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

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

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

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

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

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

Feeling supplies of personal protective equipment were insufficient

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

Inadequate staffing for safe patient care

Having a lower degree of psychological safety

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

Feeling the organization does not understand emotional support needs

Believing staff were being redeployed to areas of critical need

Having a higher degree of psychological safety

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

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

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

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

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

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

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

Articles

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

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

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

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

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

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

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

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

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

Videos

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Survey Finds 45% of Americans Already Sunburnt This Year

Being an expert on immunization and cognizant on social determinants of health for communities and patients as a whole are some of the important keys to being a successful nurse practitioner, according to Rachel C. Vandemark, MHA, BSN in an interview with 

Vandemark is a Doctor of Nursing Practice (DNP) student in the Pediatric Nurse Practitioner Primary Care Track at the University of Washington School of Nursing (Class of 2022) with experience in pre-hospital care as well as hospital safety and quality. A mother of 3 children, Vandemark was prepared to take on whatever the School of Nursing’s courses threw at her, even a worldwide pandemic.

Based in Seattle and close to the city of Kirkland, Washington, where the first major COVID-19 outbreak took place, gave her a true firsthand experience of where the pandemic was headed.

“There was a really rapid shift from 100% in-person to 100% online classes, and I saw my DNP classmates provide care to COVID-19 patients while trying to take care of young children at home, and even sharing Wi-Fi with others just to get things done,” Vandemark said.

This experience reminded her about how people’s home lives and lived experiences are not always visible to health care providers, but they are extremely essential to the health care system.

“We need experts on immunizations and such, but we also need to be advocates for systems and policies that optimize health for everyone,” Vandemark said.

As for other nurse practitioners who are about to enter the field, Vandemark highly emphasized being flexible as things begin to unfold, whether it is a pandemic or a change in direction in health care. Additionally, continuing to promote good public health always helps, such as helping with the immunization movement and practicing safe health care policies.

In an interview with Contemporary Clinic, Rachel C. Vandemark, MHA, BSN, spoke about her experience in nursing during the COVID-19 pandemic.

Flexibility, Grit, Gratitude Are Key to Being Great Nurse Practitioner

An analysis of randomized placebo-controlled trials suggests that the use of herbal and dietary supplements for weight loss cannot be justified based on the available evidence. Presented at the European Congress on Obesity, the analysis includes data from 121 trials with nearly 10,000 adult participants.

The findings indicate that although some herbal and dietary supplements show statistically greater weight loss than placebo, it is not enough to benefit health, according to the study authors. Further, the investigators call for more research into their long-term safety of these supplements.

“Over-the-counter herbal and dietary supplements promoted for weight loss are increasingly popular, but unlike pharmaceutical drugs, clinical evidence for their safety and effectiveness is not required before they hit the market”, said dietitian Erica Bessell, PhD candidate at the University of Sydney, in a press release. “Our rigorous assessment of the best available evidence finds that there is insufficient evidence to recommend these supplements for weight loss. Even though most supplements appear safe for short term consumption, they are not going to provide weight loss that is clinically meaningful.”

The researchers did a systematic review of 54 randomized trials comparing the effect of herbal supplements to placebo on weight loss up to August 2018, followed by a systematic review up to December 2019 of 67 randomized trials. Of the 14 supplements analyzed, only 4 resulted in a statistically significant increase in weight loss, and none resulted in clinically significant weight loss (5.5 lbs or greater).

Some dietary supplements, including modified cellulose—plant fibre that expands in the stomach to induce a feeling of fullness—and blood orange juice extract, showed promising results. However, these were only investigated in 1 trial and more evidence is required before recommending them for weight loss, according to the study authors.

“Herbal and dietary supplements might seem like a quick-fix solution to weight problems, but people need to be aware of how little we actually know about them,” Bessell said, in the press release. “Very few high-quality studies have been done on some supplements with little data on long-term effectiveness. What's more, many trials are small and poorly designed, and some don't report on the composition of the supplements being investigated. The tremendous growth in the industry and popularity of these products underscores the urgency for conducting larger, more rigorous studies to have reasonable assurance of their safety and effectiveness for weight loss.”

Most comprehensive studies to date find 'insufficient evidence' to support herbal and dietary supplements for weight loss [news release]. EurekAlert; May 8, 2021. Accessed May 10, 2021. 

https://www.eurekalert.org/pub_releases/2021-05/eaft-mcs050621.php

Presented at the European Congress on Obesity, the analysis includes data from 121 trials with nearly 10,000 adult participants.



Study Shows No Significant Evidence for the Efficacy of Herbal, Dietary Weight Loss Supplements

According to research selected for presentation at Digestive Disease Week 2021, combining minimally invasive endoscopic sleeve gastroplasty (ESG) with the diabetes drug semaglutide can provide additional significant weight loss for patients who are not candidates for invasive surgery.

"As the worldwide obesity rate continues to climb, so do the number of people seeking bariatric surgery to treat their condition," said Anna Carolina Hoff, MD, lead researcher on the study and founder and clinical director of Angioskope Brazil, São José dos Campos, in a press release. "Surgical procedures are some of the most successful ways to help patients lose weight, but they can eventually come with complications. Our study shows that patients may not have to undergo invasive surgery to get similar results."

In a double-blind study, researchers randomized 61 patients undergoing ESG into 2 groups with 1 group of 29 patients receiving semaglutide, an injectable glucagon-like peptide-1 receptor that has been found to stimulate weight loss, beginning 1 month after the procedure. Another group of 29 patients received a placebo administered with look-alike injector pens. Additionally, 3 patients were lost to follow-up and participants were monitored each month for body weight and body composition, with blood panels taken every 3 months, according to the press release.

Patients who received semaglutide lost an average of 26.7% of their total body weight compared to the control group, which lost an average of 19.6% of total body weight. The semaglutide group lost 86.3% of their excess weight, or the amount of weight the patients needed to lose to reach normal BMI, compared to 60.4% for the control group.

The semaglutide group also lost 12.7% of their body fat by weight compared to 9% for the control group. Further, glycated hemoglobin levels fell 0.95 for the semaglutide group and 0.61 for the controls.

Surgical procedures, such as laparoscopic sleeve gastrectomy, come with increased costs and a higher risk for complications, such as gastroesophageal reflux disease (GERD). These surgical procedures are typically limited to those with a BMI of at least 35 with comorbidities or with a BMI above 40.

ESG can be performed at an earlier stage of the disease and at a lower BMI, so more patients can get the treatment they need before their disease progresses. Additionally, treating patients with obesity earlier can help reduce death and comorbidities as well as reduce costs associated with treatments for these conditions, according to the study authors.

"ESG has been available to patients for years, but it has not always been as successful as surgical options in helping patients lose weight," Hoff said in the press release. "We now have a minimally invasive procedure that can be just as successful when combined with semaglutide and can be made available to even more people looking to lose a significant amount of weight."

ESG is performed by guiding a device through the patient’s throat and into the stomach, where an endoscopist uses sutures to make the stomach smaller. This helps patients lose weight by limiting the amount they can eat. Patients are candidates for ESG if they have a BMI at or above 30, diet and exercise have not helped them lose weight, or if they are not a candidate for surgery or do not wish to pursue surgery.

The researchers caution that long-term durability of the treatment still needs to be determined.

Pairing bariatric procedure with diabetes drug increases weight loss. EurekAlert! Published May 14, 2021. Accessed May 14, 2021. https://www.eurekalert.org/pub_releases/2021-05/ddw-pbp051221.php

Additionally, 3 patients were lost to follow-up and participants were monitored each month for body weight and body composition, with blood panels taken every 3 months.

Pairing Bariatric Procedure With Diabetes Drug Increases Weight Loss

A phase 3 trial investigating the PD-1 inhibitor cemiplimab (Libtayo, Regeneron) in patients with recurrent or metastatic cervical cancer who had previously progressed on chemotherapy showed a significant improvement in overall survival (OS), with a reduction in the risk of death by 31% compared to chemotherapy in the overall population, according to a presentation at the European Society for Medical Oncology Virtual Plenary.

These positive results add to the previously reported data showing an improvement in OS with cemiplimab compared to chemotherapy. In light of these positive findings, the data from this trial will be used as the basis for regulatory submissions in 2021.

"Improvements in progression-free survival [PFS] and objective response rate [ORR] were also demonstrated in the overall population compared to chemotherapy. Taken together, this landmark trial—which enrolled patients regardless of PD-L1 expression status—helps support the use of [cemiplimab] as a potential new second-line treatment for women with advanced cervical cancer who face a poor prognosis and limited treatment options," said trial investigator Krishnansu S. Tewari, MD, professor and director of the Division of Gynecologic Oncology at the University of California, Irvine, in a press release.

Currently, cervical cancer is the fourth leading cause of cancer mortality in women globally, with the most frequently diagnosed age group being women aged 35 to 44 years. Every year, approximately 570,000 women are diagnosed with cervical cancer, with deaths among those diagnosed totaling more than 250,000 annually. In the United States alone, there are approximately 14,500 patients diagnosed annually, with approximately 4000 women dying from the disease each year.

Although human papillomavirus infection is the cause of a majority of cases, approximately 80% are also classified as squamous cell carcinoma (SCC), which occurs from within cells in the lining at the bottom of the cervix. The remaining 20% of cases are classified as adenocarcinomas, which arises from glandular cells in the upper cervix. When detected early, cervical cancer is generally curable and can be managed; however, in advanced stages, the treatment options available become limited.

In the overall patient population, the investigators found that OS, PFS, and ORR significantly improved for those treated with cemiplimab (n=304), compared to chemotherapy (n=304). Specifically, the investigators observed a 31% reduction in mortality risk (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.56-0.84; one-sided p=0.00011), a 25% reduction in disease progression risk (HR: 0.75; 95% CI: 0.63-0.89; one-sided p=0.00048), and 16% ORR (50 patients; 95% CI: 13-21%; one-sided p=0.00004), compared to 6% with chemotherapy (19 patients).

Among this population, the median duration of response was 16 months with cemiplimab (95% CI: 12 months to not yet evaluable) and 7 months with chemotherapy (95% CI: 5-8 months), per Kaplan-Meier estimates.

Seventy-eight percent of trial participants were found to have advanced cervical cancer classified as SCC and also went on to experience significant improvements following treatment with cemiplimab (n=239) versus chemotherapy (n=238).

Specifically, patients in this population experienced a 27% reduction in mortality risk (HR: 0.73; 95% CI: 0.58-0.91; one-sided p=0.00306), a 29% reduction in disease progression risk (HR: 0.71; 95% CI: 0.58-0.86; one-sided p=0.00026), and 18% ORR (42 patients; 95% CI: 13-23%) compared to 7% with chemotherapy (16 patients; 95% CI: 4-11%).

Although the investigators did not set the assessment of adenocarcinoma as a pre-specified endpoint, a post-hoc analysis demonstrated that patients treated with cemiplimab (n=65) compared to chemotherapy (n=66) experienced a 44% reduction in mortality risk (HR: 0.56; 95% CI: 0.36-0.85; nominal one-sided p<0.005), a 9% reduction in disease progression risk (HR: 0.91; 95% CI: 0.62-1.34), and 12% ORR (8 patients; 95% CI: 6-23%), compared to 5% with chemotherapy (3 patients; 95% CI: 1-13%).

Additionally, the phase 3 trial demonstrated that patients treated with cemiplimab experienced an improvement or maintenance of their baseline Global Health Status/Quality of Life (GHS/QOL) over time. However, patients treated with chemotherapy experienced a deterioration that was clinically significant by cycle 8, per the European Organisation for Research and Treatment of Cancer QLQ-C30 (overall estimated mean change [95% CI]: improvement of 1.01 [-2.033, 4.047] for Libtayo, worsening of -6.81 [-10.977, -2.637] for chemotherapy; difference: 7.81; one-sided nominal p=0.00040).

The investigators observed no safety signals for patients treated with cemiplimab. The investigators had assessed safety in patients who received at least 1 dose of study treatment, which included 300 patients in the cemiplimab group (median duration of exposure: 15 weeks; range: 1-101 weeks) and 290 patients in the chemotherapy group (median duration of exposure: 10 weeks; range: 1-82 weeks).

In terms of adverse events (AEs) observed during the trial, investigators found 88% of cemiplimab patients and 91% of chemotherapy patients experienced AEs. In 15% or more of cemiplimab patients, AEs included anemia (25% cemiplimab, 45% chemotherapy), nausea (18% cemiplimab, 33% chemotherapy), fatigue (17% cemiplimab, 16% chemotherapy), vomiting (16% cemiplimab, 23% chemotherapy), decreased appetite (15% cemiplimab, 16% chemotherapy), and constipation (15% cemiplimab, 20% chemotherapy).

Additionally, grade 3 or higher AEs were observed in 45% of cemiplimab patients and 53% of chemotherapy patients, whereas in 15% or more of patients, certain grade 3 or higher AEs were observed more frequently in the cemiplimab group. These AEs included asthenia (2% cemiplimab, 1% chemotherapy) and pyrexia (less than 1% cemiplimab, 0% chemotherapy).

The investigators also observed immune-related AEs in 16% of cemiplimab patients and fewer than 1% of chemotherapy patients. The AEs at grade 3 or higher occurred in 6% of cemiplimab patients and fewer than 1% of chemotherapy patients. However, patients discontinuing treatment due to AEs only occurred among 8% of cemiplimab patients and 5% of chemotherapy patients.

Positive Phase 3 Libtayo® (cemiplimab) Results in Advanced Cervical Cancer Presented at ESMO Virtual Plenary. Tarrytown, NY: Regeneron Pharmaceuticals; May 12, 2021. 

https://investor.regeneron.com/news-releases/news-release-details/positive-phase-3-libtayor-cemiplimab-results-advanced-cervical

A phase 3 trial investigating the PD-1 inhibitor cemiplimab in patients with recurrent or metastatic cervical cancer who had previously progressed on chemotherapy showed a significant improvement in overall survival.

Positive Results for the Treatment of Advanced Cervical Cancer 

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

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

During the interview, Davis discussed the findings of her research in relation to the epidemiology of functional seizures.

Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, discussed the epidemiology of functional seizures.

Understanding the Epidemiology of Functional Seizures

Individuals who are fully vaccinated against COVID-19 can resume activities they were doing prior to the pandemic, according to updated guidance from the CDC. The agency also advised that fully vaccinated individuals can resume many activities without wearing a mask or social distancing.

The CDC considers individuals in the United States to be fully vaccinated 2 weeks after receiving their second of a 2-dose Moderna or Pfizer-BioNTech vaccine series, or 2 weeks after receiving a single-dose Johnson & Johnson vaccine.

According to the CDC, outdoor activities deemed safest for fully vaccinated people, but less safe for unvaccinated individuals, include:

dining with friends from multiple households

attending crowded events, such as a live performance, parade, or sporting event

Some examples of indoor activities considered safest by the CDC for fully vaccinated individuals that are less safe for unvaccinated peers include:

going to an uncrowded shopping center or museum

attending a small gathering of people from multiple households, whether fully vaccinated or not

attending a full-capacity worship service or singing with a chorus

participating in a high-intensity exercise activity

In the updated guidance released today, the CDC cautioned that masks and social distancing may still be required of fully vaccinated individuals in adherence to federal, state, local, tribal, and territorial laws, rules, and regulations, as well as policies put into place by businesses and workplaces.

The agency is advising that all travelers, regardless of vaccination status, will still need to wear a mask when using public forms of transportation, including planes, buses, and trains. They should also continue to practice social distancing and frequent hand washing or use of hand sanitizer while traveling.3 However, fully vaccinated individuals do not need COVID-19 testing before or after traveling, nor do they need to quarantine upon arrival at a destination in the United States.

Individuals who are fully vaccinated should continue paying close attention to policies and COVID-19 situations at international destinations prior to making the trip. International travelers still need to provide a negative test result for COVID-19 or documentation of recovery from the virus prior to boarding international flights, regardless of vaccination status. The CDC also advises international travelers to obtain testing for COVID-19 within 3 days upon return to the United States, but these fully vaccinated individuals do not need to self-quarantine.

CDC guidance advises individuals who are not fully vaccinated to delay taking trips, if possible, until they are fully vaccinated. Those who do travel are advised to take a viral COVID-19 test 1 to 3 days prior to taking the trip and get tested again 3 to 5 days after returning home, as well as self-quarantining for a full 7 days.

When you’ve been fully vaccinated. CDC. Updated May 13, 2021. Accessed May 13, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html

Choosing safer activities. CDC. Updated May 13, 2021. Accessed May 13, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/participate-in-activities.html

Domestic travel during COVID-19. CDC. Updated April 27, 2021. Accessed May 13, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html

The CDC considers individuals in the United States to be fully vaccinated 2 weeks after receiving a complete series of COVID-19 vaccine doses.

CDC Says Fully Vaccinated Individuals can Resume Activities Without a Mask

During National Women’s Health Week, which takes place from May 9 to May 15, CVS Health announced new initiatives to further support women’s health and wellness during the month of May.

“Through our new initiatives to support women’s health and wellness in May, we aim to use our unmatched community presence and our diversified model to meet women where they are to help make preventative care more convenient and accessible for women,” said Eileen Howard Boone, senior vice president, corporate social responsibility & philanthropy and chief sustainability officer for CVS Health, in an interview with 

An example of an initiative CVS Health is doing is the 1100 MinuteClinic locations that are promoting a no-cost heart health screening program called “Know Your Numbers.” Patients will learn 5 key personal health numbers that can help them determine their risk for heart disease, including cholesterol, high-density lipoprotein (good) cholesterol, blood pressure, blood sugar, and body mass index.

“We know that nearly 80% of cardiac events can be prevented, yet many women don't have the awareness about this disease to understand and prevent their risk. That's why offering these free heart health screenings is so important, especially this year when so many people have put off preventative care,” Boone said.

In addition, CVS Pharmacy locations nationwide will raise funds to support the Go Red for Women movement. From now until May 29, customers can support the movement by making a donation at check-out or online at 

Mental and physical health has become more crucial than ever before since the start of the COVID-19 pandemic. Through the ExtraCare Rewards program, members will receive deals on women’s wellness items in-store, including weekly promotions on products such as vitamins and skin care, as well as feminine care and beauty products, until May 22.

“Given all of the responsibilities women have taken on, it can be difficult to find time to prioritize health and wellness. During National Women’s Health Week, we hope that women learn that although it’s been hard to prioritize preventative care during the pandemic, it’s essential for women to find the time to take care of themselves,” Boone told 

CVS Health announces new initiatives to support women’s health and wellness in May. CVS Health. Published May 3, 2021. Accessed May 13, 2021. 

https://cvshealth.com/news-and-insights/press-releases/cvs-health-announces-new-initiatives-to-support-womens-health-and

CVS Health Announces New Initiatives to Support Women's Health and Wellness in May

Contemporary Clinic spoke with Patricia Ryan Krause, MS, RN, MSN, PNP-BC, from the National Association of Pediatric Nurse Practitioners (NAPNAP) about Global Health Awareness Month 2021, which takes place in May.

This second part of the interview covers how to work with refugees with chronic conditions, any special considerations while working with those who experienced trauma while/before/after immigrating, and what she hopes to see for the future of patients who are impacted by health inequalities.

Special Considerations and Helping Patients with Health Inequalities

Because several pharmaceutical companies pulled back from the federal 340B program last fall, many patients with diabetes are now seeing skyrocketing insulin prices, according to Anne Webster, NP, with UnityPoint Health.

Webster said she has been forced to prescribe less effective insulin options in recent months and has seen patients beginning to ration their medications. In addition to impacting their physical health, Webster said she has seen patients struggling with their mental and financial wellbeing over the last few months, and she sees no end in sight. The only solution, she said, is for Health and Human Services Director Xavier Becerra, JD, to enforce federal policies to ensure affordable medication access.

Because several pharmaceutical companies pulled back from the federal 340B program last fall, many patients with diabetes are now seeing skyrocketing insulin prices.

Rising Insulin Prices Impact Patients’ Diabetes Management, Holistic Wellness

Moderate alcohol intake, defined as no more than 1 alcoholic drink for women and 2 for men per day, has been associated with a lower risk of dying from cardiovascular disease when compared with individuals who abstain from drinking or partake in excessive drinking, according to a new study being presented at the American College of Cardiology's 70th Annual Scientific Session. According to the authors of the study, the finding suggests that reducing stress-related brain signals can be heart protective, and other therapies with the same effects but fewer adverse effects than alcohol should be pursued.

“We found that stress-related activity in the brain was higher in nondrinkers when compared with people who drank moderately, while people who drank excessively—more than 14 drinks per week—had the highest level of stress-related brain activity,” said Kenechukwu Mezue, MD, a fellow in nuclear cardiology at Massachusetts General Hospital, in a press release. “The thought is that moderate amounts of alcohol may have effects on the brain that can help you relax, reduce stress levels and, perhaps through these mechanisms, lower the incidence of cardiovascular disease.”

While a connection between stress and heart disease is widely accepted, there has been limited research on how modifying stress levels may improve and protect heart health, according to the authors of the study. A related study by the same team found that exercise had a similar effect on brain activity as well as on the incidence of cardiovascular disease and events.

“The current study suggests that moderate alcohol intake beneficially impacts the brain-heart connection. However, alcohol has several important side effects, including an increased risk of cancer, liver damage and dependence, so other interventions with better side effect profiles that beneficially impact brain-heart pathways are needed,” Mezue said in the release.

The researchers gathered data from the Mass General Brigham Biobank health care survey of 53,064 participants, of which 59.9% were women and the average age was 57.2 years. Alcohol intake was self-reported and was classified as low (<1 drink/week), moderate (1-14 drinks/week), or high (>14 drinks/week). Major adverse cardiovascular events, including heart attack, stroke, or related hospitalizations, were determined using diagnostic codes. Of these patients, 752 underwent 18F-fluorodeoxyglucose positron emission tomography, which can show areas in the brain that have increased activity, allowing the researchers to objectively measure activity in regions of the brain known to be associated with stress.

Fifteen percent of the participants experienced a major adverse cardiovascular event, occurring in 17% in the low alcohol intake group, and 13% in the moderate alcohol intake group. In adjusted analysis, individuals reporting moderate alcohol intake were found to have a 20% lower chance of having a major event compared to the low alcohol intake cohort and had lower stress-related brain activity. This association remained significant after controlling for demographic variables, cardiovascular risk factors, socioeconomic variables, and psychological factors.

“Previous studies by our group and others have shown a robust association between heightened amygdalar activity and a higher risk of major adverse cardiovascular outcomes, such as heart attack, stroke, or death. In the current study, path analyses showed that the link between moderate alcohol intake and lowered cardiovascular event risk is significantly mediated though reductions in amygdalar activity,” Mezue said in the release.

The current study is limited due to the self-reporting of alcohol intake based on the average consumption of drinks per week, according to its authors. Further, the data is from a single center, and each participant in the imaging sub-study only received a single brain scan. Further study would be needed to show that the observed reductions in brain activity are the direct result of moderate alcohol intake through repeated brain scans and more detailed alcohol intake assessments over time.

Alcohol in moderation may help the heart by calming stress signals in the brain [news release]. EurekAlert; May 6, 2021. Accessed May 6, 2021. 

https://www.eurekalert.org/pub_releases/2021-05/acoc-aim050421.php

According to the authors of the study, the finding suggests that reducing stress-related brain signals can be heart protective, and other therapies with the same effects but fewer adverse effects than alcohol should be pursued.

Moderated Alcohol Intake May Reduce Stress Signals in the Brain, Improve Cardiovascular Health

Today is National Nurses Day, so Bernadette Melnyk, PhD, the chief wellness officer and dean of the College of Nursing at Ohio State University, joined Contemporary Clinic to discuss the results of a recent study she was the lead author on which shone some light on the extent to which alarmingly high levels of stress, depressive symptoms, and anxiety have been affecting critical care nurses nationwide, even before the COVID-19 pandemic began.

So, Dr. Melnyk, what were some of the findings from the study you recently published, and why might critical care nurses be experiencing such high levels of stress, depressive symptoms, and anxiety?

 Our study findings showed very high rates of depressive symptoms affecting 40% of the sample, and this was a random sample of critical care nurses throughout the United States. So, we can generalize those findings to all critical care nurses in the American Association of Critical Care Nurses.

We also found a little over 50% of these nurses met the cutoff for clinical anxiety on the valid and reliable screen that we used. But very importantly, we found that the poorer the physical and mental health of these nurses, the more medical errors they made over the last 5 years, and that's very sad.

I don't want that to put a poor light on critical care nurses because they're fabulous, but it gets back to the issue of: If we don't support our clinicians’ health and well-being, it is going to affect health care quality and safety. 

Absolutely, yeah. How are these mental health concerns affecting nurses ability to also provide patient care, as well as other medical services?

 Well, I think any time any person experiences stress, depression, or anxiety to the point that it's going to interfere with concentration, judgment, or functioning, it will affect the quality and safety of care.

These are wonderful, caring, well-meaning nurses, but the level of burnout, depression, even suicide, in nurses is higher than the general population. So, health care systems really need to invest in fixing system problems that we know are the root cause of burnout, depression, and anxiety, as well as offer great screening programs and wellness evidence-based programs to protect oneself against these mental health issues.

It's just so critical. We know what works, we just got to translate it much quicker into the real world.

Right, right. How have these mental health concerns specifically impacted critical care nurses during the COVID-19 pandemic?

 They definitely have skyrocketed even further. Think about being a critical care nurse taking care of very, very sick people whose family members could not come in and be with them.

So those nurses had to be the primary support for dying people. That adds to the already stressed-out situation that they're functioning in. I think we're going to see an aftermath of skyrocketing rates of post-traumatic stress disorder and chronic grief reactions as we pull out of this.

Yeah. What are some ways nurses can approach an awareness of their experience of these mental health concerns?

 I think for one we've got to just become self-aware and honest with ourselves, and if any clinician is experiencing burnout, depression, or anxiety to the point where it's interfering with their concentration or functioning, they've got to get help.

It is not selfish to take good self-care. It's truly necessary to be able to take great care of others.

Yeah, and what has been the impact of programs like the Stress, Trauma and Resilience (STAR) Program or the Buckeye Paws program for critical care nurses?

 At Ohio State, we have such a fabulous menu of options to help all of our clinicians, faculty, staff, and students. Buckeye Paws is our pet therapy program, and honestly you should see the faces and the stress melt off of clinicians when those trained dogs step up on the unit.

We also have this other STAR programming for both patients as well as our own clinicians who are experiencing issues with stress and trauma. We offer evidence-based mindfulness programs and cognitive behavior skills building programs that we now work to decrease depression, anxiety, and stress.

Yeah, that is excellent, that is excellent. Why is it important for all medical health professionals or medical professionals to focus on continuing to care for themselves while caring for their patients?

 As clinicians, we cannot pour from empty cups. When we get on an airplane and the oxygen mass drop, we're told to put them on ourselves first before we can be effective in helping others.

Again, oftentimes clinicians want to help everybody else, but they often don't focus on their self-care. Self-care is not a nicety, it's a necessity. We have got to take a little bit of time—I call them micro-recovery breaks—during the day to focus on effective strategies that'll decrease our stress and improve our mood.

Yeah absolutely. What is the value of nurses in health care today?

 Nurses are at the bedside of patients 24/7. They are there to make observations, to pick up early complications, and to nurture the emotions and spirit of patients who are often seriously ill. They are such a valuable piece of our workforce.

Absolutely, absolutely. Is there anything you would like nurses to know on this National Nurses Day?

 I'm going to give all of our nurses a dose of vitamin G for gratitude. People honestly underestimate the power of practicing daily gratitude. If we get up every morning and just think about a few things and people we're grateful for and then do it again when we go to bed at night, it will so decrease our stress, decrease blood pressure, improve our mood.

So, I’m going to give all nurses out there a dose of vitamin G today, and just thank you, thank you so much for everything you do every day to transform health and improve lives. You are greatly appreciated.

Thank you so much for taking the time to speak with me today, Dr. Melnyk, and for sharing these important words on this National Nurses Day.

Today is National Nurses Day, so Bernadette Melnyk, PhD, the chief wellness officer and dean of the College of Nursing at Ohio State University, joined Contemporary Clinic to discuss the high levels of stress, depression, and anxiety affecting critical care nurses nationwide. 

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