youth

RPR Exchange: Results of a study of the reliability and predictive value of physical examination findings for diagnosing community-acquired pneumonia in children. James W. Mold, MD, MPH

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Abstract
Importance Community-acquired pneumonia (CAP) accounts for nearly 2 million pediatric outpatient and 375 000 emergency department (ED) visits annually in the US. Guidelines recommend relying on physical examination findings, not imaging, to diagnose CAP in youths who can be treated as outpatients.

Objective To determine the interrater reliability (IRR) of physical examination findings in youths diagnosed with CAP in EDs.

Design, Setting, and Participants This was a planned analysis from an ongoing prospective cohort study (pediatric CAP severity [PedCAPS]). Youths aged 3 months to 17 years with CAP were recruited at 7 academic pediatric EDs within the US from August 1, 2023, until May 24, 2025; participants had signs of lower respiratory tract infections, fever within 48 hours, and pneumonia on chest radiography, if performed. Youths with chronic pulmonary diseases (except asthma), sickle cell disease, immunodeficiency, cardiac disease, neurological disorders affecting respiration, and aspiration pneumonia were excluded, as were those hospitalized within the preceding 30 days or transferred from other EDs or hospitals.

Main Outcomes and Measures Two examiners evaluated the same patient within 60 minutes of each other and independently recorded their findings. IRR of physical examination findings was reported by raw agreement and Fleiss κ. A lower bound of the 95% CI of 0.4 for κ was considered acceptable reliability.

Results Among 252 youths with paired physical examinations (median [IQR] age, 5.7 [3.4-8.8] years; 127 female [50.4%]), the most frequent comorbidity was asthma (56 youths [22.2%]). In the overall study population, no physical examination finding met predefined significance for IRR. Wheezing (κ = 0.50; 95% CI, 0.39-0.62) and retractions (κ = 0.49; 95% CI, 0.37-0.60) had the highest IRR. In subanalyses of 124 youths discharged home and 128 youths who were hospitalized, IRRs of physical examinations were similar between the 2 groups.

Conclusions and Relevance In this study, individual auscultation findings, such as decreased breath sounds, crackles, or rhonchi, did not demonstrate sufficient reliability to be used alone for diagnosis.

Author/s:

Shubhada Hooli, Ron Reeder, Lauren Cutler, Laura F Sartori, Geoff Capraro, Amy Y. Cheng, Allison Cator, Matthew J. Lipshaw, Lilliam Ambroggio, Chris A. Rees, Son H. McLaren, Justin Moher, Leah Tzimenatos, Patrick S. Walsh, Chari D. Larsen, Richard M. Ruddy, Samir S. Shah, Nathan Kuppermann, Todd A. Florin

What Teens Should Know About Choosing Contraception

Alex Haga — Sat, 10 Aug 2024 18:09:38 +0000

Date Added:

August 10, 2024

Journal/Publication:

JAMA

Publication Date:

July 29, 2024

URL:

What Teens Should Know About Choosing Contraception

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.1530

Keywords

PMID (1):

39073806

MeSH

Reproductive Health Services

Information for teens and their parents regarding contraceptive options. James W. Mold, MD, MPH

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This JAMA Pediatrics Patient Page describes what teens should consider when choosing contraception methods.

Author/s:

Shaketha A Gray, Lindsay A Thompson

Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults

Devin Evans — Thu, 29 Apr 2021 05:00:00 +0000

Date Added:

May 19, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

April 1, 2021

Issue:

Volume:

URL:

Trajectories of Opioid Use Following First Opioid Prescription in Opioid-Naive Youths and Young Adults

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2021.4552

Keywords

PMID (1):

33885777

MeSH

opioid-related disorders

prescriptions

Very interesting study showing two distinct patterns of opioid use behaviors among adolescents after being given a first opioid prescription for pain. Predictors of subsequent misuse were identified. James W. Mold, MD, MPH

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Importance: Although prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks.

Objective: To identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year.

Design, setting, and participants: This cohort study examined Pennsylvania Medicaid enrollees' claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020.

Main outcomes and measures: This study used group-based trajectory modeling and defined trajectory status by opioid fill.

Results: Among the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001).

Conclusions and relevance: This study's results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.

Author/s:

Wilson, J.D., Zbebe, K.Z., Kraemer, K., Liebschutz, J., Merlin, J., Miller, E., D., Donohue, J.

Deficient Functioning of Frontostriatal Circuits During the Resolution of Cognitive Conflict in Cannabis-Using Youth

Brian Desmarais — Wed, 26 Jun 2019 19:39:50 +0000

Date Added:

June 26, 2019

Journal/Publication:

Journal of American Academy of Child Adolescent Psychiatry

Publication Date:

June 1, 2019

Issue:

Volume:

Pages:

702-711

URL:

Deficient Functioning of Frontostriatal Circuits During the Resolution of Cognitive Conflict in Cannabis-Using Youth

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jaac.2018.09.436

Keywords

cannabis use

frontostriatal circuits

functional magnetic resonance imaging

resolution of cognitive conflict

youth

MeSH

Adolescent Psychiatry

Magnetic Resonance Imaging

Functional MRI evidence supporting important adverse effects of marijuana on the brains of adolescents. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

Disturbances in self-regulatory control are involved in the initiation and maintenance of addiction, including cannabis use disorder. In adults, long-term cannabis use is associated with disturbances in frontostriatal circuits during tasks that require the engagement of self-regulatory control, including the resolution of cognitive conflict. Understudied are the behavioral and neural correlates of these processes earlier in the course of cannabis use disentangled from effects of long-term use. The present study investigated the functioning of frontostriatal circuits during the resolution of cognitive conflict in cannabis-using youth.

METHOD:

Functional magnetic resonance imaging data were acquired from 28 cannabis-using youth and 32 age-matched healthy participants during the performance of a Simon task. General linear modeling was used to compare patterns of brain activation during correct responses to conflict stimuli across groups. Psychophysiologic interaction analyses were used to examine conflict-related frontostriatalconnectivity across groups. Associations of frontostriatal activation and connectivity with cannabis use measures were explored.

RESULTS:

Decreased conflict-related activity was detected in cannabis-using versus healthy control youth in frontostriatal regions, including the ventromedial prefrontal cortex, striatum, pallidum, and thalamus. Frontostriatal connectivity did not differ across groups, but negative connectivity between the ventromedial prefrontal cortex and striatum was detected in the 2 groups.

CONCLUSION:

These findings are consistent with previous reports of cannabis-associated disturbances in frontostriatal circuits in adults and point to the specific influence of cannabis on neurodevelopmental changes in youth. Future studies should examine whether frontostriatalfunctioning is a reliable marker of cannabis use disorder severity and a potential target for circuit-based interventions.

Author/s:

Cyr, M., Tau, G.Z., Fontaine, M., Levin, F.R., Marsh, R.