Changes in Teleworking and Physical Activity Behaviors in the United States Before and After Emergence of COVID-19.

OBJECTIVES: To determine the prevalence of perceived decreases in three physical activity (PA) behaviors and meeting the PA guideline, by changes in telework. METHODS: U.S. workers (n = 2393) reported teleworking and PA behaviors before and after COVID-19 emergence. Those reporting more and less telework were compared to those reporting stable telework on prevalence of (1) decreasing behaviors and (2) meeting the aerobic guideline (≥150 min/week of moderate-intensity PA). RESULTS: Compared to workers with stable telework, those with increased telework were more likely to report decreases in any PA (by 61%), active transportation (65%), and park use (52%). Workers who deceased telework were also more likely to report decreases in these behaviors. Groups were equally likely to meet the guideline. CONCLUSION: Changes in teleworking status-either more or less-may be associated with decreased participation in PA behaviors.

Leisure-time physical activity and mortality from influenza and pneumonia: a cohort study of 577 909 US adults.

OBJECTIVE: To examine the association of leisure-time physical activity with mortality from influenza and pneumonia. METHODS: A nationally representative sample of US adults (aged ≥18 years) who participated in the National Health Interview Survey from 1998 to 2018 were followed for mortality through 2019. Participants were classified as meeting both physical activity guidelines if they reported ≥150 min/week of moderate-intensity equivalent aerobic physical activity and ≥2 episodes/week of muscle-strengthening activity. Participants were also classified into five volume-based categories of self-reported aerobic and muscle-strengthening activity. Influenza and pneumonia mortality was defined as having an underlying cause of death with an International Classification of Diseases, 10th Revision code of J09-J18 recorded in the National Death Index. Mortality risk was assessed using Cox proportional hazards, adjusting for sociodemographic and lifestyle factors, health conditions and influenza and pneumococcal vaccination status. Data were analysed in 2022. RESULTS: Among 577 909 participants followed for a median of 9.23 years, 1516 influenza and pneumonia deaths were recorded. Compared with participants meeting neither guideline, those meeting both guidelines had 48% lower adjusted risk of influenza and pneumonia mortality. Relative to no aerobic activity, 10-149, 150-300, 301-600 and >600 min/week were associated with lower risk (by 21%, 41%, 50% and 41%). Relative to <2 episodes/week of muscle-strengthening activity, 2 episodes/week was associated with 47% lower risk and ≥7 episodes/week with 41% higher risk. CONCLUSIONS: Aerobic physical activity, even at quantities below the recommended level, may be associated with lower influenza and pneumonia mortality while muscle-strengthening activity demonstrated a J-shaped relationship.

Kentucky's equine markets amidst COVID-19

COVID-19 pandemic-related restrictions on society have resulted in a recession, which is commonly defined as 2 consecutive quarters of decline in GDP (gross domestic product) growth. Restrictions within the equine industry have varied, with some governments mandating the closure of equine facilities to reduce the spread of the virus and minimize the chance of injuries, while others provided health guidelines and assigned responsibility to equine operation owners/managers. Because the equine industry is one of the most important sectors in Kentucky's agricultural economy, understanding the potential impact of COVID-19 on Kentucky's equine markets is vital. To that end, in this study we examined short run COVID-19 impacts on Kentucky's equine markets. In particular, we focused on 2 segments of the industry associated with vigorous business activities. First, we examined how Thoroughbred and Quarter Horse breeding activity and auction markets have responded to general market changes precipitated by COVID-19 restrictions. Second, we investigated the effect of COVID-related regulations on equine enterprises, including stallion farms, boarding/training/lesson operations (BTLO's) and competition enterprises. To achieve the first objective, for the calendar year 2020, we collected and analyzed data on number of mares bred, stud fees, and auction results. To accomplish the second objective, we designed and distributed a survey to 280 commercial equine enterprise owners/managers across the state. Data were collected between November 30, 2020, and January 11, 2021, and the average response rate was about 25%. Preliminary results from the first objective suggest that while there are downward trends in breeding activities and mean auction prices, few of those short-run declines are statistically significant. For the second objective, survey results suggest at least minimal impacts on most commercial enterprises. About 46% of stallion farms reported anticipate revenues losses of 10% or less, but about 23% expect revenue losses of 26 to 50%. Just under 60% of BTLO's anticipate a revenue loss of 10% or less, while about 10% expect a loss of more than 50%. The most damaging effects appear to have been experienced by competition enterprises. About 35% expect only minimal revenue losses, while nearly 40% expect losses of $50,000 or more. Overall, results from our study suggest that with the exception of competition-related enterprises, Kentucky's commercial equine enterprises may have avoided serious short run impacts;however, it will be some time before the long run impact of COVID-19 related restrictions on the industry can be fully determined.

Examining STEM Learning Motivation Challenges in Undergraduate Students During the COVID-19 Pandemic

The COVID-19 pandemic disrupted global educational systems with institutions transitioning to e-learning. Undergraduate STEM students complained about lowered motivation to learn and complete STEM course requirements. To better prepare for more effective STEM education delivery during high-risk conditions such as pandemics, it is important to understand the learning motivation challenges (LMCs) experienced by students. As part of a larger national research study investigating decision-making in undergraduate STEM students during COVID-19, the purpose of this research is to examine LMCs experienced by undergraduate STEM students. One hundred and ninety students from six U.S. institutions participated in Qualtrics-based surveys. Utilizing a five-point Likert scale, respondents ranked the extent to which they agreed to LMC statements. Using Qualtrics Data Analysis tools and MS Excel, data from 130 useable surveys was analyzed utilizing descriptive and inferential statistics. Results revealed that regardless of classification, GPA, age, or race, STEM students experienced LMCs. The top five LMCs were: (1) Assignment Overloads;(2) Lack of In-Person Peer Interactions;(3) Uncaring Professors;(4) Lack of In-Person Professor Interactions;and (5) Lack of In-Person Laboratory Experiences. Significant relationships existed between three characteristics (GPA, classification, and age) and few LMCs to include assignment overloads. Students tended to attribute lowered motivation to Institutional and Domestic challenges which were typically out of their control, rather than to Personal challenges which were typically within their control. Crosstab analysis suggested that Sophomores, Asians, as well as students with GPAs between 2.00 and 2.49 and aged 41 to 50 years may be the most vulnerable due to higher dependence on traditional in-person STEM educational environments. Early identification of the most vulnerable students should be quickly followed by interventions. Increased attention towards sophomores may reduce exacerbation of potential sophomore slump and middle-child syndrome. All STEM students require critical domestic, institutional, and personal resources. Institutions should strengthen students' self-regulation skills and provide increased opportunities for remote peer interactions. Training of faculty and administrators is critical to build institutional capacity to motivate and educate STEM students with diverse characteristics in e-learning environments. Pass/fail policies should be carefully designed and implemented to minimize negative impacts on motivation. Employers should expand orientation and mentoring programs for entry-level employees, particularly for laboratory-based tasks. Research is needed to improve the delivery of STEM laboratory e-learning experiences. Findings inform future research, as well as best practices for improved institutional adaptability and resiliency. These will minimize disruptions to student functioning and performance, reduce attrition, and strengthen progression into the STEM workforce during high-risk conditions such as pandemics. With caution, findings may be extended to non-STEM and non-student populations. © American Society for Engineering Education, 2022

Children, adolescents, and young adults hospitalized with COVID-19 and diabetes in summer 2021.

INTRODUCTION: More information is needed to understand the clinical epidemiology of children and young adults hospitalized with diabetes and COVID-19. We describe the demographic and clinical characteristics of patients <21 years old hospitalized with COVID-19 and either Type 1 or Type 2 Diabetes Mellitus (T1DM or T2DM) during peak incidence of SARS-CoV-2 infection with the B.1.617.2 (Delta) variant. METHODS: This is a descriptive sub-analysis of a retrospective chart review of patients aged <21 years hospitalized with COVID-19 in six US children's hospitals during July-August 2021. Patients with COVID-19 and either newly diagnosed or known T1DM or T2DM were described using originally collected data and diabetes-related data specifically collected on these patients. RESULTS: Of the 58 patients hospitalized with COVID-19 and diabetes, 34 had T1DM and 24 had T2DM. Of those with T1DM and T2DM, 26% (9/34) and 33% (8/24), respectively, were newly diagnosed. Among those >12 years old and eligible for COVID-19 vaccination, 93% were unvaccinated (42/45). Among patients with T1DM, 88% had diabetic ketoacidosis (DKA) and 6% had COVID-19 pneumonia; of those with T2DM, 46% had DKA and 58% had COVID-19 pneumonia. Of those with T1DM or T2DM, 59% and 46%, respectively, required ICU admission. CONCLUSION: Our findings highlight the importance of considering diabetes in the evaluation of children and young adults presenting with COVID-19; the challenges of managing young patients who present with both COVID-19 and diabetes, particularly T2DM; and the importance of preventive actions like COVID-19 vaccination to prevent severe illness among those eligible with both COVID-19 and diabetes.

Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19.

OBJECTIVES: To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness. METHODS: We abstracted data from medical charts to conduct a cross-sectional study of patients aged <21 years hospitalized at 6 United States children's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. RESULTS: Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with respiratory syncytial virus (RSV) (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1 to 4 years (PR 1.96); and obesity in patients aged 5 to 11 (PR 2.20) and 12 to 17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged <1 (PR 1.82), 5 to 11 (PR 3.72), and 12 to 17 years (PR 3.19). CONCLUSIONS: Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged <5 years, obesity in those aged 5 to 17 years, and other underlying conditions for all age groups <18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19.

Observation of and intention to use new places and changed spaces for physical activity during the COVID-19 pandemic - United States, June 2021.

The COVID-19 pandemic prompted built environment changes throughout the United States. We assessed the prevalence of new places and changed spaces for physical activity as observed by US adults and their intentions to use them. We used data from SummerStyles, a web-based survey of US adults conducted in June 2021 (n = 4073). Respondents were asked if they had discovered new places to be physically active during the past year, and if changes had been made to streets or outdoor areas to allow additional space for recreating. Those responding "yes" were asked if they intended to use the respective space. We estimated the weighted prevalence of adults who observed new places and changed spaces, and their intended use, by sociodemographic and geographic characteristics, physical activity level, and walking status. We compared subgroups with prevalence ratios (PR). Overall, 25.0% of US adults reported discovering new places for physical activity, and 25.3% reported changes to streets and outdoor spaces. Intention to use new places and changed spaces exceeded 50% among all sociodemographic and geographic subgroups. Among those reporting changes, adults who were physically inactive compared to those who were sufficiently active had similar intentions to use new places (PR = 0.83; 95% CI = 0.63, 1.10) and changed spaces (PR = 0.90; 95% CI = 0.69, 1.17). Approximately 1 in 4 adults reported discovering new places or changed spaces to support physical activity during the COVID-19 pandemic, and most intended to use these features. Expanding access to such supportive environments may help promote physical activity participation.

Melville’s Anatomies Two Decades Later: A Forum

Melville scholars gathered virtually as part of the 2021 American Literature Association Conference to celebrate and re-assess the contribution made by a landmark volume in late twentieth-century scholarship on Melville, Samuel Otter’s Melville’s Anatomies (1999). The roundtable had initially been planned as a face-to-face contribution to the 2020 ALA Conference, which was cancelled due to COVID, and so the scholars who had initially meant to discuss Otter’s book near the occasion of the twentieth anniversary of its publication found that their conversations had to be delayed by a year. We offer the full reflections of the six scholars who discussed the volume in hopes that this can serve as a model for future reflections on landmarks of Melville scholarship and major new contributions to the field that can appear in this venue. © 2022 The Melville Society and Johns Hopkins University Press

Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 - Six Hospitals, United States, July-August 2021.

During June 2021, the highly transmissible† B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, became the predominant circulating strain in the United States. U.S. pediatric COVID-19-related hospitalizations increased during July-August 2021 following emergence of the Delta variant and peaked in September 2021.§ As of May 12, 2021, CDC recommended COVID-19 vaccinations for persons aged ≥12 years,¶ and on November 2, 2021, COVID-19 vaccinations were recommended for persons aged 5-11 years.** To date, clinical signs and symptoms, illness course, and factors contributing to hospitalizations during the period of Delta predominance have not been well described in pediatric patients. CDC partnered with six children's hospitals to review medical record data for patients aged <18 years with COVID-19-related hospitalizations during July-August 2021.†† Among 915 patients identified, 713 (77.9%) were hospitalized for COVID-19 (acute COVID-19 as the primary or contributing reason for hospitalization), 177 (19.3%) had incidental positive SARS-CoV-2 test results (asymptomatic or mild infection unrelated to the reason for hospitalization), and 25 (2.7%) had multisystem inflammatory syndrome in children (MIS-C), a rare but serious inflammatory condition associated with COVID-19.§§ Among the 713 patients hospitalized for COVID-19, 24.7% were aged <1 year, 17.1% were aged 1-4 years, 20.1% were aged 5-11 years, and 38.1% were aged 12-17 years. Approximately two thirds of patients (67.5%) had one or more underlying medical conditions, with obesity being the most common (32.4%); among patients aged 12-17 years, 61.4% had obesity. Among patients hospitalized for COVID-19, 15.8% had a viral coinfection¶¶ (66.4% of whom had respiratory syncytial virus [RSV] infection). Approximately one third (33.9%) of patients aged <5 years hospitalized for COVID-19 had a viral coinfection. Among 272 vaccine-eligible (aged 12-17 years) patients hospitalized for COVID-19, one (0.4%) was fully vaccinated.*** Approximately one half (54.0%) of patients hospitalized for COVID-19 received oxygen support, 29.5% were admitted to the intensive care unit (ICU), and 1.5% died; of those requiring respiratory support, 14.5% required invasive mechanical ventilation (IMV). Among pediatric patients with COVID-19-related hospitalizations, many had severe illness and viral coinfections, and few vaccine-eligible patients hospitalized for COVID-19 were vaccinated, highlighting the importance of vaccination for those aged ≥5 years and other prevention strategies to protect children and adolescents from COVID-19, particularly those with underlying medical conditions.

Health-Related Behaviors and Odds of COVID-19 Hospitalization in a Military Population.

INTRODUCTION: Understanding the impact of behaviors on COVID-19 severity can improve health promotion strategies. We investigated the association between health-related behaviors and odds of hospitalization for COVID-19 in a cohort of military personnel. METHODS: This case-controlled study compared all active-duty US Air Force service members hospitalized for COVID-19 between March 5, 2020, and March 10, 2021 (cases), with their geographically matched peers who had COVID-19 and were treated as outpatients (controls). We used logistic regression to compare cases and controls according to self-reported sleep duration, physical activity, dietary factors, binge alcohol consumption, and tobacco use - with and without adjustment for sociodemographic factors, body mass index, physical fitness level, pertinent disease history, and psychological distress - resulting in crude and adjusted odds ratios (ORs) with 95% CIs. The trend between sugar-sweetened beverage (SSB) consumption and hospitalization odds was assessed by using the Cochran-Armitage test. RESULTS: Ninety-three hospitalized cases were matched to 372 ambulatory controls. Adjusting for baseline characteristics and other health-related behaviors, cases were more likely than controls to report fewer than 7 hours of sleep, compared with 7 to 9 hours (OR = 1.84; 95% CI, 1.07-3.16), and were more likely than controls to consume 3 or more SSBs per week, compared with fewer than 3 SSBs (OR = 1.74; 95% CI, 1.03-2.92). In a dose-response relationship, higher SSB consumption was associated with greater odds of being hospitalized (P value for trend = .02). CONCLUSION: Interventions that address short sleep duration and SSB consumption may reduce morbidity from COVID-19 among military service members and potentially in the broader US population.

Notes From the Field: Use of Emergency Medical Service Data to Augment COVID-19 Public Health Surveillance in Montgomery County, Maryland, From March to June 2020.

Epidemiologic and syndromic surveillance metrics traditionally used by public health departments can be enhanced to better predict hospitalization for coronavirus disease (COVID-19). In Montgomery County, Maryland, measurements of oxygen saturation (SpO2) by pulse oximetry obtained by the emergency medical service (EMS) were added to these traditional metrics to enhance the public health picture for decision makers. During a 78-day period, the rolling 7-day average of the percentage of EMS patients with SpO2 <94% had a stronger correlation with next-day hospital bed occupancy (Spearman ρ=0.58, 95% CI 0.40-0.71) than either the rolling 7-day average of the percentage of positive tests (ρ=0.55, 95% CI: 0.37-0.69) or the rolling 7-day average of the percentage of emergency department visits for COVID-19-like illness (ρ=0.49, 95% CI: 0.30-0.64). Health departments should consider adding EMS data to augment COVID-19 surveillance and thus improve resource allocation.