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Background Long-standing health disparities experienced by American Indians (AIs) are associated with increased all-cause mortality rates and shortened life expectancies when compared to other races and ethnicities. Nationally, these disparities have persisted with the COVID-19 pandemic as AIs are more likely than all other races to be infected, hospitalized, or die from SARS-CoV-2. The Mississippi Band of Choctaw Indians, the only federally recognized American Indian tribe in the state, has been one of the hardest hit in the nation. Methods Using de-identified data from the University of Mississippi Medical Center’s COVID-19 Research Registry, a retrospective cohort study was conducted to assess COVID-19 inpatient mortality outcomes among adults (≥ age 18) admitted at the state’s safety net hospital in 2020. Results Exactly 41% (n = 25) of American Indian adults admitted with a deemed diagnosis of COVID-19 died while in hospital, in comparison to 19% (n = 153) of blacks and 23% (n = 65) of whites. Racial disparities persisted even when controlling for those risk factors the CDC reported put adults at greatest risk of severe outcomes from the disease. The adjusted probability of inpatient mortality among American Indians was 46% (p

American Indian and Alaska Native populations have some of the highest COVID-19 hospitalization and mortality rates in the US, with those in Mississippi being disparately affected. Higher COVID-19 mortality rates among Indigenous populations are often attributed to a higher comorbidity burden, although examinations of these associations are scarce, and none were believed to have included individuals hospitalized in Mississippi.To evaluate whether racial mortality differences among adults hospitalized with COVID-19 are associated with differential comorbidity experiences.The described cross-sectional study used retrospective hospital discharge data from the Mississippi Inpatient Outpatient Data System. All adult (aged ≥18 years) Mississippians of a known racial identity and who had been hospitalized with COVID-19 from March 1 to December 31, 2020, in any of the state's 103 nonfederal hospitals were included. Data were abstracted on June 17, 2021.Racial identity.In-hospital mortality as indicated by discharge status.A total of 18 731 adults hospitalized with a COVID-19 diagnosis and known racial identity were included (median age, 66 [IQR, 53-76] years; 10 109 [54.0%] female; 225 [1.2%] American Indian and Alaska Native; 9191 [49.1%] Black; and 9121 [48.7%] White). Pooling across comorbidity risk groups, odds of in-hospital mortality among Black patients were 75% lower than among American Indian and Alaska Native patients (odds ratio [OR], 0.25 [95% CI, 0.18-0.34]); odds of in-hospital death among White patients were 77% lower (OR, 0.23 [95% CI, 0.16-0.31]). Within comorbidity risk group analyses, Indigenous patients with the lowest risk (Elixhauser Comorbidity Index score ≤0) had an adjusted probability of in-hospital death of 0.10 compared with 0.03 for Black patients (OR, 0.29 [95% CI, 0.10-0.82]) and 0.04 for White patients (OR, 0.37 [95% CI, 0.13-1.07]). Probability of in-hospital death at the highest comorbidity risk levels (Elixhauser Comorbidity Index score ≥16) was 0.69 for American Indian and Alaska Native patients compared with 0.28 for Black patients (OR, 0.16 [95% CI, 0.08-0.32]) and 0.25 for White patients (OR, 0.14 [95% CI, 0.07-0.27]).This cross-sectional study of US adults hospitalized with COVID-19 found that American Indian and Alaska Native patients had lower comorbidity risk scores than those observed among Black or White patients. Despite empirical associations between reduced comorbidity risk scores and reduced odds of inpatient mortality, American Indian and Alaska Native patients were significantly more likely to die in the hospital of COVID-19 than Black or White patients at every level of comorbidity risk. Alternative factors that may contribute to high mortality rates among Indigenous populations must be investigated.

Objectives An increasing number of children with medical complexity spend months or more in PICUs, lending to isolation for their parents and providers. We sought to better describe the experiences of parents and providers of children with chronic critical illness specifically around isolation during PICU admission. Design In-person interviews and surveys of pediatric critical care providers and parents of children with chronic critical illness. Interview transcripts were analyzed for themes. Setting Academic institution; PICU. Subjects Seven PICU physicians, eight nurse practitioners, and 12 parents of children with chronic critical illness. Interventions Surveys and semi-structured interviews. Measurements and main results PICU providers acknowledge feeling medically isolated from children with chronic critical illness, fueled by a lack of chronic critical illness training and burnout. Providers also perceive medical isolation in parents of children with chronic critical illness manifesting as a declining level of parental engagement. Parents did not feel medically isolated in our study. Providers also perceive social isolation in families of children with chronic critical illness, identifying the child's protracted disease and lack of tangible support systems as contributing factors. Parents self-reported adequate social supports but scored high on depression scales suggesting a disconnect between perceived and actual support. Both parents and providers acknowledge that the child's chronic critical illness could be a source of support. Conclusions PICU providers perceived social and medical isolation in parents of children with chronic critical illness; however, parents did not endorse either directly. A majority of parents showed signs of depression despite reporting good social support. Providers reported feeling medically isolated from children with chronic critical illness and their families related to burnout and insufficient training. Novel methods to address these issues are needed.

OBJECTIVE: The objective of this scoping review is to map the available literature on school-based obesity prevention programs in rural communities. INTRODUCTION: Significant health disparities are associated with childhood obesity, and these disparities disproportionately affect children in disadvantaged communities, such as rural areas. Youth in rural areas are 26% more likely to be obese than youth in urban communities. To combat obesity in children, schools have become an avenue for educating children about the importance of healthy diet and physical activity. Although many school-based obesity prevention programs have been implemented in recent years, more information is needed on programs in rural communities. INCLUSION CRITERIA: This scoping review will consider studies that include children 5 to 18 years of age who are enrolled in elementary, middle or high school in a rural setting and that investigate school-based obesity prevention programs. Studies that include children who are in non-rural areas, who are home-schooled, who are in an alternative setting (e.g. juvenile detention) or who are hospitalized will be excluded. Studies published in English since 1990 will be included. METHODS: Multiple databases will be searched, including PubMed, CINAHL, ERIC, Embase, Scopus and Academic Search Premier. Trials registers and gray literature will also be searched. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data will be extracted by independent reviewers and presented in a diagrammatic or tabular form, accompanied by a narrative summary.

The national or local lockdowns in response to COVID-19 forced education systems to rapidly shift from in-person to distance learning. The hasty transition undoubtedly imposed tremendous challenges on teachers, students and distance learning infrastructure. The purpose of this study was to investigate how high school science teachers who had previously been trained in flipped-learning and advanced educational technology through the Science Teaching Excites Medical Interest (STEMI) program perceived their transition to distance learning during this pandemic. In this study eleven teachers were interviewed with a semi-structured interview guide. Data were analyzed using the deductive-inductive content analytic approach. Our results indicated that teachers reported having more confidence in using technology for teaching online due in part to their participation in the STEMI program. They also reported internet access as one of the most significant barriers, both for students and teachers. While some teachers thought that students may feel more in control of learning due to absence of time and place limits with distance learning, others may struggle to stay engaged without the classroom support they would normally have received. Teachers generally experienced increased workloads and harder work–life balance with online teaching. In spite of the unforeseen challenges, the pandemic situation afforded teachers with opportunities to adopt different technology in teaching and foresee the need for technology integration in order to better prepare for the unexpected in the future.

Objective: The purpose of this systematic review is to summarize the best available evidence on interventions that could be implemented in the college environment to increase HPV vaccination uptake in college students who were not previously vaccinated. Methods: Pubmed, CINAHL, PsycINFO, Cochrane, and EBSCO were searched in December 2017 to identify all literature meeting the following criteria: human subjects, English language, HPV, HPV vaccination, and college. PRISMA recommendations were followed. We focused only on manuscripts that reported vaccine uptake, excluding studies that only reported vaccine intentions. We identified 2989 articles; 101 relevant after screening; nine eligible for final qualitative review. Results: Vaccine uptake rates ranged from 5% to 53%. Theory-based variables (e.g., perceived susceptibility and self-efficacy) were associated with vaccine uptake in most studies. A study exposing participants to a narrative video about HPV vaccination led by a combination of peers and medical experts produced the greatest difference in HPV vaccination initiation compared to a control group (21.8% vs 11.8%) of all the studies reviewed. Conclusions: Few interventions resulted in substantial HPV vaccine uptake. A combination of peer and provider encouragement may be the most effective method to increase vaccine uptake in this population. Keywords: Systematic review, HPV vaccination, College health, HPV vaccine uptake, Intervention

This chapter examines social constructions of children’s needs within a faith-based organization (FBO) in a southern U.S. city. Building upon analyses of child-centered humanitarian efforts, I argue that age was used to configure assistance and shape the construction of “vulnerability” for participating urban children. Staff members conceptualized children’s needs using representations of innocent childhoods, while intertwining these representations with racialized portrayals of low-income, African American families to mark participating children as in need of “saving,” socially, morally, and primarily from “problematic” adult family members who were viewed as obstacles, more than assets, to children’s success. This programmatic focus on individual children both funneled services away from family needs and shifted agency efforts and funds from the social, political, and economic processes that produced and maintained inequality in the urban neighborhood sites of this research. Yet, children spoke differently about their families and lives, and understood participation in the afterschool program as one place of support among many. In light of these differences, this chapter explores the relationships of power that exist in the contested spaces between the construction of children’s needs and children’s lived realities to show how U.S. charitable FBO discourses and practices affect the available resources for low-income families.

The Science Teaching Excites Medical Interest (STEMI) program is a collaboration of university-based biomedical clinical and research experts, graduate students in clinical anatomy, and Mississippi K-12 schools that seeks to develop a technologically-enhanced teacher-centered community of health learners. The STEMI community is developing, implementing, and disseminating high school learning products utilizing new technological approaches for engaging students in the overall STEMI focus of exploring relationships between health literacy, the state’s epidemic of obesity, and ensuing anatomic and functional pathophysiology. An evaluation team utilizes a robust mixed-methods approach to examine the program goals and the potential for program expansion and replication. A social network analysis is tracking the development of the community learners. As STEMI aims to improve teacher quality by developing key competencies necessary for implementation of the flipped classroom technologically-engaged modules, a competency model was developed. Competencies were identified via participatory evaluation techniques and assessments are aligned to the competencies. The competency of teachers in the skills needed for creation and delivery of effective flipped lessons is tracked using a radar graph to guide tailored professional development. Preliminary evaluation data indicate the community is growing and strengthening and the competency assessment model is effective in guiding continuing professional development.

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.