, AllerVie Health allergist Maxcie Sikora, MD, discussed steps that parents and clinicians can take to minimize the risk of food-induced allergic reactions during the holiday season. Parties and get-togethers often present challenges for patients with allergies, particularly with home-cooked food that may have unclear ingredients. To avoid allergic reactions, Sikora suggested some steps families can take, including hosting events themselves and teaching children to ask before eating food from others.

Perfect. So, just to get started, what potential allergens do you see at kind of the Thanksgiving and holiday type of gatherings?

Well, you know, just like we talked about before, the incidence of food allergy is so incredible. As we mentioned in our Halloween discussion, 1 in 4 children in a classroom basically have a food allergy. One in 13 people in general have a food allergy or a food intolerance. So, you know, the likelihood, especially at large family gatherings, that you're going to have somebody there that actually has a food allergy or food intolerance is quite high. So, you know, for young children, especially children under the age of 2, you still have the most common food allergies as problems, which are milk and wheat, soy, peanuts, seafood—those are all major allergens. So, you know, knowing that is of utmost importance if you're hosting a big gathering, that you ask people if they have any food allergies or food intolerances that you need to be aware of. I think that's just classy as a host, and responsible as a host to just know that.

I know in our last conversation we discussed that it was really important to really look at how to deal with those situations. As a parent, I think, you know, unfortunately, kind of the best way to deal with a group setting situation as a parent when you're dealing with a big holiday such as Thanksgiving or Christmas is to host it yourself. I wish that I could say there was a better way to do it. But I think from a from a control standpoint—and if you read any of and I'm sure parents who are listening this know this, if you read any of the major food allergy blogs, etc., they're really discussing like how to deal with holidays. Their biggest recommendation is that you host whatever the event is, so that you have control of the food that's there. Because unfortunately, you know, so many people that haven't dealt with a child or a family member with food allergy, they don't really understand the implications of even trace quantities of that food allergen being in some of those products. And they might not even recognize that traces of certain food allergens are actually in those products. So, it kind of takes that responsibility off of those people, and basically allows you to have control of the situation.

One of the things that I read somewhere, and also I had thought about, is the way to kind of make that happen to where you're still having a family gathering and still having people participate is potentially inviting family members and friends over to help you prepare the meal. You know, it doesn't have to be you doing all of this yourself. But maybe having it be a fun thing where you provide the ingredients, they come over and help you cook for the holiday, and then you have the meal there and you have control. And it's also a great way to educate people who aren't fully aware of what you deal with on a regular basis. How to educate them on reading labels and knowing hidden sources of food allergens. As we age, the adult population, the biggest food allergens for them are nuts and seafood. Seafood is not such a big deal during the holidays, unless you live in a coastal area, like where I grew up, because you know, definitely around New Orleans and like in Charleston, the bigger cities that are coastal, you know, there are seafood dishes that we prepare for holidays. But in general, all over our country, it's more nut products that people use and holiday dishes that we don't even think about potentially as being very harmful to people who are allergic. But in a lot of cases, those are the major food allergens where people can have anaphylaxis and sometimes even die from trace amounts. So, it is it is definitely a time of year where those things are prolific. And you definitely can harm people at your family meals or your friend meals. Now granted, most of those people that have food allergies, they're very aware of this and they're going to alert you before they even come to your home regarding this, but I think it is important to be mindful of that when hosting a big gathering.

Yeah, absolutely. We talked about packaged candy before, which a lot of them have the ingredients listed, but homemade food can present different challenges. I know for myself, I don't even know the ingredients half the time in something. How can parents make sure they’re safe?

They basically, unfortunately, can't. They shouldn't allow their children to eat things made by other people. I mean, I hate to say that, but it's one of those things where it's very difficult to know what is in homemade candies. And as we know, that's such a lovely gift to give people because it's so thoughtful, and it's something that you've given and made from the heart for other people. So, I guess one of the things I would say is don't be offended if people say that they can't take that home, because it's probably not because they don't want to eat it. It's just because they're trying to protect other family members that potentially have a food allergy. But really, truly, even like processed foods, you know. There was an article on foodallergy.org, which I talked about in the Halloween discussion we had, just recently talking about candy canes, like some candy canes actually are processed with other food allergens. So, even though you think candy canes are basically just sugar and food coloring, in certain places where those candy canes are produced, they're actually produced on lines of things that have milk and have nuts. And so, you know, even our best thought processes, we were thinking, “Oh, a candy cane should not be a problem, or peppermint shouldn't be a problem.” To somebody who's food allergic, you really have to be mindful of reading those labels. And just like with our Halloween discussion, snack size things sometimes contain different ingredients, even in pre-packaging, than their full-size sisters and brothers do when it comes to candy.

So, you really do have to read those labels very, very mindfully and know that truly, in our country, the standard food allergens—milk, egg, wheat, soy, peanut, and all the tree nuts—those should be in bold print on the label. But sometimes that doesn't happen, especially with specialty foods and specialty candies. And so, in general, I would just say if you know this ahead of time, and you know you're providing things for a household with food allergy, you may want to give them gifts of non-food items. And I would also say that for parents who are trying to deal with the holidays with their children, like stocking stuffers and things, just like with Halloween with the Teal Pumpkin Project, it may be better to do stocking stuffers that aren't candy derived, you know, non-food items for fun, versus food items for fun. And then with the knowledge that if you do have a family gathering, that you kind of see, well, you definitely need to be the person supervising and overseeing the food preparation. And you know, if people ask what they can bring, just ask them to bring themselves to enjoy the holiday, that this is your gift to them to provide a meal without any stressors, or they can bring ice, or they can bring, you know, bottled beverages, you know, nothing really homemade, because you just never know. But that's what I would say.

Yeah, that makes sense. How can parents have these conversations with family? We talked before about kind of meeting some resistance or people just not understanding, so how can they do that?

I think, you know, it's mainly just education. And maybe it also is, like we talked about, like helping them prep the meal. I mean, I don't think that people understand how hard it is for parents and people with food allergy to plan a meal and to prepare a meal. I mean, it's a whole different level, it's not just opening like your favorite cookbook and going through and finding these fabulous recipes. You really have to be mindful of all the ingredients you're using, reading labels for everything, really knowing where they're sourced. And the general public I don't feel understands the gravity that goes into prepping a meal for somebody with a life-threatening food allergy. So, potentially, it is more allowing them to be part of the process, knowing, kind of sharing in that, and sympathizing with everything that goes into that, because that's a huge deal.

I also think it is good to have like other resources to allow them to realize kind of the gravity of it. Just like some of the parent-run websites, as I've mentioned before, foodallergy.org. There's a lot of good data to allow family members to just kind of look at, and even posting. I think families do really well, families with food allergy do a lot. You know, whether or not we agree with all the social media platforms or not, you know, there is a lot of good from the standpoint of posting informative articles and videos through your social media to potentially allow some of your friends and family to see what you deal with on a regular basis, through an educational and informative post, not negative post.

Yeah, that's wonderful. How can parents start educating the really young children who just want to grab everything?

So, I think the biggest thing is that, you know, you kind of unfortunately have to instill a tiny bit of fear and respect, just to start allowing them to understand that they can't have certain foods or things in certain foods that it could harm them. And that if they are uncertain about what is in the food—or, actually, don't even give them that choice, especially, you know, under the age of 2- to 3-year-old range, you know. Unfortunately for them, they don't always have that discernment, they just want to eat the candy, or eat the goodie that somebody has given them. So, anything that's not given to them by their parents, they really should be taught to ask before they eat whatever that item is. And, you know, at Halloween, we discussed don’t eat your candy before you get home, and your parents can look at it. It’s kind of the same thing with this. If you guys go to a social gathering at church or at a friend's house, or at a party or at a community center where they're giving out candy, you know, if you haven't been part of the organizational aspect of it and had something provided for your child that was allergen free, you really want to tell your children before you guys even get there. Like, “Okay, we need to see all the candy that you've been given before you eat it, so we can check it and make sure that it won't hurt you.” And it is one of those things that’s very difficult from the aspect of you want them to enjoy the holiday. You don't want them to be frightened about the holidays, you want them to enjoy this and feel the love and laughter and brightness of the holiday season. But they also have to be a tiny bit fearful that something that they are given by others might cause a reaction. And so that's the fine line that you have to deal with. And it really is probably more of an issue to make it less about food, and more about festivities and non-food items. And that's hard, because we eat all the time during the holidays. But it's probably more just changing the social group that you're in, it’s mindset, where it's probably really better in your case to do more activity-driven things versus food-driven socialization.

What medications should parents have on hand? What should they know in case something goes wrong.

Absolutely. So, you know, obviously, the epinephrine device is key. Any person—child or adult—who has a food allergy should have an epinephrine device that can be provided. The prescription can be provided by your provider, whether it be your primary care provider, your specialist, whomever, and then that epinephrine device is then filled by the pharmacists of the world. And so, and if you have a question about how to use that device, you then can ask your primary care office, you can ask your pharmacist, you can ask anybody how to use it. And there's also videos online for that as well. So definitely that, and then for other minor type reactions that you can discern, probably have some generic Benadryl, which would be diphenhydramine, with you. But the mainstay of treatment for any sort of severe allergic reaction is going to be your epinephrine device and administering that and going to your local emergency room following the administration or the reaction, not because you gave epinephrine, but because those symptoms can sometimes come back after an allergic reaction, and you need to be monitored by medical professionals for a few hours after the reaction to make sure that no symptoms return.

Is there anything you want to add anything that I didn't ask about?

Just like with our Halloween discussion, I just think that we all could do, meaning the world could do with some patience and love and empathy and sympathy for others. And so, in this situation, this is a large group of people that sometimes is not truly identified or sometimes marginalized, that we really need to reach out and try to understand and know that this is very difficult for parents and for adults with food allergy during holiday seasons, because they are fearful of ingesting something or coming in contact with something, even if it's a cross contamination, you know, like preparing a meal. And their allergen just happens to have the same utensil used and there's a small amount of it, that small amount could trigger a life-threatening allergic reaction. We just need to be mindful of that and if a parent or a friend says, “Look, you know, I appreciate you inviting me to this dinner. But do you mind if I just hosted at my house? It would make me feel more comfortable,” that you're not offended by that. It's just an understanding that it's their safety measure to try to provide safe a safe environment for their children, their spouse, their partner, or them themselves, you know that they want to spend time with you, but they need that security measure as part of the process.

Yeah, absolutely. Thank you so much for talking with me about all of this.

No problem. Thanks. Again, this is a good platform to do this.

Videos

Parties and get-togethers often present challenges for patients with allergies, particularly with home-cooked food that may have unclear ingredients. 

Parents, Clinicians Can Take Steps to Manage Food Allergies During the Holidays

Study authors of a recent study published in 

 explained that they observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes following COVID-19 infection. Although long-term health issues from COVID-19 are a major public health concern, evidence on post-acute COVID-19 syndrome, or post-COVID-19, is still limited, specifically among children and adolescents.

During the study, the researchers used comprehensive health care data on approximately 46% of the German population and analyzed post-COVID-19-associated morbidity among 2 groups—children/adolescents and adults. The study authors noted that routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020 were used for their analysis, with the base population including all individuals insured for at least 1 day in 2020. The team then identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020.

The researchers then assigned a control cohort using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. Further, the date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.

In all, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical, mental, and physical/mental overlap). The researchers then used Poisson regression to estimate incidence rate ratios with 95% confidence intervals.

The population of participants included 11,950 children/adolescents between age 0 and 11 years and 145,184 adults between age 18 and 49 years. The mean follow-up time was 236 days in children/adolescents and 254 days in adults, and the COVID-19 and control cohorts were well balanced regarding covariates.

In at least 1/100 person-years in the COVID-19 cohort in children and adolescents, the specific outcomes with the highest incidence rate ratios (IRR) and an incidence rate (IRs) were malaise/fatigue/exhaustion, cough, and throat/chest pain.

In adults, this included disturbances of smell and taste, fever, and dyspnea. For health outcomes combined, IRs per 1000 person-years in the COVID-19 cohort were significantly higher than those in the control in both children/adolescents and adults. The magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain.

In the COVID-19 cohort, IRs were higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. The IRR estimates were similar for age groups 0 to 11 and 12 to 17, and IRs in children/adolescents were consistently lower than those in adults.

Additionally, the study authors noted that there were study limitations, such as potentially unmeasured confounding and detection bias. However, the study authors also explained that these findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults.

Roessler M, Tesch F, Batram M, et al. Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany. PLOS Medicine. November 10, 2022. Accessed November 18, 2022. 

https://doi.org/10.1371/journal.pmed.1004122

Articles

Although long-term health issues from COVID-19 are a major public health concern, evidence on post-COVID-19 symptoms are still limited, specifically among children and adolescents. 

Data Analysis Shows Significant New Onset Morbidity Post-COVID-19 in Children, Adolescents, Adults

A recent study discovered the first evidence in humans that short-term lifestyle changes can disrupt the response to insulin of blood vessels and the first analysis showing men and women reacting differently to these changes, according to the authors of a study conducted at the University of Missouri School of Medicine.

Previous studies had analyzed the topic of sugary diets, with researchers suggesting that the consumption of sugary drinks is associated with higher cancer risk and the risk of obesity.

 A feature of obesity and type 2 diabetes is vascular insulin, which contributes to vascular disease.

During this trial, the researchers examined vascular insulin resistance in 36 young and healthy men and women by exposing them to 10 days of reduced physical activity and cutting their step count from 10,000 to 5,000 steps per day. The participants also increased their sugary beverage intake to 6 cans of soda per day.

“We know that incidence of insulin resistance and cardiovascular disease is lower in premenopausal women compared to men, but we wanted to see how men and women reacted to reduced physical activity and increased sugar in their diet over a short period of time,” said Camila Manrique-Acevedo, MD, associate professor of medicine, in a press release.

The results highlighted that only in men did the sedentary lifestyle and high sugar intake cause decreased insulin-stimulated leg blood flow and a drop in a protein, called adropin, which regulates insulin sensitivity and is an important biomarker for cardiovascular disease.

“These findings underscore a sex-related difference in the development of vascular insulin resistance induced by adopting a lifestyle high in sugar and low on exercise,” Manrique-Acevedo said in a press release. “To our knowledge, this is the first evidence in humans that vascular insulin resistance can be provoked by short-term adverse lifestyle changes, and it’s the first documentation of sex-related differences in the development of vascular insulin resistance in association with changes in adropin levels.”

Manrique-Acevedo added that she would like to analyze how long it takes to reverse these vascular and metabolic changes and more fully assess the impact of the role of sex in the development of vascular insulin resistance.

Sedentary Lifestyle and Sugary Diet More Detrimental to Men. University of Missouri School of Medicine. October 27, 2022. Accessed November 2, 2022. 

https://medicine.missouri.edu/news/sedentary-lifestyle-and-sugary-diet-more-detrimental-men

Antrim A. Sugary Drinks Consumption Associated with Higher Cancer Risk. 

. July 17, 2019. Accessed November 2, 2022. 

https://www.contemporaryclinic.com/view/sugary-drinks-consumption-associated-with-higher-cancer-risk

A feature of obesity and type 2 diabetes is vascular insulin, which contributes to vascular disease.

Study: Sedentary Lifestyle, Sugary Diet More Detrimental to Men

In an interview, allergist with AllerVie Health, Maxcie Sikora, MD, discussed some risks associated with Halloween for children with food allergies. She also discussed precautions that parents can take as well as alternatives to candy.

Q: What risks are associated with Halloween for children with allergies?

I would just say from a food allergy perspective, Halloween is very daunting for families of patients with food allergy. In general, you know, as you mentioned, it really does depend on the age. In the younger age group, they're much more likely to have the common kind of food allergy triggers like milk, egg, wheat, soy, and those allergens are typically outgrown as they become older. So, in the older child population, you know, meaning like elementary school and above, that's when the majority of those children should start outgrowing their food allergens, but they still have food allergies. As we all know, nut allergy, whether it's peanut or tree nut, is a major allergen. But then there are also still children who have milk and egg and wheat and soy. And then you also have children who have sesame allergy, you have some other rare allergies. And you also have children who have food intolerances that don't fall under that allergy spectrum, that may not have anaphylaxis to the foods, but will have other complaints such as gastrointestinal complaints when they ingest these foods.

Q: What are some precautions parents can take for particularly young children, who might not completely understand their allergy or which foods could be dangerous?

Absolutely. So, just in case parents and watchers of this video want to look at that the Food Allergy Research and Education (FARE) Organization, they have a website called FoodAllergy.org. And so, they have some great tips on there and I gleaned a lot of this from them just to have kind of a standard protocol. But mainly, you know, the biggest thing for children, both young and old, is to not eat the candy while they're trick-or-treating. That's a huge deal. No eating of candy while you're out trick-or-treating. Like right when you get the candy, don't eat it, because that candy needs to be evaluated to make sure that it does not contain the allergens to which they're allergic. And as we all remember from childhood, as soon as we received our favorite candy, we wanted to eat it immediately. So, I'd say that's the number one rule.

In the past, I've had parents tell me that what they've done in neighborhoods in which they live for young children is distribute safe candy to their neighbors, like a goodie bag just for their child. And especially in a community where you know your neighbors, then when your child goes to the door for trick-or-treating and does their trick-or-treat and, you know, is excited about receiving their candy, they are given candy that is specifically for them, that is safe for them, provided by the parents ahead of time. So, that's another option.

The other thing that I highly recommend is that you don't eat candy that doesn't have the ingredients on the label because the snack-size candies that are that are given out at Halloween sometimes contain different ingredients than the full-size candies. So even if you've, you know, eaten this particular candy before and not had any problems with it, the snack sized candy still may contain some of those allergens that you're trying to avoid. So that for sure is a big deal. And then also just not ingesting candy that you can't see the label because the labeling on candies or foods in general are also going to tell you if it's processed with other major food allergens, and so some children and adults can have food reactions from cross contact with allergens to which they're allergic and they wouldn't even think about it by eating this particular candy that obviously doesn't have their food allergens in that particular candy.

Q: How do precautions change as children get older?

Obviously, as children get older, we're not always out there with them, observing them and trick-or-treating. I think definitely the not eating the candy while trick-or-treating goes for any age, just so they're aware that they need to wait until they get to a space where they can sit down and look at everything and look at the labels. Definitely, as children age, if they've had food allergy from a very early age, they're even better than their parents usually at being able to read a label and identify what they can and cannot have, to the point where some of them will even pick the candy that they want from the actual house in which they're visiting that doesn't contain a food allergy. Then, I think the biggest thing that parents and people, neighbors who are providing candy and other things to trick-or-treaters, is to have a teal pumpkin like what's behind me, that allows you to have other things to give out for Halloween that are not allergenic. Meaning like non-food items, you know, like little trinkets, stickers, or you know, glow in the dark bracelets, you know, things like that, that are easily obtained that you can keep in that bucket. And it actually can be, if you don't use them all, you can reuse them. So, it's nice that you can offer something that isn't candy to somebody with a food allergy. And I think to people who have the teal pumpkin, most food-allergic parents recognize that and appreciate that. And, you know, they kind of also try to steer their children towards the teal pumpkin items versus like the food items, if that makes sense.

So, I think there's definitely ways to keep children safe and, like we all know, it definitely takes a village to have a healthy child. And in this case with, you know, one in 13 children having a food allergy, that's 2 in every classroom. So, it's a huge deal. And especially if you live in a neighborhood where many trick-or-treaters come by your home, it is super-duper important to have something available that is safe for a child with food allergy to enjoy and to not feel left out in a in a wonderful holiday such as Halloween.

Q: Are there any medications or anything parents should have on hand in case of an allergic reaction?

So, in general, many of us who are pediatric allergists, probably all of us actually, recommend that the parent always carry an EpiPen, no matter what the situation is. And in this case, this is a situation that could potentially lead to some sort of accidental exposure, even with them being as cautious as possible. So, for sure, they should have their EpiPen. And, you know, for severe allergic reaction that is your first line of defense. And so, I would definitely recommend that it varies on what everybody else chooses to carry. But most parents carry their EpiPen and also carry like Benadryl as well. But in the case of any suspected severe allergic reaction, your EpiPen is your first line of treatment and then seek care at an emergency center.

Q: What is the role of pharmacists in educating parent and children about the risks and precautionary steps to take?

So, I think there's a huge role in pharmacy for this, the first being the importance of their EpiPen. Because you guys in the pharmacy world are the gatekeepers for their epinephrine. So, the epinephrine devices are majorly important. And also, I know that you guys also are wonderful at reminding them about when their epinephrine device expires, which is also super important because, you know, they may have their epinephrine device, but it may actually be already expired. And I would prefer that in a situation with high risk such as trick-or-treating that they have their current and in-date epinephrine device. So that, for sure, is an important thing that pharmacists can do.

The other thing is just reminding them about the precautions, you know, just things that we talked about—not eating the candy while they're out trick-or-treating, reading labels. Things that you guys already tell people because you're giving them the information on side effects of medications all the time and cross reactivity of medications, and it's a very similar thing, except in this case, you're protecting them from their food allergy and you're providing them with extra care which is part of our need in health care as to help care for our all of our patients.

Q: Do you have any tips for approaching these conversations?

I think that it's really important when somebody addresses or ask about an allergy, especially to food, that people are very open minded about it. I find that a lot of parents and people with food allergy are not respected or believed when they tell somebody that they're allergic to a food. You know, people generally kind of blow that off or make it less important than it actually is. And I think just a little bit of compassion and sympathy for the day-to-day life where they're really living in fear of encountering something that could cause major health problems and sometimes, in certain situations, the possibility of death if they ingest it. It's just so important that we really respect others and show compassion every day, whether or not you know anybody that has a food allergy—which I find very hard to believe now that the ratio is 1 in 13—that we just try to help others and really see the need in the community and step up and try to protect those children and adults that have this food allergy. And one of those things we can do is help enjoy a holiday, you know, that a lot of us participate in and fully enjoy and allow these people to not feel ostracized because of their food allergy, they you know. They’re able to trick or treat, dress up, visit other houses, and feel safe in those communities doing so. The FARE Organization also has a teal pumpkin map on their website. So, if you are a person who has a teal pumpkin at your house, you can add your address to the list. And parents with children with food allergies actually utilize that list in order to know where to go to be safely trigger-free. So that's another thing that we all can do to help out.

Q: Is there anything you’d like to add?

I think, you know, my whole spiel about compassion with food allergy, I just find that that is something that I really feel like puts a lot of stress and strain and anxiety on both parents and people suffering with food allergy, the lack of understanding and the lack of compassion of the general public, to where they don't feel safe, in their community. Sometimes they don't feel safe going to grab a cup of coffee or going to a local restaurant or a cafe. And so, it's really important to understand that this is a serious issue. It's definitely a health problem that is growing throughout the world. And unfortunately, it doesn't seem to be going away. So, we need to understand that and help try to facilitate a safer lifestyle for these people who have this problem.

Pharmacists can remind parents to have an EpiPen on hand and to carefully review candy after trick-or-treating.

Counsel Patients About Pediatric Allergy Risks, Precautions On Halloween

Children and young adults with Down syndrome are 4 times more likely to be diagnosed with diabetes, according to the findings of a study published in 

The study, by Queen Mary University of London and King’s College London, examined just under 10,000 individuals with Down syndrome and almost 40,000 individuals without. Data from the UK Clinical Practice Research Datalink, from 1990 to 2020, were used.

This is the first time that investigators examined the incidence of diabetes and obesity in Down syndrome across one of the disorder’s biggest cohorts.

“This is the largest study ever conducted in Down syndrome patients to show that they have unique needs with regards to diabetes and obesity, and that screening and intervention, including a healthy diet and physical activity, at younger ages is required compared to the general population,” Andre Strydom, MRCPsych, MSc, PhD, professor in intellectual disabilities at King’s College London, said in a statement. “The results will help to inform the work of NHSE's LeDeR program to reduce inequalities and premature mortality in people with Down syndrome and learning disabilities.”

Investigators found that children aged 5 to 14 years with Down dyndrome have about a 10 times greater chance of having type 2 diabetes (T2D) than children without. They think, based on the results, that children with Down syndrome must be more closely monitored for early signs of diabetes, excess weight, and obesity.

Investigators emphasize that identifying diabetes as early as possible helps individuals with the complications that diabetes can bring later in life.

Despite the findings, investigators found that individuals with Down syndrome were typically diagnosed with diabetes much earlier. The average age of diagnosis of diabetes for an individual with Down syndrome was aged 38 years compared to with aged 53 years for those without the genetic disorder.

Excess body weight and genetics could be the reason behind the increased risk, investigators said.

Individuals with Down syndrome were found to have a higher body mass index and reach its peak at an earlier age, which increases the risk of T2D at a younger age.

Additionally, investigators found that there was also an increased risk of T1D, because of extra chromosomes and issues with the immune system for those with Down syndrome.

“This study highlights the importance of early screening for diabetes and weight issues in [individuals] with Down syndrome, especially children and young adults,” Li Chan, PhD, reader in Molecular Endocrinology and Metabolism and Consultant Pediatric Endocrinologist at Queen Mary University of London, said in the statement.

“Currently there is a sizeable gap in research into the condition, which affects around 40,000 people in the [United Kingdom],” Chan said. “To help plug this gap in knowledge, we are conducting further research into how genetics affects a[n individual] with Down syndrome’s predisposition to diabetes and obesity and hope to shed further light on this important medical issue."

Children and young adults with Down syndrome four times more likely to have diabetes. News release. Science Daily. October 4, 2022. Accessed October 17, 2022. https://www.sciencedaily.com/releases/2022/10/221004104957.htm

Investigators find that individuals aged 5 to 14 years with the genetic disorder are also at greater risk for TD2.

Study: Children, Young Adults With Down Syndrome Have 4 Times Greater Chance of Diabetes

Mandatory mask wearing caused communication challenges for more than 90% of the deaf community during the peak of the COVID-19 pandemic, according to a study from the University of Essex. The study further revealed that 76% of missed important information and 59% felt isolated from society from having their faces covered.

Because masks prevent reading lips and seeing facial expressions and cues, communicating with masks is a major challenge, particularly among the population over 55 years of age who became deaf later in life.

These effects were particularly pronounced among those who sign or who are profoundly deaf, whose feelings of disconnect from society had a significantly detrimental impact on their wellbeing.

Eva Gutierrez-Sigut, MD, led a team of deaf and hearing researchers in creating a survey that was accessible in all different sign languages. Approximately 400 people were surveyed to assess the impact of the COVID-19 pandemic on the deaf community with the intent to help shape public policy in health emergencies.

"Mask mandates were vital in fighting the spread of the deadly coronavirus but meant some of our most vulnerable communities were left isolated. The pandemic lockdowns were hard for everyone but even more so for the deaf and hard-of-hearing. This research exposes the unexpected consequences policies can have in a fast-moving international emergency and how people can fall through the cracks,” Gutierrez-Sigut said in a press release. "If the world is gripped by a pandemic again governments need to do more to be inclusive and engage with communities to find out what they need to thrive and survive."

The researchers also discovered how cultural differences and mask wearing affected comprehension and understanding, with the British population experiencing more difficulties than the Spanish population.

The investigators did not find a single uniform approach to manage mask wearing among the deaf or hard-of-hearing communities because signing, speech reading, and other communication methods affect comprehension in combination with levels of deafness, whether they can use sign language, and when their hearing loss began. The researchers found that a clear mask with the mouth and lower face visible was the preferred option for many individuals surveyed.

"Most deaf people we spoke to agreed these masks made a real difference and made everything from a trip to the shops to a vital doctor's appointment easier. It is worth remembering though that there isn't a one-size-fits-all solution for these communities. The deaf and hard-of-hearing are not a homogenous group and have different needs,” Gutierrez-Sigut said in a press release.

She added that more needs to be done to engage with this community in public safety efforts.

"To do this we made a real effort to create an accessible study using sign language to reach them,” she said in a press release. “We are so thankful deaf and hard of hearing shared their experiences and we hope we can make their voices heard and seen."

Masks saw more than 90 percent of deaf people struggle to communicate during pandemic, study finds. ScienceDaily. October 3, 2022. Accessed October 5, 2022. 

https://www.sciencedaily.com/releases/2022/10/221003132752.htm

More Than 90% of Deaf Community Struggled After Initiation of Mask Mandate During COVID-19 Pandemic

Bright light therapy and time management tools may help teenagers regulate their sleep schedules for better and longer sleep, according to researchers at Rush University Medical Center, who published their findings in the journal 

. Following use of therapy and behavioral tools, researchers observed that participants felt less tired and irritable.

"There are a lot of changes a teen goes through," said Stephanie J. Crowley, PhD, associate professor of psychiatry and behavioral sciences and director of the Pediatric Chronobiology and Sleep Research Program, Rush University, in a press release. "One specifically is a change to sleep biology that happens during puberty."

Researchers suggest that there are 2 competing forces in a teenager’s brain—1 force encourages teenagers to regulate sleep by going to bed earlier during the school year. The other force is biological, which makes it possible for teenagers to stay up very late.

"The brain systems that control sleep change in such a way that it's easier for an adolescent to stay awake later into the evening. One of these systems—the 24-hour circadian clock—shifts later in time," Crowley said.

The National Sleep Foundation and the American Academy of Sleep Medicine determined that adolescents need 8 to 10 hours of sleep every night for physical health, emotional wellbeing, and good performance in school. But adolescents often get less than 8 hours of sleep each night, especially on school nights), according to the study.

The researchers at Rush University performed a 2-week intervention to help teens have a better nighttime routine. Using behavioral measures to target the circadian system, the investigative team aimed to combat the widespread phenomenon of sleep deprivation in teenagers.

Researchers used bright light therapy for 2.5 hours in 2 weekend morning sessions. It is suggested that bright light can signal our internal clock to wake up earlier. Consequently, it may help regulate an appropriate time for a teen to go to bed. The team also implemented time management tools, such as limiting afterschool activities, to increase the likelihood of an earlier bedtime.

The results showed that teenagers who were part of the intervention went to bed 1.5 hours earlier and their total sleep time increased by nearly 1 hour. Crowley found that "teens with late circadian clocks shifted by up to 2 hours earlier."

After 2 weeks, the teenagers reported feeling less worried and less irritable, and had better concentration. They also reported feeling more alert in the morning.

Even teenagers whose circadian clock did not need to shift benefited from the time management intervention.

“They [just] needed the behavioral support of trying to manage their time in the evening and increase their sleep duration," Crowley said in the press release.

Researchers are studying participants again to see whether they maintained their improved sleep routine.

Rush University Medical Center. Researchers find ways to help teens get more sleep. Science Daily. October 3, 2022. Accessed on October 4, 2022. https://www.sciencedaily.com/releases/2022/10/221003141357.

Bright light therapy and better time management could make it possible for teenagers to get the recommended 8 hours of sleep, according to new research.

Teenagers May Hit Sleep Goals with Bright Light Therapy, Time Management 

Sharon Hesterlee, PhD, is the executive vice president and chief research officer at the Muscular Dystrophy Association.

On average, individuals with the neurodegenerative condition amyotrophic lateral sclerosis (ALS) are diagnosed approximately 12 months after their first symptom and survive for approximately 3 to 5 years following diagnosis.

ALS is relentlessly progressive; the loss of motor neurons in individuals with ALS can cause weakness and impaired function of axial, bulbar, limb, and respiratory muscles, eventually leading to disability and death. There are factors associated with more favorable survival, such as younger age at symptom onset and body site of first symptoms, such as limb rather than bulbar onset, but longer survival is in part dependent upon the ability to make informed management decisions based upon a definitive ALS diagnosis.

A variety of factors contribute to the delay in diagnosis of ALS. First, there are only about 17,000 individuals in the United States who have ALS, and the presentation of symptoms and course of disease is highly variable among them. The early signs and symptoms of ALS are easy to dismiss as signs of aging or mistake for another neuromuscular condition. There is also no test that can provide a rapid or definitive diagnosis for ALS. An estimated 10% to 15% of individuals with ALS have a family history of the disease, and approximately 70% of these cases may be diagnosed by genetic testing. In the remaining cases, however, clinicians must evaluate clinical history, electromyography, neuroimaging, and physical examinations to diagnose ALS. As a result, ALS can be difficult to identify, and the diagnostic journey of an individual with the disease may involve many health care professionals and testing before the correct diagnosis is established.

Delayed diagnosis is a problem, because it prevents individuals with ALS from seeking multidisciplinary care that may improve their quality of life and defers the initiation of disease-modifying treatment. Although treatment for ALS was previously limited to the glutamate blocker riluzole (Rilutek), which moderately increases life expectancy by 3 to 6 months, the availability of new therapeutic options and the promise of investigational therapies, makes early diagnosis more critical for individuals living with ALS. In 2017, the FDA approved intravenous (IV) administration of the antioxidant drug edavarone (Radicava) for treatment of ALS.

 Participants receiving edaravone in clinical trials experienced a significantly reduced decline in a measure of daily function (ALSFRS-R score), meaning that edaravone treatment slowed progression of disease. The FDA approved a new drug application (NDA) for an oral formulation of edaravone for treatment of ALS on May 12, 2022. This new formulation will allow the drug to be taken easily at home rather than requiring an IV.

Delayed diagnosis of ALS not only defers access to approved treatments, but it also prevents timely enrollment in clinical trials, which often require a clinical definition of definitive or probable diagnosis of ALS for eligibility. There are 100-plus products in development

 for management of ALS, including numerous investigational therapies

 in phase 3 trials. Delayed diagnosis prevents individuals with ALS from gaining access to investigational therapies that may improve their disease and simultaneously hinders the research and development process for new, potentially effective treatments.

Animal studies of ALS have shown that interventions assessed preclinically are more effective when implemented earlier in the course of disease. Typically, however, individuals are not diagnosed with ALS until they have already lost a considerable number of motor neurons and are demonstrating clinical symptoms. Although it may not yet be feasible to diagnose individuals before they experience symptoms, it may be possible to close the gap between the start of symptoms and a formal diagnosis. This will allow individuals with ALS to begin treatment as early as possible.

The revised Awaji and El Escorial criteria are the most commonly used diagnostic criteria for ALS, and consensus diagnostic classifications based on these 2 criteria are also available. Although use of these scales is commonplace, their diagnostic sensitivity is relatively low, often leading to a diagnosis of probable ALS. There is an effort in the research community, therefore, to determine better methods to identify ALS in patients.

A recent study from Juan F. Vázquez-Costa, associate professor of neurology at the University of Valencia in Spain, and colleagues, analyzed factors that may contribute to the diagnostic delay in ALS.

The study demonstrated that the type of hospital center, departmental vs referral ALS centers, can significantly affect the time to diagnosis. Patients evaluated in an ALS referral unit, which is a center that typically receives referrals from the private and public hospitals in the region, were diagnosed in a median of 8.5 months compared with the 12 months of patients studied in departmental hospitals. The study included 25% of ALS patients who did not meet Awaji criteria for ALS at the time of the diagnosis but for whom the ALS diagnosis was confirmed after 2 years of follow up. This finding emphasizes the importance of connecting with experienced clinicians, who may better recognize the early signs and symptoms of disease, when an ALS diagnosis is suspected.

Searching for Pre-Symptomatic Disease Markers

It is increasingly clear that conditions such as Alzheimer disease, frontotemporal dementia, Huntington disease, Parkinson disease, and spinal muscular atrophy are preceded by a pre-symptomatic period, during which affected individuals experience no clinical symptoms, but the underlying disease process begins. Insights from the study of these diseases highlights opportunities for understanding ALS. For example, the identification of amyloid, tau, and other biomarkers of AD has allowed earlier definition based on histopathology.

Similarly, deciphering the biology of pre-symptomatic ALS could help define the earliest stages of disease. Although the 10% to 15% of individuals with familial ALS have potentially identifiable genetic markers, the vast majority have an unknown cause of disease. Investigators are working to identify non-genetic risk factors and biomarkers for use in predicting emergence of clinical ALS. They are also searching for behavioral, cognitive, or motor impairments that may precede clinical presentations of ALS.

Investigators at Columbia University are on the forefront of efforts to detect ALS before symptoms arise. Matthew Harms, associate professor of neurology and a member of Columbia’s Institute for Genomic Medicine; Elizabeth Harrington, genetic counselor at the Eleanor and Lou Gehrig ALS Center; and Neil Shneider, associate professor of neurology at Columbia’s Vagelos College of Physicians and Surgeons, run the ALS Families Project,

 which follows asymptomatic relatives of patients living with familial ALS. These relatives share known disease-associated gene mutations with the affected patients and have an elevated risk of developing ALS. This study represents a major effort to identify early changes associated with ALS in the months or years preceding the appearance of obvious symptoms.

Another effort, directed by Michael Benatar, MD, professor of neurology and the chief of the neuromuscular division at the Miller School of Medicine at the University of Miami, has led to the creation of a “roadmap” to early intervention for ALS.

 The study relied on the understanding that like ALS, conditions, such as AD, frontotemporal dementia, Huntington disease, Parkinson disease, and spinal muscular atrophy present with neurodegenerative and neuroinflammatory changes in the brain. By mapping neuroimaging markers, pre-symptomatic identifiers, and gene mutations found in these other neurodegenerative diseases before the appearance of clinical symptoms, investigators were able to predict pre-symptomatic changes that may take place in ALS.

One of the goals of detecting ALS earlier is to prevent the emergence of disease symptoms with early interventions. Toward this end, Benatar’s group, in collaboration with Biogen, is testing treatment of presymptomatic participants with ALS in the multicenter, phase 3 ATLAS clinical trial.

 gene cause about 2% of all cases of ALS. ATLAS will evaluate the effects of the investigational drug tofersen, which targets 

 mutation but do not yet have clinical manifestations of disease. The trial will evaluate whether tofersen can delay onset or slow progression of ALS in this high-risk population.

The Muscular Dystrophy Association (MDA) is committed to funding research and education that improves the lives of individuals with neuromuscular diseases. In 2023, the MDA research team plans to release a request for applications to support projects promoting innovations in the early diagnosis of ALS. Additionally, the MDA’s professional medical education program is developing content to support clinicians in early ALS detection. Raising awareness and educating health care providers about the signs and symptoms of ALS, as well as the new scales and studies centered on diagnosis, may help reduce the diagnostic journey of individuals with ALS. Finally, the MDA’s multi-disease patient registry, neuroMuscular ObserVational Research,

 has collected clinic-entered data from more than 2000 patients with ALS, which is being used to track the gap between symptom onset and formal diagnosis. This multi-pronged approach supports the innovative work being done by clinicians and investigators in the area of early diagnosis and intervention. Although efforts are still focusing on the search for effective targets for ALS therapies, meaningful improvements in care can be achieved by earlier diagnosis.

1. Cho H, Shukla S. Role of edaravone as a treatment option for patients with amyotrophic lateral sclerosis. Pharmaceuticals. 2021;14(1):20. doi:10.3390/ph14010029

2. Amyotrophic lateral sclerosis. Delve Insight. January 2022. Accessed September 28, 2022. https://www.delveinsight.com/report-store/amyotrophic-lateral-sclerosis-als-pipeline-insight?utm_source=globenewswire&utm_medium=pressrelease&utm_campaign=vpr

3. Chen JJ. Overview of current and emerging therapies for amyotrophic lateral sclerosis. 

 2020;26(9 Suppl):S191-S197. doi:10.37765/ajmc.2020.88483

4. Martínez-Molina M, Argente-Escrig H, Polo MF, et al. Early referral to an ALS center reduces several months the diagnostic delay: a multicenter-based study. Front Neurol. 2020;11:604922. doi:10.3389/fneur.2020.604922

5. New program hopes to make early detection and treatment of ALS a reality. Columbia University Irving Medical Center. November 19, 2018. Accessed September 28, 2022. https://www.cuimc.columbia.edu/news/new-program-hopes-make-early-detection-and-treatment-als-reality

6. Benatar M, Wuu J, McHutchinson C, et al. Preventing amyotrophic lateral sclerosis: insights from pre-symptomatic neurodegenerative diseases. 

7. A study of BIIB067 when initiated in clinically presymptomatic adults with a confirmed superoxide dismutase 1 mutation (ATLAS). ClinicalTrials.gov. Updated September 28, 2022. Accessed October 1, 2022. https://clinicaltrials.gov/ct2/show/NCT04856982

8. MOVR data hub (neuroMuscular ObserVational Research). Muscular Dystrophy Association. Accessed October 2, 2022. https://www.mda.org/science/movr-data-hub-neuromuscular-observational-research

Amyotrophic lateral sclerosis is difficult to diagnose early because it can mimic other neurological diseases.

Early Diagnosis of ALS Benefits Patients

Older individuals who were infected with COVID-19 show a substantially higher risk of developing Alzheimer disease (AD) within a year than those in the control group, according to the results of a study of more than 6 million individuals aged 65 years and older.

, investigators also reported that the highest risk was observed in women aged 85 years and older.

“The factors that play into the development of [AD] have been poorly understood, but 2 pieces considered important are prior infections, especially viral infections, and inflammation,” Pamela Davis, Distinguished University Professor and the Arline H. and Curtis F. Garvin Research Professor at the Case Western Reserve School of Medicine, said in a statement. “Since infection with [severe acute respiratory syndrome coronavirus 2] has been associated with central nervous system abnormalities including inflammation, we wanted to test whether, even in the short term, [COVID-19] could lead to increased diagnoses.”.

The results showed that the risk of developing AD in older individuals nearly doubled to 0.68% from 0.35% over a 1-year period, following a COVID-19 infection.

Investigators analyzed anonymous electronic health records of approximately 6.2 million individuals aged 65 years and older in the United States who received medical treatment between February 2020 and May 2021. The individuals also had no prior diagnosis of AD.

The population was divided into 2 groups: individuals who contracted COVID-19 during the time period and those who did not. Investigators reported that more than 400,000 individuals had COVID-19 and 5.8 million did not.

“If this increase in new diagnoses of [AD] is sustained, the wave of patients with a disease currently without a cure will be substantial and could further strain our long-term care resources,” Davis said. “[AD] is a serious and challenging disease, and we thought we had turned some of the tide on it by reducing general risk factors, such as hypertension, heart disease, obesity, and a sedentary lifestyle.”

The investigators plan to continue studying the effects of AD and COVID-19, as well as other neurodegenerative disorders. Additionally, they plan to study the potential to repurpose FDA-approved drugs to treat COVID-19’s long-term effects.

Additional studies have shown that individuals with dementia are twice as likely to contract COVID-19, and those with substance use disorder order are also more likely to get the infection.

Furthermore, approximately 5% of individuals who took Paxlovid for treatment of COVID-19 symptoms experienced rebound infections within a month.

Risk factor for developing Alzheimer's disease increases by 50-80% in older adults who caught COVID-19. News release. Science Daily. September 13, 2022. Accessed September 26, 2022. https://www.sciencedaily.com/releases/2022/09/220913140850.htm

Study results of more than 6 million elderly patients show women at least aged 85 years are most affected.

Risk Factor for Alzheimer Disease Increases by up to 80% in Older Adults Who Had COVID-19

A new study suggests that moral values and beliefs have a significant impact on regional disparities in vaccination rates, according to investigators from the University of Southern California who published their research findings in 

Despite the fact that COVID-19 vaccines are safe, effective, and widely available, many Americans are still hesitant. In some counties in the country, nearly all residents are vaccinated, whereas other counties have only a minority of vaccinated residents.

According to a press release, structural barriers such as access to health care, historic under-vaccination rates, and political barriers explained why residents of some counties were less likely to be vaccinated against COVID-19. This finding is in line with what was already known about vaccination behavior. However, the researchers also showed that Americans’ moral values were also an important aspect of understanding the stark disparities.

“If you look at a map of the proportion of vaccinations across US counties, you find very stark differences across counties, across regions, and across states,” said study co-author Nils Karl Reimer, PhD, in the press release. “Our goal is to interrogate why these differences in political ideology coincide with differences in vaccination rates.”

The study utilized moral foundation theory, which argues that there are 5 basic moral foundations: care, fairness, loyalty, authority, and purity. Using data from an online crowd-sourced website that collects a range of psychological data, the researchers estimated county-level moral values and conservatism. This data was combined with county-level vaccination rates from the CDC, the US COVID-19 Vaccine Coverage Index, and presidential election data to control for variables not included in the study.

The analysis found that moral concerns about fairness, loyalty, and purity influenced county-level vaccination rates, but care and authority did not. Counties with residents who prioritized purity were 0.8 times less likely to be vaccinated, and the researchers pointed to previous research showing that “conservatives care more about contamination and things they find disgusting.”

“We found that some values that are traditionally associated with conservatism were associated with lower vaccination rates, the biggest of which was a desire for bodily and spiritual purity,” Reimer said in the press release. “Endorsing these beliefs is related to all kinds of opinions such as being opposed to non-mainstream sexual practices or immigration.”

On the other hand, the investigators found that counties with higher loyalty were 1.14 times more likely to have higher vaccination rates. Or, if loyalty increased while other values remained the same, the vaccination rate could have been expected to rise 3% countywide. Placing a high value on fairness was associated with a 2% increase in vaccination rates in similar conditions.

To verify the accuracy of the model, the researchers compared it against 2 other models, one of which included only structural and demographic predictor variables, and the other in which partisanship was an additional predictor variable. Both models failed to predict county-level vaccination rates as accurately as the third model, which included county-level endorsement of moral concerns.

Although the researchers’ hypotheses were largely borne out in the study, they did see a few surprising trends. Notably, loyalty is typically associated with conservative values, which in turn are associated with vaccine skepticism. However, the study found that loyalty is associated with higher vaccination rates, but only when controlling for the 4 other moral foundations.

“The loyalty finding is quite surprising because there is a lot of rhetoric about anti-vaccination among conservatives. However, what we’re showing is that typical conservatives do not tend to be anti-vaxxers,” said co-author Morteza Dehghani, PhD, in the press release. “The anti-vaxxers tend to be not high on loyalty, but high on purity. These include conservatives who are low on loyalty, and also liberals who tend to prioritize purity concerns, most likely focusing on bodily aspects of purity contamination.”

Although the findings support the idea that county-level moral values can predict COVID-19 vaccination rates, the authors urged policymakers to exercise caution when utilizing the insights. Notably, the results from the county level cannot be extrapolated to smaller (cities, neighborhoods, or individuals) or larger (states) groups.

However, policymakers and public health communicators could use the findings to reframe their public health communications related to COVID-19. The researchers suggest appealing to loyalty concerns by framing vaccination as a patriotic duty to fellow citizens. In regions prioritizing purity, they suggest communications emphasizing the vaccine’s ability to protect from spreading the virus.

“I think a lot of people who are skeptical of vaccination might think of it as a foreign chemical introduced into your body,” Reimer said in the press release. “This sounds very scary, like something you wouldn’t necessarily want to put in your body, but I think framing it in terms of the natural immune system response could resonate with some skeptics. These things are, importantly, mere speculation before further experiments, but our findings could point toward public health messaging that could be tested.”

Moral values explain differences in COVID-19 vaccination rates across US counties. News release. USC News; September 15, 2022. Accessed September 23, 2022. 

https://news.usc.edu/202178/moral-values-explain-differences-in-covid-19-vaccination-rates-across-u-s-counties/

The data showed moral concerns about fairness, loyalty, and purity influenced county-level vaccination rates, but care and authority did not.

Study Suggests Moral Values Predict Regional Differences in COVID-19 Vaccination Rates

The Native Hawaiian (NH) and Pacific Islander (PI) communities were severely impacted by the COVID-19 pandemic, according to 2 studies published in 

. During the pandemic, 1 in 5 NH/PI participants lost a family member; they also had a mortality rate of 1 per 400 individuals by the end of 2021. Further, the NH/PI communities’ rates of alcohol use disorder were 2.6 times greater than the national rates.

"NH/PIs may carry the highest rates of COVID-19 infections and deaths of any US racial/ethnic minority group during the pandemic," said Andrew Subica, PhD, associate professor in the School of Medicine's Department of Social Medicine, Population, and Public Health, at the University of California, Riverside, in a press release.

In an earlier study, Subica noted that the data demonstrated the NH/PI population had the most deaths per capita in 90% of all states. To investigate this further, Subica and a team of researchers surveyed more than 300 NH/PIs in states with the highest NH/PI populations—including Washington, Utah, Oregon, California, and Arkansas—between April 2021 and November 2021.

More than 50% of NH/PI participants had a family member who was diagnosed with COVID-19, and 30% were diagnosed themselves. The results of the first study identified factors that increased NH/PI COVID-19 exposure risk—these include a job on the frontline, living in a densely populated house or neighborhood, or participation in large-scale group social events.

The second study observed that the NH/PI communities consumed high levels of alcohol, tobacco, and other drugs during the pandemic. Among NH participants, 47% used alcohol or cigarettes, and in PIs the rate was 22%. Additionally, 35% of all NH/PIs used illegal substances. Among NH/PIs, 1 in 4 screened positive for alcohol use disorder.

Based on the data, smoking has been shown to be a comorbidity of severe COVID-19 outcomes, making the high rate of smoking among NH/PIs an increased risk factor during the pandemic, explained Subic. The author added that the NH/PI communities have other high-risk comorbidities as well, such as obesity, cancer, and heart disease, which can further increase the severity of COVID-19 outcomes in NH/PIs.

This population also had high levels of depression, anxiety, and unmet treatment needs. During the pandemic, the researchers found that 27% of patients had major depressive disorder, 20% had generalized anxiety disorder, and 50% of non-binary NH/PI participants screen positive for probable alcohol use disorder.

"Our findings call for greater attention and funding of NH/PI research to prevent and reduce NH/PIs' glaring health disparities associated with COVID-19," Subica said in the press release. "This illuminates the need for further research exploring the behavioral health needs of these at-risk individuals. We need to develop and implement culturally responsive prevention, intervention, and recovery programs to reduce NH/PI substance use and mental health disparities during and after the COVID-19 pandemic."

University of California- Riverside. COVID-19 took serious toll on Native Hawaiian/Pacific Islander mental and physical health. Science Daily. September 19, 2022. Accessed on September 20, 2022. https://www.sciencedaily.com/releases/2022/09/220919103205.htm

Native Hawaiians and Pacific Islanders are suggested to have had some of the highest levels of mortality, depression, alcohol use, and anxiety disorders during the COVID-19 pandemic.

Native Hawaiian, Pacific Islander Communities Faced Significant Disparities in Mental, Physical Health During Pandemic  

Probiotics are live organisms that have a symbiotic relationship with the body, most often in the gastrointestinal (GI) tract.

The most common probiotics included in various formulations are bidifobacteria, lactobacilli, and the yeast 

 Probiotics are available in a wide range of products, formulations and strains. 

Evidence indicates that certain probiotics are possibly effective for GI conditions, such as antibiotic-associated diarrhea, chronic pouchitis associated with ulcerative colitis, constipation, diarrhea in adults and children, Helicobacter pylori in conjunction with standard therapies, irritable bowel syndrome (IBS), and reducing the risk of C. difficile infection.

The natural medicines database generally defines a “possibly effective” rating as “some clinical evidence supporting its use for a specific indication.”

The live organisms help maintain immunologic equilibrium through direct interaction with immune cells.

News

All Content

More Than 90% of Deaf Community Struggled After Initiation of Mask Mandate During COVID-19 Pandemic

Teenagers May Hit Sleep Goals with Bright Light Therapy, Time Management

Early Diagnosis of ALS Benefits Patients

Risk Factor for Alzheimer Disease Increases by up to 80% in Older Adults Who Had COVID-19

Study Suggests Moral Values Predict Regional Differences in COVID-19 Vaccination Rates

Native Hawaiian, Pacific Islander Communities Faced Significant Disparities in Mental, Physical Health During Pandemic

Probiotics Play Key Role in the Gastrointestinal Tract

Low Testosterone Levels Is Linked to Increased Risk of COVID-19 Hospitalization for Men

Women Who Perform Paid, Unpaid Labor May Have Worse Mental Health Outcomes

Researchers Call for Change in Guidelines About Eating Fish During Pregnancy