Problem solving and collaborative involvement among adolescents with spinal cord injury and their caregivers

ObjectiveTo determine the relationship between constructive adolescent problem solving (positive problem-solving orientation and rational problem-solving style) and caregiver problem solving and collaborative involvement with primary caregiver among adolescents with spinal cord injuries (SCIs). Positive constructive adolescent problem solving was hypothesized to be predicted by more effective caregiver problem solving and higher collaborative involvement.MethodsParticipants in this cross-sectional study were 79 adolescent and primary caregiver dyads recruited from a pediatric rehabilitation care system in North America. All participants completed a standardized problem-solving instrument and adolescent participants completed an adapted measure of collaborative parent involvement.ResultsMore effective caregiver problem solving and adolescent perceptions of more collaboration with caregivers around SCI care were significantly associated with higher positive problem-solving orientation and higher rational problem-solving style among adolescents.ConclusionsResults underscore the importance of caregiver problem-solving skills and their collaboration with adolescents with SCI when addressing care needs. Clinically, findings highlight opportunities for parent involvement and skill-building as an important factor of rehabilitation for adolescents with SCI

Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees

Background: There are limited studies focusing on resident and fellow attitudes on family planning and egg freezing. Surgical training programs are often longer and more time consuming than other fields. It is important to understand how this training affects family planning decisions. Objective: This study aimed to describe fertility knowledge and viewpoints on family planning among US residents or fellows. Study design: The Advocate Aurora Health Institutional Review Board approved this study on October 8, 2019 (IRB# AHC-7213-S5500413). A 32-question survey was emailed to trainees across US programs in a variety of specialties (obstetrics/gynecology; ophthalmology; otolaryngology; urology; and neurology, plastic, general, thoracic and orthopedic surgery) to assess fertility knowledge. Pearson chi square tests were conducted to investigate differences in fertility knowledge by groups of interest (trainee specialty, gender, trainee program type). Demographics and viewpoints on family planning and egg freezing are described. All analyses were performed using SAS, version 9.4. Results: A total of 447 surveys were collected from October 2019 to January 2020. Participants included 309 residents, 94 fellows, and 44 with unknown status across the 9 specialties. Participants were mostly female (73%), aged 26 to 30 years (48%), White (69%), married (59%), and heterosexual (95%), with no children (72%). When asked at what age a woman\u27s fertility slightly decreases, obstetrics/gynecology trainees had 39% less likelihood of answering correctly compared with non-obstetrics/gynecology respondents (P=.0207). Female respondents had 18% less likelihood of answering correctly relative to male respondents, and trainees in academic programs were 20% to 60% more likely to answer correctly relative to those in community programs, but these findings were not statistically significant. Interestingly, female respondents had 2.89 times increased odds of having 0 children (P\u3c.0001), 0.42 times increased odds (ie, 58% decreased odds) of being married (P=.0003), and 1.33 times increased odds of postponing childbearing (P=.2438). Conclusion: This study found that despite their sex or focused training in reproductive endocrinology and infertility, female respondents and obstetrics/gynecology trainees were not more well-versed in basic female fertility knowledge than their counterparts. Furthermore, female respondents were less likely to have children or be married, and more likely to report postponing childbearing, highlighting differences in family planning by sex. Fertility-focused educational interventions for obstetrics/gynecology trainees are necessary. More research into barriers to family planning, particularly by sex, are also merited

Factors associated with COVID-19 breakthrough infections in large midwestern healthcare system: Implications for vulnerable healthcare personnel

Objective: The aim of the study is to identify factors associated with breakthrough infection among a cohort of Midwestern healthcare personnel (HCP). Methods: SARS-CoV-2-positive test results between March 1, 2020, and July 31, 2021, were collected from electronic medical records of HCP to identify breakthrough infections. Results: Healthcare personnel who were younger than 35 years, received the Pfizer vaccine, and worked in COVID clinical units had greater adjusted odds of breakthrough infection. COVID infection before full vaccination was associated with reduced odds of breakthrough infection. Conclusions: Our study concluded that the most vulnerable HCP are younger, working in COVID-19 clinical units, and received Pfizer-BioNTech primary series vaccines. Healthcare personnel who had COVID before vaccination were at reduced risk of breakthrough infection, indicating that supplemental immunity could better protect at-risk HCP groups

Heart disease in adults with Down syndrome between 1996 and 2016

PURPOSE: To describe demographic factors and calculate prevalence of heart disease-related conditions among the adult Down syndrome (DS) sample population and to compare demographic and heart disease-related conditions between the DS sample population (n = 2342) and the general population. Methods: Using a retrospective, descriptive cohort study design, analyses were based on 20 years of data collected on the Adult Down Syndrome Center patient population. Prevalence of heart disease, stroke, and associated risk conditions are reported as counts (%) with corresponding odds ratio (OR) indicating odds of diagnosis among the DS sample compared with the general population. Corresponding Pearson c2 P-values were calculated to represent statistically significant differences between prevalence of diagnoses in the DS sample compared with the general population. In cases where prevalence was low, Fisher\u27s Exact Test P-value were calculated. Results: Adults with DS had lower odds of diagnosis of heart disease and most associated risk conditions, specifically coronary heart disease (OR = 0.0537, P \u3c .0001), heart failure (OR = 0.6353, P = .0091), hypertension (OR = 0.0325, P \u3c .0001), diabetes (OR = 0.4840, P \u3c .0001), and high total cholesterol (OR = 0.2086, P \u3c .0001), while experiencing higher odds of overweight status (OR = 1.2185, P = .0002) and obese status (OR = 1.3238, P \u3c .0001). Conclusion: Adults with DS generally experience less heart disease and associated risk conditions commonly seen in the general population. Prevention and treatment guidelines for heart disease for the DS population should be adjusted after more research is conducted

Resident versus attending prenatal care models: An analysis of the effects of race and insurance on appointment attendance

Objective: To describe patient differences by prenatal care (PNC) model and identify factors that interact with race to predict more attended prenatal appointments, a key component of PNC adherence. Methods: This retrospective cohort study used administrative data targeting prenatal patient utilization from two OB clinics with different care models (resident vs. attending OB) from within one large midwestern healthcare system. All appointment data among patients receiving prenatal care at either clinic between September 2, 2020, and December 31, 2021, were extracted. Multivariable linear regression was performed to identify predictors of attended appointments within the resident clinic, as moderated by race (Black vs. White). Results: A total of 1034 prenatal patients were included: 653 (63%) served by the resident clinic (appointments = 7822) and 381 (38%) by the attending clinic (appointments = 4627). Patients were significantly different across insurance, race/ethnicity, partner status, and age between clinics (p \u3c 0.0001). Despite prenatal patients at both clinics being scheduled for approximately the same number of appointments, resident clinic patients attended 1.13 (0.51, 1.74) fewer appointments (p = 0.0004). The number of attended appointments was predicted by insurance in crude analysis (β = 2.14, p \u3c 0.0001), with effect modification by race (Black vs. White) in final fitted analysis. Black patients with public insurance attended 2.04 fewer appointments than White patients with public insurance (7.60 vs. 9.64) and Black non-Hispanic patients with private insurance attended 1.65 more appointments than White non-Hispanic or Latino patients with private insurance (7.21 vs. 5.56). Conclusion: Our study highlights the potential reality that the resident care model, with more care delivery challenges, may be underserving patients who are inherently more vulnerable to PNC non-adherence at care onset. Our findings show that patients attend more appointments at the resident clinic if publicly insured, but less so if they are Black than White

Factors associated with COVID-19 breakthrough infections in large Midwestern healthcare system: Implications for vulnerable healthcare personnel

Response to letter to the editor for original publication: Rivelli A, Fitzpatrick V, Copeland K, Richards J. Factors Associated With COVID-19 Breakthrough Infections in Large Midwestern Healthcare System: Implications for Vulnerable Healthcare Personnel. J Occup Environ Med. 2022;64(8):635-641. doi:10.1097/JOM.000000000000257

Incidence of COVID-19 recurrence among large cohort of healthcare employees

PURPOSE: To quantify COVID-19 recurrence among clinical and nonclinical healthcare employees with SARS-CoV-2 IgG antibodies or prior COVID-19 infection. METHODS: This prospective, cohort study collected and resulted SARS-CoV-2 IgG serum samples as positive or negative from June 8 to July 10, 2020 from a convenience sample of 16,233 adult participants employed by a large Midwestern healthcare system. Documented positive polymerase chain reaction test results representing COVID-19 infections were recorded up to four months prior to and post-IgG testing. RESULTS: Nine hundred and thirteen (6.12%) participants, including 45 (4.93%) IgG positive participants, experienced COVID-19 infections after study initiation, representing a 51% increased risk of COVID-19 infection among IgG positive participants (IRR = 1.51). Regressions adjusted for documented disparities showed no difference in COVID-19 infection by IgG status (OR=1.19; P = .3117) but significantly greater odds in COVID-19 recurrence among participants with a prior documented COVID-19 infection (OR=1.93; P \u3c .0001). CONCLUSIONS: SARS-CoV-2 IgG antibodies and prior COVID-19 infection do not appear to offer meaningful protection against COVID-19 recurrence in healthcare workers. Recurrence would impact decisions regarding ongoing healthcare resource utilization. This study can inform considerations for vaccine administration to vulnerable groups