The War at Home, Fall of 1970

by Philip A. Faruggio / September 27th, 2024

When you’re 20, playing college football, chasing girls and barely keeping enough passing grades to stay out of the draft, what could be better? That was this writer in the fall of 1970, at the height of the Vietnam debacle (I never would call it a war). Just completed the greatest summer of my life (even now 54 years later) and living at home with not a damn care in the world, other than how to get more weed for the weekends. My cousin Mick and I spent June and July in beautiful (to us city boys) Virginia Beach, with our own furnished apartment, days at the beach and evenings working part time. The stone promenade and the white sands blending into the clean salt of the ocean was as close to paradise this Brooklyn boy could ever experience. And the girls! Unreal! We met girls from the South and Midwest who just wanted fun in the sun and male companionship. They sure got it from us.

In May of 1970 I had my first taste of protest. Up until then I was as naive as a guy could be. The Vietnam thing was just whatever the mainstream media would offer us at the 6 O’clock News. Eating dinner with my folks and viewing the news footage of rice paddy battles, along with hype and spin by LBJ and his surrogates, was still not in my own purview. After all, I had my 2-S student deferment that kept me safe at home in Brooklyn. It wasn’t until the war, as they called it, skirted close to me that I started to grow up. First it was when my neighbor Fran from across the street, when she married this ex-GI who just returned from what he explained to me was ‘The Shit’. His stories of being an infantryman there for his one year tour (yeah, some tour) and how he spent every moment out on patrol being scared shitless. Then, our church’s crossing guard Mrs. L had her only child, a Marine, come home in a wooden box. All I could remember about her afterwards was that Mona Lisa look on her face. About the same time I heard that my friend David’s apartment building super’s son, Vito, a US Ranger, got killed on some hill in ‘The Shit’. His family were Poles who came to our country a few years earlier. I could never forget seeing him, home on leave less than a year before, standing next to me at Mass, dressed in his Ranger browns replete with beret tied outside his pants leg. Vito had a younger brother, 17, who I knew from the schoolyard where we played ball. Within a few years of Vito’s death the kid got into horse and OD’d.

I could have done more after this new political education… and chose not to. It was back to playing football, chasing girls, driving the yellow cab and smoking weed. I didn’t take part in the many marches and demonstrations against the phony war when I should have.

Mea Culpa. I guess I made up for it when the Bush/Cheney Cabal did their illegal and immoral attack and occupation of Afghanistan and Iraq. It took me over 30 years to finally grow up! And grown up I am nowFacebookTwitter

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Philip A Farruggio is regular columnist on itstheempirestupid website. He is the son and grandson of Brooklyn NYC longshoremen and a graduate of Brooklyn College, class of 1974. Since the 2000 election debacle Philip has written over 500 columns on the Military Industrial Empire and other facets of life in an upside down America. He is also host of the It’s the Empire… Stupid radio show, co produced by Chuck Gregory. Philip can be reached at paf1222@bellsouth.net. Read other articles by Philip.

Right-Wing Watch

The tentacles of the Atlas Network: Progressive politicians beware…

Gabrielle Pickard-Whitehead 

Yesterday

LEFT FOOT FORWARD


As the Atlas Network and its affiliates pose a clear threat to meaningful climate action, Starmer should be wary of any association with them or their ideological allies.

With the Tories firmly locked into an internal crisis, their former allies among prominent right-wing think tanks appear to be shifting their focus towards Reform UK. The TaxPayers’ Alliance (TPA), the Adam Smith Institute (ASI), and the Institute of Economic Affairs (IEA) all joined forces with Nigel Farage at Reform’s first annual conference in Birmingham last week.

As the party embraced these think tanks, reporters from independent media organisations which have been critical of Reform, including Byline Times,DeSmog, and LFF, were denied access to the event.

One especially concerning aspect of these groups’ alliance with Reform is their mutual opposition to ‘green’ agendas and support for the interests of the fossil fuel industry. These think tanks have long opposed climate policies, framing measures to reduce greenhouse gas emissions as placing too many costs on ordinary people. The IEA, for example, has consistently downplayed the human role in climate change, while the TPA has long been critical of the government’s green subsidies. Reform’s leader Nigel Farage, who hopes to become “the voice of opposition” in Parliament, is a vocal critic of climate science and opponent of climate action. He has called for the UK’s 2050 net zero emissions target to be scrapped entirely.

At the Reform Conference, a session entitled The Bully State: How Nanny is Taking Over Britain featured James McMurdock, a Reform UK MP, alongside George Morris Seers, the UK public affairs head of Japan Tobacco International (JTI). The ASI website declared that the conference event was to focus on how “burgeoning public health interventions” are allegedly restricting individual freedoms. “We are asking where these coercions have come from and how we can limit them,” the event page stated.

The Atlas Network

These think tanks, which seek to popularise policies and arguments that right-wing politicians can use to achieve their aims, are part of the Atlas Network. This Washington, D.C.-based coalition comprises of almost 600 free-market groups operating in around 100 countries. Founded in 1981 by British businessman Anthony Fisher, the network has been instrumental in promoting radical free-market policies and has had particular influence over the Conservative Party. Following the EU referendum in 2016, conservative think tanks in the UK and US exploited the crisis. Two UK Atlas partners, the IEA and the Legatum Institute, gained unprecedented access to ministers as they pushed for a hard Brexit. They consistently briefed Brexiteer MPs in the European Research Group (ERG). “They had lots of meetings with ministers because politicians like people promising simple answers, but often those answers were not there,” Raoul Ruparel, a former special adviser to Theresa May on Europe, told the Guardian.

These ultra-free market think tanks also have a history of opposing climate action, often working to protect the interests of fossil fuel companies. Atlas Network affiliates, including the IEA, have also used their influence to vilify climate protesters, portraying them as extremists. These groups have lobbied governments, produced white papers, and collaborated with the media to paint climate action as not only unnecessary but dangerous.

A 1991 report from Atlas member The Mackinac Institute refers to early environmentalists like EarthFirst activists and the prominent US environmentalist David Brower, as “reactionaries” who are “anti-human.” Fast-forward to 2019, and the IEA, a supposed champion of freedom of expression and the right to protest, referred to Extinction Rebellion (XR) as an “extremist group.”

“I am not saying that every member of Extinction Rebellion advocates violence, or will at some point start advocating violence. I am saying that Extinction Rebellion’s apocalyptic mindset lends itself to justifying violence, and very easily so,” wrote Andy Mayer, CEO, company secretary and energy analyst at the IEA.

Such anti-climate activist rhetoric and lobbying is often fed directly to Conservative politicians. Take Liz Truss. As foreign secretary, she held secret meetings with think tanks advocating for the UK to embrace a hardline free-market agenda. When Truss became leader of the Conservative Party, a former climate adviser to the Obama administration, warned that her leadership would be disastrous if she followed the tactics of groups like the Heritage Foundation, American Enterprise Institute (AEI), Cato Institute, and the American Legislative Exchange Council (ALEC).

“One of the reasons that the politics around climate change in the US is different to the UK right now is because of this powerful force of right-wing think tanks funded by fossil fuel interests,” Jonathan Phillips, who advised the US House of Representatives’ climate committee, told openDemocracy.

As prime minister, Truss prioritised efforts to reduce high energy costs amid the cost-of-living crisis. These measures included a promise to increase oil and gas production in the UK. She also spoke of her intent to extract more fossil fuels from the North Sea and lift the ban on fracking. When Truss launched her “Popular Conservatism” faction of the Tory Party in February, it immediately attacked net-zero targets and environmental organisations, following, as DeSmog described, “the playbook established by libertarian lobby groups.”

Truss is not the only prominent figure within this faction who opposes climate policies. Lord Frost, another leading “PopConner,” is a vocal critic of climate science and serves as a director of the Global Warming Policy Foundation, a group known for its climate change denial. Unsurprisingly, the director of PopCons is Mark Littlewood, the former managing director of the IEA. The IEA is widely credited with shaping Truss’s disastrous political platform. After the infamous mini-budget, Mark Littlewood said: “We’re on the hook for it now. If it doesn’t work it’s your fault and mine.”

Far from succeeding, the mini-budget crashed the UK economy, and its repercussions are still being felt today. But as Guardian columnist George Monbiot wrote in a piece about the Atlas Network, despite its failure, media outlets, including the BBC, continue to treat these corporate lobbyists with undue credibility. Monbiot noted how, in 2023, the IEA was platformed on British media an average of 14 times a day.

Monbiot certainly raises a valid point. Coverage of Rachel Reeves’ speech at this week’s Labour conference in mainstream media was notably influenced by references to right-wing think tanks. For example, in its report on the chancellor’s decision to keep the single-person council tax discount, the Telegraph featured analysis from the TaxPayers’ Alliance, a member of the Atlas Network. The think tank claimed that scrapping the discount would have generated £5.4 billion, significantly more than the £1.5 billion expected from the cuts to the winter fuel allowance. Yet another example of the right-wing media and right-wing think tanks working in tandem.

Atlas Network’s growing support in Europe

As well as its long-held influence on US and UK politicians and policy, Atlas has a rising presence in Europe. Just a few days before the EU elections in May, the European Liberty Forum took place in Madrid, which was organised by the Atlas Network, and attended by far right leaders. It came on the heels of another gathering of the global far right, also in Madrid, which was organised by the Spanish party Vox, and attended by Marine Le Pen, the Italian and Hungarian prime ministers Georgia Meloni and Viktor Orban, the Argentine president Javier Milei and close allies of Donald Trump such as Roger Severino of the Heritage Foundation. The Heritage Foundation is a key member of the Atlas Network, and Milei’s radical austerity and deregulatory political platform is said to be heavily influenced by Atlas Network think tanks.

Meloni, leader of the far-right Brothers of Italy party, has ties to the Atlas Network and its partners. In April 2023, during her first visit to the UK as prime minister of Italy, when she met her “friend” Rishi Sunak, as she described him, Meloni gave a speech at the Policy Exchange think tank, a former member of the Atlas Network. In 2017 the Policy Exchange received $30,000 from oil and gas giant ExxonMobil. When he was prime minister, Sunak praised the think tank for laws that target green activists, and “helped us draft” a crackdown on climate protests.

Starmer meets Meloni

Last week, Keir Starmer met with the Italian leader to discuss immigration. “You’ve made remarkable progress,” in tackling migration, the PM said at a joint press conference with Meloni. Starmer’s praise of Meloni’s immigration policies raised eyebrows within the Labour Party. During several fringe events I attended at this week’s Labour Conference, the discussion referenced the controversial meeting. Delegates I spoke to largely viewed the encounter as “outrageous.” Such concern was also publicly raised among several left-wing Labour MPs.

“Why is Starmer meeting with Italian PM Giorgia Meloni, a literal fascist, to discuss immigration? What does he hope to learn from her?” tweeted Diane Abbott.

Kim Johnson, Labour MP, told the Guardian that it was “disturbing” to see Starmer seeking to learn lessons from Italy. MP Nadia Whittome tweeted that Labour should build “an asylum and immigration system with compassion at its heart” instead.

In line with George Monbiot’s critique of the media’s failure to scrutinise influential right-wing think tanks and their influence on government policy, the Starmer-Meloni meeting received little critical coverage in the UK media. The National Scot was one of the few publications to provide any critical commentary, describing how the meeting was labelled as “deeply disturbing.”

Another concern raised by speakers and delegates at the Labour conference was that as Reform UK, which is cosying up to influential anti-green Atlas Network factions, grows in popularity, its right-wing demands such as abolishing net zero, are likely to put pressure on Labour.

In an era where populism and extremism are gaining ground, Starmer puts at risk Labour’s core values by courting figures like Meloni. As the Atlas Network and its affiliates pose a clear threat to meaningful climate action, Starmer should be wary of any association with them or their ideological allies. Unlike the US with its long history of cheap energy, there is little evidence yet that the right-wing attack on green policies is gaining traction with voters. Indeed, they remain mildly supportive of a ‘save the planet’ political agenda. Immigration though, is a wholly different ball game. Inevitably politicians are attracted to the siren voices of ‘what works’ but Meloni’s immigration policy is not working and will not work. Outsourcing immigration control to the Tunisians has brought only corruption and inhumanity. Starmer would do well to steer clear of policies that are doomed to fail, both morally and practically.

Right-wing media watch – The Murdoch soap opera that could shake up right-wing media

A real-life family feud that outshines the drama of an earlier TV series based on the same family. It could only be the Murdochs. The cameras might not be allowed in the Nevada courtroom, but speculation is brewing about a legal battle that could determine the future of the world’s most powerful media empire.

The crux of the court battle is what will happen to the media empire when 93-year-old Rupert Murdoch dies. Could his children, some of whom lean a little too left for the media mogul’s liking, wrest control of the company from his chosen successor, Lachlan, the loyal Conservative son?

To prevent such a scenario, the media baron is trying to rewrite the rules of the family trust, as first revealed by the New York Times in July. The trust currently gives his four eldest children equal control of the future of his media empire following his death. But Daddy dearest wants to shake things up, pushing for Lachlan to take the reins solo, ensuring the empire stays firmly Conservative.

James, the youngest sibling, left the family media empire in 2020, because of “disagreements” over its editorial content. Disagreements, we can assume, mean that he’s not exactly on board with Fox News’ pro-Trump agenda. In 2022, he welcomed Joe Biden to his home for a fundraiser. Earlier this month, he endorsed Kamala Harris by adding his name to a list of 88 US business leaders who have thrown their support behind the Democratic nominee in what they called an effort to preserve American democracy. He has also privately described Fox’s prime talk shows as “poison” and said that the misinformation peddled on the network distorts the public discourse. A source familiar with the matter said James gathered detailed plans for taking Fox News away from pro-Trump propaganda and toward what he considered more reality-based news, as reported by CNN.

The prospect of a James Murdoch-led media empire is reportedly feared by many inside Fox News, with prominent hosts having talked openly about how they might reposition their brands to appeal to James. Liberal critics, who have long slammed Fox News as a misinformation machine, have been fantasising about a James-led revolution for years. In a 2020 NYT column, Maureen Dowd suggested that James could be the “anti-venom” to Fox’s poison.

No wonder Murdoch is doing his best to make sure his eldest son Lachlan, who has been described as “more Conservative” than his dad, remains in control of his empire. Along with James, sisters Elisabeth and Prudence oppose the change, and with all three in opposition, James could theoretically take control of the family business one day.

Could we really see a future where Murdoch-owned media outlets like the Sun become champions of progressive ideals and woke causes? It’s a nice thought, but perhaps about as likely as the Sun endorsing tofu over a full English breakfast.

Woke bashing of the week – Right-wing outrage over shrinking pints

Britons are famous for their love of pints. At 568ml, the much-loved pint is one of the largest standard beer servings globally, compared to Germany’s 500ml, the US pint at 473ml, and Australia’s 425ml schooner. From “bants with the lads” after work to enjoying a few whilst watching the football, this large measure has become a cornerstone of British culture. So, when an experiment surfaced that suggested reducing the size of beer servings to improve public health, a wave of panic was triggered among patriotic right-wingers.

The Daily Mail captured the reaction, or perhaps led it, with the dramatic headline: “Now woke scientists want to shrink your PINT – as they claim smaller servings of beer could reduce the UK’s alcohol consumption.” According to the report, “woke scientists from the University of Cambridge want to do away with the humble pint to curb the nation’s boozing.”

The Cambridge trial explored the idea that people tend to think in terms of portions, like “one beer,” “one cup of tea,” or “one piece of cake,” rather than specific quantities like millilitres or grams.

To test whether this approach would work for beer, researchers invited over 1,700 pubs, bars, and restaurants to take part in the study. The response was overwhelmingly negative, and despite being offered compensation for potential revenue loss, only 13 establishments agreed to participate.

Lead researcher Professor Theresa Marteau, director of the Behaviour and Health Research Unit at Cambridge, clarified the health benefits of drinking less. “Alcohol harms health, increasing the risk of over 200 different diseases and injuries including bowel, breast and liver cancers,” she told the Mail Online.

The study also found there were concerns for the pub industry, which is already struggling. A spokesperson for the British Beer and Pub Association warned that reducing alcohol consumption must be approached carefully, as the research showed that some customers compensated for smaller beer servings by purchasing stronger alcoholic drinks. None of the participating pubs permanently scrapped the pint.

Pubs’ wariness to abolish pints in favour of more continental measures might be understandable but why did the Mail label the researchers woke? Probably because the study was perceived as an attempt to influence consumer behaviour in-line with health-conscious or socially progressive ideals. Reducing portion sizes or changing how alcohol is served could be seen as part of a broader movement toward promoting healthier lifestyles or curbing excessive drinking, which some critics interpret as part of a “woke” agenda focused on controlling personal choices in the name of public health.

There was a similar reaction when news emerged that the government was considering banning smoking outside pubs. The pint-loving, cig-puffing Nigel Farage was so incensed, that he said he’d never step foot into a pub again if the policy became law – much to the delight of left-wing pubgoers.

Ultimately, the debate is less about beer or cigarettes and more about the clash between modern health interventions and deep-rooted British cultural traditions, providing a perfect opportunity for some classic woke bashing from the patriots.

Gabrielle Pickard-Whitehead is author of Right-Wing Watch

RACIST AMERIKAN MEDICINE

Racial disparities exist in emergency department treatment of children with unintentional ingestions

Research found that Black children seeking emergency treatment for an unintentional ingestion more likely than white children to be referred for social worker and Children Services Bureau interventions

American Academy of Pediatrics

ORLANDO, Fla.— Unintentional injuries like falls, drownings and poisonings are the leading cause of death in patients ages 1-4, and a significant portion of these deaths are linked to unintentional ingestions—such as swallowing a drug or poison. New research shows racial and socioeconomic disparities exist in the emergency management of unintentional ingestions in children.  

Black patients younger than age 6 with the diagnosis of unintentional ingestion were more likely than white children to have a social work consult, Children Services Bureau referral, and urine drug screen, according to a research abstract, “Disparities in the Emergency Evaluation and Management of Unintentional Ingestions in Preschool Children,” presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.  

The research also found that children from poorer backgrounds (lower childhood opportunity index), those with higher severity of illness and pharmaceutical ingestions resulted in either a social work consultation, a Children Services Bureau referral, or both.  

“This study is important in understanding where underlying bias exists in emergency departments and hospital management and where changes can be made to address this problem, thus providing equitable care for all children,” said principal investigator Jennifer Allen, DO, FAAP.  “These findings could be useful to healthcare workers in emergency departments to help develop a framework for standardized clinical decision making.” 

Researchers examined the records of 4,411 patients, younger than age 6, who had unintentional ingestions between January 2013 and March 2024 identified by the International Classification of Disease in the electronic health record. They found: 

• Most ingestions were non-pharmaceutical (56%) 

• Patients with pharmaceutical ingestions had higher odds of a social work consult and a Children Services Bureau referral 

• Independent of ingestion type, non-white children were more likely to have a social worker consult or Children Services Bureau referral  

• White children were less likely to be exposed to cannabis 

• Private insurance was associated with reduced odds of social worker or Children Services Bureau referral.  

“This isn’t the only research to find racial disparities in the emergency department,” Dr. Allen said. “Disparity has been identified among different races regarding pain management for fractures and appendicitis in the emergency department.” 

Akron Children’s Hospital supported this research.  

Study author Dr. Jennifer Allen is scheduled to present this research, which is below, from 2:30 - 2:40 p.m. Friday, Sept. 27, 2024, during the Section on Emergency Medicine program during the AAP’s National Conference and Exhibition. 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

# # #  

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

 

ABSTRACT 

 

Program Name: 2024 AAP National Conference-Abstracts 

Submission Type: Section on Emergency Medicine 

Abstract Title: Disparities in the emergency evaluation and management of unintentional ingestions in preschool children 

Unintentional injuries consisting of trauma and poisonings are the leading cause of death in patients aged 1-4 years old with a significant portion attributed to ingestions. National Poison Control data in 2021 showed there were 37 incidences of poison exposure per 1000 children under 6 years old (2023). Between 2010-2019, poisoning deaths among minority children increased (West, 2021). Evidence of treatment disparity exists as seen in the decreased use of opioids or analgesia in minority children with long bone fractures or appendicitis in the emergency department (ED) (Goyal, 2015 and 2020). There is a knowledge gap regarding the extent, causes, and impact of disparities in assessing and managing acute ingestions in children. This study aimed to determine whether there is a difference in the evaluation and management of children with unintentional ingestions in a pediatric tertiary care center’s ED. 

From January 2013 to March 2024, patients less than 6 years of age were identified by International Classification of Disease (ICD) 9 and 10 codes in the electronic health record (EHR). Independent variables included: race, childhood opportunity index (COI), payor status, severity, age, sex, and substance type. Dependent variables included: urine drug screen (UDS), social work (SW) consult, and child service bureau (CSB) referral. Summary statistics were calculated and described as mean (sd). The relationship between independent and dependent variables was described using odds ratio (OR) with 95% confidence interval (CI). The relationship between pharmaceutical ingestion type was described using the receiver operating characteristic curve (ROC). Significance was defined as p-value < 0.05. Races are defined as White, African American, and Other; due to low numbers in categories comparisons are between all White and Non-White children. 

4411 patients had unintentional ingestions and most ingestions were non-pharmaceutical (56%). Patients with pharmaceutical ingestions had higher odds of a social work consult and a CSB referral (OR 8.3, 9.0). Independent of ingestion type, Non-White children were more likely to have a SW consult, CSB referral, and UDS order (ROC 0.78, 0.84, and 0.86). Looking at pharmaceutical ingestions, Non-White children had more cannabis ingestions than White children (Figure 1). Private insurance and ED discharge were associated with reduced odds of SW consults or CSB referral. A lower COI was associated with higher odds of SW consult and CSB referral (Table 1). When adjusted for COI, payor type, and severity, African Americans had higher odds of a SW consult, CSB referral, and UDS order (OR 1.8, 2.8, 2.3). 

This study revealed there are racial disparities in the management of unintentional ingestions within the ED setting. The next step would be to discuss findings with ED professionals and develop a framework for standardized clinical decision making. 

Childhood opioid prescription rates vary by patient’s background, research finds

Research presented during American Academy of Pediatrics 2024 Conference & Exhibition analyzes opioid prescriptions following fracture diagnoses

American Academy of Pediatrics

ORLANDO, Fla.—Children born to greater socioeconomic backgrounds are significantly more likely to be prescribed opioids, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1. 

The abstract, “Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures,” looked at the rates in opioid prescriptions following childhood broken elbow diagnoses from 2012 to 2021.

Apurva Shah, MD, MBA, Attending Surgeon, Orthopaedic Surgery at the Children’s Hospital of Philadelphia, who authored the abstract, also pointed to results that showed a third of patients in the abstract received at least one opioid dose during their visit.

“As orthopaedic surgeons, we clearly need improved opioid use stewardship to improve healthcare outcomes for our patients,” Dr. Shah said.

Results found disparities in patient racial backgrounds, with Black children 27% less likely to receive an opioid prescription compared to other patients. By comparison, white patients were also shown to be 10% more likely to be given opioids.

Other factors that impacted patients’ likelihood of being given opioids included age and where they live, according to Dr. Shah.

“Non-opioid pain management has proven sufficient for pain management,” Dr. Shah said. “Knowing this, along with this abstract, pediatricians must consider the potential harm these drugs can have on populations with disproportionately easier access to healthcare.”

This research was funded by Children’s Hospital of Philadelphia, Division of Orthopaedics.

Scott Mahon is scheduled to present the research, which is below, at 8:51 – 8:55  a.m. on Sunday, Sept. 29 during the Section on Orthopaedics program at Orange County Convention Center, West Building, W311H. To request an interview with the authors, contact Ashley Moore at moorea1@chop.edu.

 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

 

# # #  

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

ABSTRACT 

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Orthopaedics

Abstract Title: Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures

Apurva Shah

Philadelphia, PA, United States

Nonmedical use of opioids in children and adolescents is a well-established public health concern. For many adolescent patients, an initial opioid prescription can act as a gateway that may lead to opioid misuse later in life. The purpose of this study is to investigate if patient factors, including sex, race, ethnicity, or Childhood Opportunity Index (COI), are associated with higher or lower likelihood of opioid prescription in children with fractures, utilizing pediatric supracondylar humerus fracture as an archetypal example.

Data was obtained from the Pediatric Health Information System (PHIS), an administrative database consisting of patient encounters across 52 pediatric hospitals. Patients with supracondylar humerus fractures who presented to an emergency department and were treated non-operatively were included. The primary outcome variable of interest was whether or not patients received an opioid prescription. We also extracted and assessed patient-level predictors for opioid use, including age, sex, race, ethnicity, primary payer, COI, and geographic region. To account for hospital level variation, we conducted mixed-effects logistic regression.

In total, 35,452 children (52% male) with non-operative supracondylar humerus fractures at a mean age of 5.7 ± 2.8 years were included. About one-third of patients (10,731; 30.3%) received at least one dose of opioids. After accounting for hospital-level characteristics, White patients were significantly more likely to receive an opioid prescription (OR 1.1, p=0.016), while those with public insurance were less likely (OR 0.85, p=0.001). Kids from moderate, high, and very high COI regions were significantly more likely to receive opioids compared to very low COI regions (OR 1.1-1.2). Additionally, older children (5-13 years) were significantly more likely to be prescribed more opioids compared to younger children (1-5 years) (OR 1.4, p< 0.001). No differences due to region or sex were found statistically significant. Results are further described in Table 1.

Opioids for supracondylar humerus fractures, despite the efficacy of non-opioid alternatives, are prescribed at high rates and disproportionately to White children and patients from higher COI areas, reflecting important socioeconomic disparities in opioid prescription patterns. Though non-opioid pain management using acetaminophen or ibuprofen provides sufficient pain control for treating supracondylar humerus fractures, unfortunately, almost one-third of patients being treated non-operatively were prescribed opioids. Our investigation demonstrates that White patients and children with higher COI are especially likely to be prescribed opioids, indicating that prescription pattern disparities may be harming the portion of the population that has historically had better access to healthcare.

Black infants with heart abnormalities more likely to die in first year

Study of infant mortalities from heart defects finds while death rates decreased, white infants more likely to survive than Black infants

Reports and Proceedings

American Academy of Pediatrics

ORLANDO, Fla.— Some babies are born with abnormalities involving the structure of the heart, known as congenital heart disease (CHD). While many studies have shown that more babies with congenital heart disease are surviving past their first birthday as deaths from CHD have significantly decreased in the United States, a research abstract found that race impacts these survival rates.

Black infants with congenital heart disease are 40% more likely to die in the first year of life than white infants with congenital heart disease, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.

The research, “Trend in Racial Differences in Mortality Attributed to Congenital Heart Diseases in Infants in the United States from 2005 to 2019," found that improvements in death rates for children with heart abnormalities were due to reduced death rates for white babies with congenital heart disease.

“The death rate in white infants decreased significantly but the rate in Black infants did not. Overall, we also found that Black infants died from these abnormal heart structures at a rate that was 1.4 times that of white infants,” said lead author Kwadwo Danso, MBChB.

Researchers examined data from the Centers for Disease Control and Prevention on 60,243,988 live births, which included 19,004 congenital heart disease-related infant deaths, to investigate if death rates varied based on race for children born with CHD. They found that the overall congenital heart disease infant mortality rate declined from 36.1 to 27.0 per 100,000 live births, down 25.2%. However, throughout the study, Black infants with congenital heart disease died at higher rates.

“Our findings may have implications for patient care and public health policy by serving as a foundation for additional studies to determine the drivers behind these disparities,” Dr. Danso said. “More research is needed on this disparity to understand why Black infants with congenital heart disease are more likely to die.”

Study author Kwadwo Danso, MBChB, is scheduled to present the research, which is below, during the Section on Cardiology and Cardiac Surgery program at the AAP’s National Conference and Exhibition.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

 

# # #

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Cardiology & Cardiac Surgery

Abstract Title: Trend in racial differences in mortality attributed to Congenital Heart Diseases in infants in the United States from 2005 to 2019

Kwadwo Danso

Peoria, IL, United States

Deaths from congenital heart disease (CHD) in children have been decreasing. We examined the differences in CHD mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants in the United States from 2005 to 2019. We hypothesized that a disparity in mortality rates exists between NHB and NHW infants.

We performed a retrospective cross-sectional analysis of publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research. The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10th revision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P< 0.05 was considered statistically significant.

Out of 60,243,988 live births, there were 19,004 CHD-related infant deaths. The characteristics of the study population are displayed in Table 1. The overall CHD-IMR declined from 36.1 to 27.0 per 100,000 live births (25.2%) with an average annual percentage change (AAPC) of -2.1 [95% confidence interval (CI)-2.6, -1.572] (Figure 1). The CHD-IMR was significantly higher in NHB than in NHW (40 vs 29.3; P< 0.0001) and this difference remained when the CHD mortality rate was stratified by the neonatal and post-neonatal period. The CHD-IMR decreased significantly in NHW [AAPC: -2%; 95% CI: -2.5, -1.5%], however, it was not significant in NHB [AAPC of -1.4%, 95% CI, -3.0, 0.3%]. The NHB-to-NHW CHD-IMR ratio, a measure of CHD-IMR disparity averaged 1.4 and there was no significant change during the study period [AAPC: 0.8%; 95% CI: -0.2, 1.8%] (Figure 2).

The CHD-IMR declined significantly for NHW, but not in NHB in the US from 2005 to 2019. The CHD-IMR was significantly higher in NHB than in NHW. There was no significant change in the NHB-to-NHW CHD-IMR ratio, signifying no change in the disparity that exists between NHB and NHW IMR. These findings may have implications for patient care and public health policymaking. They lay the groundwork for additional studies to determine and understand the drivers behind these findings such as in prenatal diagnosis.

 

Figure 1 shows the overall CHD-IMR decline over the study period

 

Figure 2 shows the NHB-NHW CHD IMR ratio over the time

Preterm births are on the rise, with ongoing racial and economic gaps

Study identifies how changes in risk factors may be contributing to growing number of babies born prematurely

Peer-Reviewed Publication

New York University

Preterm births have increased by more than 10 percent over the past decade, with racial and socioeconomic disparities persisting over time, according to a new study analyzing more than five million births.

The study, published in the journal JAMA Network Open, also found that some factors that increase the risk for preterm birth—such as diabetes, sexually transmitted infections, and mental health conditions—became much more common over the past decade, while other factors that protect against preterm birth declined. 

“Our findings not only show that preterm births are on the rise, but provide clues as to why this may be the case,” said Laura Jelliffe-Pawlowski, the study’s lead author, an epidemiologist and professor at the NYU Rory Meyers College of Nursing and professor emeritus of epidemiology, biostatistics, and of global health sciences in the University of California San Francisco (UCSF) School of Medicine. “Understanding patterns of and factors related to preterm birth is important for informing clinical care and the development of public health programs to address this critical need.”

Babies born preterm or prematurely—before the 37th week of pregnancy—are more likely to experience a range of short and longer-term problems, including a higher risk for illness, intellectual and emotional difficulty, and death. Certain factors are known to increase the risk of preterm birth, including mothers having high blood pressure, diabetes, an infection, or smoking. In addition, Black, Native American, and Hawaiian and Pacific Islander expectant mothers are at higher risk for preterm birth, which is thought to be driven by a long history of structural racism experienced by these groups.

To understand recent trends around preterm births, Jelliffe-Pawlowski and her colleagues looked at more than 5.4 million singleton births (not twins or other multiples) from 2011 to 2022 in the state of California. They examined how preterm birth rates changed over time and explored patterns in risk and protective factors within racial/ethnic and socioeconomic groups. Health insurance type was used as a proxy for socioeconomic status, comparing public insurance (MediCal, California’s Medicaid program) with nonpublic insurance (including private insurance and coverage through the military and the Indian Health Service). 

A growing risk and “alarm bells”

The researchers found that preterm births increased by 10.6 percent over the decade studied, from 6.8 percent in 2011 to 7.5 percent in 2022—echoing a report from the Centers for Disease Control and Prevention (CDC) released earlier this year that also found an increase in preterm birth across the nation from 2014 to 2022.

Rates of preterm birth grew across nearly all groups, but varied by racial/ethnic and socioeconomic group. The highest rates of preterm birth were among Black mothers with public insurance (11.3 percent), while the lowest rates were among white mothers who had nonpublic insurance (5.8 percent). Preterm birth rates decreased slightly over time among Black mothers with nonpublic insurance, from 9.1 percent in 2011 to 8.8 percent in 2022, but were still significantly higher than rates among white mothers. In contrast, preterm birth rates jumped from 6.4 percent to 9.5 percent among Native American mothers with nonpublic insurance.

“We found stark differences in terms of what it looks like to be a Black or Native American pregnant person compared with a white individual who is of middle or higher income,” said Jelliffe-Pawlowski.

Expanding on the CDC report’s findings by looking at risk and protective factors over time, the researchers determined that several factors were linked to an increased risk for preterm birth, including diabetes, high blood pressure, previously having a preterm birth, having fewer than three prenatal care visits, and housing insecurity. Notably, the rates of preexisting diabetes, sexually transmitted infections, and mental health conditions more than doubled during the decade studied.

“These patterns and changes in risk factors should be setting off alarm bells,” said Jelliffe-Pawlowski. 

Several factors were found to protect against preterm birth among low-income expectant mothers, including receiving prenatal care and participation in WIC, the supplemental nutrition program supporting women and children. Unfortunately, the researchers observed a decline in WIC participation across most low-income racial/ethnic groups over the period studied.

What can be done to improve birth outcomes

The researchers note that their findings underscore the need to improve pregnancy care and promote treatments that address risk factors associated with preterm birth—which are often underutilized during pregnancy, especially among mothers of color.

“We need to do a better job of sharing information with pregnant people about risk factors for preterm birth and interventions that may be able to help them address this risk. Some providers report not wanting to scare or overwhelm pregnant people, but pregnant people tend to report wanting to have this information,” said Jelliffe-Pawlowski. “For those who are at increased risk due to factors like hypertension or previous preterm birth, for example, providers should be having conversations about how taking low-dose aspirin might be helpful to them and their growing baby. This also extends to things like screening for sexually transmitted infections and offering mental health care in a non-judgmental, supportive way.”

“There is also important work to be done to improve structural issues and respectful care in WIC to increase participation,” added Jelliffe-Pawlowski.

Jelliffe-Pawlowski and her colleagues are also working to develop a digital platform called Hello Egg to help expectant mothers better understand their risk for preterm birth, identify interventions that may be helpful to them, and create a healthy pregnancy plan co-developed with prenatal providers. Jelliffe-Pawlowski and the team at the start-up, EGG Healthy Pregnancy, aim to conduct a large study to see if using the platform boosts a pregnant person’s knowledge; a key outcome will be seeing if this information sharing leads to increases in the use of interventions and, ultimately, to a reduced risk of preterm birth and other adverse outcomes. 

The research was supported by the University of California, San Francisco California Preterm Birth Initiative. Additional study authors include Audrey Lyndon of NYU Meyers and collaborators from the University of California, San Francisco; University of California San Diego; Stanford University; UCLA Medical Center; California State University, Northridge; San Francisco State University; Indiana University Bloomington; University of Alabama at Birmingham; and the University of Illinois Urbana-Champaign.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2024.35887 

Method of Research

Observational study

Subject of Research

People

Article Title

Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California

Article Publication Date

27-Sep-2024

 

Do natural disasters jeopardize women’s reproductive health?

Wiley

In research published in Brain and Behavior, investigators found increased rates of menstrual irregularities in women living in areas affected by the 2023 earthquake in Turkey.

In the study, 309 women of reproductive age living in regions declared as disaster areas completed online forms 9 months after the earthquake. Responses revealed an increase of menstrual irregularities from 14.3% before the earthquake to 44.8% after the earthquake. Risk factors for menstrual irregularities included post-traumatic stress symptoms, chronic diseases, and smoking.

The findings reveal that reproductive health can be significantly affected in the aftermath of natural disasters, and they highlight the importance of addressing mental health in post-disaster interventions to mitigate these effects.

“Traumatic events like earthquakes can disrupt not only physical but also hormonal and psychological balances, which can directly affect women's reproductive health,” said corresponding author Sibel Kiyak, RN, PhD, of Necmettin Erbakan University.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/brb3.7003

 

Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.

About the Journal
Brain and Behavior is an open access journal that publishes research relating to every area of neurology, neuroscience, psychology and psychiatry. We publish interdisciplinary research reports - all enhancing the understanding of the brain and behavior. Brain and Behavior is part of Wiley’s Forward Series which are inclusive open access journals increasing discoverability.

About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram.

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Journal

Brain and Behavior

DOI

10.1002/brb3.70034 

Article Title

The Relationship Between Menstrual Cycle Pattern and Post-traumatic Stress in Women Following the 2023 Earthquake in Turkey

Article Publication Date

25-Sep-2024

AMERIKA

Growing divide: Rural men are living shorter, less healthy lives than their urban counterparts

The urban-rural gap in life expectancy and health quality for men nearing retirement age has widened over two decades

University of Southern California

 

image: 

Source: Authors' analysis of data from the Health and Retirement Study and life-course projections using the Future Elderly Model.

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Credit: USC Schaeffer Center for Health Policy & Economics

Rural men are dying earlier than their urban counterparts, and they’re spending fewer of their later years in good health, according to new research from the USC Schaeffer Center for Health Policy & Economics.

Higher rates of smoking, obesity and cardiovascular conditions among rural men are helping fuel a rural-urban divide in illness, and this gap has grown over time, according to the study published this week in the Journal of Rural Health. The findings suggest that by the time rural men reach age 60, there are limited opportunities to fully address this disparity, and earlier interventions may be needed to prevent it from widening further.

The findings also point to a rising demand for care in rural areas, which will particularly challenge these communities. Rural areas are more likely than urban ones to have shortages of healthcare providers and are aging faster as younger residents move to cities, which further shrinks the supply of potential caregivers.

"Rural populations face a higher prevalence of chronic diseases, which has serious implications for healthy aging," said lead author Jack Chapel, a postdoctoral scholar at the Schaeffer Center. "With an aging population and fewer physicians available, the burden on rural communities is set to grow, leading to significant challenges in providing care for those who will face more health issues in the future."

Researchers used data from the Health and Retirement Survey and a microsimulation known as the Future Elderly Model to estimate future life expectancy for rural and urban Americans after age 60. They also assessed their likely quality of health in those years – a measure known as heath-quality-adjusted life expectancy (QALE). They estimated health trajectories for a cohort of Americans who were 60 years old between 2014-2020 and compared it with a similarly aged cohort from 1994-2000.

They found 60-year-old rural men can now expect to live two years less than their urban counterparts – a gap that’s nearly tripled from two decades ago. Rural men can also expect to live 1.8 fewer years in quality health than urban men, with this disparity more than doubling over the same period. For women, the urban-rural gap in life expectancy and health quality is much smaller and grew more slowly over time.

Nearly a decade after a landmark study found that people with lower levels of education are more likely to die from so-called “deaths of despair” – such as drug overdose or suicide – this new study finds that while education was an important factor in determining health quality, it cannot fully explain the gap between urban and rural populations. After adjusting rural education levels to match those of urban areas, the gap in healthy life expectancy was cut nearly in half. However, disparities existed even within each educational group, suggesting important geographic factors beyond education contribute to differences in healthy life expectancy.

Researchers found that interventions to reduce smoking, manage obesity, and treat and control widespread heart disease would benefit older rural residents more than urban ones. However, most interventions researchers tested were not able to completely bridge the urban-rural divide in healthy life expectancy.

“While education matters, so does smoking, prevalent obesity, cardiovascular conditions – and simply living in a rural area – which leads not only to more deaths but more illness among rural American men,” said co-author Elizabeth Currid-Halkett, the James Irvine Chair in Urban and Regional Planning and a senior scholar at the USC Schaeffer Institute for Public Policy & Government Service.

“Closing the gap in healthy life expectancy between urban and rural areas for older adults would require encouraging health behavior changes earlier in life and making broader social and economic improvements in rural areas,” said co-author Bryan Tysinger, director of health policy simulation at the Schaeffer Center.

This work was supported by funding from the National Institute on Aging of the National Institutes of Health under award P30AG024968.

About the USC Schaeffer Center

The USC Schaeffer Center for Health Policy & Economics is a joint enterprise between the USC Price School of Public Policy and the USC Mann School of Pharmacy and Pharmaceutical Sciences. The Schaeffer Center is one of two flagship programs at the USC Leonard D. Schaeffer Institute for Public Policy & Government Service, formed in 2024 to develop evidence-based solutions to policy issues and educate future generations of public service leaders.

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Journal

The Journal of Rural Health

DOI

10.1111/jrh.12875 

Article Title

The urban–rural gap in older Americans’ healthy life expectancy