PER Survey

Clinical ShowCase™: Developing a Personalized Treatment Plan for a Patient with Sickle Cell Disease

Clinical Showcase Sickle Cell 

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Period poverty isn’t just an issue in third-world countries or among low-income women. Across the United States, women of all ages still struggle to afford menstrual products—which are too-often viewed by commercial markets and governments as a luxury item rather than a basic necessity for personal hygiene.

For teens and young women, a lack of access to menstrual supplies can have far-reaching effects, even detracting from things like time in the classroom.

Menstrual equity movements have gained traction in recent years, but the COVID-19 pandemic highlighted the fact that there is still much work to be done.

a survey commissioned by Thinx and PERIOD

, nearly a quarter of all school-aged students struggle to afford period products, and 16% have had to make the choice between purchasing menstrual products of food and clothing. While this is a problem that is faced across the spectrum of socioeconomic groups, the report indicates that Latinx, low-come, rural, and college-age students are most impacted.

Schools have long been a resource for many students who struggle to get access to menstruation products, but the COVID-19 pandemic made that more difficult. Nearly a third of students in the survey reported that going back to school after COVID-19 lockdowns was a relief in terms of menstrual support, but 3 in 5 students say free hygiene products are still rarely available in their school bathrooms.

It isn’t just anxiety and shame that can develop from period poverty, though. Roughly half of the students surveyed reported wearing menstrual products for longer than recommended due to lack of resources, and 1 in 10 students globally are believed to miss school during their periods because of a lack of access to hygiene items.

There are a lot of issues that contribute to the problem of period poverty, but about three-quarters of the students surveyed want more education and advocacy when it comes to menstrual health and access to hygiene products. This is where pediatricians can help.

Pediatricians often ask families and patients about access to all sorts of basic needs like housing and food, but period products might not often make the cut.

Elise Joy, executive director and co-founder of the New Jersey-based non-profit Girls Helping Girls Period, says pediatricians should keep in mind that several forms of poverty often go hand-in-hand. Joy and her daughters formed Girls Helping Girls Period after volunteering at a local food bank and realizing that nutrition wasn’t the only thing visitors to the resource center were lacking.

“Where there is period poverty there is, most likely, food insecurity. I recommend anyone who is struggling begin visiting a food pantry. While they are not created equal, more and more are seeing the need to supply menstrual products,” Joy says. “They can be in short supply at food pantries, too, but in many states, like our state of NJ, the state food banks have started to make period products available.”

Organizations like Girls Helping Girls Period raise funds and awareness to help secure hygiene products for food banks so that they can be distributed to those in need. Joy says the need has been there a long time, but increased reliance on food banks during the COVID-19 pandemic really highlighted the problem.

Pediatricians should direct patients and families who report or are suspected to have food or housing insecurity to additional resources that can help them with all their needs, including period products.

Advocacy is another important area where pediatricians can have a strong voice about period poverty. There are numerous state and federal laws either recently passed or in consideration that aim to reduce period poverty and biased pricing on gender-based hygiene products. Some states have repealed or banned so-called “pink taxes” or “tampon taxes” that add a luxury tax to basic period products, but 

“Slowly states are realizing that providing basic period products is part of their responsibility in publicly educating students,” Joy says. “There has been a huge groundswell of advocacy across the nation from students and families demanding that pads and tampons be offered, free of charge, to students for use in school.”

Pediatricians shouldn’t limit their advocacy efforts to the legislature, either. Check your state laws and make sure that they are being enforced in your local schools, she says.

“There are many places that have these mandates on the books but they have not been implemented well. If your state law says there should be free products in school and your child does not find them, help make a change. Write a letter to the principal. Make a presentation to the school board. Get other parents involved, too,” Joy says. “Can you imagine having to make this much of a fuss to get toilet paper in bathrooms? Of course not. Students tell us not having pads or tampons in bathrooms sends a strong message that they are not a priority, and that their education is not as important to educators as that of their peers who do not menstruate.”

Pediatricians can also help parents and their children have open discussions about menstruation, period products, and other personal hygiene methods to help reduce the stigma and fears around these topics.

“It doesn't have to be dinner table discussion, but there is no way we will normalize periods if we all don't help break the taboos. It is primarily because we don't talk about them openly that this problem of period poverty exists,” Joy adds. “Until we all play a role in making change, we can expect things to stay the same. Students today are fantastic about talking about tough subjects—they need to teach their parents to do the same. I think pediatricians can really help in normalizing the conversation simply in their approach to talking to patients and families. If they are open and matter-of-fact in the doctor's office, it will go a long way toward letting a patient and their family know it's ok to talk about it, ask for help, ask questions about their own bodies.”

The national non-profit Alliance for Period Products also offers national support for menstrual supplies in partnership with the National Diaper Bank Network. The Alliance for Period Products works with a network of 120 community-based organizations that can be found 

Program Director Jennifer Gaines offers the follow advice to pediatricians whose have patients facing period poverty.

Take a basic needs-informed approach with the patient and ask direct questions:

Do you know how to use menstrual products?

Do you have access to the period supplies you need to manage your period?

Do you and/or your family struggle to afford the period supplies you need to manage your period?

Do you know resources in your area that can help supply free period products?

Organize or identify educational workshops for both parents and children about periods and using products.

Consider keeping period supplies in stock in the office and providing the patient with enough products to manage a full cycle.

Identify and build community partnerships with local basic needs organizations.

To find out if an agency in your area provides period supplies to individuals in need, please contact the local service directory in your area by calling 2-1-1 or going online to 

Ask about or search for period supplies or basic needs.

Also check the listings under women, girls, families, or transgender individuals.

If you still can’t find a resource, try local faith-based organizations and food pantries.

State of the period: The widespread impact of period poverty on U.S. students.

2013/4 Education for All Global Monitoring Report.

State of the period 2021: The widespread impact of period poverty on U.S. students.

Articles

Period poverty isn’t just an issue in third-world countries or among low-income women. Across the United States, women of all ages still struggle to afford menstrual products.

What pediatric providers can do to help with period poverty 

Today, the annual World’s Largest Swimming Lesson (WLSL) event takes place in 14 countries and 42 states across the United States. Coordinated by the World Waterpark Association, water safety and training organizations, YMCAs, and swim schools bring together hundreds of swim instructors to teach tens of thousands of kids water safety skills to help prevent childhood drowning.

Research from the American Academy of Pediatrics in 2021 showed that drowning is now the leading cause of death in children aged 1 to 4 years. Additionally, drowning continues as the second leading cause of unintended injury related to death in children aged 4 to 14 years, and third for ages 15 to 17 years. The World Health Organization reported that drowning accounts for 7% of all injury related deaths worldwide.

Showing the benefits of life saving swim education, the AAP also showed that participation in formal swimming lessons can reduce the risk of drowning for children ages 1 to 4 by 88%. Due to the ongoing COVID-19 pandemic, there continues to be a lifeguard and swim instructor shortage, making finding swimming lessons difficult. The World Waterpark Association urges parents to find local WLSL Host locations at WLSL.org and even after enrollment in swim lessons, to back up that training with constant adult supervision whenever a child is in or near the water.

World's Largest Swimming Lesson™ (#WLSL2022) takes place Thursday, June 23rd on five continents to battle leading cause of death for kids ages 1-4. Cision PR Newswire. Press release. Published June 21, 2022. Accessed June 23, 2022. 

https://www.prnewswire.com/news-releases/worlds-largest-swimming-lesson-wlsl2022-takes-place-thursday-june-23rd-on-five-continents-to-battle-leading-cause-of-death-for-kids-ages-1-4-301571498.html

The annual WLSL event brings together hundreds of swim instructors across to world to hold life-saving swim lessons in the hopes of preventing childhood drowning. 

Annual World’s Largest Swimming Lesson event hosted today in 14 countries and 42 US states

A study by Orbis International found that children with myopia experienced significantly higher levels of depression and anxiety than their peers without vision impairment.

In addition, findings indicated that surgery to correct strabismus significantly improved symptoms of depression and anxiety in children.

The study, which was published in the peer-reviewed journal 

, builds our understanding of the link between vision impairment, strabismus and children's mental health. While there is an existing large body of work focused on the impact of vision impairment on depression and anxiety in adults, studies investigating mental health in children with vision impairment are few and have not previously been reviewed in this comprehensive way.

Globally, an estimated 19 million children below the age of 14 years have vision impairment or are blind. While the prevalence of eye disorders, depression and anxiety is lower among children than adults, these conditions pose a greater risk to children when not identified and corrected promptly. The lifetime burden in terms of years affected by these conditions is also much higher.

Orbis's new study posits that the mental health of children with vision impairment may be adversely affected because they tend to participate in fewer physical activities, have lower academic achievement and are more socially isolated. Further, common vision conditions like strabismus can also negatively impact children's development and maturation, affecting not just their appearance, which can in turn affect their confidence and feelings of social belonging, but also their ability to carry out certain activities and their state of mind.

"Resilient mental health is an important requirement for children to thrive. As we see in the newly published research findings, this can be negatively impacted if a child has a vision impairment," says Prof. Nathan Congdon, Director of Research at Orbis International. "With this research, Orbis has pulled together for the first time the kind of convincing evidence that can help spur governments to action on children's vision. These results are all the more compelling because the very strongest evidence we found for impact on mental health was among kids with near-sightedness, treatable with a simple pair of glasses."

This research has profound implications for health care planners when allocating resources and designing interventions to curb vision impairment. For example, in some countries, strabismus surgery is seen as a cosmetic procedure and excluded from insurance coverage, forcing families to pay out-of-pocket. These barriers could deter patients of low socioeconomic status from seeking treatment and keep the mental health benefits of corrective surgery out-of-reach. More accessible eye care treatments will improve children's mental health and overall well-being.

Originally published on our sister brand, 

Children with vision impairment more likely to suffer from depression, anxiety

Medicare Part D would have saved $3.6 billion if it purchased 77 generic 

 at prices charged by billionaire entrepreneur 

The findings “suggest that Medicare is overpaying for many generic drugs,” said the study, “Potential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company,” or MCCPDC, published June 21 in the 

, a journal of the American College of Physicians.

 suggested policy reforms that could make generic drugs more affordable.

“Although direct-to-consumer private companies like MCCPDC may offer savings for some patients on select drugs, policy reforms that improve price transparency, increase competition for high-cost generic drugs, prevent annual price increases, and limit pharmacy and distribution costs could increase affordability of essential generic medicines for all Americans,” said the study, led by corresponding author Hussain S. Lalani, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School in Boston.

The results “highlight inefficiencies in the existing generic pharmaceutical distribution and reimbursement system, which includes wholesalers, pharmacy benefit managers, pharmacies, and insurers,” the study said.

 that estimated the supply chain retains 64% of every dollar spent on generic drugs, compared with 25% of every dollar spend on brand-name drugs before rebates. Generic drugs have lower ingredient and manufacturing costs than brand-name drugs, so dispensing fees represent a greater share of the price.

The study noted MCCPDC sets prices at the cost of ingredients and manufacturing plus a 15% margin, a $3 dispensing fee, and a $5 shipping fee.

It did not mention the current economy with skyrocketiing 

, or the business goals of Cuban, the outspoken owner of the 

 NBA team and cohost of the ABC television show “Shark Tank.”

Cuban and MCCPDC cofounder Alex Oshmyansky started the company in 2016 with a “pledge to provide radical transparency in how we price our drugs,” according to its website.

“Our goal is that everyone should be able to afford their medicine. Everyone should know what it cost to make their medicine. Everyone should feel the price they paid for their medicine was fair,” the MCCPDC website said.

MCCPDC sells 109 generic medications. The study compared that company’s prices and Medicare Part D spent for 89 of those; it excluded 20 with multiple dosage forms, such as cream and ointment, because prices by ingredient were not comparable.

Researchers calculated prices in 2022 U.S. dollars, with use data based on 2020, the most recent Medicare data available.

Among the available savings for buying maximum quantities of drugs:

$1.9 billion for ingredients and manufacturing

$402 million for the 15% margin of the MCCPDC

Savings were greater when purchasing drugs in larger quantities to minimize fees. Even buying the minimum quantities of drugs, Medicare would have saved $1.7 billion on 42 of the 89 drugs. In that scenario, shipping would have cost $872 million and pharmacy fees would have cost $523 million, making up a higher percentage of the total spending.

The study included a chart with the top 10 generic drugs with the highest estimated savings, with drug name and dosage form; Medicare Part D vs MCCPDC prices per 90 count; estimated Medicare Part D spending; and estimated MCCPDC savings:

Esomeprazole, oral capsule; $160 vs $17; $327 million Medicare Part D spending; $293 million estimated savings

Rosuvastatin, oral tablet; $39 vs $19; $469 million Medicare Part D spending; $241 million estimated savings

Aripiprazole, oral tablet; $187 vs $22; $263 million Medicare Part D spending; $233 million estimated savings

Duloxetine, oral capsule; $39 vs $9; $295 million Medicare Part D spending; $226 million estimated savings

Losartan-hydrochlorothiazide, oral tablet; $62 vs $14; $208 million Medicare Part D spending; $160 million estimated savings

Ezetimibe, oral tablet; $59 vs $13; $198 million Medicare Part D spending; $153 million estimated savings

Memantine, oral tablet; $50 vs $13; $187 million Medicare Part D spending; $141 million estimated savings

Tizanidine, oral tablet; $35 vs $10; $194 million Medicare Part D spending; $141 million estimated savings

Colchicine, oral tablet; $381 vs $25; $140 million Medicare Part D spending; $131 million estimated savings

Bupropion, oral tablet, extended release; $56 vs $16; $183 million Medicare Part D spending; $131 million estimated savings

Entrepreneur beats prices of supply chain wholesalers, PBMs, pharmacies, and insurers.

Medicare could save billions buying generics through Mark Cuban prescription drug company

The American Academy of Pediatrics (AAP) recently announced the launch of a new public health campaign to educate caregivers about the benefits of getting COVID-19 vaccines for all ages.

“Parents have been waiting a long time to vaccinate their youngest children so they can get the same protection against serious illness and hospitalization that the rest of us have been offered,” said AAP president Moira Szilagyi, MD, PhD, FAAP. “The months, and even years, of worry have been especially hard on these families as they adjusted their activities through the pandemic to keep their children safe. COVID-19 vaccination for this age group is one more tool parents now have in their toolbox to help their children thrive.”

With the FDA approval of both the Moderna and Pfizer-BioNTech COVID-19 vaccines for children aged 6 months and older, the AAP highlighted the need for parents and caregivers to contact their pediatricians with any questions they may have and to learn how to access the vaccines.

For children under the age of 5, families or caregivers can choose to get either the 2-dose Moderna vaccine or 3-dose Pfizer-BioNTech vaccine. After the FDA approval, the academy updated its policy statement on COVID-19 vaccines for those aged 6 months and older to reflect the availability of safe and effective vaccines. They recommend all children aged 6 months and older receive a COVID-19 vaccine authorized for their age group—including a primary series and boosters—unless contraindicated.

“Both vaccines are safe and offer good protection against the most severe effects of the virus,” said Yvonne A. Maldonado, MD, FAAP, chair of the AAP Committee on Infectious Diseases, in the release. “Millions of children and teens have been vaccinated, and we know a lot about how safe and effective the vaccines are in older age groups. The data are also very reassuring in this youngest age group.”

In the release, the AAP urged one-on-one conversations with doctors as the best way to get factual information on the vaccine from a trusted source. The public service announcement (PSA) will encourage those conversations, according to the academy. The announcement will be launched in both English and Spanish encouraging patients to talk with their child’s pediatrician about the vaccine. The PSAs are currently available in both languages on YouTube. Additionally, TV and radio outlets can access them via Extreme Reach starting on June 27.

As COVID-19 vaccines become available for children ages 6 months to 4 years, AAP urges families to reach out to pediatricians to ask questions and access vaccine. American Academy of Pediatrics. Published June 21, 2022. Accessed June 23, 2022. 

https://www.aap.org/en/news-room/news-releases/aap/2022/as-covid-19-vaccines-become-available-for-children-ages-6-months-to-4-years-aap-urges-families-to-reach-out-to-pediatricians-to-ask-questions-and-access-vaccine/

Recently, the AAP announced the launch of a public health campaign to educate caregivers on the benefits of vaccinating all ages. 

AAP launches PSA on COVID-19 vaccine education for youngest children

American Diabetes Association 82nd Scientific Sessions

 could increase risk of type 1 diabetes in young adulthood.

Although typically associated with increased risk of type 2 diabetes, the study leveraged data from more than 1.4 million adolescent patients and found an increased risk of type 1 diabetes among adolescents with overweight and obesity, with a graded increase for type 1 diabetes observed across BMI categories.

“Our findings have public health implications. The prevalence of adolescent obesity is rising worldwide at an alarming rate, with dire projections for the near future,” wrote investigators.

Led by Gilad Twig, MD, PhD, of Tel Aviv University, along with colleagues from other Israel-based institutions and Canada, the study was designed to estimate potential associations between BMI in late adolescence and incident type 1 diabetes in late adulthood. With this in mind, investigators designed their study as a retrospective cohort study using data from a pair of data sources aggregating information from patients in Israel. The first database provided investigators with information on all Israeli adolescents ages 16-19 years, unless they had a history of dysglycemia, who underwent medical valuation in mandatory military conscription from 1996-2016. The second database was the Israeli National Diabetes Registry, which investigators used to assess the incidence of adult-onset type 1 diabetes.

The primary outcome of interest for the investigators’ analysis was the incident of type 1 diabetes, which was defined as use of short-acting insulin that was initiated within 1 year of diabetes onset without the prescription of other antiglycemic properties. For the purpose of analysis, weight and height at age 17 were used in the investigators’ Cox proportional hazards model, which assessed BMI as both a categorical and continuous variable.

Overall, investigators obtained data related to 1,426,362 individuals without type 1 diabetes in adolescence and a total of 777 incident cases of type 1 diabetes during 15,810,751 person-years of follow-up. Investigators pointed out the mean age at diagnosis among these patients was 25.2±3.9 years and initial analysis indicated BMI was associated with incident type 1 diabetes.

In models adjusted for age, sex, and sociodemographic variables, a graded increase in risk was observed across BMI categories. Specifically, the hazard ratios for incident type 1 diabetes were 1.05 (95% CI 0.87-1.27) for the 50th to 74th BMI percentiles, 1.41 (1.11-1.78) for the 75th to 84th BMI percentiles, 1.54 (1.23-1.94) for adolescents with overweight, and 2.05 (95% CI, 1.58-2.66) for adolescents with obesity. Of note, overweight was considered a BMI in the 85th to 94th percentiles and obesity was considered being among the 95th percentile or greater. Further analysis suggests a single standard deviation increase in BMI was associated with a 25% increase in risk of type 1 diabetes (HR, 1.25 [95% CI, 1.17-1.32]).

“Our study adds to the growing evidence regarding the health hazards associated with adolescent obesity. Not only is adolescent obesity correlated with adult-onset of type 2 diabetes as previously reported, but also with type 1 diabetes,” investigators noted. “Further work needs to be done to unravel this association so that we can better address the full spectrum of risks posed by the obesity epidemic or identify common environmental factors affecting both weight and type 1 diabetes.”

Obesity in late adolescence and incident type 1 diabetes in young adulthood

,” was presented at ADA 2022 and published in 

New research suggests adolescent obesity could increase risk of type 1 diabetes in young adulthood.

Obesity in adolescence could raise type 1 diabetes risk in adulthood

Today, Merck announced the US Food and Drug Administration (FDA) approval of an expanded indication for its pneumococcal 15-valent conjugate vaccine (Vaxneuvance; Merck) to include children aged 6 weeks through 17 years old. The active immunization is now indicated for the prevention of invasive disease caused by 

7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older. This approval follows the December 2021 FDA Priority Review acceptance of Merck’s supplemental application.

Invasive pneumococcal disease (IPD) is an infection caused by the bacterium 

, or pneumococcus, according to the press release announcing the approval. Of the approximately 100 different types of 

, a smaller number of serotypes are responsible to IPD in children including serotypes 3, 22F, and 33F, among others. Examples of IPD include bacteremia—infection in the blood—and meningitis—infection of the coverings of the brain and spinal cord—which can result in long-term neurological complications. IPD can lead to hospitalization or death and children under the age of 2 are particularly vulnerable.

This FDA approval is based on data from 7 randomized, double-blind clinical studies examining the safety, tolerability, and immunogenicity of the company’s pneumococcal 15-valent conjugate vaccine in infants, children, and adolescents.

Following a 4-dose pediatric series in the pivotal study, it was shown to be noninferior to the currently available 13-valent pneumococcal conjugate vaccine (PCV13) based on “serotype-specific immunoglobulin G (IgG) geometric mean concentrations (GCMs),” according to the release. Additionally, a secondary analysis examining immune responses for the 15-valent vaccine showed that a 4-dose pediatric series were superior to PCV13 for shared serotype 3 and 2 serotypes unique to the pneumococcal 15-valent conjugate vaccine, 22F and 33F. Merck noted that randomized controlled trails assessing clinical efficacy of the pneumococcal 15-valent conjugate vaccine vs PCV13 have not been conducted.

Data supports the use of the vaccine concomitantly with other routine pediatric vaccines commonly administered and its use in special populations like pre-term infants, children living with HIV or sickle cell disease, according to the release.

“Despite decreases in incidence of invasive pneumococcal disease in children, certain key serotypes continue to cause serious illness that can lead to death in children under the age of 5, with serotypes 3, 22F, and 33F responsible for more than a quarter of all invasive pneumococcal disease cases in this population,” said Steven Shapiro, DO, chairman, Department of Pediatrics, Jefferson Abington Hospital, and investigator for the PNEU-PED trial. “With the robust clinical data supporting Vaxneuvance and this FDA approval, Vaxneuvance will be an important new option to help advance protection for children.”

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) is expected to meet today on the use of the pneumococcal 15-valent conjugate vaccine in pediatric populations.

US FDA approves Merck’s Vaxneuvance (pneumococcal 15-valent conjugate vaccine) for the prevention of invasive pneumococcal disease in infants and children. Merck. Published June 22, 2022. Accessed June 22, 2022. 

https://www.merck.com/news/u-s-fda-approves-mercks-vaxneuvance-pneumococcal-15-valent-conjugate-vaccine-for-the-prevention-of-invasive-pneumococcal-disease-in-infants-and-children/

The FDA today approved the pneumococcal 15-valent conjugate vaccine for the prevention of invasive pneumococcal disease in infants and children. 

FDA approves Merck pneumococcal 15-valent conjugate vaccine for ages 6 weeks through 17 years

Despite an emphasis in recent years on improving the uptake of new diabetes technologies, new research presented at the 

Endocrine Society’s annual meeting (ENDO 2022)

 paints a grim picture related to the uptake of insulin pumps in pediatric patients with 

 across different racial and ethnic backgrounds.

An analysis of data from the SEARCH for Diabetes in Youth study, results of the study detail the increase in CGM uptake from 2001-2019, with results providing evidence of significant improvements in terms of overall uptake, but also pointing to a lack of improvements among certain patient groups, including Black patients, those using public insurance, and those with lower household incomes.

"We found there is a huge divide in who actually has access to insulin pumps," said lead investigator Estelle Everett, MD, MHS, of the David Geffen School of Medicine at University of California, 

. “Racial-ethnic minority groups and those of lower socioeconomic status still have unequal access to this very beneficial management tool. This is really concerning because these groups have more challenges managing their diabetes and have higher risk of complications. Changes in the approach to diabetes care and health policies are needed to ensure equal access to this life-changing diabetes device."

Nearly 50 years removed from the invention of the first insulin pump, the conversation has shifted from the potential benefits to eliminating barriers preventing optimized uptake of these devices. As the prevalence of pump use has increased, an understanding of contemporary barriers to insulin pump access stands to have a tangible impact on patient-level care and diabetes management as a whole. With this in mind, Everett and a team of colleagues from institutions across the US conducted the current study with the intent of evaluating how inequities in insulin pump use among pediatric patients with type 1 diabetes may have increased or diminished over time.

To do so, investigators designed their study to leverage data from the SEARCH for Diabetes in Youth study in order to perform a serial cross-sectional analysis to assess changes in insulin pump between 2001-2005, 2006-2010, 2011-2015, and 2016-2019. Patients of interest for the analyses were participants aged 19 years or less with type 1 diabetes. Subgroups of interest for the analysis were defined by racial and ethnic group, health insurance, household income, and formal parental education. For the purpose of analysis, multivariable generalized estimating equations with a binomial distribution were used to assess the probability of insulin pump use, and models were further adjusted for the other predictors, including age, diabetes duration, and clinic site, with clustering for individuals.

Initial analysis demonstrated the overall prevalence of insulin pump use had increased among pediatric patients with type 1 diabetes from 30% in 2001-2005 to 58.3% in 2016-2019. When compared to non-Hispanic White patients, a statistically significant increase in prevalence of pump use among Hispanic patients, with the adjusted odds ratio (OR) increasing from 0.08 (95% CI, 0.01-0.63) in 2001-2006 to 0.65 (95% CI, 0.48-0.87) in 2016-2019 (

=.004). However, the OR for Black patients (

=.439) did not change over the course of the study period.

In additional analyses, results demonstrated those with some high school education (OR, 0.38 [95% CI, 0.30-0.48]; 

) or a high school degree (OR, 0.69 [95% CI, 0.57-0.82]; 

=.894) were less likely to be using an insulin pump when compared to their counterparts with a bachelor’s degree or more and this did not change over time. When compared to their counterparts with private insurance, those with public health insurance were less likely to be using an insulin pump and this did not change over time (OR, 0.84 [95% CI, 0.68-1.03]; 

=.815). Investigators also pointed those with an annual household income below $25,000 (OR, 0.43 [95% CI, 0.34-0.54]; 

=.937), $25,000-$49,000 (OR, 0.57 [95% CI, 0.46-0.71]; 

=.870), and $50,000-$74,999 (OR, 0.80 [95% CI, 0.65-0.97]; 

=.821) were less likely to be using an insulin pump than those with an annual household of $75,000 or more and this did not change over the course of the study period.

“Inequities in access to diabetes technologies are unacceptable because everyone deserves the opportunity to improve their diabetes health," Everett added. "Studies that evaluate barriers and test interventions to improve technology access are needed to address the persistent inequities in diabetes care."

This study, “Assessing Longitudinal Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes,” was presented at ENDO 2022.

An analysis of the SEARCH for Youth in Diabetes details historic and contemporary disparities in insulin pump use for pediatric type 1 diabetes based on racial/ethnic background, household income, and insurance type.

In pediatric type 1 diabetes, race, income, insurance remain barriers to insulin pump use

While much attention is rightfully bestowed on the physiological toll of infectious disease epidemics and pandemics, 

mental health also can be significantly impacted

. The current COVID-19 pandemic is the most recent public health threat; however, over the past 2 decades we experienced severe acute respiratory syndrome (SARS), influenza A H5N1 (bird flu), Zika, Ebola, and Middle East respiratory syndrome (MERS). An international team of scientists conducted a meta-analysis of studies reporting on depression, anxiety, and insomnia as a result of these epidemics.

The scientists examined 283 different studies conducted during past epidemics and the current COVID-19 pandemic up until August 2020, encompassing data on nearly 950,000 individuals in 45 countries. Among the studies, 219 offered data on the prevalence of depression, 232 examined the prevalence of anxiety, and 46 delved into the prevalence of insomnia. The studies categorized the subjects as the general public, healthcare workers, university students, older adults, currently infected patients, people who had recovered from infection, and pregnant women.

The results from all of the studies were pooled. Overall, university students had the highest pooled prevalence of depression, with 43.3% affected (95% confidence interval [27.1-59.6]). This was followed by health care workers, who experienced depression at a rate of 37.7% (95% CI [33.5-41.8]), infected patients, whose pooled rate was 37.2% (95% CI [30.3-44.2]), and the general public, whose pooled rate was 34.9% (95% CI [31.7-38.0]). Somewhat lower were the pooled rates of depression for pregnant women (27.8%, 95 CI [22.8-32.8]) and older people (26.0%, 95% CI [18.5-33.4]).

When it came to anxiety, however, pregnant women scored highest, with a pooled rate of 43.3% (95% CI [23.3-63.3]). Health care workers came next, with a pooled rate of 35.9% (95% CI [31.5-40.3]). Following closely were the general public (35.1%, 95% CI [32.1-38.2]), university students (34.8%, 95% CI [23.5-46.1]), infected patients (34.3%, 95% CI [25.4-43.2]), and infection survivors (28.5%, 95% CI [13.0-44.0]). The lowest anxiety rates were seen in older people at 25% (95% CI [12.0-38.0]).

Sleep problems plagued university students at the highest rates, with a prevalence of 58.4% (95% CI [28.1-88.6]), followed by infected patients at 54.1% (95% CI [48.7-59.5]) and pregnant women at 53.3% (95% CI [38.7-67.9]). Survivors reported insomnia at a prevalence of 40.1% (95% CI [37.6-42.5]), while health care workers reported insomnia at a rate of 39.3% (95% CI [31.1-47.4] and the general public reported it a rate of 29.7% (95% CI [24.4-34.9]).

Although health care workers had the second highest rates of depression overall, the scientists discovered that they had the lowest rates of moderate to severe depression at 18.8% (95% CI [16.2-21.3]). The researchers attributed this to a solid base of knowledge and effective coping strategies despite their greater levels of stress. University students had the highest rate of moderate to severe depression at 24% (95% CI [17.6-30.6]), while the general public experienced the highest prevalence of moderate to severe anxiety at 25% [95% CI [23.0-28.0]).

Analyzing the results, the scientists found that different populations had different propensities toward specific mental health conditions during epidemics, such as university students scoring high in anxiety and depression, pregnant women tending toward anxiety, and university students and infected patients experiencing insomnia. They concluded that risk factors included being female, having physical or psychiatric disorders, being infected or having family or friends infected, having close contact with infected patients, and being highly concerned about epidemics in general.

On the flip side, the scientists found that participants who indicated they engaged in regular exercise and had a solid base of friendships and relationships tended to score lower on measures of depression and anxiety. “Frequent and high intensity exercise reduces inflammation, which may further help relieve mental health symptoms,” they wrote. “Perceived support from the social environment may help [people] resist and effectively cope with the risk factors related to mental health.”

Limitations of this study include a lack of data collected after August 2020; the exclusion of studies measuring outcomes more than 6 months after infection; the self-reported nature of the symptoms; and the absence of less common mental health conditions encompassing psychosis and cognitive impairments.

 were more prevalent during the COVID-19 pandemic than during past epidemics, possibly due to more severe symptoms in those affected, faster spread of the virus, and a much higher level of information dissemination, the team said.

The stress of enduring an infectious disease pandemic expresses itself in a variety of mental health conditions, but the likelihood of experiencing particular symptoms depends on who you are.

Mental health during pandemics: prevalence and risk factors

In the updated academy policy statement, “Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment,” they emphasized the need for infants to sleep on their backs on flat, noninclined surfaces without soft bedding. Additionally, they detailed the risks of bed-sharing, according to the press release announcing the updates.

Approximately 3,500 infants are victims of sleep related infant deaths annually, according to the AAP, with research indicating that sleep-related death can occur when an intrinsically-vulnerable to SIDS infant is placed in an unsafe sleep environment.

This is the first update to the safe infant sleep recommendations since 2016 and will be published in the July edition of 

, and online on June 21, 2022. Accompanying the statement, AAP will also supply a technical report that provides evidentiary value to the recommendations given.

The report highlighted the 67 times higher risk of sleep related infant deaths when sleeping with someone on a couch, armchair, or cushion and 10 times higher risk when sleeping with someone who is impaired due to fatigue, using sedating medications, or substances like alcohol, illicit drugs, or smoking. As a baseline, the risk of sleeping on the same surface as someone else as an infant under 4 months of age increases infant death by 5 to 10 times.

“We’ve made great strides in learning what keeps infants safe during sleep, but much work still needs to be done,” said Rachel Moon, MD, FAAP, professor of pediatrics at the University of Virginia School of Medicine and lead author of the statement and technical report, generated by the AAP Task Force on Sudden Infant Death Syndrome and the AAP Committee on Fetus and Newborn, in the release. “A baby’s death is tragic, heartbreaking and often preventable. If we’ve learned anything, it’s that simple is best: babies should always sleep alone in a crib or bassinet, on their back, without soft toys, pillows, blankets, or other bedding.”

To reduce these risks, the AAP recommends:

Infant should sleep on a firm, flat, and noninclined surface that is marketed exclusively for sleep.

Do not use sitting devices—car seats, strollers, swings, infant carriers, infant slings— for routine sleep.

Breastfeeding for at least 2 months partially or exclusively reduces the risk of sleep related infant death.

Parents should sleep in the same room but not the same bed as baby.

Avoid parent and infant exposure to illicit substances.

Pacifier use is associated with reduced risk.

Avoid use of commercial devices that claim to reduce risk of SIDS.

Supervised tummy time is recommended while awake.

There is no evidence that swaddling reduces the risks of SIDS.

American Academy of Pediatrics updates safe sleep recommendations: back is best. American Academy of Pediatrics. Published June 21, 2022. Accessed June 21, 2022. 

https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-updates-safe-sleep-recommendations-back-is-best/

This week, the American Academy of Pediatrics updated their safe sleep recommendations and released the 2022 bright futures/AAP periodicity schedule for preventive pediatric health care. In part 1, we focus on the updates in sleep recommendations. 

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Mental health during pandemics: prevalence and risk factors

This week from the AAP: updated infant sleep recommendations