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Cover -- Half Title -- Title -- Dedication -- Copyright -- Contents -- Preface -- Acknowledgments -- Editors' Notes -- Acronyms -- 1 Introduction -- PART ONE The Physical and Socioeconomic Environment, the Population, Nutrition, and Disasters -- 2 Movement Toward Modernization: A Century of Progress -- 3 The Physical and Biotic Environment -- 4 Population -- 5 The Economy, with Particular Reference to the Agricultural Sector -- 6 Food, Diet, and Nutrition -- 7 Famine and Malnutrition -- 8 Health Impacts of War -- PART TWO Health Services and Sexually Transmitted and Other Nonvectored Diseases -- 9 Modern Health Services -- 10 Traditional Medicine -- 11 Water Supply and Sanitation -- 12 Childhood Diseases and Immunization -- 13 Acute Childhood Diarrhea -- 14 Viral Hepatitis -- 15 Intestinal Parasitism -- 16 Eye Diseases and Blindness -- 17 Leprosy -- 18 Tuberculosis -- 19 Meningococcal Meningitis -- 20 Sexually Transmitted Diseases -- 21 Social Aspects of Obstetrics and Gynecology -- 22 AIDS -- PART THREE Vector-Borne Diseases -- 23 Malaria -- 24 Trypanosomiasis -- 25 Onchocerciasis -- 26 Leishmaniasis -- 27 Yellow Fever and Other Arboviral Diseases -- 28 Relapsing Fever -- 29 Typhus and Other Rickettsial Diseases -- 30 Schistosomiasis -- PART FOUR Chronic Noninfectious Diseases, Injuries, Mental Health, and Other Health Problems -- 31 Chronic Noninfectious Diseases of Adults -- 32 Diabetes Mellitus -- 33 Podoconiosis (Nonfilarial Elephantiasis) -- 34 Fluorosis -- 35 Dental Health -- 36 Unintentional and Intentional Injuries -- 37 Neurological Disorders -- 38 Mental Illness -- 39 Other Diseases -- 40 Conclusion: Prospects of the Future -- Index -- Contributors.

The Senator from Kansas discusses efforts being made to identify causes of & solutions to childhood obesity in the United States. It is argued that solutions may only be found through multiple programs with a variety of targets.

Background: Prenatal exposure to air pollutants has been suggested as a possible etiologic factor for the occurrence of autism spectrum disorder. Objectives: We aimed to assess whether prenatal air pollution exposure is associated with childhood autistic traits in the general population. Methods: Ours was a collaborative study of four European population-based birth/child cohorts—CATSS (Sweden), Generation R (the Netherlands), GASPII (Italy), and INMA (Spain). Nitrogen oxides (NO2, NOx) and particulate matter (PM) with diameters of ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and between 2.5 and 10 μm (PMcoarse), and PM2.5 absorbance were estimated for birth addresses by land-use regression models based on monitoring campaigns performed between 2008 and 2011. Levels were extrapolated back in time to exact pregnancy periods. We quantitatively assessed autistic traits when the child was between 4 and 10 years of age. Children were classified with autistic traits within the borderline/clinical range and within the clinical range using validated cut-offs. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. Results: A total of 8,079 children were included. Prenatal air pollution exposure was not associated with autistic traits within the borderline/clinical range (odds ratio = 0.94; 95% CI: 0.81, 1.10 per each 10-μg/m3 increase in NO2 pregnancy levels). Similar results were observed in the different cohorts, for the other pollutants, and in assessments of children with autistic traits within the clinical range or children with autistic traits as a quantitative score. Conclusions: Prenatal exposure to NO2 and PM was not associated with autistic traits in children from 4 to 10 years of age in four European population-based birth/child cohort studies. ; Funding was provided as follows: ESCAPE Project— European Community's Seventh Framework Program (FP7/2007-2011-GA#211250). CATSS, Sweden— Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Research Council (VR) Formas, in partner hip with FORTE and VINNOVA (cross-disciplinary research program concerning children's and young people's mental health); VR through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework grant 340-2013-5867; HKH Kronprinsessan Lovisas förening för barnasjukvård; and the Strategic Research Program in Epidemiology at Karolinska Institutet. Generation R, the Netherlands—The Generation R Study is conducted by the Erasmus University Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam; the Municipal Health Service Rotterdam area, Rotterdam; the Rotterdam Homecare foundation, Rotterdam; and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus University Medical Center, Rotterdam; the Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); the Netherlands Organization for Scientific Research (NWO); and the Ministry of Health, Welfare and Sport. The Netherlands Organisation for Applied Scientific Research (TNO) received funding from the Netherlands Ministry of Infrastructure and the Environment to support exposure assessment. GASPII, Italy—grant from the Italian Ministry of Health (ex art.12, 2001). INMA, Spain— grants from Instituto de Salud Carlos III (Red INMA G03/176 and CB06/02/0041 FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, CP11/00178, FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090), PI13/1944, PI13_02032, PI14/0891, PI14/1687, MS13/00054, UE (FP7-ENV-2011 cod 282957, and HEALTH.2010.2.4.5-1); Generalitat de Catalunya-CIRIT 1999SGR 00241; La Fundació La Marató de TV3 (090430); Conselleria de Sanitat Generalitat Valenciana; Department of Health of the Basque Government (2005111093 and 2009111069); and Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001). V.W.V.J. received an additional grant from the Netherlands Organization for Health Research and Development (ZonMw 90700303, 916.10159). A.G.'s work was supported by a research grant from the European Community's 7th Framework Programme (FP7/2008–2013-GA#212652). A full roster of the INMA project investigators can be found online (http://www. proyectoinma.org/presentacion-inma/listado-investigadores/ en_listado-investigadores.html).

This article first documents evidence on the changing prevalence of childhood physical and mental health problems, focusing on the development of childhood health conditions in the United States. Authors Liam Delaney and James Smith present evidence on the changing prevalence of childhood chronic conditions over time using recalled data as well as contemporaneous accounts of these childhood health problems. The raw data from both sources show sharp increases in the prevalence of most childhood physical health problems (such as asthma, allergies, respiratory problems, and migraines) over time. However, inferring trends is difficult because such data are also consistent with improved detection of childhood disease, and many of the causes of childhood disease have not worsened over time. Conclusions about rapidly rising rates of childhood physical health problems over time are premature at best, especially concerning the magnitude of trends. Documenting real changes in the prevalence of specific diseases is a high-priority research topic. In contrast, the evidence is much stronger that childhood mental health problems are becoming worse. The authors next present new evidence on the effects of early childhood physical and mental problems on health and economic status in adulthood. They find that both childhood physical and mental health problems contribute significantly to poorer adult health. However, they also find that childhood mental health problems have much larger impacts than do childhood physical health problems on four critical areas of socioeconomic status as an adult: education, weeks worked per year, individual earnings, and family income. Finally, the authors examine evidence regarding the efficacy of early mental health treatment for children in terms of promoting good health later on. Existing studies suggest that a combination of cognitive behavioral therapy and medication appears to be effective in the treatment of both anxiety and depression in children. However, much more research is needed on the efficacy of these childhood interventions into adulthood. Clinical trials have been too short to evaluate the long-term impacts of various forms of treatment, and these impacts are definitively long term.

Abstract
Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002–2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16–1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19–1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.

Discharge information for all Hong Kong government hospitals, which is routinely collected through the Clinical Management System (CMS), was used to assess the relative importance of all causes of diarrhoeal illness and to address the issue of under-diagnosis of rotavirus by linking discharge diagnostic codes with actual laboratory results for one hospital. Of all children less than 5 years of age hospitalized in Hong Kong in the 2-year period July 1997 to June 1999, 12,257 (11%) were discharged with a primary diarrhoea diagnosis (74% coded as non-specified, 10.4% as rotavirus, 11% as Salmonella and 5% as other viral or bacterial). Linked laboratory and discharge data for one hospital demonstrated that 15% (n = 1522) of all admissions had a primary diarrhoea diagnosis and that 40% of these had a specimen sent for rotavirus testing, of which 37% were positive. However, 46% (67/145) of children with a diagnosis of rotavirus infection had no virology result, and 69% (172/248) of positive rotavirus results were in children with no diagnosis indicating rotavirus infection. Modification of the CMS to routinely combine existing computerized laboratory data with the CMS discharge diagnoses and to develop mechanisms to enhance reliability of discharge diagnosis coding could produce a powerful resource for disease surveillance, auditing and for monitoring the impact of future vaccination and other prevention programmes.

The publication in this issue of an article describing the fatal strangulation of two children on clothing drawstrings (see pages 1417 to 1419) coincides with National Child Day. This juxtaposition prompts the author to examine Canadian child health policy and practices in relation to injury prevention and product safety. The absence of a central body in Canada responsible for injury prevention may reflect the absence of advocacy groups concerned exclusively with the prevention of childhood injuries and stands in sharp contrast to the attention given to various "high-profile" but comparatively rare childhood diseases. In Canada, taking a firm regulatory or legislative approach to product safety appears to be the exception rather than the rule. Instead, we rely on product safety bulletins, the effectiveness of which has never been evaluated. The adoption of tougher measures would be facilitated by the establishment of a national centre for injury prevention and control. Such centres in the United States and Sweden have been successful and demonstrate that the creation of a Canadian body responsible for addressing the epidemic of accidental injury is long overdue.

"The COVID-19 pandemic and the global response to it have disrupted the daily lives of children in innumerable ways. These impacts have unfolded unevenly, as nation, race, class, sexuality, citizenship status, disability, housing stability and other dimensions of power have shaped the ways in which children and youth have experienced the pandemic. COVID-19 and Childhood Inequality brings together a multidisciplinary group of child and youth scholars and practitioners who highlight the mechanisms and practices through which the COVID-19 pandemic has both further marginalized children and exacerbated childhood disparities. Featuring an introduction and ten chapters, the volume "unmasks" childhood inequalities through innovative, real-time research on children's pandemic lives and experiences, situating that research within established child and youth literatures. Using multiple methods and theoretical perspectives, the work provides a robust, multidisciplinary, and holistic approach to understanding childhood inequality as it intersects with the COVID-19 pandemic, particularly in the USA. The chapters also ask us to consider pathways toward resilience, offering recommendations and practices for challenging the inequities that have deepened since the entrée of SARS-CoV-2 onto the global stage. Ultimately, the work provides a timely and vital resource for childhood and youth educators, practitioners, organizers, policymakers, and researchers. An illuminating volume, each chapter brings a much-needed focus on the varied and exponential impacts of COVID-19 on the lives of children and youth"--

Abstract Background The proportion of incompletely immunized children in Pakistan varies from 37-58%, and this has recently resulted in outbreaks of measles and polio. The aim of this paper is to determine the factors associated with incomplete immunization among children aged 12-23 months in Pakistan. Methods Secondary analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2006-07. The analysis was limited to ever-married mothers who had delivered their last child during the 23 months immediately preceding the survey (n = 2,435). 'Complete immunization' was defined as the child having received twelve doses of five vaccines, and 'incomplete immunization' was defined if he/she had missed at least one of these twelve doses. The association between child immunization status and determinants of non-utilization of vaccines was assessed by calculating unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals using a multivariable binary logistic regression. Results The findings of this research showed that nearly 66% of children were incompletely immunized against seven preventable childhood diseases. The likelihood of incomplete immunization was significantly associated with the father's occupation as a manual worker (AOR = 1.47; 95% CI: 1.10-1.97), lack of access to information (AOR = 1.35; 95% CI: 1.09-1.66), non-use of antenatal care (AOR = 1.33; 95% CI: 1.07-1.66), children born in Baluchistan region (AOR = 1.74; 95% CI: 1.12-2.70) and delivery at home (AOR = 1.39; 95% CI: 1.14-1.69). Conclusions Despite governmental efforts to increase rates of immunization against childhood diseases, the proportion of incompletely immunized children in Pakistan is still high. Targeted interventions are needed to increase the immunization rates in Pakistan. These interventions need to concentrate on people with low socioeconomic and educational status in order to improve their knowledge of this topic.