Amish Children Research Articles

A Simple Handshake: Public Schools for Amish Students in a Lancaster County, Pennsylvania, School District, 1953–1994

Public school consolidation during the 1950s and 1960s in Lancaster and Chester Counties, Pennsylvania, sparked an exodus of Amish children from the area’s public schools and the establishment of Amish schools. The politics of consolidation in one location, however, resulted in a unique arrangement whereby the Lampeter-Strasburg School District, formed in 1953 in southcentral Lancaster County, operated two one-room schools for Amish residents of the district for more than forty years. The positive relationship between Amish families and public school leaders exemplifies the possibility of comity and cooperation in contrast to the narrative of discord and conflict around Amish schooling in the mid-twentieth-century.

Bilateral Subluxation of Microspherophakic Lens in a Child with Cohen Syndrome

ABSTRACT Cohen Syndrome is a rare autosomal recessive condition characterized by facial abnormalities with or without microcephaly, non-progressive intellectual delay, hypotonia, ophthalmic abnormalities, and neutropenia. Due to its low incidence and variable presentation, much about the disorder, including ophthalmic manifestations, is not fully understood. Here, we present the first documented case of a 5-year-old Amish child with Cohen Syndrome who presented with bilateral subluxation of microspherophakic lenses – rare findings themselves, let alone coexisting in a patient with a rare genetic syndrome. The child underwent bilateral lensectomy and is being managed with aphakic spectacles.

Is ethnicity a 'treatable trait' in asthma?

Is ethnicity a 'treatable trait' in asthma?

Vaccination patterns of the northeast Ohio Amish revisited

ObjectivesThe Holmes County Amish have low vaccination rates, an increasingly diverse population, and have an increased incidence of certain inherited diseases. The objectives were to evaluate; the rate and influences of vaccine hesitancy compared to a decade ago, vaccination patterns between Amish affiliations, vaccine practices of Amish special needs children, and the Amish’s acceptance of a COVID-19 vaccine.Study design.In April of 2020, a survey assessing vaccination patterns and beliefs were mailed to 1000 Amish families, including ultra-conservative Amish sects and special needs families. ResultsThe response rate was 39%. Among 391 respondents, 59% did not vaccinate their children, compared to only 14% that refused all vaccinations reported by Wenger et al in the same community only a decade ago. The ultra-conservative Amish rejected vaccines more often. Amish special needs children were more likely to receive vaccines than healthy Amish children. 75% responded they would reject a COVID-19 vaccine. Fear of adverse effects was the most common reason to reject vaccines. Families that accepted vaccines were more likely to cite a healthcare worker as the primary influence to vaccinate. Wives were more likely to cite their spouse as the primary influence to vaccinate. Families that rejected vaccines were more likely to state their bishop was the most influential person on vaccination. ConclusionThe Holmes County Amish have decreasing vaccine acceptance. Efforts to improve vaccination will require a targeted focus on the primary influences and beliefs of sub-populations within the Amish. Physician advocacy, peer mentorship, father-directed education, and close partnership with Church leadership will be needed to limit vaccine-preventable disease. The Amish may be at risk for low uptake of a COVID-19 vaccine.

Identifying barriers and considerations for cochlear implantation in Amish children

ObjectiveTo determine if barriers to cochlear implantation (CI) exist with respect to Amish children and to describe unique considerations associated with CI and subsequent otologic care in the Amish population. MethodsOut of all patients who underwent CI at a tertiary care pediatric hospital from 2008 to 2019, Amish children were age-matched to the remainder of the cohort to compare demographics and care-related metrics including etiology of hearing loss, age at time of initial hearing-related appointment and at CI, total number of pre- and post-operative audiologic and otologic appointments, and post-operative complications. Social considerations that may pose barriers to care were collected for descriptive analysis. ResultsSince 2008, 232 children underwent CI, of which 8 implants were performed on Amish children. Six (75%) Amish children underwent newborn hearing screening and 3(38%) were found to have syndromic etiology for hearing loss. While Amish patients had a lower number of both audiologic (15 vs 33.5, p<.001) and otologic (4.5 vs 8.5, p=.028) appointments when compared to age-matched controls, median age at the time of implantation for the whole sample was not different between groups (2.5 vs 2.0 years, p=.211). From a social standpoint, limitations in transportation, telephone communication, and ability to recharge processor batteries must be considered in the Amish population. ConclusionAmish children undergoing CI face unique barriers to care including transportation and technologic limitations, leading to overall fewer hearing-related appointments when compared to an age-matched cohort. Understanding societal differences is important to facilitate optimal care for Amish children with hearing loss.

Religious prohibition and sacrifice: evidence from the Amish restriction on high school education

AbstractThe Amish collective objection to high school education and refusal to comply with compulsory schooling laws can be interpreted with a religious-club-good framework. According to the religious-club interpretation, the Amish use the restriction on secular education as a religious prohibition and sacrifice to improve the welfare of sect members. I exploit the 1972 U.S. Supreme Court's decision inWisconsin vs. Yoder, which exempts Amish children from compulsory high school education, as a policy shock to test several key predictions of the religious-club explanations. The evidence suggests that the successful restriction on high school education helped the Amish sect exclude individuals with low religious participation, lower members' shadow cost of time, and grow the sect through higher fertility.

700 A Comparison of Pediatric Burn Injuries Based on Cultural Environment

Abstract Introduction The Amish maintain cultural customs that preserve their identity minimizing assimilation into American culture and selectively use technology. Cultural beliefs and environmental situations can predispose the Amish, especially children to burn injuries. As a burn center it is important to examine demographics, incidence and causes of burn injury to bring awareness for prevention efforts. The purpose of this study was to determine if burns in Amish children are associated with greater severity when compared to non-Amish children. Methods A retrospective analysis of the burn registry at a verified burn center collected data on inpatient children &amp;lt; 14 years with an acute burn injury from 2012 through 2018. Children with frostbite and non-accidental burn trauma were excluded. Results Of the 273 children, 16 (5.9%) Amish children were similar to the 257 (94.1%) non-Amish children in age (mean age 4.8y, SD=3.8 vs. 4.0y, SD=3.7), male gender (63% vs. 59%) and percent needing surgery (44% vs. 26%, p=0.14). However, Amish children had a greater median injury severity score (ISS) (9.0, IQR [1, 25] vs. 1.0, [1, 4], p&amp;lt; 0.0001), median TBSA (19.5% [5.2, 52] vs. 4.0 [1.7, 7], p&amp;lt; 0.0001), median length of stay (LOS) (10.5 days [4, 50] vs. 2.0 days [1, 8], p&amp;lt; 0.0001), and median number of surgeries (0.5 [0, 6.5] vs. 0 [0, 1], p&amp;lt; 0.0074). Complications of ARDS (25%), sepsis (25%), compartment syndrome (18.8%), acute renal injury/failure (12.5%) and amputation (18.8%) were more prevalent among Amish children (all p&amp;lt; 0.0033) and non-existent in the non-Amish group. Amish children had a higher incidence of fire/flame burn (43.8% vs. 19.5%) and need for rehabilitation (37.5% vs. 0.8%). Conclusions In this study, Amish children had greater burn area, severity, longer LOS, more surgical interventions and complications than non-Amish children. Applicability of Research to Practice Culturally appropriate prevention efforts and education are needed to enhance existing care and burn or fire awareness with the Amish population.

Injuries among Amish children: opportunities for prevention

ObjectivesThe purpose of this study was to examine the injury risk patterns among Amish children, many of whom may be exposed to uncommon injuries and limited access to care due to their agrarian lifestyle and remote communities.DesignRetrospective Chart Review.MethodsWith IRB approval, we performed a retrospective review of Amish patients age ≤ 12 years presenting to a level I pediatric trauma center between January 1, 2005, and December 31, 2015. Data abstracted from the institutional trauma registry and electronic medical record were analyzed using descriptive statistics and univariate/multivariate analysis.ResultsOne hundred eighty-three Amish children were admitted, and 2 died from injuries. Patients were 72.1% male; the median age was 5 (IQR 3–8); median injury severity score (ISS) was 9 (IQR 4–14), Most injuries were the result of blunt force trauma (91.8%). The most frequent mechanisms were falls (42.6%), followed by animal-related (15.3%), and buggy (12.5%). Most injuries occurred at home (44.4%) or on a farm (33.9%). Hay hole falls were a unique source of injury with a high ISS (12; IQR 6–17). The overall median length of stay (LOS) was 2 days (IQR 1–3), with animal-related injuries associated with the longest LOS (3 days; IQR 1–4.75).ConclusionsThe majority of injuries among Amish children are due to falls. Hay hole falls and animal-related injuries result in the highest ISS and longest LOS. These findings identify the farm as a potential target for culturally appropriate interventions for risk modification.

T-cell phenotypes are associated with serum IgE levels in Amish and Hutterite children

Amish children raised on traditional farms have lower atopy and asthma risk than Hutterite children raised on modern farms. In our previous study we established that the Amish environment affects the innate immune response to decrease asthma and atopy risk. Here we investigated T-cell phenotypes in the same Amish and Hutterite children as in our earlier study to elucidate how this altered innate immunity affects adaptive T cells. Blood was collected from 30 Amish and 30 Hutterite age- and sex-matched children; cells were cryopreserved until analysis. Flow cytometry was used to analyze cell subsets. Atopy was determined based on allergen-specific and total IgE levels. Children exposed to Amish farms had increased activated regulatory CD4+ T-cell phenotypes, whereas conventional CD4 T cellsexpressed lower levels of costimulation molecules and other activation markers. The increase in numbers of circulating activated regulatory CD4+ T cells was associated with an increase in inhibitory receptors on monocytes in Amish, but not Hutterite, children. Strikingly, the Amish children had a higher proportion of CD28null CD8 T cells than the Hutterite children (P<.0001, nonparametric t test), a difference that remained even after accounting for the effects of age and sex (conditional log regression exponential β=1.08, P=.0053). The proportion of these cells correlated with high T-cell IFN-γ production (rs=0.573, P=.005) and low serum IgE levels (rs=-0.417, P=.025). Furthermore, CD28null CD8 T-cell numbers were increased in Amish children, with high expression of the innate genes TNF and TNF-α-induced protein 3 (TNFAIP3) in peripheral blood leukocytes. Amish children's blood leukocytes are not only altered in their innate immune status but also have distinct T-cell phenotypes that are often associated with increased antigen exposure.

Vaccine-Preventable Diseases Requiring Hospitalization.

Plain children often have lower immunization rates than non-Plain children. Penn State Health Children's Hospital is a tertiary medical center with large nearby Plain (Amish and Mennonite) communities. We sought to describe the characteristics of children hospitalized with vaccine-preventable diseases (VPDs). We hypothesized that Amish children would have a higher risk of VPDs than non-Amish children. International Classification of Diseases, Ninth Revision codes were used to identify patients <18 years diagnosed with a VPD from January 1, 2005, to December 31, 2015, at Penn State Children's Hospital. Demographic information, immunization status, and outcomes were obtained from medical records. By using the number of children in our primary service area, we calculated the risk of VPD requiring hospitalization for Amish and non-Amish children. We assessed the relationship between Plain affiliation and vaccination status by using the Pearson correlation coefficient. There were 215 children with 221 VPDs. Most occurred in non-Plain children: 179 of 221 (81%). Except for pneumococcal infections, VPD occurred mostly in unvaccinated or immunocompromised children, regardless of Plain affiliation. There were 15 Haemophilus influenzae type b and 5 tetanus infections that occurred in children with an unvaccinated or unknown vaccination status. The risk of a VPD requiring hospitalization was greater for Amish than for non-Plain children (risk ratio: 2.67 [95% confidence interval: 1.87-3.82]). There was a strong correlation between Plain affiliation and lack of vaccination (r = -0.63, P < .01). Amish children had an increased risk of a VPD requiring hospitalization than non-Plain children. With the exception of those with pneumococcal disease, most vaccinated children hospitalized with a VPD were immunocompromised.

At the Intersection of Faith, Culture, and Family Dynamics: A Complex Case of Refusal of Treatment for Childhood Cancer

Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child's maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment. First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally. Second, the maternal grandfather's ardent refusal of treatment and his rationale appeared to be inconsistent with the beliefs expressed by other family members and by members of the same Amish community, leading members of the medical team to question whether refusal of treatment should be treated differently when it appears to be based on the idiosyncratic beliefs of an individual rather than on community-wide values. Third, the medical team perceived tension and dissension between the nonverbal behavior of some family members and the verbal statements made by the maternal grandfather, leading the team to question the parents' true wishes and debate how to weigh nonverbal and indirect forms of communication. Finally, building upon the conclusions of these queries, I explore whether, if the child's prognosis was less favorable or if he were to relapse later, the maternal grandfather should have been permitted to drive a decision to refuse further treatment.

Evaluation of low immunization coverage among the Amish population in rural Ohio

The Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Review included childhood immunizations among the 10 great public health achievements in the United States in the 20th century. Despite this acknowledged success, childhood immunization rates continue to be much lower in select populations. Amish communities have persistently lower immunization rates. Recent outbreaks in Amish communities include a 2014 measles outbreak in Ohio, resulting in 368 cases reported. A recent outbreak of pertussis in an Amish community in Ohio resulted in the death of a 6-week-old Amish baby. A study was designed to determine the knowledge, beliefs, attitudes, and opinions of Amish parents relative to the immunization of Amish children. Data were collected through a questionnaire. Each potential participant was mailed a copy of a letter describing the proposed study. The questionnaire, a copy of the current immunization schedule, and a return stamped envelope were also included in the mailed packet. The study sample consisted of 84 Amish individuals who voluntarily filled out and returned questionnaires. The findings from the data analysis demonstrated that fear, especially concern over too many recommended immunizations and immunizations overwhelming the child's system, was the most frequent reported reasons for not having children immunized according to recommendations. Religious factors and access to care were not among reasons most reported. Designing an educational campaign for educating Amish parents on the risks and benefits of immunizations with focus on specific concerns may improve immunization rates.

New York Amish: Life in the Plain Communities of the Empire State

New York Amish: Life in the Plain Communities of the Empire State

Oral health and medical conditions among Amish children.

Background: The Amish are a growing population who live a traditional, rural way of life, which makes them less accepting of modernism. Most Amish live in poverty and are detached from modern health care. In addition, the recent change of their lifestyle has been reported, such as consuming a nontraditional diet and the usage of electronic devices. As a result, their lifestyle change may have impacted their oral health. However, since only a single report about oral health among Amish children has been published approximately three decades ago it has not yet been updated. This study describes oral health among Amish children and their medical conditions during visits to a mobile dental unit (MDU). Material and Methods: The dental records of all patients (N=216) who visited a mobile dental unit were reviewed, which covers 1 year from May 20, 2011, the first date of service. The following factors were taken into consideration during the review process: parental perceptions of their children’s oral health care, dental care experiences, and general health information. Results: Fifty-four (27.8%) children, ages 3 to 17, have never received dental treatment before visiting the MDU; the average number of untreated decayed teeth was 6.8. In spite of this, most parents rated their children’s oral health as good or very good (87.7%). The high cost and long distance travel associated with routine, professional dental care makes it difficult for children to maintain good oral hygiene. Our analysis revealed that bleeding disorders were more prevalent among this gene pool compared to the nation at large; however, asthma was less common. Conclusions: There are oral and general health disparities among Amish children. There is a lack of awareness among Amish parents with regard to their children’s oral health. Key words:Amish, child, dental caries, mobile health units.

Asthma and innate immunity in Amish and Hutterite communities

A small elegant mixed-methods study examined the pathogenesis of asthma.1 Amish children were age and sex-matched with Hutterite children. Because they have similar genetic ancestries (Fig. 1a), this is a quasi-twin study. Both communities have large families, diets rich in fat, salt and raw milk and live in low-pollution, low-tobacco environments. However, Amish communities use traditional farming practices, whereas the Hutterites use modern technology. Investigators took immune and genetic blood samples, analysed house dust, and then used an ovalbumin mouse model of allergic asthma to compare immune responses and broncho-responsiveness. As expected, principal component analysis confirmed remarkable genetic similarities between the Amish and Hutterites. Dust analysis (Fig. 1b) revealed median endotoxin levels 6.8 times higher in Amish homes (P < 0.001). Amish children had more neutrophils, but lower eosinophils and median levels of 23 cytokines (P < 0.001). Gene expression profiles showed clustering around genes encoding inflammation (e.g. tumour necrosis factor and interferon regulatory factor 7). Mice exposed to Amish dust had less airway hyper-responsiveness and their bronchoalveolar lavage samples had less eosinophilia than mice exposed to Hutterite dust. The unique populations studied enable hypothesis generation from this small study. The risk of asthma may be reduced through environmental exposure to aeroallergens from microbe-rich dust which trigger activation of innate immunity, or through interventions targeting innate immunity triggering pathways.

Haemophilus influenzae Type b Invasive Disease in Amish Children, Missouri, USA, 2014.

During 5 months in 2014, three Amish children in Missouri, USA, were diagnosed with invasive Haemophilus influenzae type b infection. Two were rural neighbors infected with a genetically similar rare strain, sequence type 45. One child had recently traveled, raising the possibility of maintenance of this strain among unvaccinated carriers in Amish communities.

Environmental Exposures and Asthma

Research Article| December 01 2016 Environmental Exposures and Asthma AAP Grand Rounds (2016) 36 (6): 67. https://doi.org/10.1542/gr.36-6-67 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Environmental Exposures and Asthma. AAP Grand Rounds December 2016; 36 (6): 67. https://doi.org/10.1542/gr.36-6-67 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: asthma, environmental exposure Stein MM, Hrusch CL, Gozdz J, et al. Innate immunity and asthma risk in Amish and Hutterite farm children. N Engl J Med. 2016; 375(5): 411– 421; doi: https://doi.org/10.1056/NEJMoa1508749Google Scholar Investigators from multiple institutions studied the effect of the environment on asthma among 2 distinctive US farming populations—the Amish of Indiana and the Hutterites of South Dakota. These 2 populations were chosen because the prevalence of asthma in each is strikingly different (5% in Amish and 21% in Hutterites) despite having similar lifestyles with respect to most of the factors known to influence the risk of asthma (eg, large sibship size, minimal exposure to tobacco smoke and air pollution, long durations of breastfeeding) and similar genetic ancestry (both populations originated in Europe and have remained reproductively isolated since immigrating to the United States). One important difference between the 2 populations is that the Amish practice traditional farming (eg, single-family dairy farms and use of horses for fieldwork) and the Hutterites live on large, highly industrialized communal farms. Amish children aged 7–14 years were eligible. Hutterite children were age- and gender-matched to the enrolled Amish children. Whole blood was collected from all participants to measure serum IgE and cytokine levels. Investigators also extracted DNA to assess ancestry by performing genotyping and comparing allele frequencies with European populations included in the Human Genome Diversity Project. Dust was collected in 10 Amish and 10 Hutterite homes and analyzed for endotoxin levels. Extract from Amish or Hutterite dust was then instilled intranasally every 2–3 days for 7 days in wild-type mice and mice deficient in proteins (MyD88 and Trif) involved in multiple innate immunity signaling pathways. Airway inflammation in mice was measured by assessing airway hyperresponsiveness and bronchoalveolar lavage (BAL) eosinophilia. The investigators compared the differences in distributions of IgE and cytokine levels between Amish and Hutterite children as well as differences in airway inflammation in mice exposed to Amish and Hutterite dust extract. There were 30 Amish and 30 Hutterite children enrolled. None of the Amish children had asthma, and 20% of the Hutterite children did. In ancestry analysis, Amish and Hutterite children were genetically similar compared with other European populations. Serum IgE and cytokine levels were significantly lower in Amish children compared to Hutterite children. Mean endotoxin levels were significantly higher in Amish versus Hutterite homes. When Hutterite dust extract was administered to wild-type mice, airway inflammation was observed. When Amish dust extract was administered, airway inflammation was suppressed. This protection was lost when Amish dust extract was applied to mice lacking the innate immunity proteins MyD88 and Trif. The investigators conclude that the Amish farm dust is protective against asthma through stimulation of innate immunity. Dr. Phillipi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Asthma is increasingly common, affecting 6.3 million US children with an estimated prevalence of 8.6%.1 Reasons... You do not currently have access to this content.

Haemophilus influenzae Type b (Hib) Invasive Disease in Amish Children, Missouri 2014

Haemophilus influenzae Type b (Hib) Invasive Disease in Amish Children, Missouri 2014

MG-137 Autosomal recessive disorders are common in the old order amish population of southwestern ontario

Background The Old Order Amish in Milverton, Ontario, represent a genetically isolated group which originated with 12 founding families in 1824. Due to inbreeding and founder effect, certain genetic disorders have become highly prevalent in Ontario Amish. Objective This study aims to describe the spectrum of genetic disorders observed in the Old Order Amish of Southwestern Ontario (population size ˜ 2500). Design and method Over the past 25 years, we have documented the clinical phenotype, and molecular aetiology of genetic disorders in Old Order Amish children. Results A disorder characterised by acute encephalopathy with fever, visual hallucinations, hearing loss, and retinal dystrophy was observed in 7 out of about 220 families, caused by mutation in the histidyl t-RNA synthetase (HARS) gene. Acute respiratory distress syndrome may lead to sudden death. This disorder was first reported in the Amish in Pennsylvania. Other disorders observed in the Ontario Amish but not in American Amish include endocrine-osteodysplasia syndrome (ICK), cerebral atrophy (TMPRSS4), cystinosis (CTNS), sodium diarrhoea (SPINT2), juvenile-onset glaucoma (CYP1B1), epidermolysis bullosa simplex, and Fraser syndrome (FRAS1). Lethal disorders include a central hypoventilation syndrome, a disorder with oligohydramnios and renal hypoplasia, and ichthyosis-microcephaly. In total, the causative mutations have been found for 8 disorders, while another 5 disorders are presumed autosomal recessive. Knowledge of these disorders enabled molecular diagnosis of a child affected concurrently with two conditions within 5 days of birth. Conclusion Awareness of genetic disorders common in this population will aid in early diagnosis and management, and avoid the diagnostic odyssey.

Monocyte and Treg phenotypes in two U.S. farming populations mirror differential asthma and atopy risk: studies in Amish and Hutterite children (HYP7P.254)

Abstract The differences in asthma prevalence between farming and non-farming families in central Europe are recapitulated in two unique U.S. farming populations, the Amish of Indiana and the Hutterites of South Dakota. The prevalence of asthma and allergic sensitization was 5.2% and 7.2%, respectively, in Amish children and &amp;gt;15% and &amp;gt;40%, respectively, in Hutterite children. Compared to Hutterite children, Amish children’s PBLs had lower eosinophils, but higher neutrophils. Amish had higher gene expression of IRF7 and TNFA, which may be the result of the elevated levels of endotoxin found in Amish homes. To determine how the Amish environment alters antigen presentation, we measured the activation status of monocytes. The Amish had increased percentages of inhibitory monocytes that expressed low HLA-DR and high ILT3 and ILT5. We investigated how these changes in innate activation influenced the adaptive immune response. Amish had low ICOS expression on their CD4 effector cells and high ICOS expression on their Tregs. The expression of ILT5 on monocytes correlated to the level of CD45RO+ICOS+ Tregs. Consistent with the idea that microbial exposure could be promoting a regulatory immune phenotype similar to endotoxin-induced tolerance, PBLs from the Amish were hyporesponsive to LPS. These results indicate that environmental exposure has a profound impact on baseline immune function and may prevent the induction of atopic disease in children.