Cyber-empathy: Teaching counseling skills in the post-COVID era

COVID-19 has required a transformation of skill sets in counseling - what was previously done in face-to-face environments is now done in telehealth settings. Telehealth communication is evolving. As instructors and supervisors respond to this need, changes in training may impact interns as they learn to express empathy for clients whose nonverbal responses, at the very least, may be less evident in a telecommunication environment. Empathy has evolved from responding and relating to a client to a more involved, multidimensional skill that requires the perception of the various dimensions of the person including biological, psychosocial, genetic, and cultural components. This empathy is more than just a response;it is a commitment to understanding through the integration of these components within expressive communication. How can instructors best demonstrate concepts in a counseling relationship that is bound by distance and telecommunication? This chapter explores the definition, development, and use of empathy and introduces the concept of "cyber-empathy" as exercised in the training of counseling interns, as well as some of the potential obstacles that may be encountered in training and expression of empathy in this post-COVID era. Cyber-empathy expands and defines the work of training and supervising this new cohort of counseling professionals. © Springer Nature Switzerland AG 2021. All rights reserved.

SEROPREVALENCE and RISK FACTORS for SARS-CoV-2 among INCARCERATED ADULT MEN in QUEBEC

Background: People in prison are at increased risk of SARS-CoV-2 infection due to overcrowding and the challenges in implementing infection prevention and control measures;however, seroprevalence studies are lacking in correctional settings. We examined the seroprevalence of SARS-CoV-2 and associated modifiable risk factors among incarcerated adult men in Quebec, Canada. Methods: We conducted a cross-sectional seroprevalence study in three provincial prisons, representing 45% of Quebec's incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity, detected by the Roche Elecsys® anti-SARS-CoV-2 serology test. Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard error. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were calculated. Results: Between January 19 and September 15, 2021, 246 of 1,100 (22%) recruited individuals tested positive across three prisons (range 15-27%). Of these, 192 (78%) reported having at least one previous SARS-CoV-2 PCR test, with 122 (64%) testing positive and 70 (36%) testing negative;73 (30%) individuals with a positive serology test were asymptomatic. Seropositivity increased with time spent in prison since March 2020 (aPR 2.17, 95%CI 1.53-3.07 for all vs. little), employment during incarceration (aPR 1.64, 95%CI 1.28-2.11 vs. not), shared meal consumption during incarceration (with cellmates: aPR 1.46, 95%CI 1.08-1.97 vs. alone;with sector: aPR 1.34, 95%CI 1.03-1.74 vs. alone), and incarceration post-prison outbreak (aPR 2.32, 95% CI 1.69-3.18 vs. pre-outbreak) (see Table). Shared (vs. single) cells were not associated with increased seropositivity. Conclusion: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied between prisons. Several modifiable carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.

A COVID-19 primer for primary care clinicians.

COVID-19 has challenged primary care clinicians to rapidly learn new information and adapt clinical practice in response to the continuous evolution of prevention, diagnosis, and management measures. The introduction of COVID-19 vaccination for age-eligible children has afforded increased opportunities for disease prevention, and the pandemic has highlighted the need for primary care clinicians to serve as advocates for their young patients and their communities.

H2C2 (HOME HOSPITAL AND CRITICAL CARE) - A 2.5 YEAR EXPERIENCE USING A NEW MODEL OF HOSPITAL AT HOME: DEVELOPMENT AND IMPLEMENTATION

Background: The CMS Hospital at Home (H@H) program during the COVID 19 pandemic was successfully applied as a suitable alternative to unnecessary admissions in lower risk patient populations. As the top 5% pts ($50,000/Year) account for 50% of the US healthcare expenditure over 15 years (5:50 Rule), we sought to investigate the long-term clinical and financial effectiveness and sustainability of new model of home hospital and critical care (H2C2) on the top 5% patients. Methods: 68 consecutive pts with top 5% annual cost profile (~4 admissions/pt with severe chronic dx [CHF, CAD, CODP, sepsis] +/-ventilator, PEG, dialysis, LifeVest) were enrolled in a multiple MSO program. On-site & On-line care started 3/2019 via patented processes and individualized protocols/devices (24/7 monitoring + ICU level Telemetry, 12-lead ECG). All Medicare Part A, B & D costs, admissions and LOS for pts were computed and normalized per phase (PRIOR, DURING, POST H2C2) to determine effectiveness and sustainability. Results: Of the 68 patients, 90% discharged to PCP, 6% admitted to hospice and 4% remained on the program for continuous care. There were no deaths at home. Compared to baseline, H2C2 had an over 70% sustained total cost reduction. Conclusion: This is 1st study to assess long-term clinical & financial impacts of H2C2 in top 5% of high-risk/cost pts. H2C2 was safe with a significantly sustained reduction of admissions and costs both during and 1.5 years post H2C2. Further studies are warranted for scalability. [Formula presented]

A COVID-19 Primer for Pediatric Primary Care Providers

COVID-19 has challenged pediatric primary care practitioners to rapidly learn new information and adapt clinical practice in response to the continuous evolution of prevention, diagnosis, and management measures. The introduction of COVID-19 vaccination for age-eligible pediatric populations has afforded increased opportunities for disease prevention, and the pandemic has highlighted the need for pediatricians to serve as advocates for their patients and for their communities.

Intrapersonal, interpersonal and environmental correlates of moderate to vigorous physical activity and sedentary time in adolescents with intellectual and developmental disabilities.

BACKGROUND: Although correlates of physical activity (PA) have been extensively examined in both children and adolescents who are typically developing, little is known about correlates of moderate to vigorous physical activity (MVPA) and sedentary time in adolescents with intellectual and developmental disabilities (IDD). Therefore, we examined intrapersonal, interpersonal and environmental factors and their association with device-based MVPA and sedentary time in adolescents with IDD. METHODS: MVPA and sedentary time was assessed using a hip-worn ActiGraph model wGT3x-BT tri-axial accelerometer across a 7-day period in adolescents with IDD and one of their parents. Pearson and point-biserial correlations were calculated to inspect the associations of PA (MVPA, sedentary time) with intrapersonal factors (demographic characteristic, BMI, waist circumference, motor ability, muscle strength, grip strength, cardiovascular fitness and self-efficacy for PA), interpersonal factors (parent demographics, parent BMI, parent MVPA and sedentary time, family social support for PA, parent barriers and support for PA, parent's beliefs/attitudes towards PA and number of siblings), and environmental factors (meteorologic season and COVID-19). Ordinary least squares regression was used to estimate the unique contributions of key factors to PA after controlling for participants' age, sex, race, waist circumference and total wear time. RESULTS: Ninety-two adolescents (15.5 ± 3.0 years old, 21.7% non-White, 6.5% Hispanic, 56.5% female) provided valid accelerometer data. Average sedentary time was 494.6 ± 136.4 min/day and average MVPA was 19.8 ± 24.2 min/day. Age (r = 0.27, P = 0.01), diagnosis of congenital heart disease (r = -0.26, P = 0.01) and parent sedentary time (r = 0.30, P = 0.01) were correlated with sedentary time. BMI (r = -0.24, P = 0.03), waist circumference (r = -0.28, P = 0.01), identifying as White (r = -0.23, P = 0.03) and parent MVPA (r = 0.56, P < 0.001) were correlated with MVPA. After adjusting for the adolescent's age, sex, race, waist circumference, and total wear time, the association between parent and adolescent MVPA remained significant (b = 0.55, P < 0.01, partial η2  = 0.11). CONCLUSION: The results of this study provide evidence that race, waist circumference and parental MVPA may influence the amount of MVPA in adolescents with IDD. The limited available information and the potential health benefits of increased MVPA highlight the need to evaluate the effectiveness of multi-component interventions targeting both intrapersonal and interpersonal levels to promote increased PA in adolescents with IDD.

Development and Application of a Polydimethylsiloxane-Based Passive Air Sampler to Assess Personal Exposure to SARS-CoV-2

Exhaled respiratory droplets and aerosols can carry infectious viruses and are an important mode of transmission for COVID-19. Recent studies have been successful in detecting airborne SARS-CoV-2 RNA in indoor settings using active sampling methods. The cost, size, and maintenance of these samplers, however, limit their long-term monitoring ability in high-risk transmission areas. As an alternative, passive samplers can be small, lightweight, and inexpensive and do not require electrical power or maintenance for continual operation. Integration of passive samplers into wearable designs can be used to better understand personal exposure to the respiratory virus. This study evaluated the use of a polydimethylsiloxane (PDMS)-based passive sampler to assess personal exposure to aerosol and droplet SARS-CoV-2. The rate of uptake of virus-laden aerosol on PDMS was determined in lab-based rotating drum experiments to estimate time-weighted averaged airborne viral concentrations from passive sampler viral loading. The passive sampler was then embedded in a wearable clip design and distributed to community members across Connecticut to surveil personal SARS-CoV-2 exposure. The virus was detected on clips worn by five of the 62 participants (8%) with personal exposure ranging from 4 to 112 copies of SARS-CoV-2 RNA/m(3), predominantly in indoor restaurant settings. Our findings demonstrate that PDMS-based passive samplers may serve as a useful exposure assessment tool for airborne viral exposure in real-world high-risk settings and provide avenues for early detection of potential cases and guidance on site-specific infection control protocols that preempt community transmission.