Phased Return of Students to 77 Transitional Kindergarten-8th Grade Schools With Cohesive Mitigation Strategies Serving as Protective Factors Against the Increase of COVID-19 Cases in Marin County: September 2020-January 2021.

Background and objective Earlier uncertain implications of the coronavirus disease 2019 (COVID-19) pandemic on the pediatric population prompted the authorities to close schools worldwide under the premise that school settings would serve as drivers of an increase in the cases of COVID-19. Safe and equitable full-in-person school instruction is a critical factor in the continued educational gains of children and for their general well-being. The objective of this study was to report epidemiological trends related to the increasing percentage of students returning to in-person instruction, the suspected in-school transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, and countywide COVID-19 case rates during the first 21 weeks of school reopening in Marin County, CA, in the fall of 2020. Materials and methods The institutional review board (IRB) approval was waived for this study as it did not involve any identifiable human subjects data. Retrospective electronic reviews of countywide COVID-19 daily case count and COVID-19-related reports associated with in-person school participants from 77 schools in Marin County, CA, from September 8, 2020, to January 29, 2021, were conducted. The data were made available in collaboration with the Marin County Office of Education (MCOE) and Marin County Department of Health and Human Services (Marin HHS). Descriptive trends analyses were performed to determine whether the phased increase of students attending in-person learning was a significant contributor to countywide COVID-19 incidence rate, crude rate, and in-school COVID-19 viral transmission. This is the first long retrospective study of COVID-19 data among the reopened school population during the second half of the first pandemic year. It was conducted in a 21-week surveillance period involving an immense collaboration between Marin County's public health officials and school administrators. Results Over the 21-week observational period involving 17,639 students, 4,938 school staff, and 899,175 student days, the countywide COVID-19 crude rate decreased (from 89.9 to 35.89 per 10,000) as more students returned to in-person learning. The schools' strict adherence to public health guidance and site-specific safety plans against COVID-19 yielded a significantly reduced incidence rate of 0.84% among in-person learning participants; only nine cases were traced to suspected in-school SARS-CoV-2 transmission by way of rigorous contact tracing. The countywide COVID-19 incidence rate was 2.09%. Conclusions It is possible to minimize COVID-19 transmissions in in-person learning settings with cohesive mitigation strategies, specifically strict adherence to proper masking by students and staff while on school grounds. There is no clear correlation that the increasing phased return of students to in-person school drove an increase in countywide COVID-19 cases in Marin County, CA. Our findings revealed that schools were capable of safely resuming operations by following public health orders and recommendations. The increasing percentage of students returning to in-person school did not drive an increased COVID-19 case rate in the community. On the contrary, this analysis revealed that there was a drop in countywide COVID-19 cases as the phased student return percentage increased.

A two-generation approach to postpartum care: Building on the well-baby visit.

BACKGROUND: Although postpartum (PP) care is essential for the health and well-being of women and their infants, many women in the United States do not receive PP care. In order to ensure that women's PP needs are met, it is essential to develop delivery models that address their barriers to care. The objective of the current study was to obtain women's feedback and perspectives about delivering women's health care at the well-baby visit (WBV) using a modified mixed-methods approach including open-ended interviews and surveys. METHODS: Twenty brief open-ended interviews were conducted with PP women at a large urban medical center in Chicago. The interviews were recorded, transcribed, and coded following a mixed deductive and inductive approach and analyzed using Dedoose. Following the interview analysis, surveys with 50 immediate PP women and 50 who were 2-4 months PP were conducted. Statistical analyses included frequencies and chi-square tests to determine differences between participants interviewed at the two time periods. RESULTS: Key themes that emerged from the open-ended interviews include the tension between the desire for continuity of care (prenatal to PP) and the desire for convenient care. The surveys found that 86%-94% of women would be interested in receiving PP care at the same clinic site and time as their new baby. CONCLUSIONS: One approach to addressing women's PP health and need for convenient care is the provision of components of women's health care at the WBV. Therefore, we present an innovative two-generation model for PP care focusing on needs of both the woman and infant.

Persisting Gaps in Coverage and Services of Illinois Women Who Acquired Insurance After Implementation of the Affordable Care Act.

OBJECTIVES: Before implementation of the Affordable Care Act, many uninsured women in Illinois received care through safety-net programs. The new law allowed them to acquire health insurance through Medicaid or the Illinois Health Exchange. We examined (1) the health care experiences of such women who previously used a safety-net program and acquired this new coverage and (2) persisting gaps in coverage for breast and cervical cancer services and other health care services. METHODS: We interviewed a stratified random sample of 400 women aged 34-64 in Illinois each year during 2015-2017 (total N = 1200). We used multivariable logistic regression models to determine the association between health insurance status (Illinois Health Exchange vs Medicaid) and past 12-month gaps in coverage (ie, delaying care, not having a recent mammogram, having a medical cost, and having a medical cost not covered) for the 360 women who were former participants of the Illinois Breast and Cervical Cancer Program. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for race/ethnicity, age, income, and education. RESULTS: We found no significant differences by health insurance status in the prevalence of delaying preventive, chronic, or sick care; timeliness of the most recent mammogram; and having a major medical cost. However, of women who reported a major medical cost, women with health insurance through the Illinois Health Exchange had a higher prevalence of not having a cost covered than women with Medicaid (adjusted OR = 4.86; 95% CI, 1.48-16.03). CONCLUSIONS: The results of this study suggest that many women who gained health insurance lacked adequate coverage and services. Safety-net programs will likely continue to play an essential role in supporting women as they navigate a complex system.

Universal Early Home Visiting: A Strategy for Reaching All Postpartum Women.

Objective The objective of this study is to consider the role of universal nurse home visiting in the postpartum period as a potential strategy to promote women's postnatal health. This study was derived from a formative research project aimed at understanding the early implementation of the Illinois Family Connects (IFC) universal postpartum home visiting program as perceived by key informants. Methods Data from eighteen key informant (KI) interviews conducted between January and February 2018 and quantitative data extracted from reports from two IFC pilot counties were analyzed. Qualitative data were analyzed using Dedoose Version 8.0. Results Data suggest that universal postpartum nurse home visiting has appeal as a postpartum women's health strategy. The data also suggest that the success of such a strategy likely depends on: the value women, families, and community stakeholders attach to the program; the appeal of its universality and the support for home visiting by nurses in particular; the processes adopted by the hospitals and agencies implementing the program; strategies for engaging women after leaving the hospital; and, the initial and ongoing marketing of the program, which ultimately may affect women's willingness to participate. Conclusions for Practice Universal early postpartum home visiting is not a substitute for a woman's visit with a medical provider; however, it should be viewed not only as an early childhood program but an important strategy for improving the delivery of postpartum care for women.