Miranda Hester

With the rise of vaping and electronic cigarette use among teenagers, there has been greater scrutiny to the role that marketing has played in the increasing use. A 

 examines the impact of loosened restriction on marketing in Canada.

Investigators sent repeated cross-sectional surveys to 12,004 Canadian adolescents who were aged 16 to 19 years. The surveys were completed online in 2017, 2018, and 2019. They used the results to look at the impact on exposure to marketing and use as well as to examine the difference between provinces with varying restrictions.

In 2017, 13.6% of the teenagers said that they noticed e-cigarette promotion either often or very often. By 2019, the percentage had roughly doubled to 26.0%. The researchers found that overall marketing exposure was found to be more prevalent in the provinces that had fewer restrictions. Teenagers who reported often noticing marketing were also more likely to report they had vaped in the past 20 days; had vaped in the past week; and had vaped ≥20 days in the past month. Participants in provinces with fewer restrictions had a higher prevalence of vaping within the past 30 days and in the past week.

The investigators concluded that exposure to vaping marketing can be tied to an increased prevalence of vaping. Further they concluded that more restrictions placed on marketing appeared to be tied to lower exposure to marketing as well as a lower prevalence of vaping.

1. Hammond D, Reid JL, Burkhalter R, Rynard VL. E-cigarette marketing regulations and youth vaping: cross-sectional surveys, 2017–2019. 

. 2020;146(1):e20194020. doi:10.1542/peds.2019-4020

Articles

Marketing for traditional cigarettes has long been curtailed to stem smoking, but the regulations haven’t always caught up with the marketing needs for vaping. A report examines the impact of promoting vaping on the prevalence of vaping.

The impact of marketing on adolescent vaping behavior

Neonatal intensive care unit (NICU) utilization hasn’t been fully studied. A 

 examines the trends in a large integrated health care system.

Investigators used data from electronic medical records from the Kaiser Permanente Southern California health care system. The study’s participants included every woman who gave birth in a Kaiser Permanente Southern California hospital and her newborn from January 2010 to December 2018. The rates of NICU admission, NICU patient-days, readmission rates, and mortality rates were measured in the total population; newborns with gestational age (GA) 35 weeks or greater and a birth weight (BW) 2000 grams or more (high GA and BW group); and within the remaining newborns (low GA and BW group).

During the study period, there were 320,340 births. During the period, the risk-adjusted NICU admission rate decreased from an average of 14.5% to 10.9%. Ninety-two percent of the change was linked with changes in the care given to newborns in the high GA and BW group. Overall, the number of risk-adjusted NICU patient-days per birth decreased from an average of 1.50 patient-days to 1.40 patient-days and 70% of the change was in newborns in the high GA and BW group. There was no change in the unadjusted 30-day readmission rates and mortality rates.

The researchers concluded that NICU utilization had decreased over the study period, but it did not lead to an increase in readmissions or mortality. They said that further investigation into the effect of quality improvement programs on NICU utilization are merited.

1. Braun D, Braun E, Chiu V et al. Trends in neonatal intensive care unit utilization in a large integrated health care system. 

. 2020;3(6):e205239. doi:10.1001/jamanetworkopen.2020.5239

How are neonatal intensive care units (NICUs) being utilized in the Kaiser Permanente Southern California health care system? A new report investigates.

Examining NICU utilization trends

 The guidance stresses that the organization strongly urges schools to start in the fall with students being physically present.

The guidance recommends that all re-entry policies follow certain principles:

Policies should be flexible and nimble to better respond to new information

Develop strategies that can be adapted according to the level of viral transmission found in the community

All policies should be practical and appropriate for the students’ developmental stage.

Considerations and accommodations should be made for vulnerable populations of students

No student should be excluded from school, unless the exclusion is required to adhere to public health mandates

Policies should be created with the intent to support the overall health of student and families. All policies should communicated in languages other than English, as needed.

The guidance also provides information on physical distancing, cleaning, mental health of staff, and other considerations.

1. American Academy of Pediatrics. COVID-19 planning considerations: guidance for school re-entry. 

. Published June 25, 2020. Accessed July 1, 2020. 

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools

The American Academy of Pediatrics (AAP) has strongly advocated that schools open in the fall with students being physically present.

AAP advocates for in-school education in the fall

The US Food and Drug Administration has approved Fintepla (fenfluramine) from Zogenix, Inc., which is a Schedule IV controlled substance, for treating seizures associated with Dravet syndrome in children aged 2 and older.

 Seizures in children with Dravet Syndrome are often severe, even with medical treatment.

Two studies were used to show the efficacy of the drug on treating seizures. The studies included 202 participants aged 2 to 18 and both examined the change from baseline in the frequency of convulsive seizures. Participants treated with fenfluramine were found to have greater reductions in the frequency of seizures than the participants who were given a placebo. The reduction was frequently seen by 3 to 4 weeks of treatment and mostly consistent over a 14- to 15-week treatment cycle.

The drug will be required to have a boxed warning that says fenfluramine is linked to both valvular heart disease (VHD) and pulmonary arterial hypertension (PAH). Due to the risks, children who are prescribed the drug must have cardiac monitoring via echocardiograms performed before treatment, at a 6-month interval during the course of treatment, and once every 3 to 6 months after treatment. If VHD, PAH, or any other cardiac abnormality is seen, the risks and benefits of the drug must be considered. Due to the cardiac risks, the drug is only available under a risk evaluation and mitigation strategy (REMS). The plan requires both the health care professionals and the pharmacies dispensing the drug to be specially certified in the REMS. Patients must also be enrolled in it.

In addition to the risk of VHD and PAH, common adverse reactions found in the clinical study included drowsiness, constipation, decreased appetite, ataxia, gait disturbance, fatigue, diarrhea, increased blood pressure, drooling, fever, vomiting, status epilepticus, risk of falls, and upper respiratory tract infection.

The application was granted Priority Review. Fintepla was given an Orphan Drug designation.

1. US Food and Drug Administration. FDA approves new therapy for Dravet syndrome. US Food and Drug Administration. Published June 25, 2020. Accessed June 29, 2020.

 https://www.fda.gov/news-events/press-announcements/fda-approves-new-therapy-dravet-syndrome

The US Food and Drug Administration (FDA) approves Fintepla (fenfluramine) through Priority Review.

Author | Miranda Hester

Articles

The impact of marketing on adolescent vaping behavior

Examining NICU utilization trends

AAP advocates for in-school education in the fall

FDA approves Fintepla for treatment of Dravet Syndrome