Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study.

INTRODUCTION: Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). METHODS: This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. RESULTS: Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR = 1.17; 95% CI, 1.04-1.31; p = .004) and the four-dose pneumococcal conjugate vaccine series (OR = 1.36; 95% CI, 1.18-1.57; p < .001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. CONCLUSIONS: Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.

Roles of Sleep Quality, Self-Efficacy, and Coping Style in the Frailty of Community-Dwelling Older Adults: A Cross-Sectional Study.

OBJECTIVES: Although the association between sleep disorders and frailty has been well established, little is known about the cognitive appraisal mechanisms underlying this association. Building on the transactional theory of stress and coping, this study explores the role of self-efficacy and coping style in the association between sleep quality and frailty among community-dwelling older adults. METHODS: In this cross-sectional study, 585 community-dwelling older adults were investigated using the Pittsburgh Sleep Quality Index, Tilburg Frailty Indicator, General Self-Efficacy Scale, and Simplified Coping Style Questionnaire. Descriptive statistics and hierarchical regression were performed. A moderated mediation model was established using the PROCESS macro. RESULTS: Poor sleep quality affects frailty directly (B = 0.193, p < .01) and indirectly via self-efficacy (B = 0.063, p < .01). The negative impact of poor sleep on frailty through self-efficacy was moderated by both positive and negative coping style (index = -0.007). The moderating effect was stronger when participants' negative coping tendencies increased. CONCLUSIONS: Poor sleep quality indirectly influences frailty by modifying self-efficacy. Effective coping strategies can help attenuate this association. CLINICAL IMPLICATIONS: Timely sleep assessment and tailored strategies such as psychoeducational programs and targeted coping skills training may be beneficial for preventing frailty in older adults.

A Mixed Methods Pilot Study of an Equity-Explicit Student-Teacher Relationship Intervention for the Ninth-Grade Transition.

BACKGROUND: Student-teacher relationships are associated with the social and emotional climate of a school, a key domain of the Whole School, Whole Community, Whole Child Model. Few interventions target student-teacher relationships during the critical transition to high school, or incorporate strategies for enhancing equitable relationships. We conducted a mixed-methods feasibility study of a student-teacher relationship intervention, called Equity-Explicit Establish-Maintain-Restore (E-EMR). METHODS: We tested whether students (N = 133) whose teachers received E-EMR training demonstrated improved relationship quality, school belonging, motivation, behavior, and academic outcomes from pre- to post-test, and whether these differences were moderated by race. We also examined how teachers (N = 16) integrated a focus on equity into their implementation of the intervention. RESULTS: Relative to white students, students of the color showed greater improvement on belongingness, behavior, motivation, and GPA. Teachers described how they incorporated a focus on race/ethnicity, culture, and bias into E-EMR practices, and situated their relationships with students within the contexts of their own identity, the classroom/school context, and broader systems of power and privilege. CONCLUSIONS: We provide preliminary evidence for E-EMR to change teacher practice and reduce educational disparities for students of color. We discuss implications for other school-based interventions to integrate an equity-explicit focus into program content and evaluation.