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New Studies Show Growing Number of Trans, Nonbinary Youth in US

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New Studies Show Growing Number of Trans, Nonbinary Youth in US

Two new studies point to an ever-increasing number of young people in the United States who identify as transgender and nonbinary, with the figures doubling among 18- to 24-year-olds in one institute’s research — from 0.66% of the population in 2016 to 1.3% (398,900) this year.

In addition, 1.4% (300,100) of 13- to 17-year-olds identify as trans or nonbinary, according to the report from that group, the Williams Institute at the UCLA School of Law in Los Angeles.

Williams, which conducts independent research on sexual orientation and gender identity law and public policy, did not contain data on 13- to 17-year-olds in its 2016 study, so the growth in that group over the past 5+ years is not as well documented.

Overall, some 1.6 million Americans older than age 13 now identify as transgender, reported the Williams researchers.

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And in a new Pew Research Center survey, 2% of adults aged 18-29 identify as transgender and 3% identify as nonbinary, a far greater number than in other age cohorts.

These reports are likely underestimates. The Human Rights Campaign estimates that some 2 million Americans of all ages identify as transgender.

The Pew survey is weighted to be representative, but still has limitations, said the organization. The Williams analysis, based on responses to two CDC surveys — the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Survey (YRBS) — is incomplete, say researchers, because not every state collects data on gender identity.

Transgender Identities More Predominant Among Youth

The Williams researchers report that 18.3% of those who identified as trans were 13- to 17-year-olds; that age group makes up 7.6% of the US population 13 and older.

And despite not having firm figures from earlier reports, they comment: “Youth ages 13 to 17 comprise a larger share of the transgender-identified population than we previously estimated, currently comprising about 18% of the transgender-identified population in the US, up from 10% previously.”  

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About one quarter of those who identified as trans in the new 2022 report were aged 18-24; that age cohort accounts for 11% of Americans.

The number of older Americans who identify as trans are more proportionate to their representation in the population, according to Williams. Overall, about half of those who said they were trans were aged 25-64; that group accounts for 62% of the overall American population. Some 10% of trans-identified individuals were over age 65. About 20% of Americans are 65 or older, said the researchers.

The Pew research — based on the responses of 10,188 individuals surveyed in May — also found growing numbers of young people who identify as trans. “The share of US adults who are transgender is particularly high among adults younger than 25,” reported Pew in a blog post.

In the 18- to 25-year-old group, 3.1% identified as a trans man or a trans woman, compared with just 0.5% of those ages 25-29.  

That compares to 0.3% of those aged 30-49 and 0.2% of those older than 50.

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Racial, and State-by-State Variation

Similar percentages of youth aged 13-17 of all races and ethnicities in the Williams study report they are transgender, ranging from 1% of those who are Asian, to 1.3% of White youth, 1.4% of Black youth, and 1.8% of American Indian or Alaska Native and 1.8% of Latinx youth. The institute reported that 1.5% of biracial and multiracial youth identified as transgender.

The researchers said, however, that “transgender-identified youth and adults appear more likely to report being Latinx and less likely to report being White, as compared to the US population.”

Transgender individuals live in every state, with the greatest percentage of both youth and adults in the Northeast and West, and lesser percentages in the Midwest and South, reported the Williams Institute.

Williams estimates as many as 3% of 13- to 17-year-olds in New York identify as trans, while just 0.6% of that age group in Wyoming is transgender. A total of 2%–2.5% of those aged 13-17 are transgender in Hawaii, New Mexico, Maryland, and Washington, DC.

Among the states with higher percentages of trans-identifying 18- to 24-year-olds: Arizona (1.9%), Arkansas (3.6%), Colorado (2%), Delaware (2.4%), Illinois (1.9%), Maryland (1.9%), North Carolina (2.5%), Oklahoma (2.5%), Massachusetts (2.3%), Rhode Island (2.1%), and Washington (2%).

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Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on Twitter @aliciaault.

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn

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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

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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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New study shows an increased prevalence of headaches in adolescents during COVID-19 pandemic (2022, June 24)
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