Pandemic Challenges and Opportunities for Gender Equity in Clinical Research

In the arena of clinical research, gender equity accelerates research excellence: we need multiple perspectives and all the brain power we can muster to maximize research productivity and quality. [...]women physician investigators enhance enrollment of women as participants in clinical trials, which is crucial to our ability to generalize from the data and to maintain the health of women. Women are underrepresented among academic grand rounds speakers,14 speakers at medical conferences15, and award recipients from medical specialty societies.16 Time pressure is especially intense on young women faculty. Besides spending more time on domestic chores, they spend more time at work on teaching, service, and mentoring. Female primary care physicians spend more time with patients.22 Elderly hospitalized patients treated by female internists experience lower mortality and readmission rates.23 Patients undergoing coronary artery bypass grafting had shorter hospital length of stay when treated by an all-female physician team as compared with an all-male team.24 Female patients treated by male physicians following acute myocardial infarction have higher mortality than those treated by female physicians.25 Sex discordance between patient and surgeon is associated with increased likelihood of adverse postoperative outcomes-and that observation that is driven by worse outcomes for female patients treated by male physicians.26 Clinical trials play a fundamental role in bringing new medications and interventions to our patients, yet women have often been excluded from participation. Among 60 randomized controlled trials (RCTs) of lipidlowering therapies reported between 1990 and 2018, there was a modest increase in enrollment of women over time, but women remain underrepresented compared with the relative burden of disease.30 In another study of 317 RCTs of heart failure with reduced ejection fraction published in highimpact journals over the past 20 years, only 25% of participants overall were female, and females were under-enrolled in 72% of these trials.

What about the baby? Infancy and parenting in the COVID-19 pandemic

This article reviews the evolution of a newborn through the first year of life and the potential impacts of COVID-19 on the infant, parent, and the parent-infant relationship. Babies grow in the context of relationships, and the quality of those relationships affects the physiological and psychological organization of the baby. Precisely because each baby is a being with unique biology, temperament, and ways of experiencing, feeling, and learning, much is to be discovered and understood about them. The baby's wordless communications require their parents to intuit, infer, hypothesize, and experiment as parents come to know the needs of their baby. As we walk alongside parents who struggle to come to know their infant-even as the infant is coming to know them-we are required to have conceptual knowledge of how a newborn becomes a fully awakened infant. Under typical conditions, the birth of a firstborn baby presents a caregiving challenge and developmental opportunity for the emerging parent. Environmental context can serve to support or interfere in the success of the adjustment. This paper will explore some theoretical underpinnings that contribute to infant and parent well-being and the possible impact of being born during the COVID-19 pandemic. Also considered will be the undue burden of families bearing the weight of economic inequities, oppression, and structurally supported racism. This article will explore the influence of parental perception, the development of attachment relationships, and how that is influenced by and influences infant communication. Finally, it will suggest ways that psychotherapists seeing individuals who are parents can hold the infant in mind as they work to understand and respond to their adult clients navigating the impacts of this pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Policy, Practice, and Parenthood: A Study of Teacher Mothers

This phenomenological study extends the current research on working mothers to teacher mothers. Themes highlighted include work/life enrichment, support for motherhood role, challenge to find balance, challenging cultural norms, financial challenges, and strategies for managing multiple roles. Findings reveal and highlight challenges and opportunities that exist at the intersection of the field of education and motherhood. Also provided are suggestions for advocacy efforts for norms and policies that support teacher mothers. Implications of this work are particularly relevant in the contemporary era, wherein the roles of motherhood and teacher are intensified by "the shift to online learning" as a result of the pandemic.

Daily stress, family functioning and mental health among Palestinian couples in Israel during COVID-19: A moderated mediation model

The COVID-19 pandemic created a range of stressors, among them difficulties related to work conditions, financial changes, lack of childcare, and confinement or isolation due to social distancing. Among families and married individuals, these stressors were often expressed in additional daily hassles, with an influence on mental health. This study examined two moderated mediation models based on Bodenmann's systemic-transactional stress model. Specifically, the models tested the hypothesis that intra-dyadic stress mediates the association between extra-dyadic stress and mental health, while two measures of family functioning, cohesion and flexibility, moderate the relationship between extra and intra-dyadic stress. Participants were 480 Palestinian adults in Israel who completed self-report questionnaires. All were in opposite-sex marriages and identified as either cisgender women or cisgender men. The results showed partial mediation patterns supporting both models, indicating that family cohesion and flexibility weakened the mediating effect of intra-dyadic stress on the relationship between extra-dyadic stress and mental health. These findings increase our understanding of the variables that affected mental health during the pandemic, and suggest that when faced with extra-dyadic stress, married individuals with good family environments are less likely to experience high levels of intra-dyadic stress, which is in turn associated with preserved mental health. Limitations and implications for planning interventions for couples and families during the pandemic are discussed.

Putting the 'virtual' into supervision during the covid-19 pandemic and beyond

This study examined the experiences of practicing Children's Services Social Workers in a London Local Authority accessing virtual (online) social work supervision during the COVID-19 pandemic between March 2020 and January 2021. This study applied a reflective framework and guiding theories for exploring how supervision brings opportunities for reflective learning, and it considered individual needs within supervision. Study methods comprised an anonymised online questionnaire and semi-structured interviews. Twenty-two participants completed the questionnaire, and eight participants took part in the semi-structured interviews. This research aimed to explore the impacts on practitioners of the change from face-to-face to 'virtual' supervision and if all core elements of supervision are addressed. The findings suggest that there was a mixed experience for supervisees with some elements of the supervision functions being consistently met, and others being more variable. Generally, participants found virtual supervision a positive experience, whilst however missing some face-to-face elements. Having a pre-existing relationship with the supervisor was noted to help, and connectivity was also highlighted as important. However, for some participants, particular elements of supervision appeared to have been missed altogether such as Continuing Professional Development (CPD), and part of the Mediation function. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Learning from the coronavirus pandemic about the future of family support services a focus group study with parents and professionals

Background: The onset of the coronavirus pandemic created diverse stressors for families with small children such as isolation, limited public and private childcare options, and balancing work and childcare. Fear of the future, feelings of uncertainty and loneliness led to a rise in mental health problems. Public family support services also faced significant challenges: while families felt more need for support, established means of reaching families and providing services were severely curtailed. Objectives: The current study aimed at capturing pandemic-related changes in family needs and at documenting experiences in the use of newly developed analog and digital services provided by public family support institutions in the city of Hamburg, Germany. Materials and methods: We conducted focus groups with staff members of different types of public family support services and parents who were using these services. Central topics of discussion were pandemic-related experiences and ideas for the future of public family support services. Results: Results confirm an increase in family pressures. Parents and staff members missed low-threshold accessibility of services and personal contact and dialogue. Creative approaches to complement services digitally were developed. Several of these approaches were considered beneficial, especially for reaching new target groups and strengthening interprofessional cooperation in the field. Conclusions: In-person support services need to be upheld. However, digital services can effectively complement analog formats. A successful combination requires effective resource distribution and staff member qualification measures.

A review of state regulations for child care: Preventing, recognizing and reporting child maltreatment.

BACKGROUND: Prior to the COVID-19 pandemic, nearly 60% of children under 5 years of age were cared for in out-of-home child care arrangements in the United States. Thus, child care provides an opportunity to identify and address potential child maltreatment. However, during the pandemic, rates of reporting child maltreatment decreased-likely because children spent less time in the presence of mandated reporters. As children return to child care, states must have regulations in place to help child care providers prevent, recognize and report child maltreatment. However, little is known about the extent to which state regulations address child maltreatment. Therefore, the purpose of this cross-sectional study was to assess state regulations related to child maltreatment and compare them to national standards. METHOD: We reviewed state regulations for all 50 states and the District of Columbia for child care centres ('centres') and family child care homes ('homes') through 31 July 2021 and compared these regulations to eight national health and safety standards on child maltreatment. We coded regulations as either not meeting, partially meeting or fully meeting each standard. RESULTS: Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations consistent with the standards requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes. CONCLUSIONS: Generally, states lacked regulations related to the prevention, recognition and reporting of child maltreatment for both centres and homes. Encouraging states to adopt regulations that meet national standards and further exploring their impact on child welfare are important next steps.

The State of Childcare: Exploring Childcare Center Directors' Perceptions on the Past, Present, and Future

The purpose of this exploratory study was to examine childcare directors' perceptions of the state of childcare centers throughout southwest Ohio. Seventeen directors were surveyed regarding the changes they have witnessed over the past decade, and how they envision the future of childcare. The results indicated that the childcare field has experienced many challenging issues such as, teacher retention, a lack of professionalism, and an increase in children's behavior problems. In addition, directors discussed the need for higher pay and incentives to attract (and keep) qualified teachers. With added requirements from Ohio's Quality Rating Improvement System (QRIS), program directors were feeling overwhelmed and stressed. The COVID-19 pandemic also put a significant financial strain on programs, however, some directors believed that the pandemic also helped to recognize the importance of childcare. The article concludes with recommendations for the future, and possible strategies to address the concerns discussed by the directors.

Childcare Directors' Perceptions of the Past Decade and What the Future Holds

In an effort to learn more about childcare directors' perceptions, this study surveyed seventeen directors in southwest Ohio. The participants were asked about specific challenges they have experienced over the last decade, and how they envision the future of childcare. The results revealed that the topics most commonly discussed by directors were related to teacher shortages, retention of staff, and an increase in children's behavior problems. The COVID-19 pandemic exacerbated many of the issues mentioned by directors, especially with the addition of new state, federal, and licensing requirements. Many also feared the permanent closure of centers due to financial strains and a lack of resources at the state and federal level. The article concludes with implications for childcare directors to be able to move forward and continue providing high-quality care and education for children and families.

Sleep quality of first-line medical workers fighting against COVID-19 in Wuhan

[Background] Sleep is closely related to immune function and human health, and adequate sleep is an important foundation for human health. [Objective] This study investigates the sleep status of the first-line medical staff in Wuhan in a fight against the coronavirus disease 2019 (COVID-19) outbreak, provides reference for improving the sleep quality of the first-line medical staff in public health emergencies. [Methods] Through convenience sampling, 112 medical workers (first-line group) who aided the COVID-19 fight in Wuhan and 134 medical staff (non-first-line group) who did not participate in the fight were selected. The Pittsburgh Sleep Quality Index (PSQI) was employed to collect data on the incidence of sleep disorders, time to fall asleep, duration of sleep, sleep efficiency, sleep disorders, use of sleep aid, and daytime functions. In addition, a self-made questionnaire was used to investigate the common concerns and time allocation characteristics of the first-line medical workers in the context of major infectious disease outbreaks. [Results] There were no significant differences between the two groups in demographic variables such as gender, age, job title, educational background, marriage status, number of children, and working years (P > 0.05). In the first-line group, 62 medical workers (55.36%) reported sleep disorders, while in the non-first-line group, 54 medical workers (40.30%) did;the difference was statistically significant (P=0.008). Among the seven components of the PSQI, the median sleep time (component 3) score of the first-line group was 1.5, which was higher than that of the non-first-line group (median 1.0) (P < 0.001);the median sleep efficiency (component 4) score of the first-line group was 1.0, which was higher than that of the non-first-line group (median 0) (P < 0.001). The actual sleep duration of the first-line group [(5.65+/-1.15) h] was lower than that of the non-first-line group [(7.00+/-1.40) h] (P < 0.001). The distributions of common concerns were different between the two group. The top three concerns were being infected (76.79%), exhausted (37.50%), and overloaded (27.68%) in the first-line group, and family members being infected (53.73%), being infected (45.52%), and child care (33.58%) in the non-first-line group. [Conclusion] The first-line medical team members report poor sleep quality, short sleep time, low sleep efficiency, sleep disorders, and many psychological concerns. It is necessary to take appropriate measures to improve their sleep quality.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

Disruptions in Health Care among Mwccs Participants during the Covid-19 Pandemic

Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.

Classics and the Precariat

WHEN I (CHIARA) TOOK UP MY POSITION at Vanderbilt in 2016, I was given a one-year contract. Since I teach at a well-resourced university, there was a network of child care centers where I could enroll my child—a nice perk that many academic jobs do not include. While those with full-time or tenure-stream positions may not have had to worry about health insurance coverage or paid sick leave (Douglas-Gabriel 2020), questions continue to abound over hiring, pay freezes or cuts (Woolston 2021), parental leave policies and tenure clock extensions, as colleges and universities have scrambled to develop clear and equitable responses to the crisis. [...]the grand revelation of COVID is that, in the words of Chris Caterine, author of Leaving Academia, "All faculty are contingent.” For this reason, programs should be encouraged to work toward converting long-term contingent faculty members into tenured or tenure-track hires whenever possible, or to ensure that contingent positions have as much security and permanence as possible through the use of longer-term contracts.

Can You Spare 100 Days? Allogeneic Hematopoietic Cell Transplant Caregiver Requirements from the Perspective of Recipients and Caregivers

Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for individuals diagnosed with blood cancers (e.g., acute myeloid leukemia) and blood disorders (e.g., sickle cell disease). Most transplant centers (TCs) require a caregiver to proceed with alloHCT. Caregiver requirements can be one of many barriers to alloHCT, as individuals without a caregiver can have limited or no access to this treatment. Few studies have described TC caregiver requirements, particularly from the perspective of recipients and caregivers. To learn more about alloHCT caregiver requirements and perspectives on those requirements, we conducted web-based interviews with adult alloHCT recipients and adult caregivers of adult alloHCT recipients in the United States (US) starting in May 2022. Recipients needed to be between 100 days and 1-year post-HCT and in remission;Table 1 describes participant demographics.(Table Presented)The majority of participants noted that their TC required a caregiver to proceed to alloHCT;however, there was variation in the length of time required to have a caregiver. When asked their perspective on the amount of time the TC required, the majority of participants noted that the actual length of time depended on the recipient's recovery (with some noting more time was needed and others noting less). Participants were also asked to share barriers they faced regarding the caregiver role. A common barrier included not fully understanding the specifics of the caregiver requirements, or what it would entail. Some recipients described being provided with too much information, making it difficult to sort through, while others reported feeling like they did not receive enough information. Other barriers identified by recipients included competing priorities of the caregiver (such as work/ home responsibilities and childcare), language barriers, and finances. Common barriers identified by caregivers included: feeling like they could not take time for themselves/their own health suffered and needing to be trained to perform medical tasks. Many recipients and caregivers also noted the impact of the COVID-19 pandemic (e.g., postponing alloHCT, trepidation about going to the TC, post-alloHCT housing restrictions, and increased telework for caregivers). Preliminary analysis of recipients and caregivers interviews showed variation in caregiver requirements across TCs. There is a need for clear, accessible information to help recipients and caregivers understand the caregiver role and requirements. This study included recipients and caregivers;further research is needed to identify barriers faced by individuals unable to access alloHCT. Results from this study will help facilitate the development of programs to help improve access to alloHCT.Copyright © 2023 American Society for Transplantation and Cellular Therapy

A qualitative life course perspective on covid-lockdowns and couples? division of unpaid labour

Covid-19 lockdowns in many countries were characterised by increases in unpaid labour (e.g. home-schooling), as well as changing working conditions (e.g. remote work). Consequently, a large body of research assesses changes in dual earner couples' gender division of unpaid labour. However, despite the increasingly detailed picture of households' division of labour before and after the onset of the pandemic, it remains unclear how dual earner parents themselves perceive their decision-making regarding labour divisions during lockdowns. Conse-quently, using data from 31 individual in-depth interviews in Belgium, this study adopts a biographical -interpretative method to assess variation in narratives regarding the household division of labour before and during lockdown. Results indicate five ideal type narratives which vary in the extent to which lockdown divisions of unpaid labour exhibit path-dependency or constitute new gender dynamics, but also regarding the balance between individual agency and societal factors as determinants of labour divisions. Taken together, narratives discussing new gender dynamics during lockdowns put forward sector-specific changes in working hours and remote work as external and exogenous determinants. However, most importantly, findings indicate that household decision-making regarding unpaid labour during lockdowns is mostly perceived as path-dependent on pre-covid decision-making (e.g. gender specialisation) in the context of structural (e.g. gendered leave schemes) and normative boundaries (e.g. gendered parenting norms). Such path-dependencies in the decision-making underlying quantitatively identifiable divisions of unpaid labour during lockdowns are likely to be neglected in the absence of a qualitative life course perspective.

Addressing the unmet social needs of gynecologic oncology patients as identified by a universal screening tool in a safety net hospital

Objectives: To identify the unmet, actionable social needs of gynecologic oncology patients using a self-administered social needs assessment tool and quantify the interventions subsequently provided to our patients. Method(s): This is a study of data collected in an ongoing performance improvement initiative in a gynecologic oncology clinic at a safety net hospital and was determined to be exempt from review by the institutional IRB. Eligible patients completed the social needs screening tool from October 2021 to March 2022. The following social needs domains were assessed: food insecurity, utility insecurity, housing insecurity, transportation insecurity, need for childcare, exposure to violence, lack of companionship, difficulty reading, or difficulty accessing medical care due to fear of losing job. Patients were asked if they desired to speak with a social worker and if any needs were urgent. Data from the screening tool was collected and supplemented by data from the EMR. Univariate descriptive statistics were used to report the patient demographic information, prevalence of social needs, and referral rates for social needs identified. Result(s): There were 475 patients seen in the gynecologic oncology clinic since October 2021. 286 (60%) patients completed the screening tool. 139 (49%) screened positive for at least 1 social need;of those 98 (70%) were Hispanic with a median age of 56 years. 27 (6%) patients were receiving treatment for a gynecologic malignancy, of whom 19 (70%) had at least 1 social need. 25 (92%) patients were insured through Medi-Cal. 12 (44%) patients were being treated for endometrial cancer, followed by ovarian (7, 26%) and cervical (4, 15%). The social needs identified in all patients and in patients actively receiving cancer treatment are summarized in Fig. 1. Patients reporting lack of companionship were referred to mental health or cancer support groups through the American Cancer Society or the Los Angeles County Department of Public Health. Those needing transportation or utility services were linked with services available through their insurance or LA County, ride share vouchers, low-income energy assistance programs, COVID rent/mortgage relief programs. Patients with food and housing insecurity were assisted in applying for public housing or food stamps;local food banks were provided. Patients were assisted with applying for disability insurance as needed. To date, all actively treated patients reporting lack of companionship, need for transportation, avoiding medical care for fear of losing their job, and utility insecurity were provided resources;80% received resources for food insecurity. Conclusion(s): Universal screening for social needs in gynecologic cancer patients identifies a high rate of unmet needs within a safety net hospital. Cancer care navigators can successfully provide these patients community-based resources tailored to their individual social needs. Our next steps will be to determine if and how these resources impact our patients' experiences and treatment outcomes.[Formula presented]Copyright © 2022 Elsevier Inc.

Lessons learned from COVID-19: provider suggestions for improving service delivery in sexual violence resource centers and children's advocacy centers in Kentucky

The COVID-19 pandemic has presented unique challenges for human service providers, especially as face-to-face services were limited by both formal and informal efforts to protect public health. Telehealth has emerged as a main strategy to ensure continuity of care. This study explored adaptations to services in child advocacy centers (CACs) and sexual violence resource centers (SVRCs) across the Commonwealth of Kentucky, particularly using telehealth. This study highlights respondents' suggestions about improving these service delivery systems and the particular emphasis on challenges and strengths of telehealth for reaching those in rural areas.

Pandemic Depression: COVID-19 and the Mental Health of the Self-Employed: ET&P

We investigate the effect of the COVID-19 pandemic on self-employed people's mental health. Using representative longitudinal survey data from Germany, we reveal differential effects by gender: whereas self-employed women experienced a substantial deterioration in their mental health, self-employed men displayed no significant changes up to early 2021. Financial losses are important in explaining these differences. In addition, we find larger mental health responses among self-employed women who were directly affected by government-imposed restrictions and bore an increased childcare burden due to school and daycare closures. We also find that self-employed individuals who are more resilient coped better with the crisis.

In brief

Research shows that while inhaling gas and air (Entonox) in labour is safe for mothers and babies, long-term cumulative exposure may carry health risks. Work notice The right to strike The UK government's Strikes (Minimum Service Levels) Bill is, at the time of going to press, at the committee stage in the House of Lords (the first chance for line-by-line examination). Visit bit.ly/ Clementine-register Working mums Maternity leave Careers After Babies research has found that of 848 mothers interviewed, 98% want to return to work after having a child but just 13% can make it work full-time, citing the cost of childcare and lack of flexibility from businesses as the reason. Find out more at hegenbergermedical.com/training Research Healthy eating support Researchers at the University of Hertfordshire are calling for better information on diet and nutrition to be made available to expectant parents.

Mental health of caregivers of children with neurodevelopmental disorders during the pandemic.

Caregivers are especially likely to be more psychologically affected during the social and health care system constraints generated by the COVID-19 pandemic. Caregivers of children with neurodevelopmental disorders (i.e., autism, intellectual disability, attention deficit, hyperactivity, motor disability) have a more essential role than caregivers of healthy children. A quantitative cross-sectional study was designed, using descriptive, comparative and correlational statistical techniques to analyze health-related quality of life, emotional distress and overload in four subgroups of caregivers, classified according to the child's diagnosis. A total of 132 caregivers (86.4% women) were included. In group 1 (cognitive disability), 28 caregivers participated;in group 2 (ADHD), 51 were included;in group 3 (autism spectrum disorder), 33 caregivers participated, and in group 4 (motor disability), 20 were included. The main findings of this study were: i) alterations in physical role, bodily pain, general health and vitality;ii) very low percentages of depression, anxiety, stress and overload symptomatology;iii) differences in social functioning between the motor disability and ADHD groups;and in stress and overload between the autism and motor disability groups;and iv) moderate correlations between the dimensions of bodily pain and emotional role and depression, anxiety, stress and overload. It was concluded that there is more impairment in variables associated with physical health than with mental health.Copyright © 2023