Overcrowding and Frequent Moves Undermine Children's Health

Children need stability in their lives -- whether it is in their daily routines, the adults that care for them, or their housing. Recent economic conditions are putting families at risk, not just of outright homelessness but of being housing insecure (frequent moves, overcrowding, or doubling up with another family for economic reasons)

Funding Shortfall for Housing Vouchers Could Have Serious Health Consequences for Children

In the fourth brief in its Policy Action series, Children's HealthWatch finds that unaffordable housing endangers the health and development of young children. Due to a federal funding shortfall, state and local housing agencies will be forced to reduce or eliminate rental assitance to thousands of families starting this month. Voucher cuts will push more families into the ranks of the "hidden homeless" -- families that move frequently, crowd into apartments that are too small, or live doubled up with other households when they cannot find affordable housing. Children in hidden homeless families are at increased risk for poor health, nutrition, and growth, as well as developmental delays. Timely Congressional action to protect the Housing Choice Voucher Program will ensure that families have stable, affordable housing essential to children's health

Household food insecurity positively associated with increased hospital charges for infants

Objective: To test whether household food insecurity (HFI) was associated with total annual hospitalization charges, annual days hospitalized, and charges per day, among low-income infants (months) with any non-neonatal hospital stays. Methods: Administrative inpatient hospital charge data were matched to survey data from infants\u27 caregivers interviewed 1998-2005 in emergency departments in Boston and Little Rock. All study infants had been hospitalized at least once since birth; infants whose diagnoses were not plausibly related to nutrition were excluded from both groups. Log-transformed hospitalization charges were analyzed, controlling for site fixed effects. Results: 24% of infants from food-insecure households and 16% from food-secure households were hospitalized \u3e2 times (P=0.02). Mean annual inpatient hospital charges ($6,707 vs$5,735; P Conclusion: HFI was positively associated with annual inpatient charges among hospitalized low income infants. Average annual inpatient charges were almost $2,000 higher (inflation adjusted) for infants living in food-insecure households. Reducing or eliminating food insecurity could reduce health services utilization and expenditures for infants in low-income families, most of whom are covered by public health insurance

Can the Hunger Vital Sign™ act as a prescreen for other social needs?

Background: Addressing health-related social needs is essential for improving health and reducing longstanding disparities. However, barriers to screening – including clinician and patient time burden of screening for multiple social needs – limit identification. To address this concern and promote the uptake of screening by clinicians, it is important that screening tools effectively and efficiently identify social needs’ presence and absence among patients. Objective: This study evaluated whether a validated and widely implemented 2-question food insecurity screening tool, the Hunger Vital Sign™ (HVS™), has adequate negative predictive value to serve as a pre-screen for other social needs. Methods: In 2007-2015, Children\u27s HealthWatch interviewed 28,611 publicly insured caregivers from households with low incomes with children age 0-48 months at 5 pediatric clinic/emergency departments (AR, MA, MD, MN, PA). Caregivers self-reported information about their households. Descriptive data were used to describe the sample and negative predictive value was calculated between the Hunger Vital Sign™ and other household hardships. Results: A negative Hunger Vital Sign™ identified 18,259 households (63.8%) as food secure. The negative predictive value in these households was 77.4% (95% CI 76.7, 78.2) for housing instability, 82.4% (95% CI 81.9, 83.0) for energy insecurity, 87.2% (95% CI 86.7, 87.7) for foregone health care at the household level, and 97.5% (95% CI 97.3, 97.7) at the child level. Results demonstrate, at varying levels, high NPV of the HVS™ to correctly identify other hardships’ absence, indicating that families who do not endorse the HVS™ may not be the highest priority for screening for other hardships. However, clinicians should be aware that roughly 20% of families who do not endorse the HVS™ do, in fact, experience other hardships and would not be identified as warranting further hardship-specific screening by this method. Conclusions: This is the first paper to our knowledge that examines the NPV of a screening tool for other social needs. While acknowledging the limited amount of time during a clinical visit, we recommend clinicians choose a multi-domain screener to obtain a nuanced understanding of their patients’ unique challenges. To best inform screening tool selection, providers seeking to screen for and address health-related social needs should first and foremost achieve clarity of purpose - by identifying the social needs of concern, the institution\u27s ability to suitably identify those needs, and what targeted actions will be taken. Further research to replicate and expand these findings in diverse samples of children of varying ages and more economically diverse circumstances as well as in other geographic regions is needed to develop a maximally efficient approach for clinical screening for social determinants of health. Beyond adopting a SDOH framework, providers and the health care sector can advocate for strong evidence-based policies that enable them to better address health inequities and improve health outcomes

The Global Epidemiological Transition in Cardiovascular Diseases:Unrecognised Impact of Endemic Infections on Peripheral Artery Disease

An epidemiological transition in the prevalence of peripheral artery disease (PAD) is taking place especially in low- and middle-income countries (LMICs) where an ageing population and adoption of western lifestyles are associated with an increase in PAD. We discuss the limited evidence which suggests that infection, potentially mediated by inflammation, may be a risk factor for PAD, and show by means of an ecological analysis that country-level prevalence of the major endemic infections of HIV, tuberculosis and malaria are associated with the prevalence of PAD. While further research is required, we propose that scientists and health authorities pay more attention to the interplay between communicable and non-communicable diseases, and we suggest that limiting the occurrence of endemic infections might have some effect on slowing the epidemiological transition in PAD

Co-enrollment for Child Health: How Receipt and Loss of Food and Housing Subsidies Relate to Housing Security and Statutes for Streamlined, Multi-Subsidy Application

In light of recent policy debates around funding food and housing subsidies, the combined influence of these programs on housing security (HS), defined as housing without crowding or frequent moves, remains unstudied. In a multi-city study of young children, federal nutrition and housing subsidies together increased the odds of HS, whereas loss of nutrition subsidies lowered the odds of HS even after controlling for housing subsidy receipt. Ensuring eligible families’ access to both nutrition and housing subsidies may sustain HS. The results of this study inform and support current efforts by states to streamline online applications for social services and remove statutory legal barriers to accessing these subsidies simultaneously

Trends in Household and Child Food Insecurity Among Families with Young Children from 2007 to 2013

Background: 2007-2013 spanned an economic downturn with rising food costs. While Supplemental Nutrition Assistance Program (SNAP) benefits increased during those years by 13.6% from the 2009 American Recovery Reinvestment Act (ARRA), the impact of these competing conditions on household food insecurity (HFI, household food insecure but child food secure) and child food insecurity (CFI, household and child food insecure) in households with infants and toddlers has not been investigated. Objective: To describe HFI and CFI in households participating in SNAP vs. households likely eligible but not participating (No SNAP). Design: Repeat cross-sectional Participants/Setting: 19,999 caregivers of childrenChildren’s HealthWatch survey in emergency and primary care departments in 5 US cities. Main Outcome Measures: The 18-item U.S. Household Food Security Survey (HFSS) measured HFI (≥3 affirmative responses on non-child-specific questions) and CFI (≥2 affirmative responses to eight child-specific questions). Statistical analyses performed: The sample was stratified by SNAP/ No SNAP. Multinomial logistic regression analyses examined the association between SNAP receipt and HFI and CFI. Results: Across the study period, controlling for confounders including year, households with SNAP were 17% less likely to experience HFI (AOR 0.83; 95% CI,0 .75, 0.91; p Conclusions: Receipt of SNAP vs. No SNAP was associated with decreased prevalence of HFI and CFI during much of the economic downturn; this impact waned as the buying power of the boost in benefit amounts during the ARRA period eroded

Robotic telescopes and student research in the school curriculum around the OECD countries

The aim of this paper is to explore the presence and possible incorporation of inquiry-based learning approaches using Robotic Telescopes and Student Research in the regular science curriculum. This study uses preliminary findings from an extensive ongoing study, which is currently reviewing the extent of astronomy content in the school curriculum of the 35 member countries from the OECD in addition to two emerging nations in modern astronomy – China and South Africa, which are not part of the OECD. Analysis of curriculum documents from 28 OECD countries, including China and South Africa, reveals that although there is a prevalence of astronomy related content in most grades, incorporating Robotic Telescopes and Student Research into the regular science curriculum is limited by two interdependent factors. Firstly, the majority of curricula introduce astronomy-related concepts through a descriptive lens, with a focus on the “what?”, rather than the “how?” or “why?”. Secondly, astronomy in comparison to other topics gets very little time allocation. Robotic Telescopes provide teachers with enormous potential to teach students not only topics related to science, but also to afford students the opportunity to engage in “authentic science”. Thus, it is vital for the members of the astronomy community to play a greater role in the development of curricula

Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial.

BACKGROUND: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. FINDINGS: Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). INTERPRETATION: Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. FUNDING: Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe