ABSTRACT
Policy changes resulting from the coronavirus 2019 (COVID-19) pandemic have had a substantial and positive impact on the clinical care of persons with opioid use disorder. These innovative paradigm shifts created a ripe environment for re-evaluating traditional approaches to recruiting and retaining persons who use drugs into research studies. For example, changes to methadone prescribing requirements and authorization of buprenorphine prescriptions via telehealth have both increased access to medications. In this commentary, we contribute to ongoing conversations about the ethics of compensation for participants in addiction-related clinical research and share methods of payment that proved successful in research performed during the pandemic. We also discuss approaches to enrollment and follow-up that were implemented during the height of COVID restrictions. These approaches may mutually benefit both participants and researchers in a post-pandemic era.
ABSTRACT
OBJECTIVE: To reduce children's sugar-sweetened beverage intake, California's Healthy-By-Default Beverage law (SB1192) mandates only unflavoured dairy/non-dairy milk or water be the default drinks with restaurant children's meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighbourhoods. DESIGN: This observational, cross-sectional study examines beverage availability, upcharges (additional cost) and presentation of beverage options consistent with SB1192 (using four increasingly restrictive criteria) within a random sample of quick-service restaurants (QSR) in Supplemental Nutrition Assistance Program Education eligible census tracts selling children's meals online from November 2020 to April 2021. SETTING: Low-income California neighbourhoods (n 226 census tracts). PARTICIPANTS: QSR that sold children's meals online via a restaurant-specific platform, DoorDash, GrubHub and/or UberEats (n 631 observations from 254 QSR). RESULTS: Seventy percent of observations offered water; 63 % offered unflavoured milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n 445), 41 % had an upcharge (average $0·51). Among observations offering unflavoured milk (n 396), 11 % had an upcharge (average $0·38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40·5 % (using the least restrictive criteria) to 5·6 % (most restrictive) of observations. CONCLUSIONS: Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSR located in low-income neighbourhoods are not offering children's meal beverages consistent with the state's Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants offering healthy default beverages with children's meals sold online is necessary.
ABSTRACT
Children's naive immune systems allow for a unique course of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus when compared to adults. In multi-system inflammatory syndrome in children (MIS-C), a current or recent SARS-CoV-2 infection can cause fever and elevated inflammatory markers in individuals under the age of 21. Similar to Kawasaki disease, Kikuchi disease, systemic lupus erythematosus, toxic shock syndrome (TSS), and macrophage activation syndrome (MAS), there is an influx of inflammation associated with MIS-C that creates this pathologic state. Because MIS-C affects numerous organ systems, its presentation varies substantially, thus making it difficult to diagnose and treat in a timely fashion. In our case, a previously healthy four-year-old African American female initially presented to the emergency department (ED) with high fever, abdominal pain, and headache after recent SARS-Co-V-2 exposure. After initially being diagnosed with a urinary tract infection (UTI), she returned with a myriad of symptoms, including persistent fever, abdominal pain, and conjunctivitis. Her initial SARS-CoV-2 test returned positive, and she was admitted and placed on broad-spectrum antibiotics then requiring vasopressors, mechanical ventilation, and an appendectomy. Her workup revealed elevated inflammatory markers, elevated brain natriuretic peptide (BNP), anemia, thrombocytopenia, pyuria, and hypercoagulability meeting the criteria for MIS-C. In addition to antibiotics, her treatment included IV immunoglobulin and methylprednisolone until the patient was stabilized for discharge. As more is learned about SARS-CoV-2, it will become increasingly important to consider the development and implications of MIS-C. Educating providers on the wide range of MIS-C presentations can lead to more effective preventative measures and treatments.
ABSTRACT
BACKGROUND AND AIMS: The COVID-19 pandemic has resulted in associated lockdown restrictions for individuals across England, including the postponement of all recreational sporting provisions. The beneficial effects of regular physical activity are well established yet to the authors' knowledge, no research addresses the cancellation of all recreational provisions. Using quantitative and qualitative methods, this study assessed the impact of COVID-19 restrictions on recreational sports players, what alternative exercise methods have been sought and how players feel about returning to their sport. METHOD: An online survey was distributed across England for six-weeks commencing in May 2020. A questionnaire explored differences in the impact of COVID-19 restrictions between sex, winter/summer/year-round sports, team/individual sports, age, and resilience groups. The use of alternative exercise methods, coping strategies and feelings about returning to sport were also investigated. Responses were gathered from 2023 adults whose recreational sport had been cancelled by COVID-19. All completed questionnaires (n = 1213) were taken for analysis (mean age = 49.41 years, SD = 17.165, 55.2% female). RESULTS: Quantitative findings showed the negative impact of COVID-19 restrictions was greater for females, those involved in winter and team sports, those aged 18-39 and low-resilient copers (p < .05). No significant differences were found between individuals that had had COVID-19 or were considered vulnerable by government guidelines. Acceptance was the most common coping strategy. The average number of days per week that participants exercised significantly increased during lockdown, with significant increases also seen in the use of online workouts, fitness apps and home-gym exercise. Qualitative findings suggested that participants are looking forward to the social and physical benefits of recreational activity restarting yet are concerned about the logistics of returning under social distancing restrictions. Other worries included loss of fitness, spreading (younger age groups) and catching (older age groups) COVID-19 and being in a crowd. CONCLUSIONS: Results highlight what is currently accessible to home-based exercisers and inform the reintroduction of recreational sports clubs. As COVID-19 restrictions look to persist, club representatives should provide accessible home-exercise options and be cautious of participant concerns when considering the return of recreational sport.