A Qualitative Study Defining Perspectives on Rurality and Surgery From Midwestern Medical Schools.

INTRODUCTION: Rural general surgery faces a crisis as more surgeons undergo fellowship training and then practice in metropolitan areas, leaving rural Americans with decreasing surgical care. This study aims to identify how hometown rurality affects medical students' current level of knowledge and potential educational gaps within their understanding of the definition, benefits, and challenges of rural general surgery to define the need for enhanced education within medical schools. METHODS: In Spring 2021, 11 Midwestern medical schools participated in an electronic survey. Participants were divided into three groups (rural, urban, or suburban) based on their hometown rurality using Rural-Urban Continuum Codes. Qualitative analysis was performed for three questions addressing the definition, benefits, and challenges of rural surgery. RESULTS: Responses were analyzed from 411 students whose hometowns were representative of 33 states. The majority of respondents were female (n = 260; 63.4%) and Caucasian (n = 230; 56.9%) from self-reported suburban backgrounds who grew up and remained in the Midwest for their education. Major themes identified across all students were defining rural surgery as "Rural"/"Farmland"/"Nowhere" and specified the challenges of rural surgery to be relating to funding, facilities, and/or technology. Benefits identified were breadth of surgical procedures and community engagement. CONCLUSIONS: Most students do not understand the concept of rurality by definition or Rural-Urban Continuum Codes. However, students were able to identify a broad range of challenges and benefits faced by rural surgeons today. This provides a foundational needs assessment to drive future educational efforts to increase exposure to and knowledge of rural general surgery.

Local climate change velocities and evolutionary history explain multidirectional range shifts in a North American butterfly assemblage.

Species are often expected to shift their distributions either poleward or upslope to evade warming climates and colonise new suitable climatic niches. However, from 18-years of fixed transect monitoring data on 88 species of butterfly in the midwestern United States, we show that butterflies are shifting their centroids in all directions, except towards regions that are warming the fastest (southeast). Butterflies shifted their centroids at a mean rate of 4.87 km year-1. The rate of centroid shift was significantly associated with local climate change velocity (temperature by precipitation interaction), but not with mean climate change velocity throughout the species' ranges. Species tended to shift their centroids at a faster rate towards regions that are warming at slower velocities but increasing in precipitation velocity. Surprisingly, species' thermal niche breadth (range of climates butterflies experience throughout their distribution) and wingspan (often used as metric for dispersal capability) were not correlated with the rate at which species shifted their ranges. We observed high phylogenetic signal in the direction species shifted their centroids. However, we found no phylogenetic signal in the rate species shifted their centroids, suggesting less conserved processes determine the rate of range shift than the direction species shift their ranges. This research shows important signatures of multidirectional range shifts (latitudinal and longitudinal) and uniquely shows that local climate change velocities are more important in driving range shifts than the mean climate change velocity throughout a species' entire range.

Factors associated with PrEP use in a community sample of African American men who have sex with men (MSM) and transgender women (TGW) in the United States Midwest.

Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.

Abnormal blood pressure among individuals evaluated for tuberculosis infection in a U.S. public health tuberculosis clinic.

Tuberculosis infection (TBI) has been associated with increased cardiovascular risks. We aimed to characterize abnormal blood pressure (BP) readings in individuals with TBI. We conducted a retrospective study of adults with TBI presenting for their initial medical visit at a large midwestern U.S. public health clinic between 2019 and 2020. Abnormal BP was defined as having a systolic BP ≥ 130 mmHg and/or a diastolic BP ≥ 80 mmHg. Of 310 individuals with TBI, median age was 36 years (interquartile range 27-48), 34% were male, 64% non-US-born; 58 (18.7%) were previously diagnosed with hypertension. The prevalence of any hypertension (i.e., had a history of hypertension and/or an abnormal BP reading) was 64.2% (95% confidence interval 58.7-69.4). Any hypertension was independently associated with older age, male sex, higher body mass index, and individuals of Black race. In conclusion, any hypertension was present in over half of the adults evaluated for TBI in our clinic. Established hypertension risk factors were also common among this group, suggesting that individuals with TBI could benefit from clinical and public health interventions aiming to reduce the risk of future cardiovascular events.

Nameability supports rule-based category learning in children and adults.

The present study tested the hypothesis that verbal labels support category induction by providing compact hypotheses. Ninety-seven 4- to 6-year-old children (M = 63.2 months; 46 female, 51 male; 77% White, 8% more than one race, 4% Asian, and 3% Black; tested 2018) and 90 adults (M = 20.1 years; 70 female, 20 male) in the Midwestern United States learned novel categories with features that were easy (e.g., "red") or difficult (e.g., "mauve") to name. Adults (d = 1.06) and-to a lesser extent-children (d = 0.57; final training block) learned categories composed of more nameable features better. Children's knowledge of difficult-to-name color words predicted their learning for categories with difficult-to-name features. Rule-based category learning may be supported by the emerging ability to form verbal hypotheses.

Evaluating the feasibility and acceptability of a co-designed physical activity intervention for rural middle schoolers: a pilot study.

BACKGROUND: Lack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth. METHODS: This prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis. RESULTS: Key findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the "good" threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport. CONCLUSIONS: This study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents.

Insights from a COVID-era health needs assessment of rural Midwestern Latinos.

Latino health and well-being are crucial to the growth and vibrancy of rural areas across the United States, particularly at a time when the demographics of many rural communities are transitioning from minority Latino to majority Latino populations. This manuscript details the findings of a study that explored the health and healthcare benefit status of 524 Latino households in rural Indiana during the COVID-19 pandemic. Via 20-minute, door-to-door interviews conducted by bilingual researchers, survey participants answered questions about access to healthcare services and benefits, dietary and safety habits, medical issues, and vaccination status. The study found that slightly more than half of those surveyed were enrolled in healthcare benefit plans; approximately a third were unsatisfied with their health/health status; almost two-thirds had not received a flu shot and were eating fast food/processed food on a daily basis. Top health concerns reported included: stress (52%), vision problems (34%), neck and back pain (30%), headaches/migraines (28%), anxiety and depression (28%) and weight problems (26%). The study also discovered that half of the respondents could not identify a primary healthcare provider (PCP) by name and that pregnant women faced a lack of resources for maternal health in the county where the study was conducted. The results indicate that Latinos in rural communities continue to endure significant health issues and barriers to healthcare. The study provides an excellent model of how a rural community can monitor the health of its residents, which can inform health interventions for underserved populations.

Predictors of Improvement in Parental Stress After the First Three Months at Home with a Medically Fragile Infant.

OBJECTIVES: Little is known about the early stress experiences of parents of infants with serious life-limiting/life-threatening conditions during the initial months after discharge from hospital. The aim of the study was to measure change, and predictors of change, in parenting stress at the time of transition from hospital to home (T1) with a medically fragile infant, and after a 3-month period (T2). METHODS: Parents of infants identified as meeting ≥ 1 palliative care referral criterion were recruited in a Midwestern United States tertiary pediatric hospital (2012-2014) within 2 weeks of hospital discharge. A repeated measures design was used to assess change on a validated parenting stress inventory over the two timepoints (T1 and T2). Fifty-two parents (61 infants) participated at T1 and 44 (85%) at T2. RESULTS: On discharge (T1) stress was moderately high 3 months post discharge (T2) overall and domain-specific stress scores improved, except stress related to parent role functioning and participation in their child's medical care. Independent predictors of improvement in overall parenting stress scores (T2-T1) were being a younger parent and having experienced prior pregnancy-related loss. CONCLUSIONS FOR PRACTICE: The time of discharge from hospital to home is often stressful for parents of medically fragile infants. Improvements were found during the first 3 months at home, but improvement was minimal for stress related to role function and providing medical care. Past experience with pregnancy-related loss and being younger were associated with improvement in stress across theoretical domains. Screening for stress should be included as part of routine pre- and post-neonatal intensive care unit discharge psychosocial assessments of parents caring for infants with serious illness to ensure their unique support needs continue to be met over time.

What is already known about the topic? Stress in parents of sick infants is well-documented in the post-birth hospitalization period. Early management of parent stress after a child is born with a life-limiting/life-threatening condition is critical in promoting healthy infant attachment and development.What this study adds? Parents of medically fragile infants experience notable stress during the initial months at home. Pre-hospital discharge attention to medical and psychosocial characteristics of infants and parents may help health care teams anticipate post-discharge parenting challenges and facilitate personalized home support strategies aimed at minimizing parent stress and poor parent­child outcomes.

Emergent dual scaling of riverine biodiversity.

A prevailing paradigm suggests that species richness increases with area in a decelerating way. This ubiquitous power law scaling, the species-area relationship, has formed the foundation of many conservation strategies. In spatially complex ecosystems, however, the area may not be the sole dimension to scale biodiversity patterns because the scale-invariant complexity of fractal ecosystem structure may drive ecological dynamics in space. Here, we use theory and analysis of extensive fish community data from two distinct geographic regions to show that riverine biodiversity follows a robust scaling law along the two orthogonal dimensions of ecosystem size and complexity (i.e., the dual scaling law). In river networks, the recurrent merging of various tributaries forms fractal branching systems, where the prevalence of branching (ecosystem complexity) represents a macroscale control of the ecosystem's habitat heterogeneity. In the meantime, ecosystem size dictates metacommunity size and total habitat diversity, two factors regulating biodiversity in nature. Our theory predicted that, regardless of simulated species' traits, larger and more branched "complex" networks support greater species richness due to increased space and environmental heterogeneity. The relationships were linear on logarithmic axes, indicating power law scaling by ecosystem size and complexity. In support of this theoretical prediction, the power laws have consistently emerged in riverine fish communities across the study regions (Hokkaido Island in Japan and the midwestern United States) despite hosting different fauna with distinct evolutionary histories. The emergence of dual scaling law may be a pervasive property of branching networks with important implications for biodiversity conservation.

The extent of soil loss across the US Corn Belt.

Soil erosion in agricultural landscapes reduces crop yields, leads to loss of ecosystem services, and influences the global carbon cycle. Despite decades of soil erosion research, the magnitude of historical soil loss remains poorly quantified across large agricultural regions because preagricultural soil data are rare, and it is challenging to extrapolate local-scale erosion observations across time and space. Here we focus on the Corn Belt of the midwestern United States and use a remote-sensing method to map areas in agricultural fields that have no remaining organic carbon-rich A-horizon. We use satellite and LiDAR data to develop a relationship between A-horizon loss and topographic curvature and then use topographic data to scale-up soil loss predictions across 3.9 × 105 km2 of the Corn Belt. Our results indicate that 35 ± 11% of the cultivated area has lost A-horizon soil and that prior estimates of soil degradation from soil survey-based methods have significantly underestimated A-horizon soil loss. Convex hilltops throughout the region are often completely denuded of A-horizon soil. The association between soil loss and convex topography indicates that tillage-induced erosion is an important driver of soil loss, yet tillage erosion is not simulated in models used to assess nationwide soil loss trends in the United States. We estimate that A-horizon loss decreases crop yields by 6 ± 2%, causing $2.8 ± $0.9 billion in annual economic losses. Regionally, we estimate 1.4 ± 0.5 Pg of carbon have been removed from hillslopes by erosion of the A-horizon, much of which likely remains buried in depositional areas within the fields.

Community resource facilitation use by ethnic minority groups with traumatic brain injury in the Midwestern United States.

OBJECTIVE: This study surveyed the use of community-based resource facilitation (RF) services by ethnic minority survivors of traumatic brain injury (TBI) living in the Midwestern United States. METHOD: Past records of RF use by survivors of TBI were reviewed. Demographics and patterns of RF use across 3 ethnic groups were documented. Reported barriers to community integration related to ethnic identity were identified using Chi-square test of independence. RESULTS: Ethnic minority survivors were less likely to use RF services than white survivors. Caucasian women and men utilized RF services at similar rates, whereas more African American men and Latina women used RF services. Caucasians received information about RF from a greater variety of sources than ethnic minority survivors. Ethnic identity was significantly associated with greater reported needs for TBI awareness. CONCLUSIONS: A pattern of differential RF use by survivors from ethnic minority groups was noted, suggesting potential socio-cultural influences on help-seeking behavior after TBI. These factors should be considered to develop more accessible and equitable strategies of RF service referral and support. Future investigations of cultural perspectives of TBI and injury-related services may improve understanding of the likelihood and necessity of community-based RF service use by diverse populations.

Effect of an Inflatable Colon on Colorectal Cancer Knowledge and Screening Intent Among Male Attendees at State Fairs in Two Midwestern States, 2023.

Introduction: Colorectal cancer (CRC) is the third most-diagnosed cancer among men and women in the US. This study aimed to evaluate the influence of an interactive inflatable colon exhibit on CRC knowledge and screening intent among men attending state fairs in 2 midwestern states. Methods: At the 2023 state fairs in 2 midwestern states, eligible participants (men aged 18-75 y who could speak and read English and resided in 1 of the 2 states) completed a presurvey, an unguided tour of the inflatable Super Colon, and a postsurvey. Primary outcomes were changes in knowledge (actual and perceived) and CRC screening intent from presurvey to postsurvey. We used χ2 tests to examine differences in survey results between the 2 sites and the association between demographic characteristics and behaviors (knowledge and intentions) before entering the Super Colon exhibit. We used the McNemar test to examine differences in presurvey to postsurvey distributions. Results: The study sample (N = 940) comprised 572 men at site A (60.8%) and 368 men at site B (39.2%). Except for 1 question, baseline CRC knowledge was relatively high. Greater perceived knowledge was inversely associated with greater actual knowledge. After touring the Super Colon, participants improved their actual knowledge of CRC prevention and self-perceived CRC knowledge. Most participants (95.4%) agreed that the Super Colon was effective for teaching people about CRC. Conclusion: These findings emphasize the role of community-based educational initiatives in encouraging CRC screening uptake and increasing research participation among men and affirm that the inflatable colon is as an effective educational tool for increasing CRC knowledge and encouraging early-detection screening behavior among men.

A Mixed Methods Examination of Decision-Making During Program Exploration and Implementation in Schools.

Schools are a critical setting to promote healthy youth development through the provision of evidence-based programs (EBPs), yet preventive EBPs in schools are underutilized. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework highlights numerous factors that may influence program adoption during the Exploration phase and progress monitoring during the Implementation phase. However, no research has systematically and simultaneously identified the factors that influence school administrators' decision-making during these important processes. We conducted semi-structured interviews with 24 school administrators in the Midwestern region of the U.S. to understand how they weigh various considerations that inform their adoption and progress monitoring of prevention programs. Results indicated that school administrators consider five separate factors during the adoption decision, prioritized in the following order: need for the program, school community buy-in, contextual fit, resources, and program characteristics (including the evidence-base). Further, administrators consider five indicators to monitor program performance, prioritized as follows: intervention fidelity, quantitative and qualitative data that determine if the identified need was met, school community buy-in, resource consumption, and program characteristics. Implications for prevention scientists and suggestions for future research are discussed.

The transition from physical sibling abuse to bullying perpetration through trait anger: A longitudinal study.

OBJECTIVES: Experiencing physical sibling abuse is a form of family violence that is common but understudied. While it is often perceived as a normative aspect of sibling relationships, there are apparent behavioral consequences. The current study aims to advance the literature by utilizing the displaced aggression model and I3 theory to longitudinally examine trait anger as a pathway linking physical sibling abuse to bullying perpetration. METHODS: Using data from the Bullying, Sexual, and Dating Violence Trajectories from Early to Late Adolescence in the Midwestern United States, 2008-2013, adolescents (n = 851, M = 14.8 years) completed questionnaires at baseline and were reassessed 6 months later. RESULTS: Results suggested that when adolescents experience physical sibling abuse, they are more likely to engage in bullying perpetration. Mediation analyses indicated that as adolescents were physically abused by a sibling at home, they were more likely to report higher levels of trait anger, which subsequently increased their risk of engaging in bullying perpetration. CONCLUSION: These results suggest that experiencing physical sibling abuse has long-term detrimental consequences, including elicitation of trait anger, subsequently predicting bullying perpetration.

Evaluation of an enhanced depression and anxiety screening with targeted pharmacist intervention.

BACKGROUND: Depression is a major source of morbidity but often goes undiagnosed. Broader screening is recommended, and pharmacists could contribute. OBJECTIVES: This study aimed to assess the feasibility of community pharmacy depression and anxiety screening and describe the medication-related problems (MRPs) identified, pharmacist interventions, and provider responses for high-risk patients. METHODS: This pilot was conducted between October 2022 and January 2023 at an independently owned community pharmacy in the Midwest United States. Patients aged 18-45 years with ready prescriptions were identified through weekly reports, and tags were placed on prescription bags. A convenience sample of patients fluent in English were offered the Patient Health Questionnaire (PHQ2) and Generalized Anxiety Disorder (GAD2), with follow-up PHQ9 and GAD7 for at-risk individuals. High-risk individuals met with the pharmacist for consultation and recommendations were discussed. Descriptive statistics were calculated for participant demographics, questionnaire responses, MRPs, and provider responses. Patient profiles were examined 2 months after the workup to identify medication changes. RESULTS: A total of 29 patients volunteered to be screened for anxiety and depression; of these, 41% scored in the high-risk category for depression or anxiety and met with the pharmacist for the consultation. The pharmacist identified multiple MRPs. The most common was the need for additional therapy and inadequate dosages. Patients were reluctant for the pharmacist to follow up with their prescriber and were unreachable for telephone follow-up. Profiles reviewed 2 months after assessment showed half of the at-risk patients had one or more mental health medication changes. CONCLUSION: Community pharmacists may have a role in the screening and management of patient mental health, although there were challenges with screening uptake and follow-up. The pharmacist identified multiple MRPs for this high-risk group for which greater routine monitoring and follow-up may be beneficial. More work seems needed to engage both patients and prescribers.

Evaluation of an enhanced depression and anxiety screening with targeted pharmacist intervention.

BACKGROUND: Depression is a major source of morbidity but often goes undiagnosed. Broader screening is recommended, and pharmacists could contribute. OBJECTIVES: This study aimed to assess the feasibility of community pharmacy depression and anxiety screening and describe the medication-related problems (MRPs) identified, pharmacist interventions, and provider responses for high-risk patients. METHODS: This pilot was conducted between October 2022 and January 2023 at an independently owned community pharmacy in the Midwest United States. Patients aged 18-45 years with ready prescriptions were identified through weekly reports, and tags were placed on prescription bags. A convenience sample of patients fluent in English were offered the Patient Health Questionnaire (PHQ2) and Generalized Anxiety Disorder (GAD2), with follow-up PHQ9 and GAD7 for at-risk individuals. High-risk individuals met with the pharmacist for consultation and recommendations were discussed. Descriptive statistics were calculated for participant demographics, questionnaire responses, MRPs, and provider responses. Patient profiles were examined 2 months after the workup to identify medication changes. RESULTS: A total of 29 patients volunteered to be screened for anxiety and depression; of these, 41% scored in the high-risk category for depression or anxiety and met with the pharmacist for the consultation. The pharmacist identified multiple MRPs. The most common was the need for additional therapy and inadequate dosages. Patients were reluctant for the pharmacist to follow up with their prescriber and were unreachable for telephone follow-up. Profiles reviewed 2 months after assessment showed half of the at-risk patients had one or more mental health medication changes. CONCLUSION: Community pharmacists may have a role in the screening and management of patient mental health, although there were challenges with screening uptake and follow-up. The pharmacist identified multiple MRPs for this high-risk group for which greater routine monitoring and follow-up may be beneficial. More work seems needed to engage both patients and prescribers.

Structural risks and family adjustment in midwestern Latine immigrant families: Extending the family stress model.

OBJECTIVES: We tested an extended family stress model of economic hardship (FSM; Conger et al., 2010) incorporating structural risks (discrimination, immigration, and COVID-19 experiences) and qualitative data, to better understand the impact of culturally relevant experiences on family stress processes in rural, immigrant Latine families in the U.S. Midwest. METHOD: Participants were Latine families (N = 307) with a child aged 10-15 (Mage = 12.21 years, 51.0% boys; 71.5% two parent; 93.1% of caregivers and 29% of youth born outside the United States) Mean household income was 25-30K and 65% of caregivers had less than a high school education. We tested a cross-sectional structural equation model in Mplus and analyzed qualitative interviews with a subsample of mother-youth dyads (n = 19). RESULTS: COVID-19 experiences predicted economic pressure, and both COVID-19 and discrimination experiences were linked to caregiver psychological distress. Consistent with the FSM, economic pressure predicted psychological distress, which was associated with interparental relationship problems and parenting. Parenting was associated with youth global health. Unexpectedly, interparental relationship problems to parenting were not significant. The indirect association linking COVID-19 experiences to youth global health via psychological distress and parenting was significant. Qualitative data revealed five themes demonstrating how structural and economic risks contributed to distress, conflict, and maladjustment within the family system. CONCLUSIONS: Culturally relevant structural risks exert a negative influence on family processes in rural Latine immigrant families through contributing to economic pressures and parental distress. The additional impact of these experiences should be considered when addressing the FSM in Latine populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhancing clinical reasoning and student confidence through pediatric simulation.

BACKGROUND: The education-to-practice gap is magnified in pediatric nursing due to decreasing pediatric content offered in undergraduate programs, including less pediatric clinical time and inconsistent and inadequate clinical experiences. PURPOSE: Examine student perceptions of learning and confidence by comparing a high-fidelity pediatric simulation series and acute care pediatric clinical. METHODS: The SET-M tool compared settings and included open-ended questions to add insight. SAMPLE: In an undergraduate nursing program in a university in the Midwest United States, 124 students completed the anonymous survey rating each experience for learning and confidence in assessment, clinical decision-making, communication, and safety. RESULTS: Students rated the simulation series higher than clinical for all categories except patient communication. CONCLUSION: Student perceptions of learning in high-fidelity simulation revealed increased confidence and competence and the belief that simulation complements the clinical experience and bridges the theory and clinical courses.

Role of Telehealth Use in Chronic Care Management and Disparity Reduction Among the Aging Population.

Introduction: To examine telehealth use in chronic care management and disparity reduction among the aging population. Methods: This longitudinal cohort study compared the changes in chronic care quality measures among patients with and without telehealth visits during the COVID-19 pandemic relative to patients in the previous years and by patient sociodemographic subgroup. Participants were Medicare fee-for-service beneficiaries 65 years or older from an Accountable Care Organization in the Midwest United States. Three utilization-based measures included having 2+ A1C tests, breast cancer screening, and depression screening. Three outcome-based measures included A1C control, blood pressure control, and depression diagnosis. Results: During the study period, the pandemic cohort experienced 5-17 percentage points' decrease in utilization-based measures (e.g., 2+ A1C tests 63.9% vs. 51.1%; OR [95% confidence intervals] = 0.35 [0.34-0.36]) from baseline relative to the control cohort. The outcome-based measures also significantly decreased but at smaller magnitudes (3-5 percentage points). About 51.5% patients had at least one telehealth visit. The utilization-based measures for these patients were significantly higher than those without any telehealth visit (e.g., 2+ A1C 57.1% vs. 51.1%, p < 0.01). However, the outcome-based measures were comparable. Patients from historically underserved groups had a larger decline in health care outcomes than their counterparts. Among patient with at least one telehealth visit, these disparities were no longer significant. Discussions: Telehealth was associated with less negative impact of the pandemic and better performance in chronic care management, but more for utilization-based measures and less for outcome-based measures. Telehealth was also associated with less disparities in care outcomes.

Knowledge of emergency dental management among a localized sample of athletic trainers.

BACKGROUND/AIMS: Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels. MATERIAL AND METHODS: A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions. RESULTS: Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports. CONCLUSIONS: This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.