Effect of a Financial Education and Coaching Program for Low-Income, Single Mother Households on Child Health Outcomes.

The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017-2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes.

Time in Nature: A Prescription for the Prevention or Management of Hypertension.

Growing evidence suggests time in nature may positively influence a broad range of health outcomes including blood pressure. The mechanism(s) by which nature exerts this influence is not fully understood, but it has been proposed that nature or natural environments promote health due to opportunities for physical activity and stress reduction. Experimental and observational studies suggest that time in forests or other green spaces is associated with reduced blood pressure, lower prevalence of hypertension, and reduced odds of using antihypertensive medications. Therefore, prescribing time in nature for patients at risk or diagnosed with hypertension may have substantial benefits.

Potential Benefit of Vitamin D Supplementation in COVID-19.

Vitamin D is an important nutrient in the body that plays a vital role in immune system function. Several epidemiologic studies have shown that low vitamin D levels are found in a large percentage of COVID-19 patients with acute respiratory failure and that vitamin D levels may predict mortality in COVID-19 infection. Based on these findings, vitamin D supplementation may be an effective approach to preventing and/or treating COVID-19. Potential underlying mechanisms and clinical trial data evaluating the impact of supplementation in humans are described below.

Drug-Induced Microbiome Changes: Considerations in Pregnancy.

During pregnancy, the maternal microbiome is associated with both the health of the mother as well as the developing fetus. Several classes of drugs are known to influence the microbiome and their use in pregnancy may impact maternal/fetal outcomes and long-term health of offspring. The drug-microbiome interactions of antibiotics, proton pump inhibitors, laxatives, metformin, and probiotics will be described, along with considerations for use of these agents in pregnancy.

Potential Benefits of Curcumin in Rheumatoid Arthritis.

Widely known as a curry spice, curcumin has a long history of use in the treatment of inflammatory conditions in Eastern Medicine. The spice is gaining interest in modern medicine for a diverse array of conditions, including rheumatoid arthritis. Evidence indicates curcumin can effectively suppress inflammation through inhibition of pro-inflammatory cytokine production as well as modulate B cell and T cell differentiation and function. The following article will evaluate the existing clinical trial literature assessing the impact of curcumin on patients with rheumatoid arthritis. Potential mechanisms of action, bioavailability issues, and effective dosing will be described.

Vaccine Equity: Lessons Learned from the COVID-19 Pandemic.

The COVID-19 pandemic has disproportionately affected racial and ethnic minorities, a group who is also less likely to be fully vaccinated. Vaccine hesitancy and vaccine access both play a role in the vaccine inequities observed during the COVID-19 pandemic. Strategies to improve access and reduce hesitancy are discussed.

Vitamin B12 and Plant-Predominant Diets.

Vitamin B12 deficiencies are common in individuals consuming plant-predominant diets, including those who consume diary and/or eggs. Deficiencies can lead to megaloblastic anemia and peripheral neuropathy, among other multi-system manifestations. The prevalence, assessment and prevention of vitamin B12 deficiency in patients following plant-predominant diets will be discussed.

Maintaining Good Oral Health With Fluoridated Water.

Community water fluoridation (CWF) has been a public health measure against tooth decay since 1945. Strong evidence supports the use of CWF in reduction in caries risk in the pediatric population, and numerous studies also show benefit in adults. CWF remains an important contributor to oral health despite the availability and widespread use of other fluoride-containing dental products. The efficacy, safety, and optimal use of CWF will be discussed.

Gluten, Inflammation, and Neurodegeneration.

Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.

Mitigating Medication-Related Fall Risk Through Pharmacist-Prescriber Collaboration.

Medications are known to increase the risk for fall in older adults, and pharmacists can contribute to fall risk prevention through medication therapy management services. STEADI-Rx is an initiative developed to facilitate fall risk reduction through pharmacist-prescriber collaboration. Key components of the STEADI-Rx algorithm are described as well as evidence supporting its integration in practice.

Produce Prescriptions, Food Pharmacies, and the Potential Effect on Food Choice.

When it comes to health and longevity, what we eat may be the most important choice we make on a daily basis. This choice is influenced by a variety of determinants, including cost and accessibility of healthy foods as well as knowledge, attitudes and beliefs about how food impacts health. Produce prescriptions and food pharmacies are innovative care models directed at promoting intake of healthy foods. These programs as well as their potential effect on food choice is described.

Using the SMART-EST Goals in Lifestyle Medicine Prescription.

Lifestyle modifications can effectively decrease chronic disease risk but studies show little to no time during patient encounters is spent on lifestyle medicine counseling. The SMART-EST goal framework facilitates both a rich discussion of lifestyle medicine and a comprehensive patient-centered action plan for health behavior change. The tenets of the SMART-EST goal-setting process are discussed.

Flash Glucose Monitoring Technology Impact on Diabetes Self-Care Behavior.

Individuals with diabetes play a significant role in the control of their condition by participating in their own care. Self-monitoring of blood glucose is of particular importance in maintaining adequate glycemic control but when obtained using traditional fingerstick methods, is often limited with by cost, fear of needles or pain and inconvenience. Flash glucose monitoring is an innovative technology available to address these barriers and help people with diabetes better manage their blood glucose levels. Data demonstrating increased frequency in glucose monitoring, patient perspectives related to self-care behaviors, and implications for practice and future research are described.

Financial Education and Coaching: A Lifestyle Medicine Approach to Addressing Financial Stress.

Economic stability is a well-documented social determinant of health, and financial stress is an important driver for the health disparities observed in the poor. Persons under financial stress are more likely to engage in smoking, alcohol consumption, overspending, poor diet, and reduced exercise. Financial education and coaching is one strategy that can be used to reduce financial stress and potentially improve engagement in healthy lifestyle behaviors, quality of life, and objective health outcomes. A conceptual model describing the link between financial education/coaching and health is described along with preliminary data from a randomized controlled trial evaluating this intervention.

Messaging and Multivitamin Use: Rethinking the "It Can't Hurt" Philosophy.

Fifty-two percent of American adults report use of a dietary supplement, most commonly for improved health and disease prevention. However, literature supporting such use is inconsistent. Many providers suggest that the addition of a multivitamin "couldn't hurt," but this messaging may promote unintentional consequences including a shift of emphasis on intake of healthy foods to nutrient supplements and a neglected opportunity to discuss the profound benefits of a healthy diet. Potential implications of such messaging and recommendations for counseling are described.

Approaches to Reduce Sports Drink Consumption Among Adolescents.

Sports drinks originally developed to improve performance and prevent or treat dehydration, heat stroke, and muscle cramps in elite athletes are consumed regularly by nearly 60% of the adolescent population. Sports drinks are often perceived as healthy, and marketing campaigns fail to delineate the types and amount of activity that warrant appropriate use. Current trends in adolescent consumption of sports drinks will be reviewed and approaches to reduce consumption, including counseling on the appropriate use of sports drinks, will be discussed.

Increasing Naloxone Access and Use to Prevent Opioid Overdose Death and Disability.

In 2018, the Surgeon General released a public health advisory emphasizing the importance of naloxone in preventing opioid overdose deaths. Legislation is rapidly changing to simplify the process of obtaining naloxone by expanding who can receive and distribute the life-saving drug. Even with legislation in place expanding access to naloxone, the drug is underutilized and health care providers are responsible for ensuring these efforts are put to use within their practice. Legislative changes will be summarized and the role of the health care provider will be discussed.

Long-Term Outcomes of a Cardiovascular and Diabetes Risk-Reduction Program Initiated by a Self-Insured Employer.

BACKGROUND: Cardiovascular disease remains the leading cause of death in America and poses a significant challenge for self-insured employers attempting to improve employee health and well-being while controlling healthcare costs. Disease state management programs can be an effective means of achieving these outcomes, but the durability and long-term effects of such programs have limited evaluation. OBJECTIVE: To assess the 5-year health, economic, and quality-of-life patient outcomes of an employer-sponsored disease state management program. METHODS: This was a longitudinal, 5-year, quasi-experimental, pre-/postenrollment study. Self-insured health plan members with hypertension, hyperlipidemia, diabetes, or a combination of these conditions met with a pharmacist regularly (monthly for the first year, then varied by participant) to implement lifestyle medicine programs, optimize medication therapy, and facilitate the coordination of care. Biometric markers, lifestyle behaviors, quality of life, and work productivity were assessed on an annual basis. RESULTS: The significant biometric improvements (mean) seen after 5 years of program participation compared with pre-enrollment included decreased low-density lipoprotein cholesterol levels (96.71 mg/dL vs 84.83 mg/dL, respectively), increased high-density lipoprotein cholesterol levels (39.32 mg/dL vs 46.12 mg/dL), and decreased systolic blood pressure (132.04 mm Hg vs 123.63 mm Hg) and diastolic blood pressure (85.75 mm Hg vs 75.83 mm Hg). The average exercise time increased (50 minutes weekly vs 156.04 minutes weekly), as did fruit and vegetable consumption (3.98 servings daily vs 5.27 servings daily). The program participants reported improved general health and a reduced number of unhealthy days. The combined healthcare and productivity return on investment for the program at 5 years was $9.64 for every $1 invested. CONCLUSIONS: Significant changes in employees' health, well-being, and health-related costs are possible through sustained participation in an employer-sponsored disease state management program.

Lifestyle and Pharmacotherapy for Weight Loss in Preventing or Delaying Diabetes.

Preventing or delaying the conversion of prediabetes to overt diabetes can reduce mortality and morbidity rates, improve health-related quality of life, and reduce other comorbid complications associated with diabetes. Studies have shown that a modest weight loss is one strategy for preventing or delaying diabetes diagnosis. First-line therapy in preventing progression of prediabetes to overt diabetes is weight loss through lifestyle modifications; however, pharmacotherapy for weight loss may be initiated if lifestyle alone is ineffective. The purpose of this article is to describe the pharmacotherapeuptic options for weight loss that can be used in conjunction with lifestyle in the prevention or delay of diabetes in patients with prediabetes.

Prevention of Pediatric Pharmaceutical Poisonings.

Pediatric poisoning remains a common, preventable childhood injury and incidence is on the rise. Child-resistant packaging has been shown to prevent pharmaceutical poisoning, but must be applied and used appropriately to be effective. Prescription drug use among adults is also increasing and may be contributing to the problem through a greater number of medications in the child's environment. Drug take back programs are designed to reduce the number of unused medications in the home. These programs are expanding and health care providers should be aware of and encourage safe drug disposal practices.