interviewed Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in 

 on the epidemiology of functional seizures among adults treated at a university hospital.

Could understanding and treating functional seizures also help to potentially support the treatment process for other comorbid conditions as well?

 I think that's a great question, and I think that that is absolutely the hope. I think that certainly people who are dealing with PTSD, anxiety disorders, depression—to have this added burden of the functional seizure condition, where seizures can come on at any point and can be incredibly disruptive—to be able to get the seizures under control, that alone would really improve the quality of life, and I think also open some doors for being able to treat the other comorbid psychiatric conditions as well.

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Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, discussed how the effective treatment of functional seizures could help to support the treatment of other comorbid psychiatric conditions as well. 

Expert: Effectively Treating Functional Seizures May Help to Treat Other Comorbid Psychiatric Conditions

More than 40% of nurses and other health care professionals had risks associated with an increased likelihood of burnout early in the COVID-19 pandemic, according to a survey published in the 

The study investigates risk factors for poor well-being and factors associated with greater resilience, which may reduce the risk of burnout for hands-on care providers, according to research from Lindsay Thompson Munn, RN, PhD, and her colleagues of a North Carolina health care system.

"The insights gained from this study can help health care leaders to target these risk factors and develop strategies that allow organizations to better support well-being and resilience among clinicians," the study authors said in a press release.

The online survey of nurses and other non-physician health care workers received 2459 responses from participants who provided direct patient care and focused on risk factors for decreased well-being, which was a key contributor to the burnout epidemic among health care professionals. Data were collected in June and July 2020.

During the time of the survey, 44% of health care workers surveyed had “at risk” well-being, which is closely associated with increased risk of burnout, fatigue, and patient care errors.

The analysis of the responses identified several factors linked to increased odds of poor well-being, such as:

Feeling supplies of personal protective equipment were insufficient

Believing the organization did not understand health care workers’ emotional support needs during COVID-19

Inadequate staffing for safe patient care

Having a lower degree of psychological safety

There were opposite levels of some of these factors associated with higher scores for resilience, including:

Feeling the organization does not understand emotional support needs

Believing staff were being redeployed to areas of critical need

Having a higher degree of psychological safety

Further, fewer than one-fourth of health care workers surveyed had used available resources to support their well-being and resilience, such as meditation apps and counseling. Munn and her co-authors believe that this study had practical implications for health care professionals to promote well-being and resilience among other workers during the pandemic and beyond.

"While it may seem obvious that nurses and other [health care workers] would sustain burnout and poor well-being after dealing with providing care under arduous circumstances, it's important to establish the contributing factors and to learn how some were able to mitigate the effects of the stressors," said Maureen Shawn Kennedy, MA, RN, FAAN, in the press release. "We're in serious need of successful strategies to support frontline caregivers."

Munn noted some of the next steps that will help support resilience while addressing the factors that are negatively attached to burnout in the environment.

"[L]eaders can take crucial steps toward optimizing workers' well-being by paying careful attention to workload and staffing, creating a culture of psychological safety within teams and units, and recognizing and actively addressing the unique challenges posed by the pandemic," Munn said in the press release.

During COVID-19, nurses face significant burnout risks, reports 

. EurekAlert! July 22, 2021. Accessed July 26, 2021. 

https://www.eurekalert.org/pub_releases/2021-07/wkh-dcn072221.php

Articles

Survey Shows Nurses Face Significant Burnout Risks in COVID-19 Pandemic

interviewed Carrie Cuttler, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 on the use of cannabis in treating symptoms of obsessive-compulsive disorder (OCD).

 What are some, as you're discussing, future research avenues worth pursuing in light of this study on the use of cannabis and treating OCD?

 Yeah, well we really need good, well-powered, double-blind, placebo-controlled studies of the acute effects of whole plant cannabis and cannabidiol (CBD) on OCD systems.

So, the primary limitation of my research is that, since I'm analyzing data from a mathematical cannabis app, Strainprint, I was not able to obtain a placebo-control group. People using this app aren't using placebos.

As such, some of the reductions in the symptoms that people are reporting are likely also due to their expectations of the effects of cannabis on OCD symptoms and may not actually be drug effects per se.

Placebo effects can be pretty large, and so this is a very important limitation to consider. Now, there was one placebo-controlled trial that was published around the time that my paper was under review, and they also found that OCD symptoms were reduced from before to after cannabis use, but the reduction in symptoms was not significantly different than that that was observed after placebo administration, suggesting that reductions were due to a placebo effect and were no greater than that.

However, in that study, they used a very small sample, which would really reduce their power to find significant effects, and, like all clinical trials conducted in the United States, they had to use cannabis from the National Institutes of Drug Abuse drug supply, which is really very low potency, and it's not reflective of the types of high potency cannabis products that people are obtaining from dispensaries.

Contemporary Clinic® interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on the outlook around research investigating cannabis in the treatment of OCD.

Looking to the Future of Research Assessing Efficacy of Cannabis in Treatment of OCD

interviewed Bethany Hall, MSN, the owner of Healing Connection, on the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall explains how the COVID-19 pandemic has impact the occurrence of CDT among children during quarantine, and the need for greater awareness of this issue in light of the potential increase in need for care in this area.

 Do you think the COVID-19 pandemic has affected the occurrence of CDT or the need for greater attention to this issue?

 So, I think we're all going through acute trauma, and something I talk a lot about with my colleagues and with my patients is this idea of the window of tolerance.

So, imagine on the table in front of you, you have 3 glasses of water. One glass of water is just barely full, another one is about halfway full, and the next one is full almost to the tippy top. So, if I shake that table in front of you, very different things are going to happen to each glass. The one with very little water probably will spill nothing, the one with the middle amount of water may spill a little bit, but likely would still contain most of that water. The cup that's full almost to the tippy top when you shake that table, water is going to go everywhere. So, the proverbial water is going everywhere right now.

These kids that have a small window of tolerance that already, because of the way their brains and their bodies have been affected by trauma, a new onset of acute trauma really just causes them to react in a much larger way on a much grander scale than a person that did not undergo significant childhood trauma.

So, 100%, yes. I think the acute impact on chronic trauma is a real issue. Then we've seen in cities—like where you're based in Philadelphia—some of these very large cities went to all virtual, so then you have all these children in already poverty-stricken areas who have parents with low resources, many of them who've also experienced trauma that are now stuck in a home 24/7 with very little resources.

So, if you think even just about the effect on the parents’ ability to parent, you have parents who already have a small window of tolerance who may have experienced abuse and neglect in their own lives that now are under an extreme amount of stress. So, I believe that we already have some data, but I believe we will see even more that childhood abuse and neglect go up significantly because of these parents’ inability to have the resources that they need, to have the break that they need, the mental health care and self-care that they need to parent well.

But also, we do see the compounded effect on children that already have a small window of tolerance. This acute trauma on them is also really wreaking havoc, and it's really imperative during this time that we understand how to increase their resiliency, increase their window of tolerance, increase the abilities that we're giving to these parents as far as tools to help promote mental flexibility, resilience, all of those things.

Again, I think, in the future, we're going to, as they say, reap the whirlwind in these coming years as these children grow into adulthood if we are not making a concerted effort to help them process traumatic events so that they do not become traumatic and cause a negative impact on that child.

Bethany Hall, MSN, the owner of Healing Connection, discusses how the COVID-19 pandemic has impacted the occurrence of complex developmental trauma among children.

Expert: The Experience of the Pandemic May Have a Compounding Effect on Children With Complex Development Trauma

Recent survey results from ValuePenguin found that the rate for sunburn is higher among the younger generations, specifically 61% of Gen Zers and 58% of millennials, according to a press release.

Sun protection etiquette is still low in practice, with many Americans not wearing sunscreen daily. In particular, 82% reported that they do not wear sunscreen every day in the summer whereas 64% typically wear sunscreen 5 to 6 days a week.

In terms of getting checked for skin cancer, half of the survey participants are not confident they can detect a cancerous mole themselves and most have not visited a doctor for a professional skin exam. Approximately 45% do not think they could detect a cancerous mole on their body, and around the same percentage (43%) have never been given a full skin exam.

Cost concerns play a major role in sun protection, with more than a third of respondents (35%) reporting they have not done so due to cost concerns. Additionally, 43% did not know funds from a health savings account (HSAs) or flexible spending account (FSAs) could be used towards sunscreen purchases.

"People may think of contributions as money leaving their pockets since it is taken from their salary before taxes," said ValuePenguin insurance analyst Sterling Price in a press release. "But they need to realize that the money in that account can actually be used for a ton of items that they might be buying anyway."

The online survey was conducted between June 18 to June 22, 2021 and analyzed 1048consumers in the United States using a nonprobability-based sample. Generations were defined as the following ages:

45% of Americans have already been sunburned this year. ValuePenguin. July 12, 2021. Accessed July 14, 2021. 

https://www.valuepenguin.com/skin-care-survey

Sun protection etiquette is still low in practice, with many Americans not wearing sunscreen daily.

Survey Finds 45% of Americans Already Sunburnt This Year

interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 You mentioned that there may be value in investigating the treatment of compulsions, intrusions, and anxiety with pure CBD. Specifically, why might pure CBD be beneficial, and how would you define pure?

For example, there are isolate, broad spectrum, and full spectrum as common terms used for CBD products sold on the market today. Would any of these terms apply or perhaps not?

 The finding that higher levels of CBD were associated with larger symptom reduction led me to suggest that future investigations should really examine whether pure CBD effectively reduces compulsions, and by that I just meant CBD, either with no THC or with very low THC.

Really, I think all 3 products would be very interesting to investigate. The idea is really just that the intoxicating effects of cannabis, the most detrimental effects of cannabis, and the negative side effects of cannabis are really more associated to THC, so reducing or eliminating THC may be more desirable.

The other thing I wanted to mention in response to your last question was just that we really didn't have enough data on CBG, CBN, or any of the minor phytocannabinoids or terpenes to explore their potential effects, but future research should definitely do so.

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, discusses recent findings that pure CBD may help to reduce the symptoms of OCD for patients.

Research Finds Potential Benefit of Pure CBD for the Management of OCD Symptoms

The first step to address mild to moderately elevated blood pressure and cholesterol in otherwise healthy adults should be advising them to sit less and move more, according to a new scientific statement published in 

An estimated 21% of adults in the United States have systolic blood pressure between 120- and 139-mm Hg, or diastolic blood pressure between 80- and 89-mm Hg, according to the American Heart Association (AHA). Both of these values are abnormally high and meet the American College of Cardiology (ACC)/AHA High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.

Similarly, the scientific statement authors estimated that 28% of adults in the United States have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. This patient population would meet the 2018 ACC/AHA Cholesterol Treatment Guidelines criteria for lifestyle-only treatment, which includes increased physical activity, weight loss, improving diet, smoking cessation, and moderating alcohol intake.

“The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks,” said Bethany Barone Gibbs, PhD, FAHA, chair of the statement writing group, in a press release. “The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity.”

Increasing physical activity has been shown to result in clinically meaningful reductions in both systolic and diastolic blood pressure, typically with an average reduction of 3- or 4-mm Hg. Similar improvements have been seen with blood cholesterol, according to the press release. The statement emphasized research demonstrating that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.

According to the AHA, a “prescription” for increased exercise includes several steps. Health care providers should screen patients about their physical activity at every interaction, whether by asking a few questions or by having patients use a wearable device. Health professionals should also provide ideas and resources for supporting patients to improve and sustain regular physical activity.

Importantly, providers should help patients find activities that they enjoy and should provide ideas for early success in order to optimize the patient’s chances of implementing a life-long change. Similarly, encouraging and celebrating small improvements and increases in physical activity, such as walking more or taking the stairs, can keep patients motivated.

“Even small initial increases of 5 to 10 minutes a day can yield health benefits,” Gibbs said in the press release.

To improve overall health, the US Department of Health and Human Services 2018 Physical Activity Guidelines for Americans recommend that individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise or 75 minutes of vigorous aerobic activity weekly, in addition to 2 or more strength training sessions each week.

“In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit—and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus—the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever,” Gibbs concluded.

“Prescription” to sit less, move more advised for mildly high blood pressure & cholesterol [news release]. American Heart Association; June 2, 2021. 

https://newsroom.heart.org/news/prescription-to-sit-less-move-more-advised-for-mildly-high-blood-pressure-cholesterol?preview=9fe0

Health care professionals can help patients improve mild to moderate hypertension and elevated cholesterol by encouraging them to find activities they enjoy and celebrating small improvements.

Improving Blood Pressure, Cholesterol With Increased Physical Activity

The COVID-19 pandemic negatively impacted the pediatric-focused advanced practice registered nursing (APRN) workforce, which could create long-term barriers to pediatric care, according to a study conducted by the National Association of Pediatric Nurse Practitioners (NAPNAP). The study, published in the 

, surveyed almost 900 pediatric-focused APRNs.

According to the investigators, more than one-third of respondents reported moderate or extreme concern for feeling professionally burned out, while one-quarter reported anxiety. Seventy-three percent of respondents reported increased presentations of child mental or behavioral health concerns throughout the pandemic.

“This problem is, of course, multifactorial, with isolation, loss of safety net services, family stressors and trauma, and deferred care and services all compounding this issue across communities worldwide,” said Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, NAPNAP secretary, in a press release.

The investigators said that the rapidly evolving policy changes and the constant struggle to respond to disinformation is likely to be responsible for the professional burnout.

“The sustained professional and personal impacts of the pandemic are placing pediatric APRNs at high risk for moral distress and burnout,” said NAPNAP President Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, in the press release. “In addition to practicing clinicians feeling anxious or burned out, 70% of educator respondents in the study reported moderate or extreme concern with clinical training site availability, delaying the pipeline of new pediatric nurse practitioner graduates from entering the workforce to increase patient access to care.”

NAPNAP stated that they were committed to supporting a high-quality, accessible, and affordable care continuum for pediatric patients while protecting and supporting the pediatric workforce pipeline. According to the organization, NAPNAP has commenced efforts to direct resources and advocacy tools to best support the critical needs of the pediatric-focused APRN workforce.

COVID-19 Study Reveals Significant Risk for Pediatric-focused APRN Workforce [news release]. NAPNAP; June 8, 2021. Accessed June 9, 2021. 

https://www.napnap.org/covid-19-study-reveals-significant-risk-for-pediatric-focused-aprn-workforce/

According to the investigators, more than one-third of respondents reported moderate or extreme concern for feeling professionally burned out, while one-quarter reported anxiety. 

Study: Pediatric-Focused APRN Workforce Experienced Increased Burnout, Anxiety During COVID-19 Pandemic

Starting that fateful week in March 2020 when everyone’s life changed, health care settings closed their doors en masse.

From primary care to ambulatory surgery, physical therapy to massage therapy, nearly every setting of care suspended operations, except for emergency departments connected to hospitals and pharmacies. Yes, pharmacies. More than 60,000 remained open to patients, and most pharmacists continued their role as a source for OTC products and the free-of-charge counseling that often goes with them.

Telemedicine grew at an unprecedented rate starting in April 2020, but it did not entirely fill the health care void. Individuals needing acute medications, dose adjustments, or treatment for chronic diseases lost direct access to practitioners, but pharmacies remaining open meant patients could still receive their lifesaving medications. Of course, foot traffic slowed, and the flu was practically nonexistent in 2020, but hundreds of millions of Americans had access to basic triage, care delivery, medications, and testing supplies.

More than 80% of adults use OTC products as first-line treatment for common ailments. With Americans making approximately 3 billion trips to purchase OTC products annually and 60 million Americans using them who would otherwise not seek treatment, patient access to these products is essential to a well-functioning health care system. It is inconceivable these days to schedule an office visit, procure a prescription, and have it adjudicated by insurance just to get ibuprofen for an ankle sprain. A prescription for loratadine? Laughable. Yet less than 2 decades ago, nonsedating antihistamines were deemed too unsafe to be sold over the counter.

Making products available without a prescription does not have to mean patients go without care. Pharmacists and other health care professionals can counsel patients on all types of accessible and affordable OTC products. Does an Apple Watch’s electrocardiograph or pulse oximetry app keep patients from seeing their cardiologists? Do pregnancy tests keep women from visiting their gynecologists? Do wetting drops prevent patients from going to their ophthalmologists?

Do niacin or omega oils keep patients from getting their cholesterol checked? The answer to all these questions is no. Pharmacists have multiple encounters with patients every day, and most are just as meaningful to a patient’s care as billable encounters.

Expanding Access Through OTCs and Testing

COVID-19 self-administered testing is approved and available. Health plans have picked up on the power of patient convenience. Waning resistance against self-empowerment, which the pandemic necessitated, has enlisted a host of home-based diagnostics providing accessible and affordable screening and rescreening directly to health plan members—without a prescription. Need to improve A1c testing and reporting? Why not look to pharmacies or even send the tests directly to patients’ residences?

Postpandemic Self-Care and OTC Product Use

We are only a summer away from what will likely be the first widely prevalent cough and cold season of asthma flare ups, influenza, middle-ear infections, and rhinovirus in nearly 2 years. As social distancing and masking disappear, we will again share microbes. Disease surveillance and patient care will still have a prime spot in the consciousness of the frontline pharmacist’s mind in all seasons. Education, triage, testing, and counseling have a greater meaning and purpose than ever before, and much of this purpose is enabled by access to OTC products.

Click here to view the OTC products that pharmacists recommend the most to their patients

is vice president of pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors of the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

OTC use statistics. Consumer Healthcare Products Association. Accessed May 24, 2021. https://www.chpa.org/about-consumer-healthcare/research-data/otc-use-statistics.

COVID-19 permanently changed how pharmacists recommend and sell nonprescription options.

OTC Products Are Accessible When Traditional Health Care Delivery Is Not

interviewed Bethany Hall, the owner of Healing Connection, on the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall explains why training on the recognition of symptoms of CDT in children can be essential in supporting their identification by nurse practitioners in order to best approach care for that child.

Without this training, would nurse practitioners be able to recognize the symptoms of CDT in children?

So, I can speak for myself as a nurse practitioner—I didn't know anything about it.

So, there were often times where I had this little feeling in my chest when we'd interact with the child that had come in and had a suicide attempt like I just feel like the way we're doing this isn't the best.

This child is being shut down, clearly doesn't feel safe in this environment. We bring them in the emergency department, and we strip them down for safety reasons. They're put in basically just a nightgown, so if you can imagine a child that's experienced sexual trauma, then being asked to completely disrobe in a very cold sterile environment with a security guard standing outside the door.

I just remember feeling like this just feels really wrong to me and I don't know how to do things differently or why this isn't right, but I just feel like it's not right.

So, I think probably any nurse practitioner that's encountered a child that has gone through severe neglect, abuse, childhood dysfunction in their home, there may be something that goes this just doesn't feel right. I feel like heavily medicating this 5-year-old until they can't even really cry when they're hurt kind of a thing feels unnatural to us.

I think as nurses we're often very perceptive to that, and you may feel that there should be more we're doing. I can say, in my experience, 100% I did not receive any education in this, and I wouldn't have had the tools to diagnose this, to recognize it, and much more.

I would definitely not have had the tools necessary to be a part of the solution. So, I think it's really important that, as the CDC just came out with a report on Adverse Childhood Experiences scores, and I think as there's this increasing awareness in the mental health and psychology counterparts that we really need to jump on that train and understand what we can. How can I educate myself, how can I get the tools necessary to be a part of the solution, not only to recognize the problem but to do something about it.

Bethany Hall, MSN, the owner of Healing Connection, discusses the importance of training nurse practitioners on how to identify signs and symptoms of complex developmental trauma in pediatric populations.

Training Nurse Practitioners on Symptoms of Complex Developmental Trauma in Children is Critical as a Part of the Solution

Daily use of probiotics was associated with reduced upper respiratory symptoms in overweight and older people, in a recent study, suggesting that probiotics could help to prevent respiratory infections. Results of the study were presented at Digestive Disease Week 2021.

"This is not necessarily the most intuitive idea, that putting bacteria into your gut might reduce your risk of respiratory infection," said Benjamin Mullish, MD, a lead researcher on the study and clinical lecturer in the Division of Digestive Diseases, Imperial College London, England, in a press release. "It's further evidence that the gut microbiome has a complex relationship with our various organ systems. It doesn't just affect how our gut works or how our liver works, it affects aspects of how our whole body works."

The researchers examined daily diaries of 220 patients who participated in a prior double-blind placebo-controlled study examining probiotics and weight loss. An analysis of the common symptoms of upper respiratory infection, including cough, sore throat, and wheezing, showed that individuals who took probiotics during the 6-month study period had a 27% lower overall incidence of upper respiratory tract symptoms compared with the placebo group. This effect was found to be greatest among individuals who were 45 years of age and older, as well as those with obesity, according to the current study.

Previous research indicates that probiotics decrease upper respiratory infections in healthy adults and children, but limited data exist on this vulnerable population of older, overweight, and people with obesity, according to the current study.

"These findings add to growing interest in the gut-lung axis—how the gut and the lungs communicate with each other," Mullish said in the press release. "It's not just the gut sending out signals that affect how the lungs work. It works in both directions. It adds to the story that changes in the gut microbiome can affect large aspects of our health."

The research team did not evaluate immune response, only respiratory symptoms, and future randomized clinical trials could help identify the mechanisms related to decreased respiratory symptoms and explore the possible impact of probiotics on the immune system.

Probiotics associated with fewer respiratory symptoms in overweight and older people. EurekAlert! Published May 14, 2021. Accessed May 17, 2021. 

https://www.eurekalert.org/pub_releases/2021-05/ddw-paw051221.php

Previous research indicates that probiotics decrease upper respiratory infections in healthy adults and children, but limited data exist on older, overweight, and people with obesity.

Fewer Respiratory Symptoms in Overweight, Older People Linked to Probiotics in Study

A version of this article as originally published by PharmacyTimes.com.

The 2020-2021 influenza season was strikingly quiet. Cumulative positivity between September 27, 2020 and May 15, 2021 was 0.2%, a rate substantially lower than the 17% average positivity for the 3 previous seasons.

 Although some have argued that positive tests were reduced due to a lack of testing, testing for influenza in North America was consistent with previous years.

 More likely, the low infection rate is the credit of a combination of social distancing, face masks, and vaccinations.

Although the virus did not pose its usual seasonal burden, it was not eradicated. The dominant circulating influenza virus varied worldwide. In the United States, tests conducted by clinical laboratories indicate that Influenza B accounted for approximately two-thirds of infections.

 Influenza B was also dominant in China and the Middle East, while Influenza A appeared to be predominate in North Korea and Japan.

When the flu season for the northern hemisphere ends in spring, it begins for the southern hemisphere and runs through September. The southern hemisphere season is considered to precede the northern hemisphere and provided valuable insight on what to expect when flu season returns in October. The southern hemisphere, so far, is also experiencing a substantially calm flu season.

 Although clinically this may sound positive, it also makes preparing for the next flu season in the northern hemisphere more difficult.

With fewer virus specimens, experts say that it is more difficult to identify and characterize the full extent of the circulating influenza viruses’ genetic and antigenic diversity. In animals, the southern hemisphere’s 2021 vaccines have had mixed efficacy in producing antisera that recognizes, and subsequently affords protection against, circulating viruses.

 Though the match in these models seems to be stronger with the Influenza B lineages and circulating strains, there is more inconsistent efficacy with the Influenza A composition. In fact, changes in circulating Influenza A viruses, especially H3N2 strains, led experts to recommend changes to the composition of the 2021-2022 vaccine for the northern hemisphere.

The recommendations for influenza vaccine composition for Fall 2021 were released in February 2021 by the World Health Organization.

 For the second year in a row, the composition of the vaccine will depend on whether it is egg-based or cell-based or recombinant vaccine. However, the different compositions do not necessarily mean that there is a substantial difference in vaccine-produced immunity to circulating strains. According to the World Health Organization, not all viruses are optimal for the different production systems seen with egg-based vaccines versus cell or recombinant based vaccines. To accommodate this, different viruses with similar properties were selected as prototypes for timely vaccine production to ensure adequate supply by Fall 2021.

In 2021-2022, all influenza vaccines, regardless of type, will contain the same lineages of Influenza B, which are unchanged from the 2020-2021 season. This coincides with the matched protection seen in both the northern hemisphere’s 2020-2021 season and the southern hemisphere’s season so far. When lineage has been determined, most Influenza B viruses in 2020-2021 were B/Victoria/2/87 or B/Yamagata/16/88 lineage, which were closely related genetically and antigenically to the strains included in the vaccine. Quadrivalent vaccines will again include B/Washington/02/2019 (B/Victoria lineage)-like virus and B/Phuket/3073/2013 (B Yamagata lineage)-like virus. Trivalent vaccines will only contain the Victoria lineage, but the majority of available vaccines in the United States have transitioned to a quadrivalent composition.

Both strains of Influenza A for the northern hemisphere vaccines will be different from those included last season. Unlike last flu season, they will only differ by the H1N1 component rather than both strains of Influenza A. The H1N1 composition will resemble the current southern hemisphere vaccines’ H1N1 composition. Vaccines that are egg-based will include A/Victoria/2570/2019(H1N1)pdm09-like virus while cell and recombinant-based vaccines will include A/Wisconsin/588/2019 (H1N1)pdm09-like virus. The southern hemisphere’s current H3N2 component (Influenza A/Hong Kong/ 45/2019 (H3N2)-like virus in cell or recombinant-based vaccines and A/Hong Kong/2671/2019 (H3N2)-like virus) is identical to what was included in the northern hemisphere’s vaccines for 2020-2021, but appear to be producing inconsistent efficacy and protection to current circulating strains. As a result, vaccines administered in the fall will contain an updated strain of H3N2, an A/Cambodia/e0826360/2020 (H3N2)-like virus.

It is impossible to predict if the low rates of influenza in the 2020-2021 season will be repeated or serve as an isolated anomaly. The impact of the change in vaccine composition will not be known for almost another year. Eased infection control practices related to COVID-19, such as reduced face mask wearing, will also likely return influenza transmission to its usual potential. Although these measures had a noticeable contribution to the decrease in transmission of the influenza virus, the influenza vaccine remains the best way to protect against the potentially fatal virus.

It is important that patients be encouraged to receive the vaccine, even if Influenza B continues to dominate in the upcoming season, since there is a post-vaccination decline in protective antibodies. This past year has introduced the possibility that influenza season does not have to consistently produce a high health burden. The prevention strategies championed by pharmacists and other health care providers for years, vaccination and practical infection prevention practices demonstrated their capabilities in full force. While it is unlikely that all of the practices employed during the 2020-2021 season for the COVID-19 pandemic will be broadly utilized during future flu seasons, pharmacists can and should continue to champion common-sense preventative strategies such as hand hygiene, staying home when sick, and most importantly, annual influenza vaccination.

World Health Organization. Recommended composition of influenza-virus vaccines for use in the 2021-2022 northern hemisphere influenza season. Updated February 26, 2021. Accessed May 25, 2021. 

https://www.who.int/influenza/vaccines/virus/recommendations/2021-22_north/en/

Centers for Disease Control and Prevention. FluView. Updated May 15, 2021. Accessed May 25, 2021. 

Both strains of Influenza A will be different from those included the northern hemisphere's last season.

Vaccination Updates for the 2021-2022 Flu Season

A recent study linked facial and truncal acne with more significant impact on health-related quality of life than only facial acne. Additionally, investigators also found that the adverse impact on health-related quality of life (HRQoL) is increased with greater severity of truncal acne, regardless of the severity of facial acne.

Acne can influence an increased risk of physical, psychiatric, and psychological sequelae, potentially affecting multiple dimensions of HRQoL; however, the morbidity associated with truncal acne is commonly misunderstood, according to the study findings.

According to the investigators, the objective of the study was to determine the severity and location of acne lesions and how they impact the HRQoL of those with the condition.

Participants included 694 subjects with facial and truncal acne and 615 with only facial acne, who all completed an international online survey. The participants self-graded the severity of their acne at different anatomical locations and completed the dermatology life quality index, according to the study authors.

The facial and truncal acne participants were twice as likely to report “very large” to “extremely large” impact on HRQoL as compared with the facial acne only participants. Further, the impact of acne on HRQoL increased with noticeable increasing acne severity on the face, chest, and back.

One major limitation of the study was the fact that temporal acne was not evaluated or estimated along with the other body parts, according to the study authors.

Tan J, Beissert S, Cook-Bolden F, et al. Impact of facial and truncal acne on quality of life: A multi-country population-based survey. 

. Volume 3, P102-110. April 27, 2021. Doi:https://doi.org/10.1016/j.jdin.2021.03.002

Acne can influence an increased risk of physical, psychiatric, and psychological sequelae, potentially affecting multiple dimensions of health-related quality of life.

Study: Facial, Truncal Acne Associated with Greater Impact on Health-Related Quality of Life

Switching to a high-deductible health plan (HDHP) is not associated with changes in asthma exacerbations or asthma medication use when medications are exempted from the deductible, according to research results published in 

Clinical guidelines for pediatric asthma recommend the use of controller medications, though the investigators noted in a statement that adherence to these medications is generally suboptimal. Not taking medications as prescribed can lead to exacerbations, and high out-of-pocket costs have been associated with decreased controller medication use and adverse asthma outcomes.

Most research on HDHPs has focused on adult patients, according to the statement.

The new study, however, examined how enrollment in HDHPs may affect asthma controller medication use and exacerbations in children.

The study population included children ages 4 to 17 and adults ages 18 to 64 and was drawn from a commercial, large national database. Participants had persistent asthma and switched from traditional plans to HDHPs during a 24-month study period.

The investigators found that compared with those who remained in traditional plans, children who switched to HDHPs experienced small decreases in annual 30-day fills for inhaled corticosteroid-long-acting beta agonist medications but not for other controller medications.

Adults switching to HDHPs did not have significant reductions in 30-day fills for any asthma controller medications, according to the statement.

“One challenge of insurance design is balancing affordable coverage with access to necessary care for chronic conditions for both children and adults,” team leader Alison Galbraith, MD, MPH, associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston, said in the statement. “Our findings highlight the potential protective effect of exempting asthma medications from the deductible in high-deductible health plans.”

The investigators found no statistically significant differences in asthma-related emergency department visits, medication adherence, or oral steroid bursts for either adults or children.

Future areas of research could focus on the impact of value-based insurance designs on asthma control and medication adherence, Galbraith said.

“Asthma is a major cause of preventable disease burden for both children and adults,” she said. “Policy makers should consider adopting value-based designs and other policies exempting important medications for asthma and other chronic conditions—which might prevent adverse clinical outcomes—from the deductible.”

Asthma Medication Use and Exacerbations. Press Release. Harvard Pilgrim Health Care Institute; May 25, 2021. Accessed May 26, 2021. 

https://www.populationmedicine.org/press/GalbraithJAMAPeds0521

Individuals who switched to high-deductible health plans had small decreases in annual 30-day fills for inhaled corticosteroid-long-acting beta agonists but not for other controller drugs.

HDHPs Do Not Affect Asthma Exacerbations, Medication Use for Children

 What are the implications of your research on the use of THC, CBD, and other compounds in cannabis, such as CBG or CBN, as potential treatments for OCD? Are there any potential benefits to one compound over another?

Yeah. So, we examined whether THC, CBD, or the interaction between THC and CBD might predict the size of the symptom reductions.

We found that as CBD increased, so did the size of the reduction in compulsions. That's actually consistent with a couple of previous animal studies that showed that CBD reduced compulsive behavior in rodents.

In contrast, THC and interactions between THC and CBD really did not predict the size of symptom reductions people reported.

So, these findings suggest that cannabis with higher concentrations of CBD may be more beneficial for managing compulsions. Well, inhaling really any cannabis product might produce perceived reductions in intrusions and anxiety.

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on recent findings that show CBD may reduce intrusive thoughts and anxiety for patients with OCD.

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