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80 websites make it easy for kids to buy marijuana online

Access to Marijuana by Minors Via Online Dispensaries; JAMA Pediatrics, Sept. 25, 2023.

Children can easily buy marijuana products from at least 80 websites that have little or no regard for local laws or their customers’ health, according to a study published this month in JAMA Pediatrics.

Many of these online vendors accept readily accessible cash or gift cards — without requiring proof of legal age.

Led by Dr. Ruth Milanaik, researchers at the Steven and Alexandra Cohen Children’s Medical Center of New York used Google searches to identify online sites that sold pot products to U.S. consumers. Searches occurred between April 1, 2022, and June 15, 2023.

The investigators concluded that the ready availability of marijuana products to children calls for “strict age verification” and “stringent surveillance … to protect youth. Pediatricians and caregivers must be aware of the widespread availability of online dispensaries and potential dissemination of marijuana to minors.”

They found:

    • 80 online marijuana dispensaries based in 32 states, of which 22 offered delivery options across state lines and 21 delivered regardless of laws in the purchaser’s state.
    • Products included vapes, edibles and “medical formulations.”
    • 67% of outlets offering edibles used colorful packaging that could make products more attractive to minors.
    • No site required formal age verification for entry, and 18.8% did not ask for proof of age for purchases.
    • Just half of the sites provided legal information safety warnings, and although 67.5% listed an age requirement, 24% of these sites did not bother to check for age on purchase.
    • Untraceable payment methods that children can access, including cash, prepaid cards and cryptocurrency, were accepted by 67% of sites.
    • Discounts were available for first-time buyers at 18.8% of sites, 2.5% offered cryptocurrency discounts and 5% offered student discounts.

The National Institute of Health’s 2022 Monitoring the Future survey, which follows drug use among youth, found that 6.3% of 12th graders, 2.1% of 10th graders and 0.7% of 8th graders had used marijuana daily over the previous month.

Ultra-processed foods: the more the unmerrier

Consumption of Ultraprocessed Food and Risk of Depression. JAMA Network Open, Sept. 20, 2023.

Consuming ultra-processed foods may increase the risk of depression, according to a study in the Journal of the American Medical Association.

According to the Cleveland Clinic, ultra-processed foods are “like Frankenstein’s monster: Changed by science until they’re almost unrecognizable from their original form.” Packed with preservatives and additives, they’ve been associated with a host of ills including cognitive decline.

A group of Harvard Medical School researchers, between 2003 and 2017, surveyed 31,712 women ages 42-62 who had no history of depression. They used NOVA, a food classification system, to estimate how much ultra-processed foods the women consumed.

Within the NOVA classification, ultra-processed foods contain mostly artificial ingredients and little or no whole foods.

Women were surveyed on eating habits and observed for the development of depression. Since neither the effect (depression) nor its frequency was known before the study began this qualifies as a prospective study.

The women’s intake of ultra-processed foods was broken down into five consumption levels. Women with high intakes also had the greatest number of health problems — including high blood pressure, abnormal blood lipids (fats), and being overweight — at study inception. They were also more likely to lead sedentary lives.

Subjects were followed for depressive symptoms by two different standards: a strict definition based on clinical diagnosis plus antidepressant use, or a broader definition involving either diagnosis or an antidepressant. Depression status was self-reported.

Of the 6,962 reported cases of depression, 2,122 fell under the “strict” definition and 4,840 under the broad definition. Women in the highest category — whose diets consisted of 20% ultra-processed foods at the start of the study — experienced a 49% higher incidence of depression according to the broad definition, and a 34% greater occurrence under the broader definition.

Subject age, body mass index, physical activity and smoking did not affect results. A separate lag analysis, which examines the temporal relationship between cause and effect, eliminated the possibility that depression caused women to eat more ultra-processed foods.

An additional analysis for which components of ultra-processed foods were most harmful found just one with statistical relevance: artificial sweeteners, when consumed in foods, increased depression risk by 26%, but when consumed in drinks, increased the risk by 37%.

Common surfactant therapy for premature babies with breathing distress: No benefit

Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial; JAMA Network, Sept. 11, 2023.

Premature babies treated with pharmaceutically produced surfactants for respiratory distress syndrome (RDS) died at the same rate as infants treated with a placebo, according to a new paper in JAMA.

RDS, a condition that affects infants born six or more weeks before their due dates, occurs when the baby’s lungs aren’t developed enough to make surfactant — a liquid that coats the inside of the lungs and keeps them open so the baby can breathe in air when it’s born.

Doctors often treat the condition using a therapy that infuses the lungs with detergent-like chemicals that mimic the body’s own natural lung surfactants, including proteins and fats, to facilitate breathing.

Pulmonary surfactants are on the World Health Organization’s Model List of Essential Medicines for Children for their importance in treating babies in respiratory distress.

But an international team of investigators, led by Dr. Peter A. Dargaville at the University of Tasmania, Australia, found that although children treated with synthetic surfactants experienced fewer “adverse respiratory outcomes” during the study period, died at the same rate as infants that received placebo.

The researchers used data from 453 infants admitted to a neonatal intensive care unit, limiting inclusion to children who had required oxygen supplementation at birth and were subsequently diagnosed with respiratory distress.

They excluded children who needed to be put onto a ventilator immediately upon admission, those with breathing problems unrelated to RDS and children with serious congenital anomalies.

Researchers looked for three main outcomes: survival to age 2 without neurodevelopmental disability, hospitalizations for respiratory illness and parent-reported breathing difficulties.

Death or serious neurodevelopmental issues occurred in 36.3% of babies in the treatment group and in 36.1% of infants receiving the placebo — essentially a tie.

Treatment did provide some benefits in the form of hospitalization for respiratory illness, which occurred in 25.1% of treated infants compared with 38.2% in the control group. Treated children also experienced fewer breathing difficulties — 40.6%, vs. 53.6% for controls.

The chatbot will see you — eventually

Performance of a Large Language Model on Practice Questions for the Neonatal Board Examination; JAMA Pediatrics, July 17, 2023.

ChatGPT, an artificial intelligence (AI) chatbot — a computer program that simulates human conversation to answer questions — isn’t yet able to pass a medical board licensing exam, but it still may have a role in diagnosing medical conditions.

A study published in JAMA Pediatrics reported that ChatGPT version 3.5, an AI “large language” program, scored 46% on a medical board licensing exam. The study’s authors concluded the test score points to a likely role for AI in medical diagnosis, though more research is needed.

Researchers led by Dr. Kristyn Beam, at Beth Israel Deaconess Medical Center, Boston, began with the multiple-choice questions from a neonatal-perinatal medicine board examination. They removed questions containing images or equations and categorized each of the 936 remaining questions according to Bloom’s taxonomy — a system for analyzing language-based learning objectives.

Questions fell into three categories of increasing complexity: knowledge recall, simple reasoning or multilogical reasoning.

Guided by two independent reviewers, investigators entered questions into ChatGPT and instructed the program to answer and provide a short textual explanation for why it chose its response. They tallied the number of correct answers and, with the reviewers’ help, judged the validity of the computer’s reasoning based on a standardized process for evaluating test questions and responses.

ChatGPT scored 46% but the program did better in some topics than others. Its poorest result was 37.5% on questions about gastroenterology. It scored 78.5% on ethics.

ChatGPT did worse on multilogical questions (33.8% correct) compared to answers requiring simple recall (55.5%) and basic clinical reasoning (44.1%). While evaluators rated ChatGPT’s justification responses highly, its answers fully aligned with scientific consensus just 54% of the time.

Close to one-third of the time the program provided information that was either factually incorrect or contained errors of omission.

Fatherly nurturing aids development

Paternal involvement in infant care and developmental milestone outcomes at age 3 years: the Japan Environment and Children’s Study (JECS); Pediatric Research, July 8, 2023.

A study in Pediatric Research reported a positive association between levels of paternal care and a child reaching appropriate developmental milestones.

Led by Tsuguhiko Kato, Ph.D., at Japan’s National Center for Child Health and Development, Tokyo, investigators tapped into data on 28,050 children from the Japan Environment and Children’s Study, the country’s largest pediatric health database.

They tested whether paternal involvement in childcare at 6 months affects the attainment of developmental milestones at 3 years.

Investigators assessed developmental delays through the Ages & Stages Questionnaires, and separately assessed maternal parenting stress at the child’s age of 1.5 years.

They found that high levels of paternal care were associated with a lower risk of developmental delays compared with low involvement. After correcting for other variables, the fewest delays for children of high-care fathers were observed in gross-motor, fine-motor, problem-solving and personal-social domains.

The risk for delayed gross motor development, for example, was reduced by 24%.

The extent of these effects depended to some degree on “maternal parenting stress,” the feeling of helplessness in the face of normal child-rearing responsibilities.

Maternal stress is a complex and evolving issue in Japan. In traditional Japanese culture, men are expected to concentrate on work and finances. However, an increasing number of Japanese mothers are entering or returning to the workforce, adding to the usual stresses of child-rearing and the need to balance family and career obligations.