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High frequency of discrimination and microaggressions in health care settings were reported by Black patients with serious illness. HealthDay News — Epistemic injustice is the most common manifestation of racism experienced by Black patients with serious illness and is associated with worsened mistrust and negative patient-clinician communication outcomes, according to a study published online July 5 in JAMA Network Open. Crystal E. Brown, M.D., from the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle, and colleagues examined whether experiences with racism are associated with patient-clinician communication and decision-making among Black patients with serious illness. The analysis included data from semistructured interviews conducted with 25 Black patients with serious illness hospitalized at an urban academic medical center between January 2021 and February 2023. Researchers found that the participants had substantial socioeconomic disadvantage and reported high levels of medical mistrust and high frequency of discrimination and microaggressions experienced in health care settings. The most common manifestation of racism participants reported was epistemic injustice, including silencing of their own knowledge and lived experiences about their bodies and illness by health care workers. These experiences made participants feel isolated and devalued, especially if they had intersecting, marginalized identities, such as being underinsured or unhoused. These experiences exacerbated existing medical mistrust and poor patient-clinician communication. “These findings suggest that race-conscious, intersectional approaches may be needed to improve patient-clinician communication and support Black patients with serious illness to alleviate the distress and trauma of racism as these patients near the end of life,” the authors write. Full Article

Children exposed to physical assault were twice as likely to be diagnosed with mental illness in the years following the assault than those who weren't exposed, a new population-based study shows. The greatest risk was found in the first year following the assault, increasing to three times the risk of being diagnosed with mental illness compared with children not assaulted. Mood and anxiety disorders were the most common diagnoses. "From a clinical and policy perspective, our study highlights that there is a critical opportunity for healthcare clinicians to support children in the first year following physical assault," report Natasha Saunders, MD, MSc, of the Hospital for Sick Children in Toronto, Canada, and colleagues. "There is a need to develop and implement targeted mental illness prevention, screening, and treatment programs for assaulted children." The findings were published online August 16 in JAMA Network Open. While it has been well-established that children exposed to assault have an increased risk for subsequent mental illness, Saunders and her co-investigators noted that using an age-matched, population-based cohort study would enable them to obtain detailed information on the patterns and timing of subsequent psychiatric diagnoses. To that end, the researchers used several medical databases in Ontario to find 5487 children (infants to age 13 years) who required an emergency room visit or hospitalization for a physical assault in Ontario between 2006 and 2014. These children were matched on a 1:4 basis with 21,948 children not exposed to physical assault. The children were followed until their 18th birthday or until the study ended in March 2019. The researchers found that more than a third of the children (39%) who were exposed to assault received a mental health diagnosis, according to health records, compared with 23% of unexposed children. Mood and anxiety disorders were the most common diagnoses among children exposed to assault (16.2% vs 10.6%, respectively); followed by select childhood behavior disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder (9.9% vs 5.2%); and substance use disorders (2.4% vs 0.4%). Triple Risk of Mental Illness in First Year The researchers found that the children exposed to assault were nearly twice as likely to be diagnosed with a mental illness over a median follow-up of 7 years compared with those not exposed to assault (adjusted hazard ratio [aHR], 1.96; 95% CI, 1.85 - 2.08). In the year following the assault, children exposed to assault bore three times the risk of being diagnosed with a mental illness compared with unexposed children (aHR, 3.08; 95% CI, 2.68 - 3.54). In addition, the children who had been assaulted were more likely to be diagnosed in an acute care setting than those who were not assaulted (14% vs 2.8%). The children who had been assaulted were an average age of 7 years and were more often boys (55% vs 45%). Children who were assaulted were also more likely to have mothers with mental illness (35% vs 19%). The investigators noted that the study likely underestimated the number of children exposed to assault, as many do not end up in the ER. In addition to highlighting the need for medical personnel to support children in the first year following assault, the investigators noted that "our results also advocate for accessible mental health care outside of the acute setting and for care that addresses the social and health needs of mothers, who themselves have high social and health risks." This study received funding from the National Foundation to End Child Abuse and Neglect and the Ontario Ministry of Health and the Ministry of Long-Term Care. Saunders reported receiving personal fees from The BMJ Group, Archives of Diseases in Childhood outside the submitted work. Full Article

Superagers Even at an advanced age, superagers have the memory of someone 20 or 30 years their junior. But why is that? A new study shows that in superagers, age-related atrophy of the gray matter, especially in the areas responsible for memory, develops much more slowly than in normal older adults. However, the study also emphasizes the importance of physical and mental fitness for a healthy aging process. "One of the most important unanswered questions with regard to superagers is, 'Are they resistant to age-related memory loss, or do they have coping mechanisms that allow them to better offset this memory loss?' " wrote Marta Garo-Pascual, a PhD candidate at the Autonomous University of Madrid, Spain, and colleagues in the Lancet Healthy Longevity. "Our results indicate that superagers are resistant to these processes." Six Years' Monitoring From a cohort of older adults who had participated in a study aiming to identify early indicators of Alzheimer’s disease, the research group chose 64 superagers and 55 normal senior citizens. The latter served as the control group. While the superagers performed just as well in a memory test as people 30 years their junior, the control group’s performance was in line with their age and level of education. All the study participants were over age 79 years. Both the group of superagers and the control group included more females than males. On average, they were monitored for 6 years. During this period, a checkup was scheduled annually with an MRI examination, clinical tests, blood tests, and documentation of lifestyle factors. For Alessandro Cellerino, PhD, of the Leibniz Institute on Aging–Fritz Lipmann Institute in Jena, Germany, this is the most crucial aspect of the study. "Even before this study, we knew that superagers demonstrated less atrophy in certain areas of the brain, but this was always only ever based on a single measurement." Memory Centers Protected The MRI examinations confirmed that in superagers, gray matter atrophy in the regions responsible for memory (such as the medial temporal lobe and cholinergic forebrain), as well in regions important for movement (such as the motor thalamus), was less pronounced. In addition, the volume of gray matter in these regions, especially in the medial temporal lobe, decreased much more slowly in the superagers than in the control subjects over the study period. Garo-Pascual and her team used a machine-learning algorithm to differentiate between superagers and normal older adults. From the 89 demographic, lifestyle, and clinical factors entered into the algorithm, two were the most important for the classification: the ability to move and mental health. Mobility and Mental Health Clinical tests such as the Timed Up-and-Go Test and the Finger Tapping Test revealed that superagers can be distinguished from the normally aging control subjects with regard to their mobility and fine motor skills. Their physical condition was better, although they, by their own admission, did not move any more than the control subjects in day-to-day life. According to Cellerino, this finding confirms that physical activity is paramount for cognitive function. "These people were over 80 years old — the fact that there was not much difference between their levels of activity is not surprising. Much more relevant is the question of how you get there — i.e., how active you are at the ages of 40, 50 or even 60 years old," he stressed. Remaining Active Is Important As a matter of fact, the superagers indicated that generally they had been more active than the control subjects during their middle years. "Attempting to stay physically fit is essential; even if it just means going for a walk or taking the stairs," said Cellerino. On average, the superagers also fared much better in tests on physical health than the control subjects. They suffered significantly less from depression or anxiety disorders. "Earlier studies suggest that depression and anxiety disorders may influence performance in memory tests across all ages and that they are risk factors for developing dementia," said Cellerino. To avoid mental health issues in later life, gerontologist Cellerino recommended remaining socially engaged and involved. "Depression and anxiety are commonly also a consequence of social isolation," he underlined. Potential Genetic Differences Blood sample analyses demonstrated that the superagers exhibited lower concentrations of biomarkers for neurodegenerative diseases than the control group did. In contrast, there was no difference between the two groups in the prevalence of the APOE e4 allele, one of the most important genetic risk factors for Alzheimer’s disease. Nevertheless, Garo-Pascual and her team of researchers assume that genetics also play a role. They found that, despite 89 variables employed, the algorithm used could only distinguish superagers from normal older adults 66% of the time. This suggests that additional factors must be in play, such as genetic differences. Body and Mind Since this is an observational study, whether the determined factors have a direct effect on super-aging cannot be ascertained, the authors wrote. However, the results are consistent with earlier findings. "Regarding the management of old age, we actually haven’t learned anything more than what we already knew. But it does confirm that physical and mental function are closely entwined and that we must maintain both to age healthily," Cellerino concluded.

Improvement was seen in measures of sleepiness and cataplexy over 8 weeks vs placebo, but the drug was associated with hepatotoxic effects. HealthDay News — For patients with narcolepsy type 1, an orexin receptor 2 agonist, TAK-994, improves measures of sleepiness and cataplexy over 8 weeks compared with placebo but is associated with hepatotoxic adverse events, according to a study published in the July 27 issue of the New England Journal of Medicine. Yves Dauvilliers, M.D., from Gui de Chauliac Hospital and the University of Montpellier in France, and colleagues conducted a phase 2 randomized, placebo-controlled trial of TAK-994 in patients with narcolepsy type 1. Seventy-three patients were randomly assigned to receive twice-daily oral TAK-994 (30 mg [17 patients], 90 mg [20 patients], and 180 mg [19 patients]) or placebo (17 patients). Owing to hepatotoxic adverse events, the phase 2 trial and extension trial were terminated early. Primary end point data were available for 41 patients. Researchers found that the least-squares mean changes to week 8 in average sleep latency on the Maintenance of Wakefulness Test were 23.9, 27.4, 32.6, and −2.5 minutes in the 30-, 90-, and 180-mg groups and placebo group, respectively. The corresponding least-squares mean changes to week 8 in the Epworth Sleepiness Scale were −12.2, −13.5, −15.1, and −2.1, respectively. The corresponding weekly incidences of cataplexy at week 8 were 0.27, 1.14, 0.88, and 5.83 (rate ratios vs placebo, 0.05, 0.20, and 0.015, respectively). “The outcomes described in the current report may be seen as a backward step because of the decision to terminate the trial,” write the authors of an accompanying editorial. “However, the impressive efficacy is a major step forward in helping patients with narcolepsy type 1.” The study was funded by Takeda Development Center Americas

Psychedelics PARIS — "We need to develop new therapies to treat addiction because of the related cost to society, which is extremely high," said Bruno Roméo, MD, psychiatrist and addiction specialist at the Paul Brousse Hospital in Villejuif, France, at the Paris-based Neuroscience, Psychiatry and Neurology Conference. Roméo spoke about the current place of psychedelics in the treatment of addiction. "Smoking and alcohol consumption are the two main preventable causes of death in France," he said. "Current management strategies for these addictions rarely involve pharmacological therapies, which are not very effective, in any case. We have massive relapse rates, signaling the need to develop other treatments, like psychedelic drugs." But what data are available on the efficacy of psychedelics in treating addiction? Alcohol Use Disorder There are few data concerning the role of psychedelics in the treatment of alcohol use disorder, but one controlled, randomized trial evaluated the efficacy of psilocybin. That trial was published in JAMA Psychiatry in 2022. That study included 95 patients with alcohol use disorder; 49 were treated with psilocybin, and 46 were treated with diphenhydramine. An initial medication session of psilocybin was given in week 4, then another in week 8 at a higher dose. The number of drinking days, the number of heavy drinking days, and the number of drinks consumed between weeks 32 and 36 were assessed. The investigators showed that after two sessions with psilocybin, there was a significant reduction in the number of heavy drinking days. In the control group, between weeks 5 and 36, 20% of days involved heavy drinking, whereas in the psilocybin group, 10% of days involved heavy drinking. There was also a significant and rapid reduction in the number of drinking days, and this was maintained over time. Between weeks 5 and 36, just over 40% of days were reported as drinking days in the control group, vs slightly more than 30% in the psilocybin group. Similarly, the number of glasses per day was drastically reduced after taking psilocybin, and the effect occurred extremely quickly. Consumption went from six drinks to less than one drink between weeks 5 and 8. Overall, between weeks 5 and 36, the number of drinks consumed per day was more than two in the placebo group and more than one in the psilocybin group. "Psilocybin was seen as having potential efficacy in treating alcohol use disorder. But we must tread carefully with these results; the profile of the patients enrolled in this study is different to that of the patients we regularly see in our addiction clinics. The patients enrolled in the study reported less than 60% of days as heavy drinking days," said Romeo. Candidates for Psilocybin According to a retrospective survey of 160 respondents that was conducted online at the Paul Brousse Hospital, patients with the most severe cases of alcohol use disorder who have the most mystical psychedelic experiences seem to respond best to psilocybin and to reduce their alcohol use. It also appears that patients whose alcohol use decreased the most had lower psychological flexibility on enrollment in the study. (Psychological flexibility is the ability to adapt to change and to cope with positive and negative experiences in real time without being fazed or trying to flee from the situation.) "It's as if they had a broader capacity for change, and psychedelics helped them more," said Roméo. Smoking Cessation "There are even fewer studies for smoking," said Roméo. In a pilot study with 15 patients, the researchers gave two or three doses of psilocybin at 20 mg to 30 mg in combination with cognitive-behavioral therapy one session per week for 10 weeks. Thereafter, patients were assessed three times: after 6 months, 12 months, and 30 months. The results showed a significant reduction in smoking. Patients went from smoking more than 15 cigarettes per day to smoking one to two cigarettes per day before going back up to six cigarettes daily. Regarding abstinence rates, 12 of 15 patients had stopped smoking after 6 months, eight of 15 after 1 year, and seven of 15 after 30 months. "This study produced some interesting results, although caution must obviously be taken due to the very low number of patients enrolled," said Roméo. As is the case for alcohol, a retrospective survey conducted via questionnaire at the Paul Brousse Hospital showed that the patients who smoked the most and who had the most mystical psychedelic experiences seemed to respond best to psilocybin and therefore to reduce their tobacco use. It also seemed to be the case that patients who reduced tobacco use the most had lower psychological flexibility on enrollment in the study. Constraints on Psychedelics "Psychedelics are somewhat effective in treating addiction, but there are various limitations to their use," said Roméo. One of those limitations is societal. Laurence Bézo, MD, of the addiction services clinic at Paul Brousse Hospital, asked doctors to respond to a questionnaire to determine what they thought about psychedelics. To date, 407 have responded, including 280 general practitioners, 50 addiction specialists, and 50 specialist physicians. Overall, 50% think that psychedelics have no therapeutic potential. Three of five doctors also said that psychedelics are dangerous. Just over half thought that their use is associated with a severe risk of aggression aimed at oneself and toward others. Likewise, half think that the risk of dependency is very high and that there is a risk of co-occurring psychiatric disorders. "From the pool of physicians queried, the consensus is that psychedelics are pretty dangerous. People also seem to frown upon prescribing psychedelics in France," said Roméo. Participants went as far as to classify psychedelics as some of the most dangerous drugs out there. Using a 7-point scale, they classified psychedelics below heroin and cocaine in terms of dangerousness. They are deemed much more harmful than alcohol, tobacco, and cannabis. "A survey of the public carried out several years ago by leading French market research group IFOP had the exact same findings. Nevertheless, a number of studies have set out to determine how dangerous psychedelics are, and their findings point to this class of drugs as being among the least harmful for the individual patient and those around them. On the contrary, alcohol, heroin, crack cocaine (or even cocaine),methamphetamine, and tobacco were shown to be the most harmful. Additionally, psychedelics have a very low risk of dependency and the lowest risk of lethality. There is complete dissonance between what recent studies show us and what society, and some doctors, think," said Roméo. Besides these assumptions, another constraint to the use of psychedelics relates to methods adopted in related clinical studies. "Due to the effect psychedelics have, in the trials conducted, nine participants and nine doctors out of 10 are aware of what they have taken or given, respectively. This is a very important limitation. Nowadays, researchers don't know how to conduct accurate double-blind studies," said Roméo. In sum, for psychiatrists, psychedelics are promising in addiction therapy, but healthcare professionals, public authorities, and society as a whole must be better informed about their use, and received ideas must be dispelled. "The findings need to be replicated, but overall, psychedelics are really quite promising in treating both alcohol and tobacco use disorder. They are generally well-tolerated with few serious side effects. There is no deterioration in patients with psychiatric conditions while they are taking psychedelics. And if persistent symptoms of psychosis do occur, which is extremely rare, it's probably because there are preexisting underlying issues at play. We also don't see increased blood pressure or any other serious physical anomalies. In a supervised setting, as is the case with studies involving psychotherapeutic support, we can no longer say, in this day and age, that psychedelics are harmful," said Roméo. Roméo reported no conflicts of interest regarding the content of this article.

Researchers found that a 1200-IU dose of vitamin D3 supplementation is tied to a decreased risk for psychiatric symptoms at ages 6 to 8 years vs 400-IU dosing. HealthDay News — Higher doses of vitamin D3 supplementation up to age 2 years are associated with a decreased risk for internalizing problems in later childhood, according to a study published online May 19 in JAMA Network Open. Samuel Sandboge, M.D., Ph.D., from the University of Tampere in Finland, and colleagues conducted a secondary analysis of a randomized clinical trial of 346 children to assess the impact of high-dose (1,200 IU) versus standard-dose (400 IU) vitamin D3 supplementation during the first two years of life on psychiatric symptoms at ages 6 to 8 years. The researchers found that clinically significant internalizing problems occurred in 5.6 percent of participants in the 1,200-IU group versus 11.8 percent in the 400-IU group (odds ratio, 0.40), when adjusting for sex, birth season, maternal depressive symptoms at birth, and parental single status at follow-up. Among 48 children in the 400-IU group with maternal 25(OH)D concentrations <30 ng/mL, higher internalizing problems scores were seen compared with children in the 1,200-IU group, including 44 children with maternal 25(OH)D concentrations <30 ng/mL (adjusted mean difference, 0.49) and 91 children with maternal concentrations >30 ng/mL (adjusted mean difference, 0.37). No differences were seen between the groups for externalizing or total problems. “This should be interpreted cautiously, however, and be considered only as hypothesis generating given the absence of interactions between maternal 25(OH)D level and supplementation status,” the authors write. One author reported receiving grants from the Novo Nordisk Foundation.

Nearly 42.6% of children were prenatally exposed to antiseizure medication. HealthDay News — Prenatal exposure to the antiepileptic medication valproate is associated with an increased risk for later psychiatric disorders among children of mothers with epilepsy, according to a study published online April 17 in JAMA Neurology. Julie Werenberg Dreier, Ph.D., from Aarhus University in Denmark, and colleagues examined the association between prenatal exposure to antiseizure medication (ASM) with a spectrum of psychiatric disorders in childhood and adolescence among children of mothers with epilepsy. The analysis included 38,661 children of mothers with epilepsy born in Denmark, Finland, Iceland, Norway, and Sweden between 1996 and 2017. The researchers found that 42.6 percent of children were prenatally exposed to ASM. Prenatal valproate exposure was associated with an increased risk for the combined psychiatric end point (adjusted hazard ratio [aHR], 1.80; cumulative risk at 18 years in ASM-exposed children, 42.1 versus 31.3 percent in unexposed children), which was driven mainly by disorders within the neurodevelopmental spectrum. There was no increased risk for psychiatric disorders seen with prenatal exposure to lamotrigine, carbamazepine, or oxcarbazepine, while there were associations for prenatal exposure to topiramate with attention-deficit/hyperactivity disorder (aHR, 2.38) and exposure to levetiracetam with anxiety (aHR, 2.17) and attention-deficit/hyperactivity disorder (aHR, 1.78). “This study provides reassuring evidence that lamotrigine, carbamazepine, and oxcarbazepine are not associated with long-term behavioral or developmental disorders but cannot rule out risks with higher doses,” the authors write. Several authors disclosed ties to the pharmaceutical industry.

Lexapro is a SSRI approved by the FDA for the treatment of generalized anxiety disorder in pediatric patients aged 7 years and older. The Food and Drug Administration (FDA) has approved Lexapro (escitalopram) for the treatment of generalized anxiety disorder (GAD) in pediatric patients 7 years of age and older. Previously, the treatment had only been approved for adult patients. Lexapro is a selective serotonin reuptake inhibitor (SSRI). The expanded pediatric approval was based on data from an 8-week, flexible-dose study (ClinicalTrials.gov Identifier: NCT03924323) that compared escitalopram (10 mg and 20 mg daily) to placebo in outpatients 7 to 17 years of age who met DSM-V criteria for GAD. The primary endpoint of the trial was the change in Pediatric Anxiety Rating Scale (PARS) severity score from baseline to week 8. The PARS is a clinician-rated instrument for assessing the severity of anxiety symptoms; PARS severity scores for GAD range from 0 (none) to 25 (extreme severity), with a score of 15 indicating moderate illness severity. Findings showed a statistically significant treatment difference with escitalopram compared with placebo on the PARS severity score for GAD (least squares mean difference, -1.42 [95% CI, -2.69, -0.15]). As for safety, the overall profile of adverse reactions in pediatric patients with GAD was similar to that seen in adult studies. The prescribing information for Lexapro contains a Boxed Warning regarding an increased risk for suicidal thoughts and behaviors in pediatric and young adult patients taking antidepressants. Patients should be monitored closely for clinical worsening and the emergence of suicidal thoughts and behaviors. The treatment is not approved for patients younger than 7 years old.

Those with 4 or more ACEs by the fall of 2020 had 2.71-fold increased likelihood of reporting a new ACE in spring of 2021. HealthDay News — Adverse childhood experience (ACE) exposure was common before and during the pandemic, and new ACEs were more likely among those who had multiple ACEs before or early in the pandemic, according to a study published online May 9 in Pediatrics. Marci Hertz, from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues recruited adolescents aged 13 to 18 years (727 in the fall of 2020 [wave 1] and 569 in the spring of 2021 [wave 2]) who responded to questions about household challenges, violence or neglect, and community ACE exposure. There were 506 respondents to both survey waves. The researchers found that 27.2, 50.9, and 34.9 percent experienced violence or abuse, a household challenge, and a community ACE, respectively, by wave 1. By wave 2, 17.6, 6.1, and 2.7 percent experienced one, two, and four or more new ACEs, respectively. The likelihood of reporting a new ACE at wave 2 was increased 2.71-fold for those with four or more ACEs by wave 1 versus those with none. “This study’s findings highlight the occurrence of new ACEs among vulnerable adolescents who had multiple ACEs before or early in the pandemic,” the authors write. “The burden of ACEs and their associated impacts on health necessitates the implementation and scale-up of prevention and intervention strategies across school, home, and community settings to mitigate negative health and academic impacts and promote resilience.” Full Article

Resolving excess weight by adulthood may mitigate mental health risks in adolescents. Increasing weight or persistent overweight status from childhood to adulthood is associated with a higher risk for depression, according to the results published by Obesity Reviews. Researchers conducted a systematic review of the MEDLINE, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for studies with a longitudinal design that assessed weight change from childhood to adulthood that were associated with depression and anxiety. A total of 17 studies were included in the final review. A meta-analysis could not be performed due to a high level of heterogeneity observed across all the studies. The Newcastle-Ottawa scale was used to assess and rate the quality of included studies. The researchers found that 11 studies were determined to be of moderate quality, and the remaining 6 were considered high quality. Of the 17 studies, 11 defined weight change between 2 points in time, and the remaining articles defined weight change based on 3 or more documented weights. Weight status was measured using body mass index (BMI) or BMI z-scores in 14 studies. The remaining articles used retrospective measures to define weight status. Depression outcomes were evaluated in 13 studies, and only one evaluated anxiety as the sole outcome. The remaining 5 studies evaluated a composite risk of anxiety and depression. "[P]ersistent and/or increasing adiposity from childhood to adulthood is associated with an increased risk of depression in adulthood, particularly in women." Depression outcomes were measured as depressive symptoms in 4 studies. Among of the 2 studies that observed BMI change as a continuous variable, one study reported a significant association with depressive symptoms (P <.01). Of the 2 studies that utilized BMI categories to measure weight change, 1 found that there was no association of overweight status changes and depressive symptoms whereas the other study observed the opposite outcome; participants obesity was associated with more severe depressive symptoms (P <.001).

Nearly 1 million children are victims of physical abuse every year and every day, 4 to 7 children die from their injuries. These statistics are particularly grim because children who die from maltreatment often have had a healthcare encounter prior to their death. “We all know what physical abuse is, but it’s so much bigger than a lot of us recognize,” said Sheri Carson, DNP, APRN, CPN, CPNP-PC, assistant clinical professor at the University of Arizona. “I want to stress that child maltreatment involves a lot of different things and abuse has a lot of different components to it.” With every child and family encounter, Dr Carson urged practitioners to screen the child for physical abuse, during a presentation at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Orlando, Florida. Early Detection Is Often Missed The early detection of child physical abuse is estimated to be around only 10%, and overall, 1.3% to 15% of emergency department visits for a childhood injury are caused by physical abuse, Dr Carson said. If abuse is not detected at the initial health care visit, the recurrence rate is 35% to 50% and the risk for death is 10% to 30%. In 2021, 1820 children died from maltreatment, or 2.46 children per 100,000, according to a report from the Child Welfare League of America. "We must report any suspicion of abuse or neglect. We do not need proof to report, only reasonable belief or suspicion." Nurse practitioners (NPs) and other pediatric providers are often the first medical contact during a health care encounter, and sometimes the only medical contact, placing pediatric NPs in the ideal position to not only start, but also advance, the screening process for child physical abuse, Dr Carson said.

Only 26.2% of children with parent-reported ADHD had ever received outpatient mental health care. HealthDay News — Most children with parent-reported attention-deficit/hyperactivity disorder (ADHD) are not receiving medications and have never received outpatient mental health care, according to a study published online April 28 in JAMA Network Open. Mark Olfson, M.D., M.P.H., from Columbia University and the New York State Psychiatric Institute in New York City, and colleagues describe current ADHD medication use and lifetime outpatient mental health care in a sample of children with ADHD. Data were included from the first wave of the Adolescent Brain and Cognitive Development Study (11,723 participants); 1,206 participants had parent-reported ADHD (aged 9 to 10 years). Of the 1,206 children with ADHD, 12.9 percent were currently receiving ADHD medications. The researchers found that receipt of ADHD medications was increased for boys versus girls (15.7 versus 7.0 percent), Whites versus Blacks (14.8 versus 9.4 percent), children of parents without a high school education versus those with a bachelor’s degree or higher (32.2 versus 11.5 percent), and children with the combined versus the inattentive subtype of ADHD (17.0 versus 9.5 percent). Outpatient mental health care had ever been received by about 26.2 percent of children with parent-reported ADHD. The proportion of children receiving outpatient mental health care was higher for those whose parents had a high school education or some college versus a bachelor’s degree or higher (36.2 and 31.0 percent, respectively, versus 21.3 percent), children with family incomes <$25,000 or $25,000 to $49,999 versus ≥$75,000 (36.5 and 27.7 percent, respectively, versus 20.1 percent), and for children with the combined versus the predominantly inattentive or hyperactive-impulsive subtype of ADHD (33.6 versus 20.0 percent, respectively, and 22.4 percent). “These patterns suggest that attitudinal rather than socioeconomic factors often impede the flow of children with ADHD into treatment,” the authors write. Full Article