COVID-19 Vaccine Strategy Left Small Primary Care Practices On The Sidelines.

We report on the experience of small primary care practices participating in a national clinical registry with COVID-19 vaccines and vaccination data. At the end of 2021, 11.2 percent of these practices' 3.9 million patients had records of COVID-19 vaccination; 43.1 percent of clinics had no record of patients' COVID-19 vaccinations, but 93.4 percent of clinics had provided or recorded other routine vaccinations.

Quantifying Exposure to Wildfire Smoke Among Schoolchildren in California, 2006 to 2021.

This cross-sectional study quantifies exposure to wildfire particulate matter less than 2.5 µm among schoolchildren in California.

Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study.

OBJECTIVES: To describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes. DESIGN: Prospective observational cohort study. SETTING AND PARTICIPANTS: Stable, moderately LBW (1.50 to <2.50 kg) infants were enrolled at birth from 12 secondary/tertiary facilities in India, Malawi and Tanzania and visited nine times over 6 months. VARIABLES OF INTEREST: Key variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes. RESULTS: Between 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining. CONCLUSION: LBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants. TRIAL REGISTRATION NUMBER: NCT04002908.

Tropical ant community responses to experimental soil warming.

Climate change is one of the primary agents of the global decline in insect abundance. Because of their narrow thermal ranges, tropical ectotherms are predicted to be most threatened by global warming, yet tests of this prediction are often confounded by other anthropogenic disturbances. We used a tropical forest soil warming experiment to directly test the effect of temperature increase on litter-dwelling ants. Two years of continuous warming led to a change in ant community between warming and control plots. Specifically, six ant genera were recorded only on warming plots, and one genus only on control plots. Wasmannia auropuctata, a species often invasive elsewhere but native to this forest, was more abundant in warmed plots. Ant recruitment at baits was best predicted by soil surface temperature and ant heat tolerance. These results suggest that heat tolerance is useful for predicting changes in daily foraging activity, which is directly tied to colony fitness. We show that a 2-year increase in temperature (of 2-4°C) can have a profound effect on the most abundant insects, potentially favouring species with invasive traits and moderate heat tolerances.

Development of a Novel and Scalable Simulation-Based Teamwork Training Model Using Within-Group Debriefing of Observed Video Simulation.

THE CHALLENGE: Effective teamwork and communication skills are essential for safe and reliable health care. These skills require training and practice. Experiential learning is optimal for training adults, and the industry has recognized simulation training as an exemplar of this approach. Yet despite decades of investment, this training is inaccessible and underutilized for most of the more than 12 million health care professionals in the United States. DESIGNING A SOLUTION: This report describes the design process of an adapted simulation training created to overcome the key barriers to scaling simulation-based teamwork training: access to technology, time away from clinical work, and availability of trained simulation educators. The prototype training is designed for delivery in one-hour segments and relies on observation of video simulation scenarios and within-group debriefing, which are promising variations on traditional simulation training. To our knowledge, these two simulation approaches have not been previously combined. The resulting prototype minimizes the need for an on-site trained simulation educator. This report details the development of a training model, its subsequent modification based on pilot testing, and the evaluation of the resulting redesigned prototype. PRELIMINARY EVALUATION: Participant evaluations of the redesigned prototype were highly positive, with 92% reporting that they would like to participate in additional, similar training sessions. Positive results were also found in assessment of feasibility, acceptability, psychological safety, and behavioral intention (reported intention to alter behavior).

The Impact of Social Support on Treatment Participation and Completion in a Disability Prevention Intervention for Older Adults.

Objectives: This study evaluates the role of emotional and instrumental social support on treatment participation and completion using the Positive Minds-Strong Bodies (PMSB) disability prevention program. Methods: Data from a multisite randomized controlled trial of the PMSB program for older adults (≥60 years) with physical impairment and mild to severe depression and/or anxiety were used. Participants were randomly assigned to receive 10 sessions of cognitive behavior therapy (CBT) plus 36 sessions of group exercise or usual care. Results: Adjusting for covariates, higher levels of emotional social support at baseline were associated with increased odds of completing the recommended number of CBT sessions (6 or more, OR = 2.58, p = .030), attending 5.56 more exercise sessions (p = .006), and increased odds of completing the recommended exercise sessions (25 or more, OR = 2.37, p = .047). Discussion: Emotional social support appears to increase dosage in a disability prevention program.

Author Correction: Soil carbon loss by experimental warming in a tropical forest.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Soil carbon loss by experimental warming in a tropical forest.

Tropical soils contain one-third of the carbon stored in soils globally1, so destabilization of soil organic matter caused by the warming predicted for tropical regions this century2 could accelerate climate change by releasing additional carbon dioxide (CO2) to the atmosphere3-6. Theory predicts that warming should cause only modest carbon loss from tropical soils relative to those at higher latitudes5,7, but there have been no warming experiments in tropical forests to test this8. Here we show that in situ experimental warming of a lowland tropical forest soil on Barro Colorado Island, Panama, caused an unexpectedly large increase in soil CO2 emissions. Two years of warming of the whole soil profile by four degrees Celsius increased CO2 emissions by 55 per cent compared to soils at ambient temperature. The additional CO2 originated from heterotrophic rather than autotrophic sources, and equated to a loss of 8.2 ± 4.2 (one standard error) tonnes of carbon per hectare per year from the breakdown of soil organic matter. During this time, we detected no acclimation of respiration rates, no thermal compensation or change in the temperature sensitivity of enzyme activities, and no change in microbial carbon-use efficiency. These results demonstrate that soil carbon in tropical forests is highly sensitive to warming, creating a potentially substantial positive feedback to climate change.

Marginal structural modelling of associations of occupational injuries with voluntary and involuntary job loss among nursing home workers.

OBJECTIVES: Qualitative studies have highlighted the possibility of job loss following occupational injuries for some workers, but prospective investigations are scant. We used a sample of nursing home workers from the Work, Family and Health Network to prospectively investigate association between occupational injuries and job loss. METHODS: We merged data on 1331 workers assessed 4 times over an 18-month period with administrative data that include job loss from employers and publicly available data on their workplaces. Workers self-reported occupational injuries in surveys. Multivariable logistic regression models estimated risk ratios for the impact of occupational injuries on overall job loss, whereas multinomial models were used to estimate OR of voluntary and involuntary job loss. Use of marginal structural models allowed for adjustments of multilevel lists of confounders that may be time varying and/or on the causal pathway. RESULTS: By 12 months, 30.3% of workers experienced occupational injury, whereas 24.2% experienced job loss by 18 months. Comparing workers who reported occupational injuries to those reporting no injuries, risk ratio of overall job loss within the subsequent 6 months was 1.31 (95% CI 0.93 to 1.86). Comparing the same groups, injured workers had higher odds of experiencing involuntary job loss (OR 2.19; 95% CI 1.27 to 3.77). Also, compared with uninjured workers, those injured more than once had higher odds of voluntary job loss (OR 1.95; 95% CI 1.03 to 3.67), while those injured once had higher odds of involuntary job loss (OR 2.19; 95% CI 1.18 to 4.05). CONCLUSIONS: Despite regulatory protections, occupational injuries were associated with increased risk of voluntary and involuntary job loss for nursing home workers.

The Effectiveness of a Culturally Sensitive Cognitive Behavioral Group Intervention for Latino Alzheimer's Caregivers.

PURPOSE OF THE STUDY: Demographic projections suggest that the older Latino population will experience the fastest growth among all racial/ethnic groups; and by 2050 will constitute 20% of the nation's seniors. Yet, Latino Alzheimer's elders and their families remain underrepresented in the health care system and caregiver intervention studies. To address this gap, this study tested the effectiveness of Circulo de Cuidado, a culturally-sensitive, cognitive behavioral (CBT) group intervention, in supporting Latino families' ability to manage the disease's neuropsychiatric symptoms and improve caregiver well-being. DESIGN AND METHODS: Using a randomized controlled trial design, 67 caregivers were assigned to the CBT experimental condition or the psychoeducational (PED) control condition and interviewed at baseline, post-group, and 3 months follow-up. The 2 manualized interventions had the same structure: 5 weekly 90-minute group sessions, followed by telephone coaching at 3, 6, 9 and 12 weeks post-group. RESULTS: Repeated measures analysis of covariance revealed significant group by time interaction effects. Compared with the PED participants, CBT participants reported lower neuropsychiatric symptoms in their relative, less caregiver distress about neuropsychiatric symptoms, a greater sense of caregiver self-efficacy, and less depressive symptoms over time. IMPLICATIONS: Our findings offer preliminary evidence that a culturally tailored, CBT group intervention targeted toward neuropsychiatric symptom management has positive psychological benefits for Latino caregivers.

Shaping the future of prevention in social work: an analysis of the professional literature from 2000 through 2010.

In light of the Patient Protection and Affordable Care Act's goals of better patient care, cost control, and improved population outcomes, prevention has emerged as an important component of health reform. Social work, with its extensive involvement in the health system and deep roots in public health, can benefit from a better understanding of its role in prevention. This study builds on the Social Work Interest in Prevention Study (SWIPS), which evaluated extent, type, and levels of prevention content in nine social work journals from 2000 to 2005. The goal of the expanded study, the SWIPS-Expansion, was to assess whether interest in prevention increased over the years in which health reform was enacted. Of the 3,745 articles reviewed, 9.0 percent (n = 336) met the criteria for "prevention articles." Between 2000 and 2010, prevention articles rose from 4.1 percent to 14.3 percent of all articles. A secondary analysis focused on topics within social work prevention, with violence, aging, and disease as primary focal areas. The findings suggest that although prevention interest appears to be growing, it remains a minority focus in the profession's journals. A national conversation on prevention can help expand the profession's role in health reform at this critical time.

Mapping Dual-Degree Programs in Social Work and Public Health: Results From a National Survey.

Dramatic changes in the health system due to national health reform are raising important questions regarding the educational preparation of social workers for the new health arena. While dual-degree programs in public health and social work can be an important response to what is needed educationally, little is known about them. The National MSW/MPH Programs Study surveyed MSW/MPH program administrators to better understand the prevalence, models, structure, and challenges of these dual-degree programs. Forty-two programs were identified, and 97.6% of those contacted participated (n=41). Findings indicate that MSW/MPH programs are popular, increasing, geographically dispersed, and drawing talented students interested in trans-disciplinary public health social work practice. Challenges for these programs include the need for greater institutional support, particularly funding, and a general lack of best practices for MSW/MPH education. While findings from this study suggest graduates appear especially well-prepared for leadership and practice in the new health environment, additional research is needed to assess their particular contributions and career trajectories.