Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic.

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors. Methods: This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies. Results: Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages. Conclusions: Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.

Credit card behaviors in young adults: Influences of parents' unintentional financial behaviors

Today's young adults are faced with challenging economic times ranging from extreme debt to the COVID-19 pandemic. They have also been raised with powerful technology, which has created an instant gratification world. This instant gratification may cause irrational thoughts to obtain products and services immediately despite the high costs of credit. To help understand the family's role in a person's financial wellbeing, Family Financial Socialization Theory (FFST) has shown that parents are influential on young adults' credit card demographics, but little is known about actual behaviors. Thus, how do young adults manage their credit cards behaviors based on what they observed from their parents?This research focuses on the relationship of family influences on young adult credit card behaviors, specifically parents' unintentional financial behaviors. Also, this analysis uses financial attitudes and knowledge as a mediator to that relationship. This study employed structural equation modeling (SEM) to analyze the relationships among the latent factors and measured variables and test the associations hypothesized in the research model. The sample consisted of 850 responses from a panel of young adults ages 18-26, living in the United States. This study found that, while there is not a direct relationship between family influences and credit card behaviors, a young adult's financial attitudes and knowledge weakly mediates an indirect relationship between them. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Dual impacts of Medicare payment reform and the COVID-19 pandemic on therapy staffing in skilled nursing facilities.

BACKGROUND: Implementation of new skilled nursing facility (SNF) Medicare payment policy, the Patient Driven Payment Model (PDPM), resulted in immediate declines in physical and occupational therapy staffing. This study characterizes continuing impacts of PDPM in conjunction with COVID-19 on SNF therapy staffing and examines variability in staffing changes based on SNF organizational characteristics. METHODS: We analyzed Medicare administrative data from a national cohort of SNFs between January 2019 and March 2022. Interrupted time series mixed effects regression examined changes in level and trend of total therapy staffing minutes/patient-day during PDPM and COVID-19 and by type of staff (therapists, assistants, contractors, and in-house staff). Secondary analyses examined the variability in staffing by organizational characteristics. RESULTS: PDPM resulted in a -6.54% level change in total therapy staffing, with larger declines for assistants and contractors. Per-patient staffing fluctuated during COVID-19 as the census changed. PDPM-related staffing declines were larger in SNFs that were: Rural, for-profit, chain-affiliated, provided more intensive therapy, employed more therapy assistants, and admitted more Medicare patients before PDPM. COVID-19 resulted in larger staffing declines in rural SNFs but smaller early declines in SNFs that were hospital-based, for-profit, or received more relief funding. CONCLUSIONS: SNFs that historically engaged in profit-maximizing behaviors (e.g., providing more therapy via lower-paid assistants) had larger staffing declines during PDPM compared to other SNFs. Therapy staffing fluctuated during COVID-19, but PDPM-related reductions persisted 2 years into the pandemic, especially in rural SNFs. Results suggest specific organizational characteristics that should be targeted for staffing and quality improvement initiatives.

The effect of non-invasive vagus nerve stimulation on memory recall in reading: A pilot study.

Expert reading acquisition is marked by fluent, effortless decoding, and adequate comprehension skills and is required for modern daily life. In spite of its importance, many individuals struggle with reading comprehension even when decoding skills are adequate. Unfortunately, effective reading comprehension interventions are limited, especially for adults. A growing body of research suggests that non-invasive transcutaneous stimulation of the auricular vagus nerve (taVNS) may drive neural plasticity for low-level reading skills such as speech sound perception and letter-sound learning, but it is unknown whether taVNS can improve higher level skills as well. Thus, the current pilot study was designed to evaluate the effect of taVNS paired with passage reading on reading comprehension performance. Twenty-four typically developing young adults were recruited and screened for baseline reading and working memory skills. Participants received either sham or active taVNS while reading short passages out loud. Immediately following each passage, participants answered a series of test questions that required either direct recall of passage details or more complete comprehension of the passage content. While taVNS did not improve the mechanics of reading (e.g., reading rate or accuracy), there was a significant effect of active taVNS on test performance. This effect was driven by significant improvement on accuracy for memory questions while there was no effect of taVNS on comprehension question accuracy. These findings suggest that taVNS may be beneficial for enhancing memory, but its efficacy may be limited in higher cognitive domains.

Adolescent Mental Health Priorities During the Covid-19 Pandemic.

Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents' mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents' mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health; school work; and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

Undue burden: Black faculty, COVID-19, and the racial justice movement.

A crucial reckoning was initiated when the COVID-19 pandemic began to expose and intensify long-standing racial/ethnic health inequities, all while various sectors of society pursued racial justice reform. As a result, there has been a contextual shift towards broader recognition of systemic racism, and not race, as the shared foundational driver of both societal maladies. This confluence of issues is of particular relevance to Black populations disproportionately affected by the pandemic and racial injustice. In response, institutions have initiated diversity, equity, and inclusion (DEI) efforts as a way forward. This article considers how the dual pandemic climate of COVID-19-related health inequities and the racial justice movement could exacerbate the "time and effort tax" on Black faculty to engage in DEI efforts in academia and biomedicine. We discuss the impact of this "tax" on career advancement and well-being, and introduce an operational framework for considering the interconnected influence of systemic racism, the dual pandemics, and DEI work on the experience of Black faculty. If not meaningfully addressed, the "time and effort tax" could contribute to Black and other underrepresented minority faculty leaving academia and biomedicine - consequently, the very diversity, equity, and inclusion work meant to increase representation could decrease it.

Leveraging patient-centric sampling for clinical drug development and decentralized clinical trials: Promise to reality.

Advances in the technologies to enable patient-centric sampling (PCS) have the potential to improve blood sample collection by enabling clinical trial participants to collect samples via self-collection or with the help of a caregiver in their home. Typically, blood samples to assess pharmacokinetics and pharmacodynamics of a drug during clinical development are collected at a clinical site via venous blood draw. In this position paper by the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ), the potential value PCS can bring to patients, to the clinical datasets generated, and to clinical trial sponsors is discussed, along with considerations for program decision making, bioanalytical feasibility, operations, and regulatory implications. With an understanding of the value of PCS and considerations when implementing during clinical drug development, we can bring the promise of PCS closer to reality and enable decentralized clinical trials.

Adolescent Mental Health Priorities During the Covid-19 Pandemic

Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents’ mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents’ mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health;school work;and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

COVID-19 vaccination program at a student-run free clinic: A descriptive study.

People historically excluded from receiving medical care in the United States, in addition to being at greater risk for SARS-CoV-2 infection, have had slower vaccine uptake due to structural barriers to availability. We present one student-run free clinic's SARS-CoV-2 vaccination program from January 15 to August 1, 2021, in Nashville, Tennessee. We tracked SARS-CoV-2 vaccine primary series completion among 273 free clinic patients with the help of medical student volunteers, who scheduled appointments and answered vaccine-related questions. We worked with our academic medical center partner to host a single-dose vaccination event at our clinic. We compared vaccine series completion in our clinic to adult vaccine completion in Davidson County, Tennessee on August 1, 2021. Of the 273 free clinic participants, 144 identified as Spanish-speaking (52.7%) and 172 (63%) had at least one qualifying comorbidity per the December 30, 2020, Tennessee COVID-19 Vaccination Plan. As such, 183 (67%) were characterized as vaccine eligible in Phase 1a2, 1b, or 1c. On August 1, 2021, 63.1% of free clinic patients had completed their primary SARS-CoV-2 vaccination series compared with 58.9% of adults in Davidson County, Tennessee (RD 4.2%, 95% CI: -1.5% to 9.9%). Spanish-speaking free clinic patients were most likely to have completed their vaccination series. We describe a framework for a patient-centered vaccination effort to reach individuals traditionally missed by large vaccination campaigns. We highlight structural hurdles experienced by vulnerable populations, including language barriers, lack of technology or reliable internet access, inflexible working schedules, lack of transportation, and vaccine misinformation.

Impact of the Global Pandemic on Accrual for a Non-Covid-19 ICU Clinical Trial

RATIONALE: Enrollment and retention of participants for any research study is challenging. The unpredictable nature of the ICU environment coupled with tenuous physiological status of patients can significantly thwart clinical trial accrual goals. The COVID-19 pandemic has pushed ICU census numbers to unprecedented levels with severely ill patients experiencing lengthy hospitalizations, delaying turn-over of beds. Anecdotal reports suggest challenges in achieving trial recruitment goals. The aims of this study were to describe the impact of the pandemic on a non-COVID-19 ICU clinical trial's screening and accrual of patients receiving mechanical ventilatory support. METHODS: A descriptive, retrospective design was used to address the study aims. Screening and accrual data were obtained from a Midwestern academic medical center in North America's parent clinical trial (R01HL130881). The primary aims of the efficacy trial are to test if patient selfadministration of dexmedetomidine (n = 190) reduces anxiety, delirium, ventilator days and ICU stay. A 3-step screening process prior to informed consent consists of (1) electronic health record (EHR) automated ICU census reports of mechanically ventilated patients, (2) in-depth review of the EHR for inclusion criteria, then (3) bedside assessment of grip strength to use a push-button medication delivery device and ability to follow commands. Descriptive statistics and Chi-square were used to compare screening and accrual data from a pre-pandemic timeframe (8/27/2018- 3/15/2020) to a pandemic timeframe (3/16/2020-12/31/2021). RESULTS: Of 91 eligible patients, 49 were accrued (53.8%) during the pre-pandemic timeframe. Patients were not accrued due to patient/LAR declination (78%) or primary medical team declination (22%). The three most frequent reasons for ineligibility were unarousable (25%), hypotension (11%) and not following commands (9%). While the pandemic timeframe had 30 fewer eligible patients, 40 of 61 (67%) were accrued. Patients were not accrued due to patient/LAR declination (87%) or medical team declination (13%), similar to pre-pandemic timeframe (p = 0.7). Pandemic timeframe had significantly more unarousable patients (32%, p < 0.0001) with fewer patients hypotensive (7%, p < 0.0001) or not following commands (7%, p = 0.01). Once COVID-19 infection was resolved, lengthy ventilator days, higher sedation levels, and prolonged immobility contributed to extremely weak grip strength, precluding trial eligibility. CONCLUSIONS: These retrospective data confirm this trial's enrollment was hampered by the COVID-19 pandemic due to fewer eligible, unarousable patients. Declinations from patients/LARs were similar during both timeframes. Inability to meet accrual milestones risks continued.

Rates, perceptions and predictors of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents.

Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14-18 years) took part in the 'in isolation instead of in school' (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.

The Assistive Technology Services Experience of the 2020-2021 School Year

Assistive Technology Services (ATS) is the central group of itinerants and resource staff directly working with students and schools to provide assistive technology accommodations within the Fairfax County Public School (FCPS) system in Virginia. When schools closed in March 2020 because of the COVID-19 pandemic, the group was required to make immediate, yet impactful adjustments to its daily operation. ATS worked within the purview of the evolving technology climate that was gradually occurring with the district’s FCPSOn technology initiative. This initiative went from a yearly rollout to placing computer devices in all students’ hands in the scope of a few months. Assistive Technology Services was able to collaborate with diverse groups in the school system, assist in safely providing access to technology devices, assess specific student assistive technology needs, and develop effective training practices within a new virtual learning environment. As concurrent learning emerged and students returned to school in January 2021, Assistive Technology Services adapted its standard operating procedures to that of the “new normal” that will continue to evolve not only as the pandemic subsides, but as emerging technologies continue to change the face of education. © ATIA 2022.

A Media Literacy Education Approach to High School Sexual Health Education: Immediate Effects of Media Aware on Adolescents' Media, Sexual Health, and Communication Outcomes.

Media may function as sex educators for adolescents; unfortunately, media messages often glamorize risky sexual behaviors and unhealthy relationships and neglect sexual health behaviors and communication. Media Aware is a web-based comprehensive sexual health program for high school students that uses a media literacy education approach. It is designed to improve adolescents' critical thinking about media messages and provide medically-accurate information and skills building related to sexual health and communication. A randomized controlled trial was conducted in 2019-2020 with students (grades 9 and 10; n = 590) from 17 high schools across the United States. The sample was 53% female, 58% white/Caucasian; and 13% Hispanic/Latinx. One high school teacher per school and all of their 9th and 10th grade students were randomly assigned to either the intervention or delayed-intervention (control) condition. The study assessed the immediate (posttest) and short-term (3-month) effects of Media Aware on adolescents' media, sexual health, and communication outcomes. For 9 of the 17 schools, students were home from school due to the beginning of the COVID-19 pandemic during the time of their 3-month data collection, which left the short-term analyses underpowered. However, several impacts of the program were found in the immediate posttest analyses. Media Aware was found to improve sexual health knowledge and redress inaccurate normative beliefs about the frequency of risky teen sex. Media Aware also improved critical thinking about media messages with demonstrated improvements in media message deconstruction skills and decreases in the perceived realism of media messages. Moderator analyses found some differential immediate effects of the program attributable to gender. Media Aware reduced girls' normative beliefs about teen sex, generally, and increased their sexual health communication with parents as well as reduced boys' acceptance of dating violence. Students gave positive feedback about Media Aware, especially related to the online format of the program. The results from this study provide evidence that Media Aware is an effective web-based program for positively enhancing high school students' media, sexual health, and sexual health communication outcomes.

A Comprehensive Review of Vaping Use in Pediatric Patients and Recent Changes in Regulatory Laws.

The use of electronic cigarettes (e-cigarettes), also known as vapes, by adolescents and young adults has dramatically increased over the past several years. E-cigarettes continue to be the most used form of tobacco among youth. As a result of this concerning trend, policies at both the state and federal levels have been implemented to limit availability in this population. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has had some positive and negative effects on the youth vaping epidemic with adolescent consumers reporting limited access to retail sites during the stay-at-home executive orders, but easier access with online purchasing because age verification was often not required. Complications resulting from vaping have been reported and include e-cigarette or vaping product use-associated lung injury (EVALI) and thrombotic events. Data suggest that the use of vaping devices can lead to both short- and long-term respiratory morbidity in the pediatric population. This review serves to provide a comprehensive examination of vaping use in pediatric patients and recent changes in regulatory laws to equip pharmacists with the knowledge to be aware of the different devices and products available, ask their pediatric patients regularly about use, and counsel and educate on the potential harmful effects.

A social media microinfluencer intervention to reduce coronavirus disease 2019 vaccine hesitancy in underserved Tennessee communities: A protocol paper.

BACKGROUND: Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the United States. Recent data suggest that the trustworthiness of information about the coronavirus 2019 (COVID-19) vaccine was a larger concern than the vaccine's adverse effects or risks. OBJECTIVE: This study aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the Social-Ecological Model (SEM) and Social Cognitive Theory may address vaccine hesitancy using community pharmacies. METHODS: In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the State of Tennessee Department of Health and the University of Tennessee Health Science Center College of Pharmacy. The project involved a 3-pronged, pharmacy-based COVID-19 vaccination outreach project, including (1) social media messaging (i.e., microinfluencer approach), (2) community partner collaboration, and (3) in-pharmacy promotion. Quantitative and qualitative data will assess the quality and effectiveness of the program. Social media outcomes will also be assessed to measure the impact of the microinfluencer social media training. RESULTS: Project implementation is planned for 6 months (January 2021 to June 2021) after an initial month of planning by the research team (December 2020) and preceding several months of assessment (July 2021 and beyond). CONCLUSIONS: Novel, theory-based approaches will be necessary to improve vaccine confidence. One approach to promoting public health, derived from the SEM, may be to use trusted microinfluencers on social media platforms, such as local community pharmacists and community leaders.

Skilled Nursing Facility Organizational Characteristics Are More Strongly Associated With Multiparticipant Therapy Provision Than Patient Characteristics.

OBJECTIVES: Multiparticipant physical and occupational therapy provision has fluctuated significantly in skilled nursing facilities (SNFs) under shifts in Medicare reimbursement policy. Multiparticipant therapy includes group (2-6 individuals per therapist) and concurrent therapy (2 individuals per therapist). This study uses recent patient-level data to characterize multiparticipant therapy provision in SNFs to help anticipate shifts under new Medicare policy and the COVID-19 pandemic. METHODS: This secondary analysis used data on 1,016,984 post-acute rehabilitation stays in SNFs in 2018. This analysis identified patient predictors (eg, demographic, clinical) and organizational predictors (eg, ownership, quality, staffing) of receiving multiparticipant therapy using mixed-effects logistic regression. Among individuals who received any multiparticipant therapy, those patient or facility factors associated with high rates of multiparticipant therapy provision were also determined. RESULTS: Less than 3% of individuals received multiparticipant therapy in 2018. Patient functional and cognitive impairment and indicators of market regulation were associated with lower odds of multiparticipant therapy. Effect sizes for organizational factors associated with multiparticipant therapy provision were generally larger compared with patient factors. High multiparticipant therapy provision was concentrated in <2% of SNFs and was positively associated with for-profit ownership, contract staffing, and low 5-star quality ratings. CONCLUSION: SNF organizational characteristics tended to have stronger associations with multiparticipant therapy provision than patient factors, suggesting that changes in patient case-mix, as expected during the COVID-19 pandemic, may have less of an impact on multiparticipant therapy provision than organizational factors. Results suggest that for-profit SNFs in states with higher market regulation, SNFs providing high volumes of therapy, and SNFs utilizing high proportions of assistants and contract staff may be more responsive to Medicare policy by increasing multiparticipant therapy provision. IMPACT: This study may help identify SNFs that are more likely to increase multiparticipant therapy provision under new Medicare payment policy.

Fostering social connectedness: The Official Voice of Perioperative Nursing

Key determinants of loneliness included a lack of social support and infrequent meaningful social interactions, negative feelings about personal relationships, poor physical and mental health, and a lack of balance in daily activities (i.e., doing too much or little of any given thing).5 A number of studies corroborate this survey and stipulate negative health risks associated with loneliness and isolation. Social connectedness can provide different types of support, such as emotional (e.g., trust, love), instrumental (e.g., assisting a person in doing something), informational (e.g., providing advice), and appraisal (e.g., providing feedback).11 In stark contrast to loneliness and social isolation, there are many benefits associated with social connectedness, including that it enhances brain health and improves memory;drives quality of life and feelings of belonging;mitigates stress levels during unfavorable events;and provides support when dealing with negative emotions, such as distress and worry, especially in times of adversity and uncertainty.12-14 Tips for fostering social connectedness It has become increasingly challenging to foster meaningful social connectedness, especially with the COVID-19 pandemic and the necessity of social distancing practices at work and in the community. The tips for fostering social connectedness below are provided with the hope that they will have a profoundly positive effect on the common challenges perioperative nurses and other health care professionals face in fostering social connectedness, while acknowledging some of the unique considerations associated with their professional environment. Because the social connectedness that individuals desire varies and cannot be prescribed, the tips can be customized so that individuals can find the approaches that best suit their needs. Knowing that managers can either increase or decrease the stress of their team depending on their own actions and words, the team at Johns Hopkins Medicine trains all new managers on their role in the stress of their employees. Because of the great influence managers have on the emotions of employees, the training helps them understand the impact of their behavior, teaches them practices they can embrace to lower stress, and outlines additional resources available to them to help manage stress.