Racial Inequities in Palliative Referral for Children with High-Intensity Neurologic Impairment.

OBJECTIVE: To evaluate whether racial and socioeconomic inequities in pediatric palliative care utilization extend to children with high-intensity neurologic impairment (HI-NI), which is a chronic neurological diagnosis resulting in substantial functional morbidity and mortality. STUDY DESIGN: We conducted a retrospective study of patients with HI-NI who received primary care services at a tertiary care center from 2014 through 2019. HI-NI diagnoses that warranted a palliative care referral were identified by consensus of a multidisciplinary team. The outcome was referral to palliative care. The primary exposure was race, categorized as Black or non-Black to represent the impact of anti-Black racism. Additional exposures included ethnicity (Hispanic/non-Hispanic) and insurance status (Medicaid/non-Medicaid). Descriptive statistics, bivariate analyses, and multivariable logistic regression models were performed to assess associations between exposures and palliative care referral. RESULTS: A total of 801 patients with HI-NI were included; 7.5% received a palliative referral. There were no differences in gestational age, sex, or ethnicity between patients who received a referral and those who did not. In multivariable analysis, adjusting for ethnicity, sex, gestational age, and presence of complex chronic conditions, Black children (aOR 0.47, 95% CI 0.26, 0.84) and children with Medicaid insurance (aOR 0.40, 95% CI 0.23, 0.70) each had significantly lower odds of palliative referral compared with their non-Black and non-Medicaid-insured peers, respectively. CONCLUSIONS: We identified inequities in pediatric palliative care referral among children with HI-NI by race and insurance status. Future work is needed to develop interventions, with families, aimed at promoting more equitable, antiracist systems of palliative care.

Voter Participation is Associated with Child Health Outcomes at the Population Level.

Civic engagement, including voting, has been linked to health outcomes for adults. Here, we found that census tract-level voter participation rates are significantly associated with pediatric inpatient bed-day rates even after adjustment for socioeconomic deprivation. Such links suggest that promotion of voting participation could be warranted in healthcare settings.

The Most Cruel and Revolting Crimes: The Treatment of the Mentally Ill in Mid-Nineteenth-Century Jamaica.

In 1860 the appalling conditions that patients at the lunatic asylum in Kingston, Jamaica, endured came under public scrutiny. The most notorious of the "most cruel and revolting crimes" which were exposed was the practice of tanking - forcibly holding patients under water. Following the death of a patient, the matron and two nurses at the asylum were charged with manslaughter. Although they were acquitted by the jury, the case erupted into a public scandal. This article explores the insights that this shameful episode offers on Jamaica's colonial past. First, it exposes the fractures between the Jamaican governing classes and the imperial government; second, it reveals the internal divisions within colonial society; and third, it highlights the low level of government commitment to the health of the Jamaican people. It concludes by suggesting that the conditions at the asylum were a legacy of slavery and thus looked back to that period; but it also argues that at the same time the scandal acted as a trigger to the metropolitan government to improve colonial hospitals throughout its empire.

Methylmalonic aciduria unresponsive to vitamin B12: description of two cases and prenatal diagnosis in a brazilian family

Metilmalonicacidúria secundária à deficiência da mutase da metilmalonil CoA foi diagnosticada em duas crianças filhas de pais näo consangüíneos. A primeira criança morreu um dia antes que o diagnóstico correto fosse feito. Nesse período, sua mäe estava no terceiro trimestre de gestaçäo. Os níveis urinários de ácido metilmalônico foram medidos ao longo do terceiro trimestre de gestaçäo, mostrando um aumento gradual e indicando a presença de um feto homozigoto para a doença. A presença de metilmalonicacidúria foi confirmada no recém-nascido e o tratamento pode ser começado precocemente. A criança está sendo tratada com uma dieta com pouca proteína, com suplementaçäo de uma mistura de aminoácidos (exceto treonina, metionina, valina e isoleucina), DL-carnitina e bicarbonato. Está no momento fisicamente e mentalmente normal com doze meses de idade