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About sex, adults aren’t talking or kids aren’t listening
TORONTO – Almost half of adolescents (45%) reported that their primary care providers (PCPs) do not routinely ask them about sex, and only 13% report they’ve been offered screening for sexually transmitted infections (STIs), according to a survey study presented at the Pediatric Academic Societies meeting.
And it appears the teenagers aren’t even listening to much of what their parents are saying on the subject: The survey also found that 90% of parents reported that they talk to their adolescents about sex, but only 39% of adolescents reported the same.
Regarding the discrepancy between the parents’ and adolescents’ responses, “Our best guess is that parents may have mentioned sex with their adolescents at some point, but the conversation was not meaningful enough to register on the adolescents’ radars! That type of discussion is probably best had more than once and in more than one way,”she said in an interview.
The adolescents, aged 13-17 years, and parents of adolescents attending the 2017 Minnesota State Fair were invited to complete an 18-question anonymous survey. The teens were queried whether they had seen a PCP in the last year and asked about their discussions about sexual activity and STIs with their physicians and parents. Parents were asked about their knowledge of discussions the teens had with their PCPs and their own discussions with their children. A total of 582 adolescents and 516 parents completed the survey.
One-quarter of parents who completed the survey felt that PCPs should not discuss sex with their teens.
“I think that primary care physicians have a lot to cover when doing preventive health visits with adolescents, and talking about sex is not necessarily an easy or comfortable thing to do and so may be something that falls to a lower priority. And it certainly doesn’t help if parents are not supportive of the concept of confidential adolescent care,” Dr. Schneider related.
“We were very surprised to see that 25% of parents did not feel that PCPs should be discussing sex with their child. I think that we need to next work on getting the parents on board and building an expectation that adolescents, when visiting their PCP, will have confidential discussions about sexual health,” she said.
TORONTO – Almost half of adolescents (45%) reported that their primary care providers (PCPs) do not routinely ask them about sex, and only 13% report they’ve been offered screening for sexually transmitted infections (STIs), according to a survey study presented at the Pediatric Academic Societies meeting.
And it appears the teenagers aren’t even listening to much of what their parents are saying on the subject: The survey also found that 90% of parents reported that they talk to their adolescents about sex, but only 39% of adolescents reported the same.
Regarding the discrepancy between the parents’ and adolescents’ responses, “Our best guess is that parents may have mentioned sex with their adolescents at some point, but the conversation was not meaningful enough to register on the adolescents’ radars! That type of discussion is probably best had more than once and in more than one way,”she said in an interview.
The adolescents, aged 13-17 years, and parents of adolescents attending the 2017 Minnesota State Fair were invited to complete an 18-question anonymous survey. The teens were queried whether they had seen a PCP in the last year and asked about their discussions about sexual activity and STIs with their physicians and parents. Parents were asked about their knowledge of discussions the teens had with their PCPs and their own discussions with their children. A total of 582 adolescents and 516 parents completed the survey.
One-quarter of parents who completed the survey felt that PCPs should not discuss sex with their teens.
“I think that primary care physicians have a lot to cover when doing preventive health visits with adolescents, and talking about sex is not necessarily an easy or comfortable thing to do and so may be something that falls to a lower priority. And it certainly doesn’t help if parents are not supportive of the concept of confidential adolescent care,” Dr. Schneider related.
“We were very surprised to see that 25% of parents did not feel that PCPs should be discussing sex with their child. I think that we need to next work on getting the parents on board and building an expectation that adolescents, when visiting their PCP, will have confidential discussions about sexual health,” she said.
TORONTO – Almost half of adolescents (45%) reported that their primary care providers (PCPs) do not routinely ask them about sex, and only 13% report they’ve been offered screening for sexually transmitted infections (STIs), according to a survey study presented at the Pediatric Academic Societies meeting.
And it appears the teenagers aren’t even listening to much of what their parents are saying on the subject: The survey also found that 90% of parents reported that they talk to their adolescents about sex, but only 39% of adolescents reported the same.
Regarding the discrepancy between the parents’ and adolescents’ responses, “Our best guess is that parents may have mentioned sex with their adolescents at some point, but the conversation was not meaningful enough to register on the adolescents’ radars! That type of discussion is probably best had more than once and in more than one way,”she said in an interview.
The adolescents, aged 13-17 years, and parents of adolescents attending the 2017 Minnesota State Fair were invited to complete an 18-question anonymous survey. The teens were queried whether they had seen a PCP in the last year and asked about their discussions about sexual activity and STIs with their physicians and parents. Parents were asked about their knowledge of discussions the teens had with their PCPs and their own discussions with their children. A total of 582 adolescents and 516 parents completed the survey.
One-quarter of parents who completed the survey felt that PCPs should not discuss sex with their teens.
“I think that primary care physicians have a lot to cover when doing preventive health visits with adolescents, and talking about sex is not necessarily an easy or comfortable thing to do and so may be something that falls to a lower priority. And it certainly doesn’t help if parents are not supportive of the concept of confidential adolescent care,” Dr. Schneider related.
“We were very surprised to see that 25% of parents did not feel that PCPs should be discussing sex with their child. I think that we need to next work on getting the parents on board and building an expectation that adolescents, when visiting their PCP, will have confidential discussions about sexual health,” she said.
Key clinical point:
Major finding: Of the adolescents who responded to the survey, 45% said their PCPs don’t routinely discuss sex with them, and only 13% reported being offered screening for STIs.
Study details: Survey study including 582 adolescents aged 13-17 years and 516 parents of adolescents.
Disclosures: Dr. Schneider reported no financial conflicts of interest.
Off-label prescribing of SGAs in children varies by diagnosis
TORONTO – On-label prescribing of second-generation antipsychotics in hospitalized pediatric patients with bipolar disorder and schizophrenia was greater than off-label prescribing, but not for patients with autism spectrum disorder, results from a single-center study showed.
“There is an increasing trend for using second-generation antipsychotics (SGAs) in children,” lead study author Debra V. McQuade, MD, PhD, said in an interview in advance of the Pediatric Academic Societies meeting. “This trend has already been widely acknowledged as concerning, due to the relatively high adverse event burden associated with them. Also, and perhaps more concerning, the great majority of these prescriptions are prescribed as ‘off-label’ (without Food and Drug Administration approval or indication). This is true in all settings, whether outpatient or inpatient. And, this off-label use is really high – usually reported as 60%-95% of all SGA prescriptions to children. We wanted to understand more about this practice of off-label prescribing of SGAs to children – to understand what drives it, to see if there were any organizing principles that might help to better explain it.”
Dr. McQuade and her associates found that for the three diagnostic groups overall, on-label prescribing of SGAs was greater than off-label prescribing (65% vs. 35%, respectively; P less than .001). Prescriptions for patients with bipolar disorder and schizophrenia followed this pattern, with on-label and off-label prescribing rates of 73% vs. 27%, for bipolar disorder, and 85% vs. 14% for schizophrenia. However, this prescription pattern was reversed for patients with autism spectrum disorder (35% vs. 64%; P less than .001), a finding that the researchers did not expect.
She said that while off-label prescribing of SGAs to pediatric patients remains widespread and is a concerning trend, the study findings suggested that prescribers “do select and prescribe SGAs in ways that are directly or indirectly influenced by FDA guidelines, mitigating risk to their pediatric patients.” Dr. McQuade acknowledged certain weaknesses of the study, including the fact that it was limited to one hospital setting and by the small number of prescribers who contributed to the overall pool of data.
She reported having no relevant financial disclosures.
TORONTO – On-label prescribing of second-generation antipsychotics in hospitalized pediatric patients with bipolar disorder and schizophrenia was greater than off-label prescribing, but not for patients with autism spectrum disorder, results from a single-center study showed.
“There is an increasing trend for using second-generation antipsychotics (SGAs) in children,” lead study author Debra V. McQuade, MD, PhD, said in an interview in advance of the Pediatric Academic Societies meeting. “This trend has already been widely acknowledged as concerning, due to the relatively high adverse event burden associated with them. Also, and perhaps more concerning, the great majority of these prescriptions are prescribed as ‘off-label’ (without Food and Drug Administration approval or indication). This is true in all settings, whether outpatient or inpatient. And, this off-label use is really high – usually reported as 60%-95% of all SGA prescriptions to children. We wanted to understand more about this practice of off-label prescribing of SGAs to children – to understand what drives it, to see if there were any organizing principles that might help to better explain it.”
Dr. McQuade and her associates found that for the three diagnostic groups overall, on-label prescribing of SGAs was greater than off-label prescribing (65% vs. 35%, respectively; P less than .001). Prescriptions for patients with bipolar disorder and schizophrenia followed this pattern, with on-label and off-label prescribing rates of 73% vs. 27%, for bipolar disorder, and 85% vs. 14% for schizophrenia. However, this prescription pattern was reversed for patients with autism spectrum disorder (35% vs. 64%; P less than .001), a finding that the researchers did not expect.
She said that while off-label prescribing of SGAs to pediatric patients remains widespread and is a concerning trend, the study findings suggested that prescribers “do select and prescribe SGAs in ways that are directly or indirectly influenced by FDA guidelines, mitigating risk to their pediatric patients.” Dr. McQuade acknowledged certain weaknesses of the study, including the fact that it was limited to one hospital setting and by the small number of prescribers who contributed to the overall pool of data.
She reported having no relevant financial disclosures.
TORONTO – On-label prescribing of second-generation antipsychotics in hospitalized pediatric patients with bipolar disorder and schizophrenia was greater than off-label prescribing, but not for patients with autism spectrum disorder, results from a single-center study showed.
“There is an increasing trend for using second-generation antipsychotics (SGAs) in children,” lead study author Debra V. McQuade, MD, PhD, said in an interview in advance of the Pediatric Academic Societies meeting. “This trend has already been widely acknowledged as concerning, due to the relatively high adverse event burden associated with them. Also, and perhaps more concerning, the great majority of these prescriptions are prescribed as ‘off-label’ (without Food and Drug Administration approval or indication). This is true in all settings, whether outpatient or inpatient. And, this off-label use is really high – usually reported as 60%-95% of all SGA prescriptions to children. We wanted to understand more about this practice of off-label prescribing of SGAs to children – to understand what drives it, to see if there were any organizing principles that might help to better explain it.”
Dr. McQuade and her associates found that for the three diagnostic groups overall, on-label prescribing of SGAs was greater than off-label prescribing (65% vs. 35%, respectively; P less than .001). Prescriptions for patients with bipolar disorder and schizophrenia followed this pattern, with on-label and off-label prescribing rates of 73% vs. 27%, for bipolar disorder, and 85% vs. 14% for schizophrenia. However, this prescription pattern was reversed for patients with autism spectrum disorder (35% vs. 64%; P less than .001), a finding that the researchers did not expect.
She said that while off-label prescribing of SGAs to pediatric patients remains widespread and is a concerning trend, the study findings suggested that prescribers “do select and prescribe SGAs in ways that are directly or indirectly influenced by FDA guidelines, mitigating risk to their pediatric patients.” Dr. McQuade acknowledged certain weaknesses of the study, including the fact that it was limited to one hospital setting and by the small number of prescribers who contributed to the overall pool of data.
She reported having no relevant financial disclosures.
Key clinical point:
Major finding: Overall, on-label prescribing of SGAs was greater than off-label prescribing (65% vs. 35%, respectively; P less than .001), but this prescription pattern did not hold true for patients with autism spectrum disorder.
Study details: A retrospective review of 86 hospitalized pediatric inpatients with a diagnosis of autism spectrum disorder, bipolar disorder, or schizophrenia.
Disclosures: Dr. McQuade reported having no financial disclosures.
Reduce referrals: Skip eye chart with automated vision checker for kids
TORONTO – Using an automated photorefractor-based vision screening in preschool-age children reduced referrals to ophthalmologists and optometrists by one-third, compared with standard chart-based screening, according to a nonrandomized trial conducted in Boston. The handheld device that was used requires minimal cooperation from the child and also checks ocular alignment.
“This device requires almost zero cooperation from the child. The nurse or assistant holds the device and the child has to look at it for about two seconds, as opposed to several minutes to do a chart-based test,” reported Louis Vernacchio, MD, at the 2018 Pediatric Academic Societies meeting.
They found a 33.7% decline in initial ophthalmology and optometry visits after practices switched from chart-based vision screening to the hand-held screening device.
“Optometry and ophthalmology is the No. 1 specialist to whom our patients of all ages are referred to in our pediatric network, and the No. 1 diagnosis was normal vision, so in most cases, there’s nothing wrong, and they’re clogging up the system.”
Instrument-based vision screening has been shown to have high sensitivity and specificity, compared with ophthalmic vision screening, and has much better testability in young children than traditional eye chart–based screening.
In previously reported data, Dr. Vernacchio’s group showed that, with instrument-based vision screening, completed screening rates among children aged 3-5 years improved. The most marked improvement was in the 3-year-olds, among whom completed screening rates increased from 39% with chart-based screening to 87% with instrument screening. (Modest JR et al. Pediatrics. 2017 Jul;140[1]. pii: e20163745.) Family satisfaction is also improved with the automated method.
The automated vision screening device used in the study was the Spot Vision Screener produced by Welch Allyn.
“Our nurses are in heaven with these devices, so besides the billing that you can do, you can save staff time and easily justify the cost of the device. My office now has 4 or 5 of these devices because it just saves so much time to have them readily available.”
Professional societies endorse automated vision screening
Amblyopia is seen in 2 or 3 children per 100 in the United States, reported Dr. Vernacchio. Chart-based vision screening is notoriously difficult to accomplish in young children and there is both a risk of missing amblyopia in those who do not cooperate and a risk of overreferral because of poor performance on the test.
Recently, the American Academy of Pediatrics, the U.S. Preventive Services Task Force, and others have endorsed the use of instrument-based vision screening in place of chart-based screening for children aged 3-5 years based on evidence of improved testability and acceptable sensitivity and specificity.
The Spot Vision Screener has a retail cost between $6000 and $7000, according to Dr. Vernacchio. “Many” insurance companies will pay a separate fee for vision screening using an instrument, but others bundle the screening into a well visit, he noted.
“So, you can actually calculate the time to recover the cost of the device based on your payer practices,” he said. Another option is a smart phone app that uses a subscription model, in which the test results are interpreted by the company within a few minutes with a per test charge of about .99 cents.
“The Holy Grail is whether this process will reduce the incidence of amblyopia,” said Dr. Vernacchio. That study is next on his to-do list, he said, but “it’s going to take longer to answer that question.”
The authors reported no conflicts of interest. There was no external funding.
TORONTO – Using an automated photorefractor-based vision screening in preschool-age children reduced referrals to ophthalmologists and optometrists by one-third, compared with standard chart-based screening, according to a nonrandomized trial conducted in Boston. The handheld device that was used requires minimal cooperation from the child and also checks ocular alignment.
“This device requires almost zero cooperation from the child. The nurse or assistant holds the device and the child has to look at it for about two seconds, as opposed to several minutes to do a chart-based test,” reported Louis Vernacchio, MD, at the 2018 Pediatric Academic Societies meeting.
They found a 33.7% decline in initial ophthalmology and optometry visits after practices switched from chart-based vision screening to the hand-held screening device.
“Optometry and ophthalmology is the No. 1 specialist to whom our patients of all ages are referred to in our pediatric network, and the No. 1 diagnosis was normal vision, so in most cases, there’s nothing wrong, and they’re clogging up the system.”
Instrument-based vision screening has been shown to have high sensitivity and specificity, compared with ophthalmic vision screening, and has much better testability in young children than traditional eye chart–based screening.
In previously reported data, Dr. Vernacchio’s group showed that, with instrument-based vision screening, completed screening rates among children aged 3-5 years improved. The most marked improvement was in the 3-year-olds, among whom completed screening rates increased from 39% with chart-based screening to 87% with instrument screening. (Modest JR et al. Pediatrics. 2017 Jul;140[1]. pii: e20163745.) Family satisfaction is also improved with the automated method.
The automated vision screening device used in the study was the Spot Vision Screener produced by Welch Allyn.
“Our nurses are in heaven with these devices, so besides the billing that you can do, you can save staff time and easily justify the cost of the device. My office now has 4 or 5 of these devices because it just saves so much time to have them readily available.”
Professional societies endorse automated vision screening
Amblyopia is seen in 2 or 3 children per 100 in the United States, reported Dr. Vernacchio. Chart-based vision screening is notoriously difficult to accomplish in young children and there is both a risk of missing amblyopia in those who do not cooperate and a risk of overreferral because of poor performance on the test.
Recently, the American Academy of Pediatrics, the U.S. Preventive Services Task Force, and others have endorsed the use of instrument-based vision screening in place of chart-based screening for children aged 3-5 years based on evidence of improved testability and acceptable sensitivity and specificity.
The Spot Vision Screener has a retail cost between $6000 and $7000, according to Dr. Vernacchio. “Many” insurance companies will pay a separate fee for vision screening using an instrument, but others bundle the screening into a well visit, he noted.
“So, you can actually calculate the time to recover the cost of the device based on your payer practices,” he said. Another option is a smart phone app that uses a subscription model, in which the test results are interpreted by the company within a few minutes with a per test charge of about .99 cents.
“The Holy Grail is whether this process will reduce the incidence of amblyopia,” said Dr. Vernacchio. That study is next on his to-do list, he said, but “it’s going to take longer to answer that question.”
The authors reported no conflicts of interest. There was no external funding.
TORONTO – Using an automated photorefractor-based vision screening in preschool-age children reduced referrals to ophthalmologists and optometrists by one-third, compared with standard chart-based screening, according to a nonrandomized trial conducted in Boston. The handheld device that was used requires minimal cooperation from the child and also checks ocular alignment.
“This device requires almost zero cooperation from the child. The nurse or assistant holds the device and the child has to look at it for about two seconds, as opposed to several minutes to do a chart-based test,” reported Louis Vernacchio, MD, at the 2018 Pediatric Academic Societies meeting.
They found a 33.7% decline in initial ophthalmology and optometry visits after practices switched from chart-based vision screening to the hand-held screening device.
“Optometry and ophthalmology is the No. 1 specialist to whom our patients of all ages are referred to in our pediatric network, and the No. 1 diagnosis was normal vision, so in most cases, there’s nothing wrong, and they’re clogging up the system.”
Instrument-based vision screening has been shown to have high sensitivity and specificity, compared with ophthalmic vision screening, and has much better testability in young children than traditional eye chart–based screening.
In previously reported data, Dr. Vernacchio’s group showed that, with instrument-based vision screening, completed screening rates among children aged 3-5 years improved. The most marked improvement was in the 3-year-olds, among whom completed screening rates increased from 39% with chart-based screening to 87% with instrument screening. (Modest JR et al. Pediatrics. 2017 Jul;140[1]. pii: e20163745.) Family satisfaction is also improved with the automated method.
The automated vision screening device used in the study was the Spot Vision Screener produced by Welch Allyn.
“Our nurses are in heaven with these devices, so besides the billing that you can do, you can save staff time and easily justify the cost of the device. My office now has 4 or 5 of these devices because it just saves so much time to have them readily available.”
Professional societies endorse automated vision screening
Amblyopia is seen in 2 or 3 children per 100 in the United States, reported Dr. Vernacchio. Chart-based vision screening is notoriously difficult to accomplish in young children and there is both a risk of missing amblyopia in those who do not cooperate and a risk of overreferral because of poor performance on the test.
Recently, the American Academy of Pediatrics, the U.S. Preventive Services Task Force, and others have endorsed the use of instrument-based vision screening in place of chart-based screening for children aged 3-5 years based on evidence of improved testability and acceptable sensitivity and specificity.
The Spot Vision Screener has a retail cost between $6000 and $7000, according to Dr. Vernacchio. “Many” insurance companies will pay a separate fee for vision screening using an instrument, but others bundle the screening into a well visit, he noted.
“So, you can actually calculate the time to recover the cost of the device based on your payer practices,” he said. Another option is a smart phone app that uses a subscription model, in which the test results are interpreted by the company within a few minutes with a per test charge of about .99 cents.
“The Holy Grail is whether this process will reduce the incidence of amblyopia,” said Dr. Vernacchio. That study is next on his to-do list, he said, but “it’s going to take longer to answer that question.”
The authors reported no conflicts of interest. There was no external funding.
Key clinical point: Switching from a chart-based to an instrument-based vision screening reduced unnecessary pediatric eye care referrals.
Major finding: Use of an automated vision screening system reduced referrals for pediatric eye care by 33.7%.
Study details: A nonrandomized analysis of referral patterns from January 2015 to June 2015 from 12 pediatric primary care practices, with findings compared with a prior time period before the vision screening device was used.
Disclosures: The authors reported no conflicts of interest. There was no external funding
Safety and support experiences of transgender and gender nonconforming youth explored
TORONTO – Youth with nonbinary identities – those that are beyond or outside of the categories of male/man and female/woman – feel significantly safer and more supported at school, compared with their transgender and gender nonconforming peers with binary identities, results from a survey of more than 300 youth showed.
“There has been little research specifically about the experiences of transgender and gender nonconforming youth that have nonbinary identities,” lead study author Brittany Allen, MD, said in an interview in advance of the Pediatric Academic Societies meeting.
Dr. Allen, a pediatrician at the University of Wisconsin–Madison, and her associates conducted an online survey of 311 transgender, nonbinary, and gender nonconforming youth in the state who ranged aged 12-22 years. Study participants were asked about their school safety and support experiences, and the researchers used Wilcoxon rank-sum tests to compare Likert scale responses among youth who reported nonbinary identities with those who reported binary identities. On the 1-5 scale, 1 meant “strongly agree” while 5 meant “strongly disagree.”
Dr. Allen, who is also comedical director of the Pediatric and Adolescent Transgender Health Clinic at American Family Children’s Hospital, Madison, reported that 311 young people completed more than 70% of the survey. Of those, 287 identified as having either binary (164; 57%) or nonbinary (123; 43%) gender identities. That percentage of those reporting nonbinary identities “is striking,” she said, and is “a much higher percentage than seen in adult studies of transgender and gender nonconforming people.”
Compared with respondents with binary identities, those with nonbinary identities were more often Caucasian/White (81% vs. 65% for those with binary identities; P = .003) and less likely to qualify for free lunch (28% vs. 55%; P = .001). Both binary and nonbinary groups reported similar school attendance and belonging. However, compared with the binary group, the nonbinary group reported significantly higher ratings of school safety (Likert score of 2.62 vs. 2.96, respectively; P = .0078) and peer support (Likert score of 2.54 vs. 2.87; P = .0139) and also were more likely to report being able to access adult support at school if needed (Likert score of 2.31 vs. 2.66; P = .0085).
“The primary message is that many transgender or gender nonconforming youth have identities outside of a gender binary and that transgender and gender nonconforming youth with different gender identities may have different strengths and challenges in different settings,” Dr. Allen said.
“Our work shows that nonbinary youth have relative safety and support at school compared to their transgender and gender nonconforming peers with binary identities – though it’s important to note that transgender and gender nonconforming youth overall are still at high risk of school harassment and violence. Interventions to promote school safety for youth of all gender identities should consider that transgender and gender nonconforming youth with different gender identities have different risks related to school safety and support.”
She acknowledged certain limitations of the study, including the fact that the researchers used a convenience sample to recruit participants, “which means that we may not have reached transgender and gender nonconforming youth that were less connected to support services or transgender and gender nonconforming peers,” Dr. Allen said. “This study also specifically assessed transgender and gender nonconforming youth; we did not have a comparison group of cisgender participants for comparison due to our study design.”
The study was funded by the National Institutes of Health, the Baldwin Wisconsin Ideas Endowment, the University of Wisconsin Advancing Health Equity and Diversity initiative, and the Wisconsin Partnership Program. Dr. Allen reported having no financial disclosures.
TORONTO – Youth with nonbinary identities – those that are beyond or outside of the categories of male/man and female/woman – feel significantly safer and more supported at school, compared with their transgender and gender nonconforming peers with binary identities, results from a survey of more than 300 youth showed.
“There has been little research specifically about the experiences of transgender and gender nonconforming youth that have nonbinary identities,” lead study author Brittany Allen, MD, said in an interview in advance of the Pediatric Academic Societies meeting.
Dr. Allen, a pediatrician at the University of Wisconsin–Madison, and her associates conducted an online survey of 311 transgender, nonbinary, and gender nonconforming youth in the state who ranged aged 12-22 years. Study participants were asked about their school safety and support experiences, and the researchers used Wilcoxon rank-sum tests to compare Likert scale responses among youth who reported nonbinary identities with those who reported binary identities. On the 1-5 scale, 1 meant “strongly agree” while 5 meant “strongly disagree.”
Dr. Allen, who is also comedical director of the Pediatric and Adolescent Transgender Health Clinic at American Family Children’s Hospital, Madison, reported that 311 young people completed more than 70% of the survey. Of those, 287 identified as having either binary (164; 57%) or nonbinary (123; 43%) gender identities. That percentage of those reporting nonbinary identities “is striking,” she said, and is “a much higher percentage than seen in adult studies of transgender and gender nonconforming people.”
Compared with respondents with binary identities, those with nonbinary identities were more often Caucasian/White (81% vs. 65% for those with binary identities; P = .003) and less likely to qualify for free lunch (28% vs. 55%; P = .001). Both binary and nonbinary groups reported similar school attendance and belonging. However, compared with the binary group, the nonbinary group reported significantly higher ratings of school safety (Likert score of 2.62 vs. 2.96, respectively; P = .0078) and peer support (Likert score of 2.54 vs. 2.87; P = .0139) and also were more likely to report being able to access adult support at school if needed (Likert score of 2.31 vs. 2.66; P = .0085).
“The primary message is that many transgender or gender nonconforming youth have identities outside of a gender binary and that transgender and gender nonconforming youth with different gender identities may have different strengths and challenges in different settings,” Dr. Allen said.
“Our work shows that nonbinary youth have relative safety and support at school compared to their transgender and gender nonconforming peers with binary identities – though it’s important to note that transgender and gender nonconforming youth overall are still at high risk of school harassment and violence. Interventions to promote school safety for youth of all gender identities should consider that transgender and gender nonconforming youth with different gender identities have different risks related to school safety and support.”
She acknowledged certain limitations of the study, including the fact that the researchers used a convenience sample to recruit participants, “which means that we may not have reached transgender and gender nonconforming youth that were less connected to support services or transgender and gender nonconforming peers,” Dr. Allen said. “This study also specifically assessed transgender and gender nonconforming youth; we did not have a comparison group of cisgender participants for comparison due to our study design.”
The study was funded by the National Institutes of Health, the Baldwin Wisconsin Ideas Endowment, the University of Wisconsin Advancing Health Equity and Diversity initiative, and the Wisconsin Partnership Program. Dr. Allen reported having no financial disclosures.
TORONTO – Youth with nonbinary identities – those that are beyond or outside of the categories of male/man and female/woman – feel significantly safer and more supported at school, compared with their transgender and gender nonconforming peers with binary identities, results from a survey of more than 300 youth showed.
“There has been little research specifically about the experiences of transgender and gender nonconforming youth that have nonbinary identities,” lead study author Brittany Allen, MD, said in an interview in advance of the Pediatric Academic Societies meeting.
Dr. Allen, a pediatrician at the University of Wisconsin–Madison, and her associates conducted an online survey of 311 transgender, nonbinary, and gender nonconforming youth in the state who ranged aged 12-22 years. Study participants were asked about their school safety and support experiences, and the researchers used Wilcoxon rank-sum tests to compare Likert scale responses among youth who reported nonbinary identities with those who reported binary identities. On the 1-5 scale, 1 meant “strongly agree” while 5 meant “strongly disagree.”
Dr. Allen, who is also comedical director of the Pediatric and Adolescent Transgender Health Clinic at American Family Children’s Hospital, Madison, reported that 311 young people completed more than 70% of the survey. Of those, 287 identified as having either binary (164; 57%) or nonbinary (123; 43%) gender identities. That percentage of those reporting nonbinary identities “is striking,” she said, and is “a much higher percentage than seen in adult studies of transgender and gender nonconforming people.”
Compared with respondents with binary identities, those with nonbinary identities were more often Caucasian/White (81% vs. 65% for those with binary identities; P = .003) and less likely to qualify for free lunch (28% vs. 55%; P = .001). Both binary and nonbinary groups reported similar school attendance and belonging. However, compared with the binary group, the nonbinary group reported significantly higher ratings of school safety (Likert score of 2.62 vs. 2.96, respectively; P = .0078) and peer support (Likert score of 2.54 vs. 2.87; P = .0139) and also were more likely to report being able to access adult support at school if needed (Likert score of 2.31 vs. 2.66; P = .0085).
“The primary message is that many transgender or gender nonconforming youth have identities outside of a gender binary and that transgender and gender nonconforming youth with different gender identities may have different strengths and challenges in different settings,” Dr. Allen said.
“Our work shows that nonbinary youth have relative safety and support at school compared to their transgender and gender nonconforming peers with binary identities – though it’s important to note that transgender and gender nonconforming youth overall are still at high risk of school harassment and violence. Interventions to promote school safety for youth of all gender identities should consider that transgender and gender nonconforming youth with different gender identities have different risks related to school safety and support.”
She acknowledged certain limitations of the study, including the fact that the researchers used a convenience sample to recruit participants, “which means that we may not have reached transgender and gender nonconforming youth that were less connected to support services or transgender and gender nonconforming peers,” Dr. Allen said. “This study also specifically assessed transgender and gender nonconforming youth; we did not have a comparison group of cisgender participants for comparison due to our study design.”
The study was funded by the National Institutes of Health, the Baldwin Wisconsin Ideas Endowment, the University of Wisconsin Advancing Health Equity and Diversity initiative, and the Wisconsin Partnership Program. Dr. Allen reported having no financial disclosures.
Key clinical point: Nonbinary youth felt significantly safer and more supported at school, compared with transgender peers with binary identities.
Major finding: Compared with the binary group, the nonbinary group reported significantly higher ratings of school safety (Likert score of 2.62 vs. 2.96, respectively) and peer support (Likert score of 2.54 vs. 2.87).
Study details: An online survey of 311 transgender, nonbinary, and gender nonconforming youth in Wisconsin who aged 12-22 years.
Disclosures: The study was funded by the National Institutes of Health, the Baldwin Wisconsin Ideas Endowment, the University of Wisconsin Advancing Health Equity and Diversity initiative, and the Wisconsin Partnership Program. Dr. Allen reported having no financial disclosures.
Poor parent-infant relationship may affect a child’s motor skill development
TORONTO – In what is believed to be a landmark finding, researchers have shown than modifiable risk factors, such as parent-infant relationships, may play a role in preventing children from developing high motor problems during early life.
“Our findings suggest that early health and clinical problems, such as neonatal complications and abnormal neonatal neurological status, are useful indicators to help identify children at risk of poor motor development,” lead study author Nicole Baumann said in an interview in advance of the Pediatric Academic Societies meeting. “Additionally, as a possible implication, children may benefit in motor development from early interventions that incorporate and focus on improving parent-infant relationships.”
For the current study, she and her associates investigated motor development using data from two different cohorts: the Bavarian Longitudinal Study in Germany (BLS) and the Arvo Ylppö Longitudinal Study in Finland (AYLS). A total of 4,741 and 1,423 children, respectively, underwent assessment from birth to age 56 months. Motor functioning was evaluated via standard physical and neurological assessments at birth and at 5, 20, and 56 months. Perinatal, neonatal, and early environmental information was collected at birth and at 5 months via medical records and reports from parents and research nurses.
The researchers identified two distinct trajectories of motor development problems from birth to 56 months: low (94.3% of BLS and 97.3% of AYLS) and high (5.7% of BLS and 2.7% of AYLS) motor problems.
In the BLS cohort, high motor problem trajectory was predicted by poor parent-infant relationship, such as the mother feeling insecure when taking care of the infant at home (OR 1.52); abnormal neonatal neurological status (odds ratio, 1.16); neonatal complications (OR, 1.12); and duration of initial hospitalization (OR, 1.02).
In the AYLS cohort, high motor problem trajectory was also predicted by abnormal neonatal neurological status (OR, 1.69) and duration of hospitalization (OR, 1.02). Although neonatal complications (OR, 1.08) and poor parent-infant relationship (OR, 1.09) did not significantly predict high motor problem trajectory in the AYLS cohort, trends identified were comparable with those obtained from the BLS cohort.
“Most surprising was that one of the four risk factors that remained as independent predictors of high motor problem trajectory was poor parent-infant relationship,” Ms. Baumann said. “As far as we are aware, parent-infant relationship has not been previously reported as a predictor of poor motor development.”
She acknowledged certain limitations of the study, including the fact that nearly 33% of children could not be assessed throughout the study period because of dropout. “Families with children who had poor health and were socially disadvantaged were less likely to continue participation, and may even suggest that our findings have an even larger effect than reported,” Ms. Baumann said. “This is a problem that affects many longitudinal studies, and it may affect group comparisons. However, simulations have shown that even when dropout is selective or correlated with the outcome that predictions only marginally change (Br J Psychiatry. 2009;195[3]:249-56).”
She reported having no financial disclosures.
dbrunk@mdedge.com
TORONTO – In what is believed to be a landmark finding, researchers have shown than modifiable risk factors, such as parent-infant relationships, may play a role in preventing children from developing high motor problems during early life.
“Our findings suggest that early health and clinical problems, such as neonatal complications and abnormal neonatal neurological status, are useful indicators to help identify children at risk of poor motor development,” lead study author Nicole Baumann said in an interview in advance of the Pediatric Academic Societies meeting. “Additionally, as a possible implication, children may benefit in motor development from early interventions that incorporate and focus on improving parent-infant relationships.”
For the current study, she and her associates investigated motor development using data from two different cohorts: the Bavarian Longitudinal Study in Germany (BLS) and the Arvo Ylppö Longitudinal Study in Finland (AYLS). A total of 4,741 and 1,423 children, respectively, underwent assessment from birth to age 56 months. Motor functioning was evaluated via standard physical and neurological assessments at birth and at 5, 20, and 56 months. Perinatal, neonatal, and early environmental information was collected at birth and at 5 months via medical records and reports from parents and research nurses.
The researchers identified two distinct trajectories of motor development problems from birth to 56 months: low (94.3% of BLS and 97.3% of AYLS) and high (5.7% of BLS and 2.7% of AYLS) motor problems.
In the BLS cohort, high motor problem trajectory was predicted by poor parent-infant relationship, such as the mother feeling insecure when taking care of the infant at home (OR 1.52); abnormal neonatal neurological status (odds ratio, 1.16); neonatal complications (OR, 1.12); and duration of initial hospitalization (OR, 1.02).
In the AYLS cohort, high motor problem trajectory was also predicted by abnormal neonatal neurological status (OR, 1.69) and duration of hospitalization (OR, 1.02). Although neonatal complications (OR, 1.08) and poor parent-infant relationship (OR, 1.09) did not significantly predict high motor problem trajectory in the AYLS cohort, trends identified were comparable with those obtained from the BLS cohort.
“Most surprising was that one of the four risk factors that remained as independent predictors of high motor problem trajectory was poor parent-infant relationship,” Ms. Baumann said. “As far as we are aware, parent-infant relationship has not been previously reported as a predictor of poor motor development.”
She acknowledged certain limitations of the study, including the fact that nearly 33% of children could not be assessed throughout the study period because of dropout. “Families with children who had poor health and were socially disadvantaged were less likely to continue participation, and may even suggest that our findings have an even larger effect than reported,” Ms. Baumann said. “This is a problem that affects many longitudinal studies, and it may affect group comparisons. However, simulations have shown that even when dropout is selective or correlated with the outcome that predictions only marginally change (Br J Psychiatry. 2009;195[3]:249-56).”
She reported having no financial disclosures.
dbrunk@mdedge.com
TORONTO – In what is believed to be a landmark finding, researchers have shown than modifiable risk factors, such as parent-infant relationships, may play a role in preventing children from developing high motor problems during early life.
“Our findings suggest that early health and clinical problems, such as neonatal complications and abnormal neonatal neurological status, are useful indicators to help identify children at risk of poor motor development,” lead study author Nicole Baumann said in an interview in advance of the Pediatric Academic Societies meeting. “Additionally, as a possible implication, children may benefit in motor development from early interventions that incorporate and focus on improving parent-infant relationships.”
For the current study, she and her associates investigated motor development using data from two different cohorts: the Bavarian Longitudinal Study in Germany (BLS) and the Arvo Ylppö Longitudinal Study in Finland (AYLS). A total of 4,741 and 1,423 children, respectively, underwent assessment from birth to age 56 months. Motor functioning was evaluated via standard physical and neurological assessments at birth and at 5, 20, and 56 months. Perinatal, neonatal, and early environmental information was collected at birth and at 5 months via medical records and reports from parents and research nurses.
The researchers identified two distinct trajectories of motor development problems from birth to 56 months: low (94.3% of BLS and 97.3% of AYLS) and high (5.7% of BLS and 2.7% of AYLS) motor problems.
In the BLS cohort, high motor problem trajectory was predicted by poor parent-infant relationship, such as the mother feeling insecure when taking care of the infant at home (OR 1.52); abnormal neonatal neurological status (odds ratio, 1.16); neonatal complications (OR, 1.12); and duration of initial hospitalization (OR, 1.02).
In the AYLS cohort, high motor problem trajectory was also predicted by abnormal neonatal neurological status (OR, 1.69) and duration of hospitalization (OR, 1.02). Although neonatal complications (OR, 1.08) and poor parent-infant relationship (OR, 1.09) did not significantly predict high motor problem trajectory in the AYLS cohort, trends identified were comparable with those obtained from the BLS cohort.
“Most surprising was that one of the four risk factors that remained as independent predictors of high motor problem trajectory was poor parent-infant relationship,” Ms. Baumann said. “As far as we are aware, parent-infant relationship has not been previously reported as a predictor of poor motor development.”
She acknowledged certain limitations of the study, including the fact that nearly 33% of children could not be assessed throughout the study period because of dropout. “Families with children who had poor health and were socially disadvantaged were less likely to continue participation, and may even suggest that our findings have an even larger effect than reported,” Ms. Baumann said. “This is a problem that affects many longitudinal studies, and it may affect group comparisons. However, simulations have shown that even when dropout is selective or correlated with the outcome that predictions only marginally change (Br J Psychiatry. 2009;195[3]:249-56).”
She reported having no financial disclosures.
dbrunk@mdedge.com
AT PAS 2018
Key clinical point: Four risk factors are independent predictors of high motor problem trajectory in young children.
Major finding: In the Bavarian Longitudinal Study cohort, high motor problem trajectory was predicted by abnormal neonatal neurological status (odds ratio, 1.16), duration of initial hospitalization (OR 1.02), neonatal complications (OR 1.12), and poor parent-infant relationship (OR 1.52).
Study details: A longitudinal analysis of 4,741 children from the Bavarian Longitudinal Study in Germany and 1,423 children from the Arvo Ylppö Longitudinal Study in Finland.
Disclosures: Ms. Baumann reported having no financial disclosures.
ED visits higher among pediatric asthma patients with comorbid depression, anxiety
TORONTO – Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.
“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.
In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)
“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”
She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”
The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.
TORONTO – Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.
“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.
In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)
“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”
She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”
The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.
TORONTO – Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.
“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.
In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)
“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”
She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”
The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.
Key clinical point: Anxiety and depression are associated with higher rates of ED use in children with asthma.
Major finding: (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01).
Study details: An analysis of 71,326 patients with asthma from the Massachusetts All Payer Claims Database for 2014-2015.
Disclosures: The researchers reported having no financial disclosures.