Background Recent surge in knee replacements has been assumed to be due to aging and increased obesity of the US population. Objectives We described the trend in prevalences of knee pain and symptomatic knee osteoarthritis and assessed whether age, obesity, and change in radiographic osteoarthritis explained this trend. Design We used data from six National Health and Nutrition Examination Surveys (NHANES) between 1971 and 2004 and from three examination periods in the Framingham Osteoarthritis (FOA) Study between 1983 through 2005 (Original cohort 1983–5 and 1992–5, Offspring 1992–5 and 2002–5, and a Community sample 2002–5). Setting NHANES included nationally representative samples of the non-institutionalized US population, and the Framingham Study was a population-based cohort. Participants We included data from NHANES participants 60 to 74 years of age, of White or Black race, and data from Framingham Study of mostly White participants, 70 years or older. Measurements Subjects in NHANES were asked about pain in or around the knee on most days. In the Framingham Study, subjects were asked about knee pain and had bilateral weight-bearing anteroposterior knee x-rays to define radiographic osteoarthritis. We used radiographic evidence and pain to define symptomatic osteoarthritis. We used marginal standardization with logistic regression first to calculate age-adjusted, and then age and BMI-adjusted prevalence by sex, and compared the adjusted prevalence of knee pain and osteoarthritis at later exams with earlier exams using the ratio of the prevalence estimates. Results The age-adjusted prevalence of knee pain and symptomatic osteoarthritis increased over time in all samples studied. With adjustment for both age and BMI the prevalence of knee pain increased by about 65% in NHANES from 1974 to 1994 among Non-Hispanic White and Mexican men and women and among African American women. In the Framingham Osteoarthritis (FOA) Study, the age and body mass index (BMI)-adjusted prevalences of knee pain and symptomatic knee osteoarthritis approximately doubled in women and tripled in men over a 20-year period. No such increasing trend was observed in radiographic osteoarthritis prevalence in Framingham subjects. After age adjustment, additionally adjusting for BMI resulted in a 10–25% decrease in the prevalence ratios for knee pain and symptomatic knee osteoarthritis. Limitations We cannot rule out differences in sampling of Framingham subjects over time or birth cohort effects (generational factors) as possible explanations of the increased reporting of knee pain. Increases in prevalence at the last time period in Framingham might be due to differences in cohort membership by time period. Conclusions Results suggest that independent of age and BMI prevalence of knee pain has increased substantially over a 20–year period. Obesity accounted for only part of this increase. In the FOA Study, there was an increase in symptomatic osteoarthritis but no increase in radiographic osteoarthritis. Primary Funding...

OBJECTIVES: This study characterized ethnic disparities for children in demographics, health status, and use of services; explored whether ethnic subgroups (Puerto Rican, Cuban, and Mexican) have additional distinctive differences; and determined whether disparities are explained by differences in family income and parental education. METHODS: Bivariate and multivariate analyses of data on 99,268 children from the 1989-91 National Health Interview Surveys were conducted. RESULTS: Native American, Black, and Hispanic children are poorest (35%, 41% below poverty level vs 10% of Whites), least healthy (66%-74% in excellent or very good health vs 85% of Whites), and have the least well educated parents. Compared with Whites, non-White children average fewer doctor visits and are more likely to have excessive intervals between visits. Hispanic subgroup differences in demographics, health, and use of services equal or surpass differences among major ethnic groups. In multivariate analyses, almost all ethnic group disparities persisted after adjustment for family income, parental education, and other relevant covariates. CONCLUSIONS: Major ethnic groups and subgroups of children differ strikingly in demographics, health, and use of services; subgroup differences are easily overlooked; and most disparities persist even after adjustment for family income and parental education.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent for coronavirus disease 2019 (COVID-19), and its ensuing mitigation measures have negatively affected the Maternal and Child Health (MCH) population. There is currently no surveillance system established to enhance our understanding of SARS-CoV-2 transmission to guide policy decision making to protect the MCH population in this pandemic. Based on reports of community and household spread of this novel infection, we present an approach to a robust family-centered surveillance system for the MCH population. The surveillance system encapsulates data at the individual and community levels to inform stakeholders, policy makers, health officials and the general public about SARS-CoV-2 transmission dynamics within the MCH population. Key words: • COVID-19 • Coronavirus • Maternal and child health • Family-centered • Surveillance system • Individual level data elements • Community level data elements • Community transmission of SARS-CoV-2   Copyright © 2020 Ajewole et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Adverse childhood experiences (ACEs) are a major public health concern in the United States as childhood trauma can lead to long-term health and mental health consequences. They disproportionally affect low-income children of diverse backgrounds; however, parent education can potentially reduce ACEs among low-income young children. This study aims to examine whether parents’ perceptions toward ACEs changed after exposure to ACEsrelated infographic education. In this study, we identified three main themes across the focus group interviews that highlight the importance of ACEs-related educational intervention. Following the ACEs-related education, our study found that the vast majority of participants’ attitudes toward and perceptions of ACEs changed from normalizing ACEs to acknowledging and accepting the consequences of ACEs; the participants also reported feeling empowered to prevent the cycle of ACEs. More importantly, the participants recognized that ACEs could cause long-term traumatic damage to the exposed child’s health outcomes, and they felt empowered to seek resources for ACEs-related interventions. These findings shed positive light on the significance of educating parents on ACEs, which should be considered for policy implications and program interventions to prevent child maltreatment in the United States. We propose an intervention model using the health literacy and educational empowerment frameworks along with other policy recommendations that highlight the importance of culturally and linguistically appropriate services for diverse families living in low-income housing communities.