Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009–2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non–ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization.

Book Summary: This book provides a broad overview of quality health care for people with intellectual and developmental disabilities (IDD). It focuses on providing the reader a practical approach to dealing with the health and well-being of people with IDD in general terms as well as in dealing with specific conditions. In addition, it offers the reader a perspective from many different points of view in the health care delivery system as well as in different parts of the world. This is the 3rd , and much expanded edition, of a text that was first published in 1989 (Lea and Fibiger). The second edition was published in 2006 (Paul Brookes) and has been used as a formal required text in training programs for physicians, nurses and nurse practitioners as well as by administrators who are responsible for programs serving people with IDD. This book is considered the “Bible” in the field of health care for people with IDD since 1989 when the first edition came out.

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Childhood overweight and obesity have experienced epidemic growth in recent years. Excessive adiposity presents challenges to orthopedic, neurological, pulmonary, gastroenterological, endocrinal, and social development. Thus, the time course of weight development in early childhood is of special public health concern. A major goal of childhood obesity research is to identify mechanisms contributing to excess weight gain. In infancy, executive function has been identified as one possible contributor. Unfortunately, no studies have yet examined infant obesity risk with respect to executive function development. In this study, we present the first evidence that executive function may be linked to obesity risk in infancy. Thirty middle-class, primarily White infants visited the lab of the ETSU Program for the Study of Infancy at 18 and 21 months of age. Measures of infant weight and recumbent length were taken at both ages. Weightfor-length BMI z-scores were derived from international growth curves published by the World Health Organization. Executive function was measured at the 21-month visit, using the Multilocation Search Task. In this task, infants are shown the location of a cracker in one of five drawers. Once infants select the correct drawer on three successive trials, the cracker is moved to a new drawer in plain view of the child, and the child is asked to find the cracker again. The location of the cracker is changed on two more trials. Children’s perseverating responses to the old cracker location is viewed as an inverse measure of executive function. Results showed that from 18 to 21 months of age, BMI z-scores decreased significantly [t(30) = 2.63, p = .013]. This finding suggests that on average, infant BMI scores decreased across the three-month period. To explore whether executive function performance varied as a function of infant BMI, we divided our sample into two BMI groups via median split. A mixed-design ANOVA revealed that infants with the greatest decreases in BMI from 18 to 21 months (i.e., the “Hi Decrease” group), showed the greatest gains in performance across the three trials of the executive function task [F(2, 25) = 5.29, p = .012]. Specifically, by Trial 3 of the multilocation search task, Hi Decreasers were making an average of 0.57 perseverative errors, whereas the Lo Decreasers were making an average of 2.231 perseverative errors. These results are consistent with expectations. To the extent that executive function capacity helps regulate weight gain, it stands to reason that infants with greater executive function capacity would be advantaged in regulating their eating behaviors. Although we recognize that there are likely multiple contributors to infant and child obesity, findings from the present study supports the possibility that one of these contributors may be executive function. To our knowledge, this is the first study documenting a link between executive function and infant BMI.

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