Barriers and facilitators to COVID-19 testing among staff and parents from San Diego schools.

COVID-19 testing is an important risk mitigation strategy for COVID-19 prevention in school settings, where the virus continues to pose a public health challenge for in-person learning. Socially vulnerable school communities with the highest proportion of low-income, minority, and non-English speaking families have the least testing access despite shouldering a disproportionate burden of COVID-19 morbidity and mortality. Through the Safer at School Early Alert (SASEA) program, we investigated community perceptions of testing in San Diego County schools, with a focus on barriers and facilitators from the perspective of socially vulnerable parents and school staff. Using a mixed-methods approach, we administered a community survey and conducted focus group discussions (FGDs) with staff and parents from SASEA-affiliated schools and childcares. We recruited 299 survey respondents and 42 FGD participants. Protecting one's family (96.6%) and protecting one's community (96.6%) were marked as key motivators to testing uptake. School staff in particular reported that the reassurance of a negative status mitigated concerns about COVID-19 infection in schools. Participants expressed that COVID-19-related stigma, loss of income as a result of isolation/quarantine requirements, and lack of multilingual materials were the most significant barriers to testing. Our findings suggest that the testing barriers faced by school community members are predominantly structural. Testing uptake efforts must provide support and resources to manage the social and financial consequences of testing while continuously communicating its benefits. There is a clear need to continue to incorporate testing as a strategy to maintain school safety and facilitate access for vulnerable community members.

Disproportionately High Rates of Burnout Among Disabled Caregivers During the COVID-19 Pandemic.

Background: Burnout is exhaustion caused by exposure to chronic stress. Prior to the COVID-19 pandemic, people with disabilities experienced high levels of burnout due to discrimination, barriers to accessing resources, and lack of accommodations. Caregivers have also experienced high levels of burnout during the COVID-19 pandemic. Background: While researchers have examined burnout among caregivers of disabled children, less research has focused on the experiences of disabled caregivers. We examined the association between caregiver disability and burnout during the pandemic. Methods: We distributed an online survey to caregivers of children enrolled in socially vulnerable elementary and middle schools in San Diego County, California between September and December, 2022. Our survey included demographic questions, questions about pandemic experiences, and a continuous burnout measure. We analyzed survey data to test our hypothesis that caregivers with a disability experienced higher levels of burnout than their non-disabled counterparts during the height of the COVID-19 pandemic. We used multivariable linear regression analysis adjusting for household income and caregiver education level. Results: Disabled caregivers self-reported higher levels of burnout than non-disabled caregivers (B = 0.72; p < 0.001) during the COVID-19 pandemic in bivariate and multivariable analyses. Caregivers with a higher household income (B = 0.04; p = 0.017) and more education (B = 0.13; p = 0.005) also reported higher levels of burnout. Conclusion: The COVID-19 pandemic exacerbated existing difficulties faced by disabled caregivers who often struggle to balance the demands of caregiving with their available resources. Targeted programs and policies are needed to support disabled caregivers during health emergencies that exacerbate existing inequities in access to resources.

Assessing the impact of institutional mistrust on parental endorsement for COVID-19 vaccination among school communities in San Diego County, California.

BACKGROUND: Institutional mistrust has weakened COVID-19 mitigation efforts. Assessing to what extent institutional mistrust impacts parental decision making is important in formulating structural efforts for improving future pandemic response. We hypothesized that institutional mistrust is associated with lower parental endorsement for COVID-19 vaccination. METHODS: We distributed an online survey among parents from schools in areas with high levels of social vulnerability relative to the rest of San Diego County. We defined vaccination endorsement as having a child aged 5 years or older who received at least one COVID-19 vaccine dose or being very likely to vaccinate their child aged 6 months-4 years when eligible. Institutional mistrust reflected the level of confidence in institutions using an aggregate score from 11 to 44. We built a multivariable logistic regression model with potential confounding variables. FINDINGS: Out of 290 parents in our sample, most were female (87.6%), reported their child as Hispanic/Latino (73.4%), and expressed vaccination endorsement (52.1%). For every one-point increase in mistrust score, there was an 8% reduction in the likelihood of participants endorsing vaccination for their child. Other statistically significant correlates that were positively associated with vaccination endorsement included parent vaccination status, child age, parent age, and Hispanic/Latino ethnicity. CONCLUSION: Our study further demonstrates how institutional mistrust hinders public response during health emergencies. Our findings also highlight the importance of building confidence in institutions and its downstream effects on pandemic preparedness and public health. One way that institutions can improve their relationship with constituents is through building genuine partnerships with trusted community figures.

"It's hard for everyone" systemic barriers to home confinement to prevent community spread of COVID-19.

Rapid identification and isolation/quarantine of COVID-19 cases or close contacts, respectively, is a vital tool to support safe, in-person learning. However, safe isolation or quarantine for a young child also necessitates home confinement for at least one adult caregiver, as well as rapid learning material development by the teacher to minimize learning loss. The purpose of this study is to better understand barriers and supports to student home confinement. We conducted a mixed-methods study using focus group discussions and a self-administered online survey with parents and staff members from 12 elementary schools and childcare sites across San Diego County serving low-income and socially vulnerable families. Focus group participants reported that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing were major barriers related to home confinement. The experiences described by FGD participants were prevalent in a concurrent community survey: 25% of participants reported that isolation would be extremely difficult for a household member who tested positive or was exposed to COVID-19, and 20% were extremely concerned about learning loss while in isolation or quarantine. Our findings suggest that there are serious structural impediments to safely completing the entire recommended course of isolation or quarantine, and that the potential for isolation or quarantine may also lead to increased hesitancy to access diagnostic testing.

BACKGROUND: During the COVID-19 pandemic, home confinement (isolation and quarantine) are important public health tools to keep children learning in-person at schools. However, isolation or quarantine for young children also means that often their caregivers must also go into home confinement, as well as forcing teachers to adapt their lessons to online teaching. PURPOSE: The purpose of this study is to better understand what makes home confinement comfortable or difficult for students and their families. METHODS: We did focus group discussions and shared an online survey with parents and staff members from 12 elementary schools and childcare centers across San Diego County vulnerable families. RESULTS: Focus group participants said that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing made home confinement hard to do. Also 25% of survey participants said that isolation would be difficult for a household member who tested positive or was exposed to COVID-19, and 20% were really concerned about their child's learning loss if the family had to isolate or do quarantine. CONCLUSIONS: Our study's results suggest that there are serious structural issues for school families to safely go into isolation or quarantine, and because of this may make families more hesitant to get tested for COVID-19.

Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools.

Background: Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown. Methods: The objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 to March 2021. Findings: In 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88%-98%); 67% were associated with a positive wastewater sample (95% CI: 57%-77%), and 40% were associated with a positive surface sample (95% CI: 29%-52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. Interpretation: Passive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy. Funding: County of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.

Wastewater and surface monitoring to detect COVID-19 in elementary school settings: The Safer at School Early Alert project.

Background: Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown. Methods: The objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 - March 2021. Findings: In 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88% - 98%); 67% were associated with a positive wastewater sample (95% CI: 57% - 77%), and 40% were associated with a positive surface sample (95% CI: 29% - 52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. Interpretation: Passive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy. Funding: County of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.

Características epidemiológicas, clínicas y bioquímicas de los pacientes pediátricos con cetoacidosis diabética. Hospital de Especialidades Pediátrica Omar Torrijos Herrera 2003-2011

Introducción. La cetoacidosis diabética (CAD) es una complicación importante de la diabetes mellitus tipo 1 (DM1) que se presenta de novo o en pacientes ya diagnosticados, sin datos publicados en la literatura nacional. Objetivos. Describir las características epidemiológicas, clínicas y bioquímicas de los pacientes admitidos al Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) con diagnóstico de CAD. Métodos. Se realizó una revisión retrospectiva de los expedientes clínicos de los pacientes con diagnóstico de CAD admitidos a las salas de hospitalización del HEPOTH para describir las variables edad, sexo, glicemia, gravedad de la CAD, tiempo de resolución, complicaciones y uso de bicarbonato. Se utilizó estadística descriptiva (frecuencias, media y desviación estándar) y analítica con α=0.05 para cada comparación. Resultados. Encontramos 58 casos de CAD (28 masculinos, 30 femeninos). Observamos un pico bimodal de frecuencias entre los 8 y 11 años para ambos sexos. En el 62% de los casos no se encontró un factor evidente para la descompensación. Las variables metabólicas de todos los casos fueron evaluadas y se establecieron las medias (desviación estándar) de glicemia (530.9 [144.9]), bicarbonato (8.16 [3.58]) y pH (7.12 [0.12]). Se observó que, a mayor gravedad, menor valor de bicarbonato y de pH sanguíneo; además de una relación inversa, estadísticamente significativa (p<0.001) entre el pH al inicio del tratamiento con el tiempo requerido hasta alcanzar el pH de 7.30. La complicación más frecuente fue la hipokaliemia (44.8%). El edema cerebral ocurrió en 9% de los casos, de los cuales se registró una muerte (tasa de letalidad cruda = 1.7%). Conclusiones. La CAD es más frecuente entre los 8 y 11 años de edad y usualmente se presenta con criterios de gravedad. La hipokaliemia es la complicación más frecuente y el factor predisponente es difícil de detectar. A pesar de la baja letalidad encontrada, se debe vigilar por edema cerebral.

Background Diabetic ketoacidosis (DKA) is an important complication of type 1 diabetes mellitus, presenting either de novo or in patients already diagnosed, without data published in the national literature. Aims To describe the epidemiological, clinical, and biochemical characteristics of patients admitted to the "Omar Torrijos Herrera" Pediatric Specialties with diagnosis of DKA. Methods We performed a restrospective review of clinical records of patients diagnosed with DKA admitted to the wards of the Hospital to describe the variables age, sex, glycemia, DKA severity, time to resolution, complications, and use of bicarbonate. Descriptive (frequencies, mean, standard deviation [SD]) and analysitcal statistics were used with α=0.05 for each comparison. Results We found 58 cases of DKA (28 males, 30 females). We observed a bimodal peak of frequencies between ages 8 and 11 for both genders. In 62% of the cases there was no evident factor for the descompensation. Metabolica variables in all of the cases were assessed and mean (SD) of glycemia (530.9 [144.9]), bicarbonate (8.16 [3.58]) and blood pH (7.12 [0.12]) were established. The higher the severity, the lower bicarbonate and blood pH value; besides an inverse and statistically significant relationship (p<0.001) between pH at the beginning of the treatment and the time required to reach a blood pH value of 7.30. The most frequent complication was hypokalemia (44.8%). Cerebral edema occurred in 9% of the cases, among which one decease was registered (crude lethality rate = 1.7%). Conclusions Diabetic ketoacidosis is more frequent between 8 and 11 years of age and usually presents with severity criteria. Hypokalemia is the most frequent complication and the predisposing factor is difficult to detect. Even though we found a low lethality rate secondary to cerebral edema, this complication must be always beared in mind.

Bronquiectasis en Pediatría

La Bronquiectasia es una enfermedad poco frecuente en pediatría y representa el estado final de una variedad de procesos patológicos. El objetivo de este trabajo es llamar la atención en hace el diagnóstico temprano y brindar un tratamiento temprano y adecuado de las enfermedades pulmonares agudas y crónicas en pediatría para tratar de evitar las complicaciones como las Bronquiectasias. Materiales y métodos: Se realizó este estudio prospectiva durante el periodo comprendido entre el 1 de enero 2006 y el 30 de abril de 2010 en el Hospital de Especialidades Pediátrica. Se incluyeron en este trabajo todos los pacientes mayores de 1 mes hasta los 15 años que durante el periodo de estudio se le realizó el diagnóstico de bronquiectasias de forma ambulatoria u hospitalaria. Se registraron y analizaron las siguientes informaciones como la edad y sexo, diagnóstico de la enfermedad de base, edad de presentación de las bronquiectasias, características de las imágenes radiográficas de las bronquiectasias, , análisis espirométricos, resolución de las bronquiectasias, características de las bronquiectasias, y la mortalidad. Resultados: Un total de 7 pacientes se le realizó el diagnóstico de bronquiectasias durante el periodo de estudio. En relación a la distribución de los pacientes por edad podemos observar que el 57.1% ( 4 pacientes) se presentaron a una edad de 10-15 años. Con respecto al sexo hubo predilección por el sexo femenino en el 57.1% ( 4 pacientes). El 86% ( 6 pacientes) cursaban con una enfermedad de base. La edad de presentación de las bronquiectasias observada más frecuentes fue a la edad de 5-15 años en el 57% de los casos. En relación a las imágenes de las bronquiectasias fueron más frecuentes las cilíndricas y focales en el 100% de los pacientes y además 2 de los cuales presentaron imágenes quística y varicosas. En 4 de nuestros casos se le pudo realizar una espirometría siendo informada como limitación ventilatoria restrictiva. Conclusiones: Aunque se considera que las bronquiectasias son poco frecuentes en la población pediátrica, en nuestro medio como en otros países en vías de desarrollo, las infecciones respiratorias agudas bajas son una de las principales causas de morbi-mortalidad en los niños, siendo un importante factor de riesgo para el desarrollo de las bronquiectasias.

The bronchiectasis is a slightly frequent disease in pediatrics and represents the final condition of a variety of pathological processes. The aim of this work is to call the attention in doing the early diagnosis and offering an early and suitable treatment of the pulmonary sharp and chronic diseases in pediatrics to try to avoid the complications as the bronchiectasis. Materials and methods: This market study was realized during the period understood between 1 January, 2006 and April 30, 2010 in the Hospital de Especialidades Pediátricas. There were included in this work all the major patients of 1 month up to 15 years that during the period of study, the diagnosis was realized of bronchiectasis of ambulatory or hospitable form. They registered and analyzed the following information like the age and sex, diagnosis of the base disease, age of presentation of the bronchiectasis, characteristics of the radiographic images of the bronchiectasis, and the mortality. Results : A total of 7 patients carried out the diagnosis of bronchiectasis during the period of study. In relation to the distribution of the patients for age we can observe that 57.1% ( 4 patients) appeared to an age of 10- 15 years. With regard to the sex there was predilection for the feminine sex in 57.1% (4 patients). 86%( 6 patients) was dealing with a base disease. Conclusions: Though it thinks that the bronchiectasis are slightly frequent in the pediatric population, in our way as in other developing countries, the respiratory sharp low infections are one of the principal reasons of morbid-mortality in the children, being an important factor of risk for the development of the bronchiectasis.

Efecto del extracto alcohólico de mimosa pudica (mimosa) sobre la fertilidad en ratas / Effect of Mimosa pudica (mimosa)'s alcoholic extract on rat fertility

Objetivos: Determinar si la administración por vía oral del extracto etanólico de las hojas de Mimosa pudica (mimosa) modifica la fertilidad en ratas normales. Diseño: Estudio experimental. Institución: Instituto de Investigaciones Clínicas, Facultad de Medicina, Facultad de Farmacia, Universidad Nacional Mayor de San Marcos y Hospital Nacional Hipólito Unanue, Lima, Perú. Material biológico: Ratas albinas, y hojas de Mimosa pudica. Métodos: Cuarentiocho animales fueron divididos aleatoriamente en grupos de seis animales cada uno. El primero fue control, con solución de suero fisiológico 5 mL/kg, y los siguientes recibieron extracto vía oral 50, 250 y 500 mg/kg, durante 21 días. Cada grupo consideró 6 hembras y 6 machos juntos. Los animales fueron sacrificados para observar la presencia de fetos en el útero. A las hembras se les extrajo muestra de sangre, para conocer el nivel de FSH, estradiol y progesterona, expresándose en µg/dL. El dosaje hormonal se realizó por el método de electroquimioluminiscencia. En el estudio de antiimplantación se usó 2 grupos de 5 ratas hembras grávidas; un grupo recibió agua y el otro recibió el extracto de la planta, en dosis de 600 mg/kg, durante 10 días. Principales medidas de resultados: Disminución del número de fetos y niveles hormonales. Resultados: Los flavonoides, compuestos fenólicos y taninos estuvieron en mayor cantidad en el extracto etanólico. Las ratas que recibieron 250 mg/kg presentaron mayor número de fetos, seguidas por las de 50 mg/kg; en tanto que con la dosis de 500 mg/kg disminuyó el número de fetos comparativamente con las ratas que no recibieron la planta; hubo incremento de FSH y de progesterona. Conclusiones: En condiciones experimentales se muestra que en dosis de hasta 250 mg/kg aumenta la fertilidad, pero a 500 mg se reduce la fertilidad en ratas normales.

Objectives: To determine whether oral administration of Mimosa pudica (mimosa) leaves ethanol extract modifies fertility in normal rats. Design: Experimental study. Setting: Instituto de Investigaciones Clinicas, Facultad de Medicina, Facultad de Farmacia, Universidad Nacional Mayor de San Marcos, Hospital Nacional Hipolito Unanue, Lima, Peru. Biological material: Albino rats and Mimosa pudica leaves. Methods: Forty-eight animals were divided randomly into groups of six animals each. The first was control and received saline solution 5 mL/kg and the others 50, 250 and 500 mg/kg oral extracts for 28 days. Each group considered 6 males and 6 females together. The animals were killed to observe the presence of fetuses in uterus. FSH, estradiol and progesterone levels were determined in µg /dL in female ratsÆ blood samples and hormone dosage was done by electrochemoluminiscence method. In the antiimplantation study 2 groups of 5 pregnant female rats were used; one group received water and the other 600 mg/kg plant extract doses for 10 days. Main outcome measures: Reduction in the number of fetuses and hormone levels. Results: Flavonoids, phenolics and tannins were in larger quantity in the ethanol extract. Rats that received 250 mg/kg showed a greater number of fetuses followed by 50 mg/kg, while 500 mg/kg dose decreased the number of fetuses as compared with rats not given the plant; FSH and progesterone showed increased levels. Conclusions: In experimental conditions Mimosa pudicaÆs 250 mg/kg doses increased fertility but 500 mg reduced fertility in normal rats.

Efecto citoprotector y antisecretor del aceite de Copaifera officinalis en lesiones gástricas inducidas en ratas / Copaifera officinalis oil cytoprotector and antisecretory effects in induced gastric lesions in rats

Objetivos: Demostrar el efecto gastroprotector del aceite de Copaifera officinalis usando indometacina y ligadura de píloro en ratas. Diseño: Estudio preclínico. Lugar: Facultades de Medicina, de Farmacia y Bioquímica. Universidad Nacional Mayor de SanMarcos, Lima, Perú. Material biológico: Ratas y aceite de copaiba. Intervenciones: Se colectó el aceite de copaiba en Ucayali, Pucallpa. La citoproteccción fue evaluada con indometacina, considerando un grupo control normal, indometacina, grupos deaceite de copaiba y omeprazol. Las lesiones de la mucosa gástrica fueron calificadas como las compatibles con necrosis local (tejido no viable), hiperemia, enrojecimiento presente y hemorragia, empleando la escala de puntaje observacional; y la úlcera,según la escala de Macallister modificado. El ensayo de antisecreción fue realizado por el modelo de ligadura del píloro, en el que 24 ratas albinas fueron divididas al azar en 3 grupos; un control, otro de aceite de copaiba 40mg/kg y un tercero de omeprazol10 mg/kg. Después de 4 horas de ligazón, fueron sacrificados, extrayéndose los estómagos; con mucho cuidado se midió el volumen y se determinó el pH de la secreción gástrica, por potenciometría. Se realizó evaluación histopatológica segúnDevi. Principales medidas de resultados: Lesiones ulcerosas. Resultados: Losresultados indicaron 100 por ciento de efecto citoprotector con el aceite de copaiba y de 97,8 por ciento para el omeprazol (p menor que 0,0001), ratificado con los hallazgos histopatológicos; la disminución del volumen de secreción fue 79,4 por ciento para omeprazol y 42,8 por ciento para el aceite de copaiba (p menor que 0,001), con incremento del pH. Conclusiones: En condicionesexperimentales, el aceite de copaiba fue efectivo como agente gastroprotector enratas con inducción de úlcera gástrica.

Objetives: To determine the gastroprotector effect of Copaifera officinalis oil using indomethacin and pyloric ligature in rats. Design: Preclinical study. Setting: Faculties of Medicine, Pharmacy and Biochemistry, National University of San Marcos, Lima, Peru. Biological material: Rats and copaiba oil. Interventions: Copaiba oil was collected in Ucayali, Pucallpa. Cytoprotection was tested withindomethacin considering a normal control group, and indomethacin, copaibaand omeprazole groups. Using visual analogue scale mucosa gastric injuries were referred as those compatible with local necrosis (unviable tissue), hyperemia, flushing, and hemorrhage, and ulcers according to the modified MacallisterÆs scale. The anti-secretion trial used the pyloric ligature model. Twenty-four albino rats were randomized in three groups: control, copaiba oil 40 mg/kg and omeprazole 10 mg/kg, respectively. After 4 hours of linkage, they were sacrificed. Stomachs were removed, their volume measured carefully and gastric secretion pH determined by potentiometry. DevisÆs histopathological evaluation was used. Main outcome measures: Ulcerous injuries. Results: There was 100 per centcytoprotection with copaiba oil and 97,8 per cent with omeprazole (p minor that 0,0001), ratified by histological findings. Decrease in secretion volume was 79,4 per cent for omeprazole and 42,8 per cent for copaiba oil (p minor thet 0,0001) with pH increment. Conclusions: In experimental conditions copaiba oil was effective as gastroprotective agent in gastric ulcers-induced rats.