AWARENESS OF CLINICAL RESEARCH INCREASES AMONG UNDERREPRESENTED GROUPS

When initially surveyed between April and July of 2021, more respondents reported that they heard of clinical research studies looking for volunteers in the last six months compared to previous studies. Among all survey respondents, a significant increase in awareness of clinical research studies seeking volunteers was reported (63%) compared to 2019 (54%). Awareness of clinical research studies looking for volunteers was significantly higher among both Black (69%) and Hispanic (71%) respondents (Figure 1), as compared to those identifying as white (62%) or Non-Hispanic (61%). When asked how they became aware of clinical research studies looking for volunteers, top-cited sources for both Hispanic and Black respondents included: social media sites (38%, 40%);traditional advertisements (e.g., on TV, newspaper, radio;37%, 37%);and online advertisements (31%, 35%).

Remote Schooling and Mothers' Employment During the COVID-19 Pandemic by Race, Education, and Marital Status

Public schools in the United States saw unprecedented reductions to in-person instruction during the 2020–2021 school year. Using the Elementary School Operating Status database, the American Community Survey, and the Current Population Survey, we show remote instruction was associated with reduced employment among mothers compared with fathers and women without children. The gender gap in employment between mothers and fathers grew as much as 5 percentage points in areas with remote instruction. Compared to women without children, mothers' employment fell by as much as 2 percentage points under remote schooling. Employment disparities among mothers deepened by race, educational attainment, and marital status. We show employment disparities endured through spring 2021, even as many school districts returned to in-person instruction.

ASSOCIATION OF SOCIAL DETERMINANTS OF HEALTH AND COVID-19-RELATED BEHAVIORS WITH CERVICAL CANCER SCREENING IN HISPANIC WOMEN

While cervical cancer is highly preventable through early detection, Hispanic women are 40% more likely to develop cervical cancer and 20% more likely to die from the disease compared to non-Hispanic Whites (NHWs) in the U.S. Specifically, the COVID-19 pandemic resulted in decreased screenings due to safety concerns;however, very limited information is available to evaluate the COVID-19 disruptions on cervical cancer screenings among Hispanics. This study investigated the association of social determinants of health (SDOH) and COVID-19-related behaviors with cervical cancer screening among Hispanic women. The National Institutes of Health (NIH) All of Us data was utilized, in which Hispanic (N = 37,253), NHW (N = 75,756), and non-Hispanic Black (NHB;N = 32,325) women aged 21 to 65 years were included. Within- and between-group characteristics were analyzed using descriptive statistics. Differences in measured variables between Hispanic and NHW women were investigated by performing Wilcoxon test/Student's t-test for continuous variables and Pearson chi-square/Fisher's exact test for categorical variables. Logistic regression models were used to estimate nonadherence to cervical cancer screening. Data analysis was performed in R using Jupyter Notebook in the All of Us research workbench. The rate of cervical cancer screening averaged 2-3% for all ethnic groups, with Hispanic women consistently averaging lower than NHB and NHW women in 20172020 (p<.05). There was a noticeable drop in cervical cancer screening rates (0.92-1.03%) in 2021. Among the women adherent to cervical cancer screening, Hispanics demonstrated non-optimal SDOH and poorer general health status and lifestyle habits, as well as tended to be obese compared to NHWs. In Hispanics, social distance-related stress was significantly associated with adherence to cervical cancer screening during COVID-19 (p=.034). In the adjusted regression model with demographics, health status, and COVID-19 factors, the age group of 41-50, higher income, human papillomavirus (HPV) vaccination, and more social distance-related stress were associated with lower odds of nonadherence. Better general health status and 2nd COVID-19 vaccination were associated with higher odds of nonadherence. Our results suggest that SDOH and COVID-19-related behaviors are associated with cervical cancer screening in Hispanics. The knowledge gained could provide new insights into outreach efforts to prevent Hispanic individuals at risk from suffering the consequences of delayed screening and diagnosis and later-stage presentation of cervical cancer. The findings will inform future public health guidelines for planning Pap and HPV screening.

What I Learned Leading America's First Public School

If your loved ones have lived in Boston for even one generation, they know someone who graduated from or attended BLS for a period of time. [...]more recent years, the headmaster would assemble students in the auditorium on the first day of school and say, "Look to the left of you. In 2010, under Lynne Mooney Teta's leadership, honors classes, which had served as unnecessary barriers to Advanced Placement courses and also to track a school that was already tracked by nature of its selective admissions status, were eliminated. [...]most spend more hours with us than they do with their families. Before becoming the head of the school, I left for years of rich professional experiences elsewhere, including my first school-leader position as headmaster of Another Course to College (a small pilot high school within the Boston Public Schools), chief of staff for Boston Public Schools, and deputy chief of leadership development for D.C. Public Schools.

Outcomes of pediatric lupus care delivery in an electronic health record-based pediatric lupus registry

618 Table 2Factors associated with timely outpatient rheumatology follow-up RR 95% CI p-value Month of fol ow-up 0.99 [0.98 - 1.00] 0.09 Post-MOC 1.09 [0.93 - 1.28] 0.29 Age at visit 0.97 [0.94 – 1.00] 0.09 Male sex 0.92 [0.73 - 1.16] 0.49 Race/ethnicity  Reference: Non-Hispanic White -  Asian alone or in combination 1.20 [0.91 - 1.58] 0.19  Black alone or in combination 1.22 [0.92 - 1.62] 0.17  Hispanic White/Other 1.51 [1.15 - 1.99] 0.00  Non-Hispanic Other race 0.54 [0.28 - 1.02] 0.06 Social Vulnerability Index  Lowest  Medium Low 1.00 [0.75 - 1.33] 0.98  Medium High 0.94 [0.71 - 1.25] 0.68  Highest 1.03 [0.82 - 1.29] 0.82 Within 6 months of diagnosis at last visit 1.26 [1.05 - 1.53] 0.02 Prednisone use at last visit 1.17 [0.93 - 1.46] 0.17 SLEDAI score at last visit 1.02 [1.01 - 1.04] 0.01 Any DMARD use at last visit 1.52 [1.04 - 2.24] 0.03 History of synovitis 0.85 [0.70 - 1.05] 0.13 History of lupus nephritis 1.13 [0.95 - 1.35] 0.17 Estimates from modified robust Poisson models with subject-level random effects

Improving electronic portal use in groups with low utilization at a family medicine practice: OJNI

Background: Electronic patient portals benefit health outcomes;yet, they are underutilized in certain patient sub-populations including adolescents, adults over age 65, racial/ethnic minorities, and non-English-speaking patients. Purpose: This study describes a multi-faceted intervention to increase patient portal use and assesses the program’s effectiveness in these patient subgroups. Method: An intervention was developed with three areas of focus: 1) patient education, 2) provider engagement and education, and 3) health information technology engagement. Baseline data were collected for the entire patient population and segmented by sub-populations of interest. The percentage of patients with an active patient portal were monitored at 12 months and 18 months. Analysis: Logistic regression models examined the change in portal activation over time within sub-populations. Portalactivation increased significantly in all sub-populations examined (ranging from 5-12%), and changes in activation rate within sub-populations were consistent with other patient groups that were higher utilizers. Despite the significant increases, the disparities in portal activation remained. Results: This study suggests that, while disparities were not reduced, a multifaceted intervention involving patient education, provider engagement and education, health information technology increased activation in patient groups that are low utilizers. This increased activation is an important first step toward reducing disparities in patient portal use, which can impact patients’ experiences and outcomes. Patient portals are internet-based services that allow patients to view health records and appointment information and to submit requests for appointments and medication refills. The effective use of online patient portals through which patients can access their health information and communicate with their clinical team members has become increasingly important. The Centers for Medicaid and Medicare Services’ (n.d.) Medicare and Medicaid Promoting Interoperability Program Basics outline requirements for the use of electronic health records, a component of which is provider-to-patient exchange including patient electronic access to personal health information. Further, in the COVID-19 pandemic era during which telemedicine increased across many primary care practices, patient portals are instrumental in bridging care gaps. Patient portals are a potentially under-utilized resource with many actual and perceived barriers to its adoption ( Miller et al., 2016). Patient portal use benefits include improved patient satisfaction, patient-provider communication, patient self-management, and quality of care (Miller et al., 2016;Osborn et al., 2010;Zhong et al., 2020). Improved chronic disease monitoring and overall outcomes associated with diabetes, cholesterol and blood pressure control have been demonstrated among patients using electronic portals (Sorondo et al., 2016;Zhong et al., 2020). Furthermore, patient portal use can increase the utilization of health services resources. Zhong et al., (2020), demonstrated that patients who used a portal for messaging and laboratory functions had lower rates of appointment no-shows compared to non-users. Another study that examined healthcare utilization outcomes following a patient portal education intervention demonstrated a 21% decrease in emergency department admissions (per 1,000) and a 38% decrease in hospital admissions (per 1,000) after seven months (Goel et al., 2011). Despite the benefits of patient portal use, several disparities in activation and engagement are well-documented (elderly, racial and ethnic minorities, low health literacy, chronic illness, insurance status). Compared to non-Hispanic White patients, Latino and African-American patients are less likely to use a patient portal (Sarkar et al., 2011). The Health Information National Trends Survey suggested Hispanic and Black non-Hispanic patients are less likely to use patient portals and were less likely to be offered access to thei patient portal (Clarke et al., 2021). Patients with limited English proficiency (LEP) also lagged behind in patient portal utilization (Ancker et al., 2011). Older adults (aged 65+) are less likely to be willing or able to enroll in and use patient portals (Goel et al., 2011). Adults age 70+ are especially less likely to register for patient portals, own a digital device, use the Internet, or be willing to use an electronic platform for health management. Among older adults who do not use patient portals, common concerns are security of information, lack of personalization, and limited understanding of portal utility (Price-Haywood et al., 2017). Patient stakeholders have recommended strategies to increase portal use in older adults, including explaining to them what patients can do on portals, how to use portals, and why increasing portal use in older adults is useful (Price-Haywood et al., 2017). Another group with notable underutilization of patient portals is adolescents (Goldzweig et al., 2013;Olphert & Damodaran, 2013;Riippa et al., 2014). Despite adolescents being early adopters of technology, uptake of and engagement with patient portals has been challenging. In a feasibility assessment of a portal uptake intervention in adolescents, Ramsey et al., (2018), reported that most intervention participants felt there was a high need for access to the electronic health record through patient portals. Another study in a California detention center suggested 90% of 13-18 year olds were interested in accessing their health information (Irizarry et al., 2015). Despite this interest, rates of patient portal activation in youth are low. Specific Aims The transition to telemedicine for a large portion of patient care at the start of the COVID-19 pandemic placed an urgent emphasis on patient portal use and its benefits. Patient portals are helpful tools to assist patient-provider and patient-nursing communication, appointment scheduling, and the flow of telemedicine visits through delivery of secure links via messaging. The specific aim of this study was to assess the preliminary effectiveness of a practice-level, multi-faceted intervention - engaging patients, providers and information technology - on increasing the activation of patient portals among demographics known for underutilization (Black/African American, Hispanic, adults age 65+, adolescents aged 13-18, and non-English-speaking patients).  For patients under age 18, parents could activate the portal as a proxy and use the portal on the child’s behalf. Youth aged 13 and above were allowed confidential access to their patient portal and could grant parents proxy rights. The intervention was developed with the intention to benefit all patients at the practice;however, this study presents the assessment of effectiveness in underutilizers, comparing changes in portal activation status between these patients and the larger patient population. Understanding how practice-wide interventions impact underutilizers can provide beneficial information about whether targeted interventions are needed for sub-populations in the future.

COVID-19's Impact on Community-based Long-Term Services and Supports

The COVID-19 pandemic has had an enormous impact on older adults and people with disabilities everywhere, but one area that has not been fully examined is how it affected home- and community-based services (HCBS) systems. This article fills some of that gap and identifies how policy responses to COVID-19 deprioritized HCBS systems. It discusses the implications of this for consumers, providers, and government programs. The authors make recommendations for action to prepare for and better support HCBS in the future. The article also discusses the urgent need to strengthen the HCBS workforce. COVID-19 exacerbated the long-existing worker shortage, which must be addressed to meet the large and growing demand for HCBS.

Editorial innovation on social networks of the #CoronavirusFactCheck Alliance Hispanic verifiers: contents and vision of those responsible

Introducción: Este trabajo explora el uso de las redes sociales por medios hispanos de la #CoronavirusFactCheck Alliance de la International Fact-Checking Network (IFCN) ante la pandemia de la Covid-19 como herramientas para generar contenidos multimedia o interactivos innovadores con los que llegar a nuevos públicos y aumentar su visibilidad. Metodología: Mediante la observación y el análisis de los canales en red se identifican casos relevantes de adaptación de contenidos y se catalogan prácticas innovadoras. Y, a través de entrevistas en profundidad a sus promotores, se determina si esta producción se plantea como estrategia editorial y se recogen percepciones sobre limitaciones, posibilidades y proyectos futuros de contenidos innovadores en red. Resultados: Al margen de la presencia generalizada en Twitter y Facebook, las mayores innovaciones se dan sobre contenidos audiovisuales y sonoros, que van desde resúmenes y curación de contenidos a lo explicativo. Se realizan a través de redes como YouTube, Instagram e incluso TikTok, Twitch y canales de podcasting, empleando narrativas adaptadas a estos canales. Conclusiones: En el marco de determinada estrategia o de forma táctica, más allá de informar, los verificadores buscan formar y movilizar a las audiencias en la lucha contra la infodemia con formatos atractivos, comprensibles y viralizables desde los propios canales donde fluye la desinformación. Si bien algunos cuentan con recursos limitados, participar en la IFCN abre nuevas oportunidades para la innovación editorial.Alternate :Introduction: This work explores the use of social networks by the Hispanic platforms of the #CoronavirusFactCheck Alliance of the International Fact-Checking Network (IFCN) in the Covid-19 pandemic, as tools to generate innovative multimedia or interactive content with which to reach new audiences and expand their visibility. Methodology: By observing and analyzing network channels, we identified relevant cases of adapted digital content and we catalog innovative practices. And through in-depth interviews with its promoters, we determine if this production is considered as an editorial strategy and we collect their perceptions about limitations, possibilities, and future projects of online innovative content. Results: Apart from the generalized presence on Twitter and Facebook, the greatest innovations are materialized in videos and podcasts, ranging from summaries and curation of content to explanatory. They are carried out through networks such as YouTube, Instagram, and even TikTok, Twitch, and podcasting channels, using narratives adapted to these channels. Conclusions: These practices, developed within the framework of a certain strategy or tactically, seek in addition to informing, training, and mobilizing audiences in the fight against the infodemic with attractive, understandable, and viralizable formats from the same channels where disinformation flows. Although some verifiers have limited resources, joining IFCN opens up new opportunities for editorial innovation

Cohort profile: The Bariatric Experience Long Term (BELONG): a long-term prospective study to understand the psychosocial, environmental, health and behavioural predictors of weight loss and regain in patients who have bariatric surgery

PurposeThe Bariatric Experience Long Term (BELONG) prospective study cohort was created to address limitations in the literature regarding the relationship between surgical weight loss and psychosocial, health, behaviour and environmental factors. The BELONG cohort is unique because it contains 70% gastric sleeve and 64% patients with non-white race/ethnicity and was developed with strong stakeholder engagement including patients and providers.ParticipantsThe BELONG cohort study included 1975 patients preparing to have bariatric surgery who completed a baseline survey in a large integrated health system in Southern California. Patients were primarily women (84%), either black or Hispanic (59%), with a body mass index (BMI) of 45.1±7.4 kg/m2, age 43.3±11.5 years old, and 32% had at least one comorbidity.Findings to dateA total of 5552 patients were approached before surgery between February 2016 and May 2017, and 1975 (42%) completed a baseline survey. A total of 1203 (73%) patients completed the year 1 and 1033 (74%) patients completed the year 3 postoperative survey. Of these survey respondents, 1341 at baseline, 999 at year 1, and 951 at year 3 were included in the analyses of all survey and weight outcome data. A total of 803 (60% of eligible patients) had survey data for all time points. Data collected were self-reported constructs to support the proposed theoretical model. Height, weight and BMI were ed from the electronic medical record to obtain the main outcomes of the study: weight loss and regain.Future plansWe will collect self-reported constructs and obtain height, weight and BMI from the electronic medical record 5 years after bariatric surgery between April 2022 and January 2023. We will also collect patient experiences using focus groups of 8–12 patients each throughout 2022.

The POTENCY of EVIDENCE

Engage Students do a whole-class brainstorm on the different races and ethnicities in America, then use their inquiry skills and current conceptions on diffusion to investigate population density and the rate of spread of the coronavirus. Mimicking the spread of coronavirus by diffusion of particulate matter in the air, students use an interactive simulation platform (PhET) to depict the relationship between population density and COVID cases. Draw a bar graph to represent total coronavirus cases in the counties. * What county has the most COVID cases? * What county has the least cases? * If you combine the number of cases in two predominantly white communities, how would that compare to one mostly Black/African American? * Are more COVID cases identified in counties with large populations or small populations? * What is the difference in the number of cases between Whites and Blacks? * What is the difference in the number of cases between Whites and Hispanics? * What conclusion can you make about the differences between COVID-19 cases between races? * Does the graph affect your opinion about the COVID-19 infection rate? * Infer: Why is there a difference in COVID-19 cases between races? * What do you think the data would look like for even more populated countries? * If as many Blacks as Whites had the same access to health care, do you think the total cases would be the same? * Why is there a difference in the number of cases between races? [...]it follows that the number of Blacks and Hispanics with acute difficulties paying their bills or mortgages increased sharply compared to Whites. [...]it is only logical that psychological and mental stress is most prevalent among Hispanics who cannot meet with basic needs.

Liver Steatosis: A Marker of Metabolic Risk in Children

Obesity is one of the greatest health challenges affecting children of all ages and ethnicities. Almost 19% of children and adolescents worldwide are overweight or obese, with an upward trend in the last decades. These reports imply an increased risk of fat accumulation in hepatic cells leading to a series of histological hepatic damages gathered under the acronym NAFLD (Non-Alcoholic Fatty Liver Disease). Due to the complex dynamics underlying this condition, it has been recently renamed as ‘Metabolic Dysfunction Associated Fatty Liver Disease (MAFLD)’, supporting the hypothesis that hepatic steatosis is a key component of the large group of clinical and laboratory abnormalities of Metabolic Syndrome (MetS). This review aims to share the latest scientific knowledge on MAFLD in children in an attempt to offer novel insights into the complex dynamics underlying this condition, focusing on the novel molecular aspects. Although there is still no treatment with a proven efficacy for this condition, starting from the molecular basis of the disease, MAFLD’s therapeutic landscape is rapidly expanding, and different medications seem to act as modifiers of liver steatosis, inflammation, and fibrosis.

Evaluation of an After-School Program for African-American and Hispanic Male Youth: Please Call Me Mister

The novel coronavirus significantly impacted the lives of people worldwide. In the United States, the lives of children and youth were disrupted with school closures and lack of access to afterschool programs they previously attended. African American and Hispanic boys attending an after-school program in Franklin County, Kentucky, called Please Call Me Mister, were among the young people affected. A study was conducted to assess the impact of the afterschool program. The boys were surveyed at the start of the program in November 2017 and again in November 2020 to assess their injury risk, substance use, future orientation, resilience, and exposure to cyberbullying. It was anticipated that the COVID-19 pandemic and associated stay-at-home orders would negatively impact program outcomes. Program participants showed outstanding resilience and resistance to most negative behaviors with the exception of marijuana use that increased though not significantly. Their level of depression decreased, but remained at a level that warrants concern. The data collected suggest that the Please Call Me Mister program that continued remotely throughout the pandemic had an overall, long-term, positive impact on program participants. Key Take Away Points •Afterschool programs offer benefit for improving behavioral outcomes among African American and Hispanic male program participants. •Long-term participation in after-school program may positively impact participants’ resilience. •The potential negative mental health consequences of the COVID-19 pandemic were lessened due to African American and Hispanic males’ involvement in an afterschool program.

Introduction to Special Issue on “Social Justice in Agricultural and Environmental Economics”

Whereas, addressing food insecurity sheds light on public health problems in weight control, nutritional monitoring, and chronic and life-threatening illnesses (Campbell, 1991;Gunderson and Ziliak, 2015;Seligman etal., 2007, 2010), which are generally attributable to economic disparities (Coleman-Jenson etal. 2018). [...]food insecurity has increased as a result of labor market pressures, leading to joblessness, income losses, and supply chain disruptions (United Nations 2020;Cardoso etal., 2021;Udmale etal., 2020). [...]varying aspects of agricultural disparities have warranted much attention because of their global implications for food insecurity (O’Hara and Toussaint, 2021;Power etal., 2020;Battersby, 2020;Liverpool-Tasie etal., 2021). [...]behavioral food demands and agricultural supply chains have become important for the social justice perspective in agriculture. If teaching healthy food habits has a limited impact on sustainable demand for healthy food (Janda etal. 2021), then areas where food worries, supplemental assistance, poor access to healthy food options, and environmental health concerns are insurmountable experience institutional barriers to agricultural demand (Clay and Rogus, 2021;Wolfson and Leung CW, 2020 (1 and 2);Niles etal. 2020;Rosas etal. 2022).

Cancer death rates continue to decline, but 'more work ahead' toward prevention

The American Cancer Society, CDC, NCI and North American Association of Central Cancer Registries collaborated to compile the report, which provided updates on trends in cancer incidence and death rates using data on new cancer diagnoses between 2001 and 2016 and cancer deaths between 2001 and 2017. Among women of all racial and ethnic groups, cancer incidence rates increased by 0.2% annually between 2012 and 2016, driven by increases in liver cancer (AAPC, 3.7%), melanoma (1.9%), uterine cancer (1.3%), myeloma (1.2%), pancreatic cancer (1%), kidney cancer (0.6%), breast cancer (0.5%) and oral cavity and pharyngeal cancer (0.5%). Derek Raghavan, MD, PhD, president of Levine Cancer Institute at Atrium Health and HemOnc Todays Chief Medical Editor for Oncology, commented: "Every day, clinicians on the line integrate the products ofbasic research with high-quality, ethical clinical trials and service delivery, balancing against the impact of rightto-try legislation, and now are putting their lives on the line in trying to maintain these gains during the [COVID-19] crisis." - by John DeRosier Disclosures: The researchers report no relevant financial disclosures.