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Healthcare personnel face higher risk of infection during the coronavirus disease (COVID-19) pandemic because of their essential role in identifying and treating persons affected (2,2). Although essential workers in many [...]

Coronavirus disease (COVID-19) was recognized in New York City (NYC), New York, USA, in late February 2020 and had spread throughout the community by March 2020 (1). First responders and [...]

Healthcare, first response (e.g., firefighters, paramedics, emergency medical technicians), and public safety (e.g., law enforcement officers) personnel have served on the front lines of the coronavirus disease (COVID-19) pandemic response [...]

BackgroundChildhood respiratory allergies, which contribute to missed school days and other activity limitations, have increased in recent years, possibly due to environmental factors.ObjectiveIn this study we examined whether air pollutants are associated with childhood respiratory allergies in the United States.MethodsFor the approximately 70,000 children from the 1999-2005 National Health Interview Survey eligible for this study, we assigned between 40,000 and 60,000 ambient pollution monitoring data from the U.S. Environmental Protection Agency, depending on the pollutant. We used monitors within 20 miles of the child's residential block group. We used logistic regression models, fit with methods for complex surveys, to examine the associations between the reporting of respiratory allergy or hay fever and annual average exposure to particulate matter < or = 2.5 microm in diameter (PM2.5), PM < or = 10 microm in diameter, sulfur dioxide, and nitrogen dioxide and summer exposure to ozone, controlling for demographic and geographic factors.ResultsIncreased respiratory allergy/hay fever was associated with increased summer O3 levels [adjusted odds ratio (AOR) per 10 ppb = 1.20; 95% confidence interval (CI), 1.15-1.26] and increased PM2.5 (AOR per 10 microg/m3 = 1.23; 95% CI, 1.10-1.38). These associations persisted after stratification by urban-rural status, inclusion of multiple pollutants, and definition of exposures by differing exposure radii. No associations between the other pollutants and the reporting respiratory allergy/hay fever were apparent.ConclusionsThese results provide evidence of adverse health for children living in areas with chronic exposure to higher levels of O3 and PM2.5 compared with children with lower exposures.

Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status., Author(s): Brian K. Kit [sup.1] , Lara J. Akinbami [sup.1] , Neda Sarafrazi Isfahani [sup.1] , Dale A. Ulrich [sup.2] Author Affiliations: (1) Division of Health and Nutrition Examination Surveys, [...]

Multisystem inflammatory syndrome in children (MIS-C) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; in the United States, reporting of MIS-C after coronavirus disease 2019 (COVID-19) vaccination is required for vaccine safety monitoring. Pfizer-BioNTech COVID-19 vaccine was authorized for children aged 5−11 years on 29 October 2021. Covering a period when approximately 7 million children received vaccine, surveillance for MIS-C ≤ 90 days postvaccination using passive systems identified 58 children with MIS-C and laboratory evidence of past/recent SARS-CoV-2 infection, and 4 without evidence. During a period with extensive SARS-CoV-2 circulation, MIS-C illness in children after COVID-19 vaccination who lacked evidence of SARS-CoV-2 infection was rare (<1 per million vaccinated children). [ABSTRACT FROM AUTHOR]

Comprehensive clinical programs for teenage mothers and their children have been a promising intervention to improve outcomes of teenage childbearing and parenting. Evaluations in this study reported moderate success in preventing repeat pregnancies, continuing education, and improving health care. It is concluded that increased support and funding for programs and more complete evaluations are warranted. (BF)

Background. Racial and ethnic disparities exist in reported childhood asthma prevalence, but it is unclear if disparities stem from true prevalence differences or a different likelihood of receiving a diagnosis from a health professional. Concern has been raised that asthma may be underdiagnosed, particularly among minority children who have more restricted access to high-quality health care. Objective. To examine racial/ethnic differences among currently symptomatic children in acquiring an asthma diagnosis to determine if relative underdiagnosis among minorities exists. Children for whom no symptoms were reported (a group that includes those with well-controlled symptoms) were excluded from the analysis. Methods. The 1999 National Health Interview Survey includes a nationally representative sample of children with reported wheezing symptoms. We included children 3 to 17 years old in the study and analyzed racial/ ethnic differences in asthma diagnosis, controlling for young age, gender, parental education, single-parent household, central-city residence, region of residence, health insurance, having a usual place of care, and parent-reported severity of wheezing symptoms. Results. Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04, 1.63) for Puerto Rican, 1.22 (95% CI: 1.03, 1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94, 1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children. Conclusions. Our findings do not provide evidence for the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children, asthma, ethnic disparity, prevalence, racial differences, wheezing., ABBREVIATIONS. NHIS, National Health Interview Survey; NAEPP, National Asthma Education and Prevention Program. Many researchers have noted higher asthma prevalence rates among non-Hispanic black children, with prevalence rates ranging as [...]

Background. Little is known about availability of services and confidential care for adolescents in primary care practices or how availability among pediatric practices compares to that among other primary care practices. The objective of this study was to assess self-reported availability of services for medically emancipated conditions and confidential care in primary care practices, to compare physician responses to those from office staff who answer appointment lines, and to compare availability in pediatric practices to other primary care practice types. Methods. We conducted a telephone survey of randomly selected practices from the Washington, DC, metropolitan area in pediatrics (Peds), internal medicine (IM), and family medicine (FM). We asked staff who answer appointment lines about availability of services for medically emancipated conditions and confidential appointments for adolescents. Physicians received the same questions via a mail survey. Responses from office staff and physicians in the same practice were linked for comparison. Results. Of 434 practices contacted by telephone, 372 (86%) responded. Of the 615 physicians surveyed from these 372 practices, 264 (43%) from 170 practices responded to the mail survey. Peds practices were less likely than FM and IM practices to offer services for medically emancipated conditions and were less likely than FM practices to offer confidential services to adolescents. Office staff and physicians from FM and IM had higher agreement compared with Peds about availability of services for medically emancipated conditions. Agreement between office staff and physicians about provision of confidential appointments to adolescents was low among all practice types. However, having a written office policy on adolescent confidentiality was significantly associated with agreement between office staff and physicians about availability of confidential services. Conclusions. Care for medically emancipated conditions and confidential services for adolescents are limited among primary care practices, especially among pediatric practices. All primary care practice types had significant disagreement between office staff and physicians about availability of confidential services to adolescents. Adolescents who call appointment lines are likely to receive inaccurate information about confidentiality policies. Establishing written office policies on adolescent confidentiality may help to improve access to confidential care for adolescents. Pediatrics 2003;111: 394-401; adolescent health services, confidentiality, primary health care., ABBREVIATIONS. STD, sexually transmitted disease; Peds, pediatric medicine; FM, family medicine; IM, internal medicine; AOR, adjusted odds ratio; CI, confidence interval. Adolescents have identified lack of confidentially as a barrier [...]

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus testing among first responders and healthcare personnel who participated in a May 2020–August 2020 serosurvey that assessed spike protein antibodies provided an opportunity to assess reinfection. Methods Serology survey data were merged with virus testing results from Rhode Island (1 March 2020–17 February 2021) and New York City (10 March 2020–14 December 2020). Participants with a positive virus test ≥14 days before their serology test were included. Reinfection was defined as a second positive SARS-CoV-2 test ≥90 days after the first positive test. The association between serostatus and reinfection was assessed with a proportional hazards model. Results Among 1572 previously infected persons, 40 (2.5%) were reinfected. Reinfection differed by serostatus: 8.4% among seronegative vs 1.9% among seropositive participants (P  < .0001). Most reinfections occurred among Rhode Island nursing home and corrections personnel (n = 30) who were most frequently tested (mean 30.3 tests vs 4.6 for other Rhode Island and 2.3 for New York City participants). The adjusted hazard ratio (aHR) for reinfection in seropositive vs seronegative persons was 0.41 (95% confidence interval [CI],.20–.81). Exposure to a household member with coronavirus disease 2019 (COVID-19) before the serosurvey was also protective (aHR, 0.34; 95% CI,.13–.89). Conclusions Reinfections were uncommon among previously infected persons over a 9-month period that preceded widespread variant circulation. Seropositivity decreased reinfection risk. Lower reinfection risk associated with exposure to a household member with COVID-19 may reflect subsequently reduced household transmission. [ABSTRACT FROM AUTHOR]

ABSTRACT. Objectives. Our objective was to use national data to produce a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality to assess changes in the disease burden among US children. Methods. Five data sources from the National Center for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 1980 to the most recent year for which data were available. These included the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System. Results. Asthma prevalence increased by an average of 4.3% per year from 1980 to 1996, from 3.6% to 6.2%. The peak prevalence was 7.5% in 1995. In 1997, asthma attack prevalence was 5.4%, but changes in the NHIS design in 1997 preclude comparison to previous estimates. Asthma attack prevalence remained level from 1997 to 2000. After a decrease between 1980 and 1989, the asthma office visit rate increased by an average of 3.8% per year from 1989 to 1999. The asthma hospitalization rate grew by 1.4% per year from 1980 to 1999. Although childhood asthma deaths are rare, the asthma death rate increased by 3.4% per year from 1980 to 1998. Children aged 0 to 4 years had the largest increase in prevalence and had greater health care use, but adolescents had the highest mortality. The asthma burden was borne disproportionately by black children throughout the period. Racial disparities were largest for asthma hospitalizations and mortality: compared with white children, in 1998-1999, black children were >3 times as likely to be hospitalized and in 1997-1998 >4 times as likely to die from asthma. Conclusions. Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend. Racial and ethnic disparities remain large for asthma health care utilization and mortality. Pediatrics 2002;110:315-322; asthma, child, prevalence, office visits, hospitalization, mortality., ABBREVIATIONS. NHIS, National Health Interview Survey; NCHS, National Center for Health Statistics; NAMCS, National Ambulatory Medical Care Survey; NHDS, National Hospital Discharge Survey; NHAMCS, National Hospital Ambulatory Medical As a [...]

Background Reports suggest that some persons previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lack detectable immunoglobulin G (IgG) antibodies. We aimed to determine the proportion IgG seronegative and predictors for seronegativity among persons previously infected with SARS-CoV-2. Methods We analyzed serologic data collected from healthcare workers and first responders in New York City and the Detroit metropolitan area with a history of a positive SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) test result and who were tested for IgG antibodies to SARS-CoV-2 spike protein at least 2 weeks after symptom onset. Results Of 2547 persons with previously confirmed SARS-CoV-2 infection, 160 (6.3%) were seronegative. Of 2112 previously symptomatic persons, the proportion seronegative slightly increased from 14 to 90 days post symptom onset (P  = .06). The proportion seronegative ranged from 0% among 79 persons previously hospitalized to 11.0% among 308 persons with asymptomatic infections. In a multivariable model, persons who took immunosuppressive medications were more likely to be seronegative (31.9%; 95% confidence interval [CI], 10.7%–64.7%), while participants of non-Hispanic Black race/ethnicity (vs non-Hispanic White; 2.7%; 95% CI, 1.5%–4.8%), with severe obesity (vs under/normal weight; 3.9%; 95% CI, 1.7%–8.6%), or with more symptoms were less likely to be seronegative. Conclusions In our population with previous RT-PCR–confirmed infection, approximately 1 in 16 persons lacked IgG antibodies. Absence of antibodies varied independently by illness severity, race/ethnicity, obesity, and immunosuppressive drug therapy. The proportion seronegative remained relatively stable among persons tested up to 90 days post symptom onset. [ABSTRACT FROM AUTHOR]