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Background Cadmium is a toxic metal with modifiable exposure sources including diet. In pregnant women and children, unique dietary habits may contribute to DCd, and the relationship of diet to overall cadmium exposure can depend on specific factors during these transitional time periods. Objectives This study aimed to identify and quantify food sources of DCd, describe the distribution of UCd, and determine the relationship of DCd and intake of specific foods with UCd, stratified by maternal smoking history, among pregnant women and children in a well-characterized Mexico City birth cohort. Methods Our sample included 192 pregnant women (third trimester) and 223 children (7-15 years). DCd was calculated using FFQ and the U.S. TDS. We also measured UCd, maternal history of smoking, and additional covariates. Results Pregnant women and children had geometric mean UCd concentrations of 0.19±0.78 μg/L and 0.14±0.60 μg/L, respectively. On average, estimated daily DCd intake was 9.3±3.5 μg for women and 12.2±5.4 μg for children. Adjusted linear regression models showed a positive association between DCd and UCd among women (p=0.03) and children (p=0.03) without a maternal history of smoking. Intake of fruit and vegetables among women and potato consumption among children were positively associated with UCd. Conclusions Pregnant women and their children are exposed to cadmium at dietary and urinary levels similar to those previously reported. Higher estimated DCd for children than for women could be attributed to the different FFQs or related to dietary pattern changes between age groups. DCd contributed to UCd in those without a maternal smoking history.

Background: Patients with severe asthma may remain uncontrolled despite biologic therapy in addition to standard therapy, but this disease burden has not been quantified. Objective: To estimate the clinical and economic burden in a US national sample. Methods: Patients who have severe asthma with indicated biologic treatment (earliest use = index date) were selected from the MarketScan database between January 1, 2013, and June 30, 2018. Inclusion criteria were continuous enrollment for 12 months postindex with a minimum of 2 biologic fills, greater than or equal to 12 years of age, evidence of medium-to high-dose inhaled corticosteroids and long-acting b-agonist combination before the index, and absence of other respiratory diagnoses and malignancies. Disease exacerbations (used to classify asthma control), health care costs, and treatment characteristics were reported during the 12-month postindex period. Results: The sample included 3262 biologic patients; 88% with anti−immunoglobulin E therapy (omalizumab) and 12% non−anti-immunoglobulin E (reslizumab, mepolizumab, benralizumab). The mean age was 49 ( §15) years; 64% were women. Prescriptions included inhaled corticosteroids and long-acting b-agonist (82%), systemic corticosteroids (76%), and leukotriene receptor antagonists (68%). Notably, 63% of patients presented greater than or equal to 1 asthma exacerbation (mean 1.3 per patient/year). Furthermore, 35% of patients were categorized as having controlled asthma, whereas 28% were suboptimally controlled and 29% were uncontrolled.

Objective: To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD). Methods: Administrative claims data from the IBM Watson Health MarketScan Databases (2010)(2011)(2012)(2013)(2014)(2015)(2016) were used. Women with live births (index date ¼ delivery date) were identified and linked to their newborns. The mother-child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother-child pairs with PPD exposure were propensity score matched 1:3 to mother-child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother-child pairs with and without preterm delivery. Results: Overall, 33,314 mother-child pairs with PPD exposure were propensity score matched to 102,364 mother-child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all p < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946; p < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all p < .001). Conclusion: The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD. ARTICLE HISTORY

DT claims during pre-index period). Included patients had a diagnosis of SCD or thalassemia, were 2-63 years of age, and were continuously enrolled in Texas Medicaid during the study period. Kruskall Wallis and Chi-square tests were used for continuous and categorical variables, respectively. Results: A total of 201 Texas Medicaid patients met the study criteria (24.4% DFX-DT-Only, 20.4% DFX-FCT-Only, 55.2% Switched). Patients who switched from DFX-DT to DFX-FCT had fewer hospitalizations and emergency department (ED) visits compared to DFX-DT-Only and DFX-FCT-Only groups (P< 0.001). Annual inpatient expenditures were lower for patients who switched compared to DFX-DT-Only and DFX-FCT-Only patients (P= 0.001). Mean annual medical expenditures (inpatient, ED, outpatient visits) were lowest for patients who switched, followed by DFX-FCT-Only patients (+11.5%) and DFX-DT-Only patients (+35.9%). ConClusions: In study patients taking DFX, medical resource utilization and expenditures varied by type of DFX (DT vs. FCT). The patient group that switched from DFX-DT to DFX-FCT had fewer hospitalizations, fewer ED visits, and lower medical expenditures. To optimize patient health outcomes and resource use, health care providers and decision-makers should be aware of differences in these measures by DFX formulation.