Childhood Hospitalization Research Articles

An investigation of the risk factors of chronic obstructive pulmonary disease in natural population-based cohorts in China - a nested case-control study.

Chronic obstructive pulmonary disease (COPD) has become one of the most significant chronic diseases in China. According to conventional wisdom, smoking is the pathogenic factor. However, current research indicates that the pathophysiology of COPD may be associated with prior respiratory system events (e.g., childhood hospitalization for pneumonia, chronic bronchitis) and environmental exposure (e.g., dust from workplace, indoor combustion particles). Dyspnea, persistent wheezing, and other respiratory symptoms further point to the need for pulmonary function tests in this population. Reducing the burden of chronic diseases in China requires a thorough understanding of the various factors that influence the occurrence of COPD. Using a cohort from the natural population, this study used nested case-control analysis. We carried out a number of researches, including questionnaire surveys and pulmonary function testing, in the Northwest and Southeast cohorts of China between 2014 and 2021. After removing any variations in the baseline data between patients and control subjects using propensity score matching analysis, the risk factors were examined using univariate or multivariate regression. It was discovered that prior history of chronic bronchitis, long-term wheezing symptoms, and environmental exposure-including smoking and biofuel combustion-were risk factors for COPD. Dyspnea, symptoms of mobility limitation, organic matter, and a history of hospitalization for pneumonia at an early age were not significant in the clinical model but their incidence in COPD group is higher than that in healthy population. COPD screening effectiveness can be increased by looking for individuals with chronic respiratory symptoms. Smokers should give up as soon as they can, and families that have been exposed to biofuels for a long time should convert to clean energy or upgrade their ventilation. Individuals who have previously been diagnosed with emphysema and chronic bronchitis ought to be extra mindful of the prevention or advancement of COPD.

Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis

IntroductionTooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk...

A nationwide birth cohort in Japan showed increased risk of early childhood hospitalisation in infants born small for gestational age.

To examine associations between children being born small for gestational age and childhood hospitalisation following term and preterm births. This study included 34 564 children from a nationwide population-based longitudinal survey starting in 2010, comprising 32 603 term births and 1961 preterm births. Children's hospitalisation history was examined during two observational periods, 6-18 and 6-66 months of age. Logistic regression analysis was conducted, adjusting for child and parental confounders, with children born appropriate for gestational age as reference. Children born small for gestational age were more likely to be hospitalised during early childhood than those born appropriate for gestational age. The odds ratio (95% confidence interval) for hospitalisation from 6 to 66 months of age was 1.19 (1.05-1.34) in term children born small for gestational age and 1.47 (1.05-2.06) for preterm children born small for gestational age, compared with those born appropriate for gestational age. The risk of hospitalisation from 6 to 66 months of age in children born small for gestational age was observed for bronchitis/pneumonia. We observed the adverse effects of small for gestational age on hospitalisation during early childhood in both term and preterm births, particularly for bronchitis and pneumonia.

Distribution of ABO and Rh (D) Blood Groups and their Genotypes in Amran Governorate, Yemen

Background: The ABO and Rh blood group system is essential for blood bank inventory, blood transfusion services, and organ transplants. Relatively very little data is available about ABO and Rh (D) blood groups distributions in the Amran governorate. Therefore, this study aimed to determine the distribution of ABO and Rh (D) blood group and their genotypes in the Amran governorate, Yemen. Methods: A cross-sectional prospective and retrospective study was carried out from January 2020 to December 2021, on 1949 volunteer blood donors; 414 medical students were obtained from Amran University and 1535 from clinical records in the blood bank of Maternity and childhood hospital at Amran Governorate. The ABO and RhD grouping was done by using commercially available monoclonal antibodies (anti-A, anti-B, and anti-D) by slide methods. The allele and genotype frequency of the donors was determined by the Hardy-Weinberg equilibrium assumption. Descriptive statistics were analyzed using the SPSS program. The difference between the observed and expected frequency was tested by an online Chi-square calculator. A P-value of <0.05 was considered statistically significant. Results: Out of 1949 participants; were 78.8% of hospital donors, 92.2% of males, and 63.5% of rural areas. Blood group O was the most prevalent (51.2%), followed by A (31.5%), B (13.9%), and AB (3.5%) with statistically significant differences (P= 0.002). The Rh (D) positive was present in 86.8% of participants and 13.2% were Rh (D) negative. Moreover, the allele frequencies were in the order of (IO > IA > IB > AB), where (IO i = 0.513, IA = 0.313, IB = 0.138, and AB= 0.035). While the Rh(D) and d allelic frequencies were 0.868 and 0.132, respectively. Also, there was no statistically significant difference between observed and expected allele and genotype frequency (P-value >0.05). Conclusion: The frequency of distribution of ABO and Rh (D) blood group and their genotypes among the study population was found to be similar to those reported from most Asian populations. This crucial information may be helpful in planning for future health challenges, particularly planning with regard to blood transfusion services.

Breastfeeding and impact on childhood hospital admissions: a nationwide birth cohort in South Korea

Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.

School building energy efficiency and health: Modelling childhood asthma and hospital admissions in England and Wales

School building energy efficiency and health: Modelling childhood asthma and hospital admissions in England and Wales

Income and immunity: The consequences of a pre- and neo-natal income shock on childhood infection risk

ObjectivesThe experiences and conditions that children are exposed to in utero and early infancy impact their health in adulthood. Understanding the channels through which these effects emerge is important, because this may help us to anticipate which children are at highest risk of adverse effects, and provide early interventions to help. In this paper, we test a new channel linking perinatal experiences to later-life health: immunity.
 MethodWe use administrative birth records, linked with hospital admissions episodes and primary care consultations for children in the Northern Territory of Australia. This data forms part of the Child and Youth Development Partnership data linkage project. We analyse the impact of a shock to household income in Aboriginal communities, resulting from a change in government transfer policy. We estimate the impact of exposure to this shock in utero or in the first 3 months of life, relative to exposure later in childhood, to isolate the impact of an income shock during this key developmental period.
 ResultsWe find that children who were exposed to the shock in utero or in their first three months of life were at higher risk of severe infection requiring hospital admission. They spend, on average, 4.5 more days in hospital from birth to their 6th birthday (a 45 percent increase). Most of this impact is concentrated in admissions for infection. Only a small share of the effect can be explained by the immediate impact of the policy on birthweight.
 ConclusionOur findings are consistent with the explanation that an income shock worsens nutrition, and that worse nutrition during key developmental stages can permanently weaken children’s immune systems. This finding speaks to the importance of attention to key phases in childhood development, when designing policies that affect households’ financial resources. Furthermore, we find birthweight is a poor predictor of childhood hospital admission. However, use of longitudinal administrative data helps us to identify alternative markers of new-born health that are better predictors.

Exacerbated lung inflammation following secondary RSV exposure is CD4+ T cell-dependent and is not mitigated in infant BALB/c mice born to PreF-vaccinated dams.

Respiratory syncytial virus (RSV) is the leading cause of childhood hospitalizations due to bronchiolitis in children under 5 years of age. Moreover, severe RSV disease requiring hospitalization is associated with the subsequent development of wheezing and asthma. Due to the young age in which viral protection is needed and risk of vaccine enhanced disease following direct infant vaccination, current approaches aim to protect young children through maternal immunization strategies that boost neutralizing maternal antibody (matAb) levels. However, there is a scarcity of studies investigating the influence of maternal immunization on secondary immune responses to RSV in the offspring or whether the subsequent development of wheezing and asthma is mitigated. Toward this goal, our lab developed a murine model of maternal RSV vaccination and repeat RSV exposure to evaluate the changes in immune response and development of exacerbated lung inflammation on secondary RSV exposure in mice born to immunized dams. Despite complete protection following primary RSV exposure, offspring born to pre-fusion F (PreF)-vaccinated dams had exaggerated secondary ILC2 and Th2 responses, characterized by enhanced production of IL-4, IL-5, and IL-13. These enhanced type 2 cellular responses were associated with exaggerated airway eosinophilia and mucus hyperproduction upon re-exposure to RSV. Importantly, depletion of CD4+ T cells led to complete amelioration of the observed type 2 pathology on secondary RSV exposure. These unanticipated results highlight the need for additional studies that look beyond primary protection to better understand how maternal immunization shapes subsequent immune responses to repeat RSV exposure.

School building energy efficiency and NO2 related risk of childhood asthma in England and Wales: Modelling study

BackgroundClimate change legislation will require dramatic increases in the energy efficiency of school buildings across the UK by 2050, which has the potential to affect air quality in schools. We assessed how different strategies for improving the energy efficiency of school buildings in England and Wales may affect asthma incidence and associated healthcare utilization costs in the future. MethodsIndoor concentrations of traffic-related NO2 were modelled inside school buildings representing 13 climate regions in England and Wales using a building physics school stock model. We used a health impact assessment model to quantify the resulting burden of childhood asthma incidence by combining regional health and population data with exposure-response functions from a recent high-quality systematic review/meta-analysis. We compared the effects of four energy efficiency interventions consisting of combinations of retrofit and operational strategies aiming to improve indoor air quality and thermal comfort on asthma incidence and associated hospitalization costs. ResultsThe highest childhood asthma incidence was found in the Thames Valley region (including London), in particular in older school buildings, while the lowest concentrations and health burdens were in the newest schools in Wales. Interventions consisting of only operational improvements or combinations of retrofit and operational strategies resulted in reductions in childhood asthma incidence (547 and 676 per annum regional average, respectively) and hospital utilization costs (£52,050 and £64,310 per annum regional average, respectively. Interventions that improved energy efficiency without operational measures resulted in higher childhood asthma incidence and hospital costs. ConclusionThe effect of school energy efficiency retrofit on NO2 exposure and asthma incidence in schoolchildren depends critically on the use of appropriate building operation strategies. The findings from this study make several contributions to fill the knowledge gap about the impact of retrofitting schools on exposure to air pollutants and their effects on children's health.

Evaluation and Forecasting Analysis of the Association of Conditional Cash Transfer With Child Mortality in Latin America, 2000-2030

Latin America has implemented the world's largest and most consolidated conditional cash transfer (CCT) programs during the last 2 decades. As a consequence of the COVID-19 pandemic, poverty rates have markedly increased, and a large number of newly low-income individuals, especially children, have been left unprotected. To evaluate the association of CCT programs with child health in Latin American countries during the last 2 decades and forecast child mortality trends up to 2030 according to CCT alternative implementation options. This cohort study used a multicountry, longitudinal, ecological design with multivariable negative binomial regression models, which were adjusted for all relevant demographic, socioeconomic, and health care variables, integrating the retrospective impact evaluations from January 1, 2000, to December 31, 2019, with dynamic microsimulation models to forecast potential child mortality scenarios up to 2030. The study cohort included 4882 municipalities from Brazil, Ecuador, and Mexico with adequate quality of civil registration and vital statistics according to a validated multidimensional criterion. Data analysis was performed from September 2022 to February 2023. Conditional cash transfer coverage of the target (lowest-income) population categorized into 4 levels: low (0%-29.9%), intermediate (30.0%-69.9%), high (70.0%-99.9%), and consolidated (≥100%). The main outcomes were mortality rates for those younger than 5 years and hospitalization rates (per 1000 live births), overall and by poverty-related causes (diarrheal, malnutrition, tuberculosis, malaria, lower respiratory tract infections, and HIV/AIDS), and the mortality rates for those younger than 5 years by age groups, namely, neonatal (0-28 days), postneonatal (28 days to 1 year), infant (<1 year), and toddler (1-4 years). The retrospective analysis included 4882 municipalities. During the study period of January 1, 2000, to December 31, 2019, mortality in Brazil, Ecuador, and Mexico decreased by 7.8% in children and 6.5% in infants, and an increase in coverage of CCT programs of 76.8% was observed in these Latin American countries. Conditional cash transfer programs were associated with significant reductions of mortality rates in those younger than 5 years (rate ratio [RR], 0.76; 95% CI, 0.75-0.76), having prevented 738 919 (95% CI, 695 641-782 104) child deaths during this period. The association of highest coverage of CCT programs was stronger with poverty-related diseases, such as malnutrition (RR, 0.33; 95% CI, 0.31-0.35), diarrhea (RR, 0.41; 95% CI, 0.40-0.43), lower respiratory tract infections (RR, 0.66, 95% CI, 0.65-0.68), malaria (RR, 0.76; 95% CI, 0.63-0.93), tuberculosis (RR, 0.62; 95% CI, 0.48-0.79), and HIV/AIDS (RR, 0.32; 95% CI, 0.28-0.37). Several sensitivity and triangulation analyses confirmed the robustness of the results. Considering a scenario of moderate economic crisis, a mitigation strategy that will increase the coverage of CCTs to protect those newly in poverty could reduce the mortality rate for those younger than 5 years by up to 17% (RR, 0.83; 95% CI, 0.80-0.85) and prevent 153 601 (95% CI, 127 441-180 600) child deaths by 2030 in Brazil, Ecuador, and Mexico. The results of this cohort study suggest that the expansion of CCT programs could strongly reduce childhood hospitalization and mortality in Latin America and should be considered an effective strategy to mitigate the health impact of the current global economic crisis in low- and middle-income countries.

PCOS as a generational disease - risks to mother and children

INTRODUCTION: Polycystic ovary syndrome (PCOS) is the dominant endocrine and metabolic disorder in young women. The incidence has increased significantly over the years and now affects approximately 6-20% of women of childbearing age. AIM: The aim of the work is to present the current state of knowledge about PCOS, to show what complications it brings and to present the disease as a multi-generational problem. TECHNICAL CONDITION. DESCRIPTION: It is widely accepted that hyperandrogenism plays a fundamental role in the development of most of the reproductive and metabolic disorders associated with PCOS. Excess androgens have a detrimental effect on the metabolic homeostasis of women with PCOS, acting on various metabolic tissues. PCOS is associated with reduced fertility or infertility. Women should be aware of factors affecting fertility, especially the effects of obesity and age. After pregnancy, women with PCOS have a significantly increased risk of pregnancy-related complications, including gestational diabetes, high blood pressure disorders, preterm and caesarean delivery, and pre-eclampsia.The offspring of women with PCOS may have an increased risk of birth defects and hospitalization in childhood. According to the DOHaD theory, the unfavorable uterine environment caused by mothers with PCOS, consisting in changes in fetal metabolism, may increase the susceptibility of the offspring to diseases in adulthood, according to the DOHaD theory. In addition, the offspring of PCOS are prone to a range of metabolic diseases in early adulthood, which will also affect the health of their children. CONCLUSION: The effects of endocrine disorders affect women with PCOS as well as their offspring. Diet, weight maintenance, physical activity, anti-androgenic drugs and metformin are recommended to reduce symptoms in mothers and their children. Breaking the vicious circle of intergenerational transmission remains a huge challenge.

Non-specific benefit of seasonal influenza vaccine on respiratory syncytial virus-hospitalisations in children: An instrumental variable approach using population-based data

BackgroundSeasonal influenza vaccine is effective against influenza hospitalisations, but little is known about non-specific effects of the vaccine on other respiratory pathogens with similar seasonal patterns. We aimed to assess the causal impact of seasonal influenza vaccine on laboratory-confirmed hospitalisations for respiratory syncytial virus (RSV) in children using an instrumental variable (IV) strategy. MethodsWe used probabilistically linked population-based data on childhood immunisations, births, deaths, hospitalisations, perinatal factors, and microbiology test results (2000–2013) of all Western Australian (WA) children born 2000–2012, observed longitudinally until the earliest of 7 years of age or 31 December 2013. We exploited a unique natural experiment created from the WA’s state-funded preschool influenza vaccination policy commencing in 2008 and used this as an instrument for children’s seasonal influenza vaccination status. We estimated a system of two simultaneous probit equations: determinants of influenza vaccine uptake, and determinants of RSV-confirmed hospitalisation. ResultsInfluenza vaccine coverage was low prior to 2008 but increased to 36 % in children aged 6–23 months in 2009. The majority (90 %) of RSV-hospitalisations occurred in children <2 years. Receipt of influenza vaccine reduced RSV-hospitalisations, especially in those <2 years with a rate reduction of 2.27 per 1000 (95 % CI: −3.26; −1.28), and a smaller rate reduction of 0.53 per 1000 (95 % CI: −1.04; −0.02) in those 2–7 years. Over the 5-year period (2008–2013), the state-funded preschool-influenza vaccine program resulted in 1,193 fewer RSV-hospitalisations. Of these, 793 (67 %) were in young children <2 years. ConclusionsTo our knowledge, this is the first analysis utilising an IV estimation strategy on a population level to assess the causal impact of seasonal influenza vaccine on risk of RSV-hospitalisations. We estimated a small protective effect that warrants further investigation.

Water fluoridation: what, why, where and when

Dental UpdateVol. 50, No. 6 Guest EditorialWater fluoridation: what, why, where and whenBarry Cockcroft, Simon HearnshawBarry CockcroftChair of the British Fluoridation SocietySearch for more papers by this author, Simon Hearnshawemail: E-mail Address: [email protected]Training Programme Director Health Education England, Coordinator National Community Water Fluoridation NetworkSearch for more papers by this authorBarry Cockcroft; Simon HearnshawPublished Online:13 Jun 2023https://doi.org/10.12968/denu.2023.50.6.475AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Mullen J; European Association for Paediatric Dentistry. History of water fluoridation. Br Dent J 2005 Oct 8; 199(7 Suppl): 1–4. doi: https://doi.org/10.1038/sj.bdj.4812863. PMID: 16215546. Medline, Google ScholarFrom the Centers for Disease Control and Prevention. 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Effect of Overcrowding on Childhood Hospital Admissions for Acute Respiratory Infection: A Matched Case–Control Study

Objective: To determine the association between in-house overcrowding and acute respiratory infections (ARIs) in children. Methods: This case-control hospital-based study wad conducted in Saidu Teaching hospital from March-2022 to December-2022. For cases we included 80 patients of age 6 to 59 months, who presented with newly diagnosed or relapsed cases of ARI. Controls were age and gender matched individuals who presented to outdoor hospital department for non-ARI evaluation and had no history of ARI since past 2 months. The in-house crowding was defined as &gt;3 persons living in one bedroom in a home. Results: Mean age in this study was 18.3±8.9 months in ARI group and 19.7±7.8 months in control group (p-value 0.41). There were higher number of patients belonging to poor class in ARI group; 36 (45%) versus 21 (26.2%) in controls, 26 (32.5%) patients in ARI and 31 (38.7%) patients in controls were belonging to middle class, 18 (22.5%) patients in ARI and 28 (35.0%) patients in control group were belonging to upper class (p-value 0.03). Majority of patients in ARI group were from rural areas; 53 (66.3%) in ARI and 37 (46.3%) in control group (p-value 0.01). In-house overcrowding was found in 19 (20%) patients in ARI group and in only 9 (11.3%) patients in control group (p-value 0.03). Conclusion: In-house crowding is significantly associated with increased risk of ARI. The issue of overcrowding in rural regions is more serious than in cities. For Pakistani populations, the problem of overcrowded housing needs to be addressed. Keywords: In-house overcrowding, Acute respiratory infections, Rural living, socio-economic status.

Risk factors for poorer respiratory outcomes in adolescents and young adults born preterm

RationaleThe respiratory outcomes for adult survivors of preterm birth in the postsurfactant era are wide-ranging with prognostic factors, especially those encountered after the neonatal period, poorly understood.ObjectivesTo obtain comprehensive ‘peak’...

Respiratory syncytial virus promotes allergic predisposition via gastrointestinal microbiome alteration

Abstract Respiratory syncytial virus (RSV) is a leading cause of childhood hospitalizations and increases the relative risk for the development of wheezing and asthma following acute bronchiolitis. Previously, we observed increased allergic predisposition following early life RSV infection in response to cockroach allergen (CRA) with a concurrent alteration in the gastrointestinal microbiome in mouse models of RSV infection and allergy. Importantly, differences in the gastrointestinal microbiome have been reported in children at a high risk for asthma. However, the effect of viral infection induced gastrointestinal microbiome alteration on allergic predisposition has not been studied. Our initial studies showed that early life RSV infection led to altered microbiome development that corresponded with disease development. We hypothesized that RSV-induced alteration of the microbiome can predispose infected animals to enhanced allergic inflammation. To address this, neonatal germ-free mice were colonized with normal microbiome from specific pathogen free mice with subsequent RSV infection followed by CRA modeling at 4 weeks post-infection. Colonization of germ-free neonatal mice protected the development of severe allergic asthma later in life, while an early life RSV infection of colonized mice reduced the protective effect of the microbiome by increasing airway hyperreactivity and T helper 2 induced responses. Taken together, our data indicate that early life RSV infection alters the neonatal microbiome leading to enhanced allergic predisposition. Supported by grants from NIH (R35 HL150682, R01 AI138348)

Potential role of FKBP5 single-nucleotide polymorphisms in functional seizures.

We investigated the associations between FKBP5 single-nucleotide polymorphisms (SNPs) and functional seizures (FS). Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3' region and rs9470080 in the 5' region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group.

Associations among fear of childbirth, resilience and psychological distress in pregnant women: A response surface analysis and moderated mediation model.

Prenatal psychological distress is prevalent during pregnancy. This study aimed to estimate the associations among fear of childbirth, resilience and psychological distress. A total of 1,060 Chinese pregnant women were enrolled from Be Resilient to Postpartum Depression (ChiCTR2100048465) and the following instruments were administered to them: Childbirth Attitudes Questionnaire, Connor-Davidson Resilience Scale, Perceived Social Support Scale, General Self-Efficacy Scale, Adverse Childhood Experience scale and Hospital Anxiety and Depression Scale. A dominance, a response surface analysis and a moderated mediation analysis were performed. In terms of psychological distress, resilience and fear of childbirth could explain 41.6% (0.148/0.356) and 33.1% (0.118/0.356), respectively. Pregnant women with high resilience-low fear of childbirth had significantly lower levels of psychological distress than those with low resilience-high fear of childbirth. The indirect effects of fear of childbirth on psychological distress through resilience was significantly (B = 0.054, 95% CI 0.038 to 0.070). The interactions between fear of childbirth and adverse childhood experiences (β = 0.114, 95% CI -0.002 to 0.231, p = 0.054) and between resilience and adverse childhood experiences (β = -0.118, 95% CI -0.222 to -0.012, p < 0.05) were significant. Resilience, fear of childbirth and adverse childhood experiences may be three important factors to psychological distress in Chinese pregnant women.

The longer-term effects of IVF on offspring from childhood to adolescence.

It is well established that there are increased pregnancy-related complications for a woman who conceives through assisted reproductive treatment (ART). Furthermore, it is known that the risk to the child born is greater, believed to be related to prematurity and growth restriction. Studies have also reported epigenetic changes in the DNA of offspring conceived through ART. In addition, it is believed that they have a greater risk of congenital malformations, although some of these risks may relate to underlying infertility, rather than the ART treatment per se. As a result, it may be expected that there is a greater risk to the longer-term health of the child who is born from ART; however, evidence about the long-term health of children conceived through ART is reassuring. Even though, it is recognised that many of the studies in this field come with limitations. Low numbers of participants is one of the major limitations, which makes subgroup analyses for diverse types of ART, or diverse types of infertility, not feasible. Furthermore, studies are often limited by short follow-up periods because of the difficulty and costs involved in longitudinal study designs. In addition, the rapid changes over time in ART limit the generalisability and significance of long-term findings. Well-designed studies investigating the long-term health outcomes of ART-conceived offspring and the potential influences of various aspects of the ART procedure, as well as studies of the potential underlying epigenetic mechanisms, are imperative. Furthermore, conclusions from childhood hospitalisation data from the United Kingdom, the long-term follow-up and quality of life study from researchers in Melbourne, and the data published from the Western Australian Growing Up Healthy Study will go a long way to help reassure current and prospective parents who may require ART to conceive.

Depressive symptoms among mothers with hospitalized children in South Asia and sub-Saharan Africa

BackgroundPoor maternal mental health during childhood hospitalization is associated with post-discharge child mortality. We aimed to establish if maternal PHQ-9 scores during hospitalization are associated with acute stressors or longer trends in mental health status. MethodMothers of children admitted to nine hospitals in six countries completed a PHQ-9 assessment during hospitalization and 45-days post-discharge. Community participants were recruited from homes near the hospitalized children. The prevalence and correlates of high PHQ-9 scores among hospitalized and community mothers were compared. OutcomesAmong 2762 mothers of hospitalized children, 514 (19 %) had PHQ-9 scores ≥10, significantly more than the 116 (10 %, p < 0·001) of 1159 community participants. Recruitment site and food insecurity were PHQ-9 correlates in both groups. Correlates of higher mean PHQ-9 scores among the hospitalized cohort included maternal illness (mean difference [MD]: 1·27, 95%CI: 0·77, 1·77), pregnancy (MD: 0·77, 95%CI: 0·27, 1·28), child HIV-infection (MD: 2·51. 95%CI: 1·55, 3·52), and lower child weight-for-height (MD: 0·21, 95%CI: 0·32, 0·11). Marriage (MD −0·92, 95%CI: −1·36, −0·48) and a positive malaria test (MD: −0·63, 95%CI: −1·15, −0·10) were associated with lower PHQ-9 scores among mothers of hospitalized children. Among mothers with PHQ-9 ≥10 during admission, 410 had repeat assessments 45-days after their child's discharge, and 108 (26 %) continued to meet the high PHQ-9 criterion. InterpretationAmong mothers of hospitalized children, there are subgroups with transient and persistent depressive symptoms. Interventions tailored to address acute stressors may improve post-discharge pediatric and maternal health outcomes. FundingBill & Melinda Gates Foundation OPP1131320.