Weight loss is frequently a popular topic in the United States, with 73.6% of the population over the age of 20 years overweight and 42.5% obese.

However, the coronavirus disease 2019 (COVID-19) pandemic appears to be accelerating this. A quick search on Instagram reveals 59,600 results for the hashtag “#quarantine15.” Many of these results display people either sharing that they have gained weight during the pandemic or how they have managed to stave off the weight or even lose weight. Weight gain during the pandemic is not just a vanity concern on social media but is increasingly becoming a health concern that could lead to long-term health consequences for adults and children alike.

Survey results released by biotechnology company Gelesis in December 2020 showed that 71 million Americans had gained weight during the pandemic, and 63% had found it more difficult to maintain healthy lifestyle habits.

 The 71 million figure is extrapolated from an online survey among 1012 adults in the United States from October 26, 2020, to November 3, 2020. 2 Nonetheless, this shows that a significant number of Americans may be struggling to maintain a healthy weight during the pandemic. The disruption of daily lives, food insecurity, physical restrictions, and stress all play a role in gaining weight. Many people are also increasing their unhealthy snacking habits.

According to the results of an online cross-sectional survey between April 2020 and June 2020, participants reported increased consumption of salty snacks (37.4%) and sweets (43.8%),

Children are not immune to the pandemic weight gain. Prior to the pandemic, more than 20% of children ages 6 years and older were obese.1 Evidence is starting to show that limited access to healthy food and places to be physically active can increase a child’s risk for obesity.

Here are some tips to maintain a healthy weight:

 That means avoiding snacking while watching television or simply out of boredom. This can quickly increase calorie intake.

 Any snacks between meals should also be nutrient-dense. Avoid foods that are devoid of nutritional value. For example, a piece of whole fruit or raw vegetables with a side of hummus provide macro and micronutrients that make an individual feel full.

 Individuals who are given larger portions tend to eat more.5 The results of one study showed that increasing portions by 75% increased food intake by a mean 27% and 

 Adults can practice making appropriate portions by checking out MyPlate.gov and adhering to the recommended portion sizes. They should also be aware of the portions they are giving to children.

Drinking more water has myriad direct and indirect benefits. Drinking water instead of sweetened beverages can reduce overall caloric intake, but it also can help improve alertness, cognition, metabolism, and workouts; remove waste from the body; and suppress the appetite.

 Individuals should drink between 8 and 16 glasses of water each day, though amount should also be dictated by thirst and the color of urine. If the urine appears dark or concentrated, that indicates dehydration. Healthy urine is colorless or light yellow.

Meals should be full of nutritious foods. It may sound obvious, but many foods are overly processed and stripped of nutrients. This leads to calorie-laden food with little nutritional value. Ideally, the food should be a rich source of healthy macronutrients (healthy fats and sources of carbohydrates and high-quality protein) and micronutrients (minerals and vitamins), as well as lower in calories. Foods that are high in calories but low in nutritional value, such as candies, chips, and sweetened beverages, lead to weight gain and can increase the risk of cardiovascular disease and metabolic disorders. Foods that are high in fiber and protein provide vital nutrients but also help ward off hunger. Avoid both regular and sugar-free soda, as it is a huge culprit behind weight gain.

Studies have shown that insufficient sleep can increase hunger and lead to weight gain. How much sleep should people get?

 Newborn should sleep 14 to 17 hours a day, babies who are 12 months of age should sleep 10 hours at night and nap for 4 hours each day, two-year-olds should sleep 11 to 12 hours at night and have 1-to-2-hour afternoon nap each day, children age 3 to 5 years should sleep 10 to 13 hours a day, those 6 to 13 years of age should sleep between 9 and 11 hours each night, teenagers age 14 to 17 should sleep between 8 and 10 hours each night, and adults should get 7 to 9 hours’ worth of shut eye each night.

Fiber has many benefits, including helping with bowel regularity and a feeling of fullness. It can help lower cholesterol and stabilize blood sugar. Additionally, foods that are naturally high in fiber generally are healthier and offer other nutritional benefits. For example, fruits and vegetables are great sources of fiber but also are lower in calories and have antioxidants, minerals, and vitamins. Legumes are high in fiber and are also great sources of protein. Nuts and seeds are high in fiber, healthy fatty acids, minerals, protein, and vitamins.

 When individuals are stressed, it can lead to a rise in hormone levels that can cause craving fatty or sugary food and overeating. There are many ways to reduce stress, including asking for help, creating a relaxing nighttime routine, eating healthy, exercising, finding time for leisure, meditating, practicing yoga, prioritizing quality sleep, setting personal boundaries, spending time with family and friends, and taking a break from negative news.

 Both children and adults need to be physically active and should be active every day. Before the pandemic, 80% of Americans were not getting enough physical activity.

 Humans are meant to be active, and there is extensive research on the negative health consequences of being sedentary. Physical activity has myriad benefits, including reducing the risk of death from heart 

, and reducing anxiety, dementia, and depression. Physical activity also improves cognition and sleep. How much exercise is suggested? Children ages 3 to 5 years should be active throughout the day, while those who are 6 to 17 years should get at least 60 minutes of moderate to intense exercise each day.

 Adults should get 150 to 300 minutes of moderate exercise or 75 to 150 minutes of vigorous exercise each week.

Try an evidence-based diet or weight loss strategy.

 Avoid crash diets and dangerous trends. It is important that a diet be well-balanced and realistic for the long term. Crash diets tend to fail and lead to rebound weight gain, and there is no need to lose weight quickly. The key is to create a healthy lifestyle. One good plan to follow is the Mediterranean diet, which focuses on regularly consuming beans, flavorful herbs and spices, fruits, legumes, nuts, olive oil, vegetables, and whole grains; fish and seafood at least a couple of times a week; cheese, eggs, poultry, and yogurt in moderation; and red meats and sweets sparingly.

 Other diets may lead to more or faster weight loss, but many are lacking in nutrients and not sustainable. Individuals who are interested in intermittent fasting or low-carbohydrate diets should consult a health care professional for guidance to see if these methods are appropriate or safe for them and how to incorporate these into a healthy, well-rounded diet.

CDC. Obesity and overweight. Updated January 11, 2021. Accessed February 18, 2021. 

https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

New survey finds 71 million Americans have gained weight throughout the pandemic [news release]. Boston, MA; December 22, 2020: Gelesis. Accessed February 17, 2021. 

https://www.gelesis.com/2020/12/22/new-survey-finds-71-million-americans-have-gained-weight-throughout-the-pandemic/

Bin Zarah A, Enriquez-Marulanda J, Andrade JM. Relationship between dietary habits, food attitudes and food security status among adults living within the United States three months post-mandated quarantine: a cross-sectional study. 

. 2020;12(11):3468. doi:10.3390/nu12113468

State of Childhood Obesity. Impact‌ ‌of‌ ‌the‌ ‌COVID-19 pandemic‌ ‌on‌ ‌childhood‌ ‌obesity‌‌. Accessed February 18, 2021. 

https://stateofchildhoodobesity.org/stories/impact-of-the-pandemic-on-childhood-obesity/

Zuraikat FM, Roe LS, Sanchez CE, Rolls BJ. Comparing the portion size effect in women with and without extended training in portion control: a follow-up to the Portion-Control Strategies Trial. 

. 2018;123:334-342. doi:10.1016/j.appet.2018.01.012

Johns Hopkins University. Yes, drinking more water may help you lose weight. The Hub. January 15, 2020. Accessed February 19, 2021. 

https://hub.jhu.edu/at-work/2020/01/15/focus-on-wellness-drinking-more-water/

Olson EJ. How many hours of sleep are enough for good health? Mayo Clinic. June 6, 2019. Accessed February 18, 2021. 

https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/how-many-hours-of-sleep-are-enough/faq-20057898

Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. 

2018;320(19):2020–2028. doi:10.1001/jama.2018.14854

https://health.usnews.com/best-diet/mediterranean-diet

Articles

Weight gain during the pandemic is becoming a real health concern that could lead to long-term consequences for both adults and children. #quarantine15

Weight gain during the pandemic is becoming a real health concern that could lead to long-term consequences for both adults and children.

Help Patients Avoid the Quarantine 15

A new study has found that antibodies that guard against coronavirus disease 2019 (COVID-19) can transfer from mothers to babies while in the womb, according to researchers from Weill Cornell Medicine and New York-Presbyterian.

American Journal of Obstetrics and Gynecology

, the discovery adds to growing evidence that suggests that pregnant women who generate protective antibodies after contracting the COVID-19 virus often convey some of that natural immunity to their fetuses. The findings also support that vaccinating mothers-to-be may have benefits for their newborns, according to the study authors.

“Since we can now say that the antibodies pregnant women make against COVID-19 have been shown to be passed down to their babies, we suspect that there’s a good chance they could pass down the antibodies the body makes after being vaccinated as well,” said senior study author Yawei Jenny Yang, MD, an assistant professor of pathology and laboratory medicine at Weill Cornell Medicine, in a press release.

The research team analyzed blood samples from 88 women who gave birth at New York-Presbyterian/Weill Cornell Medical Center between March and May 2020 during the time in which New York City was the global epicenter of the pandemic. All of the women had COVID-19 antibodies in their blood, indicating that they had contracted the virus at some point, even though 58% of those women had no symptoms, according to the study authors.

Further, although antibodies were detected in both symptomatic and asymptomatic women, the researchers observed that the concentration of antibodies was significantly higher in symptomatic women. They also found that the general pattern of antibody response was similar to the response seen in other patients, confirming that pregnant women have the same kind of immune response to the virus as the larger patient population, which was not previously known due to women’s immune system changes throughout pregnancy.

In addition, the vast majority of the babies born to these women (78%) had detectable antibodies in their umbilical cord blood. The researchers said they found no evidence that any of the infants had been directly infected with the virus and all were COVID-19-negative at the time of birth, further indicating that the antibodies had crossed the placenta, the organ that provides oxygen and nutrients to a growing baby during pregnancy, into the fetal bloodstream. Newborns with symptomatic mothers also had higher antibody levels than those whose mothers had no COVID-19 symptoms, according to the study authors.

These data imply that pregnant women could pass along vaccine-generated antibodies in the same way, potentially shielding both mother and child from future infection. However, it is not yet known exactly how protective these antibodies might be or how long that protection might last.

Study co-author Laura Riley, MD, chair of the department of obstetrics and gynecology at Weill Cornell Medicine, obstetrician and gynecologist-in-chief at New York-Presbyterian/Weill Cornell, is still advising pregnant patients who decide to get vaccinated to continue to follow current safety guidelines to prevent the spread of the disease.

Follow-up investigations are enrolling pregnant women who receive the vaccine, as well as vaccinated mothers who are breastfeeding, to assess the antibody response in these groups after vaccination. This information could help guide maternal vaccination strategies moving forward, according to the study authors.

Researchers learn that pregnant women pass along protective COVID antibodies to their babies. Weill Cornell Medicine. 

https://news.weill.cornell.edu/news/2021/02/researchers-learn-that-pregnant-women-pass-along-protective-covid-antibodies-to-their

. Published February 22, 2021. Accessed February 24, 2021.

The discovery adds to growing evidence that suggests that pregnant women who generate protective antibodies after contracting the COVID-19 virus often convey some of that natural immunity to their fetuses. 

Study: Pregnant Women Pass Along Protective COVID-19 Antibodies to Babies

interviewed Donald Wood, PhD, the recently elected president and CEO of the Muscular Dystrophy Association (MDA), on muscular dystrophy research and care during the coronavirus disease 2019 (COVID-19) pandemic and beyond.

Would you mind discussing further the Task Force on Genetics, and the importance and impact of its findings on understanding muscular dystrophy?

 Well to your audience, there was a time probably before many of you were born when we didn't know how to do research into human genetics because we couldn't actually study human DNA. The first time we were allowed to study human DNA was back in the 70s—that's last century folks. Then in the 80s, the Muscular Dystrophy Association created the Task Force on Genetics, whose specific aim was to identify the genetic cause of muscular dystrophy.

No one had ever identified a gene underlying a human disease without knowing what that gene did. When we started looking for the gene, we didn't know if the gene was expressed in muscle—even though muscle was hurt, the gene could have been expressed in nerve. There were even some theories that the gene somehow disoriented capillarity, and so it could have been in that area. We didn't know what area it was in.

So, the Task Force on Genetics set up a program which I oversaw, and we had a strategy for going after the genes underlying Duchenne muscular dystrophy. There are a lot more diseases, but we knew that Duchenne muscular dystrophy was an x-linked disorder, so it was on the x chromosome, and anyway, without going through all the details, that was our focus.

We held a conference in Cold Spring Harbor in 1983 to develop the overall strategies. In 1986, I was on a stage with Jerry Lewis and Dr. Lou Kunkel's lab that had discovered the gene underlying Duchenne muscular dystrophy, the very first gene underlying a human disease ever discovered without knowledge of the gene protein. The gene protein came next, so we have in the 70-year history of the Muscular Dystrophy Association created history in terms of human genetic diseases, and it's been my great, good fortune to have been involved every step of the way.

Videos

Contemporary Clinic® interviewed Donald Wood, PhD, the recently elected president and CEO of the Muscular Dystrophy Association, on the history of the Task Force on Genetics, and the importance and impact of its findings on understanding muscular dystrophy.

How the Groundbreaking Discovery of the Gene Underlying Duchenne Muscular Dystrophy Changed the Field

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

In this discussion, Hall discusses the cumulative nature of the economic and social burden of childhood trauma, making trauma competent caregiving in the field of nursing critical.

What is the role of trauma competent caregiving in the field of nursing, and what role do nurse practitioners have in understanding and approaching care for children with CDT?

So, I love nurses. I was a nurse before I was a nurse practitioner. Nurses are, in my opinion, the hearts and hands of the medical community. So, nurses spend a lot more time in a patient bedside in building a rapport with patients than any of us as nurse practitioners or physicians do. So, they have a unique opportunity as they raise their own education and awareness to build rapport with these patients, to be advocates for them, to help train the other people around them, and how to approach a child that has experienced trauma, to do things like increase their feeling of safety, to make their surroundings more comfortable, to help them know that they have a voice in their medical care, that they can speak out about how they're feeling or how their medications are making them feel, or interacting with their other activities of daily living.

So, the more nurses are educated, I think they can do great work with the patients one-on-one, and in their multiple interactions with patients. As far as nurse practitioners and physicians, I think the more we understand that there is meaning behind the behavior of our patients, the better we can create plans that are holistic in nature and that take into account the changes that have occurred in these children as a result of trauma in their brains, their bodies, and their biology.

So, I mentioned earlier I think this is changing somewhat. Dr. Nadine Burke Harris has written a book called 

 and basically [it] catalogs her journey of educating herself on childhood trauma, how she created her pediatric practice, and how she changed it to really create a holistic and family-based approach that takes into account a child's [Adverse Childhood Experiences (ACE)] score. So, in her practice now, utilizing the ACE score is just like getting a vital sign, so it's just like a blood pressure, every child gets their ACE score. That really helps drive care, helps them make sure that if there are problems in the family, that if the child is still in the midst of trauma that they're experiencing, then providing resources to the parents.

Oftentimes children who have parents who are neglectful or abusive, it is a direct result of their parents’ experiences as children. So, she takes a family-based approach of saying how can we help you to heal from your trauma so that you can be a better parent to your child, and how can we give you resources—if it's food, clothing, or safety as far as a living situation—how can we help you and give you resources because, when we can help the parents, then we help the children, and we really improve health outcomes across the board. So, I think the more that we educate ourselves, the better we can do, and from a public health standpoint, the need for us to educate ourselves as nurse practitioners can't be overstated.

So, the cumulative economic and social burden of childhood trauma is extremely high, and I think it's something that we just don't realize as a medical community. I have here based on the data from a variety of sources I was looking up right before our interview a conservative annual cost of childhood abuse and neglect is estimated at about 103.8 billion dollars, so that includes like the direct cost associated with hospitalizations like I was talking about with the emergency department mental health care for these children—child welfare systems, law enforcement—to kind of create these systems that we need around them. But it also includes indirect costs related to the secondary or long-term effects of their abuse, which again then you're talking about special education services, juvenile delinquency services, long-term mental health care, criminal justice system, loss of productivity to society.

So, it's our job—I feel like the onus is on us as a medical community to understand that this is a public health crisis that's gone unnoticed for a long period of time as we live through this pandemic. That's only likely to increase. So, the impact on parents and their ability to parent well and the impact on these children with compounded stressors that may or may not be able to be discussed and given space to help them work through these things, so that they don't become traumatic is often not there. So, I think it can't be overstated the role that we have as nurse practitioners to educate ourselves and then to become champions among our colleagues in this area.

Contemporary Clinic® interviewed Bethany Hall, MSN, the owner of Healing Connection, on the role of trauma competent caregiving in the field of nursing.

Understanding and Approaching Care for Children with Complex Developmental Trauma

New research suggests that ‘smart’ asthma inhaler sensors may improve control of asthma in children as well as improving the quality of life for caregivers. According to Ann & Robert H. Lurie Children’s Hospital of Chicago, this intervention should be considered to help engage diverse populations of pediatric asthma patients.

More than 25 million Americans are diagnosed with asthma and most are prescribed inhalers that are designed to prevent and treat asthma attacks. Most patients can achieve disease control with effective management and live symptom-free. However, patients with moderate-to-severe disease, asthma control may also require use of ‘controller’ medications as well as occasional use of ‘rescue’ medications.

Connected inhalers, or ‘smart’ inhalers, use Bluetooth sensors that attach to participants’ asthma inhalers to detect medication use, and they share data with physicians. According to the study results, the data could help improve treatment decisions, and these inhalers could also promote adherence to recommended controller medication use and proactively detect worsening of asthma symptoms.

“Emerging connected technologies can help improve patient health, with this randomized-controlled clinical trial showing that pediatric asthma patients with access to inhaler sensors report better asthma control and quality of life than patients who only received a standardized asthma education curriculum,” said study lead Ruchi Gupta, MD, in a statement.

The study included 252 children with moderate or persistent asthma who were recruited from 5 clinics. They were 24% non-Hispanic white, 23% non-Hispanic Black, and 40% Hispanic, while 60% were on public insurance. The study lasted 1 year and had assessments at enrollment, 3 months, 6 months, 9 months, and 12 months.

Study participants were evaluated based on an Asthma Control Test questionnaire, which measured their asthma symptom control on a scale from 0 (poor control) to 27 (well-controlled). According to the Lurie children’s hospital, average scores among those who received the intervention increased by 10.1% over the course of the study. The researchers noted the greatest improvements among non-Hispanic Black participants.

Caregivers were assessed with their own questionnaire, which measured how the sensor-based monitoring adherence affected their day-to-day involvement. They reported improved quality of life after the first month of the study due to easier asthma management, which was sustained through the year-long trial.

“This study is another clear example that digital health is here to stay, as it allows for us to stay connected to patients living with chronic disease, provide a level of automated watchfulness, and intercept disease in a timely measure,” said Deneen Vojta, MD, chief physician executive for Optum Labs, in a statement. “This is a terrific example of moving from the best care out there today to the best care possible.”

“Smart” Asthma Inhaler Sensors Improve Pediatric Asthma Control [news release]. Ann and Robert H. Lurie Children’s Hospital of Chicago; February 17, 2021. Accessed February 18, 2021. 

https://www.luriechildrens.org/en/news-stories/smart-asthma-inhaler-sensors-improve-pediatric-asthma-control/

Investigators found the greatest improvements among non-Hispanic Black participants, suggesting that the intervention could help engage diverse populations of pediatric asthma patients.

Study Finds Sensor-Based Inhalers Improve Asthma Control in Children

A new study has found that nearly 1 in 4 families said they would be unlikely to bring their child to the emergency department (ED) if they had an emergency condition during the coronavirus disease 2019 (COVID-19) pandemic.

The authors found the greatest hesitancy among families living in under-resourced communities, those who rely on public insurance, and in families who are Black, Latinx, or Asian. These findings could exacerbate health inequities that already exist during the pandemic, according to the study authors.

“We observed greater hesitancy to use the emergency department among more vulnerable demographic groups who historically showed high utilization of emergency care for their children,” said lead author Michelle Macy, MD, pediatric emergency care specialist at Lurie Children’s Hospital, in a press release. “This reluctance to seek care in a real emergency might further exacerbate health inequities.”

The survey was conducted in Illinois during the first week of May 2020, following a stay-at-home order issued by the governor in March that limited health care seeking to emergencies and COVID-19 care. Although pediatric outpatient care has rebounded since the restrictions were lifted, the study authors noted that emergency care continues to lag.

The survey included 3896 families in metropolitan Chicago during the first wave of the pandemic. Overall, 23% of families said they were hesitant to seek emergency care for their child, with the greatest hesitancy observed in families from the most under-resourced communities (27%) compared with those in more affluent neighborhoods (19%).

Among families of color, approximately one-third said they would be unlikely to bring their child to the emergency department, and that number was similar for families on public insurance. Among Spanish speakers, 36% said they were hesitant to seek emergency care.

“At Lurie Children’s Emergency Department, we are still seeing about half of the patients we would normally expect to see,” Macy said in the statement. “This is concerning, since delays in emergency care may lead to a child’s condition worsening to the point where they require hospital admission. To avoid a true health crisis, children need to be brought in earlier in the course of their illness. If families are ever concerned, they should contact their child’s primary care provider to determine if emergency care is advised. Our emergency department is safe and always ready to help.”

Nearly 1 in 4 families hesitant to take their child to ER during COVID-19 pandemic [news release]. EurekAlert; January 25, 2021. 

https://www.eurekalert.org/pub_releases/2021-01/arh-noi012521.php

Study shows the greatest hesitancy in seeking emergency medical services among families living in under-resourced communities, which highlight health inequities that already exist during the pandemic.

Study Finds Many Families Hesitant to Take Children to Emergency Department During COVID-19 Pandemic

interviewed Bethany Hall, the owner of Healing Connection, on how understanding complex developmental trauma (CDT) can be an important component of approaching care for pediatric populations affected by CDT.

So Bethany, what is complex developmental trauma, or CDT, and how does it affect the lives of children with CDT?

So, there's a lot of different types of trauma. There's acute trauma, which we're all living right now in the middle of a global pandemic. So, we have things that come in our lives that hopefully we all hope and pray won't be forever—they're for an acute period of time and they raise our stress level. So that's acute trauma.

Then there's chronic trauma, which some people in the pandemic are living [through], where they may be displaced from their homes, they may start a struggle with substance abuse, or venture into depression that they've never had before.

But complex developmental trauma is very unique. Complex developmental trauma is trauma that occurs usually early in the life of a child. So, in those really formative years of development of brain, which is 0 to 3, sometimes some experts say 0 to 5, and it is chronic. So, it's something that goes on over a long period of time.

The interesting thing about complex developmental trauma is it also often almost always involves a primary caregiver. So that doesn't necessarily have to be mom or dad, if it was a grandma that child was placed with or relative care. But some type of abuse or neglect or household dysfunction is involved with a primary caregiver.

Then how it affects the lives of children, honestly, I could go on about this for hours, but trauma in those early years of life is just very detrimental and wide-reaching in their effects. So, they affect a child's brain in a lot of ways in that early neglect. When they have neglect in those early periods of life or abuse, oftentimes their brains are less developed overall globally, so just the brain mass will be smaller. There's been studies that show imaging of brains of children that were on a severe spectrum, like children that were left in an orphanage to lay in their beds for hours and hours a day from a very young age, and their brains are actually significantly smaller in size and mass.

It also has an effect on the prefrontal cortex, which is the front part of the brain. So that area of the brain often has rapid development from birth to 3. So, when a child experiences significant neglect in those early years, they lack the development of that prefrontal cortex. So then you say, well, what does that matter, right? So, the prefrontal cortex is the part of the brain that controls what we call executive functioning, so that's where we learn how to regulate our emotions, the centers for language and cognition, abstract thought, future planning, and future orientation, empathy, all of those things.

So, when a child grows up in a chaotic and unpredictable environment, their bodies stress response systems also take a hit. So, in addition to what's going on in the chemistry and the development of the brain, their stress responses, or that the very back part of their brain, the fight, flight, or freeze portion of their brain, often gets either over or under responsive. So, because of this constant battery of experiences on that portion of the brain, they either become either over responsive or under responsive to future stressors. So, in comparison to their peers, an equal stressor may cause them to numb out much more quickly or to a deeper level or may cause them to explode. So physically, we're talking about a lot of changes in the brain.

It also causes a whole gamut of emotional changes. So, when a child fails in those early ages to connect to a primary caregiver, that causes a lot of relational problems later on down the line. So, it causes them to have difficulties in attachment with other family members, and then even interactions with friends, spouses, bosses all of that, because it affects our ability to self-regulate, our ability to learn well. So, they may have learning disabilities, our understanding of our own self-concept, and our future orientation. So, there's a lot of ways that this affects—what we say at Healing Connection—we say it affects the ‘brain, body, belief system, biology.’

So, there's a lot of different ways that trauma affects children, and as a medical community, we're probably going to talk more about the ACE study, but it looked at adverse childhood experiences, and it shows from a public health standpoint, there's a huge risk of increased high-risk behavior, such as substance abuse, smoking, chronic illnesses, such as heart disease, hypertension, hyperlipidemia, cancer, and even premature death. So, this definitely has a large far-reaching effect and a very prolonged effect in the lives of these children.

Contemporary Clinic ® interviewed Bethany Hall, the owner of Healing Connection, on how understanding Complex Developmental Trauma (CDT) can be an important component of approaching care for pediatric populations affected by CDT.

How Complex Developmental Trauma Can Affect the Lives of Children

A recent survey by the National Rosacea Society (NRS) found the majority of patients with rosacea have never heard of antibiotic resistance, despite that many of the most commonly prescribed treatments for rosacea are oral or topical antibiotics. The finding highlights the importance of proper care in the use of antibiotics by dermatologists and patients, and the need for greater awareness and education about 1 of the most serious public health challenges facing the United States.

Rosacea is an acne-like chronic condition of the facial skin that affects 16 million Americans and is often characterized by flare-ups and remissions. According to the NRS, rosacea typically begins at any time after age 30 years as a flushing or redness on the cheeks, nose, chin or forehead that may come and go. Over time, the redness tends to become ruddier and more persistent, and small blood vessels may appear. Without treatment, bumps and pimples often develop, and in severe cases the nose may become swollen from excess tissue. In about half of patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

According to a recent study by the CDC, in 2015, dermatologists wrote more prescriptions for antibiotics than any other medical specialty, with individual dermatologists writing an average of 162 more prescriptions for oral antibiotics annually than primary care physicians.

 Although antibiotics are commonly used for their bacteria-killing capabilities, dermatologists also use these drugs for their anti-inflammatory properties to treat common conditions that include rosacea. The problem of antibiotic resistance can arise when high doses of antibiotics are used, as the affected bacteria may evolve an ability to withstand the drugs designed to eliminate them.

Antibiotic-resistant strains of bacteria are commonly referred to as “superbugs.” According to the CDC, Americans contract more than an estimated 2.8 million infections caused by superbugs each year, and at least 35,000 people die as a result. The fight against antibiotic resistance is multifaceted and includes environmental strategies and health care- and community-based policy changes, as well as the research and development of new antibiotic treatments. Multiple governmental organizations, including the FDA and the CDC, as well as nongovernmental organizations are leading initiatives to protect Americans against a future without effective antibiotics.

“Dermatologists and rosacea patients can both practice antibiotic stewardship to help protect against resistance,” said Dr. James Del Rosso, adjunct clinical professor of dermatology at Touro University College of Osteopathic Medicine, in a prepared statement. “It requires avoiding oral antibiotic dosing as much as possible and remaining aware of guideline suggestions that may be applied to patient care.”

According to standard management options for rosacea— recently published by the NRS—oral and topical therapies are often initially prescribed in combination, followed by long-term use of a single therapy to maintain remission.

There is strong clinical evidence supporting the use of low-dose doxycycline to treat the bumps and pimples of rosacea, including a 40 mg doxycycline modified-release capsule developed specifically for rosacea.

 The 40 mg dosage is sub-antimicrobial, avoiding antibiotic resistance while reducing the inflammation associated with this condition.

In severe cases, higher doses of oral antibiotics may be prescribed. However, since higher doses may also have an antimicrobial effect, Del Rosso recommended that such treatment be carefully managed and not used for long-term maintenance.

“Topical formulations are advantageous for long-term therapy because they deliver effective concentrations to the skin without much risk of systemic exposure,” Del Rosso said. For long-term maintenance therapy, low-dose doxycycline or common topical treatments such as ivermectin, azelaic acid and metronidazole have been found to result in increased rates of remission.

Patients with rosacea should ask their health care providers about an effective, nonantibiotic dose option of oral medication and a topical therapy to treat rosacea, and follow dosage and application instructions, to receive the most benefit from medical treatment and to stop the spread of antibiotic resistance. Prescribed oral therapy may mean taking the correct number of doses at the appropriate time. Patients with topical medication should follow application instructions, making sure not to forgo or reduce treatment that is meant to continue indefinitely in order to retain remission.

“The good news is that multiple treatment options for rosacea are now available that can be tailored for each rosacea patient while minimizing the risk of bacterial resistance,” Del Rosso said.

Rosacea sufferers and dermatologists can play important role in fighting antibiotic resistance [news release]. Barrington, IL; January 26, 2021: National Rosacea Society. Accessed February 1, 2021. 

https://www.rosacea.org/press/2021/rosacea-sufferers-dermatologists-can-play-important-role-in-fighting-antibiotic-resistance

Outpatient Antibiotic Prescriptions—United States, 2015. CDC. Reviewed September 12, 2017. Accessed February 1, 2021. 

www.cdc.gov/antibiotic-use/community/programs-measurement/state-local-activities/outpatient-antibiotic-prescriptions-US-2015.html

Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. 

 2020;82(6):1501–1510. doi:10.1016/j.jaad.2020.01.077

Nagler AR, Del Rosso J. The use of oral antibiotics in the management of rosacea. 

Del Rosso J, Zeichner J. The clinical relevance of antibiotic resistance: thirteen principles that every dermatologist needs to consider when prescribing antibiotic therapy. 

A recent survey by the National Rosacea Society (NRS) found the majority of patients with rosacea have never heard of antibiotic resistance, despite that many of the most commonly prescribed treatments for rosacea are oral or topical antibiotics. 

A recent survey found the majority of patients with rosacea have never heard of antibiotic resistance, despite that many of the most commonly prescribed treatments for rosacea are oral or topical antibiotics. 

Fighting Antibiotic Resistance in Patients With Rosacea

US Representatives Abigail Spanberger (D-VA) and David B. McKinley (R-WV) have sent a letter to the Department of Health and Human Services (HHS) urging President Biden’s administration to follow the lead of states that have used a community pharmacist-led approach in the national coronavirus disease 2019 (COVID-19) vaccine distribution strategy.

The correspondence follows a joint letter sent earlier this week from the National Community Pharmacists Association (NCPA) and the American Society of Consultant Pharmacists, which urged governors to utilize independent pharmacies.

“Community pharmacists are integral parts of the communities they serve, especially in rural and underserved communities,” said the letter by Spanberger and McKinley. “Their years of providing patient-centered care and wrap-around pharmacy services means they have earned their patients’ and their communities’ trust. This experience makes them uniquely capable of addressing the high rates of vaccine hesitancy we’ve seen among minority and underserved communities.”

In their letter, Spanberger and McKinley said states where community pharmacists have taken a larger leadership role have seen a much faster distribution of COVID-19 vaccines to vulnerable populations. The letter also urged HHS to learn from these approaches and incorporate them into the federal vaccination strategy, including in efforts to increase education and combat misinformation about the vaccine.

“Community pharmacists have the flexibility to cut through red tape and reduce paperwork burdens for patients and their guardians in many cases,” Spanberger and McKinley wrote. “For example, in West Virginia, the community pharmacists demonstrated great ingenuity in establishing a vaccine drive that finished administering the first round of the vaccine to nursing home residents by the end of December. By comparison, at the end of December most other states had only just begun administering the first dose of the vaccine to nursing home residents.”

Click to continue reading on Pharmacy Times. 

The letter said states where community pharmacists have taken a larger leadership role have seen a much faster distribution of COVID-19 vaccines to vulnerable populations.

Bipartisan Correspondence Urges HHS to Increase Focus on Community Pharmacies for COVID-19 Vaccine Distribution

A new survey by the Point of Care Network (POCN) has found that not only is the gap shrinking between physicians’ responsibilities and those of nurse practitioners (NPs) and physician assistants (PAs), but NPs and PAs also want to learn about specialty and disease states outside of primary care.

NPs and PAs comprise a large and growing workforce, with more than 460,000 providers in over 60 specialties. According to the survey results, both professions work independently and in collaboration with other health care professionals to deliver chronic and acute care, treating more than 1 billion patients annually and writing more than $1 billion in retail prescriptions.

The number of NPs and PAs is expected to grow significantly in the coming years, with the Bureau of Labor Statistics predicting an increase of between 26% and 31% from 2018 to 2028. This growth will result in more patient visits, diagnostic and treatment procedures, drug and device usage, and cost-efficient care, according to the survey.

To better understand the roles of NPs and PAs, POCN conducted an electronic survey in the summer of 2020. Respondents received an email invitation with a link to the online survey, which included 37 mainly close-ended questions. By the final tally, 673 NPs and PAs had responded, representing over 45 specialties. Of those 673, 39% identified as NPs and 61% as PAs.

According to the results, the majority of respondents (55.9%) work in primary care, with 27% saying they worked in a specialty not included in the 10 listed. Furthermore, 12% said they work in emergency medicine, 11.5% in orthopedics, and 9.4% in urgent care. When asked about their practice settings, nearly half (45.2%) said they work in a group practice or clinic, while 21.5% work in a hospital and 13.5% in a hospital clinic.

The respondents are busy, seeing an average of 66 patients per week. Notably, however, 64.2% said they see up to 75 patients per week, and 35.8% said they see between 76 and 150 patients per week. Nearly 60% of the respondents said that up to half of their patients are Medicare or Medicaid beneficiaries, while 38.2% indicated that more than half of their patients receive CMS benefits.

Based on these responses, the survey authors said NPs and PAs require easy access to timely, relevant clinical information. Between 81% and 88% of respondents said they provide the initial diagnosis, general patient education, initial prescription, and counseling on treatment adherence. Between 63% and 76% are responsible for patient follow-up, prescription refills, chronic disease care, and complete care, meaning they see no distinction between physicians and themselves.

Although 56% designate themselves as primary care clinicians, the survey noted that they want to learn about specialty and disease states outside of primary care, including chronic disease management, as it relates to their patient populations. With this goal in mind, the respondents said the most helpful resources include data on the latest treatments or technologies, digital resources that they can repost or use with patients, and opportunities to make extra money.

About one-third of the respondents said they use social media professionally, whether to access clinical information or to get updates on state and local regulations. Specifically, 69% said the most important reason for professional digital use is to establish themselves as a subject matter expert, 55% said to expand their referral base, 29% said to expand their patient base, and 29% said they hope to impact a broad audience with helpful tips.

In addition to finding that NPs and PAs are a growing workforce, the survey findings demonstrate that their use of online resources and social media will be essential in future efforts to take on more responsibilities and improve patient care.

Point of Care Network 2020 Survey; Received January 26, 2021. https://go.pocn.com/ebook/?utm_source=LinkedIn&utm_medium=social&utm_campaign=pocn_LG3&utm_term=NA&utm_content=social_1&utm_list_ID=NA. Accessed January 28, 2021.

New survey findings demonstrate that professional use of online resources and social media will be essential in future efforts to take on additional tasks and improve patient care. 

Nurse Practitioners, Physician Assistants Continue to Take On More Responsibilities

 spoke with pediatric nurse practitioner Dr. Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, from NAPNAP about COVID-19 vaccines, specifically when/if children under 16 may get the vaccine.

Petraco discussed the importance of pediatric patients getting the COVID-19 vaccine as they begin to roll out, in addition to the impact of younger populations enrolled in schools for the fall and the impact of the vaccine for the future. 

Contemporary Clinic spoke with pediatric nurse practitioner Dr. Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, from NAPNAP about COVID-19 vaccines, specifically when/if children under 16 may get the vaccine.

COVID-19 Vaccines and the Younger Population

interviewed Lea Davis, 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.

During the discussion, Davis explains what functional seizures are and why better understanding them can help to address medical stigma for patients who experience them.

So, Dr. Davis, what are functional seizures, and why were you and your research team interested in investigating them further?

 So functional seizures are seizures that occur in the absence of aberrant electrical activity happening in the brain, which is typical of epileptic seizures. Functional seizures have been really understudied.

So, I actually became interested in understanding more about functional seizures and their etiology (so what causes them), what other kinds of conditions are they associated with, [and] what's the biology behind the development of functional seizures after hearing a story on NPR that was really the patient perspective. So, they interviewed several people who experienced functional seizures, and I think the thing that spoke to me the most in this patient population was the stigma that they experienced even within the medical system.

So, I think that actually speaks to me at a personal level. As a kid, my mom had Crohn disease and while Crohn disease is really well understood now, back in the early 90s it was not so well understood, and she actually had doctors telling her that it was all in her head, and that she needed to see a psychiatrist instead of an internal medicine doctor.

And so, hearing [that] patients [are] kind of still experiencing difficulty with medical stigma and the lack of knowledge on functional seizures, it occurred to me that this was something that a) we really needed a lot more research on, and b) we were actually in a really good position to be able to do this research at Vanderbilt because we have an incredible neurology department and a really active research relationship with them.

So, I basically contacted some colleagues in neurology and said, ‘Hey is this something that you guys would be willing to consult with us on and work with us in a collaboration,’ and they said yes, and so that's where we went.

Contemporary Clinic ® interviewed Lea Davis, of Vanderbilt University Medical Center and the Vanderbilt Genetics Institute, on what functional seizures are and why better understanding them can help to address medical stigma for patients who experience them.

Understanding Functional Seizures In Order to Better Treat Patients

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 

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

What were the findings of this most recent study that you published?

 Yes, actually, I'm just going to briefly mention the methodology, and that's because we use kind of an unconventional methodology for this study as well. So, for this study, we were really looking at the acute effects of cannabis on intrusive thoughts, compulsive behaviors, and anxiety in people with OCD, and we were really able to accomplish this for the generous support of Strainprint, which is a Canadian company with a real-world technology platform and journaling application that allows medical cannabis patients to indicate their conditions and symptoms and rate the severity of those symptoms immediately before and then again shortly after cannabis use.

Further, patients can provide information about the strains of cannabis they're about to use, including THC and CBD concentrations method of administration and dose. The Strainprint app was really developed to help medical cannabis patients find the strains and doses of cannabis that reduce their symptoms the most, but they were generous enough to freely and openly provide us with some of the global back data from this application.

Specifically, they provided us with symptom ratings of intrusions, compulsions, and anxiety made by individuals self-identifying with OCD before and after over 1800 cannabis-use sessions. They also provided us with data on doses, methods of administration, and, again, THC and CBD content in the strains.

So, we use some advanced modeling methods to examine changes in the severity of these symptoms from before to after use, and we found on average that intrusions were reduced by about 49%, compulsions were reduced by 60%, and anxiety was reduced by 52%, indicating that acute cannabis use is associated with about a 50% reduction in the perceived severity of symptoms of OCD.

Contemporary Clinic ® interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored on the use of cannabis in treating symptoms of OCD.

Acute Cannabis Use Associated With Reduction in OCD Symptoms

Based on earlier research showing that depression, stress, loneliness, and poor health behaviors can weaken the body’s immune system and lower the effectiveness of certain vaccines, a new report suggests that the same may be true for the coronavirus disease 2019 (COVID-19) vaccines.

Vaccines are among the safest and most effective advances in medical history, according to the report published in 

. Their success, however, depends on ensuring that a critical percentage of the population is effectively vaccinated to achieve herd immunity.

Despite rigorous testing showing that the COVID-19 vaccines approved for distribution in the United States are highly effective and safe, not all recipients will experience the full benefit. Environmental and genetic factors, as well as factors such as physical and mental health, can weaken the body’s immune system and slow the response to the vaccine.

These effects are concerning as COVID-19 continues to spread, triggering a concurrent mental health crisis caused by isolation, economic stress, and uncertainty about the future. These stressors are the same factors that have been shown in earlier research to weaken vaccine efficacy, particularly among elderly patients. Fortunately, the report authors said it is possible to reduce these negative effects with simple steps like exercise and sleep.

“In addition to the physical toll of COVID-19, the pandemic has an equally troubling mental health component, causing anxiety and depression, among many other related problems,” said lead author Annelise Madison, a PhD candidate at Ohio State University, in a press release. “Emotional stressors like these can affect a person’s immune system, impairing their ability to ward off infections. Our new study sheds light on vaccine efficacy and how health behaviors and emotional stressors can alter the body’s ability to develop an immune response. The trouble is that the pandemic in and of itself could be amplifying these risk factors.”

Vaccines work by creating an innate, general immune response on the cellular level as the body recognizes a potential biological threat. This response is eventually helped by the production of antibodies, which target specific pathogens. The continued production of antibodies helps determine how effective a vaccine is at conferring long-term protection.

“In our research, we focus most heavily on the antibody response, though it is just one facet of the adaptive immune system’s response,” said senior author Janice Kiecolt-Glaser, PhD, director of the Institute for Behavioral Medicine Research at Ohio State University, in a press release.

According to the researchers, the good news is that the COVID-19 vaccines already in circulation are approximately 95% effective. However, these psychological and behavioral factors can lengthen the amount of time it takes to develop immunity and can shorten the duration of effectiveness.

“The thing that excites me is that some of these factors are modifiable,” Kiecolt-Glaser said. “It’s possible to do some simple things to maximize the vaccine’s initial effectiveness.”

The researchers noted that one potential strategy could be to engage in vigorous exercise and get a good night’s sleep in the 24 hours before vaccination, to ensure the immune system is operating at peak performance. This may help encourage the best and strongest immune response.

“Prior research suggests that psychological and behavioral interventions can improve vaccine responsiveness,” Madison concluded. “Even shorter-term interventions can be effective. Therefore, now is the time to identify those at risk for a poor immune response and intervene on those risk factors.”

Depression and Stress Could Dampen Efficacy of COVID-19 Vaccines: Interventions and Health Behavior Changes Could Boost Immunity [news release]. Association for Psychological Science; January 13, 2021. Accessed January 19, 2021. 

https://www.psychologicalscience.org/news/releases/2021-jan-depression-covid-vaccines.html

Environmental and genetic factors, as well as factors such as physical and mental health, can weaken the body’s immune system and slow the response to the COVID-19 vaccine.

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