Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Tina L. Schuh ◽  
Leena B. Mithal ◽  
Sara Naureckas ◽  
Emily S. Miller ◽  
Craig F. Garfield ◽  
...  
Keyword(s):  
Health Center ◽  
Low Income ◽  
Growth Parameters ◽  
Clinical Status ◽  
Genetic Diagnosis ◽  
The United States ◽  
Growth Patterns ◽  
Publicly Insured ◽  
In Pregnancy

Abstract Objectives We evaluated inpatient management, transition to home, breastfeeding, growth, and clinical outcomes of infants born to mothers diagnosed with SARS-CoV-2 infection in pregnancy and followed in a Federally Qualified Health Center (FQHC), that serves a diverse and low-income patient population, from birth through 6 months of life. Methods Infants born between 4/3/20 and 7/26/20 at Prentice Women’s Hospital with mothers who received prenatal care at Erie Family Health Center (Erie), the second largest FQHC in Illinois, and had confirmed SARS-CoV-2 during pregnancy were included. Data were abstracted from delivery hospital admission and outpatient follow-up appointments between 4/8/20 and 2/4/21. Results Thirty-three infants met inclusion criteria. Average gestational age was 38.9 weeks (IQR 37.6–40.4), 3 (10%) were premature and 5 (15%) required NICU admission. Nearly all (97%) mothers expressed intent to breastfeed. Outpatient follow-up rates were similar to historical cohorts and 82% (23/28) of infants were vaccination compliant. Growth parameters showed normal distributions at all time points. At 6 months, any and exclusive breast milk feeding rates were lower compared to historic cohorts (18 vs. 36%, p<0.05, 0 vs. 21%, p<0.01). Three infants (10%) received development-related referrals, one carried an underlying genetic diagnosis. Outpatient visits were predominantly face-to-face with telemedicine use comprising only 6% of visits (11/182). Conclusions Longitudinal follow-up of 33 publicly insured infants born to mothers with SARS-CoV-2 infection in pregnancy followed in an FQHC showed high rates of follow-up and vaccination compliance, normal growth patterns and reassuring clinical status, and lower than expected rates of breastfeeding.

scholarly journals The mutational landscape of spinal chordomas and their sensitive detection using circulating tumor DNA

2020 ◽  
Author(s):  
Austin K Mattox ◽  
Beibei Yang ◽  
Christopher Douville ◽  
Sheng-fu Lo ◽  
Daniel Sciubba ◽  
...  
Keyword(s):  
Clinical Status ◽  
Spinal Column ◽  
Disease Recurrence ◽  
The United States ◽  
Circulating Tumor Dna ◽  
Blood Draw ◽  
Primary Tumors ◽  
Whole Exome ◽  
Tumor Dna

Abstract Background Chordomas are the most common primary spinal column malignancy in the United States. The aim of this study was to determine whether chordomas may be detected by evaluating mutations in circulating tumor DNA (ctDNA). Methods 32 patients with a biopsy-confirmed diagnosis of chordoma had blood drawn pre-operatively and/or at follow up appointments. Mutations in the primary tumor were identified by whole exome sequencing and liquid biopsy by ddPCR and/or RACE-Seq was used to detect one or more of these mutations in plasma ctDNA at concurrent or later time points. Results 87.1% of patients were ctDNA positive at the time of initial blood draw (p &lt; 0.001). Follow up blood draws in twenty of the patients suggest that ctDNA levels may reflect the clinical status of the disease. Patients with positive ctDNA levels were more likely to have greater mutant allele frequencies in their primary tumors (p = 0.004) and undergo radiotherapy (p = 0.02), and the presence of ctDNA may correlate with response to systemic chemotherapy and/or disease recurrence. Conclusions Detection of ctDNA mutations may allow for the detection and monitoring of disease progression for chordomas.

scholarly journals Hepatitis C Virus in Pregnancy: Case Reports and Literature Review

1995 ◽  
Vol 3 (6) ◽  
pp. 248-251 ◽  
Author(s):  
Gary M. Joffe
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Vertical Transmission ◽  
Case Reports ◽  
Sexual Transmission ◽  
Severity Of Illness ◽  
The United States ◽  
Maternal Disease ◽  
In Pregnancy

Background: Hepatitis C virus (HCV) is now recognized as the cause of 90% of non-A, non-B (NANB) hepatitis. This virus is responsible for a large percentage of chronic persistent and chronic active hepatitis in the United States. Parenteral and sexual transmission are well described, so a significant population of pregnant patients is at risk. Vertical transmission of the virus to the fetus is dependent upon the level of maternal viremia.Case: The cases described in the following report demonstrate that fulminant disease may present in pregnancy. They also demonstrate the cofactors promoting the severity of illness, methods of diagnosis, potential treatment, and outcome of the infection.Conclusion: HCV may be encountered in pregnancy. Although most acute-phase illness will be self limiting, some patients will manifest liver failure during gestation. Because vertical transmission to the fetus is possible, the pediatrician should be informed of the maternal disease. Chronic hepatitis is almost the rule rather than the exception, so patients require close postpartum follow-up. Interferon, which may alter the course of the chronic disease, has been used on rare occasions in pregnancy.

scholarly journals Growth patterns of patients with Noonan syndrome: correlation with age and genotype

2016 ◽  
Vol 174 (5) ◽  
pp. 641-650 ◽  
Author(s):  
Catie Cessans ◽  
Virginie Ehlinger ◽  
Catherine Arnaud ◽  
Armelle Yart ◽  
Yline Capri ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Noonan Syndrome ◽  
Growth Parameters ◽  
Standard Deviation Score ◽  
Growth Patterns ◽  
Healthy Population ◽  
Length Standard ◽  
Study Population ◽  
Multiple Lentigines

Background Growth patterns of patients with Noonan syndrome (NS) were established before the involved genes were identified. Objective The goal of this study was to compare growth parameters according to genotype in patients with NS. Subjects and methods The study population included 420 patients (176 females and 244 males) harboring mutations in the PTPN11, SOS1, RAF1, or KRAS genes. NS-associated PTPN11 mutations (NS-PTPN11) and NS with multiple lentigines-associated PTPN11 mutations (NSML-PTPN11) were distinguished. Birth measures and height and body mass index (BMI) measures at 2, 5, 10 years, and adulthood were compared with the general population and between genotypes. Results Patients with NS were shorter at birth (mean birth length standard deviation score (SDS): –1.0 ± 1.4; P < 0.001) and throughout childhood than the healthy population, with height SDS being –2.1 ± 1.3 at 2 years, and –2.1 ± 1.2 at 5 and 10 years and adulthood (P < 0.001). At birth, patients with NS-PTPN11 were significantly shorter and thinner than patients with NSML-PTPN11, SOS1, or KRAS. Growth retardation was significantly less severe and less frequent at 2 years in patients with NSML-PTPN11 and SOS1 than in patients with NS-PTPN11 (P < 0.001 and P = 0.002 respectively). Patients with NS had lower BMI at 10 years (P < 0.001). No difference between genotypes was demonstrated. Conclusion Determining the growth patterns of patients with NS according to genotype should better inform clinicians about the natural course of growth in NS so that they can optimize the follow-up and management of these patients.

Access to primary care child weight management programs: Urban parent barriers and facilitators to participation

2017 ◽  
Vol 21 (4) ◽  
pp. 509-521 ◽  
Author(s):  
Noel L Kulik ◽  
Erica M Thomas ◽  
Samantha Iovan ◽  
Margaret McKeough ◽  
Stephanie Kendzierski ◽  
...  
Keyword(s):  
Weight Management ◽  
Low Income ◽  
Intervention Program ◽  
The United States ◽  
Management Program ◽  
Barriers And Facilitators ◽  
Referral Process ◽  
Program Participation ◽  
Framework Analysis

The prevalence and comorbidities of childhood obesity among low-income urban children are a significant health issue in the United States. Programs designed to assist families are underutilized. The aim of this study is to describe barriers and facilitators relevant to intervention program participation from the perspective of parents who have children who are overweight or obese. Systematic thematic analysis of focus groups and semi-structured interviews with parents from multiple urban pediatrics and family medicine practices were used to gather data. A framework analysis approach was used and a codebook of themes was developed. Transcripts were coded independently by the research team and consensus among researchers was reached. Forty-eight parents participated in the study. Perceived barriers to participation included (1) varied referral process (lack of follow-up or varying referral experience), (2) costs (time and program fee), (3) logistics (location and program schedule), and (4) child motivation. Perceived facilitators to participation included (1) systematic referral process (in-office referral and timely follow-up), (2) program content and organization, and (3) no cost. Multiple barriers and facilitators affect weight management program participation among families, which should be specifically targeted in future obesity interventions in order to effectively reach urban, minority parents and children.

scholarly journals Sociodemographic predictors of early postnatal growth: evidence from a Chilean infancy cohort

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033695
Author(s):  
Ann Von Holle ◽  
Kari E North ◽  
Sheila Gahagan ◽  
Raquel A Burrows ◽  
Estela Blanco ◽  
...  
Keyword(s):  
Growth Rate ◽  
Growth Curve ◽  
Low Income ◽  
Maternal Education ◽  
Growth Parameters ◽  
Growth Parameter ◽  
Postnatal Growth ◽  
Growth Patterns ◽  
Velocity Change ◽  
Average Growth

ObjectivesInfant anthropometric growth varies across socioeconomic factors, including maternal education and income, and may serve as an indicator of environmental influences in early life with long-term health consequences. Previous research has identified sociodemographic gradients in growth with a focus on the first year and beyond, but estimates are sparse for growth before 6 months. Thus, our objective was to examine the relationship between sociodemographic factors and infant growth patterns between birth and 5 months of age.DesignProspective cohort study.SettingsLow-income to middle-income neighbourhoods in Santiago, Chile (1991–1996).Participants1412 participants from a randomised iron-deficiency anaemia preventive trial in healthy infants.Main outcome measuresLongitudinal anthropometrics including monthly weight (kg), length (cm) and weight-for-length (WFL) values. For each measure, we estimated three individual-level growth parameters (size, timing and velocity) from SuperImposition by Translation and Rotation models. Size and timing changes represent vertical and horizontal growth curve shifts, respectively, and velocity change represents growth rate shifts. We estimated the linear association between growth parameters and gestational age, maternal age, education and socioeconomic position (SEP).ResultsLower SEP was associated with a slower linear (length) velocity growth parameter (−0.22, 95% CI –0.31 to –0.13)—outcome units are per cent change in velocity from the average growth curve. Lower SEP was associated with later WFL growth timing as demonstrated through the tempo growth parameter for females (0.25, 95% CI 0.05 to 0.42)—outcome units are shifts in days from the average growth curve. We found no evidence of associations between SEP and the weight size, timing or velocity growth rate parameters.ConclusionPrevious research on growth in older infants and children shows associations between lower SEP with slower length velocity. We found evidence supporting this association in the first 5 months of life, which may inform age-specific prevention efforts aimed at infant length growth.

scholarly journals Establishing a SARS-CoV-2 (COVID-19) Drive-Through Collection Site: A Community-Based Participatory Research Partnership With a Federally Qualified Health Center

2021 ◽  
Vol 111 (4) ◽  
pp. 658-662
Author(s):  
LaPrincess C. Brewer ◽  
Cynthia Woods ◽  
Aarti Patel ◽  
Jennifer Weis ◽  
Clarence Jones ◽  
...  
Keyword(s):  
Health Center ◽  
Low Income ◽  
Diagnostic Testing ◽  
Community Based Participatory Research ◽  
The United States ◽  
Academic Community ◽  
Collection Site ◽  
Disadvantaged Population ◽  
Federally Qualified Health Center ◽  
Structural Inequities

The COVID-19 pandemic has disproportionately affected underserved and minority populations in the United States. This is partially attributable to limited access to diagnostic testing from deeply rooted structural inequities precipitating higher infection and mortality rates. We describe the process of establishing a drive-through collection site by leveraging an academic–community partnership between a medical institution and a federally qualified health center in Minnesota. Over 10 weeks, 2006 COVID-19 tests were provided to a socioeconomically disadvantaged population of racial/ethnic minorities and low-income essential workers.

scholarly journals Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

2014 ◽  
Author(s):  
Michelle Park ◽  
Jay Bhattacharya ◽  
KT Park
Keyword(s):  
Inflammatory Bowel Disease ◽  
Low Income ◽  
Bowel Disease ◽  
Clinical Care ◽  
The United States ◽  
Medical Expenditure ◽  
Insurance Status ◽  
Inflammatory Bowel ◽  
Publicly Insured ◽  
Insured Patients

Background: Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD). Aim: To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods: We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn’s disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures. Results: Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94, CI 1.26-19.47), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI 0.15-0.95) and office-based care (OR 0.21, CI 0.07-0.62). Conclusions: In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

scholarly journals Assessment of Cooking Matters Facebook Platform to Promote Healthy Eating Behaviors among Low-Income Caregivers of Young Children in the United States: A Pilot Study

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2694
Author(s):  
Qi Zhang ◽  
Jill Panichelli ◽  
Leigh Ann Hall
Keyword(s):  
Young Children ◽  
Healthy Eating ◽  
Low Income ◽  
Eating Behaviors ◽  
The United States ◽  
Convenience Sample ◽  
The Impact ◽  
The Relationship ◽  
Healthy Eating Behaviors

How best to deliver healthy-eating education through social media among a low-income population remains understudied. To assess the impact of the Cooking Matters (CM) Facebook page on healthy eating behaviors among low-income caregivers, we conducted a pre–post survey of new CM Facebook followers in early 2020. A convenience sample was recruited at baseline from WICShopper app users and the CM Facebook page. The recruited sample included 397 low-income caregivers of a child younger than 6 who never followed CM Facebook. Among the baseline caregivers, 184 completed the follow-up survey. Paired t-test and McNemar–Bowker tests were conducted to compare the outcomes pre- and post-following CM Facebook. A binary indicator was developed to measure whether the outcomes were improved (1 = Improved; 0 = Not improved). Multi-variable logistic regressions were applied to examine the relationship between whether the outcome was improved with reference to the baseline socio-demographics. No significant differences were detected between pre and post outcomes overall (p > 0.05), except improvement in feeding healthy meals within the budget available (p < 0.05). However, improvement in select outcomes was more significant in men and single-parent households. The CM Facebook page could be an important platform to influence low-income caregivers of young children.

scholarly journals SUN-093 Prospective Clinical Assessment Study in Children with Achondroplasia: The PROPEL Trial

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ravi Savarirayan ◽  
Peter Kannu ◽  
Carl L Dambkowski ◽  
Daniela Rogoff ◽  
Melita Irving
Keyword(s):  
Growth Parameters ◽  
Final Height ◽  
Clinical Status ◽  
Chronic Otitis Media ◽  
The United States ◽  
Foramen Magnum ◽  
Current Status ◽  
The European Union ◽  
Interventional Trial ◽  
Obstructive Sleep

Abstract BACKGROUND: Achondroplasia (ACH) is the most common non-lethal form of skeletal dysplasia, affecting between 1 in 15,000 to 1 in 30,000 live births [Horton et al. 2007; Waller et al. 2008]. Children and adults with ACH have disproportionate short stature, with a final height of approximately 131 cm for males and 124 cm for females. They are prone to significant co-morbidities, including obstructive sleep apnea, chronic otitis media with conductive hearing loss, spinal stenosis and a propensity towards obesity. In some infants, narrowing of the foramen magnum may result in compression of the spinal cord with neurologic sequelae, requiring timely neurosurgical intervention. There are currently no approved therapies for the treatment of ACH in either the United States or the European Union, and management is generally supportive in nature. The PROPEL trial is a prospective, non-interventional study examining baseline growth parameters and health status in children with ACH being assessed for potential enrollment into interventional studies with infigratinib, an oral FGFR1-3 inhibitor in development for achondroplasia. Methods: Children with ACH between the ages of 2.5 and 10 years are eligible for enrollment in this prospective, non-interventional trial to evaluate growth parameters and determine clinical status. Participants will be assessed at baseline, month 3, month 6, and every 6 months thereafter. The primary endpoint is annualized height growth velocity. Secondary endpoints include change from baseline in other growth parameters (including body proportionality); analysis of bone biomarkers (e.g., bone alkaline phosphatase, collagen X fragment); and the occurrence of medical events and surgical procedures. Participants will be enrolled in the study for a minimum of 6 months up to a maximum of 2 years before being considered for enrollment in a QED-sponsored phase 2/3 interventional trial. Current status: The PROPEL study is underway with the first patient enrolled in August 2019. Planned total enrollment is 200 children with ACH.

Association between food insecurity, cardiorenal syndrome and all-cause mortality among low-income adults

2019 ◽  
Vol 25 (4) ◽  
pp. 245-252 ◽  
Author(s):  
Srikanta Banerjee ◽  
Timothy Radak
Keyword(s):  
Food Security ◽  
Chronic Disease ◽  
General Population ◽  
Food Insecurity ◽  
Low Income ◽  
Cardiorenal Syndrome ◽  
The United States ◽  
Household Food Security ◽  
All Cause Mortality

Background: Food insecurity is known to be a major public health issue. There is limited data on food insecurity and chronic disease in the general population. Aim: We aimed to assess effect of food insecurity on mortality of individuals with chronic disease like cardiorenal syndrome (CRS). Methods: The study was conducted on participants aged 20 years or older in the United States living below the 130% Federal Poverty Level. We assessed food insecurity utilizing the Household Food Security Survey Module in NHANES survey for the years 1999 to 2010 with mortality follow-up. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of food insecurity and CRS. Results: Prevalence of food insecurity among the low-income population was 16.1% among males and 21.7% among females. The mean follow-up was 6.5 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of food insecurity to no food insecurity was 1.28 (95% confidence interval [CI], 1.18–1.37, p < 0.001). Adjusted HR was elevated, 2.81 (CI 1.57–5.05, p < 0.001), among participants who were CRS-positive and food insecure but closer to 1.0 (2.48 CI 1.73–3.55, p < 0.001) among those who were CRS-positive and food secure, after controlling for medical and demographic risk factors. Conclusions: Food insecurity is associated with higher mortality than food security. Food insecurity also may modify the effect of CRS on all-cause mortality in a representative general population. Social policy, when addressing food insecurity, should be inclusive among those with specific chronic diseases.

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