Family Foundations To promote parent mental health and family functioning during the COVID-19 pandemic in Australia: A mixed methods evaluation

Evidence-based family-based interventions targeting parent mental health and partner conflict during community-wide crises such as the COVID-19 pandemic are scarce. Family Foundations (FF), a 10-week couple/parent-based intervention targeting parent mental health, conflict and co-parenting was delivered via video-conferencing during the COVID-19 pandemic. This study aimed to: (1) explore parents' and clinicians' experiences and perceived benefits of FF, and (2) assess pre–post intervention changes in parent mental health, interparental conflict and co-parenting behaviour. A mixed methods evaluation was conducted with 62 families with young children experiencing parent mental health difficulties and/or parental conflict. Qualitative interviews with parents and FF clinicians were conducted, and intervention outcomes were assessed using mother-report surveys. Maternal stress and anxiety symptoms decreased and co-parenting support and parenting warmth increased following FF. Parents expressed high satisfaction with FF despite the perceived limited cultural and family structure diversity in the videos. Although some activities were modified and clinicians were more directive in their style of delivery, FF was implemented with fidelity. Importantly, telehealth delivery made FF accessible to meet the needs of families during the pandemic when in-person services were not available. These findings will inform further development and evaluation of telehealth FF during community-wide crises such as the COVID-19 pandemic. [ FROM AUTHOR] Copyright of Journal of Family Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course.

Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. We analyzed pulse oximeter accuracy and association with COVID-19 treatment outcomes using electronic health record (EHR) data from Sutter Health, a large, mixed-payer, integrated healthcare delivery system in northern California, United States (US). We analyzed two cohorts: (1) 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/SpO2 measurement pairs taken January 2020-February 2021 for Non-Hispanic white (NHW) or Non-Hispanic Black/African American (NHB) adults, and (2) 8,735 adults who went to the emergency department (ED) with COVID-19 July 2020-February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage-points), dexamethasone treatment (-3.1 percentage-points), and supplemental oxygen treatment (-4.5 percentage-points), as well as increased time-to-treatment: +37.2 minutes before dexamethasone initiation and +278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters, and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.

FXR inhibition may protect from SARS-CoV-2 infection by reducing ACE2.

Prevention of SARS-CoV-2 infection through the modulation of viral host receptors, such as ACE21, could represent a new chemoprophylactic approach for COVID-19 complementing vaccination2,3. However, the mechanisms controlling ACE2 expression remain elusive. Here, we identify the farnesoid X receptor (FXR) as a direct regulator of ACE2 transcription in multiple COVID19-affected tissues, including the gastrointestinal and respiratory systems. We then use the over-the-counter compound z-guggulsterone (ZGG) and the off-patent drug ursodeoxycholic acid (UDCA) to reduce FXR signalling and downregulate ACE2 in human lung, cholangiocyte and intestinal organoids and in the corresponding tissues in mice and hamsters. We demonstrate that UDCA-mediated ACE2 downregulation reduces susceptibility to SARS-CoV-2 infection in vitro, in vivo and in human lungs and livers perfused ex situ. Furthermore, we illustrate that UDCA reduces ACE2 expression in the nasal epithelium in humans. Finally, we identify a correlation between UDCA treatment and positive clinical outcomes following SARS-CoV-2 infection using retrospective registry data, and confirm these findings in an independent validation cohort of liver transplant recipients. In conclusion, we identify a novel function of FXR in controlling ACE2 expression and provide evidence that modulation of this pathway could be beneficial for reducing SARS-CoV-2 infection, paving the road for future clinical trials.

Psychosocial factors associated with adolescent depressive and anxiety symptoms during the COVID-19 pandemic

The COVID-19 pandemic has created many challenges for adolescents across the world. The current study aimed to investigate the prevalence of depressive and anxiety symptoms and suicidal ideation in adolescents living in Melbourne, Australia, during the state of Victoria?s second lockdown. The study also sought to identify pre-existing and current psychosocial stressors associated with adolescent?s depressive and anxiety symptoms, and to identify the extent to which adolescents experiencing mental health difficulties sought professional help during the pandemic. A COVID-19 sub-study of the Mothers? and Young People?s Study?an 18-year longitudinal cohort study?was conducted between July and September 2020, an online survey completed by 257 adolescents aged 14?17 years and their mothers, which asked about pandemic-related stressors, remote learning, family life, and mental health. Descriptive statistics and hierarchical multiple regression analysis were conducted. Mental health difficulties were common with 38% and 20% of adolescents reporting clinically significant depressive and anxiety symptoms, respectively, and 21% reporting frequent suicidal or self-harm ideation. Factors associated with depressive and anxiety symptoms included being female, exposure to current maternal depressive symptoms, lower levels of resilience, experiences of loneliness, stressful life events, and school- and family-related stressors. Two-thirds of adolescents who were experiencing clinically significant depressive or anxiety symptoms had not sought professional help. Our findings highlight the urgent mental health need among adolescents and the importance of reducing barriers to accessing support.

Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic.

BACKGROUND: There is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients' social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California. METHODS: The pilot screened for SDOH needs using an 11-question Epic-compatible paper questionnaire assessing eight SDOH and health behavior domains: financial resource, transportation, stress, depression, intimate partner violence, social connections, physical activity, and alcohol consumption. Eligible patients for the pilot receiving a Medicare wellness, adult annual, or new patient visits during a five-week period (February-March, 2020), and a comparison group from the same time period in 2019 were identified. Sociodemographic data (age, sex, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from electronic health records, and a staff experience survey was administered. The evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS: Two-hundred eighty-nine patients were eligible for SDOH screening. Responsiveness by domain ranged from 55 to 67%, except for depression. Half of patients had at least one identified social need, the most common being stress (33%), physical activity (22%), alcohol (12%), and social connections (6%). Physical activity needs were identified more in females (81% vs. 19% in males, p < .01) and at new patient/transfer visits (48% vs. 13% at Medicare wellness and 38% at adult wellness visits, p < .05). Average length of visit was 39.8 min, which was 1.7 min longer than that in 2019. Visit lengths were longer among patients 65+ (43.4 min) and patients having public insurance (43.6 min). Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources. CONCLUSION: Use of evidence-based SDOH screening questions and associated workflow was effective in gathering patient SDOH information and identifying social needs in an ambulatory setting. Future studies should use qualitative data to understand patient and staff experiences with collecting SDOH information in healthcare settings.

Persistence of Disparities Among Racially/Ethnically Marginalized Groups in the Coronavirus Disease 2019 Pandemic Regardless of Statewide Shelter-in-Place Policies: An Analysis From Northern California.

To measure disparities in coronavirus disease 2019 (COVID-19) hospitalization and intensive care unit (ICU) transfer among racially/ethnically marginalized groups before and after implementation of the California statewide shelter-in-place (SIP) policy, we conducted a retrospective cohort study within a health-care system in California. COVID-19 patients diagnosed from January 1, 2020, to August 31, 2020, were identified from electronic health records. We examined hospitalizations and ICU transfers by race/ethnicity and pandemic period using logistic regression. Among 16,520 people with COVID-19 (mean age = 46.6 (standard deviation, 18.4) years; 54.2% women), during the post-SIP period, patients were on average younger and a larger proportion were Hispanic. In adjusted models, odds of hospitalization were 20% lower post-SIP as compared with the SIP period, yet all non-White groups had higher odds (odds ratios = 1.6-2.1) than non-Hispanic White individuals, regardless of period. Among hospitalized patients, odds of ICU transfer were 33% lower post-SIP than during SIP. Hispanic and Asian patients had higher odds than non-Hispanics. Disparities in hospitalization persisted and ICU risk became more pronounced for Asian and Hispanic patients post-SIP. Policy-makers should consider ways to proactively address racial/ethnic inequities in risk when considering future population-level policy interventions for public health crises.