Our climate has significantly changed, exceeding what the world has experienced over the last 650,000 years, and has been cited as the most significant health threat of the twenty-first century. ...Climate change is impacting health in unprecedented ways. While everyone is vulnerable to the health impacts associated with climate change, children are disproportionately affected because of their physical and cognitive immaturity. Climate change impacts that include rising temperatures, extreme weather, rising sea levels, and increasing carbon dioxide levels are associated with a wide range of health issues in children such as asthma, allergies, vector-borne diseases, malnutrition, low birth weight, and post-traumatic stress disorder. Pediatric health providers play a critical role in advancing the science and translating findings to improve public understanding about the link between climate changes and children's health, and establishing strategies to address these issues. This review will provide an overview of research exploring the impact of climate change on children's health impacts, as well as provide recommendations for pediatric research moving forward.
Children spend over 6 h a day in schools and have higher asthma morbidity from school environmental exposures. The present study aims to determine indoor and outdoor possible sources affecting indoor ...PM2.5 in classrooms. Weeklong indoor PM2.5 samples were collected from 32 inner-city schools from a Northeastern U.S. community during three seasons (fall, winter and spring) during the years 2009 to 2013. Concurrently, daily outdoor PM2.5 samples were taken at a central monitoring site located at a median distance of 4974 m (range 1065–11,592 m) from the schools. Classroom indoor concentrations of PM2.5 (an average of 5.2 μg/m3) were lower than outdoors (an average of 6.5 μg/m3), and these averages were in the lower range compared to the findings in other schools' studies. The USEPA PMF model was applied to the PM2.5 components measured simultaneously from classroom indoor and outdoor to estimate the source apportionment. The major sources (contributions) identified across all seasons of indoor PM2.5 were secondary pollution (41%) and motor vehicles (17%), followed by Calcium (Ca)-rich particles (12%), biomass burning (15%), soil dust (6%), and marine aerosols (4%). Likewise, the major sources of outdoor PM2.5 across all seasons were secondary pollution (41%) and motor vehicles (26%), followed by biomass burning (17%), soil dust (7%), road dust (3%), and marine aerosols (1%). Secondary pollution was the greatest contributor to indoor and outdoor PM2.5 over all three seasons, with the highest contribution during spring with 53% to indoor PM2.5 and 45% to outdoor PM2.5. Lower contributions of this source during fall and winter are most likely attributed to less infiltration indoors. In contrast, the indoor contribution of motor vehicles source was highest in the fall (29%) and winter (25%), which was presumably categorized by a local source. From the relationship between indoor-to-outdoor sulfur ratios and each source contribution, we also estimated the local and regional influence on indoor PM2.5 concentration. Overall, the observed differences to indoor PM2.5 are related to seasonality, and the distinct characteristics and behavior of each classroom/school.
•Relative source contributions of indoor and outdoor PM2.5 were determined for inner-city school classrooms;•Four outdoor sources and two indoor sources were identified as contributors to indoor PM2.5 concentrations, and;•Regional sources were the greatest contributor to indoor and outdoor PM2.5 in all seasons.
Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most ...common referral departments at Boston Children’s Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.
Background Children with food allergies spend a large proportion of time in school but characteristics of allergic reactions in schools are not well studied. Some schools self-designate as ...peanut-free or have peanut-free areas, but the impact of policies on clinical outcomes has not been evaluated. Objective We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools. Methods In this retrospective study, we analyzed (1) rates of epinephrine administration in all Massachusetts public schools and (2) Massachusetts public school nurse survey reports of school peanut-free policies from 2006 to 2011 and whether schools self-designated as “peanut-free” based on policies. Rates of epinephrine administration were compared for schools with or without peanut-restrictive policies. Results The percentage of schools with peanut-restrictive policies did not change significantly in the study time frame. There was variability in policies used by schools self-designated as peanut-free. No policy was associated with complete absence of allergic reactions. Both self-designated peanut-free schools and schools banning peanuts from being served in school or brought from home reported allergic reactions to nuts. Policies restricting peanuts from home, served in schools, or having peanut-free classrooms did not affect epinephrine administration rates. Schools with peanut-free tables, compared to without, had lower rates of epinephrine administration (incidence rate per 10,000 students 0.2 and 0.6, respectively, P = .009). Conclusions These data provide a basis for evidence-based school policies for children with food allergies. Further studies are required before decisions can be made regarding peanut-free policies in schools.
Objectives
Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using ...a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated a risk-factor based questionnaire to detect elevated blood lead levels in pregnancy.
Methods
We performed a secondary analysis of a cohort of parturients enrolled to evaluate the association of lead with hypertensive disorders of pregnancy. We included participants in this analysis if they had a singleton pregnancy ≥ 34 weeks’ gestation with blood lead levels recorded. Participants completed a lead risk factor survey modified for pregnancy. We defined elevated blood lead as ≥ 2 μg/dL, as this was the clinically reportable level.
Results
Of 102 participants enrolled in the cohort, 92 had blood lead measured as part of the study. The vast majority (78%) had 1 or more risk factor for elevated lead using the questionnaire yet none had clinical blood lead testing during routine visits. Only two participants (2.2%) had elevated blood lead levels. The questionnaire had high sensitivity but poor specificity for predicting detectable lead levels (sensitivity 100%, specificity 22%).
Conclusions for Practice
Prenatal risk-factor based lead screening appears underutilized in practice and does not adequately discriminate between those with and without elevated blood levels. Given the complexity of the risk factor-based approach and underutilization, the benefit and cost-effectiveness of universal lead testing should be further explored.
Outdoor air pollution penetrates buildings and contributes to total indoor exposures. We investigated the relationship of indoor to outdoor particulate matter in inner-city school classrooms. The ...School Inner City Asthma Study investigates the effect of classroom-based environmental exposures on students with asthma in the northeast United States. Mixed effects linear models were used to determine the relationships between indoor PM
(particulate matter) and black carbon (BC), and their corresponding outdoor concentrations, and to develop a model for predicting exposures to these pollutants. The indoor-outdoor sulfur ratio was used as an infiltration factor of outdoor fine particles. Weeklong concentrations of PM
and BC in 199 samples from 136 classrooms (30 school buildings) were compared with those measured at a central monitoring site averaged over the same timeframe. Mixed effects regression models found significant random intercept and slope effects, which indicate that: (1) there are important PM
sources in classrooms; (2) the penetration of outdoor PM
particles varies by school and (3) the site-specific outside PM
levels (inferred by the models) differ from those observed at the central monitor site. Similar results were found for BC except for lack of indoor sources. The fitted predictions from the sulfur-adjusted models were moderately predictive of observed indoor pollutant levels (out of sample correlations: PM
: r
=0.68, BC; r
=0.61). Our results suggest that PM
has important classroom sources, which vary by school. Furthermore, using these mixed effects models, classroom exposures can be accurately predicted for dates when central site measures are available but indoor measures are not available.
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