Social Determinants of Mental and Behavioral Health.

Both mental illness and overall mental health are determined by a complicated interplay of life experiences and genetic predisposition. While genetic predisposition is difficult to modify, many of the life experiences that worsen mental health and exacerbate serious mental illness are associated with social policies and cultural norms that are changeable. Now that we have identified these associations, it is time to rigorously test scalable interventions to address these risks. These interventions will need to focus on high-impact stages in life (like childhood) and will need to address risk beyond the individual by focusing on the family and community.

Youth experiences with and perspectives on long covid.

BACKGROUND: Research on the long-term effects of COVID-19 infection is ongoing, and the psychological and physical impacts of Long Covid on youth is poorly understood. To assess these impacts, we surveyed youth regarding their experiences with, and perspectives on, the long-term effects of COVID-19. METHODS: We conducted a nationwide text message survey of youth ages 14-24 years in the United States. The survey asked four open ended questions regarding their experiences and perceptions regarding the long-term effects of COVID-19. Qualitative data was analyzed independently by three investigators using thematic analysis. Prevalence of codes were summarized using descriptive statistics. RESULTS: Among 1150 participants, 991 responded to at least one survey question (response rate 86.1%). The vast majority of our sample had COVID-19 or knew someone who did (75%), and approximately one third (32%) of youth indicated that they knew someone who had experienced symptoms consistent with Long Covid. Many youth (50%) reported worry and concern about Long Covid even if they, or someone they knew, did not have Long Covid. Among youth who were not concerned about Long Covid, the most commonly reported reasons were having received the vaccine (29%) and not having a prior COVID-19 infection (24%). CONCLUSIONS: Our findings suggest that among younger populations, there is significant concern regarding the long-term effects of COVID-19. Vaccination campaigns and youth-centered public health communication about Long Covid may not only reduce COVID-19 transmission, but also alleviate worries and concerns about Long Covid among youth.

Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalisations in people aged at least 80 years: a test-negative, case-control study.

BACKGROUND: On Dec 8, 2020, deployment of the first SARS-CoV-2 vaccination authorised for UK use (BNT162b2 mRNA vaccine) began, followed by an adenoviral vector vaccine ChAdOx1 nCoV-19 on Jan 4, 2021. Care home residents and staff, frontline health-care workers, and adults aged 80 years and older were vaccinated first. However, few data exist regarding the effectiveness of these vaccines in older people with many comorbidities. In this post-implementation evaluation of two COVID-19 vaccines, we aimed to determine the effectiveness of one dose in reducing COVID-19-related admissions to hospital in people of advanced age. METHODS: This prospective test-negative case-control study included adults aged at least 80 years who were admitted to hospital in two NHS trusts in Bristol, UK with signs and symptoms of respiratory disease. Patients who developed symptoms before receiving their vaccine or those who received their vaccine after admission to hospital were excluded, as were those with symptoms that started more than 10 days before hospital admission. We did logistic regression analysis, controlling for time (week), sex, index of multiple deprivations, and care residency status, and sensitivity analyses matched for time and sex using a conditional logistic model adjusting for index of multiple deprivations and care residency status. This study is registered with ISRCTN, number 39557. FINDINGS: Between Dec 18, 2020, and Feb 26, 2021, 466 adults were eligible (144 test-positive and 322 test-negative). 18 (13%) of 135 people with SARS-CoV-2 infection and 90 (34%) of 269 controls received one dose of BNT162b2. The adjusted vaccine effectiveness was 71·4% (95% CI 46·5-90·6). Nine (25%) of 36 people with COVID-19 infection and 53 (59%) of 90 controls received one dose of ChAdOx1 nCoV-19. The adjusted vaccine effectiveness was 80·4% (95% CI 36·4-94·5). When BNT162b2 effectiveness analysis was restricted to the period covered by ChAdOx1 nCoV-19, the estimate was 79·3% (95% CI 47·0-92·5). INTERPRETATION: One dose of either BNT162b2 or ChAdOx1 nCoV-19 resulted in substantial risk reductions of COVID-19-related hospitalisation in people aged at least 80 years. FUNDING: Pfizer.

Knowledge, Behaviors, and Social Factors That Influence Pregnancy Weight Gain among Youth Ages 16-24 Years.

STUDY OBJECTIVE: A large proportion (50%-75%) of youth (younger than 21 years old) who become pregnant gain more weight during pregnancy than is recommended by the National Academy of Medicine. Excess weight gain during pregnancy is a strong risk factor for long-term obesity among mothers and their infants. There is a significant gap in our understanding of youth's knowledge and behavior related to weight gain during pregnancy. To develop effective interventions for pregnant youth, it is necessary to understand their distinct needs and preferences. Using a youth-centered qualitative approach, the purpose of this study was to explore the knowledge, behaviors, and social factors that influence weight gain during pregnancy for youth. DESIGN: Participants completed weekly text message surveys and semistructured interviews to explore their perspectives of weight gain during pregnancy. Data were analyzed using qualitative thematic analysis on the basis of grounded theory. SETTING AND PARTICIPANTS: Pregnant youth ages 16-24 years old recruited from 2 urban, low-income, primary care clinics in Southeast Michigan. INTERVENTIONS, MAIN OUTCOME MEASURES, AND RESULTS: Among our sample (N = 54) 4 themes emerged. First, many youths were knowledgeable about healthy behaviors in pregnancy. However, the second theme showed that many youths reported barriers to engaging in these healthy behaviors, including stress, poor motivation, and issues of convenience. Third, they showed inadequate knowledge about exercise in pregnancy, and fourth, many endorsed food cravings that significantly influenced diet choices. CONCLUSION: Many pregnant youths have appropriate knowledge about healthy behaviors during pregnancy, but face many youth-specific barriers to achieving these behaviors. Interventions should address logistical challenges (eg, food access, cost, transportation) to healthy behaviors in pregnancy to make healthy diet and exercise more convenient for pregnant youth.

Health Maintenance in School-Aged Children: Part I. History, Physical Examination, Screening, and Immunizations.

The goals of the health maintenance visit in school-aged children (five to 12 years) are promoting health, detecting disease, and counseling to prevent injury and future health problems. During the visit, the physician should address patient and parent/caregiver concerns and ask about emergency department or hospital care since the last visit; lifestyle habits (diet, physical activity, daily screen time, secondhand smoke exposure, hours of sleep per night, dental care, safety habits); and school performance. Poor school performance may indicate problems such as learning disabilities, attention-deficit/hyperactivity disorder, or bullying. Previsit questionnaires and psychosocial screening questionnaires are also useful. When performing a physical examination, the physician should be alert for signs of abuse. Children should be screened for obesity (defined as body mass index at or above the 95th percentile for age and sex), and obese children should be referred for intensive behavioral interventions. Although its recommendations are primarily based on expert opinion, the American Academy of Pediatrics recommends screening for hypertension annually, vision and hearing problems approximately every two years, and dyslipidemia once between nine and 11 years of age; regular screening for risk factors related to social determinants of health is also recommended. There is insufficient evidence to recommend routine screening for depression before 12 years of age, but depression should be considered in children younger than 12 years presenting with unexplained somatic symptoms, restlessness, separation anxiety, phobias, or hallucinations. Children living in areas with inadequate levels of fluoride in the water supply (0.6 ppm or less) should receive daily fluoride supplements. Age-appropriate immunizations should be given, as well as any catch-up immunizations.

Randomized controlled trial of a primary care-based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for Skeletal Health in Bristol and Avon (COSHIBA).

Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs); these are associated with excess morbidity and mortality and a high risk of future osteoporotic fractures. Despite this, less than one-third come to clinical attention, partly due to lack of clear clinical triggers for referral for spinal radiographs. The aim of this study was to investigate whether a novel primary care-based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis. A randomized controlled trial was undertaken in 15 general practices within the Bristol area of the UK. A total of 3200 women aged 65 to 80 years were enrolled, with no exclusion criteria. A simple screening tool was carried out by a nurse in primary care to identify women at high risk of osteoporotic VFs. All identified high-risk women were offered a diagnostic thoracolumbar radiograph. Radiographs were reported using standard National Health Service (NHS) reporting, with results sent back to each participant's general practitioner (GP). Participants in the control arm did not receive the screening tool or radiographs. The main outcome measure was self-reported prescription of medication for osteoporosis at 6 months with a random 5% subsample verified against electronic GP records. Secondary outcome was self-reported incidence of new fractures. Results showed that allocation to screening increased prescription of osteoporosis medications by 124% (odds ratio [OR] for prescription 2.24 at 6 months; 95% confidence interval [CI], 1.16 to 4.33). Allocation to screening also reduced fracture incidence at 12-month follow-up (OR for new fracture 0.60; 95% CI, 0.35-1.03; p = 0.063), although this did not reach statistical significance. This study supports the use of a simple screening tool administered in primary care to increase appropriate prescription of medications for osteoporosis in postmenopausal women in the UK.

Determinants of fracture risk in a UK-population-based cohort of older women: a cross-sectional analysis of the Cohort for Skeletal Health in Bristol and Avon (COSHIBA).

BACKGROUND: Identification of individuals with high fracture risk from within primary care is complex. It is likely that the true contribution of falls to fracture risk is underestimated. METHODS: Cross-sectional analysis of a population-based cohort of 3,200 post-menopausal women aged 73 ± 4 years. Self-reported data were collected on fracture, osteoporosis clinical risk factors and falls/mobility risk factors. Self-reported falls were compared with recorded falls on GP computerised records. Multivariable logistic regression was used to identify independent risk factors for fracture. RESULTS: A total of 838 (26.2%) reported a fracture after aged 50; 441 reported falling more than once per year, but 69% of these had no mention of falls on their computerised GP records. Only age [odds ratios (OR): 1.37 per 5 year increase, 95% confidence interval (CI): 1.23-1.53], height (1.02 per cm increase, 95% CI: 1.01-1.04), weight (OR: 0.99 per kg increase, 95% CI: 0.98-0.99) and falls (OR: 1.49 for more than once per year compared with less, 95% CI: 1.13-1.94) were independent risk factors for fracture. Falls had the strongest association. CONCLUSION: When identifying individuals with high fracture risk we estimate that more than one fall per year is at least twice as important as height and weight. Furthermore, using self-reported falls data is essential as computerised GP records underestimate falls prevalence.