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Anchor lead: More data is emerging on the health consequences of adverse events in childhood, Elizabeth Tracey reports.

Almost two thirds of us experience an adverse event in childhood, the latest data from the Centers for Disease Control and Prevention indicate. Kevin Sowers, president of the Johns Hopkins Health System, says we all need to acknowledge the impact of such events on health.

Sowers:  The new CDC report states that 61% of the US adults experienced at least one adverse event such as violence, growing up in a family with substance abuse or mental health issues. More and more we’re recognizing that mental health and substance use issues are actually driving outcomes in chronic illnesses, so clearly putting resources around decreasing a child’s experience of mental health issues or substance use at home will have better outcomes long term. Also having interventions in place for families that have mental health and substance use issues.  :34 

Sowers notes that there are already such interventions in place in many health systems nationally. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should women use acetaminophen during pregnancy? Elizabeth Tracey reports

Pain relief during pregnancy is a problem, as everyone is reluctant to expose a developing child to drugs that may have negative consequences. Now a study by Xiaobin Wang, a pediatrician and researcher at Johns Hopkins, and colleagues brings up questions about the safety of acetaminophen, marketed as Tylenol, because it shows an association between its use and both ADHD and autism.

Wang: For a long time acetaminophen use has been regarded as a safe medication for minor aches, pains and fevers for women during pregnancy. This study just adds another piece of concern. Before more studies can be done to be certain whether there is or is no association health care providers and parents should consider the benefits and also the potential risks associated with acetaminophen use in pregnancy.   :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Acetaminophen use during pregnancy may adversely affect the child, Elizabeth Tracey reports

Use of acetaminophen, marketed under the brand name Tylenol, may result in increased risk for autism or attention-deficit hyperactivity disorder, or ADHD, in offspring. That’s according to a study by Xiaobin Wang, a pediatrician and researcher at Johns Hopkins, and colleagues.

Wang: (Xiaobin): This study was conducted in the Boston Birth Cohort. It’s a longitudinal cohort, we recruited a mother-baby pair at birth.  We have been following this cohort, the oldest is now already 20 years old. We found a significant association between cord blood biomarkers of acetaminophen and increased risk of childhood autism as well as ADHD risk.   :27

Wang points out that the markers of acetaminophen use in cord blood persist and can be measured later, and notes that there was more of a risk to develop these conditions the higher the level of the biomarkers, indicating greater use. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What should you do if you find something amiss in your medical record? Elizabeth Tracey reports

Open Notes is an effort to ensure that patients can see and review their complete medical chart, with some studies finding that when physicians use language patients find troubling, it can compromise trust. Tatiana Prowell, a breast cancer expert at Johns Hopkins and advocate for intentional language in medical communications, says if you see something, say something.

Prowell: If you feel there’s misinformation in your medical record, that you have to bring up. Sometimes something incorrect gets into the medical record, in the interest of time people copy and paste things or forward a last note and then edit that, so errors can get propagated in the medical record. It’s one of the bigger dangers I think of electronic medical records but if there’s something like learning about a poor prognosis through a note that really is an issue of trust. I think that that’s something that also needs to be brought to the physician’s attention and it probably needs to be done in person.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What’s the impact of words physicians choose on patients? Elizabeth Tracey reports

When you hear the word obese, does that sound different to you than fat? How about non-compliant versus forgets to take medicine? Such phraseology is important in physician interactions with patients, according to Tatiana Prowell, a breast cancer expert at Johns Hopkins.

Prowell: I worry about the shortening that we use when we use disease first language instead of patient first language. So we say the study enrolled a thousand diabetics instead of a thousand people with diabetes. Or we say the patient progressed instead of the tumor progressed. What we mean is the tumor got worse but we say the patient got worse. We conflate the patient and her disease. And so I worry about the message that that sends to our patients. I worry that that makes them think that we are thinking about them first and foremost as their disease.   :30

In a recent op ed, Prowell argues that among the many tasks today’s doctors must take on, sensitivity to choice of language and intentional communication is needed, especially in electronic medical records open to patients. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The American Academy of Pediatrics now supports bariatric surgery for some under the age of 18, Elizabeth Tracey reports

Severely obese children and adolescents should have access to weight loss or bariatric surgery, the American Academy of Pediatrics has stated. Kimberly Steele, an adolescent bariatric surgery expert at Johns Hopkins, comments.

Steele: This is the very first time that they are endorsing bariatric surgery in kids and adolescents. Why is that? Well, we have a real issue right now. There’s 4.5 million kids and teens that are suffering with obesity. There is now enough evidence in the literature to demonstrate that intervening sooner might be the right thing to do because kids and teens who undergo the bariatric surgery actually do better than adults.  :30

Steele says conditions such as diabetes usually resolve very quickly and thus younger people are able to avoid the long term consequences of such chronic health conditions. She notes that choosing a center with expertise in this population is prudent. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is bariatric surgery cost effective in the long run? Elizabeth Tracey reports

Men who had bariatric surgery 10 years ago didn’t have lower healthcare costs overall than men who did not, a recent study in the Veteran’s Administration health system showed. Kimberly Steele, a bariatric surgeon at Johns Hopkins, says those who undergo bariatric surgery now differ significantly.

Steele: In today’s world our population, unfortunately I think is mostly women. It should be even, and a younger population, mean age around 45. Nowadays really it is the laparoscopic vertical sleeve that’s the go to operation. So in that sense there is some difficulty to look at just the negative the cost. We shouldn’t just be looking at cost we should be looking at health. What are the health  outcomes because that’s what’s of value to our society.  :30

Steele notes that overall health includes things like resolution of diabetes and subsequent reduced cardiovascular risk. At Johns Hopkins, I’m Elizabeth Tracey.