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Poverty, lack of insurance can make heart failure prognosis worse, AHA says

Poverty and poor or non-existent health insurance coverage might worsen the effects of heart failure, the American Heart Association said Thursday.




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Blood test may effectively spot multiple cancers

A new blood-test approach for cancer screening was able to identify 26 previously undetected cases of the disease, according to the findings of a new study published Friday by the journal Science.




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Researchers discover microbe that could control spread of malaria

A microbe found in mosquitoes that appears to block malaria could be used to control spread of the disease in humans, according to researchers in Kenya and Britain.




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British researchers evaluate asthma, COPD drug for COVID-19

Interferon beta, a drug originally developed to treat chronic obstructive pulmonary disease, or COPD, is being explored as a possible cure for the severe lung infections caused by COVID-19, media reports confirmed Monday




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Johns Hopkins to launch trials of blood plasma treatment for COVID-19

Johns Hopkins University will start two clinical trials of convalescent blood plasma for treatment of COVID-19, the disease caused by the new coronavirus.




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Poverty, poorer health make some in the Bronx more vulnerable to COVID-19

New York City has been the epicenter of the COVID-19 outbreak in the United States, with immigrant populations in areas such as the Bronx "disproportionately" affected, a commentary in JAMA Internal Medicine says.




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The Association of Lipoprotein(a) Plasma Levels With Prevalence of Cardiovascular Disease and Metabolic Control Status in Patients With Type 1 Diabetes

OBJECTIVE

To investigate the association of the cardiovascular risk factor lipoprotein (Lp)(a) and vascular complications in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Patients with type 1 diabetes receiving regular care were recruited in this observational cross-sectional study and divided into four groups according to their Lp(a) levels in nmol/L (very low <10, low 10–30, intermediate 30–120, high >120). Prevalence of vascular complications was compared between the groups. In addition, the association between metabolic control, measured as HbA1c, and Lp(a) was studied.

RESULTS

The patients (n = 1,860) had a median age of 48 years, diabetes duration of 25 years, and HbA1c of 7.8% (61 mmol/mol). The median Lp(a) was 19 (interquartile range 10–71) nmol/L. No significant differences between men and women were observed, but Lp(a) levels increased with increasing age. Patients in the high Lp(a) group had higher prevalence of complications than patients in the very low Lp(a) group. The age- and smoking-status–adjusted relative risk ratio of having any macrovascular disease was 1.51 (95% CI 1.01–2.28, P = 0.048); coronary heart disease, 1.70 (95% CI 0.97–3.00, P = 0.063); albuminuria, 1.68 (95% CI 1.12–2.50, P = 0.01); and calcified aortic valve disease, 2.03 (95% CI 1.03–4.03; P = 0.042). Patients with good metabolic control, HbA1c <6.9% (<52 mmol/mol), had significantly lower Lp(a) levels than patients with poorer metabolic control, HbA1c >6.9% (>52 mmol/mol).

CONCLUSIONS

Lp(a) is a significant risk factor for macrovascular disease, albuminuria, and calcified aortic valve disease in patients with type 1 diabetes. Poor metabolic control in patients with type 1 diabetes is associated with increased Lp(a) levels.




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Rapid Corneal Nerve Fiber Loss: A Marker of Diabetic Neuropathy Onset and Progression

OBJECTIVE

Corneal nerve fiber length (CNFL) represents a biomarker for diabetic distal symmetric polyneuropathy (DSP). We aimed to determine the reference distribution of annual CNFL change, the prevalence of abnormal change in diabetes, and its associated clinical variables.

RESEARCH DESIGN AND METHODS

We examined 590 participants with diabetes [399 type 1 diabetes (T1D) and 191 type 2 diabetes (T2D)] and 204 control patients without diabetes with at least 1 year of follow-up and classified them according to rapid corneal nerve fiber loss (RCNFL) if CNFL change was below the fifth percentile of the control patients without diabetes.

RESULTS

Control patients without diabetes were 37.9 ± 19.8 years old, had median follow-up of three visits over 3.0 years, and mean annual change in CNFL was –0.1% (90% CI, –5.9 to 5.0%). RCNFL was defined by values exceeding the fifth percentile of 6% loss. Participants with T1D were 39.9 ± 18.7 years old, had median follow-up of three visits over 4.4 years, and mean annual change in CNFL was –0.8% (90% CI, –14.0 to 9.9%). Participants with T2D were 60.4 ± 8.2 years old, had median follow-up of three visits over 5.3 years, and mean annual change in CNFL was –0.2% (90% CI, –14.1 to 14.3%). RCNFL prevalence was 17% overall and was similar by diabetes type [64 T1D (16.0%), 37 T2D (19.4%), P = 0.31]. RNCFL was more common in those with baseline DSP (47% vs. 30% in those without baseline DSP, P = 0.001), which was associated with lower peroneal conduction velocity but not with baseline HbA1c or its change over follow-up.

CONCLUSIONS

An abnormally rapid loss of CNFL of 6% per year or more occurs in 17% of diabetes patients. RCNFL may identify patients at highest risk for the development and progression of DSP.




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Performance of High-Sensitivity Cardiac Troponin Assays To Reflect Comorbidity Burden and Improve Mortality Risk Stratification in Older Adults With Diabetes

OBJECTIVE

Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification.

RESEARCH DESIGN AND METHODS

We used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67–89 years, 43% male, 31% black) at visit 5 (2011–2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels.

RESULTS

Elevations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio [HR] 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (HR 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality.

CONCLUSIONS

Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.




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Reduced Myocardial Perfusion Reserve in Type 2 Diabetes Is Caused by Increased Perfusion at Rest and Decreased Maximal Perfusion During Stress

OBJECTIVE

To examine differences in myocardial blood flow (MBF) at rest and during stress between patients with type 2 diabetes and controls, and to identify potential predictors of changes in MBF at rest and during stress.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 193 patients with type 2 diabetes and 20 age- and sex-matched controls. Cardiovascular magnetic resonance was used in order to evaluate left ventricular structure and function, and MBF at rest and during adenosine-induced stress. MBF was derived as the mean of the flow within all segments of a midventricular slice.

RESULTS

Patients with type 2 diabetes had higher global MBF at rest (0.81 ± 0.19 mL/min/g) and lower global MBF during stress (2.4 ± 0.9 mL/min/g) than did controls (0.61 ± 0.11 at rest, 3.2 ± 0.8 mL/min/g under stress; both P < 0.01). Patients with macroalbuminuria had lower MBF during stress (1.6 ± 0.5 mL/min/g) than did patients with microalbuminuria (2.1 ± 0.7 mL/min/g; P = 0.04), who in turn had lower MBF during stress than did normoalbuminuric patients (2.7 ± 0.9 mL/min/g; P < 0.01). Patients with severe retinopathy had lower MBF during stress (1.8 ± 0.6 mL/min/g) than did patients with simplex retinopathy (2.3 ± 0.7 mL/min/g; P < 0.05) and those who did not have retinopathy (2.6 ± 1.0 mL/min/g; P < 0.05). Albuminuria and retinopathy were associated with reduced MBF during stress in a multiple regression analysis. Stress-related MBF inversely correlated with myocardial extracellular volume (P < 0.001; R2 = 0.37), a measure of diffuse myocardial fibrosis. A trend toward lower basal MBF was observed in patients treated with sodium–glucose cotransporter 2 inhibitors (P = 0.07).

CONCLUSIONS

Patients with type 2 diabetes have higher global MBF at rest and lower maximal MBF during vasodilator-induced stress than do controls. Reduced MBF during stress is associated with diabetes complications (albuminuria and retinopathy) and is inversely correlated with diffuse myocardial fibrosis.




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Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users

OBJECTIVE

The vast number of antihyperglycemic medications and growing amount of evidence make clinical decision making difficult. The aim of this study was to investigate the safety of antihyperglycemic dual and triple therapies for type 2 diabetes management with respect to major adverse cardiovascular events, severe hypoglycemia, and all-cause mortality in a real-life clinical setting.

RESEARCH DESIGN AND METHODS

Cox regression models were constructed to analyze 20 years of data from the Danish National Patient Registry with respect to effect of the antihyperglycemic therapies on the three end points.

RESULTS

A total of 66,807 people with type 2 diabetes were treated with metformin (MET) including a combination of second- and third-line therapies. People on MET plus sulfonylurea (SU) had the highest risk of all end points, except for severe hypoglycemia, for which people on MET plus basal insulin (BASAL) had a higher risk. The lowest risk of major adverse cardiovascular events was seen for people on a regimen including a glucagon-like peptide 1 (GLP-1) receptor agonist. People treated with MET, GLP-1, and BASAL had a lower risk of all three end points than people treated with MET and BASAL, especially for severe hypoglycemia. The lowest risk of all three end points was, in general, seen for people treated with MET, sodium–glucose cotransporter 2 inhibitor, and GLP-1.

CONCLUSIONS

Findings from this study do not support SU as the second-line treatment choice for patients with type 2 diabetes. Moreover, the results indicate that adding a GLP-1 for people treated with MET and BASAL could be considered, especially if those people suffer from severe hypoglycemia.




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Erratum. Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach. Diabetes Care 2020;43:852-859




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Acrylamide Exposure and Oxidative DNA Damage, Lipid Peroxidation, and Fasting Plasma Glucose Alteration: Association and Mediation Analyses in Chinese Urban Adults

OBJECTIVE

Acrylamide exposure from daily-consumed food has raised global concern. We aimed to assess the exposure-response relationships of internal acrylamide exposure with oxidative DNA damage, lipid peroxidation, and fasting plasma glucose (FPG) alteration and investigate the mediating role of oxidative DNA damage and lipid peroxidation in the association of internal acrylamide exposure with FPG.

RESEARCH DESIGN AND METHODS

FPG and urinary biomarkers of oxidative DNA damage (8-hydroxy-deoxyguanosine [8-OHdG]), lipid peroxidation (8-iso-prostaglandin-F2α [8-iso-PGF2α]), and acrylamide exposure (N-acetyl-S-[2-carbamoylethyl]-l-cysteine [AAMA], N-acetyl-S-[2-carbamoyl-2-hydroxyethyl]-l-cysteine [GAMA]) were measured for 3,270 general adults from the Wuhan-Zhuhai cohort. The associations of urinary acrylamide metabolites with 8-OHdG, 8-iso-PGF2α, and FPG were assessed by linear mixed models. The mediating roles of 8-OHdG and 8-iso-PGF2α were evaluated by mediation analysis.

RESULTS

We found significant linear positive dose-response relationships of urinary acrylamide metabolites with 8-OHdG, 8-iso-PGF2α, and FPG (except GAMA with FPG) and 8-iso-PGF2α with FPG. Each 1-unit increase in log-transformed level of AAMA, AAMA + GAMA (UAAM), or 8-iso-PGF2α was associated with a 0.17, 0.15, or 0.23 mmol/L increase in FPG, respectively (P and/or P trend < 0.05). Each 1% increase in AAMA, GAMA, or UAAM was associated with a 0.19%, 0.27%, or 0.22% increase in 8-OHdG, respectively, and a 0.40%, 0.48%, or 0.44% increase in 8-iso-PGF2α, respectively (P and P trend < 0.05). Increased 8-iso-PGF2α rather than 8-OHdG significantly mediated 64.29% and 76.92% of the AAMA- and UAAM-associated FPG increases, respectively.

CONCLUSIONS

Exposure of the general adult population to acrylamide was associated with FPG elevation, oxidative DNA damage, and lipid peroxidation, which in turn partly mediated acrylamide-associated FPG elevation.




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Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

OBJECTIVE

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

RESEARCH DESIGN AND METHODS

Asymptomatic patients (8–45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months.

RESULTS

Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9–8.2%, N = 1,298] vs. 4.7% [95% CI 3.4–5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI –0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4–2.7; P = 0.014) emerged with a GFD.

CONCLUSIONS

CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.




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Dietary Manganese, Plasma Markers of Inflammation, and the Development of Type 2 Diabetes in Postmenopausal Women: Findings From the Womens Health Initiative

OBJECTIVE

To examine the association between manganese intake and the risk of type 2 diabetes in postmenopausal women and determine whether this association is mediated by circulating markers of inflammation.

RESEARCH DESIGN AND METHODS

We included 84,285 postmenopausal women without a history of diabetes from the national Women’s Health Initiative Observational Study (WHI-OS). Replication analysis was then conducted among 62,338 women who participated in the WHI-Clinical Trial (WHI-CT). Additionally, data from a case-control study of 3,749 women nested in the WHI-OS with information on biomarkers of inflammation and endothelial dysfunction were examined using mediation analysis to determine the relative contributions of these known biomarkers by which manganese affects type 2 diabetes risk.

RESULTS

Compared with the lowest quintile of energy-adjusted dietary manganese, WHI-OS participants in the highest quintile had a 30% lower risk of type 2 diabetes (hazard ratio [HR] 0.70 [95% CI 0.65, 0.76]). A consistent association was also confirmed in the WHI-CT (HR 0.79 [95% CI 0.73, 0.85]). In the nested case-control study, higher energy-adjusted dietary manganese was associated with lower circulating levels of inflammatory biomarkers that significantly mediated the association between dietary manganese and type 2 diabetes risk. Specifically, 19% and 12% of type 2 diabetes risk due to manganese were mediated through interleukin 6 and hs-CRP, respectively.

CONCLUSIONS

Higher intake of manganese was directly associated with a lower type 2 diabetes risk independent of known risk factors. This association may be partially mediated by inflammatory biomarkers.




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Predicting the Risk of Inpatient Hypoglycemia With Machine Learning Using Electronic Health Records

OBJECTIVE

We analyzed data from inpatients with diabetes admitted to a large university hospital to predict the risk of hypoglycemia through the use of machine learning algorithms.

RESEARCH DESIGN AND METHODS

Four years of data were extracted from a hospital electronic health record system. This included laboratory and point-of-care blood glucose (BG) values to identify biochemical and clinically significant hypoglycemic episodes (BG ≤3.9 and ≤2.9 mmol/L, respectively). We used patient demographics, administered medications, vital signs, laboratory results, and procedures performed during the hospital stays to inform the model. Two iterations of the data set included the doses of insulin administered and the past history of inpatient hypoglycemia. Eighteen different prediction models were compared using the area under the receiver operating characteristic curve (AUROC) through a 10-fold cross validation.

RESULTS

We analyzed data obtained from 17,658 inpatients with diabetes who underwent 32,758 admissions between July 2014 and August 2018. The predictive factors from the logistic regression model included people undergoing procedures, weight, type of diabetes, oxygen saturation level, use of medications (insulin, sulfonylurea, and metformin), and albumin levels. The machine learning model with the best performance was the XGBoost model (AUROC 0.96). This outperformed the logistic regression model, which had an AUROC of 0.75 for the estimation of the risk of clinically significant hypoglycemia.

CONCLUSIONS

Advanced machine learning models are superior to logistic regression models in predicting the risk of hypoglycemia in inpatients with diabetes. Trials of such models should be conducted in real time to evaluate their utility to reduce inpatient hypoglycemia.




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The Association of Energy and Macronutrient Intake at Dinner Versus Breakfast With Disease-Specific and All-Cause Mortality Among People With Diabetes: The U.S. National Health and Nutrition Examination Survey, 2003-2014

OBJECTIVE

This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.

RESEARCH DESIGN AND METHODS

A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences () in energy and macronutrient intake between dinner and breakfast ( = dinner – breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between and diabetes, cardiovascular disease (CVD), and all-cause mortality.

RESULTS

Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]energy 1.92, 99% CI 1.08–3.42; HRprotein 1.92, 99% CI 1.06–3.49) and CVD (HRenergy 1.69, 99% CI 1.02–2.80; HRprotein 1.96, 99% CI 1.14–3.39). The highest quintile of total fat was related to CVD mortality (HR 1.67, 99% CI 1.01–2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94–0.98) and CVD (HR 0.95, 95% CI 0.93–0.97) mortality, respectively.

CONCLUSIONS

Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.




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Effects of Novel Dual GIP and GLP-1 Receptor Agonist Tirzepatide on Biomarkers of Nonalcoholic Steatohepatitis in Patients With Type 2 Diabetes

OBJECTIVE

To determine the effect of tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptors, on biomarkers of nonalcoholic steatohepatitis (NASH) and fibrosis in patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

Patients with T2DM received either once weekly tirzepatide (1, 5, 10, or 15 mg), dulaglutide (1.5 mg), or placebo for 26 weeks. Changes from baseline in alanine aminotransferase (ALT), aspartate aminotransferase (AST), keratin-18 (K-18), procollagen III (Pro-C3), and adiponectin were analyzed in a modified intention-to-treat population.

RESULTS

Significant (P < 0.05) reductions from baseline in ALT (all groups), AST (all groups except tirzepatide 10 mg), K-18 (tirzepatide 5, 10, 15 mg), and Pro-C3 (tirzepatide 15 mg) were observed at 26 weeks. Decreases with tirzepatide were significant compared with placebo for K-18 (10 mg) and Pro-C3 (15 mg) and with dulaglutide for ALT (10, 15 mg). Adiponectin significantly increased from baseline with tirzepatide compared with placebo (10, 15 mg).

CONCLUSIONS

In post hoc analyses, higher tirzepatide doses significantly decreased NASH-related biomarkers and increased adiponectin in patients with T2DM.




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A Randomized Controlled Trial Comparing Glargine U300 and Glargine U100 for the Inpatient Management of Medicine and Surgery Patients With Type 2 Diabetes: Glargine U300 Hospital Trial

OBJECTIVE

The role of U300 glargine insulin for the inpatient management of type 2 diabetes (T2D) has not been determined. We compared the safety and efficacy of glargine U300 versus glargine U100 in noncritically ill patients with T2D.

RESEARCH DESIGN AND METHODS

This prospective, open-label, randomized clinical trial included 176 patients with poorly controlled T2D (admission blood glucose [BG] 228 ± 82 mg/dL and HbA1c 9.5 ± 2.2%), treated with oral agents or insulin before admission. Patients were treated with a basal-bolus regimen with glargine U300 (n = 92) or glargine U100 (n = 84) and glulisine before meals. We adjusted insulin daily to a target BG of 70–180 mg/dL. The primary end point was noninferiority in the mean difference in daily BG between groups. The major safety outcome was the occurrence of hypoglycemia.

RESULTS

There were no differences between glargine U300 and U100 in mean daily BG (186 ± 40 vs. 184 ± 46 mg/dL, P = 0.62), percentage of readings within target BG of 70–180 mg/dL (50 ± 27% vs. 55 ± 29%, P = 0.3), length of stay (median [IQR] 6.0 [4.0, 8.0] vs. 4.0 [3.0, 7.0] days, P = 0.06), hospital complications (6.5% vs. 11%, P = 0.42), or insulin total daily dose (0.43 ± 0.21 vs. 0.42 ± 0.20 units/kg/day, P = 0.74). There were no differences in the proportion of patients with BG <70 mg/dL (8.7% vs. 9.5%, P > 0.99), but glargine U300 resulted in significantly lower rates of clinically significant hypoglycemia (<54 mg/dL) compared with glargine U100 (0% vs. 6.0%, P = 0.023).

CONCLUSIONS

Hospital treatment with glargine U300 resulted in similar glycemic control compared with glargine U100 and may be associated with a lower incidence of clinically significant hypoglycemia.




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Make Homework Routine

By Guest Blogger, Penny Williams of {a mom’s view of ADHD}

ADHD children do better with routine. It’s a proven fact. In a brain characteristically in chaos, the order routine provides is soothing. They need to know what to expect in advance and have time to make the mental transition as well.

Everything goes more smoothly for my son when he knows what’s coming and when, and everything falls apart when our schedule changes unexpectedly. As parents of neurologically different children, we make their world more comfortable by publicizing the family schedule and sticking to a routine as much as a family can. We have a routine for getting up and ready for school in the morning. We have a bedtime routine. We even have an {unpopular} dinnertime routine. Why should homework time be any different?

It has taken me two years to establish a fairly comfortable homework routine for Luke, my 8-year-old, third grade son who has ADHD and sensory integration issues. Two years of a lot of trial and error. And we aren’t set yet, nor do I predict we will be for many years. As the full extent of Luke’s written expression disorder has been revealed this year, the homework routine has changed quite a bit, but for the better.

Like Clockwork

I’ve experimented quite a bit with the time of day that we do homework. It was quickly apparent that waiting until after dinner (and after medications had worn off) was not going to work for Luke (or for me). We then tried right after school and at 4 pm, which is about 30 minutes after we arrive home from school. I liked the idea of some free time for Luke to unwind and a break from schoolwork that the 4 pm schedule offered. However, it hasn’t always worked out. In 30 minutes time he can get engrossed in something fun and then it’s a battle to get him to stop and do homework. I feel a little like a schoolmarm making him do homework the minute we get home, but he does his best work at that time.

Now sure we don’t always come straight home from school. Sometimes I’m working and grandma picks him up. Sometimes we have afterschool activities or just need to run to the grocery store. But Luke knows that we do homework when we return home from school, whatever time that may read on the clock. He has come to expect it.

Even Homework Needs a Home

Give homework papers and supplies a home and keep them in the same spot. When I say, “time to do homework,” Luke immediately goes to his homework spot. Well, not immediately. Even the best laid plan will not cure the typical resistance to homework. We keep Luke’s homework folder, pencils, etc. on his end of the snack bar. Up until a month or so ago, he sat there or just behind at the dining table to do his homework. We kept all needs there so he wouldn’t have the distraction of getting up to fetch something.

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Consider a Homework Toolkit: The toolkit will be some sort of box or desktop organizer, even an actual toolbox, with every single item necessary to complete homework, prepped and ready to go:

  • pencils (sharpened -- sharpening pencils is a favorite procrastination technique of children),

  • pencil sharpener (in case it breaks),

  • pencil grips (if used),

  • markers,

  • colored pencils (sharpened),

  • appropriate scissors,

  • notebook paper,

  • construction paper or blank copy paper,

  • calculator,

  • ruler,

  • dictionary,

  • index cards,

  • highlighter,

  • tape,

  • glue stick,

  • post-it notes,

  • clip board (if not working at a table or desktop),

  • anything else your child may use for homework

____________________________________________

Now that Luke has some technological accommodations for his written expression disability, he does his spelling homework on the computer. When I announce “homework time,” he gets his folder off the snack bar and brings it to my desk to work on my computer. (I am looking for a good place in my office to create a new homework spot now that things have changed.) He’s great with technology, and typing is so much easier for him than hand writing assignments was, so this change has actually allowed me to stop standing over him, constantly nagging, during homework for the first time since he started school. It’s wonderful!

He finishes his spelling assignment and then takes his book to the sofa and I set the timer for reading. If you don’t have a timer or don’t use one with your ADHD child, I super-strongly recommend its implementation. My favorite is the Time Timer, but any household timer will work. When the timer sounds at the end of his 15 minutes, he jumps up, completes his homework log, and then puts the homework folder back in its home on the snack back (with a little prodding and a lot of reminders).


Don’t Make Them Bite Off More Than They can Chew

Homework is designed to prove to a teacher that a child has mastered the subject matter and is sometimes an exercise in repetition for knowledge retention. Every child in the class is given the same homework, regardless of their differences, unless there’s already an IEP or 504 Plan to the contrary. It’s your duty as your child’s advocate and #1 cheerleader to be sure the homework is appropriate for your child. Yes, this is negotiable, either through teamwork with the teacher or through a formal IEP or 504 Plan.

Scaling the amount of homework to your child’s differences and needs is a crucial element in the success of the homework routine. For example, Luke reads for 15 minutes each day while the original 3rd grade homework structure called for 20 minutes. There was a lot of resistance and inability to finish 20 minutes of reading but 15 minutes is just the right amount for Luke. While he is above grade level in reading, he is allowed to have me read aloud to him if that’s what it takes to get the assignment finished. I have found that he often asks me to read to him just to have time together. I agree, but on the condition that we take turns reading aloud by alternating paragraphs. He usually ends up reading most of it himself anyway, just with me alongside him.

Spelling is also a regular homework task. He has 15 words each week and his teacher suggests a list of activities from which to complete three. We alter these activities to accommodate his handwriting issues. He types all activities which means there are some that don’t apply to him (like writing each word in cursive three times). Sometimes there aren’t three on the list that can be typed so I let him pick from activities he’s done previous weeks.

Also, get creative and tailor homework to the way your child learns. Luke is a visual and tactile learner so we make homework visual and hands-on as much as we can – it was easier to do so in the younger grades. Use dried macaroni for math or even spelling. Does your child love to paint? Let them paint their spelling words or their illustration for their writing assignments. Painting letters is actually a common therapy tool for children that struggle with handwriting. What about play dough? I purchased a box of cookie cutters with all the letters and numbers for play dough play. You could do spelling and math with these. It will take longer but make homework more interesting and fun.

Luke’s teacher is perfectly content with our customization of the homework plan. Since they don’t get a grade on homework in third grade, it’s easy to make this change. Similar alterations can be made for middle school and high school homework too though. For instance, a student should be allowed to complete a percentage of the problems on a math worksheet to show they have mastered the content when the entire assignment will take too long or is overwhelming. Shortening the assignments will reduce their anxiety too, making it easier to work and study in the first place.

Don’t Forget Good Study Habits

Good study habits are even more crucial for children with ADHD and learning disabilities. There are some general ground rules that should always be followed:

  1. TV and other distractions must be turned off. However, music in the background actually helps some children focus. It is a distraction for me, but Luke and his sister both do homework better with music on, especially when listening with headphones. Experiment with this and see what is best for your child.

  2. Praise and reward often (typically more often than feels natural).

  3. Take breaks as needed. Who says you have to finish homework in one sitting? Allow your child to get up and stretch, get a snack, jump on the trampoline, etc. Just don’t allow them any screen time during breaks because you won’t likely get back to the homework amicably.

There is so much more than the few ideas I've covered here, especially for older children. Take a look at these other resources on the subject of homework with ADHD children:



Penny Williams is the creator and editor of {a mom's view of ADHD}, where she writes candidly about the everyday experiences of parenting her young ADHD son. In her immersion in all things ADHD since her son's diagnosis, Penny has published, My ADHD Story: Love Notes, Blah, Blah, Blah!, and Teachers We Love: Learning for All in ADDitude Magazine, the #1 national publication dedicated to ADHD. She has been quoted in Parenting.com's Family Health Guide on ADHD and The High Desert Pulse, Summer/Fall 2010, When Ritalin Works.




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Differing DREAMs: Estimating the Unauthorized Populations That Could Benefit under Different Legalization Bills

2017 saw the introduction of several bills—two of them by Senate Republicans in the weeks following the Trump administration’s announcement that it would terminate the Deferred Action for Childhood Arrivals (DACA) program—that would provide a pathway to conditional and then legal permanent residence to unauthorized immigrants brought to the United States as children, if they meet a range of educational, professional, and other criteria.




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Mainstreaming 2.0: How Europe’s Education Systems Can Boost Migrant Inclusion

Rising numbers of young immigrants and refugees entering European schools following the 2015–16 migration crisis strained system capacity and injected new urgency into debates about how to support diverse learners and their families. This report examines the challenges facing European education systems and identifies key lessons to improve migrant inclusion in schools and integration more broadly.




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Immigration Data Matters

This useful online guide links users directly to the most credible, high-quality data on immigrants and immigration in the United States and internationally. The easy-to-use guide includes more than 220 data resources compiled by governmental and nongovernmental sources, covering topics ranging from population stock and flow numbers to statistics on enforcement, public opinion, religious affiliation, and much more.




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Preparing Newcomers for the Jobs of Today and the Labor Markets of Tomorrow

This Migration Policy Institute Europe webinar examines possible scenarios for how social, economic, and technological trends could affect jobs, labor market policy, education and social policies, and migrant integration. Speakers also explored the potential of coding schools for refugees to help alleviate skills shortages and provide a pathway to work.




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Police arrest two men in shooting death of Ahmaud Arbery

More than two months after Ahmaud Arbery was fatally shot while jogging near Brunswick, Georgia police arrested two men for the shooting, authorities said.




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Gujarat university, second MBBS examination, pharmacology question papers (2010-2014)

Gujarat university, second MBBS examination, pharmacology question papers (2010-2014)




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Gujarat university, second MBBS examination, pharmacology question papers, January 2015

Gujarat university, second MBBS examination, pharmacology question papers, January 2015




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MD pharmacology examination, question papers, Gujarat university, April 2012

MD pharmacology examination, question papers, Gujarat university, April 2012




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MD pharmacology examination, question papers, Gujarat university, October 2012

MD pharmacology examination, question papers, Gujarat university, October 2012




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MD pharmacology examination, question papers, Gujarat university, April 2013

MD pharmacology examination, question papers, Gujarat university, April 2013




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Electrolyte disorders in a young female following short-term omeprazole therapy

A 29 years old female presented to us in the metabolic clinic of the University of Port Harcourt Teaching Hospital (UPTH) on account of a week history of easy fatigability, weakness, and lower extremity muscle cramps associated with numbness and tingling sensation in the peri-oral area, fingers and toes. Two weeks prior to the onset of her presenting symptoms, she had visited a local pharmaceutical shop on account of a distressing epigastric discomfort and was subsequently placed on daily oral omeprazole 20mg daily for a month by a pharmacist. She had been on the omeprazole medication for two weeks before her present symptoms manifested. Her past medical history was not suggestive of hypoparathyroidism nor pancreatitis. She was married with three children and has an uneventful family, social and obstetric histories. On examination, she was a healthy well-oriented young female with positive Trousseau’s, Chvostek’s and epigastric tenderness signs. Further Laboratory evaluation revealed she had low plasma magnesium, low plasma albumin-corrected calcium, and low serum parathyroid hormone levels, while other laboratory parameters were essentially normal. A diagnosis of omeprazole-induced electrolyte disorders (hypomagnesaemia and hypocalcaemia) associated with hypoparathyroidism was made following the review of her clinical examination and laboratory findings. She was subsequently managed with oral magnesium supplements following the withdrawal of the omeprazole medication (replaced with oral ranitidine), monitored weekly, and full recovery was achieved after three weeks.




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Coldest material in the cosmos could help scientists find dark matter particles

Researchers suggest the coldest material in the universe could reveal the presence of dark matter particles.




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Mars' magnetic field emerged earlier and lasted longer than previously thought

Mars' ancient magnetic field emerged earlier and persisted for longer than scientists previously thought, according to a new study.




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Amino acid swap may help wheat tolerate rising heat, scientists say

British scientists said Monday that an amino acid swap can help protect wheat crops from rising heat due to global warming.




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Intensive farming makes epidemics more likely

Intensive farming, characterized by the overuse of antibiotics, large numbers of animals and limited genetic diversity, increases the odds of animal pathogens making the jump to humans and triggering an epidemic.




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Climate change is influencing where tropical cyclones are formed

Over the last 40 years, climate change has been influencing where tropical cyclones form, according to a new study.




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Artificial tongue with gold taste buds to test maple syrup

Scientists in Quebec have developed an artificial tongue that can taste the flavor profiles of maple syrup, researchers revealed in a paper published on Tuesday.




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Tests show heating is the best way to disinfect N95 masks for reuse

Test results suggest N95 masks can be safely disinfected through heating 50 times before their filtration efficiency begins to decline.




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Scientists unveil fossil fuel-free jet propulsion that uses microwave air plasmas

Engineers in China have developed a fossil fuel-free jet propulsion prototype design that uses microwave air plasmas.




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Wetter climate to trigger global warming feedback loop in the tropics

As the tropics get wetter, soils are likely experience greater rates of respiration and decomposition, limiting the carbon storage abilities of tropical soils and intensifying global warming.




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Unlike 'Jurassic Park,' real raptors may not have hunted in packs

While the coordinated attacks of Velociraptor dinosaurs depicted in the 1993 blockbuster made for compelling movie viewing, a study published this week claims raptors most likely hunted solo, not in packs.




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Smarter hardware to make artificial intelligence more energy efficient

Artificial intelligence requires a lot of energy. Simply solving a puzzle can require the equivalent of the energy produced by three nuclear plants in a single hour.




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New map highlights China's export-driven CO2 emissions

China produces a whole lot of stuff -- stuff that gets bought by the rest of the world. In 2019, China exported approximately $2.5 trillion dollars worth of goods.




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Early marine reptiles used pebble-like teeth to crush shellfish

Some early ichthyosaurs used rounded, pebble-like teeth to crush the shells of snails and clam-like bivalves, according to new research.




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Neanderthals preferred bovine bones for leather-making tools

When it came to selecting bones for leather-making tools, Neanderthals were surprisingly choosy. New archaeological analysis shows Neanderthals preferentially selected bovine rib bones to make a tool called a lissoir.




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Migration &amp; Coronavirus: A Complicated Nexus Between Migration Management and Public Health

This webinar, organized by MPI and the Zolberg Institute on Migration and Mobility at The New School, discussed the state of play around the globe surrounding COVID-19 and examined where migration management and enforcement tools may be useful and where they may be ill-suited to advancing public health goals. 




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Immigration Enforcement in the United States: The Rise of a Formidable Machinery

MPI has released a major study that describes and analyzes today’s immigration enforcement programs, as they have developed and grown in the 25 years since IRCA launched the current enforcement era.




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Immigration Enforcement in the United States: The Rise of a Formidable Machinery

Release of a major report that describes and analyzes the immigration enforcement system in the United States as it has developed and grown in the quarter century since the Immigration Reform and Control Act of 1986 launched the current era of enforcement.




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Leadership Visions: A Discussion with Mexican Foreign Minister Claudia Ruiz-Massieu

An MPI Leadership Visions discussion with the Foreign Minister of Mexico, Claudia Ruiz-Massieu, for her first public appearance in Washington, DC. 




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Texas court stays execution of Randall Mays

A Texas appeals court has issued a stay of execution for a death row inmate on grounds he is intellectually disabled.