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Tag: children

  • CHOP Researchers Identify Molecules that Optimize Immune Presentation of Antigens across the Human Population

    CHOP Researchers Identify Molecules that Optimize Immune Presentation of Antigens across the Human Population

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    Newswise — Philadelphia, February 24, 2023—Researchers at Children’s Hospital of Philadelphia (CHOP) have identified variants of a chaperone molecule that optimizes the binding and presentation of foreign antigens across the human population, which could open the door to numerous applications where robust presentation to the immune system is important, including cell therapy and immunization. The findings were published today in Science Advances. 

    Class I major histocompatibility complex (MHC-I) proteins are found on the surface of cells from all jawed vertebrates and play an essential role in the immune system. The MHC-I displays peptide fragments of proteins from within the cell on the cell surface, effectively “presenting” them to the immune system, which is constantly scanning the body for foreign or toxic antigens. When foreign peptides are identified, they trigger a cascade that allows cytotoxic T cells to eliminate intruders.

    For a peptide to be presented to the immune system, it needs to be loaded on a folded MHC-I protein. Several molecules facilitate this process, including proteins known as molecular chaperones, which assist with MHC-I folding. Tapasin and a similar molecule known as TAPBPR are both molecular chaperones that facilitate MHC-I folding and peptide loading. Because TAPBR functions independently outside of the peptide-loading complex, it is well-suited for clinical applications that involve peptide exchange, such as loading immunogenic peptides on MHC-I molecules and generating libraries to detect T-cells that recognize peptides or antigens from infected or cancerous cells.

    However, TAPBPR-mediated peptide exchange has thus far only worked for a limited set of common allotypes of human MHC-I, known as human leukocyte antigen (HLA), which has limited wider use of these technologies in biomedical applications. Over time, HLA subtypes, which include HLA-A, HLA-B, and HLA-C, have evolved such that not all alleles interact equally well with TAPBPR. This has been a roadblock in developing and enhancing novel therapies with the help of molecular chaperones, as some HLA allotypes do not interact with these molecules. 

    To solve this problem, the CHOP researchers analyzed three different TAPBPR proteins: one from humans, one from chickens, and one from mice. They found that unlike human TAPBPR, chicken TAPBPR co-evolved with its class I genes, so that it maintains high affinity across MHC-I allotypes. In their analysis, they found that chicken TAPBPR was able to react with multiple HLA allotypes, many of which were not able to bind to human TAPBPR. They also demonstrated that TAPBPR stabilizes the empty MHC-I groove in an “open” conformation, boosting its affinity for peptide loading.

    Simultaneously, in close collaboration with researchers at the University of Illinois led by Erik Procko, PhD, the research team used deep mutational scanning to characterize the effects from 100s of point mutations on human TAPBPR and found a variant that mimics the chicken sequence. Like the chicken TAPBPR, this variant enhanced peptide exchange across a broad range of HLA types.

    “Although the highly polymorphic nature of MHC-I molecules makes it challenging to engineer ‘universal’ chaperones, our research team demonstrated that both a chicken ortholog of TAPBPR and a human variant with minor adjustments could enhance peptide exchange across multiple disease-relevant HLAs,” said senior author Nikolaos G. Sgourakis, PhD, Associate Professor in the Center for Computational and Genomic Medicine at Children’s Hospital of Philadelphia. “These TAPBPR orthologs could be utilized in various cancer immunotherapeutic settings to narrow the peptide repertoire and increase immunogenicity. The knowledge gained by our studies can guide the design of engineered TAPBPR variants with tailored HLA specificity and catalytic efficiency for peptide exchange applications both in vitroand in vivo.”

    This research was supported by funding from the National Institute of Allergy and Infectious Diseases (5R01AI143997) and National Institute of General Medical Sciences (5R35GM125034). 

    Yi Sun, Georgia F. Papadaki, Christine A. Devlin, Julia N. Danon, Michael C. Young, Trenton J. Winters, George M. Burslem, Erik Procko, and Nikolaos G. Sgourakis. “Xeno-interactions between MHC-I proteins and molecular chaperones enable ligand exchange on a broad repertoire of HLA allotypes,” Science Advances, February 24, 2023, DOI: 10.1126/sciadv.ade7151 

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    About Children’s Hospital of Philadelphia: A non-profit, charitable organization, Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as a new inpatient hospital with a dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children’s Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

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    Children’s Hospital of Philadelphia

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  • Gender dysphoria in young people is rising—and so is professional disagreement

    Gender dysphoria in young people is rising—and so is professional disagreement

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    Newswise — More children and adolescents are identifying as transgender and offered medical treatment, especially in the US. But some providers and European authorities are urging caution because of a lack of strong evidence. 

    In a new report from The BMJ Investigations Unit, Jennifer Block, investigations reporter, looks into the evidence base behind this surge in treatment.

    More adolescents with no history of gender dysphoria are presenting at gender clinics. For example, a recent analysis of insurance claims found that nearly 18,000 US minors began taking puberty blockers or hormones from 2017 to 2021, the number rising each year.

    Meanwhile, the number of US private clinics focused on providing hormones and surgeries have grown from just a few a decade ago to more than 100 today.

    American medical professional groups are aligned in support of “gender affirming care” for gender dysphoria, which may include hormone treatment to suppress puberty and promote secondary sex characteristics, and surgical removal or augmentation of breasts, genitals, and other physical features.

    Three organisations in particular have had a major role in shaping the US approach to gender dysphoria care: The World Professional Association for Transgender Health (WPATH), the American Academy of Pediatrics, and the Endocrine Society, all of which have guidelines or policies that support early medical treatment for gender dysphoria in young people.

    These endorsements are often cited to suggest that medical treatment is both uncontroversial and backed by rigorous science, but governing bodies around the world have come to different conclusions regarding the safety and efficacy of certain treatments, notes Block. 

    For example, Sweden’s National Board of Health and Welfare, which sets guidelines for care, determined earlier this year that the risks of puberty blockers and treatment with hormones “currently outweigh the possible benefits” for minors.

    And NHS England, which is in the midst of an independent review of gender identity services, recently stated that there is “scarce and inconclusive evidence to support clinical decision-making” for minors with gender dysphoria, and that for most who present before puberty it will be a “transient phase,” requiring clinicians to focus on psychological support and to be “mindful” of the risks of even social transition 

    Experts are also questioning the evidence underpinning these guidelines.

    Professor Mark Helfand at Oregon Health and Science University identified several deficiencies in WPATH’s recommendations, such as lack of a grading system to indicate the quality of the evidence, while Professor Gordon Guyatt at McMaster University found “serious problems” with the Endocrine Society guidelines, including pairing strong recommendations with weak evidence.

    Helfand explains that calling a recommendation ‘evidence-based’ should mean a treatment has not just been systematically studied, but that there was also a finding of high quality evidence supporting its use. 

    Despite these concerns, WPATH recommends that youth have access to treatments following comprehensive assessment, stating “the emerging evidence base indicates a general improvement in the lives of transgender adolescents.”

    Eli Coleman, lead author of WPATH’s Standards of Care and former director of the Institute for Sexual and Gender Health at the University of Minnesota, told The BMJ that WPATH’s new guidelines emphasise “careful assessment prior to any of these interventions” by clinicians who have appropriate training and competency to assure that minors have “the emotional and cognitive maturity to understand the risks and benefits.”

    But without an objective diagnostic test, others remain concerned, pointing to examples of teenagers being “fast-tracked to medical intervention” with little or no mental health involvement. 

    And in her interim report of a national review into services for young people with gender identity issues, Hilary Cass noted that some NHS staff reported feeling “under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.”

    For Guyatt, claims of certainty represent both the success and failure of the evidence-based medicine movement. “When there’s been a rigorous systematic review of the evidence and the bottom line is ‘we don’t know,’” he says, then “anybody who then claims they do know is not being evidence based.”

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    BMJ

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  • Cleft lip and palate surgery procedures are undervalued, study suggests

    Cleft lip and palate surgery procedures are undervalued, study suggests

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    Newswise — February 24, 2023 – Plastic surgery procedures performed to correct cleft lip and palate deformities in infants and children are economically undervalued, relative to pediatric craniofacial procedures, concludes an analysis in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

    The study finds unbalanced allocation of relative value units (RVUs) used in billing and compensation for cleft surgery in children, compared to craniofacial procedures, report Roberto L. Flores, MD, of Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, and colleagues. “The current RVU allocation to cleft and craniofacial procedures creates arbitrary disparities in physician efficiency, with cleft procedures disproportionately negatively affected,” the researchers write.

    Procedures with the lowest RVUs are mainly for cleft surgery

    The RVU system is a standardized coding method to account for a wide range of factors affecting the value of physicians’ work, such as the time, effort, and risks of specific procedures and services. Each surgical procedure (or component of a complex procedure) has a specified RVU. The values assigned to RVUs have important implications for surgeons’ reimbursement and productivity.

    Using a national database, the researchers identified 50,450 pediatric cleft or craniofacial surgery cases performed by plastic surgeons between 2012 and 2019. For each of 69 different procedures, efficiency was assessed by dividing the total RVUs by the total operative time, to arrive at RVUs per hour. The analysis accounted for a range of variables affecting patient complexity and surgeon effort.

    Four of the five most frequently performed procedures involved primary or secondary repair of cleft palate. Yet most procedures in the top quartile (one-fourth) of efficiency were craniofacial procedures: average efficiency 15.65 RVUs per hour.

    In contrast, most procedures in the bottom quartile of efficiency were cleft procedures, with an average efficiency of 7.39 RVUs per hour. Average operating time was 167 minutes for craniofacial procedures versus 108 minutes for cleft procedures.

    Thus even though they accounted for some of the most frequently performed plastic surgery procedures in children, cleft procedures were rated as having an average efficiency roughly half that of the most-efficient procedures. The researchers note that a relatively simple procedure such as performing a local skin flap would be rated more efficient than a more complex procedure such as palatal lengthening for cleft palate correction.

    ‘Arbitrary disparities’ may create disincentives to perform cleft surgery

    RVUs were correlated with operative time, as well as with serious adverse events, other patient health conditions (comorbidity), patient age, and hospital readmission risk. However, these factors accounted for just 38% of the variance in RVUs – “suggesting that other factors are at play in explaining RVU allocation,” the researchers write.

    The study builds on a previous analysis of adult plastic surgery procedures, which concluded that “RVU allocation did not confer a consistent accurate representation of physician efficiency.” The new analysis extends the analysis to pediatric plastic surgery cases – most of which consist of cleft surgery or craniofacial surgery to correct congenital malformations such as craniosynostosis.

    “[T]he current RVU allocation system undervalues cleft surgical services relative to craniofacial procedures,” Dr. Flores and colleagues conclude. “In order to avoid disincentivizing surgeons from performing cleft procedures and thus constructing artificial barriers to quality care for children with cleft lip and palate, the current RVU allocation should be re-evaluated.”

    “Cleft lip and palate disproportionately affects vulnerable patient populations,” Dr. Flores comments. “Therefore, addressing RVU inequities is all the more important in with regards to the service of the underserved.”

    Read [National Undervaluation of Cleft Surgical Services: Evidence from a Comparative Analysis of 50,450 Cases]

    Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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    About Plastic and Reconstructive Surgery

    For over 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

    About ASPS

    The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

    About Wolters Kluwer

    Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the healthcare; tax and accounting; governance, risk and compliance; and legal and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

    Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

    For more information, visit www.wolterskluwer.com, follow us on LinkedIn, Twitter, Facebook, and YouTube.

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    Wolters Kluwer Health: Lippincott

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  • Reducing social media use significantly improves body image in teens, young adults

    Reducing social media use significantly improves body image in teens, young adults

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    Newswise — Teens and young adults who reduced their social media use by 50% for just a few weeks saw significant improvement in how they felt about both their weight and their overall appearance compared with peers who maintained consistent levels of social media use, according to research published by the American Psychological Association.

    “Adolescence is a vulnerable period for the development of body image issues, eating disorders and mental illness,” said lead author Gary Goldfield, PhD, of Children’s Hospital of Eastern Ontario Research Institute. “Youth are spending, on average, between six to eight hours per day on screens, much of it on social media. Social media can expose users to hundreds or even thousands of images and photos every day, including those of celebrities and fashion or fitness models, which we know leads to an internalization of beauty ideals that are unattainable for almost everyone, resulting in greater dissatisfaction with body weight and shape.”

    However, much of the psychological research on social media, body image and mental health is correlational, according to Goldfield, so it is uncertain whether people with body image and mental health issues spend more time on social media or if social media use leads to greater body image and mental health issues. 

    To better understand the causal effects of reducing social media use on body image, Goldfield and his colleagues previously conducted a pilot study with 38 undergraduate students with elevated levels of anxiety and/or depression. Some of the participants were asked to limit their social media use to no more than 60 minutes per day, while others were allowed unrestricted access. Compared with participants who had unlimited access, participants who restricted their use showed improvements in how they regarded their overall appearance (but not their weight) after three weeks. Due to the small sample size, though, the researchers were unable to conduct a meaningful analysis of the effect of gender.

    The current experiment, involving 220 undergraduate students aged 17-25 (76% female, 23% male, 1% other) and published in the journal Psychology of Popular Media, sought to expand the pilot study and address the gender limitation. In order to qualify, participants had to be regular social media users (at least two hours per day on their smartphones) and exhibit symptoms of depression or anxiety.

    For the first week of the experiment, all participants were instructed to use their social media as they normally would. Social media use was measured using a screentime tracking program to which participants provided a daily screenshot. After the first week, half the participants were instructed to reduce their social media use to no more than 60 minutes per day. At the start of the experiment, participants also responded to a series of statements about their overall appearance (e.g., “I’m pretty happy about the way I look,”) and weight (e.g., “I am satisfied with my weight,”) on a 5-point scale, with 1 indicating “never” and 5 “always.” Participants completed a similar questionnaire at the end of the experiment.

    For the next three weeks, participants who were instructed to restrict their social media use reduced it by approximately 50% to an average of 78 minutes per day versus the control group, which averaged 188 minutes of social media use per day.

    Participants who reduced their social media use had a significant improvement in how they regarded both their overall appearance and body weight after the three-week intervention, compared with the control group, who saw no significant change. Gender did not appear to make any difference in the effects.

    “Our brief, four-week intervention using screentime trackers showed that reducing social media use yielded significant improvements in appearance and weight esteem in distressed youth with heavy social media use,” said Goldfield. “Reducing social media use is a feasible method of producing a short-term positive effect on body image among a vulnerable population of users and should be evaluated as a potential component in the treatment of body-image-related disturbances.”

    While the current study was conducted as a proof of concept, Goldfield and his colleagues are in the process of conducting a larger study to see if reduction in social media use can be maintained for longer periods and whether that reduction can lead to even greater psychological benefits.

    Article: “Reducing Social Media Use Improves Appearance and Weight Esteem in Youth with Emotional Distress,” by Helen Thai, BA, McGill University; Christopher Davis, PhD, Wardah Mahboob, MA, Sabrina Perry, BA, and Alex Adams, BA, Carleton University; and Gary Goldfield, PhD, Children’s Hospital of Eastern Ontario. Psychology of Popular Media, published online Feb. 23, 2023.

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    American Psychological Association (APA)

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  • Bridging a Neonate With a Single Ventricle to Heart Transplant

    Bridging a Neonate With a Single Ventricle to Heart Transplant

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    BYLINE: Katie Sweeney

    Newswise — In a rare and high-risk procedure, a 1-month-old baby became the first patient with single-ventricle heart disease to receive a ventricular assist device (VAD) at Children’s Hospital Los Angeles.

    The baby, who went on to receive a successful heart transplant, spent six months on mechanical support at CHLA in 2022—first on a PediMag device, followed by the Berlin Heart. The child is now 1 year old and doing well.

    Surgeon John Cleveland, MD, who implanted the VAD and later performed the baby’s transplant, and Jennifer Su, MD, Director of the Ventricular Assist Device Program at Children’s Hospital Los Angeles, discuss this milestone procedure, the innovative way the VAD was connected—and the future of VADs in these high-risk patients.

    How rare is it for a neonate with single-ventricle heart disease to receive a VAD?

    Dr. Cleveland: It’s pretty rare. Only a few centers are doing these procedures in patients with single-ventricle disease, and in neonates it’s particularly unusual. In this case, the baby was only 3.2 kilograms when we put in the VAD.

    In the past, our program had been reluctant to offer VADs for these patients because of the substantial risks. Nationally, only 30% of patients in their first stage of palliation end up surviving to transplant with a VAD. The odds are really stacked against them.

    Talk about this case. Why was a VAD the only option?

    Dr. Su: The baby came to our hospital at 1 week of age and was diagnosed with pulmonary atresia with intact ventricular septum—with a severely underdeveloped right side of the heart—as well as left ventricular noncompaction, a type of cardiomyopathy.

    Because the baby was too unstable for surgery, we performed a patent ductus arteriosus (PDA) stent procedure in the Cardiac Catheterization Lab to try to improve blood flow to the lungs. But the patient remained unstable and later spent a week on extracorporeal membrane oxygenation (ECMO).

    Dr. Cleveland: At that point it was clear the patient was in acute heart failure and would not survive to transplant without mechanical support. With the whole team on board, including the patient’s amazing family, we implanted the VAD just one day after the baby came off of ECMO.

    You took a unique approach in connecting the VAD. What happened?

    Dr. Cleveland: VADs need blood to flow into them to work. Because of this patient’s unique anatomy, we needed to take a different approach to ensure that the cannulas didn’t get blocked and that they had access to as much blood as possible.

    To do this, I reversed the utility of the cannulas, which are the tubes that connect the VAD to the heart. I placed the aortic cannula on the atrium instead of the aorta—so instead of delivering blood to the body, it took it from the body back to the VAD. Then I took the cannula that we normally put in the ventricle and put it on the aorta to send blood to the body.

    Why did you start with a PediMag?

    Dr. Cleveland: In first-stage palliated disease, you’re asking a VAD to supply blood flow to both the body and the lungs. The PediMag is a magnetically levitated pump, and you can dial it up and down much more easily than with the Berlin Heart. That allowed us to make continual adjustments until we found the optimal cardiac output levels.

    Dr. Su: After 2 ½ months, we switched the patient to the Berlin Heart because it’s designed for longer-term use. The PediMag was still working well, but we wanted to make the change before any complications occurred. We did this right at the bedside, and it went very smoothly. Three months later, the patient received a new heart.

    How do you see the future of VADs for children with single ventricles?

    Dr. Su: We’ve already performed our second single-ventricle VAD in another child who is a little older. We were able to make quick decisions based on our previous experience. Children with single ventricles often have limited options for mechanical support while awaiting heart transplant, and innovative VAD strategies allow us to buy more time as they wait for a new heart.

    Dr. Cleveland: While we’re beginning to have some success with VADs in this population, mortality remains extremely high. My own research is focused on finding a viable alternative to VADs for these patients. My hope is that eventually we will have a better option to bridge these children, but we’re not there yet.

    What was most rewarding for you about this experience?

    Dr. Su: It’s been exciting to see such a positive outcome for this child. In the past, this option was simply not available for babies like this. To see this patient make it to a successful transplant and thrive with a new heart has been really rewarding.

    Dr. Cleveland: I’m incredibly proud of the entire team. Everyone had to constantly be in tune to what the patient’s body was saying it needed, so we could make the necessary adjustments. This child’s life is a testament to the dedication and expertise of countless people across our Heart Institute. It is a moment to celebrate.

    Learn more about the Heart Institute.

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    Children’s Hospital Los Angeles

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  • 145,000 cans of Enfamil ProSobee infant formula recalled over bacterial risk | CNN

    145,000 cans of Enfamil ProSobee infant formula recalled over bacterial risk | CNN

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    CNN
     — 

    Reckitt, one of the main formula manufacturers in the US, said Monday that it is recalling two batches of Enfamil ProSobee Simply Plant-Based Infant Formula because of possible cross-contamination with Cronobacter sakazakii bacteria.

    The recall is being conducted out of an abundance of caution, the company says, as tests of the product have been negative for the bacteria and no illnesses have been reported.

    Reckitt is recalling about 145,000 12.9-ounce cans of formula manufactured between August and September and distributed to stores across the US, Guam and Puerto Rico. They have a use-by date of March 1, 2024, on the bottom, along with the codes ZL2HZF or ZL2HZZ.

    Consumers should throw out these products or return them to the place of purchase for a refund. No other ProSobee or Reckitt products are affected.

    The company says that the cause of the issue “was linked to a material from a third party” and that it has taken “all appropriate corrective actions, including no longer sourcing this material from the supplier.”

    Cronobacter was behind a recall of Abbott Nutrition formula last year that exacerbated a nationwide shortage. Cronobacter infections are rare, but they can be serious and even fatal, especially in newborns. The bacteria lives in the environment, but infections in infants are often linked to powdered formula.

    The US Food and Drug Administration received reports of four Cronobacter illnesses and two deaths in three states last year. The infants had all consumed powdered formula made at Abbott’s Sturgis, Michigan, plant. The FDA identified Cronobacter in the plant, but genetic testing did not match it to the sick babies.

    In the wake of the recall and shortage, the FDA said it is working on a plan to enhance its surveillance of baby formula for Cronobacter.

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  • London is handing out free meals for all primary school children | CNN Business

    London is handing out free meals for all primary school children | CNN Business

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    London
    CNN
     — 

    London’s mayor has announced an emergency program to provide free meals for all children attending state primary schools in the capital, adding to a string of fresh evidence that Brits are struggling to afford necessities.

    “The cost-of-living crisis means families and children across our city are in desperate need of additional support,” Sadiq Khan, who himself received free school meals as a child, said in a statement Monday.

    The £130 million ($156 million) program will run for the academic year starting in September and save families around £440 ($529) per child. It will also help reduce the “stigma that can be associated with being singled out as low income,” the statement added.

    It is expected to help around 270,000 pupils who, according to estimates by researchers for the city government, would benefit from free school meals but are not currently eligible under national criteria, which are broadly based on household income. On this basis, a quarter of all London pupils, including those in high school, qualify for free school meals, according to official data.

    This number tallies with an estimate by the Child Poverty Action Group that about 210,000 children living in poverty in London don’t qualify for free school meals because the eligibility criteria are “so restrictive.”

    There was further evidence Monday that more and more Brits are struggling to afford food and electricity as inflation, which is near its highest level in four decades, erodes wages and welfare payments.

    A survey of 85 food banks by the Independent Food Aid Network, an advocacy group, found that 89% saw demand increase in December and January, compared with the same period 12 months ago.

    More than 80% of food banks reported a significant number of people needing help for the first time, as well as an increase in the number of people needing ongoing support rather than occasional food parcels. Just over a third of organizations said they had served staff working for the National Health Service (NHS), which has been hit with successive strikes since December over pay and working conditions.

    “Our fastest-growing client group are working people on low wages who cannot make ends meet,” said Su Parrish from The Easter Team, a food bank in Crawley, south of London.

    Parrish added that the food bank had provided a “record” number of Christmas parcels and modified their usual contents as “clients told us they wouldn’t be able to afford to put ovens on, even on Christmas Day.”

    A survey of more than 2,700 UK adults, published by the Office for National Statistics (ONS) on Monday, found that 51% were worried about keeping warm in their homes this winter.

    Some 60% of respondents, who were polled between January 25 and February 5, said they were using less gas or electricity at home to cope with the increased cost of food, fuel and energy bills.

    “We hear horror stories of people living in cold flats keeping their entire energy budget for keeping the fridge going,” said Andi Hofbauer of St Aidan’s FoodShare in Leeds.

    Also on Monday, a separate ONS survey of nearly 18,500 UK adults between September and January found that 34% of those aged 25 to 34 years reported borrowing more money or using more credit than usual compared with a year ago.

    And over half of adults living in rented accommodation said they would be unable to afford an unexpected, but necessary, expense of £850 ($1,000).

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  • Media Advisory: Patients and Families Will Share Children’s Center Stories During Mix 106.5’s 34th Annual Radiothon

    Media Advisory: Patients and Families Will Share Children’s Center Stories During Mix 106.5’s 34th Annual Radiothon

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    What:

    Mix 106.5’s 34th Annual Radiothon benefiting Johns Hopkins Children’s Center kicks off this week on Thursday, Feb. 23, and runs through Friday, Feb. 24. It is the Children’s Center’s largest fundraising event of the year, and airs on the Baltimore radio station throughout the two days.  

    Children from across the country and their families come to Johns Hopkins Children’s Center to receive the highest quality pediatric care. This annual event, which has raised nearly $27 million since it began in 1990, and the generous assistance of donors allow physicians, clinicians and staff members to continue providing world-class care to patients, while supporting their families in a time of need. Funds raised in previous years have helped the hospital purchase lifesaving tools and technology, support patient care, fund important research, and develop innovative tools and programs. Funds have also been used to purchase books, toys, games, art supplies and more to help make each child’s patient experience more special.

    During this year’s radiothon, eight patients and their families will be featured. Among the patients are 12-year-old Colson and 10-year-old Marybeth. Learn about their stories below.

    When:

    Media are welcome to visit Thursday, Feb. 23, from 11 a.m. to 1 p.m.

    Who:

    • David Hackam, M.D., Ph.D.Co-Director and Surgeon-in-Chief, Johns Hopkins Children’s CenterProfessor of Surgery, Johns Hopkins University School of Medicine
    • Margaret Moon, M.D., M.P.H.Pediatrician-in-Chief and Co-Director, Johns Hopkins Children’s CenterDirector, Department of Pediatrics, Johns Hopkins University School of Medicine

    Where:

    Johns Hopkins Children’s Center — The Charlotte R. Bloomberg Children’s Center Building1800 Orleans St.Baltimore, MD Parking is available for media in the Orleans Street garage. Please cross the overpass bridge to the Children’s Center.

    RSVP:

    If you would like to visit the radiothon or to set up interviews with featured patients, their families and physicians, please reply by Wednesday, Feb. 22, at 5 p.m. to Kaitlyn Roman at 440-465-3645 or [email protected].

    Colson’s Story

    Colson was first diagnosed with pneumonia when he was 2 years old. Pneumonia returned frequently in the years that followed, and each year, the illness seemed to get worse. “It was never on anyone’s radar that there might be something more serious,” recalls Colson’s mother, Emily Sparks. That was until March 2020, when Colson was 10 years old, and a serious case of pneumonia and the flu sent him to the pediatric intensive care unit in their hometown of New Orleans, Louisiana, for three days. “His entire lung was covered with pneumonia, and we were having discussions about possibly putting him on a ventilator,” she says.

    After Colson’s hospitalization, his family began meeting with local specialists to learn why the pneumonia kept returning. It was then that doctors discovered a cyst in the bottom of Colson’s right lung, also known as “bronchopulmonary sequestration,” which made it difficult for him to breathe and run. The cyst was collecting bacteria, and had its own blood vessel sources, which was causing him to continue becoming extremely sick. Doctors explained that Colson needed to have that part of his lung removed in order to prevent him from getting sick again. Without the surgery, doctors cautioned that Colson ran the risk of developing lung cancer.

    After doing research, his parents consulted with a care team at Johns Hopkins Children’s Center — including pediatric surgeon Shaun Kunisaki, one of a handful of surgeons in the country who could perform the specialized surgery. In June 2020 — because of his condition and the COVID-19 pandemic, a flight was not an option — Colson and his mom made the more than 15-hour drive to Baltimore for a successful five-hour surgery to remove part of his lung. Now, two years later, Emily says Colson is a happy, active 12-year-old who plays soccer. “It is a miracle I found a place like Johns Hopkins,” Colson says. “They changed my life for the better.”

    Marybeth’s Story

    During a routine wellness visit in 2017, a doctor noticed 5-year-old Marybeth had not grown during the past year. Her doctor recommended seeing an endocrinologist, who then urgently connected her family with pediatric nephrologist Olga Charnaya and a team at Johns Hopkins Children’s Center. The Ellicott City, Maryland, family’s lives turned upside down when they received a shocking diagnosis: Marybeth had failing kidneys, already at stage 4. “I was just shocked with disbelief that my little girl’s kidneys were failing,” recalls Marybeth’s mom, Katherine Di Cristofaro. Weeks later, after a kidney biopsy, the family learned Marybeth would need at least one kidney transplant, and possibly multiple throughout her life. She was put on the transplant waiting list, but Charnaya preferred she receive a live kidney — especially if it came from a parent, which would extend the life of the kidney and prevent her from needing another transplant sooner. Marybeth’s father, Brian, was healthy and willing to donate a kidney. “You would do anything to save your child’s life,” Brian says. “Whether it’s jumping in front of a train or donating a kidney.”

    The day of the transplant surgery, Katherine watched her husband and daughter be wheeled away for the lifesaving surgery. Four and half hours later, a successful transplant surgery was complete, and eight days later, Marybeth was back home. Now, almost three years later, 10-year-old Marybeth and her father are doing well. Marybeth is tested monthly to ensure her kidney is functioning properly, and she sees Charnaya every few months. “She truly is a living miracle, and the transplant itself is a miracle of an extension of life,” Katherine says.

    Colson and his mother, Marybeth and her parents, and their doctors are available for interviews. Johns Hopkins Children’s Center co-directors Margaret Moon, M.D., M.P.H., and David Hackam, M.D., Ph.D., are also available to speak about radiothon.

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  • 1 in 3 parents may unnecessarily give children fever-reducing medicine

    1 in 3 parents may unnecessarily give children fever-reducing medicine

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    TV/RADIO: Click link for broadcast-quality sound bites & b-roll, visuals and script suggestions (Full report and accompanying graphics also included.)

    Newswise — For many children, winter season comes with regular exposure to circulating viruses at school or daycare. And a warm forehead is often one of the first clear signs a child has caught a bug.

    But some parents may not be properly measuring or responding to elevated temperatures in children, a new national poll suggests.

    While most parents recognize that a low-grade fever helps a child’s body fight off infection, one in three would give fever-reducing medication for spiked temperatures below 100.4 – which isn’t recommended – according to the C.S. Mott Children’s Hospital National Poll on Children’s Health at University of Michigan Health.

    Half of parents would also use medicine if the fever was between 100.4 and 101.9 degrees, and a quarter of parents would likely give another dose to prevent the fever from returning.

    “Often parents worry about their child having a fever and want to do all they can to reduce their temperature. However, they may not be aware that in general the main reason to treat a fever is just to keep their child comfortable,” said Mott Poll co-director and Mott pediatrician Susan Woolford, M.D.

    “Some parents may immediately rush to give their kids medicine but it’s often better to let the fever runs its course. Lowering a child’s temperature doesn’t typically help cure their illness any faster. In fact, a low-grade fever helps fight off the infection. There’s also the risk of giving too much medication when it’s not needed, which can have side effects.”

    The report is based on 1,376 responses from parents of children ages 12 and under polled between August and September 2022.

    Two in three parents polled say they’re very confident they know whether their child needs medication to reduce a fever. But just over half are sure they understand how temperature readings can change according to the method used.

    The method used to take a child’s temperature matters and can affect the accuracy of the measurement, Woolford notes. Parents polled most commonly take their child’s temperature by forehead scan or mouth while less than a sixth use ear, underarm or rectal methods.

    Remote thermometers at the forehead or inside the ear canal can be accurate if used correctly. But forehead readings may be inaccurate, Woolford says, if the scanner is held too far away or if the child’s forehead is sweaty. With ear thermometers, which aren’t recommended for newborns, earwax can also interfere with the reading.

    For infants and young children, rectal temperatures are most accurate. Once children are able to hold a thermometer in their closed mouth, oral temperatures also are accurate while armpit temperatures are the least accurate method.

    “Contact thermometers use electronic heat sensors to record body temperature but temperatures may fluctuate depending on how it’s measured,” Woolford said.

    “Regardless of the device used, it’s important that parents review the directions to ensure the method is appropriate for the child’s age and that the device is placed correctly when measuring temperature.”

    Three in four parents say they take their child’s temperature as soon as they notice a possible problem, while a little less than a fourth wait to see if the problem continues or worsens before taking the temperature.  

    Two-thirds of parents also prefer to try methods like a cool washcloth before using fever-reducing medication. Most parents also say they always or usually record the time of each dose and re-take their child’s temperature before giving another dose.

    “A quarter of parents would give their child more medicine to prevent a fever from returning even though it doesn’t help them get better,” Woolford said. “If a child is otherwise doing well, parents may consider monitoring them and using alternative interventions to help keep them comfortable.”

    However, if a newborn or infant less than three months old has a fever, they should immediately see a health professional, Woolford adds.

    She shares more tips on how to handle fevers in kids:

    Fevers can help fight infections

    A fever can be beneficial, and there are several reasons to let a low-grade fever run its course in older children – mainly because it’s working as a weapon to kill the virus or bacteria causing sickness, Woolford says.

    Evidence shows that fevers are part of the immune response to prevent viruses and bacteria from replicating and also produce more white blood cells and antibodies.

    Fever-reducing medicinations also mask symptoms.

    “Medications used to lower temperatures also treat pain, but pain is often a sign that helps to locate the source of an infection,” Woolford said. “By masking pain fever-reducing medication may delay a diagnosis being made and delay receiving treatment if needed.”

    She adds that parents may also be tempted to take kids in public when they noticeably seem better after medicine when in fact they’re still highly contagious and may infect others.

    If you do use medicine, be careful about not overmedicating

    When parents choose to give fever-reducing medicine, it’s helpful to keep a log of temperature readings and when it was given. This will provide an accurate record in the event that the child’s fever continues for an extended period of time.

    Parents of young children in particular should also avoid using combination cold medications along with fever-reducing medications due to the risk of over dosage.

    “As we know, all medications can have side effects and we really don’t want children to get too much medication when it’s not necessary,” Woolford said.

    When communicating with the child’s provider to help determine the best recommendations about treatment, it’s helpful for parents to share the timeline of the child’s fever, doses of fever-reducing medication, other symptoms and how the child is acting compared to their “usual” behavior.

    Try alternatives to relieving child’s discomfort

    Parents may consider other interventions to relieve discomfort and aid in more restful sleep instead of medicine, Woolford says.

    Such approaches could include keeping their room cool and not letting them overexert themselves, as well as ensuring the child is in light clothing and encouraging them to stay well hydrated with fluids or popsicles.

    Be aware of signs to call the doctor

    For infants and newborns three months and younger, any sign of a fever should prompt a call to the provider.  

    For children 4-12 months, parents should consult with a doctor if a fever is accompanied by signs such as decreased activity, increased fussiness, or decreased urine output. Parents should also call if their child has signs of pain or if they are not acting themselves even when their temperature comes down.

    Fevers that reach 104 degrees or fevers that remain for an extended period (more than 24 hours for children under two, or more than three days for children ages two and older) should prompt contact with the provider.

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  • Illinois poised to mandate paid leave for nearly all workers

    Illinois poised to mandate paid leave for nearly all workers

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    CHICAGO — When Joan Van is sick, she doesn’t get paid.

    The East St. Louis-area restaurant server and single mother of three said she works doubles to make up the money when she or one of her children gets sick.

    “You can’t let your kids see you break down because you’re tired and exhausted, ’cause you gotta keep pushing. You got to. And if you don’t, then who’s gonna do it?” she said.

    She may not have to for much longer. Expansive paid leave legislation requiring Illinois employers to give workers time off based on hours worked, to be used for any reason, is ready for action by Democratic Gov. J.B. Pritzker, who said he will sign it.

    Requiring paid vacation is rare in the U.S. — just Maine and Nevada have similar laws — although common in other industrialized nations.

    Fourteen states and Washington, D.C., require employers offer paid sick leave via similar laws, although employees may only use it for health-related issues. What sets Illinois’ new legislation apart is workers won’t have to explain the reason for their absence as long as they provide notice in accordance with reasonable employer standards.

    Maine and Nevada also allow workers to decide how to use their time, but substantial exemptions apply. Maine’s Earned Paid Leave law only applies to employers with more than 10 employees, and Nevada’s exempts businesses with less than 50. Illinois’ will reach nearly all employees and has no limit based on the business size.

    Seasonal workers such as lifeguards will be exempt, as will federal employees or college students who work non-full-time, temporary jobs for their university.

    The legislation would take effect on Jan. 1, 2024. Employees will accrue one hour of paid leave for every 40 hours worked up to 40 hours total, although the employer may offer more. Employees can start using the time once they have worked for 90 days.

    “Working families face enough challenges without the concern of losing a day’s pay when life gets in the way,” Pritzker said on Jan. 11, when the bill passed both chambers.

    Ordinances in Cook County and Chicago already require employers to offer paid sick leave, and workers in those locations will continue to be covered by the existing laws rather than the new bill.

    Johnae Strong, an administrative worker at a small media company in Chicago, said paid sick time helps her take care of her two children, a 10-year-old and a 6-year-old. But expanding the time to be used for any reason would be helpful.

    “Life happens,” she said, adding that she hopes Chicago will update its law to be more flexible, like the state bill.

    The Chicago and Cook County ordinances served as pilot programs for the statewide legislation, and assuaged critics who predicted mass business closures that didn’t come to fruition, said Sarah Labadie, director of advocacy and policy at Women Employed, a nonprofit that has fought for paid leave since 2008 and helped push through the legislation.

    “Obviously we had some strange things happen during the pandemic, but pre-pandemic that was not the case. Chicago was a thriving economic engine,” she said.

    Peoria Democratic Rep. Jehan Gordon-Booth sponsored the bill, which she said will “help to uplift working families” and “immediately help people.”

    Newly-elected House Republican Leader Tony McCombie said the mandated benefits could have a “detrimental effect” on small businesses and nonprofits “in an already unfriendly business climate.”

    “We all want a great working environment with an equitable work/life balance,” she said in an emailed statement. “However, Senate Bill 208 failed to address the concerns of those providing that work environment.”

    For Leslie Allison-Seei, who runs a promotion and sweepstakes management company with her husband in DuPage county, taking care of their three full-time employees is a priority, but it is “difficult” to compete with corporate paid time off policies.

    “We’re thrilled that this is getting passed and that it’s going to be signed. But it’s also a little bit frightening because, you know, a week’s worth of time — I don’t know what that would do to our business,” Allison-Seei said. “I think a lot of businesses are just doing the very best that they can to stay afloat.”

    Small business advocacy organization National Federation of Independent Business opposes the bill, saying that it “imposes a one-size fits all mandate on all employers.”

    Small business owners face steep inflation, increased fuel and energy costs and an absence of qualified workers, and the requirement will be an “additional burden,” NFIB state director Chris Davis said in a statement following the bill’s passage. “The message from Illinois lawmakers is loud and clear, ‘Your small business isn’t essential.’”

    However, the potential burden on small businesses clashes with the needs of their workers, particularly those with children.

    Van, a parent leader with Community Organizing and Family Issues said she has no paid leave until she has worked for one year. Knowing she will miss a day of pay when she or one of her kids gets sick is a constant stress for the Belleville mom, but guaranteed PTO “would be awesome,” offering her peace of mind and alleviating some financial worries.

    Molly Weston Williamson, paid leave policy expert and senior fellow at think tank Center for American Progress, called the Illinois legislation “a huge step in the right direction.”

    In addition to establishing workers’ right to paid time off, the bill forbids employers from retaliating against employees for using it. This is key to making sure “low-income workers or other folks who are more vulnerable are really, practically able to take the time,” Williamson said.

    Paid leave is both a labor rights issue and a public health issue, Williamson said. Service workers like Van who handle food and beverage without paid time off are more likely to go to work sick and to send their children to day care sick, “at which point they get everyone else sick,” she said.

    “Especially now that we are three-plus years into a global pandemic, I think all of us have a much more visceral understanding of the ways that all of our health is tied together,” Williamson said. ____

    Savage is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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  • Illinois poised to mandate paid leave for nearly all workers

    Illinois poised to mandate paid leave for nearly all workers

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    CHICAGO — When Joan Van is sick, she doesn’t get paid.

    The East St. Louis-area restaurant server and single mother of three said she works doubles to make up the money when she or one of her children gets sick.

    “You can’t let your kids see you break down because you’re tired and exhausted, ’cause you gotta keep pushing. You got to. And if you don’t, then who’s gonna do it?” she said.

    She may not have to for much longer. Expansive paid leave legislation requiring Illinois employers to give workers time off based on hours worked, to be used for any reason, is ready for action by Democratic Gov. J.B. Pritzker, who said he will sign it.

    Requiring paid vacation is rare in the U.S. — just Maine and Nevada have similar laws — although common in other industrialized nations.

    Fourteen states and Washington, D.C., require employers offer paid sick leave via similar laws, although employees may only use it for health-related issues. What sets Illinois’ new legislation apart is workers won’t have to explain the reason for their absence as long as they provide notice in accordance with reasonable employer standards.

    Maine and Nevada also allow workers to decide how to use their time, but substantial exemptions apply. Maine’s Earned Paid Leave law only applies to employers with more than 10 employees, and Nevada’s exempts businesses with less than 50. Illinois’ will reach nearly all employees and has no limit based on the business size.

    Seasonal workers such as lifeguards will be exempt, as will federal employees or college students who work non-full-time, temporary jobs for their university.

    The legislation would take effect on Jan. 1, 2024. Employees will accrue one hour of paid leave for every 40 hours worked up to 40 hours total, although the employer may offer more. Employees can start using the time once they have worked for 90 days.

    “Working families face enough challenges without the concern of losing a day’s pay when life gets in the way,” Pritzker said on Jan. 11, when the bill passed both chambers.

    Ordinances in Cook County and Chicago already require employers to offer paid sick leave, and workers in those locations will continue to be covered by the existing laws rather than the new bill.

    Johnae Strong, an administrative worker at a small media company in Chicago, said paid sick time helps her take care of her two children, a 10-year-old and a 6-year-old. But expanding the time to be used for any reason would be helpful.

    “Life happens,” she said, adding that she hopes Chicago will update its law to be more flexible, like the state bill.

    The Chicago and Cook County ordinances served as pilot programs for the statewide legislation, and assuaged critics who predicted mass business closures that didn’t come to fruition, said Sarah Labadie, director of advocacy and policy at Women Employed, a nonprofit that has fought for paid leave since 2008 and helped push through the legislation.

    “Obviously we had some strange things happen during the pandemic, but pre-pandemic that was not the case. Chicago was a thriving economic engine,” she said.

    Peoria Democratic Rep. Jehan Gordon-Booth sponsored the bill, which she said will “help to uplift working families” and “immediately help people.”

    Newly-elected House Republican Leader Tony McCombie said the mandated benefits could have a “detrimental effect” on small businesses and nonprofits “in an already unfriendly business climate.”

    “We all want a great working environment with an equitable work/life balance,” she said in an emailed statement. “However, Senate Bill 208 failed to address the concerns of those providing that work environment.”

    For Leslie Allison-Seei, who runs a promotion and sweepstakes management company with her husband in DuPage county, taking care of their three full-time employees is a priority, but it is “difficult” to compete with corporate paid time off policies.

    “We’re thrilled that this is getting passed and that it’s going to be signed. But it’s also a little bit frightening because, you know, a week’s worth of time — I don’t know what that would do to our business,” Allison-Seei said. “I think a lot of businesses are just doing the very best that they can to stay afloat.”

    Small business advocacy organization National Federation of Independent Business opposes the bill, saying that it “imposes a one-size fits all mandate on all employers.”

    Small business owners face steep inflation, increased fuel and energy costs and an absence of qualified workers, and the requirement will be an “additional burden,” NFIB state director Chris Davis said in a statement following the bill’s passage. “The message from Illinois lawmakers is loud and clear, ‘Your small business isn’t essential.’”

    However, the potential burden on small businesses clashes with the needs of their workers, particularly those with children.

    Van, a parent leader with Community Organizing and Family Issues said she has no paid leave until she has worked for one year. Knowing she will miss a day of pay when she or one of her kids gets sick is a constant stress for the Belleville mom, but guaranteed PTO “would be awesome,” offering her peace of mind and alleviating some financial worries.

    Molly Weston Williamson, paid leave policy expert and senior fellow at think tank Center for American Progress, called the Illinois legislation “a huge step in the right direction.”

    In addition to establishing workers’ right to paid time off, the bill forbids employers from retaliating against employees for using it. This is key to making sure “low-income workers or other folks who are more vulnerable are really, practically able to take the time,” Williamson said.

    Paid leave is both a labor rights issue and a public health issue, Williamson said. Service workers like Van who handle food and beverage without paid time off are more likely to go to work sick and to send their children to day care sick, “at which point they get everyone else sick,” she said.

    “Especially now that we are three-plus years into a global pandemic, I think all of us have a much more visceral understanding of the ways that all of our health is tied together,” Williamson said. ____

    Savage is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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  • Black Baltimoreans fight to save homes from redevelopment

    Black Baltimoreans fight to save homes from redevelopment

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    BALTIMORE — In 2018, Angela Banks received bad news from her landlord: Baltimore officials were buying her family’s home of four decades, planning to demolish the three-story brick row house to make room for a beleaguered urban renewal project aimed at transforming a historically Black neighborhood. Banks and her children became homeless almost overnight. With nowhere else to go, they spent months sleeping in her aging Ford Explorer.

    Roughly five years later, the house remains standing, and plans to redevelop west Baltimore’s Poppleton neighborhood have largely stalled, even after the city displaced Banks and many of her neighbors.

    Banks filed a complaint Monday asking federal officials to investigate whether Baltimore’s redevelopment policies are perpetuating racial segregation and violating fair housing laws by disproportionately displacing Black and low-income residents. Her experience presents the latest example of Black Baltimoreans losing their homes to redevelopment after watching their neighborhoods suffer from growing disinvestment — while whiter, more affluent communities flourish, Banks and her attorneys argue.

    “I lost everything,” Banks told The Associated Press. “It’s like we had no voice. We could make noise, but nobody would hear us.”

    Ordered to vacate quickly, her family ended up leaving behind many of their belongings.

    During a recent visit to the neighborhood, Banks stepped cautiously through an unsecured back door and peered inside the house, wondering aloud whether squatters had moved in. Her eyes settled first on the marbled vinyl floor tiles she installed herself many years ago. She also encountered extensive water damage and rotting drywall, unfamiliar furniture, clothes and other personal items. Startled by her presence, two black cats scurried down the second-floor hallway and disappeared into a hiding spot.

    “This was home,” she said, shaking her head.

    Her landlord sold the house to the city voluntarily in 2018, but other Poppleton homeowners have been subjected to eminent domain, when the government seizes private property for public use.

    Once relatively common in American cities, using the practice for revitalization and infrastructure projects has largely fallen out of favor. Some cities are currently working to provide reparations to Black residents, acknowledging the harm caused by urban renewal efforts and other discriminatory practices.

    Banks reminisced about her children swimming in Poppleton’s public pool while she socialized with neighbors on their stoops. Since then, over 100 occupied homes have been seized, according to the complaint. The pool and nearby recreation center closed years ago, Banks said. Poppleton is about 93% Black, according to 2020 census data.

    “Baltimore has long been a tale of two cities,” said Marceline White, executive director of Economic Action Maryland, which joined Banks in filing the complaint and organized a news conference Monday in Poppleton.

    In 1910, Baltimore leaders enacted the country’s first residential segregation ordinance that restricted African American homeowners to certain blocks.

    In addition to redlining, Poppleton residents experienced “slum clearance” starting in the 1930s with construction of Poe Homes, a public housing complex named after a nearby onetime residence of the famous poet Edgar Allan Poe. The number of displaced Black families was larger than the number of housing units created, according to the complaint.

    Then came Baltimore’s so-called “Highway To Nowhere,” which was designed to connect the downtown business district to interstates surrounding the city. Officials used eminent domain to demolish nearly 1,000 homes in the 1960s and ’70s, cutting a swath through majority-Black west Baltimore and severing ties between Poppleton and other nearby communities.

    Construction of the thoroughfare was never finished — partly because residents in more affluent neighborhoods successfully campaigned against it — and the endeavor became largely pointless.

    “What’s happening now in Poppleton is a reflection of what has happened before, part of an unbroken chain of policies and practices,” said Lawrence Brown, a research scientist at Morgan State University. “There is a pattern.”

    Plans for Poppleton’s urban renewal surfaced in the 1970s. By that time, Brown said, the neighborhood had already been experiencing mistreatment and disinvestment for decades.

    In 2006, city officials signed an agreement with a New York-based company, La Cite Development. Construction has been completed on two mixed-use buildings with 262 rental units, but many other aspects of the $800 million project haven’t materialized. Initial plans identified over 500 properties the company would redevelop near a University of Maryland biomedical research park, just outside the downtown business district.

    Company officials didn’t respond to a recent request for comment.

    Baltimore leaders have said they’re committed to revitalizing an increasingly blighted community suffering from population loss, but Poppleton residents accuse them of catering to big developers at the expense of homeowners and renters.

    In 2015, the city agreed to partially subsidize the Poppleton redevelopment project. That was after officials tried to terminate their agreement with the developer, citing a lack of progress, but the company sued and won.

    Mayor Brandon Scott, who took office in 2020, pledged his commitment to “advancing fairness and equity in housing for all residents.” In a statement Thursday, he said his administration “has taken significant steps to address the housing inequities of the past through substantial investments in formerly redlined communities.”

    The movement to save Poppleton’s existing homes galvanized around longtime resident Sonia Eaddy, who recently won a decadeslong fight when Scott announced her row house would be removed from the redevelopment plan after negotiations with the developer. A nearby block of rainbow-colored historic row houses will be rehabbed by a local nonprofit that helps Black women achieve homeownership, officials also announced.

    Eaddy said she celebrated the victory, but she’s not done fighting for reform.

    “Eminent domain is an act of violence. It’s being used to perpetuate gentrification,” she said during Monday’s news conference.

    Most displaced residents have been offered financial assistance. Banks said she didn’t initially qualify because her landlord sold the property voluntarily, but the city later gave her compensation she used to pay off debts.

    Her complaint lists a series of potential remedies, including additional compensation and priority access to affordable housing for displaced residents. She filed the complaint with the U.S. Department of Housing and Urban Development, which said it was unable to comment on pending investigations.

    Banks’ former neighbor, Parcha McFadden, recently left the family home she inherited after losing her father, who invested in the property with future generations in mind. She and her daughter have been living in a rented apartment while their old house sits vacant.

    “Homeownership is part of the American dream, but it can so easily be ripped away,” she said. “How is this American? How is this the American dream?”

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  • Nigerian cash crisis brings pain: ‘Everything is just tough’

    Nigerian cash crisis brings pain: ‘Everything is just tough’

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    ABUJA, Nigeria — No one in Godgift Inemesit’s family of eight is sure when they will eat each day — except for her three kids, two of whom have malaria. She can’t pay for the drugs they need or feed the rest of her family regularly.

    Like most Nigerians, the family’s savings are trapped in the bank. A changeover to redesigned currency has plunged Africa’s largest economy into crisis just ahead of a presidential election: There aren’t enough new banknotes in a country reliant on cash.

    For Inemesit, 28, the shortage of cash means even basics like food and medicine are getting trimmed for her husband, mother, kids ages 4 to 8 and two other relatives. One recent afternoon, only the children had gotten bread and hot drinks.

    “We usually eat three square meals, but now we eat once sometimes because there is no money to use,” Inemesit said in her house in Banana village, an overcrowded shanty town tucked in the southern corner of the Nigerian capital of Abuja.

    “We were told to drop the old currency (notes) in the bank and that new one is coming,” she said. “But we don’t have the new currency and no old currency. Everything is just tough.”

    Customers are waiting all day at banks and ATMs to withdraw only enough money — called naira — to last a day. Fights have broken out in bank halls, angry customers have attacked workers and protesters have set financial institutions on fire. Businesses unable carry out transactions have been forced to close, and people are illegally selling new currency notes at higher rates.

    As people become more desperate for cash, the impact is likely to spill into the Feb. 25 presidential election. Nigerians hope to elect someone to fix challenges ranging from a security crisis that has killed thousands in the past year to an ailing economy.

    The shortage of currency “has already created significant hardship, which could make a greater number of voters vulnerable to vote-buying and ratchet up election tensions even further,” said the International Crisis Group, which works to prevent conflict.

    Facing increasing pressure to find a solution, President Muhammadu Buhari, who has reached his term limits and leaves office in May, said he directed the Central Bank of Nigeria to “deploy all legitimate resources and legal means” to ensure people “enjoy easy access to cash withdrawal.”

    “I am deeply pained and sincerely sympathize with you all over these unintended outcomes,” he said, while still defending the changes.

    Experts blame policymakers for a “rushed” introduction of the new naira notes. Central bank leader Godwin Emefiele argued that some government officials are “buying the new notes and storing them for whatever purposes.”

    The central bank has said the revamped currency would help curb money laundering before the election, transform the West African nation into a cashless economy and fight inflation of over 21%, a 17-year high.

    Inemesit said she — like many others — have started losing interest in the election, dampening hopes of increased voter participation after years of steady decline in turnout.

    She voted in 2019 when only 34% of registered voters cast their ballot for president. But as this year’s election draws closer, her vote and hopes for a better country have been dashed.

    “With what we are facing now, I don’t have the aim of voting again. When you don’t have the strength to walk to where they are voting, how will you be able to vote?” she said.

    The cash shortages have made life even more difficult in Nigeria, where 63% of the population is poor, 33% is unemployed and as of 2021, only 45% of adults had a bank account, according to the World Bank. The crisis has added to the woes of surging inflation and a weakened currency.

    The three top contenders in the presidential race have made pledges to deliver democratic change to Nigerians. The ruling party’s Bola Tinubu has said he is seeking to “renew hope,” while the main opposition party’s Atiku Abubakar wants to “rescue” Nigeria. The Labour Party’s Peter Obi — who leads the crowded field in recent polls — has p romised to “rebuild” the country.

    Lack of access to cash has affected consumption patterns and trade for small and medium businesses in the informal sector, a major employer that includes farming, street and market trade, and public transport, said Joachim MacEbong, a senior governance analyst at Stears, a Nigerian intelligence company.

    The central bank’s yearslong push to make the economy cashless led digital transactions to increase 150% last year. However, unreliable digital payment platforms have forced many businesses to use paper naira.

    “The cost of denying people access to cash far outweighs any benefit,” MacEbong said.

    At ATMs, people are making choices they never would have imagined: Sunny Eze, a father of two, was hungry but was saving the little money on him for transportation if he couldn’t get cash. Esther Ugonna waited for about 10 hours to withdraw 10,000 naira ($22). Nasir Yusuf closed his shop for the day, devoting his time to trying to withdraw cash he needed.

    Inemesit, meanwhile, waited in line until 8 p.m. one day last week and returned home empty-handed. Like dozens of others, she was told the bank branch had run out of new banknotes.

    “If someone were to tell me that I can have the money but I cannot make use of the money, I would not believe it,” she said, frustrated and downcast. With her 1.7 million naira ($3,680) in the bank, “you have the money, but you cannot see it.”

    The family’s income from selling bags such as luggage and backpacks has fallen drastically as Nigerians with little cash on hand are prioritizing food over other needs.

    “People will not leave feeding their family to come and buy bags,” she said.

    The crisis has left Inemesit too tired and frustrated to think of the upcoming presidential vote.

    “The government failed us very well. They disappointed us,” she said, grabbing her 4-year-old who was coughing incessantly. “Things are difficult and everything has been increasing prices.”

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  • Meat plant cleaning service fined $1.5M for hiring minors

    Meat plant cleaning service fined $1.5M for hiring minors

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    MINNEAPOLIS — One of the country’s largest cleaning services for food processing companies employed more than 100 children in dangerous jobs at 13 meatpacking plants across the country, the U.S. Department of Labor said Friday as it announced over $1.5 million in civil penalties.

    The investigation into Packers Sanitation Services Inc., or PSSI, began last summer. Department officials searched three meatpacking plants owned by JBS USA and Turkey Valley Farms in Nebraska and Minnesota, and found 31 underage workers as young as 13. They also searched PSSI’s headquarters in Kieler, Wisconsin. Underage workers were found at plants in eight states.

    The department went on to review records for 55 locations where PSSI provided cleaning services and found even more violations, involving children ages 13 to 17. The agency obtained a temporary restraining order in November and a permanent injunction in December, when PSSI entered into a consent judgment that committed the company to no longer employ minors illegally.

    Over the past three years, children were found to be using caustic cleaning chemicals and cleaning “dangerous power-driven equipment, like skull-splitters and razor-sharp bone saws,” Jessica Looman, principal deputy administrator of the department’s Wage and Hour Division, told reporters.

    At least three of those minors, including a 13-year-old, suffered burns from the chemicals used for cleaning at the JBS plant in Grand Island, Nebraska, officials said.

    Some of the children worked overnight shifts and were also enrolled in schools during the day, department spokeswoman Rhonda Burke said in an email.

    The fine PSSI paid on Thursday, $15,138 for each minor, is the maximum allowed under federal law. But investigators believe the company actually employed many more than the 102 children they verified. Under the consent judgment, Looman said, PSSI must identify and remove them from dangerous work.

    “Make no mistake, this is no clerical error, or actions of rogue individuals or bad managers,” Looman said. “These findings represent a systemic failure across PSSI’s entire organization to ensure that children were not working in violation of the law. PSSI’s systems in many cases flagged that these children were too young to work, and yet they were still employed at these facilities.”

    The company’s vice president of marketing, Gina Swenson, said in a statement Friday that the company has “a zero-tolerance policy against employing anyone under the age of 18.”

    As soon as PSSI became aware of the allegations, she said, it conducted audits and hired an outside law firm to help strengthen its policies. PSSI has also conducted additional training for hiring managers, including on spotting identity theft, she said.

    None of the minors identified by federal investigators still work for PSSI, and the Department of Labor “has also not identified any managers aware of improper conduct that are currently employed” by the company, Swenson added.

    PSSI has said it employs about 17,000 people working at more than 700 locations nationwide, making it one of the largest food-processing-plant cleaning companies.

    The 13 plants where violations were found were in Arkansas, Colorado, Indiana, Kansas, Minnesota, Nebraska, Tennessee and Texas. The ones with the most violations were the JBS plant in Grand Island, Nebraska, where PSSI employed 27 minors; the Cargill plant in Dodge City, Kansas, where 26 children worked; and a JBS plant in Worthington, Minnesota, where 22 minors worked. The Labor Department also searched a Tyson facility in Sedalia, Missouri, but found no verifiable violations there.

    The United Food and Commercial Workers International Union, which represents meatpacking plant workers, called PSSI “one of the worst actors” in the industry.

    “Paying a simple fine is not enough, their entire business model relies on the exploitation of workers, vicious union-busting tactics, and the violation of human rights,” Marc Perrone, the union’s international president, said in a statement. He called on the meatpacking industry to use its power over contractors like PSSI to end the exploitation of children for good.

    Asked about the immigration status of the children, Labor Department solicitor Seema Nanda said the department focuses only on whether they are minors.

    And because the department is a civil law enforcement agency, officials can’t comment on whether any of the plants might face criminal charges or whether any of the children were victims of labor trafficking, said Michael Lazzeri, regional administrator of the department’s Wage and Hour Division. He said any detected trafficking is referred to other agencies.

    Looman said the Wage and Hour Division has seen around a 50% increase in child labor violations since 2018, including minors working more hours than permitted in otherwise legal jobs, using types of equipment they shouldn’t while doing legal jobs, and children working where they should never be employed in the first place.

    “Nobody under 18 should be working in a meat processing plant,” she said.

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  • Meat plant cleaning service fined $1.5M for hiring minors

    Meat plant cleaning service fined $1.5M for hiring minors

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    MINNEAPOLIS — One of the country’s largest cleaning services for food processing companies employed more than 100 children in dangerous jobs at 13 meatpacking plants across the country, the U.S. Department of Labor said Friday as it announced over $1.5 million in civil penalties.

    The investigation into Packers Sanitation Services Inc., or PSSI, began last summer. Department officials searched three meatpacking plants owned by JBS USA and Turkey Valley Farms in Nebraska and Minnesota, and found 31 underage workers as young as 13. They also searched PSSI’s headquarters in Kieler, Wisconsin. Underage workers were found at plants in eight states.

    The department went on to review records for 55 locations where PSSI provided cleaning services and found even more violations, involving children ages 13 to 17. The agency obtained a temporary restraining order in November and a permanent injunction in December, when PSSI entered into a consent judgment that committed the company to no longer employ minors illegally.

    Over the past three years, children were found to be using caustic cleaning chemicals and cleaning “dangerous power-driven equipment, like skull-splitters and razor-sharp bone saws,” Jessica Looman, principal deputy administrator of the department’s Wage and Hour Division, told reporters.

    At least three of those minors, including a 13-year-old, suffered burns from the chemicals used for cleaning at the JBS plant in Grand Island, Nebraska, officials said.

    Some of the children worked overnight shifts and were also enrolled in schools during the day, department spokeswoman Rhonda Burke said in an email.

    The fine PSSI paid on Thursday, $15,138 for each minor, is the maximum allowed under federal law. But investigators believe the company actually employed many more than the 102 children they verified. Under the consent judgment, Looman said, PSSI must identify and remove them from dangerous work.

    “Make no mistake, this is no clerical error, or actions of rogue individuals or bad managers,” Looman said. “These findings represent a systemic failure across PSSI’s entire organization to ensure that children were not working in violation of the law. PSSI’s systems in many cases flagged that these children were too young to work, and yet they were still employed at these facilities.”

    The company’s vice president of marketing, Gina Swenson, said in a statement Friday that the company has “a zero-tolerance policy against employing anyone under the age of 18.”

    As soon as PSSI became aware of the allegations, she said, it conducted audits and hired an outside law firm to help strengthen its policies. PSSI has also conducted additional training for hiring managers, including on spotting identity theft, she said.

    None of the minors identified by federal investigators still work for PSSI, and the Department of Labor “has also not identified any managers aware of improper conduct that are currently employed” by the company, Swenson added.

    PSSI has said it employs about 17,000 people working at more than 700 locations nationwide, making it one of the largest food-processing-plant cleaning companies.

    The 13 plants where violations were found were in Arkansas, Colorado, Indiana, Kansas, Minnesota, Nebraska, Tennessee and Texas. The ones with the most violations were the JBS plant in Grand Island, Nebraska, where PSSI employed 27 minors; the Cargill plant in Dodge City, Kansas, where 26 children worked; and a JBS plant in Worthington, Minnesota, where 22 minors worked. The Labor Department also searched a Tyson facility in Sedalia, Missouri, but found no verifiable violations there.

    The United Food and Commercial Workers International Union, which represents meatpacking plant workers, called PSSI “one of the worst actors” in the industry.

    “Paying a simple fine is not enough, their entire business model relies on the exploitation of workers, vicious union-busting tactics, and the violation of human rights,” Marc Perrone, the union’s international president, said in a statement. He called on the meatpacking industry to use its power over contractors like PSSI to end the exploitation of children for good.

    Asked about the immigration status of the children, Labor Department solicitor Seema Nanda said the department focuses only on whether they are minors.

    And because the department is a civil law enforcement agency, officials can’t comment on whether any of the plants might face criminal charges or whether any of the children were victims of labor trafficking, said Michael Lazzeri, regional administrator of the department’s Wage and Hour Division. He said any detected trafficking is referred to other agencies.

    Looman said the Wage and Hour Division has seen around a 50% increase in child labor violations since 2018, including minors working more hours than permitted in otherwise legal jobs, using types of equipment they shouldn’t while doing legal jobs, and children working where they should never be employed in the first place.

    “Nobody under 18 should be working in a meat processing plant,” she said.

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  • East Palestine residents worry rashes, headaches and other symptoms may be tied to chemicals from train crash | CNN

    East Palestine residents worry rashes, headaches and other symptoms may be tied to chemicals from train crash | CNN

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    CNN
     — 

    Some residents of East Palestine, Ohio, say they have developed rashes, sore throats, nausea and headaches after returning to their homes this week, and they’re worried these new symptoms are related to chemicals released after a train derailment two weeks ago.

    The February 3 incident caused a massive fire and prompted officials to evacuate hundreds of people who lived near the site because of fears that a hazardous, highly flammable material might ignite. To prevent a potentially deadly explosion, toxic vinyl chloride gas was vented and burned, releasing a plume of black smoke over the town for days.

    Other chemicals of concern at the site include phosgene and hydrogen chloride, which are released when vinyl chloride breaks down; butyl acrylate; ethylene glycol monobutyl ether acetate; and 2-ethylhexyl acrylate, according to the US Environmental Protection Agency. All these chemicals can change when they break down or react with other things in the environment, creating a stew of potential toxins.

    Residents were given the all-clear to return to their homes February 8 after air monitoring in East Palestine did not detect any elevated chemicals of concern.

    Officials say further testing of indoor air in about 500 homes has also not shown any hazards. Tests of tap water from the municipal system didn’t show any chemicals at levels that would pose a health hazard, although officials are still testing water from rivers, streams and residential wells in the area.

    These test results have failed to reassure some residents, who say something is making them sick – even if officials can’t find it.

    “When we went back on the 10th, that’s when we decided that we couldn’t raise our kids here,” Amanda Greathouse said. There was a terrible, lingering smell that “reminded me of hair perming solution.”

    Greathouse said she was back in their house, about a block from the crash site, for 30 minutes when she developed a rash and nausea.

    “When we left, I had a rash on my skin on my arm, and my eyes were burning for a few days after that,” said Greathouse, who has two preschool-age children.

    She and her husband have returned to their home only twice since the derailment, to pick up paperwork and clothing.

    “The chemical smell was so strong that it made me nauseous,” Greathouse said. “I just wanted to quickly pick up what I needed and leave. I only took a few pieces of clothes because even the clothes smelled like chemicals, and I’m afraid to put them on my kids.”

    She says she’s also kept her children out of preschool since the derailment. Even though her son’s teacher has promised her that students are using only bottled water, she’s worried about other types of contamination.

    “I don’t want to take my son out of the preschool they’re in because I really like the teachers he has, but I’m still scared. Some teachers have even expressed their concerns about the air quality,” Greathouse said.

    “We are very fortunate that we rent our home. Didn’t think I would ever say that. I feel awful for my landlord, but I just can’t risk my family’s health.”

    Ohio Gov. Mike DeWine said a request for medical experts from the US Department of Health and Human Services has been granted, and officials should be arriving early next week to help prop up a clinic for patients.

    “We know the science indicates that this water is safe, the air is safe. But we also know very understandably that residents of East Palestine are concerned,” he said Friday.

    DeWine said he plans to set up a clinic where HHS officials and others will answer questions, evaluate symptoms and provide medical expertise.

    The Agency for Toxic Substances and Disease Registry, part of the US Centers for Disease Control and Prevention, also says it expects to have a team on site Monday, according to a CDC spokesperson who requested that they not be named because they weren’t authorized to share the details. The team will conduct an Assessment of Chemical Exposure investigation, which surveys the impact of a chemical release on people and the community.

    The volatile organic compounds released by the controlled explosion can cause symptoms similar to those reported by some East Palestine residents, including headache, sore throat, and nose and eye irritation, but experts say it’s extremely difficult to connect chemical exposures to health effects.

    “That is a major challenge,” says Erin Haynes, chair of the Department of Epidemiology and Environmental Health at the University of Kentucky.

    “The community is now exposed to a mixture of numerous petroleum-based volatile organic compounds, so it may not just be one, it could be the mixture of them,” Haynes said.

    Haynes, who has experience investigating toxic exposures in communities, says she is seeking approval from her university’s Institutional Review Board to start a study in East Palestine to help give residents more information on their chemical exposures in air, water and soil.

    “They need all the help they can get,” she said. “This is a major emergency. This is a major disaster. They need all the assistance that we all can provide.

    “The evidence of a toxic exposure could very well be the rashes,” she said.

    Audrey DeSanzo would like some answers, too.

    “How safe is it, really?” said DeSanzo, who lives about half a mile from the derailment with her two grade-school-age children. “It’s not in all these people’s heads that are getting rashes, that are having the conjunctivitis, the pinkeye, from chemicals.”

    “You have a sore throat when you’re staying here. It smells out here.”

    After the derailment, DeSanzo evacuated with her kids just over the state line in Pennsylvania, where her uncle had an empty duplex. They slept on the floor and the couch.

    When she came home this week, DeSanzo says, she aired out her house, changed the furnace filter and washed their sheets and clothes. Even so, she says, they all recently went to a local immediate care clinic because her kids were coughing, and “our throats were raw.”

    Tests for strep throat were negative. The doctor prescribed cough medicine for the kids and told DeSanzo that the chemicals were probably to blame.

    The doctor said she had seen a number of East Palestine residents with similar symptoms, DeSanzo said, and advised them to call poison control and go to the local hospital for a blood test. She hasn’t gotten the blood test yet.

    Debbie Pietrzak, a spokesperson for Salem Regional Medical Center, which runs the clinic DeSanzo went to, confirmed that it has treated a small number of residents with symptoms like sore throats and respiratory problems. The hospital’s emergency room has seen fewer than 10 patients from East Palestine, she said.

    “Our facilities and primary care providers stand ready to help anyone who is seeking medical attention, and we are working closely with the County’s Health Department and other local, state and federal agencies, which are monitoring the situation,” Pietrzak said in an email.

    Natalie Rine, a pharmacist who directs the Central Ohio Poison Center, said the state’s poison control centers are getting calls from East Palestine residents, too. Experts who staff the help lines are trained in toxicology and can help if chemicals are a health concern.

    DeSanzo says she wants to leave but can’t afford to. Her mortgage is about $400 a month, less than half of those of other homes she’s found in the area that are farther from the accident site.

    “I make $14 an hour. Where am I supposed to go?” she said. “I don’t want to be here now with with my kids.”

    Ayla and Tyler Antoniazzi and their two daughters have been living in East Palestine since April. After the train crash, they weren’t sure about moving out, Ayla says, but they’re now considering it.

    The Antoniazzis returned to their house less than a mile from the accident site the day after the evacuation notice was lifted.

    “Before bringing my kids back home, I washed all the linen and a bunch of clothes, cleaned surfaces and aired the house out,” Ayla said. “But the next day when they woke up, they weren’t themselves. My oldest had a rash on her face. The youngest did too but not as bad. The 2-year-old was holding her eye and complaining that her eye was hurting. She was very lethargic, so I took them back to my parents’ home.”

    Ayla says her daughters are staying with her parents in Leetonia, about 20 minutes west of East Palestine, until the couple is able to make sure their home is safe.

    The kids’ symptoms got better in Leetonia, she said, but one got another rash when she returned to school in East Palestine on February 13.

    Ayla Antoniazzi's 4-year-old daughter developed a rash after going back to school in East Palestine.

    “I did allow my 4-year-old to return to preschool, which is in the East Palestine Elementary School. She went back for two days and developed another rash on her hands and started complaining of itching, so I pulled her back out,” Ayla said.

    Ayla has scheduled a medical appointment with her daughters for next week to discuss their symptoms and testing options, she said.

    That’s the right thing to do, says Dr. Kari Nadeau, an allergist and chair of the Department of Environmental Health at Harvard’s TH Chan School of Public Health.

    Nadeau says rashes, sore throat, and headaches can be clinical signs of a chemical sensitivity.

    “There are people that are highly sensitive to chemicals and can feel it before necessarily a monitor can pick it up,” Nadeau said. “There’s not a great diagnostic pathway for chemical sensitivities. A lot of it is based off clinical symptoms, including rashes.”

    Nadeau and other environmental health experts advise people who are having symptoms to see a health care provider, primarily for medical care but also so their case can be documented.

    “So that if there is a cluster, or if there’s a group of people that all of a sudden have complained about a rash or given symptoms, that really helps doctors come together with institutions like the CDC and do a little bit more fact-finding,” she said.

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  • Mothers with depression take longer to respond to their child

    Mothers with depression take longer to respond to their child

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    Newswise — COLUMBIA, Mo. – A recent study at the University of Missouri found mothers who are struggling with depression tend to take longer to respond to their child during back-and-forth dialogue. The findings provide the basis for further research to determine if the slower response time has any long-term impacts on the children’s language development, vocabulary or academic outcomes.

    Nicholas Smith, an assistant professor in the MU School of Health Professions, and his team listened to audio recordings of more than 100 families who were involved in the Early Head Start program, a federal child development program for children whose family’s income is at or below the federal poverty line. Some of the moms involved were struggling with depression, and Smith’s team documented how much time passed in between responses for a mother and her child during back-and-forth dialogue.

    “We found that the time gap in between responses, in general, gets shorter between mother and child as the child ages, and we also found the mom’s timing tended to predict the child’s timing and vice versa,” Smith said. “Mothers and children are in sync. Children who were slower to respond to their mom often had moms who were slower to respond to the child, and children who were faster to respond to their mom had moms who were faster to respond to the child. The significant new finding was that the moms who were more depressed took longer to respond to their child compared to moms who were less depressed.”

    In the longitudinal study, using audio recordings, they compared the response time of back-and-forth dialogue between mothers and their children when the children were 14 months old and 36 months old. Going forward, Smith plans to further study the dialogue response timing for the same individuals that were recorded in this study when the children were in pre-kindergarten and also when they were in fifth grade to examine how these effects play out later on in the children’s development.

    “The overall objective we are hoping to accomplish is to better understand how mother-child interaction works as well as the underlying mechanisms and potential factors at play,” Smith said. “Once we identify what factors drive successful development outcomes and what factors potentially impair development, we can better identify at-risk children and then tailor potential interventions toward those that can benefit from them the most.”

    “Maternal depression and the timing of mother-child dialogue” was recently published in Infant and Child Development. Funding was provided by the Mizzou Alumni Association.

    -30-

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    University of Missouri, Columbia

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  • Tablet-based screening doubles detection of psychosis symptoms in youth

    Tablet-based screening doubles detection of psychosis symptoms in youth

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    BYLINE: Lisa Howard

    Newswise — (SACRAMENTO, CALIF.) — Asking patients to take a short survey on a tablet before their appointments may help mental health providers identify young people at risk of psychosis. A UC Davis Health study found that when patients took a 21-question pre-visit survey, more than twice as many were identified at risk of psychosis compared to those who did not complete the survey.

    But despite the improvement in detecting individuals at risk, the technology-based screening did not reduce the time between the participants’ first psychotic symptoms and when they received treatment.

    The findings are in a new UC Davis Health study published in JAMA Psychiatry.  

    Previous studies have shown that the longer the time between the first psychotic incident — such as hallucinations or delusions — and receiving treatment, the more severe the course of the disease. According to the National Institute of Mental Health, psychosis often begins when a person is in his or her late teens to mid-twenties. About 100,000 new cases of psychosis are diagnosed each year in the U.S.

    “The addition of a brief screener at the initial evaluation can make a dramatic difference in clinical decision-making, helping you to realize that an individual needs specialized care,” said Tara A. Niendam, first author of the study. Niendam is a professor and executive director of the UC Davis Health Early Psychosis Programs.

    Methods

    Data came from ten community clinics and four school sites in California. Sites were divided by those that used tablets for screening (“active screening”) and those that screened using clinical judgment (“treatment as usual”).

    For the sites with active screening, individuals between the ages of 12 and 30 completed a questionnaire on a tablet before their visit with a mental health care provider.

    Known as the PQ-B (Prodromal Questionnaire, Brief Version), questions included “Do familiar surroundings sometimes seem strange, confusing, threatening or unreal to you?” and “Have you seen things that other people can’t see or don’t seem to see?”

    If the questionnaire score was 20 or above, the participant was offered a referral to an early psychosis clinic for further evaluation.

    Sites not using active screening relied on clinical judgment for further evaluation and referrals to early psychosis clinics.

    Results

    The researchers evaluated data from 2,432 individuals at the active-screening sites and 2,455 at the treatment-as-usual sites.

    Active-screening sites reported a significantly higher detection rate of psychosis spectrum disorders, with 136 cases (5.6%), compared to 65 (2.6%) in the sites that did not use the tablet screening.

    The active-screening sites also referred 13 individuals with first-episode psychosis compared to four in the sites that did not use active screening.

    But despite the early detection, the data showed no statistically significant difference in the duration of untreated psychosis. The mean for the active screening group was 239 days. The mean was 262.3 for the treatment-as-usual group.

    The researchers noted this was likely due to multiple factors leading to delayed access to the mental health system in the U.S.

    “On average, our participants experienced untreated psychosis for approximately six months before presenting at one of our participating clinic sites,” said Mark Savill, assistant professor in the Department of Psychiatry and Behavioral Sciences and a co-author of the study. “A multifaceted approach that focuses on supporting individuals to seek help quicker and improving the pathway to appropriate services once they present for care may be necessary to achieve meaningful reductions in the duration of untreated psychosis.”

     

    Young people at risk are not being identified

    Twenty-four sites agreed to participate. However, only ten community clinics and four school sites were able to fully implement the screening. Some study sites, such as primary care clinics, faced challenges implementing the screenings and reporting feedback; schools struggled with staffing issues and parent engagement.

    The setbacks highlight some of the challenges that might be faced scaling up programs that offer the active screening. But the results highlight how many young people at risk of psychosis are not being identified with the current system.

    “Population-based screening for psychosis has not been addressed systematically in the U.S. prior to this study,” said Cameron S. Carter, senior author of the paper. Carter is a distinguished professor of psychiatry and psychology and director of the UC Davis Health Imaging Research Center and the Behavioral Health Center for Excellence.

    “Our increased identification of cases using the PQ-B questionnaire is an important finding. More people in this active group are getting into care,” Carter said. “That’s important because we know from previous research that individuals who are identified and receive treatment at the very early stages in their illness are likely to have the best outcomes.”

    If you or a loved one think you may be experiencing symptoms of psychosis, the Early Psychosis Programs at UC Davis Health offer a free online screening survey.

    Additional authors on the study include Tyler A. Lesh, Daniel Ragland, Khalima Bolden, Haley Skymba, Sarah Gobrial, Monet Meyer, Katherine Pierce, Adi Rosenthal, Taylor Fedechko, Laura Tully, Valerie Tryon, Rosemary Cress and Richard Kravitz from UC Davis; Rachel Loewy and Kevin Delucchi from UCSF; and Howard Goldman from University of Maryland, Baltimore.

    Funding for this study was provided by grants from the National Institute of Mental Health (5R01MH104235) and (5T32MH018261-35).

    Resources

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    UC Davis Health

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  • Finding Comfort and Meaning After a Child’s Suicide

    Finding Comfort and Meaning After a Child’s Suicide

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    Feb. 16, 2023 – Janet Shedd lost her youngest son to suicide 7 years ago.

    “Tom had suffered from depression for about 9 months. We had gotten counseling for him, and he had been taking medication. We thought things were starting to turn around,” says Shedd, who lives in Kentucky. 

    But as soon as he turned 18 and was legally allowed to buy a gun, he died by suicide. Shedd’s life was shattered. “After his death, I became the walking wounded. It was hard to function,” she says. “I spent days crying and not getting out of bed.”

    She calls the loss “devastating because, as a parent, one of your major functions is to keep your child safe. When you’re not able to do that – usually through no fault of your own – you go through a lot of guilt.” 

    Shedd is far from alone. In 2020, suicide was the second leading cause of death in youngsters and young adults (ages 10 to 34) and the 12th leading cause of death in the U.S..

    And more young people are apparently considering taking their own lives. 

    Just this week, the CDC released a study showing a crisis in mental health among teen girls. The report found girls are experiencing record high levels of sexual violence, and nearly 3 in 5 girls report feeling persistently sad or hopeless.

    Nearly one-third of girls (30%) reported seriously considering suicide, up from 19% in 2011. In teenage boys, serious thoughts of suicide increased from 13% to 14% from 2011 to 2021. The percentage of teenage girls who had attempted suicide in 2021 was 13%, nearly twice that of teenage boys (7%).

    All these hurting children, and all those lost lives, have left a significant number of bereaved parents.

    No Universal Pattern

    William Feigelman, PhD, a professor emeritus of sociology at Nassau Community College in Garden City, NY, lost a son to suicide 20 years ago. 

    “He had a lot of winning characteristics, was engaged to be married, and was getting ahead in the film industry,” Feigelman says. “We were shocked and stunned, and it was the worst experience of our lives.”

    It turned out that their son had been “coming off a drug high in an industry where drugs are commonplace and was depressed and self-punishing at the time.” 

    The decision to die by suicide is complex and shouldn’t be reduced to single issues, Feigelman says. 

    “Drugs are common and played a role in my son’s suicide. But people take their lives for a variety of reasons. Maybe something went wrong. They were jilted by a girlfriend or boyfriend or lost their job. They feel dishonored and humiliated and can’t face other people. Maybe they feel they’ve let their families down. They’re in deep psychic pain and see suicide as the only way out.”

    Traditional bullying and cyberbullying have played a role in suicides of youngsters. Last week, a 14-year-old girl in New Jersey died by suicide. She had been beaten up in school, with a video of the assault posted online afterward. Unfortunately, many parents aren’t aware if their child is being bullied. The girl’s father says the school and the school district have not done enough to respond. 

    Just being aware of a child’s mental health problems doesn’t guarantee they’ll be resolved, Feigelman says. Many parents have struggled, “going from one clinic to another, one medication to another, and never successfully getting the right kind of help for their child who was in pain.” 

    On the other hand, some parents have seemingly successful, high-functioning children “who suddenly have one mishap – such as a bad math test – which pushes them over the edge into suicide, and they feel they can’t go home and tell their parents about it.”

    The point, according to Feigelman, is that “the reasons for suicide vary from case to case, with no universal pattern.” 

    A Combination of Events

    Erin Hawley and Angela Wiese agree. They are sisters in Lexington, KY, who lost children to suicide. 

    Wiese’s oldest son, Mason, died by suicide when he was 19 years old. 

    “He had just graduated from high school and was going through a transitional time,” she says. 

    Her son wasn’t sure he wanted to go to college. He enlisted in the Navy Reserves instead. “Maybe the stress of his schooling was getting to him, or maybe he was feeling overwhelmed,” Wiese says. “Maybe he just didn’t want to share things with us because he thought we’d be upset. He was a quiet kid but also fun and outgoing and athletic, with a lot of friends. We don’t know why he chose to kill himself.”

    Then, 23 months later, Wiese’s 18-year-old son, Ethan, also took his life. “We didn’t realize at the time how much at risk Ethan was after Mason’s suicide. We now believe he was struggling and just didn’t know how to cope with that loss,” she says.

    Hawley, whose 13-year-old daughter, Myra, also died by suicide, says her daughter’s death was particularly shocking and “came out of the blue” because she “came from a family who already had two children – her first cousins – die by suicide, and we talked about it all the time in our house.”

    For Hawley, the “hardest part was her choosing not to tell us that she was struggling or having these thoughts and that she wanted to kill herself. I never imagined we would lose another child to suicide in our family.”

    Some research suggests that the risk of suicide is higher in those who have been bereaved by another family member or close friend’s suicide. But Feigelman says that multiple suicides in the same family are “relatively rare.”

    And Hawley has learned that the motives for suicide are “unique to every situation, and it’s usually a ‘perfect storm’ of several events, some of which may be common, everyday things that parents may think they understand and can connect to.” 

    At the end of the day, “our children were the only people who knew the reasons, and we don’t want to speculate,” Hawley says.

    Get the Best Support

    After her older son’s death, Wiese and her husband “reached out to resources and therapists and whatnot, but they didn’t have experience with suicide grief and the understanding that Ethan felt the stigma and was mourning the loss of his brother,” she says.

    Wiese recommends that parents seeking help after a child’s suicide – for themselves or their other children – should “find professionals and support systems that deal specifically with suicide bereavement.”

    Shedd agrees. “My advice to other parents is to know you’re not alone. One of the best things I did was to hook up with someone else who had gone through the experience of losing a child to suicide, which was a touchstone during the early days,” she says. “Having someone to talk to who had been through it and was standing upright and functioning in the world was incredibly helpful to me.”

    Feigelman and his wife, Beverly Feigelman, a licensed social worker, joined support groups for people who lost loved ones to suicide. Eventually, they founded a support group of their own – Long Island Survivors of Suicide.

    “The group is still flourishing, and we’ve been running it for the last 15 years,” Feigelman says. “It’s important to be with people who have sustained a similar loss because we have unique issues that don’t affect people bereaved by other losses – we’re racked by guilt, shame, and anger toward the loved one who died by suicide, and we’re shaken and mystified that our children, whom we loved and even thought we knew well, could take their own life.” 

    Turning Pain Into Purpose

    “I’m definitely in a better place than I was immediately after Tom’s death,” Shedd says. “Time helps, and you move slowly forward. But even 7 years later, it’s still very fresh, and little things can tick off the memories – if I see someone who looks like him walking down the street, for example. And of course, you miss your child forever.”

    Nevertheless, “Helping other people who have gone through this type of loss and working to change things has been very helpful.”

    Shedd became involved in advocating for changes in gun laws. “If I can save someone else from going through a similar tragedy, this honors Tom, and that’s a comfort,” she says.

    After the death of her second son, Wiese founded Brothers’ Run, a nonprofit organization dedicated to raising money for suicide prevention efforts within schools and communities. The money also supports critical services and mental health professionals who care for suicide-bereaved families. 

    “Since losing my sweet boys, I’ve found that pain can be turned into purpose,” says Wiese.

    Beyond running the support group, Feigelman and his wife joined forces with two psychologists to conduct a large study of people bereaved by suicide, including 462 parents. And together, they also wrote Devastating Losses, a book for health care professionals working with suicide-bereaved family members.

    Some parents may not be drawn to involvement in volunteer work, advocacy, or similar activities. But there are still many healing approaches, including spiritual practice, yoga, mindfulness, art, and physical exercise. 

    “But I think the most helpful thing is working with a good, trained clinician and getting the support of other parents,” Feigelman says. “Engaging with other bereaved parents contributes to posttraumatic growth.”

    Shedd says her posttraumatic growth led to a deepening of empathy and compassion. 

    “I hesitate to say this because some people might regard it as a punch in the face, but a mentor told me, ‘You’re going to get gifts from this experience.’ I didn’t want any ‘gifts.’ I just wanted my child back. But I have to admit that – although I would never have chosen to pay the price for these ‘gifts’ – what happened has indeed changed me into a better person.”

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  • I Study Parents Who Kill Their Kids. There’s 1 Thing People Don’t Understand About These Cases.

    I Study Parents Who Kill Their Kids. There’s 1 Thing People Don’t Understand About These Cases.

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    From rural South Carolina to suburban Boston, cases of alleged child murder by parents ― known as filicide ― have been top news stories in recent weeks.

    Alex Murdaugh, the scion of a Lowcountry legal dynasty, is on trial for the double murder of his wife and young adult son. He faces the possibility of life in prison for their June 2021 slayings. Last week in Massachusetts, Lindsay Clancy — a labor and delivery nurse — was arraigned from a hospital bed over the deaths of her three children. Clancy allegedly strangled her infant son, her 3-year-old son and her 5-year-old daughter before jumping from a second-story window.

    As the only person in America who is a forensic psychiatrist, a reproductive psychiatrist and an academic whose research has focused on filicide for two decades, I always have a professional interest in these news stories and the effect they could have on public consciousness.

    Too often, because of the way these cases are presented in the media ― and in popular films and TV shows like “Law & Order,” among others ― we may believe that those who commit filicide are mentally ill. However, the most important thing I want people to know is that there are multiple different reasons why parents kill their children, and mental illness may— or may not — have a role in individual cases.

    It’s critical that we never presume why a parent killed. Lumping together mental illness and homicidality risks further stigmatizing many who have never been ― and will never be ― homicidal, and it can prevent people with mental health issues from getting the help they need.

    Working as a reproductive psychiatrist, I have treated many mothers and some fathers struggling with mental health during a pregnancy and the postpartum. Working as a forensic psychiatrist, I have conducted evaluations to understand the mental health and acts of parents who have killed their child, and to help courts ascertain their motives. I have also, in my roles, treated such parents after these tragedies in forensic hospitals and in correctional settings. I’ve led research studies related to parents who kill their children, considering dozens of cases of filicide and exploring mental health records, court reports by expert witnesses, coroner files and evidence from police investigations.

    One of the most important things to understand in filicide cases is that so much depends on the population studied. Mothers and fathers who kill their child and are subsequently imprisoned have different characteristics than those who commit suicide or who are treated in a forensic hospital. When my colleagues and I studied parents who committed filicide and suicide in a joint act, we found that twice as many fathers as mothers had done so. These parents often suffered from depression or psychosis.

    When we studied the characteristics of mothers who were found not guilty by reason of insanity for killing their child, we found women with high rates of serious mental illness, who believed that they were doing what was morally right by killing their child or who were unable — because of their symptoms — to control their actions. This group of mothers found insane had, unsurprisingly, high rates of postpartum psychosis. It was not uncommon for these mothers to have planned suicide too. However, data about mothers who were found insane or who committed suicide can’t be generalized to all mothers who kill.

    Filicide cases are often much more complex than they initially appear. As part of my work, I gather information from the parent after the homicide — about their life, their child’s life, their mental health and any substance abuse. Police reports and evidence are often crucial. Interviews, especially around the time of the killing, can be immensely helpful. Obstetric, pediatric and child protective services records provide clues. Any mental health records from before — and immediately after — the homicide can provide valuable insights into the parent’s state of mind.

    Anger, greed, hatred and revenge — feelings any one of us who has lived in a family might have experienced at some point — can be seen in various types of family murder.

    In 1969, my mentor, Dr. Phillip Resnick (who testified in the Andrea Yates trial, which I accompanied him to) described five motives for child murder by parents — both fathers and mothers — after reviewing many cases described in the world literature. Today, those descriptions are commonly used by forensic psychiatrists around the globe who evaluate parents after such cases, and our own research in the past two decades has helped us further understand these motives.

    In cases of fatal maltreatment — the most common pattern — the child dies as the end result of abuse or neglect. Often, these children have experienced that treatment over a period of time, and one day their body cannot bounce back. Occasionally, however, their death occurs after a one-off instance of abuse or neglect. In these cases, mental illness or substance abuse may be involved, but so may personality disorders or parenting struggles.

    Alternatively, in instances of “unwanted child” filicide, the parent’s needs or wants win out over the child’s life. This is a commonly described motive in neonaticide cases — in which an infant is killed at birth, often after a hidden pregnancy. But a child can be unwanted at any age and for a range of reasons, such as the parent desiring a child-free relationship. Here, the parent usually is not thinking of the child as their own person, but rather as someone whose fate the parent has ultimate control over.

    In cases of partner revenge, a parent kills their child to get back at a partner (or an ex) and emotionally wound them. This may happen in a custody battle, for example. The mythological Medea killed her children in partner revenge.

    In contrast to these first three motives, the much smaller populations of those found not guilty by reason of insanity and those who commit filicide-suicide tend to have altruistic or “acutely psychotic” motives.

    In an altruistic filicide, a parent kills their child out of love. Our research further described that the mother or father may be psychotic — and out of touch with reality — or depressed at that time. If the parent is psychotic, they may be experiencing delusions that a fate worse than death is about to befall the child, and thus they believe they are sparing the child from that outcome by killing them “gently.” A parent who is severely depressed may plan their own suicide and not want to leave the child alone in this “cruel world.” (We also see altruistic motives in other types of family murder — such as one older adult killing a partner who is medically unwell or suffering from dementia.)

    In the acutely psychotic cases, a parent kills with no rational reason. For example, they may hear the command of God in the context of a psychosis.

    When the public reads the news and hears arguments from prosecutors and defense attorneys, it might seem simple to figure out the mental health issues that a defendant has (or doesn’t have) and their motive. However, this is almost always far from the truth.

    Meanwhile, ethical psychiatrists bound by the so-called Goldwater rule should not share their hunches with the media about a defendant whom they have not evaluated. It’s easy to get swept up in the media circuses that surround these deaths, but without proper evaluations, complicated cases can be easily misunderstood — and mental illness and homicidality can become conflated, which is dangerous and unfair to people dealing with mental health conditions and challenges.

    Media buzz about postpartum mental illness can shine a light on these issues, which may help to inform or even educate the public about this important (and often invisible) topic. But it’s crucial to remember that mental illness may or may not be relevant to an individual case. Health systems and human services need to screen for mental health, substance abuse and parenting difficulties — and from a public health perspective, the needed care should be funded appropriately.

    As these cases continue to occur, we should keep in mind that there are various complex reasons why parents kill their children, and we should not make assumptions or correlations where they do not and should not exist. Most people with mental illness would never harm their child, and a great many parents who kill are not suffering from a mental illness.

    Dr. Susan Hatters Friedman is a reproductive psychiatrist and the Phillip Resnick professor of forensic psychiatry at Ohio’s Case Western Reserve University. She edited the Guttmacher Award-winning book “Family Murder: Pathologies of Love and Hate,” and she has authored dozens of scientific articles on filicide and maternal mental health.

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