It appears you are using Internet Explorer as your web browser. Please note, Internet Explorer is no longer up-to-date and can cause problems in how this website functions This site functions best using the latest versions of any of the following browsers: Edge, Firefox, Chrome, Opera, or Safari. You can find the latest versions of these browsers at https://browsehappy.com
Read this article:
Suicide: Blueprint for Youth Suicide Prevention - American Academy of Pediatrics
Julie Linton, MD, FAAP, immediate past chair of the American Academy of Pediatrics (AAP) Council on Immigrant Child and Family Health, addressed disparities within health care services impacting immigrant populations in the United States. Linton discussed cultural differences, different types of immigration status, and how access to care can vary based on the state in which these patients are living.
The American Thoracic Society 2024 international conference included a keynote series where Linton and other expert speakers highlighted disparities and discussed ways to improve access to care for immigrant populations.
Transcript
What are the biggest challenges immigrant children face in accessing quality pediatric care in the US? How do these challenges differ based on the child's immigration status, country of origin, or socioeconomic background?
That's really a huge question. Before jumping in, I just want to quickly make sure we're talking about the same population I think you're asking about, which is immigrant children. The broader term of children in immigrant families refers to children who they themselves, or at least 1 parent, were born outside of the United States, and the specific population of immigrant children are children who they themselves were born outside of the United States. Those children may comprise a number of immigration statusesthat could include anything from being a US citizen who's already been naturalized, or it could include some types of humanitarian visa programs such as refugee status or having asylum status. It could include being part of a family who's come for work-related or family unification, or for some children, it could include being undocumented.
And all these different statuses, their eligibility for health coverage will vary. It will vary based on federal law. For instance, undocumented people are excluded from federal Medicaid, excluded from purchasing into the ACA [Affordable Care Act]. However, there are some states that cover children with state-sponsored Medicaid, including states like California, where we are today, as well as New York and Illinois, the District of Columbia, and I think there's 9 other states. You can actually find that information, if you're interested in knowing whether your state does or doesn't offer that coverage, on the National Immigration Law Center website. There's some maps there that are really helpful.
In terms of other factors, country of origin is relevant only in how it relates to immigration status. Certain countries, for instance, are eligible for Temporary Protected Status, meaning that if somebody is coming from Haiti, or Venezuela right now, under the current presidential administration, those families may be eligible for Temporary Protected Status, which would mean that they're eligible to buy into the Affordable Care Act and they're also, in some states, eligible to actually get state-funded Medicaid if those states took up a piece of legislation called the CHIPRA [Children's Health Insurance Program Reauthorization Act] option. Again, that map I mentioned will show you that from the National Immigration Law Center.
In terms of socioeconomic status, that really depends on the state eligibility for Medicaid in terms of how high of a poverty level that somebody could qualify for is one of the big pieces. Then there's other factors around socioeconomic status and other demographic factors that may make it more or less easy for somebody to enrolllanguage access, transportation, other things that can make it easier or more difficult for somebody to access services.
See the original post:
The treatment paradigm for acute lymphoblastic leukemia (ALL) has made significant progress in recent years for both adult and pediatric patients with the addition of cellular therapies; however, significant unmet needs remain for these patients that investigators are working to address, according to Carrie L. Kitko, MD.
There is a certain amount of effort [that is required] to be able to offer these products to our patients, Kitko said. [When physicians] are [wondering whether] their patient might be able to qualify for one of these emerging therapies, [whether the agent is] FDA approved or [the physician must] reach out to find out if we have the latest clinical trial available for some of these agents, [time is critical]. The earlier we put these patients on the radar, the earlier well be able to help them navigate the system to be able to get that innovative treatment.
In August 2017, the FDA approved the CAR T-cell therapy tisagenlecleucel (tisa-cel; Kymriah) for the treatment of patients up to age 25 years with B-cell precursor ALL that is refractory or in second or later relapse. The approval was based on findings from the phase 2 ELIANA trial (NCT02435849), which showed that patients with relapsed/refractory pediatric precursor B-cell ALL who received tisa-cel (n = 63) achieved an overall remission rate (ORR) of 82.5% (95% CI, 70.9%-91.0%); 63% of patients experienced complete remission (CR) and 19% experienced a complete remission with incomplete hematological recovery.1
Then, in October 2021, the FDA approved another CAR T-cell agent, brexucabtagene autoleucel (brexu-cel; Tecartus) for the treatment of adult patients with relapsed/refractory B-cell precursor ALL. The regulatory decision was supported by findings from the phase 1/2 ZUMA-3 study (NCT02614066), which showed that patients with relapsed/refractory B-cell precursor ALL who were treated with brexu-cel (n = 54) achieved a 3-month CR rate of 52% (95% CI, 38%-66%).2
In an interview with OncLive, Kitko, the medical director of the Pediatric Stem Cell Transplantation Program, the Ingram Professorship in Pediatric Oncology in theDepartment of Pediatrics, and an associate professor of pediatrics in the Department of Hematology/Oncology, at Vanderbilt University Medical Center in Nashville, Tennessee, discussed a presentation she gave during the 2024 Vanderbilt Stem Cell Transplant and Cellular Therapy Symposium in May. During the presentation, Kitko outlined the current treatment landscape of pediatric and adult ALL, as well as unmet needs and future directions in the field.
Kitko: [I discussed] the pivotal trials that led to the FDA approvals of tisa-cel for patients under the age of 26 and brexu-cel for adult patients. Those [agents] have been [approved] for a bit now, but it has been helpful that theres more long-term follow-up for the ZUMA-3 trial looking at how durable remissions are and the differences in patient populations based on prior treatment or treatments received [following] CAR T-cell therapy.
Whats important with the pediatric population is the recognition that, unfortunately, a lot of the pharmaceutical companies have abandoned further trials of some of the other novel CAR T-cell products. Were relying on real-world consortium data to try and tease out the different groups of patients who do better [as well as those] who are more or less likely to experience relapse post-treatment. [Also], how do we better tackle this toxicity profile?
We are hopeful that we can have more pharmaceutical interest in pediatric oncology, and there may be some hope on that horizon. A newer product, obecabtagene autoleucel [obe-cel], was developed in the UK and is now [being explored in] more global trials. It is a slightly different CAR construct; [although] the CAR still binds to CD19, which is what drives the anti-leukemia activity, it has a lower binding affinity meaning that it has fast-on, fast-off kinetics. We believe that may lead to increased T-cell persistence and less exhaustion of T cells, and it also seems to make the product potentially safer.
A product that were excited about potentially being able to see more of is WU-CART-007 in T-cell ALL. Weve been talking a lot about B-cell, and thats where a lot of work has been done, but T-cell ALL is very common in our adolescent and young adult patient populations. Luckily, work [from groups such as] the Childrens Oncology Group has found that very intensive chemotherapy can result in CR rates of approximately 90% and approximately a 70% chance of long-term cure.
However, when patients fall into that 30% where theyve unfortunately relapsed, they are [in] a very high-risk group. Second remissions are extremely rare, and the long-term survival rate is approximately 10% to 15%. Were desperate to find emerging therapies to help these patients and thats where the trial [examining] WU-CART-007 potentially comes in.
This is an allogeneic CAR T-cell therapy and that is helpful because these patients tend to be quite sick, and it would be difficult to mobilize their own cells. [WU-CART-007] is an off-the-shelf product; you can use a healthy donor to manufacture these cells, and then do some CRISPR modification to decrease the chances of adverse effects. The T-cell receptor [is taken out] which will hopefully mitigate the risk of graft-vs-host disease by these allogeneic cells. CD7 [is also eliminated] which is a very common marker on T cell ALL; on the CAR T cells they get rid of CD7 so that theyre not killing off those cells that theyre trying to produce to treat the patients leukemia.
[Study authors] published results from a phase 1/2 [WU-CART-007 1001 (NCT04984356) trial] at the ASH Annual Meeting this past year, where several patients, including some pediatric patients as the trial went down to age 12, who had relapsed/refractory T-cell ALL or lymphoblastic lymphoma were treated. There were some encouraging results [showing] that these patients did seem to, at the highest dose that was then expanded into a phase 2 cohort, have significant responses. A few of these patients eventually [received] an allogeneic transplant for consolidation after achieving a CR. The study has since closed because [investigators] were so encouraged by those results that theyre designing a larger trial [and are] hoping to go for FDA approval [of WU-CART-007] if the follow-up study shows promising results.
One of our biggest challenges is that these are expensive therapies and were trying to work closely with our managed care group to understand the urgency of patients and to be able to go directly up the chain as fast as possible with our insurance partners to get our patients approved to get therapy. This has been an ongoing project, [but] weve come to a better place where weve been able to streamline that process of not only getting the insurance company to say yes but agreeing to pay for the treatment as well because thats critical.
There are still some critical issues to be resolved. With the CD19-[directed CAR T-cell agents] since we have FDA-approved products, [were trying] to better understand who is the most likely to respond to these treatments, who is most likely to have long-term responses, and how to improve the toxicity profile. Those are essential questions to be answered to be able to deliver these treatments in the safest way possible and to provide that long-term cure that many patients and families are hoping for. There will be a combination of efforts to be able to answer those questions. A lot of that work will come from real-world consortium [studies], potentially even through groups like the Childrens Oncology Group.
The rest is here:
CAR T-Cell Therapies Move Ahead in Pediatric and Adult ALL - OncLive
Key Takeaways
The American Academy of Pediatrics now supports breastfeeding by HIV-positive moms, if their infection is controlled
The risk of HIV transmission through breastfeeding is less than 1% if the mom is virally suppressed
That risk should be weighed against the many benefits of breastfeeding, the AAP says
MONDAY, May 20, 2024 (HealthDay News) -- The nations top pediatrics group has reversed its decades-old position on HIV-positive mothers breastfeeding their infants.
When managed appropriately, having multiple credit cards provides both practical and financial benefits. An extra card can come in handy if one is lost or needs to be canceled, and having multiple lines of credit available can be helpful when unexpected expenses arise. However, tracking bala Click for more.Which Americans Hold the Most Credit Cards?
The American Academy of Pediatrics now says its generally safe for moms with HIV to breastfeed or provide breast milk to babies if their infection is properly controlled.
The risk of HIV transmission through breastfeeding from a mother who is virally suppressed is less than 1%, according to an AAP evidence review published May 20 in the AAP journal Pediatrics.
That small risk should be weighed against the health and financial benefits of breastfeeding, the AAP says.
Research now shows that the risk of HIV transmission through breastfeeding is quite low when the lactating parent is on anti-retroviral treatment and has no detectable viral load, said Dr. Lisa Abuogi, lead author of the AAP review.
While avoiding breastfeeding is the only option to guarantee that the virus is not transmitted, pediatricians should be ready to offer family-centered and nonjudgmentalsupport for people who desire to breastfeed, said Abuogi, who is medical director for the Children's Hospital Colorado Immunodeficiency HIV Prevention Program.
Nearly 5,000 people with HIV in the United States give birth every year, the AAP says.
Without treatment, women with HIV can pass the virus to their infants during pregnancy, delivery or breastfeeding.
However, daily medications can keep people with HIV healthy and reduce their viral load below detectable levels, the AAP noted.
The AAP says it is following the lead of the U.S. Centers for Disease Control and Prevention, which starting in 1985 had recommended against breastfeeding for people with HIV. The CDC now supports breastfeeding for HIV-positive mothers after discussing the option with a doctor.
The AAP recommends that pediatricians:
Know the HIV status of pregnant women, to provide appropriate counseling and prescribe antiretroviral treatment
Be prepared to support HIV-positive women who want to breastfeed if they started antiretroviral treatment early in or prior to pregnancy and are committed to maintainingviral suppression through breastfeeding
Counsel pregnant women and new mothers at increased risk of HIV infection regarding the risk of transmitting the virus through human milk, if infection occurred while breastfeeding
Healthcare professionals, researchers and people with HIV have made amazing strides over the past few decades towards eliminating perinatal transmission of HIV in the United States, Abuogi said in an AAP news release. "We encourage families to share information with their pediatricians about HIV and discuss what will work best for them when it comes to feeding their baby.
SOURCE: American Academy of Pediatrics, news release, May 20, 2024
Moms with HIV who want to breastfeed should talk with their doctor about whether it will be safe for their baby.
See the original post:
(Associated Press) A top U.S. pediatricians group is making a sharp policy change about breastfeeding by people with HIV.
The group says they can breastfeed as long as they are taking medications that effectively suppress the virus that causes AIDS.
Its a reversal in a longstanding policy from the American Academy of Pediatrics.
The group made the changes on Monday, effectively overturning guidance that dated back decades.
Experts say drugs used to treat HIV can reduce the risk of passing the virus to infants to less than 1%.
About 5,000 people who have HIV give birth in the U.S. each year.
Read the original here:
Sang Pediatrics: When to see the doctor for a fever YourCentralValley.com
The rest is here:
Sang Pediatrics: When to see the doctor for a fever - YourCentralValley.com
Espaol
When you go outdoors with your infant, whether for a quick stroll in the park or a day at the beach, its important to keep your little one out of the sun. But should you put sunscreen on your baby to protect them from the suns bright rays? Not usually.
Your infants sensitive skin is vulnerable to serious burns. But sunscreen isnt the answer, according to the U.S. Food and Drug Administration. Thats because infants are at greater risk than adults of sunscreen side effects, such as a rash.
The FDA and the American Academy of Pediatrics (AAP) recommend keeping newborns and babies younger than 6 months out of direct sunlight. The best sun protection for these infants is to stay in the shade. Look for natural shade, such as under a tree. Or create your own shade under a beach umbrella, a pop-up tent, or a stroller canopy.
Its especially important to keep your baby out of the sun between 10 a.m. and 2 p.m., when the sun is at its strongest and ultraviolet (UV) rays are most intense. If you do need to be outside in the sun during those times, be sure to take extra precautions. And check with your pediatrician before applying sunscreen to children younger than 6 months.
The AAP suggests dressing infants in lightweight clothing, such as long pants and long-sleeve shirts. Babies should wear a hat with a brim that shades the neck to prevent sunburn. Not baseball caps, which dont shade the neck or ears, both of which are sensitive areas for a baby. And for fabrics, tight weaves are better than loose ones.
Summers heat presents other challenges for babies. Our sweat naturally cools us down when were hot. But younger babies dont sweat like adults do. Their bodies havent fully developed that built-in heating-and-cooling system, so they can become easily overheated and have a greater risk of becoming dehydrated.
Here are some things to keep in mind this summer when outside with infants younger than 6 months:
05/09/2024
Read the rest here:
Since the program's launch in 2011, more than 100,000 free helmets have gone to Ohio children.
COLUMBUS, Ohio Thousands of bike helmets will be handed out to children across the state this year as part of theOhio American Academy of Pediatrics bike helmet safety awareness campaign.
This is the ninth year that the Ohio Department of Transportation has teamed up with AAP to distribute helmets during Bike Helmet Safety Awareness Month in May. This year, 10,000 bike helmets were passed out to law enforcement agencies and community-based groups in Ohio.
Since the program's launch in 2011, more than 100,000 free helmets have gone to Ohio children.
The Honda USA Foundation provided a $25,000 grant for the helmets this year.
ODOT Press Secretary Matt Bruning said groups and agencies apply to get the helmets that they can then distribute to their community. Those groups will also get educational resources and a helmet-fitting demonstration.
Its something were proud of and happy to do because we know that biking is very important. We want kids to go out and do that, but we want to make sure theyre safe when they do it," Bruning said.
More than 150 law enforcement agencies and community organizations traveled to Columbus to pick up their allotment of helmets on Tuesday.
Wearing a helmet can reduce the risk of head injury by 85%, helping prevent unnecessary trips to hospitals, said Melissa Wervey Arnold, Chief Executive Officer of the Ohio AAP. We are incredibly grateful for ODOTs support of our Put a Lid on It program. Through this partnership, we are protecting kids and creating a safer environment for them to thrive.
Originally posted here:
Thousands of bike helmets to be distributed to Ohio children | 10tv.com - 10TV
How to talk to your teenaged patient about pregnancy and contraception | Image Credit: JPC-PROD - JPC-PROD - stock.adobe.com.
Here is some sobering news: Teenaged mothers are twice as likely to experience postpartum depression (PPD) as adults.1 For this population who are still maturing on a cognitive level and have not yet fully developed their basic coping skills, the impact of PPD can be crippling. Additionally, the stress that a pregnancy adds to this population group can lead to other increased mental health concerns, including severe depression and anxiety.2 Furthermore, parenthood is the leading reason why teenaged girls drop out of school, with more than half of teenaged mothers never graduating from high school.3
Although the national teen pregnancy rates for girls aged 15 to 17 years and 18 to 19 years (the number of pregnancies per 1000 females in the specified age group) have declined almost continuously for the past 30 years,4 the teen birth rate in the United States is still higher than in many developed countries, including Canada and the United Kingdom.5 At the same time, sexual intercourse among adolescents has become the norm: by age 19, approximately 70% of teenagers have had sexual intercourse at least once.6
For these and other reasons surrounding sexual health, initiating discussion of sexual activity, pregnancy, and contraception is a necessity for health care providers. According to the American Academy of Pediatrics (AAP), Pediatricians [should] spend one-on-one time with adolescents starting at the 11- to 13-year-old checkups. The pediatrician will ask about sexual behaviorsand, if indicated, talk with the young person about birth control and ways to prevent sexually transmitted infections [STIs].7 The question is how to broach issues of pregnancy and contraception with this patient population to produce optimal outcomes.
Initiating the discussion As the Nike ad says, just do it. Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, clinical professor of nursing at Baylor University Louise Herrington School of Nursing in Dallas, Texas, says to simply start a discussion, honestly and plainly. Having an established relationship with a primary care provider makes it easier to initiate conversation on both sides. As girls progress into the teen years, its important to give anticipatory guidance before any risk-taking behaviors occur.
Additionally, with the current laws on abortion having changed dramatically, Peck notes, It is critical to know your state laws and your scope of practice according to your education, training, licensure, and certification, and providers should adhere to those boundaries, referring when necessary. She adds, Its important to emphasize regular well childcare, where questions about reproductive health are easier to ask in the context of health promotion.
A recent paper published in Frontiers in Pediatrics8 discusses the actions that health care providers can take in the prevention of unplanned pregnancy. Study authors note it is crucial to be empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.8
The paper cites several factors contributing to adolescent pregnancy, including personal vulnerability, family context, lack of information, poor access to contraception, and religious and cultural background. Adolescents, especially under the age of 16 or 17 years, lack a long-term vision of the consequences of their behavior and are driven by experimentation and emotions. Therefore, although they cognitively know about contraception and the risk of pregnancy, they may choose to ignore these aspects of their behavior as a kind of denial (it cannot happen to me). This explains why, even in high-income countries with a good coverage of health care needs, some adolescents find themselves pregnant, the authors state.8
What the discussion should include The authors developed several recommendations for health care providers in terms of discussing pregnancy and contraception with their teenaged patients and educating them about it (Table). Key elements that impact on the quality and effectiveness of service provisions are, among others, easy access to health services, including sexual and reproductive health (SRH); confidential, respectful empathetic care; communication and counseling skills; [and] easy link with specialized colleagues and the community, the investigators note.8
Birth control recommendations When it comes to counseling teenagers on methods of birth control, the AAP continues to recommend long-acting reversible contraceptives (LARCs), which include contraceptive implants and intrauterine devices, as the most effective contraceptives to prevent pregnancy. They also recommend that teenagers who use LARCs should also use a condom or other type of barrier protection during sexual activity to prevent sexually transmitted infections (STIs).
Additionally, the AAP notes that hormonal contraceptivescombined oral contraception pills, progestin-only contraception pills, patches, injections, and vaginal ringsare more than 90% effective in preventing infection. They recommend use of a condom here as well to prevent STIs.
The progestin-only pill containing norgestrel (Opill) is the first nonprescription birth control approved by the FDA and is now being sold over the counter (OTC).
Finally, should a teenager decide they want to see their pregnancy through and become a parent, the AAP affirms that all pregnant adolescents should be counseled in a nonjudgmental, developmentally appropriate manner about their full range of pregnancy options.9
Click here for more from the May issue of Contemporary Pediatrics.
References:
1. Ladores S, Corcoran J. Investigating postpartum depression in the adolescent mother using 3 potential qualitative approaches. Clin Med Insights Pediatr. 2019;13:1179556519884042. doi:10.1177/1179556519884042
2. Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics. 2014;133(1):114-122. doi:10.1542/peds.2013-0927
3. Teen moms. American Society for the Positive Care of Children. 2024. Accessed March 26, 2024. https://americanspcc.org/teen-moms/
4. About teen pregnancy. CDC. November 15, 2021. Accessed March 26, 2024. https://www.cdc.gov/teenpregnancy/about/index.htm
5. About teen pregnancy and childbearing. US Department of Health and Human Services. Accessed March 27, 2024. https://opa.hhs.gov/adolescent-health/reproductive-health-and-teen-pregnancy/about-teen-pregnancy-and-childbearing
6. Lindner J. Sexually Active Teen Statistics: Market Report & Data. Gitnux. Updated December 20, 2023. Accessed March 27, 2024. https://gitnux.org/sexually-active-teen-statistics/
7. Ott MA, Alderman EM. Contraception explained: birth control options for teens & adolescents. HealthyChildren.org. Updated March 8, 2024. Accessed March 26, 2024. https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Birth-Control-for-Sexually-Active-Teens.aspx
8. Martins MV, Karara N, Dembiski L, et al. Adolescent pregnancy: an important issue for paediatricians and primary care providers-a position paper from the European Academy of Paediatrics. Front Pediatr. 2023;11:1119500. doi:10.3389/fped.2023.1119500
9. American Academy of Pediatrics; Committee on Adolescence. Options counseling for the pregnant adolescent patient. Pediatrics. 2022;150(3):e2022058781. doi:10.1542/peds.2022-058781
See the original post:
How to talk to your teenaged patient about pregnancy and contraception - Contemporary Pediatrics