Topical Pharyngeal Anesthesia in Sedated Pediatric Patients Undergoing Esophagogastroduodenoscopy.

OBJECTIVES: Pediatric patients undergoing esophagogastroduodenoscopy (EGD) commonly receive procedural sedation for comfort and to facilitate the procedure. EGD with procedural sedation carries the risk of several airway incidents and/or adverse events (AIAE). Topical pharyngeal anesthetics (TPAs) can blunt the airway reflexes and decrease the incidence of laryngospasm but has not been well studied with EGD under procedural sedation. We aimed to study the effect of adding a TPA to propofol-based sedation on the rate of AIAE. METHODS: This is a single-center, retrospective, observational cohort study. We compare AIAE rates (coughing, gagging, apnea, airway obstruction, and laryngospasm) in children who received TPA as part of their propofol-based procedural sedation for EGD with those who did not receive TPA. RESULTS: In 2021, 73 patients received TPA as part of the procedural sedation for EGD and 123 did not. The overall rate of AIAE was high with 75 (38%) patients experiencing 1 or more AIAE. Patients who received benzocaine spray experienced more AIAE than the control group [adjusted odds ratio (aOR) = 1.16; 95% confidence interval (CI): 1.01-1.34; P = 0.037]. Coughing, gagging, apnea with desaturation rates, and laryngospasm were similar in both groups (coughing aOR = 1.01; 95% CI: 0.91-1.13; P = 0.814; gagging aOR = 1.01; 95% CI: 0.91-1.13; P = 0.814; apnea aOR = 0.99; 95% CI: 0.95-1.04; P = 0.688; laryngospasm OR = 1.01; 95% CI: 0.95-1.07; P = 0.71). The rate of airway obstruction requiring jaw thrust was higher in the benzocaine group but did not reach statistical significance (aOR = 1.11; 95% CI: 0.97-1.26; P = 0.133). CONCLUSION: The use of topical pharyngeal benzocaine in children undergoing EGD with propofol-based sedation is associated with a higher overall AIAE rate. Most of the AIAE were mild incidents and only 7 patients experienced true adverse events.

Disaster Preparedness and Housing Tenure: How Do Subsidized Renters Fare?

Homeowners are significantly more prepared for disasters than renters. However, disaster preparedness among subsidized renters is an understudied topic despite their increased vulnerability to negative disaster outcomes. Previous research shows that one in three subsidized units is at risk for exposure to disasters, relative to one in four unsubsidized rental units, and one in seven owner-occupied units. Subsidized housing residents often fall into many vulnerable statuses that would make them less prepared than renters and owners. Using 2017 American Housing Survey data, we examine differences in household disaster preparedness by housing tenure, with and without controls for such factors. Logistic regression analyses indicate that subsidized renters are significantly less prepared than unsubsidized renters, and both renter types are significantly less prepared than homeowners, controlling for demographic and neighborhood characteristics. The policy implications of this research are considered as they relate to the location and management of subsidized housing in an era of climate change.

Screen Time in the Coronavirus 2019 Era: International Trends of Increasing Use Among 3- to 7-Year-Old Children.

OBJECTIVE: To evaluate changes in electronic screen-based media use in 3- to 7-year-old children across 6 countries as a result of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Between April and July 2020, parents of 2516 children completed online survey measures reporting current ("now") and retrospective ("before the pandemic") screen-based media use for the purposes of entertainment, educational app use, and socializing with family and friends. Parents also reported family socioeconomic characteristics and impacts of the pandemic to their physical wellbeing (eg, whether a family member or friend had been diagnosed with COVID-19) and social disruption (eg, whether family experienced a loss of income or employment due to the pandemic). RESULTS: On average, children engaged with screens more than 50 minutes more during the pandemic than before. This was largely driven by increases in screen use for entertainment purposes (nearly 40 minutes) and for use of educational apps (over 20 minutes). There was no overall change in screen use for socializing with family and friends. Children from lower socioeconomic status households increased screen use both for entertainment and educational app use more so than did children from higher socioeconomic status households. CONCLUSIONS: The global pandemic caused by COVID-19 has increased overall electronic screen-based media use. As lives become increasingly digital by necessity, further research is needed to better understand positive and negative consequences of electronic screen-based media use.

Methadone's Effect on Cardiac Repolarization: Safety in the PICU.

OBJECTIVES: Opioids are routinely used in the PICU. Methadone is an effective method of preventing and treating iatrogenic opioid withdrawal; however, it carries an Food and Drug Administration Boxed Warning due to the potential to prolong the corrected QT interval and potentially lead to life-threatening arrhythmias. Guidelines on the safe use of methadone have limited applicability to children since their cardiac intervals differ from those of adults. There is little data on the electrophysiologic effects in the pediatric population. We set out to describe the safety of methadone use in the PICU, hypothesizing that methadone does not cause a significant change in corrected QT interval from baseline. DESIGN: Retrospective cohort study. SETTING: Children's Hospital of Wisconsin, Milwaukee, WI. PATIENTS: Fifty-one patients, age less than or equal to 18 years old, initiated on methadone during PICU admission, over an 11-month period, for the prevention or treatment of opioid withdrawal. INTERVENTIONS: Retrospective data queried from the electronic health record and stored telemetry waveforms obtained from an automated real-time patient data acquisition software system (BedMasterEx; Anandic Medical Systems AG, Feuerthalen, Switzerland). MEASUREMENTS AND MAIN RESULTS: Corrected QT intervals were not significantly different at 12 hours, 96 hours, or PICU discharge (p values: 0.57, 0.54, and 0.34) when compared to baseline. The median change in corrected QT from baseline to 12 hours after the first dose of methadone was 5 ms (interquartile range, -12 to 11 ms), 0 ms to steady state (interquartile range, -18 to 18 ms), and 5 ms from baseline to 12 hours after the highest dose of methadone (interquartile range, -14 to 16 ms). The most common primary diagnosis was structural heart disease (29% of subjects) in our cohort and every subject that experienced an increase in corrected QT interval greater than or equal to 40 ms had some form of structural heart disease. CONCLUSIONS: Methadone did not significantly prolong the corrected QT interval in a population of critically ill children, suggesting that it can be safely used in this population, although patients with structural heart disease may warrant closer monitoring.

Muslim-Non-Muslim Locational Attainment in Philadelphia: A New Fault Line in Residential Inequality?

This study examines Muslim-non-Muslim disparities in locational attainment. We pool data from the 2004, 2006, and 2008 waves of the Public Health Management Corporation's Southeastern Pennsylvania Household Survey. These data contain respondents' religious identities and are geocoded at the census-tract level, allowing us to merge American Community Survey data and examine neighborhood-level outcomes to gauge respondents' locational attainment. Net of controls, our multivariate analyses reveal that among blacks and nonblacks, Muslims live in neighborhoods that have significantly lower shares of whites and greater representations of blacks. Among blacks, Muslims are significantly less likely than non-Muslims to reside in suburbs. The Muslim disadvantages for blacks and nonblacks in neighborhood poverty and neighborhood median income, however, become insignificant. Our results provide support for the tenets of the spatial assimilation and place stratification models and suggest that Muslim-non-Muslim disparities in locational attainment define a new fault line in residential stratification.

Prothrombin Complex Concentrate for Intracerebral Hemorrhage Secondary to Vitamin K Deficiency Bleeding in a 6-Week-Old Child.

Four-factor prothrombin complex concentrate is approved for use of life-threatening bleeding secondary to vitamin K antagonism in adults. We describe the use of four-factor prothrombin complex concentrate for hemostasis in a 6-week-old child with life-threatening vitamin K dependent-bleeding who never received vitamin K prophylaxis at birth.

Declining segregation through the lens of neighborhood quality: does middle-class and affluent status bring equality?

Middle- and upper-class status along with suburban residence are together considered symbolic of the American dream. However, the question of whether they mean access to better quality residential environments has gone largely unexplored. This study relies on data from the 2009 panel of the American Housing Survey and focuses on a range of neighborhood conditions, including indicators of physical and social disorder as well as housing value and a neighborhood rating. Contrary to the tenets of the spatial assimilation model, we find that middle-class and affluent status do not consistently lead to superior conditions for all households. Neighborhood circumstances vary considerably based on householder race and ethnicity, with blacks and Hispanics experiencing the greatest disparities from whites. In addition, suburban residence does not attenuate such differences, and in some cases, well-to-do minorities do even worse than whites in neighborhood quality in suburbs.

"It Helps Make the Fuzzy Go Away": Autistic Adults' Perspectives on Nature's Relationship with Well-being Through the Life Course.

Background: While previous work highlights the links between nature and various positive well-being-related outcomes, the experiences of autistic people in nature have received limited empirical research. Our study aimed at gathering autistic adults' perspectives on the relationship between nature and well-being in both childhood and adulthood. Methods: We used an online survey to capture the views of 127 autistic adults across the United Kingdom. Using reflexive thematic analysis, we analyzed responses to three questions focused on nature experiences in childhood and adulthood and how the participants felt that nature was (or was not) related to well-being. Guided by self-determination theory, we used both inductive and deductive analysis. Results: We developed three main themes to reflect the nature experiences of autistic adults: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. Compared with many other contexts, nature provides a non-judgmental space through which (in both childhood and adulthood) many, but not all, autistic individuals can meet individual needs and experience autonomy, relatedness, and competence. Conclusion: This analysis of how autistic adults in the United Kingdom utilize nature to support well-being has implications for how nature can be used in social prescribing as well as in ensuring that existing outdoor spaces, organizations, and activities are supportive of autistic people.

Why is this an important issue? Autistic adults often experience poorer mental health and overall well-being than neurotypical adults. Since some autistic adults are very interested in nature and often report that they feel better after spending time in nature, natural spaces and activities taking place outside could be one way of improving well-being for autistic adults. What was the purpose of this study? There is very little research on how autistic adults experience nature, although some autistic people have written about their experiences. The purpose of this study was to develop an understanding of how autistic people experience nature and how nature might benefit their well-being. What did the researchers do? We created a survey that asked 26 questions about how autistic adults experience nature. This survey included questions about how often they visited nature, if they had a focused interest in nature, whether and how nature was related to their well-being, and childhood experiences of nature. Focusing on three of the questions, we used reflexive thematic analysis (a way of identifying patterns in data) to develop three themes. What were the results of the study? The three themes we developed were: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. These themes illustrate the different ways that autistic adults experienced nature. For some, nature was a way of relating to others and relating more deeply with themselves. Nature was also a way of escaping from people who were unkind, from situations that were uncomfortable, and from other stresses in life. Many autistic participants reported that nature was helpful to their well-being, because they experienced less judgment from natural spaces and creatures­though other people were sometimes judgmental, which made nature experiences worse. What do these findings add to what was already known? These findings confirm previous research showing that many autistic people have focused interests in nature. The findings not only add to the numerous existing anecdotal accounts about how autistic people feel in nature but also demonstrate a diverse range of perspectives. Not all autistic participants in this study felt that nature was beneficial to their well-being. What are the potential weaknesses of the study? Unfortunately, surveys are only accessible to people who have Wi-Fi/internet access, can use a computer or phone, and have the time to complete the survey. The survey might also have drawn in participants who were specifically interested in this topic, which might influence the findings. How will these findings help autistic adults now or in the future? These findings will help autistic adults, practitioners, and carers to identify a potential source of support for well-being. As autistic adults in this study used nature to meet different needs related to their well-being, natural space and nature-based activities may help improve well-being in autistic adults who enjoy nature.

Ambient heat and diabetes hospitalizations: Does the timing of heat exposure matter?

BACKGROUND: Although ambient heat exposure is linked with diabetes mortality, the impacts of heat exposure on diabetes-related hospitalizations remain controversial. Previous research did not examine the timing of heat-diabetes associations and relation with comorbidities/risk factors. OBJECTIVE: We examined the association between heat exposure and diabetes-related hospitalizations in the transitional and summer months and identified populations vulnerable to heat. METHODS: We conducted a time-stratified case-crossover study. Data on diabetes hospital admissions (primary diagnosis of type 1 and type 2 diabetes, 2013-2020) were collected by the New York State (NYS) Department of Health under the state legislative mandate. We treated temperature and air pollutants as continuous variables and defined the heat exposure as per interquartile range (IQR, a measure between the 25th and 75th percentiles) increase of daily mean temperature. Conditional logistic regressions were performed to quantify the heat-diabetes associations after controlling for air pollutants and time variant variables. Multiplicative-scale interactions between heat and demographics/comorbidities/risk factors on diabetes hospitalizations were investigated. RESULTS: Each IQR increase in temperature was associated with significantly increased risks for diabetes admissions that occurred immediately and lasted for an entire week during multi-day lags in the transitional month of May (ranges of excess risk: 3.1 %-4.8 %) but not in the summer (June-August) (ranges of excess risk: -0.3 %-1.3 %). The significant increases in the excess risk of diabetes were also found among diabetes patients with complications of neuronopathy (excess risk: 27.7 %) and hypoglycemia (excess risk: 19.1 %). Furthermore, the modification effects on the heat-diabetes association were significantly stronger in females, Medicaid enrollees, non-compliant patients, and individuals with comorbidities of atherosclerotic heart disease and old myocardial infarction. CONCLUSIONS: Ambient heat exposure significantly increased the burden of hospital admissions for diabetes in transitional rather than summer months indicating the importance of exposure timing. Vulnerability to heat varied by demographics and heart comorbidity.

Spatial Variation in COVID-19 Mortality in New York City and Its Association with Neighborhood Race, Ethnicity, and Nativity Status.

We examined the association between variation in COVID-19 deaths and spatial differences in the racial, ethnic, and nativity-status composition of New York City neighborhoods, which has received little scholarly attention. Using COVID-19 mortality data (through 31 May 2021) and socioeconomic and demographic data from the American Community Survey at the Zip Code Tabulation Area level as well as United-Hospital-Fund-level neighborhood data from the Community Health Survey of the New York City Department of Health and Mental Hygiene, we employed multivariable Poisson generalized estimating equation models and assessed the association between COVID-19 mortality, racial/ethnic/nativity-status composition, and other ecological factors. Our results showed an association between neighborhood-level racial and ethnic composition and COVID-19 mortality rates that is contingent upon the neighborhood-level nativity-status composition. After multivariable adjustment, ZCTAs with large shares of native-born Blacks and foreign-born Hispanics and Asians were more likely to have higher COVID-19 mortality rates than areas with large shares of native-born Whites. Areas with more older adults and essential workers, higher levels of household crowding, and population with diabetes were also at high risk. Small-area analyses of COVID-19 mortality can inform health policy responses to neighborhood inequalities on the basis of race, ethnicity, and immigration status.

Respite and connection: Autistic adults' reflections upon nature and well-being during the Covid-19 pandemic.

LAY ABSTRACT: The Covid-19 pandemic and associated lockdowns provided opportunities to spend time in nature, with many people reporting that this benefitted their well-being. However, existing research from the pandemic period has focused on the way general populations experienced nature; less is known about how autistic people used nature to support their well-being during the pandemic. We created a survey that invited autistic adults living in the United Kingdom to reply to text box questions. A total of 127 people responded to our survey; we analysed their responses using a method called reflexive thematic analysis and developed themes based on patterns among all the responses. We developed two themes: respite in nature and connecting amid widespread disconnection. For some autistic adults during the pandemic, nature provided physical distance from others or from crowded homes, which helped them reduce their stress. In addition, some participants felt more psychologically connected to nature itself during the pandemic, while for others, nature served as a way of connecting with others during a potentially isolating time. These findings are important for autistic people and their families and carers who may want to seek out nature-based activities to support well-being in the wake of the pandemic.

Understanding changes to children's connection to nature during the COVID-19 pandemic and implications for child well-being.

While psychological connection to nature is known to be associated with both pro-environmental behaviours and well-being, there is an urgent need to extend this research to consider impacts from the COVID-19 lockdown period. Examining whether children's connection to nature changed during this period, identifying the drivers of these changes and determining the links between connection to nature and child well-being can each serve to guide post-lockdown initiatives to promote children's connection to nature.Three findings emerged from this UK sample of 376 families with young children. First, nearly two thirds of parents reported a change (most typically, an increase) in their child's connection to nature. Explanations for this increase included having more time, increased enjoyment of nature and increased awareness or interest in nature. Second, a third of children whose connection to nature decreased during the pandemic displayed increased problems of well-being-manifest as either 'acting out' (externalising problems) or sadness/anxiety (internalising problems). Third, an increase in connection to nature during the pandemic was more evident for children from affluent families than for their less affluent peers.While connecting to nature may be an effective means of addressing child problems of well-being, the divergent findings for children from different family backgrounds indicate that efforts to enhance connection to nature should focus on the barriers experienced by children from less affluent families. A free Plain Language Summary can be found within the Supporting Information of this article.

Association between extreme ambient heat exposure and diabetes-related hospital admissions and emergency department visits: A systematic review.

Background and objectives: Diabetes is an increasing public health concern worldwide. The impact of extreme heat exposure on diabetes healthcare utilization such as diabetes-related hospital admissions and emergency department (ED) visits was understudied although extreme temperature exposure was linked with diabetes mortality. In addition, very few systematic reviews have been conducted in this field. This review aims to systematically evaluate the currently available evidence on the association between extreme ambient heat exposure and hospital admissions/ED visits for diabetes and the vulnerable population to heat extremes. Methods: A systematic literature review was conducted by using the keywords/terms "ambient temperature or heatwave or heat wave or extreme temperature or high temperature effect " and "diabetes morbidity or diabetes hospital admissions or diabetes emergency room visits " for available publications until August 2022. The heat exposure was categorized into four groups using difference definitions. The outcomes were diabetes-related hospital admissions/ED visits. A meta-analysis was performed to estimate the pooled effects of relative risk (RR)/odds ratio (OR) and 95% confidence intervals (CI) for each of the associations of interest. Results: Eighteen articles were selected from forty full-text, English written papers based on the inclusion and exclusion criteria. The overall pooled effect of excessive heat on diabetes, across all groups, was 1.045 (95% CI 1.024-1.066). The pooled effects for each exposure group were significant/borderline significant. Additionally, the pooled effect of the RR/OR was 1.100 (95% CI: 1.067-1.135) among adults aged 65 years or older. The most controlled confounders were air pollutants. The commonly listed limitation in those studies was misclassification of exposure. Conclusions: The body of evidence supports that ambient extreme heat exposure is associated with diabetes-related hospital admissions/ED visits. Additionally, adults 65 years of age or older with diabetes are vulnerable to heat extremes. Future studies should consider controlling for various biases and confounders.

Building a predictive model to identify clinical indicators for COVID-19 using machine learning method.

Although some studies tried to identify risk factors for COVID-19, the evidence comparing COVID-19 and community-acquired pneumonia (CAP) is inconclusive, and CAP is the most common pneumonia with similar symptoms as COVID-19. We conducted a case-control study with 35 routine-collected clinical indicators and demographic factors to identify predictors for COVID-19 with CAP as controls. We randomly split the dataset into a training set (70%) and testing set (30%). We built Explainable Boosting Machine to select the important factors and built a decision tree on selected variables to interpret their relationships. The top five individual predictors of COVID-19 are albumin, total bilirubin, monocyte count, alanine aminotransferase, and percentage of monocyte with the importance scores ranging from 0.078 to 0.567. The top systematic predictors for COVID-19 are liver function, monocyte increasing, plasma protein, granulocyte, and renal function (importance scores ranging 0.009-0.096). We identified five combinations of important indicators to screen COVID-19 patients from CAP patients with differentiating abilities ranging 83.3-100%. An online predictive tool for our model was published. Certain clinical indicators collected routinely from most hospitals could help screen and distinguish COVID-19 from CAP. While further verification is needed, our findings and predictive tool could help screen suspected COVID-19 cases.

The independent and synergistic impacts of power outages and floods on hospital admissions for multiple diseases.

Highly destructive disasters such as floods and power outages (PO) are becoming more commonplace in the U.S. Few studies examine the effects of floods and PO on health, and no studies examine the synergistic effects of PO and floods, which are increasingly co-occurring events. We examined the independent and synergistic impacts of PO and floods on cardiovascular diseases, chronic respiratory diseases, respiratory infections, and food-/water-borne diseases (FWBD) in New York State (NYS) from 2002 to 2018. We obtained hospitalization data from the NYS discharge database, PO data from the NYS Department of Public Service, and floods events from NOAA. Distributed lag nonlinear models were used to evaluate the PO/floods-health association while controlling for time-varying confounders. We identified significant increased health risks associated with both the independent effects from PO and floods, and their synergistic effects. Generally, the Rate Ratios (RRs) for the co-occurrence of PO and floods were the highest, followed by PO alone, and then floods alone, especially when PO coverage is >75th percentile of its distribution (1.72% PO coverage). For PO and floods combined, immediate effects (lag 0) were observed for chronic respiratory diseases (RR:1.58, 95%CI: 1.24, 2.00) and FWBD (RR:3.02, 95%CI: 1.60, 5.69), but delayed effects were found for cardiovascular diseases (lag 3, RR:1.13, 95%CI: 1.03, 1.24) and respiratory infections (lag 6, RR:1.85, 95%CI: 1.35, 2.53). The risk association was slightly stronger among females, whites, older adults, and uninsured people but not statistically significant. Improving power system resiliency could be a very effective way to alleviate the burden on hospitals during co-occurring floods. We conclude that PO and floods have independently and jointly led to increased hospitalization for multiple diseases, and more research is needed to confirm our findings.

Hispanic Disaster Preparedness in the United States, 2017: Examining the Association with Residential Characteristics.

The number of highly destructive disasters is increasing in regions of the United States where the Hispanic population is growing fastest. Up-to-date studies of disaster preparedness are needed that include housing measures and other factors that may account for differences in disaster preparedness between Hispanics and other racial and ethnic groups. This study fills this gap in the literature by using data from the 2017 American Housing Survey, which includes a topical module on disaster planning along with the core measures of housing and neighborhood characteristics, including housing tenure. The results reveal that Hispanics are generally less prepared than non-Hispanic Whites regarding resource- and action-based measures, with a few exceptions. Hispanics, Blacks, and Asians are significantly more likely than Whites to have at least 3 gallons of water per person, and Hispanics and Blacks are significantly more likely than Whites and Asians to have flood insurance. The findings show that housing and residential characteristics are consistently significant in predicting preparedness-controlling for other relevant variables-although they do not attenuate the disadvantages that Hispanics and Blacks face in their disaster preparedness relative to Whites. Future research would benefit from further exploration of the linkage between racial and ethnic inequalities in housing and neighborhood characteristics and household disaster preparedness.

Housing tenure and residential segregation in metropolitan America.

Homeownership, a symbol of the American dream, is one of the primary ways through which families accumulate wealth, particularly for blacks and Hispanics. Surprisingly, no study has explicitly documented the segregation of minority owners and renters from whites. Using data from Census 2000, this study aims to fill this gap. Analyses here reveal that the segregation of black renters relative to whites is significantly lower than the segregation of black owners from whites, controlling for relevant socioeconomic and demographic factors, contrary to the notion that homeownership represents an endpoint in the residential assimilation process. The patterns for Hispanics and Asians conform more to expectations under the spatial assimilation model. The findings here suggest that race and ethnicity continue to be as important in shaping residential segregation as socioeconomic status, and raise concerns about the benefits of homeownership, particularly for blacks.

Bringing proximate neighbours into the study of US residential segregation.

The race and ethnicity of neighbours are thought to be critical in shaping household mobility underlying residential segregation. However, studies on this topic have used data at the census-tract level of analysis rather than at the proximate-neighbour level. Using a non-publicly available version of the neighbour-cluster sample within the American Housing Survey, this study incorporates data on the race, ethnicity and socioeconomic characteristics of the proximate neighbours of White, Black and Latino households and examines their impact on household residential satisfaction, out- and in-mobility. Results indicate that proximate-neighbour race and ethnicity matter in influencing endpoints of the mobility process and do not necessarily parallel those at the census-tract level. Implications of these findings are discussed as they relate to the study of residential segregation.