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.

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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.

Nonmedical Opioid Use Has Doubled Over a Decade

Nurse practitioners, physician assistants, and the patients they care for should be aware that working long hours regularly is associated with a few chronic diseases.

This association is especially true for women, according to a study published in the

Journal of Occupational & Environmental Medicine.

The researchers sought to determine any links between long work schedules and 8 major chronic diseases: heart disease, non-skin cancer, arthritis, diabetes, chronic lung disease, asthma, chronic depression, and hypertension. To do so, they used data from the National Longitudinal Survey of Youth, which collected the job histories of nearly 7500 individuals between 1978 and 2009. The survey examined health status and chronic conditions, in addition to hours worked.

The majority of those surveyed worked more than 40 hours. Around 56% worked between 41 and 50 hours, and 13% worked between 51 and 60 hours. Around 3% worked more than 60 hours, on average.

The researchers found that over the 32-year period, working long hours on a regular basis was linked to a higher risk for the following 4 conditions among women:

Women who worked around 60 hours per week or more over 3 decades seemed to have 3 times the risk of developing these conditions. The risk climbs at more than 40 hours and “takes a decidedly bad turn above 50 hours,” according to an Ohio State University press release.

In the press release, lead study author Allard Dembe, ScD, a professor of health services management and policy at Ohio State University, theorized that women may be struck harder by long work hours because they may have more responsibilities on top of work, which might make work feel less satisfying.

“Perhaps the additional demands that women face—such as pregnancy, raising children, and domestic responsibilities&mdash;are partially responsible for the much greater risk for women, compared with men, that was observed in this study,” Dr. Dembe told

In fact, men who worked around 41 to 50 hours actually had lower risk of heart disease, lung disease, and depression compared with men who worked 40 hours or fewer. The one chronic condition that was linked to working long hours in men was arthritis.

Dr. Dembe pointed out that there may be a difference between an individual being forced to work overtime and he or she deciding to work overtime.

“You might still be working hard, but the fact that it’s your choice might help you stay healthier,” he said.

Dr. Dembe suggested that health coaching at the workplace, flexible schedules, screening, and support could help prevent employees from developing these conditions. Companies that are vigilant about preventing their employees from working too many hours can benefit from lower medical costs and better quality of work.

“The study suggests that more emphasis should be placed on early screening for chronic disease, especially among patients who work long-hour shifts, for example, an average of more than 50 or 60 hours per week,” Dr. Dembe told

4 Chronic Diseases Linked to Working Long Hours

Retail clinicians should make sure that their female patients at high risk for atrial fibrillation-related stroke are on appropriate therapy, as new study results published in

suggest that women aren’t prescribed blood thinners as often as men.

This retrospective study involved around 1500 adults aged 28 to 93 years with nonvalvular atrial fibrillation between March 2013 and February 2014. The patients were treated based on an atrial fibrillation decision support tool (AFDST) that considered quality-adjusted life expectancy and risk factors for stroke and hemorrhage.

The researchers found that treatment was discordant from AFDST-recommended treatment in 45% of women and 39% of men. In 44% of female cases, the women took aspirin or no therapy when oral anticoagulant therapy was recommended by AFDST.

“Women were 1.8 times as likely to be undertreated as men,” the researchers stated.

Lead study author Mark H. Eckman, MD, professor and director of the Division of General Internal Medicine and the Center for Clinical Effectiveness at University of Cincinnati Medical Center, told

that the research team was disappointed, but not surprised, that these results matched what has been seen nationally in terms of women being undertreated with blood thinners to prevent stroke related to atrial fibrillation.

The research team similarly discovered that seniors were often undertreated and only taking aspirin as their sole antithrombotic agent. Nurse practitioners and physician assistants should be aware that elderly patients who only take aspirin instead of oral anticoagulant therapy face a greater risk of bleeding and are probably seeing little or no help in stroke prevention from the aspirin.

In the past, prescribers have cited that they see fall risk, dementia, and nonadherence as barriers to their willingness to prescribe warfarin to elderly patients. However, the current researchers argued that given the higher risk of atrial fibrillation-related stroke in elderly adults, the benefits of oral anticoagulant therapy outweigh the risks.

Overall, 37% of patients who should have been prescribed oral anticoagulant therapy were only taking aspirin or no therapy at all.

“We found that the reason for discordant treatment in women and the elderly was under-use of blood-thinning therapy, while in men and younger patients, a larger proportion of discordance was due to overtreatment,” Dr. Eckman noted.

Those aged 31 to 50 years were most likely to be overtreated.

Dr. Eckman’s take-home message for practitioners was that women face higher risks for atrial fibrillation-related stroke even after controlling for other risk factors, such as hypertension, diabetes, or heart failure. In addition, women’s risk for death from atrial fibrillation is underappreciated.

“Therefore, we must be especially vigilant to make sure that we are aggressive enough in prescribing appropriate blood thinning therapy (oral anticoagulants) in women at high risk of atrial fibrillation-related stroke, using tools such as the CHA

c to assess stroke risk,” Dr. Eckman said.

Atrial fibrillation is expected to affect 3 million Americans by 2020. By 2050, around half of Americans with atrial fibrillation will be aged 80 years or older.

Retail clinicians should make sure that their female patients at high risk for atrial fibrillation-related stroke are on appropriate therapy, as new study results published in Journal of the American Geriatrics Society suggest that women arenâ€™t prescribed blood thinners as often as men.