Psychological Distress in Teen Years Tied to Later Economic Outcomes
Psychological distress in adolescence is tied to economic outcomes 10 years later, according to a study published online Jan. 16 in PLOS Medicine.
Nathaniel Z. Counts, J.D., from the Kennedy Forum in Brigantine, New Jersey, and colleagues estimated the relationship between adolescent psychological distress (ages 15 to 17 years) and health and economic outcomes approximately 10 years later. The analysis included data from 3,343 individuals participating in the National Longitudinal Study of Youth 1997.
The researchers found that past-month clinically significant psychological distress in adolescence led to a 6 percentage-point reduction in past-year labor force participation 10 years later and $5,658 fewer past-year wages earned. A hypothetical policy that expands access to mental health preventive care and reaches 10 percent of youth who would otherwise develop clinically significant psychological distress could lead to an estimated $52 billion in federal budget benefits over 10 years from labor supply impacts alone.
"By estimating the offsetting budget impacts of policies that address adolescent mental health, policymakers will be better equipped to appropriately respond to the growing adolescent mental health crisis in the United States," the authors write.
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Radiological Society of North America, Dec. 1 to 5
The annual meeting of the Radiological Society of North America was held from Dec. 1 to 5 in Chicago, drawing participants from around the world, including radiologists, radiation oncologists, physicists in medicine, radiologic technologists, and other health care professionals. The conference featured scientific papers from a number of subspecialties covering the newest trends in radiological research, as well as education and informatics exhibits.
In an observational study, Elena Ghotbi, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues identified an association between bone loss and levothyroxine, the second most commonly prescribed medication among older adults in the United States. The association did not include an increased prevalence of clinically significant low bone density, such as rates of osteoporosis.
The authors aimed to determine if levothyroxine use and higher thyroid hormone levels within the reference range were associated with higher bone loss with normal thyroid function. Data from the prospective, observational, Baltimore Longitudinal Study of Aging were evaluated.
During a median follow-up of 6.3 years, the researchers found that levothyroxine use was associated with greater loss of total body bone mass and bone density, even in participants with thyroid-stimulating hormone (TSH) levels within the normal range and when accounting for baseline TSH and other risk factors.
Data also indicated that levothyroxine may be prescribed in some older adults when it is not truly indicated. However, to establish causality and clarify the potential long-term musculoskeletal risks of levothyroxine use in this population, further research, including randomized trials, is necessary, according to the authors.
"While it is too early to draw clinical conclusions based on these preliminary observational findings, the study raises important questions. For instance, thyroid hormone is sometimes initiated in patients who do not have hypothyroidism, such as for managing symptoms despite normal hormone levels," Ghotbi said. "Patients with concerns should consider discussing their diagnosis and treatment goals with their health care provider to ensure the appropriateness of their therapy."
In another study, Kevin C. Yu, of the Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues found that concussions are related to reduced cortical excitability in the frontal cortex, which is associated with worse cognitive function.
The authors collected preseason and postseason resting-state magnetoencephalography data to identify the impacts of concussions on aperiodic activity. The Post-Concussive Symptom Inventory, a clinical evaluation tool for concussions, was used to correlate preseason and postseason physical, cognitive, and behavioral symptoms.
The researchers found that concussion reduces cortical excitability in parts of the brain important for cognitive function, like attention. These concussion-related changes in cortical excitability were also associated with worse cognitive symptoms.
"We believe these findings are important, both because they provide insight into the mechanisms and clinical implications of concussion in the adolescent brain, and because they may inform recommendations for clinical monitoring and intervention strategies for individuals with head trauma," Yu said. "This study highlights the importance of monitoring the brain signaling of adolescents carefully after any head injury and taking concussion seriously. It also underscores the importance of protective measures in sports and ensuring that young adults take the necessary time to fully recover before returning to play."
Mahsa Dolatshahi, M.D., of the Mallinckrodt Institute of Radiology at the Washington University School of Medicine in St. Louis, and colleagues found that visceral adipose tissue, or deep belly fat -- but not other types of fat -- plays a role in the hallmark pathologies of Alzheimer disease.
The authors evaluated 80 cognitively normal middle-aged individuals who underwent brain positron emission tomography, body magnetic resonance imaging (MRI), metabolic assessment, and blood lipid level evaluation.
The researchers found that visceral adiposity mediated the link between high body mass index (BMI) and amyloid deposition in the brain, and is likely linked to early tau pathology, independent of BMI.
While high BMI, as the classic definition of obesity, is important, it is not the whole story, as other types of fat or muscle mass are not particularly linked to these pathologies, the authors note. They stress that modification of visceral adiposity, coupled with dyslipidemia, should be the focus of interventions for brain health-related outcomes. The effect of visceral fat on amyloid accumulation is partly mediated by lower high-density lipoprotein.
"The impacts on clinical practice for now are mostly limited to suggestions at preventive levels for modifying excess body fat," Dolatshahi said. "We need more longitudinal and interventional studies to understand the effects of different lifestyle and social determinants in visceral adiposity and brain health."
Marianne Nabbout, M.D., of the University of Arkansas for Medical Sciences in Little Rock, and colleagues found that one episode of electronic cigarette inhalation can have an acute and measurable effect on vascular beds.
The researchers aimed to demonstrate the acute effects of tobacco smoking and nicotinized and nonnicotinized e-cigarette vaping on vascular function among healthy smokers and vapers using quantitative MRI. Study participants underwent two MRI exams, one before and one after each of the following smoking/vaping episodes: tobacco cigarette, e-cigarette aerosol with nicotine, and e-cigarette aerosol without nicotine.
Following nicotinized and nonnicotinized e-cigarette vaping challenges, baseline venous oxygen saturation significantly decreased in the superficial femoral vein, which suggests an immediate decrease in the uptake of oxygen by the lungs following e-cigarette smoking. In the superficial femoral artery, the time of forward flow (the duration of monophasic waveform during reactive hyperemia that occurs due to decreased microvascular resistance) was significantly decreased following both nicotinized and nonnicotinized e-cigarette vaping challenges. Following inhalation of each type of vaping or smoking, there was a significant decrease seen in the resting blood flow velocity in the superficial femoral artery. The hyperemic index (at the superficial femoral artery) was significantly decreased following nicotinized e-cigarette vaping.
"These observations may suggest depressed hyperemia in the femoral artery following induced ischemia via cuff occlusion at the level of the upper thigh," Nabbout said. "The reason we saw significant effects following nonnicotinized electronic cigarette vaping may be due to the presence of harmful constituents other than nicotine. The study is ongoing to acquire more data. The larger the sample size, the more likely we are to detect statistically significant effects."
Keegan Staab, of the University of Iowa in Iowa City, and colleagues identified a link between lung function and brain function in patients with long COVID that could lead to a better understanding of the mechanisms responsible for the persistent dyspnea and cognitive symptoms observed after COVID-19 infection.
The researchers aimed to gain insight into the link between pulmonary MRI gas exchange, structural and functional brain MRI, and cognition among patients with long COVID. They found that pulmonary gas exchange measured using hyperpolarized xenon MRI was related to cognitive function assessed using the National Institutes of Health Toolbox and brain perfusion measured via MRI.
"Previous work has attributed perceived cognitive deficits to psychological distress rather than an underlying disease process," Staab said. "Our data provide evidence that this may not be the case and could be caused by underlying physiological and persistent lung abnormalities."
RSNA: Opportunistic Assessment of Aortic Calcium Predicts MACE
MONDAY, Dec. 9, 2024 (HealthDay News) -- A fully automated algorithm to quantify aortic artery calcification on computed tomography scans performed for other clinical purposes can predict the risk for subsequent major adverse cardiovascular events, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Genicular Artery Embolization Effective, Safe for Knee Osteoarthritis
FRIDAY, Dec. 6, 2024 (HealthDay News) -- Genicular artery embolization is effective and safe for reducing osteoarthritis symptoms among patients with knee osteoarthritis that is refractory to conservative therapy, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Obesity, VAT Linked to Measures of Amyloid Burden in Midlife
WEDNESDAY, Dec. 4, 2024 (HealthDay News) -- Obesity and visceral fat are associated with measures of amyloid burden in the brain among cognitively normal midlife individuals, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Silicosis Often Missed in Engineered Stone Countertop Workers
TUESDAY, Dec. 3, 2024 (HealthDay News) -- Few primary clinicians or radiologists recognize silicosis among engineered stone countertop workers, according to a study presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
RSNA: Levothyroxine Tied to Bone Loss Over Time in Older Adults
MONDAY, Nov. 25, 2024 (HealthDay News) -- Levothyroxine use is associated with longitudinal loss of bone mass and density in older adults, according to a study scheduled to be presented at the annual meeting of the Radiological Society of North America, held from Dec. 1 to 5 in Chicago.
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Long-Term Upadacitinib Use Feasible for Adolescents With Atopic Dermatitis
Long-term treatment of adolescents with moderate-to-severe atopic dermatitis (AD) with upadacitinib is safe and effective through 76 weeks, according to a study published online Oct. 23 in JAMA Dermatology.
Amy S. Paller, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues evaluated the efficacy and adverse events of upadacitinib in adolescent patients with moderate-to-severe AD through 76 weeks. The analysis included data from 542 adolescents participating in the Measure Up 1, Measure Up 2, and AD Up clinical trials.
The researchers found that at week 76, ≥75 percent reduction in the Eczema Area and Severity Index Score (EASI-75) was achieved by 89.1, 84.4, and 87.8 percent of adolescents taking upadacitinib 15 mg in the Measure Up 1, Measure Up 2, and AD Up trials, respectively. For a dose of 30 mg, EASI-75 was achieved by 96.1, 93.6, and 82.7 percent of adolescents, respectively. Across both upadacitinib doses, results indicated maintenance or improvement of EASI-75 across 76 weeks. Long-term outcomes in trial participants were consistent with the known adverse event profile of upadacitinib (herpetic infection: 4.0, 1.9, and 1.1 events per 100 patient-years, respectively; creatine kinase elevation: 11.6, 11.0, and 7.1 events per 100 patient-years, respectively), with no new signals noted with either dose.
"While the difference in the proportions of patients achieving at least EASI-75 between the two upadacitinib treatment groups is small, the difference between the two doses becomes more pronounced over time in the more stringent efficacy end points, such as EASI-90," the authors write.
Several authors disclosed ties to pharmaceutical companies, including AbbVie, which manufactures upadacitinib and funded the study.
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Texas AG Sues Dallas Doctor Over Transgender Care for Minors
A Dallas doctor has been sued by Texas Attorney General Ken Paxton for allegedly providing transgender care to nearly two dozen minors in violation of state law.
In the lawsuit filed Thursday, Paxton claimed that Dr. May Chi Lau, who specializes in adolescent medicine, provided hormone replacement therapy to 21 minors who were transitioning from October 2023 to August 2024. Last year, Texas enacted a law banning hormone replacement therapy and other forms of gender-affirming care for minors.
“Texas passed a law to protect children from these dangerous unscientific medical interventions that have irreversible and damaging effects,” Paxton said in a statement announcing the lawsuit. “Doctors who continue to provide these harmful ‘gender-transition’ drugs and treatments will be prosecuted to the full extent of the law.”
The statement also claimed that Lau used "false diagnoses and billing codes" to mask "unlawful prescriptions."
Paxton’s suit is the first filed in the country by an attorney general against an individual doctor alleging violation of a restriction on transition-related care for minors, NBC News reported.
Neither Lau nor her employer, the University of Texas Southwestern Medical Center, responded to a request for comment from NBC News.
If Lau is found guilty, she could lose her medical license and face a financial penalty of hundreds of thousands of dollars, NBC News reported.
Texas’ law includes a provision that allows doctors to continue to prescribe puberty blockers and hormone therapy to patients who began treatment before June 1, 2023, to safely wean them off the medications, according to Paxton’s suit.
Minors are also required to have attended at least 12 counseling or psychotherapy sessions for at least six months before they start treatment. It wasn't clear whether Lau’s patients could fall under that provision, NBC News said.
Twenty-six states ban at least some forms of gender-affirming care for minors, according to the Movement Advancement Project, an LGBTQ think tank.
The U.S. Supreme Court is expected to hear oral arguments and rule this session on whether to strike down a similar law in Tennessee, NBC News reported. How the court rules on the Tennessee law will affect similar restrictions in other states.
Major medical organizations, such as the American Medical Association and the American Academy of Pediatrics, state that transition-related care is an effective and medically necessary way to treat gender dysphoria, which is distress felt by people whose gender identities differ from their genders assigned at birth.
More information
Johns Hopkins has more on transgender healthcare.
SOURCE: Texas Attorney General's office, news release, Oct. 17, 2024; NBC News
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IDSA: MVA-BN Vaccine Against Mpox Tolerated, Effective for Teens
The Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine, licensed in the United States to prevent smallpox and mpox, is well tolerated and seems effective in adolescents, according to a study presented at the annual meeting of the Infectious Diseases Society of America (IDWeek), held from Oct. 16 to 19 in Los Angeles.
Catherine Mary Healy, M.D., from Baylor College of Medicine in Houston, and colleagues examined the safety and immunogenicity of two doses of MVA-BN vaccine administered subcutaneously 28 days apart in adolescents aged 12 to 17 years compared to adults (aged 18 to 50 years) in a phase 2, open-label, multisite clinical trial. A total of 315 adolescents were compared to 211 adults.
The researchers found that both groups had similar solicited systemic and local events and unsolicited adverse events. Adolescents had dizziness more often (nine events in eight patients versus none in adults), which was similar to rates reported after other adolescent vaccines. MVA-BN was well tolerated overall. The day 43 antibody responses elicited by MVA-BN in adolescents were noninferior to the response in adults (geometric mean titer ratio for adolescents to adults, 1.60).
"These findings mark an important milestone for people living in areas with mpox," Healy said in a statement. "This mpox vaccine is an increasingly important solution to protect vulnerable adolescents and manage current and future outbreaks."
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American Academy of Pediatrics, Sept. 27-Oct. 1
The annual meeting of the American Academy of Pediatrics was held this year from Sept. 27 to Oct. 1 in Orlando, Florida, and attracted participants from around the world, including primary care pediatricians, pediatric medical subspecialists, pediatric surgical specialists, and other health care professionals. The conference featured scientific sessions that focused on the latest advances in the care of infants, children, adolescents, and young adults.
In one study, Stephanie Chao, M.D., of the Stanford University School of Medicine in Palo Alto, California, and colleagues found that a ban on high-capacity magazines could have the greatest impact on reducing child deaths from mass shootings.
The authors evaluated mass shootings by state using 10 categories of gun violence prevention laws and identified 131 pediatric mass shootings between 2009 and 2020. The researchers found that a ban on high-capacity magazines reduced the risk for child mass shootings by 91 percent. At the time of the study, only eight states had high-capacity magazine bans, including California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New York, and Vermont. Currently, only 14 states have such bans.
"Sadly, because gun violence is the leading cause of death in children, physicians are often called upon to answer clinical questions about guns, which really are safety practice and policy implication questions," Chao said. "Many physicians (surgeons, pediatricians, primary care) are also actively engaged in trying to create safer communities. So I think this research, sadly, applies to the new reality of clinical practice for physicians."
In another study, Jennifer Allen, D.O., of Akron Children's Hospital in Ohio, and colleagues found that racial and socioeconomic disparities exist in the emergency management of unintentional ingestions in children.
The authors assessed the health records of 4,411 children younger than 6 years of age who had unintentional ingestions between January 2013 and March 2024. The researchers identified racial and socioeconomic disparities with the management of unintentional ingestions among children in the emergency department. Specifically, African American patients younger than the age of 6 years were more likely to have a social work consult, children services bureau referral, and urine drug screen compared with their White counterparts. A higher severity of illness, a lower Childhood Opportunity Index, and pharmaceutical ingestions also resulted in either a social work consultation, a children services bureau referral, or both.
"Unintentional ingestions happen. However, as pediatric emergency medicine providers, it is our job to provide equitable care for all patients," Allen said. "This study is important in understanding where underlying bias exists in emergency department management and where changes can be made to address this problem."
Taylor Rosenbaum, M.D., of the Baylor College of Medicine/Texas Children's Hospital in Houston, and colleagues found that parents of young people hospitalized for suicidal thoughts or actions want to ensure firearm safety in the home and securely store firearms to prevent harm.
The authors surveyed 100 caregivers of young people (ages 8 to 21 years) admitted to the hospital for suicidal ideation or suicide attempt. The caregivers were questioned regarding their attitudes toward firearm safe storage counseling and firearm lock distribution in the hospital setting, and interested families were provided with safe storage counseling and a free firearm lock. The researchers found that only just over half of all caregivers were screened for firearm ownership. Meanwhile, almost 20 percent of firearm owners did not store them safely. The vast majority of parents -- both those who owned and did not own firearms -- felt that it was very important for their health care team to screen for firearm ownership, offer guidance on safe storage of firearms, and distribute firearm locks.
"Caregivers of children admitted for suicidality wanted to discuss firearm safe storage during their child's hospitalization and were extremely grateful to receive a free firearm lock," Rosenbaum said. "Health care teams do not routinely screen for firearm ownership and have an opportunity to provide a potentially life-saving intervention."
AAP: Disparities Seen in Infant Mortality Rate for Congenital Heart Disease
THURSDAY, Oct. 3, 2024 (HealthDay News) -- The infant mortality rate from congenital heart disease declined significantly for White, but not Black, infants in the United States from 2005 to 2019, according to a study presented at the annual meeting of the American Academy of Pediatrics, held from Sept. 27 to Oct. 1 in Orlando, Florida.
AAP: Breastfeeding During Birth Hospitalization Lowers Risk for Childhood Asthma
THURSDAY, Oct. 3 , 2024 (HealthDay News) -- Early breastfeeding patterns during birth hospitalization are associated with decreased rates of childhood asthma, according to a study presented at the annual meeting of the American Academy of Pediatrics, held from Sept. 27 to Oct. 1 in Orlando, Florida.
AAP: Low Vitamin D Linked to Slower Fracture Healing in Pediatric Patients
TUESDAY, Oct. 1, 2024 (HealthDay News) -- For pediatric patients with lower-extremity fracture and surgical management, low vitamin D is associated with slower clinical and radiographic healing, according to research presented at the annual meeting of the American Academy of Pediatrics, held from Sept. 27 to Oct. 1 in Orlando, Florida.
AAP: Pediatric Heat-Related ED Visits Increased 170 Percent Over Last Decade
FRIDAY, Sept. 27, 2024 (HealthDay News) -- Pediatric heat-related illness emergency department volume is associated with higher temperatures and is increasing over time, according to a study presented at the annual meeting of the American Academy of Pediatrics, held from Sept. 27 to Oct. 1 in Orlando, Florida.
AAP: Opioid Poisonings Increasing Among Young Children
FRIDAY, Sept. 27, 2024 (HealthDay News) -- Opioid poisonings are increasing among children, according to a study presented at the annual meeting of the American Academy of Pediatrics, held from Sept. 27 to Oct. 1 in Orlando, Florida.
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Gestational Diabetes Risk Higher in Women With Preconception Prediabetes
Preconception prediabetes is associated with increased odds of gestational diabetes among adolescents and young adults, according to a study published online Sept. 24 in JAMA Network Open.
Katharine J. McCarthy, Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a retrospective cohort study using linked 2009 to 2017 birth registry, hospital discharge, and New York City Department of Health A1C Registry data for pregnant individuals aged 10 to 24 years. Eligibility criteria were met by 14,302 individuals: 41.0 percent Hispanic, 29.0 percent Black, 18.1 percent White, 10.6 percent Asian, and 1.3 percent other or unknown race and ethnicity.
The researchers found that 79.7 and 20.2 percent of participants had normoglycemia and prediabetes, respectively. Compared with those with normoglycemia, those with preconception prediabetes had more than twice the risk for gestational diabetes (adjusted relative risk [aRR], 2.21) after adjusting for prepregnancy characteristics. Small increases in the likelihood of a hypertensive disorder of pregnancy (aRR, 1.18) and preterm delivery (aRR, 1.18) were seen in association with preconception prediabetes. Increases were seen in the risks for cesarean delivery and macrosomia, but they were not statistically significant. For identifying gestational diabetes among adolescents and young adults, the optimal hemoglobin A1c threshold was 5.6 percent.
"Given alarming trends in adolescent obesity and diabetes risk and the high prevalence of unplanned pregnancies in adolescence and young adulthood, our results support expanded preconception screening as a mechanism to intervene on excess cardiometabolic risk earlier in the life course," the authors write.
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Guideline Developed for Opioid Prescribing in Children With Acute Pain
In a clinical practice guideline issued by the American Academy of Pediatrics and published online Sept. 30 in Pediatrics, recommendations are presented for opioid prescribing for acute pain management in children and adolescents in outpatient settings.
Scott E. Hadland, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues recommend that acute pain should be treated using a multimodal approach, including appropriate use of nonpharmacologic therapies, nonopioid medication, and opioid medication, when needed. For children and adolescents with acute pain, opioids should not be prescribed as monotherapy. Clinicians should prescribe immediate-release opioid formulations, start with the lowest age- and weight-appropriate doses, and provide an initial supply of five or fewer days when using opioids for acute pain management, unless the pain is related to trauma or surgery with an expected duration of more than five days. Codeine or tramadol should not be prescribed for children younger than 12 years; for adolescents age 12 to 18 years with obesity, obstructive sleep apnea, or severe lung disease; for treating postsurgical pain after tonsillectomy or adenoidectomy in patients younger than 18 years; or for any breastfeeding patient. Caution should be exercised when prescribing opioids for acute pain in children or adolescents who are taking sedating medications. Naloxone should be provided when opioids are prescribed, and patients and families should be counseled on the signs of opioid overdose and how to respond.
"For a patient with mild-to-moderate pain, doctors should always start nonopioid medications and treatment," coauthor Rita Agarwal, M.D., from the Stanford University School of Medicine in California, said in a statement.
Two authors disclosed ties to the pharmaceutical industry.
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Index of Symptoms Can Identify Long COVID in Children, Adolescents
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) can be identified using an index of symptoms, which differs for school-aged children and adolescents, according to a study published online Aug. 21 in the Journal of the American Medical Association.
Rachel S. Gross, M.D., from the NYU Grossman School of Medicine in New York City, and colleagues conducted a multicenter, longitudinal observational cohort study involving participants recruited from more than 60 U.S. health care and community settings between March 2022 and December 2023. Data were included for 898 school-aged children (751 with previous SARS-CoV-2 infection [infected] and 147 without [uninfected]) and 4,469 adolescents (3,109 infected and 1,360 uninfected).
The researchers found that in both school-aged children and adolescents, 14 symptoms were more common in those with versus without infection history, with four additional symptoms in school-aged children only and three in adolescents only in adjusted models. Almost every organ system was affected by these symptoms. For each age group, a PASC research index was developed based on combinations of symptoms most associated with infection history; these indices correlated with poorer overall health and quality of life. In school-aged children, the index emphasized neurocognitive, pain, and gastrointestinal symptoms, while in adolescents, change or loss in smell or taste, pain, and fatigue/malaise-related symptoms were emphasized. In school-aged children and adolescents, clustering analyses identified four and three PASC symptom phenotypes, respectively.
"Symptoms that characterized pediatric PASC differed by age group, and several distinct phenotypic PASC presentations were described," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Fewer U.S. Teen Girls Are Reporting 'Persistent Sadness'
There's a hint of good news for parents concerned about teen mental health: After 57% of U.S. teen girls surveyed in 2021 said they felt "persistent sadness," that number declined somewhat by 2023, to 53%, new government data show.
In the latest biennial poll of over 20,000 high school students nationwide, called the Youth Risk Behavior Survey, researchers from the U.S. Centers for Disease Control and Prevention found that pandemic-era rates of despair may be ebbing, although they remain high.
“One of our main priorities at CDC is improving Americans’ mental health,” Dr. Debra Houry, the CDC's chief medical officer and deputy director for program and science, said in an agency news release. “The data released today show improvements to a number of metrics that measure young people's mental well-being -- progress we can build on. However, this work is far from complete.”
In general, girls tend to feel persistent sadness more than boys: About 28% of boys surveyed in both the 2021 and 2023 surveys said they felt that way.
In other survey findings, suicide risk among girls did not change between the two surveys. However, a rise in suicide attempts among Black students that appeared in 2021 has now declined significantly.
“These data show that we've made some progress in tackling these issues in recent years, which proves that they are not insurmountable. However, there's still much work ahead,” Kathleen Ethier, head of the CDC’s adolescent and school health program, said in an agency news release. “But we’re also seeing some really important glimmers of hope."
Still, rates of persistent sadness among lesbian, gay, bisexual and transgender high school students remained troublingly high: About 65% said they felt this way in the 2023 survey, compared to 31% among their cisgender and heterosexual students.
The decline in some markers of mental health woes among teens might be attributed to an increased focus in recent years on timely diagnosis and treatment, said Corinne Catarozoli, a clinical psychologist at Weill Cornell Medicine in New York City. She said that, increasingly, pediatricians are initiating and providing such care when teens come in for a checkup.
Speaking to the Times, Catarozoli said she's seen pediatric emergency visits at Weill Cornell for psychiatry care start to level off over this year.
“This [CDC] data we’re seeing today is promising and shows that we’re on the right track,” Catarozoli said. But, “there is still a long way to go in terms of access and in terms of insurance coverage.”
In other data on the current stressors hitting U.S. teens, the 2023 survey found that nearly 2 in 10 female students said they'd experienced sexual violence, while more than 1 in 10 reported being forced to have sex.
Violence affected LGBTQ teens as well, with nearly 1 in 5 saying they'd skipped school over the past 30 days out of fears of violence. More than 1 in 5 LGBTQ teens also said they'd been bullied over the past year, according to the report.
But certain risks are ebbing. Risky sexual behavior among teens is down, with just 6% of teenagers saying they have had four or more lifetime sexual partners, compared with 15% in 2013, the survey found.
Drinking rates have also fallen, from 35% of teens saying they drink in 2013 to just 22% a decade later. And while 23% of teens said they used marijuana in 2013, that number had fallen to 17% by 2023.
Social media use is rampant among youth, especially girls: By 2023, 82 percent of girls reported frequent social media use compared with 73 percent of boys.
Racism is still an issue, too: In 2023, exposure to racism at school was reported by more than a third of teens, with Asian students reporting the highest rate, at 57%, and 46% of Black students saying they faced racism at school.
If you or someone you know is in mental health crisis, free, anonymous help is available 24/7 at the 988 Suicide and Crisis Lifeline.
More information
Learn the warning signs of depression in teens at the Mayo Clinic.
SOURCES: U.S. Centers for Disease Control and Prevention, Youth Risk Behavior Survey, Aug. 6, 2024; New York Times
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Twice-Yearly Lenacapavir Prevents HIV Infection in Young Women
For adolescent girls and young women, lenacapavir every 26 weeks is beneficial for preventing acquired HIV infection, according to a study published online July 24 in the New England Journal of Medicine to coincide with the 25th International AIDS Conference, held from July 22 to 26 in Munich.
Linda-Gail Bekker, M.B., Ch.B., Ph.D., from the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, and colleagues conducted a phase 3 trial involving adolescent girls and young women who were randomly assigned to receive subcutaneous lenacapavir every 26 weeks, daily oral emtricitabine-tenofovir alafenamide (F/TAF), or daily oral emtricitabine-tenofovir disoproxil fumarate (F/TDF; active control) in a 2:2:1 ratio (2,134; 2,136; and 1,068 participants, respectively). The relative efficacy of lenacapavir and F/TAF was assessed by comparing the incidence of HIV infection versus the estimated background incidence in the screened population (8,094 participants); relative efficacy was compared with F/TDF.
The researchers observed 55 incident HIV infections among 5,338 participants who were initially HIV-negative (0.0, 2.02, and 1.69 infections per 100 person-years in the lenacapavir, F/TAF, and F/TDF groups, respectively). In the screened population, background HIV incidence was 2.41 per 100 person-years. HIV incidence with lenacapavir was significantly lower than background HIV incidence and than HIV incidence with F/TDF (incidence rate ratio for both, 0.00). No significant difference was observed for HIV incidence with F/TAF and background HIV incidence, and no meaningful difference was seen for HIV incidence between F/TAF and F/TDF.
"Twice-yearly lenacapavir offers a highly efficacious and discreet choice to potentially improve preexposure prophylaxis use among women," the authors write.
Several authors disclosed ties to pharmaceutical companies, including Gilead Sciences, which manufactures lenacapavir and funded the study.
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Clinical Report Addresses Management of Sickle Cell Disease in Children, Teens
Management of children and adolescents with sickle cell disease (SCD) requires comprehensive care from a pediatric primary care provider and a multidisciplinary team, according to a clinical report published online July 22 in Pediatrics.
Amber M. Yates, M.D., from the Baylor College of Medicine and Texas Children's Hospital in Houston, and colleagues present an overview focusing on the practical management of children and adolescents with SCD.
The authors note that SCD is a complex disorder with multisystem manifestations requiring comprehensive care from a pediatric primary care provider and a multidisciplinary SCD team. All aspects of general pediatric care should be managed by the pediatric primary care provider, and they should co-manage SCD-specific manifestations with the SCD team. The patient and family should be involved in all decisions. At least annual consultation with a multidisciplinary SCD team is strongly advised, although the extent to which the comprehensive care is delivered by a pediatric primary care provider versus the multidisciplinary specialist team will vary by community as well as family preference and the frequency and severity of SCD manifestations. Age-specific screening for disease complications is important at all SCD comprehensive visits. Education about and planning for urgent medical evaluation should be developed early and reviewed at each visit. The patient and family should be made aware that SCD is treatable but requires attention and active management to achieve optimum life outcomes.
"Improvements in care have resulted in almost all children with SCD surviving into adulthood and transitioning into adult care, which has allowed shifting the goal of care to improved quality of life," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Housing Insecurity Linked to Poorer Teen Health Outcomes
There is an association for housing insecurity starting in infancy and poorer adolescent outcomes, according to a study published online July 1 in Pediatrics.
Kristyn A. Pierce, M.P.H., from the NYU Grossman School of Medicine in New York City, and colleagues created a composite measure of housing insecurity using five indicators for participants at ages 1, 3, 5, 9, and 15 years based on data from the Future of Families and Child Wellbeing Study. Group-based trajectory modeling was used to identify distinct patterns of housing insecurity, sociodemographic predictors of these patterns, and how these patterns relate to health outcomes among adolescents.
The researchers identified three trajectories of housing insecurity from infancy to adolescence: secure, moderately insecure, and highly insecure. Reduced odds of excellent health were seen for adolescents who experienced moderately and highly insecure housing (adjusted odds ratios, 0.81 and 0.67, respectively); they also experienced more depressive symptoms compared to adolescents with secure housing (adjusted incidence rate ratio, 1.05). Significantly higher anxiety symptoms were reported by adolescents who experienced highly insecure housing (adjusted incidence rate ratio, 1.06).
"Housing insecurity is preventable and addressable through policy and public health intervention," the authors write. "Future work is needed to validate a universal measure for housing insecurity and implement screening and referral procedures for families with young children to appropriate services."
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AI Can Identify Guardian Authorship of Messages in Teen Patient Portal
Large language model (LLM)-based classifiers can accurately detect guardian authorship of messages sent from an adolescent patient portal, according to a research letter published online June 25 in JAMA Network Open.
April S. Liang, M.D., from the Stanford University School of Medicine in Palo Alto, California, and colleagues examined the ability of a LLM to detect guardian authorship of messages originating from adolescent patient portals. Messages from adolescent patient portal accounts at Stanford Children's Health were sampled and manually reviewed for authorship. Two prompts were iteratively engineered on a random subset of 20 messages until perfect performance was achieved: one focusing on authorship identification (single task) and one that generated response to the message and identified authorship (multitask). Both prompts were tested on remaining messages.
Of the 2,088 test messages, 71.8 and 28.2 percent were labeled as parent- or guardian-authored and patient-authored, respectively. The researchers found that the single-task LLM achieved sensitivity and specificity of 98.1 and 88.4 percent, respectively, while the multitask LLM achieved sensitivity and specificity of 98.3 and 88.9 percent, respectively. This corresponded to a positive predictive value and negative predictive value above 95 percent for multitask LLM. Statistically identical performance was seen for the single-task and multitask classifiers.
"Ultimately, reliable identification of nonpatient-authored messages has implications beyond adolescent medicine. Among adults, care partners commonly access patient portals using the patient's credentials, especially relevant for geriatric patients or individuals with developmental differences," the authors write. "Our results found that this study's LLM has potential in improving safeguards for patient confidentiality."
One author disclosed ties to nference.
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Endocrine Society, June 1-4
The annual meeting of the Endocrine Society (ENDO 2024) was held from June 1 to 4 in Boston, attracting approximately 7,000 participants, including clinicians, academicians, allied health professionals, and others interested in endocrine and metabolic disorders. The conference highlighted recent advances in the diagnosis and management of obesity, endocrine disorders, diabetes, and growth hormone and thyroid diseases.
In one study, Alexander Turchin, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues found that it is important to reduce the weight of individuals with overweight/obesity to decrease their risk for heart attack and stroke, and they noted this should be addressed at the earliest age possible.
Using data from the Nurses' Health Study and Health Professionals Follow-Up Study, the authors evaluated individuals with a body mass index (BMI) greater than 25 kg/m2 at least once during a 10-year period (1990 to 1999) to determine how having overweight/obesity impacted cardiovascular risk (heart attack or stroke) between 2000 and 2020.
The researchers found that individuals who were exposed to excess weight for a prolonged period of time had an increased risk for heart attack and stroke. In addition, prolonged exposure had a greater impact on heart attack and stroke risk than someone's weight at a single point in time. The increase in risk for heart attack and stroke from the prolonged excess weight was only observed in younger individuals (younger than 50 years for women and younger than 65 years for men).
"The key conclusion is that a person's weight at a given point in time is not the final 'sentence' -- one can 'appeal,'" Turchin said. "What matters is what is done about it next. I see this as a glass half-full: even if someone has overweight/obesity at some point in time, they can reduce their risk for heart attack/stroke if they lower their weight over time."
In another study, Gabriel Castano, M.D., of the Texas Children's Hospital in Houston, and colleagues found that 64 percent of adolescents with obesity and 32 percent of adolescents with type 2 diabetes are denied insurance coverage for glucagon-like peptide 1 (GLP-1) receptor agonists.
The authors evaluated 599 adolescents (average age, 15 years) being prescribed a GLP-1 receptor agonist and found that less than 70 percent of GLP-1 receptor agonists were approved for children with type 2 diabetes and less than 40 percent were approved for weight management. Once a medication was approved, 44 percent of patients treated for obesity did not reach the full treatment dose.
"There is more than just sending a GLP-1 receptor agonist prescription when taking care of children with type 2 diabetes and weight management," Castano said. "There are several limitations that are important to highlight: insurance approval, medication titration, medication engagement, as well as side effects."
Sriram Machineni, M.D., of the Albert Einstein College of Medicine/Montefiore Medical Center in Bronx, New York, and colleagues found that individuals with no obesity-related medical issues respond to tirzepatide just as well as individuals with two or more medical issues other than type 2 diabetes.
The authors evaluated 4,726 individuals from four different clinical trials. The participants either had obesity or overweight, along with an obesity-related medical condition, and 938 also had comorbid type 2 diabetes. The researchers found that individuals who had two or more obesity-related medical issues were older and had a longer duration of obesity than those with fewer obesity-related complications. In addition, BMI was not higher in patients with more obesity-related medical problems. The presence of more obesity-related medical problems did not affect weight loss from the medication tirzepatide.
"Providers and patients can look forward to a good weight loss response to tirzepatide whether or not they suffer from other medical problems related to their obesity," Manchineni said.
Mahmoud Nassar, M.D., Ph.D., of the University at Buffalo in Getzville, New York, and colleagues found that GLP-1 receptor agonists are safe to use among individuals with a history of acute pancreatitis.
The authors sought to assess the risk for recurrent acute pancreatitis among individuals with a history of acute pancreatitis treated with GLP-1 receptor agonists. A retrospective cohort study was performed using data from 127 million patients (five cohorts based on type 2 diabetes, obesity, and history of acute pancreatitis, with and without risk factors). The medications assessed included GLP-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase 4 inhibitors (DPP-4i), and older medications (i.e., metformin and thiazolidinediones).
The researchers found that GLP-1 receptor agonists significantly reduced the risk for recurrent acute pancreatitis compared with SGLT2i, DPP-4i, and not taking GLP-1 receptor agonists, SGLT2i, or DPP-4i. Similar trends were observed in all categories, indicating a consistent reduction in acute pancreatitis risk with GLP-1 receptor agonist treatment.
"GLP-1 receptor agonists are a safe option for treating type 2 diabetes and obesity in patients with a history of acute pancreatitis, but more research is needed to confirm these benefits," Nassar said.
Alexandra Donovan, Ph.D., of the Charles R. Drew University of Medicine and Science in Los Angeles, and colleagues found early-life stress to be associated with an increased risk for substance use initiation by the age of 13 years.
By separating early-life stress into type (limited resources, family conflict, and traumatic events), the investigators found that family conflict was a predictor of increased risk for substance use in both males and females. Limited resources predicted an increased risk for substance use in females, while traumatic events predicted an increased risk in males, specifically for nicotine use.
"Sex moderates the association between early-life stress and substance use initiation by age 13," Donovan said. "Clinicians working with low-resourced or high-conflict families should advise parents to discuss substance use with their children earlier, and provide alternate positive coping mechanisms."
ENDO: Novel Male Contraceptive Gel May Achieve Faster Sperm Suppression
WEDNESDAY, June 12, 2024 (HealthDay News) -- A novel male contraceptive gel suppresses sperm production faster than other hormone-based methods for male birth control, according to a phase 2 study presented at the annual meeting of the Endocrine Society, held from June 1 to 4 in Boston.
ENDO: Teprotumumab Shows Long-Term Efficacy for Thyroid Eye Disease
TUESDAY, June 11, 2024 (HealthDay News) -- Most patients with thyroid eye disease treated with teprotumumab do not require additional treatments nearly two years later, according to a study presented at the annual meeting of the Endocrine Society, held from June 1 to 4 in Boston and simultaneously published online June 2 in Thyroid.
ENDO: Early Menopause Tied to Heightened Risk for Breast, Ovarian Cancer
TUESDAY, June 11, 2024 (HealthDay News) -- Women with early menopause have a two times greater risk for breast cancer and a nearly four times higher risk for ovarian cancer, according to a study presented at the annual meeting of the Endocrine Society, held from June 1 to 4 in Boston.
ENDO: Cardiovascular Events Occur Less Often With GLP1-RA, SGLT-2i for T2D, Liver Disease
FRIDAY, June 7, 2024 (HealthDay News) -- For adults with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are associated with reduced risk of cardiovascular events compared with dipeptidyl peptidase 4 inhibitors, according to a study presented at the annual meeting of the Endocrine Society, held from June 1 to 4 in Boston.
ENDO: Crinecerfont Aids Patients With Congenital Adrenal Hyperplasia
WEDNESDAY, June 5, 2024 (HealthDay News) -- Crinecerfont results in a greater decrease from baseline in the mean daily glucocorticoid dose among patients with congenital adrenal hyperplasia, according to a study published online June 2 in the New England Journal of Medicine to coincide with the annual meeting of the Endocrine Society, held from June 1 to 4 in Boston.
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Cervical Spine Injury Prediction Rule in Children Can Guide Imaging Use
A cervical spine injury prediction rule can assist physicians in determining which children should undergo imaging on arrival to the emergency department after blunt trauma, according to a study published online June 3 in The Lancet Child & Adolescent Health.
Julie C. Leonard, M.D., from The Ohio State University College of Medicine in Columbus, and colleagues conducted a prospective observational cohort study involving children aged 0 to 17 years presenting with known or suspected blunt trauma at 18 specialized children's emergency departments. A total of 22,430 children presenting with known or suspected blunt trauma were enrolled: 11,857 and 10,573 in the derivation and validation cohorts, respectively. Overall, 433 patients (1.9 percent) had confirmed cervical spine injuries.
The researchers found that altered mental status; abnormal airway, breathing, or circulation findings; and focal neurological deficits, including paresthesia, numbness, or weakness were associated with a high risk for cervical spine injury. Overall, 118 (12.7 percent) of the 928 patients in the derivation cohort presenting with at least one of these risk factors had cervical spine injury (risk ratio, 8.9). Neck pain; altered mental status; substantial head injury; substantial torso injury; and midline neck tenderness were associated with a nonnegligible risk for cervical spine injury in a classification and regression tree (CART) analysis. The combination of high-risk and CART-derived risk factors applied to the validation cohort performed with 94.3, 60.4, and 99.9 percent sensitivity, specificity, and negative predictive value, respectively.
"When incorporated into a risk-stratified imaging algorithm, the rule can potentially spare children exposure to medical radiation by reducing computed tomography use," the authors write.
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Meal Replacement + Financial Incentives Beneficial for Teens With Obesity
For adolescents with severe obesity, meal replacement therapy (MRT) plus financial incentives (FIs) yield a greater reduction in body mass index (BMI) and total body fat mass than MRT alone, according to a study published online June 17 in JAMA Pediatrics.
Amy C. Gross, Ph.D., from the University of Minnesota Center for Pediatric Obesity Medicine in Minneapolis, and colleagues examined the effect of MRT plus FIs versus MRT alone on BMI, body fat, and cardiometabolic risk factors in adolescents with severe obesity in a randomized clinical trial conducted from 2018 to 2022. A total of 126 adolescents with severe obesity were included in the study: Half received MRT plus FIs and half received MRT alone.
The researchers found that the mean BMI reduction was −5.9 percentage points greater at 52 weeks in the MRT plus FIs group versus MRT-alone group. A greater reduction in mean total body fat mass by −4.8 kg was seen for the MRT plus FIs group, and it was cost-effective compared with MRT alone (incremental cost-effectiveness ratio, $39,178 per quality-adjusted life year). No significant between-group differences were seen in cardiometabolic risk factors or unhealthy weight control behaviors.
"It is possible that incentives allowed participants to better adhere to the meal plan over the course of the year, resulting in meaningful BMI and body fat reduction," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Surgeon General Calls for Warning Labels on Social Media Sites
The U.S. Surgeon General announced Monday that he will push for warning labels on all social media platforms, stating that they may harm teens' mental health.
"The mental health crisis among young people is an emergency -- and social media has emerged as an important contributor," Dr. Vivek Murthy wrote in an essay published Monday in the New York Times. "Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms, and the average daily use in this age group, as of the summer of 2023, was 4.8 hours. Additionally, nearly half of adolescents say social media makes them feel worse about their bodies."
"It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents," he added.
Still, such warning labels require Congressional approval, and no legislation on the issue has yet been introduced in either chamber.
In his essay, Murthy asserted that the dangers of social media are as significant as those seen with road accidents or contaminated food.
“Why is it that we have failed to respond to the harms of social media when they are no less urgent or widespread than those posed by unsafe cars, planes or food?” Murthy wrote. “These harms are not a failure of willpower and parenting; they are the consequence of unleashing powerful technology without adequate safety measures, transparency or accountability.”
Meanwhile, teens are spending more time than ever on social media.
A Gallup survey released last fall found that teens are logging in an average of 4.8 hours per day on platforms like YouTube, TikTok and Instagram.
If history is any example, past warning labels can alter public behavior. After a landmark report on the dangers of smoking was released by the Surgeon General in 1965, Congress voted to require all cigarette packaging carry a warning that using the products “may be hazardous to your health.”
When the warning labels first appeared, around 42 percent of U.S. adults smoked every day; that portion had dropped to 11.5 percent by 2021, the Times reported.
This is not the first time Murthy has warned of the dangers of social media: In May 2023, he issued an advisory that stated, “There are ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents.”
In that advisory, Murthy acknowledged that research suggests the platforms offer both risks and benefits, providing community for young people who might otherwise feel marginalized.
Still, it urged parents to limit their children’s social media use, and to keep meals free of devices.
With his new call for a warning label, Murthy is making an even more urgent plea for the mental health of America's young people.
“One of the most important lessons I learned in medical school was that in an emergency, you don’t have the luxury to wait for perfect information,” he wrote. “You assess the available facts, you use your best judgment and you act quickly.”
“There is no seatbelt for parents to click, no helmet to snap in place, no assurance that trusted experts have investigated and ensured that these platforms are safe for kids,” Murthy wrote. “There are just parents and their children, trying to figure it out on their own, pitted against some of the best product engineers and most well-resourced companies in the world.”
More information
Yale Medicine has more on social media and teens.
SOURCE: New York Times
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