Timing and Persistence of Material Hardship Among Children in the United States.

OBJECTIVE: Screening for social determinants of health (SDH) has been widely adopted to identify child health risks associated with exposure to material hardship. Whereas SDH screening typically addresses a 12-month span, we sought to compare the prevalence of exposure to present (within the past year) as compared to recent (2-4 years ago) hardship among children in the United States. METHODS: We analyzed the 2014 Survey of Income and Program Participation, a nationally representative survey that interviewed participating households annually between 2014 and 2017. We included data from households with children in all waves. As of 2017, households were categorized as (1) experiencing present hardship (within the last year); (2) experiencing recent but not present hardship (any year between 2014 and 2016); and (3) experiencing no hardship over the 4-year period. RESULTS: Of 2422 households, 27% experienced present hardship and 29% experienced recent but not present hardship. Households presently experiencing hardship were more likely to have Medicaid insurance, less likely to be married, and had more children than families who had experienced recent hardship. However, these groups were similar on caregivers' educational attainment, race/ethnicity, language spoken in the home, and age of the youngest child. CONCLUSIONS: Our results suggest that clinical screening tools for SDH that use a 12-month time frame risk missing many children who have recently (within the past 4 years) experienced material hardship and may benefit from interventions to improve social support; a longer time frame could provide clinicians with valuable information for understanding social factors that impact child health and development.

Extended spectrum beta-lactamase testing of community Enterobacteriaceae in the west of Australia: poor performance of phenotypic methods.

Expanded spectrum ß-lactamase (ESBL) producing organisms have long been recognised in institutions worldwide. Recently, community isolates producing ESBL have been reported overseas and in eastern Australia. We tested 571 consecutive Enterobacteriaceae urinary isolates from Western Australia and the Northern Territory phenotypically by calibrated dichotomous sensitivity (CDS) methods in two periods (2007 and 2012). Eleven ESBL-producing isolates from 2012 and 39 banked strains were genotyped by PCR. Twenty-six (4.6%) strains produced ESBL by CDS. Only 57.7% of CDS-confirmed ESBL strains had an initial reduced cephalosporin zone. Vitek 2 identified only nine (34.6%) CDS-ESBL strains. There was no significant change in ESBL strain prevalence over the two periods by CDS, but our laboratory information system showed a steady increase from 2007-2012 in ESBL strain prevalence (identified by multiple methods) at a rate of 0.02% per month to reach 2% by 2012. Genotyping of 50 CDS-confirmed isolates demonstrated ESBL genes in 44 (88%), mainly CTX-M genes. Twenty-five ESBL strains contained more than one ß-lactamase gene, up to a maximum of three genes. There is a rising prevalence of ESBL strains in our communities. CDS and Vitek-2 testing is neither sensitive nor specific in detecting ESBL enzymes. Routine laboratories need access to genotyping to identify and monitor ESBLs in the community.