Diet and Respiratory Infections: Specific or Generalized Associations?

Background: Based on our recently reported associations between specific dietary behaviors and the risk of COVID-19 infection in the UK Biobank (UKB) cohort, we further investigate whether these associations are specific to COVID-19 or extend to other respiratory infections. Methods: Pneumonia and influenza diagnoses were retrieved from hospital and death record data linked to the UKB. Baseline, self-reported (2006–2010) dietary behaviors included being breastfed as a baby and intakes of coffee, tea, oily fish, processed meat, red meat (unprocessed), fruit, and vegetables. Logistic regression estimated the odds of pneumonia/influenza from baseline to 31 December 2019 with each dietary component, adjusting for baseline socio-demographic factors, medical history, and other lifestyle behaviors. We considered effect modification by sex and genetic factors related to pneumonia, COVID-19, and caffeine metabolism. Results: Of 470,853 UKB participants, 4.0% had pneumonia and 0.2% had influenza during follow up. Increased consumption of coffee, tea, oily fish, and fruit at baseline were significantly and independently associated with a lower risk of future pneumonia events. Increased consumption of red meat was associated with a significantly higher risk. After multivariable adjustment, the odds of pneumonia (p ≤ 0.001 for all) were lower by 6–9% when consuming 1–3 cups of coffee/day (vs. <1 cup/day), 8–11% when consuming 1+ cups of tea/day (vs. <1 cup/day), 10–12% when consuming oily fish in higher quartiles (vs. the lowest quartile—Q1), and 9–14% when consuming fruit in higher quartiles (vs. Q1); it was 9% higher when consuming red meat in the fourth quartile (vs. Q1). Similar patterns of associations were observed for influenza but only associations with tea and oily fish met statistical significance. The association between fruit and pneumonia risk was stronger in women than in men (p = 0.001 for interaction). Conclusions: In the UKB, consumption of coffee, tea, oily fish, and fruit were favorably associated with incident pneumonia/influenza and red meat was adversely associated. Findings for coffee parallel those we reported previously for COVID-19 infection, while other findings are specific to these more common respiratory infections

Emergency Department Use across 88 Small Areas after Affordable Care Act Implementation in Illinois

Introduction: This study analyzes changes in hospital emergency department (ED) visit ratesbefore and after the 2014 Affordable Care Act (ACA) insurance expansions in Illinois. We comparethe association between population insurance status change and ED visit rate change between a24-month (2012-2013) pre-ACA period and a 24-month post-ACA (2014-2015) period across 88socioeconomically diverse areas of Illinois.Methods: We used annual American Community Survey estimates for 2012-2015 to obtain insurancestatus changes for uninsured, private, Medicaid, and Medicare (disability) populations of 88 IllinoisPublic Use Micro Areas (PUMAs), areas with a mean of about 90,000 age 18-64 residents. Over 12million ED visits to 201 non-federal Illinois hospitals were used to calculate visit rates by residents ofeach PUMA, using population-based mapping weights to allocate visits from zip codes to PUMAs. Wethen estimated n=88 correlations between population insurance-status changes and changes in EDvisit rates per 1,000 residents comparing the two years before and after ACA implementation.Results: The baseline PUMA uninsurance rate ranged from 6.7% to 41.1% and there was 4.6-fold variation in baseline PUMA ED visit rates. The top quartile of PUMAs had >21,000 reductionsin uninsured residents; 16 PUMAs had at least a 15,000 person increase in Medicaid enrollment.Compared to 2012-2013, 2014-2015 average monthly ED visits by the uninsured dropped 42%,but increased 42% for Medicaid and 10% for the privately insured. Areas with the largest increasesin Medicaid enrollment experienced the largest growth in ED use; change in Medicaid enrollmentwas the only significant correlate of area change in total ED visits and explained a third of variationacross the 88 PUMAs.Conclusion: ACA implementation in Illinois accelerated existing trends towards greater use of hospitalED care. It remains to be seen whether providing better access to primary and preventive care tothe formerly uninsured will reduce ED use over time, or whether ACA insurance expansion is a partof continued, long-term growth. Monitoring ED use at the local level is critical to the success of newhome- and community-based care coordination initiatives. [West J Emerg Med. 2017;18(5)811-820.

Emergency Department Use across 88 Small Areas after Affordable Care Act Implementation in Illinois

Introduction: This study analyzes changes in hospital emergency department (ED) visit ratesbefore and after the 2014 Affordable Care Act (ACA) insurance expansions in Illinois. We comparethe association between population insurance status change and ED visit rate change between a24-month (2012-2013) pre-ACA period and a 24-month post-ACA (2014-2015) period across 88socioeconomically diverse areas of Illinois.Methods: We used annual American Community Survey estimates for 2012-2015 to obtain insurancestatus changes for uninsured, private, Medicaid, and Medicare (disability) populations of 88 IllinoisPublic Use Micro Areas (PUMAs), areas with a mean of about 90,000 age 18-64 residents. Over 12million ED visits to 201 non-federal Illinois hospitals were used to calculate visit rates by residents ofeach PUMA, using population-based mapping weights to allocate visits from zip codes to PUMAs. Wethen estimated n=88 correlations between population insurance-status changes and changes in EDvisit rates per 1,000 residents comparing the two years before and after ACA implementation.Results: The baseline PUMA uninsurance rate ranged from 6.7% to 41.1% and there was 4.6-fold variation in baseline PUMA ED visit rates. The top quartile of PUMAs had >21,000 reductionsin uninsured residents; 16 PUMAs had at least a 15,000 person increase in Medicaid enrollment.Compared to 2012-2013, 2014-2015 average monthly ED visits by the uninsured dropped 42%,but increased 42% for Medicaid and 10% for the privately insured. Areas with the largest increasesin Medicaid enrollment experienced the largest growth in ED use; change in Medicaid enrollmentwas the only significant correlate of area change in total ED visits and explained a third of variationacross the 88 PUMAs.Conclusion: ACA implementation in Illinois accelerated existing trends towards greater use of hospitalED care. It remains to be seen whether providing better access to primary and preventive care tothe formerly uninsured will reduce ED use over time, or whether ACA insurance expansion is a partof continued, long-term growth. Monitoring ED use at the local level is critical to the success of newhome- and community-based care coordination initiatives. [West J Emerg Med. 2017;18(5)811-820.

The Association between Toddlers’ Temperament and Well-Being in Norwegian Early Childhood Education and Care, and the Moderating Effect of Center-Based Daycare Process Quality.

Children who experience well-being are engaging more confidently and positively with their caregiver(s) and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children’s well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children’s temperament and well-being in early childhood education and care (ECEC), and whether this association is affected by ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers’ (N = 1,561) temperament (shyness, emotionality, sociability, and activity) and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children’s needs

The Association between Toddlers’ Temperament and Well-Being in Norwegian Early Childhood Education and Care, and the Moderating Effect of Center-Based Daycare Process Quality.

Children who experience well-being are engaging more confidently and positively with their caregiver(s) and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children’s well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children’s temperament and well-being in early childhood education and care (ECEC), and whether this association is affected by ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers’ (N = 1,561) temperament (shyness, emotionality, sociability, and activity) and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children’s needs

The Association between Toddlers’ Temperament and Well-Being in Norwegian Early Childhood Education and Care, and the Moderating Effect of Center-Based Daycare Process Quality.

Children who experience well-being are engaging more confidently and positively with their caregiver(s) and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children’s well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children’s temperament and well-being in early childhood education and care (ECEC), and whether this association is affected by ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers’ (N = 1,561) temperament (shyness, emotionality, sociability, and activity) and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children’s needs

The Association between Toddlers’ Temperament and Well-Being in Norwegian Early Childhood Education and Care, and the Moderating Effect of Center-Based Daycare Process Quality.

Children who experience well-being are engaging more confidently and positively with their caregiver(s) and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children’s well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children’s temperament and well-being in early childhood education and care (ECEC), and whether this association is affected by ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers’ (N = 1,561) temperament (shyness, emotionality, sociability, and activity) and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children’s needs