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Support Over Silence for KIDS is a training program that equips bystanders with confidence and skills to defuse challenging moments between caregivers and their children in public. The purpose of this study was to assess the satisfaction with and effectiveness of Support Over Silence for KIDS within three training settings: a community organization, university, and children's hospital. Participants completed pre-program and follow-up assessments to capture demographic characteristics and change in behaviors, attitudes, self-efficacy, and perceived barriers related to bystander intervention. Participants completed an immediate post-program questionnaire to assess program satisfaction and post-program intentions. Univariate statistics were used to describe the demographic characteristics of the sample, bystander behaviors, and program satisfaction. Wilcoxon signed-rank tests were used to assess change between pre-program and follow-up. Sixty-six adults participated in the training program. Favorable outcomes were demonstrated at post-program for satisfaction with the program, future bystander intentions, and self-efficacy for bystander intervention. At follow-up, participants reported more favorable attitudes toward bystander intervention and significantly increased self-efficacy for intervention despite acknowledged barriers. Participants reported increased bystander intervention; at follow-up, none of the participants reported avoiding a challenging moment between a caregiver and their child in public. Support Over Silence for KIDS was effective in promoting supportive bystander intervention with caregivers navigating challenging interactions with their children in public. A bystander training program may help community members, university students, and hospital personnel respond in a positive way to caregiver struggles and create an environment where caregivers and their children feel supported., Author(s): Meghan E. Taylor [sup.1] , Nancy L. Weaver [sup.1] , Terri L. Weaver [sup.2] , Travis M. Loux [sup.3] , Timothy J. Kutz [sup.4] Author Affiliations: (1) grid.262962.b, 0000 [...]

Uses of the propensity score to obtain estimates of causal effect have been investigated thoroughly under assumptions of linearity and additivity of exposure effect. When the outcome variable is binary relationships such as collapsibility, valid for the linear model, do not always hold. This article examines uses of the propensity score when both exposure and outcome are binary variables and the parameter of interest is the marginal odds ratio. We review stratification and matching by the propensity score when calculating the Mantel-Haenszel estimator and show that it is consistent for neither the marginal nor conditional odds ratio. We also investigate a marginal odds ratio estimator based on doubly robust estimators and summarize its performance relative to other recently proposed estimators under various conditions, including low exposure prevalence and model misspecification. Finally, we apply all estimators to a case study estimating the effect of Medicare plan type on the quality of care received by African-American breast cancer patients.

This study compares characteristics and outcomes of 70 defendants with and 1,122 without intellectual and developmental disabilities (IDD) participating in a mental health court. Demographic and clinical characteristics differed, but criminal justice or program characteristics did not. Age, race, marital status, living situation, court location, health insurance status, and likelihood of mental illness or substance abuse diagnosis differed between the two groups. When controlling for other factors, a diagnosis of IDD did not affect the odds of negative termination from the court but did reduce the odds of rearrest within 1 year of leaving the court. Some mental health courts exclude people with IDD; the study concludes inclusion is appropriate.

Flipped classrooms have become an interesting alternative to traditional lecture-based courses throughout the undergraduate curriculum. In this article, we compare a flipped classroom approach to the traditional lecture-based approach to teaching introductory biostatistics to first-year graduate students in public health. The traditional course was redesigned to include video lectures and online quizzes which the students were expected to complete before coming to class, followed by a short in-class lecture and time working on applied statistics problems in class. We compared the opinions of the biostatistics field and confidence applying biostatistics methods of 46 students who took the flipped course to 52 students who took the traditional, lectured-based course offering. We found similar end-of-semester opinions and levels of confidence between students in the flipped classes and those in the traditional, lecture-focused classes, though students in the flipped course reported very high satisfaction with the model.

Introduction Little is known about childcare staff's and parents' uptake of and attitudes towards pertussis vaccine. Methods Questionnaires were distributed to St. Louis parents and childcare staff in fall, 2014. Parents versus staff and vaccinated versus unvaccinated individuals' beliefs regarding pertussis vaccine were compared using chi square tests. Multivariate logistic regressions were run to develop predictive models for staff's and parents' vaccine uptake. Results Overall, 351 parents and staff from 23 agencies participated (response rate = 32%). Parents were more likely than staff to have received pertussis vaccine (66.5 vs. 45.8%, X.sup.2 = 12.5, p < .001). Predictors for staff vaccination included willingness to get vaccinated even if there was a cost (OR 6.6; CI 1.8-24.6; p < .01), awareness of vaccination recommendations (OR 5.2; CI 1.2-22.8; p < .05), and healthcare provider recommendation (OR 4.2; CI 1.2-15.1; p < .05). Parents' predictors of vaccination included perceived importance of vaccination (OR 9.9; CI 4.1-23.8; p < .001), healthcare provider recommendation (OR 4.6; CI 1.7-12.6; p < .01), believing vaccination is effective (OR 4.4; CI 1.1-18.0; p < .05), and knowing where to get vaccine (OR 3.5; CI 1.5-8.1; p < .01). Among unvaccinated staff (n = 52), 74.5% (n = 38) and 70.0% (n = 35) would receive pertussis vaccine if it were offered free of charge and onsite, respectively. Conclusions for Practice Childcare staff's and parents' pertussis vaccine uptake was higher than overall U.S. rates, though significantly lower than the Global Pertussis Initiative target. Implementing an education campaign and providing free vaccine on-site are likely to result in increased vaccine uptake., Author(s): Terri Rebmann [sup.1] [sup.3] , Travis M. Loux [sup.2] , Daphne Lew [sup.2] , Mary Wakefield [sup.1] Author Affiliations: (1) Institute for Biosecurity, Epidemiology & Biostatistics, College for Public [...]

There is a paucity of research on antisocial personality disorder (ASPD) in the geriatric population and the majority of knowledge on the disorder is drawn from young adult samples. Researchers posit that the prevalence of ASPD as well as other personality disorders (PDs) is underestimated among older adults. Using a nationally representative sample, the present study examines the prevalence and correlates of ASPD in adults ages 50 and older. We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions Waves I and III. Multivariate logistic regression analyses were employed to investigate associations between ASPD and sociodemographic characteristics. A series of logistic regression analyses were also conducted to study associations between ASPD and medical conditions (liver and cardiovascular disease, arthritis, and stomach ulcer), major psychiatric disorders (lifetime major depressive disorder, mania, and generalized anxiety disorder), and substance use disorders (lifetime alcohol, marijuana, cocaine, heroin, and nicotine use disorders). Findings indicated that the prevalence of ASPD increases through early adulthood, with a peak at 3.91% in younger adults and decline to 0.78% in adults ages ≥65. Older adults with ASPD are more likely to be diagnosed with a substance use disorder, major depression, mania, and generalized anxiety disorder as well as each medical condition. Older adults with ASPD experience increased rates of medical and psychiatric comorbidities. These conditions exacerbate the existing challenges associated with diagnosing and treating this population and may have serious consequences for the patient, their caregivers and society. [ABSTRACT FROM AUTHOR]

In many experimental situations, researchers have information on a number of covariates prior to randomization. This information can be used to balance treatment assignment with respect to these covariates as well as in the analysis of the outcome data. In this paper, we investigate the use of propensity scores in both of these roles. We also introduce a randomization procedure in which the balance of all measured covariates is approximately indexed by the variance of the empirical propensity scores and randomization is restricted to those permutations with the least variable propensity scores. This procedure is compared with recently proposed methods in terms of resulting covariate balance and estimation efficiency. Properties of the estimators resulting from each procedure are compared with estimates which incorporate the propensity score in the analysis stage. Simulation results show that analytical adjustment for the propensity score yields results on par with those obtained through restricted randomization procedures and can be used in conjunction with such procedures to further improve inferential efficiency. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Flipped classrooms have become an interesting alternative to traditional lecture-based courses throughout the undergraduate curriculum. In this article, we compare a flipped classroom approach to the traditional lecture-based approach to teaching introductory biostatistics to first-year graduate students in public health. The traditional course was redesigned to include video lectures and online quizzes which the students were expected to complete before coming to class, followed by a short in-class lecture and time working on applied statistics problems in class. We compared the opinions of the biostatistics field and confidence applying biostatistics methods of 46 students who took the flipped course to 52 students who took the traditional, lectured-based course offering. We found similar end-of-semester opinions and levels of confidence between students in the flipped classes and those in the traditional, lecture-focused classes, though students in the flipped course reported very high satisfaction with the model. [ABSTRACT FROM AUTHOR]

Universities open for in-person instruction during the 2020-21 academic year implemented a range of prevention strategies to limit the transmission of SARS-CoV-2, the virus that causes COVID-19, including physical distancing, mask use, vaccination, contact tracing, case investigation, and quarantine protocols (1). However, in some academic programs, such as health-related programs, aviation, and kindergarten through grade 12 (K-12) education, maintaining physical distance while still providing instruction is difficult; for universities with such programs, a single confirmed case of COVID-19 could result in a large number of students, staff members, and instructors being designated close contacts and requiring quarantine if they are not fully vaccinated, even if masks were worn when contact occurred. In January 2021, the St. Louis City Health Department allowed Saint Louis University (SLU) to implement a modified quarantine protocol that considered mask use when determining which close contacts required quarantine.* To assess the impact of the protocol, SLU assessed positive SARS-CoV-2 test result rates by masking status of the persons with COVID-19 and their close contacts. During January-May 2021, 265 students received a positive SARS-CoV-2 test result; these students named 378 close contacts. Compared with close contacts whose exposure only occurred when both persons were masked (7.7%), close contacts with any unmasked exposure (32.4%) had higher adjusted odds ratios (aORs) of receiving a positive SARS-CoV-2 test result (aOR = 4.9; 95% confidence interval [CI] = 1.4-31.1). Any additional exposures were associated with a 40.0% increase in odds of a positive test result (aOR = 1.4; 95% CI = 1.2-1.6). These findings reinforce that universal masking and having fewer encounters in close contact with persons with COVID-19 prevents the spread of SARS-CoV-2 in a university setting. Universities opening for in-person instruction could consider taking mask use into account when determining which unvaccinated close contacts require quarantine if enforced testing protocols are in place. However, this study was conducted before the B.1.617.2 (Delta) variant became the dominant strain of SARS-CoV-2 in the United States, which could have affected these findings given that the Delta variant has been found to be associated with increased transmissibility compared to previous variants., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Lauren D. Arnold reports a contract from the St. Louis County Department of Health and having sold several shares of stock in Pfizer and Merck in July 2019; no current stock ownership was reported. No other potential conflicts of interest were disclosed.

Background: Points of dispensing (PODs) are deployed for medical countermeasure mass dispensing. However, infection prevention and vaccine administration pre-event training offered and just-in-time (JIT) education planned for POD workers have not been assessed., Methods: Disaster planners were sent an online questionnaire in 2013. McNemar tests compared training offered to staff versus volunteers and pre-event training versus JIT training., Results: In total, 301 disaster planners participated. The most frequent pre-event training included hand hygiene (59.1% and 28.0%) and personal protective equipment (PPE) selection (52.1% and 24.1%) for staff and volunteers, respectively. Few provided pre-event training on the cold chain technique (14.8% and 5.1%) or smallpox vaccine administration (4.7% and 2.3%) for staff or volunteers. For all topics except smallpox vaccine administration, more staff than volunteers received pre-event training (P < .01). The most frequent planned JIT training includes hand hygiene (79.8% and 73.5%) and PPE selection (79.4% and 70.0%) to staff and volunteers. For all topics, more JIT education is planned for staff than volunteers (P < .001). More JIT training is planned than has been given pre-event for all topics (P < .001)., Conclusion: More pre-event training is needed on infection prevention and vaccine administration to ensure safe and successful POD deployment., (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.)

The Centers for Disease Control and Prevention recommends using open points of dispensing (PODs) and alternative modalities, such as closed PODs, for mass dispensing of medical countermeasures. However, closed POD existence has not been assessed. In 2013 we sent an online questionnaire to US Cities Readiness Initiative (CRI) and non-CRI public health disaster planners. Chi-square tests were used to determine differences between CRIs and non-CRIs when comparing having at least 1 closed POD, and to compare having a closed POD and perceived mass dispensing preparedness. A total of 301 disaster planners participated. Almost all (89.3%, n=218) jurisdictions have considered establishing a closed POD, and three-quarters (74.2%, n=181) currently have at least one. CRIs were more likely than non-CRIs to have a closed POD (85.0% vs 58.5%, X(2)=21.3, p<.001). Those with 1 or more closed PODs were more likely to believe their jurisdiction could distribute medical countermeasures within 48 hours compared to those without a closed POD (78.5% vs 21.5%; X(2)=10.8, p=.001). Half had a written plan and/or written standing orders (59.1% and 52.5%, respectively). Almost half (42%, n=72) have done no preevent training for POD staff in the past 2 years; almost 20% (18%, n=32) do not plan to offer any just-in-time training. Nearly 40% (n=70) have conducted no exercises in the past year. Closed PODs contribute to community preparedness; their establishment should be followed by development of written plans, worker training, and exercises.