 a.m.
During these times, the flu shot will be free for everyone over the age of 18. Children cannot receive a flu shot during
the free clinic. If your child needs a flu shot, please contact your pediatrician.
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Pediatric Doc Chat
posted on: 1/7/2013 3:33:18 PM
North End Waterfront Health is hosting a Doc Chat for parents on Friday, January 11, from 9:30 a.m. to 10:15 a.m., at the Nazzaro
Center, during the regularly scheduled indoor play group.
Doc Chat is designed to provide parents with an opportunity to join in a conversation with one of NEW Health’s
pediatricians in an informal setting.
Gail LoPreste, MD, Director of Pediatrics for NEW Health, will host the session. Dr. LoPreste has recently returned to
North End Waterfront Health; she had previously practiced pediatrics at the health center from 2000 to 2007.
For those who cannot attend: Our first Doc Chat has been designed to coincide with an ongoing play group in the
neighborhood. If any parents would like to attend one and cannot make it during the workweek, please let us know and we will do
our best to organize one at a different time of day. Contact Denise at deniseclancey@gmail.com or 617-973-6688.
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Tips for Flu Season
posted on: 1/3/2013 12:01:18 PM
Flu hotline number: 617-643-8114
The common cold and the flu are both respiratory infections caused by viruses. The flu is considered to be
more serious because it can lead to pneumonia and even death in persons who have other chronic illnesses.
Symptoms of a cold come on gradually over a few days and are less severe than flu symptoms. The most common
symptoms of a cold are: stuffy/runny nose, sneezing and mild sore throat. You rarely have a fever or body aches with a cold.
Symptoms of the flu come on very quickly and are usually more severe than cold symptoms. The most common
symptoms are: tiredness, fever, chills, headache and major body aches and pains….your entire body feels sick.
Neither needs to be treated with antibiotics (antibiotics only work against bacteria); but if symptoms get worse or
persist for more than a few days, call your doctor.
There is a vaccine for the flu. It is recommended that everyone over the age of 6 months get vaccinated.
Colds can be treated with nasal decongestants, cough medicine and Tylenol. Drink fluids. If temperature is over
101, call your doctor.
The flu should be treated with bed rest, fluids, using a humidifier and avoiding alcohol and tobacco. Use
Tylenol to relieve the aches and pains and a cough suppressant to treat a cough. Don’t take antihistamines. Call your doctor, if
the symptoms persist longer than a week, get worse or are very severe. Most people recover from both a cold and the flu at home.
The best protection against the flu is to get a flu shot, wash your hands often, cover your cough and sneeze and avoid
touching your eyes, nose and mouth. If you are sick, stay home, away from work, school and other public places.
What is called the “stomach flu” is not flu but is a mild form of food poisoning. This is usually gone within
24 hours.
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Holiday Stress Reduction Session
posted on: 12/5/2012 3:45:19 PM
'Tis the season to be…stressed? While the holidays can bring joy and happiness, they can also bring stress. Money troubles, a
never ending to-do list, crowds – there's a lot going on that can put a damper on the season.
Margaret LeBlanc, LICSW, from North End Waterfront Health’s Behavioral Health Department, will lead a stress-reduction
session, giving tips for dealing with holiday stress and directing a relaxation exercise.
The session will be held in NEW Health’s third floor conference room on Tuesday, December 18 from 6:30 p.m. to 8
p.m. and is free and open to all North End and Waterfront residents, including health center patients, staff, and families.
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It's National Health Center Week!
posted on: 12/5/2012 3:39:36 PM
North End Waterfront Health is proud to be a part of the health care network that serves half of Boston residents –
community
health centers. In honor of National Health Center Week, here are a few facts about this vital health care network:
- There are 1,250 Health Centers in all 50 states and US territories that provide care to 20 million people in more than 8,100 communities.
- Health Centers produced more then 189,000 jobs.
- Health Centers are community driven and patient centered.
- Health Centers provide high quality, affordable primary and preventive care as well as mental health and substance abuse services and dental care.
- Health Centers meet or exceed nationally accepted practice standards for treatment of chronic conditions.
- Health Centers are vital mainstays in America’s communities.
- Health Centers produce cost savings for their communities and the nation.
- Health Centers mobilize communities and their people to make health and prevention priorities.
- Health Centers are open to all residents, regardless of insurance status.
For more information on the vital work health centers do across the country or to learn about local health center week events, visit www.healthcenterweek.org.
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Patient-Centered Medical Home Accreditation
posted on: 7/31/2012 11:24:38 AM
The Joint Commission, an independent organization that accredits health care facilities, renewed North End Waterfront Health’s
ambulatory health care and behavioral health accreditation and awarded the organization Patient-Centered Medical Home
accreditation for the first time.
“We are extremely proud of our three Joint Commission accreditations,” says Jim Luisi, CEO of NEW Health. “The surveyors
were impressed by our entire staff's dedication, loyalty, and commitment to high-quality care for our patients. We were the first
health center in the state to receive Joint Commission accreditation and now we are among the first to be accredited as a
Patient-Centered Medical Home.”
The Patient-Centered Medical Home is a nationally recognized way of providing the best primary care to patients. It is
patient-centered, team-based, comprehensive care in which a system-based approach to quality, safety, and enhanced patient access
is a priority.
The Joint Commission surveyors made their decision to accredit the health center in each of the three areas after
spending two days at the organization shadowing patients and interviewing staff.
“Through their various patient tracers over the past two days in adult medicine, pediatrics, dental, behavioral health,
the lab, and X-ray, the surveyors were able to first handedly observe us performing patient-centered, team-based, and coordinated
care,” says Vincenzo Scibelli, NEW Health’s director of behavioral health and chief compliance officer. “In fact, they stated that
we are the best Patient-Centered Medical Home practice that they have yet surveyed.”
The Joint Commission accredits health centers every three years. NEW Health’s next survey will occur in 2015.
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Summer Food Safety Tips
posted on: 7/13/2012 7:58:37 PM
Hot weather often causes people to lose their appetite but it is important to eat and drink enough to keep you healthy. When it
is hot and you do not feel like eating big meals, have five or six smaller snack like meals during the day. Be sure to drink
plenty of water – at least eight glasses during the day. For cool meals or snacks, eat fruits and vegetables that do not need to
be cooked.
Food safety is very important during the hot weather. Chill or refrigerate perishable foods promptly. Do not eat raw
or undercooked meat, poultry, eggs or fish. Keep hot foods hot and cold foods cold. When in doubt about the safety of food,
throw it out. For example, if food has been left at room temperature longer than 2 hours (1 hour if the temperature is higher
than 90), throw it out. Do not taste it.
For more information, call the USDA Meat and Poultry Hotline at 1-800-535-4555 or the FDA Food Information Line at
1-800-SAFE FOOD.
More Summer Food Safety Tips:
- Chill or refrigerate perishable foods promptly.
- Do not eat raw or undercooked meat, poultry, eggs or fish.
- Keep hot foods hot and cold foods cold.
- When in doubt about the safety of food, THROW IT OUT.
- If food has been left at room temperature longer than 2 hours (1 hour if the temperature is higher than 90), throw it out.
For more information, call the USDA Meat and Poultry Hotline at 1-800-535-4555 or the FDA Food Information Line at 1-800-SAFE FOOD.
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Joint Commission Accreditation
posted on: 5/24/2012 8:41:53 PM
As a Joint Commission Accredited Health Center, North End Waterfront Health is due for our accreditation survey for both our
Ambulatory Services and Behavioral Health Services. This survey will be a two day unannounced assessment of our practice. If you
would like to communicate with one of our surveyors while they are onsite, please contact, Vin Scibelli, chief compliance officer
at 617-643-8082.
In addition to this upcoming accreditation survey, we have also elected to have the Primary Care Medical Home Option
added to our survey. The Primary Medical Home Option will evaluate how well we are doing with providing Patient Centered Medical
Care. The Patient Centered Medical Home (PCMH) is a nationally recognized way of providing primary care to our patients. It is
patient-centered, team-based comprehensive care in which a system-based approach to quality, safety, and enhanced patient access
is a priority.
Patients are supported in selecting a primary care physician (PCP). The PCP and other team providers are involved in
the treatment plan, obtaining and tracking referrals, coordinating care, and collaborating with clinicians who provide specialty
care or second opinions. Please refer to the FAQ section in website for more information about how to select a PCP.
Patient responsibilities include: providing health history, current medication list, participation in self-management
activities.
Patient rights include: the right to obtain care from other clinicians within the PCMH, to seek a second opinion, and to
seek specialty care.
NEW Health respects patients’ rights to make decisions about the management of their own care. We involve the patient in
the development of a treatment plan and work in partnership with the patient to achieve planned outcomes. We respect patients’
rights by identifying patients’ oral and written communication needs including preferred language for discussing health care. We
also provide interpretation and translation services, educate the patient on self-management tools and techniques, and offer Same
Day Only appointments.
NEW Health collects data on disease management outcomes, patient access to care, patient satisfaction, patient
experience, and patient perception. This data is then used to evaluate how effectively NEW Health works in partnership with the
patient to support the continuity of care and the provision of comprehensive and coordinated care.
More information about NEW Health PCMH can be found in the “Patient Guide” and FAQ section of the website.
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Drug Take Back Initiative
posted on: 4/19/2012 7:00:27 PM
On Saturday April 28th the Boston Police Department will be participating in the DEA National Prescription Take Back Initiative. It is an opportunity for residents to turn in any unused or expired medications for safe disposal. There will be a drop off location at the North End Waterfront Health, 332 Hanover Street, from 10 a.m. to 2.p.m.
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Why We Need Sleep
posted on: 3/20/2012 3:59:26 PM
Why we need sleep:
- Need 7-8 hours sleep/night
- Body and brain need rest
- Prepares body for the next day
- The brain has time to sort and store information, replace chemicals, and solve problems
As people age their sleep patterns may change. But you still have the same requirement for sleep as younger people. Older people tend to nap more, get sleepier early in the evening, and wake up earlier in the morning. These habits make it more difficult to get a good night’s sleep. Also, older adults may wake up more often to go to the bathroom. They may also have heartburn, arthritis, menopause or cancer which may cause pain or discomfort. Lung disease and heart failure make it harder to sleep. Stress can be a factor.
Signs of Insomnia:
- Waking up tired
- Waking up many times during the night
- Waking up early and being unable to get back to sleep
- Taking a long time…longer that 30-45 minute………to fall asleep
Lack of sleep can cause:
- Depressed mood
- Attention and memory problems
- Excessive daytime sleepiness
- More nighttime falls
- To use more over the counter or prescription sleep aids
- Low energy
- roblems thinking and doing things
- Delayed response time
- Car accidents
- Cannot do their normal tasks after 2 days without sleep
- Hallucinations after 5 days without sleep
Tips for a good night sleep:
- Establish a ritual for bedtime: for example brushing teeth, wash face
- Set a schedule: go to bed at the same time every night and get up at the same time every am.
- Keep your bedroom at a comfortable temperature.
- Avoid eating or drinking alcohol or caffeine right before going to bed.
- Exercise: get 20-30 min/day; try to get the exercise 5-6 hours before bedtime
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Heart Health Event on February 16
posted on: 3/8/2012 8:24:51 PM
North End Waterfront Health is hosting a “Circle of Red” women’s heart health event on Thursday, February 16 from 10
a.m. to 2 p.m.
The event, which is sponsored by the American Heart Association and Massachusetts General Hospital, will
include heart
health screenings, games and prizes, heart healthy snacks, and a health information table – all for free.
Heart disease is the leading cause of death in women in the United States. In fact, more women than men die
each year
from heart attacks. One in four women die from heart disease every year, while one in 30 women die from breast cancer.
Women may
have different symptoms than men and are often not aware that they are having a heart attack.
Anyone is welcome to stop by between 10 a.m. and 2 p.m. on Thursday. The table will be set up on the first floor.
See
you there!
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Petition Drive to Support Health Centers
posted on: 2/8/2012 10:09:16 AM
North End Waterfront Health is participating in a national petition drive organized by the National Association of Community
Health Centers calling on Congress and the President to oppose Medicaid Cuts and increase funding to health centers.
Health Centers like NEW Health are currently the family doctor and health care home for nearly 23 million people in nearly 8,000
medically-underserved communities across the country. Yet, there are still 60 million people, including many with insurance who
still do not have access to a regular source of health care.
What’s more, 37% of all health center patients—some 8.5 million people—are covered by Medicaid. Health centers treat 14% of all
Medicaid patients and they do it for only 1% of total Medicaid spending.
America’s Health Centers’ system of community-based health care homes has had a remarkable record of success over more than 45
years in providing quality health care and saving the entire health care system money. NEW Health has been serving local patients
for 41 years and is a vital component of helping to solve the health care crisis in the United States.
Therefore, health centers across the country are calling on Congress and the President to:
1) Oppose cuts in the Medicaid program including efforts to reduce or eliminate fair payment protections for Health Centers;
2) Increase Health Centers’ funding by $200 million in fiscal year 2012, toward the goal of allowing health centers to serve 40
million Americans by 2015.
“We are asking patients, employees, and community members to support all of the great work health centers like ours do by signing
the petition,” says NEW Health CEO Jim Luisi. “As a non-profit organization, the cuts that Congress is suggesting would have a
negative impact on funding for the high-quality services we provide.”
If you would like to sign the petition, please ask any NEW Health staff member. You can also sign online at www.saveourchcs.org.
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7 Choices for a Healthy 2012
posted on: 2/8/2012 10:09:01 AM
For a “Healthy New Year” the American Cancer Society suggests the following seven choices:
C - Cut out tobacco
H: Hold the fat
O: Opt for high fiber fruits, vegetables and grains
I: Drink alcohol only in moderation
C: Call your doctor for regular check ups
E: Exercise every day (30 minutes, 5 days/week)
S: Safeguard your skin (SPF of at lest 30)
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Thanksgiving Holiday Hours
posted on: 11/23/2011 6:35:09 AM
Due to the holiday, the health center will close at 3 p.m. Wednesday 11/23 and Friday 11/25, and will be closed all day on
Thursday 11/24. You can call 617-643-8000 to reach the answering service at any time.
Happy Thanksgiving!
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New Policy to Protect Patients' Identities
posted on: 9/26/2011 11:08:29 AM
The safety of our North End Waterfront Health’s patients is our top concern. As you may have heard, medical identity theft is one
of the
fastest growing crimes in America. Medical identity theft occurs when someone comes to a health care facility and uses someone
else's identity to get care. As a result, health care providers make patient care decisions based on information belonging to
someone else, which can be medically dangerous. For example, allergies can be missed or the incorrect blood type considered during
treatment. This also means insurance claims can be filed for the wrong patient, which can have serious financial repercussions for
the victim.
In our efforts to protect our patients' physical—and financial—health and to combat medical identity theft, North End
Waterfront Health will ask patients for a photo ID upon appointment check-in or hospital admission beginning on October 1, 2011.
Please help us to care for you safely by bringing identification to all future appointments. Should you have any questions or
concerns regarding this information, please contact the Patient Privacy Officer at 617-643-8082.
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Information about the 2011 Flu Vaccine
posted on: 9/19/2011 8:00:12 AM
We are currently offering the flu vaccine to our adult and pediatric patients at scheduled primary care visits. The 2011 vaccine contains both the seasonal and H1N1 types in one single injection and there is no anticipated shortage of vaccine this year, so everyone who wants the shot should be able to get one. The current recommendation is for all people ages six months and above to be vaccinated, although we will be paying particular attention to patients high risk for complications of the flu. We encourage patients to be vaccinated at any site that is convenient, be it our facility, a town vaccination program, your worksite, or a pharmacy. The Mass General flu program starts on September 26 and will be open for any patient on a walk-in basis five days a week from 8 a.m. to 6 p.m. in the Wang lobby. It will run until mid November. NEW Health will update the flu hotline, 617-643-8114, on a regular basis to include any new information.
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Tips for Backpack Safety
posted on: 8/16/2011 10:47:43 AM
Backpacks are a great way to carry all of your school supplies. It is also a way to help you stay organized.
But they can cause problems. They can cause injury to you and others. If you leave your backpack in the way, other
people can
trip over it. Backpacks can fall out of your locker or off shelves. You can hit people with the backpack when you are taking it off.
They can cause pain to your back, neck and shoulders. So it is important to:
- Stand up straight. If your backpack makes you hunch forward or lean to one side, you maybe carrying too much weight or not using both straps.
- Use both shoulder straps so that the weight is distributed evenly.
- Limit the weight. Place the heaviest items closest to your back. You should carry no more than 10-15% of your body weight.
- When putting on the backpack, bend at the knees and use your legs to lift the backpack. Place one shoulder strap at a time.
- Choose a backpack with wide padded shoulder straps, a padded back and a waistband. You should have reflective material on the backpack so you are easier to see.
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NEW Health Celebrates National Health Center Week
posted on: 8/11/2011 6:45:52 AM
North End Waterfront Health is proud to be a part of the health care network that serves half of Boston residents – community
health centers. In honor of National Health Center Week, here are a few facts about this vital health care network:
- There are 1,250 health centers in the United States that provide care to 20 million people.
- Health centers provide jobs for 70,000 people.
- One in two Boston residents receive care at a community health center.
- Health centers are the most popular health care network in the state, with one in eight Massachusetts residents going to a health center for their care.
- Health centers are community-driven and patient-centered.
- Health centers provide comprehensive care, including physical, mental, and dental.
- Health centers produce cost savings for their communities and the nation.
- Health centers mobilize communities and their people to make health and prevention priorities.
- Health centers make an enormous contribution by keeping the doors of health care open to all who seek their care.
For more information, visit the Massachusetts League of Community Health Centers website.
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Understanding Teen Dating Violence
posted on: 7/18/2011 8:35:20 AM
Understanding Teen Dating Violence
adapted from a CDC fact sheet by North End Waterfront Health
Dating violence is a type of intimate partner violence. It occurs between two people in a close relationship. The nature of dating
violence can be physical, emotional, or sexual.
Physical – This occurs when a partner is pinched, hit, shoved or kicked.
Emotional – This means threatening a partner or harming his or her sense of self-worth. Examples include name
calling, shaming, bullying, embarrassing on purpose, or keeping him/her away from friends and family.
Sexual – This is forcing a partner to engage in a sex act when he or she does not or cannot consent.
Unhealthy relationships can start early and last a lifetime. Dating violence often starts with teasing and name calling.
These behaviors are often thought to be a “normal” part of a relationship. But these behaviors can lead to more serious violence
like physical assault and rape.
Why is dating violence a public health problem?
Dating violence is a serious problem in the United States. Many teens do not report it because they are afraid to tell
friends and family.
One in four adolescents report verbal, physical, emotional, or sexual abuse from a dating partner each year. About 10%
of students nationwide report being physically hurt by a boyfriend or girlfriend in the past 12 months.
How does dating violence affect health?
Dating violence can have a negative effect on health throughout life. Teens who are victims are more likely to be
depressed and do poorly in school. They may engage in unhealthy behaviors, like using drugs and alcohol, and are more likely to
have eating disorders. Some teens even think about or attempt suicide. Teens whoa re victims in high school are at higher risk for
victimization during college.
How can we prevent dating violence?
The ultimate goal is to stop dating violence before it starts. Strategies that promote healthy relationships are vital.
During the preteen and teen years, young people are learning skills they need to form positive relationships with others. This is
an ideal time to promote healthy relationships and prevent patters of dating violence that can last into adulthood.
Where can I learn more?
Choose Respect Initiative
www.cdc.gov/chooserespect
National Domestic Violence Hotline
1-800-656-HOPE (4673)
National Sexual Violence Resource Center
www.nsvrc.org
Dating Matters: Understanding Teen Dating Violence Prevention
www.vetoviolence.org/datingmatters
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Summer Food Safety
posted on: 7/5/2011 11:38:26 AM
Hot weather often causes people to lose their appetite but it is important to eat and drink enough to keep you healthy. When it is
hot and you do not feel like eating big meals, have five or six smaller snack-like meals during the day. Be sure to drink plenty
of water—at least eight glasses during the day. For cool meals or snacks, eat fruits and vegetables that do not need to be cooked.
Food safety is very important during the hot weather. Chill or refrigerate perishable foods promptly. Do not eat raw or
undercooked meat, poultry, eggs, or fish. Keep hot foods hot and cold foods cold. When in doubt about the safety of food, throw it
out. For example, if food has been left at room temperature longer than two hours (one hour if the temperature is higher than 90
degrees), throw it out. Do not taste it.
For more information, call the USDA Meat and Poultry Hotline at 1-800-535-4555 or the FDA Food Information Line at
1-800-SAFE FOOD.
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New Pediatricial Dr. David Tortorella
posted on: 7/5/2011 8:46:23 AM
A new pediatrician just landed at North End Waterfront Health. David Tortorella, MD, is a board-certified pediatrician
who has immediate appointments available and is accepting patients from newborns to young adults. He is also a newly licensed pilot.
Dr. Tortorella received his bachelor’s degree from Harvard University, his medical degree from St. Louis University, and
completed his residency in Chicago at Children’s Memorial Hospital, which is part of Northwestern University. He comes to NEW
Health after four years at a primary care practice in Biddeford, Maine.
“Working with children and families is very important to me,” Dr. Tortorella says. “My favorite thing about being a
pediatrician is getting to know families and watching kids grow. It’s extremely rewarding to start seeing a patient as a baby and
then watching him or her grow up—it’s like you get to be part of the family.”
Dr. Tortorella joins family medicine physicians Elizabeth Turnock, MD, and Martha McLoughlin, MD. Family doctors take
care of everyone from infants to grandmothers, while pediatricians focus solely on the care of newborns to young adults.
A Waltham, Mass. native, Dr. Tortorella says he is excited to work in the North End and truly get a taste of the
neighborhood.
“Coming from a small town in Maine, I’m eager to work in a city like Boston,” he says. “I’m especially lucky to be
working in the North End because the area has a great neighborhood feeling, so it’s like working in a smaller community. I’m also
looking forward to experiencing the food and cultural heritage—and I can’t wait to go to my first feast!”
In addition to flying the friendly skies, Dr. Tortorella enjoys cooking in his free time. He will see patients on
Tuesdays, Wednesdays, and Fridays. Call 617-643-8000 to schedule an appointment.
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Six Adolescent Health Problem Areas
posted on: 7/5/2011 8:46:06 AM
A new goal for the Healthy People 2020 Initiative is “Adolescent Health”. This goal will help to make the transition from
childhood to adulthood healthier and safer. Adolescents and young adults from ages 10-24 make up 21 percent of the US population.
This is a time in a young person’s life when they will begin to establish healthy behaviors and make lifestyle choices that will
affect their health in later years. This is generally a healthy time of life but several public health problems may start or peak
during these years.
The areas of concern are:
Substance use and abuse including alcohol and smoking: Although illicit drug use has declined among youth; non
medical use of prescription and over the counter medication is high. The most commonly used illicit drug is marijuana. Alcohol is
used more than tobacco or illicit drugs combined. Alcohol use and binge drinking are a major public health issue for youth.
Noise-induced hearing loss: This can lead to difficulty with communication and learning, pain, or ringing in the
ears and an inability to hear warning signals.
STDs and unplanned pregnancies: 3 in 10 girls get pregnant by the age of 20. Teen mothers are less likely to
finish high school and are more likely to live in poverty.
Mental health issues: Every year 1 in 5 youth between the ages of 9-17 experience symptoms of mental health
problems that can cause impairment.
Homelessness: 1/3 of the US homeless population is youth. 50 percent of these youth drop out of school and begin
to use drugs as a means of coping. Most of the homeless teens are runaways.
Accidental death or injury: This is the #1 cause of death between the ages of 1-44. Most often these deaths are
due to motor vehicle accidents, homicide, or suicide.
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Information and Tips for Better Sleeping Habits
posted on: 4/29/2011 11:37:58 AM
Why we need sleep:
- Need 7-8 hours sleep/night
- Body and brain need rest
- Prepares body for the next day
The brain has time to sort and store information, replace chemicals, and solve problems As people age their sleep patterns may change. But you still have the same requirement for sleep as younger people. Older people tend to nap more, get sleepier early in the evening, and wake up earlier in the morning. These habits make it more difficult to get a good night’s sleep. Also, older adults may wake up more often to go to the bathroom. They may also have heartburn, arthritis, menopause or cancer which may cause pain or discomfort. Lung disease and heart failure make it harder to sleep. Stress can be a factor.
Signs of Insomnia:
- Waking up tired
- Waking up many times during the night
- Waking up early and being unable to get back to sleep
- Taking a long time…longer that 30-45 minutes…to fall asleep
Lack of sleep can cause:
- Depressed mood
- Attention and memory problems
- Excessive daytime sleepiness
- More nighttime falls
- To use more over the counter or prescription sleep aids
- Low energy
- Problems thinking and doing things
- Delayed response time
- Car accidents
- Cannot do their normal tasks after 2 days without sleep
- Hallucinations after 5 days without sleep
Tips for a good night sleep:
- Establish a ritual for bedtime: for example brushing teeth, wash face
- Set a schedule: go to bed at the same time every night and get up at the same time every am.
- Keep your bedroom at a comfortable temperature.
- Avoid eating or drinking alcohol or caffeine right before going to bed.
- Exercise: get 20-30 min/day; try to get the exercise 5-6 hours before bedtime
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7 Choices for a Healthy New Year
posted on: 1/6/2011 1:39:43 PM
For a “Healthy New Year” the American Cancer Society suggests the following seven choices:
C - Cut out tobacco
H - Hold the fat
O - Opt for high fiber fruits, vegetables and grains
I - Intake alcohol only in moderation
C - Call your doctor for regular check ups
E - Exercise every day
S - Safeguard your skin
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Flu Vaccine Information as of 1/3/2011
posted on: 1/3/2011 10:13:30 AM
A combined flu vaccine containing both the seasonal and H1N1 components in one shot is now available, and The
Department of Public Health recommends that all persons age 6 months and above receive vaccine this year.
Adult and Pediatric patients of the Health Center may obtain a flu shot at a regularly scheduled visit only. If you are an
adult patient and have a question, please call and leave a message for Carol Brooks, our adult nurse manager at 617-643-
8000. If you are a pediatric patient, ask to be connected to the pediatric department.
There are reports of influenza outbreaks starting in New York at this time, so we should expect cases here soon. If you
feel you may have the flu – usually starting with the sudden onset of fever, body aches and cough – the general advice is
to use treatments for your symptoms available at any pharmacy, and stay home from work. You may call for an
appointment at 617-643-8000 if you feel more comfortable being evaluated by a medical provider.
For more updated information, please call this number, 617-643-8114.
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Holiday Safety
posted on: 12/7/2010 8:05:16 AM
*Never leave candles unattended.
*Keep burning candles, matches and lighters out of reach of children.
*Keep candles away from drapes or other materials that might catch fire.
*Turn off the tree lights, put out fires and candles when you leave the house or go to bed.
*Keep the tree away from heat sources…..fireplaces, heating vents or radiators.
*When decorating a tree, keep small ornaments, tinsel and other decorations on high branches out of reach of children.
*Keep harmful plants, such as holly berries, mistletoe, poinsettias and Christmas cactus, out of reach of children.
*Keep alcohol, including vanilla and almond extract, out of reach of children.
*Keep round, hard food and candy out of reach of children.
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Flu Vaccine Information
posted on: 11/19/2010 12:35:47 PM
A combined flu vaccine containing both the seasonal and H1N1 components in one shot is now available, and The Department of Public Health recommends that all persons age 6 months and above receive vaccine this year. Adult patients of the Health Center may obtain a flu shot at a regularly scheduled visit, or at our second free public flu shot clinic that will be held on Tuesday November 23th from 4 to 7 PM. Adults participating in this public clinic do not have to be patients of the Health Center. If you have a question, please call and leave a message for Carol Brooks, our adult nurse manager at 617-643-8000. Our pediatric vaccination program for health center patients has been completed. If your child is a patient of the pediatric department and has missed the flu shot, please call the department at 617-643-8096. For updated information, please call this number, 617-643-8114.
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FLU SHOT INFORMATION
posted on: 11/2/2010 1:01:14 PM
A combined flu vaccine containing both the seasonal and H1N1 components in one vaccine is now available, and The Department of Public Health recommends that all persons age 6 months and above receive the vaccine this year. Adult patients of the Health Center may obtain a flu shot at a regularly scheduled visit, or at our free public flu shot clinic that will be held on Tuesday November 16th from 4 to 7 PM. Adults participating in this clinic do not have to be patients of the Health Center. If you have a question, please call and leave a message for Carol Brooks, our adult nurse manager at 617-643-8000. For pediatric patients of the Health Center, if your child has a scheduled visit in the fall your child can receive a flu shot at that visit. If your child is a patient of the pediatric department and will miss the options for a shot, please call the department at 617-643-8096. There is no anticipation of a vaccine shortage for this year, and we may be able to offer a second adult public flu shot clinic later in November or early December. For updated information, please call this number, 617-643-8114
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Don't Forget the Flu!
posted on: 9/28/2010 6:41:39 AM
It's not too late to get the flu. H1N1 flu is not the same as seasonal flu. It began last spring and may continue though spring 2010. The important things to know about H1N1 are: Get a flu shot. Wash your hands. Cover your cough. Cover your sneeze. Avoid touching your eyes, nose and mouth. That?s how germs are spread. Stay home if you are sick and stay at home for at least 24 hours after your fever is gone. Follow public health department advice. The signs and symptoms of the flu are a sudden onset of: Fever Cough Sore throat Body aches Fatigue. Antibiotics are not needed to treat the flu. Rest, drinking liquids and using a humidifier will help you feel better. Call your health care provider if you have: Fever over 102 Difficulty breathing Confusion Chest pain It is important to get a flu shot every year for high risk people. These people include: Anyone over age 50. Children and young people up to age 25. Pregnant women. People with health problems such as diabetes, asthma or heart disease. Caregivers of any of the above. To schedule an appointment for a flu shot, call the appointment line at 617-643-8040 For more information: Call the flu hotline at the health center is 617- 643-8114. Websites: www.mass.gov/dph/swineflu www.cdc.gov/swineflu
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Don't Forget the Flu! Update
posted on: 9/28/2010 6:40:55 AM
A combined flu vaccine containing both the seasonal and H1N1 components in one shot is now available, and The Department of Public Health recommends that all persons age 6 months and above receive vaccine this year. Adult patients of the Health Center may obtain a flu shot at a regularly scheduled visit or make an appointment with one of our nurses by calling 617-643-8000. For pediatric patients of the Health Center, there are two options. If your child has a scheduled visit in the fall, your child can receive a flu shot at that visit. The second option is to schedule your child for a shot during one of our pediatric flu shot appointment sessions. These sessions are for Health Center pediatric patients only, and will be held on Tuesday October 5th from 2 to 6 PM, Thursday October 7th from 8:30 AM to 12:30 PM and Saturday October 16th from 8 AM to noon. To book into one of these sessions, please call 617-643-8000. There is no co-payment for these special pediatric flu shot appointments. Finally, free adult flu vaccine clinics will be offered to the general public later in the fall, and dates will be announced in the future. Adults participating in these clinics do not have to be patients of the Health Center. There is no anticipation of a vaccine shortage for this year. For updated information, please call this number, 617-643- 8114.
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FLU SHOT INFORMATION
posted on: 9/23/2010 10:11:35 AM
A combined flu vaccine containing both the seasonal and H1N1 components in one shot is now available, and The Department of Public Health recommends that all persons age 6 months and above receive vaccine this year. Adult patients of the Health Center may obtain a flu shot at a regularly scheduled visit or make an appointment with one of our nurses by calling 617-643- 8000. For pediatric patients of the Health Center, we will be offering several sessions in October in our department for your child to receive a flu shot. Children with scheduled physicals in the fall will receive a shot at their scheduled visit. At this time, we are not booking pediatric visits with our physicians only to receive flu vaccine. We will update this message when dates for pediatric vaccine sessions are scheduled, and ask that you then call to book into one of these sessions. Finally, free adult flu vaccine clinics will be offered to the general public later in the fall, and dates will be announced in the future. Adults participating in these clinics do not have to be patients of the Health Center. There is no anticipation of a vaccine shortage for this year. Our Flu Hotline number is (617) 643-8144. This message is current as of Thursday, September 23, 2010.
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Back To School
posted on: 8/31/2010 8:04:21 AM
It’s back to school and time to think about what your child may need to make a smooth transition to school hours and rules. Here are some things to think about before that first day of school: Immunizations need to be up to date. Check with your health care provider and the school. Also include emergency contact information and any illness such as asthma or diabetes that your child may have. If your child needs to take medication during the school day, make arrangements with the school nurse. It is important that children get enough sleep. Ages 6-9 years need 10 hours of sleep and pre-teens need 9 hours of sleep. Good nutrition is essential for growing children to help them learn. If your child is buying their lunch, find out the cost so you can provide the correct amount of money. Be sure to notify the school of any food allergies your child has. Children should have 60 minutes of physical activity most days. Check to see if the school has a dress code and if your child needs to bring a change of clothes for PE class. Backpacks are a great way to carry school supplies. But it should be packed lightly, have wide padded straps and back with multiple compartments. Be sure that both straps are used. Remember to review traffic safety re: to cross at the cross walk and obey traffic signals and signs. Know what time your child will arrive home from school. Make sure that they know who to check in with and who their emergency contact person is. Help your child to organize what they need to bring to school each day. Write down important information that they need to know about the school day such as time that classes begin, the time that classes begin and end, teachers’ names and classroom numbers.
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Celebrate National Health Center Week
posted on: 8/9/2010 12:17:19 PM
Health and Human Services Asst. Sec. Koh will celebrate National Health Center week at the North End Health Center next Monday. All are welcome to attend this media event.
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Summer Food Hints
posted on: 7/8/2010 10:47:27 AM
Hot weather often causes people to lose their appetite but it is important to eat and drink enough to keep you healthy. When it is hot and you do not feel like eating big meals, have 5 or 6 smaller snack like meals during the day. Be sure to drink plenty of water…at least 8 glasses during the day. For cool meals or snacks, eat fruits and vegetables that do not need to be cooked. Food safety is very important during the hot weather. Chill or refrigerate perishable foods promptly. Do not eat raw or undercooked meat, poultry, eggs or fish. Keep hot foods hot and cold foods cold. When in doubt about the safety of food, throw it out. For example, if food has been left at room temperature longer than 2 hours (1 hour if the temperature is higher than 90), throw it out. Do not taste it. For more information, call the USDA Meat and Poultry Hotline at 1-800-535-4555 or the FDA Food Information Line at 1-800- SAFE FOOD.
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Hot Weather Tips
posted on: 6/21/2010 12:54:40 PM
It is important to beat the heat and stay cool during these hot and humid days of summer. This is the kind of weather that can lead to heat stroke or heat exhaustion when you don’t take proper care of yourself. There are several important things to remember that will keep you healthy: o Drink plenty of cool, nonalcoholic fluids. o Stay in the shade, in air conditioning or near a fan. o If you don’t have a fan or air conditioning, spend time in a public cooling space (Nazzaro Center). o If you have to be out in the sun, wear a hat or use an umbrella. o Avoid overexertion. o Don’t exercise when it is hot and humid. o Wear light colored and loose fitting clothes. o Don’t plan activities during the hottest part of the day. Warning signs or symptoms of heat related problems that should be taken seriously are: o Weakness. o Nausea/vomiting/diarrhea. o Rapid heartbeat. o Chest pain. o Lack of energy and appetite. If you have any of these signs or symptoms, call your health care provider immediately.
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Healthy Aging
posted on: 5/6/2010 10:07:21 AM
You can’t stop getting older but you can do a lot to keep yourself healthy and active as you age. People are living longer now because of better nutrition, better medical care and better protection against infection. There are a lot of things that we can do to help us stay healthy and active in our later years. It’s important to keep both mind and body active. Start to think positively about your age. It is important to start to having regular medical check ups and developing healthy lifestyle habits. Here are some guidelines to help you stay healthy though the years: Tests that you should have done: Weight check: at least once a year. Blood Pressure test: at least every 2 years. Cholesterol test: check with your doctor how often this should be done. Colon cancer screening tests: check with your doctor how often this should be done and which test you need. Dental check up: once or twice a year. Flu shot: every year. Pneumonia shot: one dose for adults over age 65. For women: Osteoporosis test or bone density test: routine testing after age 65, check with your doctor when to begin. Breast cancer screening test: breast exam and mammogram every 1-2 years after age 40. Cervical cancer screening test or pap test: as your doctor recommends after age 65. For men: Prostate cancer screening test: rectal exam and PSA for some men as directed by your doctor after age 50. Healthy habits: If you smoke, stop. Get regular exercise. Eat a healthy diet with whole grains, fruits and vegetables and healthy protein. Avoid foods high in fat and sugar. Drink plenty of water. If you drink alcohol, drink in moderation. For men this means no more than 2 drinks a day and for women 1 drink a day. You can help your brain or mind with regular social activity; doing some mental exercise (cross word puzzles, reading, computer use) and regular physical activity.
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Drug Prevention Lecture
posted on: 4/14/2010 8:58:30 AM
Due to a scheduling conflict, we find it necessary to cancel this talk. We will reschedule a new date for May. Please accept our apologies for any inconvenience.
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Osteoporosis Facts
posted on: 4/2/2010 2:16:01 PM
Osteoporosis is a disorder that causes bones to become fragile and weak. The bones become porous and there is a decrease in bone mass. This causes a weakness that can lead to broken bones. It is called a silent disease because you may not know you have it until you break a bone. As bone mass is lost, a person becomes more likely to break a hip or wrist or develop a curving of the spine called a ?dowager?s hump?. Women are affected more often than men. 50% of people over the age of fifty are affected with this disorder. Risk factors for osteoporosis are if you are: Caucasian or Asian women Thin Postmenopausal or early menopause Smoking Not eating enough calcium rich foods Not being physically active Drinking alcohol excessively Drink more than 3 cups of caffeinated beverages per day Family history Some medicines (antacids, heparin, anticonvulsants) There is no cure for osteoporosis but there are some things that may help to prevent this condition: Physical activity including weight-bearing exercise Eating a healthy diet with the recommended amount of calcium Medicines (Fosamax, actonel, estrogen) The bone density test is used to make the diagnosis of osteoporosis.
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Drug Prevention Lecture
posted on: 4/2/2010 2:15:07 PM
THURSDAY APRIL 15, 2010 AT THE NAZZARO CENTER 5:30 pm EVERYTHING A PARENT NEEDS TO KNOW ABOUT DRUG USE: ? HOW TO TALK TO YOUR KIDS ABOUT DRUGS ? THE SIGNS OF DRUG USE ? WHAT ARE THE KIDS? DRUGS OF CHOICE PRESENTED BY The North End Community Health Center The Nazzaro Community Center North End Against Drugs Guest speaker: Norma Reppucci Babysitting will be provided. Pizza will be provided at 6:30 pm Raffle prizes: $50.00 for CVS For more information call: Mary Wright 617-643-8064
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16th Annual Taste of the North End
posted on: 3/25/2010 3:02:22 PM
Join us May 14, 2010 for the 16th annual Taste of the North End celebration, presented by the North End Community Health Center at the New England Aquarium; featuring over 25 local restaurants. Visit www.tasteofthenorthend.org for more details and to purchase tickets.
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EARLY RECOVERY GROUP
posted on: 2/23/2010 10:50:29 AM
Are you struggling with alcohol or other drugs? Would you like to learn strategies to moderate your drinking or drug use? Have you recently stopped using alcohol or drugs, but would like to receive more support? The North End Community Health Center?s Behavioral Health Department has started a support group for adults 20 and older who would like to explore their drinking or drug use in a safe and confidential setting. The group sessions are on Friday afternoons at 3:00pm and are facilitated by Susan Noto-Moniz, LICSW and Mark Pooler, LICSW. We accept most insurances and also have a sliding fee scale for those who qualify. Please contact the Behavioral Health Department at 617-643-8108 for more information.
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ANTIBIOTICS AND HOW TO USE THEM
posted on: 2/23/2010 10:49:58 AM
Antibiotics are strong medicines that are used to treat bacterial illnesses. They do not work against viruses. Colds and the flu are examples of a virus. If you have concerns about having a bacterial infection, call your health care provider. They can prescribe antibiotics if needed. Bacteria can become resistant to antibiotics if they are not used correctly or if they are overused.If you are given an antibiotic, you must take your medicine as directed and take all of the pills (even if you feel better before they are gone). If you are not better when your prescription is gone, call your health care provider. Don?t use any left over pills for another illness. If you are taking the medication as prescribed, there should not be any left over. Never give your antibiotics to someone else. Antibiotics do not cure every illness. You may need a different antibiotic for every illness. If your health care provider prescribes antibiotics for you, be sure to tell them if you are taking other medications, have any allergies or if you use alcohol or other drugs. Call your health care provider if you develop any trouble breathing, swelling of the face, throat or mouth, a skin rash or have persistent nausea or diarrhea.
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