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The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices–such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future. [ABSTRACT FROM AUTHOR]

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9–11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed. [ABSTRACT FROM AUTHOR]

Last responders constitute an occupational category that includes all those who are involved in the postmortem care of deceased persons and their families. The work of last responders is often considered "dirty work" and, as a result, stigmatized. Last responders are aware of this stigma, and stigma consciousness has been associated with negative health outcomes. Despite the wide acknowledgment of stigma among last responders, specific risk, or protective factors for experiencing stigma have not been investigated. This paper aims to identify determinants of stigma among last responders in the United States. The data for this study were obtained from a national cross-sectional survey of last responders. The survey included a measure of stigma and multiple sociodemographic characteristics. A hurdle model was used to assess the association between the characteristics of last responders and their perceived stigma. Respondents were predominantly male (55.1%), White non-Hispanic (90.2%), and employed full-time (96%). Seventy-seven percent reported having experienced at least one form of occupation-related stigma. There was no significant association between the experience of stigma and any socio-demographic variables. The experience of stigma is nearly ubiquitous among last responders—>75% of last responders in the sample experienced at least one form of stigma. Another aspect of its ubiquitous nature is the lack of evidence that stigma was experienced differentially across sex, race/ethnicity, employment type, and length of years as a last responder. Interventions are needed to decrease stigma among last responders and to support last responders in managing the consequences of the stigma they experience. [ABSTRACT FROM AUTHOR]

Background: Students' tendencies to seek feedback are associated with improved learning. Yet, how soon this association becomes robust enough to make predictions about learning is not fully understood. Such knowledge has strong implications for early identification of students at‐risk for underachievement via digital learning platforms. Objectives: We sought to understand how early in the academic year students' end‐of‐year learning outcomes could be predicted by their performance and feedback‐seeking behaviours within a digital learning platform. We analysed data collected at different time points in the academic year and across different cohorts of students within the context of high school advanced placement (AP) Statistics courses. Methods: High school students enrolled in AP Statistics spanning three academic years between 2017 and 2020 (N = 726; Mage = 16.72 years) completed 3 or 4 homework assignments, each 2 and 3 months apart. Results and conclusions: Across the three cohorts, and even as early as the first assignment, a model consisting of demographic variables (gender, race/ethnicity, parental education), assignment performance, and interaction with the digital score report explained significant variation in students' final course grades (R2 = 0.314–0.412) and AP exam scores (κ = 0.583–0.689). Students' assignment performance was positively associated with end‐of‐year learning outcomes. Students who more frequently checked their digital score reports tended to receive better learning outcomes, though not consistently across cohorts. Implications: These findings further an understanding of how students' early performance and feedback‐seeking behaviours within a digital learning platform predict end‐of‐year learning outcomes. Lay Description: What is already known about this topic: Students' early academic performance predicts end‐of‐year success.Students' self‐regulated learning behaviours are another predictor of academic success.Clickstream data have been used as an indicator of the application of self‐regulated learning strategies, particularly behaviours associated with seeking feedback.Indicators of feedback‐seeking behaviours reflected via clickstream data have been shown to predict student learning.Yet, how soon associations between early performance and such indicators of self‐regulated learning as feedback‐seeking are robust across different groups of learners, different learning circumstances, and different types of learning outcomes has yet to be more fully understood. What this paper adds: We investigated whether performance and feedback‐seeking behaviours predict end‐of‐year learning outcomes at different points during the academic year across multiple cohorts of learners (2017–2018, 2018–2019, and 2019–2020) and using two different learning outcomes (class grades, AP exam scores).One cohort was affected by COVID‐19 during the 2019–2020 academic year, allowing us to examine whether differences emerge amidst unprecedented circumstances.We used assignment scores and online feedback‐seeking to predict end‐of‐year learning outcomes.Assignment scores were positively associated with end‐of‐year grades.First assignment performance predicted AP exam scores.Use of feedback (an indication of self‐regulated learning behaviours) tended to predict learning outcomes, though not consistently across cohorts. Implications for practice and/or policy: The findings from this study could improve understanding of how digital learning platform measurements predict end‐of‐year learning outcomes though also highlight the importance of context differences.Such findings hold implications for early identification of at‐risk students and appreciation for differences between learners and contexts.These findings also contribute to a growing understanding of the impact of the COVID‐19 pandemic on student engagement and learning. [ABSTRACT FROM AUTHOR]

Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. Results: We included 14 papers reporting on six studies. All services were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. Conclusions: DCN services have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required. Key points: Evidence on the impact of Dementia Care Navigators (DCNs) is limited but shows promising benefits for people living with dementia and their carers.More research needs to be conducted in countries other than the US, where all evidence was reported, and with similar outcome measures to allow comparison.DCNs are a highly useful professional group without medical training, who can navigate people living with dementia and their carers to support and provide support themselves. [ABSTRACT FROM AUTHOR]

Background: Teachers often rely on the use of open‐ended questions to assess students' conceptual understanding of assigned content. Particularly in the context of mathematics; teachers use these types of questions to gain insight into the processes and strategies adopted by students in solving mathematical problems beyond what is possible through more close‐ended problem types. While these types of problems are valuable to teachers, the variation in student responses to these questions makes it difficult, and time‐consuming, to evaluate and provide directed feedback. It is a well‐studied concept that feedback, both in terms of a numeric score but more importantly in the form of teacher‐authored comments, can help guide students as to how to improve, leading to increased learning. It is for this reason that teachers need better support not only for assessing students' work but also in providing meaningful and directed feedback to students. Objectives: In this paper, we seek to develop, evaluate, and examine machine learning models that support automated open response assessment and feedback. Methods: We build upon the prior research in the automatic assessment of student responses to open‐ended problems and introduce a novel approach that leverages student log data combined with machine learning and natural language processing methods. Utilizing sentence‐level semantic representations of student responses to open‐ended questions, we propose a collaborative filtering‐based approach to both predict student scores as well as recommend appropriate feedback messages for teachers to send to their students. Results and Conclusion: We find that our method outperforms previously published benchmarks across three different metrics for the task of predicting student performance. Through an error analysis, we identify several areas where future works may be able to improve upon our approach. Lay Description: What is already known about this topic: Open‐ended questions are used by teachers in the domain of mathematics to assess their students understanding but automated support for these types of questions are limited in online learning platforms. Recent advancements in areas of machine learning and natural language processing have led to promising results in a range of domains and applications. What this paper adds: Emulating how teachers identify similar student answers can be used to build tools that support teachers in assessing and providing feedback to student open‐ended work. Implications for practice: Developing better automated supports can increase the amount of direct feedback students receive to guide their learning. [ABSTRACT FROM AUTHOR]

Introduction: Action 3 of the UN Decade of Healthy Ageing plan is to deliver integrated care to improve older adults' lives. Integrated care is vital in meeting the complex needs of people with dementia but little is known about how this is or could be delivered in low and middle income countries (LMIC). This paper provides insights into previously unknown care system structures and on the potential and reality of delivering integrated care in Central America for people with dementia. Methods: A social network analysis (SNA) methodology was adopted to engage with providers of services for older adults and families with dementia in Guatemala, El Salvador, Honduras, Costa Rica and Panama. Sixty-eight (68) semi-structured interviews were completed, 57 with organisations and 11 with families. Results: Across the five countries there was evidence of fragmentation and low integration within the dementia care systems. A variety of services and types of providers are present in all five countries, and high levels of diversified connections exist among organisations of differing disciplines. However, unawareness among network members about other members that they could potentially form active links with is a barrier on the path to integration. Conclusion: This innovative and robust study demonstrates SNA can be applied to evaluate LMIC care systems. Findings provide baselines of system structures and insights into where resources are needed to fortify integration strategies. Results suggest that Central American countries have the building blocks in place to develop integrated care systems to meet the needs of people with dementia, but the links across service providers are opportunistic rather than context based coordinated integration policies. [ABSTRACT FROM AUTHOR]

Moral thinking and communication are critical competencies for confronting social dilemmas in a challenging world. We examined these moral competencies in 70 college students and graduates from Taiwan, the United Kingdom, and the United States. Participants were assessed through semi-structured written interviews, Facebook group discussions, and a questionnaire. In this paper, we describe the similarities and differences across cultural groupings in (1) the social issues of greatest importance to the participants; (2) the factors influencing their approaches to thinking about social issues and communicating with others; and (3) the characteristics of their moral functioning in terms of moral awareness, moral judgment, moral discourse, and moral decision-making. [ABSTRACT FROM AUTHOR]

Objectives This paper examines the family ties of older adults in the United States and how they are associated with mental health and social activity. We compare older adults with 4 types of family ties: adults "close" to family in proximity and social network, "kinless" older adults without a partner or children, "distanced" adults who live far from close kin, and "disconnected" older adults who do not report kin in their social network or do not report a location for some kin. Methods Using pooled data from the National Health and Aging Trends Study 2015–2019 for older adults aged 70 and older (N = 24,818 person-waves), we examine how family ties are associated with mental health and social activity, and whether lacking family is tied to poor well-being because older adults' needs are not being met. Results Kinless older adults and disconnected older adults have poorer outcomes (lower mental health scores and less social activity), compared to those close to their family. These findings suggest that both the presence and quality of the connection, as measured here via both location and social network, are critical for understanding which older adults are "at risk." Older adults who were not geographically proximate to their close kin (i.e. distanced) were not disadvantaged relative to those close to their families. Unmet needs do not help explain these patterns. Discussion Our results highlight that family ties are important for older adults well-being, not just through their existence but also their quality and strength. [ABSTRACT FROM AUTHOR]

This paper presents findings from a qualitative study exploring how students at a university in the southern USA conceptualize, theorize, and attempt to influence the role 'social factors' play in mental illness and well-being. Drawing on models of research co-production and principles of critical pedagogy, a group of 10 university students ('student researchers') worked with a faculty member to develop and conduct the study. The results highlight three ways in which the student interviewees ('student interlocutors') theorize 'the social'. The first two – (1) via the 'social determinants of health' and (2) by means of theories on 'neoliberal subjectivity' – provide a powerful frame for interrogating hierarchical systems of power. However, because neither of these corresponds to our interest in producing knowledge for social change, we used prefigurative and speculative approaches to explore a third notion of the social, that of (3) 'world-making practices'. We conclude by reflecting on the relevance of this project for educators, learners, and researchers seeking to deepen knowledge and theories of the social in mental health. We argue that co-produced research that draws from principles of critical pedagogy can enhance interdisciplinary collaboration and lead to more nuanced, transformative, and innovative analyses. [ABSTRACT FROM AUTHOR]

During the early months of the COVID-19 pandemic, 12 states banned or restricted abortion access under elective-procedure restrictions. The rationale was preserving hospital capacity and personal protective equipment (PPE); however, abortions commonly take place in clinics and use less PPE than childbirth. This paper investigates the discursive construction of abortions, the people who get them, and the fetuses in this legislation. The authors analyzed 13 antiabortion documents using an iterative process of thematic coding and memo writing. Twenty-three percent of the legislation listed abortion as banned, whereas the remaining laws implied abortion within the terms "elective" or "nonessential." Legislation used common antiabortion tactics, such as the trivialization of abortion, risk discourses, and constructions of motherhood and fetal personhood. Discourses delegitimized abortion providers and used quasi-medical justifications for banning abortion. Finally, legislation constructed abortion clinics as sites of contagion and waste and consequently as risks to public health. The results highlight the vulnerability of abortion and the connection between abortion policy and other conservative policies, and they gesture toward a strategic attempt to ban abortion federally. These findings have several implications for a post-Roe United States and for stakeholders wishing to increase abortion access. [ABSTRACT FROM AUTHOR]

Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective. [ABSTRACT FROM AUTHOR]

There is much discussion in the literature regarding the role public child welfare has played in disproportionately intervening with children and families of color, and debate regarding how this has impacted their wellbeing and the role systemic racism has played. The voice of individuals serving as regional and state-level administrators of public child welfare agencies regarding this topic and how to address existing inequities has been missing in this dialogue. This paper reports on semi-structured interviews conducted with sixteen such administrators regarding where they have observed these issues in their agencies and a wide array of strategies they believe have the best likelihood of promoting racial equity and antiracist practice in the child welfare system, with some describing approaches currently being implemented. Participants discussed what they need from community and university partners to support this work. [ABSTRACT FROM AUTHOR]

Purpose: We examined positive behavioral resources and characteristics that might distinguish resilient personality prototypes among persons with chronic spinal cord injury/disorder (SCID). Positive psychology variables with clear linkages to existing psychological interventions were examined as potential mediators of the resilience–well-being relationship. Research Method and Design: A cross-sectional, self-report study was conducted. Two hundred and ninety-eight consenting members of the Paralyzed Veterans of America (268 male; 236 self-identified as white) provided useable survey data for analysis (including 161 veterans with tetraplegia, 107 with paraplegia, 30 with cauda equina). Cluster analysis of Big Five personality traits identified resilient and nonresilient personality profiles. Tests of mean differences between resilient and nonresilient participants on behavioral resources and characteristics were performed. Path models predicting well-being and health-related quality of life (HRQL) were conducted. Results: One hundred and sixty-three respondents had resilient personality profiles and 135 had nonresilient profiles. Resilient individuals reported significantly more optimal scores on every positive psychology variable, and greater well-being and HRQL than nonresilient respondents. Path models found the relationship of resilience to well-being was explained through its beneficial associations with psychological flexibility, use of personal strengths, meaning in life (MIL), and gratitude. Psychological flexibility also mediated the resilience–HRQL relationship. Cauda equina was significantly associated with higher pain interference and lower HRQL. Conclusions: Higher gratitude, MIL, use of personal strengths, and psychological flexibility appear to characterize resilience and well-being among persons with chronic SCID. Further studies are needed to understand the impact of pain interference on HRQL among individuals with cauda equina. Impact and Implications: The present study documents several positive behavioral resources and characteristics that typify resilience among persons with chronic spinal cord injury/disorder. The results should prompt rehabilitation psychologists to consider further study of the positive psychology variables examined in this paper, and the potential use of the existing interventions associated with each one. [ABSTRACT FROM AUTHOR]

Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four‐day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music‐ and food‐evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music‐ and food‐evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music‐evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic negatively influenced the entire life globally including various aspects of patients' care. Its effect on medical research production is not known. The aim of this study is to assess the impact of COVID-19 pandemic on medical research reporting trend. Methods: Advanced search on PubMed was performed over 2011- August, 2021. Monthly comparison was done for the years 2019, 2020, and 2021. Kruskal Wallis test was used to compare continuous distributions. Results: The total publication count showed constant increment over the study period. Faster rise was noticed on 2020 (15.7%). A steady growth in publications over the years and through the pandemic was also seen in seven studied countries with variable, both in total and also after exclusion of COVID-19 related papers. Italy and India have the highest proportions of COVID-19 related publications in comparison to the total papers in 2020, but USA has the highest quantity. Statistically significant differences exist between the first eight months of the last three years with and without counting COVID-19 related publications (p-values=0.0003907 and 0.001084, respectively). Conclusion: Our results reflect that investigators world-wide succeeded to reconfigure their work style and utilize the spared time induced by the lockdown to enrich the medical research platform. [ABSTRACT FROM AUTHOR]

This paper sought to provide a fuller picture of mental health and wellness by examining flourishing among young adult college students, focusing on potential disparities. I analyzed data from the Healthy Minds Study (2020–2021; N = 115,225). About one-in-three students in the sample reported flourishing. Logistic regression models showed transgender/nonbinary/other gender (aOR:0.48; 95%CI: 0.41–0.56), sexual minority (aOR:0.39; 95%CI: 0.37–0.42), Asian American (aOR:0.76; 95%CI: 0.70–0.83), and Multiracial students (aOR:0.91; 95%CI: 0.84–0.99) each had lower odds flourishing when compared with their respective reference groups, while Black students had greater odds of flourishing (aOR:1.36; 95%CI: 1.23–1.51). Flourishing disparities are evident, calling for targeted interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: The prescription opioid epidemic in the United States (US) is well documented, and recent measures have reduced prescribing rates in that country. Evidence suggests opioid prescriptions have been rising recently in other countries too. OBJECTIVE: The current paper aimed to compare trends in opioid prescribing in England and the US. METHODS: Trends in rates of prescriptions per 100 members of the population were calculated for England and the US using publicly available government data on prescriptions and population statistics. RESULTS: Rates of prescribing are converging. At the peak of the US epidemic in 2012, there were 81.3 prescriptions per 100 people, but this had fallen to 43.3 by 2020. Prescribing peaked in England in 2016 at 43.2 prescriptions per 100 people, but has fallen only slightly, so that in 2020 there were 40.9 prescriptions per 100 people. CONCLUSION: The data indicate that levels of opioid prescribing in England are now similar to those in the US. They remain high in both countries, despite recent falls. This suggests the need for further measures to prevent over-prescribing and to support people who would benefit from withdrawing from these drugs. [ABSTRACT FROM AUTHOR]

ObjectiveThe current paper presents a comparison of university policies and health and academic accommodations offered to undergraduate students following sexual assault (SA) and sports-related concussions (SRC). Procedures and protocols for universities to consider adapting from their SRC policies to their SA policies are detailed.Participants: The SRC and SA policies at the 50 United States public flagship universities were analyzed.Methods: The research team coded for a number of policy details including health referrals, academic and financial accommodations, and requirements for follow-up with university personnel.Results: Compared to SA polices, SRC policies at the public flagship universities offer more comprehensive academic accommodations and physical and mental health resources. Conclusions: Comprehensive policies for student SA survivors, like those available for students who suffer SRCs, would improve student health and academic outcomes and increase SA survivors' likelihood of graduating college, thereby reducing individual and societal human capital loses. [ABSTRACT FROM AUTHOR]

Research has repeatedly shown the positive effects of early diagnosis and intervention in improving the quality of life and symptom trajectory of individuals with autism spectrum disorder (ASD). Immigrant and racial/ethnic minority children are diagnosed with ASD at significantly older ages, and have access to interventions later than their White peers. Recent efforts to address diagnostic disparities have focused on universal ASD screening in pediatric primary care. However, little is known about immigrant families' experiences with ASD screening and with navigating subsequent referrals after receiving a positive ASD screen. In the current study, we explored cultural influences on: mothers' perceptions of child development and disability, communication with pediatric healthcare providers, and perceived benefits of Early Intervention services. We interviewed 26 mothers (14 US-born and 12 immigrant—representing twelve different nationalities) of children who screened positively for ASD in primary care but did not receive an ASD diagnosis after a formal evaluation (i.e., false positive ASD screen). Mothers completed semi-structured qualitative interviews that explored their perceptions of child development, experiences with the ASD screening and developmental evaluation process, and experiences with developmental services. Data were stratified by U.S. nativity and analyzed using applied thematic analysis. Immigrant mothers described different ways of monitoring child development than US-born mothers, and described a mismatch between their own views and the child development frameworks used in the U.S. Due to this mismatch, immigrant parents may be less likely to raise concerns to their pediatricians, and therefore may particularly benefit from routine screening. This paper uses data from a supplemental study to a larger clinical trial. The clinical trial registration number is NCT02359084. Highlights: Immigrant families view child development as a process that unfolds uniquely for each child, therefore, monitoring development through milestones can be a new idea for culturally diverse families. Immigrant children with elevated risk for ASD may be at higher risk for later identification of developmental delays if they are not screened at their well-child visits. Culturally and linguistically accessible explanations of child development and disabilities can help immigrant families throughout the ASD screening process. Immigrant families emphasize benefiting from family navigation and logistical support during the developmental evaluation process. [ABSTRACT FROM AUTHOR]

This paper explores how obstacles to disengagement and push and pull factors combine to produce pathways out of extremism. Using Qualitative Comparative Analysis and a sample of 50 far-right extremists in the United States, including 25 who disengaged and 25 who did not, we show how certain exit barriers, like the presence of extremist family members, poor social mobility, and past criminal convictions, determine which push and pull factors are capable of assisting individuals in leaving extremism. We conclude with how these findings can be used to support intervention and reintegration programs. [ABSTRACT FROM AUTHOR]

Background: Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. Methods: This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. Results: Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2–6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. Conclusions: Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of the divorce trends in the United States and China since 1980 and examines the consistency and disparity of alternative measures of divorce rate. While divorce rate is a special sociodemographic indicator, with different measures often yielding inconsistent or even contradictory results, this study contributes to the literature with a comparative analysis using data from the United States and China over 40 years. Results suggest that, as compared to the refined divorce rate (number of divorces per 1,000 married population) that counts only people with a possibility to divorce, the widely used crude divorce rate (number of divorces per 1,000 population) overestimated the increase in China's divorce rate from 1980 to 2019 by 60.76% and the decrease in U.S. divorce rate over the same period by 15.13%. Also, although in 1980 the U.S. divorce rates were much higher than the corresponding Chinese rates, divorce rates in these two nations, with very different socioeconomic systems and stages of economic development, are progressively getting closer in recent years. However, whether and when China's divorce rate may start to decrease, following an inverted U-shaped pattern over time observed in the United States and some other nations, remains a question for future research. [ABSTRACT FROM AUTHOR]

Healthcare professionals are the vanguard of battling the COVID-19 pandemic and they experience major challenges associated with their jobs in the context of this pandemic. We carried out a survey of 253 healthcare professionals and 189 employees working in other domains to explore differences in how they adapted to COVID-19. Our results show that healthcare professionals perceive a higher mortality threat, lower job satisfaction and engage in fewer counterproductive work behaviors compared to respondents from other professions. Building on the tenets of the Terror Management Theory, we show that dispositional differences in death anxiety are the main drivers of perceived mortality threat in relation to COVID-19, yet this positive association is weaker for healthcare professionals, pointing to the engagement of proximal defenses specific to this work domain. Mortality threat mediates the association between death anxiety and job satisfaction only when supervisory support is low, pointing towards the crucial role of social support at work as a buffering mechanism against the deleterious effects of COVID-19 threat. Our paper presents one of the first empirical attempts to compare healthcare professionals with other workers with respect to job satisfaction and counterproductive work behaviors during the pandemic. [ABSTRACT FROM AUTHOR]

Self-determination theory posits that satisfaction of basic psychological needs is essential for well-being. Empirical evidence for the distinction between need frustration and need satisfaction has been growing within the last decade. However, research on player experience of need frustration is lagging behind. This paper investigates whether player experience of need frustration is distinct from need satisfaction in the online video games context. In addition, it examines whether in-game need frustration is a stronger predictor for negative outcomes such as problematic gaming, escapist motivations, real-life stress and exit intentions and whether in-game need satisfaction is a stronger predictor for positive outcomes such as satisfaction, concentration, subjective vitality and voice. We collected survey data from online video gamers. Path analyses showed that in-game need frustration is a distinct construct, predicting negative outcomes uniquely and more strongly than in-game need satisfaction, whereas in-game need satisfaction was more strongly associated with positive outcomes. The findings suggest that assessing both need satisfaction and frustration in gaming research could prove valuable. [ABSTRACT FROM AUTHOR]

This article maps and compares four universities' policies and procedures for addressing faculty and staff sexual misconduct in higher education in the UK and US. While universities have engaged in significant work to grapple with student-student sexual misconduct, attention to misconduct perpetrated, and experienced, by higher education employees is relatively nascent. In this paper, we explore the maze of institutional processes and actors that victimsurvivors of FASSM might encounter. We describe what is known about prevalence of FASSM in the US and UK and offer an overview of the policy landscape in both settings. Inspired by Patricia Yancey Martin, we analyze publicly available policy documents on FASSM from two US and two UK universities and map out visually the range of investigative, reporting, and sanctioning processes. We introduce an analytic distinction between an actor and a practitioner within the FASSM context, whereby actors are those tasked with administrative duties in handling sexual misconduct reports, while practitioners are those with specialized knowledge and training that enables them to prioritize victim-survivor needs. These illustrative diagrams suggest that while university employees are tasked to act on reports and disclosures of sexual misconduct, it is difficult to identify specialist practitioners with expertise to support victim-survivors of FASSM. Ultimately, this work provides a deeper understanding of what practice looks like in relation to higher education FASSM, and we outline implications for future research directions. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. Design The study used a cross‐sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. Methods: We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018–2019. The work environment was measured using the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner‐Administration Relations, Nurse Practitioner‐Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed‐effect proportional‐odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. Results: Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one‐unit increase in the organizational‐level Nurse Practitioner‐Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational‐level Nurse Practitioner‐Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. Conclusion: Improvements in work environments may improve nurse practitioner job satisfaction and retention. Impact This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity. [ABSTRACT FROM AUTHOR]

The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a frequently used cancer-specific health-related quality of life (HRQoL) questionnaire. To aid interpretation of data obtained via EORTC QLQ-C30, general population norm data have been published for many countries. However, despite its frequent use in the United States, no normative data by sex and age exist to date. Therefore, this study aimed to generate sex- and age-specific EORTC QLQ-C30 normative data for the United States. Recruitment and data collection were carried out via online panels as part of a larger cross-sectional study. For the recruitment, the sample was stratified by sex and age (18–39, 40–49, 50–59, 60–69, ≥ 70 years) to achieve a balanced distribution, with n = 100 per subgroup. Descriptive statistics are presented by age and age/sex. A total of N = 1009 respondents completed the survey (n = 508 females, n = 501 males). More than two thirds of participants (72.5%) reported at least one health condition, e.g., arthritis (26%). Across EORTC QLQ-C30 scales, women and men 60 years and older reported generally better/higher functioning and better/lower symptom scores compared to the younger age groups. To date, no specific EORTC QLQ-C30 general population normative data have been published for the United States. This paper provides these important normative data, which will greatly support the interpretation of EORTC QLQ-C30 scale scores obtained from US cancer patients, and also enable comparison with European norms. • EORTC QLQ-C30 is a cancer-specific health related quality of life (HRQoL) measure. • HRQoL normative data from US general population was collected (1009 respondents). • EORTC QLQ-C30 look-up tables for the US general population by sex/age are presented. • Participants ≥ 60 years reported overall better functioning than younger age groups. • Results will enhance interpretation and validity from EORTC QLQ-C30 data in the US. [ABSTRACT FROM AUTHOR]

Transgender patients are at elevated risk of intimate partner violence (IPV), but national guidelines do not recommend routine screening for this population. This paper explores the feasibility and effectiveness of routine IPV screening of transgender patients in a primary care setting by describing an existing screening program and identifying factors associated with referral and engagement in IPV-related care for transgender patients. An IPV "referral cascade" was created for 1,947 transgender primary care patients at an urban community health center who were screened for IPV between January 1, 2014 to May 31, 2016: (a) Of those screening positive, how many were referred? (b) Of those referred, how many engaged in IPV-specific care within 3 months? Logistic regression identified demographic correlates of referral and engagement. Of the 1,947 transgender patients screened for IPV, 227 screened positive. 110/227 (48.5%) were referred to either internal or external IPV-related services. Of those referred to on-site services, 65/103 (63.1%) had an IPV-related appointment within 3 months of a positive screen. IPV referral was associated with being assigned male at birth (AMAB) versus assigned female at birth (AFAB) (AOR = 2.69, 95% CI 1.52, 4.75) and with nonbinary, rather than binary, gender identity (AOR = 2.07, 95%CI 1.09, 3.73). Engagement in IPV-related services was not associated with any measured demographic characteristics. Similar to published rates for cisgender women, half of transgender patients with positive IPV screens received referrals and two-thirds of those referred engaged in IPV-specific care. These findings support routine IPV screening and referral for transgender patients in primary care settings. Provider training should focus on how to ensure referrals are made for all transgender patients who screen positive for IPV, regardless of gender identity, to ensure the benefits of screening accrue equally for all patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to provide a comparative analysis on the psychological and socio-cultural impacts of COVID-19 on victims of intimate partner violence (IPV) in South Africa (SA) and the USA. Design/methodology/approach: The authors collected media and scholarly articles that dealt with IPV victims during the early phase of the pandemic. This study focused solely on SA and the USA because of their unique contexts and the fact that the authors are residents of these countries. The authors observed how both presidents dealt with IPV amidst the COVID 19 pandemic, especially when stay-at-home orders were in place. Aspects relating to the psychological and socio-cultural impacts amidst the pandemic were considered. Findings: The authors found that in both countries, many black women from low socio-economic backgrounds experience IPV. Being in isolated spaces with their perpetrators prohibits victims from reporting the abuse. As the world attempts to curb the spread of COVID-19 infections, effective strategies have been suggested for victims and perpetrators. The authors found the approaches of the two governments (until the Biden Administration in 2021) to be starkly different in terms of effective strategies and the neglect and downplaying of the extent of one or both pandemics (i.e. COVID-19 and IPV). Pro-safety, equality, gender and race-conscious embracing approaches to overcome IPV are urgently needed. Originality/value: The paper focused on IPV during the early phase of the COVID-19 pandemic. It provides relevant information about IPV in both countries, especially when stay-at-home orders are in place. [ABSTRACT FROM AUTHOR]

Background: Ever since alexithymia was defined in the 1970s, robust associations have been observed between alexithymia and a variety of symptoms of psychopathology. Alexithymia is now widely regarded as an important transdiagnostic risk factor, and it is frequently assessed in clinical and research settings. However, despite this strong interest, it remains unclear exactly why (i.e., by which mechanisms) alexithymia is linked to psychopathology. In this paper, we hypothesise that alexithymia is linked to affective disorder symptoms because alexithymia impairs people's ability to regulate their emotions, and we empirically test this hypothesis.Method: We administered a battery of psychometric measures to 501 adults in the United States, and examined the direct and indirect effects between alexithymia (Perth Alexithymia Questionnaire), emotion regulation ability (Perth Emotion Regulation Competency Inventory), and affective disorder symptoms (Depression Anxiety Stress Scales-21).Results: In the Pearson bivariate correlation matrix, alexithymia, emotion regulation difficulties, and affective disorder symptoms were all significantly correlated. In the modelling of direct and indirect effects, alexithymia was indirectly associated with affective disorder symptoms through emotion regulation difficulties (no significant direct effect).Limitations: Our online survey data were all self-report data and cross-sectional. Future longitudinal work would be beneficial.Conclusions: Our findings support contemporary theorising that alexithymia is linked to affective disorder symptoms via emotion regulation difficulties. These results help to clarify the mechanisms by which alexithymia may predispose people to affective disorder symptoms, and highlight the importance of considering the roles of alexithymia and emotion regulation in case conceptualisations and treatment planning. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross‐cultural perspective. Background: Persons with serious or life‐limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well‐being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures. Design: A quantitative, cross‐sectional, observational cross‐cultural comparison was undertaken. Methods: The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness‐related variables were also assessed using paper‐and‐pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis. Results: The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self‐reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs. Conclusions: In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently. Relevance to clinical practice: Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in‐depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs. [ABSTRACT FROM AUTHOR]

Recent changes to clinical psychology training and supervision in Australia have been driven by a deliberate endeavour by regulatory authorities and professional bodies to align education and training with competency-based models of training, a development that is apparent internationally across health disciplines. A critical question is: how do reforms in Clinical Psychology training standards match international benchmarks for competency-based pedagogies? Objective: To outline key principles of competency-based pedagogies and to critically examine whether Australia's new standards and guidelines for accreditation of coursework, practicum requirements, and supervision are consistent with competency principles, and match similar guidelines proposed in the U.K. and the U.S.A. Method: Following a critical analysis of the extant literature, the authors highlight progress achieved, discuss major gaps and challenges, and examine the extent to which current accreditation changes constitute a reliable blueprint for the development of a competent psychology workforce for the country. Results and Conclusions: The current review indicates that in an overall sense, practitioner training in Australia is tracking well in comparison to international developments. Specifically, the decreased emphasis on the regulation of inputs (e.g., nature and type of coursework and practicum) is pedagogically sound and has the potential to promote training innovation and efficiencies. However, a revision of the current competency framework is required to underpin future progress. Also, the lack of reliable and valid competence instruments in combination with less than rigorous adherence to systematic, timely, and ecologically valid assessments constitute a major challenge and a serious threat to ensuring safe and competent psychology practice. What is already known about this topic: (1) Competency-based education and clinical training play important coordinated roles in ensuring the competence of clinical psychologists, consistent with the accreditation standards and registration requirements of the Psychology Board of Australia. (2) The Australian Psychology Accreditation Council (APAC, 2019) have recently published new accreditation standards for psychology programs that are based on competency principles. (3) The shift to the new paradigm is both exciting and challenging. It is exciting because it provides opportunities for innovation; it is challenging because it demands systemic change. What this topic adds: (1) The current paper compares and contrasts current standards and guidelines for accreditation in Australia with their counterparts in the U.K. and the U.S.A. (2) Although significant progress has been made in Australia, additional implementation efforts should be taken to establish a comprehensive and authoritative competency framework, incorporating empirically-supported means of assessment. Such a framework should be fit-for-purpose providing a grid that maps shared and unique aspects of competencies across registration levels and specialised endorsements. (3) The progressive relaxing of input criteria has the potential to seriously compromise the commitment to safe and competent psychological practice if training institutions do not adopt a re-designed system of ecologically valid assessments both during training and at the point of entry to the profession. (4) The need to ensure competence is maintained throughout a psychologist's career will remain a major challenge, given the ongoing and rapid advance of science. A commitment to the competency-based approach provides the necessary scaffolding for ongoing professional development. [ABSTRACT FROM AUTHOR]

The response process of problem‐solving items contains rich information about respondents' behaviours and cognitive process in the digital tasks, while the information extraction is a big challenge. The aim of the study is to use a data‐driven approach to explore the latent states and state transitions underlying problem‐solving process to reflect test‐takers' behavioural patterns, and to investigate how these states and state transitions could be associated with test‐takers' performance. We employed the Hidden Markov Modelling approach to identify test takers' hidden states during the problem‐solving process and compared the frequency of states and/or state transitions between different performance groups. We conducted comparable studies in two problem‐solving items with a focus on the US sample that was collected in PIAAC 2012, and examined the correlation between those frequencies from two items. Latent states and transitions between them underlying the problem‐solving process were identified and found significantly different by performance groups. The groups with correct responses in both items were found more engaged in tasks and more often to use efficient tools to solve problems, while the group with incorrect responses was found more likely to use shorter action sequences and exhibit hesitative behaviours. Consistent behavioural patterns were identified across items. This study demonstrates the value of data‐driven based HMM approach to better understand respondents' behavioural patterns and cognitive transmissions underneath the observable action sequences in complex problem‐solving tasks. Lay Description: What is already known about this topic?: Process data of interactive problem‐solving tasks contains rich information about test‐takers.To extract underlying information from process data is a big challenge. ​ What this paper adds?: The hidden Markov model helps identify latent states underlying problem‐solving process.Different performance groups displayed different behaviour characteristics.A consistent behavioural pattern was observed across problem‐solving items. ​ Implications for practitioners: The use of HMM holds promise in better visualize and understand behaviour patterns in response process.HMM is potential in understanding cognitive transmissions underneath the observable action sequences. ​ [ABSTRACT FROM AUTHOR]

In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018–September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48–63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research. [ABSTRACT FROM AUTHOR]

Export controls are domestic trade restrictions placed on technologies that have been determined to be important to the national security concerns of a country. In recent years, the policy purpose for maintaining export control regulations have shifted, and how these new export control regulations would interact with new emerging technologies is something that should be analyzed and considered. The passage of the United States (US) Export Control Reform Act (ECRA) of 2018 and the proposed regulatory changes for the European Union's (EU) Council Regulation (EC) No. 428/2009 have shifted the focus of dual-use export controls so that the national security goals of these controls have broadened to include economic security and human rights concerns. This paper argues that the infusion of geoeconomics into US national security considerations and the proposed expansion to include human rights considerations into EU export control regulations are made mutually exclusive of each other and were not made to expand the reach of export controls in a unifying way. Rather, the purpose and structural change to export control regulations serves to create more regulatory barriers on the trade of emerging technology industries that would not only impact the US and the EU, but also their international trading partners. [ABSTRACT FROM AUTHOR]

Empirical evidence points to a persistent Black-White racial gap in police-caused homicides. Some scholarship treats the gap as denoting criminal justice exposure either in terms of involvement in crime or living in a high-crime context. By contrast, health scholarship typically points to the importance of racism including the attitudes, institutional practices, and overall structures that operate to privilege one group over another. Still, given the demographics of US society, the Black-White racial contrast overlooks the 25% of Americans who are neither Black nor White: Native Americans, Latinos, and Asians. The question of how the groups should be organized vis-a-vis the current Black-White model and theories arises. An answer is not straightforward. There is a rank-ordering to the groups' mortality rates as well as an exponential increase in the number of possible comparisons. In this paper we systematically review the literature on race and police-caused homicide with a particular focus on studies that attempt to move beyond the Black-White model. We find that studies on race and police-caused homicide either make no comparison between the groups, or, alternatively, use a White-non-White, a Black-non-Black, and/or a Black-Native American-Latino vs. White-Asian comparison. We use data on group-specific mortality rates to examine the strengths and limits of each of these practices. The limits are the selection of counterfactual gaps, the selection of smaller gaps, and/or the omission of larger gaps. To address these limits, we propose that a Black-Native American vs. Latino-White-Asian model best captures the higher and lower mortality rates in police-caused homicide data. • Mortality rates from police-caused homicide vary by race and ethnicity. • The Black group has the highest rate followed by the Native American, Latino, White and Asian groups. • The literature makes one of several contrasts between these groups. • These are White-non-White; Black-non-Black, or Black-Native American-Latino vs. White-Asian. • Black-Native American vs. Latino-White-Asian contrast best reflects the groups' mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: Integrated primary care (IPC) models have empirical support for improving access to and quality of behavioral health care and can be effectively implemented in a diverse range of formats1. Various studies have demonstrated that primary care service providers tend to positively endorse IPC models of pediatric behavioral health care, especially in comparison to traditional, non-integrated care2-3. However, there is a paucity of research evaluating parent perceptions and attitudes towards behavioral health care, especially when delivered in an IPC setting. The present paper describes a survey tool designed to better understand and meet patient care needs. Methods and Aims: The Parent Acceptance of Pediatric Integrated Care Survey (PAPICS) was developed by a multidisciplinary panel of integrated care experts at the University of Michigan Medicine to evaluate parent perceptions and acceptance of integrated primary care (IPC) models for treatment of behavioral health problems in children. In response to the COVID-19 pandemic, the PAPICS was expanded to include more items focused on virtual services in IPC and revised to address items with poor factor loadings. Methods include Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to analyze and validate the survey. Results: The original 35-item PAPICS was distributed to parents pre-pandemic with children under 18 across the United States and was completed by 422 respondents4. Items on this survey largely pertained to face-to-face care within the clinic and an EFA only was conducted to analyze the data. Parents overwhelming favored an IPC model and supported learning skills to help their child. More variability was evidenced for parents' perceptions of one-on-one talk therapy between their child and the psychologist. Some parents had concerns about stigma and privacy, but agreement was more inconsistent. After the World Health Organization (WHO) declared COVID-19 a global pandemic, Michigan Medicine's IPC clinics converted to 100% virtual care. The PAPICS was revised using patient feedback data for applicability to virtual care delivery and was completed by 875 respondents. Conclusions: Data collection from the revised PAPICS was completed in December 2021. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are presently be conducted and will be reviewed at ICIC22. Results will provide insight into parent perceptions of virtual IPC and allow for comparison to those for face-to-face care. Implications for applicability/transferability, sustainability, and limitations: The PAPICS survey provides a template for assessing beliefs and preferences of families to provide high-quality, patient-centered behavioral health care in an IPC setting. Though certain items on the survey may not be applicable in some settings, the scale can be adapted as needed. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

Background: Side effects of medications for opioid use disorder (MOUD) such as weight gain contribute to their stigma. Substantial evidence suggests that women have a more severe side effect profile to MOUD than men, and concerns about weight gain during treatment are prevalent. However, the few studies reporting sex differences in weight gain during treatment show conflicting results and are restricted to methadone. In addition, little is known about possible sex differences in weight gain to buprenorphine, which is the most commonly prescribed MOUD in the United States.Methods: To address these issues, we performed a systematic review and meta-analysis on the few studies reporting longitudinal data on sex differences in body mass index (BMI) gain during methadone treatment (Study 1). In a separate study, we also re-analyzed data from trial CTN-0030 of the National Institute on Drug Abuse Clinical Trial Network (NIDA CTN), which involved a 12-week buprenorphine treatment regimen (Study 2; n = 360; 209 Male, 151 Female).Results: For Study 1, across all papers reporting longitudinal data (k = 4, n = 362 OUD patients), there were BMI increases that ranged from 2.2 to 5.4 BMI after at least one year of methadone treatment, but there were no significant sex differences in BMI increases (Standardized Mean Difference, Female > Male = 0.352, SE =0.270; 95 % CI = [-0.18 0.88]; p = .193). Study 2 showed no significant differences in weight before and after 12 weeks of buprenorphine treatment nor did it show sex differences in weight change with treatment (β = 2.34, p = .511).Conclusion: These analyses corroborate evidence of weight gain with methadone treatment but did not observe a sex-based disparity in weight gain with methadone or buprenorphine treatment for OUD. [ABSTRACT FROM AUTHOR]

Although local policies aimed at reducing childhood health inequities can benefit from local data, sample size constraints in population representative health surveys often prevent rigorous evaluations of child health disparities and health care patterns at local levels. Electronic Health Records (EHRs) offer a possible solution as they contain large amounts of information on pediatric patients within a health system. In this paper, we consider the suitability of using EHRs from a large health system to study local children's health by evaluating the extent to which the EHRs capture the county's child population. First, we compare the demographic characteristics of Duke University Health System pediatric patients who live in Durham County, NC (USA) to the child population estimates in the 2015–2019 American Community Survey. We then examine geographic variation in census tract rates of children captured in the EHR data and estimate negative binomial models to assess how tract characteristics are associated with these rates. We also perform these analyses for the subset of pediatric patients who have a well-child encounter. We find that the demographic characteristics of pediatric patients captured by the EHRs are similar to those of the county's child population. Although the county rate of children captured in the EHRs is high, there is variation across census tracts. On average, census tracts with higher concentrations of non-Hispanic Black residents have lower capture rates and tracts with higher concentrations of poverty have higher capture rates, with the poorest tracts showing the largest racial gap in rates of children captured by EHRs. Our findings suggest that EHRs from a large health system can be used to assess children's population health, but that EHR-based evaluations of children's health disparities and health care patterns should account for differences in who is captured by the EHRs based on census tract characteristics. • EHRs from a large health system are suitable for studying local children's health. • Local children in EHRs are demographically similar to county population estimates. • Rates of children captured in health system differ by census tract characteristics. • EHR-based analyses should adjust for local differences in capture rates. [ABSTRACT FROM AUTHOR]

The patient-provider relationship is considered a cornerstone to delivering high-value healthcare. However, in Medicaid managed care settings, disruptions to this relationship are disproportionately common. In this paper, I evaluate the impact of a primary provider's exit from a Medicaid managed care plan on adult beneficiary healthcare utilization and outcomes. Using an event study approach, I estimate a 5% decrease in the number of beneficiaries with primary care visits in the year following the exit, with slightly larger effects in terms of percentage points for patients with chronic conditions. Additionally, I observe a nearly 50% increase in the number of beneficiaries with a chronic condition who are hospitalized following a disruption. [ABSTRACT FROM AUTHOR]

Background: Prescription opioids played a major role in the current opioid overdose epidemic. High rates of opioid prescribing and dispensing exposed many people to opioids, and high-dose opioid prescriptions (e.g., 90 morphine milligram equivalents [MME] per day) contributed to increases in opioid overdoses. The Centers for Disease Control and Prevention (CDC) Prevention for States (PfS) program provided funding to jurisdictions ("PfS recipients") with a high burden of opioid-involved overdoses. This paper examines associations between strategies addressing high-dose opioid prescribing and changes in high-dose opioid dispensing.Methods: Monthly opioid dispensing data (2014-2019) from IQVIA Xponent were analyzed using longitudinal growth models (LGM) to compare high-dose opioid dispensing rates in the 29 jurisdictions that participated in PfS with rates in non-PfS jurisdictions. Additional models examined associations between specific PfS activities and changes in high-dose dispensing among PfS recipients.Results: High-dose dispensing rates decreased significantly in both PfS and non-PfS jurisdictions from 2014 to 2019. Rates of high-dose opioid dispensing rates in PfS jurisdictions were not significantly different than those in non-PfS jurisdictions (p = 0.07). Among PfS recipients, multiple activities were associated with decreases in high-dose dispensing rates over time, including moving towards real-time prescription drug monitoring program (PDMP) reporting (p < 0.001) and implementation of opioid dispensing interventions for insurers/ health systems (p < 0.05).Conclusions: High-dose opioid dispensing rates decreased throughout the United States from 2014-2019. As the drug epidemic continues to evolve, implementation of prevention activities by state and local partners is important. These findings highlight two potential prevention strategies and activities that jurisdictions can utilize. [ABSTRACT FROM AUTHOR]