“It’s hard for everyone” systemic barriers to home confinement to prevent community spread of COVID-19

Rapid identification and isolation/quarantine of COVID-19 cases or close contacts, respectively, is a vital tool to support safe, in-person learning. However, safe isolation or quarantine for a young child also necessitates home confinement for at least one adult caregiver, as well as rapid learning material development by the teacher to minimize learning loss. The purpose of this study is to better understand barriers and supports to student home confinement. We conducted a mixed-methods study using focus group discussions and a self-administered online survey with parents and staff members from 12 elementary schools and childcare sites across San Diego County serving low-income and socially vulnerable families. Focus group participants reported that mental distress and loneliness, learning loss, childcare, food, income loss, and overcrowded housing were major barriers related to home confinement. The experiences described by FGD participants were prevalent in a concurrent community survey: 25% of participants reported that isolation would be extremely difficult for a household member who tested positive or was exposed to COVID-19, and 20% were extremely concerned about learning loss while in isolation or quarantine. Our findings suggest that there are serious structural impediments to safely completing the entire recommended course of isolation or quarantine, and that the potential for isolation or quarantine may also lead to increased hesitancy to access diagnostic testing

Obstetric anesthesia services profile in cesarean section in Indonesian population: A prospective, observational, multicenter study

Background: All obstetrics or pregnant patients potentially require anesthesia during their delivery, both planned and emergency. The rate of cesarean deliveries in Indonesia has also increased from 9.8% to 17.6%. This study was conducted to provide a profile of anesthesia services in obstetric patients in Indonesian population. Materials and Methods: This observational prospective multicenter study was conducted from March to June 2022 in 67 hospitals in Indonesia. A total of 1731 subjects were enrolled. The study population consisted of patients who received obstetric anesthesia services during cesarean section. Data collection was conducted via the REDCap application. Results: A total of 1731 subjects were included in this study. Most cases were emergency surgeries (66.44%), with an American Society of Anesthesiologists classification of ASA II with emergency situation (53.96%). Spinal anesthesia was the most frequent technique (96.42%), although 1.16% of subjects had a conversion of anesthesia technique. The most common complication during the surgery, in the recovery room, and in the ward was hypotension (8.55%, 1.50%, and 0.58%, respectively), and the maternal mortality rate was 0.29%, with some identified causes being prolonged shock. A total of 120 (6.93%) subjects experienced postoperative care in the intensive care unit, whereas the remaining 1511 (93.17%) subjects did not. Conclusion: Anesthesia services in this study showed proper and representative results for obstetrics services in Indonesia. Our study demonstrated that single shot spinal anesthesia is the most commonly preferred mode of anesthesia for both elective and emergency cesarean delivery cases. However, there is still room for improvement in the anesthesia field, which should be continuously evaluated