Laura Stewart MPAS, PA-C

Laura Stewart, Member-at-Large and Board Member of SPAP, received her Bachelor of Arts degree in Biology from Baylor University and Masters of Science degree in Communication Sciences and Disorders. Following a 9 year career as a Speech Therapist, she then sought a Masters degree in Physician Assistant Studies at UT Southwestern which she completed in 2017.  Ms Stewart is now a Physician Assistant member of the Inpatient Pulmonary Team at Children's Medical Center of Dallas.

discusses the issues of bullying and highlights evidence- based recommendations for both prevention and identification of affected children and seeks to help us maximize the impact of the care we give.

Bullying has been identified in relatively recent years as a medical problem in addition to being a social problem. The article’s authors, Drs. Bass, Scholer, Flannery, and Lichtenstein, begin by providing us with a definition of bullying from the Centers for Disease Control and Prevention (CDC).  Not only has the CDC provided a definition of “traditional” bullying, but it also differentiates this from cyberbullying, which has become all too prevalent in our social-media frenzied culture.  In short, both types of bullying come down to a real or perceived power imbalance.

The article goes on to describe the catastrophic effects bullying has had on our culture and highlights the importance of our awareness, as providers of pediatric medicine, of this issue.

The potential consequences of bullying are discussed including depression, anxiety, poor overall health, as well as academic performance and suicidality. Working in an inpatient acute-care setting, it is all too often that we see these effects play themselves out in suicide attempts.  The authors describe one way in which bullying becomes a vicious cycle wherein the once-bullied child then becomes a bully as well. This second at-risk group has been shown to have even worse outcomes lasting into adulthood including thoughts of self-harm and suicidality, anxiety/depression, smoking, substance abuse, as well as less likelihood of graduating from high school.

Risk factors associated with both bullying and being bullied are described. According to the authors, certain groups are at elevated risk of being bullied including ethnic and religious minorities as well as those with health conditions such as obesity, food allergies, and learning disabilities.  They emphasize that LGBTQ adolescents are bullied as much as 2 times more than their heterosexual counterparts. Negative parenting styles and low socioeconomic status are 2 additional factors described as risk factors for being bullied.

Protective factors against both bullying and being bullied are expressed in the article such as parental connectedness, peer connectedness, and positive parenting.

In terms of the provider role, the authors provide suggestions of how to both screen for bullying and to provide support. These strategies include identifying the problem itself, getting more information, and finally, assisting with support of the at- risk patients.

The gravity of this subject is heavy. Suicidality, anxiety, depression, and obesity are escalating quickly and quietly among our adolescent population.  This article outlines helpful strategies to assist providers in caring for our patients to provide a sense of safety, help build interpersonal skills, and refer for additional outside care.

Ultimately, it is clear that bullying is a medical problem that requires adequate intervention for the well-being of our patients’ mental and physical health. This article provides both primary and secondary providers with practical ways to address and facilitate health in the adolescent population for which we care. 

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Bullying has been identified in relatively recent years as a medical problem in addition to being a social problem. Here's how the article "How to identify and treat bullying" highlights evidence- based recommendations for both prevention and identification of affected children and seeks to help us maximize the impact of the care we give our patients.

Tackling bullying in the medical arena

Certainly, these are interesting times in medicine as the integration of homeopathic remedies and over-the-counter supplements has become increasingly more common in the past few decades-from the use of elderberry to boost immunity or o

However, with inconsistent medical research and a lack of US Food and Drug Administration regulation, it remains unclear what the most safe and efficacious role these substances will play in the future of medical care.  Fish oil is one such supplement that has now been well studied and demonstrated to have value in lowering cholesterol, limiting heart disease, improving cognitive function, and helping to foster brain and eye development.  The article in review in the latest issue of 

“Fish oil supplements not a fix for obese patients with asthma”

 addresses this subject of fish oil, specifically for the treatment of patients with asthma.

The primary focus of the article is a discussion of 

Jason E. Lang, MD, MPH’s study, published by the American Thoracic Society

, which seems to debunk the premise that there is a viable role for fish oil in the treatment of asthma.  It becomes apparent throughout the article, by the comments on Lang’s study by multiple researchers, that the verdict, however, remains outstanding whether fish oil will have a beneficial role in the treatment of kiddos with asthma.  It seems to be agreed by all parties that there is still the need for additional research.  The article points out that Lang’s study was quite specific to a subset of the pediatric asthmatic population who were specifically obese and overweight. The mechanism of action for fish oil in treatment of asthma is generally to reduce immunoglobulin E and an allergic inflammatory response. The article notes that children with obesity or who are overweight will have more of a chronic inflammatory response independent of their diagnosis of asthma which could account for the lack of efficacy of fish oil in treating patients with asthma.

Many of the participants in Lang’s study did not reflect improvement in asthma control and lung function despite elevated blood levels of omega-3. Additional evidence has been previously discussed in the literature about whether chronic use of systemic steroids may block the end effect of the omega-3 fatty acids in the fish oil, thus providing additional information that may affect the ultimate outcomes of these studies.

John La Puma, MD, FACP, an internist, and 

 best-selling author on nutrition from Santa Barbara, California, makes specific reference in the article to the physiologic effect of chronic inflammation that is present in the obesity setting.  An additional co-founding factor is presented by Augusto Litonjua, MD, MPH, division chief of Pediatric Pulmonary Medicine at the University of Rochester School of Medicine, Rochester, New York.  Dr.  Litonjua suggests that, in addition to the factor of obesity, genetic differences and variations may also contribute to the reason why some patients with asthma respond more favorably to fish oil supplements than others.  As more and more variables become apparent in this discussion, I would agree with both of these physicians that larger and more comprehensive studies need to be done before final conclusions are drawn with regard to the efficacy of fish oil supplementation in the treatment of asthma.

It is clear that the strength of evidence around the effectiveness of most homeopathic remedies leaves much to be desired. This article discusses one such example. However, in spite of the current absence of strong evidence, there remains mounting hope for those suffering with illnesses such as asthma for the potential use of homeopathic remedies and over-the-counter supplements.  Wouldn’t it be wonderful to be able to treat children with asthma with improved safety and, at least, equivalent efficacy without the harmful side effects of chronic steroid use? While the ultimate conclusions regarding the use of fish oil in treating asthma remain to be drawn, as noted by Lang et al, there are additional promising studies just on the horizon.

Certainly, these are interesting times in medicine as the integration of homeopathic remedies and over-the-counter supplements has become increasingly more common in the past few decades. However, with inconsistent medical research and a lack of US Food and Drug Administration regulation, it remains unclear what the most safe and efficacious role these substances will play in the future of medical care.

Author | Laura Stewart MPAS, PA-C

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Tackling bullying in the medical arena

Fish oil: The promise and the proof