Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians. On this podcast, twice a month, we cover the latest in healthcare news and research evidence.
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We begin this episode by discussing our article of the week from Pediatrics, entitled “COVID-19 Vaccine Hesitancy Among Parents: A Qualitative Study”.
We begin this episode by discussing our article of the week from Pediatrics, entitled “HIV Preexposure Prophylaxis Provision among Adolescents: 2018 to 2021”. We then dive deeper into a discussion about seasonal affective disorder, its treatment, and its impact on the population. Then we take a closer look at the Movember movement and how it relates to men’s health. After that, we discuss the recent surge in syphilis cases and what can be done about it. Last, but not least, we have a conversation about substance use disorders in the wake of Matthew Perry’s passing.
We are excited to share that the highly anticipated 2nd edition of our Classics in Medicine book is now available in stores and on Amazon! Buy your copy today at: https://bit.ly/2zZnJt9
[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.
For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in health care news and research evidence. We are your hosts Deepti and Andrew. On today’s episode, we’ll start off by discussing our two articles of the week. In the second half of the episode, we will look at health issues that have arisen in popular media.
[Andrew] Our article of the week comes from Pediatrics and is entitled “HIV Preexposure Prophylaxis Provision among Adolescents: 2018 to 2021”. Approximately 20% of all new HIV diagnoses in the United States are made in people from 13 to 24 years of age. HIV preexposure prophylaxis (PrEP) safely and effectively reduces the risk of HIV infection, and is recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics for adolescents and adults at increased risk. That said, adolescents face unique barriers to care and had limited access to PrEP before 2018. Given the scarcity of data on PrEP prescribing in adolescents, this study sought to characterize trends in PrEP provision among American adolescents from 2018 to 2021.
The study team used a validated algorithm to identify adolescents 13 to 19 years of age in the IQVIA Real World Data – Longitudinal Prescriptions database who were prescribed oral PrEP during the study period. Demographic information and prescriber’s national provider identifier were also available and used to extrapolate the provider’s type and specialty. Chi-squared tests were performed to determine the associations between the youth’s demographic characteristics by sex and age groups, and between physician specialty and patient age group. The number of adolescents prescribed PrEP increased by over 70% with an estimated annual percentage change of 18.0% [95% CI: 16.6-19.5]. Increases were seen in both males and females, in all age groups from 13 to 19 years of age, and in all geographic regions across the United States. Adolescent males accounted for a substantial proportion of PrEP prescriptions. Among the physicians prescribing PrEP to adolescents, nearly 30% were pediatricians, mostly general pediatricians. Younger adolescents were more likely to be prescribed PrEP by a pediatrician than older adolescents.
In summary, this study contributes to our understanding of the trends in PrEP provision among adolescents in the United States and highlights the importance of pediatricians in ensuring access to PrEP among youth. Future work should be directed at identifying and limiting barriers to PrEP provision.
[Andrew] Now for The Scan.
The Story: As days get shorter and nights get longer, sunshine is becoming a rare commodity, leading to increases in rates of seasonal affective disorder (SAD). This is a disorder that does not have a clear cause but is thought to be related to a lack of sunlight and shorter days causing chemical changes in the brain.
You may be wondering, what is SAD?
[Deepti]: SAD is a type of depression, often related to seasonal changes, and symptoms include losing interest in activities, sleep issues, and consistently low energy levels. These symptoms can make even day-to-day activities difficult, so treatments are very important. One commonly used treatment is cognitive behavioural therapy (CBT), a form of psychotherapy that aims to help a person select activities and behaviours that allow them to best cope with the short days and unpleasant feelings. Another therapy often used, is light therapy. This therapy uses light boxes to mimic natural, outdoor light and help resolve the chemical changes that take place in the brain during bouts of SAD.
[Andrew] Interestingly, selecting a light box is a heavy task, since there are many things to consider. Light intensity is an important parameter, with recommendations of 10,000 lux exposure for 30 minutes, or 2500 lux exposure for 1-2 hours. As well, light boxes should have harmful UV rays filtered out, since these rays can have significantly negative impacts on the eyes. Proper useof these boxes is generally through morning viewing of the light box but not through staring directly at the light. When used correctly, light therapy can show clear benefits for the treatment of SAD. Additionally, the use of medications to treat SAD has been explored, namely selective serotonin reuptake inhibitors (SSRIs). Spending more time outdoors, although potentially cold, is also associated with positive outcomes in SAD.
[Deepti] Despite being one of the most decorated athletes in history, Michael Phelps has personal experience with depressive symptoms as the seasons change. His symptoms began around October or November each year, and eventually led to him seeking help to manage these symptoms. Such experiences prompted Phelps to begin the Michael Phelps Foundation, with the goal of removing stigma and raising awareness for discussions of mental health. During the filming of the Disney show “Hannah Montana”, Miley Cyrus’s long filming hours led to her mother wanting to bring in light therapy to help combat potential SAD due to the 12-hour work days on set.
All right, next up, as we are already 2 weeks into the month of November, it’s no surprise that people may be sporting moustaches. Since 2003, Movember is a charity centered around Men’s health, and their work involves encouraging people to sport mustaches to raise awareness for men’s health.
[Andrew] This charity has partnered with other foundations, such as the Prostate Cancer Foundation, to raise funds and awareness for prostate cancer, a cancer that will affect 1 in 8 American men, and 1 in 9 Canadian men. As well as prostate cancer, the Movember charity aims to draw awareness to men’s mental health and suicide prevention. In Canada, 3 out of 4 deaths by suicide are men, and suicide is the second leading cause of death in Canadian males between 15 and 44 years of age. Societal factors and different symptom presentations are thought to contribute to the underdiagnosis of men’s mental health conditions, and part of rocking a Movember mustache is helping to end the stigma around seeking help for mental health concerns.
[Deepti] This cause is particularly relevant to the stories of some famous men who have fought the battle against prostate cancer. Ben Stiller shared his experience with prostate cancer after a routine screening appointment revealed a potential anomaly. After confirming that it was prostate cancer, Stiller underwent removal of his prostate gland, and made a recovery. Thanks to the Movember foundation, every mustache during the month of November represents a step forward in men’s health awareness. Next, let’s have a conversation about syphilis and why it has been making headlines. In 2022, 3700 babies were born with congenital syphilis, a condition occurring when a mother transmits syphilis to her baby during labor. This has drawn attention from the Center for Disease Control (CDC,) since this represents a 10-fold increase in congenital syphilis cases since 2012. Syphilis is a bacterial disease most often transmitted through sexual contact, but it can also be transmitted during labor. It first presents as a painless sore in the genital region but eventually progresses to further signs and symptoms if left untreated.
[Andrew] The second stage of symptoms is typically marked by the development of rashes or sores over the skin, mouth, vagina or anus. This stage may also be accompanied by a fever, chills, weakness and other flu-like symptoms. If the infection goes untreated, it may cause severe damage, such as heart disease, brain damage, and blindness. In infants, symptoms may include rashes, fever, enlarged liver, and an inability to move an arm or leg. Treatment of syphilis is accomplished with penicillin G, a derivative of penicillin that is especially effective against syphilis.
According to the CDC report, there were missed opportunities for testing and treatment in over 80% of cases of congenital syphilis, with over 33% of cases resulting from a lack of testing in mothers. In some cases, mothers were tested but were not given the correct treatment. In the 18th century, when Blackbeard the pirate sailed the seven seas, syphilis may have sailed with him. One of the tools found on his ship was a syringe used to inject mercury, a treatment believed to rid the body of syphilis. With current treatments far less toxic than mercury, the next step is to curb the spread of this disease. Last but not least, we are sure that you have heard that Matthew Perry, the beloved actor known for his role as Chandler Bing in the hit sitcom Friends recently passed away at age 54. Off-screen, Perry was vocal about his struggles with a substance use disorder.
[Deepti] It is estimated that nearly 20 million American adults live with a substance use disorder, which significantly impacts their lives and the lives of others. When overcoming substance use disorders, the body’s own biology tends to work against itself. Activation of key areas of the brain, associated with reward pathways, results in behavioral changes that make quitting difficult. Like Matthew Perry, many celebrities have struggled to overcome their substance use problems. Robert Downey Jr. has been vocal about his battle with drug use prior to his career as an actor taking off. Among other things, Downey Jr. credits therapy and family support for helping him beat this disorder. This story is not entirely uncommon among celebrities, who often face immense pressure and exposure to drugs and alcohol. Bradley Cooper has spoken about his fight with cocaine use, after a fellow actor had a serious discussion with him about substance use.
[Andrew] And it isn’t just actors, many musicians throughout history grappled with substance use disorders, such as Michael Jackson and Elton John. Fortunately, many individualized treatment plans are available for everyone, including medications, therapy,
We’d like to acknowledge the following members of our team for their contributions to this week’s episode
- Neerav Mullur
- Ellen Song
- Christopher Prendergast
Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.
Please head to our website at 2minutemedicine.com to learn more and to access all of our content including medical study summaries, visual abstracts, excerpts from our Classics book series which is available on Amazon, and The Scan, which is our medical newsletter.
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