A growing body of research provides support for the detrimental effects of stress during childhood on future adult health, however, less is known about how stress disrupts normal developmental processes. This pathway may be particularly relevant for urban adolescents who are exposed to additional contextual stressors. This study will longitudinally explore how psychological stress from multiple domains influences urban adolescents' career readiness. Two hundred youth (ages 14-21) completed surveys assessing their school, family, neighborhood and health stress. Path analysis using a parallel process model found that school and neighborhood stress at 6 months were significantly associated with decreased career readiness at 15 months. Health stress at baseline was related to an increased report of career readiness at 15 months, which was moderated by parental closeness. These findings suggest that experiences of stress for urban youth negatively impact their planning for the future, particularly in the absence of supportive parental relationships.
Future; Stress; Adolescent; Urban; United States
This research examined the relation between early adolescent aggression and parenting practices in an urban, predominately African American sample. Sixth graders (N = 209) completed questionnaires about their overt and relational aggressive behaviors and perceptions of caregivers’ parenting practices. Findings indicated that moderate levels of parental expectations for peaceful solutions at Time 1 were associated with a lower likelihood of overt aggression at Time 2. Furthermore, findings suggest that when caregivers’ support and knowledge of adolescents’ whereabouts were relatively low or when caregivers’ exerted high psychological control, moderate levels of parental expectations for peaceful solutions protected early adolescents against engagement in both overt and relational aggression. The implications of the findings for schools and other youth violence prevention settings are discussed.
youth aggression; parenting; low-income schools; urban; minority population
Seasonal patterns in pathogen transmission can influence the impact of disease on populations and the speed of spatial spread. Increases in host contact rates or births drive seasonal epidemics in some systems, but other factors may occasionally override these influences. White-nose syndrome, caused by the emerging fungal pathogen Pseudogymnoascus destructans, is spreading across North America and threatens several bat species with extinction. We examined patterns and drivers of seasonal transmission of P. destructans by measuring infection prevalence and pathogen loads in six bat species at 30 sites across the eastern United States. Bats became transiently infected in autumn, and transmission spiked in early winter when bats began hibernating. Nearly all bats in six species became infected by late winter when infection intensity peaked. In summer, despite high contact rates and a birth pulse, most bats cleared infections and prevalence dropped to zero. These data suggest the dominant driver of seasonal transmission dynamics was a change in host physiology, specifically hibernation. Our study is the first, to the best of our knowledge, to describe the seasonality of transmission in this emerging wildlife disease. The timing of infection and fungal growth resulted in maximal population impacts, but only moderate rates of spatial spread.
seasonality; emerging infectious disease; fungal pathogen; white-nose syndrome; Myotis lucifugus; hibernation
Family socialization, which includes parental control and support, plays an important role in reducing the likelihood of adolescent involvement in conflict. This study examined the strategies that urban parents living in neighborhoods with high crime rates suggest to help their adolescent children avoid or deescalate conflict. Data come from 48 African American parent/adolescent dyads recruited through the youths’ middle school. Dyads responded to three video-taped scenarios depicting youth in potential conflict situations. Qualitative methods were used to identify 11 strategies parents suggested to help youth avoid or deescalate conflict. Although the majority of parents advocated for non-violent solutions, these same parents described situations in which their child may need to use violence. These findings have important implications for family-focused violence prevention programs.
Adolescence; Violence; Parenting; Parent/youth communication; African Americans
The ACA establishes “essential health benefits” (EHBs) as the coverage standard for health plans sold in the individual and small group markets, including the health insurance Marketplace. “Pediatric services” are a required EHB coverage class. However, other than oral health and vision care, neither the statute nor the implementing regulations define the term. This study aimed to determine how state benchmark plans address pediatric coverage in EHB-governed plans. Our review of state benchmark plan summaries for all 50 states and D.C. found that no state specified a distinct “pediatric services” benefit class. Furthermore, although benchmark plans explicitly included multiple pediatric conditions, many state benchmark plans also specifically excluded services for children with special health care needs. These findings suggest important policy directions in preparing for the 2016 plan year.
Children's Health; Consumer Issues; Health Reform; Children Insurance Coverage
The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The “voltage drop” framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children’s health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation.
health insurance; Affordable Care Act; health reform; children; child health financing; federal policy; advocacy
To describe the state variation, demographic and family characteristics of children eligible for public health insurance but uninsured.
Using data from the National Survey of Children’s Health we selected a subset of children living in households with incomes < 200% of the FPL. The primary outcome of interest was the odds of being uninsured among those eligible for Medicaid or CHIP. We used multiple logistic regression to test for an association between insurance status among this group of children and certain demographic factors, family characteristics, and state of residence.
In adjusted models children aged 6–11 and 12–17 years were more likely to be eligible but uninsured compared to those aged 0 – 5 years (AOR 1.57; 95% CI 1.15–2.16 and AOR 1.93; 95% CI 1.41–2.64). Children who received school lunch (AOR 0.67; 95% CI 0.52–0.86) and SNAP (AOR 0.33; 95% CI 0.24–0.46) were less likely to be eligible but uninsured compared to those children not receiving those needs based services. Five states (Texas, California, Florida, Georgia, New York) accounted for 46% of the eligible uninsured children. Vermont had the lowest adjusted estimate of eligible uninsured children (3.6%) and Nevada had the highest adjusted estimate (35.5%).
Using nationally representative data we have identified specific state differences, demographic and household characteristics that could help guide federal and local initiatives to improve public health insurance enrollment for children who are eligible but uninsured.
National Survey of Children’s Health; uninsured; income eligibility; predisposing factors; enabling resources
health disparities; healthcare disparities; limited English proficiency
health insurance; SCHIP; healthcare reform; children
Although previous reports have linked preterm birth with insulin resistance in children and adults, it is not known whether altered insulin homeostasis is detectable at birth and tracks from birth onwards.
To investigate whether preterm birth is associated with elevated plasma insulin levels at birth and whether this association persists into early childhood.
Design, Setting, and Participation
A prospective birth cohort of 1358 children recruited at birth from 1998 to 2010 and followed prospectively from 2005 to 2012 at the Boston Medical Center, Boston, MA.
Main Outcome Measures
Random plasma insulin levels were measured at two time points: at birth (cord blood) and in early childhood (venous blood) (median age (25th–75th percentile): 1.4 (0.8–3.3) years) among four gestational age groups: term (≥37 weeks), and further grouped into full term (≥39 weeks) and early term (37–38 weeks); preterm (<37 weeks), and further grouped into late preterm (34–36 weeks) and early preterm (<34 weeks).
The geometric mean (95% confidence interval(CI)) of insulin levels for full term, early term, late preterm and early preterm births was 9.2(8.4–10.0), 10.3(9.3–11.5), 13.2(11.8–14.8) and 18.9(16.6–21.4) µU/ml, respectively at birth, and 11.2(10.3–12.0), 12.4(11.3–13.6), 13.3(11.9–14.8) and 14.6(12.6–16.9) µU/ml, respectively in early childhood. At birth, insulin levels were 1.13(95% CI: 0.97–1.28), 1.45(95%CI: 1.25–1.65) and 2.05(95%CI: 1.69–2.42) folds higher for early term, late preterm and early preterm, respectively, than those born full term. In early childhood, plasma random insulin levels in those born early term, late preterm and early preterm were 1.12(95%CI: 0.99–1.25), 1.19(95%CI: 1.02–1.35), and 1.31(95%CI: 1.10–1.52) folds higher, respectively, than those born full term. The association was attenuated after adjustment for postnatal weight gain and was not significant after adjustment for insulin levels at birth. Children ranked in the top insulin tertile at birth were more likely to remain in the top tertile in early childhood relative to children ranked in the lowest tertile (41.2% vs. 28.6%).
Conclusion and Relevance
There was an inverse association between gestational age and elevated plasma insulin levels at birth and in early childhood. The implications for future development of insulin resistance and type 2 diabetes warrant further investigation.
Emerging infectious diseases are a key threat to wildlife. Several fungal skin pathogens have recently emerged and caused widespread mortality in several vertebrate groups, including amphibians, bats, rattlesnakes and humans. White-nose syndrome, caused by the fungal skin pathogen Pseudogymnoascus destructans, threatens several hibernating bat species with extinction and there are few effective treatment strategies. The skin microbiome is increasingly understood to play a large role in determining disease outcome. We isolated bacteria from the skin of four bat species, and co-cultured these isolates with P. destructans to identify bacteria that might inhibit or kill P. destructans. We then conducted two reciprocal challenge experiments in vitro with six bacterial isolates (all in the genus Pseudomonas) to quantify the effect of these bacteria on the growth of P. destructans. All six Pseudomonas isolates significantly inhibited growth of P. destructans compared to non-inhibitory control bacteria, and two isolates performed significantly better than others in suppressing P. destructans growth for at least 35 days. In both challenge experiments, the extent of suppression of P. destructans growth was dependent on the initial concentration of P. destructans and the initial concentration of the bacterial isolate. These results show that bacteria found naturally occurring on bats can inhibit the growth of P. destructans in vitro and should be studied further as a possible probiotic to protect bats from white-nose syndrome. In addition, the presence of these bacteria may influence disease outcomes among individuals, populations, and species.
White-nose syndrome (WNS) caused by the pathogenic fungus Pseudogymnoascus destructans is decimating the populations of several hibernating North American bat species. Little is known about the molecular interplay between pathogen and host in this disease. Fluorescence microscopy ambient ionization mass spectrometry was used to generate metabolic profiles from the wings of both healthy and diseased bats of the genus Myotis. Fungal siderophores, molecules that scavenge iron from the environment, were detected on the wings of bats with WNS, but not on healthy bats. This work is among the first examples in which microbial molecules are directly detected from an infected host and highlights the ability of atmospheric ionization methodologies to provide direct molecular insight into infection.
The pathogenic fungus Batrachochytrium dendrobatidis (Bd) is a major conservation concern because of its role in decimating amphibian populations worldwide. We used quantitative PCR to screen 244 museum specimens from the Korean Peninsula, collected between 1911 and 2004, for the presence of Bd to gain insight into its history in Asia. Three specimens of Rugosa emeljanovi (previously Rana or Glandirana rugosa), collected in 1911 from Wonsan, North Korea, tested positive for Bd. Histology of these positive specimens revealed mild hyperkeratosis – a non-specific host response commonly found in Bd-infected frogs – but no Bd zoospores or zoosporangia. Our results indicate that Bd was present in Korea more than 100 years ago, consistent with hypotheses suggesting that Korean amphibians may be infected by endemic Asian Bd strains.
To improve the health of children and bend the health care cost curve we must integrate the individual and population approaches to health and health care delivery. The 2012 Institute of Medicine (IOM) report Primary Care and Public Health: Exploring Integration to Improve Population Health laid out the continuum for integration of primary care and public health stretching from isolation to merging systems. Integration of the family-centered medical home (FCMH) and home visitation (HV) would promote overall efficiency and effectiveness and help achieve gains in population health through improving the quality of health care delivered, decreasing duplication, reinforcing similar health priorities, decreasing costs, and decreasing health disparities. This paper aims to (1) provide a brief description of the goals and scope of care of the FCMH and HV, (2) outline the need for integration of the FCMH and HV and synergies of integration, (3) apply the IOM’s continuum of integration framework to the FCMH and HV and describe barriers to integration, and (4) use child developmental surveillance and screening as an example of the potential impact of HV-FCMH integration.
home visiting; family-centered medical home; patient-centered medical home; primary care
To examine the impact of retaliatory attitudes on subsequent violent behavior and fight-related injuries among youth who presented to the emergency department with assault-injuries.
Assault-injured youth were interviewed at baseline, 6 months and 18 months to assess fighting behavior, retaliatory attitudes, weapon carrying and injury history as part of a larger randomized control trial.
Two emergency departments in urban areas.
One hundred twenty-nine adolescents aged 10 to 15.
Fighting behavior, assault-injury, weapon carrying, and aggressive behavior.
Higher retaliatory attitudes at baseline were associated with more aggression and a higher frequency of fighting over time.
Retaliatory attitudes may fuel cycles of violence among youth. Medical professionals in acute care settings have an opportunity to identify youths at risk of future assault injury by assessing retaliation, providing anticipatory guidance and referring to intervention programs.
To determine if there is a gap between behavioral symptoms and previously recognized mental health conditions in youth victims of peer assault injuries and to describe gender differences in psychological symptoms.
A cross-sectional comparison of rates of previously diagnosed mental health conditions and clinical range behavioral symptoms as measured by the Child Behavior Checklist (CBCL) in 168 youth (10-15 years old) presenting to the emergency department (ED) after an interpersonal assault injury. Fisher’s exact test was used for comparisons.
Mental health symptoms were common among assault-injured youth. More than half of youth demonstrating clinical range symptoms on the attention problems or anxious / depressed scales of the CBCL had no prior diagnosis of these conditions. Females were more likely than males to exhibit clinical range aggressive behavior symptoms (OR 3.61, 95% CI 1.64-7.97). Aggressive behavior was associated with clinical range scores on the other problem scales of the CBCL.
After an ED visit for an assault-related injury, less than half of 10-15 year olds with significant symptoms of common mental conditions reported having a previously diagnosed disorder, reflecting a burden of unmet psychological needs. An ED visit for an assault injury provides an opportunity to screen for emotional / behavioral symptoms and to refer to appropriate follow-up mental health care.
Assault-injured youth are likely to have unmet mental health needs. This study compares mental health symptoms after an assault injury to previously diagnosed mental health conditions and describes differences in mental health characteristics of assault-injured youth by gender.
mental health; assault; gender; aggression; emergency department
Biosynthesis of extragonadal androgen may contribute to the progression of castration-resistant prostate cancer. We evaluated whether abiraterone acetate, an inhibitor of androgen biosynthesis, prolongs overall survival among patients with metastatic castration-resistant prostate cancer who have received chemotherapy.
We randomly assigned, in a 2:1 ratio, 1195 patients who had previously received docetaxel to receive 5 mg of prednisone twice daily with either 1000 mg of abiraterone acetate (797 patients) or placebo (398 patients). The primary end point was overall survival. The secondary end points included time to prostate-specific antigen (PSA) progression (elevation in the PSA level according to prespecified criteria), progression-free survival according to radiologic findings based on prespecified criteria, and the PSA response rate.
After a median follow-up of 12.8 months, overall survival was longer in the abiraterone acetate–prednisone group than in the placebo–prednisone group (14.8 months vs. 10.9 months; hazard ratio, 0.65; 95% confidence interval, 0.54 to 0.77; P<0.001). Data were unblinded at the interim analysis, since these results exceeded the preplanned criteria for study termination. All secondary end points, including time to PSA progression (10.2 vs. 6.6 months; P<0.001), progression-free survival (5.6 months vs. 3.6 months; P<0.001), and PSA response rate (29% vs. 6%, P<0.001), favored the treatment group. Mineralocorticoid-related adverse events, including fluid retention, hypertension, and hypokalemia, were more frequently reported in the abiraterone acetate–prednisone group than in the placebo–prednisone group.
The inhibition of androgen biosynthesis by abiraterone acetate prolonged overall survival among patients with metastatic castration-resistant prostate cancer who previously received chemotherapy. (Funded by Cougar Biotechnology; COU-AA-301 ClinicalTrials.gov number, NCT00638690.)
Living in violent neighborhoods has been shown to alter adolescent’s social-cognitions and increase aggressive behavior. A similar process may also occur for parents and result in parental support of aggressive behavior. This research examines the influence of perceived neighborhood violence and neighborhood collective efficacy on parents’ attitudes toward violence and the messages they give their adolescent children about how to resolve interpersonal conflict.
These data come from 143 African-American parents and their adolescent children recruited from 3 inner-city middle schools to participate in a parenting intervention. Models were fit using structural equation modeling in Mplus.
Contrary to expectations, exposure to neighborhood violence was not predictive of either aggressive attitudes or conflict solutions for parents or adolescents. Rather, a mixed effect was found for neighborhood collective efficacy, with higher perceived neighborhood collective efficacy related to less violent attitudes for adolescents but not parents. Collective efficacy also predicted the messages that parents gave their adolescents about interpersonal conflict, with higher collective efficacy related to messages that were less supportive of violence.
Parent and adolescent perception of neighborhood collective efficacy influences the messages that adolescents receive about interpersonal conflict resolution. This suggests that for parents living in violent neighborhoods their appraisal of the neighborhood is more important in shaping conflict resolution messages than parents’ own experiences with violence. Parent and family-based programs to prevent youth violence need to address neighborhood factors that influence the messages adolescents receive about how to resolve conflict.
Adolescents; Violence; Parenting; Collective Efficacy; Parent/child communications
To determine the specific aspects of early parenting in psychosocially at-risk families most strongly related to children’s social-emotional adaptation to school.
Cohort study of families (n=318) identified as at-risk for maltreatment of their newborns. Quality of early parenting was observed in the home when the child was one year old. Social-emotional adaptation to school was reported by teachers in first grade. Multivariable models assessed the independent influence of early parenting variables on social-emotional adaptation.
Early parenting and social-emotional adaptation to school varied greatly across families. Parental warmth was associated with lower teacher ratings of shyness, concentration problems, and peer rejection. Parental lack of hostility was associated with decreased teacher ratings of concentration problems and peer rejection. Parental encouragement of developmental advance was associated with lower ratings of aggression and peer rejection. Provision of materials to promote learning and literacy was associated with lower ratings of concentration problems.
In this sample of families with multiple psychosocial risks for child maltreatment, specific aspects of early parenting were associated with better social-emotional adaptation to school in the first grade in theoretically predicted ways. Improving parental knowledge about positive parenting via anticipatory guidance should be a focus of well child visits. Well child visit-based interventions to improve the quality of early parenting especially among at-risk families should be studied for their impact on parenting behavior and on children’s successful social-emotional adaptation to school. Primary care providers should reinforce complementary services, such as home visiting, that seek to promote positive parenting.
Parenting; Child Rearing; Parent-Child Relations; Social Adjustment; Social Behavior (Aggression, Shyness, Rejection); Vulnerable Populations
The disease chytridiomycosis, caused by the fungus Batrachochytrium dendrobatidis (Bd), has caused dramatic amphibian population declines and extinctions in Australia, Central and North America, and Europe. Bd is associated with >200 species extinctions of amphibians, but not all species that become infected are susceptible to the disease. Specifically, Bd has rapidly emerged in some areas of the world, such as in Australia, USA, and throughout Central and South America, causing population and species collapse. The mechanism behind the rapid global emergence of the disease is poorly understood, in part due to an incomplete picture of the global distribution of Bd. At present, there is a considerable amount of geographic bias in survey effort for Bd, with Asia being the most neglected continent. To date, Bd surveys have been published for few Asian countries, and infected amphibians have been reported only from Indonesia, South Korea, China and Japan. Thus far, there have been no substantiated reports of enigmatic or suspected disease-caused population declines of the kind that has been attributed to Bd in other areas. In order to gain a more detailed picture of the distribution of Bd in Asia, we undertook a widespread, opportunistic survey of over 3,000 amphibians for Bd throughout Asia and adjoining Papua New Guinea. Survey sites spanned 15 countries, approximately 36° latitude, 111° longitude, and over 2000 m in elevation. Bd prevalence was very low throughout our survey area (2.35% overall) and infected animals were not clumped as would be expected in epizootic events. This suggests that Bd is either newly emerging in Asia, endemic at low prevalence, or that some other ecological factor is preventing Bd from fully invading Asian amphibians. The current observed pattern in Asia differs from that in many other parts of the world.