COVID Vaccination for Kids a 'Complex' Decision for Parents

 For parents, the decision to have a child vaccinated against SARS-CoV-2 is complex, and providers need to understand how and why such decisions are made to provide tailored recommendations, a qualitative study suggests.

Dr Jonathon Maguire

"Many families who are worried about vaccinating their children against the COVID-19 virus are not antivaccination, just concerned parents," study author Jonathon Maguire, MD, of St. Michael's Hospital and the University of Toronto, Canada, told Medscape Medical News. Therefore, clinicians need to "keep an open mind."

Parents found the decision "challenging," according to the study's authors. The following four themes influenced parental attitudes toward vaccinating a child: the newness of the SARS-CoV-2 vaccines and evidence supporting their use; the perceived politicization of vaccination guidance; social pressures regarding SARS-CoV-2 vaccination; and weighing individual vs collective benefits of vaccination.

The study was published online February 21 in the Canadian Medical Association Journal.

Continuum of Concerns

Children aged 5–11 years became eligible to receive the SARS-CoV-2 vaccine in Canada in November 2021. Before regulatory approval, about two thirds of parents reported a willingness to have their child receive the vaccine, but as of October 2022, fewer than half (47%) of children in that age group had received at least one dose, according to the researchers.

To understand the factors that affect parental decision-making, the team conducted a qualitative study involving phone or video call interviews with a "purposive" sample of 20 parents in the Greater Toronto Area in Ontario.

Of the 20 participants, 18 were women. Seven were aged 31–40 years, and 13 were aged 41 years or older. Most participants (16) were White, two were Black, and two reported "other" ethnicity. Most participants (13) had a university degree, five had a college education, and two had completed elementary or high school. All had at least one child aged 5–11 years.

Parental attitudes represented a "complex continuum of concern," according to the researchers. These concerns included the novelty of the technology (eg, mRNA vaccines) and the paucity of evidence regarding associated risks and benefits for children.

Some participants wanted to wait for further evidence of the vaccine's potential long-term adverse effects. Others were not convinced by the evidence of efficacy to date, particularly compared with routine childhood immunizations.

One participant commented, "I am fully supportive of all other vaccines.... I believe in getting a vaccine even if you don't need it if it will protect other people. But it doesn't seem like this vaccine does that [for children]."

Parents expressed concern about the perceived politicization of vaccination guidance. One is quoted as saying, "I'm very uncomfortable with politicians selling vaccines on TV or on social media.... I just feel it's a decision that should have been between my doctor and myself for my children.... Maybe if the government had stayed out of it, maybe we would have [gotten vaccinated]."

The social pressure involving SARS-CoV-2 vaccinations was also a concern. One said, "Right now, it seems like you are either pro-vaccine or anti-vax. And if you haven't gotten a [SARS-CoV-2] vaccine, even if you're not anti-vax, but you just don't want that one, you're still lumped into the [anti-vax] category."

Weighing of individual vs collective benefits of vaccination was also a consideration. One participant noted, "We can't look at it as a group decision. We have to look at it as an individual family decision."

Overall, parents expressed "difficulty sourcing and evaluating evidence, determining the trustworthiness of guidance, and balancing their own conceptions of health care decisions with societal expectations and political messaging," the authors conclude.

The demographics of the participants was the study's main limitation: most were women who lived in households with high levels of income and education who were selected from an existing study of families willing to engage in longitudinal research. Therefore, the findings may not hold true for all parents in Canada.

Decision-Making Discussions

Commenting on the study for Medscape, Suzette Oyeku, MD, MPH, chief of academic general pediatrics at the Children's Hospital at Montefiore in New York City, said that she agreed with the study findings on the basis of her clinical experience. She noted that certain contextual factors weren't highlighted in the study, however, probably because of participant demographics.

Dr Suzette Oyeku

In her diverse population of patients, some parents could not take time off from work to have their children vaccinated without losing pay. "Vaccine availability has an impact in this situation," said Oyeku. "In this population, given historical influences, issues around skepticism and potential mistrust of health systems or clinical trials also play a role."

Furthermore, it is important to know how decisions are made in households, she said. "In some families, it's gender-based, and even when you're having discussions, the decider may not be in the room and needs to be brought into the conversation. As a clinician, it's important to ask which people need to hear the information so that it can really inform the family decision."

It's also important to be available to address questions from families, said Oyeku. Although time is a challenge, "this is what we pediatricians do. We have conversations about vaccinations, and with the COVID vaccines, the conversations are likely to be a little long and may happen on several occasions.

"We need to use multiple strategies to get the information out, including clergy, who clinicians may not think about but who are trusted resources for up to a third of families," said Oyeku, who served as a medical consultant with the Conference of National Black Churches on a CDC-funded project. The initiative, Trusted Voices, Trusted Content and Trusted Spaces, trained more than 3000 faith-based leaders across the US about the COVID vaccines.

She suggested that clinicians consider using short videos from The Conversation: Between Us, About Us – Greater than COVID, among other resources, to inform provider-family discussions.

The study was supported by the Canadian Institutes of Health Research and the Canadian COVID-19 Immunity Task Force. Maguire and Oyeku have disclosed no relevant financial relationships.

CMAJ. Published February 21, 2023. Full text

https://www.medscape.com/viewarticle/988532

Intermittent Fasting Plus Exercise a Good Option for Fatty Liver

 In the first study to examine how intermittent fasting combined with exercise impacts nonalcoholic fatty liver disease (NAFLD), the combined strategy was more effective than aerobic exercise alone or no intervention (control).

However, the combined approach did not give significantly added benefit compared with fasting alone, the researchers report.

Eighty patients with NAFLD were randomized to one of four lifestyle strategies (alternate-day fasting, aerobic exercise, both, or neither) for 3 months.

The primary outcome was change in intrahepatic triglyceride (IHTG) content from baseline to study end, measured by magnetic resonance imaging proton density fat fraction.

The results suggest that "combining intermittent fasting with exercise is effective for reducing hepatic steatosis [fatty liver] in patients with NAFLD, but may offer no additional benefit versus fasting alone," Mark Ezpeleta, PhD, formerly at the University of Illinois Chicago and now at the University of Colorado Anschutz Medical Campus, and colleagues conclude.

"Our findings also indicate that the combination intervention was effective for reducing body weight, fat mass, waist circumference, [the liver enzyme alanine transaminase (ALT)], fasting insulin, [and] insulin resistance, and increasing insulin sensitivity, among patients with obesity and NAFLD, versus controls," the group reports.  

"When we compared the results of our study groups, we saw clearly that the most improved patients were in the group that followed the alternate-day fasting diet and exercised 5 days a week," senior author Krista A. Varady, PhD, professor of nutrition, University of Illinois Chicago, said in a press release from the university.

"The people who only dieted or only exercised did not see the same improvements," she added, "which reinforces the importance of these two relatively inexpensive lifestyle modifications on overall health and on combating chronic diseases like fatty liver disease."

Moreover, "alternate-day fasting and exercise interventions can be difficult for people to stick to, and in prior studies we have seen significant dropout," she noted. "It was very interesting to see that in this trial we had very high adherence to the interventions."

The study was recently published in Cell Metabolism.  

Around Two Thirds of People With Obesity Have NAFLD

An estimated 65% of people with obesity have NAFLD, or fat in the liver that is not the result of excessive alcohol consumption, which is strongly related to the development of insulin resistance and type 2 diabetes, the group writes.

Thiazolidinediones such as pioglitazone reduce hepatic steatosis, but there is mounting concern about the weight-gaining effect of these compounds.

Recent attention has focused on lifestyle interventions to resolve hepatic steatosis, and previous trials showed that alternate-day fasting was effective for certain outcomes in NAFLD, but those studies did not measure changes in IHTG content or include an exercise intervention.

The researchers enrolled 80 adults with obesity and NAFLD and randomized them to one of four groups for 3 months:

• Alternate day fasting group: Participants were instructed to consume 600 kcal at dinner between 5 PM and 8 PM on a fasting day alternating with food as desired on a feasting day.

• Exercise group: A 60-minute moderate-intensity aerobic exercise session 5 times a week.

• Fasting plus exercise group.

• Control group (no intervention).

Participants were age 23-65 (mean age, 44) and 81% were women.

Half were Hispanic, and the rest were Black (30%), White (11%), or Asian (9%).

They had a mean weight of 99 kg (218 lb) and a mean body mass index of 36 kg/m².

Dropout rates were minimal in the combination group (0%) and fasting groups (5%), and moderately high in the exercise group (25%).

IHTG content was reduced by a significantly greater amount in the combination group (–5.48%) than in the exercise alone group (–1.30%; P = .02) or in the control group (–0.17%; P < .01) and by a greater amount than in the fasting alone group, although this was not significant (–2.25%; P = .05).

Lean mass, aspartate transaminase (AST), A1c, blood pressure, plasma lipids, liver fibrosis score, and hepatokines (fetuin-A, FGF-21, and selenoprotein P) did not differ between groups.

Researchers acknowledge that although the combination intervention resulted in improved NAFLD parameters, IHTG and ALT did not reach the normal range.  

Participants likely had early stage NAFLD (their baseline IHTG was in the 16% to 18% range, where 5% to 33% is mild steatosis) and they were likely highly motivated (indicated by the low dropout rate), and so the findings may not be generalizable.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Varady has reported receiving author fees from the Hachette Book Group for the book entitled, "The Every Other Day Diet." The other authors have reported no relevant financial relationships.

Cell Metab. 2023;35:56-70.e3. Abstract

https://www.medscape.com/viewarticle/988511

Biden Student Loan Forgiveness Plan In Trouble At Supreme Court, Lawyers Say

 by Matthew Vadum via The Epoch Times (emphasis ours),

President Joe Biden’s sweeping plan to partially forgive student loans will likely receive a cool reception when the Supreme Court hears challenges to the program on Feb. 28, legal experts told The Epoch Times.

Biden introduced the plan in August 2022 in a move that critics decried as a constitutionally dubious attempt to shore up Democrats’ fortunes ahead of the November 2022 congressional elections. While the Congressional Budget Office said the plan could cost about $400 billion, the Wharton School at the University of Pennsylvania estimates the price tag could exceed $1 trillion.

The student loan relief program is premised on the existence of the emergencies the Trump administration declared in March 2020 to combat the COVID-19 virus. The national emergency and the public health emergency enabled federal agencies to exercise expansive powers in managing the government’s pandemic response.

In a move that could undermine the government’s legal arguments in the pending court cases, Biden’s Office of Management and Budget said in a Jan. 30 press release (pdf) that it would extend the soon-to-expire emergencies to May 11 “and then end both emergencies on that date.”

The federal government put a pause on student loan payments and interest during the recent pandemic but then claimed in 2022 that the pandemic gave it emergency authority under the law to proceed with partial loan forgiveness. Republicans, who took the majority in the House of Representatives in January, say the emergencies aren’t justified and should be ended sooner.

About 26 million people reportedly applied under the program before courts blocked it last year. Of those 26 million, 16 million were said to have been approved before the government stopped accepting applications.

The Department of Education claims that it has the authority to move forward with the debt relief proposal, which would cancel as much as $20,000 in loan principal for 40 million borrowers, under the Higher Education Relief Opportunities for Students Act of 2003 (HEROES Act).

But lawmakers involved in the passage of the HEROES Act say the statute was enacted after the 9/11 terror attacks to provide student loan relief to military service members and their families and was never intended to be used to cancel debts en masse.

The court is scheduled to hear two related cases dealing with the program, Biden v. Nebraska (court file 22-506) and Department of Education v. Brown (court file 22-535), back-to-back on Feb. 28.

The Biden student loan forgiveness plan is flatly unconstitutional, attorney Caleb Kruckenberg of the Pacific Legal Foundation, a national nonprofit public interest law firm, told The Epoch Times.

He said Biden unveiled the debt relief program not long after the pandemic “was over anyway [and] we all sort of understood what that meant.”

Kruckenberg said that even if the Biden administration were successful at the Supreme Court, which he doubts, their stated authority would expire May 11.

https://www.zerohedge.com/political/biden-student-loan-forgiveness-plan-trouble-supreme-court-lawyers-say

US Believes Russia Conducted 'Satan 2' ICBM Test While Biden Was In Ukraine

 CNN has published a surprising report Tuesday night, claiming based on two unnamed US officials that Russia conducted an ultra-provocative intercontinental ballistic missile test while President Biden was in Ukraine on Monday.

The sources say the US believes the ICBM test "failed" - however, no explanation or details were given for the claim other than Putin simply didn't mention the test in his big Tuesday speech in Moscow.

"Russia notified the United States in advance of the launch through deconfliction lines, one official said. Another official said that the test did not pose a risk to the United States and that the US did not view the test as an anomaly or an escalation," CNN writes. 

The officials described it as a test of the heavy SARMAT missile – dubbed in the West the 'Satan II' - which is nuclear capable. 

The following is the perhaps dubious "evidence" of the purported test failure as highlighted by CNN:

It has been successfully tested before and had this one worked, US officials believe Russian President Vladimir Putin would have highlighted the test in his State of the Nation address on Tuesday.

Instead, Putin made no mention of the launch in the speech that lasted an hour and 45 minutes. He did, however, formally declare that Russia will be suspending his country’s participation in the New START nuclear arms reduction treaty with the United States, imperiling the last remaining pact that regulates the world’s two largest nuclear arsenals.

If Russia wanted to send a resounding and threatening message, there remains the possibility that footage of the SARMAT missile launch could be released later in the week, assuming it did happen.

Often, though not always, the Kremlin likes to widely publicize its major weapons tests by circulating official video. In some instances, videos are belatedly released. 

If indeed the Kremlin conducted a 'Satan II' missile test with Biden in Kyiv, and releases the video while he's still traveling in Eastern Europe (currently in Poland), this would without doubt be taken by the West as a huge escalation and direct threat, as it sends a not so subtle and ominous 'message' at a moment America's commander-in-chief is in the region.

https://www.zerohedge.com/geopolitical/us-believes-russia-conducted-satan-2-icbm-test-while-biden-was-ukraine

Walmart CEO on food inflation: Some is 'stubborn, mid-double digit'

 Executives at Walmart on Tuesday provided their observations on food inflation the company has been seeing as they discussed the retail giant’s fourth-quarter earnings.

"Generally speaking, food inflation has been the most stubborn of the categories," Walmart U.S. CEO John Furner told analysts and investors on the call. "So, we were in mid-double digits in Q3, and Q4 hasn’t come down all that much. A little bit, I guess we could say, has come down the last couple months, but it still would be a high level of disinflation at this point."

He noted prices in some other parts of the business "have come down more," giving general merchandise as an example. 

In January, the costs of groceries saw an 11.3% jump year-over-year and a 0.4% increase month-over-month, according to consumer price index data released in mid-February. 

Walmart Inc. CEO Doug McMillon called inflation in dry grocery and consumables "stubborn, mid-double digit," saying "those are going to just be with us for a while."

"And it’ll get a little confusing because you’ll hear inflation numbers that start to sound lower, but you’ll have to remember, that’s on a two-year stack," he continued. "So if inflation in dry grocery and consumables is only three or five, that’s on top of 15. And that’s still a problem for the customer and a pressure in their wallet."

According to McMillon, the situation was different in the fresh food categories. He told analysts and investors to "think of the fresh categories as kind of bouncing around, going up and down, and being more volatile."

Eggs, he noted, were "at 200% inflated in January" but have since dropped to "just 50% inflated," something he said is "still a problem." Meanwhile, milk "is actually less than a year ago," and beef "is lower in terms of pricing" as well, McMillon said.

Some factors that have been pointed to as having impacted high egg prices include production-related costs going up and the bird flu.

Walmart thinks dry grocery and consumables will "create the pressure that customers are going to feel and have the impact as it relates to us on mix over the course of the year," he added. "And that’s one of the variables that’s a little hard to call, what will GM look like in the back half of the year."

McMillon also highlighted Walmart was "profitable in food."

Overall, the company’s revenue for the final quarter of its fiscal 2023 year came in at $164 billion, marking a 7.3% year-over-year increase. Walmart posted $6.28 billion in consolidated net income attributable to it, a widening from the $3.56 billion reported in the same period the prior year.

The retail giant put out cautious guidance for the year, something CFO John David Rainey said they did "given the persistence of high prices and the potential for further macro pressures." He said Walmart was "positioned well." 

McMillon at one point on the call described the company as "naturally hedged," saying that Walmart can shift its inventory "if customers want more of something and less of something else."

Ticker	Security	Last	Change	Change %
WMT	WALMART INC.	147.33	+0.89	+0.61%
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"If the economy is strong, our customers have more money and that’s great," he added.  "If things are tougher, they come to us for value. With today’s inflation, we’re continuing to see that happen."

https://www.foxbusiness.com/economy/walmart-executives-offer-observations-food-inflation

Adams begs Albany for pot crackdown help as illicit stores reach 1,500

 Hizzoner says: Just say no!

Mayor Eric Adams slammed illegal weed sellers Tuesday — but admitted his hands are tied when it comes to cracking down thanks to lax state laws.

“We have to zero in on this cannabis stuff,” Adams fumed to reporters at City Hall. “This cannabis stuff is a real problem! And we must make sure that we can’t have people [make] a mockery of our system!

“We go in, we do enforcement, and I think we can only do $250 fines,” he added. “I thought it was less than that. But that’s the cost of doing business [to sellers]. And our police officers can’t take the necessary action.”

Under New York’s 2021 law legalizing recreational marijuana, bad actors only get slapped with a criminal court summons accompanied by meager fines. 

Adams noted an exclusive Post report last week that exposed an unlicensed marijuana shop brazenly selling pot products across the street from City Hall – that was only shut down after it was raided twice.

“We have to zero in on this cannabis stuff,” Mayor Eric Adams fumed to reporters at City Hall. “This cannabis stuff is a real problem!”

BACKGRID

“We’re going to put a package [of bills] together just to deal with cannabis so this does not get out of hand. We are about up to about … 1,500 illegal cannabis shops,” the mayor said. “And it’s not only that they’re selling illegal cannabis, but they’re targeting young people!”

“Children are getting high on their way to school,” Adams ranted. “Children are taking these gummy bears. I must be old-fashioned. People don’t realize what’s happening in our country and in our city. We have to start refocusing!”

The state cannabis law does ban legal sellers from advertising cannabis products with attractive packaging or colors, but The Post has found multiple illegal sellers displaying products with innocuous-seeming names like “Cotton Cluster.”

“These children are waking up in the morning, going into the store, getting gummy bears that’s laced with marijuana, and then they’re going to go in school and learn? And they’re opening up all around us?” the mayor fumed. “No, no, no! We are losing our grip.

“And because I say ‘no’ to that, I got to be the bad guy. No! I just know what it takes to raise healthy children and families,” Adams went on, “and we have created an environment in this city and country where we are harming our children. We always talk about build a better planet for our children, we have to build better children for our planet!”

The state cannabis law does ban legal sellers from advertising cannabis products with attractive packaging or colors.

Helayne Seidman

In addition to targeting kids for sales, illegal weed sellers have themselves become prime targets for robberies, with the NYPD responding to a string of shootings across the city in the last month.

Adams wants Albany to make it easier for city authorities to immediately close illicit smoke shops and increase fines.

Even far-left Manhattan District Attorney Alvin Bragg has gotten on board, promising to penalize landlords who knowingly lease space to unlicensed pot peddlers.

Meanwhile, City Sheriff Anthony Miranda’s office has been handling the bulk of enforcement actions, seizing more than $4 million in illegal product last year.

https://nypost.com/2023/02/21/eric-adams-begs-albany-for-pot-crackdown-help-as-illicit-stores-reach-1500/