Contemporary Clinic spoke with Dana DeShon, special interest group leader at NAPNAP, about National Influenza Vaccination Week, which is observed from December 6-12.

DeShon discusses the importance of continuing to get vaccinated through the holiday season and beyond, the change of perception towards vaccination due to the COVID-19 pandemic, and differentiating flu symptoms versus COVID-19 symptoms. 

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What to Know for National Influenza Vaccination Week 2020

Adults with type 2 diabetes (T2D) have a greater risk of developing cardiovascular disease (CVD) compared with the general population, even when risk factors associated with CVD are optimally controlled, according to research published in the American Heart Association's journal 

.

First author Alison Wright, PhD, a research associate at the Centre for Pharmacoepidemiology and Drug Safety at the University of Manchester in the United Kingdom, explained in a press release that previous studies investigating the association between T2D and CVD risk factors had demonstrated that people with T2D had little or no increased risk of CVD events or death when all risk factors are optimally controlled.

"Our team sought to determine how the degree of risk factor control in people with Type 2 diabetes impacted CVD risk and mortality compared to people with type 2 diabetes who had all risk factors optimally controlled and to people who do not have type 2 diabetes," Wright said in the press release.

The researchers analyzed data between 2006 and 2015 from the Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCI-Diabetes) dataset. After collecting the data, the researchers identified more than 101,000 people with T2D and matched them with approximately 379,000 people without diabetes in CPRD and nearly 331,000 with T2D in SCI-Diabetes.

When conducting the analysis, the researchers focused on 5 risk factors for CVD, including blood pressure, smoking, cholesterol, triglycerides, and blood glucose. They then assessed the association between future CVD events and death with these risk factors when the risk factors are optimally controlled. They also investigated whether the presence of cardiorenal (heart and kidney) disease had any impact on these connections as well.

The results demonstrated that only 6% of participants included in the analysis with T2D had all 5 risk factors within target range. Among patients with these 5 risk factors who had them optimally controlled, those patients with T2D were demonstrated to still have a 21% higher risk for CVD and 31% higher risk for hospitalization from heart failure than people without diabetes.

Additionally, the association between the number of increased risk factors and CVD event risk was greater in people with T2D who did not also have cardiorenal disease.

"People with type 2 diabetes should be treated for cardiovascular risk factors as early as possible, regardless of whether they have cardiovascular disease or not," Wright said in the press release. "There is real potential here to reduce the overall impact of type 2 diabetes on future cardiovascular events, especially for patients with type 2 diabetes who have not yet been diagnosed with CVD."

The researchers noted that although this research showed the importance of controlling all risk factors in patients, future research will investigate the individual risk factors that may have a greater impact on CVD risk and require targeted interventions.




Preventing heart disease should be a priority for people with Type 2 diabetes. Dallas, TX: American Heart Association; November 16, 2020. eurekalert.org/pub_releases/2020-11/aha-phd111620.php. Accessed November 17, 2020.

Articles

Adults with type 2 diabetes have a greater risk of developing cardiovascular disease (CVD) compared with the general population, even when risk factors associated with CVD are optimally controlled.

People With Type 2 Diabetes Have a Greater Risk of Cardiovascular Disease Even With Risk Factors Optimally Controlled

Randall A. Oyer, MD, president of the Association of Community Cancer Centers, and medical director at Penn Medicine’s Ann B. Barshinger Cancer Institute in Lancaster, Pennsylvania talks to 

® on the necessity of cancer screenings in the effort to reduce cancer mortality. The coronavirus disease 2019 (COVID-19) pandemic is projected to cause a spike in cancer deaths, which, according to Oyer, is due to the decline in screening since the pandemic began.

Cancer deaths are expected to spike due to COVID-19. 

Cancer Screenings Crucial for Mortality Reduction

Contemporary Clinic spoke with Daniel R. Wilson, MD, PhD, President of Western University of Health Sciences, about what to recommend to those who are struggling cognitively through the COVID-19 pandemic.

Wilson reminded those who may be stressed since the start of the pandemic to continue to take care of both your body and mind, such as eating well, sleeping well, and socializing when possible.

Wilson also shared his thoughts on what he hopes to see for the future of COVID-19 and the focus of future studies on it. 

The Future of Neurological Studies During COVID-19

According to 2 editorials in the journal 

, research in the nursing field has been critically influential to understanding evidence-based health care practice, care delivery, and policy during the coronavirus disease 2019 (COVID-19) pandemic. In order to investigate this influence further, researchers at the University of Pennsylvania School of Nursing assessed what the role of nursing research has been in supporting patients during the pandemic.

According to the authors of the guest editorial “Nursing Research Is Coronavirus Research

,” nursing practice has not only saved lives throughout the pandemic, but it has also played a critical role in understanding the nature of care for patients with COVID-19. The research conducted to understand this role further has helped to progress knowledge regarding the necessary elements of more supportive work environments that save patient lives and promote recovery in both hospitals and nursing homes.

Additionally, research in the field of nursing has helped to advance knowledge regarding how individuals sheltering at home with in-home nursing care are managing diets to support their health in light of chronic conditions, as well as how in-home nursing care has been able to stabilize chronic conditions during the pandemic.

The research in the field has also been able to bring to light lessons from the past around areas of concern for patients in order to positively impact policy around patient care during the pandemic.

"We know that nursing practice is saving lives in this pandemic. Nursing research also plays a critical role," write the authors of the guest editorial. “We support the move in universities to concentrate research on innovations directly related to the coronavirus crisis. But so much of nursing's research is coronavirus research. We applaud the search for reliable epidemiological data, effective treatments, and vaccines. We, though, must articulate nursing research's fundamental frame. We focus on the lived experiences of clinicians, patients, families, and communities.”

The author of the second editorial “How Effective Response to COVID-19 Relies on Nursing Research

,” Eileen T. Lake, PhD, the associate director of the Center for Health Outcomes and Policy Research and editor in chief of 

, explained further that throughout the pandemic, several clear challenges to an effective response to the public health crisis became evident. These challenges included the country’s restricted access to health care, the present surging demand for health care personnel, and the moral distress that many health care providers face during the pandemic.

Lake also noted that in order to better help institutions meet the demands that the COVID-19 pandemic posed to the health care system, nursing research was critical to effectively inform crucial elements of policy response and institutional preparedness.

"Nursing research provides answers during crises," writes Lake in the editorial. “In a time of profound upheaval, risk, and strain, it is reassuring to have evidence-based solutions to the challenges confronting our health care system and its clinicians.”

Nursing research informs response to COVID-19 pandemic. Philadelphia, PA: University of Pennsylvania School of Nursing; April 27, 2020. eurekalert.org/pub_releases/2020-04/uops-nri042720.php. November 30, 2020.

D’Antonio P, Naylor M, Aiken L. Nursing research is coronavirus research. 

Lake ET. How effective response to COVID‐19 relies on nursing research. 

2020;43(3):213-214. doi: 10.1002/nur.22025.

According to 2 editorials, research in the nursing field has been critically influential to understanding evidence-based health care practice, care delivery, and policy during the COVID-19 pandemic.

Nursing Research Has Been Critical to Improving the COVID-19 Pandemic Response

Favipiravir may be a beneficial treatment for mild-to-moderate coronavirus disease 2019 (COVID-19), according to a study published in the 

International Journal of Infectious Diseases

The COVID-19 pandemic has caused over 1.39 million deaths and there have been more than 59.2 million confirmed cases worldwide, according to the World Health Organization.

 Favipiravir is an RNA-dependent RNA polymerase (RdRp) inhibitor that is approved in Japan and China for the treatment of novel influenza virus.

Currently, 2 other trials have demonstrated that favipiravir has an advantage over other antivirals in treating COVID-19. Additionally, it is estimated that over 80% of patients with COVID-19 experience mild-to-moderate illness. However, very little antiviral research has investigated therapeutic interventions in this patient group.

The randomized, open-label phase 3 study took place across 7 sites in India. Study participation had a maximum treatment period of 28 days. Care was provided past the 14-day mark based on investigator judgement. The control arm received standard of care alone while the study group received standard of care plus favipiravir. Drugs with suspected antiviral activity against SARS CoV-2, including hydroxychloroquine, were prohibited.

Patients treated with favipiravir met the primary end point of median time to RT-PCR negativity 28.7% sooner than those treated with standard of care alone. However, according to the study, the median time to viral clearance was shorter in the control group (7 days) than in the study group (11 days). The statistically significant endpoint was not achieved.

“Faster viral clearance would be expected to reduce the duration of infectivity during the early course of disease, which would yield critical reductions in the secondary attack rate, duration of quarantine, and burden on health care providers and facilities,” study authors write.

Favipiravir was found to be well tolerated, and no adverse events led to drug discontinuation. One patient in the control group died of acute respiratory distress syndrome.

1. Udwadia, Zarir, et al. Efficacy and Safety of Favipiravir, an Oral RNA-Dependent RNA Polymerase Inhibitor, in Mild-to-Moderate COVID-19: A Randomized, Comparative, Open-Label, Multicenter, Phase 3 Clinical Trial. November 8, 2020. 

https://doi.org/10.1016/j.ijid.2020.11.142

2. WHO Coronavirus Disease (COVID-19) Dashboard

. The World Health Organization. Accessed November 25, 2020. 

The drug, which is approved for use in Japan and China, may help those with mild-to-moderate COVID-19. 

Favipiravir May be an Effective COVID-19 Treatment

A new study from researchers at the University of California (UC) Davis found that eating Ataulfo mangoes, also known as honey or champagne mangoes, may reduce facial wrinkles in older women with fairer skin.

Postmenopausal women who ate a half cup of Ataulfo mangoes 4 times a week saw a 23% decrease in deep wrinkles after 2 months and a 20% decrease after 4 months, according to the study authors.

“That’s a significant improvement in wrinkles,” said lead study author Vivien Fam, RDN, LDN, a doctoral student in the UC Davis Department of Nutrition, in a press release. “Women who ate a cup and a half of mangoes for the same periods of time saw an increase in wrinkles. This shows that while some mango may be good for skin health, too much of it may not be.”

The pilot study involved 28 postmenopausal women with Fitzpatrick skin types 2 or 3, or skin that burns more easily than it tans. The women were divided into 2 groups, with 1 group consuming a half cup of mangoes 4 times a week for 4 months, and the other group consuming a cup and a half of mangoes for the same period of time. Facial wrinkles were evaluated using a high-resolution camera system, according to the study authors.

“The system we used to analyze wrinkles allowed us to not just visualize wrinkles, but to quantify and measure wrinkles,” said study author Robert Hackman, PhD, professor in the Department of Nutrition, in a press release. “This is extremely accurate and allowed us to capture more than just the appearance of wrinkles or what the eye might see.”

Additionally, the study looked at the severity, length, and width of fine, deep, and emerging wrinkles. The study authors noted that the group that consumed a half cup of mangoes saw improvements in all categories.

Further research is needed to learn the mechanisms behind the reduction in wrinkles, considering the beneficial effects of carotenoids and other phytonutrients that could help build collagen, according to the study authors.




Can eating mangoes reduce women’s facial wrinkles? UC Davis. 

https://www.ucdavis.edu/news/can-eating-mangoes-reduce-womens-facial-wrinkles/

. Published November 19, 2020. Accessed November 23, 2020.


Although women who hate half a cup of mangoes 4 times a week saw a reduction in wrinkles, women who ate more mangoes saw an increase, suggesting that too much may have the opposite intended effect. 

Study: Eating Mangoes Can Reduce Women’s Facial Wrinkles

Officials with the FDA expanded the approved indication for baloxavir marboxil (Xofluza; Genentech) to include post-exposure prevention of influenza for patients aged 12 years and older, after contact with an individual who has the flu. The therapy previously available only in tablet form, is also now available as granules for mixing in water.

Baloxavir marboxil was originally 

 for treating uncomplicated flu in patients aged 12 years and older who have been symptomatic for no more than 48 hours. Its’ indication was first 

 for patients aged 12 years and older who are at high risk for developing influenza-associated complications.

Baloxavir marboxil’s safety and efficacy for post-flu exposure prevention is supported by a randomized, double-blind, controlled trial in which 607 subjects, aged 12 years and older who were exposed to a person with influenza in their household, received either a single dose of baloxavir marboxil or a single dose of a placebo. Of these 607 subjects, 303 received baloxavir marboxil and 304 received the placebo.

According to the FDA, the trial’s primary endpoint was the proportion of subjects who were infected with influenza virus and presented with fever and at least 1 respiratory symptom from day 1 to day 10. Of those who received baloxavir marboxil, 1% of subjects met these criteria, compared to 13% of subjects who received a placebo for the clinical trial.
The most common adverse effects of baloxavir marboxil include diarrhea, bronchitis, nausea, sinusitis and headache. Additionally, hypersensitivity, including anaphylaxis, can occur in patients taking baloxavir marboxil.

Patients should be advised not be co-administer baloxavir marboxil with dairy products, calcium-fortified beverages, or laxatives, antacids, or oral supplements containing calcium, iron, magnesium, selenium, aluminum or zinc.

Flu is a contagious respiratory illness caused by influenza viruses. According to the FDA, treating flu patients with antiviral drugs within 48 hours of their becoming sick can reduce symptoms and duration of the illness. An annual seasonal flu vaccine is the best way to protect against the flu.






FDA Expands Approval of Influenza Treatment to Post-Exposure Prevention [news release]. Silver Spring, MD; November 23, 2020: FDA. Accessed November 23, 2020. 

https://www.fda.gov/news-events/press-announcements/fda-expands-approval-influenza-treatment-post-exposure-prevention

Officials with the FDA expanded the approved indication for baloxavir marboxil (Xofluza; Genentech) to include post-exposure prevention of influenza for patients aged 12 years and older, after contact with an individual who has the flu.

FDA Expands Indication of Antiviral Therapy to Include Post-Exposure Influenza Prevention

Contemporary Clinic spoke with Daniel R. Wilson, MD, PhD, President of Western University of Health Sciences, about the impact that COVID-19 is having on the brain.

Wilson explained how certain people with COVID-19 are experiencing post-COVID-19 symptoms of cognitive changes, such as clarity in thinking and memory. 

In addition, Wilson also discusses the importance of focusing on the cognitive long-term effects of the virus and specific trials regarding this topic. 

The Neurological Impact of COVID-19

, patient with diabetes Phyllisa Deroze, PhD, and Joseph Delahunty, Global Head of Communications at Ascensia Diabetes Care, said that supporting patients’ mental health is just as important as their physical health, especially when it comes to chronic conditions, such as diabetes.

Deroze is a participant in Ascensia Diabetes Care’s 2020 World Diabetes Day campaign, which promoted the theme “Nurses Make the Difference for Diabetes” by sharing videos of 28 patients with diabetes who have written letters to their nurses to express their appreciation and gratitude. Deroze said she wrote about a nurse who gave her the skills and confidence to administer her own insulin and supported her during the emotional period following her diagnosis.

“[Nurses] really are a key and central part of diabetes management,” Delahunty said. “Some of the key messages this year are not just highlighting the important role that they play, but also the need to have more nurses and the importance in investing in education and training for nurses so that they have the right expertise to help people with diabetes.”

Supporting patients’ mental health is just as important as their physical health, especially when it comes to chronic conditions, such as diabetes.