The Impact of School Closures on Service Utilization in School-Based Health Centers.

BACKGROUND: The pandemic was followed by a severe mental health crisis in youth with both an increase in the prevalence of mental health problems and a decrease in requests for and access to care. METHODS: data were extracted from the school-based health center records in three large public high schools that include under-resourced and immigrant communities. Data from 2018/2019 (pre-pandemic), 2020 during the pandemic, and then in 2021 after the return to in-person school were compared regarding the impact of in-person, telehealth, and hybrid care. RESULTS: Despite the increase in mental health needs globally, there was a dramatic decrease in referrals, evaluations, and the total number of students seen for behavioral health care. The time course of this decrease in care was specifically associated with the transition to telehealth, although treatment did not return to pre-pandemic levels, even after in-person care became available. CONCLUSIONS: Despite ease of access and increased need, these data suggest that telehealth has unique limitations when delivered in school-based health centers.

Low-dose aspirin for the prevention of superimposed preeclampsia in women with chronic hypertension: a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis investigated whether the use of low-dose aspirin during pregnancy by women with chronic hypertension reduces the odds of superimposed preeclampsia and poor perinatal outcomes. DATA SOURCES: In September 2021, the following sources were searched: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and EU Clinical Trials Register. Only human studies were included, with no time or language restrictions. STUDY ELIGIBILITY CRITERIA: Cohort, case-control, and randomized controlled studies reporting women with chronic hypertension pregnant with a singleton were included. Eligible studies compared low-dose aspirin use during pregnancy with a control arm. METHODS: Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A meta-analysis was performed using a random-effects model, estimating odds ratios and 95% confidence and prediction intervals, and the quality of data was assessed with the GRADE approach. Heterogeneity was investigated in regard to study methodology, timing of commencement of aspirin, and the outcome of preterm preeclampsia. RESULTS: Nine studies (3 retrospective cohort studies and 6 randomized trials) including 2150 women with chronic hypertension were included. Low-dose aspirin prophylaxis did not significantly reduce the odds of superimposed preeclampsia in the randomized controlled trials (odds ratio, 0.83; 95% confidence interval, 0.55-1.25; prediction interval, 0.27-2.56; low-quality evidence) or observational studies (odds ratio, 1.21; 95% confidence interval, 0.78-1.87; prediction interval, 0.07-20.80; very low-quality evidence). Low-dose aspirin also did not reduce the odds of preterm preeclampsia (odds ratio, 1.17; 95% confidence interval, 0.74-1.86), and early aspirin initiation had no significant impact. There was no significant effect on small-for-gestational-age neonates or perinatal mortality; however, there was a significant reduction in preterm birth (odds ratio, 0.63; 95% confidence interval, 0.45-0.89; moderate-quality evidence). The quality of the evidence is limited by heterogeneity and risk of bias. CONCLUSION: This meta-analysis was unable to demonstrate a significant change in the odds of superimposed preeclampsia, small-for-gestational-age infants, or perinatal mortality with the use of low-dose aspirin in women with chronic hypertension. However, significant reduction in preterm birth justifies the continued use of aspirin prophylaxis. This work was prospectively registered on the International Prospective Register of Systematic Reviews (registration number CRD42021285921).

Recorded infection control messages delay inter-professional communication but are not associated with COVID-19 prevalence or mortality: insights from a national switchboard analysis.

Appropriate dissemination of information to the general public is a key component of the pandemic response. In 2018, recorded infection control advice messages were affixed to 30% of England's automated hospital switchboards during the seasonal influenza and norovirus outbreaks. As the majority of messages were mandatory for all callers, healthcare professionals using the hospital switchboard - including during time-critical emergencies - had their enquiries significantly delayed by these measures. Importantly, published analyses did not demonstrate an association between these messages and patient outcomes. As of May 2020, 85% of NHS trusts made use of infection control messages; on average, these delayed healthcare professionals by 59.4 seconds per call, but had no clear association with patient outcomes from COVID-19. An ongoing national switchboard quality improvement project seeks to establish a gold standard whereby healthcare professionals with urgent enquiries can press 'X' to skip past infection control messages and have their calls triaged immediately.

Volunteer doulas' experiences supporting cesarean births: A qualitative analysis for preliminary program evaluation.

BACKGROUND: Cesarean birth is common in the United States and associated with increased incidence of medical complications and maternal dissatisfaction. Doula support is associated with improved maternal and newborn outcomes but is often restricted to vaginal birth. The aim of this scoping study was to explore the experiences of volunteer doulas who provide support to women during cesarean birth. METHODS: Qualitative study using semi-structured interviews with nine doula volunteers from one program to assess their experiences caring for clients in the operating room (OR). RESULTS: Doulas described their experiences supporting cesarean births in relation to four different relationship-level themes, relationships between: doulas and their clients (and clients' support persons); doulas and the physical environment (OR, labor and delivery unit); doulas and the OR interprofessional team; and doulas and the program culture. Doulas described perceived strengths and weaknesses of the OR-based program, and suggested improvements and future development opportunities. CONCLUSION: Doulas volunteering within this program highly valued their perceived role in the care of women experiencing cesarean birth, including reports of increasing evidence-based practices such as SSC and early breastfeeding initiation in the OR. These doulas reported successfully working around the physically challenging OR environment and alongside the cesarean interprofessional team.

Missed presentation of Crohn's disease in a patient with a fistulating thigh abscess: a case report.

BACKGROUND: Musculoskeletal presentations of Crohn's disease are rare and they include psoas abscess, thigh abscesses and in extreme cases septic arthropathy. CASE PRESENTATION: Herein, we present a 53 year old gentleman with bilateral thigh fistulae discovered to be a new diagnoses of extra-intestinal Crohn's disease CONCLUSION: It is important to consider Crohn's disease in patients that present with unusual or persistent fistulae and to consider this essential when there are atypical organisms present.