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Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that negatively affects children's learning, motor behavior, social communication, and interaction. It was estimated that, in 2020, 1 in 36 children aged 8 years in the United States had ASD. Caring for children with ASD might exert significant psychological and emotional distress on parents. Receiving parental emotional support and fostering positive parent-child interactions at home have been identified as beneficial for the immediate caregiving environment for children with ASD. The current secondary analysis of the 2019-2020 National Survey of Children's Health examined parent-child interactions and accessible sources of emotional support for parents caring for 3-5-year-old children diagnosed with ASD (N = 243). Children with the following characteristics had higher odds of having ASD: male gender; having no private insurance or uninsured; and having less than excellent general health. Among parents, higher odds of caring for children with ASD were associated with accessing emotional support from various sources, especially from healthcare professionals and peers, and spending more time telling stories and/or singing to their children. Given these significant health disparities, educational interventions and strategies are needed to foster a positive home caregiving environment for young children with ASD, including equitable access to parent resources.

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Despite significant prevention efforts, childhood poison exposures remain a serious public health challenge in the United States. This study aimed to assess annual trends of pharmaceutical vs. non-pharmaceutical poison exposures in the US among children 0-19 years and compare the odds of death by children's age group. Poison exposure and fatality data were retrospectively extracted from 2009 to 2019 National Poison Data System (NPDS) annual reports for children in all reported age groups. Overall, there was a significant reduction in the annual population-adjusted poison exposures in children (annual percentage change = -2.54%, 95% CI = -3.94% to -1.15%, p < 0.01), but not in poisoning-related fatalities. Children 0-5 had similar odds of dying from exposure to non-pharmaceuticals vs. pharmaceuticals. The odds of children 6-12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ2 = 18.53, p < 0.001. In contrast, the odds of children 13-19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ2 = 141.16, p < 0.001. Suicidal intent accounted for 40.63% of pharmaceutical deaths in children 6-12, as well as 48.66% of pharmaceutical and 31.15% of non-pharmaceutical deaths in children 13-19. While a significant decline in overall childhood poison exposures was reported, a decrease in poisoning-related fatalities was not observed. Children in different age groups had contrasting relative odds of death from pharmaceutical and non-pharmaceutical exposures. Among older children, a greater proportion of poisoning-related deaths was due to intentional suicide. These findings provide evidence of age-specific trends in childhood poison exposure risk and directions for future poison prevention efforts and behavioral health partnerships.

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Public health practice and ethics address both individual and environmental health, in order to optimize the well-being of an entire population. Consideration of environmental health equity (EHE) is an evolving component of environmental ethics and public health, with evidence of disparities in exposure to vulnerable communities. Related terms for studying EHE include elements of justice, social determinants of health (SDOH), disparities, and environmental racism. The unequal protection from environmental exposures, specifically considering vulnerable and marginalized populations is significant to science, society, and health. Analyzing the environmental impact includes examining equity principles to assist policy and decision-making in the public arena, in order to address unfair burdens placed on vulnerable populations. However, the lack of a common and precise term for the idea makes it to instruct and evaluate the experiences of inequities in diverse populations. The purpose of this research is to use a concept analysis to examine the idea, utility, and conditions surrounding "EHE" for use in public health, nursing, environmental ethics, policy development, and interprofessional collaboration. A concept analysis will be conducted following the eight-step method developed by Walker and Avant (2011) Data sources will include empirical and descriptive literature; and the results will identify defining attributes of the concept. A set of operationalized standards for EHE is established through this concept analysis. This study proposes an examination of the concept in order to assess and evaluate the ethics and experiences in EHE, and determine how this impacts population health outcomes.

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Environmental exposures along the US-Mexico border have the potential to adversely affect the maternal-fetal environment. The purpose of this study was to assess placental biomarkers of environmental exposures in an obstetric population at the California-Baja California border in relation to detoxifying enzymes in the placenta and nutritional status. This study was conducted on consenting, full-term, obstetric patients (n=54), delivering in a hospital in Tijuana, Baja California (BC), Mexico. Placental polyaromatic hydrocarbon (PAH)-DNA adducts were measured in addition to placental glutathione-S-transferase (GST) activity and genotype, maternal serum folate, and maternal and umbilical cord blood lead and cadmium levels. A questionnaire was administered to the mothers to determine maternal occupation in a maquiladora, other exposures, and obstetric indicators. In univariate analysis, maternal serum folate levels were inversely correlated with total PAH-DNA adducts (rho=-0.375, p=0.007); adduct #1 (rho=-0.388, p=0.005); and adduct #3 (rho =-0.430, p=0.002). Maternal lead levels were significantly positively correlated with cord blood lead levels (rho=0.512, p<0.001). Cadmium levels were generally very low but significantly higher in mothers exposed to environmental tobacco smoke (ETS) (either at work or at home, n=10). In multivariate analysis, only maternal serum folate levels remained as a significant negative predictor of total DNA-PAH adducts levels in placenta. These findings affirm that placental tissue is a valuable and readily available source of human tissue for biomonitoring; and indicate that further study of the role of nutrition in detoxification and mitigation of environmental exposures in pregnant women is warranted.

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BACKGROUND: Patient history-taking sequences may be repeated across medical speech events with different healthcare providers and subsequently co-constructed differently, which can lead to disparate patient history information with implications for patient care outcomes. Encounters that include language discordance between patients with limited English language proficiency and healthcare workers can also impact patient outcomes. OBJECTIVES: We examined the repetition of patient history-taking sequences in consultations in which healthcare providers used Spanish as a first and second language with monolingual Spanish-speaking patients. The aim was to understand how repetition affects patient care processes and outcomes. METHODS: Conversation analysis was used. The target population was bilingual healthcare providers and monolingual Spanish-speaking patients. The accessible population was composed of healthcare providers and patients from an urban, low-income, community health clinic in Southern California. In three exemplar cases from among 50 that were studied, instances of repetition in the history-taking segment of clinical consultations were located. We identified which aspects of patient reports were repeated across intake nurse-patient consultations and nurse practitioner-patient consultations, as well as how patient reports were differently co-constructed across these events. RESULTS: Information elicited during the intake nurse-patient history event may be elicited again when a nurse practitioner repeats the elicitation of particular aspects of the patient's complaints and health history. Repetition of patient history information was co-constructed differently by different healthcare providers, sometimes led to seamless teamwork, and sometimes led to time wasting. Healthcare provider second language use of Spanish did not substantially impact how patient history information was co-constructed. DISCUSSION: This analysis sheds light on the effects of repetition across medical events and assessed the effects of repetition on communication among members of a healthcare team and patient care outcomes. It also informs how medical provider second language use may affect how information is conveyed. Our study has implications for understandings of medical consultations that involve nurse triage prior to consultation time in multilingual settings.

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This article reviews the 10 major categories of poisoning exposures, as reported to the American Association of Poison Control Centers through the national surveillance system, provides an overview of adult poisonings, and offers tips for home care clinicians to educate themselves and patients on poison exposure, prevention, and response. Home healthcare clinicians provide a critical link in the chain of home safety throughout the care continuum. The phone number for the local poison control center should be readily available in patients' homes and known to all home healthcare staff members. The top 10 categories should be reviewed during orientation of new home care staff members and at staff meetings.

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"Reality shock 1.0," which is experienced by new nursing graduates as they enter the nursing profession, has been an issue of concern for decades. Since the proliferation of multiple nursing doctoral degree programs, beginning in approximately 2004, when the American Association of Colleges of Nursing (2013) recommended that the doctor of nursing practice (DNP) replace the master's degree as the minimum for advanced practice nursing, an era of reverse "reality shock 2.0" may be developing for graduates of DNP programs. Specifically, early evidence indicates that the acquisition of an academic position, and its attendant transition back to the academia, may be difficult. The purpose of this article is to deconstruct the typical process of being interviewed and accepted (appointed) as a tenure-track faculty member at a teaching-intensive 4-year public institution and to recommend strategies for obtaining the best salary, benefits, and other resources during the negotiation process.

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BACKGROUND: Adverse events associated with dietary supplements are difficult to monitor in the USA, because such products are not registered before sale, and there is little information about their content and safety. METHODS: In 1998, 11 poison control centres in the USA recorded details of 2332 telephone calls about 1466 ingestions of dietary supplements, in 784 of which patients had symptoms. We used a multitiered review process (kappa 0.42) to select 489 cases for whom we were at least 50% certain that their negative events were associated with dietary supplements. We aimed to assess the effects of multiple ingredients and long-term use, and collated data for patterns of use and information resources. FINDINGS: A third of events were of greater than mild severity. We noted both new and previously reported associations that included myocardial infarction, liver failure, bleeding, seizures, and death. Increased symptom severity was associated with use of several ingredients, long-term use, and age. Paediatric exposures were more often unintentional than were adult ingestions, and treatment of disease was the reason for supplement use in at least 28% of reports. Most products and ingredients were not identified in the information database (Poisindex) used by poison control centres, and specific adverse events were reported variably among five additional sources. INTERPRETATION: Dietary supplements are associated with adverse events that include all levels of severity, organ systems, and age groups. Associations between adverse events and ingredients are difficult to verify if a product has more than one ingredient, and because of incomplete information systems. Research into hazards and risks of dietary supplements should be a priority.

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Despite 50 years of educational and legislative efforts aimed at increasing public awareness of the toxicity of iron, it remains a leading cause of poisoning death in children. The purpose of this study was to educate public health nurses (PHNs) on the prevention of iron poisoning utilizing, a "Train the Trainer" design. Educational programs were based on cognitive and behavioral approaches and consisted of a pretest, lecture, posttest, and evaluation. In addition, a follow-up survey was conducted at 8-months posttraining in order to determine the application of iron poison-prevention principles. Prior to the program, 71% of the PHNs were unable to identify iron as a leading household poison. Sixty percent reported storage habits of medication that predispose children to poisoning. The overall score on the pretest was 56% compared with the mean posttest score of 96%. Of the 45 respondents to the follow-up survey, 87% had used the program information to educate patients on the dangers of iron poisoning. This iron poison prevention program provided a successful educational program for PHNs that was then applied to patient education.

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