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Wednesday, April 10, 2024

Dog helps with schizophrenia hallucinations--psychiatric service dogs helpful, but hard to get

 Kody Green started having auditory and visual hallucinations, as well as paranoia and delusions, around during his freshman year of college. His symptoms drove him to drug abuse that ultimately landed him in prison. At age 21, he was diagnosed with schizophrenia: a brain disorder that affects how people think, feel and behave.

Although medication and other treatment helped control some of Green’s symptoms, his hallucinations persisted. Little did he know that four years later, a different type of help would give him the confidence he needed to live the successful and fully functional life he knew he, and many others with schizophrenia, deserved — this time it came with four paws and a tail. 

Luna helps her owner, Kody Green, handle certain schizophrenia symptoms as a supplement to his other treatments for the condition.

Luna, a Jack Russell terrier mix, helps Green identify his visual hallucinations; if he says “greet” and Luna doesn’t respond, he knows that what he’s seeing isn’t there. She also prevents Green from self-harm during auditory hallucinations. Luna will jump on his lap and put her head against his, preventing Green from hitting his face and bringing him back to the present moment. “My wife and I took a chance with Luna because there's no guarantee a dog can learn some of these tasks, but she was great,” Green, 29, told USA TODAY. “People with schizophrenia, we lose a lot of freedom because of our illness. But Luna has helped me be more confident and comfortable in my everyday life.” 

Psychiatric service dogs can be game changers for people with schizophrenia

Dogs have been helping people of all ages with varying disabilities for centuries, boosting independence, sense of safety, peace of mind and confidence. Research has found that service dogs, particularly the psychiatric kind, also help in many ways, such as reducing suicide attempts and improving an owner’s ability to attend medical appointments. 

Dr. Xiaoduo Fan, a psychiatrist and professor at UMass Chan Medical School who studies schizophrenia, said dogs in general can provide the social interaction some people with the illness need but lack. This notion is based on the “biophilia hypothesis,” which states that people are intrinsically drawn to other living things for feelings of safety and connection.

“People with schizophrenia have trouble relating to people so that affects their social relationships,” Fan said. “Humans are social animals with needs for love, friendship and acceptance, and schizophrenia patients are no different. Having an animal around can satisfy those needs with non-verbal communication.” 

Interaction with dogs may also be less stressful than interacting with other people, said Malene Kalsnes Tyssedal, a psychiatric doctor with the University of Bergen in Norway, who studied how dogs help adults with schizophrenia

As beneficial as service dogs may be, some people with schizophrenia may not be able “to take care of the physical, cognitive and emotional needs of an animal,” Tyssedal said.

That could include the potential for harm to the dog, said Fan, who called it “a possible but very rare scenario” considering people with schizophrenia are no more violent than the general population. “This is the most common misconception from society,” Fan said.

Access to psychiatric service dogs is lacking

Green didn’t plan to train Luna to help him better handle his symptoms, but he got her just as his social media presence as a schizophrenia advocate skyrocketed, which connected him to several certified dog trainers who taught Green how to train Luna to be a psychiatric service dog via FaceTime.

Training Luna himself was a more accessible option than buying a dog that was already trained or having a professional train Luna directly. The alternatives were too expensive, plus Green lives in rural Wisconsin where there aren’t many service dog trainers around — a reality that many people with disabilities face when seeking help to supplement their other treatments.

“We really couldn't afford anything else, so having that help for the training was amazing,” Green said. “It was just a lot of luck. If I didn't have social media, none of it would have been possible.”

Luna helps her owner, Kody Green, handle certain schizophrenia symptoms as a supplement to his other treatments for the condition.

Psychiatric service dog training can cost anywhere between $20,000 to $30,000 on average. Medicare and Medicaid do not cover service dogs, and most private insurances don’t either. The Veterans’ Affairs Administration and Department of the Army only provide financial support for dogs trained by an Assistance Dogs International or International Guide Dog Federation accredited facility — psychiatric dogs are excluded.

Fortunately, service dogs aren’t required to be certified or complete a professional training program, so people have the right to train their own service animal, according to the Americans with Disabilities Act. Businesses also aren’t allowed to request documentation that a dog is registered, licensed or certified as a service animal, although some airlines may require owners to complete paperwork.

It’s more of a bonding experience to train your own dog anyway, said Julie Morrissette, a training consultant at Service Dog Training School International, which provides online courses for owners for about $300.

Finding opportunities to train your own service dog, however, can be confusing because the U.S. lacks a mandatory process for the selection, training and placement of service dogs, unlike other countries that regulate the industry, a 2017 study in the journal Frontiers in Veterinary Science says. 

That’s where Green hopes to step in. His goal is to work with service dog trainers to help make these animals more accessible for people. 

“People with mental illness have the most trouble getting help, are the ones in poverty, the ones that struggle getting doctors appointments,” Green said. “I always say I'm the luckiest schizophrenic because I had a ton of resources and access to insurance and medication, but other advocates and I are just trying to make the resources we all had more accessible to others.” 

One of the ways to do that, Green said, is to get rid of the stigma associated with schizophrenia and other mental illnesses. 

Even though Green served as caregiver to his mother, who has schizoaffective disorder — a chronic mental illness that causes similar symptoms as schizophrenia — he still didn’t recognize something was wrong when he had his own psychotic break. When Green sought medical attention three years later, his diagnosis “felt like a death sentence,” he said, because portrayals of schizophrenia are often negative. 

Research shows that people who feel their schizophrenia is stigmatized can have worse depression, social anxiety and quality of life, as well as lower self-esteem, social functioning and support from loved ones. Stigma can also lead to social exclusion, fewer education and employment opportunities, and worse housing conditions.

“I just want to be the voice that I needed when I was first diagnosed,” Green said. “I want to be a face to the illness, that way the next time someone hears the word schizophrenia, they don’t think of a corny show or tragic news event, but an actual person. And maybe they'll realize that with the right help, this diagnosis isn't a death sentence.”

https://www.usatoday.com/story/life/health-wellness/2024/04/05/schizophrenia-hallucinations-psychiatric-assistance-dog/73171229007/

Gambling addiction hotlines say volume up, callers younger as online sports betting booms

 In state after state, centers for problem gambling are noticing an alarming rise in calls to their helplines.

The circumstances reported are also getting more severe, according to the directors of five problem gambling centers, a gambling researcher and an addiction counselor. People are filing for bankruptcy or losing homes or relationships. At the same time, callers are skewing younger, the experts said — often men in their 20s and 30s.

The directors say the mounting call volume has coincided with the legalization of sports betting and rising popularity of sports betting apps. 

“We believe, nationwide, the rate and severity of gambling problems have increased across the United States since 2018,” said Keith Whyte, executive director of the National Council on Problem Gambling, a nonprofit organization devoted to minimizing the costs and harms of gambling addiction. The group operates the helpline 1-800-GAMBLER. 

“We have every reason to believe the growth of online sports betting is a major contributing factor to the increase in gambling problems,” Whyte said.

In 2018, the Supreme Court struck down a law banning sports betting. To date, 38 states and Washington, D.C., have legalized the practice, according to the American Gaming Association, which advocates for the industry. Thirty of those states allow mobile sports betting

Florida legalized sports betting in November, and it has since seen calls to its Council on Compulsive Gambling double. Pennsylvania’s Council on Compulsive Gambling saw call volume more than double from 2020 to 2023. 

Calls to Ohio’s Problem Gambling Network, meanwhile, increased 55% in 2023, the first year of legalized sports betting there.

“We are seeing this new trend where it is in fact sports bettors who are making up that big bump in call volume,” said Michael Buzzelli, the organization’s associate director. By February 2023, sports betting was the top form of problematic gambling reported to the helpline, surpassing lottery and casino slot machines, he said.

The issue has gained renewed attention in recent weeks after the Los Angeles Dodgers fired Shohei Ohtani’s interpreter, Ippei Mizuhara, following allegations that he stole money from the star to cover gambling debts. (Mizuhara’s story has shifted, and he has not commented directly about the theft allegations.) Around the same time, Cleveland Cavaliers coach J.B. Bickerstaff said he had received threats from gamblers

The companies behind the apps say they’re taking steps to reduce the risk of problem gambling, and they question whether the trend is as big as others say. In their view, mobile betting allows for oversight of practices that used to happen illegally, without safeguards.

FanDuel, which has amassed roughly 2.5 million average monthly players, said it sometimes  suspends or even closes accounts if customers display problematic activity, like wagering higher and higher amounts after a series of losing bets. 

“We’re making sure that the small percentage of people in the United States that should not be using our platform — similar to how they should not be drinking alcohol if they have a problem with alcohol — are not able to get access to it,” said Chris Jones, a spokesperson for the company. He declined to specify how many such instances there have been

DraftKings — which had 3.5 million average monthly paid users at the end of last year, up from 1.5 million at the end of 2020 — declined to be quoted for this story.

Experts on problem gambling said that despite the companies’ efforts, there’s still a higher risk of addiction now that sports betting is more accessible and highly advertised. 

Several experts pointed out particular aspects of online sports betting that they said can make it more addictive than traditional gambling. For instance, the focus on sports can make bets seem less risky, since people have prior knowledge of a player’s stats or a team’s performance. And unlike a casino, mobile apps allow people to wager money directly from their bank accounts. 

“One can easily, rapidly place many bets that may make it more feasible for vulnerable individuals to experience gambling problems,” said Marc Potenza, director of the Center of Excellence in Gambling Research at Yale University. 

Plus, the possibilities are virtually endless. 

“There’s hundreds, if not thousands, of wagers within each individual game that can be placed now on a smartphone,” said Josh Ercole, executive director of the Council on Compulsive Gambling of Pennsylvania. “You’re not calling your bookie to place ‘the Eagles are going to beat the Giants’ or whatever.”

Whyte said sports betting apps should have easy-to-use, visible tools that allow players to set limits on the time and money they can spend, and they should offer easy access to the national helpline.

DraftKings, FanDuel and other apps do enable users to limit the money they can wager, number of bets, or time spent betting. DraftKings users can find that in their settings, under the title “Responsible Gaming,” while FanDuel users can do so via a small icon labeled “RG” at the top of the homepage. FanDuel also advertises a helpline when users log in, and both apps allow users to voluntarily ban themselves.

Experts also said a rise in advertising for sports betting is helping to fuel the trend: U.S. sports betting operators spent around $282 million on national TV ads from September 2021 to May 2022, according to one report.

“Before 2018, there was no advertising for sports betting during events. Now, you not only have sports betting ads saturating the events, you can even bet on the game that’s right in front of you,” Whyte said. 

Cait DeBaun, a spokesperson for the American Gaming Association, suggested that advertising is “one of the top reasons that customers move to legal, regulated sportsbooks.” Some FanDuel ads highlight the app’s voluntary time and wager limits.

Jake, a 49-year-old member of Gamblers Anonymous, said he’s not opposed to legal sports betting but worries that advertising and targeted promotions make it difficult for some people to quit. He requested that his last name not be published for privacy reasons.

Online sports betting is not yet legal in Georgia, where Jake lives, but he said he sees lots of young people at Gamblers Anonymous meetings, many of whom are addicted to mobile gaming. 

“In meetings, I’m seeing people younger and younger. When I first started meeting, I was the youngest. I was in my early 40s,” he said.

Jake said his addiction took off when he started betting illegally online via bookies and offshore websites.

“I was highly competitive in sports and played a lot of high school sports,” Jake said. “After high school, I didn’t play and I missed the competitive edge. I chased that high, and I got it from gambling.”

In the end, he said, “I lost a marriage. I lost a business. … I would get loans, I would run credit cards up — hundreds of thousands of dollars lost.”

Around 1% of U.S. adults meet the diagnostic criteria for a gambling addiction, according to the National Council on Problem Gambling. But in 2021, a council survey found that a quarter of young adults frequently experienced at least one sign of problem gambling, like hiding bets from other people or feeling restless or irritable when they tried to scale back.

“The legalization of sports betting, the ease of online betting platforms and the normalization of sports wagering contribute to its prevalence among those struggling with addiction,” Lin Sternlicht, co-founder of Family Addiction Specialist in New York City, said in an email. She added that push notifications create a sense of urgency that can foster addictive behavior. 

Both the gaming industry and federal lawmakers have endeavored to address these issues.

Last week, seven gaming companies, including DraftKings and FanDuel, announced a trade group to promote responsible gaming research and education. The group hopes to create a database that enables companies to share information — for instance, if a user voluntarily bans themselves from one app, other companies would know to ban the user as well.

Last year, the American Gaming Association also instituted a requirement that people who appeared in sports betting ads be at least 21 and prohibited college partnerships that promoted sports betting. 

Meanwhile, Democrats in the House introduced a bill in January that would set aside 50% of revenue from a federal tax on sports wagers for gambling addiction treatment and research.

Whyte said the action is much needed.

“The federal government collected, last year, more than $8 billion in gambling tax revenue. Yet they don’t put a single penny of those windfall profits back into the health system,” he said.

https://www.nbcnews.com/health/mental-health/gambling-addiction-hotline-calls-online-sports-betting-rcna145539

'Acute Adverse Effects of Therapeutic Doses of Psilocybin'

 Akhila Yerubandi, PharmD1Jennifer E. Thomas, PharmD2N. M. Mahmudul Alam Bhuiya, MPharm1et al

doi:10.1001/jamanetworkopen.2024.5960

Key Points

Question  What are the notable acute adverse effects for therapeutic doses of psilocybin in the treatment of depression and anxiety?

Findings  In this meta-analysis of 6 randomized, double-blind clinical trials with 528 patients, headaches, nausea, anxiety, dizziness, and fluctuations in blood pressure occurred significantly more frequently with psilocybin vs comparators. Psilocybin use was not associated with risk of paranoia and transient thought disorder.

Meaning  The findings of this study suggest a tolerable acute adverse effect profile for therapeutic doses of psilocybin, but rare and long-term adverse effects need to be further elucidated.

Abstract

Importance  Psilocybin has been studied in the treatment of depression and anxiety disorders. Clinical studies have mainly focused on efficacy, with systematic reviews showing favorable efficacy; however, none have primarily focused on psilocybin safety.

Objective  To evaluate the acute adverse effects of psilocybin at therapeutic doses in the treatment of depression and anxiety.

Data Sources  MEDLINE via PubMed, Web of Science, and ClinicalTrials.gov were searched for publications available between 1966 and November 30, 2023.

Study Selection  Randomized, double-blind clinical trials that reported adverse effects of psilocybin in patients treated for depression and anxiety were screened.

Data Extraction and Synthesis  Data were independently extracted by 2 authors and verified by 2 additional authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The inverse variance method with the Hartung-Knapp adjustment for the random-effects model was used, with a continuity correction of 0.5 for studies with 0 cell frequencies. Sensitivity analysis was conducted by sequentially removing 1 study at a time to assess the robustness of the results.

Main Outcomes and Measures  The primary outcome was considered as the adverse effects of psilocybin at high and moderate (ie, therapeutic) dose regimens and compared with placebo, low-dose psilocybin, or other comparator in the treatment of depression and/or anxiety.

Results  Six studies met the inclusion criteria with a total sample of 528 participants (approximately 51% female; median age 39.8 years; IQR, 39.8-41.2). Seven adverse effects were reported in multiple studies and included in the analysis. Among these, headache (relative risk [RR], 1.99; 95% CI 1.06-3.74), nausea (RR, 8.85; 95% CI, 5.68-13.79), anxiety (RR, 2.27; 95% CI, 1.11-4.64), dizziness (RR, 5.81; 95% CI, 1.02-33.03), and elevated blood pressure (RR, 2.29; 95% CI, 1.15- 4.53) were statistically significant. Psilocybin use was not associated with risk of paranoia and transient thought disorder.

Conclusions and Relevance  In this meta-analysis, the acute adverse effect profile of therapeutic single-dose psilocybin appeared to be tolerable and resolved within 48 hours. However, future studies need to more actively evaluate the appropriate management of adverse effects.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2817352

Weak Evidence for Puberty Blockers, Hormones in Youth Gender Care

 The Cass Review -- of which an interim report

opens in a new tab or window changed youth gender-affirming care services in England -- has been published in full, concluding that there's no high-quality evidence supporting puberty blockers and hormones in gender care for young people.

It also concludes that clinical guidelines currently in use are not backed by scientific evidence, but rely on expert consensus.

Review leader Hilary Cass, MD, and colleagues have suggested a more "holistic" assessment of youths with gender dysphoria, one that's provided in a broader pediatric setting by a multidisciplinary team.

"This generation ... has a much more flexible view about gender, in some ways a healthier view, less gender stereotyped than [what we grew up with]. And young people are expressing their genders in many different ways, so that's potentially breaking down many different barriers," Cass said during an interview with The BMJopens in a new tab or window.

"But the tricky question is whether and when the right thing is to medicalize that," she continued. "Certainly some of the young adults we've spoken to -- because medication is binary, but their gender expressions are often not -- have said to us, 'We wish we'd known there were more ways of being trans than just binary trans.'"

The report packageopens in a new tab or window centers around six publications, most of which are published in the Archives of Disease in Childhood. This includes four evidence reviews: one on puberty blockers; one on hormones; and one on clinical guidelines that's divided into two parts. There's also an accompanying editorial in that journal, along with an opinion piece by Cass published in The BMJ.

The report comes amid a very specific context in the U.K., which has seen a sharp increase in referrals among children and adolescents to specialist pediatric gender services. For instance, referrals rose from 201 in 2011-2012 to 3,585 in 2021-2022, according to the report.

Meanwhile, this population has a high rate of mental health complexity, the researchers said. At the same time, revised treatment protocols have broadened criteria for treatment with puberty blockers and hormones; scrapped a minimum eligibility age; and expanded eligibility from gender dysphoria to gender incongruence.

That confluence of factors led to a long waiting list at the country's sole gender care facility, known as the Tavistock clinic, and Cass subsequently was tasked with reviewing the NHS's treatment protocols for youth gender services. An interim publication of the report led to a restructuring, in which gender care will be provided by regional services and puberty blockers will only be offered as part of a clinical trial. So far, two regional clinics are slated to open, with a third following soon.

All four of the evidence reviews were led by Jo Taylor, PhD, of the University of York in North Yorkshire, England.

On puberty blockersopens in a new tab or window, Taylor and colleagues found no high-quality studies, and concluded there's insufficient or inconsistent evidence about the effects of suppressing puberty on several fronts: gender-related outcomes, mental and psychosocial health, cognitive development, cardiometabolic risk, and fertility.

In her opinion piece in The BMJopens in a new tab or window, Cass noted that the "clearest indication" for puberty blockers is in "helping the small number of birth-registered males, whose gender incongruence started in early childhood, to pass in adult life by preventing the irreversible changes of male puberty."

In particular, Cass added, there's a lack of "follow-up data on the more recent cohort of predominantly birth-registered females who frequently have a range of co-occurring conditions including adverse childhood experiences, autism, and a range of mental health challenges."

They did find consistent moderate-quality evidence that bone density and height may be compromised during treatment. Although high-quality research is still needed to confirm these findings, they concluded that "these potential risks should be explained to adolescents considering puberty suppression."

The puberty blocker review included 50 studies: 11 cohort, 8 cross-sectional, and 31 pre-post studies that were published from 2006 to 2022, conducted in the U.S., U.K., the Netherlands, Canada, Belgium, Israel, Brazil, and Germany. One cross-sectional study was of high quality, 25 studies were moderate quality, and 24 were low quality.

The review of hormone useopens in a new tab or window among youths similarly found no high-quality evidence, with insufficient or inconsistent findings on the impact on gender dysphoria, body satisfaction, psychosocial and cognitive outcomes, fertility, height, bone health, and cardiometabolic effects.

Moderate-quality evidence suggests that mental health may be improved during treatment, but this needs more robust study, they said.

Taylor and colleagues reviewed 53 studies on hormones: 12 cohort, 9 cross-sectional, and 32 pre-post studies that were published from 2006 to 2022, from a similar global distribution as the puberty blocker review. One cohort study was high quality, 33 were moderate quality, and 19 were low quality.

The researchers tackled the guideline reviews in two parts: one on qualityopens in a new tab or window, and one on the actual recommendationsopens in a new tab or window. They identified a total of 23 guidelines published from 1998 to 2022, the majority of which were published in the last 5 years.

They concluded that few guidelines were informed by a systematic review of the evidence, and that they lacked transparency about how the recommendations were developed. They also found limited guidance on how to implement the recommendations.

Most of the guidances were influenced by guidelines from the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, which the review concluded lacked rigor. They only recommended two guidances: one from Finland in 2020 and another from Sweden in 2022, which were the only guidances to publish details about how the writers reviewed and used the evidence base, along with the decision making behind the recommendations, the researchers said.

In an emailed statement to MedPage Today, the Endocrine Society said its clinical practice guidelines are developed using a "robust and rigorous process" that adheres to National Academy of Medicine guidance. "Our guideline development panels spend years developing each guideline based on a thorough review of medical evidence, author expertise, rigorous scientific review, and a transparent process."

Its 2017 guideline on gender-affirming careopens in a new tab or window "cites more than 260 research studies," the statement said, and is set to be updated soon.

WPATH did not return a request for comment from MedPage Today as of press time.

As for the review of guideline recommendations, Taylor and colleagues concluded that while many promote a similar care pathway -- psychosocial care for prepubertal children followed by hormonal interventions for some adolescents, provided by a multidisciplinary team -- there's no consensus about the specific process of assessment or about when psychological or hormonal interventions should be offered, or on what basis.

In her opinion piece, Cass wrote that medical treatment for gender dysphoria is "built on shaky foundations."

She said she took on the review "in full knowledge of the controversial nature of the subject, the polarization and toxicity of the debate, and the weakness of the evidence base."

Nonetheless, she said she believes that gender-questioning children and adolescents should be able to have a broad, holistic assessment provided by a multidisciplinary team of pediatricians, child psychiatrists, and other "allied health experts."

The new regional service program will have research embedded from the start, she wrote, and data collection will be integral to its model. A prospective puberty blocker study is already in development, she added.

"Those young people who the team feel might benefit from puberty blockers will be able to go on them as part of a research trial," Cass said in her interview. "The aim won't be to have a group who never get puberty blockers and those that do. They will go on puberty blockers if it's deemed they may be in that group that will benefit."

In an accompanying editorialopens in a new tab or window, Camilla Kingdon, MD, outgoing president of the Royal College of Paediatrics and Child Health, wrote, "I believe we are on the cusp of seeing real progress in the care of this patient group."

Christopher Bolling, MD, a retired pediatrician who practiced in Kentucky and Ohio -- states that have banned gender-affirming care -- and who has testified in front of state legislatures on gender-affirming care bans, told MedPage Today that the findings of the Cass Review are "appropriate."

"I think we need data," he said, cautioning, however, that the report needs to be looked at in totality. Unlike banning puberty blockers and hormones for youths, as some U.S. states have doneopens in a new tab or window, the report acknowledges the transgender experience and supports these individuals in getting needed healthcare.

He said gender-affirming care in the U.S. already takes a measured approach to treatment. He said Cass's interview with The BMJ appears to conflate "gender-affirming care" with "medications."

"That's not my take on what gender-affirming care is," Bolling said. "Patients in the U.S. already get really thorough mental health screenings. They get lots of counseling. It goes very slowly, and very few of them actually wind up on medications."

Bolling said a number of studies of gender-affirming care are progressing and should be reporting out soon. While it's impossible to do a randomized controlled trial (RCT) in this setting -- and the NHS program will not be an RCT -- there are research methods, such as case matching, that can help deliver quality evidence.

Will experts accept a research base that doesn't include RCTs? "We're going to have to," Bolling said. "I don't know how we do it any other way. There's a research structure you can use to give you meaningful and good data. Maybe not RCT-level, but still pretty good."

England is not the only country to pull back on puberty blockers and hormones for youths. In 2020, Finland's health agency recommended psychotherapy as the main treatment for teens with gender dysphoria, and in 2022, Sweden restricted hormone treatments in youths to exceptional cases, according to the New York Timesopens in a new tab or window.

Also, in December 2023, Norwegian health officials decided to only provide hormones to adolescents in clinical trials, while new guidelines being finalized in Denmark will limit hormone treatment to those who had gender dysphoria since childhood, the Times reported.

Disclosures

The work was funded by NHS England.

Cass, Taylor, and Kingdon declared no financial conflicts of interest.

Primary Source

Archives of Disease in Childhood

Source Reference: opens in a new tab or windowTaylor J, et al "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review" Arch Dis Child 2024; DOI: 10.1136/archdischild-2023-326669.

Secondary Source

Archives of Disease in Childhood

Source Reference: opens in a new tab or windowTaylor J, et al "Masculinizing and feminizing hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review" Arch Dis Child 2024; DOI: 10.1136/archdischild-2023-326670.

Additional Source

Archives of Disease in Childhood

Source Reference: opens in a new tab or windowTaylor J, et al "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)" Arch Dis Child 2024; DOI: 10/1136/archdischild-2023-326499.

Additional Source

Archives of Disease in Childhood

Source Reference:opens in a new tab or window Taylor J, et al “Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)” Arch Dis Child 2024; DOI: 10.1136/archdischild-2023-326500.

Additional Source

The BMJ

Source Reference:opens in a new tab or window Cass H “Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services” BMJ 2024; DOI: 10.1136/bmj.q814.

Additional Source

Archives of Disease in Childhood

Source Reference:opens in a new tab or window Kingdon CC “Holistic approach to gender questioning children and young people” Arch Dis Child 2024; DOI: 10.1136/archdischild-2024-327100.


https://www.medpagetoday.com/special-reports/transgender-medicine/109605

Palisade Bio Product Development for Crohn’s & Colitis

  Palisade Bio, Inc. (Nasdaq: PALI) (“Palisade”, “Palisade Bio” or the “Company”), a biopharmaceutical company focused on developing and advancing novel therapeutics for patients living with autoimmune, inflammatory, and fibrotic diseases, today announced that it presented at IBD Innovate: Product Development for Crohn’s & Colitis™ held April 9-10, 2024 in Cambridge, MA.


As part of the conference, Christophe Mellon, Chief Executive Officer of Giiant Pharma, Inc., the Company’s research partner, and Dr. Mitch Jones, Chief Medical Officer of Palisade Bio gave an oral presentation titled, “Advancing PALI-2108: Discovery to Strategy Positioning,” which discussed the development of PALI-2108, its differentiation and positioning in the competitive landscape as well as a clinical pathway towards late-stage development. The presentation is accessible on the Publications page under the Science section of Palisade Bio’s website, www.palisadebio.com.

“We were pleased to participate with Giiant at the premier IBD conference and provide further information on PALI-2108. We continue to generate a growing body of data from PALI-2108 for the treatment of UC and remain on track to launch our Phase 1 clinical study later this year," commented Dr. Jones.

Ionis upped to Outperform from Peer Perform by Wolfe

 Target $58

https://finviz.com/quote.ashx?t=IONS&ty=c&ta=1&p=d

Vertex Pharmaceuticals to buy Alpine Immune Sciences for $4.9 b

Vertex Pharmaceuticals will acquire therapy developer Alpine Immune Sciences for $65 per share, or about $4.9 billion in cash, the companies said on Wednesday.

With the acquisition, Vertex will add Alpine's portfolio of protein-based immunotherapies to treat autoimmune and inflammatory diseases.

The transaction, approved by Vertex and Alpine's boards, is expected to close in the second quarter of 2024.

https://finance.yahoo.com/news/1-vertex-pharmaceuticals-buy-alpine-201609049.html