As a pediatrician caring for children from low-income families, I am delighted that the AAP has d... more As a pediatrician caring for children from low-income families, I am delighted that the AAP has designated access to health care for all children and pregnant women as its top priority. However, Iam dismayed that the AAP9s president, Donald Schiff, M.D., appears to reject the possibility of a universal, comprehensive solution to the access problem for our country. In his call for the removal of barriers to child health care (February 1989 AAP News), Dr. Schiff states: "I don9t mean establishing a mandated, monolithic, Washington-directed health plan for our children such as National Health Insurance." As our escalating health care crisis has shown us, nothing short of a comprehensive solution is likely to solve either the access problem or to effectively control costs.
The early diagnosis of infection with the human immunodeficiency virus (HIV) in infancy is clinic... more The early diagnosis of infection with the human immunodeficiency virus (HIV) in infancy is clinically important but remains problematic in the asymptomatic child born to an HIV-infected mother. In addition, many such women are unaware of their HIV infection until their child manifests symptomatic HIV disease. Nonspecific signs of pediatric HIV infection, such as generalized lymphadenopathy, hepatosplenomegaly, or persistent thrush, may be important in alerting the clinician to consider the possibility of HIV infection in the child whose history of HIV risk is unknown. We report one such sign which may be evident on plain chest radiography. The pathology of the thymus gland in pediatric acquired immunodeficiency syndrome has been described by Joshi and colleagues,1-3 who have reported precocious involution with marked reduction in thymus size and weight.
The authors assess seasonal variations in the prevalence of low weight-for-age among young childr... more The authors assess seasonal variations in the prevalence of low weight-for-age among young children visiting the pediatric emergency room of a city hospital. We analyzed data on 11,118 children ages 6 to 24 months who visited the Boston City Hospital Pediatric Emergency Department between July 1989 and June 1992. Medical diagnoses were documented on a randomly selected subsample of 1,569 children. In addition, a questionnaire about food insecurity was administered to a convenience subsample of 269 families with children under 3 years of age. The percentage of children visiting the emergency room with weight-for-age below the fifth percentile was significantly higher for the three months following the coldest months than for the remaining months of the year, controlling for year of measurement. In the subsample, gastrointestinal illness was correlated with both season of measurement and weight-for-age, but the seasonal effect remained for the entire sample after controlling for dehyd...
This report describes a population of "hidden homeless" families and new research showi... more This report describes a population of "hidden homeless" families and new research showing that children in these families are more likely to be hungry and in poor health. Unrecorded by any homeless census, these families move frequently, often into overcrowded apartments, or double up with another family never knowing how long they can stay. The report estimates that there are over 14,800 hidden homeless families in Boston and that this number is likely to grow as the economy declines
The U.S. Household Food Security Scale, developed with federal support for use in national survey... more The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages 36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998– December 2001. Caregivers of 11,539 children ages 36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child’s health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic...
In the fourth brief in its Policy Action series, Children's HealthWatch finds that unaffordab... more In the fourth brief in its Policy Action series, Children's HealthWatch finds that unaffordable housing endangers the health and development of young children. Due to a federal funding shortfall, state and local housing agencies will be forced to reduce or eliminate rental assitance to thousands of families starting this month. Voucher cuts will push more families into the ranks of the "hidden homeless" -- families that move frequently, crowd into apartments that are too small, or live doubled up with other households when they cannot find affordable housing. Children in hidden homeless families are at increased risk for poor health, nutrition, and growth, as well as developmental delays. Timely Congressional action to protect the Housing Choice Voucher Program will ensure that families have stable, affordable housing essential to children's health
This report by Children's HealthWatch and the Medical-Legal Partnership | Boston finds that h... more This report by Children's HealthWatch and the Medical-Legal Partnership | Boston finds that housing plays a significant role in protecting young children from food insecurity and the health risks of being seriously underweight. This report confirms that increased support for subsidized housing must be part of the strategy for ending childhood hunger
OBJECTIVES. In this study, we evaluated the relationship between household food security status a... more OBJECTIVES. In this study, we evaluated the relationship between household food security status and developmental risk in young children, after controlling for potential confounding variables. METHODS. The Children’s Sentinel Nutritional Assessment Program interviewed (in English, Spanish, or Somali) 2010 caregivers from low-income households with children 4 to 36 months of age, at 5 pediatric clinic/emergency department sites (in Arkansas, Massachusetts, Maryland, Minnesota, and Pennsylvania). Interviews included demographic questions, the US Food Security Scale, and the Parents’ Evaluations of Developmental Status. The target child from each household was weighed, and weight-for-age z score was calculated. RESULTS.Overall, 21% of the children lived in food-insecure households and 14% were developmentally “at risk” in the Parents’ Evaluations of Developmental Status assessment. In logistic analyses controlling for interview site, child variables (gender, age, low birth weight, weig...
Lack of health insurance adversely affects children's health. Eight million US children are u... more Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. Randomized, controlled trial conducted from May 2002 to August 2004. A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a famil...
Jewish Voice for Peace (www.jvp.org) is a national membership organization dedicated to a resolut... more Jewish Voice for Peace (www.jvp.org) is a national membership organization dedicated to a resolution of the Israel/Palestine conflict based on principles of democracy, human rights and respect for international law. JVP's Health and Human Rights Project (HaHRP) sends delegations of health professionals and human rights activists to Israel and the occupied Palestinian Territories (oPT) to work with their counterparts in Palestinian civil society and Israeli human rights organizations. Major partner organizations include the Palestinian Medical Relief Society (www.pmrs.ps) and Physicians for Human Rights-Israel (www.phr.org.il). This presentation will summarize the findings of the most recent HaHRP delegation, scheduled for October 2007, with a focus on the impact of Israeli Occupation on health status and access to health care for the population of the oPT.
Background Food security has been documented as a source of concern for child health and developm... more Background Food security has been documented as a source of concern for child health and development. While homelessness has been well-studied in relationship to food security and child health, little is known about lesser degrees of housing instability. Methods From 8/98-6/07 the Children's Sentinel Nutrition Assessment Program (C-SNAP) interviewed 21,680 caregivers of children <3 years in pediatric clinic/emergency departments in 7 sites (AR,CA,MD,MA,MN,PA,DC). These sites all serve low-income, diverse populations. Interviews included demographics, perceived child health, maternal depression screen, the USDA Food Security Instrument, and the Parents' Evaluation of Developmental Status (PEDS). Logistic regression analyses were conducted controlling for site, race/ethnicity, US born mother, marital status, maternal education, child's age, child breastfed, low birth weight, number of children in home, employment, and maternal depression. Housing instability was defined...
Background: Associations between household healthcare costs and child and maternal health are unk... more Background: Associations between household healthcare costs and child and maternal health are unknown, even when children are insured. State public assistance policies, including health insurance, may influence households' ability to balance healthcare expenditures and basic needs. Design/Methods: Children's HealthWatch (2007-2009) interviewed 6447 mothers from low-income households with children age 0-36 months at 5 pediatric clinic/emergency departments (Baltimore, Boston, Little Rock, Minneapolis, Philadelphia). Mothers were asked about trade-offs (paid medical/prescription costs versus rent, utilities, food), household demographics, maternal and child health status, child developmental risk (determined by Parents' Evaluation of Developmental Status), and health insurance status. Multivariate logistic regression stratified by city examined adjusted associations between trade-offs, maternal health, and child health and development. Results: 2.8%, 5.6%, 9.9%, 3.7%, and ...
As a pediatrician caring for children from low-income families, I am delighted that the AAP has d... more As a pediatrician caring for children from low-income families, I am delighted that the AAP has designated access to health care for all children and pregnant women as its top priority. However, Iam dismayed that the AAP9s president, Donald Schiff, M.D., appears to reject the possibility of a universal, comprehensive solution to the access problem for our country. In his call for the removal of barriers to child health care (February 1989 AAP News), Dr. Schiff states: "I don9t mean establishing a mandated, monolithic, Washington-directed health plan for our children such as National Health Insurance." As our escalating health care crisis has shown us, nothing short of a comprehensive solution is likely to solve either the access problem or to effectively control costs.
The early diagnosis of infection with the human immunodeficiency virus (HIV) in infancy is clinic... more The early diagnosis of infection with the human immunodeficiency virus (HIV) in infancy is clinically important but remains problematic in the asymptomatic child born to an HIV-infected mother. In addition, many such women are unaware of their HIV infection until their child manifests symptomatic HIV disease. Nonspecific signs of pediatric HIV infection, such as generalized lymphadenopathy, hepatosplenomegaly, or persistent thrush, may be important in alerting the clinician to consider the possibility of HIV infection in the child whose history of HIV risk is unknown. We report one such sign which may be evident on plain chest radiography. The pathology of the thymus gland in pediatric acquired immunodeficiency syndrome has been described by Joshi and colleagues,1-3 who have reported precocious involution with marked reduction in thymus size and weight.
The authors assess seasonal variations in the prevalence of low weight-for-age among young childr... more The authors assess seasonal variations in the prevalence of low weight-for-age among young children visiting the pediatric emergency room of a city hospital. We analyzed data on 11,118 children ages 6 to 24 months who visited the Boston City Hospital Pediatric Emergency Department between July 1989 and June 1992. Medical diagnoses were documented on a randomly selected subsample of 1,569 children. In addition, a questionnaire about food insecurity was administered to a convenience subsample of 269 families with children under 3 years of age. The percentage of children visiting the emergency room with weight-for-age below the fifth percentile was significantly higher for the three months following the coldest months than for the remaining months of the year, controlling for year of measurement. In the subsample, gastrointestinal illness was correlated with both season of measurement and weight-for-age, but the seasonal effect remained for the entire sample after controlling for dehyd...
This report describes a population of "hidden homeless" families and new research showi... more This report describes a population of "hidden homeless" families and new research showing that children in these families are more likely to be hungry and in poor health. Unrecorded by any homeless census, these families move frequently, often into overcrowded apartments, or double up with another family never knowing how long they can stay. The report estimates that there are over 14,800 hidden homeless families in Boston and that this number is likely to grow as the economy declines
The U.S. Household Food Security Scale, developed with federal support for use in national survey... more The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages 36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998– December 2001. Caregivers of 11,539 children ages 36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child’s health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic...
In the fourth brief in its Policy Action series, Children's HealthWatch finds that unaffordab... more In the fourth brief in its Policy Action series, Children's HealthWatch finds that unaffordable housing endangers the health and development of young children. Due to a federal funding shortfall, state and local housing agencies will be forced to reduce or eliminate rental assitance to thousands of families starting this month. Voucher cuts will push more families into the ranks of the "hidden homeless" -- families that move frequently, crowd into apartments that are too small, or live doubled up with other households when they cannot find affordable housing. Children in hidden homeless families are at increased risk for poor health, nutrition, and growth, as well as developmental delays. Timely Congressional action to protect the Housing Choice Voucher Program will ensure that families have stable, affordable housing essential to children's health
This report by Children's HealthWatch and the Medical-Legal Partnership | Boston finds that h... more This report by Children's HealthWatch and the Medical-Legal Partnership | Boston finds that housing plays a significant role in protecting young children from food insecurity and the health risks of being seriously underweight. This report confirms that increased support for subsidized housing must be part of the strategy for ending childhood hunger
OBJECTIVES. In this study, we evaluated the relationship between household food security status a... more OBJECTIVES. In this study, we evaluated the relationship between household food security status and developmental risk in young children, after controlling for potential confounding variables. METHODS. The Children’s Sentinel Nutritional Assessment Program interviewed (in English, Spanish, or Somali) 2010 caregivers from low-income households with children 4 to 36 months of age, at 5 pediatric clinic/emergency department sites (in Arkansas, Massachusetts, Maryland, Minnesota, and Pennsylvania). Interviews included demographic questions, the US Food Security Scale, and the Parents’ Evaluations of Developmental Status. The target child from each household was weighed, and weight-for-age z score was calculated. RESULTS.Overall, 21% of the children lived in food-insecure households and 14% were developmentally “at risk” in the Parents’ Evaluations of Developmental Status assessment. In logistic analyses controlling for interview site, child variables (gender, age, low birth weight, weig...
Lack of health insurance adversely affects children's health. Eight million US children are u... more Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. Randomized, controlled trial conducted from May 2002 to August 2004. A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a famil...
Jewish Voice for Peace (www.jvp.org) is a national membership organization dedicated to a resolut... more Jewish Voice for Peace (www.jvp.org) is a national membership organization dedicated to a resolution of the Israel/Palestine conflict based on principles of democracy, human rights and respect for international law. JVP's Health and Human Rights Project (HaHRP) sends delegations of health professionals and human rights activists to Israel and the occupied Palestinian Territories (oPT) to work with their counterparts in Palestinian civil society and Israeli human rights organizations. Major partner organizations include the Palestinian Medical Relief Society (www.pmrs.ps) and Physicians for Human Rights-Israel (www.phr.org.il). This presentation will summarize the findings of the most recent HaHRP delegation, scheduled for October 2007, with a focus on the impact of Israeli Occupation on health status and access to health care for the population of the oPT.
Background Food security has been documented as a source of concern for child health and developm... more Background Food security has been documented as a source of concern for child health and development. While homelessness has been well-studied in relationship to food security and child health, little is known about lesser degrees of housing instability. Methods From 8/98-6/07 the Children's Sentinel Nutrition Assessment Program (C-SNAP) interviewed 21,680 caregivers of children <3 years in pediatric clinic/emergency departments in 7 sites (AR,CA,MD,MA,MN,PA,DC). These sites all serve low-income, diverse populations. Interviews included demographics, perceived child health, maternal depression screen, the USDA Food Security Instrument, and the Parents' Evaluation of Developmental Status (PEDS). Logistic regression analyses were conducted controlling for site, race/ethnicity, US born mother, marital status, maternal education, child's age, child breastfed, low birth weight, number of children in home, employment, and maternal depression. Housing instability was defined...
Background: Associations between household healthcare costs and child and maternal health are unk... more Background: Associations between household healthcare costs and child and maternal health are unknown, even when children are insured. State public assistance policies, including health insurance, may influence households' ability to balance healthcare expenditures and basic needs. Design/Methods: Children's HealthWatch (2007-2009) interviewed 6447 mothers from low-income households with children age 0-36 months at 5 pediatric clinic/emergency departments (Baltimore, Boston, Little Rock, Minneapolis, Philadelphia). Mothers were asked about trade-offs (paid medical/prescription costs versus rent, utilities, food), household demographics, maternal and child health status, child developmental risk (determined by Parents' Evaluation of Developmental Status), and health insurance status. Multivariate logistic regression stratified by city examined adjusted associations between trade-offs, maternal health, and child health and development. Results: 2.8%, 5.6%, 9.9%, 3.7%, and ...
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