The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic.

BACKGROUND: This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. METHODS: The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. RESULTS: By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. CONCLUSIONS: The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. PRACTICAL IMPLICATIONS: More efforts are needed to reduce ED visits for NTDCs.

Missed opportunities in aspirin prescribing for preeclampsia prevention.

BACKGROUND: Hypertensive disorders of pregnancy, including preeclampsia, are a leading cause of perinatal morbidity and mortality in the United States, particularly among low-income and historically marginalized populations. Evidence suggests low-dose aspirin prophylaxis may help prevent preeclampsia in individuals at increased risk of developing the disease. This study examines associations between preeclampsia risk factors and aspirin prescribing practices among patients receiving prenatal care at a network of federally qualified health centers (FQHC). METHODS: Researchers conducted retrospective chart reviews (n = 523) of pregnant individuals ages 18-50 who completed two or more prenatal visits at the FQHC between January 1, 2019 and December 31, 2020. Prescription patterns for patients at moderate and high risk for preeclampsia were analyzed using unadjusted and adjusted logistic regression models to identify the patients with the greatest risk of not receiving the recommended prophylactic treatment. RESULTS: Of 249 total patients considered at risk for preeclampsia, only 39% received an aspirin prescription. 57.89% of patients with any high-risk factor were appropriately prescribed aspirin, but only 27.27% of patients with two or more moderate-risk factors without high-risk factors received a prescription. Clinicians most frequently prescribed aspirin for patients with a history of preeclampsia and history of hypertension. However, aspirin was prescribed a maximum of 78.79% of the time for patients with a prior history of hypertension. Among moderate-risk factors, patients with advanced maternal age, Black race, or nulliparity were significantly more likely in adjusted models to be prescribed aspirin. CONCLUSIONS: Despite the documented benefits of aspirin prescribing and support from professional societies, there are still many missed opportunities for aspirin prophylaxis to prevent preeclampsia. Future interventions should focus on identifying patients who qualify for aspirin prophylaxis on the basis of having multiple moderate-risk factors without comorbid high-risk factors.

UPDATED PROTOCOL: Universal school-based programmes for improving social and emotional outcomes in children aged 3-11 years: An evidence and gap map.

This is the protocol for an evidence and gap map. The objective of this EGM is to identify and map all primary studies (including randomised and cluster randomised trials) and systematic reviews on universal, school-based social and emotional learning programmes for young children (3-11 years) to create a live, searchable, and publicly available evidence and gap map.

Predicting emergency department visits among children with asthma in two academic medical systems.

Objective: To develop and validate a predictive algorithm that identifies pediatric patients at risk of asthma-related emergencies, and to test whether algorithm performance can be improved in an external site via local retraining.Methods: In a retrospective cohort at the first site, data from 26 008 patients with asthma aged 2-18 years (2012-2017) were used to develop a lasso-regularized logistic regression model predicting emergency department visits for asthma within one year of a primary care encounter, known as the Asthma Emergency Risk (AER) score. Internal validation was conducted on 8634 patient encounters from 2018. External validation of the AER score was conducted using 1313 pediatric patient encounters from a second site during 2018. The AER score components were then reweighted using logistic regression using data from the second site to improve local model performance. Prediction intervals (PI) were constructed via 10 000 bootstrapped samples.Results: At the first site, the AER score had a cross-validated area under the receiver operating characteristic curve (AUROC) of 0.768 (95% PI: 0.745-0.790) during model training and an AUROC of 0.769 in the 2018 internal validation dataset (p = 0.959). When applied without modification to the second site, the AER score had an AUROC of 0.684 (95% PI: 0.624-0.742). After local refitting, the cross-validated AUROC improved to 0.737 (95% PI: 0.676-0.794; p = 0.037 as compared to initial AUROC).Conclusions: The AER score demonstrated strong internal validity, but external validity was dependent on reweighting model components to reflect local data characteristics at the external site.

A Meta-Analytical Assessment of the Effect of Deontological Evaluations and Teleological Evaluations on Ethical Judgments/Intentions.

Deontological and teleological evaluations are widely utilized in the context of consumer decision-making. Despite their use, the differential effect of these distinct types of evaluations, and the conditions under which they hold, remains an unresolved issue. Thus, we conduct a meta-analysis of 316 effect sizes, from 53 research articles, to evaluate the extent to which deontological and teleological evaluations influence ethical judgments and intentions, and under what circumstances the influence occurs. The effect is explored across three categories of moderators: (1) contextual elements of the ethical issue, (2) stakeholders, and (3) methodological characteristics of primary studies. We find that the overall effect of deontological evaluations on ethical judgments and intentions is stronger than for teleological evaluations; however, the magnitude of the effect is contingent on several moderators. Deontological evaluations are weaker in offline consumer contexts and stronger when there are financial implications of the ethical issue. Conversely, the effect of teleological evaluations is relatively stable across ethical consumer contexts. Teleological evaluations are stronger from a utilitarian perspective than from an egoist one. Furthermore, the effect of deontological evaluations is weaker, but the effect for teleological evaluations is stronger, when the decision-maker has a personal relationship (as compared to an organizational relationship) with the victim of the unethical act. Findings validate the effect of both deontological and teleological evaluations on ethical judgments and intentions and highlight their importance in consumers' ethical decision-making. Implications for developing programs to prevent consumer unethical behavior are discussed.

Transition Needs Compassion: a Thematic Analysis of an Online Compassion-Focused Therapy Group in a Gender Service.

Objectives: Transgender and gender non-conforming people may face elevated rates of shame and self-criticism in light of minority stress. Compassion-focused therapy has a growing evidence base in addressing trans-diagnostic processes in mental health difficulties, including shame and self-criticism. The objective of the present study was to explore the experience of an initial pilot compassion-focused therapy group delivered online in a Gender Service during the COVID-19 pandemic. Methods: Six transgender people completed a semi-structured interview after attending an 8-week compassion-focused therapy group in a national Gender Service. Inductive thematic analysis was used to identify themes in the data. Results: Four themes were identified from the data: Transition Needs Compassion; Acceptability of the Compassion-Focused Approach; Being in a group with other transgender people; and Online delivery works despite its challenges. Participants reported that the compassion-focused framework was an appropriate and helpful way of understanding their experiences of stigma and that both the content and process of the group had benefitted them. Being with other transgender people raised some anxieties, such as comparisons or fear of offending, but also enabled seeing the self in more positive and accepting ways. While online delivery had some challenges, participants largely felt it was an effective mode of delivery, aided by the experiential nature of the group. Conclusions: Compassion-focused therapy seems to be a feasible and acceptable approach for transgender and gender non-conforming people. Group processes may be helpful in increasing self-acceptance. Further quantitative exploration of therapy process and outcomes is warranted.

Gender, ethnicity differences in mental health status and COVID-19 vaccine intention among U.S. College students during COVID-19 pandemic.

Objective: To examine mental health status, COVID-19 vaccine intention and barriers among college students in the U.S. Participants: Students (n = 337) registered at a large public university in 2021. Methods: Cross-sectional survey data were collected online and analyzed using independent samples t test, chi-square test, and one-way ANOVA. Results: Compared to male students, females reported greater anxiety (p < .05) and fear (p < .01). Hispanic participants reported increased anxiety level and the least positive pandemic coping strategies (both p < .05) across the ethnic groups. Black students were the racial group with the lowest trust in the safety and effectiveness of COVID-19 vaccine (p < .05). Vaccine intention was positively correlated with factors such as vaccine safety measures, and perceptions toward vaccination (both p < .001). Conclusions: These gender- and ethnicity- based mental health struggles should be addressed immediately for better health and vaccine promotion outcomes amid the COVID-19 pandemic.

Experiences of Female Partners of People Transitioning Gender: A Feminist Interpretive Metasynthesis.

The needs of romantic partners of people transitioning gender remain neglected within academia and gender services. Following a systematic search, nine studies relating to female partners' experiences were subjected to a thematic metasynthesis. Four themes were generated and entitled Changes in sexual relationship; New roles and responsibilities; Identity and belonging; and Transformation and loss Results are considered in relation to the dominance of the gender-affirmation discourse. Limitations of the review and reviewed studies are highlighted. Clinical implications for couples and partners of people transitioning gender are offered.

Prior health care utilization among adolescents treated for a suicide attempt at a rural ED.

PURPOSE: To characterize prior contact with a rural academic health system among young people treated for a suicide attempt in the system's emergency departments (EDs). METHODS: We retrospectively examined electronic medical records from a health system serving 29 medically underserved rural counties in the Southeastern United States. Patients ages 10-25 years were included in the study if they were admitted to the ED for a suicide attempt in 2015-2018. Patients were stratified according to whether they had any encounter in the same health system in the 12 months prior to the attempt. FINDINGS: Of 236 patients meeting inclusion criteria, only 10% had contact with the health system in the 12 months prior to ED treatment for a suicide attempt. Patients who lived farther than 25 km from the flagship hospital were less likely to have had prior contact (odds ratio [OR]: 0.10, 95% confidence interval [CI]: 0.02-0.34). Young adults ages 19-25 years were also less likely to have prior contact than adolescents (OR: 0.27, 95% CI: 0.08-0.76). CONCLUSIONS: Few adolescents and young adults in this rural region received prior health care from the same health system where they were treated for a suicide attempt. Hospitals operating in rural areas need to partner with community health care providers to ensure adequate reach of screening and treatment programs to prevent youth suicide and reduce care fragmentation.

Distance from the endocrinology clinic and diabetes control in a rural pediatric population.

OBJECTIVE: We analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina. METHODS: We retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review period. RESULTS: The analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c. CONCLUSIONS: Patients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits.

Modifiable factors related to transition readiness in adolescents and young adults with epilepsy.

OBJECTIVE: To characterize transition readiness in adolescents and young adults (AYAs) with epilepsy and validate the social-ecological model of AYA readiness to transition (SMART) in a sample of AYAs with epilepsy. METHODS: This cross-sectional study included typically developing youth with epilepsy 13-25 years old seen in a comprehensive epilepsy center. Adolescents and young adults completed measures of transition readiness (Transition Readiness Assessment Questionnaire; TRAQ), epilepsy knowledge, epilepsy self-management, developmental factors, and emotional and behavioral functioning. Adolescents and young adults also completed a measure of their relationship quality with healthcare providers. Caregiver report was included when available. RESULTS: Participants included 82 AYAs (Mage = 17.3 ±â€¯2.8; 86.6% White Non-Hispanic, 53.7% females) with epilepsy. Transition Readiness Assessment Questionnaire scores (M = 3.33, SD = 0.86) were correlated with modifiable and non-modifiable factors: age (r = 0.66, p < 0.001), income (r = -0.23, p = 0.04), AYA cognitive problems (r = 0.24, p = 0.03), AYA knowledge (r = 0.31, p = 0.005), AYA expectations (r = 0.26, p ≤ 02), AYA inattention (r = -0.24, p = 0.03), AYA executive dysfunction (r = 0.25, p = 0.02), caregiver-reported AYA odd behaviors (r = -0.25, p = 0.036), and caregiver-reported AYA communication problems (r = 0.25, p = 0.04). Transition Readiness Assessment Questionnaire scores were higher in AYAs who had seen adult providers for general healthcare issues (e.g., primary care), but were not related to other demographic (e.g., minority status, insurance), medical (years since diagnosis, type of epilepsy, polytherapy, seizure frequency), developmental (e.g., adaptive skills, cognitive functioning) or emotional/behavioral factors (e.g., skills, relationship with the provider, psychosocial functioning). Linear regression including variables significantly correlated with the outcome of transition readiness (F (7, 59) = 9.70, p < 0.001) explained 54% of the variance. Specifically, age was the only significant model predictor. SIGNIFICANCE: Transition readiness in AYAs with epilepsy was predicted by non-modifiable (e.g., age) and correlated with modifiable factors (e.g., knowledge, psychosocial/cognitive functioning). Providers must better prepare patients prior to transfer, and future research should use an epilepsy-specific measure of transition readiness to identify targets for intervention.

Pilot Executive Functioning Intervention in Epilepsy: Behavioral and Quality of Life Outcomes.

OBJECTIVE: To examine changes in emotional and behavioral functioning and health-related quality of life (HRQOL) following a web-based executive functioning (EF) intervention open pilot trial (e.g., Epilepsy Journey) for adolescents with epilepsy. METHODS: Adolescents with an established diagnosis of epilepsy, EF deficits, and without developmental disorders participated in a single-arm trial of Epilepsy Journey. Epilepsy Journey is a gamified, online learning environment comprised of 10 learning modules targeting EF deficits (e.g., working memory, organization) and tailored to epilepsy with accompanying telehealth problem-solving sessions. Adolescents completed questionnaires assessing emotional and behavioral functioning and HRQOL at baseline, posttreatment, and 2 follow-ups . Longitudinal mixed models and logistic regression analyses were used for these secondary analyses. RESULTS: 39 adolescents were recruited for Epilepsy Journey (Mage=15.3 years; 67% female; 87% White: Non-Hispanic; 39% experienced seizures in the past 3 months). Preliminary data indicate significant improvements in caregiver-reported Externalizing symptoms, Behavioral Symptom Index scores and Adaptive Skills from baseline to 5-month follow-up. Significant improvements were observed for caregiver-reported Mood/Behavior and self-reported Impact, Cognitive Functioning, Executive Functioning, and Sleep subscales of the PedsQL Epilepsy Module. Clinically significant improvements (e.g., clinical/at-risk to normative levels) in behavioral and quality of life domains were also noted. CONCLUSION: Epilepsy Journey appears to contribute to changes in emotional and behavioral functioning and HRQOL in adolescents with epilepsy. Given the proof of concept trial format of this study, an important future direction is to conduct a randomized controlled trial with a larger, generalizable cohort of adolescents with epilepsy.

The case for integrated health and community literacy to achieve transformational community engagement and improved health outcomes: an inclusive approach to addressing rural and remote health inequities and community healthcare expectations.

CONTEXT: Despite the substantial investment by Australian health authorities to improve the health of rural and remote communities, rural residents continue to experience health care access challenges and poorer health outcomes. Health literacy and community engagement are both considered critical in addressing these health inequities. However, the current focus on health literacy can place undue burdens of responsibility for healthcare on individuals from disadvantaged communities whilst not taking due account of broader community needs and healthcare expectations. This can also marginalize the influence of community solidarity and mobilization in effecting healthcare improvements. OBJECTIVE: The objective is to present a conceptual framework that describes community literacy, its alignment with health literacy, and its relationship to concepts of community engaged healthcare. FINDINGS: Community literacy aims to integrate community knowledge, skills and resources into the design, delivery and adaptation of healthcare policies, and services at regional and local levels, with the provision of primary, secondary, and tertiary healthcare that aligns to individual community contexts. A set of principles is proposed to support the development of community literacy. Three levels of community literacy education for health personnel have been described that align with those applied to health literacy for consumers. It is proposed that community literacy education can facilitate transformational community engagement. Skills acquired by health personnel from senior executives to frontline clinical staff, can also lead to enhanced opportunities to promote health literacy for individuals. CONCLUSIONS: The integration of health and community literacy provides a holistic framework that has the potential to effectively respond to the diversity of rural and remote Australian communities and their healthcare needs and expectations. Further research is required to develop, validate, and evaluate the three levels of community literacy education and alignment to health policy, prior to promoting its uptake more widely.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting.

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs (n = 7) and SLPs (n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase (n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

National Trends in Pediatric Headache and Associated Functional Limitations.

Objective. Frequent or severe headaches are associated with school absenteeism and functional limitation in children, but trends in headache prevalence are uncertain. We used nationally representative data to describe trends in pediatric headache prevalence in the United States, and to evaluate whether headache has remained consistently associated with functional limitations among school-age children. Methods. We analyzed data on children age 5 to 17 years in the 2007 to 2015 National Health Interview Surveys. Caregivers reported whether each child experienced frequent or severe headache in the past 12 months. Weighted proportions and multivariable regression were used to estimate headache prevalence over the study period and associations between headache and measures of functional limitation. Results. The analysis included 57 272 children (mean age = 11 years; 52% female). Frequent or severe headache was reported for 6% of children, with no discernable trend over the study period. On multivariable Poisson regression, headache became more strongly associated with school absenteeism over time. In 2007, frequent or severe headache was associated with a 70% increase in the number of missed school days (incidence risk ratio [IRR] = 1.70; 95% confidence interval [CI] = 1.50-1.91; P < .001), whereas by 2015, headache was associated with a 139% increase in the number of missed school days (IRR = 2.39; 95% CI = 2.02-2.83; P < .001). Conclusion. Though the prevalence of frequent or severe headache in school-age children did not change in 2007 to 2015, headache became more strongly associated with school absenteeism, highlighting the need for improved management of patients with headaches to prevent negative impact on school performance and functional status.

Epilepsy Journey: A proof of concept trial of a Web-based executive functioning intervention for adolescents with epilepsy.

OBJECTIVE: To examine the preliminary feasibility and acceptability of a Web-based program, Epilepsy Journey, to improve executive function behaviors in adolescents with epilepsy. METHODS: We conducted a proof of concept single-arm pilot trial of Epilepsy Journey with 31 adolescents (average age = 15.3 ± 1.3 years) who had an epilepsy diagnosis and executive function (EF) deficits on the caregiver-report version of the Behavior Rating Inventory of Executive Function (BRIEF). Epilepsy Journey coupled a gamified problem-solving website comprised of 10 learning modules targeting EF deficits (eg, working memory, organization, problem-solving) with Skype sessions with a trained therapist. Outcomes included feasibility (attrition, sessions completed) and acceptability (satisfaction ratings). Exploratory analyses examined changes in caregiver-, self-, and teacher-reported BRIEF scores from baseline to posttreatment and at 2- and 5-month follow-ups. RESULTS: Seventy-nine percent of participants completed the program. Satisfaction was high, with 97% of caregivers and adolescents rating the program as helpful and indicating they would recommend it to others. Caregivers and adolescents reported global improvements on the BRIEF, with caregivers reporting significant improvements on all BRIEF subscales. EF symptoms rebounded slightly between the 2- and 5-month follow-ups for some of the self- and caregiver-reported BRIEF scales. Notably, clinically meaningful improvements (eg, clinical/subclinical to normative levels) were reported for several caregiver-reported BRIEF subscales, including the Global Executive Composite (62% to 33-34%) and Metacognitive Index (74% to 41-42%) from baseline to 2- and 5-month follow-up. SIGNIFICANCE: Findings suggest that a Web-based problem-solving intervention tailored to EF deficits for adolescents with epilepsy is both feasible and acceptable and may contribute to improvements in EF behaviors across domains.

Quality of life improves with integrated behavioral health services in pediatric new-onset epilepsy.

The current study compared differences in health-related quality of life (HRQOL) between youth with new-onset epilepsy with and without elevated psychological symptoms at time of epilepsy diagnosis within an integrated behavioral health and epilepsy service. Patients received both behavioral health and epilepsy care during clinic visits. A retrospective chart review was conducted between July 2011 and December 2015. Caregivers completed the Behavior Assessment System for Children-2: Parent Rating Scale (BASC-2: PRS) to assess psychological symptoms at the diagnostic visit, along with completing the Pediatric Quality of Life Inventory (PedsQL™ 4.0) at the diagnostic visit and each subsequent epilepsy clinic visit during the first year of treatment. Latent growth curve modeling was used to identify HRQOL changes over the first year of treatment. Health-related quality of life was significantly lower for youth with elevated psychological symptoms at diagnosis and over the first year of treatment compared with those without psychological symptoms. For those with elevated internalizing, inattention, withdrawal, and atypical symptoms at diagnosis, greater HRQOL improvements were detected over the first year of treatment compared with those without elevated psychological symptoms at the diagnostic visit. Within integrated behavioral health and epilepsy routine care, targeted psychological interventions can improve HRQOL over the first year of treatment, particularly for those with premorbid psychological symptoms.