Search

Background: A critical shortage of affordable housing for low-income families continues in the United States. Children in households that are food insecure are at high risk for adverse nutritional and health outcomes and thus may be more vulnerable to the economic pressures exerted by high housing costs. Only about one fourth of eligible families receive a federally financed housing subsidy. Few studies have examined the effects of such housing subsidies on the health and nutritional status of low-income children., Objective: To examine the relationship between receiving housing subsidies and nutritional and health status among young children in low-income families, especially those that are food insecure., Design: Cross-sectional observational study., Setting and Participants: From August 1998 to June 2003, the Children's Sentinel Nutrition Assessment Program interviewed caregivers of children younger than 3 years in pediatric clinics and emergency departments in 6 sites (Arkansas, California, Maryland, Massachusetts, Minnesota, and Washington, DC). Interviews included demographics, perceived child health, the US Household Food Security Scale, and public assistance program participation. Children's weight at the time of the visit was documented. The study sample consisted of all renter households identified as low income by their participation in at least 1 means-tested program., Main Outcome Measures: Weight for age, self-reported child health status, and history of hospitalization., Results: Data were available for 11 723 low-income renter families; 27% were receiving a public housing subsidy, and 24% were food insecure. In multivariable analyses, stratified by household food security status and adjusted for potential confounding variables, children of food-insecure families not receiving housing subsidies had lower weight for age (adjusted mean z score, -0.025 vs 0.205; P<.001) compared with children of food-insecure families receiving housing subsidies. Compared with children in food-insecure, subsidized families, the adjusted odds ratio (95% confidence interval) for weight-for-age z score more than 2 SDs below the mean was 2.11 (1.34-3.32) for children in food-insecure, nonsubsidized families., Conclusions: In a large convenience sentinel sample, the children of low-income renter families who receive public housing subsidies are less likely to have anthropometric indications of undernutrition than those of comparable families not receiving housing subsidies, especially if the family is not only low income but also food insecure.

Objective: To test the hypothesis that receipt of housing subsidies by poor families is associated with improved nutritional status of their children., Design: Cross-sectional study., Setting: Pediatric emergency department of an urban municipal hospital., Patients: Convenience sample of 203 children younger than 3 years and their families who were being seen during one of twenty-seven 24-hour periods., Main Outcome Measures: Anthropometric indicators (z scores of weight for age, weight-for-height, and height-for-age), and the proportion of children with low growth indicator (weight-for-height below the 10th percentile or height-for-age below the fifth percentile, or both, of the reference population)., Results: Multivariate analysis controlling for demographics and program participation showed that receipt of housing assistance contributed significantly to z scores for weight-for-age (P = .03) and weight-for-height (P = .04). The risk of a child's having low growth indicators was 21.6% for children whose families were on the waiting list for housing assistance compared with 3.3% for those whose families received subsidies (adjusted odds ratio = 8.2, 95% confidence interval = 2.2 to 30.4, P = .002), Conclusion: Receiving a housing subsidy is associated with increased growth in children from low-income families, an effect that is consistent with a protective effect of housing subsidies against childhood undernutrition.

The concern that there are too few generalist physicians and too many specialists is part of the ongoing health care debate. Medical educators have been challenged at the graduate and undergraduate levels to educate more generalists. While some question the actual effect of medical education on the choice of a generalist career, others strongly express the view that a generalist curriculum influences graduates to pursue a career in primary care. Residency training programs are largely based in hospitals, and pediatric practice is largely community based. The terms educational malpractice, educational mismatch, and, most recently, educational dysjunction have been used to describe the difference between the educational and practice experience.

Objective: To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings affected outcomes 2 years later., Design: Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians and who did and did not recall warnings were compared., Setting: A company-union employee assistance program., Participants: Two hundred problem drinkers, newly identified on the job, predominantly male, blue-collar workers., Outcomes: Drinking, drunkenness, average daily alcohol consumption, and impairment score., Results: Among the 200 participants, 74% saw physicians in the index year; only 22% recalled warnings. Recall of a warning was associated with liver disease, continued drinking while ill, supervisors' job warnings, older age, and marijuana use. Two years later, those warned were more likely to be abstaining, and sober, and were less impaired., Conclusions: Recalling a physician's warning at intake into alcoholism treatment was associated with better prognosis 2 years later. However, among this group of employees whose drinking was serious enough to be identified on the job, fewer than a quarter recalled physicians' warnings, even though more than three quarters had seen physicians in the year preceding intake.

While comparing the effects on wound healing of a heated scalpel with those of the cold scalpel, we discovered that inoculation of rat skin incisions with a strain of Staphylococcus aureus dramatically accelerated the gain in wound strength. The accelerating effect was evident four days postoperatively, was maximal at seven to ten days, and was still present at 28 days. The accelerating effect was correlated with the number of S aureus organisms introduced into the wound, and was found in conventional rats and rats germ free up to the time of monocontamination with S aureus. There was no evidence of infection on gross examination; on histologic examination an occasional microabscess was seen in some rats. There may be both local and systemic mechanisms underlying the S aureus accelerating effect. Seven strains of S aureus with varying characteristics demonstrated the wound-healing accelerating effect. In sharp contrast, Staphylococcus epidermidis (three strains), Staphylococcus hominis (one strain), and Pseudomonas aeruginosa (two strains) did not show this effect. The increases in wound healing due to S aureus were substantially greater than reported previously for any nutritional supplement, drug, or other chemical or physical agent.

Previous studies in our laboratory demonstrated that dietary supplementation with vitamin A enhances peritoneal adhesion formation in mice. Other researchers have shown that vitamin E antagonizes some effects of vitamin A in various systems, eg, wound healing. We investigated our hypothesis that dietary supplementation with vitamin E would decrease peritoneal adhesion formation. Adult mice were divided into the following groups: group 1, which ate a standard chow containing 65 IU of vitamin E per kilogram diet (twice the National Research Council's recommended daily allowance for normal mice); and group 2, which ate the same chow supplemented with vitamin E at 300 IU/kg diet (a nontoxic level). Following peritoneal ligation, all mice were killed on the tenth postoperative day and their peritoneal cavities examined for the presence and extent of adhesions. There was a statistically significant decrease in the incidence and degree of adhesions in the vitamin E-supplemented animals; these data supported our hypothesis.

We studied excision of burns with a new heated scalpel. The disposable blade resemble conventional scalpel blades, except that their edges can be heated and the temperature controlled within narrow limits. The control mechanism compensates "instantaneously" for varying losses of heat depending on the vascularity of the tissues and rate of cutting. Cutting is done by the blade's sharp edge and hemostasis results from direct transfer of heat; no electric currents are generated in the tissues. The blades can be fashioned in variety of shapes and sizes, including those suitable for tangential excisions. The heated scalpel allows excision of third-degree burns in pigs and humans with much smaller loss of blood than when the usual cold surgical scalpel is used. Skin grafts applied immediately after excisions with the heated scalpel had excellent rates of success, similar to those of grafts applied immediately after excisions with the cold scalpel.

Vitamin A may play a role systemically and locally in controlling intra-abdominal sepsis. Adult male rats were divided into three groups. Group 1 ate a standard rat laboratory chow (not vitamin A deficient), group 2 ate the same chow supplemented with vitamin A, and group 3 ate the chow supplemented with beta carotene. All animals underwent cecal ligation, and the cecum was perforated either with a 27-gauge or an 18-gauge needle. Vitamin A dietary supplementation had a significant protective effect, which was manifested by improved survival in the animals whose cecum was perforated with an 18-gauge needle, prevention of postoperative hypothermia, maintenance of peripheral WBC counts at normal or above-normal values, and better localization of the intra-abdominal inflammatory process. Dietary supplementation with beta carotene had a lesser protective effect.

Previous studies showed that dopamine and norepinephrine levels in rat brain are reduced following stress and that rats fed supplemental tyrosine do not exhibit these reductions. We hypothesized that dietary supplementation with tyrosine would enhance resistance to acute hemorrhagic shock and sepsis by increasing substrate (tyrosine) availability for catecholamine synthesis. Rats were fed either a standard rat chow (6.8 g of tyrosine per kilogram of chow), which supports normal growth, fertility, and longevity, or the same chow supplemented with 10 g of tyrosine per kilogram of chow. Seven days later, the rats underwent cecal ligation and perforation while under intraperitoneal pentobarbital anesthesia. There was a significant increase in survival in the tyrosine-supplemented group. Similarly, in another experiment, tyrosine-supplemented rats were able to tolerate acute fulminant hemorrhagic shock better than were nonsupplemented control animals.