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Diplo on the Malibu Triathlon, Social Media, and Being a Dad of 3

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Diplo on the Malibu Triathlon, Social Media, and Being a Dad of 3

DIPLO WILL TRY anything once. Like, say, running a marathon on LSD. The DJ, born Thomas Wesley Pentz, made headlines when he admitted to ingesting the psychedelic for fun at the starting line of the 2023 Los Angeles Marathon earlier this year.

He forgoed a training schedule for his first go at a 26.2—only reaching 15 miles in practice—but he had Olympian Alexi Pappas by his side the day of the race as a pacesetter to compensate for his lack of experience. He crossed the finish line with an impressive time of under four hours. However, pounding the Los Angeles pavement still took a toll on the 44-year-old, leaving him to waddle “like a penguin” for four days.

“Human beings, that energy—you feel love when you’re at something like the marathon,” he tells Men’s Health. “Maybe I was high on LSD [during that first marathon], but [I] felt love.”

Most know Diplo as a genre-blending, music-producing powerhouse, and not as someone with a strong passion for the fitness world. Sure, he’s guilty of posting an occasional thirst trap for his 6.2M Instagram followers, but that’s because he’s proud of the body he has with no plans to let it go to waste.

“I want to challenge myself,” he says. “I want to use my body. The older I get, the more goal-setting makes me feel good. The marathon was a goal. I did that. You just try to find things you want to do, and then you do it, and you never have to do it again.”

2023 los angeles marathon

Meg Oliphant//Getty Images

But he made an exception this year. It’s Diplo’s second time participating in the Malibu Triathlon: a classic test of endurance where competitors cycle, run, and swim in timed trials along the California coast. He blamed his 2022 triathlon flop, and subsequent disqualification, on an uncharged bike—as well as huge waves and “fucking monsters” out in front during the water portion—but his attempt this month told a different story. He crushed all three sections in one hour and 25 minutes without any excuses, any legitimate training, or any drugs.

When he’s not seeking medals, Diplo still likes to remain active through surfing, sparring with a trainer, or—most surprisingly—downward dogging in a yoga class. And while a hectic travel schedule often means he’s forced to break a sweat alone, he’d actually prefer to exercise with a crowd size similar to that of his sold-out performances. It leaves him feeling “so much more powerful” compared to working out solo.

After finishing a workout in the Men’s Health gym, Diplo sat down with us to discuss authenticity in the music business and in life, talking shit on the internet, and being the best role model possible for his kids.


Men’s Health: Who guided you on the path to success when it comes to music and producing?

Diplo: I don’t think anybody did actually. If anything, I applied a lot of my father’s knowledge to discipline into what I was doing, which is music. He really instilled in me that if you want to be successful, just make sure you do it. Get things done. I managed myself in the beginning [of my career]. I booked my own shows. I put my own parties on together. I bought the liquor. I knew how it all worked.

When you’re behind the booth, what percentage of being a DJ is feeling it in your soul versus knowing the right buttons to press?

To actually apply it, to release it properly, and to become a brand, it’s very difficult to make that step. The creative side was always the beauty of it, but it’s tainted when you have to do the business side of it. It’s hard to find that balance, and I have to step back sometimes because if I get too into the business, I don’t like music anymore. You have to find that balance and that’s the hardest part.

2023 governors ball music festival

Taylor Hill//Getty Images

Your music reaches all different parts of the globe, but you’ve also gotten the world’s attention by saying pretty much whatever you want. Do you have no fear of backlash?

I think I’ve always had a careless abandon of social media. I was one of the first DJs on Twitter, so I was just reckless. I was making fun of everybody there. I remember I had a fight with Flo Rida, I had a fight with Sean Paul on there. Taylor Swift, I had beef with her once. That was probably one of the biggest career mistakes I ever [made]. It took me a year to get [past] that. But I just didn’t think that it was real. It was like when the medium came out it was just people, and your thoughts are like mine.

Now it’s mainly Instagram for you—and the occasional podcast.

It’s like my journal. I like to write stories and give captions, talk about real, meaningful things, not just like what’s my cool outfit or this is how many people I DJ’ed for today. That’s tired. I do that sometimes to promote my music, but I like it because it’s a place to live. And yeah, podcasts, I just talk shit. Sometimes I just don’t care. I’m a real person. If you just add up my soundbites, you might find the sweet ones or I might be a sarcastic asshole or I might be gay. You say something that’s careless or funny or weird, and you got to work with that. That’s the format we live in.

You mentioned turning parts of social media into a journal. Do you show the health and wellness aspects of your life intentionally to contrast the galavanting around?

I do show like, ‘Hey, I woke up early today even though I DJ’ed till 5 o’clock in the morning.’ Or like, ‘Hey, I have a layover. I’m working out.’ I just show people it’s possible to do it. But it can be lonely. When we’re on the road, two weeks you’re on the road 10 of the 14 days, you’re just married to your tour manager and your assistants. So there are upsides and downsides. I get to see the world, but you have to find some pace that you’re going to have time for yourself as well.

As a proud father to three young boys, how often are you thinking about the moves you make and how your choices will influence them as they get older?

My kids are really offline. They’re confused sometimes because they’ll go to a big rave or they’ll go to my race or they’ll go down to see my family in Florida and it’s like they only get little snippets of my life. I think one day they’re going to get a flood of like, ‘Wow, your dad’s actually a psychopath for wanting to do this shit.’ But for now, I just want them to think that I’m their dad and I want them to feel like they’re great kids and I love them, so I’m not trying to show off.

A very fair approach to have at this stage of their lives.

I also don’t want my kids to have some complex where they feel like they have to compete with me or something. I can think of a lot of famous or successful people’s kids who have this. They have a complex that’s difficult for them to beat, and you can’t really beat it. You just got to tell your kids that whatever they do is going to be awesome and make them feel that way.

What words of wisdom do you have for someone looking to lead this no-holds, no-boundaries lifestyle like yours?

It’s easy to say, ‘Make sure you’re comfortable with who you are,’ but that’s a really hard thing to do. The main thing is to have people around you that are really fucking honest with you, real with you, and can support you. And if they know you, you don’t really need anybody else. You can be on the internet and people talk to you all day long, but if your real friends know who you are and they give you the right information, the right, ‘You can do better at this,’ or they love you and show you love, you just need that. You need the right community.

And some people don’t find it. It’s really easy to get lost and not find real people to be your supporters. It’s important to find people that love you. Whatever path you take, they’re going to be like, ‘That’s cool.’ If you can find those people that really care about you like that, then you can be free as fuck.

This interview has been condensed for length and clarity.

Headshot of Sean Abrams

Sean Abrams is the Senior Editor, Growth and Engagement at Men’s Health. He’s a former hip hop dancer who likes long walks on the beach and large glasses of tequila. You can find his previous work at Maxim, Elite Daily, and AskMen. 

What To Remember Before ‘Loki’ Season 2

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What To Remember Before ‘Loki’ Season 2

FOR THE VERY first time, a Marvel Cinematic Universe show now has a second season. Not speculation, not rumors, not theories—a real second season. After more than two years away (and with 17 MCU movies/shows coming in that time since), Loki is finally back for more time-traveling, universe-hopping fun.

But with all that time—and all those Marvel projects—comes a lot to store in our noggins. I can barely remember what happened in the credits scene I watched a couple months ago letalone the character happenings of a show that aired two years ago. I remember that Loki was great fun and quite exciting, and you probably remember the same. But do you remember what happened? Do you remember who the characters are?

You very well might. But on the off chance you don’t we’re here to just give you the tiniest of recaps to remember where things stand and where things are headed. What we aren’t including in this story is information about new characters to the show, such as the TVA agent played by reigning Best Supporting Actor Oscar winner Ke Huy Quan (for Everything Everywhere All At Once), for the simple purpose of… we don’t know! Watch the show, and you’ll surely find out all about him. We also aren’t including the wonderful cartoon Miss Minutes on this list, because, well, she’s more of an AI simulation of a character than an actual being with agency (though she’s still fantastic and Tara Strong does fantastic voice work as always).

So, without further ado, here’s a quick refresher on the main characters of Loki—and what you may need to recall.

Loki

loki episode 4 credits scene

Marvel Studios

The first important thing to remember about Loki in Lokithis Loki, if you will—is that he didn’t actually live any of the events that took place after The Avengers (2012). He got to the TVA because he stole the Tesseract and teleported away when Tony Stark and the Avengers attempted their great time heist during the events of Avengers: Endgame.

Still, while Loki didn’t live the events of, say, Thor: The Dark World or Thor: Ragnarok, he still saw how things played out (in that timeline) thanks to a film of his life that he was shown early on at the TVA by Mobius. M. Mobius.

Over the course of Loki, he comes a long way, eventually turning into far more of an anti-hero or even just straight-up hero (while also forming quite the bromance with Mobius in the meantime). He also finds a kinship (that, at times, is romantic in nature) with Sylvie, who is, in fact, a variant of himself. It makes sense that Loki would be in love with himself, does it not?

By the end of the series, Loki and Sylvie, seeking the truth about the TVA, are pruned, where they eventually are sent to a far off land where they meet He Who Remains, who turns out to be the person really in charge of the TVA (they had previously had some android “Timekeepers” masquerading as the powers that be). When Sylvie kills He Who Remains, a multiversal war is triggered, and Loki is transported back to the TVA, where he tells a worried Mobius that someone very, very bad (Kang) is coming. Mobius, however, has no idea who Loki is or what he’s talking about—he’s landed in another timeline.

Mobius

loki episode 4 vampires

Marvel Studios

Mobius, meanwhile, is a long-devoted TVA agent who used to be loyal to a T, but since meeting Loki, doesn’t mind bending the rules a little bit. He loves Jet Skis, and by the end of Season 1, has come around to a real friendship with Loki (and was using him at a certain point as something of a crime consultant, considering he was hunting down a Loki variant that turned out to be Sylvie). But perhaps the most important realization about Mobius (and about every TVA agent) is that they are actually variants of real people on earth—more on that in just a bit.

The fact that Loki landed in a different timeline, though, means that he’ll have to re-teach Mobius about just how close they got during the events of Season 1. Sad!

Sylvie

loki sylvie jonathan majors

Marvel Studios

Sylvie, a female variant of Loki who uses a different name, never had much of a chance. She was taken by the TVA as a child, and since escaped; she’s been hiding out in different timelines near disasters wreaking havoc ever since. Given that the TVA took her life away, you can see why she made the decision to stab He Who Remains, killing him and creating a massive, world-changing multiverse.

After killing He Who Remains, Sylvie pushed Loki through a portal and we don’t know where she ended up after that (though she’s seen working in McDonald’s in the Season 2 trailers for the show).

Ravonna Renslayer

ravonna renslayer

Marvel Studios

A judge at the TVA, Ravonna was a secondary antagonist in the first season due to her rigid loyalty to the TVA (despite the fact that she didn’t really have any idea what was going on). She has a fun back-and-forth with Mobius (though rarely are they actually on the same page), and B-15 proved that she has at least one variant on earth who is a school vice-principal. Once Ravonna figured out the truth about the TVA (that the Timekeepers were androids, etc.) she left to go on her own mission to find free will, which we can only assume will be continued in Season 2. Fun and perhaps important note: in the Marvel Comics, Ravonna is Kang the Conqueror’s on-again, off-again love interest.

Hunter B-15

a person wearing a helmet and holding a gun

Marvel Studios

Hunter B-15 has perhaps the most dramatic character arc of any in Loki Season 1, as she begins the series simply as a loyal TVA soldier, and ends it fully embracing an all-out TVA revolution. She knows that there’s a variant of her on earth who loves happy hour cocktails, and so she joins Loki, Mobius, and Sylvie’s side of wanting to kind of re-start this whole thing.

The only problem is that much like with Mobius, Loki ended up in a different timeline. So when he’s explaining to Mobius and B-15 what happened at the end of the Season 1 finale… they have no idea what he’s talking about, and a giant Kang the Conqueror statue has been erected behind them.

He Who Remains/Victor Timely/Kang the Conqueror

a man wearing glasses

Marvel Studios

And then we come to the major villain. For this one, we’re going to have to go away from Loki Season 1 just a bit and also take from Ant-Man and the Wasp: Quantumania. The final episode of Loki Season 1 was all about the real creator of the TVA: He Who Remains. He Who Remains was a variant of a future warrior named Kang the Conqueror, who had countless variants, all of whom had extreme intelligence and learned how to travel through time and universes. He Who Remains built the TVA as a way to keep them all in check, revealing to Loki and Sylvie that if he died, a multiversal war that would be unable to undo would follow. He also offered them the opportunity to take his place as the leaders of the TVA, maintaining order. They did not take this offer; Sylvie killed him, and chaos ensued.

Quantumania introduced us to the primary Kang the Conqueror, a murderous war lord who can conceivably control time and has endless power. While Scott Lang and company managed to defeat Kang in the Quantum realm (at least for the time being), the film’s post credits scene showed that another Kang variant—one calling himself Victor Timely—was putting on some kind of science presentation, and Loki and Mobius were watching from the crowd. Mobius asked if this was really the guy he was so scared of, and Loki responded resoundingly in the positive.

And so now you’re caught up with Loki, ready to dive right into Season 2. Happy streaming!

Headshot of Evan Romano

Evan is the culture editor for Men’s Health, with bylines in The New York Times, MTV News, Brooklyn Magazine, and VICE. He loves weird movies, watches too much TV, and listens to music more often than he doesn’t.

How to Watch ‘The Exorcist’ Movies In Order

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How to Watch ‘The Exorcist’ Movies In Order

WHEN THE ORIGINAL Exorcist movie, based on William Peter Blatty’s novel of the same name, came out in 1973, it was an absolute sensation, winning Oscars, getting nominated for more, and grossing a colossal $441 million—against a $12 million budget—at the box office. The movie, helmed by the late director William Friedkin, tells the story of a pair of priests who help a mother and her daughter dealing with a very specific problem; it proved to be a bona fide smash both critically and commercially, still considered one of the greatest horror movies ever made to this day.

Making a lot of money, though, also invites other ideas in: how can we do this again. That means sequels, that means prequels, that means follow-ups, that means more. And so in the 50 years since The Exorcist was originally released, attempts have rarely halted for too long to capture that original magic. And while some have been worthy (more on that in a bit), matching the success of the original has proven to be a difficult endeavor.

Next up, Universal is taking a $400 million swing at The Exorcist with a new trilogy from director David Gordon Green and co-writer Danny McBride, starring Hamilton‘s Leslie Odom Jr. and original Exorcist star Ellen Burstyn, that serves as a sequel only to the original movie, ignoring everything else (the Gordon Green/McBride duo recently completed a Halloween trilogy with a similar strategy, bringing Jamie Lee Curtis back and ignoring all the sequels and remakes).

But even if the movies themselves are ignoring some Exorcist installments, that doesn’t mean the movies no longer exist, and it doesn’t mean you won’t enjoy them. If you’re a fan of The Exoricist—or just want to get into this series and this world—it could be more than worth your time to check out the many riffs that have been made on the legendary story of horror and possession.

Below, you can check out a full guide to all of them.

The Original

The Exorcist (1973)

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The original film—you know all about this one. Ellen Burstyn plays the worried, frazzled, humane mother who cannot understand what’s happening to her young daughter (played by Linda Blair), and so she seeks the help of two priests, played by Jason Miller and Max Von Sydow. The movie is a masterpiece of horror, at times weird, at times gross, at times funny, and always very, very scary. It holds up—if you haven’t seen it somehow, the time to take the plunge is now.

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The Hated First Sequel

The Exorcist II: The Heretic (1977)

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After the success of The Exorcist, a sequel entered production, but neither director William Friedkin nor book author/screenwriter William Peter Blatty were involved (they had lots of behind the scenes problems during production of the original film and the aftermath). But ahead things rolled with a sequel, where both Linda Blair and Max Von Sydow return as a girl still dealing with the aftermath of the possession depicted in the original film, and the priest who helped to finally complete the exorcism. The movie was poorly received, currently holding only a 9% on Rotten Tomatoes.

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The Redeemed Second Sequel

The Exorcist III (1990)

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Much like Halloween III: Season of the Witch (which took the Halloween franchise in a direction away from chief villain Michael Myers), The Exorcist III takes the franchise in an entirely new direction as well. Set 15 years after the events of the original Exorcist (and ignoring the events of The Exorcist II), this film finds the return of William Peter Blatty as both writer and director for a film based on Legion, the follow-up to his original Exorcist novel (Friedkin was attached but had to drop out of the project). Rather than be centered on a possession and an exorcism, Exorcist III is more of a serial killer thriller, with the investigator from the first film (Lieutenant William F. Kinderman, now played by George C. Scott) hunting down a serial killer known as the Gemini Killer (based on the real-life Zodiac killer). But, of course, things do take a supernatural turn.

This movie received mixed reviews at the time (and Blatty has noted studio interference with the original cut of the movie), but has since been reclaimed as a pretty darn good sequel.

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The Prequels

Exorcist: The Beginning (2004)

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We should be clear: the situation with the Exorcist prequels is a bit confusing. Essentially? Paul Schrader (First Reformed, Taxi Driver) was originally hired to make an Excorcist prequel film, and when he turned in his cut… the studio was not happy with it. So unhappy with it, in fact, that they ultimately hired another director and underwent extensive reshoots to retool the movie entirely.

And that movie became Exorcist: The Beginning, a poorly-received (anyway) movie where Stellan Skarsgård plays a young version of Max von Sydow’s character from the original Exorcist film. Blatty said that watching Exorcist: The Beginning was his “most humiliating professional experience.”

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Dominion: Prequel to the Exorcist (2005)

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After Exorcist: The Beginning was a critical and commercial flop, Schrader worked out a deal to finish his version of the prequel (he was given only $35,000 to finagle things together) and get it a limited release via Warner Bros. The result, Dominion: Prequel to the Exorcist was still poorly received, but got better reviews than The Beginning. And, for what it’s worth, Blatty said Dominion was a “a handsome, classy, elegant piece of work.”

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The TV Series

The Exorcist (2016-2017)

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In 2016, The Exorcist made its first (and so far, only) jump to the small screen for a FOX TV show that ignored all the sequels and prequels and directly fed from the original film. The show’s first season featured Geena Davis playing a grown-up version of Regan MacNeil (Linda Blair’s character from the first film), while the cast also included Alan Ruck, Sophie Thatcher, and featured Ben Daniels and Alfonso Herrera as priests investigating occurrences of possession. John Cho was among the new cast members to join for the show’s second season.

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The New Continuity

The Exorcist: Believer (2023)

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And that brings us to 2023, where a new sequel to The Exorcist—titled The Exorcist: Believer and directed by David Gordon Green—is hitting theaters as the first of three planned Exorcist films from Universal and Blumhouse. The movie, like many others on this list, is a sequel only to the original film, ignoring everything else. Leslie Odom Jr. (Glass Onion, Hamilton) leads the way, while Ellen Burstyn returns as her character from the original Exorcist, giving the movie that real “requel” feel.

Buy Tickets Here

Headshot of Evan Romano

Evan is the culture editor for Men’s Health, with bylines in The New York Times, MTV News, Brooklyn Magazine, and VICE. He loves weird movies, watches too much TV, and listens to music more often than he doesn’t.

Veteran Travis Mills Lost His Limbs in Afghanistan But Found True Strength

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Veteran Travis Mills Lost His Limbs in Afghanistan But Found True Strength

For our 35th anniversary issue, we’re spotlighting 35 men who embody strength in all of its forms. To see the full list, click here.


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A LITTLE MORE than a decade ago, as a U. S. Army soldier in his mid-20s, Mills stood six feet, three inches tall and weighed 250 pounds. His biceps, he says, taped 23 inches. To realize such a physique, Mills embodied a definition of strength many young athletes would recognize. “Everything was all about how much can I lift, and how big can I get my muscles, and how strong can I be with respect to picking things up and putting them down,” he says. As an infantryman, Mills had also undergone training that forced him to develop into an endurance performer, someone who could run five miles to a timer and carry weapons, ammunition, and heavy kit for days over uneven terrain.

Much about these demands was physical. But Army training fostered mental toughness too. Mills would more fully understand the inner aspects of strength under battlefield stress. On his second combat deployment, an exhausting gunfight was followed by a difficult journey back to base, during which “everything that could go wrong did go wrong,” he says, including a truck breaking down at night. Mills summoned the resolve to see himself and his fellow soldiers through. At 21 years old, he experienced an epiphany in the night: “No matter what, time is going to keep going on, so roll with the punches and keep pushing forward.”

mens health october november 2023 cover travis mills

Mills with his wife and child.

Tony Luong

On April 10, 2012, Mills was patrolling in southern Afghanistan as a squad leader in the 82nd Airborne Division when a blast shattered or tore away much of both arms and legs. He woke days later in a hospital in Germany. He was a quadruple amputee. “I went from 250 pounds to 140,” he says “I lost 110 pounds in those seven days.”

Mills was cocooned in profound confusion. In the flash of the blast and the haze of a medically-induced coma, he had gone from being a staff sergeant with physical presence and a deep reservoir of competence and skill to a patient who needed to be fed, washed and moved around by others. He had lost more than his limbs and his job. His identity and purpose were gone, too. “I didn’t know who I was,” he says. Unable to envision a future in which he was not a burden to those he loved, Mills told his wife, Kelsey, that she should leave him. She remained. Her loyalty steeled him. He told himself that if his wife had chosen him, that she and their infant daughter, Chloe, were reasons to resist bitterness and reclaim his life.

What followed was a remarkable climb back. At first Mills could not sit up. But after intensive rounds of physical therapy at Walter Reed Army Medical Center, and month after month treating his recovery as a full-time job, Mills was fitted with prosthetics and learned to walk, drive, and feed himself. He regained a sense of purpose. His recovery came from both within and without, requiring the help of countless caregivers, loved ones, and friends.

no matter what time is going to keep going on so roll with the punches and keep pushing forward

Ever more aware of all he could do, Mills became the founder of a non-profit that assists wounded veterans and people struggling with disabilities, as well as a public speaker, the owner of businesses, and a new father as well. His son Dax was born in 2017. His name is a portmanteau of the first names—Daniel and Alexander —of the two medics who saved his life.

That name itself was a marker of Mills’ evolved understanding of strength. Still on a journey, the thirty-six-year-old possessed a definition that encompasses the many and varied aspects of recovery, and the people who help shape it. To him, strength became communal—the sum of the love and generosity and efforts he and his community poured into realizing, through a horror beyond the experience of almost anyone alive, the commitment to living a full life after a wartime odyssey like no other.

mens health october november 2023 cover travis mills

Tony Luong

This story originally appears in the October/November 2023 issue of Men’s Health.

Lettermark

CJ Chivers is a Pulitzer Prize–winning reporter for _The New York Times Magazine and the author of The Fighters and The Gun.

Children’s health leaders hopeful after implicit promise in budget

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Children’s health leaders hopeful after implicit promise in budget

Those health officials hope to meet with provincial representatives as soon as this coming week to hammer out details.

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They are just 17 words contained in a 187-page budget, but children’s health officials are optimistic they represent a new direction for pediatric health care in Ontario.

“We are hoping those 17 words will equal hundreds of millions of dollars for children’s health in Ontario,” CHEO President and CEO Alex Munter said.

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The words: “Every child in Ontario should be able to get the care they need, when they need it,” were contained in Thursday’s Ontario budget.

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Although there were no specifics attached to those words, Munter and other pediatric health leaders are optimistic they represent a response for their call to “right-size” children’s health care with funding that meets population growth and needs.

The Children’s Health Coalition, which includes CHEO and other pediatric health institutions across Ontario, released a comprehensive plan last fall to eliminate backlogs in care in children’s hospitals, child and youth mental health agencies and children’s rehabilitation centres, which have long been underfunded, according to officials.

That plans calls for an investment of $357 million annually over the next four years to ensure children have timely access to the health services they need.

Currently in Ontario, more than 8,300 children are waiting for surgeries, 9,500 children are waiting for ambulatory clinic visits and 28,000 children are waiting for mental health treatment. Meanwhile, children’s hospitals are seeing two and a half times as many emergency visits for eating disorders as they did before the COVID-19 pandemic.

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Munter said the government’s commitment to invest in children’s health care was “pedianomics in action and will pay dividends for generations to come.”

Children’s health officials hope to meet with provincial officials as soon as this coming week to hammer out details.

“I think it is a recognition that, in most parts of Ontario for most types of care, kids wait longer than adults for that care and that is something that needs to be fixed,” Munter said.

CHEO has already received an increase in some permanent funding from the province. More permanent funding for acute care beds, among other investments, came through while the hospital was dealing with an unprecedented respiratory viral surge last fall, overwhelming its resources.

CHEO now has 19 additional critical-care beds with eight mental health beds coming on line this year.

“We are making progress, but we have a lot of work to do,” Munter said.

Among other things, children’s health funding has not kept up with population growth. Within CHEO’s catchment area, the population of children and youth has grown at nine times the provincial rate.

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The Make Kids Count action plan calls for funding to provide timely access to acute care and an investment in innovative hospital and community programs to alleviate pressure on hospitals and make sure children receive care “in the right place and the right time.”

Munter said children’s hospitals across the province already had innovative models in place to improve access to care. Among them is a partial hospitalization program for children and youth with eating disorders, offering treatment during the day at CHEO, but allowing children to go home at night so they can connect with their families and sleep in their own beds.

“There are a lot of innovative models of care,” he said. “We have to find new and better ways to deliver care. The risk to kids of waiting too long is a risk to their development, to their health and the health of their families.”

Munter noted that the action plan amounted to less than 0.4 per cent of the provincial health budget.

“There are adequate funds to implement our plan,” he said. “We are ready to go. We are pleased to see this explicit callout in the budget saying children’s access to health care is a priority. I can’t remember a statement that clear in a budget.”

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Ready to right-size Ontario’s pediatric health system

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Ready to right-size Ontario’s pediatric health system


Children's Health Coalition Statement

Children’s Health Coalition Statement

TORONTO, March 23, 2023 – The Children’s Health Coalition welcomes the Ontario government’s commitments to allocate additional funding and work with frontline pediatric health partners to identify more ways to connect children and youth to the care they need.

Today, Finance Minister Peter Bethlenfalvy tabled Ontario’s 2023 budget, Building A Strong Ontario, which includes this passage:

“Every child in Ontario should be able to get the care they need, when they need it.”

We agree. We know what needs to be done. We already have the plan. And we are ready to get to work. After decades of underinvestment by successive governments, we have a lot of catching up to do.

Children’s health service organizations will use increased investments to deliver with accountability and innovation.

Ontario’s pediatric hospitals and community partners are ready to implement our plan so kids and families see the results quickly.

Quotes

  • “Children and youth across the province are waiting too long for vital health-care services. What was previously a challenge has now become a crisis, despite the best efforts of our dedicated teams across the pediatric health system. This commitment to invest from the Ontario government is a good first step in enabling system-wide improvements to ensure children and youth in Ontario receive timely, high quality health care.” – Dr. Ronald Cohn, President and CEO, The Hospital for Sick Children (SickKids)
  • “The backlogs and wait times for young people to get surgeries and so many other services have ballooned in recent years to unacceptable, and in some cases dangerous, levels. Today, the government made children’s health a priority and we are ready to put funding into action immediately so kids can get back to being kids.” – Bruce Squires, President, McMaster Children’s Hospital
  • “Every missed developmental milestone may have long-term, even life-long, effects. Rehabilitation is intrinsically linked to healthy futures that children, youth and families need and deserve. An investment in pediatric healthcare today is preventative medicine for tomorrow.” – Julia Hanigsberg, President and CEO, Holland Bloorview Kids Rehabilitation Hospital
  • “As too many Ontario families know, all too well, delaying care to kids puts their development milestones at risk. It impacts whole families and entire communities. We’re ready to put these investments to work for all.”– Nash Syed, President, Children’s Hospital – London Health Sciences Centre
  • “There is a crisis in child and youth mental health and the investments announced in today’s budget will help to stabilize the system and reduce wait times.  Investments across the children’s health system are welcome and we look forward to working collaboratively to continue to improve access to the care that kids need.” – Tatum Wilson, CEO, Children’s Mental Health Ontario
  • “Ontario’s child development providers look forward to working with the government to find ways to bring more kids into care at home, in schools and in their communities. We are ready to deliver solutions to improve kids’ health and well-being, and alleviate the stress on healthcare for all Ontarians—at every age and stage.” Jennifer Churchill, CEO, Empowered Kids OntarioJennifer Churchill, CEO, Empowered Kids Ontario
  • “We are happy to see the government acknowledge and prioritize the needs of our children.  This is a good first step towards reducing wait times so children across our province receive the care they need. We look forward to working with the government to ensure the health and well-being of children and families in our communities.”  – Lauren Ettin, Executive Director, Kids Health Alliance
  • “Invest in kids’ health now, save for a lifetime. Every day matters in the life of a child and investing in kids’ health is good for everyone – for the individual and for the system. Today’s commitment to invest is pedianomics in action and will pay dividends for generations to come.” – Alex Munter, President and CEO, CHEO

Key Facts: Pandemic Impacts on Children’s Health and Access to Care 

  • 4200+ surgeries cancelled at children’s hospitals March 1, 2020 – May 31, 2021
  • 209,000+ non-surgical appointments cancelled at children’s hospitals March 1, 2020 – May 31, 2021
  • 90,000 kids are waiting for child development and pediatric rehabilitation services at home, in schools and in the community.
  • 2.5x increase in eating disorder emergency visits
  • 28000+ kids are waiting for diagnostic imaging
  • 31000+ kids are on wait lists for ambulatory services
  • 8300+ kids are waiting for surgeries
  • 9500+ kids are waiting for ambulatory clinic visits
  • 28000+ kids are waiting for mental health treatment
  • One in nine kids has a disability.
  • In many regions of Ontario, only 1 in 3 kids receives community-based child development services within the clinical standard time.
  • Kids are waiting three years or more for speech and language therapy.
  • Before the pandemic, kids were already waiting two times longer than adults for health care.
  • During the pandemic, 300,000 babies were born in Ontario. Without urgent action in the early years – where it can make the most difference – an unprecedented wave of kids will hit the school system in the next few years who have never had the support they needed to succeed and thrive.
  • Every kid who didn’t get help from a speech pathologist, physiotherapist, neurologist or other pediatric professional will arrive at school already behind where they should be. This will hit schools hard – and won’t just affect the kids who, by then, will need extraordinary accommodation from the school system – but every other child and teacher in the classroom.

 

The Children’s Health Coalition

The Children’s Health Coalition is a network of partners committed to advancing excellence and expertise in pediatric care – leading to better outcomes and a high-quality, consistent and coordinated approach to healthcare that is centered around children, youth and their families.

The Coalition includes:

  • CHEO
  • Children’s Mental Health Ontario
  • Empowered Kids Ontario
  • Holland Bloorview Kids Rehabilitation Hospital
  • Kids Health Alliance
  • London Health Sciences Centre Children’s Hospital
  • McMaster Children’s Hospital
  • SickKids

The coalition developed the Make Kids Count Action Plan representing a detailed analysis from the 115 cross-sectoral organizations that are represented within the Coalition. This analysis identified a need for an annual investment of $357 million each year for the next four years to ensure timely access to health care as part of system recovery, to ensure hospital capacity, and to ensure community providers can meet the urgent needs of Ontario’s children.

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Province’s $330 million investment in kids’ health will help MCH free up hospital beds

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Province’s 0 million investment in kids’ health will help MCH free up hospital beds


Hamilton Health Sciences will dedicate a portion of new provincial funding to its Same Day Overnight unit at our McMaster Children’s Hospital.

Advocacy work led by a coalition of children’s hospitals, including Hamilton Health Sciences (HHS)’ McMaster Children’s Hospital (MCH), has resulted in an investment of $330 million each year by the Ontario government to expand children’s health care across the province.

“Our teams will now have access to expanded resources to enhance what they do best: provide expert care and help young people flourish.” — MCH President Bruce Squires

“As a full-service children’s care provider, our hospital takes a whole-child approach to specialized treatment and service delivery,” says MCH President Bruce Squires. “We recognize and appreciate that these government investments span the spectrum of young people’s health and well-being, supporting acute, surgery, developmental, rehabilitation, and mental health.”

This historic investment was the direct result of the Make Kids Count campaign, launched by the Children’s Health Coalition in the weeks leading up to the June 2022 provincial election to encourage significant investment in children’s health recovery.

Made-at-HHS solution

Hamilton Health Sciences will dedicate a portion of funding to its Same Day Overnight (SDO) unit at MCH. The SDO unit is for patients who have surgery, stay overnight for monitoring and return home early the next morning to recover.

The new Same Day Overnight unit should minimize risks of surgeries being postponed.

“SDO patients require overnight care, but don’t need a full hospital admission,” says Caroline Dunnett, director of perioperative support services for HHS. Typical reasons for a patient needing an SDO bed might include pain management or monitoring underlying health issues.

SDO is an established program at our Hamilton General Hospital and Juravinski Hospital sites, which both serve adult patients. An SDO unit opened at MCH in the spring, with six beds. The new provincial funding will allow MCH to continue to provide this important care to our pediatric patients, says Dunnett.

In the past, children needing to be monitored overnight were admitted to hospital, where the discharge process can take longer. This, in turn, slowed down the process for admitting patients needing beds for longer stays.  “Unfortunately, a child’s surgery could have been postponed if there was not an admitted bed available,” says Dunnett. The new SDO should minimize risks of surgeries being postponed.

“It’s really about providing the right level of care to each patient,” says Dunnett, adding that SDO patients are typically discharged early in the morning, around 7 a.m. “Our SDO unit gets kids home to their families, where they can recover best.”

Make Kids Count Campaign

The Children’s Health Coalition is a collective of children’s health organizations across the province, including MCH. Other partners are the Children’s Hospital of Eastern Ontario (CHEO), Children’s Hospital – London Health Sciences Centre, Children’s Mental Health Ontario, Empowered Kids Ontario, Holland Bloorview Kids Rehabilitation Hospital, Kids Health Alliance and Toronto SickKids.

The coalition focused on how the pandemic has negatively impacted children’s health and exacerbated pressures in the children’s health care system and called on the newly elected provincial to make significant, immediate investments in children’s health.

Children across Ontario have been waiting longer than adults for critical health care services. In fact, close to two-thirds of patients at Ontario’s children’s hospitals had already passed the clinically recommended wait time for their surgery.

$330 million investment

The July 19 funding announcement will allow children’s hospitals and community-based providers across the province to expand services and reduce wait times for essential children’s health care services, including surgeries, procedures, diagnostic imaging, mental health treatment, and child development and rehabilitation. This will allow providers to run more operating rooms, open more beds, expand clinics, hire more staff, and, perhaps most importantly, deliver more innovative programs in partnership.

The announcement is a turning point for the hundreds of thousands of children across Ontario waiting for care. This expansion of children’s health care is a critical step towards right-sizing the pediatric health system to meet the needs of Ontario’s almost three million children and their families. Not only will this lead to better access to the right care at the right time and place, but it will also prevent further complications and challenges down the road, leading to better outcomes for an entire generation.

Preoperative Algorithm Might Halve Unnecessary Oophorectomies in Children

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Preoperative Algorithm Might Halve Unnecessary Oophorectomies in Children

A new algorithm appeared promising to help reduce the number of unnecessary oophorectomies in young patients, researchers found.

At 11 children’s hospitals implementing the algorithm, the percentage of oophorectomies for benign disease decreased from 16.1% before adopting the risk predictive tool to 8.4% afterward (absolute risk reduction 7.7%, P=0.03), Peter Minneci, MD, MHSc, of Nemours Children’s Health in Delaware Valley, Delaware, and colleagues reported in JAMA.

Algorithm sensitivity for identifying benign lesions in the intervention cohort was 91.6% (95% CI 88.5-94.8), with specificity of 90.0% (95% CI 76.9-100), positive predictive value of 99.3% (95% CI 98.3-100), and negative predictive value of 41.9% (95% CI 27.1-56.6).

“Nationally, there was variability in the surgical procedures being performed in young girls who presented with ovarian masses across children’s hospitals,” Minneci told MedPage Today. “This study developed and implemented a consensus-based, preoperative risk stratification algorithm across pediatric surgical specialists who treat these patients, including pediatric surgeons and pediatric and adolescent gynecologists.”

“Algorithm use decreased variability in care and safely minimized the number of unnecessary oophorectomies for benign ovarian lesions,” Minneci added.

As evidence that many children are getting unnecessary oophorectomy, Minneci’s group pointed to the wide range in ovary-sparing surgery (OSS) rates, accounting for anywhere from 18% to 77% of procedures for benign ovarian neoplasms in kids.

“Oophorectomy can lead to premature ovarian failure, early menopause, and associated increased risks of cognitive impairment, osteopenia, impaired sexual health, and cardiovascular disease,” they added.

“Furthermore, patients with benign ovarian neoplasms are at increased risk of developing a contralateral second neoplasm. This may result in unintentional castration due to potential contralateral torsion or surgical castration if oophorectomy is ultimately required for malignant disease,” Minneci and coauthors continued. “Preoperative risk stratification through a comprehensive evaluation including history and physical examination, imaging studies, and serum tumor markers is critical to help identify lesions that are likely to be benign and appropriate for OSS.”

Their study comprised 519 kids and adolescents ages 6 to 21 years (median around 15) who were undergoing surgery for an ovarian mass in an inpatient setting at 11 children’s hospitals in the U.S. between August 2018 and January 2021.

The first 6 months of that period entailed preintervention assessment, followed by 6 months of intervention adoption and 18 months of intervention use. There were 96 patients in the preintervention phase, 105 in the adoption phase, and 318 in the intervention phase.

The algorithm directed patients to OSS if they had no suspected torsion and a symptomatic simple or hemorrhagic cyst that was unresolved or a complex mass with negative tumor markers and no concerning features.

All patients underwent an operation: 273 OSS, 43 oophorectomy, and two detorsions without additional intervention.

Benign disease was confirmed in 96.9% in the preintervention cohort and 93.7% in the intervention group.

Misclassification of patients with malignant disease as eligible for OSS occurred in a “low” 0.7% of patients after adoption of the algorithm (two of 275), “both of whom had immature teratomas that were completely excised without oophorectomy and without subsequent symptoms, ipsilateral or contralateral recurrence, or need for additional operations,” the researchers noted.

Among 318 patients in the intervention group, 174 presented with suspected torsion, one of whom was pregnant and underwent urgent detorsion with OSS, and two of whom underwent detorsion alone, the researchers reported.

Among the 165 cases presenting with suspected torsion with benign masses confirmed on pathology, unnecessary oophorectomies were performed in nine cases, with pathology revealing mature teratoma in five, mucinous tumor in two, and cyst in two.

Of 144 patients without suspected torsion, 54 had radiographically simple or hemorrhagic cysts and 90 had complex masses (85 with concerning features).

Algorithm adherence during the intervention phase was 95.0%, and fidelity was 81.8%. The most common reason for deviation was failing to evaluate tumor markers or evaluating an incomplete panel.

“One very encouraging finding was the high adherence with the algorithm, which suggests that the providers readily adopted and were able to use the algorithm,” Minneci said. “This algorithm can be readily adopted into practice and provides a simple way to decrease variability in care and safely promote ovary-sparing surgery for young females who present with ovarian masses.”

At the same time, there were several limitations of the study.

First, clinical practice at participating sites started to change during the planning of the study such that the percentage of unnecessary oophorectomies decreased from an expected 27% to 16% in the preintervention cohort, Minneci and colleagues wrote.

Additionally, results of the study may not be broadly generalizable, they noted, since it was performed at tertiary children’s hospitals with pediatric surgical subspecialists.

“Future studies are needed to determine barrier to algorithm adherence and adoption,” Minneci and colleagues concluded.

  • author['full_name']

    Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

Disclosures

The study was supported by a grant through the Thrasher Research Fund.

Minneci had no disclosures. Co-authors reported receiving honoraria from the American College of Obstetricians and Gynecologists; receiving grants from AbbVie, the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, and the National Institute on Minority Health and Health Disparities; and owning stock in FlexDex.

Primary Source

JAMA

Source Reference: Minneci PC, et al “Reducing unnecessary oophorectomies for benign ovarian neoplasms in pediatric patients” JAMA 2023; DOI: 10.1001/jama.2023.17183.