Referrals to Home Visiting: Current Practice and Unrealized Opportunities.

INTRODUCTION: Evidence supports ongoing investment in maternal and early childhood home visiting in the US. Yet, a small fraction of eligible families accesses these services, and little is known about how families are referred. This report describes priority populations for home visiting programs, the capacity of programs to enroll more families, common sources of referrals to home visiting, and sources from which programs want to receive more referrals. METHODS: We conducted a secondary analysis of data from a national web-based survey of members of the Home Visiting Applied Research Collaborative (HARC), focusing on a small set of items that directly addressed study aims. Survey respondents (N = 87) represented local programs implementing varying home visiting models diverse in size and geographic context. RESULTS: Programs prioritized enrollment of pregnant women; parents with mental health, substance abuse or intimate partner violence concerns; teen parents; and children with developmental delays or child welfare involvement. Most respondents reported capacity to enroll more families in their programs. Few reported receiving any referrals from pediatric providers, child welfare, early care and education, or TANF/other social services. Most desired more referrals, especially from healthcare providers, WIC, and TANF/other social services. DISCUSSION: Given that most programs have the capacity to serve more families, this study provides insights regarding providers with whom home visiting programs might strengthen their referral systems.

The Need for Improved Collaboration between Schools and Child Death Review Teams.

BACKGROUND: Schools are essential public health partners for safeguarding students' health. Child Death Review (CDR) is one public health activity where collaboration with schools is integral for developing strategies to prevent child death but the degree of collaboration is unknown. This study assessed school participation in CDR and the prevalence of school problems in reviewed child death cases, comparing non-suicide and suicide-related deaths. METHODS: Using the National Fatality Review-Case Reporting System, we created a dataset of school-aged children (5 to 20 years) whose death was reviewed from 2005 to 2017 and used frequencies, proportions, and chi-squared statistics on selected measures. RESULTS: Educational representatives infrequently participated in CDRs (24.9%). School records were rarely accessed for reviewed deaths (5.2%). Less than half (41.2%) of reviewed deaths had any school information and of these, 35.5% of children were indicated as having problems in school. Compared with non-suicide deaths, a larger proportion of suicide deaths had school representatives attend CDRs (28.4% vs 24.1%, P < .0001), and access to educational records (4.2% vs 9.2%, P < .0001). IMPLICATIONS: Efforts are needed to address potential barriers to systems integration, including state policies and federal educational privacy laws. CONCLUSIONS: School participation in CDRs is lacking for both suicide and non-suicide deaths.

Child Health Status and Health Care Use in Grandparent- Versus Parent-Led Households.

OBJECTIVES: To use a nationally representative sample to compare children in grandparent-led versus parent-led households with regard to diagnosed child health conditions, receipt of timely health care, and burden of caregiving responsibilities. METHODS: We used 4 years of pooled data from the National Survey of Children's Health, representative of United States children ages 0 to 17 years, and applied bivariate analyses and logistic regressions adjusted for sociodemographic confounders to compare grandparent- and parent-led households on key measures of interest. RESULTS: Compared with children in parent-led households, those in grandparent-led households had increased physical health conditions (oral health problems: 18.9% vs 13.1%, P = .0006; overweight/obesity: 40.3% vs 29.7%, P = .0002); emotional, mental, and developmental health conditions (attention deficit hyperactivity disorder: 16.3% vs 8.0%; behavioral/conduct problems: 13.9% vs 6.1%; depression: 6.6% vs 3.1%; learning disability: 13.9% vs 6.2%, P < .0001 for all); and special health care needs (28.2% vs 17.8%, P < .0001). They also had decreased prevalence of health care utilization (usual source of sick care: 65.7% vs 79.5%, preventive checkups: 64.6% vs 77.1%; preventive dental visits: 73.8% vs 80.6%; specialty care: 78.6% vs 90.2%, P ≤ .0001 for all) and increased prevalence of forgone care (5.9% vs 2.8%, P = .0020). After adjustment, the associations with caregiver type remained statistically significant for all emotional, mental, and developmental conditions listed; special health care needs; usual source of sick care and preventive checkups. CONCLUSIONS: Grandparent caregivers may benefit from additional support to ensure that grandchildren receive timely health care services.

Ultrastructural basis of enhanced antitumor cytotoxicity of cord blood-derived CTLs: a comparative analysis with peripheral blood and bone marrow.

Umbilical cord blood cells (UCBC) are a rich source of immature immune effector and accessory cells, including dendritic cells. UCBC-derived cytotoxic T lymphocytes (CTLs) generated against human breast cancer or neuroblastoma have shown an increased tumor-specific cytotoxicity compared to peripheral blood (PB)-derived CTLs. The precise mechanism of this increased cytotoxicity is not known. Since dendritic cells (DCs) play a central role in the immunostimulation, we compared the ultrastructure and antigen presenting nature of DCs from UCBC, PB and bone marrow (BM) at various stages of maturation using scanning and transmission electron microscopy as well as fluorescent microscopy to elucidate the mechanism underlying the increased cytotoxicity of UCBC-derived CTLs. DCs were examined for their immunophenotype nuclear morphology, dendritic processes and cytoplasmic endosomal vesicles after 0, 3, 7 and 10 days in culture with antigen priming on day 6. Results showed that there were smaller and more vesicles in UCB-DCs compared to DCs from the other two sources, while the endosomal vesicles in PB-DCs were heterogenous in size. The antigen processing ability of the UCB-DCs showed an increase in antigen-positive endosomes compared to PB-DCs as determined by the fluorescent microscopy. Thus, our results provided the comparative analyses of DCs from cord blood, peripheral blood and bone marrow, and suggested that UCBC-DCs might have better antigen presenting ability leading to increased CTL-mediated antitumor cytotoxicity.