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Commentary: Access to rural healthcare is bigger than hospitals – and North Carolina is leading the way
Health begins long before someone steps foot in a doctor's office. Public health experts call these factors the social determinants of health. If you don't have a balanced diet or access to nutritious foods, your health suffers.
The Sometimes-Awkward Art of Asking for a Second Opinion
A doctor has recommended a course of action that is invasive, expensive, or somehow different from what you'd prefer. Is it OK to get a second opinion? The answer is yes. Here’s how to make the ask a little less awkward.
Bipartisan bill aims to close rural NC’s health care workforce gaps
The REACH Act would offer eligible doctors, nurses and other providers a refundable federal tax credit of up to $10,000.
‘Not Exactly What I Want To See Puka Nacua Doing’ — Sports Doctor Flags Rams WR’s Risky Play vs. Bills
Fans couldn’t have asked for a better Monday Night Football matchup as the Los Angeles Rams and Buffalo Bills delivered a thriller at SoFi Stadium. Although Josh Allen and the Bills came out on top with a 37-34 overtime victory, the Rams kept the game close and forced overtime in the final seconds of regulation.
Doctors warn about the risks energy drinks pose to kids. What families need to know
Doctors nationwide have warned for years that energy drinks contain high levels of caffeine that can seriously harm children
Takeaways from probe into Roger Marshall's medical billing
A Kansas City Star analysis found that as a rural Kansas doctor before voters sent him to Washington, U.S. Sen. Roger Marshall charged an unusually high interest rate on patients’
How worried should Catholics be about the pope’s health?
Pope Leo XIV announced on Sunday that he will undergo surgery this week to remove a “nodule” from his lung. The pope made the announcement at the end of his Sunday Angelus address, asking for prayers. “Dear all, recently, during some checkups, the doctors discovered a nodule in my lung. It was detected at a very early stage and was well-localized,” Leo said. “The doctors felt it was necessary to intervene, and so, following their advice, I decided to have surgery to remove it. The procedure is already scheduled for the next few days. I thank you for your spiritual support and I entrust myself to your prayers.” The Vatican press office subsequently added that Leo is scheduled to undergo surgery at the Gamelli hospital on Tuesday, Oct. 13. The pope is expected to spend up to a week in the Gamelli recovering, after which, for the moment, he is still expected to undertake his largest and longest to-date Apostolic journey, heading to Argentina, Uruguay, and Peru, beginning Nov. 6. Prayers have, understandably, poured in from dioceses around the world, accompanied by the best wishes of heads of state and international institutions. So how worried should Catholics be for the health of the pope? The Vatican’s messaging around Leo’s pending surgery is, in many ways, a new approach to papal health issues. But, despite the pope’s personal candour, the Holy See’s messaging perhaps raises as many questions as it answers. Subscribe — Leo’s decision to announce his own medical status and pending hospital stay during the Sunday Angelus is, it should be said, already something of a big deal. Traditionally, the health of popes simply hasn’t been discussed publicly or officially, until circumstances made it absolutely necessary. Memorably, in 2023 Pope Francis was rushed to the Gemelli in an ambulance, exhibiting signs of cardiac arrest according to many close to him, only for the Sala Stampa to put out a statement insisting he was merely going in for “pre-scheduled” tests. That Pope Leo has decided to announce his condition himself, with remarkable frankness, is a significant comms policy shift around the Apostolic Palace. This might reflect a deliberately more open posture, as opposed to the traditional, otiose evasiveness, and the first fruits of an American pope and American prefect of the Dicastery for Communications favoring honesty as a baseline. Equally, it must be allowed, it could be that the pope’s situation is serious enough that there would be no keeping it under wraps or playing it off, and the decision was made to be as open as possible to head off speculation about the papal health. Certainly, Leo appeared to make every effort to sound reassuring — stressing that, whatever the diagnosis is, exactly, it is “well-localized” and “early stage.” Of course, for everyone listening, talk of a “nodule” in a lung will immediately send thoughts — and prayers — running to concerns about words not used, like “cancer,” “tumor,” “begnin” or “malignant.” To be clear, none of those words may yet be medically appropriate. And there is every reason to believe and assume that Leo is giving almost as much information as he may have himself at this stage. But the context of the pope’s announcement and the timing of his surgery do reasonably raise reasonably serious concerns for Leo. We don’t know, and this isn’t to say anyone has the right to expect to know, when the routine medical checks made this discovery. It could have been last week, last month, or even earlier. As such, it isn’t really possible to say with what kind of urgency Leo is being brought in for surgery. However, there is clearly some serious urgency to the matter. Leo making the announcement and going into hospital this week, of all weeks, means he is having to miss the balance and conclusion of his global meeting of the heads of the world’s bishops conferences, which he convened in Rome this week. That, as the Vatican has announced, has meant some serious changes to the schedule, with the newly minted dean of the College of Cardinals, Cardinal Tagle, subbing in for the closing Mass on Wednesday, and the meeting’s organizers announcing that the final working document/summary of the meeting being delayed until Leo can read and feed into it. Those changes suggest that the timing of Leo’s surgery isn’t of his own choosing, and he is acting on the best medical advice he can get by moving urgently. Had this issue been discovered weeks ago, it seems reasonable to assume the pope would have seen it dealt with before the meeting began. And were it possible to delay it, even by a few days to allow the meeting to conclude as scheduled, the expectation would surely be he’d have opted for that. It cannot be excluded that Leo is simply having to fit in with the schedules of his medical team, but a man who occupies arguably the most important and prominent role in Italy, if not Western Europe, could generally be assumed to be the one whose calendar others work around. All this points to a very recent medical discovery leading to a “days matter” diagnosis, or at least suspected possible diagnosis. Of course, another factor weighing in the balance is Leo’s upcoming apostolic visit to three South American countries, including a return to Peru, where he spent many years as a priest and bishop. It is entirely possible that the doctors, and the pope himself, are more concerned about the potential knock-on effects of surgery, and the time needed for recovery, for a 71-year-old — even one as physically sound and actively sporty as Leo. The pope is due to depart Rome November 6 for his 10-day three-country trip, returning on Nov. 17. It may be that Leo has simply made the decision to allow maximum time for his own post-op recovery, and even allow for potentially unforeseen circumstances, so that he is at full strength for the landmark trip. While it might be an inconvenience, and clearly a last-minute wrench in the works for the Amoris meeting, it is possible that Leo simply weighs the importance of that conference more lightly in the balance than even the possibility of missing his homecoming trip to Peru, or even having to scale back his itinerary for the trip. If that is the case, it would suggest a real abundance of caution by the pope approaching his Latin American tour, and a sobering indication of where Leo ranks the non-synodal meeting currently underway in Rome. In any event, what can be said for certain is that the pope having to take this, of all weeks, out of his schedule for surgery and an extended hospital stay is extremely unfortunate timing. It is clear that this is a decision Leo has made on the advice of his doctors. Together, they clearly consider that the risks of delaying, even by a little as a few days, represents an unacceptable risk for the pope. Even expecting and allowing for Leo’s full and speedy recovery, that should be a very sobering thought for Catholics everywhere. Subscribe
Pope Leo XIV Announces Surgery Following Troubling Health Discovery
Pope Leo XIV has shared an update about a recent health discovery that will require surgery. The 71-year-old pontiff said doctors found a nodule in his lung during a medical check-up. His medical team...
Doctored 2006 front page falsely portrayed as genuine article about Nigerian politician's 'madness'
As political activity intensifies ahead of Nigeria’s January 2027 election, misinformation is circulating online, including a purported 2006 newspaper front page with claims that presidential candidat...
Business as usual at the Vatican as Pope Leo prepares to have surgery to remove a lung nodule
It's business as usual at the Vatican, a day after Pope Leo XIV revealed he would have an operation this week to remove a lung nodule. The 71-year-old Leo revealed the discovery during his Sunday noon prayer and said he was following doctors’ advice to remove the nodule. The Vatican press office ...
New Doctoral Training Programme will tackle key polar science questions with a reduced carbon footprint
The Net Zero Polar Science (NZPS) Doctoral Training Programme (DTP) has welcomed its first cohort of PhD researchers, marking the launch of a new UK-based...
U.S. doctors are aging, raising concerns about patient safety
Proposals to assess older physicians have collided with fierce professional resistance, legal challenges and debate about the value of cognitive screening.
Can keeping your phone in your pocket harm sperm health? Doctor explains what the science says
The idea that carrying a phone in your pocket might affect fertility sounds like the kind of health scare that spreads faster than the science behind it. According to Dr.
Durham psychiatrist returns from Ebola response mission in Congo
A Durham psychiatrist is sharing his experience responding to an Ebola outbreak in the Congo and encouraging others to volunteer.
What We Know About Pope Leo XIV’s Health
Doctors comment on the pontiff’s news about his upcoming lung surgery.
Commentary: I opened a primary care practice. Now I see why doctors are giving up.
Traditional health insurance pressures doctors to work at volume, or if they add layers of bureaucracy that independent physicians can't easily handle, writes Dimitri Coupet, who says it's time to consider formalizing a direct payment of care model.
What we know about Pope Leo XIV’s health
Doctors comment on the pontiff’s news about his upcoming lung surgery.
Pope Leo to have surgery to remove lung nodule
Speaking during his regular Sunday blessing, the American-born pope said doctors discovered the nodule in a localized, “very initial phase.”
People on TikTok Are Stomping on Salt for Better Sleep—Here’s What Doctors Think About the Trend
Plus, what doctors think about the sleep hack.
Pope Leo says will undergo surgery for small growth on lung
VATICAN CITY, Oct 11 () - Pope Leo said on Sunday that doctors had detected a small growth on his lung during a recent health check and he would be undergoing surgery this week to remove it, in the...
Why doctors are urging women to redo early genetic tests for cancer risks
Advances in technology detect far more genetic mutations, which can be lifesaving information for a generation of women first screened years ago.
Backlash to Trump, RFK Jr. has scientists seeking office
Anti-vaxxers and attacks on the nation's public health system have spurred hundreds of doctors and scientists to seek office. In Sacramento, congressional hopeful Richard Pan is part of that wave.
Opinion: Deb Haaland for governor on New Mexico health care
A UNM resident physician urges voters to support Deb Haaland’s plans for health coverage and more doctors.
Starbucks lawsuit puts sugary drinks in spotlight as doctor warns of health risks
Dr. Michael Aziz, an attending physician at Lenox Hill Hospital, discusses the sugar content of specialty coffee beverages amid litigation involving Starbucks, with estimates reflecting specific sizes and customizations.
Macon Co. Health Department starts drive thru flu, COVID vaccination clinics
DECATUR, Ill. (WCIA) — With flu season on the rise and sooner than usual, the Macon County Health Department is hosting a series of drive-thru vaccination clinics. Doctors say flu season typi…
Russian Anti-Plague Laboratory Death Raises Questions On Biosafety And Global Health
A number of questions linger after the Russian anti-plague laboratory death. A doctor explains the most important questions that remain that impact public health.
Stomach-turning sexually transmitted infection is on the rise — and standard medicines are failing
Shigella bacteria are becoming harder to treat as drug-resistant strains rise, and doctors warn Americans should be concerned but not panicked.
Flu numbers low so far but COVID on the rise, Vt. health officials say
Cold and flu season is underway in Vermont, and the state health commissioner said that while flu cases remain low so far, doctors across the state are seeing more cases of another seasonal illness pop up.
Digital detox how-to; artificial intelligence in nursing; when to see your doctor about GI issues; plus other stories with Vanderbilt Health sources
Prevention interviewed Beth Malow, MD, Professor of Neurology and Pediatrics in the Vanderbilt Sleep Division, about a study that found insomnia is linked with a 26% higher risk of stroke and 28% higher odds of hospital admission. William Schaffner, MD, Professor of Health Policy, was quoted by Parade about the most common COVID symptoms people are experiencing right now, HealthLeaders interviewed Deonna Taylor, PhD, ACMP, RN, Vice President and Chief Nursing Officer, Adult Ambulatory Nursing, about how artificial intelligence will affect nursing practice. The Wall Street Journal interviewed Joseph Schlesinger, MD, Professor of Anesthesiology Critical Care Medicine, for a story about ICU alarms keeping patients from getting sleep and creating alarm fatigue for nurses. Cathy Eng, MD, Executive Director of the Young Adult Cancers Program was interviewed by the The New York Times about GI symptoms that patients should not ignore. Heather Jackson, PhD, APRN, Administrative Director, Advanced Practice, was interviewed by Fox17 about nurse practitioner roles becoming the fastest growing job in the next 10 years. Prevention interviewed Jonah Garry, MD, Assistant Professor of Medicine, Division of Cardiovascular Medicine, for stories about how sleep impacts your heart health and how to do a digital detox.
‘Boy Meets World’ Star Reveals Unexpected Health Scare
Will Friedle was hospitalized after waking up and urinating blood. The “Boy Meets World” star later revealed that doctors found a kidney stone. He discussed the experience on his podcast while making ...
The Science Behind Why Dietary Changes Rarely Stick
Learning new eating habits isn’t simple. Our pre-existing feelings around food—whether it’s a distaste for olives or a love of pastries—could make it harder to learn new eating habits, according to new research from Yale School of Medicine.
‘Boy Meets World’ Star Reveals Unexpected Health Scare
Will Friedle was hospitalized after waking up and urinating blood. The “Boy Meets World” star later revealed that doctors found a kidney stone. He discussed the experience on his podcast while making ...
Missing chatbot records leave doctors struggling to trace harm from AI health advice
As more people turn to AI chatbots for quick, 24/7 medical advice, a new perspective paper co-authored by faculty at Binghamton University, State University of New York, explores the risks of this practice ...
When health advice goes viral, these San Diego doctors are trying to cut through the noise
More than a third of Americans turn to social media for health information, but doctors warn some of what they find there can be dangerous.
HOMETOWN HEALTH: Cleveland Clinic doctor says influenza A cases are higher than expected for October
Respiratory viruses commonly begin appearing in the U.S. in October, but the season tends to peak between December and February.
First-of-its-kind health equity conference at UB seeks to bridge healthcare gap
The goal is to lay the groundwork that will bridge the gap in healthcare between the two cities.
Unity woman paralyzed in sledding accident partners in new styling business
Angela Vaslavsky knows she will walk again. After being launched into a pair of downed trees while sledding on New Year’s Eve, Vaslavsky, 44, suffered a paralyzing spinal cord injury. Doctors thought she might not survive the night, let alone regain mobility in her arms or legs. Ten months later,
If you’re not getting good sleep, you’re like a lot of Louisianans. This doctor has advice.
Louisianans need more sleep. Here’s how to get it.
Doctor explains postpartum mental health conditions and warning signs
Oct. Scientist in Residence At Work at Science Center
Ries Plescher, third-year doctoral student at University of Oregon in Eugene, is October’s Scientist in Residency Fellow at Sitka Sound Science Center. The SIRF program offers scientists four weeks to focus on their research while connecting with...
Activists, doctors clash over vaccine repeal proposal at Florida health panel hearing
Florida Department of Health wants to remove the immunization requirements for Hepatitis B, varicella (chicken pox), Haemophilus influenza type b (Hib) and pneumococcal conjugate to attend Florida schools. At a public meeting Thursday, parents rights activists and doctors clashed over the plan.
Aging Untold: Knowing your family health history matters more than you may think
On this episode of Aging Untold, we explore how family health history can help doctors spot medical risks early and shape a more personalized path for your care. Plus, find out how creating an “anti-bucket list” can help you let go of guilt, grudges and obligations as you age.
Aging Untold: Knowing your family health history matters more than you may think
On this episode of Aging Untold, we explore how family health history can help doctors spot medical risks early and shape a more personalized path for your care. Plus, find out how creating an “anti-bucket list” can help you let go of guilt, grudges and obligations as you age.
Health Check: Doctor discusses prostate cancer risk and screening for awareness month
Dr. David Mendoza, a surgical urologist, discussed prostate cancer risk factors and screening recommendations.
Idaho health insurance premiums see big jump for 2027
The Idaho Department of Insurance (DOI) released its 2027 rates for Individual and Small Group Health Plans on the health insurance exchange, with both going up by an average of 12%. “Despite national pressures and ongoing medical inflation, Idaho’s health insurance market remains highly competitive and stable,” Director Dean Cameron said in a news release. […]
One Doctor, Eight Billion Patients: After Stepping Back From The WHO Race, What I Stand For In The AI Society
The core of my policy manifesto, One Doctor, Eight Billion Patients, is a single proposition: Universal Intelligence Coverage (UIC) for health. Universal
Knowing your family health history matters more than you may think
Your family health history can help doctors spot medical risks early and shape a more personalized path for your care.
Knowing your family health history matters more than you may think
Your family health history can help doctors spot medical risks early and shape a more personalized path for your care.
Knowing your family health history matters more than you may think
Your family health history can help doctors spot medical risks early and shape a more personalized path for your care.
Knowing your family health history matters more than you may think
Your family health history can help doctors spot medical risks early and shape a more personalized path for your care.
6 High-Fiber Fall Foods for Better Gut Health, Recommended by a GI Doctor
In TODAY.com’s Expert Tip of the Day, a gastroenterologist shares her favorite fall produce packed with dietary fiber to support gut health.
Why this startup is taking its AI to predict breast cancer risk directly to patients
A startup didn't want to wait for doctors and insurers to get behind its breast-cancer risk prediction AI. So it's going directly to patients.
Ipsos Health Service Report 2026
Since 2018, Ipsos has been tracking perceptions of the quality of healthcare systems, the biggest health issues and the biggest public health problems.
Bay Area health officials urge getting a flu shot as flu season arrives early
Doctors are sounding the alarm about the early arrival of the flu season and urging people to get their flu shot as soon as possible.
UMC, Texas Tech Health Sciences Center trade statements in OB-GYN doctor dispute
University Medical Center and the Texas Tech University Health Sciences Center are exchanging public statements about OB-GYN services following the recent departure of two doctors.
Mayo Clinic Health System doctor urges women to discuss family breast cancer history
“It affects your mom, your sister, your aunt and sometimes, unfortunately, yourself."
The Citadel now has guaranteed admissions agreement with Mass General Brigham University of Health Professions
Students from The Citadel now have clear access to competitive graduate and doctoral programs at Mass General Brigham University of Health Professions.
In Good Health: The Evolution Of Prostate Cancer Treatment
Prostate cancer is the most commonly diagnosed cancer in American men — and the second leading cause of cancer-related deaths. One in eight men will be diagnosed in their lifetime. And Black men are more than twice as likely to die from it.Between the social stigma and misconceptions about diagnostic methods, it’s not something many men want to talk about. Some 99 percent of people diagnosed early with prostate cancer live at least 5 more years. And treatment options and guidelines are evolving rapidly.Our “In Good Health” series continues. We gather a group of doctors from three of the disciplines involved in the treatment of prostate cancer.Find more of our programs online. Listen to 1A sponsor-free by signing up for 1A+ at plus.npr.org/the1a.
Montana State doctoral student receives inaugural fellowship for human health researchers
The new fellowship was established by longtime HIV/AIDS researcher Kathryn Follis Heivilin and her husband Gerard Heivilin to support emerging scholars.
Roger Marshall's photo flub is part of a rich tradition in KS/MO politics
Campaign season is a bountiful time for misleading and doctored political photos in Kansas and Missouri. From David Hudnall:
Heart association recognizes Sanford for heart, stroke care
The awards recognize hospitals using research-based guidelines for heart disease and stroke care, helping save lives and support recovery.
OpenAI enlists doctors to enhance ChatGPT's health advice
OpenAI enlisted over 260 global physicians to improve ChatGPT's health advice amidst legal challenges and a high-stakes healthcare push.
ANF Investigates: Allegiance Health plans to sell 2 struggling Acadiana hospitals
Allegiance Health Management plans to sell four financially struggling rural hospitals in Louisiana, including two in Acadiana, at the directive of the Louisiana Department of Health. The two Acadiana hospitals involved are Mercy Regional Medical Center in Ville Platte and Acadian Medical Center in Eunice. Both facilities have dealt with a number of problems, including unpaid payroll taxes, broken equipment, overdue bills, the loss of doctors and staff, and a shortage of critical supplies.
ANF Investigates: Allegiance Health plans to sell 2 struggling Acadiana hospitals
Allegiance Health Management plans to sell four financially struggling rural hospitals in Louisiana, including two in Acadiana, at the directive of the Louisiana Department of Health. The two Acadiana hospitals involved are Mercy Regional Medical Center in Ville Platte and Acadian Medical Center in Eunice. Both facilities have dealt with a number of problems, including unpaid payroll taxes, broken equipment, overdue bills, the loss of doctors and staff, and a shortage of critical supplies.
ANF Investigates: Allegiance Health plans to sell 2 struggling Acadiana hospitals
Allegiance Health Management plans to sell four financially struggling rural hospitals in Louisiana, including two in Acadiana, at the directive of the Louisiana Department of Health. The two Acadiana hospitals involved are Mercy Regional Medical Center in Ville Platte and Acadian Medical Center in Eunice. Both facilities have dealt with a number of problems, including unpaid payroll taxes, broken equipment, overdue bills, the loss of doctors and staff, and a shortage of critical supplies.
New program brings mental health, medical care to unhoused people in Charlotte
Doctors appointments being offered in the community
Oracle Health Hack Exposes Data of Nearly 20 Million People
Patient names, Social Security numbers, doctors and diagnoses might have been breached in the cyberattack.
Former Cocoa Beach classmates are now Orlando Health doctors. Photos
Former classmates from Cocoa Beach Jr./Sr. High, Dr. Anita Fazeli and Dr. Srividya Kannan will share an Orlando Heath location in Viera.
American Journal Of Public Health Study Examines Political Differences In Perceptions Of Vaccine Safety And Effectiveness
Vaccine perceptions can influence acceptance and uptake. Dr. Dror Walter, with the Department of Communication at Georgia State University in Atlanta, and colleagues examined these perceptions using data from a national probability sample of 1,763 US adults surveyed in November 2024.
AI may soon be in more healthcare processes in Utah under new state agreements
Utahns may start seeing more AI in their doctors visits now that the state signed agreements with healthcare providers to test pilots.
Doctor: Before flu season arrives, make one health care decision that can save time and money
Nationally, up to 57 million people could get the flu this winter. As many as 25 million could seek medical care, 800,000 could be hospitalized and 81,000 could lose their lives.
A Patient and Doctor Weigh the Pros and Cons of Genetic Testing
Genetic testing, a heart scan and a blood test gave Ron Carr unexpected answers about Alzheimer’s and cardiovascular risk.
Doctors, insurers sue Newsom over health insurance premium increases
Doctors and health insurers have filed suit alleging Gov. Gavin Newsom and the California Legislature violated the law when they approved a healthcare tax that could substantially increase insurance premiums.
Doctors, insurers sue Newsom over health insurance premium increases
Doctors and health insurers have filed suit alleging Gov. Gavin Newsom and the California Legislature violated the law when they approved a healthcare tax that could substantially increase insurance premiums.
Doctors, insurers sue Newsom over health insurance premium increases
Doctors and health insurers have filed suit alleging Gov. Gavin Newsom and the California Legislature violated the law when they approved a healthcare tax that could substantially increase insurance premiums
Doctors, Insurers Sue Newsom over Health Insurance Premium Increases
In June, lawmakers passed a healthcare tax that could increase premiums in order to combat federal Medicaid cuts.
Lamar Jackson Drops 1-Word Reaction As Sports Doctor Assesses Ravens QB’s Ankle Injury
Lamar Jackson offered a brief response after a sports doctor weighed in on his ankle injury during Sunday’s win over the Tennessee Titans. Dr.
Doctors Should Keep an Eye on Your Mix of Medication. If They Don’t, You Should.
By Paula Span | KFF Health News Medications can snowball as we age. Pill organizers pile up. Prescriptions that are no longer necessary can mix with other drugs to create concerning side effects. “Once you get to six or seven prescription medications, you get a nearly 100% chance of some sort of ...
Nutritional countermeasures to spaceflight studied at URI
KINGSTON, R.I. – Oct. 5, 2026 – As humans spend longer periods of time in outer space and venture further from Earth, it’s increasingly important for scientists to learn how varied gravity levels affect muscle function and muscle loss, and how those effects can be counteracted or minimized. Theodoros Pavlidis, a second-year doctoral student who […]
Yale School of Medicine On the Science of Childhood Anxiety, Say, Anxiety Disorders Are the Most Common Mental Health Challenges In Youth
Credit: Matt Bradbury October 5, 2026 - By Isabella Backman - Anxiety disorders are the most common mental health challenges in youth. Left untreated, they can disrupt the lives of both children and their families. The good news is that with intervention, most children will overcome these conditions. Across Yale School of Medicine, scientists are working to understand anxiety at every level, from common anxious behaviors to molecular biomarkers in the brain. They are using their findings to develop and disseminate new evidence-based treatments for childhood anxiety. Today, the go-to treatment for childhood anxiety disorders is cognitive behavioral therapy (CBT). This is a form of psychotherapy that teaches children skills for confronting anxious thoughts and helps them practice managing situations that cause anxiety. While it is the gold-standard treatment backed by considerable scientific evidence, up to 50% of children will not see sufficient benefit from CBT alone. Wendy Silverman, PhD, Alfred A. Messer Professor in the Child Study Center, co-directs the Anxiety and Mood Disorders Program alongside Eli Lebowitz, PhD, associate professor in the Child Study Center. One of their main interests is learning how to improve outcomes beyond CBT. “We’re developing cutting-edge, research-based knowledge that can reduce the suffering that anxiety causes children and their families,” says Silverman. Changing parent behavior YSM experts are investigating how to improve CBT outcomes for children by involving the parents. Silverman’s research has uncovered two main components of parent intervention that improve childhood anxiety: not enabling children to completely avoid the things that make them anxious and taking steps to enhance their autonomy. Parents may unintentionally reinforce their child’s anxiety by allowing them to avoid what makes them anxious. They also may unintentionally limit the children’s sense of autonomy by being overly intrusive. “One of the things that we take pride in is that we’ve focused on trying to understand what parents need to do, and to test our ideas and see if changing the parents’ behaviors is enhancing the effects of CBT,” Silverman says. “Our findings thus far suggest that they do." As much as CBT can be helpful, it can also be challenging to get one’s child to do the necessary steps for CBT to work. This is one important reason why Lebowitz created a novel intervention program for parents named Supportive Parenting for Anxious Childhood Emotions (SPACE). Existing intervention programs often teach parents to act as therapists for their child, such as training them on how to practice breathing exercises. “It makes sense, but this doesn’t work very well in practice,” says Lebowitz. “And part of the reason, I think, is that it’s not easy to get your kid to do things, especially if they’re not excited about doing it.” SPACE is unique because it focuses entirely on parent involvement and changing parental behavior—children are not involved in the sessions. For example, parents learn how to use supportive messages that convey confidence that their child can tolerate and manage distress. “It might sound like a parent saying to a child, ‘I get that this is really hard for you, but I know that you can handle it,’” Lebowitz says. The program also works with parents to identify the ways in which they are accommodating anxious behaviors. “We’ll pick one thing that parents are doing that is an accommodation and help them make a detailed plan for how they’re going to change that,” Lebowitz explains. Treating Anxiety in Children and Adolescents Much of the existing research on SPACE has focused on parents of children under age 14. Ongoing studies are now exploring its use with parents of older teens. “Both anxiety and accommodation can interfere with normative developmental shifts during the teen years, including increased autonomy and individuation from parents,” says Rebecca Etkin, PhD, associate research scientist in the Child Study Center. “In this sense, SPACE may be particularly well-suited for anxious teens and their parents. We want to see whether it is effective during this distinct developmental window.” Unfortunately, many families in need of CBT face barriers, including limited availability of services and geographic constraints. One way to improve access is digital interventions. Silverman and her team are developing an evidence-based digitized intervention program for parents that they can access directly from their computer or smart phone. “The work we’re doing will be one of the very few parent interventions that is digitized and importantly tested for effectiveness,” she says. Creating interventions for anxiety-related challenges Silverman and Lebowitz recently received a generous gift to develop and test other interventions that help parents reduce other child anxiety-related behavioral and emotional difficulties, such as restrictive eating and unexplained somatic symptoms. One of these projects in particular focuses on understanding the risks of social media and its potential benefits, including offering a sense of connection. “A lot of research has focused on the idea that social media is harmful and the less of it the better,” says Lebowitz. “But we actually see is that this is not quite right—there are negatives, but there are also positives. So, we’re trying to get a little bit more nuanced of a picture.” The team is working with teens with social anxiety and their parents over an extended period to better understand their social media habits and how their anxiety levels affect engagement with different platforms. The teens will answer questions sent to an app on their phones about mood and social media usage in an effort to capture emotional responses as they unfold. “We hope to develop interventions that can help make the best of social media while protecting against the more problematic effects,” Lebowitz says. The brain’s role in anxiety Researchers are also testing therapies to address anxiety at the neurological and molecular levels. In collaboration with Dylan Gee, PhD, professor of psychology in Yale's Faculty of Arts and Sciences, and Hilary Blumberg, MD, John and Hope Furth Professor of Psychiatric Neuroscience at Yale School of Medicine, Lebowitz and Silverman are using brain imaging to identify changes in a child’s brain before and after parents enroll in SPACE. In one study, children viewed anxiety-inducing images while undergoing magnetic resonance imaging (MRI); the researchers conducted scans with and without the children’s parents nearby. Before SPACE, children’s brains were better able to activate the regulatory circuitry needed to turn off an anxious response when their parents were nearby. But after SPACE, children could activate this circuitry even without the parent around. “As parents work on gradually reducing some of their accommodations, you can see a child get better at regulating their own fear system in the brain,” Lebowitz says. “It’s remarkable.” Research into the molecular underpinnings of anxiety can also inform new childhood anxiety treatments. In a recent study, Lebowitz, Silverman, and Flora Vaccarino, MD, Harris Professor in the Child Study Center, discovered that a protein known as fibroblast growth factor 2 (FGF2) could be protective from the toxic effects of stress. FGF2 levels in children and their parents were linked to the children’s risk of developing anxiety and depression, the study showed. The findings could help explain why some children who are exposed to early life trauma such as poverty or abuse are more prone to developing mental health disorders. And FGF2 could be a target for treatment. “This is very novel because it starts to give a clue to what is the molecular chain that connects those lived experiences to the actual psychological outcomes,” Lebowitz says. New ways to study and treat childhood anxiety Michael Crowley, PhD, associate professor in the Child Study Center, collaborates with Silverman and Lebowitz to study the role that attention plays in development and maintenance of childhood anxiety. There is a large body of research that shows that anxious children, like anxious adults, are prone to focus on threatening stimuli such as angry faces compared with neutral faces. This has led to innovative interventions that involve attention retraining. The idea is that if experts train children to look away from threatening stimuli, it may reduce their anxiety—especially children with social anxiety who are most prone to attend to threats. The researchers have just completed a clinical trial for attention retraining with 10- to 14-year-olds with social anxiety disorders and are currently analyzing the findings. Besides this innovative attention retraining research, as Crowly notes, “I like to design tasks that are engaging to kids,” Crowley says. “My goal is to assess something without the kids knowing what we are assessing.” With this goal in mind, Crowley has created a virtual game, named Boom, to study threat processing in children with anxiety disorders. The game is similar to that of hot potato—the child and three digital players take turns virtually passing a ball to each other’s gloves. At some point, the ball turns into a bomb, and as the bomb lands in each player’s glove, the outline of the glove turns yellow. The goal is to avoid having the bomb go off in your glove. What isn’t obvious is that the game is designed to measure different types of threatening stimuli, both ambiguous and direct. In the game, the direct threat occurs as the bomb is traveling towards your glove. The ambiguous threat is the yellow outlined glove as it is unknown where the bomb will travel next. While children play the game, Crowley’s team measures their brain activity using electroencephalography (EEG). The researchers have discovered that in kids with anxiety, the brain reacts more strongly to ambiguous threats than it does in their peers, but less strongly to direct threats. They believe that the initial abnormally large brain response to not knowing where the bomb is going impairs the brain's ability to properly respond when the threat is actually traveling the child’s way. “The brains of children with anxiety are unable to differentiate between threats you need to do something about and those that are not your problem.” Michael Crowley, PhD, develops innovative games for studying anxiety in children and adolescents.Credit: Matt Bradbury Based on these insights, Crowley hopes to study whether interventions like attention training could restore appropriate threat processing. Crowley’s team is also working on a test called the Balloon Risk Avoidance Task, which evaluates risk-taking and avoidance behaviors. It features a digital balloon that is full of air and about to burst. Kids have six seconds to let air out of the balloon. The more air they let out, the less risk they face that the balloon will pop. But at the same time, the balloon becomes less valuable as it deflates. “The more air you keep in the balloon, the more points you get,” Crowley explains. So far, the researchers have found that when the balloons pop unexpectedly, teens with social anxiety show distinct brain responses. Studying these responses can help psychologists understand the underlying pathways driving the various manifestations of anxiety. The genetics of anxiety When Thomas Fernandez, MD, associate professor in the Child Study Center and of psychiatry, was still in training, there was a lot of excitement about understanding the genetics associated with autism spectrum disorder. Since then, scientists have identified around 250 genes associated with autism. The genetic contribution to anxiety disorders, on the other hand, has historically received less attention. Anxiety is less heritable than autism, but the genetic contribution for anxiety disorders that emerge in childhood may be higher than for anxiety disorders overall. While scientists estimate the heritability of anxiety disorders in general to be around 30% to 50%, some studies suggest higher heritability for certain childhood-onset anxiety presentations. “I saw firsthand how researchers in the field went about finding vulnerability genes for autism,” Fernandez says. “So, we’re using a very similar playbook for childhood anxiety.” “I saw firsthand how researchers in the field went about finding vulnerability genes for autism. So, we’re using a very similar playbook for childhood anxiety.” Thomas Fernandez, MD Associate Professor In the Child Study Center and in Psychiatry Now, Fernandez and Emily Olfson, MD, PhD, assistant professor in the Child Study Center, are studying children and their parents to identify genetic changes that are present in the child but not the parents, known as “de novo mutations.” “All of us have some de novo mutations—maybe about 50 to 100 sprinkled throughout the genome,” Olfson says. “But when they occur within the coding regions of genes, they can be really disruptive.” Previous research shows that people with autism have higher rates of damaging de novo mutations than the general population. In 2022, Olfson, Lebowitz, Silverman, and Fernandez published a study on 68 children and their families that found that children with anxiety had similarly high levels of these mutations. Studying de novo mutations can help point the researchers to where they should be looking for genes associated with anxiety. “The end game is using the genes to steer us toward the right part of biology that we can then target to come up with better treatments,” Fernandez says. Building on those findings, the team is now studying more families to better understand how these de novo mutations, along with other genetic and environmental factors, shape pediatric anxiety disorders. They recently received a National Institutes of Health grant to enroll 750 new families over the next five years. Olfson is the principal investigator, with co-investigators Lebowitz, Fernandez, Silverman, and Shuangge Steven Ma, PhD, department chair and professor of biostatistics at Yale School of Public Health. Neurodevelopment, Risk Genes, and Mental Health Conditions - The Olfson Lab Joel Gelernter, MD, Foundations Fund Professor of Psychiatry, is interested in how different anxiety disorders differ genomically. “We are studying social phobia, panic disorder, and generalized anxiety disorder, working to understand why people differ in their risk to these specific anxiety disorders and evaluating various risk factors,” he says. Gelernter was recently involved in one of the largest studies to date of the genomics underlying anxiety disorder. The study included around 122,000 people with anxiety disorders and around 730,000 without. It found that some genetic differences associated with anxiety were linked to signaling that helps reduce overactivity in the nervous system. Many anxiety medications available today work by targeting this process. “It’s nice when the biology that you get out of a large genome-wide study ratifies things that we already know because that can help increase confidence in further findings from the study,” Gelernter says. Uncovering the neurobiology of psychiatric disorders John Krystal, MD, Robert L. McNeil, Jr. Professor of Translational Research and chair of the Department of Psychiatry, is interested in the neurobiology of psychiatric disorders, including post-traumatic stress disorder (PTSD), of which anxiety is a major symptom. In the late 1980s, Krystal’s team discovered that the drug yohimbine activated symptoms in patients with PTSD. “This was the first time we could link a specific biological mechanism to the symptoms of PTSD,” Krystal says. At the time, he adds, this finding was highly controversial. “A lot of people felt that PTSD was a purely psychological syndrome that didn’t have an underlying biology.” Since then, Krystal has dived deep into understanding the neurobiology of PTSD to learn how to better treat it. His team is evaluating the use of ketamine and psychedelics. These would be among the first treatments to be developed specifically for PTSD. They may also be applicable for other disorders including anxiety disorders, Krystal adds. An important gap in PTSD treatment is the absence of biological tests that inform how to best help patients manage their PTSD symptoms. A doctor doesn’t diagnose cancer based on how they feel. Rather, they use tests of the biology of the cancer to determine the best course of treatment. “And we can’t do that in any psychiatric disorder other than Alzheimer’s disease,” Krystal says. “But now we are building a foundation for this approach to the treatment of anxiety disorders for the first time.” Source: Yale School of Medicine
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