A conceptual model for building program sustainability in public health settings: Learning from the implementation of the program sustainability action planning model and training curricula.

Background: The emergence of implementation science has driven an increase in research examining the implementation of evidence-based programs and policies. However, there has been less attention through program sustainability. To achieve the full benefit of investment in program development and implementation, there must be an understanding of the factors that relate to sustainability; additionally, there is a need for a robust set of tools and trainings to support strategic long-term program sustainability. This paper presents results of our sustainability training intervention and a new conceptual model of sustainability. The proposed conceptual model builds upon the intervention design, further specifying the implementation strategy, strategy-mechanism linkages, and effect modifiers. Methods: This research is part of the larger randomized control trial evaluating the effectiveness of the Program Sustainability Action Planning Model and Training Curricula. Specifically, this multimethod study establishes a conceptual model for program sustainability and related capacity-building interventions. The training intervention was delivered through workshops and technical assistance to 11 state tobacco control programs, principally entailing the development and implementation of a sustainability action plan. We utilize descriptive statistics and participant perspectives to evaluate the training intervention and propose an empirically-grounded conceptual model for sustainability capacity-building interventions in public health settings. Results: Participants found intervention components (workshop, workbook, instructor and resources) to be effective. Overall, participants found the intervention improved their ability to develop sustainability action plans and assess their program and partners. Throughout the study, program managers emphasized the importance of the workshop in providing direction for their sustainability work and the value of robust, ongoing technical assistance. Program managers identified several factors that interfered with intervention reception including staff turnover, competing priorities, partnership challenges, and the COVID-19 pandemic. Conclusion: The present study documents the development and implementation of a novel Program Sustainability Action Planning Model and Training Curricula, one of the first interventions designed to improve program sustainability. In addition, we present an empirically-grounded conceptual model for program sustainability. Considering the paucity of research in this understudied and undefined topic area, this is an important contribution that can serve as a framework for similar intervention designs and implementation efforts. Clinical Trail Registration: ClinicalTrails.gov identification number is NCT03598114.

A survey of Eutylone Prevalence in New Zealand during 2020 and 2021

Aim This study provides an insight into the prevalence of eutylone in New Zealand by analysis of the post-mortem forensic toxicology cases over the period 2020 and 2021, as well as analysis of suspected drug items collected from three music festivals between December 2020 and February 2021. Eutylone, also known as bk-EBDB or n-ethylbutylone, is a synthetic cathinone that has no known therapeutic use. In New Zealand it is sold recreationally as an alternative to methylendioxymethamphetamine (MDMA) and has increasingly been found as an adulterant or substitution substance in MDMA samples. Eutylone is known to cause harm and has been associated with fatalities [World Health Organization. “WHO Expert Committee on Drug Dependence: forty-fourth report.” (2022)]. In many cases, users are unaware that the eutylone is present believing they are taking MDMA. Method ESR undertakes post-mortem forensic toxicology casework for the whole of New Zealand. We investigated the post-mortem cases received during 2020 and 2021 for eutylone and investigated trends. In addition to the post-mortem forensic toxicology cases, ESR analysed 656 drug samples from three music festivals held between December 2020 and February 2021 for the presence of drugs including eutylone. Results The post-mortem blood samples were analysed using liquid chromatography with time of flight mass spectrometry (LC-TOFMS) for eutylone. Eutylone was detected in three cases during 2020 and in twelve (12) cases during 2021. Of the 12 cases from 2021, ten decedents were male, nine cases had a known cause of death (e.g. hanging), two cases were at or just after a music festival and two cases appeared to be drug overdoses where multiple drugs were involved. Eutylone was the only drug detected in three of the cases (all with a known cause of death). When other drugs were involved the most common were methamphetamine (n=4), MDMA (n=3), alcohol (n=3) and cannabis (n=3). For the 656 samples analysed from the three music festivals MDMA and eutylone were detected in 33% and 32% of the samples, respectively. This can be contrasted with a previous survey from December 2018 to March 2019 that found MDMA in 64% of samples and eutylone detected in less than 1% of the samples. If a mixture was present in a sample, it was common for it to contain both eutylone and MDMA. Conclusion There was a significant increase in eutylone detections both in blood samples from post-mortem forensic toxicology casework and in seized drug samples over the time period studied, with associated increases in the harm, including deaths, associated with the drug use. It has been postulated that this trend was influenced by factors such as the limited supply of MDMA in New Zealand due to law enforcement activity including a large MDMA seizure prior to the survey period for the music festivals, COVID-19 restrictions and the use of eutylone as an adulterant or replacement drug.

At Home and on the Brink: U.S. Parents' Mental Health during COVID-19.

Though the COVID-19 pandemic required significant changes and adaptations for most Americans, parents faced acute challenges as they had to navigate rapidly changing schooling and child care policies requiring their children to spend more time at home. This study examines the effects of COVID-19 school and workplace policies as well as environmental and economic characteristics on parental mental health, worry, hopelessness, and anxiety. Using data from four waves of the Socio-Economic Impacts of COVID-19 Survey and regression analysis, we explore associations between parents' mental health, worry, hopelessness, and anxiety and school learning environment, child grade and learning disability, employment characteristics, and sociodemographic factors. We find that having a child attend a private school or school with above average instructional quality was associated with better mental health of parents. Hybrid schooling options offering both in-person and online learning was associated with poor parental mental health, as was working from home. Being female or experiencing job or income loss were associated with worse mental health while having older children, a bachelor's degree, or high income were associated with better mental health. Results can help inform school and workplace family supports as well as opportunities to reduce mental health strains at home from various policy options.

Longitudinal associations between facets of sleep and adiposity in youth.

OBJECTIVE: Beyond sleep duration, other facets of sleep such as variability and timing may be associated with obesity risk in youth. However, data are limited. Using a longitudinal design, this study tested whether multiple facets of sleep were associated with fat mass gain over 1 year. METHODS: A convenience sample of non-treatment-seeking youth (age 8-17 years) wore actigraphy monitors for 14 days. Average weekly sleep duration, within-person sleep duration variability, weekend catch-up sleep, bedtime and wake time shift, social jet lag, bedtime, wake time, and sleep midpoint were calculated. The association of each facet of baseline sleep with 1-year fat mass, adjusting for baseline fat mass and height, was examined. RESULTS: A total of 137 youths (54.0% female; mean [SD], age 12.5 [2.6] years; 28.4% non-Hispanic Black or African American; baseline fat mass = 15.3 [8.9] kg; 1-year fat mass = 17.0 [10.0] kg; 28.5% with baseline overweight or obesity) were studied. Wake time (p = 0.03) and sleep midpoint (p = 0.02) were inversely associated with 1-year fat mass, such that earlier wake time and midpoint were associated with higher 1-year fat mass. No other facet of sleep was significantly associated with 1-year fat mass (p > 0.09). CONCLUSIONS: Using objective measures, youth with earlier wake times and sleep midpoints had greater gains in fat mass. Additional research is needed to determine whether sleep timing may be a modifiable target to prevent pediatric obesity.

How Did School Meal Access Change during the COVID-19 Pandemic? A Two-Step Floating Catchment Area Analysis of a Large Metropolitan Area.

SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students-especially those in low-income households-lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the "supply" (meal access points) and the "demand" (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals-especially for summer meal programs-could lead to positive long-term impacts on children's health and well-being.

Increased Morbidity and Mortality in COVID-19 Patients with Liver Injury.

BACKGROUND: There is a high prevalence of liver injury (LI) in patients with coronavirus disease 2019 (COVID-19); however, few large-scale studies assessing risk factors and clinical outcomes in these patients have been done. AIMS: To evaluate the risk factors and clinical outcomes associated with LI in a large inpatient cohort of COVID-19 patients. METHODS: Adult patients with COVID-19 between March 1 and April 30, 2020, were included. LI was defined as peak levels of alanine aminotransferase/aspartate aminotransferase that were 3 times the ULN or peak levels in alkaline phosphatase/total bilirubin that were 2 times the ULN. Mild elevation in liver enzymes (MEL) was defined as abnormal peak liver enzyme levels lower than the threshold for LI. Patients with MEL and LI were compared to a control group comprising patients with normal liver enzymes throughout hospitalization. RESULTS: Of 1935 hospitalized COVID-19 patients, 1031 (53.2%) had MEL and 396 (20.5%) had LI. Compared to control patients, MEL and LI groups contained proportionately more men. Patients in the MEL cohort were older compared to control, and African-Americans were more highly represented in the LI group. Patients with LI had an increased risk of mortality (relative risk [RR] 4.26), intensive care unit admission (RR, 5.52), intubation (RR, 11.01), 30-day readmission (RR, 1.81), length of hospitalization, and intensive care unit stay (10.49 and 10.06 days, respectively) compared to control. CONCLUSION: Our study showed that patients with COVID-19 who presented with LI had a significantly increased risk of mortality and poor clinical outcomes.

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study.

BACKGROUND: Although recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients. METHODS: We performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission. RESULTS: A total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07-1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04-1.80; P = 0.026). CONCLUSIONS: Obesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.

Bacteremia and Blood Culture Utilization during COVID-19 Surge in New York City.

A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the level in the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than among COVID-19-negative patients (8.0%) and those not tested (7.1%) (P < 0.001). COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, which, when excluded, reduced the bacteremia rate to 1.6%. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial coinfection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.