Ethnoracial Disparities Seen in Access to Genetic Testing in Pediatric Neurology
For pediatric neurology patients, there are marked ethnoracial disparities in genetic testing completion, according to a study published online Feb. 12 in Neurology.
Jordan Janae Cole, M.D., from the University of Colorado in Aurora, and colleagues examined whether social determinants of health (SDOH) are associated with genetic testing among pediatric neurology outpatients in a retrospective observational study using electronic health record data. Genetic testing requests, insurance denials, and test completion rates were compared for non-Hispanic single-racial or multiracial Black versus non-Hispanic single-racial White patients.
Data were included for 11,371 patients, of whom 4.9 percent completed one or more genetic test in the study interval. The researchers found that compared with Black patients, White patients were significantly more likely to have completed one or more genetic test (adjusted odds ratio, 1.88). The most common specialty through which testing was completed was outpatient pediatric neurology. There was no difference seen in neurology provider request rates for genetic testing by patient ethnoracial identity; lower insurance denial rates after neurology request were seen for White versus Black patients (relative rate ratio, 0.44); the likelihood of completing genetic testing after it was requested through neurology was lower for those with public insurance (adjusted odds ratio, 0.59). Insurance type was significantly associated only with multipanel gene completion when considering individual genetic test types (public versus private: odds ratio, 0.56).
"Recognizing ethnoracial inequities and the barriers to genetic testing due to SDOH are essential for developing interventions to eliminate testing disparities, such as improving insurance coverage and increasing availability of point-of-care genetic testing," the authors write.
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Early Childhood Sun Exposure Linked to Lower Risk for Pediatric MS Relapse
Greater prenatal and early childhood sun exposure is associated with a lower risk for relapse among children with multiple sclerosis (MS), according to a study published online Feb. 12 in Neurology: Neuroimmunology & Neuroinflammation.
Gina Chang, M.D., M.P.H., from The Children's Hospital of Philadelphia, and colleagues conducted a multicenter cohort study involving 334 children with pediatric-onset MS recruited from 18 pediatric MS clinics between Nov. 1, 2011, and July 1, 2017, to examine the correlation between time spent in the sun in early childhood and risk for relapse. Relapses were identified prospectively after enrollment; those preceding study enrollment were entered retrospectively.
The researchers found that from disease onset to the end of the follow-up period, 206 children (62 percent) experienced at least one relapse. Compared with <30 minutes, ≥30 minutes of daily sun exposure during the first summer of life was associated with a lower risk for relapse after adjustment (adjusted hazard ratio, 0.67). There was also an association seen between greater time spent in the sun during the first trimester of pregnancy and a reduced risk for relapse (adjusted hazard ratio, 0.68). No significant associations were seen for ultraviolet radiation dose and time spent in the sun later in life with relapse risk.
"Our findings suggest that sun exposure in early childhood may have long-lasting benefits on the progression of childhood-onset MS," Chang said in a statement.
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Minority Children Less Likely to Be Diagnosed With Migraine in Emergency Department
Compared with non-Hispanic White (NHW) children, non-Hispanic Black (NHB) and Hispanic/Latino (HL) children with a headache diagnosis in the emergency department have lower rates of migraine diagnosis, undergo less testing, and receive less intensive treatment, according to a study published online Feb. 5 in Neurology.
Danielle Kellier, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues examined racial and ethnic disparities in the diagnosis, testing, and treatment of pediatric patients (age 5 to 21 years) presenting to the emergency department with headache in a cross-sectional study of visits from 49 children's hospitals between 2016 and 2022.
Of the 160,466 eligible visits, 41.0, 24.8, and 26.0 percent were by NHW, NHB, and HL children, respectively. The researchers found that NHW children were more often diagnosed with migraine compared with NHB and HL children (45.5 percent versus 28.2 and 28.3 percent, respectively). Compared with NHW children, NHB and HL children received less testing, including brain magnetic resonance imaging scans (adjusted odds ratios, 0.56 and 0.54, respectively). The proportion of visits without administration of headache-related medications did not differ between the groups (23.3, 24.6, and 23.4 percent for NHW, NHB, and HLs, respectively). Compared with NHWs, NHB and HL children were more likely to receive only oral medications (adjusted odds ratios, 1.37 and 1.54, respectively) and less likely to be admitted as inpatients (adjusted odds ratios, 0.80 and 0.65, respectively).
"Further research is necessary both to understand how disparities in headache management affect outcomes and to develop interventions to reduce inequity in the management of headache, one of the most common concerns seen in the pediatric emergency department," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Social Determinants of Health Linked to Brain MRI Outcomes in Pediatric MS
For patients with pediatric-onset multiple sclerosis (POMS), social determinants of health (SDOH) are associated with worse brain magnetic resonance imaging (MRI) outcomes, according to a study published online Nov. 27 in Neurology.
Ruby Ross, M.D., from the New York University Grossman School of Medicine in New York City, and colleagues conducted a retrospective single-site cohort study of patients with POMS with brain MRI quantitatively analyzed to yield total white matter lesion, black hole, whole brain, white matter, and gray matter volumes.
Data were included for 138 patients with POMS, with a mean age of 19.86 years and median disease duration of four years at the time of MRI. The researchers observed associations for public health insurance, Black race, Hispanic ethnicity, low parental education, and a high social vulnerability index (SVI) with white matter lesion and black hole volume. The strongest individual predictor of total white matter lesion and black hole volume was SVI (β = 4.63 and 2.91, respectively). Public health insurance was the strongest predictor of total lesion and black hole volume in models incorporating all SDOH variables (β = 2.48 and 1.50, respectively), attenuating the effect of SVI. Between categories of social disadvantage, there were no differences seen in disease-modifying treatment timing or efficacy.
"Our findings suggest that childhood social disadvantage can have lasting effects on MS severity," the authors write.
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American Society of Anesthesiologists, Oct. 18 to 22
The annual meeting of the American Society of Anesthesiologists was held from Oct. 18 to 22 in Philadelphia, attracting approximately 5,000 participants from around the world, including anesthesiologists and other health care professionals. The conference featured presentations focusing on the latest advances in the relief of pain and total care of surgical patients prior to, during, and after surgery.
In one study, Ivie Izekor, of the Texas A&M College of Medicine in Bryan, and colleagues found a strong association between the number of surgeries a patient undergoes and their risk for malnutrition.
A total of 28,475,485 patients who underwent orthopedic surgery of any kind were identified through the National Inpatient Sample database between 2016 and 2019, including 1,853,360 (6.5 percent) who were diagnosed with malnutrition after admission. The researchers found that patients with more frequent surgeries were significantly more likely to be malnourished, which led to longer hospital stays, higher health care costs, and increased in-hospital mortality. For instance, patients with six to 10 surgeries had a 1.6 times greater risk for malnutrition, and those with 21 to 25 surgeries had more than a five times greater risk.
"The risk of malnutrition increases significantly with the number of surgeries," Izekor said. "Mathematically, based on our study's population, malnutrition-related mortality is higher than aspiration-related mortality."
In another study, Elizabeth Pealy, M.D., of the University of Chicago Medicine, and colleagues aimed to determine the feasibility of administering the recently developed, pediatric-specific, computerized adaptive mental health assessment tool (KCAT) on pediatric surgical patients in the preoperative area. The authors also examined the prevalence of anxiety and depression in this population.
The researchers found that all 65 patients who were enrolled in the study and were scheduled for elective surgery were able to complete KCAT in an average of two minutes and 13 seconds. There were no major issues noted with performing this assessment in the preoperative area. The prevalence of preoperative anxiety was more than 50 percent, and preoperative depression was observed in about one-third of the patients who were screened.
"Using this tool to identify preoperative anxiety and/or depression will allow the patient's care team to individualize management of these mental health issues preoperatively, intraoperatively, and postoperatively and focus resources on patients who could have the most benefit," Pealy said.
Ryan C. Nicholson, M.P.H., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues found that simple interventions such as treating a patient with a nonsteroidal anti-inflammatory drug (NSAID) around the time of surgery may reduce the incidence of postoperative delirium.
The medical records from a large database were assessed to identify patients who had surgery with anesthesia between 2014 and 2023. The researchers found that NSAIDs like ibuprofen reduced the incidence of postoperative delirium more than Tylenol when given before, during, or immediately after surgery. Furthermore, nonsalicylates were superior compared with salicylates in reducing the incidence of delirium. The reduction in delirium was most significant in patients older than 65 years, who have a higher risk for delirium due to comorbidities and age.
"We have been increasingly incorporating NSAIDs into our surgical recovery protocols. We routinely use medications like the nonsalicylate NSAID celecoxib for this purpose," Nicholson said. "Additional research needs to be completed to identify NSAIDs that are most effective, the patient population we should target most, and exact timing of the intervention (pre-, intra-, or postoperative)."
ASA: Risk for Postoperative Delirium Increased With Poor and Worsening Sleep
FRIDAY, Oct. 25, 2024 (HealthDay News) -- Inadequate sleep and worsening sleep trajectory are associated with postoperative delirium among adults undergoing noncardiac surgery under general anesthesia, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 18 to 22 in Philadelphia.
ASA: Fibrinogen-to-Albumin Ratio Is Risk Factor for Preeclampsia
THURSDAY, Oct. 24, 2024 (HealthDay News) -- The fibrinogen-to-albumin ratio is an independent risk factor for development of any preeclampsia and preeclampsia with severe features, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 18 to 22 in Philadelphia.
ASA: Repeated Fasting Increases Malnutrition Risk in Patients Undergoing Multiple Surgeries
THURSDAY, Oct. 24, 2024 (HealthDay News) -- Malnutrition is more likely among patients undergoing multiple orthopedic surgeries, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 18 to 22 in Philadelphia.
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Guidelines Provided for Diagnosis of Pediatric, Late-Onset Multiple Sclerosis
In a clinical review conducted by an international committee of multiple sclerosis (MS) experts in pediatric and adult MS and published online Sept. 16 in JAMA Neurology, consensus guidance is provided for diagnosing pediatric and late-onset MS.
Le H. Hua, M.D., from the Lou Ruvo Center for Brain Health at the Cleveland Clinic in Las Vegas, and colleagues provide guidance on approaches to differential diagnosis in suspected MS specific to those aged younger than 18 years and older than 50 years.
The authors note that compared with typical adult-onset MS, unique biological factors are seen in children younger than 18 years and adults older than 50 years. These biological differences may influence clinical presentation, resilience to neuronal injury, and differential diagnosis. Children have high immunological reactivity, increasing the likelihood of other mimicking disorders; consequently, MS needs to be differentiated from other neuroimmunological conditions. The clinical disease course of MS is distinct in children; progressive onset at presentation should warrant investigation for alternative diagnoses. Children are likely to reach disability milestones at earlier ages than adults, underscoring the need for early diagnosis to allow for timely intervention. In older adults, MS should be differentiated from more common conditions such as vascular disease, spinal stenosis/compressive myelopathy, and arthritis. Since inflammatory activity is reduced during older age, relapses triggered by inflammation occur less often, but disability progression tends to accelerate. Nonspecific white matter changes in the brain in older populations are more likely due to vascular disease or migraines, potentially leading to misdiagnosis of MS.
"There are important implications for when MS treatment begins, and improving diagnostic approach is an important step forward in providing tailored care as our research into these patient subsets continues," Hua said in a statement.
Several authors disclosed ties to the biopharmaceutical industry.
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Nonmotor Seizures Often Undiagnosed in the Emergency Department
THURSDAY, May 2, 2024 (HealthDay News) -- Nonmotor seizures are often missed in the emergency department and are only realized after conversion to motor seizures, according to a study published online May 1 in Neurology.
Nora Jandhyala, from NYU Langone Health in New York City, and colleagues investigated recognition of motor versus nonmotor seizures in the emergency department among 83 individuals (ages 12 to 18 years) who where neurotypical and within four months of treatment initiation for focal epilepsy.
The researchers found that 70 percent of participants presented to an emergency department before diagnosis of epilepsy. While most presented for motor seizures (52 patients; 90 percent), many had a history of nonmotor seizures (20 of 52; 38 percent). Individuals with initial nonmotor seizures were less likely to present to the emergency department (26 of 44 [59 percent] versus 32 of 39 [82 percent]). Nonmotor seizures were less likely to be correctly identified (33 versus 81 percent). Among adolescents who presented for a first-lifetime motor seizure, a history of initial nonmotor seizures was not recognized in any; therefore, initiation of treatment and admission from the emergency department were not more likely for those who met the definition of epilepsy versus those with no seizure history. Compared with an adult group, this lack of nonmotor seizure history recognition in the emergency department was greater (0 percent for adolescents versus 23 percent for adults), with occurrence in both pediatric and nonpediatric settings.
"Our study highlights a critical need for physicians to inquire about the symptoms of nonmotor seizures, even when the presenting seizure is motor," the authors write.
Several authors disclosed ties to the pharmaceutical and biotechnology industries.
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Which is the happiest specialty?
Plastic surgeons top list of physicians ranked by happiness. The numbers are a bright spot as physicians across all specialties are still struggling with high rates of burnout.How happy are physicians? It varies according to specialty, with plastic surgeons apparently the most content in and out of work.
Seventy-one percent of plastic surgeons reported they were happy, with public health and preventive medicine physicians coming in a close second at 69%. They topped a list of 29 specialties that were ranked based on polling conducted between June and October 2022. Infectious disease specialists ranked the lowest – at 47% they were the only specialty in which less than half of respondents reported they were happy. This is likely due to the persistent and ongoing stressors of caring for COVID-19 patients through the pandemic and beyond. In between those two extremes were orthopedics and otolaryngology, both ranking at 65%, and urology and physical medicine and rehabilitation, both at 63%.
Ophthalmology, dermatology, pathology and gastroenterology all logged happiness rates of 62%. Radiology and pediatrics ranked at 61% and 60%, respectively. General surgery (59%); pulmonary medicine (59%); nephrology (58%); diabetes and endocrinology (58%); psychiatry (58%); anesthesiology (58%); obstetrics/gynecology (57%); internal medicine (57%); family medicine (56%); cardiology (56%); emergency medicine (55%); critical care (55%); allergy and immunology (55%); neurology (54%); oncology (51%); and rheumatology (51%).
The numbers are a bright spot as physicians across all specialties are still struggling with high rates of burnout...Read more
Do these results make sense to you?
