UK HealthCare looks to improve research and help infertility heartbreak.

Knowing risks, options can aid those with infertility

Written by Patrick Hannon, post-doctoral researcher in the UK Department of Obstetrics and Gynecology.

About 15 percent of couples in the United States experience infertility, which is when a couple has tried to become pregnant for a year without success. Infertility comes as a shock to many couples who have spent years preventing pregnancy.

The inability to become pregnant leads to long-lasting and detrimental effects on a woman’s physical and emotional wellbeing. These detrimental effects include a decreased quality of life as indicated by increased levels of stress, impairments in physical and mental health, and diminished social functioning when compared to fertile women. Research has shown that being diagnosed with infertility has similar emotional and life-altering impacts as being diagnosed with cancer or a heart attack.

Infertility is a major public health concern as the diagnosis and treatment of infertility is estimated to cost society over $5 billion annually. For many couples, equally devastating is the realization that their health insurance does not cover infertility treatment, and all their medical costs must be paid out-of-pocket. It is critically important for UK infertility research to understand the causes of infertility in order to refine treatments, decrease the costs associated with infertility, and benefit the overall wellbeing of those suffering from infertility

Risk factors

The most prominent underlying causes of female infertility are defects in ovulation, or release of the egg from the ovary. The exact cause for defects in the woman’s reproductive tract is not entirely understood, but several risk factors are associated with infertility, including:

  • Untreated sexually transmitted infections
  • Pelvic inflammatory disease
  • Certain cancer treatment regimens
  • Endometriosis
  • Polycystic ovarian syndrome
  • Exposure to environmental toxicants
  • Lifestyle factors such as smoking, drug use, excessive alcohol use, abnormally high levels of stress, and extreme weight gain or loss

Age and female infertility

However, the single most significant contributing factor to female infertility is age. Fertility greatly declines with age due to the natural depletion of eggs within the ovary and decreased quality of the remaining eggs, leading to increased chances of miscarriage. Further, the potential health of the child can be impacted by a woman’s age due to genetic abnormalities in the eggs of older women. As women in today’s society are delaying child birth for personal, professional and financial reasons, age becomes an important factor contributing to infertility.

Combating infertility

To combat infertility, women can undergo treatment from a trained infertility specialist, which includes infertility testing, drug treatment to aid in ovulation, surgery to repair abnormalities in the reproductive tract and assisted reproductive technologies (ART), which includes the commonly used in vitro fertilization (IVF) procedure. In ART, the egg is fertilized outside the body before being placed back into the woman’s uterus. Unfortunately, the challenges of infertility treatments, specifically ART, are that success rates are low (approximately 56 percent) and decline with age.

UK infertility research

Scientists are continuing to refine and improve ART methods, such as working to optimize dosing regimens of the drugs that aid in ovulation, refining the conditions in which fertilization takes place outside the body, enhancing the procedures used to evaluate embryo quality prior to placing the embryo back into the woman, and investigating ways to preserve the fertility of cancer patients by using ovarian cryopreservation.

In our laboratories here at the University of Kentucky, we are determining precisely how ovulation is controlled in women and are identifying novel factors that drive ovulation. Each of these advancements aims to improve effectiveness, while decreasing the time and cost of infertility treatments.

 

Prevent Zika virus in Kentucky with repellent.

What you should know about Zika virus this summer

Talk of the Zika virus is everywhere these days, and it has many people understandably worried. On Tuesday, UK HealthCare experts held a news conference to answer questions about Zika. The bottom line? If you’re here in Kentucky and aren’t planning to travel this summer, your risk of catching Zika is very low. But there are things you can do to be prepared in case that risk increases this summer.

“At the present time, the risk for infection is low for Kentuckians not traveling to areas with active Zika,” said Dr. Phillip Chang, UK HealthCare chief medical officer. “However, the Centers for Disease Control and Prevention (CDC) continue to provide updates and if locally transmitted cases are found in the U.S., the risk could increase.”

What is Zika virus?

The Zika virus is spread through mosquito bites or through sexual contact with an infected person. Currently, virus transmission is happening in many Caribbean and Central and South American countries. Although many people who become infected have mild or no symptoms, pregnant women who contract the disease are at high risk for complications. Zika has been linked to microcephaly, a potentially fatal neurological disorder characterized by an abnormally small head.

Currently, the only cases in the U.S. have been travel-associated. But concern is growing about the possibility of travelers spreading it to mosquitoes in the U.S., which can then infect people who have not traveled to countries with the active virus. The Aedes aegypti mosquito, which is the main carrier of the virus, can be found in the U.S. during the summer months, including Kentucky. This means that the Zika virus in Kentucky could be a real possibility.

“Currently, there is no anti-viral treatment and no vaccine for the Zika virus, so we are focusing on prevention and risk reduction and, if necessary, proper screening for our patients if Zika becomes a concern in the region,” said Dr. Derek Forster, UK HealthCare medical director for infection prevention and control.

Pregnant women and Zika

Since February, UK HealthCare’s obstetrics and gynecology clinics have been educating patients on the risks of Zika, particularly for pregnant patients or pregnant patients with partners who travel to these areas, said Dr. Wendy Hansen,chair of UK Obstetrics and Gynecology.

“We have been telling pregnant patients to postpone travel to areas with outbreaks of Zika virus, which currently is nearly all of Central America and much of the Caribbean and South America,” Hansen said. “We also are counseling and advising patients on what to do if they have partners that plan to or have traveled to these areas.”

According to current CDC guidelines, the following special precautions are recommended for pregnant women:

  • Pregnant women should not travel to any area with Zika.
  • If you must travel to one of these areas, talk to your doctor or other health care provider first and strictly follow steps to prevent mosquito bites during your trip.
  • Until more is known, pregnant women with male sex partners who have lived in or traveled to an area with Zika virus should either use a condom every time they have sex or abstain from sex throughout the pregnancy.

Precautions for everyone

While the Zika virus is most dangerous for pregnant women who risk complications, everyone is urged to take precautions to prevent mosquito bites during the summer months to prevent possible spread of the disease.

Precautions include:

  • Wearing protective clothes, including long-sleeved shirts and long pants. For extra protection, treat clothing with permethrin, a chemical that repels insects and kills mosquitoes and ticks when sprayed on clothing, tents and other gear.
  • Using an EPA-registered insect repellent every day containing one or more of the following active ingredients: DEET, PICARIDIN or IR3535.
  • Using screens on windows and doors, and using air conditioning when available.
  • Keeping mosquitoes from laying eggs in and near standing water near your home.

“Although these precautions are especially important for pregnant women and women of childbearing age who want to become pregnant, we want everyone to educate themselves on how to protect their family members and friends,” Hansen said.

Watch UK HealthCare experts discuss Zika virus below.

 


Next steps:

  • The CDC recommends that testing for the Zika virus be done for pregnant women who have recently traveled somewhere with active Zika or anyone who has traveled and has symptoms.
  • For the most up-to-date information, visit the CDC’s website.
water safety

Going to the pool? Keep the kids safe with these tips

Memorial Day marks the unofficial start of summer, and pools everywhere will be opening this weekend.

Swimming and water recreation can be great fun, but they can also be dangerous. So before you and your family hit the water, check out these tips for keeping the kids safe.

Water safety tips to teach your children:

  • Learn how to swim.
  • Always swim with a buddy.
  • If you can’t swim, don’t get in water deeper than your shoulders.
  • Always wear a U.S. Coast Guard-approved life vest when you are playing water sports, when you’re near an open body of water or when you’re on a boat.
  • Never run, push or jump on others around water.
  • If you see someone struggling in the water, shout for help. Don’t try to rescue the person yourself.

Water safety tips for adults to keep in mind:

  • Never leave children alone near water – adults must supervise at all times.
  • Never let children swim alone – no exceptions to this rule, ever.
  • Children in baby bath seats and rings must be within arm’s reach every second.
  • Teach children to swim after age 4.
  • Never substitute a flotation device for supervision.
  • Do not allow children to run, push or jump on others around water.
  • Learn CPR for infants, children and adults.

In case of drowning

According to the CDC, two children 14 and younger in the United States die by drowning every day. And for every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries.

In a drowning accident, seconds make the difference between survival, recovery or death. Drownings occur when a child is left unattended, even for a brief moment. If a child is missing, always check the water first before looking elsewhere. Wading pools, swimming pools, spas, hot tubs, lakes, rivers, oceans, bathtubs, buckets and even toilets all pose a risk of drowning.

If you see someone struggling in the water:

  • Shout for help immediately.
  • Find something you can throw out to the person to pull him or her to safety, such as a life preserver, rope or towel.
  • If you can’t reach the person, throw out a floating object he or she can hold onto until additional help arrives.
  • Never swim right to the person. He or she is scared and may accidentally hurt you.
  • If no one hears your shout, call 911.

Next steps

Hip or knee pain? Know when to see a doctor

Written by Dr. Stephen Duncan, orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

Dr. Stephen Duncan

Dr. Stephen Duncan

In the past four weeks, more than one-third of people over the age of 55 in the United States have complained about hip or knee pain to their physician. In a lifetime, our hips and knees get a lot of use. There are various ways individuals can reduce the strain placed on their joints to maintain the health of their hips and knees.

Preventing knee and hip pain

Individuals have some ability to reduce the strain put on their knees and hips. The relationship between being overweight and joint pain is a contentious one. If joint pain is rooted in being overweight, it is important to healthily lose weight. Developing a stronger core can also lessen the strain placed on joints.

People who engage in “high impact” activities, like running, basketball or Zumba, can take steps to prevent joint issues like torn ligaments and inflammation. Physical therapy, to strengthen the muscles surrounding the hips and knees, can do wonders in reducing and preventing joint pain.

Supplements can aid in improving joint health and reducing pain. Omega 3s block inflammatory cytokines and prostaglandins, reducing joint tenderness and stiffness. Also, ginger has been shown to be a natural anti-inflammatory while Capsaicin reduces substance P, a pain transmitter.

Treatment options

In the United States, nearly 30 million people are treated for joint pain in their knees and hips each year. Too often, joint pain is considered part of aging, and if a person has suffered over a long period of time, it can be considered part of life. Persistent joint pain, which lasts more than six months and is not responding to activity modification and/or anti-inflammatory medicines, means it’s time to see an orthopedist.

Common treatments for knee and hip joint pain are arthroscopy and joint replacement. Arthroscopy can be done for patients with mild arthritis to remove a torn meniscus in the knee or a labrum in the hip. Recovery from this procedure is typically four to eight weeks. Hip or knee replacements are done for more advanced arthritis. Recovery for hip replacement is typically four to eight weeks, but is largely dependent on the patient’s health. Partial knee replacement recovery lasts approximately four to six weeks; a total knee replacement has a recovery time of six to 12 weeks.

Reducing the chances of needing orthopedic surgery is possible, but knowing the signs of pain that may require medical intervention is vital.


Next steps

mindful eating

Mindful eating can help you lose weight permanently

Losing weight is difficult, and keeping it off can be even harder. Many people regain the weight because typical weight loss diets involve drastic, unsustainable changes. But, learning to eat “mindfully” can fundamentally shift our relationship with food for long-term weight loss maintenance.

In our busy, convenience-oriented lives, eating has become an automatic behavior. Research shows we make more than 200 eating decisions daily, but we sometimes don’t take time to think about them. Instead, we often eat mindlessly, or out of habit. In a culture where we are surrounded by unhealthy food options, this has understandably led to a lot of weight gain.

Mindfulness means paying attention, on purpose, to the present moment — without placing judgment. Mindfulness-based approaches have been used with success in the treatment of health issues like stress, depression, eating disorders and chronic pain. When we apply mindfulness to eating, it helps us support our long-term health and well-being, because we learn to slow down and recognize when we’re truly hungry and when we’ve had enough to eat.

It’s not about meditating over breakfast — but about continually paying attention to how food affects us, so that we can make better eating choices. With gentle and attentive practice, we can reprogram the behaviors and reactions that cause us to eat mindlessly. This can lead to lasting changes from to how we react when there’s food in social situations to how we shop for and prepare food.

It might seem daunting to learn eat mindfully, but with practice it can become a habit. Here are few tips and resources to get started:

  • Before you eat, stop and ask yourself why you’re eating. Is your body actually hungry?
  • Your stomach is about the size of your clenched fist, so try to eat just that amount at one time. It actually takes 20 minutes for the brain to recognize that you are full, so try to wait before getting a second helping.
  • Pay attention to physical signs of hunger and fullness. Eat when you’re slightly hungry (not starving), and stop when you don’t feel hungry anymore (not full or stuffed).
  • Take time to look at your food, smell your food and taste your food more slowly to really experience it.
  • Minimize distractions (like screens) while eating. Sit down and focus your attention only on your food and your body.

For more information, some useful resources include The Mindful Diet from Duke Integrative Medicine and the Am I Hungry? Mindful Eating Program.

Written by Teresa Lee, RD, LD, a teaching assistant in the University of Kentucky Department of Dietetics and Human Nutrition.


Next steps:

  • Researchers at the University of Kentucky are looking for people who are interested in participating in a study about how mindfulness affects weight loss. For details, please contact Teresa Lee at 859-619-3640 or teresalee@uky.edu or visit ukclinicalresearch.com.

Appalachian Research Day shows community-based health care efforts

For many UK researchers who study health in Appalachia, the Center of Excellence in Rural Health (CERH) is an indispensable partner in conducting community-based research. The Center, located in Hazard, connects researchers with the local community and provides necessary infrastructure, from conference rooms to a team of community health workers, called Kentucky Homeplace, who engage participants and gather data.

This week, researchers shared the findings from these community-based studies at the second annual Appalachian Research Day.

“Today is an opportunity for people who do research with the Center to report back about their findings, and see what we can come up with together to better our lives here in Appalachia,” said Fran Feltner, director of the CERH.

Addressing Appalachian health issues

Rural Appalachian communities in Eastern Kentucky experience some of the nation’s most concerning health disparities, including elevated rates of obesity, diabetes, stroke, heart disease, depression, and cancer incidence and death. Residents of Appalachia might also face challenges in accessing health care, such as distance from providers, lack of insurance, or socioeconomic barriers.

Community-based research is essential in addressing disproportionate rates of poor health by collaboratively identifying problems and developing shared solutions that are a good fit for communities. For this type of research to succeed, it must begin at the local level, built upon the foundation of relationships with individuals, neighborhoods and groups who have common questions and concerns. In Eastern Kentucky, the CERH has enabled community-based studies since 1990, when it was founded to improve health through education, service, and research.

In 2015, the CERH launched Appalachian Research Day as an opportunity to share and discuss research findings with the communities that were involved in the studies. Feltner describes the day as an invitation for everyone involved in community health research to “come sit on the porch” of the Center and talk about their work and ongoing needs. More than 100 researchers, coordinators, community health workers, community advisory board members, students, and staff participated this year, with four podium presentations and 13 poster presentations.

“These research findings drive new and exciting health initiatives that are transforming lives across our rural Appalachian region,” Feltner said.

Researching change

The presen­tations focused on community research related to healthy lifestyles, depression, lung cancer screening, drug use and risk behaviors in Appalachia.

Mark Dignan, professor in the UK College of Medicine and director of the UK Prevention Research Center, discussed his work with faith-based communities to study energy balance, obesity and cancer in Appalachia.  According to the CDC, the national obesity rate in adults is about 29 percent, while in Appalachian states the rate is 31-35 percent. Dignan was particularly interested in how to help people re-engineer their lives to include more physical activity.

“When you do research in the community, hopefully you’ll make change that will be lasting,” he said.

Rates of depression are also higher in Appalachia than the rest of the country. For Appalachian women, the rate of depression is four times higher than the national rate. They are also less likely to receive adequate treatment, according to Claire Snell-Rood, PhD, who shared her research on adapting treatment options for rural settings where the traditional mental health system is both inappropriate and inadequate.

“This research focuses on how to adapt evidence-based programs to address not only limited treatment options in rural areas, but the substantial social and health challenges that impede Appalachian women from obtaining the care they need,” she said.

Snell-Rood worked with Kentucky Homeplace community health workers to conduct interviews with women, and she is currently adopting a collaborative, peer-based practice to support rural individuals in developing their own processes for wellbeing.

Roberto Cardarelli, DO, MPH, professor and chief of community medicine in the UK College of Medicine, also presented his research project, the Terminate Lung Cancer study, which aims to understand the knowledge and attitudes of lung cancer screening among high-risk rural populations. Kentucky’s lung cancer mortality rate dramatically exceeds the national lung cancer mortality rate, with 73.2 deaths per 100,000 in Kentucky versus 49.5 nationally. Cardarelli and his team conducted focus groups in order to develop an effective campaign to promote lung cancer screening in the region.

“We like to focus on research that’s important to communities, and we couldn’t find a more important topic than tobacco cessation and lung cancer screening,” he said.

The final presentation of the day addressed drug use and prescription opioid use in Eastern Kentucky. Michele Staton-Tindall, PhD, associate professor in the UK College of Social Work, conducted research in jails to learn about drug use and health-related risk behaviors among rural women in Appalachia. She said that rates of drug use are “alarmingly high” in this area of Appalachia, with many users injecting.

“Injection is the preferred route of administration, which is coupled with increased public health risks including HCV and HIV,” she said.

Solving problems together

The event was supported in part by the UK Center for Clinical and Translational Science, which aims to accelerate discoveries that improve human health, with particular focus on the Appalachian region.

For Feltner, a nurse who has worked in rural health for 35 years, Appalachian Research Day represents the best qualities of the place she calls home.

“What I love most about Appalachia is the fellowship we have together, as neighbors and friends, working together to solve problems.”

New FDA rules spotlight e-cigarette safety claims

Think e-cigarettes are a safe alternative to tobacco? You may want to think again.

Just last week the FDA announced new rules for e-cigarettes, which had been unregulated since they first became available in this country in 2007.

The new rules, which go into effect in August, treat e-cigarettes very much like the real thing. That’s because the two have a lot in common.

Unlike tobacco cigarettes, e-cigs do not burn. They use a battery to heat a cartridge containing nicotine and other chemicals, including flavorings, until those chemicals become a vapor that can be inhaled. The vapor from an e-cigarette does not contain the toxins and tar that tobacco smoke contains, but it does contain nicotine, one of the most addictive known substances.

And, at least until now, there was no way to know what other harmful substances the vapor contained. These could include formaldehyde, which is known to cause cancer, and the flavorings may themselves contain harmful toxins.

One of the biggest fears with e-cigarettes is that their flavorings will attract non-smokers, particularly teenagers, and lead to a lifelong nicotine addiction. Ask any smoker who’s tried repeatedly to quit and they will tell you they wish they’d never started smoking in the first place.

Another danger is nicotine poisoning in young children, who might be attracted to the e-cig flavorings.

The new rules prohibit misleading advertising, require health warnings on e-cigarette packaging and forbid sales to anyone under age 18.

Ellen Hahn, a professor at the UK College of Nursing and co-chair of the UK Tobacco-free Task Force, was quoted in a USA Today story about the regulations, saying the new rule is a good first step toward controlling e-cigarettes. “From a health perspective, to reduce the social acceptance of them is good because frankly, it’s the Wild, Wild West out there,” she said. “Vape stores are everywhere.”

Some fans of e-cigarettes say they can help smokers quit tobacco, but there’s not enough research at this point to know whether that is true.

The bottom line is it’s better not to smoke at all. If you’re a smoker trying to quit, be sure to seek out support to help you along the way. (See our list of resources below.) And if you’re a non-smoker, remember, that first e-cigarette could lead to a lifetime of trying to quit.

Next steps:

Hand Hygiene

Wash your hands the right way

Washing your hands is one of the easiest and most effective things you can do for your health. When you wash your hands regularly before and after certain activities, you reduce your risk of getting sick and prevent the spread of germs to other people, too. It’s a quick and simple way to help keep everyone around you healthy.

Today is World Hand Hygiene Day and a perfect time for a handwashing refresher. According to the Centers for Disease Control and Prevention, there are five steps for success: Wet, lather, scrub, rinse and dry. Here’s how to do it:

  • Wet your hands with clean water (warm or cold), turn off the faucet and apply soap.
  • Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers and under your nails.
  • Scrub your hands for at least 20 seconds. Need a timer? Sing “Twinkle Twinkle Little Star” from beginning to end or recite the ABCs in your head.
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air dry them, and use a paper towel to turn off the faucet, and then throw it away.

Make sure to wash your hands:

  • Before Also wash them before, during and after preparing food.
  • After using the bathroom.
  • After coughing, sneezing, blowing your nose or caring for someone who is ill.
  • After taking out the trash.
  • After petting animals.
  • When visiting someone who is sick.
  • Whenever your hands look or feel dirty.
managing hypertension

Here’s how you can manage high blood pressure

Written by Dr. Khaled Ziada, an interventional cardiologist at the UK Gill Heart & Vascular Institute

Dr. Khaled Ziada, managing hypertension

Dr. Khaled Ziada

What do your arteries have in common with a garden hose? Quite a lot, in fact.

Increasing the pressure in a garden hose (whether by opening your faucet to full force or by plugging the end of the hose opening) can cause it to become rigid or even burst.

Blood in the arteries functions in much the same way. Consistently high blood pressure  also called hypertension  damages the tissues of the artery walls. While it’s fairly easy to replace a garden hose, hypertension can lead to serious medical problems and even death.

Hypertension is a chronic condition in which the systolic blood pressure (the top number in the measurement that your health care provider gives you) exceeds 140 mmHg or diastolic blood pressure (the bottom number) exceeds 90 mmHg.

Although it’s normal to experience minor fluctuations throughout the day, one in three Americans experience high levels of blood pressure (exceeding 140/90) even without activity or stress. That can increase the risk of heart attack, stroke, heart failure, kidney disease and even death. This increased risk is compounded in people with diabetes, high cholesterol or smokers.

Generally, patients with hypertension can help control their high blood pressure by adopting healthy lifestyle habits such as:

  • Losing weight
  • Exercising more
  • Stopping smoking
  • Reducing stress
  • Eating a balanced low-salt diet

When lifestyle changes aren’t adequate, there are numerous drug therapies that can be used separately or in combination to reduce hypertension.

Occasionally, however, some people have what’s called “resistant hypertension,” which despite lifestyle changes and medications cannot be brought under control.

Our research team here at UK HealthCare is exploring a novel approach to treat hypertension by manipulating the sympathetic nervous system signals that contribute to high blood pressure. The sympathetic nervous system regulates the vital functions of the body by connecting the brain to major organs such as the heart, kidneys and blood vessels. If the sympathetic nerves connecting the kidney to the brain are overactive, blood pressure rises.

Our study is exploring the effect of renal denervation, a minimally invasive procedure that may potentially decrease the sensitivity of nerves lining the walls of the kidney arteries, thereby reducing the signals that cause hypertension.

Because it has no direct symptoms, hypertension is known as the “silent killer.” The best first step is to know your blood pressure readings and work with your doctor to control high blood pressure if necessary. If you’ve exhausted all other options, talk with your doctor about clinical trials such as ours, which may be able to help you better control your hypertension.

For more information about this study, call 859-323-5259 or email  h.shinall@uky.edu.

lawn mower safety

Mowing the lawn? Keep these safety tips in mind

Even though it’s easy to forget when you’re using it week in and week out, your lawn mower is actually dangerous and potentially deadly piece of equipment.

Each year 20,000 people are injured in the U.S. due to mower-related accidents, and 75 are killed. One in five of those deaths involves a child, and more than 600 children will lose a limb this year as a result of a preventable lawn mower accident. While it’s important to be extremely cautious when cutting your yard, one of the safest things you can do for your family is to keep your children inside while you’re operating a lawn mower. In many cases where children were injured, the adults involved didn’t know they were near the mower when the injuries occurred.

To raise awareness about the dangers lawn mowers pose to children, The Amputee Coalition and Limbs Matter, a group of parents whose children have undergone an amputation because of a lawn mower accident, have partnered on national safety initiatives.

Kids aren’t the only ones at risk from lawn mowers. Here are some personal safety tips to keep in mind:

Wear the right clothing. Avoid shorts or sandals. Long pants will protect your legs and closed-toed shoes protect your feet and provide better traction.

Survey the yard. Before mowing, pick up any sticks, rocks or other debris that could become dangerous projectiles if hit by a mower blade.

Tell somebody. Before you begin mowing, be sure to tell a family member or neighbor that you’re going to be working outside in case an accident happens.

Mow across the slope. If you have to mow a slope, always mow across the slope and never up and down. This removes the risk of the mower rolling back on you.

Don’t mow at night. You should only use your mower in daylight or good artificial light.

Beware the sun. If it’s hot outside, be sure to take frequent breaks and drink plenty of water. Don’t forget the sunscreen.


Next steps:

Learn more about the importance of lawn mower safety by watching the “Limbs Matter” public service announcement.