The first iteration of Crisis Point addresses the obesity crisis in the United States and beyond, with expert interviews and discussion.  

Crisis Point - Obesity Crisis

. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with 

. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

Investigators have developed a new machine learning technique to better predict high risk patients for 

 following an emergency department (ED) visit.

A team, led by Matthew K. Nock, PhD, Department of Psychology, Harvard University, identified a way to forecast suicide attempts within 1 and 6 months of presentation at an emergency department for psychiatric issues.

Research shows 50% of individuals who commit suicide make a health care visit within 1 month of death. There are a number of evidence-based interventions to reduce the risk of suicide, but to be expensive they must target high-risk patients.

In the prognostic study, the investigators assessed the 1-month and 6-month risk of suicide for 1818 patients presenting at the emergency department at Massachusetts General Hospital between February 4, 2015 and March 13, 2017. The median age of the study was 33 years.

The investigators sought main outcomes of suicide attempts 1 and 6 months following an ED visit, defined by combining data from electronic health records (EHR) with patient 1-month (n = 1102) and 6-month (n = 1220) through follow-up surveys.

The team used an ensemble machine learning technique to develop predictive models and a risk score for suicide.

In the month following the ED visit, 12.9% (n = 137) participants attempted suicide, while 22% (n = 268) attempted suicide within 6 months.

The investigators looked a clinician assessments and found these alone was a little better than chance at predicting suicide attempts, with externally validated area under the receiver operating characteristic curve of 0.67 for the 1-month model and 0.60 for the 6-month model.

However, prediction accuracy was slightly higher in the EHR models (1-month model: AUC, 0.71; 6 month model: AUC, 0.65) and was best using patient self-reports (1-month model: AUC, 0.76; 6-month model: AUC, 0.77). This was particularly true when patient-self-reports were combined with EHR data and/or clinician data (1-month model: AUC, 0.77; and 6 month model: AUC, 0.79).

The team also tested a model using the 20 patient self-report questions and an EHR-based risk score.

This model performed similarly well (1-month model: AUC, 0.77; 6 month model: AUC, 0.78).

However, the best 1-month model had a positive predicted value of 30.7% in patients classified as having the highest risk in the top 25% of the sample for suicide attempts, accounting for 64.8% of all 1-month attempts.

On the other hand, the best 6-month model had a 46% positive predicted value of patients of the highest risk class for suicide attempts, accounting for 50.2% of all 6-month attempts.

“The results of this prognostic study suggest that suicide risk assessments made using EHR-based and self-report–based risk scores may yield relatively accurate and clinically actionable predictions about the risk of suicide attempts by patients after presenting to an ED,” the authors wrote. “These results highlight the need for tests of the implementation of such risk assessment tools to target preventive interventions.”

Prediction of Suicide Attempts Using Clinician Assessment, Patient Self-report, and Electronic Health Records

Articles

Approximately 50% of individuals who commit suicide make a health care visit in the proceeding month. 

News

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Machine Learning Better Predicts Suicide Risk After Emergency Department Visits

Armand Butera is the assistant editor for 

. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining 

. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at 

A recent investigation into children with attention deficit/hyperactivity disorder (ADHD) found significant associations between the condition and common allergic conditions such as food allergy, respiratory allergy, and skin allergy.

Prior studies have predominantly considered the associations of respiratory allergy and skin allergy in patients with ADHD. However, little is known of the association between food allergy and ADHD, and available data on the subject had been inconsistent.

Investigators led by Buyun Liu, MD, PhD, Department of Epidemiology at the University of Iowa, suggested that the inconsistent findings could have been partly due to limited sample sizes and statistical power.

As such, Liu and colleagues analyzed large-sclae and nationally representative data to determine association of food allergy and other allergic conditions with ADHD in children in the United States.

The team utilized data from the National Health Interview Survey (NHIS), a leading health survey that is conducted annually by the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC).

The survey included detailed health-related information pertaining to physical and mental health, and allergic conditions were defined based on responses to several questions.

The questions, which were addressed to parents and guardians, included the following:

“During the past 12 months, has [your child] had (1) any kind of food or digestive allergy; (2) any kind of respiratory allergy; (3) eczema or any kind of skin allergy?”

ADHD was defined based on an affirmative response to the question: “Has a doctor or health professional ever told you that [your child] had Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?”

Additional demographic data, including age, sex, race/ethnicity, sex, education, family income, and geographic region were collected using standardized questionnaires featured in the interview.

All data analyses were conducted using the survey procedures of SAS 9.4 (SAS Institute Inc., Cary, NC, USA), and 2-sided p < 0.05 was considered statistically significant.

A total of 192,573 children aged 4-17 years old were included in the analysis. Among those children, 8603 had food allergy, 24,218 had respiratory allergy, and 18,703 had skin allergy.

Investigators noted that children with skin allergy were younger, more likely to be black, and they had higher family education levels than children without skin allergy, while children with respiratory allergy, compared with those without respiratory allergy, were older, more likely to be male, white, and they had higher family education levels

A diagnostic history of ADHD was reported in 15,376 children. The data gathered indicated that children with ADHD were older, more likely to be male and white, and they had lower family income levels.

The weighted prevalence of ADHD was higher among children with allergic conditions.

Among children with food allergy, ADHD prevalence was 12.66% (95% CI 11.57–13.75) compared to those without ADHD (7.99&, 95% CI 7.82–8.15) (p < 0.001)

Likewise, ADHA prevelance was 12.16% (95% CI 11.60–12.72) vs. 7.63% (95% CI 7.46–7.80) among children with and without respiratory allergy (p < 0.001), and 11.46% (95% CI 10.90–12.01) vs. 7.83% (95% CI 7.66–8.01) among children with and without skin allergy (p < 0.001).

Liu and colleagues added that their study extended findings on allergic conditions and ADHD, with insights on food allergy.

“Although the detailed mechanisms linking food allergy and other allergic conditions to ADHD remain to be understood, physicians should be aware of the increased risk of ADHD as a comorbidity of children with allergic conditions,” the team wrote.

The study, "Association of Food Allergy, Respiratory Allergy, and Skin Allergy with Attention Deficit/Hyperactivity Disorder among Children," was published online in 

Prior studies have predominantly considered the associations of respiratory allergy and skin allergy in patients with ADHD, with inconsistent data on food allergy.

Allergy

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ADHD

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ADHD Associated with Food, Skin and Respiratory Allergy

 The response with vitiligo can vary depending on which part of the body you are treating. One of the most important factors is the presence of hairs. When vitiligo occurs, the T cells kill the melanocytes of the epidermis, and sometimes they kill the melanocytes at the base of the black hairs, and the hairs grow out white. Now there is no source from which the melanocytes can repopulate in the epidermis with treatment like phototherapy and various topical oral agents. This is one reason why the hands, feet, ankles, and the wrists are so difficult to treat, because there are no hair follicles there. Once the pigment is gone on the fingers, it is very difficult to get it to repigment; this is why it’s difficult. It also appears difficult to repigment in areas that move a lot, that have a lot of motion. It’s not clear why those areas tend to be difficult; part of it could be trauma. In those areas that move a lot, that movement would make it more difficult. We also know that areas of the body where the hairs turn white are more difficult to treat than other areas.

Finally, areas where there’s a lesser concentration of hair follicles, such as the clavicle area, which has a poor concentration of hair follicles, tends to be more difficult to treat as well. These are some reasons why there is a variation of response in different areas of the body. The reason it takes so long to repigment likely has to do with the fact that melanocytes take a while to recover from the shock of being attacked by the immune system. Once they recover, they need to begin to proliferate, to extend their dendrites, produce melanin, deliver those melanosomes to adjacent keratinocytes, and then migrate into the vitiligo lesion itself. This takes time, this migration. It’s faster in areas with hair follicles, and you’ll start seeing a lot of little dots around the hair follicles, but when the melanocytes are coming from the margins it’s a slow process, about a few millimeters every 3 months.

Videos

An expert dermatologist shares insight on the differences in response to vitiligo treatment based on different body parts being treated.

Vitiligo

Vitiligo condition center page is a comprehensive resource for clinical news and insights on the dermatologic condition. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for the affected skin of vitiligo patients.

Differences in Treatment Response to Vitiligo Therapy

 When I talk to patients about treatment, I tell them that there are 3 pillars of treatment. One is to reduce the stress on the skin. There are reactive oxygen species being made all the time in the skin because of the inherent defect of melanocytes in patients with vitiligo, as well as life in general, UV [ultraviolet] damage and chemicals, a trauma that can cause the stress. I ask my patients to take oral antioxidants, vitamin C and vitamin E. I know gingko biloba has been published about, alpha-lipoic acid, these are easy to find antioxidants at the store. I also ask them to increase antioxidants in their diet, for example, 5 servings of fruit and vegetables every day and a handful of nuts. That’s the first pillar of therapy. For the second pillar of therapy I talk to them about removing those cytotoxic T cells from their skin. We want to clear those CD8-positive T cells from their skin, and we can do that with topical corticosteroids, topical immunomodulators, and now topical JAK inhibitors. They cause those T cells to be cleared from their skin so that the damage to the melanocytes by the immune system can diminish.

I also tell them about the third pillar of therapy, and that is to stimulate monocytes to repigment their skin. The primary way that we do that is with phototherapy. Phototherapy stimulates those melanocytes to repigment the areas, and causes them to migrate up the sides of the hairs and fill in the skin. After 3 or 4 months, when the phototherapy has reached certain doses, it will cause immunosuppression of the skin to help clear out the T cells. It has a dual function when you get to the higher doses after the patient’s been on the treatment for a few months. With these three pillars of therapy, patients can understand that they should combine these to have the most effective treatment of their vitiligo.

When you’re treating a patient with vitiligo, the most important aspect is to ensure that you are making treatment decisions on a shared basis with the patient. Patients can have different expectations when it comes to vitiligo. Some patients simply want it to be stable, so that it doesn’t spread to more visible areas. Some want the lesions to be repigmented 100%, or they don’t want to have treatment at all; some want to see the maximum repigmentation they can achieve. Some want the hands treated most of all, and they’re not as concerned about other areas, and others want other specific areas to be treated. There are many different desires that patients have for their vitiligo. That’s one of the first things I ask, “What do you want to achieve with the treatment of your vitiligo, and what bothers you the most about your vitiligo?” Once I hear that, I can then guide the treatment decisions. For example, if a patient says that they want an area of vitiligo treated that has completely white hairs, and it has not responded to treatment in the past, then I might suggest surgical modalities, in which we must do either a skin transplant or a melanocyte transplant of their skin. If patients want to have as much of their body repigmented as possible, then I might treat them with full body phototherapy as opposed to more localized treatment. The most important factor is to talk with the patient and determine what their goals are, and then customize your treatment plan based on their desires.

Another important factor in the treatment decision is the patient’s time and ability to afford the treatments. Patients may not be able to come into my office 3 times a week for treatment, and they may not be able to afford the various treatments, or they may not have insurance coverage. This is an important part of the conversation that I have with patients.

Amit G. Pandya, MD, FAAD, reviews the goals of therapy for patients with vitiligo and considers factors that drive treatment decisions.

Approaching the Treatment of Vitiligo

A recent investigation into cystic fibrosis in children and young adults suggested that antimicrobial stewardship initiatives could be beneficial in standardizing care and fostering positive working relationships between cystic fibrosis pulmonologists, ID physicians, and pharmacists.

Cystic fibrosis has affected more than 30,000 individuals in the United States,with a major cause of morbidity and mortality being pulmonary disease and pulmonary exacerbations (PEx), the latter of which if often treated with antibiotics.

Despite the prevalence of PEx in patients with cystic fibrosis, there is no standardized definition to diagnose these events in affected patients, although most include an increase in respiratory symptoms and/or acute decrease in lung function.

Using the framework of antimicrobial stewardship, Geovanny F. Perez MD, MS, Division of Pulmonary Medicine, Oishei Children's Hospital, and fellow investigators aimed to develop an empiric antibiotic algorithm as a quality improvement initiative to initiative to develop consistency among providers in prescribing empiric intravenous (IV) antibiotic therapy for PEx events.

The quality improvement project was conducted at the Children’s National Hospital, a tertiary-care hospital with an accredited CF center.

Pediatric patients and young adults up to 26 years were admitted to the free-standing children’s hospital, and IRB approval for routine collection of demographic and clinical data around the time of PEx in persons with cystic fibrosis was obtained.

Participants 18 years and older provided written consent for the study, while written parental consent was obtained for patients under 18 years old, and assent was obtained from children between the ages of 11 and 17 years.

From there, the data acquired from each participant was used to assess baseline antibiotic use and the impact of the quality improvement initiative on IV antibiotics used for PEx treatment between January 1, 2017 and March 31, 2020.

Soon after, a multidisciplinary team of pulmonologists, infectious disease physisicans, and pharmacists with expertise in cystic fibrosis at Children’s National Hospital was assembled to develop the empiric antibiotic algorithm beginning in July 2017.

The quality improvement project assessed the antibiotic treatment courses of a total of 56 people with cystic fibrosis, with a total of 226 PEx episodes occurring during the study period.

Of those treatment courses, 25 were prescribed in the outpatient setting only (10 in the baseline period and 15 during the intervention), and the remaining courses were all initially prescribed in the inpatient setting.

Investigators observed that the mean age at the first PEx was 12 years old (SD 6.7). Regarding demographics, 55% of all participants who experienced PEx were female, 80% were white, and 71% were non-Hispanic.

After the initiation of the algorithm, the investigators noted that the proportion of PEx with antibiotic use consistent with the algorithm increased from 46.2% to 79.5%, and documentation of justification for broad-spectrum antibiotics increased from 56% to 85%.

Additionally, the use of infectious disease consults increased from 17% to 54%.

The team added that as young patients at their institution are introduced to effective CFTR modulators, the development of an algorithm for outpatient treatment could become an unmet need.

“We would encourage other cystic fibrosis centers to explore their own trends in practice to determine whether a similar intervention may be both feasible and beneficial in the treatment of PEx in perosns with cystic fibrosis,” the team wrote.

"Measuring the Impact of an Empiric Antibiotic Algorithm for Pulmonary Exacerbation in Children and Young Adults with Cystic Fibrosis,"

 was published online in Pediatric Pulmonology.

Despite the prevalence of pulmonary exacerbations in patients with cystic fibrosis, there is no standardized definition to diagnose these events in affected patients.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Algorithm for Outpatient Treatment of Cystic Fibrosis in Young Patients Developed

A gene therapy for retinal degenerative diseases receives an investigational new drug (IND) clearance from the FDA to move forward with the Phase 2 trial of the multi-characteristic opsin (MCO-010) therapy.

Rare Disease Report®

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FDA Clears MCO-010 Gene Therapy as IND for Stargardt Macular Degeneration

Connor Iapoce is an assistant editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Joined by 5 experts in the field of burnout, Crisis Point uncovers the ways burnout manifests and the ramifications it has on both personal and professional lives. 

Major Depressive Disorder

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Internal Medicine

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The Physician Burnout Crisis: Manifestations and Ramifications  

While reporting for race and ethnicity in US studies had increased from 59.8% to 71.9%, the proportion of articles including at least 20% non-White representation remained unchanged.

Atopic Dermatitis

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Dermatologic Studies Lacking in Diversity Despite Increased Efforts

In the midst of a national blood crisis, the FDA is funding a study to examine if different questioning can be used to determine the HIV risk of gay or bisexual men who want to donate blood.

Sickle Cell

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The ADVANCE Study: Rethinking HIV Risk-Assessment for Gay Blood Donors

Investigators say that reducing COVID-19 hospitalizations among these groups will require partnerships among homeless services, correctional facilities and agencies, health care professionals, and public health agencies.

COVID-19

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Incarcerated and Homeless People Disproportionately Affected by COVID-19

A better understanding of this connection could yield preventative treatments. 

Video Series

Asthma

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Beth Krone, PhD: The Link Between ADHD and Asthma

New findings from CDC data show three-fourths of all myocarditis cases observed in the first 8 months of COVID-19 vaccination occurred in persons 30 years and younger.

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Young Men, Adolescents at Raised Risk for COVID-19 mRNA Vaccine Myocarditis

Take a Break was a 3-week interactive experience that involved motivational text messages, challenge quizzes, brief goal setting and more.

COPD

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Interactive Skills-Building Game Linked to Long-Term Smoking Cessation

The analysis also showed guselkumab showed positive joint efficacy among all published advanced therapies approved.

Psoriatic Arthritis

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Plaque Psoriasis

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Guselkumab Ranked Highest Overall in Skin Clearance for Psoriatic Arthritis

As the number of entecavir manufacturers increased from 1-11, the NADAC decreased from $30.12 to $1.93 per 0.5 mg tablet. 

Hepatitis C

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, IBS and IBD, Crohn's disease, and more.

Latest News

Machine Learning Better Predicts Suicide Risk After Emergency Department Visits

ADHD Associated with Food, Skin and Respiratory Allergy

Differences in Treatment Response to Vitiligo Therapy

Approaching the Treatment of Vitiligo

Algorithm for Outpatient Treatment of Cystic Fibrosis in Young Patients Developed