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Adult growth hormone deficiency increases medical costs, risk of additional health conditions

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Adult growth hormone deficiency increases medical costs, risk of additional health conditions

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Credit: Pixabay/CC0 Public Domain

Growth hormone deficiency (GHD) among adults is associated with greater medical costs and an increased rate of other health conditions compared with those without GHD, according to industry-sponsored research being presented Monday at ENDO 2022, the Endocrine Society’s annual meeting in Atlanta, Ga.

GHD is a rare disorder linked to poor quality of life and central adiposity, which increases the risk for metabolic syndrome, cardiovascular disease and decreased bone mineral density. Daily somatropin injections improve the condition and quality of life, but treatment rates remain low.

This study, led by Alden Smith, PharmD, Global Head of Health Economics and Outcomes Research at Ascendis Pharma in Palo Alto, Calif., was created to analyze these healthcare costs and daily somatropin use among adults with GHD with Medicaid or commercial health insurance in the United States.

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“Growth hormone deficiency in adults leads to 4-5 times higher medical costs and more than double the rate of disease-associated endocrine, metabolic, hepatic, renal and cardiovascular conditions than those seen in populations without growth hormone deficiency,” Smith said.

Smith and colleagues conducted a retrospective analysis of claims data from more than 25,000 patients diagnosed with GHD between January 1, 2008, and December 31, 2017. Those with GHD were directly matched to controls without GHD, based on age, gender, plan type (Medicaid vs. commercial health insurance), region and race.

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Data show those adults diagnosed with GHD experienced higher rates of endocrine conditions (>68% in adult GHD vs. ≤10% in control group), metabolic conditions (>93% vs. ≤39%), hepatic and renal function conditions (18-23% vs. cardiovascular disease (41-53% vs.

Mean annual healthcare costs were 4.6 times greater for adults with GHD in the Medicaid group compared with controls ($42,309 vs. $9,146). Costs were 4.1 times greater for those with commercial health insurance compared with controls ($30,111 vs. $7,376).

Only 5.8% of adult GHD patients were treated with somatropin in the commercial health insurance cohort, and just 9.5% of adult GHD patients were treated with somatropin in the Medicaid cohort.

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“As discussions on the need to treat growth hormone deficiency in adults continues to evolve, this research reinforces the significant economic burden seen in this disease,” Smith said. “Further research is needed to gain insight into reasons for low treatment rates and to determine if treatment can reduce this economic burden and improve the comorbidities that adults with GHD experience.”



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Adult growth hormone deficiency increases medical costs, risk of additional health conditions (2022, June 11)
retrieved 12 June 2022
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Childhood Melatonin Poisonings Skyrocket in the Past 10 Years

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Childhood Melatonin Poisonings Skyrocket in the Past 10 Years

The number of children in the United States who unintentionally ingested melatonin supplements over the past 10 years has skyrocketed to the point where, as of 2021, melatonin ingestions by children accounted for almost 5% of all poisonings reported to poison control centers in the United States, data from the National Poison Data System (NPDS) indicate.

This compared with only 0.6% of melatonin ingestions reported to poison control centers in 2012, the authors added.

“Basically the number of pediatric melatonin ingestions increased 530% from 8,337 in 2012 to 52,563 in 2021 so it’s a 6.3-fold increase from the beginning of the study until the end,” Michael Toce, MD, one of the study authors and attending, pediatric emergency medicine/medical toxicology, Boston Children’s Hospital, said in an interview.

“And I think the biggest driver of this increase is simply that sales of melatonin have increased astronomically so there is just more melatonin at home and studies have shown there is a correlation between the amount of an individual medication in the home and the risk of pediatric exposure — so simply put: The more of a single substance in a home, the greater the chance that a child is going to get into it,” he underscored.

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The study was published in the Morbidity and Mortality Weekly Report.

Melatonin Ingestions

All cases of single substance melatonin ingestions involving children and adolescents between Jan. 1, 2012, and Dec. 31, 2021, were included in the analysis. During the 10-year study interval, 260,435 pediatric melatonin ingestions were reported to the NPDS. Over 94% of the reported ingestions were unintentional and 99% occurred in the home.

Over 88% of them were managed on-site; most involved young male children aged 5 years and under, and almost 83% of children who ingested melatonin supplements remained asymptomatic. On the other hand, 27,795 patients sought care at a health care facility and close to 15% of them were hospitalized. Among all melatonin ingestions, 1.6% resulted in more serious outcomes; more serious outcomes being defined as a moderate or major effects or death. Five children required mechanical ventilation in order to treat their symptoms and 2 patients died.

The largest number of patients who were hospitalized were adolescents who took melatonin intentionally but the largest increase in the rate of exposure was in young, unintentional patients, as Toce observed. Interestingly, the largest yearly increase in pediatric melatonin ingestions — almost 38% — coincided with the onset of the COVID-19 pandemic.

“This might be related to increased accessibility of melatonin during the pandemic, as children spent more time at home because of stay-at-home orders and school closures,” the authors speculate. Moreover, sleep disturbances were common during the pandemic, leading to a greater likelihood that parents were buying melatonin and thus exposing children to more melatonin at home.

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Taken appropriately and at normal does, melatonin in itself is quite safe, as Toce stressed. However, “for any substance, the dose makes the poison, so taken in any significant quantity, anything is going to be dangerous.” Moreover, it’s important to appreciate that melatonin, at least in the United States, is regulated as a dietary supplement, not as a pharmaceutical.

“Thus, it doesn’t get the same rigorous testing that something like acetaminophen does by the FDA and that means two things,” Toce noted. First, if the product says that each gummy contains 3 mg of melatonin, no independent body is verifying whether or not that statement is true so there could be 3 mg of melatonin in each gummy or there could be 10 mg.

Secondly, because there is no impartial oversight for dietary supplements, there may in fact be no melatonin at all in the product or something else may be added to it that might be harmful. “Just because something is sold over-the-counter does not necessarily mean that it’s safe,” Toce stressed. To keep children safe from pharmaceuticals and supplements, he recommended several generic poison prevention tips. This advice could be passed on to patients who are parents.

  • Keep all pharmaceuticals and supplements preferably locked away so there is less risk of children and adolescents taking products either unintentionally or intentionally

  • If parents have no place to lock their products up, put them out of reach, high-up so children cannot easily access them

  • Keep the product in the original child-resistant packaging as opposed to taking the pills out of the packaging and putting it in a plastic bag. “Certainly we’ve seen that when medications are moved into a non-child-resistant container, ingestions go up,” Toce warned

  • Don’t refer to any medicine or supplement a child might take as “candy.” “A lot of children have difficulty taking medications so some families will say: ‘It’s time for your candy,’ ” Toce explained. Then, if a child does discover the “candy” on a table where they have access to it, they will not recognize it as medication and they’re likely to pop it into their mouth, thinking it is candy

Lastly, and most importantly, parents who are considering trying a melatonin supplement to help a child sleep better should first establish a stable sleep routine for their child. “They also need to limit caffeinated beverages before bed as well as screen time,” Toce added.

And they should talk with their primary care provider as to whether or not initiation of a melatonin supplement is appropriate for their child — “and not just jump right into giving them melatonin without first discussing whether it is appropriate to do so,” Toce stressed.

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Remarkable Rise

In a comment on his own experience with melatonin poisoning over recent years, toxicology expert Kevin Osterhoudt, MD, of the University of Pennsylvania, Philadelphia, and the Children’s Hospital of Philadelphia, noted that it has been their experience that there has been a remarkable rise in poison center reports of children ingesting melatonin in the recent past. For example, the Poison Control Center at CHOP received nearly 4,000 calls involving melatonin ingestion by children 5 years old or younger in the 5 years between 2017 and 2021 with increasing numbers every year.

“The [current study] supports our regional observation that this has been a national trend,” Osterhoudt said. Osterhoudt agreed with Toce that good sleep is healthy, and it is very important to develop good sleep habits and a regular bedtime routine. “In some situations, melatonin may be useful as a short-term sleep aid and that’s a good discussion to have with your child’s health care provider.”

If parents do decide to give their child a melatonin supplement, they need to keep in mind that melatonin may alter how the body handles other drugs such as those used to treat epilepsy or blood clotting. They also need to know experts are still uncertain about how melatonin affects the body over the long term and whether it is safe for mothers to take during pregnancy.

Osterhoudt offered his own recommendations for safe melatonin use in the home:

  • Discuss planned melatonin use with your health care provider

  • Buy only high-quality supplements by looking for the “USP Verified” mark

  • Insist that manufacturers sell products in child-resistant bottles

  • Periodically inspect the medications in your home and dispose of medications that are no longer being used

  • Program the phone number of your regional poison control center into your phone; poison center experts are available 24/7 to answer questions and concerns about ingestions of melatonin (in the United States the number is 1-800-222-1222)

The study authors and neither Toce nor Osterhoudt had any relevant conflicts of interest to declare.

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This story originally appeared on MDedge.com, part of the Medscape Professional Network.

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CDC Releases New Details on Mysterious Hepatitis in Children

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CDC Releases New Details on Mysterious Hepatitis in Children

A new analysis from the Centers for Disease Control and Prevention (CDC) provides further details on mysterious cases of pediatric hepatitis identified across the United States. While 45% percent of patients have tested positive for adenovirus infection, it is likely that these children “represent a heterogenous group of hepatitis etiologies,” the CDC authors write.

Of the 296 children diagnosed between October 1, 2021, and June 15, 2022, in the United States, 18 have required liver transplants and 11 have died.

On April 21, 2022, the CDC issued an alert to providers to report pediatric hepatitis cases of unknown etiology in children under 10 after similar cases had been identified in Europe and the United States. While the United Kingdom has found an uptick in cases over the past year, researchers from the CDC published data on June 14 that suggested pediatric hepatitis cases had not increased from 2017 to 2021.

This newest analysis, published Friday, June 24, in the CDC’s Morbidity and Mortality Weekly Report, provides additional demographic data on affected patients and explores possible causes, including previous infection with COVID-19. Investigators had earlier ruled out COVID-19 vaccination as a potential factor in these cases, as most children were unvaccinated or not yet eligible to receive the vaccine. According to the analysis, only five patients had received at least one dose of a COVID-19 vaccine.

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The 296 cases included in the analysis occurred in 42 US states and territories, and the median age for patients was 2 years and 2 months. Nearly 60% of patients were male (58.1%) and 40.9% were female. The largest percentage of cases occurred in Hispanic or Latino children (37.8%), followed by non-Hispanic White (32.4%) children. Black patients made up 9.8% of all cases, and 3.7% of affected children were of Asian descent. Vomiting, fatigue, and jaundice were all common symptoms, and about 90% (89.9%) of children required hospitalization..

Of 224 children tested for adenovirus, 44.6% were positive. The analysis also included information on 123 of these hepatitis patients tested for other various pathogens. Nearly 80% (98/123) received a COVID-19 test and just 10.2% were positive. Twenty-six percent of patients had previously had COVID-19, and hepatitis onset occurred, on average, 133 days after the reported SARS-CoV-2 infection.

Other viruses detected included:

  • rhinovirus/enterovirus (24.5%)

  • rotavirus (14.0%)

  • acute Epstein-Barr virus (11.4%)

Simultaneous infection with SARS-CoV-2 and adenovirus occurred in three patients.

There was no evidence of viral inclusions in the 36 patients who had pathologic evaluation liver biopsies, explants, or autopsied tissue.

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The findings suggest that there may be many different causes behind these severe hepatitis cases, the authors write, and it is estimated that about one third of hepatitis cases in children do not have a known cause. However, the identification of adenovirus infection in many cases “raises the question whether a new pattern of disease is emerging in this population or if adenovirus might be an underrecognized cause or cofactor in previously indeterminate cases of pediatric hepatitis,” the authors write. As the investigation continues, they added, “further clinical data are needed to understand the cause of these cases and to assess the potential association with adenovirus.”

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New study shows an increased prevalence of headaches in adolescents during COVID-19 pandemic

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New study shows an increased prevalence of headaches in adolescents during COVID-19 pandemic

headache
Credit: Unsplash/CC0 Public Domain

Over one third of schoolchildren who received online lessons during the COVID-19 pandemic reported a worsening of headache symptoms or new onset headaches, a study presented today at the European Academy of Neurology (EAN) Congress 2022 has found.

Prolonged exposure time to computer screens, a lack of suitable conditions for online learning from home, school exams and anxieties about COVID-19 were all found to be risk factors for the worsening of headache symptoms or triggering new onset headaches.

The multi-center study analyzed 851 adolescents aged between 10 and 18, with 756 (89%) of children reporting headaches over the study period. Among these children, 10% reported new onset headaches over the pandemic home-schooling period. Over a quarter (27%) of children said their headaches had worsened, 61% said their headaches had remained stable and 3% said their headaches had improved.

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Those who reported worsened or new onset headaches suffered from headaches an average of 8-9 times per month. Over half of children within this group (43%) used painkillers at least once a month compared to a third (33%) in the stable group.

Lead researcher Dr. Ayşe Nur Özdag Acarli from Ermenek State Hospital, Karaman, Turkey, said that in contrast to previous reports, the team’s analysis didn’t support a tendency towards reduction in headache and severity during the pandemic.

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“Although earlier studies reported that young people were having fewer headaches due to the closure of schools in the early weeks and months of COVID-19, this longer-term study has found the stresses and pressures of the pandemic eventually took their toll,” Dr. Acarli explained.

The study found that headaches had a big impact on mental health and school achievements. Depression and anxiety scores, including anxiety about catching COVID-19, were significantly higher in the worsened and new onset headache groups. These respondents also acknowledged that they had made less effort with their schoolwork and their academic achievements had fallen.

Exams, living in a city, weight gain and depression were also linked to more frequent headache occurrences within the study.

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Dr. Acarli commented, “Young people had concerns about the quality and sufficiency of online education and 62% of respondents said they were dissatisfied with it, while 21% were indecisive. Headache severity and frequency showed significant correlation with age, depression, and anxiety.”

Headache is the most common neurological issue in children and adolescents. A complex mix of factors can contribute to headaches, including sleep, use of electronic devices and socioeconomic factors.



More information:
The Burden of Coronavirus Disease (COVID-19) Pandemic on Headaches in Adolescents: Other Side of the Coin, presented at the EAN Congress 2022.

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The European Academy of Neurology

Citation:
New study shows an increased prevalence of headaches in adolescents during COVID-19 pandemic (2022, June 24)
retrieved 24 June 2022
from https://medicalxpress.com/news/2022-06-prevalence-headaches-adolescents-covid-pandemic.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no
part may be reproduced without the written permission. The content is provided for information purposes only.

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