In the United States, the COVID-19 pandemic is affecting Indigenous communities to a disproportionate degree. In this Special Feature, we bring into focus some of the mental health effects and challenges that Indigenous people face as a result of the pandemic.

Since the pandemic started, it has become increasingly clear that COVID-19 affects certain communities to a disproportionate degree. Race, biological sex, age, and socioeconomic status are some of the factors that can amplify the impact of the new coronavirus.

At Medical News Today, we’ve started to examine the racialized impact of this global pandemic, and specifically the toll that it takes on more vulnerable communities in the U.S.

In this feature, we continue by focusing on how the pandemic affects Indigenous populations in the U.S. and Canada.

“American Indians are dying of neglect’

As experts have pointed out, the COVID-19 data for Indigenous communities in the U.S. are reported inconsistently. This is partly due to racial misclassification.

Some states record data for Indigenous people with the groupings: “American Indian/Alaska Native,” “Native Hawaiian,” and “Other Pacific Islanders,” while other states lump them all together under the category “Other.”

This confusing way of reporting, together with the fact that the federal government does not collect data on all ethnicities and races equally across the country, makes it difficult to gauge with precision the impact that the pandemic is having on Indigenous communities in the U.S.

However, taking the still incomplete data concerning COVID-19 cases and deaths together with established information about social determinants of health in these communities indicates that the pandemic is hitting Indigenous people particularly hard.

For example, a frequently updated report by the nonpartisan American Public Media Research Lab found that Black Americans and Indigenous Americans are taking the brunt of the pandemic throughout the country.

The report estimates that 1 in 1,500 Black Americans have died of COVID-19, followed by 1 in 2,300 Indigenous Americans.

In some states, Indigenous populations are disproportionately affected, compared with their population share.

New Mexico is a stark example — here, Indigenous Americans make up only 8.8% of the population, but account for over 60% of deaths.

The Navajo Nation, a territory that spans parts of New Mexico, Arizona, and Utah, made international headlines for having the highest infection rates per capita, compared with any U.S. state.

Furthermore, a report from the Kaiser Family Foundation warned that American Indian or Alaska Native adults have the highest risk of developing severe illness if they contract the new coronavirus, compared with all other racial and ethnic groups.

Specifically, 34% of American Indian or Alaska Native people aged 18–64 had a higher risk of severe illness, compared with 21% of white people in this age range.

In a teleconference organized by the Robert Wood Johnson Foundation (RWJF), a philanthropic public health organization in Princeton, NJ, Dr. Donald Warne, associate dean of diversity, equity, and inclusion at the University of North Dakota School of Medicine & Health Sciences, spoke about the challenges that Indigenous communities in the U.S. face.

Limited access to healthcare, overcrowded and multigenerational housing, high rates of poverty and chronic disease, and limited access to clean water and grocery stores are only some of the social determinants of physical health in these communities during the pandemic.

A lack of testing and contact-tracing facilities in these communities further amplifies these disparities. Also, traditional practices involving large social gatherings to mark special events, such as harvests or coming of age ceremonies, may contribute to the spread of the virus.

A new analysis argues for the need to address food insecurity by recognizing the interconnected nature of global food systems.

This vast network of cells and tissues is constantly on the lookout for invaders, and once an enemy is spotted, a complex attack is mounted.

The immune system is spread throughout the body and involves many types of cells, organs, proteins, and tissues. Crucially, it can distinguish our tissue from foreign tissue — self from non-self. Dead and faulty cells are also recognized and cleared away by the immune system.

If the immune system encounters a pathogen, for instance, a bacterium, virus, or parasite, it mounts a so-called immune response. Later, we will explain how this works, but first, we will introduce some of the main characters in the immune system.

WHITE BLOOD CELLS

White blood cells are also called leukocytes. They circulate in the body in blood vessels and the lymphatic vessels that parallel the veins and arteries.

White blood cells are on constant patrol and looking for pathogens. When they find a target, they begin to multiply and send signals out to other cell types to do the same.

Our white blood cells are stored in different places in the body, which are referred to as lymphoid organs. These include the following:

• Thymus — a gland between the lungs and just below the neck.
• Spleen — an organ that filters the blood. It sits in the upper left of the abdomen.
• Bone marrow — found in the center of the bones, it also produces red blood cells.
• Lymph nodes —small glands positioned throughout the body, linked by lymphatic vessels.

There are two main types of leukocyte:

1. Phagocytes

These cells surround and absorb pathogens and break them down, effectively eating them. There are several types, including:

• Neutrophils — these are the most common type of phagocyte and tend to attack bacteria.
• Monocytes — these are the largest type and have several roles.
• Macrophages — these patrol for pathogens and also remove dead and dying cells.
• Mast cells — they have many jobs, including helping to heal wounds and defend against pathogens.

2. Lymphocytes

Lymphocytes help the body to remember previous invaders and recognize them if they come back to attack again.

Lymphocytes begin their life in bone marrow. Some stay in the marrow and develop into B lymphocytes (B cells), others head to the thymus and become T lymphocytes (T cells). These two cell types have different roles:

• B lymphocytes — they produce antibodies and help alert the T lymphocytes.
• T lymphocytes — they destroy compromised cells in the body and help alert other leukocytes.

HOW AN IMMUNE RESPONSE WORKS

The immune system needs to be able to tell self from non-self. It does this by detecting proteins that are found on the surface of all cells. It learns to ignore its own or self proteins at an early stage.

An antigen is any substance that can spark an immune response.

In many cases, an antigen is a bacterium, fungus, virus, toxin, or foreign body. But it can also be one of our own cells that is faulty or dead. Initially, a range of cell types works together to recognize the antigen as an invader.

The role of B lymphocytes

Once B lymphocytes spot the antigen, they begin to secrete antibodies (antigen is short for “antibody generators”). Antibodies are special proteins that lock on to specific antigens.

Each B cell makes one specific antibody. For instance, one might make an antibody against the bacteria that cause pneumonia, and another might recognize the common cold virus.

Antibodies are part of a large family of chemicals called immunoglobulins, which play many roles in the immune response:

• Immunoglobulin G (IgG) — marks microbes so other cells can recognize and deal with them.
• IgM — is expert at killing bacteria.
• IgA — congregates in fluids, such as tears and saliva, where it protects gateways into the body.
• IgE — protects against parasites and is also to blame for allergies.
• IgD — stays bound to B lymphocytes, helping them to start the immune response.

Antibodies lock onto the antigen, but they do not kill it, only mark it for death. The killing is the job of other cells, such as phagocytes.

The role of T lymphocytes

There are distinct types of T lymphocytes:

Helper T cells (Th cells) — they coordinate the immune response. Some communicate with other cells, and some stimulate B cells to produce more antibodies. Others attract more T cells or cell-eating phagocytes.

Killer T cells (cytotoxic T lymphocytes) — as the name suggests, these T cells attack other cells. They are particularly useful for fighting viruses. They work by recognizing small parts of the virus on the outside of infected cells and destroy the infected cells.

Everyone’s immune system is different but, as a general rule, it becomes stronger during adulthood as, by this time, we have been exposed to more pathogens and developed more immunity.

That is why teens and adults tend to get sick less often than children.

Once an antibody has been produced, a copy remains in the body so that if the same antigen appears again, it can be dealt with more quickly.

That is why with some diseases, such as chickenpox, you only get it once as the body has a chickenpox antibody stored, ready and waiting to destroy it next time it arrives. This is called immunity.

There are three types of immunity in humans called innate, adaptive, and passive:

IMMUNITY

Innate immunity

We are all born with some level of immunity to invaders. Human immune systems, similarly to those of many animals, will attack foreign invaders from day one. This innate immunity includes the external barriers of our body — the first line of defense against pathogens — such as the skin and mucous membranes of the throat and gut.

This response is more general and non-specific. If the pathogen manages to dodge the innate immune system, adaptive or acquired immunity kicks in.

Adaptive (acquired) immunity

This protect from pathogens develops as we go through life. As we are exposed to diseases or get vaccinated, we build up a library of antibodies to different pathogens. This is sometimes referred to as immunological memory because our immune system remembers previous enemies.

Passive immunity

This type of immunity is “borrowed” from another source, but it does not last indefinitely. For instance, a baby receives antibodies from the mother through the placenta before birth and in breast milk following birth. This passive immunity protects the baby from some infections during the early years of their life.

Immunizations

Immunization introduces antigens or weakened pathogens to a person in such a way that the individual does not become sick but still produces antibodies. Because the body saves copies of the antibodies, it is protected if the threat should reappear later in life.

Researchers have developed an automated system for people with type 1 diabetes. The AI-based system provides advice to help these individuals avoid dangerously low blood glucose levels.

Could AI help people manage type 1 diabetes?

A preliminary study suggests that the system’s weekly recommendations on insulin doses and diet closely match those that diabetes specialists provide.

People with type 1 diabetes produce insufficient insulin, the hormone that the body uses to regulate blood glucose levels.

To maintain optimal glucose levels and avoid episodes of dangerously low or high blood sugar levels — known as hypoglycemia and hyperglycemia, respectively — people with this condition must take carefully controlled doses of insulin.

Many people with type 1 diabetes manage their condition successfully using a dosing regimen known as multiple daily injections, which involves injecting a long acting form of insulin once or twice a day, plus fast acting insulin at each mealtime.

In between mealtimes, they also have the option of injecting “correction doses” of fast acting insulin if their blood sugar levels rise too high.

However, repeated dosing errors over time increase a person’s risk of progressive damage to their eyesight, nervous system, and kidneys, and an acute episode of hypoglycemia can lead to coma or even death.

Too much or too little

Diabetes specialists at Oregon Health & Science University (OHSU) in Portland say that several factors can lead to people giving themselves too much or too little insulin.

These factors include difficulty calculating doses, fears about overdosing, and changes in the body’s insulin sensitivity during exercise, illness, stress, and menstruation.

Endocrinologists (doctors who specialize in hormone disorders) can offer advice on any adjustments that a person needs to make to their dosing regimen and diet, but people may go for several months without an appointment.

To address this problem, researchers at OHSU used artificial intelligence (AI) to develop an algorithm that gives people weekly guidance based on data from a continuous glucose monitor, insulin pens for injecting insulin, and a wearable device that monitors physical activity.

In its final version, the algorithm issues its advice via a smartphone app called DailyDose.

The research appears in the journal Nature Metabolism.

Virtual patients

To train their AI algorithm to issue advice, the researchers used virtual patients — mathematical representations of how a real person’s metabolism responds to food, insulin injections, and exercise.

To check that the resulting algorithm’s recommendations were accurate and safe, they fed it data from 25 real patients who were receiving treatment at OHSU. They then asked a panel of endocrinologists to review the same data and issue their advice.

The researchers report that recommendations from the algorithm tallied with those from the endocrinologists 67.9% of the time.

For comparison, they cite evidence suggesting that endocrinologists fully agree with each other about insulin advice to patients only about 41% of the time.

“Our system design is unique,” says lead author Nichole Tyler, a medical and doctoral student in the OHSU School of Medicine. “We designed the AI algorithm entirely using a mathematical simulator, and yet, when the algorithm was validated on real-world data from people with type 1 diabetes at OHSU, it generated recommendations that were highly similar to recommendations from endocrinologists.”

Based on almost 100 weeks of patient data, the endocrinologists also judged the algorithm’s advice to be safe more than 99% of the time.

Culled from medicalnewstoday.com

Culled from www.medicalnewstoday.com

Have you ever heard that taking vitamin D supplements or following a ketogenic (keto) diet will protect you from the new coronavirus? In this Special Feature, we explain why these and other persistent myths are not grounded in science.
Some coronavirus claims keep making an appearance, but most are not grounded in scientific fact.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 outbreak.

Even before the World Health Organization (WHO) declared the new coronavirus outbreak a “pandemic,” their director general, Dr. Tedros Adhanom Ghebreyesus, warned of the danger associated with spreading false information about the virus.
At a conference on February 15, 2020, he declared that “we’re not just fighting an epidemic; we’re fighting an infodemic.”

“Fake news spreads faster and more easily than this virus and is just as dangerous,” he emphasized.
However, it can be difficult to tell what is credible and what is not given the sheer quantity of information that people are sharing both on and offline.
Previously on Medical News Today, we compiled a list of 28 myths surrounding the new coronavirus (SARS-CoV-2). In this Special Feature, we will take an in-depth look at five more persistent myths and explain why people should not take them at face value.

Myth 1: Vitamin D prevents infection
Some articles claim that if a person takes vitamin D supplements, they will be less likely to contract SARS-CoV-2.
In part, people have based these claims on a controversial paper that appears in the journal Aging Clinical and Experimental Research.
The paper’s authors claim to have found a correlation between low mean levels of vitamin D in the populations of certain countries and higher rates of COVID-19 cases and related deaths in those same countries.
Based on this correlation, the authors hypothesize that supplementing the diet with vitamin D may help protect against COVID-19. However, there is no evidence to suggest that this would actually be the case.
In a rapid review of the evidence published on May 1, 2020, researchers from the Centre for Evidence-Based Medicine at the University of Oxford in the United Kingdom unequivocally conclude: “We found no clinical evidence on vitamin D in [the prevention or treatment of] COVID-19.”

They also write that “[t]here was no evidence related to vitamin D deficiency predisposing to COVID-19, nor were there studies of supplementation for preventing or treating COVID-19.”
Other researchers who have conducted reviews of the existing data surrounding a potential relationship between vitamin D and COVID-19 agree.
One report by specialists from various institutions in the U.K., Ireland, Belgium, and the United States — which appeared in BMJ Nutrition, Prevention & Health in May 2020 — also points to a lack of supporting evidence in favor of taking vitamin D supplements to prevent infection with SARS-CoV-2.

The report’s authors warn that:
“[C]all’s [for high dose vitamin D supplementation as a preventive strategy against COVID-19] are without support from pertinent studies in humans at this time, but rather based on speculations about presumed mechanisms.”
They also note that although sufficient vitamin D can contribute to overall good health on a day-to-day basis, taking supplements without first seeking medical advice can be harmful.
For example, taking too much vitamin D in the form of a dietary supplement could actually jeopardize health, especially among people with certain underlying chronic conditions.
Myth 2: Zinc stops the virus in its tracks
Another widespread rumor is that taking zinc supplements could help prevent infection with SARS-CoV-2 or treat COVID-19.
It is true that zinc is an essential mineral that helps support the functioning of the human immune system.
Starting from this notion, a team of researchers from Russia, Germany, and Greece hypothesized that zinc might be able to act as a preventive and adjuvant therapeutic for COVID-19. Their results appear in the International Journal of Molecular Medicine.

The researchers refer to in vitro experiments that apparently showed that zinc ions were able to inhibit the action of a certain enzyme that facilitates the viral activity of SARS-CoV-2.
However, they also point out the lack of actual clinical evidence that zinc might have an effect against SARS-CoV-2 in humans.
Other papers that cite the potential of zinc as an adjuvant in COVID-19 therapy — including one that appears in Medical Hypotheses— are more speculative and not based on any clinical data.
In a “Practice patterns and guidelines” paper from April 2020 — which appears in BMJ Nutrition, Prevention & Health— nutritionist Emma Derbyshire, Ph.D., and biochemist Joanne Delange, Ph.D., reviewed existing data about zinc (alongside other nutrients) in relation to viral respiratory infections.
They found that, according to available research in humans, zinc supplementation may help prevent pneumonia in young children, and that zinc insufficiency may impair immune responses in older adults.
However, they note that there is not enough evidence about the role of zinc supplementation in preventing viral infections in general.

Myth 3: Vitamin C can fight SARS-CoV-2
Vitamin C is another essential nutrient that has received a lot of attention. Many people believe that it can prevent or even cure the flu or common cold.
Although it is true that sufficient vitamin C can help support immune function, current evidence regarding its effectiveness in treating or preventing colds and influenza is limited and often contradictory.
Despite this, there have been claims that this vitamin might help fight infections with the new coronavirus.
It is possible that people are basing these claims on an existing ongoing clinical trial in China, which is looking at the effects of high dose intravenous (IV) vitamin C on hospitalized patients receiving care for severe COVID-19.
The researchers expect to complete the trial by the end of September 2020. No results are available in the interim.
Commenting on the trial, experts from the Linus Pauling Institute — which focuses on health and nutrition — at Oregon State University in Corvallis explain that although high dose IV vitamin C might help alleviate COVID-19 symptoms in severely ill patients, regular vitamin C supplements are very unlikely to help people fight off infections with SARS-CoV-2.

The experts warn that “IV vitamin C is not the same as taking vitamin C supplements,” as they would never raise blood levels of this vitamin as highly as an IV infusion would.
They also warn people who may be tempted to up their dosage of vitamin C of the fact they could end up taking too much and experiencing adverse side effects.

Myth 4: The keto diet can cure COVID-19
Keto diets, which are high in fats and low in carbohydrates, have also received some attention in the context of treating or preventing COVID-19.This may be because there is some evidence to suggest that keto diets could help boost the immune system. However, much of that evidence is based on animal studies rather than human trials.
Also, an upcoming clinical trial from Johns Hopkins University in Baltimore, MD, proposes to look at whether or not a ketogenic intervention might help intubated COVID-19 patients by reducing inflammation.
The intervention would necessitate the administration of a specially devised ketogenic formula through enteral feeding. It would be a last-resort procedure for those in a critical condition.
There is currently no evidence to suggest that following a keto diet could help a healthy person prevent or treat infection with SARS-CoV-2.
However, there is evidence to suggest that keto diets can expose people to certain health risks — such as by raising cholesterol levels. Keto diets may also have side effects, such as flu-like symptoms, headaches, nausea, and changes in blood pressure.

Myth 5: Herbal remedies can help
There are also claims suggesting that various herbal medicines might be able to fight off the new coronavirus.
This may partly be based on a statement issued by a Chinese official in April 2020, suggesting that certain herbal drugs could help treat COVID-19, as a communication in The Lancet on May 15, 2020, reports.
Author Yichang Yang — from the Department of Traditional Chinese Medicine at the Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China — warns that people should take encouragements to use herbal remedies in the treatment of COVID-19 with a pinch of salt.
Yang warns that herbal remedies — including the drugs that the Chinese official names — can have unexpected risks and may not be as effective as some people claim. Also, evidence from human trials is very limited.
For similar reasons, he also notes that the mechanisms through which herbal drugs work on the body are often unclear, which may mean that they are not always safe.

A mystery “herbal cure” for COVID-19 on sale in Madagascar — a herbal tea made from artemisia plants — has also spurred worry among specialists, who say that the “remedy” may do more harm than good.
Matshidiso Moeti, director of WHO Africa, has also commented on this:
“We [the WHO] would caution and advise countries against adopting a product that has not been taken through tests to see its efficacy.”
Although people may be tempted to try anything and everything in the face of such a threat to health as SARS-CoV-2, the most important preventive step is to follow official national and international guidelines for public health, as well as individual health advice from doctors and other healthcare professionals.

Even though Delon Health provides cost-saving medical billing services including premium podiatry billing services in MA, IA, WI, MN, ND, and other states, I will like to share a few helpful tips to private practice doctors that still bill in-house.

1. School your patients.

Getting an insurance plan is complex so patients could use a bit of schooling. Copays, deductibles, and other medical billing terminology can be a bit of a mystery to most people.

You can consider having a simple flyer that will explains billing basics that can apply to any insurance plan. Directing patients toward the customer service number on the back of their insurance cards for more detailed questions can also help them in knowing more about the plans

Teaching patients on where to get more information can also help increase patient relationships. Patients often blame the doctor when billing problems are really between patients and their insurance provider.

2. Be up-to date on claims.

This is one of the most important things you need to do to improve your bottom line.

Filing claims on time (daily if possible), and have a routine system for checking open claims.

Be sure to file amended claims when necessary and never miss a resubmission deadline. For example, acupuncture billing in Massachusetts is quite new because it just got approved. So, the billing providers need to keep abreast at the changing laws at this time.

3. Have a conversation with your patients in an effective way.

Ensure to train your staff on how to communicate with patients about their bills. Never ask patients whether they want to pay their bill now. It makes you look money conscious.
Instead, suggest a choice of two options for paying. Assume that they’re going to pay and ask them if they prefer to pay by credit card or check.

4. Reassess your contracts.

 Spending time to review your contracts with payers is very important.

Make sure you are aware of any changes especially if those changes necessitate a change in workflow, process or staff (re)training.
Also ensure to note all filing deadlines for the year ahead.

This is also a good time to make a chart of when your contracts come due, so you can make plans ahead for any renegotiations.

5. Have a go-to person for billing.

Make sure you have one someone in your staff that is thoroughly trained and experienced in all things billing. Whether it has to do with pain management billing in Minnesota, or a mental health billing in Iowa, Wyoming, South Dakota or North Dakota, as long as the practice has a secretary or assistant that helps the doctor or provider, there should be a go-to person for billing that is different from the provider.

Someone that can always attend to any staff and patient questions or issues

Spend time and money on training your go-to person, too, as your revenue depends on her capabilities. It’s also wise to have a backup go-to person in case your billing pro has to miss work for a lengthy period.

6. Confirm insurance.

Always do this on the phone before and at every patient visit. In fact, DME billing companies in MA are usually required by private payers to do this before providing services to patients.

Always verify insurance, make sure to also confirm the patient’s contact information is still same. People change jobs, switch email accounts, ditch landlines and move across town but don’t always remember to notify their physicians.

Regardless of how you send bills, be sure to avoid sending statements to the wrong address.

Make sure you have a way to follow-up if patients don’t pay to avoid payment delays.

• Federal officials said if hospitals and other providers take emergency funds amid the COVID-19 pandemic, they will be barred from sending balance bills to COVID-19 patients. However, the broad terms HHS uses to describe COVID-19 patients has some analysts interpreting the text as a ban on all surprise billing, according to Kaiser Health News.

HHS Terms and Conditions

In the HHS terms and conditions for eligibility for the emergency relief funds, the agency uses the language: “HHS broadly views every patient as a possible case of COVID-19.” When hospitals received the first wave of funding, they had to sign a form saying that “for all care for a possible or actual case of COVID-19,” the provider wouldn’t charge more out of pocket if the patient’s insurance plan was out of network, a practice known as surprise billing.

As reported in the article, some say that line could ban the practice of balance billing, in which a patient is billed for the difference between what a provider charges and what the insurer pays, a major source of surprise bills ― which can be financially devastating ― for patients. The move caught groups in the surprise billing fight off guard.

“The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19,” an HHS spokesperson said in the Kaiser Health news article. “We are clarifying this in the terms and conditions.”

Additionally: “Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision,” said Rodney Whitlock, a health policy consultant and former Senate staffer.

Along with HHS, individual states have also taken action to ensure health systems and patients are protected from surprise medical bills during the pandemic. Connecticut adopted a policy to ensure patients are protected from incurring surprise medical bills for treatments provided during the pandemic. Patients who would be out-of-network must be treated as in-network for emergency care provided during the pandemic.

It’s often be said that experiencing any form of trauma as child can affect a person’s ability to handle stressful events later in their life. When such person eventually grows to become an adult, it is also often discovered that they can turn to unhealthful coping strategies. Coping strategies such as smoking and overeating.

Over the years, Research suggests that people who experienced abuse and neglect in their childhood are more likely to have diabetes, high blood pressure, inflammation, and higher levels of the hormone cortisol in response to stress.

However, few longitudinal studies have followed individuals into middle age to investigate whether childhood adversity might affect the risk of cardiovascular disease (CVD) and mortality.

But now, the largest ever study of this kind suggests that people who experience trauma, neglect, and family dysfunction as children are significantly more likely to have a CVD event, such as a heart attack or stroke, in middle age.

They may also have a higher mortality rate from all causes.

The study, which Jacob B. Pierce at Northwestern University Feinberg School of Medicine in Chicago, IL, led, appears in the Journal of the American Heart Association.

Risky behaviors as coping mechanisms

The researchers suspect that extreme adversity in childhood makes people more likely to take risks with their health.

“This population of adults is much more likely to partake in risky behaviors — for example, using food as a coping mechanism, which can lead to problems with weight and obesity,” says Pierce, a fourth-year medical student at the university.

“They also have higher rates of smoking, which has a direct link to cardiovascular disease,” he adds.

The research used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which recruited a racially and socioeconomically diverse group of people aged 18–30 years in 1985–1986. CARDIA took place in four cities across the United States: Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA.

Over the three decades of the CARDIA study through to 2018, researchers regularly checked the participants’ physical and mental health.

In 2000–2001, more than 3,600 participants filled out a questionnaire to assess their experience in relation to the following seven features in their childhood family environment:

1. parental love and support
2. verbal abuse
3. physical affection
4. physical abuse
5. presence of an alcohol or drug abuser in the home
6. organization and management of the household
7. the extent to which their parents or caregivers knew what they were up to

The questionnaire included questions such as, “How often did a parent or other adult in the household make you feel that you were loved, supported, and cared for?” and “How often did a parent or other adult in the household swear at you, insult you, put you down, or act in a way that made you feel threatened?”

Levels of adversity tied to CVD risk

The participants’ responses allowed the authors of the new study to separate them into low, moderate, and high childhood adversity groups.

They discovered that, over a 30-year follow-up, people exposed to high levels of childhood adversity were more than 50% more likely to have a CVD event compared with those in the low adversity group.

Pierce says the question that best predicted cardiovascular disease later in life was: “Did your family know what you were up to as a kid?”

Even moderate exposure to childhood adversity was associated with a more than 50% increased risk of mortality from all causes compared with low adversity.

“Early childhood experiences have a lasting effect on adult mental and physical well-being, and a large number of American kids continue to suffer abuse and dysfunction that will leave a toll of health and social functioning issues throughout their lives,” says senior author Prof. Joseph Feinglass, from the Feinberg School of Medicine.

Multiple risk factors at play

When the scientists used a fully adjusted model of the data to account for other variables, such as smoking, blood pressure, and education levels at the start of the CARDIA study, the relationship between childhood adversity and CVD was no longer statistically significant.

They believe that this suggests that multiple socioeconomic, clinical, demographic, and psychological factors may collectively mediate the link between childhood adversity and CVD in middle age.

In addition to physiological changes, such as higher blood pressure, higher cortisol, and more inflammation, childhood trauma can result in unhealthy ways of dealing with stress.

The authors write:

“Childhood adversity is known to cause behavioral dysregulation related to several known CVD risk factors both in childhood and adulthood. For example, childhood trauma disrupts ability for children to appropriately cope with and respond to emotionally stressful experiences. As a result, individuals often utilize calorie-dense foods as a mechanism to cope with psychosocial stress, which contributes to the development of obesity.”

In principle, early interventions could help. The researchers write that there are programs to help children and young adults develop healthier strategies to cope with stressful experiences, but funding is limited.

“Social and economic support for young children in the U.S., which is low by the standards of other developed countries, has the biggest ‘bang for the buck’ of any social program,” says Prof. Feinglass.

The authors nevertheless acknowledge that their study had some limitations. For instance, the research only involved participants who were alive 15 years after the CARDIA study began, so the results may underestimate the association that adversity in childhood has with CVD and mortality.

In addition, the study relied on the participants accurately remembering what happened in their childhood more than 15 years earlier.

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Some groups may face a disproportionate mental health impact during the COVID-19 pandemic. These include people of color, migrants, and people of various ethnic backgrounds.

That the current pandemic is affecting people’s mental health as much as their physical health is no secret.

Since the pandemic became a mainstay in our lives, people from all over the world have reported increased levels of stress and anxiety; it is now up to us to effectively manage how we cope no matter what

Based on the known psychological effects of other events that have left a deep mark on global communities in the past, researchers warn that the COVID-19 pandemic could have dire consequences for mental health. A recent article in the MEDICAL NEWS TODAY

For instance, a position paper in The Lancet Psychiatry in April argues that in the wake of the pandemic, the world may face an increase in anxiety and emotional distress, as well as other severe effects on mental health.

However, although the pandemic is mentally and emotionally affecting many people all over the world, past evidence suggests that it may affect certain communities more than others ; particularly because they have reduced access to mental health services and other healthcare resources.

People of color at high risk of PTSD

According to a 2008 study in the journal Health Affairs, which primarily discusses issues inherent to the United States, “mental healthcare disparities, defined as unfair differences in access to or quality of care according to race and ethnicity, are quite common.”

“In general, minorities, particularly African Americans, have poorer health and health outcomes than white people,” its authors note.

Although “Hispanics and black individuals have a lower risk of having a psychiatric disorder as compared with their white counterparts, those who become ill tend to have more persistent disorders.”

But why do people of color and certain other ethnic groups experience more long-term effects on mental health? Also, how is this pandemic affecting their mental health and what should decision makers do to support these communities?

We are considering these questions as part of a series of features looking at the disproportionate impact the current pandemic is having on certain groups and on issues of society-wide importance.

We have had cause in recent times to look at how the pandemic has been affecting women’s sexual and reproductive health, while also taking a long hard look at domestic violence rates.

For this feature, we spoke to people of diverse ethnic backgrounds in the U.S., asking them about their experiences with mental health and mental healthcare.

We also looked at existing data about mental health burdens and access to healthcare for different communities in the U.S.

To begin with, past research has shown that African American, Native Hawaiian, Hispanic, and Asian individuals have higher rates of post-traumatic stress disorder (PTSD) than white individuals.

Since some specialists have already expressed concern that the current pandemic may increase the risk of PTSD in the general population, it may be that it affects people of color and those from diverse ethnic groups even more significantly.

When asked about the impact that the current pandemic has had on their mental health, one person of color told MNT: “I live with PTSD, depression, and anxiety and I’ve had both positive and negative experiences with mental health during this time.”

“I feel I’ve been relatively lucky compared with many other people of color I know, in that I have a job that allows me to work from home, so I can keep a full-time income without taking the health risk of leaving home,” they said, adding:

“I know many others don’t have the same opportunities. For example, they work in service industries where they’ve had their hours cut, or lost their jobs altogether or they have to put themselves at risk by continuing to perform tasks that don’t allow for physical distancing.”

Data from the Centers for Disease Control and Prevention (CDC), albeit incomplete, suggest that of all confirmed cases of COVID-19 in the U.S., 27% have been in black or African American individuals and 14.2% have been in people who describe their background as “multiple” or “other.”

People of diverse ethnicity also account for a large proportion of the workforce deemed “essential” during the pandemic, which means that they are more at risk of contracting SARS-CoV-2, the new coronavirus.

In fact, according to the CDC, Hispanic people form 53% of the agricultural workforce in the U.S., while black and African American individuals make up 30% of nurses.

The aforementioned respondent said that their family members also fall into this category.

“I have many family members working in healthcare, and they don’t have the option of staying home; which then means they have to then stay away from me and other family members to avoid passing on the risk of contracting the virus,”

The significant exposure of people of color to the coronavirus is likely to leave a lasting mark on their mental health: A recent study from China shows that many COVID-19 survivors face traumatic stress in the aftermath of local outbreaks.

Rise in racism a key concern

The fact that people of color and certain other ethnic groups may face a more severe and longer lasting mental health impact than white populations is, in part, explained by the fact that they are often unable to access appropriate mental healthcare.

According to the American Psychological Association (APA), a large number of people in the U.S. who identify as a person of color or as belonging to a minority ethnic group experience a significant degree of marginalization and discrimination. This is a top risk factor for poor mental health outcomes in the long-term.

The APA explains that this is because discrimination and marginalization can hinder socioeconomic growth as well as access to appropriate healthcare, including formal mental health support.

Reports from 2001 found that even when these people do access formal mental healthcare, people of color are faced with bias from health professionals, who sometimes fall short in providing the right form of intervention for them.

However, discrimination has also taken on another aspect during the COVID-19 pandemic. Because the original epicenter of the SARS-CoV-2 outbreak was a city in China, people of Asian descent all around the world have started reporting an increase in racism and xenophobic violence.

The non-governmental human rights organization Human Rights Watch (HRW) has recently issued a statement expressing their concern about the rise in anti-Asian discrimination.

“Racism and physical attacks on Asians and people of Asian descent have spread with the COVID-19 pandemic, and government leaders need to act decisively to address the trend,” says John Sifton, HRW advocacy director for Asia.

A U.S. citizen who identifies as Chinese and Asian American expressed deep concern about this intensification of racism:

“May is actually Asian and Pacific Islander American Heritage Month, which is usually a time for us to celebrate the achievements we’ve made as a community. Instead, it has been an increasingly stressful time for the Asian community. Many of us have been reminded that despite being the ‘model minority,’ the title can be taken away from us and the underlying racism that we want to think we’ve moved past can come back instantly.”

Specialists have long recognized the fact that racism, discrimination, and xenophobia are particularly harmful to mental health.

In a 2018 position statement, the Royal College of Psychiatrists in the United Kingdom point out “that racism and racial discrimination is one of many factors that can have a significant, negative impact on a person’s life chances and mental health.”

“We are particularly concerned about the disproportionate impact on people from black, Asian, and minority ethnic communities,” they emphasize.

Remember, you can check out our Blog regularly for more relevant medical articles

In a press briefing some months back, officials from the World Health Organization (WHO) discussed the challenges that the world is facing in terms of mental and psychological health and well-being during the COVID-19 pandemic.

“Physical distancing and isolation measures, and the closure of schools and workplaces, are particularly challenging for us all, as they affect what we love to do, where we want to be, and who we want to be with,” said Dr. Hans Kluge, the WHO’s regional director for Europe, in his opening remarks.

“It is absolutely natural for each of us to feel stress, anxiety, fear, and loneliness during this time. At [the] WHO, we consider effects on our mental health and psychological well-being as being very important consequences of COVID-19,” he added.

As people all around the world find themselves working from home or being home-schooled; unable to travel even down the street to visit friends or family, staying mentally healthy could become increasingly difficult for many.

As individuals, what can we as individuals, as well as society at large, do to preserve mental well-being and cope with stressors such as anxiety and loneliness?

MEDICAL NEWS TODAY in a recent article reached out to two mental health advocates: Business Neurolinguistic programming practitioner and mental health trainer Tania Diggory, founder and director of Calmer, and leadership coach and mental health first aid instructor Kat Hounsell, founder of everyday people to share their perspectives on the challenges of mental health particularly in these times.

They both suggest some best practice tips for maintaining good mental health that Diggory and Hounsell suggested, as well as bring into focus the official advice offered by experts from the WHO.

Unique challenges of working from home

Working from home may seem like the dream set-up for some, as it offers the possibility to tap into that latent creativity from the comfort of a cozy, familiar environment.

However, it can also bring a unique set of challenges especially as an enforced measure.

“While being able to work from home can empower and up-level our working life, if taken to the extreme, we end up being switched on the whole time,” Diggory said.

“In many cases, the boundaries between home life and work life can become blurred, and these boundaries are what enable us to stay healthy and well,” she cautioned.

In an enforced “work from home” situation, people may end up continuously sharing a space with other family members, and they may start to feel as though they have to attend to both domestic tasks and work assignments at the same time.

This blending of home and work life may also lead to working longer hours than usual.

“People may fall into a pattern of overworking, a sense or feeling that they ‘should’ be working long hours, to show colleagues that they are being productive even though no one can physically see them working,” said Diggory.

Managing stress while working from home

How can people address these challenges and reduce the amount of stress that comes with working exclusively from a home environment?

“Firstly, accept that stress levels will likely be higher for many at this time; whatever you’re feeling is valid considering the current context,” said Hounsell.

That is why, “when working from home, prioritizing your mindset and well-being at the start of the day is essential,” Diggory told us.

One helpful way to set boundaries so that a person does not become overwhelmed with competing tasks is to create a physical space that is for work only, where the person will not face non-work-related disruptions and interruptions.

“If you live with family, a partner, or housemates, you could have a chat with them about what boundaries you need to put in place in order to ensure a healthy and productive mindset,” she suggested.

She also said that people who share their homes with others may actually be able to benefit from the situation by co-opting family or housemates to actively help them stay on track.

For instance, Diggory said, “If you struggle to take breaks throughout the day, you could use living with others to your advantage; perhaps ask for their help in encouraging you to take time away from your desk at lunch or for a mid-morning/afternoon break.”

Cooperation is key, Hounsell agreed. “Be kind and patient with yourself and those around you,” she advised.

She also stressed the importance of maintaining other healthful habits — such as eating regularly and sticking to a healthful diet because these are, in themselves, a cornerstone of mental health.

“When planning your day, schedule in eating regular nutritious meals, renew through exercise, make time to connect with others,” and maintain good sleep hygiene, Hounsell emphasized.

She also mentioned the importance of maintaining good communication with both housemates and work colleagues at this time.

“Be open with your plans with those you live with and your team, have clear boundaries with your non-negotiables, and be open to flexibility where your schedule may need to adapt to support someone else,” she added.

What can employers do?

There are also adjustments that employers can make to ensure that their employees do not hit burnout mode in record time while working from home.

Hounsell said that there are a few questions that employers should ask themselves if they want to help their employees maintain their well-being and remain productive.

These questions are:

1. Do my team members have the right physical set-up, such as equipment to do their work remotely, platforms for online communication (including video calls), and a comfortable chair and desk set-up?
2. Do they have meaningful connection opportunities, beyond meetings, that focus on the work? People need time to have fun and engage in supportive chats with colleagues just as they would in the office.
3. Do employees have an appropriate workload considering their change of circumstances? There are many people who are working alongside home-schooling, supporting others at risk, and self-isolating.

If the answer to any of these questions is “no,” employers should aim to address these issues to support their employees in achieving an adequate work mindset away from the office.

Hounsell also advised “regular check-ins and signposting to supports available, so that everyone’s well-being is being nurtured on a daily basis,” as well as “opening a feedback loop” to address any “communication challenges” that may appear due to the remote work setting.

How to get back into ‘home time’ mode

Another possible stumbling block when a person has to work from home for long periods of time is effectively getting out of that “work mindset” once work is done for the day.

That can be tricky, especially if the person does not have access to their usual “signals” that work is over such as their commute from the office, a regular pit stop at the mall after work, or a quick session at the gym.

Diggory emphasized further that one way of marking the end of the work day; though this could also apply to ending a study period, for example is to set up something akin to the school bell.

“Try using an alarm to signal the end of your working day, choosing the hour, or even the minute, that you can press the ‘off’ button, put down your pen, and leave the home office,” she suggested.

Bookending the start and end of the working day with suggestive activities might also help.

“Plan a simple short ritual you look forward to in order to ‘check-in’ and ‘check-out’ of your working day,” Hounsell advised.

“It could be anything, like starting the day with a cup of tea and 10 minutes of journaling learning from yesterday, or hopes for today. Then, your check-out could be a short scheduled call with a colleague, friend, or family member to share your evening plans,” she suggested.

“Planning enjoyable things to do in the evenings can be a nice reward for all your hard work, and something to look forward to each day,” Diggory noted.

However, Hounsell also advised our readers to go easy on themselves, should this strategy not work perfectly every time.

“Don’t beat yourself up if work starts bleeding into the evening, instead, just stop,” she said. “Stop, take a breath, observe what’s happening with kindness, and proceed with intention into the next part of your evening.”

Coping with loneliness

Research has shown that loneliness is one of the world’s most significant risk factors for premature death. If this is such a huge problem (at the best of times), what happens now that many people’s freedom of movement is severely limited?

In the press briefing from the World Health Organization that we highlighted above, Dr. Aiysha Malik, the WHO’s technical officer within the Department of Mental Health and Substance Abuse noted that some of the people most at risk of experiencing an increased sense of loneliness and anxiety are older individuals, as well as those already living with mental health issues.

To cope with loneliness while in relative) physical isolation, Dr. Malik said that there are some “basic strategies that

advocating across the population.

Strategies such as

1. Taking part in some form of physical activity,
2. Keeping to routines or creating new ones,
3. Engaging in activities that give a sense of achievement
4. Maintaining social connections.

Although staying connected may be more difficult now than ever before, Dr. Malik points out that now is the time to explore the full potential of digital technologies in helping us stay in touch with our loved ones.

While dissecting the WHO’s position, Diggory agreed with this perspective. “As much as an overuse of digital technology can be detrimental to our well-being, we are truly fortunate to be living in the digital age, where it’s never been so easy to stay connected with the people who matter to us most.”

“Where possible,” she said, “video calls are essential; they help to give that illusion of proximity and feel like the person or people you’re talking to are nearby.”

Also, throughout the virtual press briefing, Dr. Malik repeatedly emphasized the importance of sticking to old routines and creating new ones. This, she explained, can help give structure to our daily lives at a time when our normal activities are disrupted.

Once again, Diggory agreed:

“Routine is  very important for well-being, so if you’re living by yourself, write a list of the people and activities that lift your spirits; be sure to prioritize time for connecting with others and doing things you enjoy every day. “

For those who live on their own and are finding that enforced isolation has hit them hard, Diggory also suggested “considering the things you enjoy doing; yet haven’t had time to dedicate to them.”

1. What books do you like to read?
2. What self-care routine can you put in place to support your mind and body?
3. What nutritious foods can you cook to boost your immune system?”

People should ask themselves these questions and try to take this unexpected time to themselves to focus on aspects of their lives that they may not have paid very much attention to before.

Tools for coping with anxiety

The WHO officials also talked about how people may start experiencing increased levels of anxiety during this uncertain time.

Dr. Kluge said that “our anxieties and fears should be acknowledged, and not ignored, but better understood and addressed by individuals, communities, and governments.”

“The issue, making all of us nervous, is how we manage and react to stressful situations unfolding so rapidly in our lives and communities,” he continued.

He then shared a few personal strategies for coping with stress and anxiety:

“Personally, I am trying to stick to what has worked for me in the past when I want to be calm, for example, learning and practicing simple relaxation techniques, like breathing exercises, muscle relaxation, mindfulness, and meditation, which can all be very helpful in alleviating mental distress.”

When MNT spoke with Diggory, she also suggested that practices such as mindfulness and meditation can help relieve anxious thoughts.

“One of the key factors of experiencing anxiety is a sense of feeling out of control,” she explained. However, “the practices of mindfulness and meditations have been scientifically proven to reduce stress and anxiety, and when practiced regularly, can help you feel more in control of your own state.”

“We’re not always able to control external circumstances; however, we can learn to cultivate healthful habits where we feel in control of our personal well-being, and exercises such as meditative breathing are an example of this.”

Diggory went on to explain that since the start of the pandemic, there has been an increase in online wellness classes, which people can easily join from the comfort of their own homes.

Open communication and simple relaxation

Hounsell also stressed the fact that online classes and other resources are bringing fun and relaxing activities straight into people’s homes.

“What has been so amazing to witness is the booming wealth of online resources to support people. You can go on virtual art gallery tours, watch videos of theater and dance online, have video dinner dates with friends (this one comes tried and tested from me), online pub quizzes, live-streamed yoga and workouts, and even The Open University has released a multitude of free courses for keeping learning, such an opportunity to get creative,” she said.

“And,” she added, “what’s really great is that we can also reconnect with those hobbies and relaxation techniques that don’t require a screen — reading, taking a bath, gardening, listening to music, playing music, journaling, writing, arts and crafts, cooking new recipes, stroking your pet, daydreaming as there is so much to savor and enjoy.”

In turn, the WHO regional director for Europe also spoke of the importance of engaging in earnest communication at this time.

“I myself I also try and acknowledge upsetting thoughts when they occur, and discuss them with people around me. They are likely to have them, too, and we may be better able to find solutions collectively,” he said.

Hounsell made a similar point when she spoke to MNT. She emphasized that we should all try to check in with each other and practice our sense of empathy.

“Looking out for one another and checking in regularly to spot signs of stress or mental health issues evolving” could have a lasting impact, she suggested.

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