We still don't know that our children need vitamin D daily: a study of parents' understanding of vitamin D requirements in children aged 0-2 years.

BACKGROUND: Vitamin D deficiency has been highlighted as a serious public health problem in the United Kingdom. One in four toddlers are not achieving the recommended intake for their healthy development. This study uses quantitative and qualitative methods to explore parents' perceptions, awareness and behaviours around vitamin D intake, and the acceptability of and factors affecting purchasing of food and drink fortified with Vitamin D in children aged 0-2 years old. METHODS: One hundred and ninety-four parents completed an online questionnaire, advertised to parents with one child aged up to 2 years on popular social media websites. The majority of participants were mothers, White-British ethnic background, aged 25-44 years. Participants provided an email address if they wanted to be contacted about the focus groups. Recruitment posters advertising the focus groups were placed in community centres. Eighteen participated in 5 focus groups (13 parents), and 5 individual interviews. A thematic analysis methodology was applied. RESULTS: Fifty-seven percent (n = 110) of parents reported receiving information about vitamin D during pregnancy and 52% (n = 100) after the birth of their child. Parents reported a low level of satisfaction with vitamin D information: many thought it was limited and recommendations on supplements were unclear. Parents wanted more information about vitamin D requirements for their child (80%, n = 153 out of 192 respondents, 2 non-response), about vitamin D and breastfeeding (56%, n = 108) and vitamin D and pregnancy (49%, n = 94). The recommendations were for simpler, easier to read, with specific and clearer guidelines; delivered regularly during routine appointments, at timely stages throughout pregnancy and after the birth. 23% (n = 45, out of 194 respondents) of parents did not know why vitamin D is important for health. Only 26% (n = 49, out of 192 respondents) of parents reported giving their youngest child a vitamin D supplement on most days of the week. The majority of parents (interview/focus group) wanted more information about foods/drinks fortified with vitamin D. CONCLUSION: Parents were generally not aware of the importance of vitamin D, dietary requirements including supplementation and the availability of vitamin D fortified foods. Major improvements are required for the effective promotion of vitamin D information to parents

Assessing justice in California’s transition to electric vehicles

Summary: Passenger vehicles are an essential form of transportation and contribute significantly to greenhouse gas emissions and criteria air pollution. The health and climate effects associated with their use disproportionately impact low-income communities and people of color. A shift from conventional vehicles to zero-emission vehicles is essential to meet climate targets and reduce inequities. The transition to clean transportation is an opportunity to uplift underserved and marginalized communities while building a sustainable transportation system. We assess justice in California’s transition to electric passenger vehicles by analyzing publicly available data on electric vehicle adoption and rebate use to measure justice in three areas: distribution of electric vehicles, allocation of state incentives, and the social and historical context of redlining. We find electric vehicle adoption and rebate use are lower in low-income and Latino-majority ZIP codes and in formerly redlined neighborhoods, indicating that California’s electric vehicle transition has not been just thus far

Pathways to zero emissions in California’s heavy-duty transportation sector

California contributes 0.75% of global greenhouse gas (GHG) emissions and has a target of reaching economy-wide net zero emissions by 2045, requiring all sectors to rapidly reduce emissions. Nearly 8% of California’s GHG emissions are from the heavy-duty transportation sector. In this work, we simulate decarbonization strategies for the heavy-duty vehicle (HDV) fleet using detailed fleet turnover and air quality models to track evolution of the fleet, GHG and criteria air pollutant emissions, and resulting air quality and health impacts across sociodemographic groups. We assess the effectiveness of two types of policies: zero emission vehicle sales mandates, and accelerated retirement policies. For policies including early retirements, we estimate the cost of early retirements and the cost-effectiveness of each policy. We find even a policy mandating all HDV sales to be zero emission vehicles by 2025 would not achieve fleetwide zero emissions by 2045. For California to achieve its goal of carbon neutrality, early retirement policies are needed. We find that a combination of early retirement policies and zero emission vehicle sales mandates could reduce cumulative CO _2 emissions by up to 64%. Furthermore, we find that decarbonization policies will significantly reduce air pollution-related mortality, and that Black, Latino, and low-income communities will benefit most. We find that policies targeting long-haul heavy-heavy duty trucks would have the greatest benefits and be most cost-effective

Distributional health impacts of electricity imports in the United States

The electric grid is evolving rapidly in response to climate change. As renewables are incorporated, more interconnection of the grid is expected. Exposure to fine particulate matter (PM2.5) from fossil-fuel generation causes adverse health impacts, including thousands of premature deaths each year in the United States. It is well understood that PM2.5 exposure can occur at great distances from pollutant sources, but insufficient work has been done to understand the role of grid interconnection and trade in causing pollution-related mortality. Regions with clean generation can import electricity from regions with highly polluting generation sources, allowing them to benefit from the electricity consumption while people in other regions suffer the associated health damages. We use flow tracing and consumption-based accounting to characterize the health damages from exposure to PM _2.5 from electricity imports. We find that 8% of our estimated premature deaths from electricity consumption in the United States are due to electricity imports. There is large geographic heterogeneity, with the most impacts occurring in the Midwest. While the West Coast has much cleaner generation and lower impacts overall, in many West Coast Balancing Areas, more than 50% of the estimated premature mortality associated with electricity consumption is caused by electricity imports, with some groups experiencing larger impacts than others

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes