High temperatures and humidity can alter the components in many home-delivery medications, rendering them less effective. Here’s what to look for.Every day, millions of Americans get prescription medications delivered to their homes. It’s a convenient option, but rising temperatures can make safe transport challenging and put the drugs at risk.Temperature and humidity levels can affect drugs all year round, but the likelihood of a problem is highest during the summer. Whether you are enrolled in a mail-order pharmacy program or are ordering over-the-counter pills from Amazon, it’s important to consider how compounds could be affected on their way to your doorstep.Are my medications really being exposed to extreme heat?For many oral medications, the United States Pharmacopeia, an independent organization that sets standards for the nation’s drug supply, recommends keeping medications at temperatures of 68 to 77 degrees Fahrenheit. It allows for an expanded temperature range of 59 to 86 degrees to accommodate for mild “excursions,” as long as the average temperature does not exceed 77 degrees.Most mail-order pharmacies say that their packaging is weather resistant. But research has shown that packages sometimes spend more than two-thirds of transit time outside the appropriate temperature range.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The temperatures inside delivery trucks can reach twice the recommended threshold, but federal rules on drug storage conditions do not apply to the booming world of mail-order delivery.Melted capsules. Cloudy insulin. Pills that may no longer work.Doctors and pharmacists say the scorching temperatures enveloping the country could be endangering people’s health in an unexpected way: by overheating their medications.Millions of Americans now receive their prescription medications through mail-order shipments, either for convenience or because their health plans require it. But the temperatures inside the cargo areas of delivery trucks can reach 150 degrees Fahrenheit in the summer, according to drivers — far exceeding the range of 68 to 77 degrees recommended by the national organization that sets standards for drug handling.Mail-order pharmacies say that their packaging is weather resistant and that they take special precautions when medication “requires specific temperature control.” But in a study published last year, independent pharmaceutical researchers who embedded data-logging thermometers inside simulated shipments found that the packages had spent more than two-thirds of their transit time outside the appropriate temperature range, “regardless of the shipping method, carrier, or season.”Extreme temperatures can alter the components in many medications, from pancreatic enzymes to the thyroid replacement drug levothyroxine to oral contraceptives, medical experts say.Dr. Mike Ren, a primary care physician and an assistant professor in the department of family and community medicine at the Baylor College of Medicine, said that liquid medications like insulin or AUVI-Q, the epinephrine injection for allergic reactions, are often at heightened risk of degradation because excessive heat exposure can cause the evaporation of liquid components that were compounded at precise ratios. Aerosolized medications, too, are uniquely vulnerable because of the risk of pressure changes in the canister.A summertime delivery route in Brooklyn. Temperatures inside the cargo areas of delivery trucks can reach 150 degrees Fahrenheit in the summer, according to drivers.Johnny Milano for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

New research finds that the death rate among Black youths soared by 37 percent, and among Native American youths by 22 percent, between 2014 and 2020, compared with less than 5 percent for white youths.The NewsThanks to advancements in medicine and insurance, mortality rates for children in the United States had been shrinking for decades. But last year, researchers uncovered a worrisome reversal: The child death rate was rising.Now, they have taken their analysis a step further. A new study, published Saturday in The Journal of the American Medical Association, revealed growing disparities in child death rates across racial and ethnic groups. Black and Native American youths ages 1 to 19 died at significantly higher rates than white youths — predominantly from injuries such as car accidents, homicides and suicides.Dr. Coleen Cunningham, chair of pediatrics at the University of California, Irvine, and the pediatrician in chief at Children’s Hospital of Orange County, who was not involved in the study, said the detailed analysis of the disparities documented “a sad and growing American tragedy.”“Almost all are preventable,” she said, “if we make it a priority.”Flowers for Karon Blake, 13, who was shot and killed in Washington, D.C., in January 2023. Gun-related deaths were two to four times higher among Black and Native American youth than among white youth.Carolyn Kaster/Associated PressSome Context: A frightening trend examined more closely.Researchers at Virginia Commonwealth University and Children’s Hospital of Richmond had previously revealed that mortality rates among children and adolescents had risen by 18 percent between 2019 and 2021. Deaths related to injuries had grown so dramatically that they eclipsed all public health gains.The group, seeking to drill deeper into the worrying trend, obtained death certificate data from the Centers for Disease Control and Prevention’s public WONDER database and stratified it by race, ethnicity and cause for children ages 1 to 19. They found that Black and American Indian/Alaska Native children were not only dying at significantly higher rates than white children but that the disparities — which had been improving until 2013 — were widening.The data also revealed that while the mortality rates for children overall took a turn for the worse around 2020, the rates for Black, Native American and Hispanic children had begun increasing much earlier, around 2014.Between 2014 and 2020, the death rates for Black children and teenagers rose by about 37 percent, and for Native American youths by about by about 22 percent — compared with less than 5 percent for white youths.“We knew we would find disparities, but certainly not this large,” said Dr. Steven Woolf, a professor of family medicine at the V.C.U. School of Medicine, who worked on the research. “We were shocked.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The NewsFor parents struggling with mental health or substance use disorders, access to treatment can often mean the difference between keeping and losing their children. But a new analysis of health and child welfare records found that a significant portion of those who were eligible for Medicaid coverage for such treatment were not getting it.The analysis, published Friday by researchers at the nonprofit institute RTI International and the Department of Health and Human Services, found that fewer than half of parents on Medicaid who had substance use disorders and had been referred to authorities over suspicions of child abuse or neglect had received treatment.A temporary shelter in Brooklyn.Hiroko Masuike/The New York Times Some Context: Experts say bad situations can often be reversed with treatment.Both mental health and drug addiction crises have been roiling the country, and the effects of parental drug use and mental illness can quickly trickle down to their children. Public health experts say substance use disorders can incapacitate a previously diligent parent and lead to the involvement of child protective services.In 2021 alone, more than seven million children were referred to authorities over worries of maltreatment, according to a federal report, and more than 200,000 were removed from their homes. But research shows that when parents seek treatment for psychiatric and substance use disorders, they are far less likely to experience family separation.The Numbers: What the researchers found.To calculate treatment rates among parents on Medicaid, the health insurance program for low income people, Tami Mark, a health economist at RTI, who led the research, and her colleagues drew from a new publicly available data set that used de-identified social security numbers to link child welfare records in Florida and Kentucky with corresponding Medicaid claims records from 2020.For comparison, they also analyzed a random sample of Medicaid recipients who had no records in the child welfare system. (The study didn’t capture any counseling or medication given outside the Medicaid system, nor any cases of mental health or substance use disorders that were undiagnosed.)We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

It was 1:53 a.m., and Peter Fink was on a barren mountain plateau near Campo, Calif., passing out blankets to people from four continents who had arrived there under the cover of night.This was a nocturnal ritual for the 22-year-old, dressed in a ball cap and a wool overshirt, whose perch — just over 300 yards up a rocky incline from the United States-Mexico border wall — had become a round-the-clock boarding space for people who had crossed unlawfully onto American soil.With Mexico’s armed National Guard now stationed at the most popular crossing sites along southeastern San Diego County, migrant routes have shifted further into the remote wilderness, where people face more extreme terrains and temperatures with little to no infrastructure to keep them alive.For migrants who were aiming to be apprehended by U.S. Border Patrol agents and begin applying to stay in the country, Mr. Fink’s makeshift camp, a dirt patch under the lattices of a high-voltage tower, had become a first stop, where modest rations of donated food, water and firewood helped migrants survive while they waited for agents to traverse the landscape and detain them before their health languished dangerously.At this site and others along the border, migrants have waited for hours or sometimes days to be taken into custody, and a Federal District Court judge ruled last week that the Border Patrol must move “expeditiously” to get children into safe and sanitary shelters. But unlike outdoor waiting areas that had arisen in more populated areas, Mr. Fink’s site had no aid tents or medical volunteers, no dumpsters or port-a-potties — just a hole that he had dug as a communal toilet, and Mr. Fink himself.Michelle Cuenca, 28, with her son, Ezequiel Molina, 9, waited inside a tent. They arrived after walking for seven hours without food, though they felt their journey had been easier than most.Ariana Drehsler for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The decision established that minors at open-air sites were in legal custody of the Department of Homeland Security and thus must receive safe shelter, even if they had not yet been formally processed.The federal government is required to “expeditiously” house migrant children who cross into the United States unlawfully, rather than allow them to remain in unsafe open-air sites along the border, a Federal District Court judge ruled Wednesday night.The decision, handed down by Judge Dolly M. Gee of the United States District Court of Central California, sided mostly with the lawyers representing the children in a class-action lawsuit. It established that minors at the sites were in legal custody of the Department of Homeland Security and thus were entitled to certain rights and protections, such as a safe and sanitary environment, even if they had not yet been formally processed.The ruling comes amid a fierce political and cultural debate over the rights of migrants — including children — who enter the United States without permission. Because of an influx in crossings at the U.S.-Mexico border, immigration processing centers in southern San Diego County are strained, and migrants have waited for hours or sometimes days at makeshift camps to be taken into custody.The outdoor areas where migrants have been waiting lack shelter, food and sanitation, which has given way to an array of public health concerns for the most vulnerable. Unaccompanied children and young families sometimes arrive in poor health, according to aid workers and medical volunteers at the sites, suffering from traumatic injuries or chronic health conditions that require medications that have long since run out.During the hot desert days, dehydration and heat stroke have become common problems, according to aid groups, and nighttime temperatures, wind and rain are creating conditions ripe for hypothermia. Doctors are particularly concerned about those elements for children, since many have lower body fat than adults and may be malnourished from their journeys.The government had argued that the children were not yet in U.S. custody so it had no obligation to provide services. The judge cited Border Patrol agents’ control over the minors’ ability to leave the sites — and their power to affect whether the children have access to aid and medical treatment — as the rationale for her ruling.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A federal judge is expected to rule soon on whether the government must provide shelter, food and medical care to minors while they await processing.To Dr. Theresa Cheng, the scene was “apocalyptic.”She had come to Valley of the Moon, an open-air holding site in San Diego’s rural Mountain Empire, to provide volunteer medical care to asylum seekers who had breached the United States-Mexico border wall and were waiting to be apprehended by American authorities.Among the throngs at this and other sites, she found children with deep lacerations, broken bones, fevers, diarrhea, vomiting, even seizures. Some were hiding in dumpsters and overflowing porta-potties. An asthmatic boy without an inhaler was wheezing in the acrid smoke from brush and trash fires, which had been lit for warmth.With the capacity at immigration processing centers strained, migrants, including unaccompanied children, are waiting for hours — sometimes days — in outdoor holding areas, where a lack of shelter, food, and sanitation infrastructure has triggered an array of public health concerns for the most vulnerable.“From a public health standpoint, there are communicable diseases and outdoor exposures that would strike anyone down, much less this medically vulnerable population,” said Dr. Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center.A Federal District Court judge in California could rule as early as Friday on whether the government is legally required to shelter and feed the children as they wait.In a court filing, lawyers for the Department of Justice argue that because the children have not yet been formally taken into custody by U.S. Customs and Border Protection, they are not obligated to provide such service.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The NewsJessica Kourkounis for The New York TimesAccording to new research, “technoference” is real.Toddlers who are exposed to more screen time have fewer conversations with their parents or caregivers by an array of measures. They say less, hear less and have fewer back-and-forth exchanges with adults compared with children who spend less time in front of screens.Those findings, published on Monday in the journal JAMA Pediatrics, make up one of the first sets of longitudinal evidence to confirm an intuitive reality: Screens are not just linked to higher rates of obesity, depression and hyperactivity among children; they also curb face-to-face interactions at home — with long-term implications that could be worrisome.Some Background: What interrupts household chatter?Researchers have long known that growing up in a language-rich environment is vital for early language development. More language exposure early in life is associated with social development, higher I.Q.s and even better brain function.Given the value of such exposure, researchers in Australia were eager to investigate potential factors within the home environment that could be interrupting opportunities for parents to interact verbally with their children. Previous studies on the impact of technology mostly examined a parent’s use of a mobile device, rather than a child’s use of screens, and relied on self-reported measures of screen time rather than automated monitoring.What Researchers Found: Every minute counts.The new study, led by Mary E. Brushe, a researcher at the Telethon Kids Institute at the University of Western Australia, gathered data from 220 families across South Australia, Western Australia and Queensland with children who were born in 2017. Once every six months until they turned 3, the children wore T-shirts or vests that held small digital language processors that automatically tracked their exposure to certain types of electronic noise as well as language spoken by the child, the parent or another adult.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Cases of this rare, potentially dangerous childhood illness are growing in the U.S. It is often mistaken for scarlet fever, tick-borne diseases or common viruses. Here’s what to look for.Doctors across the United States are seeing a rise in Kawasaki disease, a mysterious condition that primarily affects children under 5. The illness is the most common cause of acquired heart disease in children worldwide but it is often unrecognized or misdiagnosed.Kawasaki disease is rare, but cases are climbing in the United States. Here are the important things to know about Kawasaki disease.What causes it?No one knows. Kawasaki disease, also known as K.D., is one of the leading pediatric mysteries. Some scientists believe it results from an environmental exposure or that it occurs after a bacterial or viral infection. Certain genes appear to make some children more susceptible to it.Whatever the cause, there was a lull in cases in the United States during the pandemic, suggesting that masking and social distancing measures might have helped protect children from exposure. Now, cases are climbing, hinting that many children are being exposed to the disease’s mysterious cause for the first time.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A new report based on records from the Trump and Biden years found the average length of solitary detainment was longer than the duration the U.N. says can constitute torture.The United States government has placed detained immigrants in solitary confinement more than 14,000 times in the last five years, and the average duration is almost twice the 15-day threshold that the United Nations has said may constitute torture, according to a new analysis of federal records by researchers at Harvard and the nonprofit group Physicians for Human Rights.The report, based on government records from 2018 through 2023 and interviews with several dozen former detainees, noted cases of extreme physical, verbal and sexual abuse for immigrants held in solitary cells. The New York Times reviewed the original records cited in the report, spoke with the data analysts and interviewed former detainees to corroborate their stories.Overall, Immigration and Customs Enforcement is detaining more than 38,000 people — up from about 15,000 at the start of the Biden administration in January 2021, according to an independent tracking system maintained by Syracuse University. A growing proportion of detainees are being held in private prison facilities with little means of accountability, and preliminary data from 2023 suggests a “marked increase” in the use of solitary confinement, according to the report.A spokesman for ICE, Mike Alvarez, said in a statement that 15 entities oversee ICE detention facilities to “ensure detainees reside in safe, secure and humane environments, and under appropriate conditions of confinement.” He added that detained immigrants are able to file complaints about facilities or staff conduct via phone or through the Homeland Security inspector general.“Placement of detainees in segregation requires careful consideration of alternatives, and administrative segregation placements for a special vulnerability should be used only as a last resort,” he said, using the agency’s terminology for solitary confinement. “Segregation is never used as a method of retaliation.”ICE issued directives in 2013 and 2015 to limit the use of solitary confinement, saying it should be a “last resort.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.