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Suicide: Blueprint for Youth Suicide Prevention - American Academy of Pediatrics
Julie Linton, MD, FAAP, immediate past chair of the American Academy of Pediatrics (AAP) Council on Immigrant Child and Family Health, addressed disparities within health care services impacting immigrant populations in the United States. Linton discussed cultural differences, different types of immigration status, and how access to care can vary based on the state in which these patients are living.
The American Thoracic Society 2024 international conference included a keynote series where Linton and other expert speakers highlighted disparities and discussed ways to improve access to care for immigrant populations.
Transcript
What are the biggest challenges immigrant children face in accessing quality pediatric care in the US? How do these challenges differ based on the child's immigration status, country of origin, or socioeconomic background?
That's really a huge question. Before jumping in, I just want to quickly make sure we're talking about the same population I think you're asking about, which is immigrant children. The broader term of children in immigrant families refers to children who they themselves, or at least 1 parent, were born outside of the United States, and the specific population of immigrant children are children who they themselves were born outside of the United States. Those children may comprise a number of immigration statusesthat could include anything from being a US citizen who's already been naturalized, or it could include some types of humanitarian visa programs such as refugee status or having asylum status. It could include being part of a family who's come for work-related or family unification, or for some children, it could include being undocumented.
And all these different statuses, their eligibility for health coverage will vary. It will vary based on federal law. For instance, undocumented people are excluded from federal Medicaid, excluded from purchasing into the ACA [Affordable Care Act]. However, there are some states that cover children with state-sponsored Medicaid, including states like California, where we are today, as well as New York and Illinois, the District of Columbia, and I think there's 9 other states. You can actually find that information, if you're interested in knowing whether your state does or doesn't offer that coverage, on the National Immigration Law Center website. There's some maps there that are really helpful.
In terms of other factors, country of origin is relevant only in how it relates to immigration status. Certain countries, for instance, are eligible for Temporary Protected Status, meaning that if somebody is coming from Haiti, or Venezuela right now, under the current presidential administration, those families may be eligible for Temporary Protected Status, which would mean that they're eligible to buy into the Affordable Care Act and they're also, in some states, eligible to actually get state-funded Medicaid if those states took up a piece of legislation called the CHIPRA [Children's Health Insurance Program Reauthorization Act] option. Again, that map I mentioned will show you that from the National Immigration Law Center.
In terms of socioeconomic status, that really depends on the state eligibility for Medicaid in terms of how high of a poverty level that somebody could qualify for is one of the big pieces. Then there's other factors around socioeconomic status and other demographic factors that may make it more or less easy for somebody to enrolllanguage access, transportation, other things that can make it easier or more difficult for somebody to access services.
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The treatment paradigm for acute lymphoblastic leukemia (ALL) has made significant progress in recent years for both adult and pediatric patients with the addition of cellular therapies; however, significant unmet needs remain for these patients that investigators are working to address, according to Carrie L. Kitko, MD.
There is a certain amount of effort [that is required] to be able to offer these products to our patients, Kitko said. [When physicians] are [wondering whether] their patient might be able to qualify for one of these emerging therapies, [whether the agent is] FDA approved or [the physician must] reach out to find out if we have the latest clinical trial available for some of these agents, [time is critical]. The earlier we put these patients on the radar, the earlier well be able to help them navigate the system to be able to get that innovative treatment.
In August 2017, the FDA approved the CAR T-cell therapy tisagenlecleucel (tisa-cel; Kymriah) for the treatment of patients up to age 25 years with B-cell precursor ALL that is refractory or in second or later relapse. The approval was based on findings from the phase 2 ELIANA trial (NCT02435849), which showed that patients with relapsed/refractory pediatric precursor B-cell ALL who received tisa-cel (n = 63) achieved an overall remission rate (ORR) of 82.5% (95% CI, 70.9%-91.0%); 63% of patients experienced complete remission (CR) and 19% experienced a complete remission with incomplete hematological recovery.1
Then, in October 2021, the FDA approved another CAR T-cell agent, brexucabtagene autoleucel (brexu-cel; Tecartus) for the treatment of adult patients with relapsed/refractory B-cell precursor ALL. The regulatory decision was supported by findings from the phase 1/2 ZUMA-3 study (NCT02614066), which showed that patients with relapsed/refractory B-cell precursor ALL who were treated with brexu-cel (n = 54) achieved a 3-month CR rate of 52% (95% CI, 38%-66%).2
In an interview with OncLive, Kitko, the medical director of the Pediatric Stem Cell Transplantation Program, the Ingram Professorship in Pediatric Oncology in theDepartment of Pediatrics, and an associate professor of pediatrics in the Department of Hematology/Oncology, at Vanderbilt University Medical Center in Nashville, Tennessee, discussed a presentation she gave during the 2024 Vanderbilt Stem Cell Transplant and Cellular Therapy Symposium in May. During the presentation, Kitko outlined the current treatment landscape of pediatric and adult ALL, as well as unmet needs and future directions in the field.
Kitko: [I discussed] the pivotal trials that led to the FDA approvals of tisa-cel for patients under the age of 26 and brexu-cel for adult patients. Those [agents] have been [approved] for a bit now, but it has been helpful that theres more long-term follow-up for the ZUMA-3 trial looking at how durable remissions are and the differences in patient populations based on prior treatment or treatments received [following] CAR T-cell therapy.
Whats important with the pediatric population is the recognition that, unfortunately, a lot of the pharmaceutical companies have abandoned further trials of some of the other novel CAR T-cell products. Were relying on real-world consortium data to try and tease out the different groups of patients who do better [as well as those] who are more or less likely to experience relapse post-treatment. [Also], how do we better tackle this toxicity profile?
We are hopeful that we can have more pharmaceutical interest in pediatric oncology, and there may be some hope on that horizon. A newer product, obecabtagene autoleucel [obe-cel], was developed in the UK and is now [being explored in] more global trials. It is a slightly different CAR construct; [although] the CAR still binds to CD19, which is what drives the anti-leukemia activity, it has a lower binding affinity meaning that it has fast-on, fast-off kinetics. We believe that may lead to increased T-cell persistence and less exhaustion of T cells, and it also seems to make the product potentially safer.
A product that were excited about potentially being able to see more of is WU-CART-007 in T-cell ALL. Weve been talking a lot about B-cell, and thats where a lot of work has been done, but T-cell ALL is very common in our adolescent and young adult patient populations. Luckily, work [from groups such as] the Childrens Oncology Group has found that very intensive chemotherapy can result in CR rates of approximately 90% and approximately a 70% chance of long-term cure.
However, when patients fall into that 30% where theyve unfortunately relapsed, they are [in] a very high-risk group. Second remissions are extremely rare, and the long-term survival rate is approximately 10% to 15%. Were desperate to find emerging therapies to help these patients and thats where the trial [examining] WU-CART-007 potentially comes in.
This is an allogeneic CAR T-cell therapy and that is helpful because these patients tend to be quite sick, and it would be difficult to mobilize their own cells. [WU-CART-007] is an off-the-shelf product; you can use a healthy donor to manufacture these cells, and then do some CRISPR modification to decrease the chances of adverse effects. The T-cell receptor [is taken out] which will hopefully mitigate the risk of graft-vs-host disease by these allogeneic cells. CD7 [is also eliminated] which is a very common marker on T cell ALL; on the CAR T cells they get rid of CD7 so that theyre not killing off those cells that theyre trying to produce to treat the patients leukemia.
[Study authors] published results from a phase 1/2 [WU-CART-007 1001 (NCT04984356) trial] at the ASH Annual Meeting this past year, where several patients, including some pediatric patients as the trial went down to age 12, who had relapsed/refractory T-cell ALL or lymphoblastic lymphoma were treated. There were some encouraging results [showing] that these patients did seem to, at the highest dose that was then expanded into a phase 2 cohort, have significant responses. A few of these patients eventually [received] an allogeneic transplant for consolidation after achieving a CR. The study has since closed because [investigators] were so encouraged by those results that theyre designing a larger trial [and are] hoping to go for FDA approval [of WU-CART-007] if the follow-up study shows promising results.
One of our biggest challenges is that these are expensive therapies and were trying to work closely with our managed care group to understand the urgency of patients and to be able to go directly up the chain as fast as possible with our insurance partners to get our patients approved to get therapy. This has been an ongoing project, [but] weve come to a better place where weve been able to streamline that process of not only getting the insurance company to say yes but agreeing to pay for the treatment as well because thats critical.
There are still some critical issues to be resolved. With the CD19-[directed CAR T-cell agents] since we have FDA-approved products, [were trying] to better understand who is the most likely to respond to these treatments, who is most likely to have long-term responses, and how to improve the toxicity profile. Those are essential questions to be answered to be able to deliver these treatments in the safest way possible and to provide that long-term cure that many patients and families are hoping for. There will be a combination of efforts to be able to answer those questions. A lot of that work will come from real-world consortium [studies], potentially even through groups like the Childrens Oncology Group.
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CAR T-Cell Therapies Move Ahead in Pediatric and Adult ALL - OncLive
Key Takeaways
The American Academy of Pediatrics now supports breastfeeding by HIV-positive moms, if their infection is controlled
The risk of HIV transmission through breastfeeding is less than 1% if the mom is virally suppressed
That risk should be weighed against the many benefits of breastfeeding, the AAP says
MONDAY, May 20, 2024 (HealthDay News) -- The nations top pediatrics group has reversed its decades-old position on HIV-positive mothers breastfeeding their infants.
When managed appropriately, having multiple credit cards provides both practical and financial benefits. An extra card can come in handy if one is lost or needs to be canceled, and having multiple lines of credit available can be helpful when unexpected expenses arise. However, tracking bala Click for more.Which Americans Hold the Most Credit Cards?
The American Academy of Pediatrics now says its generally safe for moms with HIV to breastfeed or provide breast milk to babies if their infection is properly controlled.
The risk of HIV transmission through breastfeeding from a mother who is virally suppressed is less than 1%, according to an AAP evidence review published May 20 in the AAP journal Pediatrics.
That small risk should be weighed against the health and financial benefits of breastfeeding, the AAP says.
Research now shows that the risk of HIV transmission through breastfeeding is quite low when the lactating parent is on anti-retroviral treatment and has no detectable viral load, said Dr. Lisa Abuogi, lead author of the AAP review.
While avoiding breastfeeding is the only option to guarantee that the virus is not transmitted, pediatricians should be ready to offer family-centered and nonjudgmentalsupport for people who desire to breastfeed, said Abuogi, who is medical director for the Children's Hospital Colorado Immunodeficiency HIV Prevention Program.
Nearly 5,000 people with HIV in the United States give birth every year, the AAP says.
Without treatment, women with HIV can pass the virus to their infants during pregnancy, delivery or breastfeeding.
However, daily medications can keep people with HIV healthy and reduce their viral load below detectable levels, the AAP noted.
The AAP says it is following the lead of the U.S. Centers for Disease Control and Prevention, which starting in 1985 had recommended against breastfeeding for people with HIV. The CDC now supports breastfeeding for HIV-positive mothers after discussing the option with a doctor.
The AAP recommends that pediatricians:
Know the HIV status of pregnant women, to provide appropriate counseling and prescribe antiretroviral treatment
Be prepared to support HIV-positive women who want to breastfeed if they started antiretroviral treatment early in or prior to pregnancy and are committed to maintainingviral suppression through breastfeeding
Counsel pregnant women and new mothers at increased risk of HIV infection regarding the risk of transmitting the virus through human milk, if infection occurred while breastfeeding
Healthcare professionals, researchers and people with HIV have made amazing strides over the past few decades towards eliminating perinatal transmission of HIV in the United States, Abuogi said in an AAP news release. "We encourage families to share information with their pediatricians about HIV and discuss what will work best for them when it comes to feeding their baby.
SOURCE: American Academy of Pediatrics, news release, May 20, 2024
Moms with HIV who want to breastfeed should talk with their doctor about whether it will be safe for their baby.
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(Associated Press) A top U.S. pediatricians group is making a sharp policy change about breastfeeding by people with HIV.
The group says they can breastfeed as long as they are taking medications that effectively suppress the virus that causes AIDS.
Its a reversal in a longstanding policy from the American Academy of Pediatrics.
The group made the changes on Monday, effectively overturning guidance that dated back decades.
Experts say drugs used to treat HIV can reduce the risk of passing the virus to infants to less than 1%.
About 5,000 people who have HIV give birth in the U.S. each year.
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Last Updated on May 21, 2024 12:44 pm
From mountains to lakes, ski slopes to waterfalls, and everything in between, the High Country has always drawn us to explore, experience, and to be immersed in the beauty of nature. Our rolling mountains welcome people from far and wide and provide endless opportunities for adventure. Unfortunately, more opportunities for adventure can translate to higher incidences of injuries, illnesses, and traumas.
Recognizing the need in our community, our resident doctors are set to host the second annual Wilderness Medicine Conference June 29th-30th at the Valle Crucis Conference Center. The conference is open to all including physicians, residents, PAs, NPs, nurses, students, and more.
As physicians and local leaders, we have chosen to serve our community through improving access to medical care for everyone, not just in the office, but as far reaching as in the wild, says Dr. David Brendle, Associate Program Director of the Boone Rural Family Medicine Residency Program. We hope this conference can bring new ideas and innovation to the High Country, as well as opportunities to network and learn about practicing medicine in resource-sparse environments.
What is Wilderness Medicine?
Wilderness Medicine is the development of knowledge and skills used to render medical aid in rugged, remote, and resource-limited environments, says third year resident, Dr. Connor Brunson. This makes training in wilderness medicine relevant for anyone who spends time outsidewhether its kayaking, skiing, hiking, hunting, fishing, swimming, trail running, mountain biking, or rock climbing, if your access to medical support is limited, you need to know how to manage injuries, treat pre-existing medical conditions, and prepare for the unexpected.
Wild things can and do happen in the High Country. Even just a short hike on the Blue Ridge Parkway can be surprisingly hard to access for medical personnel, and it can certainly take a long time to get help especially if you dont have cell service, says Brunson. With the diverse range of outdoor activities local to our area, I think its extremely important for anyone and everyone to have knowledge of how to help if someone theyre with is injured in a remote area.
Docs gone wild
At the heart of the Wilderness Medicine Conference is David Brendle, DO. Brendle is a family medicine physician at AppFamily Medicine and the Associate Program Director of the MAHEC Boone Rural Family Medicine Residency Program. Enjoying the outdoors through trail running, mountain biking, hiking and skiing has always fed my soul, says Brendle, pictured at the Everest Base Camp in Nepal. After becoming a physician, I felt a responsibility in gaining knowledge specific to medical care in austere environments. Over the years, I have actively sought out training specific to wilderness medicine through the Wilderness Medicine Society.
Brendle, along with 15 resident family medicine physicians, created the High Country Wilderness Medicine conference to support and equip individuals in our community with resources, tools, and training for medical care in austere environments. Given the Boone Rural Family Medicine Residency programs location in our wonderful town of Boone we felt it was important to offer Wilderness Medicine specific education to our resident physicians and our community. In addition, community outreach is an important aspect of the residency program. The High Country Wilderness Medicine conference is the culmination of both of these efforts, says Brendle.
Whether you are simply interested in the outdoors, or wish to make wilderness medicine the focus of your career, this conference can benefit you. The skills Ive developed in Wilderness Medicine has made me more confident when Im spending time outdoors, and Im glad to know I can help if something goes wrong, says Brunson.
For registration and a list of speakers/workshops, visit https://hcwmc.com/.
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During the hot summer months, pools are a great way to have fun and relax with your family. However, drowning is one of the leading causes of accidental deaths among children, so its critical that parents take the proper steps to keep everyone safe.
Rosa M. Mendoza, M.D., family medicine doctor at JFK University Medical Center, offers four ways parents can keep their kids safe at the pool this year.
When your children are splashing in or by the pool, designate yourself or another parent to take the role of active supervisor. While actively supervising, avoid distractions such as cell phones. Supervisors should avoid alcoholic beverages. It is also important to stay within arms reach of your children so that if something were to happen, you are not too far to take action, Dr. Mendoza says. If you need to step away, designate another active supervisor first.
Another way to implement safety by the pool is to teach your children about water safety and how to swim at a young age. Each childs emotional maturity level and physical development is different, so there is not a standard age for every child to start swimming lessons.
The American Academy of Pediatrics suggests that swimming lessons can begin for many children starting at age one. Studies suggest that swim lessons and water skills training reduce the risk of drowning for children. I would also recommend that parents learn CPR in case of an emergency, Dr. Mendoza says.
Always keep the necessary safety equipment close to the pool area. This includes life jackets, reaching poles and a first aid kit. It is also important to ensure that you and your children know how to use these tools in case of an emergency.
It is critical to enforce pool safety regulations for your children. Suggestions include:
By taking these proactive safety measures, you can significantly reduce the risk of accidents and ensure your child's well-being at the pool, Dr. Mendoza says.
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
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4 Fail-proof Ways to Keep Kids Safe at the Pool - Hackensack Meridian Health
In recognition of BC Family Doctor Day, celebrated annually on May 19, the BC College of Family Physicians (BCCFP) is celebrating leaders in family medicine across the province who make a difference in the lives of their patients and peers.
Dr. Jessica Zimbler of Prince George has been honoured by the B.C. College of Family Physicians (BCCFP) in recognition of B.C. Family Doctor Day, celebrated annually on May 1.
Every year, we are impressed by the dedication, passion, and care that BCs family physicians provide for their patients, says Kendra Johnson, executive director of BCCFP. They are unrelentingly committed to advancing family medicine, and pursuing innovative, hands-on ways of delivering care for their patients in every part of BC.
The annual BCCFP awards celebration, held May 16, recognizes family physicians who demonstrate exceptional leadership, professional excellence, and an unwavering commitment to their patients health, now and into the future.
As the president of BCCFP, I am proud to celebrate the unrelenting and inspiring dedication of our members to providing compassionate, innovative, and high-quality care to patients across the province, says Dr. Vincent Wong.
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Prince George doc honoured with My Family Doctor Award - Prince George Citizen
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