Disproportionate Number Of Children Research Articles

A systematic review of clinical study evidence for pulmonary vasodilator therapy following surgery with cardiopulmonary bypass in children with CHD.

Complications from pulmonary hypertension are one of the leading contributors to morbidity and mortality post-cardiopulmonary bypass surgery in children with CHD. Pulmonary vasodilator therapies are commonly used post-operatively, but the optimal target patient population, therapy choice, timing of therapy initiation, and duration of therapy are not well defined. We used PubMed and EMBASE to identify studies from 2000 to 2020 investigating the use of pulmonary vasodilator therapy post-cardiopulmonary bypass in children aged 0-18 years. To ensure eligibility criteria, studies were systematically reviewed by two independent reviewers. We identified 26 studies of 42,971 children across four medication classes; 23 were single centre, 14 were prospective, and 11 involved randomisation (four of which employed a placebo-control arm). A disproportionate number of children were from a single retrospective study of 41,872 patients. Definitions varied, but change in pulmonary haemodynamics was the most common primary outcome, used in 14 studies. Six studies had clinical endpoints, with mortality the primary endpoint for two studies. Treatment with inhaled nitric oxide, iloprost, and sildenafil all resulted in improved haemodynamics in specific cohorts of children with post-operative pulmonary hypertension, although improved outcomes were not consistently demonstrated across all treated children. Iloprost may be a cheaper alternative to inhaled nitric oxide with similar haemodynamic response. Studies were predominantly single-centre, a control arm was rarely used in randomised studies, and haemodynamic endpoints varied significantly. Further research is needed to reduce post-operative morbidity and mortality from pulmonary hypertension in children with CHD.

The Disproportionality of Poverty, Race, and Ethnicity With Child Maltreatment Reporting.

In this issue of Pediatrics, Rebbe et al1 used a population-based linked administrative data set to analyze data on nearly 4000 children <3 years of age who were hospitalized for child maltreatment. The study used diagnostic codes that were specific for, or suggestive of, maltreatment. The main findings identified that a disproportionate number of children with public health insurance (used as a proxy for poverty) were reported to Child Protective Services (CPS) as compared to children with private insurance, and this was true within each maternal race and ethnicity category. Findings regarding race and ethnicity showed that fewer children of Asian or Pacific islander mothers were reported to CPS as compared to White mothers, and children with American Indian mothers were more likely to have a diagnostic code specific (rather than suggestive) for maltreatment as comparted to all other groups. The authors interpreted these findings of disproportionality to indicate that children and families of lower socioeconomic status (SES) may be more closely scrutinized for maltreatment than those of higher SES, and that race and ethnicity is also a likely factor in CPS reporting and diagnosing abuse. The authors speculate that clinician implicit bias was a key driver behind the disproportionalities. They conclude that programs and policies are needed to prevent the inequitable way children receive protective interventions so that race and poverty “do not impact these crucial decision points regarding the intervention of child maltreatment.”Whether race and ethnicity or SES biases (implicit or otherwise) were the drivers behind the disproportionality cannot be ascertained directly from this data set because of key limitations. As stated by the authors, “it is difficult to ascertain from the available data whether the decision to assign a specific maltreatment code had more to do with the characteristics of the presenting medical problem or with racial bias.” It is highly likely, however, that biases are at play on many levels. Other studies support that underresourced families are disproportionality evaluated for maltreatment and that biased decision-making results in overinvestigations and reporting of abuse in children from Black, Hispanic, and American Indian families.2–7 Thus, efforts to tackle the impact of implicit and explicit biases on diagnosis and reporting of maltreatment are critical to decrease disparities that are adding to these disproportionalities.However, the impact of social factors on outcomes is not limited to bias at the time of diagnosis or decision-making to refer to CPS. Interacting social determinants of health such as racism, poverty, and classism, may cause some groups to be more structurally vulnerable to adverse health outcomes, including child maltreatment.8,9 Evidence indicates that the higher rates of identified and reported maltreatment among impoverished children in this study are likely influenced by real differences in rates of occurrence.3,10–15 Poverty is a known risk factor for child maltreatment,10–15 particularly in combination with other risk factors such as parental depression, substance use, and social isolation that are known to cotravel with poverty.13,16 Other low-resource factors also place children at increased risk. For example, for lower-income single parents to work, the parent may sometimes be forced to resort to less-than-optimal child care, which increases their children’s risk for maltreatment.11,13,17–19 Evidence shows that financial and social supports mitigate the increased risks of maltreatment for children in poverty.19–23 Conversely, decreased supports (ie, welfare benefits) are associated with increased rates of foster care placement (a proxy for maltreatment).24 This highlights why solutions to address maltreatment must also target economic inequities that deepen the problem.The disproportionalities of maltreatment diagnoses and reporting to CPS found in this study serve as a sentinel and likely reflect a combination of biases and true increased risk of maltreatment associated with poverty. It is critical that medical decision-makers do not conflate lower SES status or race and ethnicity with assumptions of maltreatment, because this implicit conflation is causing direct harm and further deepening existing disproportionalities as well as disparities. We must also recognize that underresourced and distressed families may have needs and stressors that contribute to a child’s increased risk of negative outcomes, including maltreatment. The effects of compounded bias, oppression, injustice, and resource scarcity for certain communities are, unfortunately, enduring problems. A public health approach is required to address these injustices at the community-level, along with simultaneous work toward behavior change at the individual level to mitigate impacts of bias, and policy change at the institutional level to reduce the harms of unjust systems. Strategies for opening our eyes to our own biases, while not turning a blind eye to the risk to children that poverty brings, are critical to achieve equitable care for all.9,25

Plasma Metabolome, PON1 Status, Environmental Exposures and Childhood Autism

BackgroundFew studies have examined Autism Spectrum Disorder (ASD) and the interplay between genetics and environmental factors. The paraoxonase 1 (PON1) gene regulates the breakdown of organophosphate (OP) pesticides in the body and serves as an important antioxidant. PON1 levels may be affected by single nucleotide polymorphisms (SNPs), therefore individuals with certain PON1 SNPs plus environmental exposure during pregnancy may be at an increased risk for having a child with autism.ObjectiveThe objective of this study was to examine a possible gene‐environment interaction that focuses on prenatal environmental exposures and child metabolic vulnerability as a consequence of polymorphisms in the PON1 gene.MethodsAll children (n=400) in the present study including children with Autism Spectrum Disorder (ASD; n=200), and typically developed control children (TD; n=200) are part of a large ongoing population based case‐control CHARGE (CHildhood Autism Risk from Genetics and Environment) Study. Blood plasma metabolome profiles were obtained by Nuclear Magnetic Resonance (NMR) spectroscopy. Untargeted metabolomics analysis using Chemomx NMR Suite 8.1 was used to identify and quantify 69 metabolites in each sample including amino acids, organic acids, sugars and other compounds. The concentration of PON1 was determined by ELISA kits (Cloud‐Clone Corp), and paraoxonase activity was measured using commercially available assay kits (Molecular Probes Inc.). SNP data and environmental exposure data were previously collected in the CHARGE Study.ResultsChildren with ASD had higher levels of lactate, a metabolic waste product, and higher levels of the amino acids: alanine, serine, glycine, and tryptophan, consistent with mitochondrial dysfunction, and altered energy metabolism. In addition, ASD was associated with higher levels of uridine, a component of RNA previously reported to be inversely correlated with methylation capacity. Although we did not find a significant difference in the PON1 concentration and paraoxonase activity of children with ASD compared to controls, we did find that PON1 SNPs in coding and non‐coding regions significantly affected its plasma concentrations. Moreover, there were a disproportionate number of children with ASD and specific PON1 SNPs that correlated with maternal organophosphate exposures.ConclusionOur results add to the growing body of literature indicating autism is associated with an altered metabolic state compared to typically developed controls. These results suggest that maternal environmental exposures during pregnancy in combination with genetics may impact a child's metabolic outcome. Further studies are needed to understand how the metabolome affects neurodevelopmental outcome, or conversely if neurodevelopmental outcome affects the metabolome.Support or Funding InformationThis study was funded by the NIH 1P30 ESO23513‐01A1 pilot grant, the Administrative Supplement to the CHARGE Study R01 ES015359, and the USDA National Institute of Food and Agriculture Hatch Project 1005945.

Bodies That Should Matter

Cherríe Moraga’s 1992 play Heroes and Saints remains a critical dramatic work for both environmental studies and Chicana/o studies. The play mirrors and shapes the lived historical reality of Chicana/o farmworkers and pesticide poisoning in the San Joaquin Valley of Southern California, where a disproportionate number of children were born with birth defects or diagnosed with cancer between 1978 and 1988. This paper examines Moraga’s representation of “slow violence” in the play, which uses arresting images to defy the invisibility of a subaltern Chicana/o community. “Slow violence” is a term coined by environmental scholar Rob Nixon; in contrast to spectacular violence, which is characterized by time- and body-boundedness, slow violence occurs gradually and often invisibly. The theoretical lens of slow violence opens up a space in which to discuss the political, temporal, and activist dimensions of Moraga’s play as well as the significance of the relationship between environmentalism and subalternity. This paper strategically rethinks environmental violence on the body and land as well as the politics of (in)visibility.

DNA methylation levels associated with race and childhood asthma severity

ABSTRACTObjective: Asthma is a common chronic childhood disease worldwide. Socioeconomic status, genetic predisposition and environmental factors contribute to its incidence and severity. A disproportionate number of children with asthma are economically disadvantaged and live in substandard housing with potential indoor environmental exposures such as cockroaches, dust mites, rodents and molds. These exposures may manifest through epigenetic mechanisms that can lead to changes in relevant gene expression. We examined the association of global DNA methylation levels with socioeconomic status, asthma severity and race/ethnicity. Methods: We measured global DNA methylation in peripheral blood of children with asthma enrolled in the Kansas City Safe and Healthy Homes Program. Inclusion criteria included residing in the same home for a minimum of 4 days per week and total family income of less than 80% of the Kansas City median family income. DNA methylation levels were quantified by an immunoassay that assessed the percentage of 5-methylcytosine. Results: Our results indicate that overall, African American children had higher levels of global DNA methylation than children of other races/ethnicities (p = 0.029). This difference was more pronounced when socioeconomic status and asthma severity were coupled with race/ethnicity (p = 0.042) where low-income, African American children with persistent asthma had significantly elevated methylation levels relative to other races/ethnicities in the same context (p = 0.006, Hedges g = 1.14). Conclusion: Our study demonstrates a significant interaction effect among global DNA methylation levels, asthma severity, race/ethnicity, and socioeconomic status.

Addressing the Needs of Low-Income School-Age Children: A Teaching Model

With a disproportionate number of children living in poverty in the United States, counseling preparation programs have the responsibility to enhance social justice and multicultural competencies for counseling trainees. The authors delineate a teaching model for an advanced school counseling course to enhance counseling trainees’ commitment to social justice and leadership skills when working at low-income schools. Course assignments, videos, experiential activities, as well as students’ reported perceptions of their participation will be explored.

A Number Sense Intervention for Low-Income Kindergartners at Risk for Mathematics Difficulties

Early number sense is a strong predictor of later success in school mathematics. A disproportionate number of children from low-income families come to first grade with weak number competencies, leaving them at risk for a cycle of failure. The present study examined the effects of an 8-week number sense intervention to develop number competencies of low-income kindergartners (N = 121). The intervention purposefully targeted whole number concepts related to counting, comparing, and manipulating sets. Children were randomly assigned to either a number sense intervention or a business as usual contrast group. The intervention was carried out in small-group, 30-min sessions, 3 days per week, for a total of 24 sessions. Controlling for number sense at pretest, the intervention group made meaningful gains relative to the control group at immediate as well delayed posttest on a measure of early numeracy. Intervention children also performed better than controls on a standardized test of mathematics calculation at immediate posttest.

Palliative care in Yorkshire, UK 1987–2008: survival and mortality in a hospice

ObjectiveTo provide new epidemiological evidence base of information on models of hospice care for children and young adults.DesignRetrospective cohort study of children referred to a hospice.SettingMartin House Children’s and Young...

Biological sensitivity to context: II. Empirical explorations of an evolutionary–developmental theory

In two studies comprising 249 children and their families, the authors utilized secondary, exploratory data analyses to examine Boyce and Ellis' (this issue) evolutionary-developmental theory of biological sensitivity to context. The theory proposes that individual differences in stress reactivity constitute variation in susceptibility to environmental influence, both positive and negative, and that early childhood exposures to either highly protective or acutely stressful environments result in heightened reactivity. In Study 1, 127 3- to 5-year old children were concurrently assessed on levels of support/adversity in home and preschool environments and on cardiovascular reactivity to laboratory challenges. In Study 2, 122 children were prospectively assessed on familial stress in both infancy and preschool and on autonomic and adrenocortical reactivity to laboratory challenges at age 7. In both studies, a disproportionate number of children in supportive, low stress environments displayed high autonomic reactivity. Conversely, in Study 2, a relatively high proportion of children in very stressful environments showed evidence of heightened sympathetic and adrenocortical reactivity. Consistent with the evolutionary-developmental theory, the exploratory analyses also generated the testable hypothesis that relations between levels of childhood support/adversity and the magnitude of stress reactivity are curvilinear, with children from moderately stressful environments displaying the lowest reactivity levels in both studies.

Older Adults and Their Children: Family Patterns of Structural Diversity

Older Adults and Their Children: Family Patterns of Structural Diversity* In a qualitative study of 45 older adults, we found evidence of diversity across individual and family life histories. In-depth analysis of the cases looking across two generations revealed four patterns of diversity: conventional/pluralistic, pluralistic/pluralistic, conventional/conventional, and pluralistic/conventional. The findings suggest the importance for family and gerontological researchers and practitioners to understand the prevalence of structural family diversity that exists in the lives of older adults and their descendants. Sociologists and historians of the family have demonstrated that the history of the family is a story of diversity and complexity (Elder, 1981). Individual and family lives were far less predictable and structured (Hareven, 1982, 1994; Mintz & Kellogg, 1988; Modell, Furstenberg, & Hershberg, 1976) than many commentators of family decline assume today (Glenn, 1997; Popenoe, 1993). The family pattern of the nuclear, two-parent, never-divorced family was actually a demographic anomaly. Family stability in the mid-part of the 20th century, the post war years, in which a large cohort of individuals married early and had a disproportionate number of children, was possible because of benefits in housing and education from the GI bill. Mostly, the White middle class benefited from these economic concessions. The conformity of the 1950s was supplanted with increasing pluralism in family structure by 1960 as mothers of young children returned to the paid labor force in large numbers (Stacey, 1990). Little empirical evidence exists to support the nostalgic belief that family life in past times was characterized by structural homogeneity and relational harmony (Coontz, 1992, 1997) . Despite the diversity and complexity social historians have documented in past family life, the current postindustrial era, characterized by globalization and technological transformations, has introduced new challenges unanticipated by theorists of modern social progress (White, 1991). The emergence of this pluralistic, or postmodern, era in the late 20th century signals a new uncertainty about the present and future (Cheal, 1993; Lather, 1991). Instead of the expectation that one's procreative family will mirror one's family of origin, proceeding through orderly stages in marital and parental careers (Hill & Rodgers, 1964), greater discontinuities with the immediate past (e.g., the conventional modern era) characterize contemporary family life (Cheal, 1991). As Uhlenberg (1980) demonstrated in his historical analysis of key family transitions, marriages were far more likely to end in death of a spouse at the turn of the century than in divorce, as they are today. Uhlenberg's demographic analysis was corroborated by Allen's (1989) qualitative study of 30 lifelong single women and widows born in 1910, one-third of whom lost a parent to death during childhood. Compared to a century ago, individuals today are far more likely to anticipate changes in family structure due to the plurality created through parental divorce, rather than death. At the beginning of the 20th century, 25% of children experienced the death of a parent prior to reaching age 15, but only 7% experienced parental separation or divorce. More than 50% of the children born in the 1990s are expected to spend some time in a single-parent home (Amato, in press). Older Americans came of age in a time when divorce was increasing, but still stigmatized (Goode, 1956). Teen pregnancy was hidden, and girls had few choices but to marry the baby's father and lie about the date of conception (Thompson, 1995). Until the mid-1970s, the American Psychiatric Association and the American Psychological Association classified homosexuality as a mental disorder (Herek, Kimmel, Amaro, & Melton, 1991). Until 1960, interracial marriages were few in number, and 29 states still had legal prohibitions against Black-White marriages. …

Children and Youth with Intellectual Disabilities: Targets for Sexual Abuse

Abstract A disproportionate number of children and youth with an intellectual disability are victims of sexual abuse. This paper examines the characteristics and behaviours which may exacerbate the vulnerability of persons with an intellectual disability toward abusive relationships. Recognition is given to the important roles educators can play in die identification, referral, intervention, and prevention of sexual abuse.

Are too many children being treated with methylphenidate?

A survey was conducted of the use of methylphenidate in British Columbia during a six month period to determine if a disproportionate number of children are being treated with methylphenidate for hyperactivity. The data obtained do not indicate a problem regarding the diagnosis of attention deficit hyperactivity disorder in children. However, the data pertaining to adults indicate that the reasons stated for prescribing methylphenidate are controversial in a significant number of cases.

Socio-economic change and cultural continuity in the lives of the older Tswana

The rural villages of Botswana have a disproportionate number of children and aged resulting from out-migration of able-bodied adults for wage employment. The social position of the rural based aged people, as perceived by urbanites and villagers, was determined through ethnographic interviews and participant observation. The traditional elder contributory roles of childcare and agriculture for women and political and pastoral involvement by men have been modified, still allowing the active old to participate in community life as elders. Social old age occurs when dependency created by physical limitations outweighs contributions possible with body mobility. Minimal economic support provided by adult children to aged parents has been substituted for the fuller traditional expression of filial piety. Grandchildren provide physical care. Low incomes, inexperience with the large numbers of aged and consequent lack of behavioral norms place social emphasis on the economic dependency of old people rather than on the social and service needs as perceived by the socially old individuals, themselves.

‘Social Totalitarianism?’: Children in care in Sweden and the British media

A number of articles in the British press have criticised the Swedish welfare state for taking a disproportionate number of children into care compared with other countries. These allegations are described and their origins investigated through an analysis of pressure group activity. Historical and comparative statistical data are presented to discover whether the allegations are justified. The author concludes that the Swedish child care rate is similar to that of England and Wales, and other Scandinavian countries with the exception of Norway.

Swimming experiences and abilities of nine year olds.

As part of a longitudinal study of children, 941 mothers were asked to report on their childrens' swimming experiences and abilities. At age nine, twenty-nine per cent of the children could swim only a few strokes or not at all. A disproportionate number of children who could swim more than a few strokes came from high socio-economic backgrounds, from families where one or more of the parents could swim, and which scored higher on an index of active recreational orientation. There were no significant sex differences in swimming ability. There were 97 incidents reported where a child had been in difficulties while in water and had to be rescued. The importance of collecting data on such incidents is discussed.

Where have all the children gone?

Current trends in education are both disenfranchising and ignoring children who could benefit from individualized instruction. Historically, identification of educationally handicapped or failing youngsters occurred in the mid to late elementary grades when problems had become overt and when failure itself had complicated the child's school problem. Recent legislative trends have made state and federal monies more available so that there now should exist a greater potential for more educationally failing youngsters to receive assistance. Recently, however, Secretary Califano faced a perplexing problem: how could it be that the heavily funded Child Find early identification programs were able to locate only 3.7 million needy children when 7 million children were to be designated for service under the Education For All Handicapped Children Act (PL 94-142)? Two recent events have set into motion a trend that appears to be producing a series of restrictive identification procedures, the result of which is to limit services to the (allegedly) truly handicapped. For example, prior to 1973 children who were in the mental retardation range (IQs ranging from 68 to 84) could receive special education services. Partly due to the fact that a disproportionate number of children from minority backgrounds were being labeled mentally retarded — often a result of test bias — minority groups, educators, and various political factions in the late 1960s and early 1970s exerted pressure for a redefinition of mental retardation. The revised classification system (Grossman 1973) deleted the retardation category and instituted a more detailed adaptive behavior index to be considered in conjunction with the IQ before classifying an individual as mentally retarded. The immediate effect was to remove service from needy slow learners and borderline retarded persons — a very large group. While this classification system may decrease so-called inappropriate retardation diagnoses, it unquestionably leaves a substantial segment of the population who needs extra-educational assistance outside of special education funding patterns.

Social Survey of Bristol

A PHBLIMINAIIY report on the (standard of living in Bristol, by H. Tout, has been issued by the University of Bristol Social Survey, of which Mr. Tout is director (“The Standard of Living in Bristol: a Preliminary Keport of the Work of tho University of Bristol Social Survey.” By Herbert Tout. Pp. 64. Bristol and London: J. W. Arrowsmith, Ltd., 1938. Is. net). The comprehensive social survey of Bristol which is nearing completion has been made possible by the Colston Research Society, which has assumed entire financial responsibility, while the University undertook responsibility for the conduct of the research work and the appointment of the Survey staff. The preliminary report is only concerned with incomes which fall below middle-class levels, and covers four fifths of all Bristol families. The report indicates that, on the whole, the typical Bristol family is fortunately placed and probably better off than the families of many other towns. There are estimated to be 12,000 families in the Survey area which are very comfortable by the prevailing standards, which are not high, in the classes covered. At the other end of the scale there are 11,000 families in poverty. Between these extremes there are 56,000 families whose standard of living calls for no special remark, and some of these have a small margin for saving or pleasure. Beneath them come 21,000 families who, whilst not in poverty, have a hard struggle and whose lot is far from comfortable. Probably 40,000 people in the area live in actual poverty, and among them a disproportionate number of children, so that one out of five working-class children comes from a home that is unable to give it a fair start in life.