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Surge of babies born with syphilis continues during pandemic

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LOS ANGELES – The woman said she was tormented by pain and disbelief on the hospital bed, her stomach was smoothed with ultrasound gel, when a hospital worker delivered the news: There was a baby inside.

It was a boy. Six months together.

And his heart wasn’t beating.

For months, the 30-year-old had waved her swollen stomach and ankles. Pregnancy seemed impossible because she had a history of difficulty getting pregnant.

She also said, “When you’re high, you push back all the bad thoughts.”

It wasn’t until days later, when she was mourning her unexpected baby at home in Los Angeles County, that a nurse called to tell her what happened, she said. She calls it “the S”, a disease that she is still embarrassed about.

More and more LA County’s babies are becoming infected with syphilis in the womb, which can lead to stillbirths, neurological problems, blindness, bone abnormalities, and other complications. Nine years ago, only six cases were reported across LA County, according to a Department of Health report. Last year, that number reached 113.

Numbers were already rising before the arrival of COVID-19, but public health officials fear the pandemic has made the problem worse, have closed clinics that screen people for syphilis and other sexually transmitted infections, and make new efforts to fight the disease.

The woman, whose baby was stillborn, who spoke on condition of anonymity to protect her privacy, said she went into labor in a hotel room in January. Despite the painful wounds, she had avoided getting medical help.

At the time, she feared that visiting a clinic could result in jail time for meth use. “You think, ‘I’m going to get in trouble because I’m high,'” she said.

The rise in congenital syphilis is particularly frustrating for experts as the disease can be thwarted if pregnant women are tested and treated in a timely manner. Other countries are credited with halting mother-to-child transmission of syphilis in recent years, including Thailand and Belarus.

Federal officials once thought the United States was about to join them. Instead, cases of congenital syphilis have skyrocketed across the country, from 334 cases in 2012 to more than 2,000 in 2020.

“There has been no sustainable investment in the years it took us to truly eradicate syphilis,” said Mario Pérez, director of HIV and STD Programs in the LA County Department of Public Health.

Experts have linked the wider rise in syphilis to a tangle of factors, including methamphetamine use and condom-free sex. Men who have sex with men have been particularly at risk, but the rise in the number of women and babies has been particularly alarming to health officials about the potentially devastating consequences.

Syphilis is curable in an infant if it is recognized and treated in good time. Mikhaela Cielo, infectious disease pediatrician at LA County-USC Medical Center.

The disease has acted like a kind of bleak prism that breaks societal problems such as addiction and homelessness. In LA County, up to two-thirds of mothers who had passed syphilis on to their babies reported using drugs while pregnant, according to Department of Public Health studies of cases between 2016 and 2018.

Between 10 and 20 percent were unhoused. 40 percent have never had prenatal care. And nearly 30 percent had a history of arrest or imprisonment. Eight cases of syphilis had been confirmed in 170 pregnant patients in LA County prisons by the end of August, said Dr. Noah Nattell, who is in charge of the county’s health department for women’s health.

Syphilis is rarely confined to prisons, but “any systems that are in place that result in someone being incarcerated,” he said, “are also those that result in people avoiding or being excluded from the medical system. “

The disease also reflects racial inequality: the vast majority of syphilis cases reported in LA County women of childbearing age were Latina and black women, according to county statistics.

The woman who lost her baby said she started using meth at an overwhelming point in her life when she faced the demands of a stressful job, school, and relationship that followed her previous struggle for one Pregnancy had become tense.

Back then, the drug felt like “a ticket to freedom”. She quit her pointless job. Your friend moved out. Meth made her feel brave, “like I could finally take a deep breath.”

She started meeting a man who told her he didn’t need a condom on her, a decision she now considers naive. After they broke up, she started a relationship with a friend who would become her baby’s father.

When waves of pain rolled over her in a hotel room where she was spending time with her boyfriend, another man, and his girlfriend, the friend quickly realized she was in labor and urged her to call 911, she said. But the men resisted the idea, she remembered, because there were drugs there and they didn’t want the police to pay attention.

Jennifer Wagman, associate professor of community health sciences at UCLA Fielding School of Public Health, said the rising incidence of congenital syphilis across the country was a sign that opportunities to stop the disease have been missed. Researchers have found that despite urging health officials nationwide, not all pregnant people are screened for syphilis.

According to an analysis by the U.S. Centers for Disease Control and Prevention, nearly a third of pregnant women with syphilis did not receive the care they needed even when diagnosed. Wagman said many reasons are linked to other problems in their life: Some are not insured. Some may have been tested but didn’t get any results or treatments because they don’t have a regular address or phone number.

And some fear that if they see a doctor and are found to be using drugs, they may be forced to abandon their child. The LA County’s report found that between 2016 and 2018, at least 30 percent of babies with congenital syphilis were taken into custody by the Department of Children and Family Services.

County officials said doctors could report child safety concerns to the DCFS, but it was “only in the most extreme cases” that an infant would be removed after an examination after birth rather than during prenatal care.

The LA County woman had also feared after her baby was stillborn that she could face criminal charges for having meth in her pregnant body – something that has led to charges for other women in California. At one point the morgue told her to put the cremation on hold because “the state was involved,” but no charges followed, she said.

Some experts see the resurgent disease as a symptom of poor sexual health. Jeffrey Klausner, clinical professor of population and health sciences at USC’s Keck School of Medicine, said federal funding collapsed about 15 years ago, followed by cuts for public health officials due to the recession that followed.

In a county as large as Los Angeles, he argued, there needs to be a proactive STD strategy that reaches affected communities. Instead, “everything was very piecemeal, reactive and incoherent”.

The pandemic didn’t help. A state survey found that most health courts that responded had more than half the workforce assigned to COVID-19 duties since September last year.

Reported cases of syphilis have fallen across California, but officials warn that this could be due to fewer tests. Many of the clinics where the LA County Department of Public Health offers STD screening, diagnosis, and treatment were temporarily closed during the pandemic.

Plans to create a new team focused on “responding quickly” to syphilis cases – including providing tests to people in homeless camps – have derailed. Nurses, who usually handle cases of women diagnosed with syphilis, were involved in coronavirus chores, which meant others to do the job, each handling 30 to 40 cases in addition to their other duties, said Dr. Sonali Kulkarni, Medical Director, District Division of HIV and STD Programs.

In August, the Los Angeles County Commission on HIV warned that “an already understaffed and inadequately resourced STD response was made worse by the redeployment of nearly all employees to COVID-19 work.” The majority of the district and community programs were “greatly reduced in their capacity or put on hold”.

A rare exception is a mobile clinic on Skid Row, established during the pandemic by the Los Angeles Christian Health Centers, People Concern, and the county’s Public Health Department to test people for sexually transmitted infections.

Since his rapid test detects any exposure to syphilis, including previous infections, more blood must be drawn to check for a current infection. Getting these results can take days, which can mean tracking patients down the street. The Skid Row promotion also distributes hot meals, hygiene kits, naloxone spray to reverse overdoses and other necessities.

To reach people who are marginalized, “you have to look for them out here to make them feel safe,” said Ciara DeVozza, director of the C3 homeless outreach team on Skid Row for People Concern. “The medical system is not designed like that.”

When her baby was cremated, the LA County woman asked that his ashes be placed in an urn adorned with an angel wrapping a child in its wings.

“I always wanted a baby,” she says. “I’ve always asked God for it, and now I’ve received this gift – and I have to decide how to bring this gift to rest.”

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Open up about barriers rural residents face in getting help for mental health

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We’re tight-lipped in the farmland. To suffer in silence seems to be the way we have been taught. But I think we need to acknowledge and address our problems. October 10th was World Mental Health Day and gave me a nudge. It’s okay to admit that we’re not okay. Write it down on a health questionnaire. Tell your doctor. Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you.

Mental health is important for everyone, whether in cities or in the country. Photo by Kallie Coates / Grand Vale Creative LLC

In the city or in the country, we are alike when it comes to mental suffering and stigma. The difference is that those of us in non-urban areas face three additional mental health challenges. According to the Rural Health Information Hub, these challenges include:

  • Accessibility: “Rural residents often travel long distances to use services, are less likely to have psychiatric insurance and are less likely to recognize an illness,” says RHIhub. Personally, I’m insured, but if I keep an appointment I’ll take two to four hours off from work to attend. There have been instances where I’ve taken a full day off to do a 200-mile round-trip for a counseling appointment. Not all rural residents can change this schedule. Telemedicine options have been expanded by the pandemic. I hope telemedicine continues to improve mental health accessibility.
  • Availability: I love rural clinics and support them with routine health care. However, at the moment I have no possibility of psychological support in a rural health clinic. According to RHIhub, “there is a chronic shortage of mental health professionals and mental health providers are more likely to practice in urban centers.” I called an expert I had seen years ago after a new appointment and was told they were six would book up to a year for new dates. At first, I had empathy for the person who had to answer the phone and make appointments. Next, I thought of those in the mental health services industry who are unable to get in touch with everyone who wants to see them. We need more experts. I still want to see this professionally and personally. I will wait for your appointment. I will also see another professional on video sooner.
  • Acceptance: The first time I wrote about mental health in this column, I received feedback from someone who felt they knew me enough in real life to comment and say I had the mental health issues or the reality Not really familiar with the effects of mental illness is a family disease. She was wrong. I usually don’t stick with the haters or negative feedback, but it did for a while. Then came a person who personally thanked them for talking about mental health. Don’t let this stop you from seeking professional mental health help. “The stigma of needing or receiving psychiatric care and the limited selection of trained professionals who work in rural areas create barriers to care,” says RHIhub. We can break down barriers by saying that it is okay to seek psychological help for you or your loved ones.

Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you, says Katie Pinke.  Erin Brown / Grand Vale Creative

Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you, says Katie Pinke. Erin Brown / Grand Vale Creative

We are all affected by mental health problems. Unless you have any mental health problems or severe mental illness, you know someone who is. Add in a global health pandemic and we’re more isolated now than we were two years ago. Don’t be silent about mental health or serious mental illness. When someone confides in you, help them get in touch with professional help. Listen more than talk. Showing up with your presence is a difference maker.

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You are not alone. You are needed. You are loved. Your presence is a crucial part of someone’s community. I made a deliberate decision not to let the waves of fear swallow me up that I sometimes feel. I fight it with a network of support. I also know that a healthy lifestyle, regular exercise, fresh air, quiet time in my beliefs, and a few things for myself that I enjoy have positive effects on my mental health.

Caring for our mental health is just as important as caring for our physical health. Let’s start by breaking down the rural mental health barriers of availability, accessibility, and acceptance by seeking the help we need regardless of the travel time, waiting time for appointments, or the stigma we need to overcome.

To read more of Katie Pinke’s The Pinke Post columns, click here.

Pinke is the editor and managing director of Agweek. You can reach her at kpinke@agweek.com or connect with her on Twitter @katpinke.

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Facebook should modify algorithms to make social media safer for teens

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Talk to a pediatrician and we will tell you: We are going through a mental crisis in teenagers. The pandemic has brought school closings and stay-at-home restrictions that resulted in social isolation among youth. With more than 721,000 COVID-19 deaths across the country, many teens know a deceased person personally and in some cases have even lost a parent.

Unsurprisingly, pediatricians like us are at the forefront of caring for more than twice as many teenagers struggling with depression, anxiety, and eating disorders.

With this in mind, social media giant Facebook – owner of Instagram, a platform used by more than half of teenagers in the United States – plays a key role. Amid these rising and unprecedented rates of mental illness among teenagers, will Facebook be part of the problem or the solution?

Instagram and eating disorders

Whistleblower and former Facebook product manager Frances Haugen recently testified before Congress that internal research by the company showed that Instagram may have worsened the mental health of young people. In these studies, teenage girls reported feeling worse about their bodies on Instagram, increasing eating disorders, and having thoughts of suicide more often.

We’ve seen examples of this at our own eating disorders clinic, where teenagers often tell us Instagram exposes them to posts that perpetuate unrealistic body shapes and share harmful diet tips.

Facebook’s internal research confirms a 2018 study by the Pew Research Center that shows 1 in 4 teenagers say social media negatively affects their lives because they experience bullying and harassment, unrealistic views about their lives Develop colleagues and get distracted from spending too much time online.

Again, these are concerns we often hear from teenagers in our practice. Such issues are likely to be compounded among teenagers who spend more time on social media, which is particularly worrying given that nearly 90% of teenagers who visit Instagram and other platforms do so several times a day.

This time of immense control presents Facebook with a pivotal opportunity to support, rather than hurt, teenage mental health. Legislators have proposed stepping in and regulating the platform, and as pediatricians we are inclined to support these measures if they are aimed at improving the health and wellbeing of teenagers. However, despite regulation, social media is likely to play a permanent role in teenage lives for years to come. Facebook should seize this moment to take action to clearly improve and support teenage mental health.

Larry Strauss:A teacher’s question: Social media harms my students, but do technical executives even care?

Perhaps most importantly, Facebook and other social media companies should reinforce healthy messages. In the same study by the Pew Research Center, 1 in 3 teenagers reported that social media had a positive impact on their lives, most often because it helped them connect with others or find important information.

However, algorithms in Facebook and Instagram – which are kept secret from public scrutiny – are based on how many people like, share and comment. This approach encourages bombastic, misleading, and unhealthy posts.

We need health-oriented algorithms

Instead, social media companies could specifically curate and actively promote messages about health and wellbeing. Numerous pediatric influencers (e.g. @teenhealthdoc, specialist in youth health in New York) already offer evidence-based advice and health information for adolescents and their families on Instagram and other platforms. Facebook could set up an advisory board of clinicians to assess the quality of influencers’ posts, offer health care providers a review (with the invaluable “blue check mark” that shows a user is authentic and remarkable), and make their posts accessible to a youthful audience do.

Social media companies should also encourage young people to post accurate, health-promoting content themselves.

Tom Kistenmacher:Facebook Revelations: Social Media Strengthened Our Voices, But Impaired Our Hearing

This approach would require Facebook to change its algorithms, which the company is likely to resist unless regulation enforced. Social media companies have come under constant fire for being too late to respond to misleading or harmful posts, which contributes to bad press and negative regulatory attention.

We claim that Facebook should be proactive in its approach and promote high quality content that is interesting to teens. Done right – with an infusion of creativity, thoughtful design, and humor – positive, health-promoting posts can receive a tremendous number of likes, shares, and comments, but may need to be actively promoted amid the negative messages currently prevailing. Realizing that it has a duty to block misinformation about COVID-19, Facebook must take similar steps to protect teenagers’ mental health.

Facebook can also help facilitate moderation in the use of its platforms among teenagers. The current business models of social media companies are driven by the persistent, compulsive use of their products and the advertising revenue they generate. In his credit, Facebook has imposed advertising restrictions on teenagers.

The company should build on this by helping teenagers put their smartphones down. To reduce screen time, Apple introduced Screen Time, an iPhone and iPad integration that allows parents to limit the time teens spend using social media apps. However, workarounds are easy to find for teenagers. Facebook should introduce its own functionality that would allow parents to limit teenagers’ use of its platforms.

We will address the after-effects of COVIC-19 on teenage mental health in the years to come. The reality is that while many of us pediatricians would like to remove social media from the lives of our teenage patients altogether, Instagram and other popular platforms are going nowhere. Social media companies wield tremendous power over young people. You should use it to empower – not hinder – the hard work we frontline pediatricians do to fight mental illness.

Dr. Scott Hadland is the Chief Medical Officer of Adolescent Medicine at MassGeneral Hospital for Children and Harvard Medical School (@DrScottHadland on Twitter and Instagram). Dr. Kathryn Brigham is the medical director of the Teenage Eating Disorders Program at MassGeneral Hospital for Children and Harvard Medical School.

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Study finds a downward trend in buprenorphine misuse among U.S. adults with opioid use disorder

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Data from a nationwide representative survey shows that in 2019, nearly three-quarters of US adults who used buprenorphine had not abused the drug in the past 12 months. In addition, buprenorphine abuse among people with opioid use disorder declined between 2015 and 2019, although the number of people receiving buprenorphine treatment increased. The study, published today on the JAMA Network Open, was conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Centers for Disease Control and Prevention.

Buprenorphine is an FDA-approved drug used to treat opioid use disorders and to relieve severe pain. Buprenorphine, used to treat opioid use disorders, works by partially activating opioid receptors in the brain, which can help reduce opioid cravings, withdrawal, and general use of other opioids.

In 2020, more than 93,000 people lost their lives to drug overdoses, with 75% of those deaths being caused by an opioid. In 2019, however, fewer than 18% of people with last year’s opioid use disorder were receiving medication to treat their addiction, in part because of stigma and barriers to accessing those medications. To prescribe buprenorphine for the treatment of opioid use disorders, doctors must do so as part of a certified opioid treatment program or submit a letter of intent to the federal government, and the number of patients they can treat at the same time is limited. Only a small fraction of doctors are authorized to treat an opioid use disorder with buprenorphine, and even fewer prescribe the drug.

Quality medical practice requires the provision of safe and effective treatments for health conditions, including substance use disorders. This includes providing life-saving drugs to people with an opioid use disorder. This study provides further evidence of the need for expanded access to proven treatment approaches such as buprenorphine therapy, despite the remaining stigma and prejudice that persists in people with addiction and the drugs used to treat them. “

Nora D. Volkow, MD, NIDA director

In April 2021, the U.S. Department of Health released updated guidelines for buprenorphine practice to expand access to treatment for opioid use disorders. However, barriers to the use of this treatment persist, including doctor’s discomfort in treating patients with opioid use disorder, the lack of adequate insurance coverage, and concerns about the risks of distraction, abuse, and overdose. Abuse is defined as patients taking medication in a manner not recommended by one doctor and may include consuming someone else’s prescription medication or taking their own prescriptions in larger quantities, more frequent doses, or for a longer duration than directed.

To better understand buprenorphine use and abuse, researchers analyzed data on prescription opioid use and abuse, including buprenorphine, from the National Surveys on Drug Use and Health (NSDUH) 2015-2019. The NSDUH is conducted annually by the Department of Substance Abuse and Mental Health. It provides representative data on prescription opioid use, abuse, opioid use disorder, and motivation for recent abuse in the civil, non-institutionalized US population nationwide.

The researchers found that nearly three-quarters of US adults who reported using buprenorphine in 2019 had not abused buprenorphine in the past 12 months. In total, an estimated 1.7 million people reported taking buprenorphine as prescribed in the past year, compared to 700,000 people who reported using the drug. In addition, the proportion of patients with opioid use disorder who have abused buprenorphine has tended to decline over the study period, although the number of patients who received buprenorphine treatment has increased recently.

Importantly, in adults with an opioid use disorder, the most common reasons for recent buprenorphine abuse were “because I am addicted to opioids” (27.3%), suggesting that people are using buprenorphine over the counter for self-treatment of cravings and withdrawal may have symptoms related to an opioid use disorder and “to relieve physical pain” (20.5%). In addition, adults who took buprenorphine were less likely to have buprenorphine abuse among those who received drug treatment than those who did not. Taken together, these results illustrate the urgent need to expand access to buprenorphine treatment, as receiving treatment can help reduce buprenorphine abuse. In addition, strategies need to be developed to further monitor and reduce buprenorphine abuse.

The study also found that people who did not receive drug treatment and those who lived in rural areas were more likely to abuse drugs. However, other factors, such as belonging to a racial / ethnic minority or living in poverty, did not influence buprenorphine abuse. The study authors suggested that addressing the current opioid crisis should improve both the access to and quality of buprenorphine treatment for people with opioid use disorder.

“Three-quarters of adults taking buprenorphine do not abuse the drug,” said Wilson Compton, MD, MPE, NIDA associate director and lead author on the study. “Many people with opioid use disorder need help, and as clinicians we need to treat their condition. Use disorder can access this life-saving drug.”

Source:

National Health Institute

Journal reference:

Han, B., et al. (2021) Trends and Characteristics of Buprenorphine Abuse Among Adults in the United States. JAMA network open. doi.org/10.1001/jamanetworkopen.2021.29409.

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