COVID-19 vaccine uptake and attitudes among pregnant and postpartum parents.

BACKGROUND: Pregnancy poses increased risks from COVID-19, including hospitalization and premature delivery. Yet pregnant individuals are less likely to have received a COVID-19 vaccine. OBJECTIVE: This study aimed to investigate COVID-19 vaccine uptake and reasons for delay or refusal among perinatal parents. STUDY DESIGN: A total of 1542 eligible parents who delivered between 2019 and 2021 were surveyed through the Ovia parenting app, which has a nationally representative user base. Adjusted and nationally weighted means were calculated. Multivariate logistic regression and survival models were used to examine uptake. RESULTS: At least 1 dose of the COVID-19 vaccine was received by 70% of the parents. Those with a bachelor's or graduate degree were significantly more likely to have received a vaccine relative to those with some college or less (adjusted odds ratio for bachelor's degree, 1.854; 95% confidence interval, 1.19-2.90; adjusted odds ratio for graduate degree, 2.833; 95% confidence interval, 1.69-4.75). Parents living in rural areas were significantly less likely to have received a vaccine relative to those living in urban areas (adjusted odds ratio for small city, 0.62; 95% confidence interval, 0.45-0.86; adjusted odds ratio for rural area, 0.56; 95% confidence interval, 0.35-0.89); 56% (281/502) of unvaccinated parents considered that the vaccine "was too new." Among those pregnant in 2021, 44% (258/576) received at least 1 dose, and 34% (195/576) reported that pregnancy had "no impact" on their vaccine decision. CONCLUSION: There was significant heterogeneity in vaccine uptake and attitudes toward vaccines during pregnancy by sociodemographics and over time. Public health experts need to consider and test more tailored approaches to reduce vaccine hesitancy in this population.

Pods in Action: Hyde Park Neighborhood Club. A Community Organization Treats Students as Individuals

Hyde Park Neighborhood Club (HPNC) is a small, hyper-local community-based organization that, before the pandemic, provided after-school care and enrichment to children living on the South Side of Chicago. During the pandemic, HPNC created a learning pod for children in grades K-8 to provide parents in the community with childcare and students with online learning support. HPNC staff supervised students' online learning and provided social experiences that were designed to mimic those that students would experience in school in a normal year. Key Lessons: (1) a community organization that provided after-school programs overcame scheduling challenges and competing parent demands to provide in-person support and enrichment to students in Chicago's Hyde Park neighborhood when school buildings closed during the first months of the COVID-19 pandemic in spring 2020, and (2) the organization hopes to provide more structured individual support to students after the pandemic, but faces logistical barriers and, more critically, a shortage of clear funding sources.

Restoring Teacher and Principal Well-Being Is an Essential Step for Rebuilding Schools: Findings from the State of the American Teacher and State of the American Principal Surveys. Research Report. RR-A1108-4

Principal and teacher well-being is a matter of immediate concern for principals and teachers themselves and for the students they teach. Stress on the job can negatively affect educators' physical health, and poor teacher wellness and mental health are linked with lower-quality student learning environments and with poorer academic and nonacademic student outcomes. Furthermore, previous research suggests that principals and teachers of color are more likely than their White peers to experience poor well-being and are more likely to leave their jobs. Understanding the relationships among teacher and principal well-being, perceived working conditions, and teachers' and principals' intentions to leave their current position is critical for pandemic recovery and for the long-term health of the principal and teacher workforce. In this report, researchers present selected findings from the 2022 State of the American Teacher (SoT) and State of the American Principal (SoP) surveys. These findings are related to teacher and principal well-being, working conditions, and intentions to leave their jobs. The authors focus specifically on the well-being and working conditions of educators of color. [For technical information about the surveys and analysis in this report, see "State of the American Teacher and State of the American Principal Surveys: 2022 Technical Documentation and Survey Results" (ED621137).]

Changes in Breastfeeding and Lactation Support Experiences During COVID.

Background: We surveyed parents who gave birth from 2019 to 2021 to examine changes in breastfeeding experiences and professional and lay breastfeeding support services due to the coronavirus disease 2019 (COVID-19) pandemic. We also examined racial and ethnic disparities in breastfeeding support. Materials and Methods: A cross-sectional opt-in survey of 1,617 parents was administered on Ovia's parenting app in January 2022. Respondents were 18-45 years of age and delivered in one of three birth cohorts: August-December 2019, March-May 2020, or June-August 2021. We fit linear and logistic regression models wherein the outcomes were six breastfeeding support and experience measures, adjusting for birth cohort and respondent demographics. Results: Parents who gave birth in the early pandemic versus those in the prepandemic had reduced odds of interacting with lactation consultants (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.44-0.90), attending breastfeeding classes (OR: 0.71; 95% CI: 0.54-0.94), meeting breastfeeding goals (OR: 0.65; 95% CI: 0.46-0.92), and reporting it was easy to get breastfeeding help (estimate: -0.36; 95% CI: -0.55 to -0.17). Birth cohort was not associated with use of donor milk or receipt of in-hospital help. The later pandemic cohort differed from the prepandemic cohort for one outcome: they were less likely to meet their breastfeeding goals (OR: 0.67; 95% CI: 0.48-0.95). There were racial and ethnic disparities in the use of multiple types of breastfeeding support. Although one-third of respondents felt that the pandemic facilitated breastfeeding because of more time at home, 18% felt the pandemic posed additional challenges including disruptions to lactation support. Conclusions: Parents who gave birth in the later pandemic did not report significant disruptions to professional breastfeeding support, likely as a result of the growth of virtual services. However, disparities in receipt of support require policy attention and action.

Walking a Fine Line -- Educators' Views on Politicized Topics in Schooling: Findings from the State of the American Teacher and State of the American Principal Surveys. Research Report. RR-A1108-5

In a time when simply carrying out the essential functions of their jobs is a herculean task, educators have been faced with the additional challenge of addressing contentious, politicized topics in their schools and classrooms. Drawing from nationally representative samples of teachers and principals who completed the 2022 State of the American Teacher and the State of the American Principal surveys and teacher interviews, the authors focus their analysis on two especially politically salient issues: (1) how to implement COVID-19 safety measures with the return to in-person schooling;and (2) the role and emphasis that discussions about race, racism, or bias may or should have in schools. They investigate how these two highly politicized topics might contribute to elevated job-related stress by examining potential contributing factors, such as the extent to which educators must manage conflicting beliefs and opinions, the adequacy of support they receive, and the hostility and aggression that they experience from others in response to related policies. The authors also explore differences by educator- and school-level characteristics. Although politicized topics are more contested in some school settings and locales than in others, survey results suggest that educators' beliefs about how schools should manage politicized issues vary within all kinds of school communities. The authors explore the consequences of politicization for educators' instructional practices, well-being, perceptions of their school and district climate, and intentions to leave their jobs. They provide implications and recommendations on how to support educators in navigating politicized issues in their schools and classrooms in a way that fosters productive discourse between communities and schools. [For the "State of the American Teacher and State of the American Principal Surveys: 2022 Technical Documentation and Survey Results. Research Report. RR-A1108-3," see ED621137.]

Ray Amputation in a Traumatic Diabetic Foot.

Diabetic foot is a complex syndrome that is co-morbid with other diabetic complications such as peripheral arterial disease (PAD) and peripheral neuropathy. Patients with the diabetic foot are increasingly prone to diabetic foot ulcers (DFUs) due to a high infection susceptibility and poor wound healing possibly prompting the need for minor or major amputations. We herein highlight the case of a 47-year-old male with a traumatic diabetic foot who necessitated a Ray amputation (RA). The notable aspects of this case are the late presentation of a patient with uncontrolled diabetes who could have avoided this complication if he went to seek help earlier and how diabetic foot is controlled and managed in a low-income resource setting. This case also highlights how physicians can better diagnose and treat diabetic foot complications with a scoring metric.

Impact of telelactation services on breastfeeding outcomes among Black and Latinx parents: protocol for the Tele-MILC randomized controlled trial.

BACKGROUND: Breastfeeding offers many medical and neurodevelopmental advantages for birthing parents and infants; however, the majority of parents stop breastfeeding before it is recommended. Professional lactation support by the International Board Certified Lactation Consultants (IBCLCs) increases breastfeeding rates; however, many communities lack access to IBCLCs. Black and Latinx parents have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. Virtual "telelactation" consults that use two-way video have the potential to increase access to IBCLCs among disadvantaged populations. We present a protocol for the digital Tele-MILC trial, which uses mixed methods to evaluate the impact of telelactation services on breastfeeding outcomes. The objective of this pragmatic, parallel design randomized controlled trial is to assess the impact of telelactation on breastfeeding duration and exclusivity and explore how acceptability of and experiences with telelactation vary across Latinx, Black, and non-Black and non-Latinx parents to guide future improvement of these services. METHODS: 2400 primiparous, pregnant individuals age > 18 who intend to breastfeed and live in the USA underserved by IBCLCs will be recruited. Recruitment will occur via Ovia, a pregnancy tracker mobile phone application (app) used by over one million pregnant individuals in the USA annually. Participants will be randomized to (1) on-demand telelactation video calls on personal devices or (2) ebook on infant care/usual care. Breastfeeding outcomes will be captured via surveys and interviews and compared across racial and ethnic groups. This study will track participants for 8 months (including 6 months postpartum). Primary outcomes include breastfeeding duration and breastfeeding exclusivity. We will quantify differences in these outcomes across racial and ethnic groups. Both intention-to-treat and as-treated (using instrumental variable methods) analyses will be performed. This study will also generate qualitative data on the experiences of different subgroups of parents with the telelactation intervention, including barriers to use, satisfaction, and strengths and limitations of this delivery model. DISCUSSION: This is the first randomized study evaluating the impact of telelactation on breastfeeding outcomes. It will inform the design and implementation of future digital trials among pregnant and postpartum people, including Black and Latinx populations which are historically underrepresented in clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT04856163. Registered on April 23, 2021.

Expanding Charter School Capacity: The Case of Propel Montour. Research Report. RR-A1184-1

In fall 2017, Propel Schools initiated the expansion of one of its schools, Propel Montour. Originally a single K-8 school with two classrooms per grade, Montour added a new high school and expanded into separate elementary and middle schools over four years, adding a classroom to each grade. In this report, the authors used difference-in-difference and doubly robust regression models to examine the academic and behavioral experiences of both continuing and expansion Montour students from fall 2017 through the onset of the coronavirus disease 2019 (COVID-19) pandemic in spring 2020. The analyses did not find evidence that the academic and behavioral experiences of either the continuing or expansion students fell below what would have been expected absent expansion. Although the expansion experiences of a single charter management organization (CMO) network might be idiosyncratic to that entity and the locale and population it serves, this report should be of interest to similarly structured CMOs, the organizations from which they might seek expansion funding, those involved in school choice policy, and state and local education leaders and policymakers. [This report was supported through a subcontract with Propel Schools Foundation.]