Determining coronavirus disease 2019 (COVID-19) community incidence threshold for preoperative testing.

Preprocedural testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) is frequently used to reduce perioperative morbidity and mortality during the pandemic. Such testing is resource intensive, and the relative benefits depend on local epidemiology. We propose a threshold of 20 per 100,000 unlinked cases to activate such testing to optimize the yield and positive predictive value.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic.

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Outcomes and Hand Use of Reaching Attempts: Comparison of Infants at Risk for Developmental Disability and Infants With Typical Development.

Background: Infants at risk for developmental disabilities often show signs of motor delay. Reaching is a skill that can help us identify atypical motor trajectories in early infancy. Researchers have studied performance after onset of reaching, but none have followed infants at risk from pre-reaching to skilled reaching. Aims: We assessed differences in reaching outcomes and hand use as reaching skill emerged in infants at risk for developmental disabilities and with typical development. Methods and Procedures: We followed infants at risk for developmental disabilities (n = 11) and infants with typical development (n = 21) longitudinally as they developed reaching skill. Infants reached for a toy at midline while sitting in the caregiver's lap. Video data were coded for reach outcome (miss, touch, partial grasp, and whole-hand grasp) and hand use (right, left, and bilateral). Outcomes and Results: Infants at risk had a larger proportion of missed reaches across visits compared to infants with typical development. Infants at risk also showed less variability in hand use when grasping over the study period. Conclusion and Implications: Our results provide information to support early differences in reaching performance to inform identification of typical and atypical developmental trajectories. Future studies should assess how the missed reaches are different and consider other quantitative measures of movement variability in infants at risk.

Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic.

The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.

Infant Reaching in the First Year of Life: A Scoping Review of Typical Development and Examples of Atypical Development.

AIMS: Our objective was to identify the most common variables used for infant reaching assessment, describe values of these variables across the first year of life, and identify methodological considerations and knowledge gaps for future research. METHODS: Studies were included if they met the following criteria: (1) assessed infant reaching in any position, (2) included a sample of infants with typical development: healthy, full-term, with no known impairments, (3) infants were under one year old at the first data collection, and (4) counted successful reaches resulting in object contact. RESULTS: We identified 6 commonly assessed kinematic reaching variables: frequency, duration, movement units, peak velocity, average velocity, and straightness index. Methodological inconsistencies limit our ability to interpret values of these variables across studies. CONCLUSIONS: Eliminating inconsistencies in study design and data analysis methods is the next step to defining a normative reference standard for reaching development. Establishing a normative reference standard for reaching in the first year of life will be important for assessment of typical and atypical reaching development.

Changes in social support of pregnant and postnatal mothers during the COVID-19 pandemic.

OBJECTIVE: Our objectives were to assess in perinatal women: the most effective methods used to meet social support needs during COVID-19, the impact of COVID-19 on self-reported social support levels, and how perceived change in social support related to distress, depression, and mental health. DESIGN: One-time survey administered from April to August 2020 SETTING: Online PARTICIPANTS: Pregnant and postpartum women with infants less than 6 months of age MEASUREMENT AND FINDINGS: Participants indicated the methods they used to meet social support needs during COVID-19. They self-rated their social support level pre- and during pandemic and their distress, depressive symptoms, and mental health changes on a Likert scale. Out of 1142 participants, the most effective methods for obtaining social support during the pandemic were virtual means (e.g. video call) and interaction with friends. There was a significant difference in distribution of self-reported levels of social support before and during the pandemic, with more respondents reporting a decrease in support. Decreases in social support were associated with higher distress levels, higher levels of depressive symptoms, and poorer mental health. KEY CONCLUSIONS: Perinatal women reported decreased social support during the COVID-19 pandemic which was associated with poorer mental health. Using virtual means of social support and support provided by friends had the largest positive effect on perceived social support levels. IMPLICATIONS FOR PRACTICE: Interventions using virtual support means from friends may be helpful to improve social support and mental health in this population.

Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among Patients Diagnosed with Cancer.

PURPOSE OF REVIEW: This review summarizes the effects of prehabilitative exercise interventions on the physical, psychosocial, and biological outcomes among patients with cancer. Current gaps and future directions in prehabilitative exercise research will be addressed. RECENT FINDINGS: Prehabilitative exercise mitigates the detrimental impact of cancer surgery on physical fitness, noted by increases in maximal oxygen consumption and 6-min walk distance. Beneficial effects on psychosocial and biological outcomes remain inconclusive. Aerobic exercise interventions were often prescribed and included low-, moderate-, or high-intensity exercise. Resistance exercise interventions were often performed in conjunction with aerobic exercise. Prehabilitative exercise elicits robust improvements in physical fitness; however, effect on psychosocial and biological outcomes remains inconclusive. Exercise prescription parameters varied greatly by frequency, intensity, time, and type across multiple cancer diagnoses. Future investigations are needed to systematically dose exercise for a wider variety of outcome measures, with an overall goal to set forth pre-operative exercise guidelines.

Infant Leg Activity Intensity Before and After Naps.

Wearable sensors are being used to measure intensity of infant physical activity across full days. The variability of infant activity intensity within and across days is important to study given the potential impact of physical activity on developmental trajectories. Using retrospective data, we analyzed the intensity of leg movements in 10 typically-developing infants before and after naptimes. Leg movement data were captured from 20 minutes before and after multiple events of naps across seven days for each infant. We hypothesized that leg movement intensity would be lower before a nap than after a nap potentially due to lower arousal and increased fatigue prior to attaining sleep. However, our results showed that leg movement intensity was not significantly different when comparing the 20-minute period pre- and post-naps (F(1,7)=3.91, p=0.089, ηp 2=0.358). Our results are a first step in describing patterns of infant activity across days and highlights the need for further research regarding infant energy expenditure and physical activity.

Quantifying Caregiver Movement when Measuring Infant Movement across a Full Day: A Case Report.

There is interest in using wearable sensors to measure infant movement patterns and physical activity, however, this approach is confounded by caregiver motion. The purpose of this study is to estimate the extent that caregiver motion confounds wearable sensor data in full-day studies of infant leg movements. We used wearable sensors to measure leg movements of a four-month-old infant across 8.5 hours, during which the infant was handled by the caregiver in a typical manner. A researcher mimicked the actions of the caregiver with a doll. We calculated 7744 left and 7107 right leg movements for the infant and 1013 left and 1115 right "leg movements" for the doll. In this case, approximately 15% of infant leg movements can be attributed to background motion of the caregiver. This case report is the first step toward removing caregiver-produced background motion from the infant wearable sensor signal. We have estimated the size of the effect and described the activities that were related to noise in the signal. Future research can characterize the noise in detail and systematically explore different methods to remove it.