Thursday, October 19, 2023

Parents of toddlers are getting facts about increasingly popular nut milks and dairy substitutes from nonmedical influencers and bloggers

In study of most Influential bloggers writing about milks substitutes, about half have no medical credentials

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.— Parents of young children under age 5, interested in alternatives to dairy milk, like nut and rice milks, are finding information online, and almost half of the most popular bloggers on this topic were neither dieticians or medical professionals, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.

Researchers of the abstract, “Milk Mania: Analyzing Online Information and Perception regarding Milk Alternatives for Toddlers,” studied the 145 most popular blogs for parents of children under age 5 on the topic of milk alternatives. They found that while many parents are seeking information online on the topic of alternatives for milk, 47% of the most popular bloggers on this topic were laypersons without medical training. Of the other bloggers, 32% were nutritionists or dieticians, 12% physicians or nurses, 5% holistic providers, and 4% PhDs and scientists.

“The large number of online blogs discussing dairy milk alternatives for toddlers suggests that this is an issue of great interest to caregivers, who may turn to blogs that provide unsupported information and nutritional recommendations about milk substitutes,” said lead author Kara Sangiuolo, a medical student at Albert Einstein College of Medicine. “I think that there is a major opportunity for pediatricians and pediatric nutritionists to enter the online space and provide more accurate, consistent information to support caregivers looking to transition their toddlers away from dairy milk.”

Of the popular blogs studied, bloggers were most likely to recommend soy milk (37%) and pea milk (17%) as the best milk alternatives, and the most common alternatives referenced were soy milk (84%), almond milk (79%), and rice milk (65%). However, 14 blogs recommended making homemade milks for toddlers, and two blogs claimed homemade milk as the best milk alternative.

“Several blogs included unsupported recommendations such as making unfortified homemade milks for growing toddlers. The lack of consistent information across blogs was concerning, and only half of all blogs discussed the nutrient compositions of dairy milk alternatives,” Sangiuolo said. “This reveals the need for greater dissemination of accurate nutritional recommendations regarding dairy milk alternatives from pediatricians and nutritionists. This information can be delivered online to reach caregivers and better promote the healthy development and nutrition of toddlers in early childhood.”

This research was supported by Cohen Children’s Medical Center in the Division of Developmental and Behavioral Pediatrics and with the support of Dr. Andrew Adesman and Dr. Charles Schleien.

Study author Kara Sangiuolo, is scheduled to present her research, which is below, Sunday, Oct. 22, 2023, from 10-10:45 a.m. as part of the Council on Early Childhood Session. To request an interview with the authors, contact Ms. Sangiuolo at ksangiuolo@northwell.edu.

In addition, Ms. Sangiuolo is among highlighted abstract authors who will give a brief presentation and will be available for interviews during a press conference Sunday, Oct 22, from 8-9 a.m. in the National Conference Press Room, 102 AB During the meeting, you may reach AAP media relations staff in the press room.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

# # #

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visits. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

ABSTRACT

Program Name: AAP National Conference & Exhibition

Submission Type: Council on Early Childhood

Abstract Title: Milk Mania: Analyzing Online Information and Perception regarding Milk Alternatives for Toddlers

Kara Sangiuolo

Fairfield, CT, United States

Alternatives to traditional dairy milk (i.e., oat, almond, soy) have become increasingly popular in recent years. The quality and content of information regarding the nutritional value of milk alternatives (MA) for toddlers is currently unknown, and it is unclear which factors influence caregivers’ decisions to switch toddlers to MA. This study seeks to highlight trends in potential benefits and drawbacks of MA discussed on online blogs to help pediatricians effectively counsel caregivers regarding proper nutrition in early childhood.

The top 200 MA blogs related to children under 5 years old were identified by a Google search of phrases (i.e., "milk substitutes for kids"). The following data were collected: a) blog name, b) writer credentials, c) concerns about MA, d) mentioned allergies/intolerances, e) MA types/nutrient composition, f) MA pros/cons, g) best MA claimed. Descriptive analysis was conducted in R.

A total of 145 blogs were analyzed. Across blogs, 32% were written by nutritionists/dieticians, 12% physicians/nurses, 5% holistic providers, 4% PhDs/scientists, and 47% laypeople. Specific types of MA mentioned included soy (84%), almond (79%), rice (65%), coconut (60%), oat (54%), hemp (43%), goat (37%), pea (35%), general plant-based milk (11%), and other milks (i.e., homemade, potato) (28%) (Figure 1). Concerns for switching to MA included: growth/development issues (27%), nutritional value (75%), and taste (21%). 83% of blogs mentioned allergies/intolerances (i.e., dairy, nut, soy, gluten); 54% described MA nutrient compositions. Common positive comments regarding MA included: proper calcium content (n=164), proper vitamins/minerals (n=157); negative comments included: lower protein content (n=297), lower fat content (n=207). Across blogs, the most commonly claimed “best” MA were soy (37%) and pea (17%) (Table 1). Of blogs discussing soy milk, 29% mentioned risk of isoflavones/phytoestrogens; 23% of blogs discussing rice milk mentioned risk of arsenic. 14 blogs recommended making homemade milks, and 2 blogs claimed homemade milks as the best MA (i.e., “homemade [is] always better than store bought”; “make a more nutritious, fuller bodied and flavored milk”).

Online blogs provide a large source of information for caregivers seeking to switch their toddlers from dairy milk to MA. While a portion of blogs were authored by medical professionals, nearly half were written by laypeople lacking the proper training necessary to counsel others regarding MA or pediatric nutrition. The lack of consistency in information across blogs was concerning, revealing the need for greater dissemination of accurate information and pediatric recommendations regarding MA from medical professionals. Additionally, unsupported recommendations such as making unfortified homemade milks presents significant concern for growing toddlers. It is imperative that pediatricians and nutritionists have a greater online presence in order to guide MA-related recommendations and ensure the healthy development and nutrition of toddlers in early childhood.

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Parents of Toddlers Are Getting Facts About Increasingly Popular Nut Milks and Dairy Substitutes from Nonmedical Influencers and Bloggers

ARTICLE PUBLICATION DATE

20-Oct-2023

Social media contributing to poor body image among teenaged athletes, associated with dropping high school sports 

Surveys show teenaged girls are quitting at higher rates 

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.— High school sports participation sets boys and girls up with healthy habits that can lead to healthier lives, and body image issues caused by social media may be contributing to teenagers making the decision to quit, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.  

Researchers who wrote the abstract, “The Effects of Body Image, Social Media and Gender Roles on Sports Attrition,” surveyed 70 current or past athletes, ages 8-18, in local athletic organizations or from sports medicine clinics. Researchers found that many teenagers were quitting because they felt they “didn’t look right for the sport” based on images seen in media and social media. 

“The benefits of youth sports participation are numerous and uncontested. Motor competence in children is positively associated with cardiorespiratory fitness, muscular strength, muscular endurance, and a healthy weight status,” said lead study author Cassidy M. Foley Davelaar, DO, FAAP, CAQSM, Nemours Children's Health, Florida Department of Orthopedics and Sports Medicine Physician, associate professor at the University of Central Florida College of Medicine, and medical provider of the United States Tennis Association. “Negative body image and poor self-esteem affect physical activity in a similar way to poor perception of skills.” 

Some of the reasons that the 70 teenagers surveyed reported for quitting sports were poor body image from social media comparisons, coaching, and competitive pressure. Body image concerns were slightly less common among the boys than the girls. The study found that 44% of males thought they looked better than the ideal and 46% of females thought they looked worse than the ideal. Approximately 70% of children will drop out of sports by age 13 years, and girls drop out of sports at a rate two times greater than that of boys. 

“In the surveys, women tend to be a bit more unhappy or uncomfortable with their body image than men. I believe this means we need to look critically at the messages we are sending female athletes as to what an athlete looks like to be more inclusive, body positive and realistic. Why are there not real athletes modeling sports clothes and why are only the top athletes seen in images?" Dr. Foley Davelaar said. “We need to demonstrate to these younger generations a more diverse, inclusive and imperfect image of what it means to be athletic in order to invite them into that world. With this study, we hope to shed light on the real reasons for sports attrition to keep more kids involved.” 

Dr. Foley Davelaar is scheduled to present her research, which is below, from 3:35 PM – 3:45 p.m. Sunday, Oct. 22, 2023, during session H3020. To request an interview with the author, contact Jennifer Reardon at Jennifer.Reardon@nemours.org or 302-300-2257. 

In addition, Dr. Foley Davelaar is among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1 p.m. Saturday, Oct. 21 in the National Conference Press Room, 102AB. During the meeting, you may reach AAP media relations staff in the press room. 

# # #

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

ABSTRACT

Program Name: AAP National Conference & Exhibition 

Submission Type: Council on Sports Medicine and Fitness 

Abstract Title: The Effects of Body Image, Social Media and Gender Roles on Sports Attrition

Cassidy Foley Davelaar 

Orlando, FL, United States 

Participation in sports helps children develop healthy dispositions and behaviors that carry over into adulthood. However, despite the benefits, 70% of children will drop out of sports by age 13 years. By age 14 years, girls drop out of sports at a rate two times greater than that of boys. The purpose of this study is to investigate the role of body image, social media, gender and cultural bias, injury, Covid-19 and other influences on sports attrition. 

Survey questions were adapted from validated surveys and validated prior to distribution. Responses were obtained from current or past athletes, 8-18 years of age, in local athletic organizations or from sports medicine clinic. 

There was a 97% survey response rate (70/72). Quantitative self-reported data was analyzed using statistical analysis and qualitative data was analyzed through participants' free-text responses. Qualitative responses indicated the number one reason for sports attrition was coaching. Quantitative responses indicated more females than males quit, secondary to the competitiveness of the sport (35.5% vs 10.3%). There was a 65% correlation between those who answered, ‘I definitely agree’, to ‘I often compare my ability to play sports based on what I see on social media’, also marked yes to the question they have not joined a sport (chi-squared p< 0.001) (Table 1). Results indicated significant statistical correlation between screen time, physical activity, and body image. Participants who were less confident in their athletic abilities also ranked themselves as “less fit” on the body image silhouette scale than they perceived an athlete would be (Table 2). Covid-19 was not a main factor of sports attrition. 

The top reasons for sports attrition were poor body image from social media comparisons, coaching, and competitive pressure. Based on the results, parental understanding of the coach’s impact on youth’s interest in sports is paramount and ensuring coaches have appropriate certifications and training may significantly influence participation. Body dissatisfaction due to social media is a major issue currently facing our generation. Healthy discussions regarding exposure and body image in social media should be had in households as they play an integral role in a child’s decision to participate in sports. Inclusionary discussions and mental health concerns must be addressed. Coaches of female athletes must understand how to motivate a team without creating too much competitive pressure. As we returned to activities post Covid-19, most athletes returned as well. By identifying underlying causes of sports attrition, we hope to influence the atmosphere of youth sports, and bring joy and participation back to the game. 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

ocial Media Contributing to Poor Body Image Among Teenaged Athletes, Associated with Dropping High School Sports

ARTICLE PUBLICATION DATE

20-Oct-2023

Body image, social media and gender biases associated with kids quitting sports

Survey of youth athletes pinpoints causes of sports attrition

Reports and Proceedings

NEMOURS

ORLANDO, Fla. (October 20, 2023) – Body image issues, social media, gender biases and coaching styles may be causing young athletes to quit sports, according to research presented by Nemours Children’s Health at the 2023 American Academy of Pediatrics (AAP) National Conference & Exhibition.

Previous studies have found that 70% of children quit sports by age 13, and by age 14 girls quit at twice the rate of boys.

“Youth sports participation sets up children for a lifetime of healthy habits. Kids who participate in youth sports have improved cardiovascular fitness, muscular strength and endurance, and a healthy weight,” said lead study author Cassidy M. Foley Davelaar, DO, FAAP, CAQSM, of the Nemours Children's Health Department of Orthopedics and Sports Medicine, an associate professor at the University of Central Florida College of Medicine, and physician for the U.S. Tennis Association. “Parents need to know what drives kids to quit sports so they can support their children’s physical and mental health.”

The study surveyed 70 current or past athletes, ages 8-18, through local athletic organizations and sports medicine clinics. Its goal was to determine the various factors that motivate youth sports attrition. The reasons participants gave for abandoning sports were coaching issues, poor body image comparison from social media and the competitive pressure of the sport.

Based on these findings, the researchers note, parents need to understand coaches’ impact on youth sports participation and ensure that coaches have proper training to foster a positive environment for participation.

Results also indicated significant correlation between screen time, physical activity and body image. Many respondents say they left sports because they feel they don’t match performance or appearance expectations of athletes that they see in media and social media. Those who were less confident in their athletic abilities ranked themselves as “less fit” on the body image silhouette scale than they perceived an athlete would be. Girls were particularly prone to quitting due to competitive pressure.

“Coaches and parents need to know that their words and actions can influence kids’ participation in sports. By being mindful to not place any importance on looking a certain way, adults can encourage a more supportive, inclusive and welcome sports environment among children of all abilities." Dr. Foley Davelaar said. “We hope these findings will reveal the drivers of sports attrition so that adults can create a sports environment that brings joy and participation back to the game.”

# # #

About Nemours Children's Health
Nemours Children’s Health is one of the nation’s largest multistate pediatric health systems, which includes two free-standing children's hospitals and a network of more than 70 primary and specialty care practices. Nemours Children's seeks to transform the health of children by adopting a holistic health model that utilizes innovative, safe, and high-quality care, while also caring for the health of the whole child beyond medicine. Nemours Children's also powers the world’s most-visited website for information on the health of children and teens, Nemours KidsHealth.org.

The Nemours Foundation, established through the legacy and philanthropy of Alfred I. duPont, provides pediatric clinical care, research, education, advocacy, and prevention programs to the children, families and communities it serves. For more information, visit Nemours.org.

Marching band injuries strike a wrong note in emergency departments

Band members most often presented with ankle and knee injuries, but 6% of injuries are reported as mild head trauma

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.—Marching band is a physically demanding task and performance art that can lead to injury similar to organized athletic activities. New research shows that 70% of marching band-related injuries reported to emergency departments over a 9-year period occurred in high school-age females, with most injuries to the ankles and knees.

The abstract, “Marching Band Injuries In Children Presenting to Emergency Departments in the United States, 2012-2021: A Trebling Tale,” will be presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.

“Like their instruments, band members must be in tune with their bodies,” said Capt. Jacob R. Coene, MD, MC, USAF, researcher. “Coaches and parents should be educated on the risk of soft tissue injury and mild traumatic brain injury to help keep their band members marching to the beat of the drum.”

Researchers reviewed an estimated 20,335 marching band injuries reported to emergency departments between 2012-2021, according to data provided by the National Electronic Injury Surveillance System. Eighty-five percent of marching band injuries occurred in those 14-18 years of age, and mild traumatic brain injury comprised 6% of all encounters. Half of the injuries occurred in the lower body, with ankles and knees most often at risk.

Recognizing the risks, the National Athletic Trainer Association issued recommendations to keep marching band members safe in 2017, according to researchers. States including Texas and Oklahoma have begun to require pre-participation physicals for marching band members. Unlike other organized athletics, such as American football, soccer and cheerleading there is a lack of evidence describing injury trends in marching band, according to the abstract authors.

Of all marching band injuries, 98% were treated and released from the emergency department.

The authors did not receive financial support for this research beyond the salary support provided for the co-authors by the United States Department of Defense.

Capt. Jacob R. Coene, MD, MC, USAF is scheduled to present the abstract, which is below, from 4:45 pm-5:45 pm ET Sunday, Oct. 22, 2023, during session H3021. To request an interview with the authors, contact Robert Whetstone at robert.a.whetstone.civ@health.mil.

# # #

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

ABSTRACT

Program Name: AAP National Conference & Exhibition 

Submission Type: Section on Uniformed Services 

Abstract Title: Marching Band Injuries In Children Presenting to Emergency Departments in the United States, 2012-2021: A Trebling Tale 

Jacob Coene 

San Antonio, TX, United States 

Marching band is both a sport and a performance art. Organized athletics like American football, soccer and cheerleading all have well established epidemiological trends of injury-related morbidity, including stigmata from head trauma. By comparison, marching band, anecdotally leads to injury. Despite this potential for significant morbidity (e.g. mild traumatic brain injury or heat injury), little evidence exists on the epidemiology of marching band related injuries. Our study seeks to close this knowledge gap by characterizing marching band injuries which led to children being evaluated in Emergency Departments (ED) in the United States (US) from 2012-2021. 

The National Electronic Injury Surveillance System (NEISS) database was queried using the product code 1200 (Sports or recreational activity, not elsewhere classified) to search for ED visits in the US. We applied a natural language processing search to evaluate the frequency of injuries in children 0-25 years of age from 2012-2021 whose narrative encounters included “marching” or “band”. Encounters were grouped based on age (10-13 [middle school], 14-18 [high school], 19-25 [college]), sex, and body part affected. Care patterns were investigated for diagnoses and escalation of care. All reported values are population national estimates generated from actual marching band-related injury encounters and were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons. 

From 2012 to 2021 there were 20,335 estimated marching band injuries (MBI) from 579 actual cases (95% Confidence interval (95% CI) 12,892- 27,777) (Table 1). Of the MBI recorded, 84% occurred in those aged 14-18 years [i.e., high school] and 71% occurred in females, P < 0.01 and P < 0.01, respectively. The ankle (18%), knee (18%) and upper trunk (10%) were most injured (Table 1). Fifty percent of injuries occurred in the lower extremity. Major diagnoses in descending order of frequency were soft tissue injuries (10,891 (95% CI 6,666-10,492), mild traumatic brain injury (918 (95% CI 437-1,399), heat injury (875 95% CI 261-1,490), and fracture (763 (95% CI 286-1,241) (Figure 1). Of MBI, 98% did not require escalation of care, P < 0.01. 

This is the first nationwide estimate of marching band injuries presenting to an ED. Marching band injuries were most likely to occur in high school aged females and soft tissue injuries of the lower extremity were the most common injury pattern observed. Sixteen percent of MBI were serious and included: mild traumatic brain injury, fractures, dislocations and or heat injury. Based on the injuries catalogued and the low rate of care escalation required, we theorize that a high proportion of these ED visits could likely be prevented. The injury patterns described provide an opportunity for targeted public health intervention by sports medicine teams. 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Marching Band Injuries Strike a Wrong Note in Emergency Departments

ARTICLE PUBLICATION DATE

20-Oct-2023

Research finds 1 out of 4 youth screen positive for suicide risk in an emergency department; majority of those who identify as transgender, gender diverse, screen positive

Universal screening for suicide risk revealed a high proportion of youth in need of mental health services at one hospital

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.— Nearly 80% of emergency department encounters involving transgender or gender diverse youth ages 10 and older screened positive for suicide risk while seeking treatment at a Chicago emergency department over a 3.5-year period, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.

The abstract, “Suicidal Ideation in Transgender and Gender Diverse Youth in the Emergency Department,” examines data provided after universal suicide screening was implemented in the Emergency Department for all youth 10 and older who presented at Ann and Robert H. Lurie Children’s Hospital of Chicago between September 2019-August 2022. Researchers found that in 24% of 12,112 ED encounters, patients screened positive for suicide risk. Using the electronic medical record, the author identified that of 565 encounters by transgender and gender diverse youth, positive suicide risk was identified in 78% of encounters, with 10% of encounters by transgender and gender diverse youth endorsing active suicidal ideation at the time of ED presentation.

“Unfortunately, these findings did not surprise me as I routinely see transgender and gender diverse youth struggling with their mental health in my practice as a clinical psychologist,” said abstract author Amanda Burnside, PhD Attending Pediatric Psychologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine. “Common contributing factors include bullying and discrimination, and it is imperative that we continue to support these youth.”

Compared to cisgender youth, transgender and gender diverse youth were 5.35 times more likely to screen positive for suicide risk.

"We should work to ensure that all youth are routinely screened for suicide risk across every health care setting,” Dr. Burnside said. “We need to develop robust systems to connect youth who screen positive with mental health services."

More than 77% of emergency department encounters by transgender and gender diverse youth were for a chief complaint centered on mental health, according to the research.

“Caregivers and other supportive adults should routinely check in with transgender and gender diverse youth about their mental health. Any concerns can be brought to the attention of the youth's pediatrician. The National Suicide and Crisis Line is also available as a resource 24/7 by calling 988.”

This work was supported by Stanley Manne Children’s Research Institute at Ann and Robert H. Lurie Children’s Hospital of Chicago through the Mental Health Springboard Award (2022).

Dr. Burnside is scheduled to present her research, which is below, from 4:45 p.m.- 4:55 p.m. ET Monday, Oct. 23. To request an interview, contact Julianne Bardele at JBardele@luriechildrens.org. 

 In addition, Dr. Burnside will be among highlighted abstract authors who will give a brief presentations and be available for interviews during a press conference from 8 -9 a.m. ET Sunday, Oct. 22 in the National Conference Press Room 102 AB. During the meeting, you may reach AAP media relations staff in the press room. 

# # #

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

ABSTRACT

Program Name: AAP National Conference & Exhibition 

Submission Type: Section on LGBT Health and Wellness 

Abstract Title: Suicidal Ideation in Transgender and Gender Diverse Youth in the Emergency Department 

Amanda Burnside 

Chicago, IL, United States 

Background: Suicide among transgender and gender diverse (TGD) youth represents a national crisis. One in four high school youth who identify as a sexual or gender minority attempts suicide during a 6-month period, and nearly half of these youth seriously consider attempting suicide. In healthcare settings, research involving TGD individuals has historically been limited to specialized clinic populations or youth with gender-specific diagnostic codes documented in the electronic medical record (EMR). However, this approach likely significantly underestimates the prevalence of TGD youth in healthcare settings. To bridge this gap, one study utilized an EMR keyword search strategy to identify transgender youth, but this study did not identify other youth on the gender diversity spectrum. Our objective was to develop a novel keyword-based method for identifying TGD youth in the EMR and to employ this method to identify rates of suicidal ideation among TGD youth in the emergency department (ED). 

Methods: We conducted a retrospective cross-sectional study of ED encounters by youth who received suicide screening at an urban tertiary children’s hospital from September 2019-August 2022. Suicide screening was conducted using Ask Suicide-Screening Questions (ASQ). TGD youth were identified using keyword searching. If any of 9 keywords (they/them, preferred name, pronouns, male-to-female, female-to-male, nonbinary, agender, transgender, gender dysphoria) were present in the ED note, the surrounding text was extracted and manually reviewed to determine whether the text conveyed TGD status. 

Results: The ASQ was administered in 12,112 ED encounters, and 1 in 4 (24%) encounters had a positive screen. We identified 565 ED encounters by 399 unique TGD youth. Thirty-one percent of ED encounters by TGD youth contained just one keyword. TGD youth ranged from 8 to 23 years old and were 43% White, 35% Latinx, 10% Black, 4% Asian, and 8% other/two or more races. Of TGD youth, 43% were publicly insured and 52% resided in a neighborhood with a “low” or “very low” Child Opportunity Index category. For TGD youth specifically, most identified ED encounters (77.5%) were for a mental health chief complaint. In 81% of TGD encounters, TGD youth screened positive on the ASQ with 10% endorsing active suicidal ideation at the time of ED presentation. 

Conclusion: Use of a keyword-based method to identify TGD youth in the EMR revealed high rates of suicidal ideation, which may inform suicide prevention efforts. Future analyses will further characterize ED encounters by TGD youth, including characteristics associated with suicidal ideation and trends in rates of suicidal ideation over time. This work was supported by Stanley Manne Children’s Research Institute at Ann and Robert H. Lurie Children’s Hospital of Chicago through the Mental Health Springboard Award (2022). 

# # #

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Research Finds 1 Out of 4 Youth Screen Positive for Suicide Risk in an Emergency Department; Majority of Those Who Identify as Transgender, Gender Diverse, Screen Positive

ARTICLE PUBLICATION DATE

20-Oct-2023

Persistently high rates of severe maternal trauma during forceps, vacuum births warrant national response, analysis shows 

Peer-Reviewed Publication

MCMASTER UNIVERSITY

A McMaster University-led analysis published in the BMJ on Oct. 19, exposes high rates of injuries with forceps and vacuum delivery in Canada that have been documented for over a decade without efforts to address them.  

The paper, titled Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked, was authored by perinatal epidemiologists, obstetricians, urogynecologists, community advocates and patient partners, and calls for increased recognition, transparency and action to prevent these injuries. 

As part of the analysis, researchers present data from the Organisation for Economic Co-operation and Development that show that since 2010, Canada has had the highest rates of maternal trauma during forceps and vacuum deliveries when compared with other high-income countries. 

The most recent data from 2019 shows Canada with the highest rate at 16.3 per cent, followed by Denmark at 12.7 per cent and the United States at 11.1 per cent. 

The paper’s lead author, Giulia Muraca, an assistant professor in the Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact at McMaster University explains that while benchmarking against other countries is informative, the key facts are about how this is affecting Canadians.  

“More than 35,000 infants are born each year in Canada with the use of these instruments and maternal injuries are occurring at an alarming frequency. We are not doing a good enough job sharing information about these risks with pregnant people or putting enough effort into reducing them.”  

Maternal trauma describes a group of injuries to the pelvis and surrounding organs that occur during childbirth, such as severe perineal and cervical lacerations. These injuries have several short- and long-term consequences, such as pelvic pain, sexual problems, and anal incontinence. One in four people sustain these injuries following forceps deliveries (25.3 per cent) and one in eight with vacuum deliveries (13.2 per cent).  

“We’re calling for a national response to recognize the frequency and severity of these injuries in Canada. We have neglected to address them for far too long, and we are urging the maternity care community to make a commitment to reducing them,’” says Muraca. Similar national initiatives to reduce maternal trauma have been underway in other countries, such as the United Kingdom and Australia. 

As part of the analysis, researchers worked with patients who have experienced the trauma caused by forceps and vacuum deliveries firsthand. One of those patients is Laura Ralph, who suffered a pelvic floor injury during her son’s delivery due to the use of forceps. 

“I remember a cesarean delivery being discussed, but I don’t recall whether one was offered to me. I was also completely uninformed of the risks of cesarean versus forceps delivery,” Ralph said.  

“I often think of that conversation about cesarean delivery and wish someone had taken a few minutes to explain the pros and cons of each potential outcome with me.” 

Ralph has long-term complications as a result of her delivery. She had to use a pessary – a device inserted into the birth canal to provide support after pelvic prolapse and feared having more children because of the trauma she endured.  

In the analysis, several potential reasons for these high rates of injuries are discussed, such as policies in Canada regarding labour interventions and challenges with training. However, the researchers caution against reflexive recommendations to increase training.  

“If we expect these injuries to decrease by simply investing in the existing training paradigms, we run the risk of harming even more people and families, and further stigmatizing people with these injuries,” says study co-author Roxana Geoffrion, an associate professor of Obstetrics and Gynaecology at the University of British Columbia. “Efforts to change the culture around these injuries need to take precedence, including improving informed consent practices, and engendering a culture in which these injuries are acknowledged as severe, avoidable complications.”  

The researchers hope the analysis will spur a national conversation about these injuries and the impacts they can have on birthing parents.  

"During labour, it is often difficult to make informed split-second decisions surrounding different modes of delivery,” adds Geoffrion, whose clinical and academic practice is devoted to patients with pelvic floor disorders following childbirth trauma. “Through this research, we hope to encourage more thorough conversations between patients and their maternity care providers to establish informed consent for various modes of delivery during pregnancy and well before labour begins." 

-30- 

JOURNAL

BMJ

DOI

10.1136/bmj-2022-073991

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked

ARTICLE PUBLICATION DATE

19-Oct-2023

With smartphone videos, clinicians can analyze human movement using open source "OpenCap" platform, 25x faster and at a fraction of the cost of labs

Peer-Reviewed Publication

PLOS

NEWS RELEASE 19-OCT-2023

With smartphone videos, clinicians can analyze human movement using open source "OpenCap" platform, 25x faster and at a fraction of the cost of labs.

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Article URL: https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.101XXXX

Article Title: OpenCap: Human movement dynamics from smartphone videos

Author Countries: US

Funding: SDU, AF, LK, JM, ASC, JLH, and SLD were supported by the National Institutes of Health (https://www.nih.gov; grant 1P41EB027060-01A1) and the Wu Tsai Human Performance Alliance (https://humanperformancealliance.org). ASC and MK were supported by Philips Healthcare (https://www.usa.philips.com/healthcare) and the National Institutes of Health (https://www.nih.gov; grant 1R01AR077604-01). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

JOURNAL

PLoS Computational Biology

DOI

10.1371/journal.pcbi.1011462

ARTICLE TITLE

OpenCap: Human movement dynamics from smartphone videos

ARTICLE PUBLICATION DATE

19-Oct-2023

COI STATEMENT

Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: SDU and AF are co-founders of Model Health, Inc., which supports the non-academic, commercial use of the open-source software described here. OpenCap, the cloud-deployed academic version of this open-source software is hosted at Stanford University and will remain freely available to the academic research community for the foreseeable future. No other authors have competing interests to declare.

New smartphone app quickly analyzes human motion to aid physical rehabilitation

NIH-funded researchers suggest app is 25 times faster than current techniques, at a small fraction of the cost

Peer-Reviewed Publication

NIH/EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

WHAT:

A research team funded by the National Institutes of Health has developed a smart phone app that can track and analyze a person’s ability to move from one place to another, known as locomotion, and other types of movements. Human motion analysis is used to evaluate patients with movement difficulties, to help clinicians plan surgery, and to assess the results of treatment procedures. The research team believes that using the app costs about 1% of conventional motion analysis techniques and works 25 times faster. The study appears in PLOS Computational Biology.

Researchers tested their app, called OpenCap, with 100 participants. Using two or more smart phones, the app recorded sufficient quality videos to allow for web-based, artificial intelligence analysis of muscle activations, joint loads and joint movements. Data collection took less than 10 hours for the 100 participants, and computation of results took 31 hours. Traditionally, locomotion analysis requires fixed lab space and more than $150,000 worth of equipment, including eight or more specialized cameras to capture three-dimensional images. The captured data also takes several days to analyze by a trained expert.

While current technology is too expensive for routine clinical use, according to the investigators, the app could potentially be used to help screen for disease risk, inform rehabilitation decisions, and track improvements in motion following treatment.

The study was conducted by Scott L. Delp, Ph.D., of Stanford University, and colleagues. NIH funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Biomedical Imaging and Bioengineering (NIBIB) and National Institute of Neurological Disorders and Stroke (NINDS).

WHO:

Joseph Bonner, Ph.D., of the NICHD National Center for Medical Rehabilitation Research, is available for comment.

Moira Bittmann, Ph.D., director of the NIBIB program in Medical Simulators, is also available for comment.

ARTICLE:

Uhlrich, SD et al. OpenCap: human movement dynamics from smartphone videos. PLOS Computational Biology. 2023.

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About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. For more information, visit https://www.nichd.nih.gov.

About the National Institute of Biomedical Imaging and Bioengineering (NIBIB): NIBIB’s mission is to improve health by leading the development and accelerating the application of biomedical technologies. The Institute is committed to integrating the physical and engineering sciences with the life sciences to advance basic research and medical care. NIBIB supports emerging technology research and development within its internal laboratories and through grants, collaborations, and training. More information is available at the NIBIB website: https://www.nibib.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov.

JOURNAL

PLoS Computational Biology

ARTICLE TITLE

OpenCap: human movement dynamics from smartphone videos

Pandemic prevention consortium announces new leadership team

STOP Spillover is strengthening our capacity to reduce the risks of emerging pathogens

Business Announcement

TUFTS UNIVERSITY

Recognizing the many milestones it has reached in recent months, Strategies to Prevent Spillover, or STOP Spillover, a project funded by the U.S. Agency for International Development (USAID) and led by Tufts University, has announced that the interim leadership team that was put in place in March 2023 will take on a permanent role for the next two years of the project.

Hellen Amuguni, an associate professor in the Department of Infectious Disease and Global Health at Cummings School of Veterinary Medicine, is the new project director. The co-deputy directors are Felicia Nutter, director of the International Veterinary Medicine Program at Cummings School, and Jonathon Gass, an assistant professor of infectious disease epidemiology at the School of Medicine. (Amuguni and Nutter have secondary appointments at Tufts University School of Medicine, and Gass has a secondary appointment at Cummings School.)

“We are entering the fourth year of STOP Spillover on a high note, and our vision for the project remains clear,” says Amuguni. “Our focus is to build capacity and prepare countries to identify high-risk interfaces, control zoonotic diseases at their source before they become epidemics or pandemics, and develop interventions that reduce risks of exposure in human populations. We are privileged to work closely with amazing country teams and government counterparts as well as our consortium partners who bring expertise in wildlife health, infectious diseases, social and behavior change.”

At least 75 percent of emerging and re-emerging infectious diseases of humans—including Ebola, Nipah virus, and zoonotic avian flu—have an animal origin. Chances are that when the next illness like COVID-19 emerges to threaten global health, it will originate in animals before it passes to humans, a process known as spillover. STOP Spillover aims to keep that tipping point from happening, or at least mitigate the dangerous effects.

“STOP Spillover has achieved so much in its third year thanks to these directors, who have been working with stakeholders in key countries in Africa and Asia to find ways to decrease the risks of harmful viral pathogens that jump—or spill over—from animals to humans,” said Caroline Genco, Tufts’ provost and senior vice president, who is also an immunologist. “Through this important work, our expert researchers and community partners demonstrate our shared commitment to One Health as a way of mitigating the significant global risk represented by zoonotic disease spillover.”

Leading a Global Consortium of Regional Partners

Begun in late 2020, STOP Spillover has so far partnered with colleagues in Bangladesh, Cambodia, Côte d’Ivoire, Liberia, Uganda, Viet Nam, and Sierra Leone to strengthen country capacities to reduce the risks of zoonotic diseases, or those that move between animals and humans. Teams of experts collaborate to develop country- and locality-specific research studies and interventions to reduce risks associated with selected viral zoonotic pathogens and to prevent their spread.

USAID administers the U.S. foreign assistance program providing economic and humanitarian assistance in more than 80 countries worldwide. For this project, Tufts leads a global consortium of partners with cross-disciplinary experience and regional knowledge.

From the outset, this consortium of experts in human, animal, and environmental health has been heavily focused on engagement, working with stakeholders at the national, regional, and local levels to reduce risks of exposure to and mitigate the spread of selected zoonotic viral pathogens, including coronaviruses, filoviruses (Ebola and Marburg viruses), avian influenza, and Lassa virus, among others.

Protecting Health and Providing Financial Stability

On the ground at the local level—in places such as wildlife farms in Dong Nai province, Vietnam, and wild animal meat markets in Kenema, Sierra Leone—community-led workshops have provided important data about the interactions humans have with wild and domestic animals in these settings, as well as the barriers they see to behavior changes that reduce spillover risk.

Gass, who recently visited wildlife farms in Viet Nam with its in-country team, said that STOP Spillover is filling major gaps in understanding the spillover ecosystem, which will improve conditions for both animals and humans.

Gass noted that wildlife farmers, government officials, and other stakeholders are very interested in working together to increase biosafety. “Farming practices are critical for the financial livelihoods of farmers and their families,” he said. “When outbreaks occur on farms and the animals either die or need to be culled, this has serious financial repercussions. STOP Spillover’s interventions will not only protect health but also provide increased financial stability via risk reduction.”

The program has formed local expert working groups to identify places where spillover is most likely to occur and to design risk-reduction interventions. In Liberia, for example, STOP Spillover is conducting research to understand Lassa virus distribution in rodent reservoir hosts both within what is considered the “Lassa belt” and beyond. Working with the Ministry of Health, National Public Health Lab, the Ministry of Agriculture, and local communities, teams are collecting and testing samples from the African soft-furred mouse and other rodents for the presence of Lassa virus RNA (an indication of infection) within and outside of the Lassa belt.

The documentation of the true distribution of Lassa virus in reservoir hosts will allow the country to better understand the risks to humans, develop more effective rodent control strategies, and inform future research, policy, and public health measures.

Technology and Space Redesign for Biosafety

At live bird markets in Dhaka, Bangladesh, where the threat of highly pathogenic avian influenza is a concern, efforts are underway to develop a coordinated and sustainable platform for pathogen surveillance and data sharing. A mobile application has been developed, enabling the public to report sick and dead poultry as well as sudden febrile illness among market vendors. Moreover, the STOP Spillover team is working with public health experts and engineers to redesign market spaces so that biosafety is optimized, and consumer and vendor health protected.

In Côte d’Ivoire, Cambodia, and Liberia, teams have been trained to safely collect samples for surveillance of wastewater and liquid waste effluent, with potential testing for multiple zoonotic viruses. The aim is to create a surveillance system that can act as an “early warning system” for potential spillover events.

The program exemplifies the One Health concept: the interconnection of human, animal, and environmental health. “STOP Spillover continues the longstanding work of Tufts University, mainstreaming One Health approaches to address complex, globally important health problems, including zoonotic diseases,” said Felicia Nutter.

“Humans make choices every day that impact our health, the health of other animals, and the ecosystems and environments that we all share. Our current work empowers people to make more informed choices that safeguard our shared health,” said Nutter.