RESUMO
BACKGROUND: There is a lack of longitudinal data to examine the impact of COVID-19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses. METHOD: This study analyzed 3-year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low-income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP). RESULTS: The study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post-traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID-19 case numbers. CONCLUSIONS: Among this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long-term impact of the pandemic on children's mental health warrants further investigation.
Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Telemedicina , Criança , Humanos , Estados Unidos , Adolescente , Serviço Hospitalar de Emergência , Estudos RetrospectivosRESUMO
BACKGROUND: While stress and the absence of social support during pregnancy have been linked to poor health outcomes, the underlying biological mechanisms are unclear. METHODS: We examined whether adverse experiences during pregnancy alter DNA methylation (DNAm) in maternal epigenomes. Analyses included 250 African-American mothers from the Boston Birth Cohort. Genome-wide DNAm profiling was performed in maternal blood collected after delivery, using the Infinium HumanMethylation450 Beadchip. Linear regression models, with adjustment of pertinent covariates, were applied. RESULTS: While self-reported maternal psychosocial lifetime stress and stress during pregnancy was not associated with DNAm alterations, we found that absence of support from the baby's father was significantly associated with maternal DNAm changes in TOR3A, IQCB1, C7orf36, and MYH7B and that lack of support from family and friends was associated with maternal DNA hypermethylation on multiple genes, including PRDM16 and BANKL. CONCLUSIONS: This study provides intriguing results suggesting biological embedding of social support during pregnancy on maternal DNAm, warranting additional investigation, and replication.
Assuntos
Metilação de DNA , Apoio Social , Proteínas Adaptadoras de Transdução de Sinal/genética , Adenosina Trifosfatases/genética , Adulto , Negro ou Afro-Americano , Boston , Proteínas de Ligação a Calmodulina/genética , Miosinas Cardíacas/genética , Ilhas de CpG , Proteínas de Ligação a DNA/genética , Epigenoma , Epigenômica , Pai , Feminino , Estudo de Associação Genômica Ampla , Humanos , Masculino , Proteínas de Membrana/genética , Antígenos de Histocompatibilidade Menor/genética , Chaperonas Moleculares/genética , Mães , Cadeias Pesadas de Miosina/genética , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etnologia , Estudos Retrospectivos , Classe Social , Fatores de Transcrição/genética , População Urbana , Adulto JovemRESUMO
OBJECTIVE: We examined whether the risk of food-allergen sensitization varied according to self-identified race or genetic ancestry. METHODS: We studied 1104 children (mean age: 2.7 years) from an urban multiethnic birth cohort. Food sensitization was defined as specific immunoglobulin E (sIgE) levels of ≥ 0.35 kilo-units of allergen (kUA)/L for any of 8 common food allergens. Multivariate logistic regression analyses were used to evaluate the associations of self-identified race and genetic ancestry with food sensitization. Analyses also examined associations with numbers of food sensitizations (0, 1 or 2, and ≥ 3 foods) and with logarithmically transformed allergen sIgE levels. RESULTS: In this predominantly minority cohort (60.9% black and 22.5% Hispanic), 35.5% of subjects exhibited food sensitizations. In multivariate models, both self-reported black race (odds ratio [OR]: 2.34 [95% confidence interval [CI]: 1.24-4.44]) and African ancestry (in 10% increments; OR: 1.07 [95% CI: 1.02-1.14]) were associated with food sensitization. Self-reported black race (OR: 3.76 [95% CI: 1.09-12.97]) and African ancestry (OR: 1.19 [95% CI: 1.07-1.32]) were associated with a high number (≥ 3) of food sensitizations. African ancestry was associated with increased odds of peanut sIgE levels of ≥ 5 kUA/L (OR: 1.25 [95% CI: 1.01-1.52]). Similar ancestry associations were seen for egg sIgE levels of ≥ 2 kUA/L (OR: 1.13 [95% CI: 1.01-1.27]) and milk sIgE levels of ≥ 5 kUA/L (OR: 1.24 [95% CI: 0.94-1.63]), although findings were not significant for milk. CONCLUSIONS: Black children were more likely to be sensitized to food allergens and were sensitized to more foods. African ancestry was associated with peanut sensitization.