Epidemiology of Current Asthma in Children Under 18: A Two-Decade Overview Using National Center for Health Statistics (NCHS) Data.

OBJECTIVE:  This study conducted a comprehensive two-decade analysis of current asthma among children under 18 in the United States using National Center for Health Statistics (NCHS) data. The primary objective was to assess the prevalence of current asthma, evaluate temporal trends, and identify disparities based on gender, age, insurance status, household poverty levels, and race/ethnicity. METHODS:  Data spanning 2003-2019 from NCHS were analyzed, focusing on current asthma prevalence among children under 18. Age-adjusted prevalence rates were calculated and stratified by various factors, including gender, age groups, health insurance status, poverty levels, and race/ethnicity. RESULTS:  The study revealed substantial disparities in current asthma prevalence. Over the two-decade period, the overall prevalence of current asthma fluctuated. It increased from 2003 (8.5%) to 2009 (9.6%) and then decreased by 2019 (7.0%). Gender disparities were evident, with males (9.9%) consistently reporting a higher prevalence than females (7.5%). Older children aged between 10-17 years (10.4%) consistently had a higher prevalence of asthma than younger children aged 0-4 (5.3%) and 5-9 years (9.5%). Children with Medicaid insurance (11.2%) had the highest prevalence, followed by insured (8.9%), privately insured (7.7%), and uninsured children (6.1%). Children living below the federal poverty level (FPL) consistently reported the highest prevalence (11.3%), while children above 400% of the FPL (7.1%) had the lowest prevalence. Racial disparities were observed, with Black children (14.3%) having higher asthma prevalence, followed by White (7.6%) and Asian children (5.4%). CONCLUSION: The study highlights significant disparities in current asthma prevalence over the two-decade period analyzed. While the overall prevalence showed fluctuations, it generally increased from 2003 to 2009 and then decreased by 2019. Gender disparities were evident, with males consistently reporting a higher prevalence compared to females. Older children in the 10-17 age group consistently had a higher asthma prevalence than younger age groups. Moreover, disparities based on insurance status and income levels were also apparent, with children on Medicaid and those living below the FPL reporting higher asthma prevalence. Racial disparities were observed, with Black children having the highest prevalence, followed by White and Asian children. These findings emphasize the importance of addressing these disparities and tailoring interventions to improve asthma management and prevention across different demographic groups.

Temporal Patterns of Diabetes in Pregnancy: Analyzing Pregestational and Gestational Diabetes Mellitus Among Women Aged 15-44 Years Using the United States Diabetes Surveillance System (USDDS) Database.

BACKGROUND: Diabetes in pregnancy, including pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), is a significant global health concern. Understanding its temporal patterns is crucial for effective healthcare planning and intervention strategies. METHODS: This retrospective observational study utilized data from the United States Diabetes Surveillance System (USDDS) spanning 2000 to 2019. We conducted a comprehensive analysis of temporal trends in PGDM and GDM prevalence among people aged 15-44 years. Additionally, age and race-based subgroup analyses were performed to identify variations in diabetes patterns. RESULTS: Over the two-decade study period, PGDM and GDM exhibited distinct temporal patterns. PGDM prevalence remained stable initially (1.1% per 100 deliveries) but gradually increased to 1.6% by 2019. In contrast, GDM prevalence showed a consistent rise, reaching 9.6% per 100 deliveries by 2019. Age-specific analysis revealed higher prevalence rates in older age groups, peaking at 40-44 years. Race-based analyses unveiled significant disparities, with Asians having the highest GDM rates and Black individuals having the highest PGDM rates. CONCLUSION: The prevalence of diabetes in pregnancy in the United States has increased significantly from 2000 to 2019, emphasizing the need for continued surveillance and tailored interventions. Age and race-specific disparities highlight the importance of the growing impact of diabetes in pregnancy on maternal and fetal health.

The Use of Cannabis and Its Effects on Postpartum Depression.

Cannabis use and depression management have been studied, with a preponderance of exacerbating effects, but there are few studies on postpartum depression (PPD). Depression affects a significant number of women, with a portion of it manifesting as PPD in childbearing women in the United States each year. The pharmacologic management approaches have disadvantages such as side effects, cost-benefit ratio, contraindications, use reluctance, medication adherence, and stigmatization in patients. Anecdotal claims of medical cannabis' therapeutic benefits have led to widespread legalization in several regions, making cannabis and its extracts a possible alternative. Cannabis is widely used during pregnancy and in general. Even though substance use disorders exacerbating depression symptoms have been reported, there are increasing reports and evidence about the therapeutic benefit of dose-dependent cannabis or its extracts in some depression symptoms, such as acute psychosocial stress relief, its purported anxiolytic effect, appetite, and sleep quality, thus stimulating more interest that may be inferred to depression. PPD marijuana use is unclear. This paper reviewed works of literature that claimed cannabis' therapeutic benefit in treating depression and, by extension, PPD. Our findings show the link between cannabis and PPD has not been fully explored. Self-reported studies link marijuana uses to positive mood, anxiety relief, sleep regulation, nausea and vomiting reduction, and appetite stimulation-all PPD symptoms. Others opposed postpartum marijuana use.

Foreign Body in the Urinary Bladder: Another Outpatient Presentation.

Primary care physicians manage a variety of medical conditions in their practice; to do this successfully, they require proper preparation and a wealth of experience, which they garner over years of practice. This case describes a 41-year-old male who presented to an outpatient clinic with a foreign body in the urinary bladder. This case report captures the level of preparedness required in primary care, the challenges that come with the broad spectrum of disease presentations, inter-specialty collaboration, and consultation or referral as appropriate with regards to having a foreign body in the urinary bladder. This report also shows how misinformation from patients can play a part in delayed diagnosis of simple presentations such as a self-inserted foreign body.

Approaches to Medication Administration in Patients With Lack of Insight.

Lack of insight typically complicates psychiatric presentations, necessitating careful thought and planning to choose the best course of treatment. Exploring methods of medication administration techniques in the context of a lack of insight is crucial to achieving the ultimate goal of overcoming the insight barrier as rapidly as possible, which will result in therapeutic benefit. This study's objective was to systematically review the evidence on medication administration techniques in a backdrop of lack of insight and how that evidence was curated in the scientific literature. This study used the literature search strategy, which entails retrieving and analyzing the existing scientific literature pertinent to medication administration techniques for individuals with no insight between 2010 and 2022. Accessing online databases, such as PubMed, Google Scholar, and Medline was utilized in this study's literature search strategy. In our findings, in the primary evidence search, no randomized control trial (RCT) comparing the various models of medication administration with a lack of insight was found. No study provided data on the superiority of utility, quality of life, or efficacy outcome. Some 17 scientific papers were identified that cited various trials about lack of insight and medication use and met the inclusion criteria. We concluded that it could be challenging to administer medication to patients who lack insight. Nonetheless, progress has been made to mitigate this obstacle. Common moral values, common sense, medicolegal support, person-centered integrated care, and cutting-edge medication techniques may play a role. However, these models of medication administration are still evolving, along with the ethical concerns accompanying them. Hopefully, the available models discussed in this analysis will serve as a foundation for future developments. Nonetheless, much remains to be done. We encourage contemporary research to investigate safer and more dynamic methods that can alleviate this condition.

A Review of Four Practice Guidelines of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a term that encompasses conditions characterized by chronic inflammation of the gastrointestinal tract (GIT). It includes Crohn's disease and ulcerative colitis. Major scientific organizations interested in gastrointestinal systems or GIT-focused organizations worldwide release guidelines for diagnosing, classifying, managing, and treating IBD. However, there are subtle differences among each of these guidelines. This review evaluates four evidence-based guidelines in the management of IBD and seeks to highlight the differences and similarities between them. The main differences in the evaluated guidelines were in diagnosis and treatment recommendations. The diagnosing recommendations were comparable amongst the four guidelines; however, some were more specific about limiting the number of interventions necessary to confirm a diagnosis. Regarding treatment options, each guideline had clear suggestions about what was considered ideal. Although the treatment options were identical, the main differences existed in the recommended diets and initial therapy in patients with moderate disease. Clinical practice guidelines (CPGs) recommend evidence-based practice from opinion leaders in clinical decision-making. Rather than dictating a one-size-fits-all approach in IBD management, reviewing various guidelines can enhance the cross-pollination of ideas amongst clinicians to improve decision-making. Clearly describing and appraising evidence-based reasoning for scientific recommendations remain driving factors for quality patient care. The effectiveness of CPGs in improving health and the complexities of their formation requires constant review to maximize constructive criticisms and explore possible improvements.