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Youth at both ends of weight spectrum challenged by global pandemic

Life in a global pandemic has been difficult for children and teens who struggle with their weight, according to experts at Stanford Children’s Health.

Whether they face anorexia nervosa or obesity, young people across the weight spectrum are finding that the restrictions of the pandemic make it harder to maintain a healthy weight. It’s an example of how, even as relatively few young people have been sickened by COVID-19, the ongoing pandemic hurts their health in other ways. Everything from lost routines to economic insecurity to grief have exacerbated the challenges of weight management. Fortunately, there are steps families can take to help.

“Everyone’s activity level has changed drastically,” said Elizabeth Shepard, MD, clinical associate professor of pediatrics and medical director of the pediatric weight clinic at Stanford Children’s Health’s Center for Healthy Weight. When stay-at-home orders and online school became widespread, many young people were no longer participating in sports or even walking the halls at school. “Overall, we’ve seen excessive weight gain during the pandemic. For some kids, that puts them suddenly into the range of overweight or obesity and that can be quite detrimental to their health over the long term.”



More burnout among pregnancy, newborn care providers during pandemic, Stanford-led study finds

Medical professionals who care for pregnant women and newborns experienced greatly increased rates of burnout during the early days of the COVID-19 pandemic, according to a small study led by Stanford University School of Medicine researchers.

The results was published online March 16 in the Journal of Perinatology.

Among the 288 people, mostly nurses and physicians, from across the United States who responded to a June 2020 survey, 66% reported symptoms of burnout. In addition, 73% felt that their co-workers were showing more burnout. The findings raise concerns for patient safety, according to the study’s authors.

“The levels of burnout are about 2.5 times the rates we observed in pre-pandemic samples,” said Jochen Profit, MD, the study’s senior author and an associate professor of pediatrics at Stanford. The extent of caregiver burnout his team documented was equivalent to implementing new electronic medical records systems — an event widely recognized as stressful — twice in a row, Profit said. The study’s lead author is Eman Haidari, MD, medical fellow in pediatrics at Stanford.



SF Chronicle: Once-cautious Bay Area counties moving swiftly to reopen. What's going on?

With coronavirus case numbers plummeting, vaccinations rising and several Bay Area counties reopening their economy, it feels like the end is in sight for the pandemic. But public health experts warned Wednesday that a false sense of optimism could have deadly consequences, particularly as highly infectious coronavirus variants continue to take hold in the state.

Even San Francisco and Santa Clara counties, which earlier in the pandemic exercised far more caution than the state are now moving aggressively to reopen.

Some public health officials fear this patchwork approach to reopening could backfire.

The new virus mutations are also emerging at a pace that may help them elude the current vaccines.

“We’re in a race against the variants, which are more infectious than the original virus,” said Dr. Yvonne Maldonado, a Stanford expert in infectious diseases and vaccines.



5 Questions: Tandy Aye on what transgender teens need from their parents

A recent Stanford study showed that, for teens exploring their gender identity, simple acts of caring from their parents were what they valued most.

When teenagers confide that they are transgender or uncertain about their gender identity, their parents may be unsure how to offer support. 

To understand what types of family support transgender adolescents consider helpful, a Stanford research team asked 25 of them for their thoughts. The team also interviewed the teens’ parents.

The actions teens said they valued most were among the simplest, the researchers discovered. Their findings were published March 8 in the Journal of Adolescent Health

Teens said they most appreciated having parents use their preferred name and pronoun, as well as knowing that their parents were emotionally available and listening to their concerns. 

The teenagers usually rated their parents as more supportive than the parents rated themselves, said Tandy Aye, MD, associate professor of pediatrics at Stanford Medicine and a pediatric endocrinologist at the Stanford Children’s Health Pediatric and Adolescent Gender Clinic. Aye is the senior author of the study.

“Even when parents are thinking that there is tension over gender identity, that parent-child relationship is still super important,” said Aye.



Vaccinating by age groups is unfair, particularly to minorities, advisory panel tells CDC

Many states prioritized COVID-19 vaccines for people over 75, then moved to those over 65, but they shouldn't keep stepping down by age, an advisory committee to the Centers for Disease Control and Prevention said Monday. 

The approach is inherently unfair to minorities, committee members said, because they have a lower life-expectancy and because people of color are dying of COVID-19 at younger ages than white Americans – even in their 30s, 40s and 50s.



It takes a team: Caring for kinds with COVID-19

In children, respiratory symptoms of COVID-19 are rare. Since the pandemic began, most of the children hospitalized at Lucile Packard Children's Hospital Stanford with the SARS-CoV-2 virus are asymptomatic and being treated for other medical problems.

But a few kids and teens have had COVID-19-related illness. Critical care physician Alan Schroeder, MD, has been on the frontlines, going above and beyond to ensure these kids return home safely.

Erin Digitale spoke with him recently as part of the Voices of COVID series to learn more.



Small Doses: Kari Nadeau is transforming the treatment of food allergies, one morsel at a time

In the United States alone, an estimated 7.6 percent of children and 10.8 percent of adults have food allergies. That’s 5 million children and 26 million adults—and, Nadeau says, about half of children are allergic to more than one food. The disease demands constant vigilance, even toward foods that are supposedly safe but have been processed in facilities with allergens. For some children, just being hit by cheese during a food fight could kill them. But, though once a life sentence, food allergies are increasingly treatable. “Some people are already getting cured,” said Kari Nadeau, a Stanford professor of medicine and of pediatrics who was conducting an allergen desensitization trial. With Sloan Barnett—a journalist whose son overcame allergies in the trial—Nadeau recently co-authored The End of Food Allergy: The First Program to Prevent and Reverse a 21st Century Epidemic. “Really more like the beginning of the end,” Nadeau says, since the treatments she pioneered are not yet in widespread use and she continues developing better therapies that, by adding medication to neutralize allergic reactions, have accelerated desensitization and revolutionized the field of allergy medicine.



Vaccine distribution not equitable for Blacks, Latinos in California, preliminary data shows

SAN FRANCISCO (KGO) -- For months, California political and public health leaders claimed equity is a top priority, but for weeks the state didn't have data to prove it. That's changed.

After repeated attempts from the ABC7 I-Team and other state publications, the California Department of Public Health released a preliminary picture of the nearly 6 million people vaccinated across the state.

"It does give us a sense of what we've been seeing all along since the beginning of the pandemic," said Dr. Yvonne Maldonado, infectious disease physician and voting member on the CDC's vaccine advisory committee.

Every vaccine administered is submitted by providers and health care systems into a statewide immunization registry. As of Monday night, the state released the following demographics:

White: 32%
Latino: 16%
Multi-race: 14%
Asian: 13%
Black: 2.9%
Other & Unknown: Around 20%
Native Hawaiian/Pacific Islander: 0.4%
American Indian/Alaska Native: 0.3%



Essential workers get lost in the vaccine scrum as states prioritize the elderly

The desire to make vaccine administration equitable was central to recommendations from the Advisory Committee on Immunization Practices.

“We cannot abandon equity because it’s hard to measure and it’s hard to do,” Grace Lee, a committee member and a pediatrics professor at Stanford University’s School of Medicine, said at the time.

On Wednesday at a committee meeting, Lee said officials need both efficiency and equity to “ensure that we are accountable for how we’re delivering vaccine."

“Absolutely agree we do not want any doses in freezers or wasted in any way,” Lee said.

But efficiency has won out in most places.



'Everywhere you look, people are infected': Covid's toll on California Latinos

Although Latinos account for 38.9% of the state’s population, they represent a whopping 55.1% of positive cases and almost half of all deaths. In Los Angeles county, where more than 850,000 infections have been recorded, Latinos are succumbing to the virus at 2.5 times the rate of their white counterparts, the LA Times reported.

But “it’s really not about race and ethnicity”, cautioned Yvonne Maldonado, a professor of global health and infectious diseases at the Stanford University School of Medicine. “It’s about race and ethnicity as a surrogate for poverty and inequity.”



Kids should be part of COVID vaccine trials, pediatricians say

If clinical trials for COVID-19 vaccines aren’t expanded soon to include children, it’s unlikely that even kids in their teens will be vaccinated in time for the next school year.

The hurdle is that COVID vaccine makers are only in the early stages of testing their products on children. The Pfizer vaccine authorized for use by the Food and Drug Administration on Friday was greenlighted only for people ages 16 and up. Moderna just started trials for 12- to 17-year-olds for its vaccine, likely to be authorized later this month.

“The longer we take to start kids in trials, the longer it will take them to get vaccinated and to break the chains of transmission,” said Dr. Yvonne Maldonado, a professor of pediatrics at Stanford University who chairs the AAP’s infectious disease committee. “If you want kids to go back to school and not have the teachers union terrified, you have to make sure they aren’t a risk.”



COVID-19 as a ‘wake-up call’ for creating more equitable health care

COVID-19 has had a devastating impact across the country, but not all populations have felt its effect equally: Members of the Black and Latinx communities have had a disproportionate number of cases and deaths from COVID-19.

"This pandemic is a real wake-up call for us," says Yvonne Maldonado, MD, Stanford senior associate dean of faculty development and diversity and professor of pediatrics and of health research and policy. "Rather than cursing the darkness, we need to light a candle. And we have plenty of candles at Stanford."

In a Q&A for Stanford Medicine's Recover, Restore and Reopen project, Maldonado and Melissa Bondy, PhD, professor and chair of the department of epidemiology and public health, discuss how COVID-19 has shaped Stanford Medicine's understanding of health disparities and how the institution is responding.