Very Low Food Security Among Low-Income Households With Children in California Before and Shortly After the Economic Downturn From COVID-19.

We examined levels of very low food security (VLFS) among low-income households with children in California before and shortly after the economic downturn from coronavirus disease 2019 (COVID-19). Households were randomly sampled in 2018, 2019, and 2020; 11,653 mothers were administered the US Department of Agriculture 6-item Food Security Survey Module. Post-COVID-19 (April 27 to July 21, 2020, a period when stay-at-home restrictions were eased in the state), 14.0% of mothers reported VLFS versus 19.3% pre-COVID-19 (November 21, 2019, to March 14, 2020) (P = .003), 22.2% in 2019 (P < .001), and 19.0% in 2018 (P = .004). Existing systems to quickly obtain food assistance benefits in California and new federal benefits available in response to COVID-19 may have reduced VLFS.

Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program-Education) eligible households across California.

OBJECTIVE: To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children. DESIGN: Cross-sectional telephone surveys using a validated 24 h dietary assessment. SETTING: Randomly sampled households with incomes ≤185 % of the US federal poverty level across California. PARTICIPANTS: Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12-17 years) and 6043 children (5-11 years). Respondents were mostly Latino. RESULTS: Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children. CONCLUSIONS: The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

Clavicle Fracture Is Not Predictive of the Need for Microsurgery in Brachial Plexus Birth Palsy.

BACKGROUND: Brachial plexus birth palsy (BPBP) and clavicle fractures occur concurrently as well as in isolation during difficult deliveries. The concept that concurrent clavicle fracture may spare nerve injury has been advocated. Our aim was to compare those children with BPBP presenting to a tertiary care center with and without concurrent clavicle fractures and assess the utility of the presence of a clavicle fracture as a predictor of injury severity in children with BPBP. METHODS: Records of all patients belonging to a large prospective multicenter cohort study of infants with BPBP (Treatment and Outcomes of Brachial Plexus Injuries study) were analyzed for demographic information and birth information including risk factors, comorbidity, presence of clavicle fracture, and injury severity. RESULTS: The records of 639 children with BPBP were examined. Thirteen patients were excluded for incomplete data. Ninety-six children who sustained concurrent birth fracture and BPBP were identified (15%). Of these, 57 sustained clavicle fractures (9%), 44 sustained humerus fractures, and 4 sustained other fractures. Of the demographic factors analyzed, only the presence of gestational diabetes was found to be significantly higher in those children with fractures versus those without. The presence of a clavicle fracture did not change the rate of microsurgical intervention, nor did clavicle fracture rates differ by Toronto score, suggesting that there was no difference in injury severity between the 2 groups. CONCLUSIONS: In a large multicenter prospective study, 9% of children presenting with BPBP also sustained a clavicle fracture at birth. The presence of a clavicle fracture did not correlate with the severity of brachial plexus injury. We suggest that in study populations of children with severe enough BPBP to present to a tertiary care center, compared with studies collected in the obstetric population, the presence of a clavicle fracture is neither protective from nerve injury nor predictive of injury severity. LEVEL OF EVIDENCE: Level 2-prognostic.

Reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, California, 2011-2012.

INTRODUCTION: This study combined information on the interventions of the US Department of Agriculture's Supplemental Nutrition Assistance Program-Education with 5,927 interview responses from the California Health Interview Survey to investigate associations between levels of intervention reach in low-income census tracts in California and self-reported physical activity and consumption of fruits and vegetables, fast food, and sugar-sweetened beverages. METHODS: We determined 4 levels of intervention reach (low reach, moderate reach, high reach, and no intervention) across 1,273 program-eligible census tracts from data on actual and eligible number of intervention participants. The locations of California Health Interview Survey respondents were geocoded and linked with program data. Regression analyses included measures for sex, age, race/ethnicity, and education. RESULTS: Adults and children from high-reach census tracts reported eating more fruits and vegetables than adults and children from no-intervention census tracts. Adults from census tracts with low, moderate, or high levels of reach reported eating fast food less often than adults from no-intervention census tracts. Teenagers from low-reach census tracts reported more physical activity than teenagers in no-intervention census tracts. CONCLUSION: The greatest concentration of Supplemental Nutrition Assistance Program-Education interventions was associated with adults and children eating more fruits and vegetables and adults eating fast food less frequently. These findings demonstrate the potential impact of such interventions as implemented by numerous organizations with diverse populations; these interventions can play an important role in addressing the obesity epidemic in the United States. Limitations of this study include the absence of measures of exposure to the intervention at the individual level and low statistical power for the teenager sample.

COVID-19 Benefits and Dietary Behaviors Among Mothers From Low-Income, Food-Insecure Households.

OBJECTIVE: To examine the dietary behaviors of mothers from very low food security (VLFS) households following the availability of coronavirus disease 2019 (COVID-19) unemployment and Supplemental Nutrition Assistance Program benefits. METHODS: Diet and food security status were obtained from 2,584 California mothers during Federal Fiscal Year 2020. Fruits, vegetables, and 100% fruit juice (FV100%FJ), sugar-sweetened beverages, and water intake, and Healthy Eating Index-2015 scores, were compared across 4 groups (before vs after COVID-19 benefits by VLFS vs non-VLFS households) with race/ethnicity and age as covariates. RESULTS: Before COVID-19 benefits, VLFS was associated with fewer cups of FV100%FJ (P = 0.010), more fluid ounces of sugar-sweetened beverages (P = 0.004), and poorer diet quality (P = 0.003). After COVID-19 benefits, mothers from VLFS vs non-VLFS households reported similar dietary outcomes. VLFS mothers reported 0.96 (95% confidence interval, 0.53-1.38) more cups of FV100%FJ after COVID-19 benefits. CONCLUSIONS AND IMPLICATIONS: Coronavirus disease 2019 benefits may have reduced dietary inequities among low-income families. Associations between increased Supplemental Nutrition Assistance Program and unemployment benefits and decreased costs associated with the negative health outcomes linked to food insecurity and poor diets would be of value.

Disparities in Perceived Availability of Healthful Foods, Dietary Behaviors, Diet Quality, and Obesity Among Mothers from Low-Income Households: Additional Evidence in the Call for Broader Approaches to Obesity Prevention.

Purpose: To examine racial/ethnic differences in dietary behaviors, diet quality, body mass, and the perceived availability of healthful foods in one's neighborhood among mothers from low-income California households. Methods: Cross-sectional telephone surveys of mothers from randomly sampled households with incomes ≤185% federal poverty level in 2018 and 2019 using a validated 24-h dietary recall assessment. Dietary outcomes were cups of fruits and vegetables, ounces of sugar-sweetened beverages, teaspoons of added sugars, and kilocalories consumed the previous day. Diet quality was assessed by calculating Health Eating Index-2015 scores. Supplemental survey items assessed mothers' weight and height. Body mass index (BMI) was calculated with a BMI of 30 or higher considered obese. Perceived availability of fresh fruits and vegetables and healthy foods in general within one's neighborhood was recorded. Results: The analytic sample of 9200 mothers was 66.3% Latina, 17.3% white, 12.6% African American, and 3.8% Asian American, Native Hawaiian, or Pacific Islander (AANHPI). African American mothers consumed the fewest cups of fruits and vegetables and the most teaspoons of added sugars, reported poor diet quality, and had the highest obesity rate, 54.7% versus 46.9% for Latinas, 39.9% for whites, and 23.5% for AANHPIs. Accordingly, a greater proportion of African Americans reported limited availability of fresh fruits and vegetables and healthy foods in general in their neighborhood. Conclusion: Findings are interpreted in light of recent calls for broader approaches to address health disparities, including strategies that focus on inequalities in racial/ethnic socioeconomic status and systemic racism.

Recent decline in the incidence of human immunodeficiency virus infection among California men who have sex with men.

Monitoring the incidence of human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is imperative for developing targeted prevention programs and evaluating their effectiveness. The authors used California counseling and testing data to estimate the temporal trend in HIV incidence among MSM in California. HIV incidence rates were retrospectively calculated among MSM who had received at least 1 HIV test at a public California counseling and testing site between 1997 and 2007 and had a prior HIV-negative test from any HIV testing source. All study subjects were weighted on the basis of the interval between the last HIV-negative test and the current HIV test to account for the right-truncation bias introduced by more frequent testers. The authors observed that the HIV incidence rate among MSM in California increased from 2.0/100 person-years (95% confidence interval (CI): 1.8, 2.2) in 1997 to 2.4/100 person-years (95% CI: 2.2, 2.6) in 2003 and then decreased to 1.9/100 person-years (95% CI: 1.7, 2.0) in 2006. Trend analyses showed that both the increase (P < 0.001) and the decrease (P < 0.01) were statistically significant. The study showed that HIV incidence among MSM in California had decreased since 2003.

Diet Quality Differs by Race/Ethnicity Among Mothers and Their Children from Supplemental Nutrition Assistance Program-Education Households.

Purpose: To investigate diet quality by race/ethnicity among mothers and their children from low-income households throughout California. Methods: Cross-sectional telephone surveys of mothers and their children from randomly sampled households using a validated 24-h dietary assessment. Healthy Eating Index-2015 (HEI-2015) scores were calculated. Results: The mean HEI-2015 scores were lower for African American and white mothers and children compared with Latinx mothers and children. Conclusion: Addressing poor levels of overall diet quality among African American and white mothers and children from low-income households is of public health importance. Reasons for Latinxs' superior diet quality may include limited acculturation to U.S. culture.

Dietary Behaviors and Obesity of Children From Low-Income Households by Gender of Caregiver and Child.

PURPOSE: To investigate the empirical support for the Supplemental Nutrition Assistance Program-Education's (SNAP-Ed) focus on mothers versus fathers by examining children's risk and protective behaviors for obesity, and obesity status, by gender of primary caregiver and by caregiver-by-child gender dyads. APPROACH: Cross-sectional survey. SETTING: Random sample of SNAP-Ed eligible households (≤ 185% of the federal poverty level) across California. PARTICIPANTS: 2,242 children and their caregivers (17.8% male): the adult who prepares the meals or buys the food for the children. MEASURES: Cups of fruits and vegetables, water, sugar-sweetened beverages; teaspoons of added sugars; kilocalories; and food-only energy density, assessed through 24-hour dietary recall interviews. Dichotomous outcome was childhood obesity. Covariates were children's race/ethnicity and age, and caregivers' obesity status. RESULTS: Only one outcome was related to caregiver gender: male versus female caregivers' children consumed fewer kilocalories (P = 0.053). Caregiver-by-child gender analyses revealed female caregivers' sons consumed more kilocalories overall (Ps < 0.02), and added sugars than female caregivers' daughters (P = 0.001) and male caregivers' sons (P = 0.018). Female caregivers' daughters versus sons reported diets lower in food-only energy density (P = 0.004) and were less likely to be obese (23.7% versus 28.7%; aOR = 0.78, P = 0.035). CONCLUSION: Our findings suggest that SNAP-Ed's focus on mothers rather than fathers is justified, but more effective childhood nutrition education and obesity prevention efforts should target families with female caregivers of male children.

Unemployment, SNAP Enrollment, and Food Insecurity Before and After California's COVID-19 Shutdown.

OBJECTIVES: To examine whether the decrease in very low food security (VLFS) observed in California shortly after California's coronavirus disease (COVID-19) shutdown remained throughout Federal Fiscal Year (FFY) 2020. To investigate associations among unemployment, Supplemental Nutrition Assistance Program (SNAP) enrollment, and VLFS across FFY 2020. METHODS: Telephone interview responses from mothers from randomly sampled households from low-income areas throughout California to the 6-item US Department of Agriculture Food Security Survey Module identified VLFS families. Logistic regression examined VLFS rates before vs after California's COVID-19 shutdown, with race/ethnicity, age, and education as covariates. Pearson correlations were calculated for unemployment, SNAP enrollment, and VLFS. RESULTS: Most (66.4%) of the 2,682 mothers were Latina. VLFS declined from 19.3% before to 14.5% after California's COVID-19 shutdown (adjusted odds ratio, 0.705; P = 0.002). The correlation for unemployment and SNAP household participation was 0.854 (P = 0.007), and for SNAP participation and VLFS was -0.869 (P = 0.005). CONCLUSIONS AND IMPLICATIONS: Publicly-funded assistance programs may lower food insecurity, even during a time of increased economic hardship. Examining the specific factors responsible for the observed decline in VLFS has merit. Whether VLFS remains below the rate observed before California's COVID-19 shutdown is worthy of ongoing study.

SNAP-Ed Policy, Systems, and Environmental Interventions and Caregivers' Dietary Behaviors.

OBJECTIVE: To examine dietary behaviors and diet quality among caregivers of children regarding the number of policy, systems, and environmental (PSE) change interventions implemented in their neighborhoods. METHODS: Households with incomes ≤185% of the federal poverty level were randomly sampled throughout California. A validated 24-h dietary recall assessment tool was administered by telephone. The independent variable was the number of Supplemental Nutrition Assistance Program Education PSE change interventions per census tract where the caregivers lived. RESULTS: Most (69.1%) of the 2,222 caregivers were Latino. Policy, systems, and environmental reach predicted decreased intake of sugar-sweetened beverages (P = 0.022, Cohen d = -0.12) and added sugar (P = 0.014, Cohen d = -0.18), and increased Healthy Eating Index-2015 scores (P = 0.046, Cohen d = 0.18), regardless of race and/or ethnicity, age, or reach of Supplemental Nutrition Assistance Program Education direct education. CONCLUSIONS AND IMPLICATIONS: Replication of these methods and findings, and comparisons of dietary outcomes in association with PSE change interventions with and without direct education activities aimed at the same population under study, are encouraged.

Development and pilot test of the shriners pediatric instrument for neuromuscular scoliosis (SPNS): a quality of life questionnaire for children with spinal cord injuries.

BACKGROUND/OBJECTIVE: Children and adolescents who have sustained a spinal cord injury (SCI) are at risk of developing spine deformities and secondary complications that may affect their quality of life. The Shriners Pediatric Instrument for Neuromuscular Scoliosis (SPINS) is a condition-specific instrument that was developed to measure the health-related quality of life (HRQOL) of this patient population. A pilot study was conducted to revise the SPINS and assess comprehensibility. METHODS: Fourteen children with SCI (ages 6-16 y) from a pediatric hospital were administered either a child version (ages 10-18 y) or a parent version (ages 5-9 y) of the SPINS. Problematic items were identified based on participants' feedback or low statistical variance. RESULTS: Ten of 14 (71.6%) respondents understood at least 90% of the items, and 13 out of 14 (92.9%) comprehended more than 80% of relevant items on the SPINS. CONCLUSION: The SPINS has demonstrated comprehensibility. The next step is to measure the validity and reliability of the instrument. The SPINS shows promise as a means of assessing quality of life related to brace effectiveness in children with SCI and neuromuscular scoliosis who primarily use a wheelchair for mobility.

Knowledge of sexual partner's HIV serostatus and serosorting practices in a California population-based sample of men who have sex with men.

OBJECTIVES: To describe knowledge of primary and secondary sexual partner's HIV serostatus and sexual practices, including serosorting, among men who have sex with men (MSM) living in California. METHODS: Men who self-identified as gay/bisexual in the 2001 California Health Interview Survey, a statewide biennial random-digit-dial survey interviewing more than 50,000 adults on a variety of health topics, were recontacted in 2002 and interviewed by telephone about injection drug use, their own and partner's HIV serostatus, and sexual risk behaviors. RESULTS: Among 220 men who reported a primary partner, 86% [95% confidence interval (CI): 77-92] knew their primary partner's serostatus; 62% (95% CI, 52-70) of the 250 men who reported a secondary partner knew their most recent secondary partner's HIV serostatus. Knowledge of one's most recent secondary partner's HIV serostatus was inversely related to history of injecting recreational drugs (odds ratio, 0.22; P < 0.01), and reporting a primary partner in the past year (odds ratio, 0.37; P < 0.05). Two-fifths (41%) of HIV-positive men and three-fifths (62%) of HIV-negative men engaged in serosorting (serocordant unprotected anal intercourse) with their primary partners, whereas 33% HIV-positive men and 20% HIV-negative men did so with their most recent secondary partners. CONCLUSIONS: This population-based survey documented the extent to which MSM know their partners' serostatus and practice serosorting behaviors. The findings emphasize the need for studies to report serocordant and serodiscordant unprotected anal intercourse separately, as the former presents significant lower risk of HIV transmission.

Impact of prostheses on function and quality of life for children with unilateral congenital below-the-elbow deficiency.

BACKGROUND: Children with unilateral congenital below-the-elbow deficiency present a dilemma to clinicians. Parents want the child to have a prosthesis and, because it seems that the deficiency will cause functional problems, one is customarily prescribed for infants. Use of the prosthesis is then encouraged throughout childhood. However, these children frequently abandon the prosthesis. There are no evidence-based guidelines regarding prescription of prostheses or standard methods for assessing use and function. METHODS: A multicenter outcomes study was done to assess the quality of life and function of 489 children with a unilateral congenital below-the-elbow deficiency; 321 wore a prosthesis, and 168 did not. The Unilateral Below-the-Elbow Test (UBET) was designed, validated, and administered to these children along with several outcomes measures, including the Pediatric Outcomes Data Collection Instrument (PODCI), the Pediatric Quality of Life Inventory (PedsQL), and the Prosthetic Upper Extremity Functional Index (PUFI). RESULTS: Use of a prosthesis was not associated with any clinically relevant differences in PODCI or PedsQL scores. Non-wearers performed either the same as or better than wearers on the UBET. When queried (with use of the PUFI) about performance of various tasks, non-wearers scored themselves higher than wearers. Children with a unilateral congenital below-the-elbow deficiency scored the same as or higher than the general population on the PedsQL. They scored significantly lower than the general population on the PODCI Upper Extremity Physical Function Domain and higher on the Happiness Domain, but the differences were small. CONCLUSIONS: Prostheses may help with social acceptance or may be useful as tools for specialized activities, but they do not appear to improve function or quality of life, which are nearly normal for children with unilateral congenital below-the-elbow deficiency regardless of whether they wear a prosthesis. These findings call into question the standard practices of fitting infants with prostheses and encouraging young children to wear the prosthesis.

Providing health care services to the formerly homeless: a quasi-experimental evaluation.

We performed a quasi-experiment to assess the effects of a focused health care intervention delivered in transitional housing facilities in Sacramento, California. Four transitional housing facilities (THFs) receiving the intervention were compared with 2 THFs that did not receive it. A multidisciplinary team provided a diverse package of services to residents at the intervention sites. Residents at comparison sites received usual care. Survey and physical examination data were collected in repeated cross-sectional surveys at baseline (pre-intervention) and after 6 and 18 months of follow-up (post-intervention). Using analysis of covariance techniques, our statistical models showed improved odds of receiving recommended gynecologic preventive care and decreased odds of frequent Emergency Department use at 18 months among residents at the intervention sites. At 6 months, residents at the intervention sites also experienced improved blood pressure control. There was no intervention effect on residents' access to specialists or on physical functioning, mental health, or dental health.

Fruit and Vegetable, Fat, and Sugar-Sweetened Beverage Intake Among Low-Income Mothers Living in Neighborhoods With Supplemental Nutrition Assistance Program-Education.

OBJECTIVE: To examine among low-income mothers the consumption of fruits and vegetables (FV), high-fat foods, and sugar-sweetened beverages (SSBs) and overall diet quality in relation to levels of reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions across 2,907 California census tracts. DESIGN: Cross-sectional telephone survey conducted from April through October, 2014 using the Automated Self-administered 24-Hour Recall dietary assessment. PARTICIPANTS: Mothers or primary caregivers (n = 6,355) from randomly selected SNAP households. The sample was 42.6% Latina, 25.5% white, and 17.6% African American. The response rate was 60.5%. MAIN OUTCOME MEASURES: Cups of FV; calories from high-fat foods; and cups of SSBs, overall and from items purchased from fast-food restaurants. Overall diet quality was assessed by the Healthy Eating Index-2010. ANALYSIS: Linear regression controlling for race/ethnicity and education, with significance at P ≤ .05. RESULTS: Mothers from high SNAP-Ed reach census tracts ate more cups of FV, consumed fewer calories from high-fat foods, and drank fewer cups of SSBs. Healthy Eating Index-2010 scores did not vary by levels of SNAP-Ed reach. CONCLUSIONS AND IMPLICATIONS: Supplemental Nutrition Assistance Program-Education interventions are related to increased intake of FV and decreased consumption of high-fat foods and SSBs, but not overall diet quality. Future studies should include assessment of physical activity to investigate caloric balance in association with levels of SNAP-Ed interventions.

Linking HIV-infected persons of color and injection drug users to HIV medical and other services: the California Bridge Project.

Our objectives were to describe the strategies and successes in linking out-of-treatment HIV-infected persons of color and injection drug users (IDUs) to a comprehensive HIV care, treatment, and prevention program and other community services. Peer-based outreach staff at 21 sites throughout California provided assessments and referrals to 1453 persons living with HIV but without routine care. A linkage was defined as the receipt of a referred service. Half (49.7%) of persons of color and 41.6% of IDUs received services at a California Early Intervention Program (EIP) site after the date of first contact with peer staff; 58.1% of clients referred to EIP were linked to the program. IDUs were less likely to link to EIP. However, IDU clients were less likely to be referred to EIP, and more likely to be referred and linked to other community programs. Interventions such as the California Bridge Project can effectively link HIV-infected persons from marginalized populations to care, treatment, and prevention services. Programs that address immediate needs such as housing are more appealing to IDUs than programs offering HIV medical care.

Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy.

BACKGROUND: For children with upper-extremity cerebral palsy (CP) who meet standard indications for tendon transfer surgery, we hypothesized that surgical treatment would result in greater functional improvement than treatment with botulinum toxin injections or regular, ongoing therapy. METHODS: Thirty-nine children with upper-extremity CP, who were four to sixteen years of age and surgical candidates for the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis, pronator teres release, and extensor pollicis longus rerouting with adductor pollicis release, were prospectively assigned, either randomly (twenty-nine patients) or by patient/family preference (ten patients), to one of three treatment groups: surgical treatment (Group 1); botulinum toxin injections (Group 2); or regular, ongoing therapy (Group 3). Seven centers participated. Assessment measurements included active range of motion, pinch and grip strength, stereognosis, and scores as measured with eight additional functional or patient-oriented outcome instruments. Thirty-four patients (twenty-five randomized and nine from the patient-preference arm) were evaluated twelve months post-treatment as the study cohort. RESULTS: For the primary outcome of the Shriners Hospital Upper Extremity Evaluation (SHUEE) dynamic positional analysis (DPA), significantly greater improvement was seen in Group 1 than in the other two groups (p < 0.001). Improvements in SHUEE DPA reflected improved supination and wrist extension during functional activities after surgical treatment. Group 1 showed more improvement in the Pediatric Quality of Life Inventory (PedsQL) CP module domain of movement and in the Canadian Occupational Performance Measure (COPM) score for satisfaction than Groups 2 and 3. Both Groups 1 and 3 showed more improvement in pinch strength than did Group 2. CONCLUSIONS: For children with upper-extremity CP who were candidates for standard tendon transfer, surgical treatment was demonstrated to provide greater improvement, of modest magnitude, than botulinum toxin injections or regular, ongoing therapy at twelve months of follow-up for the SHUEE DPA, the PedsQL CP module domain of movement, and COPM satisfaction.

A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy: 6 Months Follow-Up.

Commercially available, interactive videogames that use body movements for interaction are used clinically in burn rehabilitation and have been shown to facilitate functional range of motion (ROM) but their efficacy with burn patients has not yet been proven. The purpose of this pilot randomized control study was to prospectively compare planar and functional ROM, compliance, pain, enjoyment, and exertion in pediatric burn patients receiving two types of rehabilitation therapy. Seventeen school-aged children with 31 affected limbs who demonstrated limited shoulder ROM from burn injury were randomized to receive exercises using either standard therapy ROM activities (ST) or interactive videogame therapy (VGT). Patients received 3 weeks of the designated therapy intervention twice daily. They were then given a corresponding home program of the same type of therapy to perform regularly for 6 months. Standard goniometry and three-dimensional motion analysis during functional tasks were used to assess ROM. Measures were taken at baseline, 3 weeks, 3 months, and 6 months. Pain was measured before and after each treatment session during the 3-week intervention. There was no difference in compliance, enjoyment, or exertion between the groups. Patients in both the ST and VGT groups showed significant improvement in shoulder flexion (P < .001), shoulder abduction (P <.001), shoulder external rotation (P = .01), and elbow flexion (P = .004) ROM from baseline to 6 months as measured with goniometry. Subjects also showed significant gains in elbow flexion (P = .04) during hand to head and shoulder flexion (P = .04) during high reach. There was no difference in ROM gains between the groups. Within group comparison showed that the VGT group had significantly more recovery of ROM during the first 3 weeks than any other timeframe in the study, whereas ST had most gains at 3 months. There was a significant difference between the groups in the subjects' pain response. ST subjects showed an increase in pain during the intervention, whereas VGT subjects did not (VGT: r = .047, ST: r = .18; P = .015). In this study, interactive videogames were equally effective as traditional therapy for overall ROM gains and resulted in quicker recovery of motion with less pain experienced. Such videogames are a useful adjunct to therapy and should be considered as part of a holistic approach to rehabilitation within the hospital and at home after discharge in pediatric patients recovering from burn injury.

Ethnic disparity in HIV prevalence and zidovudine treatment among childbearing women and pediatric AIDS cases in California.

OBJECTIVE: To compare, by ethnicity, the prevalence of HIV and zidovudine treatment among a cross-sectional survey of childbearing women in California in 1998, and the number of pediatric AIDS cases from 1998 to 2001. METHODS: Blood specimens, collected via infant heel-stick for metabolic screening during the third quarter of 1998, were anonymously tested for HIV antibody. Positive specimens were subsequently tested for evidence of zidovudine therapy. Pediatric AIDS cases with diagnosis dates from 1998 to 2001 were obtained from the AIDS case registry. RESULTS: Of the 119 108 specimens tested, 77 (0.65 per 1000) were HIV-antibody positive. Most (37.7%) of the 77 HIV-positive specimens were from newborns of African-American mothers, followed closely by Latina mothers (35.1%). The absence of zidovudine therapy was highest for Latina and African-American women, 29.6 and 24.1%, respectively. Latino and African-American children accounted for the majority of California pediatric AIDS cases diagnosed between 1998 and 2001. CONCLUSION: Innovative approaches are needed to increase the rate of zidovudine therapy among African-American and Latina HIV-infected childbearing women. These could include a shorter-course zidovudine regimen or rapid HIV testing and counselling of women in late-term pregnancy.