Study: More than a quarter of American infants not received common childhood vaccines

More than a quarter of American infants in 2018 had not received common childhood vaccines that protect them from illnesses such as polio, tetanus, measles, mumps and chicken pox, new research from the University of Virginia School of Medicine reveals.

Only 72.8% of infants aged 19-35 months had received the full series of the seven recommended vaccines, falling far short of the federal government's goal of 90%. Those less likely to complete the vaccine series include African-American infants, infants born to mothers with less than a high-school education and infants in families with incomes below the federal poverty line.

The researchers warn that failure to complete the vaccine series leaves children at increased risk of infection, illness and death. It also reduces the herd immunity of the entire population, allowing diseases to spread more easily.

These findings highlight that significant disparities still exist in protecting infants from preventable diseases in the United States. The low seven-vaccine series rates in low-income families are disheartening, especially with federal programs such as Vaccine for Children, which provides coverage for their service."

Rajesh Balkrishnan, PhD, Researcher, UVA's Department of Public Health Sciences

Trends in childhood vaccination

Some good news: There was a 30% increase in the overall number of infants getting the full vaccine series during 2009-2018, the 10-year period the researchers examined.

However, disparities in vaccine uptake grew between low-income families and higher-income families in that time. In 2009, families below the federal poverty line were 9% less likely to get the full vaccine series than families with annual income above $75,000. In 2018, low-income families were 37% less likely to complete the vaccine series.

The researchers say the lower rate among low-income families is especially disheartening considering the availability of federal programs such as Vaccine for Children, which provides free vaccines for uninsured, underinsured and Medicaid-eligible children.

"Free vaccination coupled with no physician administration fees, linked with potential programs that are frequently accessed by low-income families, could be a potential solution to increase immunization rates," Balkrishnan said "The role of healthcare professionals such as pharmacists could also be expanded to provide these services cost effectively."

The study found that mothers who had not completed high school were almost 27% less likely to have their infants fully vaccinated than moms with college education. That disparity had increased sharply from a previous study evaluating 1995-2003. The previous study found that mothers with less than high-school education were 7.8% less likely to complete the vaccine series.

Among African-Americans, completion of the vaccine series was significantly lower than in both whites and Hispanics. The researchers call this disparity "unacceptable" and say cost-effective interventions are needed to increase immunization rates and address vaccine hesitancy.

"These findings are particularly important in the context of the current COVID pandemic," Balkrishnan said. "Particular attention needs to be paid to vulnerable populations in ensuring the availability and access to important life-saving vaccines."

About the research

To assemble their analysis, the researchers reviewed data from the National Immunization Survey (NIS) conducted annually by the federal Centers for Disease Control and Prevention. The research team consisted of Ansh A. Kulkarni, Raj P. Desai, Hector E. Alcala and Balkrishnan. Balkrishnan disclosed he is a consultant for Merck and Co.

The researchers have published their findings in the scientific journal Health Equity.

Source:

University of Virginia Health System

Journal reference:

Kulkarni, A.A., et al. (2021) Persistent Disparities in Immunization Rates for the Seven-Vaccine Series Among Infants 19–35 Months in the United States. Health Equity. doi.org/10.1089/heq.2020.0127.

Posted in: Child Health News | Medical Research News

Tags: Children, Education, Healthcare, Immunization, Measles, Medicaid, Medical Research, Medicine, Mumps, Pandemic, Polio, Poverty, Public Health, Research, Tetanus, Vaccine

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Michigan’s outbreak worries scientists. Will conservative outposts keep pandemic rolling?

When Kathryn Watkins goes shopping these days, she doesn't bring her three young children. There are just too many people not wearing masks in her southern Michigan town of Hillsdale.

At some stores, "not even the employees are wearing them anymore," said Watkins, who estimates about 30% of shoppers wear masks, down from around 70% earlier in the pandemic. "There's a complete disregard for the very real fact that they could wind up infecting someone."

Her state tops the nation by far in the rate of new covid cases, a sharp upward trajectory that has more than two dozen hospitals in the state nearing 90% capacity.

The nation is watching.

Michigan's outbreak could be an anomaly or a preview of what will happen in the nation as it emerges from the pandemic. Will pockets of covid denialism and vaccine resistance like that in Hillsdale — where the local college newspaper ran an opinion piece against the shots — serve as reservoirs for a wily virus, which will resurface to cause outbreaks in nearby cities and states?

"That's a million-dollar question right now," said Adriane Casalotti,chief of government and public affairs for the National Association of County and City Health Officials. "Whatever is going on there could happen in other places, especially as things start to reopen."

Some public health experts are alarmed: "In more rural or conservative communities where covid denialism and the behavior that comes with that is coupled with vaccine hesitancy, you're less likely to get vaccinated and more likely to do things that spread the virus," said Dr. Abdul El-Sayed, the former executive director of the Detroit Health Department and now a senior fellow at Harvard's T.H. Chan School of Public Health.

Multiple factors contributed to Michigan's outbreak — El-Sayed calls it "a cauldron of bad dynamics." But its magnitude is unparalleled, even as other states are also seeing increases, attributed in part to challenges like pandemic fatigue and political and economic pressure to fully reopen.

Deaths from covid in Michigan are up 219% since March 9, weekly state data shows. Hospital admissions are increasing, affecting a growing number of young people. Positive test rates are at their highest levels since last April. Dozens of outbreaks, including clusters related to youth sports, K-12 schools and colleges, are ongoing. If there is any good news, it's that the proportion of deaths among those 60 and older is declining, which is attributed to a high vaccination rate among that age group.

Fueling the trajectory in Michigan, experts say, are a highly contagious variant, first identified in the United Kingdom, known as B 1.1.7; public mobility returning to pre-pandemic levels; and optimism about vaccine rollout, leading people to drop their guard. The state, like some others, also loosened restrictions in March, allowing more people inside restaurants, gyms and entertainment venues.

Paradoxically, some experts say another factor may be the success that earlier stay-at-home orders from last year had, helping tamp down previous surges — meaning Michigan's spike may simply signal the state's catching up to other regions.

"We locked things down and had fewer cases than neighboring states," said Josh Petrie, a research assistant professor at the University of Michigan's School of Public Health. "More recently, since March, we see that steep increase again."

But those emergency orders, while tamping things down, also fueled a backlash, including a plot by extremists to kidnap Gretchen Whitmer, the Democratic governor who ordered them.

Lawsuits brought by Republican lawmakers last year diluted her power to issue emergency orders. Nationally, dozens of mainly Republican-controlled state legislatures are seeking to limit the emergency powers of governors, public health officials or both.

The resistance stretches beyond the capital, Lansing.

About 70 miles south, in Hillsdale County, where Watkins lives, the sharp divisions are complicating the effort to fight the virus.

The semi-rural region, population 45,000, has seen 3,980 cases and 82 deaths since the start of the pandemic. Staunchly conservative, the county voted overwhelmingly for incumbent Donald Trump. Nationally, polls have shown that Republicans are more hesitant to get vaccinated than Democrats or independents.

Statewide, data from the federal Department of Health and Human Services show vaccine hesitancy is high in Michigan, although not the highest in the country.

But in Hillsdale County, an estimated 21% are hesitant, with 8% strongly hesitant, according to the federal data.

There, health officials report that about 33% of Hillsdale County residents have received at least one shot, although more than 70% of those 65-plus have done so. Statewide, the overall average percentage of all adults who have had at least one shot is 45%. In the Democratic stronghold of Ann Arbor, where Washtenaw County reported 54% having had at least one shot, 15% are hesitant to do so, with 5% strongly hesitant.

Vaccination resistance "does play a role," said Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security. "We know from research that people's attitudes toward vaccination are largely influenced by what friends, family and neighbors do."

Statewide, younger residents have the lowest vaccination rate, with just under 20% of 16- to 19-year-olds getting at least one shot and about a quarter of those in their 20s, according to state data.

In an opinion piece in the newspaper of Hillsdale's local college, the Hillsdale Collegian, a student editor argued vaccines were "not worth the risk." But that was soon followed by another piece, also written by a student, urging vaccination.

There have been 323 cumulative covid cases among the approximately 1,500 Hillsdale College students and more than 700 staff members since September. Many other universities and colleges in Michigan are also seeing outbreaks, according to state data.

Unfortunately, resistance to vaccination often goes hand in hand with refusing to wear a mask. Darrel Scharp, 75, a self-described "strong Democrat" who lives in nearby Osseo, said some businesses, are still "celebrating noncompliance," such as not requiring masks or otherwise flouting rules. His doctor has told him that, sadly, he often "had to argue with his patients about masks."

Hillsdale's mayor, Adam Stockford, in July wrote on his Facebook page that he was "furious" that the local health department was warning businesses to comply with the state's emergency mandates to prevent covid spread. And Hillsdale College held an in-person graduation ceremony last summer, defying the state's law against large gatherings.

With a Michigan outbreak now in full steam, debate about how to handle the upcoming high school prom peppers the Facebook page of the Hillsdale Daily News. Would holding it in person risk even more viral spread, endangering the most vulnerable?

Oh, great, wrote one sarcastically, "spread covid like wildfire for a party."

But another responded, "Let them have their proms and graduations haven't you taken enough from them as it is!!!!!"

Politicians nationwide face similar divides. There's pressure from hard-hit business owners to reopen and growing resentment by a public tired of restrictions.

In recent weeks, Michigan's governor has tried to thread the needle. She has noted that a mask mandate remains in effect, and there are capacity limits — expanded in March — for indoor dining, retail and entertainment. Yet, while resisting any mandatory retrenchment, she has asked residents to voluntarily forgo dining indoors at restaurants, keep their children out of in-person school and pause youth activities for two weeks.

That's a hard message. Said Casalotti: People are being told, "We're not going to shut down as we did in the past, but we still want you to change your behavior. It takes four sentences to explain. It's hard to put those levels of decision on people's shoulders."

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Posted in: Healthcare News

Tags: Children, Coronavirus, Doctor, Fatigue, Health and Human Services, Hospital, Pandemic, Public Health, Research, students, Vaccine, Virus

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Surgery to correct congenital heart disease linked to increased risk of adult hypertension

In a medical records study covering thousands of children, a U.S.-Canadian team led by researchers at Johns Hopkins Medicine concludes that while surgery to correct congenital heart disease (CHD) within 10 years after birth may restore young hearts to healthy function, it also may be associated with an increased risk of hypertension — high blood pressure — within a few months or years after surgery.

Reporting their findings in the April 8, 2021, issue of JAMA Network Open, the researchers showed that children who had cardiac repair surgeries were 13 times more likely to develop hypertension as adults when compared with the general population.

"Congenital heart disease is among the most common forms of birth defects, and successful surgical interventions are usually performed before the age of 2; however, the specific risks of long-term, negative outcomes — including hypertension — are basically unknown for this population," says Chirag Parikh, M.D., Ph.D., director of the Division of Nephrology at the Johns Hopkins University School of Medicine and lead author of the new paper.

"So, we conducted what is believed to be the largest study with the longest follow-up ever of these children to better understand these risks and guide the development of methods to help them lessen the chance of hypertension-related cardiac disease or death," he says.

The hypertension study used the same data registry from a 2019 investigation of CHD repair and long-term risk of end-stage kidney disease.

Parikh says that clinical outcome studies in recent years provide evidence that surgical repair of heart problems during the first decade of life leaves behind some pathological changes that can continue in the cardiovascular system.

In an attempt to more precisely measure the problem of hypertension after childhood heart surgery, Parikh and his colleagues looked at medical records from seven linked Canadian patient databases. Since Canadians have universal access to health care services, the study population was less likely to have disparities and differences in the treatment and follow-up care they received.

From the list of all babies born in Ontario, Canada, between April 1, 2012, and March 31, 2015, the researchers selected 3,600 children who had surgeries to repair CHD within 10 years of birth, and matched them with 36,000 others who did not have the congenital condition nor any procedures performed on their hearts. The majority of the patients who had repair surgery were prematurely born males with low birth weights and around 150 days old at the time of their first surgery.

Cardiac repair surgeries performed on the patients were ranked from 1 to 4 in increasing complexity, with 43% being listed at categories 3 or 4 (the most complex), and including some even more complex than category 4. The two most commonly seen procedures (64%) were closure of a hole between the atria (upper chambers of the heart) or between the ventricles (lower chambers of the heart).

Both the cardiac repair surgery and the nonsurgery subjects were followed medically for up to 13 years, with data collected until death, diagnosis of hypertension or the end of the study (March 31, 2015). Of the 3,600 subjects who had surgery, 445 — or 12.4% — developed hypertension, compared with 398 out of 36,000 people — or 1.1% — who did not have the procedure. This means the children who had CHD repair surgery were 12 times more likely to become hypertensive.

The hypertension incidence rate — the total number of high blood pressure cases identified during the study period divided by the cumulative time in years for all of the patients participating (known as person-years) — also showed significantly higher risk of developing hypertension as an outcome of early age CHD repair surgery. For the surgery patients, the incident rate was 141.3 cases per 10,000 person-years compared with 11.1 cases per 10,000 person-years for those who did not have the surgery — a difference of nearly 13 to 1.

"We also saw that the more complex the cardiac surgery performed, the higher the risk for developing hypertension," Parikh says. "In the most extreme case, patients who had surgery to correct a hypoplastic left heart — a severe defect where the left side of the heart is underdeveloped — were three times more likely to develop hypertension than the congenital heart condition next in severity."

Other factors raising the risk of future hypertension were CHD repair surgery at age 3 months or younger, needing kidney dialysis during recovery from CHD repair surgery, and one or more cardiac surgeries after the initial repair.

Parikh cautions that medical records studies that "look back" at patient histories have limitations, but says that the research team's findings should be useful in guiding better long-term care for those at highest risk for hypertension, and subsequently, heart disease, stroke or kidney disease.

"For now, we recommend that children who have cardiac repair as infants be monitored more closely for hypertension throughout their lives," he says. "Future research will need to explore if early treatment of hypertension in these patients can prevent cardiovascular or renal problems later on."

Source:

Johns Hopkins Medicine

Journal reference:

Greenberg, J.H., et al. (2021) Long-term Risk of Hypertension After Surgical Repair of Congenital Heart Disease in Children. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2021.5237.

Posted in: Child Health News | Medical Procedure News | Medical Research News | Medical Condition News

Tags: Biopharmaceutical, Birth Defects, Blood, Blood Pressure, Cardiac Surgery, Children, Congenital Heart Defect, Congenital Heart Disease, Dialysis, Health Care, Heart, Heart Defect, Heart Disease, Heart Surgery, High Blood Pressure, Hospital, Hypoplastic, Kidney, Kidney Disease, Medicine, Nephrology, pH, Research, Stroke, Surgery

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Women experienced high rates of mental health problems early in COVID-19 pandemic

A study at the University of Chicago Medicine found U.S. women experienced increased incidence of health-related socioeconomic risks (HRSRs), such as food insecurity and interpersonal violence, early in the COVID-19 pandemic. This was associated with "alarmingly high rates" of mental health problems, including depression and anxiety. The research was published April 5 in the Journal of Women's Health.

Other studies have found evidence for higher rates of anxiety and depression and related issues, such as alcohol overuse, connected to the pandemic — but this study is the first to link early pandemic-related changes in HRSRs to mental health effects in women.

Most national surveys tend to report aggregated findings rather than stratifying by gender. Those early studies gave us snapshots of the health and behaviors of the whole population, but gave us limited insight on women. Yet, women constitute the majority of the essential workforce, including healthcare workers, and we wanted to make sure that women's experiences were being documented."

Stacy Lindau, MD, Professor of Obstetrics and Gynecology and Medicine-Geriatrics, UChicago Medicine

The researchers conducted a survey of 3,200 U.S. women over the age of 18 between April 10 and 24, 2020. More than 40% of participants reported experiencing at least one HRSR during the prior year, which included issues such as food insecurity, housing instability, difficulties with their utilities, transportation challenges and interpersonal violence; 22% reported experiencing two or more HRSRs during the year before the pandemic.

But by the first spring of the pandemic, nearly half of all women — including 29% of those who did not experience pre-pandemic HRSRs — reported new (incident) or worsening HRSRs. The greatest challenge was an increase in food insecurity. Nearly 80% of those without pre-pandemic HRSRs who reported a new HRSR became food insecure. Almost a quarter experienced interpersonal violence.

"It's incredible and concerning that nearly half of women — including more than a quarter of those who had no health-related socioeconomic risks — had experienced incident or worsening conditions," said Lindau. "It's even more striking that more than a quarter of the women who had none of these risks in January or February 2020 now had at least one by April.

That points to the likelihood that a large portion of women were already near the edge of vulnerability. When the world shut down, transportation became more difficult, food access became harder, and very soon after the crisis began, many women found themselves struggling to meet basic needs."

Those who experienced socioeconomic risks prior to the pandemic also experienced the greatest increase in insecurity. Three-quarters of women with pre-pandemic HRSRs experienced new or worsening risks during the early pandemic; 38% experienced two or more, with more than half experiencing increased food insecurity.

Significantly, the survey also found that 29% of women reported symptoms of depression and anxiety — nearly twice the estimated pre-pandemic rates. One in six women screened positive for symptoms of post-traumatic stress, a rate similar to that seen after other significant disasters, such as the SARS and Ebola epidemics. Those who experienced at least one new or worsening HRSR were at significantly higher risk of experiencing anxiety and post-traumatic stress.

"Given very high rates of these problems, we're really concerned about the current capacity of our mental health system," said co-author Marie Tobin, MD, Professor of Psychiatry at UChicago Medicine. "Women are principally responsible for parenting, family caregiving and other essential work — they are key to managing and recovering from this pandemic, and now are afflicted by very significant socioeconomic risk levels that appear to be drivers of anxiety, depression and traumatic stress. We should be especially concerned that socioeconomically vulnerable women are at high risk for developing pandemic-related psychiatric morbidity."

These results, the investigators say, should help spur healthcare providers and policy makers to address the underlying and modifiable health-related socioeconomic risk factors in order to prevent these negative outcomes.

"We can't change a person's gender, but we can act to ensure that all people have the basic nutrition and shelter they need to survive," said Lindau. "We can intervene on transportation barriers, we can pass policies to delay or offset rent or utilities payments. These are modifiable factors that can be addressed by leveraging the humanitarian resources of our communities and implementing policies that ensure everyone can live independently with their basic needs met. Ensuring equitable access to the basics would be a powerful buffer against mental illness in general and could help mitigate costly and painful mental health crisis among women and everyone who depends on us in the context of this and other public health emergencies."

Source:

University of Chicago Medical Center

Journal reference:

Lindau, S. T., et al. (2021) Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women. Journal of Women's Health. https://doi.org/10.1089/jwh.2020.8879.

Posted in: Medical Condition News | Women's Health News | Disease/Infection News

Tags: Alcohol, Anxiety, Cancer, Children, Depression, Geriatrics, Gynecology, Health Systems, Healthcare, Hospital, Medicine, Mental Health, Nutrition, Obstetrics, Pandemic, Parenting, Physiology, Psychiatry, Public Health, Research, SARS, Stress

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Encouraging COVID vaccine results for children and pregnant women

vaccine

After being safely administered to millions of adults around the world, new data shows that the Pfizer/BioNTech vaccine is effective in teenagers as well. A US trial of more than 2,000 12-15 year olds found that the vaccine had an efficacy rate of 100% and produced a strong antibody response, according to a press release from Pfizer. That’s good news, as children will eventually need to be vaccinated to prevent infection, says pediatrician James B Wood.

These results follow earlier positive results relating to the efficacy of COVID-19 vaccines during and after pregnancy. A small study of pregnant and breastfeeding women who had been given the Pfizer and Moderna vaccines found they too produced a robust immune response, and that vaccinated mothers were also able to pass on immunity to their newborns. Immunologists Catherine Thornton and April Rees explain here how it works.

The Moderna and Novavax vaccines are due to arrive in the UK in the coming months, with the latter to be entirely produced and packaged domestically. This will provide hope for those who are still waiting for their first doses, say supply chain experts Liz Breen and Sarah Schiffling, and it will hopefully bolster the country’s slow emergence from lockdown.

In the US, 15 million doses of the Johnson & Johnson vaccine have been contaminated at a manufacturing site after ingredients were conflated with those destined for the AstraZeneca vaccine.

The boost for UK production of COVID-19 vaccines will take some of the heat out of disputes with the EU over the export of doses manufactured within the bloc. The World Health Organization has described the EU rollout as “unacceptably slow”, and the UK has claimed it has preferential access to AstraZeneca vaccines because it negotiated a better contract with the drugmaker. But that’s not strictly true, writes EU law professor Gareth Davies.

The UK prime minister, Boris Johnson, reportedly hailed the lightning-fast development of COVID-19 vaccines as a victory for “greed” and “capitalism,” but the free market has not proven effective in bringing the world new vaccines in the past, writes David Whyte. The real unsung hero of the pandemic, he says, is the publicly funded research sector.

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Pediatric Bronchiolitis Admissions to ICU Fall During COVID-19

(Reuters Health) – Pediatric intensive care unit (PICU) admissions for bronchiolitis plunged in Paris during the COVID-19 pandemic, a French study suggests.

Researchers examined data on bronchiolitis PICU admissions at five hospitals in Paris for all children under 2 years of age during the autumn-winter bronchiolitis season of 2020, as well as for the same period over the five previous years.

Over the five pre-COVID seasons, there were a total of 3,099 bronchiolitis admissions to the PICU, with 2,190 (70.7%) happening from September to December. Based on this trend, researchers predicted that there should have been 444 bronchiolitis admissions to the PICU for the same four-month period of 2020. The actual number of admissions was 65, however, 85.3% lower than expected.

“I firmly believe that the most likely explanation is a reduced contamination from bronchiolitis viruses – mainly respiratory syncytial virus (RSV) – as a consequence of decreased human contacts elicited by all the public health measures that were mandated for COVID-19 including social distancing, mask-wearing, hand hygiene, curfews, and lockdowns,” said study co-author Dr. Ricardo Carbajal, chief of the pediatric emergency department at University Hospital Armand Trousseau, in Paris, and a professor at the Sorbonne University Faculty of Medicine.

It’s unlikely that the reduction in bronchiolitis PICU admissions was due to parents not bringing babies to the hospital or infants not getting admitted, Dr. Cabajal said by email.

“The monitoring of visits for bronchiolitis in the community, outside hospitals, also showed a marked decrease in visits for bronchiolitis,” Dr. Cabajal said. “Furthermore, since children have been spared by COVID-19, PICU beds were available for any child that needed intensive care.”

There were also no pediatric bronchiolitis deaths from September to December 2020, compared with a total of 19 deaths over the five precious seasons, the researchers report in Pediatrics.

The study results suggest that some hygiene measures used during the pandemic might also be deployed to help minimize the spread of respiratory viral infections and bronchiolitis among infants, the research team concludes.

While results from Paris, with about 20% of the population of France, are likely representative of what happened nationwide, the authors note, though it’s still possible that these results might not be representative of what occurred in other countries.

Even so, the results underscore that infection control practices implemented during the pandemic might be beneficial in the future to prevent RSV among children, said Dr. Lara Shekerdemian, chief of critical care at Texas Children’s Hospital and professor and vice chair of pediatrics at Baylor College of Medicine in Houston.

“Infections with viruses like RSV in particular that are typically transmitted through direct contact between small children – have fallen dramatically during the pandemic,” Dr. Shekerdemian, who wasn’t involved in the study, said by email.

Less contact leads to lower risk of transmitting or acquiring these infections, and the study results suggest that sanitizing, masking, and distancing are also effective for minimizing transmission, Dr. Shekerdemian added.

“After the pandemic, I hope that certain practices remain: these include of course hand hygiene, and in hospital or healthcare environments, masking becoming more routine,” Dr. Shekerdemian said.

SOURCE: https://bit.ly/2P9GZij Pediatrics, online March 17, 2021.

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Brain imaging may predict treatment outcomes for adolescents with anxiety disorders

As with any complex machine, sometimes a simple crossed wire or short circuit can cause problems with how it functions. The same goes for our brains, and even when the short circuit is uncovered, sometimes experts don't have a quick fix.

A new study reveals that an evidence-based treatment may "fix" this human short circuit and, with the help of brain imaging, might predict treatment outcomes for adolescents with anxiety disorders. University of Cincinnati researchers say this could determine medication effectiveness more quickly to help patients.

Study results showed that brain imaging was able to predict — after just two weeks of treatment with almost 80% accuracy — how much a patient would improve.

We also see [through imaging] that the medication in this study increases the strength of the connection between a brain area that generates anxiety and an area that serves as a 'brain brake' for the fear center. In essence, the medication allows the brain to dampen the overactivity of fear areas, and we see this dampening very early in the course of treatment using imaging."

Jeffrey Strawn, MD, Study's Senior Author, Associate Professor and Anxiety Expert, Department of Psychiatry and Behavioral Neuroscience at UC

In this National Institutes of Health-sponsored study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers used brain imaging (MRI) to see how 41 adolescents, ages 12-17, with anxiety disorders responded to a medication called escitalopram, versus a placebo, over eight weeks. Escitalopram is a medication known as a selective serotonin reuptake inhibitor (SSRI) that is approved by the Food and Drug Administration for depression in adolescents and for both depression and anxiety in adults.

Strawn, who is also a physician at Cincinnati Children's Hospital Medical Center and UC Health, says SSRIs work by boosting the activity of serotonin in the brain. Serotonin is one of the chemical messengers that nerve cells use to communicate with one another and one that is involved in anxiety disorders. These medications block the recycling of serotonin into nerve cells, making more serotonin available to improve transmission of messages between neurons.

"These medications are an effective treatment for many adolescents with anxiety disorders. However, how much a specific patient will benefit is difficult to predict," he continues.

He says clinicians typically need six to eight weeks of the patient being on the medication in order to evaluate whether or not the treatment is going to work. "But with the brain imaging in this study, doctors could determine — after just two weeks — if they would need an alternative treatment. Knowing this early in treatment could greatly improve outcomes for patients," he adds. "This study helps clinicians understand how the medication — even early in treatment — changes brain circuits that are involved in anxiety and can help to get patients back to their normal lives more quickly."

Larger studies are needed to further test this, but the results are promising and, as Strawn notes, are really important for better treating adolescents with anxiety disorders.

"Anxiety disorders are the most common mental illnesses in the U.S., with approximately 4.4 million children and adolescents affected," he says. "These disorders are not only common in children and teens, but, if untreated, result in considerable personal and economic cost over the lifetime.

"This study uncovers a way to predict how effectively a medication will treat anxiety in kids and reveals that brain changes occur within two weeks of starting the medication. Additionally, the changes that occur in the brain can predict treatment response and improvement over time which is incredibly beneficial for physicians and can help us determine promising biomarkers for drug development. While not necessarily a quick fix, this could be a quicker fix that could help patients tremendously and improve their quality of life."

Source:

University of Cincinnati

Journal reference:

Lu, L., et al. (2021) Acute Neurofunctional Effects of Escitalopram in Pediatric Anxiety: A Double-Blind, Placebo-Controlled Trial, California. Journal of the American Academy of Child and Adolescent Psychiatry. doi.org/10.1016/j.jaac.2020.11.023.

Posted in: Child Health News | Medical Science News | Medical Research News

Tags: Adolescents, Anxiety, Brain, Children, Depression, Hospital, Imaging, Mental Health, Nerve, Neurons, Neuroscience, Placebo, Psychiatry, Serotonin

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Food industry lobbying was intense on failed bill to limit marketing to Canadian children

Food industry lobbying was intense on failed bill to limit marketing to Canadian children

Researchers at the University of Toronto have found that food industry interactions with government heavily outnumbered non-industry interactions on Bill S-228, also known as the Child Health Protection Act, which died in the Senate of Canada in 2019.

The researchers looked at more than 3,800 interactions, which included meetings, correspondence and lobbying, in the three years before the bill failed. They found that over 80 per cent were by industry, compared to public health or not-for-profit organizations.

They also found that industry accounted for over 80 per cent of interactions with the highest-ranking government offices, including elected parliamentarians and their staff and unelected civil servants.

“Industry interacted with government much more often, more broadly, and with higher ranking offices than non-industry representatives in discussions of children’s marketing and Bill S-228,” said principal investigator Mary L’Abbé, a professor of nutritional sciences at U of T and a researcher in the Joannah & Brian Lawson Centre for Child Nutrition.

The journal CMAJ Open published the study today.

The researchers drew data from Health Canada’s Meetings and Correspondence on Healthy Eating database, set up in 2016, which details the type and content of interactions between stakeholders and Health Canada on nutrition policies. They also used Canada’s Registry of Lobbyists, which tracks the names and registrations of paid lobbyists but provides limited details on the content of the meetings.

“We’re fortunate to have access to this information in Canada, as it offers insight into the story of government bills,” said Christine Mulligan, a doctoral student in L’Abbé’s lab and lead author on the study. “Industry stakeholders bring important viewpoints, but the volume and breadth of their lobbying on this bill was clearly disproportionate, especially compared to public health.”

The food industry has a long history of effective lobbying in Canada and other countries, and a growing body of research has documented both that extensive influence and the need for policy makers to be aware of it when creating policy that promotes the health and safety of all citizens.

Health Canada met with industry 56 per cent of the time regarding the 2016 Healthy Eating Strategy, researchers at the University of Ottawa found earlier this year. And during creation of the recent Food Guide, Health Canada restricted industry lobbying—so effectively that industry persuaded officials at Agriculture and Agri-Food Canada to lobby Health Canada on their behalf, as The Globe and Mail and other organizations reported.

Mulligan says the disparity in interactions with government among stakeholders was even greater for S-228, and that it marks a stark contrast between this bill and interactions on the Healthy Eating Strategy more broadly.

Industry lobbying has also been prominent on a stalled bill to introduce front-of-package labelling that would inform consumers about foods high in salt, sugar and saturated fat, said L’Abbé, who advised Health Canada on both bills and the Healthy Eating Strategy.

L’Abbé said that more transparency on interactions with Agriculture and Agri-Food Canada and other federal departments would help, as would more detail in the Registry of Lobbyists. All stakeholder comments related to proposed regulations are part of a public docket in the U.S., and some groups have called for a similar approach in Canada.

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Americans coping with pandemic stress report undesired changes to weight, increased drinking

As growing vaccine demand signals a potential turning point in the global COVID-19 pandemic, the nation's health crisis is far from over. One year after the World Health Organization declared COVID-19 a global pandemic, many adults report undesired changes to their weight, increased drinking and other negative behavior changes that may be related to an inability to cope with prolonged stress, according to the American Psychological Association's latest Stress in America™ poll.

APA's survey of U.S. adults, conducted in late February 2021 by The Harris Poll, shows that a majority of adults (61%) experienced undesired weight changes – weight gain or loss — since the pandemic started, with 42% reporting they gained more weight than they intended. Of those, they gained an average of 29 pounds (the median amount gained was 15 pounds) and 10% said they gained more than 50 pounds, the poll found.

Such changes come with significant health risks, including higher vulnerability to serious illness from the coronavirus. For the 18% of Americans who said they lost more weight than they wanted to, the average amount of weight lost was 26 pounds (the median amount lost was 12 pounds). Adults also reported unwanted changes in sleep and increased alcohol consumption. Two in 3 (67%) said they have been sleeping more or less than desired since the pandemic started. Nearly 1 in 4 adults (23%) reported drinking more alcohol to cope with their stress.

We've been concerned throughout this pandemic about the level of prolonged stress, exacerbated by the grief, trauma and isolation that Americans are experiencing. This survey reveals a secondary crisis that is likely to have persistent, serious mental and physical health consequences for years to come. Health and policy leaders must come together quickly to provide additional behavioral health supports as part of any national recovery plan."

Arthur C. Evans Jr., PhD, APA's Chief Executive Officer

The pandemic has taken a particularly heavy toll on parents of children under 18. While slightly more than 3 in 10 adults (31%) reported their mental health has worsened compared with before the pandemic, nearly half of mothers who still have children home for remote learning (47%) reported their mental health has worsened; 30% of fathers who still have children home said the same.

Parents were more likely than those without children to have received treatment from a mental health professional (32% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic began (24% vs. 9%). More than half of fathers (55%) reported gaining more weight than they wanted to, and nearly half (48%) said they have been drinking more alcohol to cope with stress.

The majority of essential workers (54%), such as health care workers and people who work in law enforcement, said they have relied on a lot of unhealthy habits to get them through the pandemic. Nearly 3 in 10 (29%) said their mental health has worsened, while 3 in 4 (75%) said they could have used more emotional support than they received since the pandemic began.

Essential workers were more than twice as likely as adults who are not essential workers to have received treatment from a mental health professional (34% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25% vs. 9%).

Further, people of color reported unintended physical changes during the pandemic. Hispanic adults were most likely to report undesired changes to sleep (78% Hispanic vs. 76% Black, 63% white and 61% Asian), physical activity levels (87% Hispanic vs. 84% Black, 81% Asian and 79% white) and weight (71% Hispanic vs. 64% Black, 58% white and 54% Asian) since the pandemic began. Black Americans were most likely to report feelings of concern about the future.

More than half said they do not feel comfortable going back to living life like they used to before the pandemic (54% Black vs. 48% Hispanic, 45% Asian and 44% white) and that they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% Black vs. 51% Asian, 50% Hispanic and 47% white).

"It's clear that the pandemic is continuing to have a disproportionate effect on certain groups," said APA President Jennifer Kelly, PhD. "We must do more to support communities of color, essential workers and parents as they continue to cope with the demands of the pandemic and start to show the physical consequences of prolonged stress."

Overall, Americans are hesitant about the future, regardless of vaccination status. Nearly half of adults (49%) said they feel uneasy about adjusting to in-person interaction once the pandemic ends. Adults who received a COVID-19 vaccine were just as likely as those who had not received a vaccine to say this (48% vs. 49%, respectively).

The full report and more graphics are available at http://www.stressinamerica.org.

Methodology

This Stress in America™ survey was conducted online within the United States by The Harris Poll on behalf of the American Psychological Association between Feb. 19 and 24, 2021, among 3,013 adults age 18+ who reside in the U.S. Interviews were conducted in English and Spanish. Data were weighted to reflect their proportions in the population based on the 2020 Current Population Survey (CPS) by the U.S. Census Bureau.

Weighting variables included age by gender, race/ethnicity, education, region, household income and time spent online. Hispanic adults were also weighted for acculturation, taking into account respondents' household language as well as their ability to read and speak in English and Spanish. Country of origin (U.S./non-U.S.) was also included for Hispanic and Asian subgroups. Weighting variables for Gen Z adults (ages 18 to 24) included education, age by gender, race/ethnicity, region, household income, and size of household, based on the 2019 CPS. Propensity score weighting was used to adjust for respondents' propensity to be online.

Parents are defined as U.S. adults ages 18+ who have at least one person under the age of 18 living in their household at least 50% of the time for whom they are the parent or guardian.

Source:

American Psychological Association

Posted in: Medical Research News | Healthcare News

Tags: Alcohol, Children, Coronavirus, Education, Health Care, Language, Mental Health, Pandemic, Physical Activity, Psychology, Sleep, Stress, students, Trauma, Vaccine

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Risdiplam Promising for Spinal Muscular Atrophy

Infants with type 1 spinal muscular atrophy (SMA) showed promising signs, including an increased expression of functional survival motor neuron (SMN) protein in the blood, after 1 year of treatment with oral risdiplam (Evrysdi, Genentech), according to results of part 1 of the FIREFISH study.

A boost in SMN expression has been linked to improvements in survival and motor function, which was also observed in exploratory efficacy outcomes in the 2-part, phase 2-3, open-label study.

“No surviving infant was receiving permanent ventilation at month 12, and 7 of the 21 infants were able to sit without support, which is not expected in patients with type 1 spinal muscular atrophy, according to historical experience,” reported the FIREFISH Working Group led by Giovanni Baranello, MD, PhD, from the Dubowitz Neuromuscular Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, and Great Ormond Street Hospital Trust, London.

However, “it cannot be stated with confidence that there was clinical benefit of the agent because the exploratory clinical endpoints were analyzed post hoc and can only be qualitatively compared with historical cohorts,” they added.

The findings were published online Feb. 24 in the New England Journal of Medicine.

A Phase 2-3 Open-Label Study

The study enrolled 21 infants with type 1 SMA, between the ages of 1 and 7 months. The majority (n = 17) were treated for 1 year with high-dose risdiplam, reaching 0.2 mg/kg of body weight per day by the twelfth month. Four infants in a low-dose cohort were treated with 0.08 mg/kg by the twelfth month. The medication was administered once daily orally in infants who were able to swallow, or by feeding tube for those who could not.

The primary outcomes of this first part of the study were safety, pharmacokinetics, pharmacodynamics (including the blood SMN protein concentration), and selection of the risdiplam dose for part 2 of the study. Exploratory outcomes included event-free survival, defined as being alive without tracheostomy or the use of permanent ventilation for 16 or more hours per day, and the ability to sit without support for at least 5 seconds.

In terms of safety, the study recorded 24 serious adverse events. “The most common serious adverse events were infections of the respiratory tract, and four infants died of respiratory complications; these findings are consistent with the neuromuscular respiratory failure that characterizes spinal muscular atrophy,” the authors reported. “The risdiplam-associated retinal toxic effects that had been previously observed in monkeys were not observed in the current study,” they added.

Regarding SMN protein levels, a median level of 2.1 times the baseline level was observed within 4 weeks after the initiation of treatment in the high-dose cohort, they reported. By 12 months, these median values had increased to 3.0 times and 1.9 times the baseline values in the low-dose and high-dose cohorts, respectively.

Looking at exploratory efficacy outcomes, 90% of infants survived without ventilatory support, and seven infants in the high-dose cohort were able to sit without support for at least 5 seconds. The higher dose of risdiplam (0.2 mg/kg per day) was selected for part 2 of the study.

The First Oral Treatment Option

Risdiplam is the third SMA treatment approved by the Food and Drug Administration, “and has the potential to expand access to treatment for people with SMA,” commented Mary Schroth, MD, chief medical officer of Cure SMA, who was not involved in the research. She added that the exploratory outcomes of the FIREFISH study represent “a significant milestone for symptomatic infants with SMA type 1.”

While the other two approved SMA therapies — nusinersen and onasemnogene abeparvovec — have led to improvements in survival and motor function, they are administered either intrathecally or intravenously respectively, while risdiplam is an oral therapy.

Schroth says there are currently no studies comparing the different SMA treatments. “Cure SMA is actively collecting real-world experience with risdiplam and other SMA treatments through multiple pathways,” she said. “Every individual and family, in collaboration with their health care provider, should discuss SMA treatments and make the decision that is best for them.”

Writing in  Neuroscience Insights , a few months after risdiplam’s FDA approval last summer, Ravindra N. Singh MD, from the department of biomedical sciences, Iowa State University, Ames, wrote that, as an orally deliverable small molecule, risdiplam “is a major advancement for the treatment of SMA.”

Now, the FIREFISH study is “welcome news,” he said in an interview. “The results look promising so far,” he added. “I am cautiously optimistic that risdiplam would prove to be a viable alternative to the currently available invasive approaches. However, long-term studies (with appropriate age and sex-matched cohorts) would be needed to fully rule out the potential side effects of the repeated administrations.”

The therapy “is particularly great news for a group of SMA patients that might have tolerability and/or immune response concerns when it comes to nusinersen and gene therapy,” he noted in his article, adding that the ability to store and ship the drug at ambient temperatures, as well as its comparatively low cost are added benefits.

The study was supported by F. Hoffmann–La Roche. Baranello disclosed that he serves as a consultant for AveXis, F. Hoffmann-La Roche, and Sarepta Therapeutics, as well as PTC Therapeutics, from whom he also receives speaker honoraria. Schroth disclosed no personal conflicts and is an employee of Cure SMA. Cure SMA works to develop strategic relationships with corporate partners with the goal of working together to lead the way to a world without SMA. In advancement of that mission, Cure SMA has received funding from multiple corporate sources including Aetna, Biogen, Blue Cross Blue Shield, Genentech, Kaiser Permanente, Novartis Gene Therapies, Scholar Rock, and United HealthCare. Cure SMA has no financial stake in any treatment and does not advocate for one treatment over another. Singh disclosed that Spinraza (Nusinersen), the first FDA-approved SMA drug, is based on the target (US patent # 7,838,657) that was discovered in his former laboratory at UMASS Medical School, Worcester, Mass.

This story originally appeared on MDedge.com, part of the Medscape Professional Network.

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