Prevalence and factors associated with thyroid autoimmunity among children newly diagnosed with type 1 diabetes before and during the COVID-19 pandemic: Evidence from Kuwait.

AIMS: This study reports the prevalence and characteristics related to the development of thyroid autoimmunity among children newly diagnosed with type I diabetes (T1D) during the COVID-19 pandemic in Kuwait. MATERIALS AND METHODS: This is a prospective observational study of all children under age 14 years newly diagnosed with T1D in Kuwait. We define the duration of the COVID-19 pandemic from the official declaration of the first identified positive COVID-19 case on 24 February 2020 until 31 December 2022. For comparison, we use the time period directly before the COVID-19 pandemic, 1 January 2017 to 23 February 2020. RESULTS: One thousand twenty-four (1024) children newly diagnosed with T1D in Kuwait during the study period were included. Among newly diagnosed children, 20.3% tested positive for thyroid antibodies during the COVID-19 pandemic, compared with 14.5% during the pre-pandemic period (p = 0.015). Children with positive COVID-19 status were more likely to present with thyroid antibodies (p = 0.035). After adjusting for other characteristics, patients diagnosed with T1D during the COVID-19 pandemic had double the odds of testing positive for thyroid antibodies (Adjusted odds ratio = 2.173, 95%CI: 1.108, 4.261, p = 0.024). CONCLUSIONS: Incident cases of T1D during the COVID-19 pandemic may be different in aetiology or contextual factors leading to a higher risk of thyroid autoimmunity. Longitudinal studies are needed to understand the role of COVID-19 in the onset and progression of T1D and on thyroid autoimmunity and disease.

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. FUNDING: Bill & Melinda Gates Foundation, US Agency for International Development.

Sandwiches and subversion: Teachers' mealtime strategies and preschoolers' agency.

Mealtimes are understudied processes in the social research on childhood. Our study uses ethnographic methods in two preschools in the southeastern United States to understand the types of strategies teachers use during meals and children's responses to these strategies. We identified three strategies teachers used to attempt to modify children's consumption: gatekeeping, directives, and hyperbolic justifications of consumption. We argue that children used agency to subvert to teachers' strategies using silent and verbal techniques, including attempting to open packages of restricted foods, pretending to eat, and refusing to eat. Their subversion manifested in either "dissent" or "feigned assent."

On the basis of visa type: Insights into incorporation and health among foreign-born people in the United States.

Foreign-born people have different patterns of health, and several psychosocial and contextual factors may contribute to these differences. Type of visa with which one resettles is an important consideration because it is linked both with the reason for initially migrating and with experiences after arriving in the U.S. This study examines the association between visa type and health in terms of self-rated health and diagnosed chronic conditions. Using the New Immigrant Survey (NIS), a nationally representative study of foreign-born people at the time of receiving legal permanent residence in the U.S., we used logistic regression models to estimate the odds of having chronic conditions and the odds of reporting fair or poor health. People who had refugee, asylum, parole and post-arrival legalization visa types had the highest prevalence of any chronic condition; they were also most likely to report being in fair or poor self-rated health, even after controlling for other characteristics. Conversely, people who had diversity visas had the highest self-rated health and the fewest chronic conditions. Overall, the type of visa a person holds is associated with health and chronic disease even years after resettlement.

Race, ethnicity, and the relevance of obesity for social integration.

OBJECTIVE: To examine race and ethnic differences in the importance of obesity for social integration using the National Longitudinal Study of Adolescent Health (Add Health). DESIGN: A cross-sectional study utilizing survey-adjusted statistics and multivariate logistic and linear regression models. Models were stratified by sex and included interaction terms capturing race, ethnicity and obesity. SETTING: United States of America. PARTICIPANTS: A nationally representative sample of 15,355 respondents grades 7 through 12 who participated in both the In-School and In-Home Wave I surveys of Add Health. MAIN OUTCOME MEASURES: Four self-reported and schoolmate-reported indicators of social integration. RESULTS: The consequences of obesity for social integration are greatest for White adolescents, who were selected by almost 2 fewer schoolmates as friends and had half the odds of having their friendships reciprocated compared with non-obese White adolescents. The social disadvantage of obesity was lower for non-White adolescents; though they are selected by significantly fewer schoolmates as friends and were less likely to have their friendships reciprocated, they did not face additional discrimination from being both obese and minority. CONCLUSIONS: There are significant differences between obese and non-obese adolescents by race and ethnicity in friendships. As friendships are among the most valued assets in adolescence, understanding the impact of obesity on access to friendships for diverse adolescents is a necessary component to understanding the complex motivations that guide health-related behavior at these formative ages.

Examination of Sleep and Obesity in Children and Adolescents in the United States.

PURPOSE: This study contributes to the growing literature on the association between sleep and obesity by examining the associations between hours of sleep, consistency of bedtime, and obesity among children in the US. DESIGN: Analysis of a nationally representative sample of non-institutionalized children from the 2016-17 National Survey of Children's Health. SETTING: US, national. SUBJECTS: Children ages 10-17 years (n = 34,640). MEASURES: Parent reported weeknight average hours of sleep and consistency of bedtime. Body mass index classified as underweight, normal, overweight or obesity using parent-reported child height and weight information, classified using CDC BMI-for-Age Growth Charts. ANALYSIS: Multivariate logistic regression models were used to estimate associations between measures of sleep and body mass index weight category adjusting for individual, household and neighborhood characteristics. RESULTS: An additional hour of sleep was associated with 10.8% lower odds of obesity, net of consistency in bedtime. After controlling for sleep duration, children who usually went to bed at the same time on weeknights had lower odds of obesity (24.8%) relative to children who always went to bed at the same time. CONCLUSION: Sleep duration is predictive of lower odds of obesity in US children and adolescents. Some variability in weeknight bedtime is associated with lower odds of obesity, though there were no additional benefits to extensive variability in bedtime.

The role of age inequalities in cause of death in the slow pace of epidemiological transition in India.

In developed countries, low disparity in lifespan contributed by the reduction in the burden of noncommunicable diseases (NCDs) is the key to advances in epidemiological transition. Contrarily, India passing through a phase of the dual burden of CDs and NCDs shows a heavy burden of NCDs responsible for the high disparity in lifespan. The Gini coefficient was decomposed for examining the contribution of 22 causes of death and their repercussions for inequality in age at death for 30 years between 1990-1994 and 2015-2019, using Global Burden of Disease data. The outcomes of the study reveal that India's epidemiological transition has been just modest on account of high inequality in mortality by NCDs emplaced in the middle through old age despite a consistent mortality decline at infant through old age for communicable diseases (CDs). The structural changes in causes of death structure is shaped by CDs rather than NCDs, but overall bolstered by the adult mortality decline, especially in women. However, the process is restrained by the small contribution of the middle age group and a benign contribution of old mortality decline owing to the low threshold age. India needs to target health interventions in seeking significant mortality decline in the middle age group of 50-69 years that is warranted for epidemiological transition apace as evident in the developed nations.

Prenatal development in rural South Africa: relationship between birth weight and access to fathers and grandparents.

Birth weight is an indicator of prenatal development associated with health in infancy and childhood, and may be affected by the family environment experienced by the mother during pregnancy. Using data from KwaZulu-Natal, South Africa, we explore the importance of the mother's access to the father and grandparents of the child during pregnancy. Controlling for household socio-economic indicators and maternal characteristics, the survival and residence of the biological father with the mother are positively associated with birth weight. The type of relationship seems to matter: married women have the heaviest newborns, but co-residence with a non-marital partner is also associated with higher birth weight. Access to the maternal grandmother may also be important: women whose mothers are alive have heavier newborns, but no additional benefit is observed from residing together. Co-residence with any grandparent is not associated with birth weight after controlling for the mother's partnership.

Doctors' strikes and mortality: a review.

A paradoxical pattern has been suggested in the literature on doctors' strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctors' strikes. We identified 156 articles, seven of which met our search criteria. The articles analyzed five strikes around the world, all between 1976 and 2003. The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods. The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.

Unhealthy weight among children in Spain and the role of the home environment.

OBJECTIVE: Unhealthy weight is a major global health concern. This study examines unhealthy weight among children in Spain and the role of the home environment therein. Data are from a 2010 national survey of families with children. We examined unhealthy weight among children ages 5-10 years using the WHO Child Growth Standards and used multivariate logistic regression to assess associations with family characteristics. RESULTS: There was a high prevalence of unhealthy weight, with only 46% of children at normal weight. Both underweight and obesity were higher among boys (14%; 22%) than girls (13%; 12%). Underweight and obesity were higher among children of mothers with obesity and those with unemployed parents. Obesity was higher among children of mothers who were less educated (35%) and among children of immigrants (19%). We find high levels of unhealthy weight in children, with both underweight and obesity being predicted by the same family environment characteristics.

Incident, accident, catastrophe: cyanide on the Danube.

It has been described as the worst disaster since Chernobyl. In January 2000, a retaining wall failed at the Aurul gold processing plant in Romania, releasing a wave of cyanide and heavy metals that moved quickly from one river to the next through Romania, Hungary, the Federal Republic of Yugoslavia and Bulgaria, killing tens of thousands of fish and other forms of wildlife and poisoning drinking-water supplies. This paper examines how and why the chemical spill at Baia Mare occurred and how responses to it emerged from circumstances at the global, local and immediate levels. The spill demonstrates the importance of the flow of information in framing and interpreting disasters, suggesting that such an event can go unnoticed or be viewed as catastrophic, depending on the political, historical and personal struggles that lead to its publicity. The paper offers a framework for understanding why the spill was alternately perceived as an incident, an accident and a catastrophe based on changing perceptions of culpability.