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PACEs in Nursing

Tagged With "brain health"

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4 New Communities Join ACEs Connection: May of 2020

Christine Cissy White ·
In the past month, new communities have joined ACEs Connection . Please find details about each of them below. Community Manager: ACEs Connection Community Facilitators Support You & Your Initiatives For questions about starting or growing an initiative, using our site and tools, please reach out to one of our regional contacts. Communities in: Northeast, Mid-Atlantic states, contact @Alison Cebulla (ACEs Connection Staff) Western states, contact @Gail Kennedy (ACEs Connection Staff)...
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A call to action for public health nurses during the COVID‐19 pandemic (Wiley Online Library)

Karen Clemmer ·
Joyce K. Edmonds PhD, MPH, RN , Shawn M. Kneipp PhD , Lisa Campbell DNP . First published: 12 April 2020. https://doi.org/10.1111/phn.12733 Public health nurses (PHNs) are on the frontline of the public health crisis the world now knows as the COVID‐19 pandemic. They serve on mobile strike teams investigating case‐contacts, deliver education on self‐isolation and quarantine through hotlines and home visits, and interpret the rapidly shifting guidance from the Centers for Disease Control and...
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AMCHP Urges Congress to Support These Priorities for Maternal and Child Health in the Next COVID-19 Relief Package (AMCHP)

Karen Clemmer ·
May 7, 2020. AMCHP Urges Congress to Support These Priorities for Maternal and Child Health in the Next COVID-19 Relief Package Additional Resources for the Title V Maternal and Child Health Services Block Grant Due to COVID-19, there are already gaps being felt in Maternal and Child Health services, with additional resources needed to address these issues both now and in the aftermath of the immediate crisis. These range from delays in initial newborn hearing and bloodspot screening to...
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Announcing Trauma and Resilience Competencies for Nursing Education

Kathleen Wheeler ·
The authors are pleased to announce the Trauma and Resilience Competencies for Nursing Education. These competencies serve as a guideline of minimal expectations and reflect essential knowledge, skills and behaviors for three levels of nursing education: 1) undergraduate, 2) graduate, and 3) psychiatric nurse practitioner programs. The Trauma and Resilience Competencies, developed in 2018 at the Egan School of Nursing and Health Studies at Fairfield University in Connecticut by an Expert...
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Childhood Trauma, Neglect Linked to Increased Risk of Cardiovascular Disease Risk (HCP Live)

Karen Clemmer ·
By Patrick Campbell, May 1, 2020, HCP Live. While most ongoing research into the impact of mental stress focuses on current stress, a new analysis of the CARDIA study suggests a dysfunctional childhood could be linked to increased risk of cardiovascular disease 30 years later. Results of the analysis indicate children who experienced childhood dysfunction, such as family dysfunction, abuse, and neglect, were more likely to experience cardiovascular disease and all-cause mortality, even after...
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COVID-19 and Healthcare worker's families: behind the scenes of frontline response [thelancet.com]

By Amine Souadka, Hajar Essangri, Amine Benkabbou, et al., EClinical Medicine, May 17, 2020 During the COVID-19 outbreak, healthcare professionals are exposed to a high-risk of infection and mental health problems, but also fear of contagion and spreading the virus to their families. In fact, considering them as individuals implies looking beyond their function as frontline responders and taking into account their societal role as parents, spouses and offspring. While work-family balance is...
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Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic (JAMA Network)

Karen Clemmer ·
JAMA Pediatr. Published online April 14, 2020. doi:10.1001/jamapediatrics.2020.1436 Coronavirus disease 2019 (COVID-19) is affecting our health care community in unprecedented ways. As a pediatric oncologist who studies resilience in the context of illness, I started thinking about what this pandemic means for our professional resilience a few weeks ago, when the first US patient with fatal COVID-19 died in my home city of Seattle, Washington. Promoting resilience among health care workers...
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Efforts to Reduce Black Maternal Mortality Complicated by COVID-19 [chcf.org]

By Xenia Shih Bion, California Health Care Foundation, April 20, 2020 Latoyha Young had a birth plan. She was going to have the baby in Sacramento with community doula Joy Dean by her side. Dean was funded by the county’s Black Child Legacy Campaign , which works to reduce the disproportional number of Black infant and child deaths in Sacramento. But in mid-March, when Young went into labor just as Governor Gavin Newsom ordered Californians to stay at home to avoid spreading the novel...
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Forsyth County Trauma Informed Care Network

Laneita Williamson ·
The Forsyth County Trauma Informed Network is taking great strides into recognizing and addressing community post Covid-19 impacts. PowerPoint attached.
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GABOR MATÉ JOINS EP. 3 on May 21 with Darrell Hammond and Filmmaker Michelle Esrick. [crackedupmovie.com]

CRACKED UP THE EVOLVING CONVERSATION TRAUMA AS THE ROOT CAUSE OF ADDICTION With DARRELL HAMMOND DIRECTOR MICHELLE ESRICK and RENOWNED TRAUMA AND ADDICTION EXPERT GABOR MATÉ, M.D. author of In the Realm of Hungry Ghosts: Close Encounters With Addiction MODERATED BY JANE STEVENS, FOUNDER OF ACES CONNECTION Hosted by ACES Connection Thursday May 21st at 2pm PDT / 3p MT / 4p CT / 5pm EDT FREE FOR ALL WHO REGISTER! IF YOU REGISTER, BUT CAN NOT ATTEND, YOU WILL RECEIVE A RECORDING WITHIN ONE WEEK.
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'I Can't Turn My Brain Off': PTSD and Burnout Threaten Medical Workers [nytimes.com]

By Jan Hoffman, The New York Times, May 16, 2020 The coronavirus patient, a 75-year-old man, was dying. No family member was allowed in the room with him, only a young nurse. In full protective gear, she dimmed the lights and put on quiet music. She freshened his pillows, dabbed his lips with moistened swabs, held his hand, spoke softly to him. He wasn’t even her patient, but everyone else was slammed. Finally, she held an iPad close to him, so he could see the face and hear the voice of a...
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Primary Care & Telehealth Strategies for Addressing the Secondary Health Impacts of COVID-19

From ACEs Aware, May 13, 2020 This webinar will focus on building understanding and identifying primary care and telehealth strategies and tools to address the secondary health effects of the COVID-19 emergency. Widespread stress and anxiety regarding COVID-19, compounded by the economic distress due to lost wages, employment and financial assets; mass school closures; and necessary physical distancing measures can result in an increase of stress-related health conditions. These secondary...
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The Black Community, COVID-19 & Trauma [sdvoice.com]

By Latanya West, San Diego Voice, May 15, 2020 In January 2019, Governor Gavin Newsom appointed Dr. Nadine Burke Harris as California’s first-ever Surgeon General. An award-winning physician, researcher and advocate, Dr. Burke Harris’ career has been dedicated to serving vulnerable communities and combating the root causes of health disparities. Her work is equally dedicated to changing the way our society responds to one of the most serious, expensive and widespread public health crises of...
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University of Florida Graduate Public Health Course: Trauma-Informed Approaches for Individuals, Communities, and Public Health: Student Project Summaries

Lindsey King ·
The University of Florida College of Public Health and Health Professions partnered with Peace4Tarpon under the Robert Wood Johnson Mobilizing Action for Resilient Communities (MARC) grant. Together they created 2 online graduate courses that focus on addressing ACEs and creating trauma-informed and resilience-based programs from a public health approach. Peace4Gainesville and Peace4 TheBigBend have also contributed to these courses. This post is intended to showcase some of the work of the...
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Why Is the Pandemic Killing So Many Black Americans [podcasts.apple.com]

Carey Sipp ·
By The Daily, The New York Times, May 20, 2020 Some have called the pandemic “the great equalizer.” But the coronavirus is killing black Americans at staggeringly higher rates than white Americans. Today, we explore why. Guest: Linda Villarosa, a writer for The New York Times Magazine covering racial health disparities, who spoke to Nicole Charles in New Orleans, La. about the death of her husband, Cornell Charles, known as Dickey. He was 51. For more information on today’s episode, visit...
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ACEs Research Corner — May 2020

Harise Stein ·
[Editor's note: Dr. Harise Stein at Stanford University edits a web site -- abuseresearch.info -- that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she's posting the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens] Williams AB, Smith ER, Trujillo MA, et. al. Common health problems in safety-net primary care: Modeling the roles of trauma history and mental health. J Clin...
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Mental Health Awareness: When Suffering Is Not an Illness

Lori Chelius ·
When I was an adolescent and young adult, I struggled with depression. As I reflect back on that time, so much of what I was experiencing was deeply tied to coming to terms with my sexuality. Growing up in the 1980’s in a relatively conservative town, I was closeted (even to myself) until I was a young adult. The pain and fear of being different, of not belonging, of being judged or rejected for who I was more than my adolescent brain could wrap its conscious head around.
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Forsyth County Trauma Informed Care Network

Laneita Williamson ·
The Forsyth County Trauma Informed Network is taking great strides into recognizing and addressing community post Covid-19 impacts. PowerPoint attached.
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Experience of emergency department use among persons with a history of adverse childhood experiences [bmchealthservres.biomedcentral.com]

By Eva Purkey, Colleen Davison, Meredith MacKenzie, et al., BMC Health Services Research, May 24, 2020 Background Adverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED utilization among a group of ED users with...
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What Do Coronavirus Racial Disparities Look Like State by State [npr.org]

Carey Sipp ·
By Maria Godoy and Daniel Wood, National Public Radio, May 30, 2020 In April, New Orleans health officials realized their drive-through testing strategy for the coronavirus wasn't working. The reason? Census tract data revealed hot spots for the virus were located in predominantly low-income African-American neighborhoods where many residents lacked cars. In response, officials have changed their strategy, sending mobile testing vans to some of those areas, says Thomas LaVeist , dean of...
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What Do We Do? What Do We Do Now?

Jane Stevens ·
People’s response to the great chasms of structural inequities glaringly laid bare by the COVID-19 pandemic have been further inflamed by the murder of George Floyd and deaths of other African Americans in recent weeks. The acute emergency of the pandemic has eased, but the violence inflicted on racial minorities and now those who are protesting the inequities in our society has compounded the outrage. Right after the pandemic began running riot across the US, I often heard people ask: When...
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Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During Coronavirus Disease 2019 (COVID-19) Pandemic in Italy [jamanetwork.com]

By Rodolfo Rossi, Valentina Socci, and Francesca Pacitti, JAMA Network, May 28, 2020 Introduction Health care workers (HCWs) involved in the coronavirus disease 2019 (COVID-19) pandemic are exposed to high levels of stressful or traumatic events and express substantial negative mental health outcomes,1 including stress-related symptoms and symptoms of depression, anxiety, and insomnia. In this cross-sectional study, we report on mental health outcomes among HCWs in Italy. Methods This...
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"Addiction begins with solving a problem, the problem of human pain, emotional pain"

Laurie Udesky ·
In his groundbreaking book , In the Realm of Hungry Ghosts: Close Encounters with Addiction , trauma and addiction expert Dr. Gabor Maté writes, “There are almost as many addictions as there are people.” ACEs Connection founder and publisher Jane Stevens read that quote as a springboard to asking Maté to define addiction and explain whether or not it is always rooted in adverse childhood experiences. Maté, along with filmmaker Michelle Esrick and Saturday Night Live star Darrell Hammond,...
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Advancing Racial Equity Webinar Series [apha.org]

By Tia Taylor Williams, American Public Health Association, May 2020 Alarming disparities within the COVID-19 pandemic — such as higher hospitalizations and death rates among African Americans — are sadly predictable and highlight the urgent need to address the root causes of health inequities. APHA is hosting this four-part webinar series to give an in-depth look at racism as a driving force of the social determinants of health and equity. The series will explore efforts to address systems,...
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NEW Trauma-informed Care Podcast (CME provided)

Megan Gerber MD MPH ·
Join us as we delve into the paradigm-shifting ethos of trauma-informed care with renowned expert Dr. Megan Gerber. Dr. Gerber is an Associate Professor of Medicine at Boston University School of Medicine and serves as Medical Director of Women’s Health for VA Boston where she directs the Women’s Health Fellowship. Dr. Gerber edited the textbook, “Trauma-informed Health Care Approaches: A Guide for Primary Care.” We discuss the framework for trauma-informed universal precautions, as well as bas
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Announcing the Connected Care Accelerator (Request for Applications) [Center for Care Innovations]

Laurie Udesky ·
* CA SPECIFIC The Connected Care Accelerator, an initiative of the California Health Care Foundation , has been designed in partnership with the Center for Care Innovations to support safety net practices — including community health centers and independent physician practices that predominantly serve low-income communities — in different implementation phases of “virtual care,” also commonly known as “telehealth” or “telemedicine.” The accelerator has two separate tracks: For the...
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Recognizing history of Black nurses a first step to addressing racism and discrimination in nursing (The Conversation)

Karen Clemmer ·
By Keisha Jefferies, May 11, 2020, The Conversation. During the coronavirus pandemic, nurses are among the nation’s front-line workers. Over the years and to this day, the contributions of Black nurses are hard-fought, unrecognized and under-appreciated. Nurses are essential in care delivery, policy directives and in shaping the health-care system. The year 2020 is the year of the nurse and midwife . Yet, Canada’s history of racism and segregation has contributed to residual anti-Black...
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How nurses are coping with the stress from the coronavirus — it isn’t easy (Miami Herald)

Karen Clemmer ·
By Ana Veciana-Suarez, April 28, 2020, Miami Herald. Each has a compelling story about what inspired them to become a nurse. Now each of them has a gripping worry about contracting COVID-19. As these frontline healthcare workers mark another Nurses Week in May, it’s never been more stressful to help sick people get healthy — yet that hasn’t stopped nurses from going to work. “Typically,” says Barbara Bruce, a 42-year RN veteran who works for Memorial Healthcare System in Broward, “you don’t...
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If You’ve Lost Your Health Plan In The COVID Crisis, You’ve Got Options (Kaiser Health News)

Karen Clemmer ·
By Julie Appleby, June 12, 2020, Kaiser Health Network. The coronavirus pandemic — and the economic fallout that has come with it — boosted health insurance enrollment counselor Mark Van Arnam’s workload. But he wants to be even busier. The loss of employment for 21 million Americans is a double blow for many because it also means the loss of insurance, said Van Arnam, director of the North Carolina Navigator Consortium, a group of organizations that offer free help to state residents...
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Racism's Effect on Health, and the Heartbreak of Being a Black Parent Right Now: California's Surgeon General Speaks [kqed.org]

By KQED Science, KQED, June 14, 2020 The coronavirus pandemic and the recent killing of George Floyd have brought longstanding racial inequities into sharp focus. One of those disparities concerns the high rate of coronavirus transmission among people of color. To talk about the intersection of race and health, KQED's Brian Watt spoke last week with California Surgeon General Dr. Nadine Burke Harris, who is known for her pioneering work on the role that childhood stress and trauma play on...
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THURSDAY!! Cracked Up, The Evolving Conversation: Generational Trauma - Breaking the Cycle [crackedupmovie.com]

CRACKED UP THE EVOLVING CONVERSATION Episode 4: Generational Trauma - Breaking the Cycle with Darrell Hammond, Comedian, actor, SNL Legend Michelle Esrick, Filmmaker, activist Bessel van der Kolk, MD, Author of The Body Keeps the Score Jane Stevens, Founder of ACES Connection and special guest Jane Fonda Academy Award-winning actor, producer, author and activist Thursday June 25th at 1pm PDT / 2p MT / 3p CT / 4pm EDT Hosted by ACEs Connection THE PRICE OF THIS LIVE EVENT IS $12.50 We have...
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Linda Grabbe: Helping her communities develop resilience through the Community Resilience Model

Sylvia Paull ·
Grabbe searched for models that would help her homeless and addicted patients. “There are good body-based models for psychotherapy, which may be the most effective approach for trauma,” she says, “but hardly any of my patients were receiving any kind of therapy. There are thousands of people in our communities who have high ACE scores who will never get the years of psychotherapy they deserve. CRM is a self-mental wellness care tool and is exquisitely trauma-sensitive—so it can help enormously.”
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A Better Normal Tuesday, June 30th at Noon PDT: Reinterpreting American Identity, a Community Discussion

Alison Cebulla ·
"I think that all of us, regardless of our racial or ethnic background, feel relieved that we no longer have to deal with the racism and the sexism associated with the system of slavery. But we treat the history of enslavement like we treat the genocidal colonization of indigenous people in North America, as if it was not that important, or worse, as if it never happened." —Angela Davis, "The Meaning of Freedom" Please join us for the ongoing community discussion of A Better Normal, our...
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Physician Burnout, Interrupted (NEJM)

Karen Clemmer ·
By Pamela Hartzband, M.D., a nd Jerome Groopman, M.D. June, 25, 2020, N Engl J Med 2020; 382:2485-2487 DOI: 10.1056/NEJMp2003149. Before the onset of the Covid-19 pandemic, each day seemed to bring another headline about the crisis of physician burnout. The issue had been simmering for years and was brought to a boil by mounting changes in the health care system, most prominently the widespread implementation of the electronic health record (EHR) and performance metrics. 1 Initially, the...
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Resilient Georgia and Georgia Public Broadcasting present "Mental Fitness for Resilience" Second Panel - The Trauma of Racism

Carey Sipp ·
Resilient Georgia recently presented a roundtable discussion, featuring a distinguished panel of professionals, on the trauma associated with racism and racial discrimination, as part of the Mental Fitness for Resilience Campaign. The distinguished panel for this Georgia Public Broadcasting production included Dr. Patrice Harris, MD, MA, psychiatrist and the first African-American woman to be elected president of the American Medical Association; Dr. Terri McFadden, a General Pediatrician...
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Hollowed-Out Public Health System Faces More Cuts Amid Virus (KHN)

Karen Clemmer ·
By Lauren Weber and Laura Ungar and Michelle R. Smith, The Associated Press and Hannah Recht and Anna Maria Barry-Jester JULY 1, 2020 The U.S. public health system has been starved for decades and lacks the resources necessary to confront the worst health crisis in a century. The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century. Marshaled against a virus that has sickened at least 2.6 million in the U.S., killed...
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The Relentless School Nurse: 10 Things Parents Can Do Now to Help Prepare Children For Returning to School

Robin M Cogan ·
School nurses have been industrious during COVID-19, using innovative skills to do one of the things we do best, providing information for our families. Everyone's health literacy has been tested through the pandemic. The messaging from our most trusted institutions like the CDC has been confusing and ever-changing. As states have released vague return to school guidelines, it is clear that the details for keeping our students and staff safe will depend on each school district to create...
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Help Navigating the Road to Community Resiliency

Becky Haas ·
The first time I ever heard the words trauma-informed care and the Adverse Childhood Experiences (ACEs) study was in the summer of 2014. At the time, I was working for the local Police Department as the Director of a grant-funded Crime Reduction Project aimed at reducing drug-related and violent crime. Of the many program goals, one was to develop a rehabilitative corrections program for felony offenders with addictions in order to reduce recidivism. Though I’ve lived in this region for...
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Do safe, stable, and nurturing relationships work? New research has important findings for responding to ACEs

Alyssa Koziarski ·
While we know that adverse childhood experiences (ACEs) can cause risk behaviors, research has told us that the presence of protective factors can help mitigate the effects of ACEs. Common risk behaviors such as smoking tobacco and alcohol misuse can be a result from the trauma of childhood disadvantage. In responding to ACEs, public health research proposes that protective factors such as safe, stable, nurturing relationships (SSNRs) with a caring adult can mitigate the long-term effects of...
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Health Disparity, Racial Weathering, and Social Determinants: How Do We Create Antiracist Healthcare? [saragottfriedmd.co]

By Sara Gottfried, Dr. Sara Gottfried MD, July 13, 2020 I take respectful care of my patients regardless of skin color, but in the past few years, I’ve realized that is not enough. There are many sources of information that have influenced me. Conversations, particularly a recent interview with integrative physician Andrea Pennington MD. Books, mentioned in this article, including How to Be an Antiracist by Boston University Professor Ibram X. Kendi and founder of the Antiracism Center for...
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UCSF study shows health workers grappling with pandemic anxiety: 'It's exhausting' [sfchronicle.com]

By Mallory Moench, San Francisco Chronicle, July 21, 2020 Dr. Robert Rodriguez’s anxiety rises and falls with the number of coronavirus cases and deaths. Fear that he could get infected at his San Francisco General Hospital job, or bring the virus home, affects his sleep. He doesn’t hug his 16-year-old son as much. Other worried family members avoid interacting with him. The stress isn’t sustainable, he said. “If day after day, you’re waking up and dealing with patients that are extremely...
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ACEs and Gynecological Problems - A Conversation Starter

Dianne Couts ·
Gynecological problems as a result of ACEs, and particularly of Childhood Sexual Abuse (CSA), are rarely discussed in books and articles about the ACEs. The author would like to see that issue become part of the ACEs conversation.
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How a Pandemic Could Advance the Science of Early Adversity [jamanetwork.com]

By Danielle Roubinov, Nicole R. Bush, and W. Thomas Boyce, JAMA Pediatrics, July 27, 2020 The reach of the coronavirus disease 2019 (COVID-19) pandemic is global, a health crisis with a ubiquity never before experienced. While the physical health consequences of COVID-19 appear to affect proportionally fewer children compared with adults, its psychosocial consequences may be magnified within families who consistently weather a landscape of severe stressors or adverse childhood experiences...
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GUEST EDITORIAL: We need a new model for mental health [heraldtribune.com]

By Andrea Blanch, Sarasota Herald-Tribune, July 27, 2020 People are really stressed out right now. A recent national survey reports that “serious psychological distress” — the kind that can lead to longer-term psychiatric disorders — has more than tripled since this time last year. We are already seeing the consequences in Sarasota County, with the number of opioid-related deaths in the first half of 2020 more than double the number in all of 2019. And based on experience with SARS, experts...
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Donald Trump is the product of abuse and neglect. His story is common, even for the powerful and wealthy.

Jane Stevens ·
“In order to cope,” writes Mary Trump, “Donald began to develop powerful but primitive defenses, marked by an increasing hostility to others and a seeming indifference to his mother’s absence and father’s neglect….In place of [his emotional needs] grew a kind of grievance and behaviors—including bullying, disrespect, and aggressiveness—that served their purpose in the moment but became more problematic over time. With appropriate care and attention, they might have been overcome.”
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Why the dean of early childhood experts wants to get beyond the brain [centerforhealthjournalism.org]

By Ryan White, Center for Health Journalism, July 23, 2020 Harvard’s Jack Shonkoff, a luminary in the field of early childhood, has spent years showing that events in the earliest years of life have profound implications for how budding brains develop, and in turn, shape a child’s later potential at school and work. Now, Shonkoff says it’s time to connect the brain to the rest of the body. “The message now is to say that there is a revolution going on in molecular biology and genomics and in...
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Confessions of a California Covid Nurse (Bloomberg)

Karen Clemmer ·
By Michael Lewis, July 30, 2020, Bloomberg. Notes From A Pandemic: A California county’s efforts to stop the spread has also become a battle with the public’s denial. Erica Dykehouse will wait for minds to change. The Humboldt County Public Health department in California is inside what used to be a juvenile jail. The offices are former prison cells. A few of the doors still have the small windows with the sliding panels that allowed guards to observe prisoners. The basement is a dungeon,...
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Baby courts: A proven approach to stop the multigenerational transmission of ACES in child welfare; new efforts to establish courts nationwide

Carey Sipp ·
The organization Zero To Three estimates that in the U.S., a child is taken into the child welfare system every six seconds. “Many of society’s most intractable problems can be traced back to childhood adversity. Being in the child welfare system increases the likelihood of more adversity and criminality. Baby court is a proven approach to healing the trauma of both child and parent, and breaking the cycle of maltreatment,” says Mimi Graham, Ed.D ., director of the Florida State University...
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Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being (NEJM)

Karen Clemmer ·
Victor J. Dzau, M.D., Darrell Kirch, M.D., and Thomas Nasca, M.D. August 6, 2020 N Engl J Med 2020; 383:513-515. DOI: 10.1056/NEJMp2011027. The Covid-19 pandemic, which had killed more than 60,000 Americans by May 1, has been compared with Pearl Harbor and September 11 — cataclysmic events that left indelible imprints on the U.S. national psyche. Like the volunteers who flooded into Manhattan after the World Trade Center attacks, the health care providers working on the front lines of the...
 
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