Impact of COVID-19 on post graduate medical education and training.

PURPOSE: The novel Coronavirus Disease 19 (COVID-19) has had a significant impact worldwide that led to changes in healthcare. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on trainee's mental health and educational preparedness. METHODS: Trainees at the Indiana University School of Medicine were surveyed regarding the impact of the COVID-19 pandemic on their training. Using a Likert scale, participants were asked questions pertaining to educational preparedness, mental health, and clinical work during the pandemic. Data was analyzed using SPSS version 27. The study was approved as exempt by the Institutional review Board (IRB). RESULTS: 324 of the 1204 trainees responded to the survey. The respondents were 76% white with an equal distribution of males and females. A majority of the respondents were first year residents with an equal distribution of second, third, and fourth year residents. Twenty-three percent of respondents were in a procedural residency or fellowship program. Better perceived educational preparedness was associated with an improved home-work balance during COVID-19 (ß = 0.506, p < 0.0001) and having a department that advocated/supported focus on mental health during COVID-19 (ß = 0.177, p < 0.0001). Worse perceived educational preparedness was associated with being in procedural vs. non-procedural dominant training program (ß = - 0.122, p = 0.01). CONCLUSION: COVID-19 has had a significant impact on the training experience of residents and fellows. Departmental support increased mental well-being and perceived education preparedness in trainees. Trainees that felt they had a better home-work life balance had better educational preparedness compared to their peers. Also, trainees in procedural programs had less educational preparedness compared to their peers in non-procedural programs. This study highlights the importance for programs to find avenues to increase educational preparedness in their trainees while being attuned to the mental health of their trainees.

County-level correlates of completed HPV vaccination in Indiana.

The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9-14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9-14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.

Perception of Procedural Justice Amongst Previously Incarcerated Youth: Procedural Justice in Incarcerated Youth.

Violence among incarcerated youths is a serious public health issue and an area of marked health disparities. Procedural Justice is an ethical framework to guide policy approaches in the criminal justice system. The purpose of our study was to evaluate youth perception of neutrality, respect, trust, and voice while incarcerated. Young people ages 14 to 21 previously incarcerated in a juvenile detention facility were interviewed regarding their perceptions of procedural justice. Participants were recruited from community-based organizations. Interviews were semi-structured, lasting for 1 hr. Interviews were coded for themes related to procedural justice. Twenty-eight participants were interviewed regarding their experience with procedural justice while incarcerated. Key themes included: Neutrality: Participants felt that they were treated impartially regarding everyone receiving the same punishment for offenses; however, levels of punishments for offenses were inconsistent. Respect: Participants often felt disrespected by staff. Trust: The participants did not feel safe to trust. Voice: Participants felt they had no voice while incarcerated. Previously incarcerated youth perceptions indicated a need for more training in the juvenile detention system to enable staff members to have a better understanding of procedural justice and to appropriately utilize it.

Ethical Approaches to Vaccine Allocation and Administration in Carceral Settings, With a Focus on Youth.

COVID-19 has disproportionately impacted Americans in carceral settings and secure facilities. A disproportionate number of persons who are confined to carceral settings and secure facilities are members of racial, ethnic, and socioeconomic groups who experience a significant burden of COVID-19 morbidity and mortality. The pandemic-related disparities experienced by minoritized and detained adult populations have received national attention, but the burden of COVID-19 risk among justice-involved youth has been largely absent from these national conversations. With more than 40,000 youth in carceral settings, their COVID-19 risks and prevention needs warrant specific consideration, especially as vaccine distribution programs expand. Youth have been assigned a lower priority status in most state vaccine allocation plans, but youth in carceral settings are at increased risk compared with their peers, raising important questions about how to ethically allocate and administer vaccines to them. In this article we examine ethical issues that arise in the health care of minors in carceral settings and identify an ethical model that could be used to reconsider the allocation of COVID-19 vaccines.

Sexuality Among Adolescents With Intellectual Disability: Balancing Autonomy and Protection.

Adolescents and young adults living with intellectual disability (ID) have made significant advancements integrating into multiple aspects of western society, but there has been less progress with regards to sexual health. While advocating for individuals with ID to live life to the fullest, pediatricians have practical concerns regarding the ability to consent to sex as well as avoid coercion and manipulation in sexual encounters. This has led to tension between supporting the autonomy of a patient with ID while protecting them from harm. We present a case of a young adult with moderate ID who is engaging in a sexual relationship with her boyfriend without parental knowledge. The pediatrician must decide the most appropriate course of action to support the patient's autonomy but also ensure that the patient is a willing participant and understands the risks of engaging in sexual activity. This case highlights 4 main themes: (1) practical concerns when approaching sexual health in the adolescent with ID, (2) advocating for the rights of those with ID to live life to the fullest, (3) the critical inclusion of individuals with ID in decisions directly affecting them and their peer group, and (4) decision-making capacity and respect for autonomy in individuals with ID. This case highlights the delicate balance providers face when providing care to adolescents and young adults with ID: supporting autonomy to make decisions while reducing harm to a vulnerable population.

County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan.

BACKGROUND: The goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities. METHODS: The Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11-18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing. RESULTS: The missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities. CONCLUSIONS: We found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors. SOURCES OF SUPPORT: This study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.