No Images? Click here In This Issue - October 2018
MESSAGE: Dr. Feller, Associate Medical Officer of Health Happy Fall. This time of year brings "respiratory season" and perhaps an almost-too-quick journey through the holidays. I'll jump right into the meat of this month's edition: adverse childhood experiences, health impacts, resilience, and what that means for primary care. We have heard from you that many of your patients are struggling with stress and coping. I'll indulge in a bit of speculation to add that most of their struggles are interrelational: relational dynamics between children and parents, with partners or significant people in their lives, and with demands at work, often related to the people perceived to be making the demands. While none of this is new, the evidence from neuroscience, immunology, and even epigenetics has begun to clarify the medical underpinnings. To perhaps oversimplify a bit, ones' hypothalamic-pituitary-axis, brain architecture combined with function or "connectome", and our very DNA function (epigenetics) and telomeres are developed during childhood, in response to both predisposition and family functioning and stressors. The plasticity of the brain is profound, which is why therapy and self-improvement works, and we also increasingly know the factors for resilience. In addition to these underpinnings, health outcomes have become rigorously clear. Holding all other things equal, these family functioning/stressor differences have lifelong impacts on a child's health. While not all people will have the same adverse effects from the same home conditions, the health impacts for those who do are significant. Perhaps someday we will have more traditional medical interventions through refined screening, imaging, epigenetic sequencing, and futuristic physiologically invasive interventions that meet medical ethics standards. For now, however, we have enough information to know that asking about a parent's own ACEs score (without getting into the details), and referring to services, is becoming a well accepted and studied approach across North America. In Niagara, if you are concerned that someone is struggling with parenting due to their own ACEs history, please refer to public health's parenting support programs, as well as other community referrals that you would normally make. Our goal in this edition is to introduce the concepts and start this conversation, which we will continue to refine and address in time. Thank you for your interest and consideration of this hefty topic. Best wishes for a challenging and invigorating fall season! Dr. Andrea Feller Considering Adverse Childhood Experiences in Primary Care Early childhood is a social determinant of health. In a positive, safe, and stimulating environment, more connections are formed in the brain and the child thrives in all aspects of their life: physical health and development, social/emotional development, and cognitive ability; and these effects reach into adulthood (Marmot, M. 2007). Adverse childhood experiences (ACEs) are the stressful and traumatic events experienced during childhood with known long-term and negative consequences into adulthood. ACEs have been categorized into 3 groups: 1. Abuse: Physical, Emotional, Sexual 2. Neglect: Physical, Emotional 3. Household Dysfunction
Felitti et al (1998) embarked on the ACE Study to describe the long-term relationship of childhood experiences to important medical and public health problems. The original ACE Study, which looked at survey results from over 13,000 middle-income, mostly Caucasian adults, found the following:
Additionally, the number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.
The single most common factor for children who develop resilience is having at least one safe, stable and nurturing relationship with a supportive parent, caregiver or other adult (National Scientific Council on the Developing Child, 2004). Acknowledging that many of your patients may be parenting with their own ACEs history is an important first step. As a primary care provider, trusted by families and parents, you are well positioned to
The American Academy of Pediatrics (AAP) outlines a 4-step process that practices can use to prepare for addressing ACEs. The Canadian Paediatric Society (CPS) has also highlighted ACEs as a strategic priority and recently completed a survey of pediatricians regarding ACEs in primary care. For parenting support in Niagara, please connect families with a public health nurse by:
Please note that publications linked to in this article are for single-use, educational purposes only. REVIEW: INFLUENZA - WHAT YOU NEED TO KNOW Flu activity surveillance information regarding outbreaks in health care facilities in Niagara region is updated every Tuesday during outbreak season and can be found HERE. Influenza vaccine products: The publicly funded influenza vaccines available through the 2018-2019 Universal Influenza Immunization Program (UIIP) are
Encourage your patients to get the flu shot. To order posters and resources for your office, please visit the Health Care Professionals site. If you have questions, please contact the Vaccine Preventable Disease program at 905-688-8248 or toll-free 1-888-505-6074 ext. 7396. FOR YOUR PATIENTS: eConsult Now Available in Niagara Region eConsult is an online tool that gives you direct access to a specialist to ask clinical, non-urgent questions regarding a patient’s condition, often eliminating the need for an in-person visit – and it is now available to primary care providers in this region. Benefits:
To get started with eConsult or to inquire about other tools to enhance your practice, contact the HITS eHealth office at Hamilton Health Sciences, your first point of contact for digital health adoption and support in Niagara Region. FOR YOUR PATIENTS: Opioid Prescribing Hotline Family physicians and nurse practitioners practising in the Hamilton Niagara Haldimand Brant LHIN: Do you need real-time point-of-care support when making decisions about opioid prescribing? Call the OPIOID PRESCRIBING HOTLINE at 1-866-939-6464 (M-F 8 a.m. to 8 p.m. ET) for rapid access to drug information pharmacists who can answer your questions about tapering, switching, interactions and withdrawal. Delivered in partnership by the HNHB LHIN, Ontario Pain Management Resources and the Ontario Pharmacists Association Drug Information Resource Centre Proof-of-concept project offered to primary care providers in the Hamilton Niagara Haldimand Brant (HNHB) LHIN catchment area. IPAC REVIEW: National Infection Control Week - Thank You! Niagara Region Public Health & Emergency Services would like to thank you for your hard work and dedication towards infection prevention and control, this week and beyond! For more information on Infection Prevention and Control click HERE. |