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1. Physiologic signatures within six hours of hospitalization identify acute illness phenotypes

   https://doi.org/10.1371/journal.pdig.0000110  

   Ren, Yuanfang; Loftus, Tyler J.; Li, Yanjun; Guan, Ziyuan; Ruppert, Matthew M.; Datta, Shounak; Upchurch, Gilbert R.; Tighe, Patrick J.; Rashidi, Parisa; Shickel, Benjamin; et al (October 2022, PLOS Digital Health)

   Keim-Malpass, Jessica (Ed.)

   During the early stages of hospital admission, clinicians use limited information to make decisions as patient acuity evolves. We hypothesized that clustering analysis of vital signs measured within six hours of hospital admission would reveal distinct patient phenotypes with unique pathophysiological signatures and clinical outcomes. We created a longitudinal electronic health record dataset for 75,762 adult patient admissions to a tertiary care center in 2014–2016 lasting six hours or longer. Physiotypes were derived via unsupervised machine learning in a training cohort of 41,502 patients applying consensus k -means clustering to six vital signs measured within six hours of admission. Reproducibility and correlation with clinical biomarkers and outcomes were assessed in validation cohort of 17,415 patients and testing cohort of 16,845 patients. Training, validation, and testing cohorts had similar age (54–55 years) and sex (55% female), distributions. There were four distinct clusters. Physiotype A had physiologic signals consistent with early vasoplegia, hypothermia, and low-grade inflammation and favorable short-and long-term clinical outcomes despite early, severe illness. Physiotype B exhibited early tachycardia, tachypnea, and hypoxemia followed by the highest incidence of prolonged respiratory insufficiency, sepsis, acute kidney injury, and short- and long-term mortality. Physiotype C had minimal early physiological derangement and favorable clinical outcomes. Physiotype D had the greatest prevalence of chronic cardiovascular and kidney disease, presented with severely elevated blood pressure, and had good short-term outcomes but suffered increased 3-year mortality. Comparing sequential organ failure assessment (SOFA) scores across physiotypes demonstrated that clustering did not simply recapitulate previously established acuity assessments. In a heterogeneous cohort of hospitalized patients, unsupervised machine learning techniques applied to routine, early vital sign data identified physiotypes with unique disease categories and distinct clinical outcomes. This approach has the potential to augment understanding of pathophysiology by distilling thousands of disease states into a few physiological signatures. 

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2. The effects of household water insecurity on child health and well‐being

   https://doi.org/10.1002/wat2.1666  

   Rhue, Steven J.; Torrico, Giulia; Amuzie, Chioma; Collins, Shalean M.; Lemaitre, Andrea; Workman, Cassandra L.; Rosinger, Asher Y.; Pearson, Amber L.; Piperata, Barbara A.; Wutich, Amber; et al (June 2023, WIREs Water)

   Abstract We extend the conceptualization of the social and health burdens of household water insecurity on children beyond the traditional narrow lens of microbiological pathogens and diarrhea. The global burden of disease associated with water insecurity has traditionally focused on diarrheal disease as the most significant driver of infant and child mortality. However, there are many other pathways through which children experience adverse health and social consequences from inadequate or unsafe household water. We synthesize evidence of a broad range of health impacts, affecting children from infancy to late adolescence, across four domains: exposure to unsafe water; interruptions to growth and development through poor nutrition and hydration; negative social effects such as school absenteeism and interpersonal violence; and other non‐communicable health issues such as mental health, injuries, and reproductive health. The growing burden and urgency of these issues is implicated by forecasted increases in climate‐ and conflict‐induced water scarcity, human displacement, and environmental contamination in the decades ahead. This article is categorized under:Engineering Water > Water, Health, and SanitationHuman Water > Rights to Water 

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3. COVID‐19 in childhood: Transmission, clinical presentation, complications and risk factors

   https://doi.org/10.1002/ppul.25344  

   Siebach, Melissa K.; Piedimonte, Giovanni; Ley, Sylvia H. (March 2021, Pediatric Pulmonology)

   Abstract Children less than 18 years of age account for an estimated 2%–5% of reported severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) cases globally. Lower prevalence of coronavirus disease 2019 (COVID‐19) among children, in addition to higher numbers of mild and asymptomatic cases, continues to provide challenges in determining appropriate prevention and treatment courses. Here, we summarize the current evidence on the transmission, clinical presentation, complications and risk factors in regard to SARS‐CoV‐2 in children, and highlight crucial gaps in knowledge going forward. Based on current evidence, children are rarely the primary source of secondary transmission in the household or in child care and school settings and are more likely to contract the virus from an adult household member. Higher transmission rates are observed in older children (10–19 years old) compared with younger children ( <10 years old). While increasing incidence of COVID‐19 in neonates raises the suspicion of vertical transmission, it is unlikely that breast milk is a vehicle for transmission from mother to infant. The vast majority of clinical cases of COVID‐19 in children are mild, but there are rare cases that have developed complications such as multisystem inflammatory syndrome in children, which often presents with severe cardiac symptoms requiring intensive care. Childhood obesity is associated with a higher risk of infection and a more severe clinical presentation. Although immediate mortality rates among children are low, long‐term respiratory, and developmental implications of the disease remain unknown in this young and vulnerable population. 

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4. Extreme weather events and maternal health in low-income and middle-income countries: a scoping review

   https://doi.org/10.1136/bmjopen-2023-079361  

   Pappas, Anna; Kovats, Sari; Ranganathan, Meghna (June 2024, BMJ Open)

   BackgroundDespite global efforts to improve maternal health and healthcare, women throughout the world endure poor health during pregnancy. Extreme weather events (EWE) disrupt infrastructure and access to medical services, however little is known about their impact on the health of women during pregnancy in resource-poor settings. ObjectivesThis review aims to examine the current literature on the impact of EWE on maternal health to identify the pathways between EWE and maternal health in low-income and middle-income countries to identify gaps. Eligibility criteriaStudies were eligible for inclusion if they were published before 15 December 2022 and the population of the studies included pregnant and postpartum women (defined at up to 6 weeks postpartum) who were living in low-income and middle-income countries. The exposure of the included study must be related to EWE and the result to maternal health outcomes. Sources of evidenceWe searched the literature using five databases, Medline, Global Health, Embase, Web of Science and CINAHL in December 2022. We assessed the results using predetermined criteria that defined the scope of the population, exposures and outcomes. In total, 15 studies were included. Charting methodsWe identified studies that fit the criteria and extracted key themes. We extracted population demographics and sampling methodologies, assessed the quality of the studies and conducted a narrative synthesis to summarise the key findings. ResultsFifteen studies met the inclusion criteria. The quantitative studies (n=4) and qualitative (n=11) demonstrated an association between EWE and malnutrition, mental health, mortality and access to maternal health services. ConclusionEWE negatively impact maternal health through various mechanisms including access to services, stress and mortality. The results have demonstrated concerning effects, but there is also limited evidence surrounding these broad topics in low-resource settings. Research is necessary to determine the mechanisms by which EWE affect maternal health. PROSPERO registration numberCRD42022352915. 

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5. Maternal epigenetic clocks measured during pregnancy do not predict gestational age at delivery or offspring birth outcomes: a replication study in metropolitan Cebu, Philippines

   https://doi.org/10.1186/s13148-022-01296-6  

   Ryan, Calen P.; Rege, Raviraj J.; Lee, Nanette R.; Carba, Delia B.; Kobor, Michael S.; MacIsaac, Julie L.; Lin, David S.; Atashzay, Parmida; Kuzawa, Christopher W. (June 2022, Clinical Epigenetics)

   Abstract Adverse birth outcomes, such as early gestational age and low birth weight, can have lasting effects on morbidity and mortality, with impacts that persist into adulthood. Identifying the maternal factors that contribute to adverse birth outcomes in the next generation is thus a priority. Epigenetic clocks, which have emerged as powerful tools for quantifying biological aging and various dimensions of physiological dysregulation, hold promise for clarifying relationships between maternal biology and infant health, including the maternal factors or states that predict birth outcomes. Nevertheless, studies exploring the relationship between maternal epigenetic age and birth outcomes remain few. Here, we attempt to replicate a series of analyses previously reported in a US-based sample, using a larger similarly aged sample (n = 296) of participants of a long-running study in the Philippines. New pregnancies were identified prospectively, dried blood spot samples were collected during the third trimester, and information was obtained on gestational age at delivery and offspring weight after birth. Genome-wide DNA methylation was assessed with the Infinium EPIC array. Using a suite of 15 epigenetic clocks, we only found one significant relationship: advanced age on the epigenetic clock trained on leptin predicted a significantly earlier gestational age at delivery (β = − 0.15,p = 0.009). Of the other 29 relationships tested predicting gestational age and offspring birth weight, none were statistically significant. In this sample of Filipino women, epigenetic clocks capturing multiple dimensions of biology and health do not predict birth outcomes in offspring. 

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