The EPA's Commitment to Children's Environmental Health: History and Current Challenges.

Children's environmental health (CEH) has a 25-year history at the US Environmental Protection Agency (EPA), during which the agency has advanced CEH through research, policy, and programs that address children's special vulnerability to environmental harm. However, the Trump administration took many actions that weakened efforts to improve CEH. The actions included downgrading or ignoring CEH concerns in decision-making, defunding research, sidelining the Children's Health Protection Advisory Committee, and rescinding regulations that were written in part to protect children. To improve CEH, federal environmental statutes should be reviewed to ensure they are sufficiently protective. The administrator should ensure the EPA's children's health agenda encompasses the most important current challenges and that there is accountability for improvement. Guidance documents should be reviewed and updated to be protective of CEH and the federal lead strategy refocused on primary prevention. The Office of Children's Health Protection's historically low funding and staffing should be remedied. Finally, the EPA should update CEH data systems, reinvigorate the role of the Children's Health Protection Advisory Committee, and restore funding for CEH research that is aligned with environmental justice and regulatory decision-making needs. (Am J Public Health. 2022;112(1):124-134. https://doi.org/10.2105/AJPH.2021.306537).

[Historical milestones for the control of severe infections and sepsis in pediatrics. Approach through medical philately]. / Hitos históricos para el control de las infecciones graves y la sepsis en pediatría. Aproximación a través de la filatelia médica.

Medical philately, with its diverse themes, is a faithful testimony of the historical events that have affected humanity. Likewise, it allows us to evidence its role as a diffuser of diverse prevention cam paigns carried out to control and eradicate serious infections, together with other achievements of health policy in the child population. Nowadays, the knowledge and collection of postage stamps is an increasingly unusual pastime. On the other hand, sometimes there is a marked historical ignoran ce and lack of appreciation of the effective actions for the control of infectious diseases, forgetting the enormous effect of these on the daily life of the current society. Through the visual testimony offe red by the postage stamps, we review the sanitary, educational, and therapeutic actions destined to control the infections in the pediatric patient, with emphasis on our country. In addition, we discuss the new populations at risk for the appearance of septic episodes. Even today, serious infections and sepsis represent an important public health problem.

First permanent molars with accentuated line patterns: Assessment of childhood health in an urban complex of the fifth millennium before the present.

OBJECTIVES: The objectives are 1) to calculate the position of highly accentuated lines in dental enamel of a group of individuals from Shahr-i-Sokhta, a thriving urban centre in Bronze Age South West Asia; 2) to identify peak frequencies of physiologically stressful periods during early childhood of these individuals; and 3) to relate these peak frequencies to developmental milestones at population level. DESIGN: We analysed highly accentuated lines in the enamel of nine (n = 9) permanent mandibular first molars of nine individuals from the 5th millennium before the present urban and long-distance-trading complex, Shahr-i Sokhta (Iran). Age at death ranged between 4.5 years and 18-20 years. Permanent mandibular first molar enamel begins to mineralise before birth, and is normally completed sometime between 2.1-3.3 years, giving us insight to early childhood physiological stress, the ages at which it occurs, and any peaks in the frequencies in highly accentuated line formation, through histological sections investigated using transmitted light microscopy. RESULTS: Highly accentuated line peak frequencies occur in the sample at c. four, nine, eleven, and twelve months. After 1 year of age, no more peaks occur. CONCLUSION: The peak frequencies coincide with the timing timing of the type of developmental milestones which may have exposed the individuals to an increased pathogen load, injury, or sub-optimal diet. We note similarity in peak timings in the few published, disparate populations, suggest a potential link with attainment of developmental milestones connected with morbidity, and propose reporting standardised statistics to enable exploration of differences between populations in terms of postnatal health-related stress.

A Century Later: Rural Public Health's Enduring Challenges and Opportunities.

The US public health community has demonstrated increasing awareness of rural health disparities in the past several years. Although current interest is high, the topic is not new, and some of the earliest public health literature includes reports on infectious disease and sanitation in rural places. Continuing through the first third of the 20th century, dozens of articles documented rural disparities in infant and maternal mortality, sanitation and water safety, health care access, and among Black, Indigenous, and People of Color communities. Current rural research reveals similar challenges, and strategies suggested for addressing rural-urban health disparities 100 years ago resonate today. This article examines rural public health literature from a century ago and its connections to contemporary rural health disparities. We describe parallels between current and historical rural public health challenges and discuss how strategies proposed in the early 20th century may inform current policy and practice. As we explore the new frontier of rural public health, it is critical to consider enduring rural challenges and how to ensure that proposed solutions translate into actual health improvements. (Am J Public Health. 2020;110:1678-1686. https://doi.org/10.2105/AJPH.2020.305868).

Análise da saúde da criança no estado de Santa Catarina. Brasil: de 1982 a 2018 / Análisis de la salud infantil en el estado de Santa Catarina. Brasil: de 1982 a 2018 / Analysis of child health in the state of Santa Catarina. Brazil: from 1982 to 2018

RESUMO Objetivo Analisar as políticas e os programas direcionados à saúde da criança, no estado de Santa Catarina (SC), Brasil, entre 1982 e 2018, bem como suas contribuições para a redução da mortalidade infantil no estado. Método Pesquisa histórica, com abordagem qualitativa. Os dados foram coletados por meio de pesquisa documental, com busca manual e eletrônica; os documentos obtidos foram submetidos à análise de conteúdo. Resultados Apontam-se as estratégias de vigilância em saúde e atenção primária à saúde, voltadas ao público materno-infantil e neonatal, como as principais responsáveis pelo avanço da saúde da criança, em SC. Os indicadores de mortalidade infantil e cobertura vacinal, juntamente com a análise dos programas/estratégias de saúde catarinenses evidenciaram esses resultados. Conclusão e implicações para a prática o estado de SC investiu, ao longo de 36 anos, em diversas ações e programas que fomentaram a melhoria da saúde da criança, com destaque para as ações de caráter municipal. Analisando e sintetizando as informações previamente pulverizadas em documentos históricos, este trabalho contribui para a visualização e compreensão acerca das práticas governamentais voltadas à criança em SC, nas últimas décadas, facilitando a replicação de boas práticas.

RESUMEN Objetivo Analizar las políticas y programas dirigidos a la salud infantil, en el estado de Santa Catarina (SC), Brasil, entre 1982 y 2018, así como sus contribuciones a la reducción de la mortalidad infantil en el estado. Método Investigación histórica, con enfoque cualitativo. Los datos fueron recolectados mediante investigación documental, con búsqueda manual y electrónica; los documentos obtenidos fueron sometidos a análisis de contenido. Resultados Las estrategias de vigilancia de la salud y la atención primaria de salud, dirigidas al público materno infantil y neonatal se señalan como las principales responsables del avance de la salud del niño en SC. Los indicadores de mortalidad infantil y cobertura de vacunación, junto con el análisis de los programas / estrategias de salud de Santa Catarina, mostraron estos resultados. Conclusión y implicaciones para la práctica El estado de SC ha invertido, durante 36 años, en diversas acciones y programas que han promovido la mejora de la salud del niño, con énfasis en acciones de carácter municipal. Analizando y sintetizando la información previamente pulverizada en documentos históricos, este trabajo contribuye a la visualización y comprensión de las prácticas gubernamentales dirigidas a los niños en SC, en las últimas décadas, facilitando la replicación de buenas prácticas.

ABSTRACT Objective To analyze policies and programs directed to child health, in the state of Santa Catarina (SC), Brazil, between 1982 and 2018, as well as their contributions to the infant mortality reduction in the state. Method Historical research, with a qualitative approach. Data were collected through documentary research, with manual and electronic search; the documents obtained were submitted to content analysis. Results Health surveillance strategies and primary health care, aimed at the maternal-infant and neonatal public are pointed out as the main responsible for the advancement of the child's health, in SC. The indicators of infant mortality and vaccination coverage, together with the analysis of Santa Catarina's health programs / strategies, pointed these results. Conclusion and implications for practice The state of SC has invested, over 36 years, in various actions and programs that have promoted the improvement of child health, with emphasis on actions of municipal scope. By analyzing and synthesizing information previously pulverized in historical documents, this work contributes to the visualization and understanding about government practices aimed at children in SC, in the last decades, facilitating the replication of good practices.

[Alexandre Frias i Roig: childcare pediatrician, medical doctor and scientific disseminator. Tireless fighter in favor of breastfeeding and childhood]. / Alexandre Frias i Roig: puericultor, médico y divulgador. Luchador incansable en favor de la lactancia materna y de la infancia.

INTRODUCTION: Alexandre Frias was born in Reus, the city where he developed most of his professional activity. Medical doctor and childcare pediatrician, he worked tirelessly in order to improve children's health. He created the first Instituto de Puericultura Integral (Integral Institute of Childcare) in Spain in 1919, which remained in operation until his death. The Institute's activities began with a clinic for breastfeeding children, breastfeeding service and a biochemical analysis laboratory, later expanding with prenatal childcare services, a refectory for pregnant women and general women, a pediatric office with a vaccination service and, as a complement, a home health care service and medical obstetrics. Convinced that breastfeeding and hygiene were fundamental for the prevention of diseases, he carried out an enormous educational work among mothers, doctors, governors and society in general. Forerunner of numerous initiatives for curative and preventive purposes, he established health education for mothers and professionals, school colonies, medical-school inspection, home delivery of scales for weight control and incubators for premature children and even a hygienic dress model for newborns. He made numerous publications as books form, such as the one entitled "Lo que deben saber las madres", booklets and newspapers articles. He founded and directed the scientific journal Puericultura (child care), published in Reus and distributed throughout the country until 1936. Its incessant activity in favor of the fight against infant mortality drastically reduced infant/children mortality in Reus and influenced the health and demographic improvement of all of Spain.

INTRODUCCIÓN: Alexandre Frias nació en Reus, ciudad donde desarrolló la mayor parte de su actividad profesional. Médico y puericultor, trabajó incansablemente con el fin de mejorar la salud infantil. Creó el primer Instituto de Puericultura integral de España en 1919, que se mantuvo en funcionamiento hasta su muerte. Las actividades del instituto se iniciaron con un consultorio para niños lactantes, servicio de lactario y un laboratorio de análisis, y se ampliaron posteriormente con servicios de puericultura prenatal, refectorio para embarazadas y mujeres, un consultorio de pediatría con servicio de vacunación y, como complemento, un servicio de asistencia domiciliaria de comadrona y un médico tocólogo. Convencido de que la lactancia materna y la higiene eran fundamentales para la prevención de enfermedades, realizó una ingente labor educativa entre madres, médicos, gobernantes y sociedad en general. Precursor de numerosas iniciativas con fines curativos y preventivos, instauró la educación sanitaria para madres y profesionales, las colonias escolares, la inspección médica-escolar, el servicio a domicilio de básculas para control de peso e incubadoras para niños prematuros e incluso un modelo de vestido higiénico para recién nacidos. Realizó numerosas publicaciones en forma de libros, como el titulado "Lo que deben saber las madres", opúsculos y artículos de prensa. Fundó y dirigió la revista Puericultura, editada en Reus y distribuida a todo el país, que se publicó hasta 1936. Su incesante actividad en pro de la lucha contra la mortalidad infantil redujo drásticamente las muertes en Reus e influyó en la mejora sanitaria y demográfica de toda España.

North and south: A comprehensive analysis of non-adult growth and health in the industrial revolution (AD 18th-19th C), England.

OBJECTIVE: Stark health inequalities exist in the present day between the North and South of England, with people in the South, overall, experiencing better health across a range of parameters (e.g., life expectancy and number of years spent in good health). Bioarchaeological studies of skeletal remains from cemeteries across this geographical divide have the ability to provide a temporal perspective on the etiology, longevity, and nature of this disparity. METHODS: In total 574 non-adults (0-17 years) from six urban sites (c. AD 1711-1856) were analyzed from the North and South of England. Measurements of long bone length, cortical thickness, and vertebral dimensions were analyzed alongside both skeletal and dental palaeopathological data to assess patterns of disease and growth disruption between skeletal samples. RESULTS: There were few significant differences in growth parameters between the six sites in relation to geographical location. However, the northern-based sample Coach Lane (North Shields) demonstrated some of the highest rates of pathology, with metabolic disease being particularly prevalent. DISCUSSION: Northern and southern populations suffered alike from the detrimental environmental conditions associated with urban centers of the 18th-19th centuries. However, the elevated prevalence of vitamin D deficiency seen within the Coach Lane sample is indicative of a regionally specific risk that may be related to latitude, and/or the influence of particular industries operating in the North-East.

Periconceptional care and offspring health at birth and long term, from the perspective of Avicenna.

Periconceptional care such as lifestyle plays an important impact role in offspring health. The aim of the present study was to clarify the perspective of Avicenna on periconceptional care. Avicenna (980-1037 A.D.) was one of the outstanding Persian physicians, who made great contributions to the field of medical sciences, in particular, obstetrics. In advance, Avicenna's book, Canon of Medicine, was considered to find his perspectives on periconceptional care. Then, his ideas and theories were compared to the current findings by searching the keywords in main indexing systems including PubMed/MEDLINE, Scopus and Institute for Scientific Information Web of Science as well as the search engine of Google Scholar. Current investigations show that gamete quality, pregnancy outcome, and offspring health at birth and long term depend on both parents' lifestyle in pre- and periconceptional period, as well as the intrauterine environment. Avicenna believed that seminal fluid, sperm, ovum, and developing conditions in utero were influenced by the stages of food digestion and the function of some organs. On the other hand, food digestion and function of the organs also depend on each parent's lifestyle and environmental factors. He mentioned 6 principles of healthy lifestyle: exercise, nutrition, sleep and awareness, excretion of body wastes and retention of necessary materials, psychic features, as well as air and climate. Thus, a multicomponent healthy lifestyle should be considered by parents of child-bearing age in an appropriate period before and in early pregnancy as well as elimination of any disorders in parents, to give birth to more healthy offspring.

Always stay cheerful - health information in the 1920s. / Vær alltid i godt humør ­ helseopplysning i 1920-årene.

BACKGROUND: The interwar period was a time of comprehensive preventive health programmes in Norway. Physical exercise, nutritious diets, strict sleep regimens and better hygiene were at the centre of these efforts. A massive mobilisation of volunteers and professionals took place. The publication of House Maxims for Mothers and Children was part of this large-scale mobilisation, and consisted of ten posters with pithy health advice for hanging on the wall. Mothers were an important target group for health promotion. MATERIAL AND METHOD: The posters have previously received little attention in medical literature, but they can elucidate some features of life and the health propaganda of their time. We have used databases that provide access to newspapers, books and medical literature: Retriever, bokhylla.no, Oria, PubMed and Web of Science. RESULTS: It is hard to quantify the effect of this popular movement when compared to political measures to improve living conditions. In any case, mortality rates fell, life expectancy increased and the dreaded communicable diseases were largely defeated. Special efforts were targeted at children, also with good results. Infant mortality fell and schoolchildren became healthier, stronger, taller and cleaner. INTERPRETATION: The line between social hygiene and general disciplining is blurred, for example the boundary between a healthy diet and bourgeois norms. The education of mothers and children also included a normative aspect that concerned good manners and control.

[The Priority Directions of Children Health Support in Conditions of the Region During the Great Patriotic War].

The article presents analysis of state of children health care in Kabardino-Balkaria during the Great Patriotic War (1941-1945). The significant hardships are demonstrated concerning children health support during German occupation in winter 1942-1943 and during post-occupation period. The significant increase of morbidity children infections, especially measles, undernourishment, hard domestic conditions were specific for this period. The main causes of high mortality among children were pneumonia, acute diseases of gastro-intestinal tract, whooping cough, scarlatina, diphtheria. The acute deficiency of medical personnel and untimely implementation of planned inoculations resulted indecreasing of the level of preventive activities among children population. The number of children consultations shortened twice. The special significance for development of pediatric service played organization of municipal and district pediatricians, preventive appointments of healthy children and home-nursing activities at the pediatric districts. The development of children health care characterized by increasing of load on medical institutions, implementation of emergency activities under guidance of departments organized by the Narkomzdrav of the Republic. A significant portion of activities was implemented by public organizations. The foundations of support of children evacuated ti the Republic and foundations of support of orphan children were organized.

"Save 100,000 Babies": The 1918 Children's Year and Its Legacy.

In April 1918, President Woodrow Wilson, alarmed at the high draftee rejection rate, proclaimed the second year of American engagement in World War I as "Children's Year." The motto of the nationwide program was to "Save 100,000 Babies." Children's Year represented a multipronged child welfare campaign aimed at gathering data on best practices regarding maternal and child health promotion, documenting the effects of poverty on ill health, reducing the school drop-out rate, ensuring safe play spaces for children, and addressing the unique needs of targeted populations such as orphans and delinquents. Thousands of communities across the country participated in Children's Year, which was overseen by the Children's Bureau and the Woman's Committee of the Council of National Defense. The 1919 White House Conference on Children's Health synthesized all of the Children's Year findings into concrete recommendations. But in an effort to minimize conflict with organized medicine and those who feared governmental intrusion into family life, stakeholders accepted a series of compromises. By so doing, they inadvertently helped enshrine the means-tested, class-based, fragmented approach to child well-being in the United States that persists to this day.

Childhood health as reflected in adult urban and rural samples from medieval Denmark.

This study examines the evidence of three skeletal markers relating to childhood health that leave permanent observable changes in the adult skeleton. Two are well known to paleopathology, namely Harris lines (HL) and linear enamel hypoplasia (LEH). The third skeletal marker is less commonly used; the permanent changes in the temporal bones, induced by chronic or recurrent infectious middle ear disease (IMED) in childhood. A total of 291 adult skeletons from an urban (n = 109) and a rural (n = 182) cemetery, from the Danish medieval period (1050-1536 CE) were included. The markers were examined for their co-occurrence, and differences between the two samples. No statistically significant difference for the three skeletal markers between the two samples was found. A trend was nevertheless apparent, with greater frequencies for all three skeletal markers for the urban population. A statistically significant relationship was found only between IMED and HL. This positive relation was very low (rɸ = 0.307, 0.275) and may be considered non-existent. The lack of co-occurrence is interpreted as if an individual was exposed to conditions that could cause the osteological expression of all three markers this could be a life-threatening health condition, during developing years.

Assessing childhood stress in early mediaeval Croatia by using multiple lines of inquiry.

ABSTRACT: Childhood stress, using both subadult and adult remains from early mediaeval (8th-11th c. CE) sites on the eastern Adriatic coast is analysed in this report. A total of 242 individuals (83 subadults, 69 adult females, and 90 adult males) were assessed for the presence of linear enamel hypoplasia, cribra orbitalia, sub-periosteal new bone formation, and scurvy. In addition, the dietary profile of nine subadults was assessed by the analysis of carbon and nitrogen stable isotopes from bulk collagen. Over three quarters of individuals with preserved permanent dentition (44/56 or 78.6%) exhibited evidence of linear enamel hypoplasia, while analysis of the onset of this condition shows that all defects formed between 1.2 and 5.6 years of age. Cribra orbitalia was identified in 60 out of 190 individuals with preserved frontal bones (31.6%). Sub-periosteal new bone formation was recorded in 42.6% of analysed subadults (29/68) with fourteen cases still active at the time of death. Additionally, scurvy was identified in three subadults. The isotopic study of carbon and nitrogen suggests that diet of the analysed subadults was based on terrestrial C3 resources, with a varying input from C4 and a low intake of marine resources. The presented study strongly indicates that a large majority of the analysed individuals suffered from poor health during their childhood as indicated by the high frequencies of linear enamel hypoplasia, cribra orbitalia and sub-periosteal new bone formation.

Predictable and Preventable: Historical and Current Efforts to Improve Child Injury Prevention.

BACKGROUND: Childhood injuries are a global epidemic. Accidents resulting in childhood injury and death were first identified as a concern over a century ago. However, "accidents" leading to injury were not recognized as being predictable and preventable until more recently. OBJECTIVES: To describe the worldwide epidemic of childhood injuries, and look at international successes in the field of injury prevention. METHODS: Literature pertaining to injury prevention was reviewed to describe the history of childhood injury prevention, guiding principles of injury prevention, successful strategies for prevention, and future directions. RESULT AND CONCLUSION: Through surveillance, evidence-based injury prevention initiatives, and multi-disciplinary collaboration, we anticipate further reduction in childhood injuries.