|
|
Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
|
|
June 1, 2022 | Volume 13 | Issue 22 |
|
Examination of young US adults’ reasons for not seeking mental health care for depression |
|
“Depression ranges in seriousness from mild temporary episodes of sadness to severe persistent depression” (8.1% of American adults).
Severe persistent depression also known as major depression or major depressive disorder (17% of young adults 18-25 years of age and one of the most common mental disorders in the US) “can result in impairments which interfere with or limit one’s ability to carry out major life activities”.
Despite the increasing trajectory of depression in young adults many remain untreated.
A study of nationally representative data from the 2011-2019 National Survey on Drug Use and Health (NSDUH) for 21,012 young adults,18-25 years of age with a 12-month major depressive episode examined trends and patterns of perceived reasons for not seeking treatment.
The most common reported reason for young adults not seeking treatment for a major depressive episode appears to be cost (54.7%), followed by lack of knowledge of access to mental health services (37.8%). 30.9% think they can handle the problem, 22.8% fear having to commit to taking medication and fear of negative effect on jobs/concern over confidentiality (with different ethnic groups and sex having different specific reasons).
|
|
Read the full article at JAMA Network Open
|
|
|
Trends and management of children with acute gastroenteritis (AGE) in US Emergency Departments (EDs) |
“Among children in the US acute diarrhea accounts for >1.5 million outpatient visits, 200,000 hospitalizations and approximately 300 deaths/year”.
Oral rehydration therapy (ORT) improves AGE outcomes for children with mild/moderate dehydration, and intravenous (IV) rehydration is appropriate for those with severe dehydration or in whom ORT has failed. “IV rehydration is associated with longer hospital stays, return visits, adverse events, cost and pain”.
Oral ondansetron reduces vomiting and the need for IV rehydration.
Data from the National Hospital Ambulatory Medical Care Survey was utilized to analyze 4,122 visits in children (mean age 4.8 years) with a diagnosis of nausea, vomiting, diarrhea or dehydration and a secondary diagnosis of AGE.
While ondansetron use for children with AGE increased markedly over a 12 year period (with no decrease in IV rehydration or hospitalization), in many instances it is used in inappropriate clinical situations (many children receiving IV fluids without prior ondansetron or an adequate trial of ORT, both of which can significantly reduce the need for IV therapy and its concomitant adverse effects).
|
|
Cardiovascular outcomes in collegiate athletes following SARS CoV-2 infection: 1 year follow-up |
From a prospective, observational cohort of 3,675 College athletes (mean age: 20 years – 33% female – 64% white – 24% black) which examined 1 year cardiovascular outcomes after SARS CoV-2 infection, it appears that:
- Myocardial/myopericardial involvement occurs in 0.6%.
- Athletes with cardiovascular damage may be allowed to return to sport after ~ 86 days (median).
- At 86 days post infection 70% have complete resolution on cardiac magnetic imaging (CMR), 10% have partial resolution with 20% having persistent CMR abnormalities.
- At 1.12 years (median) follow-up, 0.05% have adverse cardiac events.
“SARS CoV-2 cardiac involvement is low among athletes with a normal workup”. “Long-term clinical surveillance will be required to clarify long-term cardiovascular implications of SARS CoV-2 infection”.
|
|
Association between Proton Pump Inhibitor (PPI) use and risk of asthma in children |
Prolonged use of PPI’s has many adverse effects; the gut microbiome being particularly negatively affected which then impacts the hosts’ immune system (enhancing the development of autoimmune diseases).
A nationwide cohort study (January 1 2007 – December 31 2016) of 80,870 matched pairs of children/adolescents on a PPI (or not) investigated whether PPI use in a broad pediatric population is associated with an increased risk of asthma in childhood (over a 3 year follow-up period).
“Initiation of PPI use compared to non-use is associated with an increased risk (57%) of asthma in children”.
|
|
Management of primary spontaneous pneumothorax (PSP) in teenagers – an 11-year study |
Primary spontaneous pneumothorax is a common finding in healthy adolescents (13-22 years of age most frequently affected) occurring without any precipitating traumatic or iatrogenic mechanism. Children present with acute chest pain at rest. Recurrences are not uncommon.
A report of 70 children (2008-2018) with PSP examined demographic data, smoking habits, clinical presentation, radiological/therapeutic management and its results, complications, length of hospital stay and recurrences.
82.9% of child with PSP are boys (mean age:16.8 years) with 31% being smokers ( and 10% asthmatics). (In younger children an underlying congenital anomaly is the most predisposing factor),
46.2% have emphysematous blebs/bullae on chest computerized tomography (CT).
Treatments include observation (20%), needle aspiration (2.9%), chest-tube insertion (75.5%) and video-assisted thoroscopic surgery (2.9%).
Intervention results in 50% having complications. 50% of children have recurrences.
Recent recommendations suggest a conservative approach to childhood PSP with more initial observation and less intervention (needle aspiration is suggested as the first-line interventional treatment).
|
|
Antibiotic use and vaccine levels |
“The majority of children are prescribed antibiotics in the first 2 years of life while vaccine-induced immunity develops”. Whether antibiotic use negatively affects immunity in children is unknown.
An unplanned secondary analysis of a retrospective cohort study (2006-2016) of 560 children 6-24 months of age, evaluated the effect of an antibiotic prescription on antibody level to Diphtheria-Tetanus-acellular Pertussis (DTaP), Haemophilus influenzae type b (Hib) and Pneumococcal conjugate vaccines (PCV).
Antibiotics lowers the vaccine-induced response to DTaP and PCV and results in a higher frequency of “below protective levels” of antibodies at 9-12 months of age.
|
|
Prolonged brace treatment acetabular indices in infantile dislocated hips |
“The Pavlik harness (PH) is commonly used to treat infantile dislocated hips”. Significant variations exist in the duration of brace treatment after the successful reduction of a dislocation.
A retrospective study of prospectively enrolled infants (53 hips) with at least 1 dislocated hip, initially treated with PH evaluated whether PH use till normal radiographic acetabular development (Institution 1) was better than a structured shorter brace treatment protocol (Institution 2).
PH bracing successfully treats dislocated hips, however at 2-year follow-up prolonged brace treatment provides no benefit over a structured shorter time frame.
|
|
REGISTER - LEARN - EARN CME CREDIT |
|
Pediatric Rehabilitation Medicine 101
At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
|
|
|
|
Underwriting Opportunities
Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
|
|
|
|
|
|
|
