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OU College of Medicine and US Department of Defense to address problematic sexual behavior of youth

When young people act out sexually in ways that are harmful to others or themselves, the stigma surrounding the issue can be paralyzing for everyone affected. However, data shows that treatment for problematic sexual behavior in youth is highly effective.

Faculty members at the University of Oklahoma Health Sciences Center are among the nation’s leaders on this topic, and they recently received a federal grant to assist the U.S. Department of Defense in addressing problematic sexual behavior of youth in the military.

The National Center on the Sexual Behavior of Youth (NCSBY) is housed within the OU College of Medicine, Department of Pediatrics.

Its personnel have been trailblazers in the research and treatment of problematic sexual behavior of youth, and in training parents, caregivers, healthcare providers and others around the world to prevent and respond to incidents.

NCSBY’s new work is funded by the Office of Juvenile Justice and Delinquency Prevention, a component of the U.S. Department of Justice.

NCSBY is assisting the U.S. Department of Defense in developing training materials and resources to address the issue of youth problematic sexual behavior in all branches of the military.

This is an issue that communities and people worldwide struggle to address.”


Jane Silovsky, Ph.D, Clinical Child Psychologist and Director, National Center on the Sexual Behavior of Youth, University of Oklahoma

“But the Department of Defense has done a remarkable job of understanding the science about the appropriate response to the children with behavior problems, as well as their caregivers and the children who are impacted.”

In many cases, problematic sexual behavior in youth involves one young person harming another young person, Silovsky said. Studies show the behavior peaks between the ages of 12 and 14, and that young people rarely act out on strangers; most of the time, they’re acting out on siblings, cousins, schoolmates and others within their social networks.

Exposure to violence is a major risk factor, whether it’s domestic violence, physical abuse, harsh parenting practices, or community violence.

Exposure to sexualized media is another risk factor; young people can access pornography on any device, despite the best efforts of their caregivers, Silovsky said. In addition, there are individual risks, such as a child having developmental disabilities, being on the autism spectrum and having impulse disorders.

“These risk factors can impact children’s emotional regulation skills, impulse control skills, and their understanding of the rules and how you treat others,” Silovsky said.

“A common myth is that all youth with problematic sexual behavior are being sexually abused themselves. While sexual abuse is a risk factor and a concern, there are many kids with problematic sexual behavior have not been sexually abused.”

Nor are children with problematic sexual behavior the same as adults who have illegal behaviors or adults with pedophilia who have inappropriate arousal toward children, Silovsky said, and treating them as adults does more harm than good.

Rather, the approach involves cognitive behavioral therapy, in which

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National Academy of Medicine president to give keynote address at 2020 CVBE Symposium – School of Engineering

The 2020 Progenitor Cell Translation Consortium (PCTC) Cardiovascular Bioengineering (CVBE) Symposium co-hosted by the UAB Department of Biomedical Engineering, will feature a keynote address by Victor Dzau, M.D., president of the National Academy of Medicine. Dzau, a professor of Medicine at Duke University will speak on “The Future of Heart Failure Therapy/Paracrine Mechanism of Stem Cell Therapy,” on December 5, 2020 at 9:10 a.m.

dzauSource: medicine.duke.eduDue to the worldwide outbreak of coronavirus (COVID-19), the symposium will be held in a virtual format via Zoom for the first time. The event was originally scheduled for the spring in Göttingen, Germany, and was anticipated to draw speakers and guests from around the globe. This collaborative conference, focusing on cardiac gene and cell therapy topics, is co-hosted and co-organized by UAB BME Chair Jay Zhang, M.D., Ph.D., and Wolfram Zimmerman, Ph.D., of the University Medical Center Göttingen. Topics addressed will include areas of gene editing, induced pluripotent stem cells, cardiac stem cells in the context of heart failure, cardiovascular bioengineering, vascular tissue engineering, cardiac development, exosomes, microRNAs, and mitochondria.

In addition to his role of president of the National Academy of Medicine (NAM) (formerly the Institute of Medicine), Dzau also serves as the vice chair of the National Research Council and is chancellor emeritus and James B. Duke Professor of Medicine at Duke University Health System. Prior to these roles, he was the Hersey Professor of Theory and Practice of Medicine and Chairman of Medicine at Harvard Medical School’s Brigham and Women’s Hospital, and Chairman of the Department of Medicine and Director of the Falk Cardiovascular Research Center at Stanford University. Dzau is a prominent world health leader and advises governments, corporations, and universities worldwide. He has also made a major impact on health and medicine through his seminal research in cardiovascular medicine and genetics and his leadership in health innovation.

Registration is free, but will be required for access to the symposium. Register online at: https://translationalcells.org/content/pctc-cardiovascular-bioengineering-cvbe-symposium

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Commentary: Why scientists and public health officials need to address vaccine mistrust instead of dismissing it

Recent polls indicate that more than a third of the country has concerns about a vaccine that in all likelihood will be the only reliable way to end to the COVID-19 pandemic.
These results reflect a similar public sentiment in the U.S. in the 1950s when a polio vaccine was introduced. There are likely multiple reasons for this suspicion, including safety concerns, lack of transparency from the scientific community, lack of trust in the government and the desire to wait until a longer track record of safety can be established.
We are experts in media literacy, health and political communication and biostatistics and biomedical research for future health care providers, from Washington State University’s Edward R. Murrow Center for Media & Health Promotion Research and the Elson S. Floyd College of Medicine. We also live in the communities we hope to serve with our science.
Based on our research, we believe that officials need to use this testing period to build trust, not to create reasons for diminishing it. Respect and forthrightness can turn the tone from adversarial to collaborative, and from a provider-directed practice to a shared decision-making process. Scientists and public health officials must anticipate and address people’s concerns and not brush aside concerns, a process that has become commonplace across other areas of the provider-patient relationship, but vaccine decisions remain a notable exception.
Vaccines and complications
Vaccines are among the safest, most transformative drugs on Earth, with adverse events so low that very nearly universal vaccination is a reasonable expectation. With such a safety record, and with so much at risk with diseases like COVID-19, measles and influenza, vaccine advocates have good reason to stress the overwhelmingly positive safety record.
History has included some vaccines of questionable quality as well as vaccination tactics of even more concern. Certain minority groups have been targeted with egregious coercion. This included cases of forced vaccination for smallpox of African Americans at gunpoint in the southern United States in the early 1900s. At a tenement house in Manhattan’s Little Italy, over 200 men in 1901 in essence performed a smallpox vaccination raid in the middle of the night, trying to vaccinate as many people as they could.
When the miracle vaccine for polio was widely distributed in 1955, speed took precedent over safety, and many doses were distributed that contained live polio virus. As a result, 70,000 children developed muscle weakness, 164 were paralyzed permanently and 10 children died. This led to direct government intervention that has led to thousands of required tests in order to ensure safety and effectiveness.
Instances like these undoubtedly fuel people’s concerns. Such occurrences should give us all pause, scientist or not, to do better next time and strive to never repeat such notable grievances.
Why can’t vaccines bounce back from mistakes?
As medical and public health researchers, we have found it interesting that corporations that have been lax and dishonest have bounced back without lasting damage to their reputations. For example, Volkswagen was caught in

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medicine

Primary Care Journals Address Systemic Racism in Medicine

Editors-in-chief at 10 leading family medicine journals have banded together to address systemic racism in research, healthcare, and the medical profession.



Dr Sumi Sexton

Sumi Sexton, MD, editor-in-chief of American Family Physician (AFP), told Medscape Medical News she had been working on changes at her journal that would answer the need for action that was made clear by this summer’s Black Lives Matter protests and realized the issue was much bigger than one journal. She proposed the collaboration with the other editors.

The editors wrote a joint statement explaining what they plan to do collectively. It was published online October 15 ahead of print and will be published in all 10 journals at the beginning of the year.

Following the action by family medicine editors, the American College of Physicians issued a statement expressing commitment to being an antiracist organization. It calls on all doctors to speak out against hate and discrimination and to act against institutional and systemic racism. The statement also apologizes for the organization’s own past actions: “ACP acknowledges and regrets its own historical organizational injustices and inequities, and past racism, discrimination and exclusionary practices throughout its history, whether intentional or unintentional, by act or omission.”

Family Medicine Journals Plan Changes

Changes will differ at each family medicine publication, according to Sexton and other interviewees. Some specific changes at AFP, for example, include creating a medical editor role dedicated to diversity, equity, and inclusion to ensure that content is not only accurate but also that more content addresses racism, Sexton said.

AFP is creating a Web page dedicated to diversity and will now capitalize the word “Black” in racial and cultural references. Recent calls for papers have included emphasis on finding authors from underrepresented groups and on mentoring new authors.

“We really need to enable our colleagues,” Sexton said.

The journals are also pooling their published research on topics of racism and inclusion and have established a joint bibliography.

The steps are important, Sexton said, because reform in research will start a “cascade of action” that will result in better patient care.

“Our mission is to care for the individual as a whole person,” Sexton said. “This is part of that mission.”

Increasing Diversity on Editorial Boards

Family physician Kameron Leigh Matthews, MD, chief medical officer for the Veterans Health Administration in Washington, DC, praised the journals’ plan.

She noted that the groups are addressing diversity on their editorial boards as well as evaluating content.

Effective change must also happen regarding the people reviewing the content, she told Medscape Medical News. “It has to be both.



Dr Kameron Matthews

“I’m very proud as a family physician that our editors came together and are giving the right response. It’s not enough to say we stand against racism. They’re actually offering concrete actions that they will take as editors and that will influence healthcare,” she said.

Matthews pointed to an example of what can happen when the editorial process fails and racism is introduced in research.

She

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Address Medical Mistrust to Recruit Minorities to COVID-19 Trials

To end HIV and control COVID-19, medicine must earn back the trust of people in Black, Latinx, and Native American communities, said Jonathan Mermin, MD, MPH, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC.

During the closing plenary of the United States Conference on HIV/AIDS October 21, Mermin laid out four principles behind those actions to the audience of USCHA:

  • Actively work with communities most affected by health inequities

  • Make plans to address them transparent

  • Work with community members on those plans and listen to their feedback

  • Do a good job

“Trust will come with proof of action,” he told the audience, watching virtually from their homes and offices.

But clinicians can take action in the exam room and during clinical trial recruitment to help the process along, said Russell Campbell, MA, deputy director of the Office of HIV/AIDS Network Coordination at the Fred Hutchinson Cancer Research Center, Seattle, Washington.

“Distrust in the medical and research establishment has deep roots,” he said during a presentation earlier in the week. To address this, clinicians must learn “culturally appropriate and meaningful engagement to influence the participation of historically underrepresented communities in healthcare and research.”

From Slavery to HeLa to Clinical Practice

Medical mistrust doesn’t stem only from the denial of treatment to the men who were part of the Tuskegee Syphilis Study. It also includes reckonings with the racist abuse of study participants by some of science’s most acclaimed leaders. Take, for instance, J. Marion Sims, MD, the so-called father of gynecology, who gained much of that information by experimenting without anesthesia on enslaved women; or Cornelius Rhoads, MD, whose name was removed from an award at the American Association for Cancer Research when objections grew concerning racist remarks Rhoads made about Puerto Rican patients in the 1930s. Or consider the story of Henrietta Lacks, the originator of the HeLa genes that have guided oncology research. Her genetic material was being mined for oncological insights without her permission and without compensation.

“The groups that have been systematically and intentionally denied treatment and known cures for diseases on behalf of research have just really taken the brunt,” Campbell said during a session role-playing best practices for addressing medical mistrust among potential clinical trial participants, conducted earlier in the conference.

“African Americans, American Indians, Puerto Ricans, Guatemalans, and others really still are heavily impacted by these abuses of research.”

And it shows in clinical outcomes. Research into HIV antiretroviral treatment adherence has found that medical mistrust was associated with a 76% likelihood that Black Americans living with HIV would be nonadherent to their treatments. But race-based medical mistrust drew into question the necessity of treatment at all.

A 2016 study in the journal AIDS Care found that although White gay men in Boston and primarily Black gay men in Jackson, Mississippi both reported concerns about side effects and lack of culturally appropriate care, it was the Black gay men in Jackson who expressed stronger medical mistrust

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Consensus Guidelines Address Inpatient Diabetes Technology

A new consensus statement offers detailed guidelines for inpatient use of continuous glucose monitors (CGM) and automated insulin delivery (AID) systems.

Aimed at clinicians, researchers, and hospital administrators, the open-access document was recently published by a multidisciplinary international panel of 24 experts in the Journal of Diabetes Science and Technology.

The statement includes 77 separate recommendations under five headings: 1) continued use of CGM by patients already using them at home, 2) initiation of CGM in hospital, 3) continuation of AID systems in hospital by patients already using them at home, 4) logistics and hands-on care of hospitalized patients using CGM and AID systems, and 5) data management of CGM and AID systems in hospital.

“This is the most comprehensive and up-to-date guideline on the use of diabetes technology in the hospital now,” lead author Rodolfo J. Galindo, MD, told Medscape Medical News in an interview.

“Overall, most experts believe that CGM and AID have the potential to overcome the current limitations of glycemic monitoring in the hospital to improve patient outcomes but we need research, first to get the approval and second to get widespread use,” said Galindo, medical chair of the hospital diabetes taskforce at Emory Healthcare System, Atlanta, Georgia. 

COVID-19 Changed Everything

The guideline is an update of a 2017 statement on hospital use of CGM. The new guideine adds AID systems — sometimes referred to as an artificial pancreas, which combines a CGM and insulin pump and uses an algorithm to guide insulin delivery — and is the first to be developed during the COVID-19 era.

The update had been planned prior to the pandemic, but the actual panel meeting took place in April 2020, after the US Food and Drug Administration allowed inpatient use of CGM despite lack of official approval.

“COVID-19 changed everything…We had to be more specific about how to implement CGM in these patients. The standard of care is hourly point-of-care glucose monitoring in the [ICU], and at least every 4 hours outside the ICU. With limited [personal protective equipment] and the burden on nursing it was unachievable,” Galindo explained.

In June 2020, Galindo and other guideline authors developed a COVID-19-specific document (also open-access), which goes more into detail about CGM and how to implement in-hospital use during the pandemic.

The current consensus guideline “provides a high-level review of the evidence by experts,” Galindo added.

Recommendations Cover Different Technologies and Hospital Settings

The panel “strongly” advises that hospital providers consult with an inpatient diabetes team, if available, to help manage patients already using CGM prior to admission. Among other recommendations, they list several situations in which CGM data should not be relied upon for management decisions, including severe hyper- or hypoglycemia, diabetic ketoacidosis, or in patients with skin infections near the sensor site.

The panel also call for more research into outcomes for CGM continuation in the hospital and optimal implementation of both CGM and point-of-care glucose testing. For hospitals, strong recommendations include developing standard CGM data reports and

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New guidelines address rise in opioid use during pregnancy

Opioid use in pregnancy has prompted new guidance from the American Academy of Pediatrics, aimed at improving care for women and newborns affected by their mothers’ drug use.

The number of affected women and infants has increased in recent years but they often don’t get effective treatment, and the pandemic may be worsening that problem, said Dr. Stephen Patrick, lead author of the academy report released Monday.

“While we have been talking about the opioid crisis for years, pregnant women and their newborns seldom make it to the top of the heap. Infants are receiving variable care and not getting connected to services,” said Patrick, a Vanderbilt University pediatrician.


The academy’s report says pregnant women should have access to opioid medication to treat opioid misuse. Two opioids, buprenorphine and methadone, are effective treatments but pregnant women often face stigma in using them and doctors who prescribe them are scarce.

The academy says hospitals should written protocols for assessing and treating opioid-affected newborns. Many don’t and practices vary widely.

Breastfeeding and other practices that promote bonding should be encouraged, and parent education and referral to services for affected newborns should be provided, the academy says. Its recommendations echo guidance from other medical groups and the U.S. government.

“This is a substantial public health problem that is still lacking solutions,” Patrick said.

According to the federal Centers for Disease Control and Prevention, 7% of U.S. women reported in 2019 that they had used prescription opioids during pregnancy. One in 5 of those women reported misusing the drugs while pregnant.

Some infants born to these women develop symptoms of opioid withdrawal, including tremors, fussiness and diarrhea.

By some U.S. estimates, nearly 80 affected infants are diagnosed every day on and the numbers have tripled in recent years.

Patrick has done research suggesting that these infants may be at risk for developmental delays, but says it’s possible those findings reflect use of alcohol or other drugs during pregnancy, poor prenatal care or stress.

“Getting into treatment may be getting even harder” because of the pandemic, he said. “There’s so much going on in the world that that issues involving opioid use are flying under the radar.”

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Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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