Associations of COVID-19 Stressors and Postpartum Depression and Anxiety Symptoms in New Mothers.

BACKGROUND AND OBJECTIVES: Early reports during the COVID-19 pandemic showed pregnant and postpartum women have increased rates of anxiety and depression. We hypothesized that exposure to more COVID-19-related events (e.g., stay-at-home orders, school closures, work layoffs, family members ill with COVID-19; Event Exposure), greater perceived impact of COVID-19 events on the family (Family Impact), and less social support would be associated with more anxiety and depression symptoms among first-time mothers. METHODS: We interviewed 125 first-time mothers of infants under 3 months of age from four pediatric primary care offices (June 2020 - February 2021) to assess COVID-19 experiences, anxiety and depression symptoms, and social support. Hierarchical linear regression evaluated relations between COVID-19 Event Exposure, COVID-19 Family Impact, and social support on maternal anxiety and depression symptoms. RESULTS: COVID-19 Event Exposure was not associated with depression or anxiety symptom scores. However, greater COVID-19 Family Impact was related to increased maternal depression and anxiety symptoms when controlling for COVID-19 Event Exposure. Reduced social support predicted higher depression symptom scores, but not anxiety symptom scores, when accounting for other variables. CONCLUSION: The number of COVID-19-related events experienced by first-time mothers did not predict anxiety or depression symptoms. However, greater perceived impact of COVID-19 on their family was associated with higher symptoms of anxiety and depression in these mothers. Pediatricians can promote resilience strategies to help new mothers adapt during the COVID-19 pandemic to help decrease anxiety and depression symptoms.

Clinical guideline highlights for the hospitalist: Management of Kawasaki disease.

GUIDELINE TITLE: 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease RELEASE DATE: March 7, 2022 PRIOR VERSION (S): 2017 DEVELOPER: American College of Rheumatology and the Vasculitis Foundation FUNDING SOURCE: American College of Rheumatology and the Vasculitis Foundation TARGET POPULATION: Children with Kawasaki disease.

Improving Adherence to Safe Sleep Guidelines for Hospitalized Infants at a Children's Hospital.

INTRODUCTION: Sudden unexpected infant deaths are a major problem nationally. We had poor adherence to safe sleep recommendations locally at our institution. Given the significance of this problem, hospital administration at a tertiary children's hospital tasked a multidisciplinary group of faculty and staff with improving sleep environments for hospitalized infants. METHODS: Our safe sleep task force implemented targeted interventions using the American Academy of Pediatrics policy statement as the gold standard and based on hospital data to address areas of greatest nonadherence to recommendations. We aimed to improve weekly average adherence to 95% over 12 months. A proportions process control chart (p-chart) tracked average weekly adherence over a 52-week time frame. In addition, we performed Student's t-testing to evaluate differences in adherence over time. RESULTS: There was a significant improvement in overall adherence to safe sleep recommendations from baseline (M = 70.8%, SD 21.6) to end of study period (M = 94.7%, SD 10.0) [t(427) = -15.1, P ≤ 0.001]. Crib audits with 100% adherence increased from a baseline (M = 0%, SD 0) to the end of the study period M = 70.4%, SD = 46) [t(381)= -21.4, P ≤ 0.001]. This resulted in two trend shifts on the p-chart using Institute for Healthcare Improvement control chart rules. CONCLUSIONS: Targeted interventions using QI methodology led to significant increases in adherence to safe sleep guidelines. Notable improvements in behavior indicated significant changes in safe sleep culture. We also noted continued adherence in follow-up audits reflecting sustainability.

Species-Level Profiling of Ixodes pacificus Bacterial Microbiomes Reveals High Variability Across Short Spatial Scales at Different Taxonomic Resolutions.

Background and Aims: Outbreaks of severe and chronic tick-borne diseases (TBDs) are on the rise. This is through the transmission of infectious disease agents to humans during tick feeding. The transmission rate and extent of microbial exchange, however, vary based on the tick microbiome composition. While select microbes are determined to be members of the normal tick microbiome and others are clearly recognized mammalian and/or avian pathogens, the status of many other members of the tick microbiota with respect to human and alternate host pathogenesis remains unclear. Moreover, the species-level 16S microbiome of prominent TBD vectors, including Ixodes pacificus, have not been extensively studied. To elucidate the I. pacificus microbiome composition, we performed a pan-domain species-specific characterization of the bacterial microbiome on adult I. pacificus ticks collected from two regional parks within Western California. Our methods provide for characterizing nuances within cohort microbiomes and their relationships to geo-locale of origin, surrounding fauna, and prevalences of known and suspected pathogens in relation to current TBD epidemiological zones. Methods: Ninety-two adult I. pacificus bacterial microbiomes were characterized using a high-fidelity, pan-domain, species-specific, full-length 16S rRNA amplification method using circular consensus sequencing performed on the Pacific Biosciences Sequel platform. Data analyses were performed with the MCSMRT data analysis package and database. Results: The species-specific I. pacificus microbiome composition illustrates a complex assortment of microflora, including over 900 eubacterial species with high taxonomic diversity, which was revealed to vary by sex and geo-locale, though the use of full-length 16S gene sequencing. The TBD-associated pathogens, such as Borrelia burgdorferi, Anaplasma phagocytophilum, and Rickettsia monacensis, were identified along with a host of bacteria previously unassociated with ticks. Conclusion: Species-level taxonomic classification of the I. pacificus microbiome revealed that full-length bacterial 16S gene sequencing is required for the granularity to elucidate the microbial diversity within and among ticks based on geo-locale.

General Pediatrician-Staffed Behavioral/Developmental Access Clinic Decreases Time to Evaluation of Early Childhood Developmental Disorders.

OBJECTIVE: To describe and evaluate the effectiveness of a quality improvement project to decrease wait time to evaluation for children referred to Developmental Behavioral Pediatricians (DBPs). METHODS: The authors created a Behavioral/Developmental Access Clinic (BDAC) staffed by a general pediatrician (GP) and pediatric psychologist. Clinicians in the BDAC provided comprehensive developmental evaluations for children in a discrete age range (<5 yr old). We describe the establishment of the BDAC along with referrals, diagnoses, and recommended follow-up for patients seen by the GP. We used 2-tailed t tests to compare the mean time with initial evaluation for patients seen in BDAC versus a DBP. RESULTS: Sixty-three children were seen in BDAC over 6 months. Referrals from the BDAC included: physical/occupational/speech therapy (71%), psychology (35%), audiology (25%), genetics (14%), and neurology (8%). Five patients (8%) were diagnosed with autism spectrum disorder (ASD). Compared with time to appointment with a DBP (327 d), mean time to developmental assessment was shorter for the 45 patients who accepted earlier appointments in the BDAC (159 d), and for the 18 children seen in the BDAC as new referrals (11 d), p < .001. Follow-up with a DBP was recommended for 9 (50%) of the new patient referrals evaluated in BDAC. CONCLUSION: The BDAC allowed for earlier developmental assessment of young children, with potential for earlier diagnosis and treatment of developmental disorders, including ASD. Opportunity for initial evaluation in BDAC decreased the number of patients requiring evaluation by DBPs, improving access to this subspecialty in our institution.