Tag: health and health care (by demographic group)

Almost half of children who go to ER with mental health crisis don’t get the follow-up care they need, study finds | CNN

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Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.



CNN
 — 

Every night that Dr. Jennifer Hoffmann works as an attending physician in the pediatric ER, she says, at least one child comes in with a mental or behavioral health emergency. Over the span of her career, she’s seen the number of young people needing help grow enormously.

“The most common problems that I see are children with suicidal thoughts or children with severe behavior problems, where they may be a risk of harm to themselves or others,” said Hoffmann, who works at Ann & Robert H. Lurie Children’s Hospital of Chicago. “We’re also seeing younger children, especially since the pandemic started. Children as young as 8, 9 or 10 years old are coming to the emergency department with mental health concerns.

“It’s just mind-blowing.”

The surge of children turning up in emergency departments with mental health issues was a challenge even before 2020, but rates soared during the Covid-19 pandemic, studies show.

ER staffers may be able to stabilize a child in a mental health care crisis, but research has shown that timely follow-up with a provider is key to their success long-term. Unfortunately, there just doesn’t seem to be enough of it, according to a new study co-authored by Hoffmann. Without the proper follow-up, these children too often wound up back in the ER.

For their study, published Monday in the journal Pediatrics, Hoffmann and her co-authors looked at records for more than 28,000 children ages 6 to 17 who were enrolled in Medicaid and had at least one trip to the emergency department between January 2018 and June 2019. They found that less than a third of the children had the benefit of an outpatient mental health visit within seven days of being discharged from the ER. A little more than 55% had a follow-up within 30 days.

Research has shown that follow-up with a mental health care provider lowers a person’s suicide risk, raises the chances that they will take their prescription medicine and decreases the chances that they will make repeated trips to the ER.

The new study found that without a follow-up, more than a quarter of the children had to go back to the ER for additional mental health care within six months of their initial visit.

“The emergency department is a safety net. It’s always open, but there’s limited extent to the types of mental health services we can provide in that setting,” Hoffmann said. “This really speaks to inadequate access to services that these kids need.”

This dynamic can be “devastating” for parents and emergency department staff alike, she said.

“We know what a child needs, but we’re just not able to schedule follow-up due to shortages among the mental health profession. They’re widespread across the US,” she said.

A lack of professional help is a problem for many children. Before the Covid-19 pandemic, the US Centers for Disease Control and Prevention found that 1 in 5 children had a mental health disorder, but only about 20% got care from a mental health provider.

Children’s mental health has become such a concern in the US that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association declared a national emergency in 2021.

Hoffmann’s study found that Black children fared worse than their peers. They were 10% less likely to have timely follow-up than White children – “which is very concerning, given that there are many disparities in access to care in our mental health system,” Hoffmann said.

The study can’t pinpoint why there is this racial disparity, but Hoffmann thinks there may be a few factors at play.

Black children are more likely to live in neighborhoods that have shortages of mental health professionals. There is also limited diversity among the mental health work force. Studies show that nearly 84% of psychologists are White, as are nearly 65% of counselors and more than 60% of social workers. And Black children more often rely on school-based mental health services, studies show.

Although the number of school counselors has been increasing over the years, few schools meet the National Association of School Psychologists’ recommended ratio of one school psychologist to 500 students. The national ratio for the 2021-22 school year was 1,127 to 1, the association found.

The new study found that the children who did not have mental health help before their ER visits had the most difficulty finding timely care afterward.

Dr. Toni Gross, chief of the Emergency Department at Children’s Hospital New Orleans, said she wasn’t entirely surprised by the study findings. Her hospital’s beds for with mental health concerns are “always busy,” she said.

“I’m well aware of the fact that we need more providers for these services. We deal with it every day,” said Gross, who was not involved in the new research.

The lack of providers who can do follow-up is a real source of concern. It’s not ideal to hand a phone number to a parent and hope they can arrange care, she said. It often takes weeks or even months to get a first appointment with a child and adolescent psychiatrist.

“It leaves a lot of us feeling like we wish we could do more,” Gross said. “When you always leave asking yourself at the end of the day, ‘did I really do what I set out to do, and that is to help people,’ it’s one of our biggest frustrations, and it may be one of the biggest reasons people in my group of physicians feel burnout.”

Like many children’s hospitals, hers has an active partnership with local school health programs that can provide some mental health care.

Hoffmann said that the amount of support varies by emergency department. Lurie has 24/7 coverage by mental health workers who can do an evaluation and provide recommendations for appropriate care, but not all areas do. For example, many rural emergency rooms don’t have pediatric mental health providers and may have few resources in the community, if any.

Several US counties have no practicing child and adolescent psychiatrists. Primary care physicians can help, but some patients would benefit from more specialized care, Hoffmann said.

President Joe Biden’s administration announced in August that plans to make it easier for millions of children to get access to mental health services by allowing schools to use Medicaid dollars to hire additional school counselors and social workers. He even mentioned the issue in his State of the Union address Tuesday.

But even more will need to be done. Hoffmann hopes her study will prompt policy-makers to invest more so children can access care no matter where they live. Investing in telehealth could also bridge the gap, she said, as would increasing Medicaid reimbursement rates for mental health services and more funding to pay for people to train to work with children as a mental health professional.

In a commentary published alongside the new study, the authors say their research shows that the US “is not meeting the behavioral health needs of our young people.”

“EDs are the last stop when all else has failed, and they, too, lack the resources to support, or even discharge, these patients,” the commentary says.

It points out that research has found this lack of access as far back as 2005.

“This new analysis adds to the overwhelming evidence that there is an urgent need for a dramatic change in our pediatric mental health care system,” the commentary says. “We believe it is time for a ‘child mental health moonshot,’ and call on the field and its funders to come together to launch the next wave of bold mental health research, for the benefit of these children and their families who so desperately need our support.”

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Restrict calories to live longer, study says, but critics say more proof is needed | CNN

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CNN
 — 

People of normal weight may be able to extend their life span by restricting calories, according to a new study that attempted to measure the pace of aging in people asked to cut their calorie intake by 25% over two years.

“We’ve known for nearly 100 years that calorie restriction can extend healthy life span in a variety of laboratory animals,” said senior author Daniel Belsky, an associate professor of epidemiology at Columbia University Mailman School of Public Health.

“It does this by changing biology in ways consistent with a slowing of the process of aging, although the specific mechanisms of how this occurs are still under investigation,” said Belsky, who studies longevity. “We decided to drill down to the cellular level in people to see if the same is true.”

The study used what are commonly known as “biological clocks” to determine the pace of aging in its participants. Bioclocks are designed to measure how old people are biologically compared with their real ages chronologically.

“Our study found evidence that calorie restriction slowed the pace of aging in humans,” said colead author Calen Ryan, an associate research scientist at the Robert N. Butler Columbia Aging Center at Columbia.

“Our findings are important because they provide evidence from a randomized trial that slowing human aging may be possible,” Ryan said in a statement.

But longevity scientist Dr. Peter Attia dismissed the study results as “noise.”

“I just don’t see any evidence that any of the biologic clocks have meaning,” Attia, who was not involved in the study, said via email. He hosts “The Drive,” a podcast dedicated to explaining and applying longevity research to everyday life.

“The only validation that matters — which to my knowledge has not been done, but hopefully will be — is to see if ‘biologic age’ can predict future life better than chronological age,” he said.

Biological age predictors are controversial, said calorie restriction researcher Pankaj Kapahi, a professor at the Buck Institute for Research on Aging in Novato, California.

“At best, they’re telling you something about a very small aspect of aging,” said Kapahi, who was not involved in the study. “For example, grip strength is also a biological age predictor, how active you are is a predictor, and we all know people who fall apart physically but are cognitively all there, so you also need to test cognitive aging.

“Some researchers are trying to boil it down with bio-aging tests,” he added. “This is a much more complex problem, and I think it’s an overstatement to say the tests really predict biological age.”

Decades of research in animals have shown that calorie restriction produces health benefits, even slowing the pace of aging. Would the same be true in people?

A study in the 1950s asked people to reduce 50% of their calories, leading to malnutrition or a lack of key micronutrients in participants. Later research often focused on calorie reduction in people whose body mass index would be considered medically obese.

The first clinical trial of calorie restriction in people at normal weight (a BMI of about 20 to 25) started in 2007. It was called CALERIE, or the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy.

Because of the malnutrition found in the earlier study that cut calories drastically, CALERIE asked 143 adults between the ages of 21 and 50 to cut 25% of the calories they typically ate for a two-year period. Another group of 75 people maintained their normal diets, serving as a control group.

During the trial, all manner of tests were done at six-month intervals to gather information on weight loss, change in resting metabolic rate, impact on cognitive function and markers of inflammation, cardiovascular health and insulin sensitivity.

The results of CALERIE, published in 2015, found that on average people in the restricted group were able to cut 14% of their calories, or about half of the 25% goal. However, that amount reduced their fat mass by about 10% and decreased their cardiometabolic risk factors with no adverse effects on quality of life, researchers said. There were also reductions in tumor necrosis factor alpha, a protein that promotes insulin resistance and obesity-induced type 2 diabetes.

A number of other studies have used blood samples and other data collected on the CALERIE participants to explore other ways modest calorie restriction might benefit the body. For example, Yale University researchers found restricting calories increased the health of the thymus, an organ that produces immune system T cells — one of the body’s key warriors against invaders.

The new study, published Thursday in the journal Nature Aging, culled DNA sequences from white blood cells taken at 12-month intervals from participants in CALERIE. Belsky’s team then analyzed methylation marks — signs of epigenetic changes — on the DNA, looking for symptoms of aging.

Epigenes are proteins and chemicals that sit like freckles on each gene, waiting to tell the gene “what to do, where to do it, and when to do it,” according to the National Human Genome Research Institute.

“Increasingly, changes to our cells’ epigenomes, the systems that control which genes in the genome are turned on and off, are being recognized as drivers of the aging process,” said anti-aging expert David Sinclair, a professor of genetics in the Blavatnik Institute at Harvard Medical School and codirector of the Paul F. Glenn Center for Biology of Aging Research.

“Clocks that measure these changes are proving to be indicators of future health and what interventions might slow and even reverse the aging process,” said Sinclair, who was not involved in the study.

In the new study, researchers used two epigenetic clocks — PhenoAge and GrimAge — and a new tool Belsky recently invented in conjunction with Duke University. This third bioclock, called DunedinPACE, attempts to determine the pace of aging from a single blood test, Belsky said.

The PhenoAge and GrimAge bioclocks showed no signs of reduced aging in the blood samples of participants in CALERIE, said Belsky, who is also a scientist with Columbia’s Robert N. Butler Aging Center.

However, DunedinPACE, the clock created by Belsky’s and Duke’s teams, did find a 2% to 3% reduction in the pace of aging, “which in other studies translates to a 10-15 percent reduction in mortality risk, an effect similar to a smoking cessation intervention,” according to a statement from Columbia.

Critics of the study, however, were not impressed. The performance of the DunedinPACE test was “mediocre at best,” Attia said, finding only a weak association with biological aging.

The fact that the two other bioclocks found no anti-aging benefits was no surprise, said the Buck Institute’s Kapahi: “These biological age predictors don’t agree with each other and don’t necessarily agree with other biological measures.

“It’s going to confuse the public, and unfortunately people are buying these tests when there’s very little useful information that comes out of them.”

While it’s true epigenetic biomarkers are not yet ready to be used in clinical trials, “many different studies in many different datasets and populations have shown these algorithms are predictive of differences between people in who gets sick and who lives or dies,” Belsky countered.

“This is not a game over moment. It’s more like game on,” Belsky said. “What we have now is a proof of concept — a methylation biomarker that shows faster aging in people we know to be at higher risk for disease, disability and death, and slower aging in people who we know to be at lower risk.”

Putting aside the debate over how slower aging is measured, there is a role for caloric restriction in extending life, especially in “overnourished” individuals, Attia said.

“I don’t want a reader to think this intervention (calorie restriction) is of no value, only that (the study) does not ‘prove’ a reduction in the pace of aging,” he said in an email.

Time-restricted eating and dietary restriction of certain foods are two additional ways to curb “overnutrition,” which Attia believes is the biggest driver of insulin resistance, type 2 diabetes and other chronic diseases.

“I am not aware of any evidence that one ‘strategy’ or method is superior. The best one is the one that works for a person, but calorie restriction certainly works for some, and therefore is clearly beneficial,” Attia said. “All of these interventions will lead to a longer and better life, but these aging clocks tell us less than zero about that process.”

There are many other ways to curb aging as well, Kapahi said.

“We’re trying to learn more about aging and we are, but calorie restriction is just one intervention,” he said. “You likely need to do that in combination with exercise, with good sleep, with a positive attitude and good mental health. All these things combined will likely play a much bigger role in slowing aging.”

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For the first time, US task force proposes expanding high blood pressure screening recommendations during pregnancy | CNN

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CNN
 — 

The US Preventive Services Task Force has released a draft recommendation to screen everyone who is pregnant for hypertensive disorders of pregnancy, by monitoring their blood pressure throughout the pregnancy, and the group is calling attention to racial inequities.

This is the first time the task force has proposed expanding these screening recommendations to include all hypertensive disorders of pregnancy, which are on the rise in the United States.

It means the average person might notice their doctor paying closer attention to their blood pressure measurements during pregnancy, as well as doctors screening not just for preeclampsia but for all disorders related to high blood pressure.

The draft recommendation statement and evidence review were posted online Tuesday for public comment. The statement is consistent with a 2017 statement that recommends screening with blood pressure measurements throughout pregnancy.

It was already recommended for blood pressure measurements to be taken during every prenatal visit, but “the difference is now really highlighting the importance of that – that this is a single approach that is very effective,” said Dr. Esa Davis, a member of the task force and associate professor of medicine at the University of Pittsburgh.

The draft recommendation urges doctors to monitor blood pressure during pregnancy as a “screening tool” for hypertensive disorders, she said, and this may reduce the risk of some hypertensive disorders among moms-to-be going undiagnosed or untreated.

“Since the process of screening and the clinical management is similar for all the hypertensive disorders of pregnancy, we’re broadening looking at screening for all of the hypertensive disorders, so gestational hypertension, preeclampsia, eclampsia,” Davis said.

The US Preventive Services Task Force, created in 1984, is a group of independent volunteer medical experts whose recommendations help guide doctors’ decisions. All recommendations are published on the task force’s website or in a peer-reviewed journal.

To make this most recent draft recommendation, the task force reviewed data on different approaches to screening for hypertensive disorders during pregnancy from studies published between January 2014 and January 2022, and it re-examined earlier research that had been reviewed for former recommendations.

“Screening using blood pressure during pregnancy at every prenatal encounter is a long-standing standard clinical practice that identifies hypertensive disorders of pregnancy; however, morbidity and mortality related to these conditions persists,” the separate Evidence-Based Practice Center, which informed the task force’s draft recommendation, wrote in the evidence review.

“Most pregnant people have their blood pressure taken at some point during pregnancy, and for many, a hypertensive disorder of pregnancy is first diagnosed at the time of delivery,” it wrote. “Diagnoses made late offer less time for evaluation and stabilization and may limit intervention options. Future implementation research is needed to improve access to regular blood pressure measurement earlier in pregnancy and possibly continuing in the weeks following delivery.”

The draft recommendation is a “B recommendation,” meaning the task force recommends that clinicians offer or provide the service, as there is either a high certainty that it’s moderately beneficial or moderate certainty that it’s highly beneficial.

For this particular recommendation, the task force concluded with moderate certainty that screening for hypertensive disorders in pregnancy, with blood pressure measurements, has a substantial net benefit.

Hypertensive disorders in pregnancy appear to be on the rise in the United States.

Data published last year by the US Centers for Disease Control and Prevention shows that, between 2017 and 2019, the prevalence of hypertensive disorders among hospital deliveries increased from 13.3% to 15.9%, affecting at least 1 in 7 deliveries in the hospital during that time period.

Among deaths during delivery in the hospital, 31.6% – about 1 in 3 – had a documented diagnosis code for hypertensive disorder during pregnancy.

Older women, Black women and American Indian and Alaska Native women were at higher risk of hypertensive disorders, according to the data. The disorders were documented in approximately 1 in 3 delivery hospitalizations among women ages 45 to 55.

The prevalence of hypertensive disorders in pregnancy was 20.9% among Black women, 16.4% among American Indian and Alaska Native women, 14.7% among White women, 12.5% among Hispanic women and 9.3% among Asian or Pacific Islander women.

The task force’s new draft recommendation could help raise awareness around those racial disparities and how Black and Native American women are at higher risk, Davis said.

“If this helps to increase awareness to make sure these high-risk groups are screened, that is something that is very, very important about this new recommendation,” she said. “It helps to get more women screened. It puts it more on the radar that they will then not just be screened but have the surveillance and the treatment that is offered based off of that screening.”

Communities of color are at the highest risk for hypertensive disorders during pregnancy, and “it’s very related to social determinants of health and access to care,” said Dr. Ilan Shapiro, chief health correspondent and medical affairs officer for the federally qualified community health center AltaMed Health Services in California. He was not involved with the task force or its draft recommendation.

Social determinants of health refer to the conditions and environments in which people live that can have a significant effect on their access to care, such as their income, housing, safety, and not living near sources for healthy food or easy transportation.

These social determinants of health, Shapiro said, “make a huge difference for the mother and baby.”

Hypertensive disorders during pregnancy can be controlled with regular monitoring during prenatal visits, he said, and the expectant mother would need access to care.

Eating healthy foods and getting regular exercise also can help get high blood pressure under control, and some blood pressure medications are considered safe to use during pregnancy, but patients should consult with their doctor.

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Alcohol and dementia: Study finds benefits in minimal drinking, but it’s complicated | CNN

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CNN
 — 

Keeping alcohol consumption to one or two drinks a day lessened the odds of developing dementia, according to a study of nearly 4 million South Koreans.

However, drinking more than two drinks a day increased that risk, according to the study published Monday in the journal JAMA Network Open.

“We found that maintaining mild to moderate alcohol consumption as well as reducing alcohol consumption from a heavy to moderate level were associated with a decreased risk of dementia,” said first author Dr. Keun Hye Jeon, an assistant professor at CHA Gumi Medical Center, CHA University in Gumi, South Korea, in an email.

But don’t rush to the liquor store, experts say.

“This study was well done and is extremely robust with 4 million subjects, but we should be cautious not to over interpret the findings,” said Alzheimer’s researcher Dr. Richard Isaacson, a preventive neurologist at the Institute for Neurodegenerative Diseases of Florida. He was not involved in the new study.

Alcohol use can be a risk factor for breast and other cancers, and consuming too much can contribute to digestive problems, heart and liver disease, hypertension, stroke, and a weak immune system over time, according to the US Centers for Disease Control and Prevention.

There are red flags for Alzheimer’s as well. For example, if a person has one or two copies of the APOE4 gene variant, which raises your risk of developing the mind-wasting disease, drinking is not a good choice, Isaacson said.

“Alcohol has been shown to be harmful for brain outcomes in people with that risk gene — and about 25% of the US population carries one copy of APOE4,” he said.

The new study examined the medical records of people covered by the Korean National Health Insurance Service (NHIS), which provides a free health exam twice a year to insured South Koreans who are 40 and older. In addition to doing various tests, examiners asked about each person’s drinking, smoking and exercise habits.

The study looked at the data collected in 2009 and 2011 and categorized people by their self-reported drinking levels. If a person said they drank less than 15 grams (approximately 0.5 ounces) of alcohol a day, they were considered “mild” drinkers.

In the United States, a standard drink contains 14 grams of alcohol, which is roughly the same as 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

If study participants told doctors they drank 15 to 29.9 grams a day — the equivalent of two standards drinks in the US — the researchers categorized them as “moderate” drinkers. And if people said they drank over 30 grams, or three or more drinks a day, researchers considered them “heavy” drinkers.

Researchers also looked at whether people sustained or changed the amount they drank between 2009 and 2011, Jeon said.

“By measuring alcohol consumption at two time points, we were able to study the relationship between reducing, ceasing, maintaining and increasing alcohol consumption and incident dementia,” he said.

The team then compared that data to medical records in 2018 — seven or eight years later — to see if anyone studied had been diagnosed with dementia.

After adjusting for age, sex, smoking, exercise level and other demographic factors, researchers found people who said they drank at a mild level over time — about a drink a day — were 21% less likely to develop dementia than people who never drank.

People who said they continued to drink at moderate level, or about two drinks a day, were 17% less likely to develop dementia, the study found.

“One has to be cautious when interpreting studies using medical records. They can be fraught with challenges in how diseases are coded and studied,” Isaacson said. “Any anytime you ask people to recall their behaviors, such as drinking, it leaves room for memory errors.”

The positive pattern did not continue as drinking increased. People who drank heavily — three or more drinks a day — were 8% more likely to be diagnosed with dementia, the study found.

If heavy drinkers reduced their drinking over time to a moderate level, their risk of being diagnosed with Alzheimer’s fell by 12%, and the risk of all-cause dementia fell by 8%.

However, people aren’t very good at judging how much alcohol they are drinking, Isaacson said.

“People don’t really monitor their pours of wine, for example,” Isaacson said. “They may think they are drinking a standard-sized glass of wine, but it’s really a glass and a half every time. Drink two of those pours and they’ve had three glasses of wine. That’s no longer mild or moderate consumption.”

In addition, too many people who think they are moderate drinkers do all of their drinking on weekends. Binge drinking is on the rise worldwide, even among adults, studies show.

“If someone downs five drinks on Saturday and Sunday that’s 10 drinks a week so that would qualify as a moderate alcohol intake,” Isaacson said. “To me, that is not that is not the same as having a glass of wine five days a week with a meal, which slows consumption.”

The new study also found that starting to drink at a mild level was associated with a decreased risk of all-cause dementia and Alzheimer’s, “which, to our knowledge, has never been reported in previous studies,” the authors wrote.

However, “none of the existing health guidelines recommends starting alcohol drinking,” Jeon said, adding that since the study was observational, no cause and effect can be determined.

“Our findings regarding a initiation of mild alcohol consumption cannot be directly translated into clinical recommendations, thereby warranting additional studies to confirm these associations further,” Jeon said.

A study published in March 2022 found that just one pint of beer or glass of wine a day can shrink the overall volume of the brain, with the damage increasing as the number of daily drinks rises.

On average, people between 40 and 69 who drank a pint of beer or 6-ounce glass of wine per day for a month had brains that appeared two years older than those who only drank half of a beer, according to that previous study.

“I’ve never personally suggested someone to start drinking moderate amounts of alcohol if they were abstinent,” Isaacson said. “But there’s really not a one-size-fits-all approach towards counseling a patient on alcohol consumption.”

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Children’s mental health tops list of parent worries, survey finds | CNN

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CNN
 — 

Forty percent of US parents are “extremely” or “very” worried that their children will struggle with anxiety or depression at some point, a new survey finds.

The Pew Research Center report said mental health was the greatest concern among parents, followed by bullying, which worries 35% of parents. These concerns trumped fears of kidnapping, dangers of drugs and alcohol, teen pregnancy and getting into trouble with the police.

Concerns varied by race, ethnicity and income level, with roughly 4 in 10 Latino and low-income parents and 3 in 10 Black parents saying they are extremely or very worried that their children could be shot, compared with about 1 in 10 high-income or White parents.

Nearly two-thirds of the respondents said that being a parent has been at least somewhat harder than they expected, about 41% say that being a parent is tiring, and 29% say it is stressful all or most of the time.

The report captured the perceptions of a nationally representative sample of 3,757 US parents whose children were younger than 18 in 2022.

Experts say mental health issues among children and adolescents have skyrocketed in recent years.

“I would say over the last 10 years, since I’ve been practicing as a general pediatrician, I have seen a shift both in the amount of patients and of all ages dealing with anxiety and depression. And their parents being concerned about this is a key issue,” said Dr. Katherine Williamson, a pediatrician and spokesperson for the American Academy of Pediatrics. “Even before the pandemic, we were seeing skyrocketing numbers of kids and adolescents dealing with mental health issues, and that has increased exponentially since the pandemic.”

Suicide became the second leading cause of death among children 10 to 14 during the Covid-19 pandemic, according to the US Centers for Disease Control and Prevention. Mental health-related emergency room visits among adolescents 5 to 11 and 12 to 17 also jumped 24% and 31%, respectively.

Many parents feel helpless when their children have mental health issues because they don’t feel equipped to offer support in this area.

“They are unable to relieve [mental health issues] and address that as they could if they were struggling with their grades or other things that seem more traditional to for kids to struggle with,” said Allen Sabey, a family therapist at the Family Institute at Northwestern University.

Parents trying to “work out and look at and connect with their own feelings will give them important information about what feels off or OK for their kid,” he said.

When it comes to anxiety and depression in children, pediatricians say, parents can watch for signs like decreased interest or pleasure in things they previously enjoyed, poor self-esteem and changes in mood, appetite or sleep.

Experts also say parents should consider the amount and content of social media their child consumes, as research has found that it can have negative effects on their mental health.

But, they say, having more parents recognize the importance of mental health in children is a step in the right direction.

“I have always felt there’s been so much resistance to seeking care for mental health among the population that I serve. And I am actually happy that since the Covid pandemic, at least people now are recognizing this as a very key and important health need,” said Dr. Maggi Smeal, a pediatrician at Stanford Medicine Children’s Health.

Smeal hopes that “all people that are interacting with children can be aware of these issues and feel empowered to identify and advocate for these children, to tell them to go to their primary care provider and have an assessment just like you do if your kid has a cough or a fever or ear infection.”

The number of parents concerned about gun violence reflects the fact that guns are the leading cause of death among children in the US, research has showed. From 2019 to 2020, the rate of firearm-related deaths increased 29.5% – more than twice the increase as in the general population.

“Gun violence is a real risk to our kids today. And that is both being killed by somebody else as well as suicide in the face of the mental health issues that we’re seeing today,” Williamson said.

The survey found that Black, Hispanic and lower-income parents were most likely to be concerned about gun violence, a finding that’s consistent with the communities most affected. Research has shown that from 2018 to 2021, the rate of firearm-related deaths doubled among Black youth and increased 50% among Hispanic youth. Another study found that children living in low-income areas are at higher risk of firearm-related death.

Direct and indirect exposure to gun violence can contribute to mental health problems.

“Even if they hear gunshots in their community, they hear adults talking, there’s all different ways that children are traumatized and victimized by gun violence. And what we see is all the symptoms of anxiety in even the youngest of children. We see children with somatic complaints – stomachaches, headaches. They have post-traumatic stress disorder,” Smeal said.

Most of the parents in the survey said parenting is harder than they expected, and that they feel judgment from various sources.

“The findings of this of this report were, as a pediatrician and a parent, just exactly what you would expect. Parenting is the hardest thing you’ll ever do, and there are very high levels of stress and fatigue, especially in the parents of young children,” Smeal said.

One of the best things parents can do is lean on fellow parents, experts say.

“The main challenge for parents is our siloed independent nature sometimes, and so we want to find people who we trust and kind of work towards being more vulnerable and open with,” Sabey said. “To where it’s like not just you and your kid, but it’s a kind of a group of people caring and working together.”

Pediatricians emphasize that no parent is perfect and that the most important thing you can do is to just be there for your child.

“We know that the best chance for a child to be successful and happy is for them to have at least one person in their life who believes in them and advocates for them. So I think it’s important for parents to know that there’s no such thing as a perfect parent, because we are all human, and humans are imperfect by nature, but that is OK,” Williamson said.

A parent’s job is to “really make sure that they know how important they are and they have a voice in this world,” she said. “Every child will have their own unique struggles, whether it is academically, emotionally, physically. Our job is to help them with the areas [where] they struggle, but even more, help them recognize their strengths.”

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FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States | CNN

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CNN
 — 

A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

Others feel that convenience is important but also stressed that data supported the switch.

“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

Another puzzle will be how to pick the strains that are in the vaccines.

The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

The FDA confirmed that the agency is taking a closer look.

“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

The FDA did not give a time frame for when these studies might have results.

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Pediatricians are giving out free gun locks to approach the gun violence epidemic as a public health crisis | CNN

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CNN
 — 

In a triage waiting room of St. Louis Children’s Hospital in Missouri, a clear basket filled with gun locks sits near the walkway, just noticeable enough to those passing by.

The hospital staff calls it the “No Questions Asked” basket, to encourage gun safety without having to confront gun owners about what can be a sensitive and divisive topic. It holds an assortment of cable gun locks free of charge, available to those who need them, alongside pamphlets explaining how to properly and safely store firearms.

The initiative, aimed at reducing the stigma of addressing gun safety, is part of a growing effort by medical professionals who are treating the country’s gun violence epidemic as a public health crisis.

“It takes standing at the bedside of one child who has been shot to realize that we all have to do more and as the leading cause of death for children in this country, pediatricians need to be front and center of the solution, of all the solutions,” said Dr. Annie Andrews, a professor of pediatrics at the Medical University of South Carolina and an expert on gun violence prevention.

Over the course of two years, thousands of gun locks have been taken from the basket, according to Dr. Lindsay Clukies, a pediatric emergency medicine physician at the hospital.

In the coming weeks, baskets filled with free gun locks will be available at more than 17 locations operated by BJC HealthCare, an organization serving metro St. Louis, mid-Missouri and Southern Illinois, Clukies said. It’s a low-cost and effective way to easily distribute firearm safety devices.

“We’ve had employees as well as patients take our locks, also their families and even a grandmother who took one for her grandson. It’s for anyone who needs them,” Clukies told CNN. In recent years, a rising number of pediatricians across the country have been engaging with the topic of gun safety in medical settings by focusing on safety and prevention, already a natural aspect of their work.

During patient visits, it’s increasingly common for pediatricians to ask the patient’s parents if there are guns at home, and if so, how they are stored. Some hospitals then offer free gun locks, often sourced from donations or police departments and paired with safe storage education.

Some pediatricians, who bear witness to the effects of gun violence on children in their workplace every day, told CNN they see it as their obligation as medical professionals to be part of the solution to the epidemic.

In 2022, 1,672 children and teenagers under 17 were killed by gun violence and 4,476 were injured, according to the Gun Violence Archive, a nonprofit organization tracking injuries and deaths by gunfire since 2014.

“We have just as an important voice in this conversation as anyone else because we’re the ones who have invested our entire careers to protecting children and ensuring that children can grow up to be the safest healthiest version of themselves,” said Andrews.

“It is only natural that we see these things that we understand that they’re preventable, and we want to get involved in finding the solutions,” she added.

So far in 2023, high-profile incidents of children accessing firearms have heeded calls for stronger, more consistent laws nationwide, requiring adults to safely secure their guns out of the reach of children and others unauthorized to use them. They have also highlighted a lack of public education on the responsibility of gun owners to store their guns unloaded, locked and away from ammunition, CNN previously reported.

In early January, a 6-year-old boy was taken into police custody after he took a gun purchased by his mother from his home, brought it to school and shot his teacher at Richneck Elementary School in Newport News, Virginia, police said. Just over a week later, a man was arrested in Beech Grove, Indiana, after video was shown on live TV of a toddler, reportedly the man’s son, waving and pulling the trigger of a handgun, CNN previously reported.

Hundreds of children in the US every year gain access to firearms and unintentionally shoot themselves or someone else, according to research by Everytown for Gun Safety, a leading non-profit organization focusing on gun violence prevention. In 2022, there were 301 unintentional shootings by children, resulting in 133 deaths and 180 injuries nationally, Everytown data showed.

Firearm injuries are now the leading cause of death among people younger than 24 in the United States, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics released an updated policy statement in October 2022, stating firearms are now the leading cause of death in children under the age of 24 in the US.

The Academy’s statement urged a “multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth.”

The Academy has free educational modules for pediatricians to guide them on how to have what can be challenging or uncomfortable conversations about firearms with families, according to Dr. Lois Kaye Lee, a pediatrician and the chair of the Academy’s Council on Injury, Violence and Poison Prevention.

“This shouldn’t be considered as something extra; it should be considered as part of the work that we do every day around injury prevention, be it around firearms, child passenger safety and suicide prevention,” Lee said.

Dr. Georges Benjamin, executive director of the American Public Health Association, told CNN the public health approach to addressing gun violence removes the politics from the issue and “puts it into a scientific evidence-based framework.”

“Physicians have a unique opportunity to engage their patients, the parents of kids or the parents themselves as individuals to make their homes safer,” Benjamin said. “We already do this for toxins under our kitchen cabinets, razor blades and outlets in the wall.”

In the emergency department at St. Louis Children’s Hospital, all patients are screened for access to firearms and offered free gun locks, as well as safe storage education, Clukies said. Gun locks can also be mailed to families, free of cost, through the hospital’s website.

“Every patient that comes into our emergency department, whether it’s for a fever or a cold or a broken arm, is asked about access to firearms,” said Clukies, adding 5,000 locks have been given out since the initiatives were started in 2021.

In a collaborative effort between trauma nurses, physicians, social workers, violence intervention experts and family partners, the hospital created a “nonjudgmental” script for doctors to follow as they ask patients about access to firearms, Clukies said.

During the screening process, pediatricians will ask parents or caretakers questions such as: Do you have access to a firearm where your child lives or plays? How is it stored? Is it stored unloaded or loaded?

“When I first started doing this, I would say, ‘Are there any guns in the home? Yes, or no?’ But I have found and learned from other experts that if you just say, ‘If there are any guns in the home, do you mind telling me how they’re secured?’ it takes away the judgment,” said Andrews, a pediatrician whose hospital, the Medical University of South Carolina, also offers free gun locks to patients.

An assortment of cable gun locks offered free of charge by the Medical University of South Carolina.

Families are asked about firearms in the “social history” phase of a patient visit, during which pediatricians will ask who lives in the home, what grade the child is in, what activities they engage in and where the child goes to school, according to Andrews. When parents indicate their firearms are not safely stored, like on the top of a shelf or in a nightstand drawer, Andrews said those are important opportunities for intervention and education about storage devices such as keypad lockboxes, fingerprint biometric safes and other types of lock systems.

It’s also important for pediatricians to understand the parents’ or caretakers’ motivation for owning a firearm to “inform the conversation about where they’re willing to meet you as far as storage goes,” she added.

Andrews and Clukies said they were pleasantly surprised by the willingness of families to discuss firearm safety, most of whom recognize it is an effort to protect their children.

“I expected more pushback than we received, which is attributed to us really focusing on how we properly word these questions,” Clukies said. “I think it’s because we turn it into a neutral conversation, and we focus on safety and prevention.”

Andrews added it is uncommon for medical schools or residencies to discuss gun violence prevention, which she says is due to the “politics around the issue.”

“Thankfully, that has evolved, and more and more pediatricians are realizing that we have to be an integral part of the solution to this problem,” Andrews said.

At the St. Louis Children’s Hospital, pediatricians followed up with patients who received a free gun lock in a research study roughly two months after they launched the initiative in the fall of 2021 to see if their storage practices changed.

The study found two-thirds of families reported using the gun lock provided to them by the hospital and there was a “statistically significant decrease” in those who didn’t store their firearms safely, as well as an increase in those who stored their firearms unloaded, according to Clukies.

But there is still much more work to be done in the medical community to fight the gun violence epidemic and scientific research on the issue is “woefully underfunded,” Andrews contended.

According to the American Public Health Association’s Benjamin, a multidisciplinary approach by policymakers, law enforcement and the medical community is essential to fostering a safer environment for children.

“Injury prevention is a core part of every physician’s job,” Benjamin said. “It’s clearly in our lane.”

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Decreasing rates of childhood immunization are a major concern. Our medical analyst explains why | CNN

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CNN
 — 

Vaccine rates for measles, polio, diphtheria and other diseases are decreasing among US children, according to a new study from the US Centers for Disease Control and Prevention.

The rate of immunizations for required vaccines among kindergarten students declined from 95% to approximately 94% during the 2020-21 school year. It dropped further — to 93% — in the 2021-22 school year.

That’s still a high number, so why is this drop in immunization significant? What accounts for the decline? What might be the consequences if these numbers drop further? If parents are unsure about vaccinating their kids, what should they do? And what can be done on a policy level to increase immunization numbers?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Why is it a problem that childhood immunization rates are declining?

Dr. Leana Wen: The reduction of vaccine-preventable diseases is one of the greatest public health success stories in the last 100 years.

The polio vaccine was introduced in the United States in 1955, for example. In the four years prior, there were an average of over 16,000 cases of paralytic polio and nearly 2,000 deaths from polio each year across the US. Widespread use of the polio vaccine had led to the eradication of polio in the country by 1979, according to the CDC, sparing thousands of deaths and lifelong disability among children each year.

The measles vaccine was licensed in the US in 1963. In the four years before that, there were an average of over 500,000 cases and over 430 measles-associated deaths each year. By 1998, there were just 89 cases recorded — and no measles-associated deaths.

These vaccines are very safe and extremely effective. The polio vaccine, for example, is over 99% effective at preventing paralytic polio. The measles vaccine is 97% effective at preventing infection.

We can do this same analysis for other diseases for which there are routine childhood immunizations.

It’s very concerning that rates of immunization are declining for vaccines that have long been used to prevent disease and reduce death. That means more children are at risk for severe illness — illness that could be averted if they were immunized. Moreover, if the proportion of unvaccinated individuals increases in a community, this also puts others at risk. That includes babies too young to be vaccinated or people for whom the vaccines don’t protect as well — for example, patients on chemotherapy for cancer.

CNN: What accounts for the decline in vaccination numbers?

Wen: There are probably many factors. First, there has been substantial disruption to the US health care system during the Covid-19 pandemic. Many children missed routine visits to the pediatrician during which they would have received vaccines due to pandemic restrictions. In addition, some community health services offered also became disrupted as local health departments focused on Covid-19 services.

Second, disruption to schooling has also played a role. Vaccination requirements are often checked prior to the start of the school year. When schools stopped in-person instruction, that led to some families falling behind on their immunizations.

Third, misinformation and disinformation around Covid-19 vaccines may have seeded doubt in other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the coronavirus emerged, but the pandemic has exacerbated the issues.

According to a December survey published by the Kaiser Family Foundation, more than one in three American parents said vaccinating children against measles, mumps, and rubella shouldn’t be a requirement for them to attend public schools, even if that may create health risks for others. This was a substantial increase from 2019, when a similar poll from the Pew Research Center found only 23% of parents opposed school vaccine requirements.

CNN: What are some consequences if immunization rates drop further?

Wen: If immunization rates drop further, we could see more widespread outbreaks. Diseases that were virtually eliminated in the US could reemerge, and more people can become severely ill and suffer lasting consequences or even die.

We are already seeing some consequences: Last summer, there was a confirmed case of paralytic polio in an unvaccinated adult in New York. It’s devastating that a disease like polio has been identified again in the US, since we have an extremely effective vaccine to prevent it.

There is an active measles outbreak in Ohio. As of January 17, 85 cases have been reported. Most of the cases involved unvaccinated children, and at least 34 have been hospitalized.

CNN: If parents are unsure of vaccinating their kids, what should they do?

Wen: As parents, we generally trust pediatricians with our children’s health. We consult pediatricians if our kids are diagnosed with asthma and diabetes, or if they have new worrisome symptoms of another illness. We should also consult our pediatricians about childhood immunizations; parents and caregivers with specific questions or concerns should address them.

The national association of pediatricians, the American Academy of Pediatrics, “strongly recommends on-time routine immunization of all children and adolescents according to the Recommended Immunization Schedules for Children and Adolescents.”

CNN: What can be done to increase immunization numbers?

Wen: There needs to be a concerted educational campaign to address why vaccination against measles, mumps, rubella, chickenpox, polio and so forth is so crucial. One of the reasons for vaccine hesitancy, in my experience, is that these diseases have been rarely seen in recent years. Many people who are parents now didn’t experience the devastation of these diseases growing up, so may not realize how terrible it would be for them to return.

Specific interventions should be targeted at the community level. In some places, low immunization levels may be due to access. Vaccination drives at schools, parks, shopping centers, and other places where families gather can help increase numbers. In other places, the low uptake may be because of vaccine hesitancy and misinformation. There will need to be different strategies implemented in that situation.

Overall, increasing immunization rates for vaccine-preventable childhood diseases needs to be a national imperative. I can’t underscore how tragic it would be for kids to suffer the harms of diseases that could be entirely prevented with safe, effective and readily available vaccines that have been routinely given for decades.

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1 in 10 Americans over 65 have dementia, study finds | CNN

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CNN
 — 

One in 10 Americans over 65 had dementia, while 22% experienced mild cognitive impairment, the earliest stage of the slow slide into senility, according to a new study conducted between 2016 and 2017.

The research, which the authors said is the first nationally representative examination of cognitive impairment prevalence in more than 20 years, was able to measure prevalence of dementia and mild cognitive impairment by age, education, ethnicity, gender and race.

The results showed older adults who self-identified as Black or African American were more likely to have dementia, while those who identify as Hispanic were more likely to suffer from mild cognitive impairment. People who had less than a high school education were more likely to have both conditions.

“Dementia research in general has largely focused on college-educated people who are racialized as white,” lead study author Jennifer Manly said in a statement.

“This study is representative of the population of older adults and includes groups that have been historically excluded from dementia research but are at higher risk of developing cognitive impairment because of structural racism and income inequality,” said Manly, professor of neuropsychology at the Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University.

“If we’re interested in increasing brain health equity in later life, we need to know where we stand now and where to direct our resources,” Manly said.

The study, published Monday in the journal JAMA Neurology, analyzed data from in-depth neuropsychological tests and interviews with nearly 3,500 people over age 65 enrolled in the Health and Retirement Study, a long-term research project sponsored by the National Institute on Aging and the Social Security Administration.

The research was based on a randomly selected sample of people from the study that completed the core survey and underwent neurological testing between June 2016 and October 2017.

Fifteen percent of people who identified as Black tested positive for dementia, while 22% had mild cognitive decline, the study found. Ten percent of people who identified as Hispanic had dementia, but the rate of milder issues was higher — 28% tested positive for mild cognitive impairment. Nine percent of White people had dementia, while 21% had mild cognitive impairment.

Educational achievement, which experts consider to be protective against cognitive decline, showed a significant divide: Nine percent of people with a college degree tested positive for dementia, compared with 13% of those who never received a high school diploma. Twenty-one percent of people over 65 with college degrees had mild cognitive decline, compared with 30% of those with less than a high school degree.

The extreme elderly had the highest rates of dementia and mild cognitive impairment. Only 3% of adults between 65 and 69 tested positive for dementia, compared with 35% of those 90 and older.

In fact, every five-year increase in age was associated with higher risk of dementia and mild cognitive impairment, the report said. The study, however, found no differences between men and women in rates of either condition

Symptoms of mild cognitive impairment can include losing items, forgetting to do things or go to appointments, or struggling to come up with words. A loss of smell and taste and movement issues can also be symptoms, according to the National Institute on Aging.

People with mild cognitive impairment are fully capable of taking care of themselves, “but what they have to go through to do so is exhausting,” Laura Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, told CNN in an earlier interview. She was not involved in the current study.

People with mild cognitive impairment may not remember where they are supposed to be, Baker said. ” ‘Let me check my calendar. Oh, I forgot to write on this calendar. Let’s check another calendar. Oh, I can’t find that calendar. I’ve lost my phone. Where is the key? I can’t find the key.’ They’re able to regroup in the early stages and accomplish things, but the toll is immense.”

Not everyone with mild cognitive impairment goes on to develop dementia, although many do, experts say. Lifestyle changes may be a key to reversing mental decline. A 2019 study found personalized lifestyle interventions -— such as diet, exercise, stress reduction and sleep hygiene — not only stopped cognitive decline in people at risk for Alzheimer’s, but actually increased their memory and thinking skills over 18 months. Women responded better than men, a follow-up study found.

A February study found about a third of women 75 years or older with mild cognitive impairment reversed their progression to dementia at some point during follow-up. All of the women, however, had high levels of education and academic performance and excellent written language skills, or what experts call “cognitive reserve.”

Signs of dementia can differ from one person to the next, and can include memory loss and confusion, difficulty speaking, understanding and expressing thoughts, or reading and writing, according to the National Institutes of Health.

People with dementia can act impulsively or show poor judgment, and they can have trouble paying bills or handling money responsibly. They may repeat questions, use strange words to refer to familiar objects and take longer than usual to complete daily tasks.

Wandering and getting lost in a familiar neighborhood is another sign of dementia, as is losing interest in daily activities or events or acting as if they don’t care about other people’s feelings. They may lose their balance or have other problems with movement. At times, people with dementia can hallucinate or experience delusions or paranoia.

Alzheimer’s disease is the most well-known cause of dementia, but cognitive issues can be caused by vascular problems that block the flow of blood to the brain or via ministrokes caused by tiny blood clots traveling to the brain. Frontal lobe dementia, a rare form thought to be associated with abnormal amounts of the proteins tau and TDP-43, often begins in people younger than 60. Another type of decline, called Lewy body dementia, is thought to be caused by abnormal deposits of the protein alpha-synuclein, which are called Lewy bodies.

A person with signs of cognitive decline or dementia needs a full workup by a neurologist to determine the underlying cause, the NIH said. Side effects from a number of medications can mimic dementia, as can certain diseases, such as Huntington’s disease.

If you’ve just been diagnosed with dementia, continue to meet with doctors and specialists and consider asking for a referral to a memory clinic, according to the National Institutes of Health. Reach out to your local Alzheimer’s Disease Research Center and consider joining a clinical trial.

The Alzheimer’s Association has detailed information on the differences between dementia and Alzheimer’s, and it offers many levels of support for both patients and caregivers.

Work on staying healthy — exercise helps with mood, balance and thinking, while eating a well-balanced diet and getting quality sleep can improve the brain’s ability to function.



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