Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations.

OBJECTIVES: Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. METHODS: Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. RESULTS: Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. CONCLUSIONS: This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.

Mass Testing for SARS-CoV-2 in 16 Prisons and Jails - Six Jurisdictions, United States, April-May 2020.

Preventing coronavirus disease 2019 (COVID-19) in correctional and detention facilities* can be challenging because of population-dense housing, varied access to hygiene facilities and supplies, and limited space for isolation and quarantine (1). Incarcerated and detained populations have a high prevalence of chronic diseases, increasing their risk for severe COVID-19-associated illness and making early detection critical (2,3). Correctional and detention facilities are not closed systems; SARS-CoV-2, the virus that causes COVID-19, can be transmitted to and from the surrounding community through staff member and visitor movements as well as entry, transfer, and release of incarcerated and detained persons (1). To better understand SARS-CoV-2 prevalence in these settings, CDC requested data from 15 jurisdictions describing results of mass testing events among incarcerated and detained persons and cases identified through earlier symptom-based testing. Six jurisdictions reported SARS-CoV-2 prevalence of 0%-86.8% (median = 29.3%) from mass testing events in 16 adult facilities. Before mass testing, 15 of the 16 facilities had identified at least one COVID-19 case among incarcerated or detained persons using symptom-based testing, and mass testing increased the total number of known cases from 642 to 8,239. Case surveillance from symptom-based testing has likely underestimated SARS-CoV-2 prevalence in correctional and detention facilities. Broad-based testing can provide a more accurate assessment of prevalence and generate data to help control transmission (4).

Racial Discrimination and Alcohol Use: The Moderating Role of Religious Orientation.

BACKGROUND: An outgrowth of research has established a relationship between racial discrimination and alcohol use, as well as factors that moderate this association. OBJECTIVES: The main objective of this study was to determine if religious orientation moderates the relationship between perceived racial discrimination and alcohol use. METHODS: This study utilized a cross-sectional data collection strategy to examine the relationship among discrimination, religious orientation, and alcohol use among undergraduate students (N = 349) at a midsize southeastern university. Data was collected in 2014. Participants completed a demographic questionnaire, the General Ethnic Discrimination Scale, the Extrinsic/Intrinsic Religious Orientation Scale-Revised and the Drinking and Drug Habits Questionnaire. RESULTS: Analyses using hierarchical linear regression indicate a significant interaction effect (lifetime discrimination × extrinsic religious orientation) on problem drinking. Additional moderation analyses reveal a significant interaction effect between lifetime discrimination and the extrinsic-personal religious orientation on problem drinking. CONCLUSIONS: Results suggest that an extrinsic religious orientation, and particularly, an extrinsic-personal religious orientation, moderates the relationship between lifetime discrimination and problem drinking, suggesting that turning to religion for comfort and protection, rather than for the superficial purpose of seeing/making friends at church, may buffer against the deleterious effects of discrimination-specifically, engaging in problem drinking to cope with the stress of discrimination. Limitations, directions for future research, and clinical implications are discussed.