Although antihistamines are commonly used to manage hives, sneezing, and watery eyes during allergy season, many patients may be taking their medications incorrectly, according to Derek Chu, MD, PhD, a McMaster University allergy expert and clinical scholar.

“People need to rethink what they stock in their home cabinets as allergy medicines, what hospitals keep on formulary, and what policymakers recommend,” Chu said in a press release. “The message needs to get out. This publication is on time for the spring allergy season and as COVID vaccines roll out, for which rashes are common and antihistamines can be helpful.”

Co-author Gordon Sussman, MD, FRCP, FACP, DIP.ABIM, FAAAAI, said in the press release that there are new second generation antihistamines that prescribers should know about. Their new study, published in the 

, lists 5 things to know about proper antihistamine use.

Antihistamines are among the most commonly and incorrectly used medications worldwide, according to the press release. Their best use is for the management of hay fever and outbreaks of hives, and not for management of asthma, eczema, coughs, or insomnia.

Notably, first-generation antihistamines are associated with substantial and sometimes fatal adverse effects (AEs). These antihistamines are ones with diphenhydramine, chlorpheniramine, or hydroxyzine, which can cause drowsiness and affect cognitive functions, such as school performance. Overdosing with these types of antihistamines can cause death and are potentially dangerous for both young and older people.

Second-generation antihistamines are safer and just as affordable and as effective as first-generation antihistamines, according to the study authors. Later-generation antihistamines are proven to be more effective and last longer with less severe AEs, such as drowsiness, according to the study authors.

In their fourth point, the authors said antihistamines should not be used instead of epinephrine to treat anaphylaxis. Oral drugs can be used in combination with epinephrine injections to treat anaphylactic reactions, but they are not a proper substitute.

Finally, they said most antihistamines are safe to use during pregnancy and breastfeeding. Researchers have shown that antihistamines at standard doses do not harm fetuses during pregnancy and may be used during breastfeeding. Similarly, the researchers said they are safe for children to use.

“These are new modern second-generation antihistamines that are potent, specific, fast acting, and of proven safety which everyone should be using to treat allergic rhinitis and hives,” Sussman said in the press release.

Are you using antihistamines properly? [news release]. EurekAlert; April 6, 2021. 

https://www.eurekalert.org/pub_releases/2021-04/mu-ayu040121.php

Articles

Second-generation antihistamines are safer and just as affordable and as effective as first-generation antihistamines, according to the study authors.

Note Proper Use of Antihistamines During Spring Allergy Season

Contemporary Clinic spoke with pediatric nurse practitioner Tina Rickenback, APRN, from NAPNAP about the latest updates on the COVID-19 vaccines and education around this topic.

Rickenback also discussed any myths or rumors surrounding the uncertainty of the vaccine and different ways that health care professionals can spread awareness and properly counsel patients on this topic. 

Videos

Latest Updates on the COVID-19 Vaccine and Education On Immunizations

Hiccups are that strange occurrence that comes out of nowhere, causes irritation, and then (usually) disappears.

Everyone has hiccups at some point, sometimes even at inconvenient times. What is going on in that body that causes hiccups, and what are ways to get rid of them? Let’s look at the biology of hiccups, the causes, and how to treat this generally harmless but annoying condition.

Hiccups are brief, involuntary, and irregular bursts of air that are really 2 different events causing 1 hiccup. First, there is an involuntary contraction of the diaphragm, the muscle at the base of the lungs. The second event is the closing of the glottis. It is here that the vocal cords are located, causing the "hic" sound.

 Most hiccups cease within hours and are harmless and self-limiting. They can last in cycles of 4 to 60 hiccups per minute and are classified by their duration into 3 categories

: acute: <48 hours; persistent: >2 days; and intractable: >1 month.

The results of a retrospective analysis of 54 charts at a community hospital between 1995 and 2000 shows that intractable hiccups are more common in men (82%) than in women, and 36 of those men were between 51 and 80 years of age.

 The results of a 2012 systemic review found that 1% to 9% of patients with advanced cancer experienced intractable or persistent hiccups.

 Because hiccups are a common occurrence with no geographical or racial variation, little is documented or known about the incidence and prevalence.

 The effects of hiccups can include inconveniences in communicating, drinking, eating, and sleeping.

Below are a few examples of risk factors that cause hiccups

. Additionally, a thorough assessment and physical examination can help determine the cause.

Central nervous system (CNS) disorders: brain injuries or seizures

Diet: alcohol consumption, eating too quickly, and overeating

Gastrointestinal disorders: esophagitis and gastroesophageal reflux disease

Medication induced: benzodiazepines and dexamethasone

Miscellaneous: cancer, imbalances, and surgery

We have all heard of or even tried home remedies, some reportedly successful. Some fun examples you might have heard of include eating a spoonful of sugar, receiving a sudden or fright, or singing a song.

 Some physical maneuvers that reportedly get rid of hiccups include drinking water, holding one’s breath, and pulling the knees to the chest.

Pharmacotherapy may be considered for intractable and persistent hiccups. The drug choice will be based on the underlying cause, and because this can vary among patient, the medication chosen will also vary. A 2015 systematic review for the pharmacological treatment of hiccups and a 2016 review of the management of hiccups in palliative care patients list the following medication recommendations:

: Considered first line for suspected CNS cause

: Considered first line for non-CNS cause

Proton pump inhibitors, omeprazole 20 mg twice daily

: Considered first line when suspecting reflux

Chlorpromazine* 10 to 50mg 3 times daily by mouth or intravenously

: Considered third line, because of adverse effects

Hiccups are generally harmless but can cause distress and inconvenience. Obtaining knowledge on the science behind and causes of hiccups provide insight on how to treat this peculiar occurrence.

 Updated February 17, 2021. Accessed March 24, 2021. 

2. Lembo A. Hiccups. In: UpToDate. Wolters Kluwer; 2021. Updated October 27, 2020. Accessed March 24, 2021. 

https://www-uptodate-com.mwu.idm.oclc.org/contents/hiccups?search=hiccups&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

3. Nausheen F, Mohsin H, Lakhan SE. Neurotransmitters in hiccups. 

. 2016;5(1):1357. doi:10.1186/s40064-016-3034-3

4. Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. 

5. Calsina-Berna A, Garcia-Gomez G, Gonzalez-Barboteo J, Porta-Sales J. Treatment of Chronic Hiccups in Cancer Patients: A Systematic Review. 

2012;15(10):1142-1150. doi:10.1089/jpm.2012.0087

6. Cole JA, Plewa MC. Singultus. In: StatPearls. StatPearls Publishing; 2021.

7. Cabrera D. Hiccups: old remedies for an old malady. 

 October 27, 2014. Accessed March 26, 2021. 

https://emblog.mayo.edu/2014/10/27/hiccups-old-remedies-for-an-old-malady/

8. Vatomsky S. 7 cures for hiccups from world folklore. 

https://www.mentalfloss.com/article/500937/7-cures-hiccups-world-folklore

9. Jeon YS, Kearney AM, Baker PG. Management of hiccups in palliative care patients. 

. 2018;8(1):1-6. doi:10.1136/bmjspcare-2016-001264

10. Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. 

Let’s look at the biology of hiccups, the causes, and how to treat this generally harmless but annoying condition.

Hiccups: What Are They, and How Can We Stop Them?

Contemporary Clinic spoke with Laura Kelly, PhD, about Columbia Nursing's newest program and first-ever certificate in Professional Achievement in Transgender/Gender Non-Binary Health Care for Nurse Practitioners beginning this September.

Kelly also discussed why programs like this are important in today's health care world and what NPs can do to continue closing the gaps in treating transgender/gender non-binary patients. 

Professional Achievement in Transgender/Gender Non-Binary Health Care Certificate for Nurse Practitioners 

There are widespread mental health concerns among children and teens currently, with 1 in 4 to 5 having a mental health problem, said Bernadette Melnyk, PhD, RN, CPNP, PMHNP, FAAN, during a session at the National Association of Pediatric Nurse Practitioners Virtual Conference 2021. The most commonly occurring mental health disorders in this population are anxiety, depression, and ADHD.

However, it is estimated that less than 50% of children and teens with a mental health disorder receive any treatment. This is of particular concern considering suicide remains the second leading cause of death in people aged 10 to 34 years in the United States.

“If every clinician, advanced practice provider, and physician could get great at providing evidence-based screening and intervention for just anxiety and depression in children, teens, and young adults, we could really put a dent in these mental health problems,” Melnyk said during the session.

Furthermore, during the struggles many have endured during the COVID-19 pandemic, there is an additional mental health epidemic that has emerged within the pandemic, Melnyk explained. The CDC and the Morbidity and Mortality Weekly Report released data showing 25% of Americans aged 18 to 25 years have thought about suicide since the start of the pandemic, highlighting the critical need for mental health promotion and development of resiliency skills so that a paradigm shift can occur around this issue.

“Because so many people are suffering from depression and anxiety related to the COVID-19 pandemic, we are seeing a rise in substance use, unhealthy eating, and a decline in physical activity. If we do not address these mental health problems urgently now, we are also going to see downstream affects in chronic disease in 3 to 5 years from now,” Melnyk said during the session.

There are a variety of risk factors for mental health disorders in children and teens. Poor self-esteem is a significant predictor, although it is often not screened for by providers. For this reason, every contact with a patient should be seen as a potential opportunity to screen for mental health disorders, especially during the pandemic, according to Melnyk. Asking a single screening question during a session such as, “On a scale from 0 to 10, how good do you feel about who you are?” can be an effective tool for assessing patient risk.

There are other valuable screening tools providers can use as well, such as the Pediatric Symptom Checklist, which has been found to be a valid and reliable first screen, as it is a short form with 17 items that takes approximately 5 minutes to complete.

For assessing risk for depression and anxiety disorders, the PHQ-9, GAD-7 and SCARED screening tools are also valuable. Additionally, the CRAFFT screen is used for assessing substance use risk, while the ACE screen helps to assess adverse childhood experiences.

If the results of the screening tool demonstrate further investigation is needed, a clinical interview should then be conducted with further evaluation completed by a health care provider.

“But we have to remember that screening is not diagnosis alone. Screening just raises a red flag that requires a good comprehensive interview and evaluation by the health care provider,” Melnyk said during the session.

Melnyk highlighted a strong outline that is available for the integration of behavioral health into primary care using the Screening, Brief Intervention and Referral to Treatment (SBIRT) model. SBIRT details that the starting point should be a screening for a mental health disorder in the primary care setting, which is then followed by a brief intervention that can be provided in the primary care location.

If necessary, a referral to a mental health provider or a consultation service can proceed this, with subsequent treatment offered by the primary care provider, integrated psychologist, mental health provider, or specialty care based on the needs of the patient.

“I like to add another letter to SBIRT, and that is H for Hope. I never let a child, teen, or young adult leave me without instilling hope that there are fabulous, evidence-based treatments to help them,” Melnyk said.

In the primary care setting, the 2 most common mental health disorders that providers observe are anxiety disorders and depressive disorders. However, there are now a rising number of trauma, stress-related, and obsessive compulsive disorders emerging.

“But again, if we could just get really good at delivering cognitive-behavioral-health based interventions for children and teens with depression and anxiety, we would avoid long wait times to mental health providers,” Melnyk said during the session. “Unfortunately, a lot of people feel that if you’re not born with resilience, you can’t develop it, and that couldn’t be further from the truth. All throughout life, you can build resiliency skills and cognitive behavioral skills that are wonderfully protective factors against mental health disorders.”

Melnyk B, Lusk P. Evidence-based Screening and Mental Health Interventions for Primary Care. Presented at: National Association of Pediatric Nurse Practitioners Virtual Conference 2021; March 27, 2021; virtual. 

https://napnap21.org/community/#/session-stream/42207

There are widespread mental health concerns among children and teens currently, with 1 in 4 to 5 having a mental health problem.

Evidence-based Screening for Mental Health Disorders in Children, Teens is Critical During Pandemic

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 why educating the medical community on how to approach care for children with CDT is important.

Why did you create Healing Connection, and what is the focus of the organization in relation to educating the medical community on CDT?

So, I founded Healing Connection based on a lot of what we just talked about. I saw that there were a lot of gaps in the system, so in addition to what we do with medical providers, we also do a lot of work with social workers, with foster and adaptive families, but as far as in the medical community, I really founded this to reach out in advocacy and education.

So, my first goal is advocacy: To help raise awareness that this is a real problem. Oftentimes, we don't realize it because these children are getting labeled with mental health diagnoses really early on in life. So, I would see in the emergency department 3, 4, or 5 year olds that were already on heavy medications, psychiatric medications, and just really to the point where they couldn't even express emotion because they were given these diagnoses that more than likely had at least a large part of that based in trauma.

So, is dealing with trauma going to get rid of all mental health problems? Of course not, but I think until we give these kids the adequate help they need to deal with their trauma, we'll never really know how much of what we're dealing with is trauma and difficulty with creating those important connections in life, and how much of this is true mental illness and would require medication.

So as a member of the medical community, as an adoptive mom, I just realized how much there was a lack of training in education, and I've witnessed that firsthand, and that the access to care is struggling. I just think that the more educated we as a medical community can become in our respective areas—so for instance family practice, internal medicine, pediatrics—those are the gatekeepers to our medical community. So, nurse practitioners in those areas have a powerful opportunity to be the gatekeepers to services.

So, when we look at Dr. Burke Harris's practice, she has got a social worker on staff, she's regularly referring children to educational services, and so that's a very robust program that she has. But we can all take steps in that direction to educate ourselves about services in our communities that our patients can utilize, and then instead of just keeping ourselves in the box of referrals to maybe a specialist with an [otorhinolaryngologist] or a kidney doctor, we're really looking to how can I broaden what I can do in referrals, whether that be social worker, psychologist, or programs like Healing Connection, in my community. Where I can find people that will coach these parents and will walk alongside them.

So, I think the more we can educate ourselves especially in those areas, the better we can advocate for our patients. And again, the more holistic we can create care plans, rather than just playing what we call whack-a-mole, trying to focus on symptom management, and throw one med, and if that doesn't work, we throw another. Sometimes in the medical community, we can kind of get stuck in that symptom management mode, and the reality is that if we can be proactive and educate ourselves in this area, I think we can really make a lot of gains and have a more holistic complementary approach.

Contemporary Clinic® interviewed Bethany Hall, MSN, the owner of Healing Connection, on the importance of educating the medical community on how to approach care for children with complex developmental trauma.

Nurses Have an Important Role in the Care of Children With Complex Developmental Trauma

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

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

In the study, did you find that participants developed a tolerance to cannabis over time, as you mentioned, and did any developed tolerance affect the benefits observed in treating OCD symptoms?

 Yeah, we explore tolerance in 2 ways. So, first, we examined whether people increased their dose of the drug over time, and we did not find evidence that people with OCD use higher quantities of the drug over time. In fact, there was even evidence that the dose they used to treat intrusions was decreasing over time, which is kind of unexpected.

The other way we explored tolerance was to examine whether people's self-reported reductions in these symptoms got smaller over time, as they continued to use cannabis to manage them. We found that the magnitude of the reduction in intrusions was smaller over time, which is evidence that they may be developing some tolerance to the effects on intrusions specifically. In contrast, symptom reductions for compulsions and anxiety remain constant over time, suggesting no tolerance was developing for those symptoms.

Contemporary Clinic® interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on recent findings that showed that patients with OCD who used cannabis to manage acute symptoms did not develop a tolerance to the drug over time.

Patients With OCD Using Cannabis Were Not Found to Develop a Tolerance to the Drug

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

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

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

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

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

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

Here are some tips to maintain a healthy weight:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Try an evidence-based diet or weight loss strategy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Help Patients Avoid the Quarantine 15

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

American Journal of Obstetrics and Gynecology

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Understanding and Approaching Care for Children with Complex Developmental Trauma

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

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

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

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

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

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

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

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

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

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

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

Study Finds Sensor-Based Inhalers Improve Asthma Control in Children

Contemporary Clinic spoke with pediatric nurse practitioner Brenda Cassidy, DNP, RN, MSN, CPNP-PC, from NAPNAP about how health care professionals can pay attention to the red flags of human/child trafficking victims.

Cassidy also discusses the dangers of online predators during the COVID-19 pandemic and what she hopes to see for the future of HCPs in this area.

Contemporary Clinic spoke with pediatric nurse practitioner Brenda Cassidy, DNP, RN, MSN, CPNP-PC, from NAPNAP about how health care professionals can pay attention to the red flags of human/child trafficking victims.

Spotting the Red Flags of Human Trafficking in the Healthcare Setting

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 

Contemporary Clinic® interviewed Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, on the difference between functional seizures and epileptic seizures, and how providers can identify the difference.

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