Acute Effects of Walking and Standing on Executive Function in Children with Attention Deficit/Hyperactivity Disorder: A Feasibility Study.

Children with attention deficit/hyperactivity disorder (ADHD) struggle with executive functioning (EF). While physical activity (PA) benefits EF, little is known about the impact of specific activities like standing. The purpose of this study was to evaluate the feasibility of performing a rigorous experimental study to compare the effects of walking and standing on EF in children with ADHD. Six areas of feasibility were assessed: recruitment, randomization, treatment adherence, retention, acceptability of the intervention, and implementation. A randomized pilot study using three parallel conditions compared the effects of two modes of activity on EF in children 6-11 with ADHD. While there were no significant differences between walking and standing for EF, analyses suggest that it is feasible to compare effects of standing vs. walking on EF among children with ADHD. This study supports the feasibility of undertaking a larger scale study to evaluate the effect of standing on EF in children with ADHD.

How current law and policy supports providers of NHS healthcare in England to respond to patient harm: A scoping review protocol.

INTRODUCTION: Harm arising from National Health Service (NHS) healthcare results in significant human cost for the patient, those who care for them, and the medical staff involved. Furthermore, patient harm results in substantial financial costs to the public purse. Improving how NHS providers in England respond to patient harm could reduce the number of claims for clinical negligence brought against NHS. Doing so will ensure those affected receive the justice they deserve and protect the public purse. Law and policy are key to supporting providers of NHS healthcare to respond to patient harm but are not necessarily understood and therefore can be challenging to apply to practice. Research exploring how law and policy supports this understanding is limited. The purpose of this scoping review is to address this knowledge gap and improve understanding by critically evaluating how law and policy supports providers of NHS healthcare in England to respond to patient harm. METHODS AND ANALYSIS: The review will use the methodological framework proposed by Arskey and O'Malley, Levac et al and the Joanna Briggs Institute. Search strategies will be developed using selected key words and index terms. MEDLINE, CINAHL, and Westlaw and reference lists of relevant publications will be searched to identify relevant grey literature. Two reviewers will independently assess the extracted data against the eligibility criteria. All studies identified will be charted and the results presented as a narrative synthesis.

Intestinal barrier disruption with Plasmodium falciparum infection in pregnancy and risk of preterm birth: a cohort study.

BACKGROUND: Malaria in early pregnancy is a risk factor for preterm birth and is associated with sustained inflammation and dysregulated angiogenesis across gestation. This study investigated whether malaria is associated with increased gut leak and whether this contributes to systemic inflammation, altered angiogenesis, and preterm birth. METHODS: We quantified plasma concentrations of gut leak markers, soluble CD14 (sCD14) and lipopolysaccharide binding protein (LBP) from 1339 HIV-negative pregnant Malawians at <24 weeks gestational age. We assessed the relationship of sCD14 and LBP concentrations with markers of inflammation, angiogenesis, and L-arginine bioavailability and compared them between participants with and without malaria, and with and without preterm birth. FINDINGS: Plasma concentrations of sCD14 and LBP were significantly higher in participants with malaria and were associated with parasite burden (p <0.0001, both analyses and analytes). The odds ratio for preterm birth associated with one log sCD14 was 2.67 (1.33 to 5.35, p = 0.006) and 1.63 (1.07-2.47, p = 0.023) for LBP. Both gut leak analytes were positively associated with increases in proinflammatory cytokines CRP, sTNFR2, IL18-BP, CHI3L1 and Angptl3 (p <0.05, all analytes) and sCD14 was significantly associated with angiogenic proteins Angpt-2, sENG and the sFLT:PlGF ratio (p <0.05, all analytes). sCD14 was negatively associated with L-arginine bioavailability (p <0.001). INTERPRETATION: Malaria in early pregnancy is associated with intestinal barrier dysfunction, which is linked to an increased risk of preterm birth. FUNDING: Open Philanthropy, Canadian Institutes of Health Research, Canada Research Chair program, European and Developing Countries Clinical Trials Partnership, Bill & Melinda Gates Foundation.

Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study.

BACKGROUND: Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors. OBJECTIVE: This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling). METHODS: This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis. RESULTS: Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60%), not married (8/10, 80%), and college graduates (5/10, 50%). The app was used on average 20.2 (SD 8.9) out of 28 days-SUS score of 72 (range 55-95)-and 70% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app. CONCLUSIONS: The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community. TRIAL REGISTRATION: ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279.

Resistance Training Behavior Is Enhanced With Digital Behavior Change Coaching: A Randomized Controlled Trial With Novice Adults.

BACKGROUND: Approximately a third of US adults meet the physical activity guidelines of engaging in resistance training 2 times per week, yet few studies have examined how to increase participation rates. The present randomized control trial compared a remotely delivered coaching intervention with an education only control group. METHODS: Eligible participants completed 2 remotely delivered Zoom-based personal training sessions during a 1-week run-in period. Participants randomized to the intervention group received synchronous weekly behavioral video coaching sessions over Zoom, whereas the control group received no further contact. Days of resistance training completed were assessed at baseline (pre), 4 weeks (post), and 8 weeks (follow-up). Linear mixed models were used to examine group differences at each time point and within-group differences over time. RESULTS: There were significant between-group differences favoring the intervention, at posttest for both the previous week (b = 0.71, SE = 0.23; P = .002) and the previous 4 weeks (b = 2.54, SE = 0.87; P = .003) but not at the follow-up period for either the last week (b = 0.15, SE = 0.23; P = .520) or the last 4 weeks (b = 0.68, SE = 0.88; P = .443). CONCLUSION: The present study showed that by providing participants with equipment, skill, and in the case of the intervention group, a remote coaching intervention, resistance training participation increased.

Prognostic accuracy of biomarkers of immune and endothelial activation in Mozambican children hospitalized with pneumonia.

Pneumonia is a leading cause of child mortality. However, currently we lack simple, objective, and accurate risk-stratification tools for pediatric pneumonia. Here we test the hypothesis that measuring biomarkers of immune and endothelial activation in children with pneumonia may facilitate the identification of those at risk of death. We recruited children <10 years old fulfilling WHO criteria for pneumonia and admitted to the Manhiça District Hospital (Mozambique) from 2010 to 2014. We measured plasma levels of IL-6, IL-8, Angpt-2, sTREM-1, sFlt-1, sTNFR1, PCT, and CRP at admission, and assessed their prognostic accuracy for in-hospital, 28-day, and 90-day mortality. Healthy community controls, within same age strata and location, were also assessed. All biomarkers were significantly elevated in 472 pneumonia cases versus 80 controls (p<0.001). IL-8, sFlt-1, and sTREM-1 were associated with in-hospital mortality (p<0.001) and showed the best discrimination with AUROCs of 0.877 (95% CI: 0.782 to 0.972), 0.832 (95% CI: 0.729 to 0.935) and 0.822 (95% CI: 0.735 to 0.908), respectively. Their performance was superior to CRP, PCT, oxygen saturation, and clinical severity scores. IL-8, sFlt-1, and sTREM-1 remained good predictors of 28-day and 90-day mortality. These findings suggest that measuring IL-8, sFlt-1, or sTREM-1 at hospital presentation can guide risk-stratification of children with pneumonia, which could enable prioritized care to improve survival and resource allocation.

How do Central American Parents in the United States View the Importance of and Obtain Information About Behaviors Associated with the Risk of Early Childhood Obesity?

Background: Data suggest that Latinx preschool-age children are at increased risk of obesity. The fastest-growing Latinx population in the United States originates from El Salvador, Guatemala, and Honduras, also known as the Northern Triangle countries. Purpose: To describe how Central American parents from the Northern Triangle countries perceive the importance of energy balance-related behaviors (EBRBs), their preferred sources to obtain information about EBRBs, and to assess whether these differ by parent's gender and country of the nativity. Methods: Cross-sectional survey. Results: Seventy-four parents with at least one child between 2 and 5 years of age participated in the study. More than half were immigrants from El Salvador, Guatemala, and Honduras and were classified as having low acculturation. Mothers perceived consuming >5 fruits and vegetables daily, limiting sugar-sweetened beverages consumption, and having <2 hours daily screen time as extremely important, whereas fathers perceived these behaviors as being less important. Although a higher proportion of foreign-born than US-born parents perceived most of the assessed EBRBs (4 out of 6) as extremely important, these differences were not significant. Parents reported multiple sources to obtain EBRB-related information. Direct person-to-person interactions were the most commonly preferred sources, with pediatricians being the top source (97.3%), followed by other parents (86.5%), and WIC professionals (74.3%). Pediatricians were the preferred source to obtain information about EBRBs, irrespective of parent's gender and country of the nativity. A higher proportion of US-born than foreign-born parents reported a preference to obtain EBRB-related information from other parents. Conclusions: Findings suggest the significance of understanding how Central American parents perceive the importance of EBRBs and the sources they would prefer to obtain information for their children's EBRBs. Study findings have implications for health education and obesity prevention interventions designed to reach and deliver key evidence-based child health information to Central American parents from the Northern Triangle countries in the United States.

Soluble Urokinase-Type Plasminogen Activator Receptor as a Prognostic Marker of Ugandan Children at Risk of Severe and Fatal Malaria.

BACKGROUND: Current malaria diagnostic tests do not reliably identify children at risk of severe and fatal infection. Host immune and endothelial activation contribute to malaria pathogenesis. Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of these pathways. We hypothesized that measuring suPAR at presentation could risk-stratify children with malaria. METHODS: Plasma suPAR levels were determined in consecutive febrile children with malaria at presentation to hospital in Jinja, Uganda. We evaluated the accuracy of suPAR in predicting in-hospital mortality, and whether suPAR could improve a validated clinical scoring system (Lambaréné Organ Dysfunction Score [LODS]). RESULTS: Of the 1226 children with malaria, 39 (3.2%) died. suPAR concentrations at presentation were significantly higher in children who went on to die than in those who survived (P < .0001). suPAR levels were associated with disease severity (LODS: 0 vs 1, P = .001; 1 vs 2, P < .001; 2 vs 3, 0 vs 2, 1 vs 3, and 0 vs 3, P < .0001). suPAR concentrations were excellent predictors of in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.92 [95% confidence interval {CI}, .91-.94]). The prognostic accuracy of LODS (AUROC, 0.93 [95% CI, .91-.94]) was improved when suPAR was added (AUROC, 0.97 [95% CI, .96-.98]; P < .0001). CONCLUSIONS: Measuring suPAR at presentation can identify children at risk of severe and fatal malaria. Adding suPAR to clinical scores could improve the recognition and triage of children at risk of death. suPAR can be detected with a point-of-care test and can now be evaluated in prospective trials.

Developmental origins of disease highlight the immediate need for expanded access to comprehensive prenatal care.

The prenatal environment plays a critical role in shaping fetal development and ultimately the long-term health of the child. Here, we present data linking prenatal health, via maternal nutrition, comorbidities in pregnancy (e.g., diabetes, hypertension), and infectious and inflammatory exposures, to lifelong health through the developmental origins of disease framework. It is well-established that poor maternal health puts a child at risk for adverse outcomes in the first 1,000 days of life, yet the full health impact of the in utero environment is not confined to this narrow window. The developmental origins of disease framework identifies cognitive, neuropsychiatric, metabolic and cardiovascular disorders, and chronic diseases in childhood and adulthood that have their genesis in prenatal life. This perspective highlights the enormous public health implications for millions of pregnancies where maternal care, and therefore maternal health and fetal health, is lacking. Despite near universal agreement that access to antenatal care is a priority to protect the health of women and children in the first 1,000 days of life, insufficient progress has been achieved. Instead, in some regions there has been a political shift toward deprioritizing maternal health, which will further negatively impact the health and safety of pregnant people and their children across the lifespan. In this article we argue that the lifelong health impact attributed to the perinatal environment justifies policies aimed at improving access to comprehensive antenatal care globally.

A biomarker assay to risk-stratify patients with symptoms of respiratory tract infection.

BACKGROUND: Patients who present to an emergency department (ED) with respiratory symptoms are often conservatively triaged in favour of hospitalisation. We sought to determine if an inflammatory biomarker panel that identifies the host response better predicts hospitalisation in order to improve the precision of clinical decision making in the ED. METHODS: From April 2020 to March 2021, plasma samples of 641 patients with symptoms of respiratory illness were collected from EDs in an international multicentre study: Canada (n=310), Italy (n=131) and Brazil (n=200). Patients were followed prospectively for 28 days. Subgroup analysis was conducted on confirmed coronavirus disease 2019 (COVID-19) patients (n=245). An inflammatory profile was determined using a rapid, 50-min, biomarker panel (RALI-Dx (Rapid Acute Lung Injury Diagnostic)), which measures interleukin (IL)-6, IL-8, IL-10, soluble tumour necrosis factor receptor 1 (sTNFR1) and soluble triggering receptor expressed on myeloid cells 1 (sTREM1). RESULTS: RALI-Dx biomarkers were significantly elevated in patients who required hospitalisation across all three sites. A machine learning algorithm that was applied to predict hospitalisation using RALI-Dx biomarkers had a mean±sd area under the receiver operating characteristic curve of 76±6% (Canada), 84±4% (Italy) and 86±3% (Brazil). Model performance was 82±3% for COVID-19 patients and 87±7% for patients with a confirmed pneumonia diagnosis. CONCLUSIONS: The rapid diagnostic biomarker panel accurately identified the need for inpatient care in patients presenting with respiratory symptoms, including COVID-19. The RALI-Dx test is broadly and easily applicable across many jurisdictions, and represents an important diagnostic adjunct to advance ED decision-making protocols.

Correlates of bike share use and its association with weight status at an urban university.

BACKGROUND: Research on the influences on bike share use and potential favorable relationships between use and obesity is limited, particularly in the U.S. context. Therefore, the aims of this exploratory study were to examine correlates of awareness and use of Boston's Bluebikes bike share system and assess the association between use and weight status. METHODS: Students, faculty, and staff (n = 256) at a public urban university completed an online survey that assessed sociodemographic, behavioral, and physical activity characteristics, Bluebikes awareness, and use of Bluebikes and personal bikes. Multivariable logistic regression models were estimated to examine associations between sociodemographic and behavioral factors and bike share awareness and use; and between use and overweight/obesity status. RESULTS: Respondents were mostly students (72.2%), female (69.1%), White (62.1%), and the mean age was 32.4±13.8 years. The percentage of respondents classified as aware of Bluebikes was 33.6% with only 12.9% reporting any use of the system. Living in a community where bike share stations were located (odds ratio (OR) = 2.01, 95% confidence interval (CI): 1.10, 3.67), personal bike ownership (OR = 2.27, 95% CI:1.27, 4.45), and not exclusively commuting to campus via car (OR = 3.19, 95% CI:1.63, 6.22) had significant positive associations with awareness. Living in a bike share community (OR = 2.34; 95% CI:1.04, 5.27) and personal bike ownership (OR = 3.09; 95% CI:1.27, 7.52) were positively associated with bike share use. Any reported use of Bluebikes was associated with 60% lower odds of being overweight/obese (OR = 0.40; 95% CI:0.17, 0.93). CONCLUSIONS: Several environmental and behavioral variables, including access to stations and personal bicycle ownership, were significantly associated with Bluebikes awareness and use. Findings also suggest a potential benefit to bike share users in terms of maintaining a healthy weight, though further longitudinal studies are needed to rule out the possibility that more active and leaner individuals tend to use bike share more frequently.

Intestinal Injury in Ugandan Children Hospitalized With Malaria.

BACKGROUND: Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract. METHODS: In a prospective cohort study in Uganda, we measured markers of intestinal injury (intestinal fatty-acid binding protein [I-FABP] and zonula occludens-1 [ZO-1]) and microbial translocation (lipopolysaccharide binding protein [LBP] and soluble complement of differentiation 14 [sCD14]) among children admitted with malaria. We examined their association with biomarkers of inflammation, endothelial activation, clinical signs of hypoperfusion, organ injury, and mortality. RESULTS: We enrolled 523 children (median age 1.5 years, 46% female, 7.5% mortality). Intestinal FABP was above the normal range (≥400 pg/mL) in 415 of 523 patients (79%). Intestinal FABP correlated with ZO-1 (ρ = 0.11, P = .014), sCD14 (ρ = 0.12, P = .0046) as well as markers of inflammation and endothelial activation. Higher I-FABP levels were associated with lower systolic blood pressure (ρ = -0.14, P = .0015), delayed capillary refill time (ρ = 0.17, P = .00011), higher lactate level (ρ = 0.40, P < .0001), increasing stage of acute kidney injury (ρ = 0.20, P = .0034), and coma (P < .0001). Admission I-FABP levels ≥5.6 ng/mL were associated with a 7.4-fold higher relative risk of in-hospital death (95% confidence interval, 1.4-11, P = .0016). CONCLUSIONS: Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.

Clinical decision analysis of elective delivery vs expectant management for pregnant individuals with COVID-19-related acute respiratory distress syndrome.

BACKGROUND: Pregnant individuals are vulnerable to COVID-19-related acute respiratory distress syndrome. There is a lack of high-quality evidence on whether elective delivery or expectant management leads to better maternal and neonatal outcomes. OBJECTIVE: This study aimed to determine whether elective delivery or expectant management are associated with higher quality-adjusted life expectancy for pregnant individuals with COVID-19-related acute respiratory distress syndrome and their neonates. STUDY DESIGN: We performed a clinical decision analysis using a patient-level model in which we simulatedpregnant individuals and their unborn children. We used a patient-level model with parallel open-cohort structure, daily cycle length, continuous discounting, lifetime horizon, sensitivity analyses for key parameter values, and 1000 iterations for quantification of uncertainty. We simulated pregnant individuals at 32 weeks of gestation, invasively ventilated because of COVID-19-related acute respiratory distress syndrome. In the elective delivery strategy, pregnant individuals received immediate cesarean delivery. In the expectant management strategy, pregnancies continued until spontaneous labor or obstetrical decision to deliver. For both pregnant individuals and neonates, model outputs were hospital or perinatal survival, life expectancy, and quality-adjusted life expectancy denominated in years, summarized by the mean and 95% credible interval. Maternal utilities incorporated neonatal outcomes in accordance with best practices in perinatal decision analysis. RESULTS: Model outputs for pregnant individuals were similar when comparing elective delivery at 32 weeks' gestation with expectant management, including hospital survival (87.1% vs 87.4%), life-years (difference, -0.1; 95% credible interval, -1.4 to 1.1), and quality-adjusted life expectancy denominated in years (difference, -0.1; 95% credible interval, -1.3 to 1.1). For neonates, elective delivery at 32 weeks' gestation was estimated to lead to a higher perinatal survival (98.4% vs 93.2%; difference, 5.2%; 95% credible interval, 3.5-7), similar life-years (difference, 0.9; 95% credible interval, -0.9 to 2.8), and higher quality-adjusted life expectancy denominated in years (difference, 1.3; 95% credible interval, 0.4-2.2). For pregnant individuals, elective delivery was not superior to expectant management across a range of scenarios between 28 and 34 weeks of gestation. Elective delivery in cases where intrauterine death or maternal mortality were more likely resulted in higher neonatal quality-adjusted life expectancy, as did elective delivery at 30 weeks' gestation (difference, 1.1 years; 95% credible interval, 0.1 - 2.1) despite higher long-term complications (4.3% vs 0.5%; difference, 3.7%; 95% credible interval, 2.4-5.1), and in cases where intrauterine death or maternal acute respiratory distress syndrome mortality were more likely. CONCLUSION: The decision to pursue elective delivery vs expectant management in pregnant individuals with COVID-19-related acute respiratory distress syndrome should be guided by gestational age, risk of intrauterine death, and maternal acute respiratory distress syndrome severity. For the pregnant individual, elective delivery is comparable but not superior to expectant management for gestational ages from 28 to 34 weeks. For neonates, elective delivery was superior if gestational age was ≥30 weeks and if the rate of intrauterine death or maternal mortality risk were high. We recommend basing the decision for elective delivery vs expectant management in a pregnant individual with COVID-19-related acute respiratory distress syndrome on gestational age and likelihood of intrauterine or maternal death.

Central American Parents' Preferences for Content and Modality for a Family-Centered Intervention to Promote Healthful Energy Balance-Related Behaviors of Their Preschool-Age Children.

This formative research used a cross-sectional survey to assess interest in informational content and intervention modalities for the design of an early childhood obesity prevention intervention for Central American families from the Northern Triangle countries (El Salvador, Guatemala, and Honduras) living in the United States. A total of 74 parents (36 mothers, 38 fathers) with a mean age of 31.6 years (SD = 5.6) completed the survey; 59.5% of whom were born outside of the United States. Although most parents reported being very interested in receiving information related to the seven assessed energy balance-related behaviors, there were significant differences by parents' gender and nativity. Most parents endorsed remote modalities for content delivery via text/SMS, WhatsApp, and e-mail. However, respondents were also receptive to in-person delivery provided by community health workers. There were also significant differences in parents' preferences for intervention modalities by parents' gender and nativity. Future steps should include investigating different intervention modalities and their integration into a linguistic and culturally sensitive family-based intervention to promote healthful energy balance-related behaviors of preschool-age children in Central American families originating from the Northern Triangle countries.

Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional Survey.

BACKGROUND: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. OBJECTIVE: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. METHODS: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. RESULTS: Of the 340 emerging adults, 257 (76%) were female, 223 (65%) White, 156 (47%) low income, and 184 (54%) reported having patient portal access. Of those reporting access, 142 (77%) used at least 1 portal feature and 42 (23%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95% CI 1.08-16.89, P=.04). CONCLUSIONS: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management.

Lessons Learned: Beta-Testing the Digital Health Checklist for Researchers Prompts a Call to Action by Behavioral Scientists.

Digital technologies offer unique opportunities for health research. For example, Twitter posts can support public health surveillance to identify outbreaks (eg, influenza and COVID-19), and a wearable fitness tracker can provide real-time data collection to assess the effectiveness of a behavior change intervention. With these opportunities, it is necessary to consider the potential risks and benefits to research participants when using digital tools or strategies. Researchers need to be involved in the risk assessment process, as many tools in the marketplace (eg, wellness apps, fitness sensors) are underregulated. However, there is little guidance to assist researchers and institutional review boards in their evaluation of digital tools for research purposes. To address this gap, the Digital Health Checklist for Researchers (DHC-R) was developed as a decision support tool. A participatory research approach involving a group of behavioral scientists was used to inform DHC-R development. Scientists beta-tested the checklist by retrospectively evaluating the technologies they had chosen for use in their research. This paper describes the lessons learned because of their involvement in the beta-testing process and concludes with recommendations for how the DHC-R could be useful for a variety of digital health stakeholders. Recommendations focus on future research and policy development to support research ethics, including the development of best practices to advance safe and responsible digital health research.

Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project.

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women's only wellness center that exchanged ExRx for free access (1-3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21-78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were "readiness" and "right timing" for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were "mismatched expectations" and "competing priorities". Common themes among all women were "sense of community" and "ease of location". ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Brief parental self-efficacy scales for promoting healthy eating and physical activity in children: a validation study.

BACKGROUND: Brief scales to measure parental self-efficacy (PSE) in relation to children's obesogenic behaviours have not been developed and validated using more rigorous methodology such as invariance testing, limiting their generalisability to sub-groups. This study aimed to assess the construct validity and measurement invariance of brief PSE scales for children's intake of vegetables, soft drinks, and sweets, and physical activity. METHODS: Parents (n = 242) of five-to-seven-year-old children in disadvantaged and culturally diverse settings in Sweden responded to a questionnaire in Swedish with 12 items assessing PSE in relation to healthy and unhealthy behaviours. Construct validity was assessed with confirmatory factor analysis, invariance testing compared the scales by groups of parental sex, education, and child weight status. Criterion validity was evaluated using objective measures of children's physical activity and semi-objective measures of diet. RESULTS: Two-factor models showed moderate to excellent fit to the data. Invariance was supported across all groups for healthy behaviour scales. Unhealthy behaviour scales were invariant for all groups except parental education where partial metric invariance was supported. Scales were significantly correlated with physical activity and diet. CONCLUSION: This study provides preliminary evidence for the validity of brief PSE scales and invariance across groups suggesting their utility for research and clinical management of weight-related behaviours.

Running a one-stop clinic for patients with inflammatory bowel disease.

Julie Carriss-Wright, Clinical Nurse Specialist, IBD, The Mid Yorkshire Hospitals NHS Trust (julie.carriss-wright@nhs.net), runner-up in the BJN Awards 2020 Gastrointestinal/IBD Nurse of the Year category.