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1.
Diabetes ; 71, 2022.
Article in English | ProQuest Central | ID: covidwho-1923954

ABSTRACT

The impact of school day routines on glycemic control in children is unclear. We compared continuous glucose monitor (CGM) metrics for youth with type 1 diabetes during weekday school hours (8AM-3PM) between two 4-week periods before and during the COVID-pandemic, when children had transitioned to virtual school. Youth with >70% CGM wear (n=209) were included;46% male, mean±SD age 10.6±1.5 years, hemoglobin A1c 7.5±0.8%, 64% on insulin pumps. Time in range (TIR, 80-180 mg/dL) was similar during the pandemic (51.6±24.1%) compared to pre-pandemic (50.8±23.3%) . Using random coefficient multilevel linear mixed models, younger age (p=0.025) and pump use (p=0.043) predicted TIR, but not race (p=0.76) , diabetes duration (p=0.07) , body mass index (p=0.54) , or insurance status (p=0.45) . TIR pre- vs. during the pandemic varied significantly by time of day (p<0.001) . With in-person school pre-pandemic, TIR increased over school hours;with virtual school during the pandemic, TIR decreased in the morning and then remained steady (Figure) . Time above range (TAR, >180 mg/dL) had the opposite pattern. These findings suggest that in-person school can contribute to better TIR and lower TAR. Possible explanations include classroom and physical activity routines, plus school nurse support. During virtual school, continued routines are important and interventions to optimize diabetes care in school may benefit glycemic control.

2.
Diabetes ; 70, 2021.
Article in English | ProQuest Central | ID: covidwho-1362283

ABSTRACT

Youth with type 1 diabetes spend half their waking weekday hours at school, yet little is known about glycemic control in school. Continuous glucose monitor (CGM) metrics for youth age 7-12 during school hours (8AM-3PM) were compared between weekdays and weekends for 14 days pre COVID-19. Youth with >70% CGM wear (n=214) were identified from a large academic center: 96% white, 46% male, mean (SD) age 10.6 (1.5) years, duration 3.5 (2.5) years, HbA1c 7.5 (0.8) %, 63% with an insulin pump. For weekday school hours, median TIR (70-180 mg/dL) was 52.4%;only 34 (15%) of youth met a TIR goal of >70%. Using random coefficient multilevel linear mixed models, TIR in school was significantly associated with younger age (p=0.008), shorter duration (p<0.001), and lower HbA1c (p<0.001), but not pump use (p=0.42). Weekday and weekend CGM metrics were clinically similar (Table), though TIR was statistically higher (p<0.001) and time high/very high (>180 mg/dL) lower on weekends (p<0.01). Time exhibited a significant fixed and random effect in mixed models;youth with lower TIR at 8AM tended to have larger improvements over subsequent hours. Notably, TIR early in the school day was nearly half of TIR during similar weekend hours, perhaps relating to sleep/meal schedules. Our data support that TIR in school is sub-optimal but may improve while in school, suggesting a benefit to school day routines and opportunity for improving glycemic control in school.

3.
Chest ; 160(6): 2123-2134, 2021 12.
Article in English | MEDLINE | ID: covidwho-1351575

ABSTRACT

BACKGROUND: Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the ICU. Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited. RESEARCH QUESTION: Has COVID-19 impacted global drug purchases of first-, second-, and third-choice agents used in intensive care? STUDY DESIGN AND METHODS: We conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world's population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April through August 2020, globally and by development status. RESULTS: Relative to 2019, ICU drug purchases increased by 23.6% (95% CI, 7.9%-37.9%) in March 2020 (P < .001) and then decreased by 10.3% (95% CI, -16.9% to -3.5%) from April through August (P = .006). Purchases for second-choice medicines changed the most, especially in developing countries (eg, 29.3% increase in March 2020). Despite similar relative changes (P = .88), absolute purchasing rates in developing nations remained low. The observed decrease from April through August 2020 was significant only in developed countries (-13.1%; 95% CI, -17.4% to -4.4%; P < .001). Country-level variation seemed unrelated to expected demand and health care infrastructure. INTERPRETATION: Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but before peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be purchased more easily in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends seemed unrelated to expected demand, and decreased purchasing from April through August 2020 may suggest overbuying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.


Subject(s)
COVID-19/therapy , Critical Care , Developed Countries , Developing Countries , Health Expenditures , Pharmaceutical Preparations , Adrenal Cortex Hormones/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Cardiovascular Agents/therapeutic use , Central Nervous System Agents/therapeutic use , Cross-Sectional Studies , Humans , Interrupted Time Series Analysis
4.
Addict Behav ; 114: 106726, 2021 03.
Article in English | MEDLINE | ID: covidwho-1070990

ABSTRACT

E-cigarette use has been increasing among middle school students. Intervention programs to prevent e-cigarette initiation administered by authority figures are met with more resistance from youth compared to peer-led programs. Therefore, this study aimed to assess the feasibility, acceptability, and implementation process of using social network analysis (SNA) to identify student peer leaders in schools and train them to deliver e-cigarette prevention programming to their peers. Nine schools were recruited to participate in the study during the 2019-2020 school year. Schools were assigned to one of three conditions: (1) expert; (2) peer-random (selected peer-leaders would teach to random students); and (3) peer-fixed (selected peer-leaders would teach to assigned students based on nominations). Study participation varied by day due to school attendance, with 686 participants at baseline and 608 at posttest. Almost all students who did not complete the study resulted from the interruption of schools being closed due to COVID-19. Implementation issues fell into three categories: (1) scheduling, (2) day-of logistics, and (3) student group dynamics. Overall, the results showed positive satisfaction among teachers, who unanimously found the program appropriate for the grade-level and that peer-leaders worked well within their groups. Peer-led students-both random and assigned-reported having more fun and willing to tell friends to try the program compared to expert-led students. This study demonstrated the feasibility of implementing a peer-led e-cigarette prevention program for 6th grade students, using SNA to provide intervention rigidity and validity.


Subject(s)
Leadership , Peer Group , Program Evaluation/methods , School Health Services , Vaping/prevention & control , Child , Cluster Analysis , Feasibility Studies , Female , Humans , Male , Pennsylvania , Prospective Studies , Students , Surveys and Questionnaires
5.
J Addict Med ; 15(6): 512-515, 2021.
Article in English | MEDLINE | ID: covidwho-978616

ABSTRACT

INTRODUCTION: COVID-19 and associated social distancing has presented challenges for individuals engaging in face-to-face mutual help groups (MHGs) such as Alcoholics Anonymous for alcohol use recovery. Online MHGs may be particularly appealing to individuals with limited access or inclination to attend in-person MHGs. We examined engagement within the popular "StopDrinking" online MHG, hypothesizing that engagement would increase due to demand for virtual peer support as COVID-19 social distancing progressed. METHODS: We collected publicly available engagement data for StopDrinking from February 19, 2018 through April 30, 2020 while considering March and April of 2020 as months initially impacted by voluntary or mandated COVID-19 social distancing. Using seasonal autoregressive integrated moving average models, we predicted daily engagement for this social distancing time period based on all available engagement data collected before April 2020. Kalman filtering with 95% prediction limits was employed to define significant thresholds for observed data to reside within. RESULTS: All days of observed engagement in March and April 2020 were lower than corresponding predicted values. Observed engagement fell below the lower 95% prediction limit for 36% of days, with 15 days in March and 7 days in April having significantly lower than predicted engagement. CONCLUSIONS: Relatively low activity on StopDrinking may signal broader population trends of problematic alcohol use and recovery disengagement during the initial COVID-19 social distancing timeframe. Continued investigation of online MHGs is needed to understand their potential for monitoring population health trends and to understand how such groups might support alcohol use recovery in contexts of crisis and isolation.


Subject(s)
COVID-19 , Alcohol Drinking/epidemiology , Humans , Physical Distancing , SARS-CoV-2
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