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Guide to Injury Healing: Heat or Ice?
Heat and ice are two of the most common treatments used to relieve pain and reduce swelling in injuries. However, each one is better suited for certain types of injuries Dr. Luis Palacio, MD explores the differences between the two. When it comes to treating aches and pains, the debate between heat and ice has been ongoing for quite some time. Both have their benefits making it crucial to understand which option is better suited for your specific needs. Determining which method is better depends on various factors such as the type of injury or pain you are experiencing. For instance, if you have recently sprained your ankle or pulled a muscle during exercise, applying ice within the first 48 hours can help minimize swelling and alleviate discomfort. It's worth noting that some individuals find alternating between heat and ice therapy beneficial as well. This approach combines the benefits of both methods by using heat to increase blood flow followed by ice to reduce inflammation. Cold Therapy Cold therapy can help to reduce inflammation after an injury, heat can have the opposite effect. Therefore, heat therapy should be reserved for those who have chronic pain issues and are not dealing with an acute injury. Cold therapy is often recommended immediately after an injury or during the initial stages of inflammation. Cold therapy such as ice packs are especially effective in treating: Sprains Strains Any injury that involves swelling Heat Therapy Heat therapy is known for its ability to relax muscles, increase blood flow and soothe pain. It is often used for chronic conditions or injuries that are not inflamed. Applying heat can help alleviate stiffness, promote healing and provide a comforting sensation. This increased circulation can bring more nutrients and oxygen to the area, helping it to heal faster. Heat therapy such as heating packs are especially effective in treating: Stiffness with associated pain Injuries that are not inflamed Muscle pain
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Why Am I So Tired? 9 Reasons for Your Chronic Exhaustion
© Africa Images via Canva.com Do you find yourself struggling to stay awake during the day or having no energy? You’re not alone. Whether you’re a full-time employee, a student or retiree, that “I’m tired” feeling comes in all shapes and sizes. What’s even more frustrating is not knowing the source of your exhaustion. Dr. Brandon Flores, a sleep medicine physician with Renown Medical Group, breaks down nine key reasons why you may be feeling so fatigued. You did not get enough sleep, or your quality of sleep is poor. This may seem obvious, but in today’s “rise and grind” culture, sleep can be considered a luxury rather than what it really is: a necessity. Ensuring you get adequate hours of sleep between 6-9 hours and quality sleep is essential. You may not be breathing well during sleep. Interruptions to your breathing, such as snoring, can decrease airflow at night causing your sleep to be less restorative. This is often due to Obstructive Sleep Apnea (OSA). OSA can lead to daytime fatigue and sleepiness and can also impact other chronic health conditions, such as hypertension, diabetes, acid reflux, migraines and heart rhythm. You are not getting enough regular exercise, or you are exercising too much. Incorporating at least 30 minutes a day of physical activity can help keep you energized throughout the day. It has also been shown to increase deep slow wave sleep, which is often associated with feeling rested. On the other hand, getting too much exercise can tire you out more easily and heighten stress levels. You drink too much caffeine. This one may seem counterintuitive – caffeine is supposed to keep you awake, right? Well, overdoing it with your favorite coffee or soda could affect your sleep quality. Pay attention to your caffeine limits and have a cut-off time, as most caffeine should not be consumed past noon. You have a food allergy or intolerance. If you find yourself feeling especially tired after eating a lot of a certain food, you could have an allergy or intolerance to it – and vice versa. Consider speaking with your primary care provider (PCP) about a food allergy test or being referred to an allergist. You’re drinking too many alcoholic beverages. Alcohol is a depressant, which as the word implies, can make you feel especially tired during the day. It can also affect your breathing at night and disrupt your sleep cycle. Cutting back on alcoholic drinks may be beneficial to your overall health. You are anemic. This is the leading cause of fatigue in women but can affect people of all genders. It can be associated with low iron. Eating foods high in iron, including leafy greens and many different meats, can help your iron levels. A blood test ordered by your PCP can help you understand if you are iron deficient. You are experiencing depression or anxiety. Emotional exhaustion can be just as taxing as physical exhaustion. Prolonged feelings of sadness, hopelessness, nervousness or panic can be signs and symptoms of depression or anxiety. Speak with your provider about the many resources available to help you. You have an underactive thyroid. Feeling fatigued can also be a symptom of hypothyroidism, which affects your metabolism and energy levels. Medication can help get your thyroid back to normal. Your PCP can order a blood test to determine your thyroid levels. If you experience severe exhaustion that lasts six months or longer, worsens after physical or mental exertion and does not get better after resting, it could be a sign of myalgic encephalomyelitis, otherwise known as chronic fatigue syndrome (CFS). This is a diagnosis of exclusion, and other causes must be ruled out. While there are no tests that detect CFS, your provider can order blood and urine tests to rule out other causes of your fatigue and help develop a care plan.
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6 Healthcare Action Items for the LGBTQIA+ Community
© Niyazz via Canva.com Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs. Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health. PrEP and PEP Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months. Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days. PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location. HPV Immunization All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime. The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never! STI Testing Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year. Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you. Prostate Exams Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old. These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened. Pap Tests and Pelvic Exams Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer. Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings. Mammograms and Breast Exams People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual. The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project. Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.
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Give the Gift of Health This Season with ELF Testing
Renown Health and the University of Nevada, Reno School of Medicine give the gift of early diagnosis and disease prevention this holiday season. With the season of giving upon us, give yourself the gift of health. The Renown Institute for Health Innovation (IHI) and the University of Nevada, Reno School of Medicine (UNR Med) are excited to offer a free Enhanced Liver Fibrosis (ELFTM) test to patients at risk for a common type of liver disease, e.g. metabolic and nonalcoholic steatohepatitis (M/NASH), and who enroll or are currently enrolled in the Healthy Nevada Project. The ELF Test is an FDA (Food and Drug Administration) approved non-invasive test to help identify people most at risk for liver scarring, e.g. cirrhosis, and allows doctors to intervene before irreversible damage occurs. If undetected and untreated, M/NASH can result in liver cirrhosis which could require liver transplantation or lead to death. This test is important as the symptoms of M/NASH can be silent or non-specific, making it difficult to diagnose. “There are currently more than 11,000 people across the U.S. on the national liver transplant waiting list, and with the heightened prevalence of NAFLD and M/NASH, this number is projected to keep rising; however, with research such as the ELF Test at our disposal, we are continuing to find ways to improve the health of those at risk for advanced liver disease,” said Bill Plauth, MD, Chief Medical Officer for Renown Health and Associate Dean of Clinical Affairs at UNR Med. “We encourage our community to participate in this early risk detection. Through this sophisticated, noninvasive, blood test, our physicians and Advanced Practice Providers can better evaluate liver fibrosis to help those affected and enable researchers to improve the prevention and treatment of nonalcoholic liver disease as a whole.” This liver health-focused sub-study of the Healthy Nevada Project seeks to enhance the understanding of both NAFLD and M/NASH and to help inform the development of treatment options for these conditions, as few currently exist. “Providing access to cutting-edge innovations such as the ELF Test is critical for both participants and the physicians and advanced practice providers that care for them.” said Joseph Grzymski, PhD, principal investigator of the Healthy Nevada Project and the Liver Disease Study and research professor at UNR Med. Those interested in determining their risk for M/NASH and its progression are encouraged to enroll in the Metabolic & Nonalcoholic Steatohepatitis study. Those who have consented and participated in the M/NASH research will be eligible and contacted with more information on how to receive the ELF Test. The Renown IHI is also happy to connect with physicians and Advanced Practice Providers interested in having their patients enroll in the Healthy Nevada Project and join the study. For members of the community who would like more information and learn how to enroll, please contact the Renown IHI at RenownIHI@renown.org or (775) 982-6914 to be connected to a Genomic Representative. About the ELF™ Test The ELF Test is a noninvasive blood test that can quickly identify which patients are at an elevated risk for developing cirrhosis and other liver-related clinical events (LREs). In contrast to standard liver enzyme tests that reflect liver damage that has already occurred, the ELF Test combines three serum direct biomarkers of active fibrosis. The ELF Test algorithm measures each of these biomarkers to create an ELF score, which can be used as an aid to assess the risk for future disease progression. Doctors may use this ELF score to help evaluate if a patient requires increased medical care and monitoring for their condition. Individuals interested in determining their risk for NASH and its progression are encouraged to enroll in the Nonalcoholic Steatohepatitis Liver Disease Genome Atlas study. Those who have already consented and participated in the study will be contacted with more information on how to receive an ELF blood test. Para obtener más información o para inscribirse, comuníquese a la casilla de correo RenownIHI@renown.org o al teléfono (775) 982-6914. In the U.S., the ELF Testing Service is available from Brio Clinical, Inc., a CLIA-certified laboratory offering specialized testing throughout the United States. Brio Clinical is regulated under CLIA as qualified to perform high complexity testing.
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¿Qué es el Healthy Nevada Project?
The Healthy Nevada Project (HNP) is one of the most visible genomic studies in the United States, and guess what? Renown Health powers it! The Healthy Nevada Project (HNP) aligns with Renown's goal to do the best for our patients. The genomic study is at no-cost for Nevadans and gives participants insight into different genetic traits, including results on three prevalent and serious health conditions known as CDC Tier 1 conditions. CDC Tier 1 Conditions Include: Hereditary Breast and Ovarian Cancer Syndrome (HBOC) Lynch Syndrome Familial Hypercholesterolemia (FH) Not only does HNP give participants insights into their genetic background, but it also facilitates Renown's ability to study population health. Research lays the foundation for the future of medicine, and Renown's HNP is on the cutting edge of genetic research. We do this by providing skilled researchers access to studies for the diseases that currently have limited treatment, including nonalcoholic steatohepatitis liver disease or NASH. For example, the observational NASH study helps researchers understand genetic links to the disease. Make an Appointment to Get Screened If you haven't already, join the over 55,000 HNP participants and make an appointment to have yourself screened. You can schedule a screening appointment through MyChart. Click “Schedule an Appointment" and select Research Appointment - Genetic Screening. Prior to your appointment, please complete e-Check-in and complete your consent form.
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Research Shows Genetic Approaches to Breast Cancer Screenings Yield More Accurate Results
Clinical researchers with the Healthy Nevada Project co-author research paper with findings that emphasize the need for a comprehensive approach to breast cancer risk assessment – including a focus on genetic medicine – to help ensure that individuals at high risk are identified and supported proactively rather than reactively. Breast cancer is a leading cause of cancer death among women in the United States. According to the American Cancer Society, about 1 in 8 women will develop breast cancer and about 1 in 39 women will die from breast cancer. Breast cancer is associated with increased age, hereditary factors, obesity, and alcohol use. Since 1990, breast cancer death rates have declined progressively due to advancements in treatment and detection. In Nevada there are an estimated 2,310 new breast cancer cases a year, and genetic mutations such as in the genes BRCA1 or BRCA2 remain a top risk factor for this prevalent disease. Recognizing the urgency for progress in breast cancer research, a collaborative effort between physicians, advanced practice providers and scientists from the Healthy Nevada Project® (HNP) and Helix have unveiled groundbreaking research. This study explores how genetic screenings are a necessary supplement to traditional testing methods, together offering more accurate insights into a patient's likelihood of developing breast cancer in the future. HNP is operated by Renown Genomic Medicine and the Institute for Health Innovation and is one of the largest community-based population health studies in the country. Their team works in collaboration with Helix, a leader in precision health that delivers comprehensive genomic solutions. Together, this dynamic partnership aims to understand breast cancer risk factors and pave the way for more effective preventative measures. The combined research team studied 25,591 female HNP participants to evaluate the performance of different genetic screening approaches to identify women at high risk of breast cancer. The results of this research suggest that a combined monogenic, or single-gene, and polygenic, or multi-gene, approach to breast cancer screenings helped produce more accurate results and more closely identify study participants who have a high genetic risk of developing the disease. "Based on this research, we are advocating a shift in approach which would improve breast cancer risk assessment through a combination of effective family history ascertainment and genetic screening,” said Joseph Grzymski, PhD, principal investigator of the Healthy Nevada Project, research professor at the University of Nevada, Reno School of Medicine and co-author of the breast cancer research paper. “This tailored approach, founded on the assessment of individual genetic risk, not only intends to elevate patient well-being but also will improve efficiency and equity in healthcare." Complementing the team’s research on leveraging genetics to identify women at low genetic risk of breast cancer that could safely defer mammogram screenings by five to 10 years that was released in late 2023 in JAMA Oncology, the study suggests that incorporating genetic information can assist in personalizing breast cancer screenings and optimizing the use of screening resources. "Existing disparities persist across various facets of breast cancer screening and treatment; however, genetic screening is clearly a powerful tool to help facilitate early intervention for those at higher risk,” said Jamie Schnell Blitstein, APRN, a primary care nurse practitioner at Renown Health and co-author of the breast cancer research paper. “By placing a heightened focus on risk, we underscore the pivotal role of preventative breast cancer screening.” Despite the availability of effective methods for early screening, co-authors of this research found that 78 percent of women with a family history of breast cancer had their risk ascertained only after a breast cancer diagnosis. The findings emphasize the need for a comprehensive approach to breast cancer risk assessment – including a focus on genetic medicine – to help ensure that individuals at high risk are identified and supported proactively rather than reactively. “These findings that can profoundly impact how healthcare is delivered were only made possible by all the participants who were willing to consent to research,” said Alex Bolze, PhD from Helix and co-author of the publication. “Broad-scale collaboration projects like these between Renown Health and UNR that engage large populations where participants share both their genetic information as well as electronic health records drive advancements in preventative medicine, as well as fundamental biological research.” The research paper was officially accepted on Jan. 29, 2024, and will be published by Elsevier, Inc. on behalf of the American College of Medical Genetics and Genomics. The contents of the paper will appear in the international journal Genetics in Medicine Open. Read the full article by visiting sciencedirect.com. The Healthy Nevada Project is currently recruiting new study participants. Free to all Nevadans with a saliva sample or blood draw, participants and their referring providers receive access to whole-exome sequencing and clinical grade results that help provide insight into their unique genetic risks tied to heart disease and certain cancers. If you are interested in enrolling in the study, schedule a Virtual Consent Appointment through MyChart or contact the Renown Institute for Health Innovation at RenownIHI@renown.org or (775) 982-6914 to be connected to a Genomic Representative. About Renown Health Renown Health is the region’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. Con una fuerza laboral diversa de más de 7,000 empleados, Renown ha fomentado una cultura de excelencia, determinación e innovación de larga data. La organización se compone de un centro de urgencias, dos hospitales de cuidados agudos, un hospital infantil, un hospital de rehabilitación, un grupo médico y una red de atención de urgencias y Hometown Health, la compañía de seguros sin fines de lucro más grande de la región y de propiedad local, Hometown Health. Renown is currently enrolling participants in the largest community-based genetic population health study, the Healthy Nevada Project®. To join the Renown Health team, visit renown.org/careers. Acerca de Helix Helix es la compañía líder en genómica y vigilancia viral de la población cuyas operaciones se basan en el cuidado clínico, la investigación y el análisis de datos. Helix enables health systems, life sciences companies, payers, and government partners to accelerate the integration of genomic data into patient care and public health decision-making. Learn more at helix.com.
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Eight Lessons from an MD-PhD Candidate at UNR Med
Meet newly minted Dr. Majid Khan, PhD., a native of Reno, and current MD-PhD candidate and first-generation medical student at the University of Nevada, Reno School of Medicine, who is on his way to a career as a Neurosurgery. While most graduate students often choose between pursuing a medical degree (MD) or a doctorate in philosophy (PhD), Majid has boldly picked both. He is one of three medical students currently in the UNR Med MD-PhD Program run by Dr. Caroline Cobine, PhD and Dr. Violeta Mutafova-Yambolieva, MD, PhD. "Research is not merely an act of sitting at a computer and reading papers – it's about answering the thought-provoking questions about things we come across on a daily basis. By critically evaluating these ideas we can implement solutions to enhance various aspects of the medical field and patient care with an overall goal of improving patient outcomes," Majid said. Majid recognizes that modern research extends beyond academia and holds significant value for hospitals. “Research contributes to improving patient outcomes. By reviewing the data from peer-reviewed research studies, medical professionals can be better prepared to deliver effective care following the most up-to-date guidelines and data,” he said. Majid's journey to pursuing his MD-PhD with a goal of becoming a physician-scientist-surgeon began following a summer in the PathMaker Cancer Research Program at the Huntsman Cancer Institute at the University of Utah. "It was by fate that I stumbled into this field – ever since I saw my first brain surgery, I haven’t been able to look back," Majid said. Here are some of the valuable lessons that Majid has learned along the way. 1. Beyond the 9 to 5, Embrace both 5 to 9s To avoid burnout and nurture personal passions, make your time spent outside of work and school intentional. Harness any free time to reconnect with friends, pursue hobbies and engage with mentors and mentees. 2. Collaboration is Key Work collectively with colleagues locally, nationwide and even worldwide. Cultivate environments to share knowledge and innovation, as well as wisdom, which will evidently lead to more impactful outcomes. 3. Shine a Spotlight on Your Colleagues Acknowledge and celebrate your colleagues in group settings when you notice something outstanding that they’ve said or done – it could anything big or small. Shining the spotlight onto those who are making positive changes within the hospital can inspire a beautiful culture of academic healthcare, which ultimately improves patient outcomes. 4. Redefine Mentorship Mentorship does not need to be confined to traditional frameworks. Seek out guidance in unexpected and untraditional places; sometimes, the most enlightening lessons and opportunities emerge from the most unlikely sources. 5. Diversify Your Experiences Embracing a diverse range of experiences enriches one's medical acumen. You never know when a seemingly unrelated job or experience will help in a scenario in your career. 6. Live By the Mamba Mentality Follow the late Kobe Bryant’s approach to life and work, the Mamba Mentality. This includes planning long-term goals, placing meaning in everything, striving for constant personal growth, following your passions and focusing on the process rather than the end goal. 7. Make Time for Your Loved Ones Don’t forget who helped you get to where you are in your life, specifically your family, friends, teachers and mentors. By making time for the most important and loving people in your life, you will be surrounded by positivity which will help propel you to new heights. 8. Plan your Next Five Moves We all have the ability to come from nothing and become something. Take the time to plan out everything and execute your moves with careful precision. Majid has plans to return to the Biggest Little City after completing Neurological Surgery Residency Program. If you would like to get in touch with Majid, please reach out to him via email at majidk@med.unr.edu.
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Un estudio demuestra la importancia de garantizar el seguimiento del participante y del proveedor después de obtener el resultado de un examen de detección genético
Lanzada en asociación con el Desert Research Institute, una nueva investigación del proyecto Healthy Nevada Project® determina que un diagnóstico confirmado no siempre produce cambios en el cuidado del paciente. El hecho de entregar a las personas información de salud que pueda cambiar sus vidas no garantiza que las personas, o sus proveedores de atención médica, actuarán en consecuencia. La educación de seguimiento y las conversaciones sobre los planes de cuidado ejecutables con los pacientes y sus médicos son los próximos pasos clave, de acuerdo con la nueva investigación del Healthy Nevada Project. El Healthy Nevada Project es un proyecto de investigación y detección genética que se lanzó en 2016 como una asociación entre DRI y Renown Health. El proyecto ahora tiene más de 50,000 participantes y cuenta con secuenciación genética proporcionada por Helix. Entre septiembre de 2018 y septiembre de 2020, el Healthy Nevada Project notificó exitosamente a 293 participantes que estaban genéticamente en riesgo de desarrollar cáncer de pecho y ovario, síndrome de Lynch o hipercolesterolemia familiar hereditarios, tres afecciones genéticas comunes conocidas colectivamente como afecciones de Nivel 1 de los Centros para el Control y la Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC). En un estudio publicado hoy en Frontiers in Genetics, los científicos del Healthy Nevada Project analizaron qué impacto tuvo el hecho de notificar a un paciente sobre un resultado positivo para una condición de Nivel 1 de los CDC en el cuidado que recibió el paciente en los meses y años posteriores. Según sus resultados, entre los 293 participantes del Healthy Nevada Project que fueron notificados del riesgo genético de desarrollar una afección del Nivel 1 de los CDC, el 71 % de participantes con registros médicos electrónicos compartieron sus hallazgos con los proveedores de atención médica. Sin embargo, solo el 30 % de los registros médicos electrónicos de estos pacientes contenía documentación del diagnóstico genético, y solo el 10 % de los pacientes examinados experimentó un posible cambio en el cuidado después de recibir los resultados de su examen de detección genético. “El Healthy Nevada Project se implementó con un enfoque ‘sin intervención’ en el que los participantes reciben sus hallazgos y deciden con quiénes y cuándo desean compartirlos. Los hallazgos no se agregaron automáticamente a sus registros médicos electrónicos”, explicó el Dr. Gai Elhanan, científico de datos médicos en DRI y coautor del estudio. “Lo que estamos aprendiendo ahora es que para garantizar que los hallazgos genéticos importantes se integren en el régimen de cuidado, es importante que su incorporación en los registros médicos electrónicos forme parte del estudio”. Este estudio se basa en investigaciones anteriores del Healthy Nevada Project publicadas en Nature Medicine. En ellas se demuestra la importancia de realizar exámenes de detección para las afecciones del Nivel 1 de los CDC, las cuales afectan a aproximadamente a 1 de cada 75 personas y se pueden mitigar e incluso se puede evitar que se conviertan en enfermedades cuando se detectan en forma temprana. Este estudio determinó que hasta el 90 % de los casos con afecciones del Nivel 1 de los CDC no son detectados por los proveedores clínicos en las evaluaciones y los exámenes de detección que se realizan durante las visitas de cuidado clínico habitual. Durante el estudio actual, los científicos del Healthy Nevada Project descubrieron que el 19 % de participantes estudiados ya había desarrollado una de las afecciones del Nivel 1 de los CDC y, por lo tanto, podrían haberse beneficiado de una notificación más temprana sobre su afección. El equipo del estudio espera que sus hallazgos estimulen a los residentes de Nevada a obtener pruebas genéticas para estas afecciones relativamente comunes. Incluso si las personas son mayores o ya han sufrido enfermedades relacionadas con estas afecciones, las pruebas también podrían ser beneficiosas para los hermanos, los niños y los nietos que también pueden estar en riesgo y que posteriormente podrían someterse a exámenes de detección en caso de un hallazgo positivo. El equipo del estudio también incita a informar a los proveedores de atención médica sobre la importancia de incorporar diagnósticos genéticos en las recomendaciones farmacéuticas (por ejemplo, para la hipercolesterolemia familiar) y de tratamiento a los pacientes. “Como resultado de este análisis, los médicos de Renown Health y los investigadores del Healthy Nevada Project han logrado cambios significativos, lo que incluye la obtención del consentimiento informado de los participantes para incorporar hallazgos positivos de sus informes genéticos directamente en su registro médico electrónico”, explicó Daniel Kiser, M.S., científico auxiliar de investigación de ciencia de datos en DRI y coautor del estudio. “Esto ayudará tanto a los participantes como a sus proveedores de cuidado clínico, y a todo el estado a maximizar los beneficios a largo plazo de los exámenes de detección genéticos voluntarios basados en la población del Healthy Nevada Project”. Información adicional: El texto completo del estudio, Incomplete Penetrance of Population-Based Genetic Screening Results in Electronic Health Record, está disponible en Frontiers in Genetics: https://www.frontiersin.org/articles/10.3389/fgene.2022.866169/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Genetics&id=866169. Este proyecto fue financiado por Renown Health, fundación de Renown Health y la Oficina de Desarrollo Económico del Gobernador de Nevada. Entre los autores del estudio se incluyen Gai Elhanan (DRI), Daniel Kiser (DRI), Iva Neveux (DRI), Shaun Dabe (Renown Health), Alexander Bolze (Helix), William Metcalf (DRI), James Lu (Helix) y Joseph Grzymski (DRI/Renown Health). Para obtener más información sobre el Healthy Nevada Project® o para solicitar un examen de detección genético, visite: https://healthynv.org/ Acerca del DRI El Desert Research Institute (DRI) es un reconocido líder mundial en investigación ambiental básica y aplicada. Comprometidos con la excelencia e integridad científicas, el cuerpo docente del DRI, los estudiantes que trabajan juntos y el personal han desarrollado conocimientos científicos y tecnologías innovadoras en proyectos de investigación en todo el mundo. Desde 1959, la investigación de DRI ha profundizado el conocimiento científico sobre temas que van desde el impacto de los seres humanos en el medioambiente hasta el impacto del medioambiente en los seres humanos. Los hallazgos científicos impactantes y las soluciones inspiradoras del DRI apoyan la economía diversa de Nevada, proporcionan oportunidades educativas basadas en la ciencia e informan a legisladores, líderes empresariales y miembros de la comunidad. El DRI tiene campus en Las Vegas y Reno y funciona como el grupo de investigación sin fines de lucro del Sistema de Educación Superior de Nevada. Para obtener más información, visite www.dri.edu. Acerca de Renown Health Renown Health es la red de atención médica integrada de administración local y sin fines de lucro más grande de la región, que presta servicios a Nevada, Lake Tahoe y el noreste de California. Con una fuerza laboral diversa de más de 7,000 empleados, Renown ha fomentado una cultura de excelencia, determinación e innovación de larga data. La organización se compone de un centro de urgencias, dos hospitales de cuidados agudos, un hospital infantil, un hospital de rehabilitación, un grupo médico y una red de atención de urgencias y Hometown Health, la compañía de seguros sin fines de lucro más grande de la región y de propiedad local, Hometown Health. Actualmente, Renown está inscribiendo participantes en el estudio genético de salud poblacional basado en la comunidad más grande del mundo, el Healthy Nevada Project®. Visite renown.org para obtener más información. Acerca de Helix Helix es la compañía líder en genómica y vigilancia viral de la población cuyas operaciones se basan en el cuidado clínico, la investigación y el análisis de datos. Helix permite que los sistemas de salud, las empresas de ciencias biológicas, los pagadores y los socios gubernamentales aceleren la integración de los datos genómicos en el cuidado médico del paciente y en la toma de decisiones de salud pública. Obtenga más información en www.helix.com.
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3 Ways to Foster the Wellbeing of LGBTQIA+ Kids and Teens
© alessandrobiascioli via Canva.com Ensuring a healthier and more inclusive future for LGBTQIA+ children and teens is of utmost importance to health systems in our community, especially Renown. Supporting the physical and mental health of youth in this community is key to those efforts, especially as they face unique challenges in terms of identity acceptance and social integration. Dr. Caroline Barangan, Adolescent Medicine Physician with Renown Children’s Pediatric Specialty Care, discusses what you as a parent, caregiver, friend or support system can do to be a safe space for children and teens who identify as LGBTQIA+. 1. Create a Safe Space at Home The most important action you can take for your LGBTQIA+ teen or child is to accept and support them for who they are, regardless of how they identify. “Being a teenager is already difficult enough, especially within the LGBTQIA+ community, which puts them at risk of being stigmatized, rejected and targets for bullying,” said Dr. Barangan. Your supportive words and actions can make a huge difference as a profound expression of love and understanding. Being patient and willing to learn are the foundations to a healthy and loving relationship with your LGBTQIA+ teen or child. 2. Encourage Regular Check-Ups with a Primary Care Provider (PCP) Establishing your child or teen with a PCP is not only important when an illness occurs but also for annual preventative visits and regular check-ups. “A primary care provider can screen for high-risk behaviors that would put a patient’s health in jeopardy, such as sexual experience, substance use, suicidality and self-harm,” said. Dr Barangan. “These screenings are an opportunity to provide the education and support these kids and teens need to stay healthy.” One of the main concerns LGBTQIA+ youth often have is that they will experience judgment from their provider, or the PCP will disclose sensitive information, including their sexuality or gender identity to their parents, when they are not ready to do so. Dr. Barangan emphatically reminds us that this legally cannot happen. “If a patient asks me to keep something confidential, unless they disclose that they have plans to harm themselves or others, I am legally not allowed to share that information with anyone without their permission,” said Dr. Barangan. 3. Locate Local Resources Northern Nevada is home to a variety of resources for the LGBTQIA+ community at large, including youth members of this community. "Finding resources to help them develop in a positive way and provide them with the information they need, whether it be in school, the household, the community or through a medical or mental health provider, is incredibly important,” said Dr. Barangan. Below is a list of local LGBTQIA+ community resources open to you and your children: Our Center LGBTQIA+ Health Services at Northern Nevada HOPES Northern Nevada Pride Festival & Community Parade (happens every July in Reno) Sassabration (happens every September in Carson City) Lake Tahoe Pride (events and resources shared on Facebook)
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Los exámenes de detección genética poblacionales demuestran que identifican de manera eficiente un aumento en el riesgo de padecer enfermedades hereditarias
El enfoque basado en la comunidad del Healthy Nevada Project revela que hasta un 90 % de los riesgos de padecer afecciones genéticas de Nivel 1 de los CDC no se detecta cuando se usan pautas de atención clínica. In a new study published today in the journal Nature Medicine, researchers behind the Healthy Nevada Project® suggest that community-based genetic screening has the potential to efficiently identify individuals who may be at increased risk for three common inherited genetic conditions known to cause several forms of cancer and increased risk for heart disease or stroke. En 2018, el Healthy Nevada Project® (el mayor estudio de salud poblacional basado en la comunidad que combina datos genéticos, clínicos, ambientales y sociales) comenzó a notificarles a los participantes del estudio que habían dado su consentimiento sobre ciertas variantes genéticas que los predisponían a padecer las afecciones genéticas de Nivel 1 de los Centros para el Control y la Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC). The study focused on identifying carriers of these conditions, which include Hereditary Breast and Ovarian Cancer, Lynch Syndrome, and Familial Hypercholesterolemia, because they are the most common conditions and early detection and treatment could significantly lower morbidity and mortality. Los resultados iniciales de casi 27,000 participantes del estudio mostraron que el 90 % de los portadores de las afecciones genéticas de Nivel 1 de los CDC no había sido previamente identificado en un entorno clínico. The authors conclude that population genetic screening would identify at-risk carriers not identified during routine care. “Our first goal was to deliver actionable health data back to the participants of the study and understand whether or not broad population screening of CDC Tier 1 genomic conditions was a practical tool to identify at-risk individuals,” explained Joseph Grzymski, Ph.D., the principal investigator of the Healthy Nevada Project®, a research professor at the Desert Research Institute (DRI), chief scientific officer for Renown Health and lead author of the study. “Now, two years into doing that, it is clear that the clinical guidelines for detecting risk in individuals are too narrow and miss too many at risk individuals.” Del grupo de 26,906 participantes del Healthy Nevada Project® que el equipo de investigación de Grzymski estudió, 358 (el 1.33 %) eran portadores de afecciones de Nivel 1 de los CDC. Sin embargo, solo el 25 % de esas personas cumplían las pautas clínicas para realizarse exámenes de detección genética. Además, más del 20 % de los portadores ya tenía un diagnóstico de enfermedad relacionada con la afección genética subyacente. “We’re at a point now where it’s possible to do clinical-grade genetic screening at population-scale,” added James Lu, M.D. Ph.D., co-founder and chief scientific officer of Helix and senior co-author of the study. “What this study demonstrates is the potential impact of doing so. By making genetic screening available more broadly, we can help the millions of Americans who are unaware that they are living at increased risk for highly actionable, genetic conditions take action.” En particular, el estudio descubrió que de los 273 participantes que eran portadores de las afecciones genéticas de Nivel 1 de los CDC y que tenían información de registros clínicos, solo 22 personas mostraron sospechas previas de tener estas afecciones genéticas subyacentes. “For the first time, we are providing information at the individual level so study participants can make lifesaving changes to reduce their risk based on their genetics,” said Anthony Slonim, M.D., Dr.PH., FACHE, president and CEO of Renown Health and co-director of the Project® study. “We’re conducting research on the community level to develop leading-edge research on health determinants for entire neighborhoods, states and eventually, the country. Returning these results allows us to understand the prevalence of genetically programmed diseases and illnesses that we have here in Nevada and ensure we are providing the best prevention and care plans. For the individual, the return of results can be life changing.” According to the CDC, early detection and intervention of the Tier 1 genetic conditions could have a meaningful potential for clinical action ability and a positive impact on public health. El Healthy Nevada Project®, que se lanzó en 2016, ofrece pruebas genéticas gratuitas a todos los residentes de Nevada, mayores de 18 años, interesados en obtener más información sobre su salud y perfil genético. Con más de 50,000 participantes del estudio inscritos en cuatro años, el Healthy Nevada Project® se ha convertido en el estudio genético de más rápida inscripción del mundo. For more about the Healthy Nevada Project® please visit healthynv.org Renown Institute for Health Innovation is a collaboration between Renown Health – a locally governed and locally owned, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California; and the Desert Research Institute – a recognized world leader in investigating the effects of natural and human induced environmental change and advancing technologies aimed at assessing a changing planet. Renown IHI research teams are focused on integrating personal healthcare and environmental data with socioeconomic determinants to help Nevada address some of its most complex environmental health problems; while simultaneously expanding the state’s access to leading-edge clinical trials and fostering new connections with biotechnology and pharmaceutical companies. Learn more at Healthynv.org. Helix is the leading population genomics company operating at the intersection of clinical care, research, and genomics. Its end-to-end platform enables health systems, life sciences companies, and payers to advance genomic research and accelerate the integration of genomic data into clinical care. Powered by one of the world's largest CLIA / CAP next-generation sequencing labs and its proprietary Exome+Ⓡ assay, Helix supports all aspects of population genomics including recruitment and engagement, clinically actionable disease screening, return of results, and basic and translational research. In response to the COVID-19 public health crisis, Helix has launched a sensitive and scalable end-to-end COVID-19 test system to meet the needs of health systems, employers, governments, and other organizations across the country. Obtenga más información en www.helix.com.
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Keeping Kids Safe on Halloween
Halloween is around the corner. So while you're prepping pumpkins for carving, putting together creative costumes and coordinating trick-or-treating plans, safety is one more detail to remember. Masks, haunted houses, witches, ghosts and ghouls — it all spells Halloween, and what could be more frighteningly fun, right? For children, however, Halloween can indeed be frightening and not so fun. According to Dr. Kristina Deeter, Physician-in-Chief of Renown Children’s Hospital and Chair of Pediatrics for the University of Nevada, Reno School of Medicine, it is common for younger children to express Halloween fears — being afraid of monsters, the dark or really anything out of the norm. “It's normal for children to struggle with separating reality from fantasy,” she explains. For children who fall into this category, the month of October can be traumatizing. Halloween may not come until the end of the month. Still, in the weeks building up to the spookiest night of the year, little ones are bombarded on all sides with decorations — mummies, skeletons, coffins, vampires, you name it. For a child with a blossoming imagination who, as Dr. Deeter said, is still learning to differentiate real from pretend, this can cause additional fears and anxieties. In commemoration of Halloween Safety Month, Dr. Deeter shares safety tips for the spooky holiday from the American Academy of Pediatrics: Dressing Up & Heading Out Plan costumes that are bright and reflective. Ensure shoes fit well and that costumes are short enough to prevent tripping, tangling or coming into contact with flames. Consider adding reflective tape or striping to costumes and trick-or-treat bags and baskets for greater visibility. Masks can limit or block eyesight. Instead, consider non-toxic makeup and hats, which should fit properly to prevent them from sliding over the eyes. Test makeup ahead of time on a small patch of skin to test for allergies before full application. When shopping for costumes, wigs and accessories, look for and purchase those with a label clearly indicating they are flame resistant. If a sword, cane or stick is a part of your child's costume, make sure it is not sharp or long. A child may be easily hurt by these accessories if he stumbles or trips. Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, serious eye disorders and infections, which may lead to permanent vision loss. Review with children how to call 9-1-1 (or their local emergency number) if they ever have an emergency or become lost. Carving Pumpkins Leave the carving to the grownups. Have children draw the pumpkin design with markers, but keep knives away. Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest. Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and not on a porch or any path where visitors may pass close by. They should never be left unattended. Prepping Your Home Keep your entryway safe for trick-or-treaters by removing all items from the porch or front yard that a child could trip over, like garden hoses, toys, bikes and lawn decorations. To ensure visibility, check outdoor lights and replace burned-out bulbs. Sweep leaves (or snow) from sidewalks and steps. If there are dogs in the home, take steps to ensure they don't jump on trick-or-treaters. Hunting for Treats Young children should always be accompanied by a parent or responsible adult. Give each child and adult a flashlight (with fresh batteries). If older children are heading out to trick-or-treat alone, plan and review a route you can agree on, as well as a specific time they are supposed to return home. Only visit homes with a lit porch light. Never enter a home or a car for a treat. Notify law enforcement authorities of any suspicious or unlawful activity immediately. Since pedestrian injuries are the most common injuries to children on Halloween, remind youngsters to take crosswalk safety precautions. For more key tips regarding Halloween safety for your young trick-or-treaters, visit our partners at Safe Kids Worldwide for a variety of spooky safety resources.
