Medical Bulletin 15/ October/ 2024

A new national survey of 1,000 American adults commissioned by The Ohio State University Wexner Medical Center and College of Medicine finds that 25% of adults now suspect they may have undiagnosed ADHD. But what worries mental health experts is that only 13% of survey respondents have shared their suspicions with their doctor.

That’s raising concerns about the consequences of self-diagnosis leading to incorrect treatment.

“Anxiety, depression and ADHD – all these things can look a lot alike, but the wrong treatment can make things worse instead of helping that person feel better and improving their functioning,” said psychologist Justin Barterian, PhD, clinical assistant professor in Ohio State’s Department of Psychiatry and Behavioral Health.

An estimated 4.4% of people ages 18 to 44 have ADHD, and some people aren’t diagnosed until they’re older, Barterian said.

“There's definitely more awareness of how it can continue to affect folks into adulthood and a lot of people who are realizing, once their kids have been diagnosed, that they fit these symptoms as well, given that it's a genetic disorder,” Barterian said.

The survey found that younger adults are more likely to believe they have undiagnosed ADHD than older generations, and they’re also more likely to do something about it.

Barterian said that should include seeing a medical professional, usually their primary care provider, to receive a referral to a mental health expert to be thoroughly evaluated, accurately diagnosed and effectively treated.

“If you're watching videos on social media and it makes you think that you may meet criteria for the disorder, I would encourage you to seek an evaluation from a psychologist or a psychiatrist or a physician to get it checked out,” Barterian said.

This study was conducted by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from August 16 – August 18, 2024, among a sample of 1,006 respondents. The survey was conducted via web (n=975) and telephone (n=31) and administered in English. The margin of error for total respondents is +/-3.8% points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in young children due to respiratory complications such as bronchiolitis and pneumonia. Yet little is understood about why some children develop only mild symptoms while others develop severe disease. To better understand what happens in these cases, clinician-scientists from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, and Boston Children’s Hospital analyzed samples from patients’ airways and blood, finding distinct changes in children with severe cases of Respiratory syncytial virus, including an increase in the number of natural killer (NK) cells in their airways. The descriptive study, which focuses on understanding the underpinnings of severe disease, may help to lay groundwork for identifying new targets for future treatments. Results are published in Science Translational Medicine.

“As a physician, I help to care for children who have the most severe symptoms, and as a researcher, I’m driven to understand why they become so sick,” said corresponding author Melody G. Duvall, MD, PhD, of the Division of Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital (BWH) and the Division of Critical Care Medicine at Boston Children’s Hospital. “NK cells are important first responders during viral infection – but they can also contribute to lung inflammation. Interestingly, our findings fit with data from some studies in COVID-19, which reported that patients with the most severe symptoms also had increased NK cells in their airways. Together with previous studies, our data link NK cells with serious viral illness, suggesting that these cellular pathways merit additional investigation.”

Duvall and colleagues, including lead author Roisin B. Reilly of the Division of Pulmonary and Critical Care Medicine at BWH, looked at samples from 47 children critically ill with Respiratory syncytial virus, analyzing immune cells found in their airways and peripheral blood. Compared to uninfected children, those with severe illness had elevated levels of NK cells in their airways and decreased NK cells in their blood. In addition, they found that the cells themselves were altered, both in appearance and in their ability to perform their immunological function of killing diseased cells.

Reference: Roisin B. Reilly et al.’An altered natural killer cell immunophenotype characterizes clinically severe pediatric RSV infection.Sci. Transl. Med.16,eado6606(2024).DOI:10.1126/scitranslmed.ado6606

A new report by the World Health Organization (WHO) finds that vaccines against 24 pathogens could reduce the number of antibiotics needed by 22% or 2.5 billion defined daily doses globally every year, supporting worldwide efforts to address antimicrobial resistance (AMR). While some of these vaccines are already available but underused, others would need to be developed and brought to the market as soon as possible.

Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines, making people sicker and increasing the risk of illness, death and the spread of infections that are difficult to treat. antimicrobial resistance is driven largely by the misuse and overuse of antimicrobials, yet, at the same time, many people around the world do not have access to essential antimicrobials. Each year, nearly 5 million deaths are associated with antimicrobial resistance globally.

Vaccines are an essential part of the response to reduce antimicrobial resistance as they prevent infections, reduce the use and overuse of antimicrobials, and slow the emergence and spread of drug-resistant pathogens.

The new report expands on a WHO study published in BMJ Global Health last year. It estimates that vaccines already in use against pneumococcus pneumonia, Haemophilus influenzae type B and typhoid could avert up to 106 000 of the deaths associated with antimicrobial resistance each year. An additional 543 000 deaths associated with antimicrobial resistance could be averted annually when new vaccines for tuberculosis (TB) and Klebsiella pneumoniae, are developed and rolled out globally. While new TB vaccines are in clinical trials, one against Klebsiella pneumoniae is in early stage of development.

“Addressing antimicrobial resistance starts with preventing infections, and vaccines are among the most powerful tools for doing that,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Prevention is better than cure, and increasing access to existing vaccines and developing new ones for critical diseases, like tuberculosis, is critical to saving lives and turning the tide on antimicrobial resistance”

Vaccinated people have fewer infections and are protected against potential complications from secondary infections that may need antimicrobial medicines or require admission to hospital. The report analyzed the impact of already licensed vaccines as well as vaccines in various stages of development.

Every year, vaccines against:

• Streptococcus pneumoniae could save 33 million antibiotic doses, if the Immunization Agenda 2030 target of 90% of the world’s children were vaccinated, as well as older adults;

• Typhoid could save 45 million antibiotic doses, if their introduction was accelerated in high-burden countries;

• Malaria caused by Plasmodium falciparum could save up to 25 million antibiotic doses, which are often misused to try to treat malaria;

• TB could have the highest impact once they are developed, saving between 1.2 to 1.9 billion antibiotic doses – a significant portion of the 11.3 billion doses used annually against the diseases covered in this report.

If vaccines could be rolled out against all the evaluated pathogens, they could save a third of the hospital costs associated with antimicrobial resistance.

A comprehensive, people-centred approach applied across health systems is needed to prevent, diagnose and treat infections. This approach recognizes vaccination as core to preventing antimicrobial resistance and especially impactful when combined with other interventions.

At the 79th United Nations General Assembly High-Level Meeting on antimicrobial resistance, world leaders approved a political declaration committing to a clear set of targets and actions, including reducing the estimated 4.95 million human deaths associated with bacterial antimicrobial resistance annually by 10% by 2030. The declaration emphasizes key aspects, including the importance of access to vaccines, medicines, treatments and diagnostics, while calling for incentives and financing mechanisms to drive multisectoral health research, innovation and development in addressing antimicrobial resistance.

Higher levels of HDL-C—known as the “good cholesterol”—have been shown to correlate with heightened risk for Alzheimer’s disease. A new study published in the Journal of Clinical Endocrinology & Metabolism might explain why. Once women reach the menopause transition, it’s a matter of the quality, rather than quantity, of the total cholesterol carried by HDL particles circulating in a woman’s bloodstream, and that quality declines over time, according to a research team led by a University of Pittsburgh School of Public Health epidemiologist.

HDL particles vary in their size, composition and level of functioning. The team measured these features in the blood of 503 women from the Study of Women’s Health Across the Nation (SWAN) HDL ancillary study. The researchers found that, over time, the number of larger HDL particles in the women’s bodies increased—and these larger particles, unfortunately, did not function as well as their smaller counterparts.

The researchers conducted repeated assessments of study participants’ cognitive function from 2000 to 2016 and compared these data to changes in the women’s HDL particles, composition and function as they aged.

“We were able to show that as early as midlife, women who have more of the smaller-sized particles and those whose particles’ concentrations of phospholipids increased over the menopause transition are more likely to experience better episodic memory later in life,” said Samar R. El Khoudary, Ph.D., M.P.H., professor of epidemiology at Pitt Public Health, adding that loss of working memory is the first sign of Alzheimer’s disease.

“That’s the good news in this developing picture of brain health and the ‘not-so-good-after-all’ cholesterol,” said El Khoudary. “Even though higher levels of HDL-C may not be protective as you get older, there are things you can do that might help, even as early as your 40s. The same, modifiable risk factors that the AHA is advocating for—including physical activity, ideal body weight and quitting smoking—can help you protect your brain, too.”

Reference: Qi M, Billheimer J, Chang CH, Janssen I, Brooks MM, Orchard T, Karlamangla AS, Barinas-Mitchell E, Derby CA, McConnell D, Crawford S, El Khoudary SR. High-density lipoprotein over midlife and future cognition in women: The SWAN HDL ancillary study. J Clin Endocrinol Metab. 2024 Oct 5:dgae697. doi: 10.1210/clinem/dgae697. Epub ahead of print. PMID: 39367567.