Psychological status and influencing factors of nurse in a Women and Children Hospital under normalized prevention and control of COVID-19 epidemic.

Objective To survey the psychological reaction status and influencing factors of the nurses in a class 3A hospital of Chengdu under the normalized prevention and control of COVID-19 epidemic to provide a theoretical basis for the related department of the hospital formulating the interventional strategy. Methods The cluster sampling methods was used to select 1 079 nurses in a class 3A Women and Children Specialized Hospital of Chengdu City as the study subjects under trending to normalized prevention and control after the outbreak of the novel coronavirus infection from May to June 2021.The self-made general data qestionnaire, Generalized Anxiety Disorder（GAD-7) scale and Maslach Burnout Inventory (MBI) were used to conduct the questionnaire survey, and the SPSS25.0 statistical soft was used for conducting the data analysis. Results Among 1 079 nurses, 304 nurses（28.2%） had the GAD-7 score ≥5 points, which was correlated with the education background, working years, professional and technical posts, working post during the epidemic, awareness of the impact of COVID-19 on work and social and family support, and the differences were statistically significant（P＜0.05）.In the work burnout scale, the subjects with meddle and high levels in the emotion burnout sense, work apathy sense and work non-achievement sense accounted for 40.7%（439/1 079）,33.3%（359/1 079） and 65.7%（709/1 079） respectively. Different professional and technical positions, work position and social and family support during the epidemic had the influence on the level of emotional burnout, different professional and technical posts, work positions during epidemic had the influence on the work apathy sense, different the educational backgrounds and profesional and technical posts and work posts during epidemic had the influence on the work non-achievement sense, and the differences were statistically significant（P＜0.05）.The nurses in the first line epidemic prevention posts had significant work burnout sense. Conclusion The nurses had a certain degree of anxiety and work burnout sense from COVID-19 epidemic outbreak to the normalized prevention and control, which needs to give the psychological support and better prevention and control strategies. (English) [ FROM AUTHOR] 目的 调查成都某三甲妇女儿童医院护士在新型冠状病毒感染(新冠)疫情常态化防控下心理反应状况及影响因素，为医院相关部门制定干预策略提供理论依据。方法 采用整群抽样方法选取2021年5-6月新冠疫情暴发流行后逐渐趋于常态化防控下成都市某三甲妇女儿童专科医院护士1 079名作为研究对象，使用自制一般资料问卷、广泛性焦虑量表、工作倦怠感量表对其进行问卷调查，采用 SPSS25.0 统计软件进行数据分析。结果 1 079名护士中广泛性焦虑量表评分大于或等于5分者304名(28.2%),与学历、工作年限、专业技术职务、疫情防控期间所在工作岗位、新冠疫情对工作影响的认知、社会家庭支持相关，差异均有统计学意义(P＜0.05);工作倦怠感量表的情感倦怠感、工作冷漠感、工作无成就感的中、高水平者分别占40.7%(439/1 079)、33.3%(359/1 079)、65.7%(709/1 079),不同专业技术职务、疫情防控期间所在工作岗位、社会家庭支持对情感倦怠感水平有影响，不同专业技术职务、疫情防控期间所在工作岗位对工作冷漠感有影响，不同学历、专业技术职务、疫情防控期间所在工作岗位对工作无成就感有影响，差异均有统计学意义(P＜0.05),一线防疫岗位护士有明显的工作倦怠感。结论 新冠疫情暴发至常态化防控下护士存在一定程度的焦虑症状和工作倦怠感，需要给予心理支持及更好的防控策略 (Chinese) [ FROM AUTHOR] Copyright of Journal of Modern Medicine & Health is the property of Journal of Modern Medicine & Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Domestic Violence

Domestic violence (DV) is a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner or member of the domestic unit. DV can be physical, sexual, emotional, economic, or psychological actions, threat of actions or negligence that influence another person. This includes any behavior that intimidates, manipulates, humiliates, isolates, deprives, frightens, terrorizes, coerces, threatens, blames, hurts, injures, or wounds someone. The World Health Organization (WHO) reports that violence against woman and girls globally is dramatically under reported. Recently, incidents of DV increased during the COVID-19 pandemic potentially due to the stay-at-home/lockdown orders and increased stress. For professionals in a forensic field, it is important to have a good knowledge of the characteristics of DV to be able to understand the dynamics of the repeating violence, the risk assessment, and the importance of an optimal forensic investigation. This article includes instruments for the diagnosis of DV, such as screening methods or typical patterns of injuries, and presents recommendations for a complete and excellent forensic documentation. The effect of DV on children is discussed briefly. If you or someone you know has been the victim of Domestic Violence, contact your relevant national/state support. © 2023 Elsevier Ltd. All rights reserved.

Physical Activity, Mental Health, and Quality of Life among School Students in the Jazan Region of Saudi Arabia: A Cross-Sectional Survey When Returning to School after the COVID-19 Pandemic.

Increasing evidence suggests that physical activity (PA) can reduce depression and anxiety in adolescents. At the same time, quality of life (QoL) is sensitive to both mental health and PA, but little is known about the mechanism between these three variables among adolescents. This study aimed to assess the physical activity, mental health, and quality of life of school students when they returned to school after two years of distance learning in the Jazan region. This current investigation represented an observational cross-sectional survey conducted in January 2022 among a random sample of 601 students from intermediate and high schools in the Jazan region, Saudi Arabia. Three standardized questionnaires were used for data collection; the Arabic version of the Pediatric Quality of Life Inventory (PedsQL), Depression Anxiety Stress Scales (DASS21), and the Fels PAQ for children. The analysis revealed a moderate level of physical activity, decreased HRQoL, and symptoms of mental health problems (anxiety, depression, and stress) among the schools' students when they returned to school following COVID-19 lockdown. The overall Pediatric Quality of Life mean score was (81.4 ± 16.4), which differed significantly according to gender, age groups, and grade levels (p < 0.05 for all). There was a negative correlation between the overall quality of life and mental health domains. Sport was negatively correlated with mental illness symptoms and positively correlated (p < 0.05) with Pediatric Quality of Life. The regression models revealed that stress was a significant predictor for the quality of life of male and female adolescents ([ß = -0.30, (95% CI (-0.59) to (-0.02), p < 0.05)] and [ß = -0.40, (95% CI (-0.70) to (-0.01), p < 0.05)], respectively). The analysis revealed a moderate level of physical activity among the schools' students when they returned to school following COVID-19 lockdown. Children's involvement in physical activity was associated with improved quality of life and mental health. The results call for the need to develop appropriate intervention programs to increase school students' physical activity levels.

COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study.

BACKGROUND: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site's user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. OBJECTIVE: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. METHODS: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. RESULTS: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. CONCLUSIONS: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19-specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution.

Parental intentions to vaccinate children against COVID-19: Findings from a U.S. National Survey.

We examined parents' COVID-19 vaccination intentions for their children, reasons for not vaccinating, and the potential impact of a school/daycare vaccination requirement or pediatrician's recommendation on vaccination intentions. Two online surveys were conducted in June-July and September-October 2021, before pediatric COVID-19 vaccines were authorized for emergency use in children age < 12 years, with an internet-based, non-probability sample of U.S. adults. Respondents with children (age < 18 years) in the household were asked about their intention (likelihood) of vaccinating these children against COVID-19. Weighted Chi-square tests using a Rao-Scott correction were performed. Vaccinated (45.7 %) versus unvaccinated (6.9 %) parents were almost seven times more likely to have vaccinated their 12-17-year-old children against COVID-19. Approximately 58.4 % of respondents with unvaccinated children ages 2-11 years and 42.4 % of those with children < 2 years said they are "very" or "extremely likely" to vaccinate these children against COVID-19. Female parents were significantly more likely (p < .01 to p < .001) to express lower levels of COVID-19 vaccine intentions. Across all age groups of children unvaccinated against COVID-19, parental vaccine intentions increased with increased household income and education levels. COVID-19 vaccine side effects and safety concerns were primary reasons for not vaccinating children. Strategies including school vaccination requirements and recommendations from pediatricians were shown to increase parental COVID-19 vaccination intentions for some. More research is needed on factors that increase/hinder COVID-19 pediatric vaccine uptake.

Causes of Fever of unknown origin (FUO) in infants and children attending Assiut University Children's Hospital (AUCH)

Background: Fever of unknown origin (FUO) continues to be a diagnostic dilemma for pediatricians because it is often difficult to distinguish clinically between benign and potentially life-threatening causes. The term is best reserved for children with persistent fever >38 ˚c for which a cause could not be identified for more than 1 week. Aim of work: to evaluate a four-stage investigative guideline for the detection of the causes of FUO among children. Methods: 70 children aged between 6weeeks to 15 years with FUO were enrolled for this study. Graded investigations were done ranging from routine to advanced and/or specific investigations were performed after revision of detailed history and thorough examination. Results: outpatient investigations were done in 8.6% of the cases. The duration of FUO in this study ranged from 12 days to 8 weeks. The causes of FUO were 31.4% bacterial infection and 11.4% viral infection including Covid-19 infection in 7.1% of them, herpes simplex, and glandular fever in 3.4% of them.ENT affection was present in 4.3%, and the cardiac cause was found in 4.3% of the cases. Malignancy was encountered in 10% of the cases. In 21.4% of the cases, the cause of FUO was not diagnosed. In 10% of the cases, connective tissue disease was detected, and auto-inflammatory disease was encountered in 7.1% of the cases. Conclusion: not all cases of FUO should be admitted to a hospital, as some of them can be diagnosed and treated on an outpatient basis,. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.

Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts.

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

Domestic Violence

Domestic violence (DV) is a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner or member of the domestic unit. DV can be physical, sexual, emotional, economic, or psychological actions, threat of actions or negligence that influence another person. This includes any behavior that intimidates, manipulates, humiliates, isolates, deprives, frightens, terrorizes, coerces, threatens, blames, hurts, injures, or wounds someone. The World Health Organization (WHO) reports that violence against woman and girls globally is dramatically under reported. Recently, incidents of DV increased during the COVID-19 pandemic potentially due to the stay-at-home/lockdown orders and increased stress. For professionals in a forensic field, it is important to have a good knowledge of the characteristics of DV to be able to understand the dynamics of the repeating violence, the risk assessment, and the importance of an optimal forensic investigation. This article includes instruments for the diagnosis of DV, such as screening methods or typical patterns of injuries, and presents recommendations for a complete and excellent forensic documentation. The effect of DV on children is discussed briefly. If you or someone you know has been the victim of Domestic Violence, contact your relevant national/state support.

Changes in frequency of park/playground utilization among children aged 4-59 months in Los Angeles County, California 2008-2020.

Child physical activity and play are critical for healthy development, and parks/playgrounds are important public spaces that provide physical activity/play opportunities. This study was conducted to assess changes in park/playground utilization by Special Supplemental Nutrition Program for Women, Infants and Children (WIC)-participating children from 2008 to 2020, and whether the COVID-19 pandemic was associated with lower park/playground utilization and racial/ethnic disparities in park/playground utilization. Cross-sectional data from the 2008-2020 triennial Los Angeles County WIC Survey (n = 21,886) were used, and analyses stratified by child age (4-23 months, 24-59 months). Odds ratios (OR) and 95 % confidence intervals (CI) for the relationship between year and park/playground utilization frequency were determined from multinomial logistic regression, and racial/ethnic disparities were assessed by interacting year with race/ethnicity. Among children 24-59 months of age, park/playground utilization increased compared to never from 2011 to 2017 compared to 2008 (Every day, 2011-2017: OR [95 % CI]: 2.69 [1.93, 3.75], 4.71 [3.23, 6.86], 10.20 [6.91, 15.06]; 3-6 days/week 2011-2017: 1.54 [1.13, 2.10], 3.11 [2.18, 4.45], 3.94 [2.71, 5.72]; 1-2 days/week, 2014-2017; 1.53 [1.08, 2.18], 1.63 [1.13, 2.37]). Associations reversed in 2020, with 36 % lower odds of every day (OR [95 % CI]: 0.64 [0.48, 0.85]), 85 % lower odds of 3-6 days/week (0.15 [0.11, 0.20]) and 89 % lower odds of 1-2 days/week (0.11 [0.09, 0.15]) park/playground utilization compared to never than in 2008. Park/playground utilization frequency increased from 2008 to 2017, but progress reversed during the COVID-19 pandemic in 2020. Results for children ages 4-23 months were similar. Future public health restrictions to public recreation facilities should consider realistic limitations to potential benefits and the potential for unintended consequences before implementation.

Reasons underlying the intention to vaccinate children aged 5-11 against COVID-19: A cross-sectional study of parents in Israel, November 2021.

Vaccination is a key tool to mitigate impacts of the COVID-19 pandemic. In Israel, COVID-19 vaccines became available to adults in December 2020 and to 5-11-year-old children in November 2021. Ahead of the vaccine roll-out in children, we aimed to determine whether surveyed parents intended to vaccinate their children and describe reasons for their intentions. We collected information on parental socio-demographic characteristics, COVID-19 vaccine history, intention to vaccinate their children against COVID-19, and reasons for parental decisions using an anonymous online survey. We identified associations between parental characteristics and plans to vaccinate children using a logistic regression model and described reasons for intentions to vaccinate or not. Parental non-vaccination and having experienced major vaccination side effects were strongly associated with non-intention to vaccinate their children (OR 0.09 and 0.18 respectively, p < .001). Parents who were younger, lived in the socio-economically deprived periphery, and belonged to the Arab population had lower intentions to vaccinate their children. Reasons for non-intention to vaccinate included concerns about vaccine safety and efficacy (53%, 95%CI 50-56) and the belief that COVID-19 is a mild disease (73%, 95%CI 73-79), while a frequent motive for vaccination was the return to normal social and educational life (89%, 95%CI 87-91). Understanding rationales for COVID-19 vaccine rejection or acceptance, as well as parental demographic data, can pave the way for intentional educational campaigns to encourage not only vaccination against COVID-19, but also regular childhood vaccine programming.

Parental intention to vaccinate children aged 5-11 is much lower than vaccine coverage in parental age groupsBeing unvaccinated and having experienced side effects following vaccination were the greatest negative predictors in parents of intention to vaccinate their childrenParents were more likely to accept a COVID-19 vaccine for their children to allow them to return to daily social life and to ensure economic security in the familyParents were more likely to reject a COVID-19 vaccination for health reasons such as safety concerns or due the belief that COVID-19 was a mild disease in children.

Protecting children from COVID-19: examining U.S. parents motivation and behaviour using an integrated model of self-determination theory and the theory of planned behaviour.

OBJECTIVES: This longitudinal study applied the integrated model of self-determination theory (SDT) and the theory of planned behaviour (TPB) to explain COVID-19 preventive behaviours among parents of young children in the United States. DESIGN: The study adopted a two-wave longitudinal study design. Parents (N = 681) completed self-report questionnaires related to measures of SDT and the TPB constructs and behavioural adherence at baseline and after one month. We used standardised residual change scores to test the structural relationships of the integrated model. RESULTS: The parameter estimates of the model (CFI > .96, TLI > .86, RMSEA = .05, SRMR = .03) fit acceptably well to the data. Psychological need support was positively and significantly linked to autonomous and controlled motivation and amotivation. Autonomous motivation was positively and significantly correlated with TPB factors, and intention. Intention was a significant and positive predictor of behavioural adherence. CONCLUSION: The integrated model of SDT and the TPB appeared to be applicable to the explanation of COVID-19 prevention among the U.S. parents. Longitudinal data showed that a psychological need supportive social environment was related to favourable motivation, social cognition beliefs, intention and behavioural adherence to the preventive behaviours of parents protecting their young children from COVID-19.

The Relationship Between States' Immigrant-Related Policies and Access to Health Care Among Children of Immigrants.

States vary in their participation in federal immigration enforcement, leading to differing state-level policy contexts that profoundly shape the lives of immigrants. This paper examines the effects of sanctuary policies and driver's licenses for undocumented immigrants on immigrants' children's access to preventative healthcare. The 2008-2016 Medical Panel Expenditure Survey merged with state-level policy data were analyzed using a difference-in-difference OLS regression. Outcome variables included whether the child had a usual source of care, any unmet medical needs, or a well child check-up. State driver's license and sanctuary policies were associated with having a usual source of care and fewer unmet medical needs among children of immigrants. The recent pandemic highlights the importance of access to preventative health care. State policies that limit federal immigration enforcement involvement are associated with improved access to preventative health services among immigrants' children, most of whom are U.S. citizens.

Barriers and Facilitators Related to Delivery of Hospital Pharmacy Services to Women, Children, and Their Families during a Pandemic: A Qualitative Study.

Background: When the COVID-19 pandemic was declared in March 2020, health care professionals were challenged to adapt quickly and efficiently to change their work practices. However, an evidence-informed approach has not yet been used to systematically gather data on barriers and facilitators related to delivery of hospital pharmacy services in Canada. Objectives: The primary objective was to identify and describe barriers and facilitators related to the delivery of hospital pharmacy services to women, children, and their families during the COVID-19 pandemic. The secondary objective was to provide recommendations for improvement in delivery of pharmacy services to enhance patient care during pandemics. Methods: This qualitative study involved semistructured virtual interviews with pharmacists who worked in direct or nondirect patient care throughout the pandemic (since March 2020) at women's and/or children's hospitals in Canada. Individual interviews were completed virtually using conferencing software. An interview guide mapped to the Theoretical Domains Framework version 2 (TDFV2) was used to facilitate the interviews. Interviews were audio-recorded and transcribed verbatim by the principal investigator. Transcribed interviews were coded, mapped to the TDFV2, and analyzed using thematic analysis. Results: Interviews were completed with 21 pharmacists in 7 provinces across Canada. Barriers and facilitators coded to the TDFV2 were grouped into 4 main themes: communication and collaboration, adaptability, health and well-being, and preparedness. Conclusions: Participants highlighted a significant number of barriers that they experienced during the COVID-19 pandemic; overall, however, participants reported that they felt prepared for subsequent waves of the COVID-19 pandemic and future pandemics.

Contexte: Lors de la déclaration de la pandémie de COVID-19 en mars 2020, les professionnels de la santé ont été mis au défi de s'adapter rapidement et efficacement à la situation en changeant leurs pratiques professionnelles. Cependant, une approche fondée sur des données probantes pour recueillir systématiquement des données sur les obstacles à la prestation des services de pharmacie hospitalière au Canada et les éléments facilitant celle-ci n'a pas encore été utilisée de manière systématique. Objectifs: L'objectif principal consistait à identifier et à décrire les obstacles à la prestation de services de pharmacie hospitalière aux femmes, aux enfants et à leur famille et les éléments facilitant celle-ci pendant la pandémie de COVID-19. L'objectif secondaire consistait, quant à lui, à fournir des recommandations pour améliorer la prestation de services de pharmacie afin d'améliorer les soins aux patients pendant une pandémie. Méthodes: Cette étude qualitative comprenait des entrevues virtuelles semi-structurées avec des pharmaciens ayant travaillé dans le domaine des soins directs ou non directs aux patients tout au long de la pandémie (depuis mars 2020) dans des hôpitaux pour femmes et/ou enfants au Canada. Les entretiens individuels ont été réalisés virtuellement à l'aide d'un logiciel de conférence. Un guide d'entretien adapté de la 2e version du cadre des domaines théoriques (TDFV2) [Theoretical Domains Framework] a été utilisé pour faciliter les entretiens. Ceux-ci ont été enregistrés sur bande audio et retranscrits textuellement par le chercheur principal. Les entretiens ainsi retranscrits ont été codés, reportés sur le TDFV2 et analysés par thème. Résultats: Des entrevues ont été réalisées auprès de 21 pharmaciens dans 7 provinces du Canada. Les obstacles et les éléments facilitateurs codés selon le TDFV2 ont été regroupés en 4 grands thèmes: communication et collaboration; adaptabilité; santé et bien-être; et état de préparation. Conclusions: Les participants ont mentionné un nombre important d'obstacles qu'ils ont rencontrés pendant la pandémie de COVID-19; dans l'ensemble, cependant, les participants ont déclaré qu'ils se sentaient préparés aux vagues ultérieures de la pandémie de COVID-19 et aux futures pandémies.

Patient and family experience with telemedicine and in-person pediatric and obstetric ambulatory encounters throughout 2020, during the COVID-19 epidemic: the distance effect.

BACKGROUND: Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team's knowledge, this is the first study evaluating pediatric and obstetrics outpatients experience with telemedicine and in-person visit types in an academic maternal and children's hospital, and its correlation with geographic distance from the medical center throughout 2020, during the COVID-19 crisis. METHODS: We aim to evaluate and compare patients' telemedicine and in-person experience for ambulatory encounters based on survey data throughout 2020, during the COVID-19 pandemic, with particular focus on the influence of distance of the patient's home address from the medical facility. A total of 9,322 patient experience surveys from ambulatory encounters (6,362 in-person and 2,960 telemedicine), in a maternal and children's hospital during 2020 were included in this study. The percentage of patients who scored the question "Likelihood to recommend practice" with a maximum 5/5 (top box) score was used to evaluate patient experience. The k-means model was used to create distance clusters, and statistical t-tests were conducted to compare mean distances and Top Box values between telemedicine and in-person models. Logistic regression analysis was used to evaluate the correlation between Top Box scores and patients' distance to the hospital. RESULTS: Top Box likelihood to recommend percentages for in-person and telemedicine were comparable (in-person = 81.21%, telemedicine = 81.70%, p-value = 0.5624). Mean distance from the hospital was greater for telemedicine compared to in-person patients (in-person = 48.89 miles, telemedicine = 61.23 miles, p-value < 0.01). Patients who live farther displayed higher satisfaction scores regardless of the visit type (p-value < 0.01). CONCLUSIONS: There is a direct relationship between the family experience and the distance from the considered medical center, during year 2020, i.e., patients who live farther from the hospital record higher Top Box proportion for "Likelihood to Recommend" than patients who live closer to the medical center, regardless of the approach, in-person or telemedicine.

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.

The impact of the COVID-19 pandemic on lifestyle behaviors in children and adolescents: an international overview.

The adverse effects of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are not limited to the related infectious disease. In children and adolescents, serious risks due to the coronavirus disease 2019 (COVID-19) pandemic are also related to its indirect effects. These include an unbalanced diet with an increased risk of weight excess or nutritional deficiencies, increased sedentary lifestyle, lack of schooling, social isolation, and impaired mental health.Pediatricians should be aware of the side effects of the COVID-19 pandemic on children's diet, physical mental health and advise the families according to their nutritional needs and financial resources. Moreover, the lack of a targeted therapy able to offer protection against the deleterious effects of SARS-CoV-2 infection should require a greater effort by scientific societies to find a more effective prevention strategy. In this context, much interest should be given to nutritional support, able to contrast malnutrition and to stimulate the immune system.

What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores?

Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.

WIC Participants' Perceptions of COVID-19-Related Changes to WIC Recertification and Service Delivery.

Many Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics implemented alternatives to in-person service delivery in response to the COVID-19 pandemic, including virtual visits and electronic document sharing. The objective of this cross-sectional study was to describe WIC participants' experiences with remote service delivery and recertification during the pandemic. Participants included mothers and infants who participated in a WIC-based intervention between June 2019-August 2020. All participants (N = 246) were invited to complete a follow-up survey between November 2020-February 2021; 185 mothers completed the survey. The survey assessed sociodemographics, employment, food security, experiences with remote WIC recertification and service delivery, and experiences with obtaining WIC foods during the pandemic. Average age for mothers was 29.2 ± 6.3 years and for infants was 17.7  ± .2 months; 80% (n = 147) identified as Hispanic. Approximately 34% (n = 62) of participants reported very low or low food security and 40% (n = 64) had difficulties buying WIC foods during the pandemic. Among participants who recalled providing documentation of income and address virtually, the majority felt comfortable providing information via email (60%) and text messaging (72%). Participants reported high levels of satisfaction with remote methods of service delivery, as well as overall satisfaction with the WIC program during the pandemic. While ~ 25% of study participants preferred for all WIC services to remain remote, 75% still desired at least some in-person contact with WIC staff after the pandemic. In conclusion, remote methods of WIC service delivery addressed existing barriers to WIC participation and were well-received by study participants.

USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Vendor Criteria: An Examination of US Administrative Agency Variations.

The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.