, 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

A new study has found that having easier access to primary care physicians may increase high blood pressure awareness and control regardless of where a person lives, according to the authors of a study published in 

Circulation: Cardiovascular Quality and Outcomes

In the study, the authors noted that health care professionals at community clinics and primary care practices specifically can help expand awareness and detection of high blood pressure by providing affordable treatment and management.

“Access to primary care is the key to hypertension management, however, many Americans have limited access to primary care where they live. This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals,” said senior study author Brisa Aschebrook-Kilfoy, PhD, an associate professor of public health sciences at the University of Chicago in Illinois, in a press release.

The study analyzed neighborhood socioeconomic status using the Area Deprivation Index (ADI) created by the Health Resources & Services Administration over 3 decades ago. This system allows for rankings of neighborhoods by socioeconomic status in a region and can be valuable to inform health care delivery and policy, especially for populations living in the most disadvantaged neighborhoods.

“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care professionals in diverse racial and ethnic neighborhoods would not reduce health disparities and improve public health. To our knowledge, there is little research to support or rebut this argument,” first study author Jiajun Luo, PhD, a post-doctoral fellow at the University of Chicago’s Institute for Population and Precision Health, said in a press release. “We conducted this study to examine whether accessibility of primary care is associated with better hypertension control and awareness across various socioeconomic and neighborhood factors.”

The study focused on Chicago, which saw a 30-year gap in life expectancy that was observed between people who live in southern neighborhoods in Chicago versus northern neighborhoods, the latter of which is more affluent compared to the former. The researchers looked specifically to assess whether the socioeconomic differences impacted the higher rates of high blood pressure, heart disease, and stroke in the southern neighborhoods of the city.

Health data was analyzed for more than 5000 predominantly African American adults who participated in the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) between 2013 to 2019, which is an initiative that explores the health of Chicagoans, primarily who are in communities in the south of the city. When the researchers did their analysis, they considered annual income, BMI, ADI, the effect of distance to primary care, and spatial accessibility during their investigation.

Approximately 80% of the COMPASS participants had previously experienced hypertension, using the standard American Heart Association guideline-based blood pressure criteria of measures ≥130 mm Hg systolic (top number) or ≥80 mm Hg diastolic (bottom number).

Approximately 38% of those with hypertension did not have their blood pressure under control, whereas 41% were not aware they had high blood pressure.

Spatial accessibility scores ranged from 16.4 (lower access to primary care) to 86.6 (higher access) per 100,000 residents.

Adults living in areas with the fewest primary health care professionals had 37% increased odds of having hypertension in comparison to the adults living in neighborhoods with the most primary care physicians.

The listed associations existed in both poor and wealthy neighborhoods, which the researchers suggest that residents in all neighborhoods may benefit from increasing the number of primary care professionals.

When clarified by neighborhood type (advantaged or disadvantaged), accessibility to primary care was not associated with use of anti-hypertension medications among those who reported they had hypertension prior to enrolling in the study.

“Based on these findings, we need to encourage primary care physicians to expand access to people who live in underserved communities with the fewest primary care professionals,” Aschebrook-Kilfoy said in the press release. “Mobile health units may be one approach to increase primary care service in underserved areas by eliminating the challenge of getting transportation to and from an office visit. The use of anti-hypertension medications also needs to be studied and addressed, especially as it was not linked to primary care accessibility in this study.”

High blood pressure awareness, control improved with better access to primary health care. American Heart Association. September 6, 2022. Accessed September 9, 2022. 

https://newsroom.heart.org/news/high-blood-pressure-awareness-control-improved-with-better-access-to-primary-health-care

The authors noted that health care professionals at community clinics and primary care practices specifically can help expand awareness and detection of high blood pressure by providing affordable treatment and management.

Study: Better Primary Health Care Access Leads to Improved Control of High Blood Pressure

Hallucinogen and marijuana use by adults aged 19 to 30 years increased significantly in 2021 compared with 5 and 10 years ago, reaching historic highs in the age group since 1988, according to the results of the Monitoring the Future panel study.

“As the drug landscape shifts over time, [these] data [provide a window into the substances and patterns of use favored by young adults. We need to know more about how young adults are using drugs, like marijuana and hallucinogens, and the health effects that result from consuming different potencies and forms of these substances,” Nora Volkow, MD, director of the National Institute on Drug Abuse, said in a statement.

“Understanding how substance use can impact the formative choices in young adulthood is critical to help position the new generations for success,” she said.

For hallucinogen use, investigators found that use in the past year had been relatively stable until 2020 when reports dramatically increased. In 2021, approximately 8% of young adults reported past-year hallucinogen use, which was an all-time high since 1998. In 2016, just 5% reported hallucinogen use, and in 2011, just 3% reported use.

Types of hallucinogens included LSD, MDMA, mescaline, peyote, psilocybin, and PCP.

MDMA was the only hallucinogen for which use significantly decreased within 1 year, as well as the past 5 years, to 3% in 2021 from 5% in both 2016 and 2020.

For marijuana use, the past-year, past-month, and daily use, defined as use on 20 or more occasions in the past 30 days, reached the highest levels ever recorded since first monitored in 1988. The proportion of adults who reported that past-year marijuana use reached 43% in 2021, increasing from 34% 5 years ago and 29% 10 years ago.

Daily use also increased during this time, at 11% of young adults in 2021 compared with 8% 5 years ago and 6% 10 years ago.

Additionally, rates of past-month nicotine vaping, which have been increasing among young adults for the past 4 years, continued the upward trend in 2021, despite leveling off in 2020.

The continued increase in 2021 reflects a long-term upward trend at 16% compared with 6% in 2017, when it was first recorded.

Past-month marijuana vaping, which decreased in 2020, rebounded to pre-pandemic levels in 2021.

These levels were first recorded in 2017 and reached 6% but doubled to 12% in 2021.

Alcohol remains the most frequently used substance among adults, though in past-year, past-month, and daily use have all decreased over the past decade, the study results showed.

Investigators found that binge drinking, defined as 5 or more drinks in a row in the past 2 weeks, rebounded in 2021 from a historic low in 2020 during the early stages of the COVID-19 pandemic to 32% compared with 28% in 2020 and 32% in 2019.

However, high-intensity drinking, defined as 10 or more drinks in a row in the past 2 weeks, has been steadily increasing over the past decade, where it reached the highest level ever recorded in 2021 of 13% compared with 11% when first recorded in 2005.

Past-month, past-year, and daily alcohol use have been declining for the past 10 years. In 2021, 66% of young adults reported alcohol use in the past 30 days, decreasing from 70% in 2016 and 69% in 2011.

The study also showed significant decreases in past-month cigarette use as well as non-medical use of opioid medications in the past year compared with a decade earlier.

The Monitoring the Future study has surveyed substance use behaviors and attitudes among a nationally representative sample of teens annually A panel study component conducts follow-up surveys on a subset of these individuals to track their drug use behaviors across 3 primary time periods: lifetime, past month, and past years.

The study was conducted by investigators at the Institute for Social Research at the University of Michigan Ann Arbor.

Data from the 2021 survey were collected online between April 2021 and October 2021.

The panel study also includes drugs use reported by adults aged 35 to 50 years old, college/non-college young adults, and various demographic subgroups.

Marijuana and hallucinogen use among young adults reached all time-high in 2021. News release. Science Daily. August 22, 2022. Accessed August 29, 2022. https://www.sciencedaily.com/releases/2022/08/220822130344.htm

Past-month vaping levels rebounded after early COVID-19 pandemic drop, analysis results indicate.

Study: Hallucinogen, Marijuana Use Among Young Adults Hits Record in 2021

A new analysis to examine and compare the effectiveness of the previously identified DAAs in PTSD symptom improvement has led to a potential new medication for PTSD in patients without hepatitis C virus infection.

Previous studies have shown that 6% of Americans will develop PTSD in their lifetime, which can disrupt lives and lead to or worsen existing health issues, like depression, anxiety, eating disorders, and suicidal thoughts.

The FDA has only approved of 2 medications to treat PTSD- sertraline and paroxetine, and both have shown limited effectiveness in reducing PTSD symptoms.

The new study revealed that the medication combination glecaprevir and pibrentasvir had the strongest connection with PTSD symptom improvement among the DAAs most prescribed in the VA.

“Many people have PTSD, but there few effective pharmacologic treatments and limited drug development for PTSD,” said co-principal investigator and study senior author Jaimie Gradus, associate professor of epidemiology, in a press release. “Existing effective treatments are mostly psychotherapy, and while they work well, there are also issues with them, including a lot of treatment drop-out and they’re time-intensive, so adding to the suite of treatment options for people is a high priority.”

The researchers also examined the same national cohort of VA patients as the prior study, but narrowed the group to include only patients who were diagnosed with hepatitis C.

“There really has been a lot of interest in finding new medications for PTSD in the field,” said co-principal investigator Brian Shiner, a psychiatrist and acting associate chief of staff for research at the White River Junction VA Medical Center, as well as associate professor of psychiatry at Dartmouth University’s Geisel School of Medicine, in a press release. “The idea to look at VA data in this way grew out of a conversation in the scientific literature between the VA PTSD Psychopharmacology Working Group and the National Institutes of Mental Health. Paula Schnurr from the National Center for PTSD connected Jaimie and I, and we were really fortunate to obtain funding to bring a team together to do this work.”

The team analyzed 254 VA patients who were diagnosed with PTSD and hepatitis C between October 1999 and September 2019. Each participant received 1 combination of FDA-approved hepatitis C medications, like glecaprevir and pibrentasvir (GLE/PIB), ledipasvir and sofosbuvir (LDV/SOF), and sofosbuvir and velpatasvir (SOF/VEL). The research team then monitored the patients’ symptoms for both PTSD and HCV between 2 clinical visits over 8 to 12 weeks.

After adjusting for variables that could potentially influence results, like opioid prescription use, liver disease diagnoses, emergency department care for psychiatric crises, the researchers found that the GLE/PIB medications were more strongly associated with PTSD symptom improvement that the LDV/SOF and SOF/VEL treatments, consistent with previous results.

“At BUSPH, we have been working with our VA colleagues to look at PTSD symptom improvement in routine care using medical records for several years,” Gradus said in a press release. “The level of improvement we see for GLE/PIB is impressive and over twice what we have seen for paroxetine and sertraline. I think we have done the best we can with medical records data, an important next step in this line of work will be a prospective placebo-controlled study in patients without hepatitis C virus infection.”

Shiner added that they recently received funding from the Department of Defense to study GLE/PIB as a potential treatment for PTSD in a prospective randomized placebo-controlled trial and will serve as principal investigator. “It will be several years until we see the results, but this is a very exciting case where we used VA patient data to identify a potential treatment for PTSD, which is a very important problem for veterans’ health. In this way, veterans have informed PTSD treatment development,” Shiner said in a press release.

Hepatitis C drugs may reduce PTSD symptoms. BU School of Public Health. August 22, 2022. Accessed August 29, 2022. 

https://www.bu.edu/sph/news/articles/2022/hepatitis-c-drugs-may-reduce-ptsd-symptoms/

Study: Hepatitis C Drugs May Reduce PTSD Symptoms

Data show neurofeedback therapy may improve symptoms of “chemo brain” in patients with cancer by returning abnormal brain waves to normal frequency, according to researchers who conducted a pilot study at University of California Los Angeles (UCLA). The study is one of the first to use neurofeedback, also known as electroencephalogram (EEG) biofeedback, to improve cognitive function in patients post-chemotherapy.

"The history of neurofeedback shows that it's helpful for a whole range of disorders and symptoms. This study was an opportunity for seeing whether neurofeedback is something that could be helpful with chemo brain," said study lead Stephen Sideroff, a professor at UCLA's Department of Psychiatry & Biobehavioral Sciences, in a press release.

Chemo brain is a term for some common neurological symptoms that occur after chemotherapy treatment, which can include memory, organization, and concentration problems. The symptom of chemo brain has also been found to cause troubled sleep and emotional distress in some patients.

Neurofeedback involves training the brain waves to operate at optimal frequency patterns. In past studies, it has been shown to remediate cognitive impairments such as attention-deficit/hyperactivity disorder, stroke, seizures, and even improve the brain activity of substance use patients.

For this study, Sideroff and UCLA colleagues David Wellisch and Valerie Yarem looked at 9 female patients with breast cancer between the ages of 21 and 65 years. All participants went through chemotherapy at least 1 year prior and complained of debilitating chemo brain symptoms, such as poor concentration, memory, organization, and confusion. Among patients included in the clinical trial, no patients currently had breast cancer, a present/recent major depressive disorder diagnosis, other mental illness, or took cognitive-altering medications.

During the trial, participants were administered pre-training neurocognitive and psychological tests, along with a quantitative EEG to measure brain wave frequency—the pre-training EEG showed that participants had abnormal brain wave activity compared to a healthy adult brain.

The test consisted of putting a sensor on the scalp and earlobes to monitor brain wave frequency. The participant saw their brain frequency in the form of a bar graph and were tasked with turning the bars green by manipulating their brain wave frequencies. They received 18 neurofeedback sessions, each 30-minutes long and administered during a 6-week period.

After the sessions, 7 of the 9 participants had completely normalized brain wave frequencies on their EEG. Every participant exhibited improved everyday functioning. The researchers also found improved psychological wellbeing among every participant.

Participants’ information processing, executive set shifting, and sustained visual attention significantly improved, according to the neurocognitive testing that followed the neurofeedback sessions.

Shortfalls of this study include a small sample size and no control group. Additionally, most participants took 7 to 9 weeks to complete the neurofeedback sessions, which is considered long when compared to prior studies evaluating the efficacy of neurofeedback therapy.

However, the study authors noted they do believe the strong study results support the pursuit of further research on neurofeedback and effectively addressing chemo brain, which may ultimately extend into finding the ideal protocols around length of time for these neurofeedback sessions.

"Our results are more impressive given we were not able to have subjects stick to the schedule," Sideroff said in the press release.

University of California – Los Angeles Health Sciences. Neurofeedback shows promise for addressing 'chemo brain'. Science Daily. August 25, 2022. Accessed on August 29, 2022. https://www.sciencedaily.com/releases/2022/08/220825120413.htm

Research looking at neurofeedback and “chemo brain” found that most patients had normal brain function after 18 weeks of neurofeedback therapy, significantly improving patient symptoms.

Groundbreaking Pilot Study Suggests Neurofeedback Can Treat ‘Chemo Brain’ 

Investigators at Tel Aviv University in Israel have developed a method of musical tests and a portable instrument for measuring brain activity that detects cognitive decline in older individuals.

The method is based on a measurement of 15 minutes of electrical activity in the brain while performing simple tasks, according to the investigators.

They added that this could be easily implemented by staff in any clinic without requiring special training, they said.

“Our method enables routine monitoring and early detection of cognitive decline in order to provide treatment and prevent rapid, severe deterioration. Prophylactic tests of this kind are commonly accepted for a variety of physiological problems such as diabetes, high blood pressure or breast cancer,” investigators said in a statement.

“However, to date no method has yet been developed to enable routine, accessible monitoring of the brain for cognitive issues,” they said.

The investigators developed the method by combining a portable device for the measurement and analysis of electroencephalography (EEG), which was developed by Neurosteer, and a short musical test of about 12 to 15 minutes, which was developed by Neta Maimon, PhD, from Neurosteer.

As part of the test, the individual is connected to the portable EEG device with an adhesive band with 3 electrodes attached to the forehead. The individual performs a series of musical-cognitive tasks according to the audible instructions given through earphones.

The tasks include short melodies played by various instruments where the individual is instructed to perform various tasks with varying difficulty. One task includes the individual pressing a button each time any melody is playing, while another is pressing it when a violin plays.

Additionally, the test has several minutes of musically guided meditation to bring the brain into a resting state, which can indicate cerebral functioning in various situations.

Music influences different centers in the brain by being a quick mood stimulant, particularly related to positive emotions, Maimon said.

Music can also be cognitively challenging, activating the frontal part of the brain.

By combining these capabilities, the cognitive tests can be complex but are still easy to perform, she said.

In the study, investigators included 50 elderly individuals who were hospitalized at Dorot-Netanya Geriatric Medical Center and scored 18 to 30 on the mini-mental test, which is a standard test to evaluate cognitive condition as part of the intake process. A higher score shows normal cognition.

The individuals performed the musical-cognitive tasks, and the EEG devices measured the electrical activity in the brain. Investigators analyzed the results using machine learning technology.

The investigators found that the mathematical indices could be correlated with the mini-mental test scores, which showed that the investigators discovered new brain markers that could stand alone as indices of an individual’s cognitive status.

“We have actually succeeded in illustrating that music is indeed an effective tool for measuring brain activity. The brain activity and response times to tasks correlated to the [individuals’] cerebral conditions, correlating to the mini-mental score assigned to them,” Maimon said.

“More importantly, all those who underwent the experiment reported that, on the one hand, it challenged the brain, but on the other it was very pleasant to perform,” she said.

Musical tests can detect mental deterioration in old age. News release. Science Daily. August 17, 2022. Accessed August 23, 2022. https://www.sciencedaily.com/releases/2022/08/220817104010.htm

The method is based on a measurement of 15 minutes of electrical activity in the brain while performing simple tasks.

Musical Tests Detect Mental Deterioration in Older Individuals

A new study led by University of California San Francisco (UCSF) showed that screening for depression at the primary care level could dramatically increase the likelihood of treatment for those who are traditionally undertreated, such as among racial and ethnic minority individuals, older adults, those with limited English proficiency, and men.

Depression tends to go unrecognized in more than half of patients presenting with symptoms in primary care, although data show that an approximate 60% of patients receive their depression care from the primary care setting.

Over a period of 2 years, the electronic health data of 52,944 adult patients seen at 6 UCSF primary care facilities was tracked by researchers. It was reported that after a routine screening policy was implemented, depression screening rates more than doubled, from 40.5% in 2017 to 88.8% in 2019.

In 2018, the research team found that for every 100 patients between the ages of 18 and 30 years screened for depression, 75 patients aged 75 years and older were likely to be screened for depression. Further, for every 100 English-speaking White patients screened for depression, there were 59 non-English-speaking patients likely to be screened for depression.

However, statistically significant disparities seemed to virtually disappear among older patients, African Americans, other English-speaking patients, and patients with language barriers by 2019. Screening for men remained relatively low, and for every 100 women screened for depression, 87 men were likely to be screened for depression.

“Our study is the largest since 2016, when the US Preventive Services Task Force recommended that adult patients be screened for depression, and the first to investigate patient predictors of screening,” said first study author Maria E. Garcia, MD, MPH, MAS, assistant professor in the UCSF Division of General Internal Medicine and the Department of Epidemiology and Biostatistics, in a press release. “Because depression impacts so many other chronic diseases, implementation of routine depression screening could also improve patient outcomes for complications from other conditions.”

The data showed that the average age of the patients was 49 years. Additionally, 59% of the patients were female, 43% English-speaking and White, 25% English-speaking and Asian, 9% Latino, 7% Black, 1.4% Pacific Islander, 0.3% American Indian/Alaskan Native, and 5.5% were patients with language barriers. There was missing or unknown data for race and ethnicity for 9% of the English-speaking patients.

“Our study shows that a systems-based approach can increase depression screening and address screening disparities,” senior author Leah S. Karliner, MD, professor in the UCSF Division of General Internal Medicine, said in the press release.

The study authors noted that several factors contributed to achieving high, more equitable screening rates. During the study, depression screening was a priority as part of a larger focus on quality improvement metrics across safety net systems in California tied to state funds. In addition, the health care system created a task force with representation from all primary care practices focused on detecting screening disparities in clinical settings.

“Depression screening is necessary, but not sufficient, to decrease care disparities,” Garcia said in the press release. “Screening may help with poor physician recognition of depressive symptoms, but it must be followed by clinical action.

According to Garcia, future investigations will be focused on whether screening is associated with increases in depression diagnosis, treatment, follow-up, and remission.

Routine Depression Screening May Capture Underdiagnosed Patient Populations. UCSF. August 18, 2022. Accessed August 23, 2022. 

https://www.ucsf.edu/news/2022/08/423496/routine-depression-screening-may-capture-underdiagnosed-patient-populations

Study Finds Routine Depression Screening May Address Underdiagnosed Patient Populations

A flexible e-learning program may help to improve nurses’ knowledge and skills for better neonatal pain management after 4 weeks, according to investigators conducting research on the subject at Hiroshima University. However, the team of investigators was not able to conclude whether an e-learning program is superior to other training methods.

"Continuing education is essential to maintain and increase nurses' proficiency in neonatal pain assessment and treatment," said study lead Mio Ozawa, associate professor in the Graduate School of Biomedical and Health Science at Hiroshima University, in a press release.

Only recently did investigators discover that neonates, or newborns, experience pain like adults and children. However, they cannot express their level pain by pointing to a happy or sad face or using a numerical scale.

Ozawa explained that research has demonstrated that nurses are not currently trained in neonatal pain management, yet newborn intensive care unit (NICU) nurses have been shown to stay at the bedside of newborns for longer than other health care professionals to provide care.

This study was inspired by a previous one that analyzed the results of the e-learning program among 52 nurses. While their test scores generally improved during the training, there was no control group to show if the program was effective.

To expand beyond the limits of the first trial, this randomized control trial investigated the effects of e-learning for certified nurses to improve skills in newborn pain management across NICUs nationwide. Conducted in Japan, researchers performed the study by randomly dividing certified NICU nurses into 2 groups. One group participated in the e-Pain Management of Neonates program, which included 4 weeks of online training in pain measurement for pre-term newborns. During the 4 week program, the training consisted of 4 modules, each about 15 minutes long, which could be done any time, or any place. The other group received no training.

Before the first group began training, both groups took a pre-test. The researchers found that participants in both groups did not differ in knowledge or skills on neonatal pain management during the pre-test. After 4 weeks, both groups completed a post-test. The results of this final test showed that the group in the e-Learning 4-week program scored higher in both factors.

A new e-learning program could enable nurses to better evaluate and manage pain in neonates, according to investigators at Hiroshima University.

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All Content

Study: Better Primary Health Care Access Leads to Improved Control of High Blood Pressure

Study: Hallucinogen, Marijuana Use Among Young Adults Hits Record in 2021

Study: Hepatitis C Drugs May Reduce PTSD Symptoms

Groundbreaking Pilot Study Suggests Neurofeedback Can Treat ‘Chemo Brain’

Musical Tests Detect Mental Deterioration in Older Individuals

Study Finds Routine Depression Screening May Address Underdiagnosed Patient Populations

Study: E-learning Program for Nurses Could Improve Infant Pain Management

Study: Academic Stress Hits Female, Nonbinary, or College Sophomore Students Hardest

Study: COVID-19 Pandemic Disproportionately Impacted the Mental Health of Minority Populations

Study: Targeting Impulsivity Early in Adolescence Could Prevent Later Behavioral Disorders