Knowledge, confidence, and reported behaviors that promote safe water drinking among women of reproductive age.

Introduction: Drinking lead contaminated water during pregnancy is associated with infant mortality. All women of reproductive age are advised by health agencies to adhere to healthy behaviors due to the chance of unintended pregnancy. Our objectives are to understand knowledge, confidence, and reported behaviors that promote safe water drinking and prevent lead exposure among women of reproductive age. Methods: A survey among females of reproductive age from the University of Michigan - Flint was administered. A total of 83 females who wished to become pregnant one day participated. Results: Low levels of knowledge, confidence, and reported preventative health behaviors related to safe water drinking and lead exposure prevention existed. Specifically, 71.1% of respondents (59 of 83) were not at all or were somewhat confident in their ability to choose an appropriate lead water filter. Most participants rated their knowledge on how to decrease exposure to lead during pregnancy as poor/fair. No statistically significant differences were detected between respondents residing inside and outside of the city of Flint, Michigan for most variables assessed. Conclusion: While the small sample size is a limitation, the study adds to an area of scarce research. Despite widespread media attention and resources directed toward reducing the negative health effects of lead exposure following the Flint Water Crisis, significant gaps in knowledge related to safe water drinking remain. Interventions are needed to increase knowledge, confidence, and healthy behaviors that promote safe water drinking among women of reproductive age.

Evaluating the Impact of a Multifaceted Distracted Driving Prevention Program.

OBJECTIVE: The aim of this study is to evaluate undergraduate college students' attitude changes toward distracted driving after participating in a multifaceted distracted driving prevention program. METHODS: This study used a quasi-experimental, pre- post-test design. Participants were undergraduate college students who were aged 18 or older and had a valid driver's license. The Questionnaire Assessing Distracted Driving was used to measure participants' attitudes and behaviors. All participants completed the entire Questionnaire Assessing Distracted Driving survey and then participated in the distracted driving prevention program that consisted of a 10-minute narrated recorded PowerPoint lecture followed by a distracted driving simulation. Descriptive statistics were calculated to describe the study sample. The Questionnaire Assessing Distracted Driving data were analyzed to ascertain any statistically significant changes in responses from pre- to postintervention. RESULTS: From pre- to post-test, there were statistically significant increases in the number of participants who reported they would tell friends to stop texting and driving if they were a passenger, refrain from texting while driving, and wait until reaching home before retrieving their cell phones from the floor of the vehicle. Participants perceived a greater threat from drivers talking on phones or texting/emailing from pre- to post-test. Moreover, attitudes toward talking on a handheld device, talking on a hands-free phone, and texting/emailing became more negative from pre- to post-test. CONCLUSION: The intervention helped promote negative attitudes toward distracted driving in a sample of college students immediately after participating in a distracted driving prevention program.

Satisfaction with pediatric telehealth according to the opinions of children and adolescents during the COVID-19 pandemic: A literature review.

Objective: To review satisfaction with telehealth among children and adolescents based on their own opinions during the COVID-19 pandemic. Methods: In the PubMed, CINAHL, PsycINFO, and Embase databases, we searched for peer-reviewed studies in English on satisfaction with telehealth among children and adolescents (rather than parents). Both observational studies and interventions were eligible. The review was categorized as a mini review because it focused on the limited time frame of the COVID-19 pandemic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers extracted information from each study and assessed risk of bias. Results: A total of 14 studies were eligible. Studies were conducted in Australia, Canada, Italy, Israel, Poland, South Korea, the United Kingdom, and the United States. They focused on a variety of health conditions. Two of the 14 studies were interventions. Participants expressed high satisfaction with video and telephone visits and home telemonitoring while also preferring a combination of in-person visits and telehealth services. Factors associated with higher satisfaction with telehealth included greater distance from the medical center, older age, and lower anxiety when using telehealth. In qualitative studies, preferred telehealth features among participants included: a stable Internet connection and anonymity and privacy during telehealth visits. Conclusion: Telehealth services received favorable satisfaction ratings by children and adolescents. Randomized-controlled trials on the effectiveness of pediatric telehealth services compared to non-telehealth services may assess improvements in satisfaction and health outcomes.

Satisfaction With Telehealth Services Compared With Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature.

BACKGROUND: Telehealth refers to the use of technology to deliver health care remotely. The COVID-19 pandemic has prompted an increase in telehealth services. OBJECTIVE: This study aimed to review satisfaction with pediatric care in studies that had at least one group of pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and at least one comparison group of those receiving nontelehealth services. METHODS: We searched for peer-reviewed studies published in the English language that compared the satisfaction with pediatric care between pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving nontelehealth services. Owing to stay-at-home orders, studies with comparison groups for nontelehealth services that took place either before or during the pandemic were eligible. We searched the PubMed, Embase, CINAHL, and PsycINFO databases on January 5, 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2 reviewers independently screened the titles and abstracts before reviewing the full text of the remaining articles. The following information was extracted from each eligible study: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. RESULTS: All 14 eligible studies assessed satisfaction among caregivers and pediatric patients participating in video or telephone visits during the COVID-19 pandemic compared with those having in-person appointments either before or during the pandemic. In 5 of the 14 studies, a comparison of nontelehealth services took place before the pandemic, and in the remaining 9 investigations, nontelehealth services took place during the pandemic. A total of 13 studies were observational investigations with different designs, and 1 study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 of the 14 studies, satisfaction with telehealth services was higher than during in-person visits. Caregivers were satisfied with video visits for the ease of use and reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider, technological challenges, and a lack of physical examination. Those participating in nontelehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction where adolescent patients completed their own surveys; a higher percentage of adolescents using telehealth services reported effective communication with the provider compared with patients using in-person visits. CONCLUSIONS: In most studies, telehealth services received more favorable or comparable satisfaction ratings than in-person visits. Needed improvements in telehealth services included strategies to address technological challenges and develop better rapport among the patient, caregiver, and medical provider. Interventions may investigate the influence of telehealth services on access to and quality of care.

Telehealth Use in Pediatric Care during the COVID-19 Pandemic: A Qualitative Study on the Perspectives of Caregivers.

This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee County, MI, participated. The caregivers were biological parents, stepparents, foster parents, adoptive parents, and guardians. A total of 105 caregivers completed a survey with open-ended questions via Qualtrics. Two independent coders developed themes based on the responses using grounded theory. Participants were primarily biological parents and non-Hispanic White and African Americans. According to the participants, the benefits of telehealth included prevention of exposure to the COVID-19 virus, quality communication with physicians, savings in travel time, and cost-effective methods to receive care. The challenges included a lack of in-person interaction, fear of compromised confidentiality, and the potential for misdiagnosis. Suggestions for improvement by caregivers included increasing access to telehealth for poorer families, offering a media educational campaign to promote telehealth use, and creating a universal platform to share patient information. Future studies may test the effectiveness of interventions such as those suggested by caregivers in this study to improve telehealth.

Development and evaluation of an intervention to promote the use of eyeglasses among Romani families in Bulgaria.

Objective: Uncorrected refractive error (i.e., lack of eyeglasses for the treatment of refractive error) is one of the leading causes of visual impairment in Eastern Europe. Limited information is available on how to promote the use of eyeglasses among Romani families in Bulgaria. In step 1, the objective was to obtain suggestions by Romani mothers on how to promote the use of eyeglasses among children. In step 2, the objective was to evaluate an intervention to promote the use of eyeglasses based on suggestions received during step 1. Methods: During step 1, 5 focus groups with Romani mothers took place in one neighborhood in Bulgaria. During step 2, the intervention used a one-group pre-test, post-test design. Families received eye examinations. Those who needed eyeglasses chose attractive eyeglasses. Parents received education on how to encourage their children to wear eyeglasses. Results: During step 1, 54 mothers participated. Mothers suggested that the whole family should receive eye examinations and eyeglasses. During step 2, of 33 family members, 14 did not have refractive errors and 19 did. Of the 19 family members with refractive error, none had eyeglasses at pre-test. Approximately 6 months following the end of the intervention, 11 of the 19 family members (57.9%) wore eyeglasses and the remaining 8 (42.1%) did not. Conclusion: Romani family members needed eyeglasses but did not have any at pre-test of the intervention. Future interventions that offer education on the importance of eye examinations may increase receipt of eye examinations and adherence to wearing eyeglasses.

Perceived barriers to and suggested interventions for physical activity during pregnancy among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California.

BACKGROUND: The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women engage in at least 20 to 30 min of moderate-intensity physical activity on most days of the week. Regular exercise during pregnancy is associated with many benefits for the mother and the developing fetus; yet, a large number of pregnant women do not engage in the recommended amounts. This study aimed to investigate barriers to and interventions for physical activity among pregnant WIC participants in Southern California. METHODS: We conducted four focus groups (FGs) with pregnant low-income women aged 18 years or older in either their second or third trimester. FGs were conducted at a WIC center in Southern California. The FGs were held according to language (English vs. Spanish-speaking) and BMI category (normal weight vs. overweight and obese). A total of 28 women participated. We used ATLAS. ti. to analyze the focus group transcripts. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: The mean age of focus group participants was 28.9 years (SD = 6.6), and the majority were Latina. Intrapersonal barriers to physical activity were fatigue and lack of energy, pain and swelling, lack of childcare, medical restrictions and safety concerns, lack of knowledge about exercise safety, and lack of time. Interpersonal barriers included concerns and lack of support from partners and families, conflicting advice from friends and neighbors, and lack of advice on safe exercise from physicians. Women in all four groups suggested a community-based intervention where they can mingle with each other and share their challenges and concerns. Other suggestions to interventions differed among groups and reflected the women's experiences and backgrounds. Specifically, to promote education, English-speaking women preferred a brochure while Spanish-speaking women preferred a video. Overweight women emphasized including children in their exercise activities to promote healthy behavior in youth. CONCLUSIONS: Interventions should be tailored to pregnant women's needs. Primary care providers should provide reassurance and information to pregnant women and their partners on the type and frequency of safe exercise.

Perceived Motivators, Barriers and Intervention Strategies Related to Weight Loss After Childbirth Among WIC Participants in Southern California.

PURPOSE: To explore perceived motivators and barriers to weight loss after childbirth and ideas for postpartum weight loss interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). APPROACH: Four (2 with English-speaking and 2 with Spanish-speaking participants) focus groups were conducted. SETTING: A WIC clinic in Southern California. PARTICIPANTS: Of 22 participants, the majority were Hispanic/Latina. The mean age of the mothers' infants was 6.18 months. MEASURES: A structured focus group guide was used. ANALYSIS: Audio-recordings were transcribed verbatim. The Spanish transcriptions were reviewed for discrepancies by a bilingual coinvestigator and translated into English for analysis. Transcriptions of the focus group audio-recordings were organized in ATLAS.ti version 8.0. and analyzed using content analysis. RESULTS: Participants had a mean age of 30.5 and a mean prepregnancy body mass index of 32.4. Motivators for weight loss after childbirth included modeling healthy behavior for children and a fear of developing chronic illness. Barriers to weight loss included lack of knowledge, self-efficacy, time, child care and support, postpartum depression, the 40-day rule, and having a c-section. Intervention ideas included providing accountability and peer support for weight loss, providing nutrition/exercise weight loss strategies, and integrating mobile phone technologies into weight loss programs. CONCLUSIONS: Weight loss strategies for postpartum WIC participants should provide knowledge, support, accountability, and preferably integrate technology.

Strategies to Promote Safe Water Drinking Identified by and for Women of Reproductive Age.

PURPOSE: The Flint, Michigan, water crisis (2014 to present) increased awareness of the dangers of lead-contaminated water. Consumption of lead-contaminated water is associated with adverse pregnancy outcomes. The purpose of this research was to identify intervention strategies to decrease consumption of lead-contaminated water among women of reproductive age. APPROACH: Qualitative data were collected via an online survey consisting of open-ended questions among 63 women and 3 focus groups among 27 women. SETTING: The University of Michigan-Flint. METHOD: Qualitative data were analyzed utilizing a grounded theory approach. RESULTS: Participants recommended professional educational reading materials regarding lead be placed in public places. Women highlighted the need for interventions where women, partners, and relatives test water in homes, install water filters, cook lead-mitigating meals, and receive education on the pregnancy risks of consuming contaminated water. CONCLUSION: The study offers women perspectives on strategies to decrease consumption of lead-contaminated water. Future investigations may examine the influence of such strategies on knowledge and behaviors that promote safe water drinking.

Poor tap water quality experiences and poor sleep quality during the Flint, Michigan Municipal Water Crisis.

OBJECTIVES: After inadequate official response to community concerns over water quality following changes in Flint's municipal water supply, this study sought evidence for a relationship between water quality and community mental health. DESIGN: The Speak to Your Health Community Survey is a community-based participatory component of the health surveillance system in Genesee County, Michigan. This cross-sectional survey recruits participants from every residential Census Tract of the county and strives for demographic representativeness. RESULTS: Respondents (n=834) rated their tap water quality (taste, smell, appearance) as poor (36%), fair (18%), good (20%), very good (17%), and excellent (10%). They rated their sleep quality as poor (12%), fair (28%), good (39%), very good (18%), and excellent (4%), and had an average (SD) sleep length of 408(90) minutes. Controlling for age, sex, years of education, and whether respondents were African American and Hispanic/Latino/a, lower perceived tap water quality was associated with lower sleep quality and shorter sleep length. CONCLUSION: Results indicate that adverse health conditions related to the water crisis extend beyond lead poisoning in children and include deterioration of sleep conditions among adult residents.

Interventions to improve child-parent-medical provider communication: A systematic review.

RATIONALE: Research related to effective communication between children/parents and medical providers is limited. OBJECTIVE: To review interventions seeking to improve communication between children/parents and medical providers. METHODS: The inclusion criteria were interventions in peer-reviewed articles and dissertations in English. Because of the limited availability of pediatric communication research, no restrictions were placed on the year, design, and length of follow-up of the interventions. Out of 4163 articles in the CINAHL, Cochrane, EMBASE, ERIC, MEDLINE, and PsycINFO databases, 34 met the inclusion criteria. The design, strategies, measurement tools, results, and conflicts of interest of the interventions were reviewed. RESULTS: Most interventions were conducted in the United States, had a small sample size, and used a pre-posttest design. Fifteen were randomized controlled trials (RCTs). The most frequent intervention strategies were role-playing sessions and seminars for medical providers. Standardized children (i.e., fictitious child patients) were frequently used to help train physicians. Most interventions improved providers' interpersonal, patient-centered interviewing skills. Interventions that targeted parents involved booklets and role-playing to encourage questions. They improved parents' satisfaction and communication. An intervention that targeted youth used a video portraying how children can communicate better with physicians. Once the children aged 5-15 years watched the video, they wrote questions for their physicians prior to the medical visit. The experimental group of children had better rapport with physicians and could recall recommendations about medications more often than the control group. CONCLUSION: More RCTs involving children as active participants are needed.

Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study.

Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

Influences of asthma on reported health indicators and access to health care among children.

BACKGROUND: Studies on the influences of pediatric asthma on health and access to health care were conducted in limited geographic areas or age groups. OBJECTIVE: To investigate associations of asthma with health, use of medical care, mental health or educational services, activity limitations, problems in paying bills, and frustrations in obtaining health care among children in the United States. Caregivers reported children's conditions. METHODS: Logistic regression models were adjusted for sociodemographic factors in the nationally representative 2011/2012 National Survey of Children's Health. RESULTS: Of the 91,116 children 0 to 17 years old, 14.6% had reported asthma. Of children 0 to 17 years old with asthma, 21.2% were non-Hispanic black. Of children 0 to 17 years old without asthma, 12.2% were non-Hispanic black. In children 0 to 17 years old, compared with children without asthma, children with asthma had an increased odds to have reported fair or poor health, receive more medical care, mental health, and educational services than usual, have activity limitations, have medical bills that the family had problems paying (odds ratio 1.5, 95% confidence interval 1.3-1.7), and have caregivers who were frustrated in obtaining care (odds ratio 1.5, 95% confidence interval 1.2-1.7). The odds ratios for the associations between asthma and all outcomes were higher in the 0- to 5-year-old compared with the 6- to 17-year-old group. CONCLUSION: When adjusting for sociodemographic variables, caregivers have problems paying bills and obtaining health care services for their child. To develop age-appropriate interventions, more research is needed to understand why families have difficulties accessing health care.

Influence of premature birth on the health conditions, receipt of special education and sport participation of children aged 6-17 years in the USA.

BACKGROUND: To investigate the influence of premature birth on conditions among children aged 6-17 years. METHODS: The National Survey of Children's Health in the USA added a question on premature birth for the first time in the 2011-12 wave. The influence of being born premature on different conditions while controlling for sociodemographic factors was assessed using logistic regression. A total of 6882 out of 62 078 (11.1%) of children aged 6-17 years were born premature. RESULTS: Compared with children who were not born premature, those who were born premature were more likely to have cerebral palsy [odds ratio (OR) = 9.6, confidence interval (CI): 7.4-12.4], vision problems (OR = 2.3, CI: 2.0-2.6), hearing problems (OR = 1.7, CI: 1.6-2.0) and a special healthcare need (OR = 1.7, CI: 1.6-1.8). Children who were born premature had an increased likelihood of not being on a sports team or not taking sports lessons after school or on weekends during the past 12 months than those who were not born premature (OR = 1.2, CI: 1.1-1.3). CONCLUSIONS: Prematurity may be associated with negative outcomes as infants transition into childhood and adolescence. Interventions within the life-course perspective are needed to alleviate the long-term consequences of prematurity.

Depressive symptoms mediate the association between fear of crime and higher body mass index.

PURPOSE: To investigate pathways in the association between fear of crime and obesity. DESIGN: A cross-sectional survey was administered among residents aged 18 years and older across all Census tracts. SETTING: Genesee County, Michigan. SUBJECTS: A total of 3192 residents. MEASURES: Body mass index (BMI) was calculated by using the respondents' reported height and weight. Composite fear-of-crime and depressive symptoms scores were calculated by using several survey items. ANALYSIS . Path analysis examined the effects of fear of crime on BMI. RESULTS . Fear of crime was associated with higher BMI. Depressive symptoms mediated the relationship between fear of crime and BMI (p < .001). Moderate exercise mediated the association between depressive symptoms and BMI (p < .001). CONCLUSION: Fear of crime was associated with depressive symptoms, which in turn were associated with reduced exercise and subsequently higher BMI.

Racial/ethnic and gender differences in the association between depressive symptoms and higher body mass index.

AIM: The study investigated the socio-demographic differences in the association between depressive symptoms and higher body mass index (BMI). SUBJECTS AND METHODS: In Genesee County, Michigan, random samples of households were drawn from all residential census tracts. The Speak to Your Health! Survey was administered among adults aged 18 years and older in these households. To conduct this cross-sectional study, data from three waves of survey data collection (2007, 2009 and 2011) were combined resulting in a sample of 3381 adults. Self-reported height and weight were used to calculate BMI. Depressive symptoms were assessed with Brief Symptoms Inventory items. Socio-demographic factors included age, race/ethnicity, gender and education. RESULTS: Using stepwise linear regression, gender (ß = 0.04, P = 0.02) and the interaction terms of race/ethnicity × depressive symptoms (ß = 0.15, P < 0.001) and gender × depressive symptoms (ß = 0.05, P = 0.01) uniquely predicted BMI. CONCLUSION: Women had a higher BMI than men, and depressive symptoms were more strongly associated with BMI among African Americans and women than among non-Latino Whites and men. Tailored interventions to alleviate depressive symptoms in African Americans and females may help decrease racial/ethnic and gender differences in depressive symptoms and obesity.

Use of eyeglasses among children in elementary school: perceptions, behaviors, and interventions discussed by parents, school nurses, and teachers during focus groups.

PURPOSE: To investigate the perceptions, behaviors, and recommendations that parents, school nurses, and teachers have regarding children's use of eyeglasses. APPROACH: Focus groups with parents, school nurses, and teachers were conducted. SETTING: The study took place in one Southern California school district. PARTICIPANTS: There were 39 participants, including 24 parents, seven school nurses, and eight teachers. METHOD: An experienced moderator guided the focus group discussions. Transcripts were analyzed using grounded theory techniques. RESULTS: Participants perceive visual impairment as a serious problem in the development of children. The lack of eyeglasses may lead to problems such as tiredness, headaches, inability to focus on school work, and decreased reading speed. Participants experienced disappointment, unhappiness, worry, and concern when they realized they needed eyeglasses at a young age. Negative societal perceptions toward eyeglasses, lack of eye doctors in minority communities, parental perceptions that children do not need eyeglasses, and peer bullying of children wearing eyeglasses are key obstacles to children's use of eyeglasses. Participants suggest school and national campaigns featuring respected public figures who wear eyeglasses to promote positive attitudes toward eyeglasses. CONCLUSION: Parents and teachers who closely follow the academic development of children have observed that visual impairment has negative consequences for the scholastic achievement of children. They recommend interventions to promote the attractiveness of eyeglasses in society. The participants discuss the need for a national preventative message for eye care similar to the message for dental care. The public health message should emphasize the importance of embracing and respecting differences among individuals.

Decreasing uncorrected refractive error in the classroom through a multifactorial pilot intervention.

The study assessed the effectiveness of a pilot intervention to promote the use of eyeglasses in one school in California. The intervention used a one-group pretest, posttest design. Between January and June 2011, during the intervention, all first- and second-grade children received eye evaluations and the children with refractive error received two pairs of attractive eyeglasses. Parents received eye care education. Teachers monitored the use of eyeglasses in the classroom. Prior to the intervention in January 2011, 1 of the 15 children with refractive error (6.7%) wore eyeglasses in the classroom and the remaining 14 (93.3%) lacked eyeglasses altogether; 6 months following the end of the intervention in December 2011, 11 of the 15 children (73.3%) wore eyeglasses in the classroom and the remaining 4 (26.7%) did not (p = .002). The multifactorial intervention increased the use of eyeglasses in the classroom even months after the end of the summer vacation.

Workplace incivility affecting CRNAs: a study of prevalence, severity, and consequences with proposed interventions.

Incivility in healthcare settings has potentially detrimental effects on healthcare providers and patient safety. This study examines the prevalence of incivility and the influence of workplace incivility on burnout among Certified Registered Nurse Anesthetists (CRNAs) in Michigan. It proposes interventions to prevent and manage incivility. The Nursing Incivility Scale and the Copenhagen Burnout Inventory were used to measure workplace incivility and professional burnout. Qualitative data were also collected to provide recommendations to address workplace incivility. The most notable sources of workplace incivility were general employee personnel or nonemployee individuals and physicians. A lesser prevalent source of incivility was other CRNA practitioners. The least prevalent source of incivility was CRNA supervisors. A statistically significant, direct relationship existed between workplace incivility and professional burnout. The only statistically significant factor contributing to professional burnout was experiencing workplace incivility, independent of other measured factors. The most notable recommendation was use of a zero tolerance policy for practice, regardless of title or role, in employment situations. Incivility is a major concern among CRNAs.

Uncorrected refractive error among first-grade students of different racial/ethnic groups in southern California: results a year after school-mandated vision screening.

CONTEXT: The California Department of Education requires that kindergartners receive vision screening in preparation for school. Information is not available in the literature, however, on the prevalence of and factors associated with uncorrected refractive error (ie, the lack of eyeglasses), which is the primary cause of decreased visual acuity in children, among first-grade students of different racial/ethnic groups in California. OBJECTIVE: To determine the proportion of first-grade students with decreased visual acuity who need eyeglasses but do not have any and whether the lack of eyeglasses is associated with racial/ethnic and other factors. SETTING: Three school districts in Southern California. PARTICIPANTS: The University of California, Los Angeles Mobile Eye Clinic examined the eyes of 11 332 first-grade students over a 7-year period. Statistical analyses included adjusted logistic regression and linear trend models. FINDINGS: Among 11 332 first-grade students, 6973 (61.5%) were Latino, 1511 (13.3%) were Asian/Pacific Islander, 1422 (12.5%) were African American, 310 (2.7%) were non-Hispanic white, and 1116 (9.8%) were from other or mixed races/ethnicities. The prevalence of decreased visual acuity was 8.0%; 95% of children with decreased visual acuity (858 of 906 children) lacked eyeglasses that would have helped them attain normal vision. The lack of eyeglasses was more common in boys and African American/Latino children compared with that in girls and non-Hispanic white children, respectively. The percentage of children lacking eyeglasses over the years exhibited an increasing linear trend (R = 0.86). CONCLUSIONS: Most first-grade students with decreased visual acuity, especially African American and Latino children, need eyeglasses but do not have any. Interventions to correct decreased visual acuity in first-grade students are important because the first grade is a period of critical academic development.