To evaluate the association between caregiver-reported social determinants of health (SDOH) and emergency department (ED) visits and hospitalizations by children with chronic disease.METHODS: This was a nested retrospective cohort study (December 2015 to May 2017) of children (0-18 years) receiving Supplemental Security Income and Medicaid enrolled in a case management program. Caregiver assessments were coded for 4 SDOH: food insecurity, housing insecurity, caregiver health concerns, and safety concerns. Multivariable hurdle Poisson regression was used to assess the association between SDOH with ED and hospital use for 1 year, adjusting for age, sex, and race and ethnicity. ED use was also adjusted for medical complexity.RESULTS: A total of 226 children were included. Patients were 9.1 years old (SD: 4.9), 60% male, and 30% Hispanic. At least 1 SDOH was reported by 59% of caregivers, including food insecurity (37%), housing insecurity (23%), caregiver health concerns (18%), and safety concerns (11%). Half of patients had an ED visit (55%) (mean: 1.5 per year [SD: 2.4]), and 20% were hospitalized (mean: 0.4 per year [SD: 1.1]). Previously unaddressed food insecurity was associated with increased ED use in the subsequent year (odds ratio: 3.43 [1.17-10.05]). Among those who had $1 ED visit, the annualized ED rate was higher in patients with a previously unaddressed housing insecurity (rate ratio: 1.55 [1.14-2.09]) or a safety concern (rate ratio: 2.04 [1.41-2.96]). CONCLUSIONS:Over half of caregivers of children with chronic disease enrolled in a case management program reported an SDOH insecurity or concern. Patients with previously unaddressed food insecurity had higher ED rates but not hospitalization rates.

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Vitamin A deficiency in rats and mice was induced by restricting dams and litters from parturition to a pelleted diet made mainly from white flour. Young rats usually developed clear signs of avitaminosis A within 60 days from birth. Mice were more resistant, and some survived for periods up to 150 days from birth. Retention of traces of vitamin A in the liver was no more prolonged in mice than in rats. In mice, enlargement of the prostates and seminal vesicles, and atrophy of the testes, were usually the most prominent pathological features. In rats, timely treatment with vitamin A acid (retinoic acid) cured xerophthalmia and restored growth. Signs of deficiency reappeared soon after its administration was stopped. This procedure allows supplies of animals to be kept in good general health, but ready for the production of acute deficiency at short notice. Retinoic acid was also effective in curing deficient mice. Incidental observations on the eyes and reproductive powers of mice or rats dosed with retinoic acid, and on the response of rats to variations in the casein contents of their diet, are recorded.

Published evidence indicates there is a growing prevalence of psychiatric illnesses on college campuses, and that approximately one quarter of students may be taking psychotropic medications. But attracting and retaining experienced mental health care professionals to college health settings is a challenging task. The psychiatric pharmacist is one professional resource that can serve as both a clinical and educational consultant for college mental health services. A pilot psychiatric pharmacist service project is described.