Meghan Ross, Senior Associate Editor

Nurse practitioners (NP) and physician assistants (PA) play an important role in curbing childhood obesity, which can lead to a variety of health and emotional problems both in adulthood and childhood.

Stephen R. Daniels, MD, PhD, professor and chair of the Department of Pediatrics at the University of Colorado School of Medicine and pediatrician-in-chief at Children’s Hospital Colorado, told

that NPs and PAs should calculate body mass index (BMI) and BMI percentiles at every health care encounter for children and adolescents.

“When overweight or obesity is identified, it allows the provider to start a discussion with the patient and the family and to emphasize the importance of abnormal weight gain on a variety of adverse health outcomes,” Dr. Daniels said. “It allows the nurse practitioner or physician assistant to assess health issues that are potentially related to obesity, such as blood pressure elevation and sleep apnea.”

In addition, he advised retail clinicians to stay up to date on community resources that may be useful for improving diet and physical activity and to encourage families to take advantage of these tools.

The following conditions are some of the problems individuals may face as a result of childhood obesity:

A new study presented at the European Obesity Summit found that children who have a high BMI at age 13 have an increased risk of colon cancer in the future.

The researchers looked at more than 250,000 individuals and found a 9% increase in colon cancer risk for each z-score unit increase in BMI. (Z-scores are used to compare the child’s BMI to a reference population).

A high BMI was also associated with an increased risk of early stroke in adulthood, according to a recent study presented at the European Obesity Summit.

The researchers looked at a group of more than 307,000 school children from the 1930s to 1980s. Around 3500 women and around 5300 men eventually had an ischemic stroke. The researchers found that a BMI z-score of 1 increased the risk for stroke by 26% in women and 21% in men.

As obesity rates increase, blood pressure levels rise, too. The European Obesity Summit study found that childhood obesity was “one of the strongest predictors of the level of blood pressure in adulthood.”

Studies have shown that youth obesity is linked to decreased insulin sensitivity and increased circulating insulin levels.

Insulin resistance often goes hand-in-hand with obesity, glucose intolerance, and type 2 diabetes.

6. High Levels of Triglycerides and Low Levels of High-Density Lipoprotein Cholesterol (HDL-C)

Patients who are obese often have a trifecta of high blood pressure, high levels of triglycerides, and low HDLC.

7. Nonalcoholic Fatty Liver Disease (NAFLD)

found that obesity is one of the most important risk factors for NAFLD. Hispanic children are more prone to the condition than white or black children.

“Presently, weight management is the most important clinical intervention for NAFLD,” the researchers stated.

Around one-third of severely obese children have obstructive sleep apnea, and it may actually aggravate severe obesity.

One study found that patients with a BMI above the 85th percentile have an increased risk of asthma, even when accounting for age, sex, ethnicity, tobacco smoke, and socioeconomic status.

Teens who seek help for obesity tend to show more depressive symptoms than their counterparts with normal weight. Childhood obesity is also associated with a lower quality of life.

Articles

Nurse practitioners and physician assistants play an important role in curbing childhood obesity, which can lead to a variety of health and emotional problems both in adulthood and childhood.

10 Health Concerns Linked to Childhood Obesity

More than three-quarters of patients given antibiotics to treat a suspected sexually transmitted disease (STD) like gonorrhea or chlamydia don’t actually test positively for the disease.

New study results highlighted the important role that retail clinicians and other health care professionals can play in antimicrobial stewardship.

“I think pharmacists are essential partners in antibiotic stewardship with valued knowledge and experience,” study author Karen Jones, MPH, BSN, RN, CIC, an infection preventionist at St. John Hospital & Medical Center, told

“Antibiotics are prescribed in situations outside of the inpatient setting, such as this study suggests, and their expertise is appreciated.”

Jones spent nearly 15 years as an emergency department (ED) nurse and saw patients as they were getting tested and treated, but she wasn’t usually aware of the testing outcome because of the lengthy time period it took to get results.

“There are many challenges from a health care provider’s point of view in the ED—it’s busy and often chaotic,” Jones said. “Testing and sending the patient home without treatment isn’t always the best option when considering the time spent trying to contact patients afterward (since the information is not always accurate or patients may not want to be contacted), and there could be additional risk of disease spread if treatment is delayed.”

In the study, 76.6% of patients treated for a suspected STD had cultures that tested negative for

Around 1100 patients’ genital cultures were tested over a 2-month period in the study. The ages of the patients ranged from 14 to 67 years, and the majority of the subjects were women and African-American.

Around one-third of the subjects had previously been diagnosed with an STD, while around 13% stopped by the ED because of “possible exposure” and didn’t show any symptoms.

The researchers found that 40% of the subjects were treated with antibiotics for gonorrhea or chlamydia, and 60% were not. Around 13% eventually tested positive for 1 or both of those STDs.

In addition to the three-quarters of patients who didn’t test positive but were given antibiotics, the researchers also found that 7% of patients not treated did test positive for gonorrhea and/or chlamydia.

Men who had STD cultures taken were more likely to test positive for an STD than women. Dysuria, vaginal discharge, vaginal bleeding, or nausea and/or vomiting weren’t associated with a positive test result.

Notably, around 21% of patients who presented with “STD check/possible exposure” actually tested positive for one or both of the STDs.

The high percentage of patients receiving unnecessary antibiotics is problematic for several reasons, including wasted medical costs, antibiotic use complications, and antibiotic resistance. The researchers suggested that focusing on clinical predictors could help curb unnecessary antibiotic prescribing. Health care providers should conduct a detailed history and physical exam, and a decision-making algorithm may be useful in addressing treatment of suspected STDs.

“Educating patients to seek primary health care providers in non-emergent settings when appropriate (such as STD testing) must be done through public health initiatives; partnering with the local public health department will allow patients better linkage to health care,” the researchers added.

Untreated STDs can cause serious reproductive health issues, like infertility, fetal health issues, and some cancers. Health care providers must balance treating a potential STD in the ED and risking unnecessary antimicrobial use versus not treating an infection promptly and losing the patient in the aftermath of discharge.

More than three-quarters of patients given antibiotics to treat a suspected sexually transmitted disease like gonorrhea or chlamydia donâ€™t actually test positively for the disease.

Many STD-Negative Patients Receive Unnecessary Antibiotics

Text messages that provide advice, motivation, and support could make a difference for patients with coronary artery disease (CAD).

explored how a mobile health intervention could affect low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, body mass index (BMI), physical activity, and smoking status.

The researchers noted that cardiovascular disease (CVD) prevention efforts—and lifestyle changes, in particular&mdash;can be powerful tools, but they’re underutilized and poorly adhered to.

The Tobacco, Exercise and Diet Messages (TEXT ME) trial involved 710 patients from a large tertiary hospital between September 2011 and November 2013. More than 80% of the patients were men, and about half were current smokers. The subjects, who had a mean age of 58 years, also had proven CAD.

Around half (352) of the patients in the intervention group received usual care, plus 4 texts per week for 6 months. The control group received only the standard care.

The texts covered topics like diet, physical exercise, smoking, and general cardiovascular information.

·      “[Patient name], try identifying the triggers that make you want a cigarette and plan to avoid them.”

·      “Did you know 90% of people don’t eat the recommended daily intake of vegetables (5 servings a day)?”

·      “Hi [patient name], don’t forget physical activity is good for you! It reduces your risk of diabetes, heart attack, stroke, and their complications.”

·      “Studies show that stress, worry, and loneliness can increase the risk of heart disease. Please talk to a health professional if you need help.”

After 6 months, the intervention patients had lower LDL-C levels than the control patients. In addition, they saw reductions in systolic blood pressure, smoking, and BMI, plus significant increases in physical activity.

However, the researchers noted that the “duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.”

The patients in the texting group reported that the program was useful and easy to understand. Around 80% of them said the texts were motivating in terms of dieting, and 73% said the texts encouraged them to make physical activity changes.

Text messaging can be a low-cost mobile health intervention. The researchers reported that they spent around $0.10 per message, and less than $10 was spent on each intervention patient during the 6-month program. They also noted that the texts were easily automated.

“Mobile phone interventions that focus on text messaging have particular value, because they do not require a smartphone and are agnostic to the mobile operating system,” they added. “Furthermore, most people across all income groups own a mobile phone, so a text message-based intervention has the potential to have substantial population effects.”

One of the study’s limitations was that its focus was on the difference in risk factor outcomes, rather than actual clinical outcomes. In addition, the texts were only sent in English, and some of the patient data were self-reported.

Text messages that provide advice, motivation, and support could make a difference for patients with coronary artery disease.

Texts Could Reduce Coronary Artery Disease Risk Factors

The percentage of Americans who have used opioids for nonmedical reasons has more than doubled over the course of a decade.

A recent study from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that, in a 12-month period, 4.1% of Americans used drugs like OxyContin and Vicodin either without a prescription or inappropriately between 2012 and 2013. By comparison, between 2001 and 2002, this percentage was 1.8%.

The data came from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and was published in the

The researchers looked at a year’s worth of prevalence, correlates, psychiatric comorbidity, and treatment of nonmedical prescription opioid use (NMPOU) and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders’ definition of NMPOU disorder (NMPOUD).

One notable finding was that the prevalence of NMPOU over an individual’s lifetime was 11.3% around 2012-2013, while it was considerably lower at 4.7% in 2001-2002.

The prevalence of NMPOUD was 0.9% in the past 12 months and 2.1% in an individual’s lifetime. Back in 2001-2002, the prevalence was 0.4% and 1.4%, respectively.

The researchers discovered a few trends in the data. For example, opioid use was more popular among men, but there were no differences in the recognized disorder between the sexes.

The patient populations most likely to use opioids for nonmedical reasons were individuals aged 18 to 64 years, white individuals, Native Americans, individuals who made less than $70,000 per year, and individuals with a high school-level of education or less.

The researchers also found a link between lifetime or 12-month use of opioids with other drug use disorders; post-traumatic stress disorder; borderline, schizotypal, and antisocial personality disorders; persistent depression; major depressive disorder (for NMPOU); and bipolar disorder (for NMPOUD).

“The increasing misuse of prescription opioid pain relievers poses a myriad of serious public health consequences,” sais Nora D. Volkow, MD, director of the National Institute on Drug Abuse, in a press release. “These include increases in opioid use disorders and related fatalities from overdoses, as well as the rising incidence of newborns who experience neonatal abstinence syndrome. In some instances, prescription opioid misuse can progress to intravenous heroin use with consequent increases in risk for HIV, hepatitis C, and other infections among individuals sharing needles.”

The researchers found that only 5% of those who misused opioids received treatment, while 17% of those with NMPOUD received help.

“NMPOU and NMPOUD have considerably increased over the past decade, are associated with a broad array of risk factors and comorbidities, and largely go untreated in the United States,” the researchers concluded.

The study authors called for more research into the characteristics and outcomes of NMPOU and NMPOUD, and they suggested that further information could be used for evidence-based interventions and prevention.

One way clinicians can help is by informing patients that combining opioids with sedative drugs is extremely dangerous.

“Given the dramatic increase in nonmedical use of prescription opioids, it is important that clinicians and patients also recognize the potent interaction of opioids with alcohol and other sedative-hypnotic drugs—an interaction that can be lethal,” said NIAAA Director George F. Koob, PhD, in a press release.

Meghan Ross, Senior Associate Editor

Articles

10 Health Concerns Linked to Childhood Obesity

Many STD-Negative Patients Receive Unnecessary Antibiotics

Texts Could Reduce Coronary Artery Disease Risk Factors

Nonmedical Opioid Use Has Doubled Over a Decade