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Written by: LAKE COUNTY NEWS REPORTS

Published: 10 August 2023

As the new school year arrives, the California Department of Public Health, or CDPH, urges children, teens, and adults to get required and recommended vaccines.

“Vaccinations help children, teen and adult’s immune systems recognize and fight off contagious diseases, keeping them healthy so they can grow, learn, and thrive while in school,” said Dr. Tomás J. Aragón, CDPH director and state Public Health officer. “If you haven't done so already, check with your child's doctor to find out what immunizations they need.”

California law requires students to receive age-specific immunizations in order to attend public and private elementary and secondary schools as well as licensed childcare centers.

Schools and licensed childcare centers are required to enforce immunization requirements, maintain immunization records of all children enrolled, and report students' immunization status to CDPH.

Families can visit CDPH’s ShotsforSchool and Don’t Wait – Vaccinate! webpages for information on immunization laws and required vaccinations for students in California.

It is also recommended that children and adolescents are vaccinated from additional vaccine-preventable diseases, including human papillomavirus, or HPV, a common infection which can slowly and silently lead to cancer.

HPV vaccination is recommended as early as age 9 years to help protect against cancers caused by HPV infection. Many teens in California have not yet been vaccinated against HPV and other vital vaccines.

Families that are having difficulty obtaining immunizations prior to the start of school can contact their local health department for help in finding a place to get needed immunizations.

Under the Affordable Care Act, most health plans are required to cover the Centers for Disease Control and Prevention vaccine recommendations without charging a deductible or copayment. Children without insurance coverage can see if they qualify for the Vaccines for Children Program, which provides free vaccines for eligible children.

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Written by: Margaret Sibley, University of Washington

Published: 10 August 2023

 

As a woman in my 30s who was constantly typing “ADHD” into my computer, I had something interesting happen to me in 2021. I started receiving a wave of advertisements beckoning me to get online help for ADHD, or attention-deficit/hyperactivity disorder. One was a free, one-minute assessment to find out if I had the disorder, another an offer for a digital game that could help “rewire” my brain. Yet another ad asked me if I was “delivering” but still not moving up at work.

The reason the term ADHD litters my digital life is because I am a clinical psychologist who exclusively treats patients with ADHD. I’m also a psychiatric researcher at the University of Washington School of Medicine who studies ADHD trends across the life span.

But these advertisements were a striking new trend.

The following year, in October 2022, the U.S. Food and Drug Administration announced a nationwide shortage of mixed amphetamine salts, a drug that is marketed as Adderall. The brand name Adderall and its generic counterparts have become one of the most common medication treatments for ADHD. Over the next several months, additional ADHD medications joined Adderall on the list of prescription drugs in short supply.

As of August 2023, the U.S. is still experiencing a shortage of several ADHD medications, with some not expected to be resolved for at least a few more months.

The shortage appears to have been triggered by a combination of high demand and access to key ingredients. In recent months, millions of Americans have found themselves with no guarantee of access to their daily medications.

In March 2023, the U.S. Centers for Disease Control and Prevention reported an unprecedented spike in stimulant prescriptions between 2020 and 2021. Perhaps most surprising was that the demographic showing the greatest increases in stimulant use – an increase of almost 20% in one year – were in women in their 20s and 30s.

The CDC’s findings, along with the stimulant shortage, raise some interesting – and still unanswered – questions about what factors are driving these trends.

The challenge of diagnosing adult ADHD

Despite the growth in awareness of ADHD over the past couple of decades, many people with ADHD, particularly women and people of color, go undiagnosed in childhood.

But unlike depression or anxiety, ADHD is quite complicated to diagnose in adults.

Diagnosing ADHD in either kids or adults first involves establishing that ADHD-like traits, which exist on a continuum and can fluctuate, are severe and chronic enough to prevent a person from living a normal, healthy life.

The average person has a couple of symptoms of ADHD, so it can be hard to draw the line between ADHD-like tendencies – such as a tendency to lose keys, having a messy desk or often finding your mind wandering during a dull task – and a diagnosable medical disorder. There is no objective test to diagnose ADHD, so doctors typically conduct a structured patient interview, ask family members to fill out rating scales and review official records to come up with an actual diagnosis.

Diagnostic challenges can also arise for psychiatrists and other health care practitioners because ADHD shares features with many other conditions. In fact, difficulty concentrating is the second most common symptom across all psychiatric disorders.

Further complicating things, ADHD is also a risk factor for many of the conditions that it resembles. For example, years of negative feedback may lead some adults with ADHD to develop secondary depression and anxiety. Zeroing in on the correct diagnosis requires a well-trained clinician who is able to take enough time to thoroughly gather necessary patient history.

Stress of the COVID-19 pandemic

Looking back, some clear factors have been at play, but it remains unclear the degree to which they are driving the spike in stimulant prescriptions.

In 2021, the U.S. was still deep in the acute phase of the COVID-19 pandemic. People were still losing jobs, facing financial strains and juggling work-from-home challenges such as having children at home doing online schooling. Many families were losing loved ones, and there was a huge sense of uncertainty over when normal life would return.

The demands of the pandemic took a toll on everyone, but research shows that women may have been disproportionately affected. This may have led to a greater proportion of adults seeking stimulant treatments to help them keep up with the demands of daily life.

In addition, without access to in-person recreational spaces, the pandemic increasingly drove many people to spending more time on digital media.

In 2021, a social justice movement focused on “neurodiversity” was gaining momentum online. Neurodiversity is a nonmedical term that refers to the wide diversity of brain processes that diverge from what has traditionally been considered “typical.” In this moment, #ADHD became the seventh most popular health topic on TikTok. Relatable anecdotes of missing keys, procrastination, romantic mishaps and secret signs of ADHD began to flood the internet.

But while the internet exploded with ADHD content, researchers in Canada began sorting #ADHD TikTok videos into categories based on their accuracy and helpfulness. They reported something important: A majority of #ADHD content was misleading. Only 21% of the posts provided useful and accurate information.

So, amid the growing online community of newly self-diagnosed people with ADHD, many probably did not actually have the condition. For some, cybochondria – or health-focused anxiety after online searching – may have been creeping in. Others may have mistaken ADHD for another condition, which is surprisingly easy to do. Still others may have had mild attentional issues that do not rise to the severity of ADHD.

What ADHD care looked like in 2021

In 2021, the U.S. mental health system was overloaded. Most traditional ADHD providers such as psychiatrists, psychologists, mental health therapists and psychiatric nurse practitioners, had monthslong wait lists for new patients. People who were newly seeking help for ADHD found faster appointments with their primary care providers, who may or may not be comfortable diagnosing and treating adult ADHD. Since demand for ADHD care exceeded capacity, new options were needed to meet patient needs.

Around that time, online ADHD care startups began to pop up, reaching prospective consumers with appealing digital ads like the ones I received.

Compared with traditional care, the startup models were reportedly using cost-cutting methods, such as favoring quick assessments and a low-cost workforce. The startups were also reported to be relying on a uniform care model that did not adequately personalize treatments, often prescribing stimulants over treatments that may have been better indicated.

Some of these companies are now under investigation by the federal government.

Although they were controversial in the medical community, these models may also have reduced barriers to ADHD care for many people.

The verdict is still out

Until the CDC releases its 2022 and 2023 stimulant prescription data, researchers like me will not know whether the 2021 trends of increased prescribing to adults and high demand for ADHD medications will continue.

If the trends stabilize, it may mean that patients who have been unable to access care may finally be getting the help they need.

If ADHD prescribing returns to pre-pandemic levels, we may learn that a perfect storm of COVID-19-related factors caused a momentary blip in people seeking ADHD treatment.

What is clear is that the current shortage of mental health care workers who feel comfortable diagnosing and treating ADHD in adults will continue to affect the ability of new patients to get proper diagnostic evaluation for ADHD.

Margaret Sibley, Professor of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Written by: Elizabeth Larson

Published: 09 August 2023

LAKE COUNTY, Calif. — The Bureau of Land Management on Tuesday unveiled what it called an ambitious and coordinated approach to tackle high wildfire risk through an accelerated process for creating fuel reduction projects on millions of acres throughout California and northwest Nevada.

At the BLM’s Sacramento headquarters on Tuesday morning, California State BLM Director Karen E. Mouritsen signed the decision record for the Statewide Wildland-Urban Interface Fuels Treatment Programmatic Environmental Assessment.

“This plan helps reduce the intensity, severity and spread of wildfire near communities that border public lands managed by the BLM,” said Mouritsen. “Through partnerships with local and state agencies we will prioritize and coordinate fuels treatments to protect people, property and vital infrastructure.”

The assessment is meant to accelerate fuels reduction projects on 930,000 acres of public lands in Lake and 43 other California counties and two Nevada counties by streamlining plans to protect communities, reduce wildfire risk and improve forest health.

The BLM said the assessment conducted a broad analysis across the public lands slated for fuel reduction.

As local communities and the BLM identify wildfire concerns, the new streamlined fuels treatment plans will permit on-the-ground work to begin in a matter of months. This will allow the BLM to treat an anticipated additional 20,000 acres of public lands each year.

Jessica Gallimore, the BLM’s California state fuels specialist, told Lake County News that the framework is the result of two years of development work.

She said the BLM did an earlier programmatic assessment for the Hazardous Vegetation Removal Management Plan, or HVRM, in 2018.

“It’s a similar tool that allows for us to do hazardous vegetation removal,” she said of the HVRM, adding that the plan allows them to remove vegetation within 200 feet of infrastructure, like roads, power lines and homes.

The new assessment unveiled on Tuesday built off the HVRM, Gallimore said.

She said they focused on areas of high fire risk and analyzed all the types of vegetation management treatments — including prescribed burns, mechanical means like cutting and mastication, herbicides and grazing — to use on BLM lands.

“Without this process, everybody would have to do their own full analysis. We’ve just taken that piece off the table by doing it up front,” said Gallimore.

This will expedite the process significantly. Gallimore said it will now be a couple of months for field offices to go through the project preparation process, versus up to two years to get to the point of implementing a project.

Under this plan, fuels treatment projects will be coordinated across land ownerships to provide the best results for communities, creating a landscape-level network of strategic fuels treatments and breaks within the wildland-urban interface, the BLM said.

Gallimore said field offices will be able to develop local projects, determining what treatments are needed and at what size and scale specific to their areas, and they will do that work in partnership with other agencies and the community.

She said it opens up the ability to partner with neighbors — including private landowners, counties, the states and the U.S. Forest Service — and work together on “meet at the fence” projects in the expedited treatment areas. “The work can happen anytime, year round.”

The BLM manages 15 million acres in California and 1.5 million acres in northwest Nevada. “The goal was really to focus in on the urban interface,” said Gallimore, in an effort to make the most positive impact for communities and the urban interface.

“We honed in on a one-mile radius around the urban interface, in the high and very high risk areas,” said Gallimore. “That’s where they came up with the 900,000 acres that this project covers.”

Lake County is part of the Ukiah Field Office. The BLM said 13,240 acres in Lake County were assessed as part of this project.

Gallimore said the process locally would include Lake County entities working together to conduct coordinated planning of fuel reduction projects in an expedited manner.

The plan covers 44 counties in California: Amador, Butte, Calaveras, Colusa, El Dorado, Fresno, Glenn, Humboldt, Imperial, Inyo, Kern, Lake, Lassen, Los Angeles, Madera, Mariposa, Mendocino, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Joaquin, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Tehama, Trinity, Tulare, Tuolumne, Yolo and Yuba; and two counties in northwest Nevada, Douglas and Washoe.

Gallimore said projects under this program can begin as soon as this fall.

Email Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it.. Follow her on Twitter, @ERLarson, or Lake County News, @LakeCoNews.