Halloween kicks off the holiday season this weekend, but in 2021 there are new considerations.

With COVID-19 still present and approximately 33%

 of the population unvaccinated, precautions must be taken, in addition to regular safety precautions.

Here are some tips that pharmacists can share to keep family members and neighbors safe during the holiday:

The No. 1 safety concern on Halloween is preventing children from being struck by a vehicle. Children are more likely to be fatally injured by a car on Halloween, and children ages 4 to 8 have a 10-fold increase in pedestrian fatality risk.

 Adults can reduce the chances of children being injured by a car by taking the following precautions: carry flashlights, glow gear, or glow sticks to increase visibility; use reflective tape on costumes to make children more visible to drivers; walk with children, especially those younger than aged 12 years; wear bright or light colored costumes, especially after dark, to be visible to drivers.

Many factors on Halloween can increase children’s risk of tripping, such as costumes, masks, poorly lit houses and neighborhoods, and walking in the evening hours. Ensure that masks do not obstruct vision, make sure that clothing and costumes fit children properly, use flashlights, and walk with children in well-lit areas.

 Small hard foods, such as gum, hard candy, nuts, popcorn, seeds, and taffy, pose a choking risk, especially in children under the aged 5 years. Small toys that are often given out during Halloween, such as marble-size balls and plastic rings and spiders also pose a choking hazard. To prevent choking, inspect food before allowing children to eat it and do not allow very young to eat their treats while crawling, lying down, playing, or walking.

 Do not give children treats while they are in car seats, because it might be difficult to help them in time if they are choking. Additionally, it is best to avoid costumes with buttons or small pieces that could break off easily on infants and toddlers.

If a child has food allergies, make sure to carefully read the ingredient list as well as any warnings on packages, such as “processed in a facility that manufactures foods with peanuts.” Avoid homemade food items from people who are not known and trusted. Adults handing out candy can provide non-food items for children with allergies, such as stickers or small toys. A great resource for further information on food allergies and how to safely participate in Halloween is the Teal Pumpkin Project.

 It aims to bring food allergy awareness and suggests safer goodies for children with allergies. In general, for anyone who suffers from a potentially life-threatening or severe allergy, it is important to always carry two non-expired, epinephrine pens in case of accidental exposure to an allergen.

Just like poor fitting Halloween costumes can become tripping hazards, costumes with dangling or long cords or strings can become strangulation hazards. Dangling ropes, strings, or thin pieces of cloth can also get entangled in car doors, fences, or furniture, posing further risk of injury. Young children should also not be left alone with a plastic bag, as these can lead to unintentional suffocation or strangulation. Use a Halloween bucket instead.

When trick or treating, make sure to stick to safe, and well-known neighborhoods. Trick or treat in well-lit areas, and walk with children. Do not allow children to enter do-it-yourself haunted houses or stranger’s homes. Consider trick or treating earlier in the day for younger ones, and make sure to cross streets in crosswalks, which can help decrease the risk of being struck by a car.

Do not drink and drive. For those celebrating Halloween with alcohol, plan for transportation. Those hosting events should help guests with transportation and remember COVID-19 precautions. When driving, be extra carefully, and be on the lookout for children.

 Pumpkin carving is wonderful fun but can quickly turn into a visit to emergency department or urgent care center if not done safely. Young children should not handle sharp tools but can draw or paint on a pumpkin and watch an adult do the carving. Experts recommend using actual pumpkin carving tools for carving instead of kitchen knives, because of the greater risk of injury.

The lowest0risk activities include staying at home with family or so-called pod members. For families who have a loved one in poor health or who are immunocompromised, being extra cautious may be best. Instead of trick or treating, consider carving or painting pumpkins, doing a scavenger hunt, dressing up and watching movies, or playing games.

Unfortunately, COVID-19 is still with us. That means that even though it is a time of celebration and friendship, we should still get vaccinated, practice social distancing, wash hands frequently, and wear a mask. If trick or treating, consider doing that with a pod or smaller group. It is still advisable to avoid large crowds and groups of people with unknown vaccination health or vaccination status. Asymptomatic individuals can still spread COVID-19, so it is especially important to continue practicing precautions, even for those who are vaccinated.

1. Holland S, Mason J. (2021) U.S. vaccine mandates are working, Biden says, but 66 million still don't have shot. 

. October 14, 2021. Accessed October 19, 2021. https://www.reuters.com/world/us/biden-tout-jump-us-vaccination-rates-after-mandates-white-house-2021-10-14/

2. Don’t be spooked by injuries this Halloween; follow CPSC’s tips to protect children from harm. Consumer Product Safety Commission. October24, 2019. Accessed October 21, 2021. 

https://www.cpsc.gov/Newsroom/News-Releases/2020/Dont-Be-Spooked-by-Injuries-This-Halloween-Follow-CPSCs-Tips-to-Protect-Children-from-Harm

3. Staples JA, Yip C, Redelmeier DA. Pedestrian fatalities associated with Halloween in the United States. 

. 2019;173(1);101-103. doi:10.1001/jamapediatrics.2018.4052

4. Choking hazards. CDC. Updated September 2, 2021. Accessed October 19, 2021. 

https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/choking-hazards.html

5. Teal Project. Food Allergy Research & Association. Accessed October 21, 2021. https://www.foodallergy.org/our-initiatives/awareness-campaigns/living-teal/teal-pumpkin-project

6. Marcus AM, Green JK, Werner FW. The safety of pumpkin carving tools. 

. 2004;38(6);799-803. doi:10.1016/j.ypmed.2004.01.008

Here are 10 tips for precautions that need to be taken during this fun holiday that are both evergreen and related to COVID-19.

Stay Safe This Halloween

Sara Hunt, MSN, RN, PHN, FNP-C

Jennifer Bourgeois 

Have you ever had a thought that was not true?

Maybe you didn’t realize it at the time. You may have been wrought with emotion and had no idea you were believing a lie. At times, these lies we believe can be about ourselves or of others. Sadly, these false thoughts can lead to emotional struggles that may even be debilitating.

When we find ourselves worried, stressed out, or feeling down, often it’s because we are believing a lie. Have you ever had a thought that sounds something like this?

Negative self-talk and the long-term focus on it can deteriorate not only your mental health, but your emotional and physical health as well. The thoughts we dwell on effect how we feel and impact the things we say and do. Knowing we have a choice on what thoughts we allow space for in our mind is the first step to bettering our mental health. Yes, you have the power to choose!

Having negative thoughts is a normal part of life. Dismissing this fact is erroneous. However, choosing to be mindful by taking a regular inventory of our thoughts is an essential practice in our mental well-being. Finding ways to be intentional with our thinking habits is vital in navigating the challenges in life.

Bax and His Bubbles – All About a Kid and His Thoughts,1

 cognitive behavioral therapy (CBT) is used to help kids learn a simple strategy of filtering their thoughts. Though the book is aimed toward children, the concept is one that we all can apply.

According to the American Psychological Association, CBT is a form of psychological treatment that has been demonstrated to be effective for a range of problems, including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness.2

CBT treatment usually involves strategies to change destructive thinking patterns. Some can include learning to recognize distorted thinking and reevaluating those thoughts in light of reality, gaining an accurate understanding of the behavior and motivations of others, whereas other strategies may include gaining problem-solving skills to cope with challenging circumstances.

, readers are encouraged to picture their thoughts as bubbles. Then, the questions below are used as filters to help guide whether it is a thought they should keep or if it’s a thought that should be released.

Often, we believe lies about ourselves or lies about others. They can be momentary thoughts or perpetual.

When we have unkind thoughts, we may speak unkindly or do things that are unkind. This is an occurrence that is not solely applicable to children. Imagine how our interactions, responses, and social media posts would be different through this filter!

If the thought is excellent, then these are the thoughts we should speak and act on. Just because something is true, doesn’t mean it should be spoken.

Using these questions as filters is something I invite you to do yourself. In those moments when you are triggered to lash back at an ungrateful person in your life, in that moment when you want to reply to a rude comment on a post you completely disagree with, when you feel the urge to react to a snarky remark by a family member or coworker, just stop and take a moment to think. Rather than reacting in the moment, choose to be intentional with your thoughts and thereby, your actions.

The questions I have included above may not apply to all thoughts that come up in life, but I believe it’s a starting point in being intentional with our mental health. This is just one tool to have in our mental health toolbox.

As pharmacists, we can have a lot thrown at us at different times, not to mention the other roles we may have as spouse, parent, sibling, and friend. Having the right mindset and tackling things with the knowledge that we have a choice in our attitude and thinking habits will prove to be much more productive than ignoring this fact. And just imagine the ripple effect you can have on those around you.

The above is for informational purposes only and not medical advice. Please consult your medical provider/therapist for your particular needs and situation.

https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.pdf

Dr. Sonia Amin is a pharmacist and award-winning author of 

Bax and His Bubbles - All About a Kid and His Thoughts

. She is passionate about encouraging others to live a healthy life and values the importance of nurturing physical, spiritual, and mental health. As a pharmacist, she has a background in Ambulatory Care, Academia and Community Pharmacy. She is a registered Consultant Pharmacist, a certified MTM Pharmacist and lives in Florida with her husband and two sons. You can find out more at 

Dr. Sonia E. Amin talks about how to navigate through negative thoughts and changing the way you think about yourself

Get Ready to Start Thinking Differently

Sonia E. Amin

Katie Pierce

Allie Butler

As of 2020, approximately 62%-75% of pharmacists in the United States are female.

 That is a dramatic rise from the approximately 14% proportion that existed in the mid 1960s, and would have been an almost unimaginable amount just a century ago.

Although October has long been celebrated as National Pharmacy Month, it is only in recent years that female pharmacists have been celebrated for their contributions to the profession and patient care. Starting in 2018, October 12 is now annual observed as 

 after its creation by Pharmacist Moms Group leader Suzanne Soliman, PharmD, BCMAS.

Pharmacy, as a profession, is one of the oldest in recorded history. Although females may not have always been allowed to pursue formal education and training, they have long participated in many aspects of what historically was a family-centered business.

It is considered one of the most egalitarian of all professions in the United States because of a comparatively low gender wage gap, an earnings base that is more linearly related to hours and more non-punitive flexibility in part-time and per diem employment in relation to other professions.

Although not as routine in modern times by all, the ability to balance work and family responsibilities has long roots of acknowledgement. In fact, the date of National Women Pharmacists Day was chosen because Elizabeth Gooking Greenleaf, the recognized first female pharmacist in the United States, had 12 children.

Unfortunately, most of the pioneering female pharmacists up through the early twentieth century may be considered “hidden women” in that although they were successful in pharmacy practice—with many owning or operating pharmacies and participating in pharmacy advocacy and organizations—the lack of publicity regarding their activities is lost in historical record.

Although many colonial women practiced what was called family “physic,” or the preparation and use of herbals and natural medicines, there is little record of practicing female pharmacists prior to 1776.

 Greenleaf is one of the only women of colonial times for whom a written record of her practice exists.

Still, despite being on a list of apothecaries in colonial New England and being known for helping to run a Boston apothecary shop with her husband, there is nothing to indicate that Greenleaf ever received the same education and training as her contemporaries.

Whereas pharmacy students today are majority female, Greenleaf’s lack of formal training is unsurprising for her time. Until the latter part of the 19th century, pharmacy education was administered under the apprentice system. Between the colonial period and 1804, only 4 women are known to have received the training necessary to practice pharmacy commercially.

The most prominent of these was Elizabeth Marshall, the granddaughter of the famed Christopher Marshall, who owned Marshall Apothecary in Philadelphia and was renowned as a pioneer in pharmacy education. Once prominent, Marshall Apothecary declined into financial difficulty before Elizabeth took over and restored the business.

It was not until 1863 that Mary Jacobi became the first female to receive a pharmacy degree from the New York College of Pharmacy.

 The transition to college- or university-based education helped facilitate female education as most programs were at institutions that could facilitate the coeducation of women.

This may not have been as much of a progressive stance as one of financial need and opportunity, because schools depended on student fees to function and there was not fee discrepancies among the genders. As many as 1500 women are estimated to have attended a US pharmacy school between the time Jacobi graduated and the year 1900.

By the end of World War II, the number of women enrolled annually had increased to more than 2300.

 Although most faculty members remained male, there were a few notable female pioneers who left legacies still impacting pharmacy education today.

The first documented female faculty member was Josephine R. Barbat, who taught at the California College of Pharmacy starting in the 1889.

Unfortunately, very little is known of Barbat’s influence.

One of the most notable of her time, Zada Mary Cooper served on the faculty at the University of Iowa from 1887 until 1942.

 and was known for her dedication to pharmacy advocacy and service. She founded several major pharmacy groups and organizations, including Rho Chi, Kappa Epsilon, and the Women’s Section of the American Pharmaceutical Association.

In fact, the advocacy of women such as Cooper resulted in female membership and leadership in professional pharmacy organizations decades earlier than occurred in medicine.

 Despite the inroads made by women in the profession, they did not have an easy pursuit.

In 1901, a pharmacy journal published an article stating that they “did not believe that pharmacy is a profession that women will universally aspire to nor wone that they are universally fitted to fill properly.”

 The author’s opinion, thankfully, was not shared by many pharmacy deans at the time, many of whom are known to have gone on the record with their positive opinion of women in the profession.

Eleven years after the article’s appearance, Cooper wrote her own article in the same journal, countering that “if there is a place for women’s peculiar talents in other lines of human endeavor, why is there not work in pharmacy to which she is especially suited.”

The tenacity of Cooper and her contemporaries ensured women not only continued to be educated as pharmacists, but were increasingly integrated into the profession. Without them, the abundant growth, prominence, influence, and contributions of women to the profession would never have occurred. Unfortunately, most of what is recorded of women pharmacists is limited to features such as school attendance, state of license and/or practice, and service to a pharmacy organization.

However, there are a few pioneers whose actions and impacts are better documented than others. In 1893, the Woman’s Pharmaceutical Association of Illinois was formed to accommodate women who would be attending the Colombian Exposition of 1893 held in Chicago.

The group, led by Jean Gordon and May Reynolds, ran a model pharmacy that provided medications to visitors at the World’s Fair and won a coveted award by fair leaders. The group disbanded shortly afterwards, but their temporary existence lasted long enough to show not just Americans, but visitors from around the world, exactly how competent a female pharmacist can be.

Although it is not known exactly if Anna Louise James was the first African American female pharmacist in the United States, she was one of the first to graduate from pharmacy school and become licensed in Connecticut.

 When her brother-in-law left to serve in World War I in 1917, Anna took over operations and ran the pharmacy for next 50 years.

She is well remembered by those in her community for her dedication and care. She also served as a muse for Anna’s niece Ann Petry, a fellow pharmacist and one of the first best-selling African American female authors who immortalized the pharmacy in her writings. Almost 7 decades after Anna’s entry into pharmacy, Mary Munson Runge was elected the first African American president of the American Pharmacists Association (APhA).

Hospital pharmacy grew under the influence of several women, including 2 nuns. Sister Mary John Geiermann was a charter member of the American Society of Hospital Pharmacists (ASHP) and served as treasurer from 1943-1946.

 Three decades later, Sister Mary Gonzales Duffy became the organization’s first female president.

Gloria Niemeyer Franck, who also served as the first female ASHP secretary, was the first woman to receive the Remington Honor Medal in 1987 and was the first female to have a major award from a national pharmacy organization in the United States named for her (The APhA Gloria Niemeyer Francke Mentor Leadership Award)

The practice of pharmacy that modern women in pharmacy know is almost unrecognizable from that of our forebearers. Women are not only members of the profession, but are leaders, innovators, and mentors.

It would not be too presumptuous to assume that those early pioneers would be proud of the role women in pharmacy have played in the past century and the substantial contributions that female pharmacists make every day.

One thing we do have in common with many of the early female pharmacists is that most of us will not be recorded in the history books. However, our dedication to our profession and to patient care will ensure that each of us leaves behind a legacy that will not be forgotten as long as we pass down that standard to future generations of women in pharmacy.

U.S. Bureau of Labor Statistics. Labor Force Statiscs from the Current Population Survey. Available: 

Fitzgerald J. Pharmacy and the evolution of a family-friendly occupation. The Digest. National Bureau of Economic Research.2003;2. Available: 

https://www.nber.org/digest/feb13/pharmacy-and-evolution-family-friendly-occupation

Goldin C, Katz LF. The most egalitarian of all professions: pharmacy and the evolution of a family-friendly occupation. National Bureau of Economic Research Working Paper 18410.2012:doi:10.3386/w18410

American Pharmacist Association Foundation. Women in Pharmacy. Available: 

https://www.aphafoundation.org/sites/default/files/ckeditor/files/WIP%20mural%20descriptions.pdf

Henderson ML. Charting the history of women pharmacist. Pharmacy in History.2019;61:118-120

Gallagher TC. From family helpmeet to independent professional: women in American pharmacy, 1870-1940. Pharmacy in History.1989;31:60-77

Henderson ML, Worthen DB. (2002) American women pharmacists, contributions to the profession. Haworth Press. Binghamton, NY

Poirier S. Ann Petry; from pharmacist to novelist. Pharmacy in History.1986;28:26-33

Although October has long been celebrated as National Pharmacy Month, it is only in recent years that female pharmacists have been celebrated for their contributions to the profession and patient care.

Women Pharmacists Day: The Evolution of Women’s Role in US Pharmacy Practice

Marilyn Bulloch, PharmD, BCPS, FCCP

How many times have you gone to the grocery store and been overwhelmed with all the health claims on product labels? Natural, low-calorie, and low-fat are all terms that I like to call red flags. When you see these words, you may automatically think you're looking at healthy food. But, be careful! 

● Natural doesn't necessarily mean that the product is healthy. As it relates to food products, the definition of the term is a bit murky. 

● Low-calorie versions of products don't always equal healthy choices. For example, the calories on one brand's low-calorie version may be the same as another brand's original version. Also, low-calorie versions may be full of artificial, harmful ingredients. 

● Low-fat can mean less fat but more sugar. So, read your nutrition labels carefully and look at the complete list of ingredients when making food choices. 

Here are four simple tips for selecting healthy food that will fuel your body and mind well:

1. Stick to whole, unprocessed, single-ingredient foods as much as possible.

2. Stick to the outer aisles of the grocery store (and the frozen section, in some cases).⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀

3. When looking at ingredient lists, try choosing products that have whole foods (such as fruits or vegetables) listed as the first ingredients.⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀ 

4. In general, try to avoid products with ingredient lists that are longer than two to three lines; when you see this, it usually means that the products are highly processed and full of junk! Knowing how to interpret red flag words on food labels and quickly evaluate ingredient lists is key to reaching your health and wellness goals! 

*Nothing in the preceding article should be construed as medical advice. Always consult your healthcare provider for individual recommendations.*

Coach Beth Thomas discusses how you can shop smarter and better to meet your nutrition goals

Four Tips for a Healthy Grocery Cart

Beth Thomas

That little meanie, the voice in my head, would keep bugging me each time I wanted to start new projects and take on new opportunities in my career.

Each time I wanted to work on my professional growth, there was a need to silence that voice down so I could reach my dreams and goals, and that was truly exhausting.

My achievements still became a reality despite feeling imposter and not enough, but the price I paid was a little too high, since I was fighting with that little meanie in my head, while conquering life and my pharmacy career.

Being a foreign-trained pharmacist, all I remember in my early career was a lot of suffering with every achievement. I had to take the English language proficiency exam and multiple tests to qualify for NAPLEX, while being pregnant and a young mom, and feeling not enough.

My imposter was fueled by my own personality, being shy and introvert. I constantly justified to myself that being a foreign-trained pharmacist is not any less credentialed or inferior.

Starting my second school for Doctorate in Pharmacy in 2014 at MCPHS, Boston, while already working as a licensed pharmacist for a retail chain was the next step to fulfill the dream to become enough and equal to others, although I learned and gained superior clinical skills and expertise during that time.

The revelation I had in 2020 was I am more than enough. One and a half years of active coaching and working on my limiting beliefs helped me realize success is not measured by degrees and credentials but by my own inner confidence.

Imposter syndrome among any highly educated professionals and especially women in healthcare is real!

If someone demeans our skills and expertise the way we do it to ourselves, can easily lead to feeling harassed or bullied. Yet we’re more likely to inflict that indignity upon ourselves: Seventy percent of women and men unfortunately doubt themselves despite compelling professionalism and achievements. Imposter phenomenon affects minorities, women of color in a much greater way, literature suggests.

Dr. Clance and Dr. Imes first referred to this phenomenon in 1978, and it gained significant public attention in their 1985 published book. Interestingly, the syndrome is present in high-achieving, successful and well-regarded professionals who, on the outside seem extremely confident and prosperous, but truly struggle with each professional move and feel they don’t deserve the recognition.

Important to note, impostor syndrome is not yet included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and it seems that professionals rarely seek mental health support solely for this reason, but a large body of literature suggests it is a root cause for many comorbidities such as anxiety and depression.

Studies researching the imposter phenomenon among women health care professionals describe how much it affects job performance, creates fear to seek promotion at work, contributes to higher level of burnout, lowers job satisfaction, and leads to departure from the workforce in some cases.

Considering all the available evidence, it is incumbent on employers to recognize the burden of this phenomenon on productivity by training, mentoring, and coaching employees to counter the ill effects of the imposter syndrome. Employers who are focused on growth, leadership, and equality at workplace, must provide their employees self-paced learning materials, access to therapy and resilience training on this.
Giving health care workers the opportunity to be heard and using de-identified assessments will normalize and hopefully destigmatize imposter syndrome among them and help cope with the syndrome rather than ponder leaving the profession.

My own advice that helped me recover from imposterism is to start vocalizing your feelings and find a group of supportive and like-minded women professionals who share your experience.

A final thought - you are best valued by the quality of care you give to your patients and the positive impact you have on their lives, far more than your credentials, degrees, and recognition from superiors.

Ani Rostomyan PharmD, BCPS, APh, talks about imposter syndrome for women in healthcare and how they can conquer it 

Imposter syndrome among women in healthcare and how to conquer it!

Ani Rostomyan

Once the body perceives an event as a stressor, physiological changes begin to happen immediately.

The Central Nervous System (CNS) activates the Sympathetic division, which stimulates the adrenal glands to release the stress hormones adrenaline and cortisol. These hormones increase heart rate and cause the blood vessels to constrict which increases blood pressure. During the stress response the breathing rate increases to distribute oxygen-rich blood throughout the body.

Under stress the liver releases more glucose and insulin levels decrease in an effort to keep more glucose in the bloodstream. Blood flow is rushed to main organs and away from the digestive system. This slows digestion and can directly affect nutrient absorption. The stress hormones can also increase stomach acid production.

Under stress, the muscles tense up and may remain contracted for long periods. Cortisol can inhibit Thyroid Stimulating Hormone (TSH) leading to partial suppression of the main thyroid hormone, thyroxine. The stress hormones can cause irregular menstrual cycles, decrease libido, and weaken the immune system’s defenses.

The most common signs and symptoms of stress are directly related to these physiological changes and include worry, anxiety, moodiness, irritability, depression, eating more/less, alcohol or drug abuse, infections, insomnia, fatigue, GI changes, dizziness, and headaches.

Repeated exposure to stress for chronic periods causes imbalances and dysregulation in the body that eventually lead to disease and illness. Dr Mark Hyman states “90% of all disease and illness are rooted in stress”.

In this issue of our wellness series with Dr. Jennifer Bourgeois, the article will look at the physiological effects of stress and how it impacts our health.

