Contemporary Clinic spoke with Dr. Sara Hunt, DNP, FNP-C, about wellness and safety tips for the upcoming Halloween holiday.

Hunt covered trick-or-treating tips, costume safety, how to celebrate while staying safe from COVID-19, and more. 

Videos

Maintaining Wellness and Safety for Halloween 2021

Factors such as climate change, widening distributions of host populations, and better clinician awareness are some of the main reasons for the geographic spread of Lyme disease over the past few months, according to recent data from epocrates.

Acey Albert, MD, director of clinical content at epocrates, is board certified in internal medicine and pediatrics with 15 years of experience in outpatient primary care and medical group leadership. He was able to combine his interest of technology, medicine, and physician leadership as a part of the epocrates team.

Albert explained how there was an increased interest in Lyme disease incidence compared to 2020 among clinicians who use epocrates’ medical application this summer, which measured at a 90% increase YoY.

“This was surprising because, while we know Lyme disease is becoming more common, this was a much steeper increase than we expected,” Albert said in an interview with 

. “For comparison, CDC data showed a doubling of Lyme disease cases between 1991 and 2018, while cases over the last 3 years of data (most recently, 2019) remained relatively flat.”

The increase in Americans traveling again this year and predictions of a warmer, wetter weather pattern could have also played a major factor in the uptick of Lyme disease this past summer, according to Albert.

As for the main implications that both providers and patients should know about in the spread of Lyme disease, Albert said diagnosis of the disease is highly dependent on the patient’s location and travel history.

“By current CDC and IDSA guidelines, patients with the pathognomonic rash, erythema migrans (EM), and tick exposure in an area where Lyme disease is common can be diagnosed and treated without further testing,” Albert said in an interview with 

. “Those exposed in areas with Lyme who don’t have EM but have other symptoms require testing.”

These guidelines also focus on when to empirically treat asymptomatic patients with tick bites in areas where Lyme disease is endemic, according to Albert.

“For clinicians, the possible geographic expansion of Lyme means that more of us might need to include it in the differential diagnoses of patients experiencing a fever, headache, myalgia, and joint pain. For patients, it means that more of us should take vital protective measures when venturing outdoors,” Albert said in an interview with 

At epocrates, an issue that was addressed in the summary of Lyme guidelines was how clinicians are often confronted by patients with concerns about chronic Lyme disease at the point-of-care. This term is not usually acknowledged by gold-standard medical organizations, but clinicians are still being asked about it, according to Albert.

Symptoms such as fatigue, pain, and “brain fog” are usually seen in 10% to 15% of patients who are fully treated for the disease, according to the CDC, which is also known as post-treatment Lyme disease syndrome. However, Albert said there have been some controversies around this condition. The society that promotes “Lyme literate” clinicians who believe the condition represents chronic, persistent 

 infection, despite a scarcity of evidence supporting this assertion is an example of this issue.

“Unsurprisingly, these tests and treatment aren’t typically covered by insurance, and they’re administered in the offices of those ‘Lyme literate’ providers on a cash-pay basis. (National Institutes of Health)-funded studies show this approach is no better than placebo, and that fatal complications of long-term antibiotic treatment have been observed,” Albert said in an interview with 

. “Nonetheless, this group is surrounded by large patient advocacy groups with scientific-sounding websites, aggressive social media campaigns, legislative lobbyists, and celebrity spokespeople. As we’ve seen in COVID-19, anti-science disinformation abounds and shapes patient interactions with health care.”

As for suggestions to know about combatting Lyme disease, Albert recommends knowing the evidence-based guidelines for treatment or having a quick, point-of-care reference that summarizes this guidance. Further, keeping an eye out for newer evidence in areas that are more generalized to the rest of the country is also highly recommended. 

 in ticks around the San Francisco Bay area doesn’t necessarily mean that clinicians in Denver need to think about Lyme disease right now. That said, the study is likely to raise interest in broader investigations of the current geographic range of the disease, and clinicians should be ready to adapt,” Albert said in an interview with 

Articles

Lyme Disease Continues to Be Top-Of-Mind for Clinicians Based on Past Summer Data

 interviewed Jennifer Andrews, MD, pediatric hematologist-oncologist at Vanderbilt University Medical and the medical director of the blood bank, on the national blood shortage in the United States. As the national inventory was beginning to recover toward the end of this summer, COVID-19 cases began to significantly increase as a result of the Delta variant, directly impacting donor turnout.

During the discussion, Andrews addressed what this blood shortage may mean for health systems, how this shortage may affect patient care and outcomes throughout the country, how the shortage may impact nurses caring for patients in health care settings, what nurses can do to help encourage patients to donate blood while receiving other health care services, and what health systems can do to further address this issue and increase blood donations.

Jennifer Andrews, MD, pediatric hematologist-oncologist at Vanderbilt University Medical and medical director of Vanderbilt University Medical’s blood bank, discusses the national blood shortage and its impact on health systems and patient care.

During National Blood Shortage, Nurses’ Efforts Can Make All the Difference

For a Contemporary Clinic interview, Anna Legreid-Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists discussed Pfizer’s request to approve their COVID-19 vaccine for children 5 to 11.

She talked about what parents should know, the benefits of the vaccine for children this young, and why the FDA proceeds with extreme caution when considering the approval for the 5 to 11 age group.

Anna Legreid-Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists discusses Pfizer’s request to approve their COVID-19 vaccine for children 5 to 11.

Expert: Pfizer Requests the Approval of COVID-19 Vaccine for Ages 5 to 11

New research has found that ketone supplements may be a novel strategy for protecting and improving brain health in people with obesity, according to a study published in 

Because those with obesity are known to be at a higher risk of developing cognitive impairment and neurodegenerative diseases, this study found that giving a ketone supplement 3 times a day for 14 days improves blood flow to the brain and enhanced aspects of cognitive function, such as working memory and processing speed.

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment, according to the researchers.

Volunteers included adults with obesity who consumed either a ketone supplement or a taste-matched placebo supplement 3 times per day 15 minutes before breakfast, lunch, and dinner. The participants were randomly assigned to take the supplement or the placebo for the first 14-day period before switching to the other condition for another 14-day period. All meals and snacks were provided by the researchers for both 14-day intervention periods.

Cognitive function was measured using validated tests via an iPad application and brain blood flow was measured using a duplex ultrasound of neck arteries. Following this, blood samples were taken to measure hormones that the study authors likened to fertilizer for the brain, helping neurons grow and improving cognitive function.

“Once validated with a larger group of people, we expect that these supplements can be used to protect and improve brain health in people with obesity,” said first study author Jeremy Walsh, MD, in the press release.

Ketone supplement might be a novel therapeutic for boosting brain function in obesity. EurekAlert! October 4, 2021. Accessed October 5, 2021. 

https://www.eurekalert.org/news-releases/930078

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment.

Study: Ketone Supplement May Be Therapeutic for Boosting Brain Function in Obesity

Osteoporosis is a systemic skeletal disease involving low bone mass and microarchitectural deterioration of bone tissue, resulting in increased bone fragility and fracture risk.

Bone density corresponds to the amount of mineral within a volume, and bone quality depends on architecture, bone matrix composition, bone turnover, damage accumulation, and mineralization.

 Osteoporosis develops silently over years before it becomes apparent through bone mineral density (BMD) screening or fractures. Fragility fractures are the main physical manifestation and occur at diverse sites, such as the distal radius, proximal femur, and vertebral bodies.

Recommend a dual-energy x-ray absorptiometry (DXA) to check BMD and screen for osteoporosis in the following patients at high risk

Adults on chronic glucocorticoid therapy, such as oral prednisone ≥5 mg/day for 3 or more months or an equivalent

Individuals aged 50 years and older with a recent low-trauma fracture

Other patients may also be good candidates for a DXA to check BMD, especially those with multiple risk factors. Assess risk factors to see if BMD testing is warranted with a thorough history in men aged 50 to 69 years or postmenopausal women younger than age 65 years with the following medical concerns

Excessive alcohol intake of 3 or more drinks per day

Radiographic osteopenia (DXA T-score between -1 and -2.5)

Taking medications that decrease BMD, such as aromatase inhibitors, glucocorticoids, GnRH agonists, phenobarbital, or phenytoin

There are 3 different categories of bone health for classification purposes:

: BMD 1 standard deviation or less below that of young white women reference mean (ie, T-score of −1 or greater)

: BMD between 1 and 2.5 standard deviations below that of young white women reference mean (ie, T-score between −1 and −2.5)

: BMD more than 2.5 standard deviations below that of young white women reference mean (ie, 

There are specific indications for pharmacotherapy:

T-score of −2.5 or less (ie, or worse) in distal third of radius, femoral neck, spine, or total hip

T-score from −1 down to −2.5 in distal third of radius, femoral neck, spine, or total hip, and fragility fracture of hip or spine

T-score from −1 down to −2.5 in distal third of radius, femoral neck, spine, or total hip, and FRAX score shows that that 10-year probability of hip fracture is 3% or greater or the 10-year probability of a major osteoporotic fracture is 20% or more

There are different approaches to screening. Some think that it is not necessary to check a DXA in patients who are receiving osteoporosis treatment because women receiving osteoporosis treatment may have reduced fractures, regardless of the impact on BMD. Others recommend continuing to check a DXA during treatment until BMD has stabilized or after 3 to 5 years of bisphosphonate therapy.

There are several pharmacotherapeutic options for osteoporosis treatment. Medications are classified mechanistically as antiresorptive agents that slow bone breakdown or anabolic “bone building” agents.

Antiresorptive medications include intravenous (IV) and oral bisphosphonates; selective estrogen receptor modulators (SERMs), specifically raloxifene and calcitonin nasal spray; and subcutaneous denosumab. Romosozumab-aqqg is a subcutaneously administered monoclonal antibody with anabolic/antiresorptive properties.

Anabolic agents are the subcutaneous parathyroid hormone analogs abaloparatide and teriparatide. Oral bisphosphonates, such as alendronate or risendronate, are generally preferred first-line agents for osteoporosis prevention and treatment in most patients. The choice of osteoporosis medication depends on multiple factors, including cost, osteoporosis fracture risk and severity, route of administration, and tolerability. The 

details the adverse effects (AEs), contraindications, and dosing of osteoporosis medications.

There are specific circumstances for which other osteoporosis medications may be considered.Raloxifene may be an option for women at high risk for breast cancer and in women who cannot tolerate bisphosphonates or denosumab.

 Calcitonin may be an option to reduce acute bone pain associated with vertebral fractures as well.

Patients with severe osteoporosis and very high fracture risk who cannot tolerate or respond poorly to IV and oral bisphosphonates may be candidates for anabolic agents abaloparatide or teriparatide or alternatively romosomuzab.

 Denosumab is an alternative to anabolic agents for high-risk older patients who cannot take or tolerate or respond poorly to bisphosphonates.

AE indicates adverse effect; BMD, bone mineral density; IV, intravenous; PTH, parathyroid hormone; PTHrP, parathyroid hormone-related protein; and SERM, selective estrogen receptor modulator.

Osteoporosis is a common medical condition that increases fracture risk and requires individualized screening and management. Lifestyle management includes adequate vitamin D and calcium intake, increased physical activity, and smoking cessation. Oral bisphosphonates are first line for most patients with osteoporosis. Other agents may be reserved for high-risk patients who are intolerant or poorly responsive to bisphosphonates. Follow-up BMD testing is recommended to monitor response to therapy.

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 is a clinical associate professor at Pace University’s College of Health Professions in New York, New York.

 is a clinical professor at a department chairperson at Pace University’s College of Health Professions.

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Black DM, Rosen CJ. Postmenopausal osteoporosis. 

. 2016;374(3):254-262. doi:10.1056/NEJMcp1513724

 7th ed. Jameson JL, De Groot L, eds. Saunders; Philadelphia, PA: 2016;1184-213.e6.

Allen S, Forney-Gorman A, Homan M, Kearns A, Kramlinger A, Sauer M. Diagnosis and treatment of osteoporosis. Institute for Clinical Systems Improvement. Updated July 2017. Accessed February 11, 2021. 

https://www.icsi.org/wp-content/uploads/2019/01/Osteo.pdf

Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. 

. 2019;104(5):1595-1622. doi:10.1210/jc.2019-00221

Qaseem A, Forciea MA, McLean RM, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. 

 2017;166(11):818-839. doi:10.7326/M15-1361

Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. 

Silverman S, Christiansen C. Individualizing osteoporosis therapy. 

. 2012;23(3):797-809. doi:10.1007/s00198-011-1775-y

Cranney A, Papaioannou A, Zytaruk N, et al. Parathyroid hormone for the treatment of osteoporosis: a systematic review. 

. 2006;175(1):52-59. doi:10.1503/cmaj.050929

Cosman F, Crittenden DB, Adachi JD, et al. Romosozumab treatment in postmenopausal women with osteoporosis. 

 2016;375:1532-1543. doi:10.1056/NEJMoa1607948

Forteo [prescribing information]. Indianapolis, IN; Lilly USA: 2020. Accessed February 18, 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021318s053lbl.pdf

Ringe JD, Doherty JG. Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. 

. 2010;30(7):863-869. doi:10.1007/s00296-009-1311-y

Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. 

 2009;361(8):756-765. doi:10.1056/NEJMoa0809493

Osteoporosis is a common medical condition that increases fracture risk and may require patients to make lifestyle changes.


Osteoporosis Requires Individualized Screening and Management

A recent study from Michigan State University’s (MSU) Sleep and Learning Lab found that a nap during the day will not restore a sleepless night.

“We are interested in understanding cognitive deficits associated with sleep deprivation. In this study, we wanted to know if a short nap during the deprivation period would mitigate these deficits,” said study author Kimberly Fenn, director of MSU’s Sleep and Learning Lab, in a press release. “We found that short naps of 30 or 60 minutes did not show any measurable effects.”

This study was among the first to measure the effectiveness of shorter naps, according to the study authors.

“While short naps didn’t show measurable effects on relieving the effects of sleep deprivation, we found that the amount of slow-wave sleep that participants obtained during the nap was related to reduced impairments associated with sleep deprivation,” Fenn said in the press release.

The deepest and most restorative stage of sleep is known as slow-wave sleep (SWS), which is marked by high amplitude, low frequency brain waves, and is the sleep stage when the body is most relaxed.

“SWS is the most important stage of sleep,” Fenn said in a press release. “When someone goes without sleep for a period of time, even just during the day, they build up a need for sleep; in particular, they build up a need for SWS. When individuals go to sleep each night, they will soon enter into SWS and spend a substantial amount of time in this stage.”

Fenn and her research team recruited 275 college-aged participants for the study who completed cognitive tasks when arriving at MSU’s Sleep and Learning Lab in the evening. They were then randomly assigned into 3 groups: the first group being sent home to sleep, the second staying in the lab overnight and having the option to take either a 30- or 60-minute nap, and the third did not nap at all in the deprivation condition.

The next morning, participants resumed in the lab to repeat the cognitive tasks, which measured attention and placekeeping, or the ability to complete a series of steps in a specific order without skipping or repeating them even after interruption.

“The group that stayed overnight and took short naps still suffered from the effects of sleep deprivation and made significantly more errors on the tasks than their counterparts who went home and obtained a full night of sleep,” Fenn said in a press release. “However, every 10-minute increase in SWS reduced errors after interruptions by about 4%.”

According to Fenn, these numbers are significant when considering the types of errors that are likely to occur in sleep-deprived operators, such as surgeons or police officers, and the 4% decrease in errors could potentially save lives.

“Individuals who obtained more SWS tended to show reduced errors on both tasks. However, they still showed worse performance than the participants who slept,” Fenn said in a press release.

Fenn and her team hope these findings highlight the importance of prioritizing sleep and that naps cannot replace a full night of sleep.

Scrap the nap: study shows short naps do not relieve sleep deprivation. MSU Today. August 12, 2021. Accessed August 17, 2021. 

https://msutoday.msu.edu/news/2021/napping-effectiveness

Study Finds Short Naps Do Not Relieve Sleep Deprivation

Higher levels of dietary vitamin D may help protect patients against developing young-onset colorectal cancer or precancerous colon polyps, according to a study published in 

. The study could potentially lead to recommendations of higher vitamin D intake as a colorectal cancer prevention strategy for adults under 50 years of age.

The overall incidence rate for colorectal cancer has been declining, but cases in younger adults have been increasing without explanation, according to the investigators. They noted that vitamin D intake from food sources—including fish, mushrooms, eggs, and milk—has decreased over the past several decades and there is growing evidence of an association between vitamin D and the risk of colorectal cancer mortality.

“Vitamin D has known activity against colorectal cancer in laboratory studies,” said Kimmie Ng, MD, MPH, director of the Young-Onset Colorectal Cancer Center at Dana-Farber, in a press release. “Because vitamin D deficiency has been steadily increasing over the past few years, we wondered whether this could be contributing to the rising rates of colorectal cancer in young individuals. We found that total vitamin D intake of 300 IU per day or more—roughly equivalent to three 8-oz. glasses of milk—was associated with an approximately 50% lower risk of developing young-onset colorectal cancer.”

The study examined data from 94,205 women participating in the Nurses’ Health Study 2 (NHS 2) and calculated the total vitamin D intake of each participant, both from dietary sources and supplements. Between 1991 and 2015, the investigators documented 111 cases of young-onset colorectal cancer and 3317 colorectal polyps.

Analysis demonstrated an association between higher total vitamin D intake and a significant reduction in the risk of early-onset colorectal cancer. This association was stronger for dietary vitamin D than for vitamin D supplements. According to the investigators, this is either due to chance or unknown factors that have yet to be understood.

“Our results further support that vitamin D may be important in younger adults for health and possibly colorectal cancer prevention,” Ng said in the release. “It is critical to understand the risk factors that are associated with young-onset colorectal cancer so that we can make informed recommendations about diet and lifestyle, as well as identify high risk individuals to target for earlier screening.”

The study did not find an association between vitamin D intake and a decreased risk of colorectal cancer in patients over 50 years of age. The cause for this inconsistency is uncertain and further research with a larger sample of patients will be necessary to determine whether the protective effect of vitamin D is actually stronger in young-onset colorectal cancer, according to the investigators.

Vitamin D may protect against young-onset colorectal cancer [news release]. EurekAlert; August 17, 2021. Accessed August 17, 2021. 

https://www.eurekalert.org/news-releases/925198

The study could potentially lead to recommendations of higher vitamin D intake as a colorectal cancer prevention strategy for adults under 50 years of age.

Higher Dietary Vitamin D Associated With Lower Risk of Young-Onset Colorectal Cancer

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

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

During the discussion, Cuttler addressed how research into the use of cannabis for the treatment of mental health conditions could impact the way treatment of these conditions is approached and understood by health care professionals.

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, discusses how clinical research into the use of cannabis may impact the treatment of mental health conditions.

Impact of Cannabis Research on Treatment of Mental Health Conditions

A 5-minute breathing exercise can lower blood pressure just as well as increased aerobic exercise or pharmaceutical treatments, according to researchers at the University of Colorado (UC) Boulder.

Journal of the American Heart Association,

 provides the strongest evidence yet that high-resistance inspiratory muscle strength training (IMST) could help aging adults lower their blood pressure and prevent cardiovascular disease., according to the authors. The study noted that 65% of American adults over 50 years of age have above-normal blood pressure, yet fewer than 40% meet recommended aerobic exercise guidelines.

“There are a lot of lifestyle strategies we know can help people maintain cardiovascular health as they age. But the reality is, they take a lot of time and effort and can be hard for some people to access,” said lead author Daniel Craighead, PhD, an assistant research professor in the Department of Integrative Physiology at UC Boulder, in a press release. “IMST can be done in 5 minutes in your own home while you watch TV.”

IMST was developed in the 1980s as part of an effort to help strengthen the diaphragms of critically ill patients with respiratory diseases. The exercise involves inhaling vigorously through a hand-held device that provides resistance.

It was initially recommended as a 30-minute-per-day regimen at low resistance, but researchers have been testing whether a more time-efficient protocol could also have benefits for cardiovascular health, cognitive ability, and athletic performance. This shorter protocol involves 30 inhalations per day at high resistance, done 6 days per week.

For their study, researchers recruited 36 otherwise healthy adults between 50 and 79 years of age with above normal systolic blood pressure. Half of these patients did high-resistance IMST for 6 weeks, whereas the other half did a placebo protocol in which the resistance was much lower.

After 6 weeks, researchers found that the high-resistance group saw an average 9-point decrease in systolic blood pressure. This reduction generally exceeds reductions achieved by walking 30 minutes a day, 5 days per week and is equal to the effects of some medications used to lower blood pressure, according to the study authors. Even 6 weeks after they stopped doing IMST, this group maintained most of that improvement.

“We found [that] not only is it more time-efficient than traditional exercise programs, but the benefits may be longer lasting,” Craighead said in the press release.

The treatment group also saw a 45% improvement in vascular endothelial function and a significant increase in levels of nitric oxide, which is key to the dilation of arteries and the prevention of plaque buildup. Nitric oxide levels naturally decline with age, according to the study.

Furthermore, the research team noted that inflammation and oxidative stress markers were significantly lower in the group that did IMST for 6 weeks, suggesting a lower risk of heart attacks. They also found that those in the IMST group completed 95% of the sessions, which is a significantly higher adherence level than physical exercise.

“We have identified a novel form of therapy that lowers blood pressure without giving people pharmacological compounds and with much higher adherence than aerobic exercise,” said senior author Doug Seals, PhD, a distinguished professor of integrative physiology at UC Boulder, in the press release. “That’s noteworthy.”

The practice may be especially beneficial for postmenopausal women, according to the study. Earlier research found that postmenopausal women who are not taking supplemental estrogen do not reap as many benefits from aerobic exercise programs as men when analyzing vascular endothelial function. The new study, however, found that IMST improved it just as much in women as in men.

“If aerobic exercise won’t improve this key measure of cardiovascular health for postmenopausal women, they need another lifestyle intervention that will,” Craighead said in the press release. “This could be it.”

5-minute breathing workout lowers blood pressure as much as exercise, drugs. News release. UC Boulder; June 29, 2021. Accessed August 11, 2021. 

https://www.colorado.edu/today/2021/06/29/5-minute-breathing-workout-lowers-blood-pressure-much-exercise-drugs

The practice may be especially beneficial for postmenopausal women, who do not reap as many benefits from aerobic exercise programs as men in analyses of vascular endothelial function.

Study: Breathing Exercise Lowers Blood Pressure As Well As Exercise, Medications

A vitamin K-rich diet is associated with a reduced risk of atherosclerosis-related cardiovascular disease—conditions that effect the heart or blood vessels—of up to 34%, according to a study published in the 

Journal of the American Heart Association

. The investigators examined data from more than 50,000 individuals participating in the Danish Diet, Cancer, and Health study over a 23-year period.

“Current dietary guidelines for the consumption of vitamin K are generally only based on the amount of vitamin K1 a person should consume to ensure that their blood can coagulate,” said Nicola Bondonno, PhD, in a press release. “However, there is growing evidence that intakes of vitamin K above the current guidelines can afford further protection against the development of other diseases, such as atherosclerosis. Although more research is needed to fully understand the process, we believe that vitamin K works by protecting against the calcium build-up in the major arteries of the body leading to vascular calcification.”

There are 2 types of dietary vitamin K: vitamin K1, which is found primarily in green leafy vegetables and vegetable oils, and vitamin K2, which is found in meat, eggs, and fermented foods. According to the investigators, participants with the highest intakes of vitamin K1 had a 21% lower likelihood of being hospitalized with cardiovascular disease related to atherosclerosis.

Vitamin K2 was associated with a 14% reduction in risk. This lower risk was observed across all types of cardiovascular disease related to atherosclerosis, with the highest response being from peripheral artery disease at 34%.

“Cardiovascular disease remains a leading cause of death in Australia and there’s still a limited understanding of the importance of different vitamins found in food and their effect on heart attacks, strokes and peripheral artery disease,” said Dr. Jamie Bellinge in the release. “These findings shed light on the potentially important effect that vitamin K has on the killer disease and reinforces the importance of a healthy diet in preventing it.”

According to the study authors, although there are comprehensive databases on vitamin K1 content in foods, there is much less data currently available on vitamin K2 content. Further, there are 10 forms of vitamin K2 commonly found in dietary sources, and each may act and be absorbed differently by the body.

“The next phase of the research will involve developing and improving databases on the vitamin K2 content of foods,” Bondonno said in the release. “More research into the different dietary sources and effects of different types of vitamin K2 is a priority.”

Growing evidence of vitamin K benefits for heart health [news release]. EurekAlert; August 8, 2021. Accessed August 10, 2021. 

https://www.eurekalert.org/news-releases/924783

The investigators examined data from more than 50,000 individuals participating in the Danish Diet, Cancer, and Health study over a 23-year period.

Diet High in Vitamin K Associated With Lower Cardiovascular Health Risks

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

In this discussion, Hall explains her hopes for the future in relation to how the medical community approaches and responds to the occurrence of CDT in pediatric populations.

Bethany Hall, MSN, owner of Healing Connection, discusses her hopes for the future of treatment and care for children suffering from complex developmental trauma.

Expert: The Future of Treatment, Care for Children Suffering From Complex Developmental Trauma

New research points to 4 reasons that clean environments and hygiene may not negatively impact childhood immunity against allergic diseases, according to investigators at University College London.

The “hygiene hypothesis” has been popular for many years and theorizes that early childhood exposure to some microorganisms help provide protection against allergic diseases by strengthening the immune system. However, the researchers said there is a related view that suggests that modern society is too hygienic, meaning young children are less likely to be exposed to these microorganisms.

“Exposure to microorganisms in early life is essential for the ‘education’ of the immune and metabolic systems,” said lead author Graham Rook, MD, BA, MB, in a press release. “Organisms that populate our guts, skin, and airways also play an important role in maintaining our health right into old age. So, throughout life we need exposure to these beneficial microorganisms, derived mostly from our mothers, other family members, and the natural environment.”

Researchers aimed to reconcile the conflict between necessary cleanliness and exposure to microorganisms for the immune system. According to the press release, they identified 4 factors that suggest cleanliness and immune system development are not mutually exclusive.

Firstly, the authors found that the microorganisms in a modern home are typically not the ones needed for immunity. They added that vaccines significantly help to develop the immune system in addition to providing protection from infections, so exposure to pathogens is less necessary than it would be without vaccines.

Research has also confirmed that the microorganisms found in natural outdoor environments are vital for immune health, so cleaning indoor spaces and personal hygiene have no impact on exposure to natural microorganisms.

Finally, more recent research has found that links between home cleaning and allergies are often not caused by the removal of organisms, but rather by exposure of the lungs to cleaning products. The chemicals in many cleaning products cause lung damage, which encourages the development of allergic responses, according to the study authors.

“So cleaning the home is good and personal cleanliness is good, but, as explained in some detail in the paper, to prevent spread of infection it needs to be targeted to hands and surfaces most often involved in infection transmission,” Rook said in the press release. “By targeting our cleaning practices, we also limit direct exposure of children to cleaning agents.”

Rook concluded that exposure to family members, outdoor environments, and vaccines provide all of the necessary microorganism exposure for childhood immune system development. Exposures such as these are not in conflict with hygiene and cleaning practices.

Being clean and hygienic need not impair childhood immunity. News release. University College London; July 5, 2021. Accessed August 5, 2021. 

https://www.ucl.ac.uk/news/2021/jul/being-clean-and-hygienic-need-not-impair-childhood-immunity

Researchers seek to reconcile the conflict between necessary cleanliness and exposure to microorganisms for the immune system.

Research Suggests Cleanliness Does Not Negatively Impact Childhood Immunity

Health care professionals regularly have to judge whether they can cure patients of a medical condition or manage the condition to enable them to live the best life they can. Many pharmaceutical interventions and treatment options are designed to manage people’s illnesses, however, they are not necessarily a cure.

There are many medical conditions that have been difficult to cure from a historical perspective, from diabetes to high blood pressure, for which a maintenance approach to treatment has been the only option. However, this is expensive and challenging, both in terms of medicine and clinical resources.

Curing a condition is better than management, because managing these conditions can result in an increased burden on the health care system. This is particularly applicable as people live longer and the proportion of illnesses that are manageable increase versus those that are curable.

New interdisciplinary approaches to treatment include rebalancing the scales and exploring non-pharmaceutical interventions, such as dietary changes, exercise, and medical devices, to work alongside or instead of traditional care management techniques.

An example of this would be in the treatment process for leg ulcers. According to the Wound Healing Society, 15% of older adults in the United States suffer from chronic wounds, including predominantly venous stasis ulcers, pressure ulcers, and diabetic foot ulcers.

Every year, up to 3 million more Americans are diagnosed with various types of chronic wounds, with the annual cost of treating venous ulcers alone to the US health care system estimated to be $2.5 to $3.5 billion, which highlights the sheer scale of the growing problem.

These wounds often take months of traditional treatment to heal, and for health care professionals, managing the condition and its symptoms is a huge therapeutic challenge. It may require regular visits from health care professionals, which is expensive and time consuming. As the incidence of ulceration rises due to the aging population, and increased risk factors such as smoking and diabetes, so does the cost of intervention.

New medical technology devices offer an alternative because many of these devices can not only maintain people’s wellbeing, but provide a permanent treatment to chronic medical conditions. This new breed of technology has the potential to deliver better patient outcomes at a lower cost.

Technology has been one of the most significant disruptors to society. From Amazon in retail to new competitors banks in financial services, technology-first businesses are aiming to achieve both cost reduction and improved efficiencies.

In health care systems, technology is increasingly being seen as the key to reducing financial pressure while enhancing patient outcomes simultaneously. Implementing new medical devices into health care systems is challenging, because it requires time, money, clinical data, regulatory approval, and support from clinicians within the system.

Using the example of leg ulcers, clinical data now demonstrates that by increasing blood circulation to wound surfaces to enhance oxygen and nutrient delivery,

 ulcers can be cured rather than simply managed, with wounds closing in a matter of weeks as opposed to months or not at all.

Managing the care of patients with these types of conditions is always complex, but after receiving regulatory approval from the FDA, bioelectronic medical devices that increase blood flow in the lower limbs are now being deployed by forward-thinking clinicians to treat patients with the condition.

 This has dramatically reduced the financial and staffing impact on the health care system while achieving improved results for the patients.

Instead of requiring nurses to attend people’s homes 3 times a week to assess and redress ulcers, connected devices have the potential to monitor patients remotely and provide feedback data to health care providers enabling them to manage treatment plans and focus resource where it is most needed.

The current challenge is reshaping how health care systems reward positive outcomes to allow new solutions to continue to be adopted effectively, which rewards innovation and risk without reducing the impact of what already exists.

The US health care system presents a unique landscape because the process of paying for health care products or services is managed by either private commercial health insurers or public government payers. Traditionally, health care providers operate a fee-for-service model, which means they are paid separately for each service they provide regardless of whether that service leads to a positive and lasting outcome. For patients suffering with chronic conditions that require long-term care, specifically in wound care, this can result in expensive medical bills over a long period of time.

The US government has already legislated for change, which has led to the Centers for Medicare and Medicaid Services starting an episode-based approach to treatment and payment. With episode-based payments, the cost for a patient’s care related to any single medical issue is predetermined versus having to pay separately for each service and provider.

Based on the projected costs, a single amount is issued to all health care providers and institutions working on the same case. This will include physicians, hospitals, nurses, medical equipment providers, and post-acute care operators. The more effectively health care providers control expenses and stay within the budgeted amount, the better they share in the savings generated.

This approach means it is in the interests of both the patient and the provider to adopt the best possible treatment plan using the most effective medical technologies in the attempt to cure the patient’s condition.

Medical technology is uniquely placed to help facilitate positive change in health care, especially in the United States. Instead of trying to ensure the adoption of new innovations within the confines of the previous system, the health care system is actively fostering adoption of new, innovative solutions.

The hope is that this important shift will not only enable more investment in the development of new medical technologies, but will help decrease the pressure on the entire health care operation, creating a brighter, more effective, and affordable system for all.

Jones NJ & Harding KG et al, Neuromuscular electrostimulation on lower limb wounds. British Journal of Nursing VOL. 27, No. 20. Published Online: 12 Nov 2018. 

https://doi.org/10.12968/bjon.2018.27.Sup20.S16

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