Early COVID-19 Pandemic Research Articles

"They Knew They Were Still Safe with Us": Experiences of Domestic Violence Shelter Staff on Survivors' Experiences in Shelter in the Early COVID-19 Pandemic.

Domestic violence (DV) shelters are an essential service for survivors and their children. While research has demonstrated global increases in DV during COVID-19, little is known about the experiences of DV shelter staff. This study aimed to understand DV shelter staff's experiences and how they navigated the early stages of the pandemic. Researchers disseminated a cross-sectional online survey, first to state DV coalitions and then directly to DV shelters. Univariate and bivariate analyses were used for multiple-choice items, and patterns were identified using thematic analysis for open-ended responses. Survey participants included 368 DV staff (180 leadership, 167 direct services, and 21 other roles) from 48 states. They reported little change to their schedules and mixed feelings of shelter preparedness for the pandemic. Participants described shelter methods for preventing the spread of COVID-19, changes in shelter policies and satisfaction with such policies, and the impacts of the pandemic on themselves and survivors. Balancing survivor autonomy with the health and safety of staff and other residents proved to be one of the most consistently challenging tasks. Participants also described how programs adapted to changing regulations and continued to serve survivors throughout this challenging time. Several innovative practices were implemented by staff throughout the pandemic, including expansions in technology use and non-residential services. Most reported feeling prepared for a similar crisis in the future. We offer five recommendations for DV shelters and their funders, including increased mental health support for staff and greater transparency in policies for both shelter residents and staff.

Alcohol misuse, health-related behaviors, and burnout among clinical therapists in China during the early Covid-19 pandemic: A Nationwide survey.

This study aimed to assess the extent of alcohol use and misuse among clinical therapists working in psychiatric hospitals in China during the early COVID-19 Pandemic, and to identify associated factors. An anonymous nationwide survey was conducted in 41 tertiary psychiatric hospitals. We collected demographic data as well as alcohol use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and burnout using the Maslach Burnout Inventory Human Services Survey. In total, 396 clinical therapists completed the survey, representing 89.0% of all potential participants we targeted. The mean age of participants was 33.8 years old, and more than three-quarters (77.5%) were female. Nearly two-fifths (39.1%) self-reported as current alcohol users. The overall prevalence of alcohol misuse was 6.6%. Nearly one-fifth (19.9%) reported symptoms of burnout with high emotional exhaustion in 46 (11.6%), and high depersonalization in 61 (15.4%). Multiple logistic regression showed alcohol use was associated with male gender (OR = 4.392; 95% CI =2.443-7.894), single marital status (OR = 1.652; 95% CI =0.970-2.814), smoking habit (OR = 3.847; 95%CI =1.160-12.758) and regular exercise (OR = 2.719; 95%CI =1.490-4.963). Alcohol misuse was associated with male gender (OR = 3.367; 95% CI =1.174-9.655), a lower education level (OR = 3.788; 95%CI =1.009-14.224), smoking habit (OR = 4.626; 95%CI =1.277-16.754) and high burnout (depersonalization, OR = 4.848; 95%CI =1.433-16.406). During the COVID-19 pandemic, clinical therapists' alcohol consumption did not increase significantly. Male gender, cigarette smoking, and burnout are associated with an increased risk of alcohol misuse among clinical therapists. Targeted intervention is needed when developing strategies to reduce alcohol misuse and improve clinical therapists' wellness and mental health.

Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic.

Interrupted time series analysis, adjusted for seasonality and autocorrelation where present, evaluating trends in common ICU practices prior to the pandemic (March 2016 to February 2020), at the onset of the pandemic (April 2020) and intra-pandemic (April 2020 to December 2020). Premier Healthcare Database, containing data from 25% of U.S. discharges from January 1, 2016, to December 31, 2020. Patients without COVID-19 receiving mechanical ventilation for acute respiratory failure. We assessed monthly rates of chest radiograph (CXR), chest CT scans, lower extremity noninvasive vascular testing (LENI), bronchoscopy, arterial catheters, and central venous catheters. We identified 742,096 mechanically ventilated patients without COVID-19 at 545 hospitals. At the onset of the pandemic, CXR (-0.5% [-0.9% to -0.2%; p = 0.001]), LENI (LENI: -2.1% [-3.3% to -0.9%; p = 0.001]), and bronchoscopy rates (-1.0% [-1.5% to -0.6%; p < 0.001]) decreased; use of chest CT increased (1.5% [0.5-2.5%; p = 0.006]). Use of arterial lines and central venous catheters did not change significantly. Intra-pandemic, LENI (0.5% [0.3-0.7%; p < 0.001]/mo) and bronchoscopy (0.1% [0.05-0.2%; p < 0.001]/mo) trends increased relative to pre-pandemic trends, while the remainder of practices did not change significantly. We observed several statistically significant changes to practice patterns among patients without COVID-19 early during the pandemic. However, most of the changes were small or temporary, suggesting that routine practices in the care of mechanically ventilated patients in the ICU was not drastically affected by the pandemic.

Nursing Home to Nursing Home Transfers during the Early COVID-19 Pandemic.

To examine the nursing home to nursing home transfer rates before and during the early COVID-19 pandemic and to identify risk factors associated with those transfers in a state with a policy to create COVID-19-care nursing homes. Cross-sectional cohorts of nursing home residents in prepandemic (2019) and COVID-19 (2020) periods. Michigan long-term nursing home residents were identified from the Minimum Data Set. Each year, we identified transfer events as a resident's first nursing home to nursing home transfer between March and December. We included residents' characteristics, health status, and nursing home characteristics to identify risk factors for transfer. Logistic regression models were conducted to determine risk factors for each period and changes in transfer rates between the 2 periods. Compared to the prepandemic period, the COVID-19 period had a higher transfer rate per 100 (7.7 vs 5.3, P < .05). Age≥80 years, female sex, and Medicaid enrollment were associated with a lower likelihood of transfer for both periods. During the COVID-19 period, residents who were Black, with severe cognitive impairment, or had COVID-19 infection were associated with a higher risk of transfer [adjusted odds ratio (AOR) (95% CI): 1.46 (1.01-2.11), 1.88 (1.11-3.16), and 4.70 (3.30-6.68), respectively]. After adjusting for resident characteristics, health status, and nursing home characteristics, residents had 46% higher odds [AOR (95% CI): 1.46 (1.14-1.88)] of being transferred to another nursing home during the COVID-19 period compared to the prepandemic period. In the early COVID-19 pandemic, Michigan designated 38 nursing homes to care for residents with COVID-19. We found a higher transfer rate during the pandemic than during the prepandemic period, especially among Black residents, residents with COVID-19 infection, or residents with severe cognitive impairment. Further investigation is warranted to understand the transfer practice better and if any policies would mitigate the transfer risk for these subgroups.

Emergency Department Utilization within a Rural Health System during Early COVID-19 Pandemic

Background: Stay-at-home orders were issued during March 2020 to contain the spread of COVID-19. We sought to understand the impact of COVID-19 on emergency care utilization within one rural health system. Methods: This studied a retrospective cohort of patients presenting to system emergency departments (EDs). Primary outcome was ED volume. Secondary outcomes were admission rate for stroke, acute coronary syndrome (ACS), and critical illness states. A report was generated for all ED visits during study period March 19–May 31, 2020, and reference period: March 19–May 31, 2019. For the primary outcome, a regression model was used. Mixed-effects logistic and linear models were used for evaluating differences in rates for secondary outcomes. Results: There was a decrease in weekly volume (−609 ±57, p &lt; 0.001). There was an increase in admission rate for sepsis (OR 1.43 [95% CI 1.18–1.72]), stroke (OR 1.54 [95% CI 1.11–2.12]), and overall critical illness presentation (OR 1.59 [95% CI 1.41–1.8]). There were higher rates of vasopressor use (OR 1.91 [95% CI 1.56–2.33]) and inpatient mortality (OR 1.49 [95% CI 1.09–2.05]). There were 37 cases of COVID-19. Conclusions: ED volume decreased by 40% with evidence of greater severity of illness in the setting of low COVID-19 disease burden. Efforts should be developed to reassure the public of the importance and safety of timely hospital care during future pandemics. Hospital staffing models should anticipate greater severity of illness despite lower patient volume.

Psychological Stress among Emergency Nurses during the Early COVID-19 Pandemic

Psychological Stress among Emergency Nurses during the Early COVID-19 Pandemic

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran

ObjectivesGood sleep quality is crucial for medical staff especially nurses and midwives to prevent possible errors and injuries during the providing care. The aim here is to investigate the sleep quality of nurses and midwives during the early corona pandemic and its related factors. MethodsAn online observational and cross-sectional study included 340 medical staff who engaged in the treatment of patients with COVID-19 infection in 2020. Participants completed questionnaires about working characteristics, Pittsburgh Sleep Quality Index (PSQI), and Social Support Indexes (SSI). Pearson’s correlation analysis and Multivariate logistic regression identified the interactions between these factors. ResultsThe mean PSQI and SSI were 8.4 ± 4.46 and 28.6 ± 13.29, respectively, indicating poor sleep quality and moderate social support. The condition of the participants was serious in terms of sleep efficiency, and sleep disturbance. More than half of the participants reported severe and very serious daytime dysfunction. Poor sleep quality was more common, in nurses than in midwives (OR:0.074, CI; 0.032–0.098, P < 0.001), nurses working in intensive care units than in other wards (OR:1.082, CI; 1.003–4.023, P = 0.005), in people who had long shifts (OR:1.757, CI; 1.123–4.323, P = 0.003), and in people working more than 5 years (OR:4.949, CI; 1.673–6.023, P = 0.028). Social support has a statistically significant relationship with the quality of sleep (OR:0.013, CI; 0.001–0.244, P = 0.004). ConclusionThe sleep quality of the medical staff has been impaired during the epidemic period, especially among nurses. Targeting staff who are more prone to sleep disturbance, such as nurses with longer work experience, helps us design an optimal strategy to support them through sleep hygiene education.

Statewide assessment of telehealth use for obstetrical care during the COVID-19 pandemic

The COVID-19 pandemic started a period of rapid transition to telehealth in obstetrical care delivery to maintain social distancing and curb the spread of the virus. The use of telehealth, such as telephone and video visits, remote imaging interpretation, and provider-to-provider consultations, increased in the early months of the pandemic to maintain access to prenatal and postpartum care. Although there is considerable literature on the use of telehealth in obstetrical care, there are limited data on widespread telehealth use among different practice types and patient populations during the pandemic and whether these are preferred technologies. This study aimed to describe variations in telehealth use for obstetrical care among practices in North Carolina during the COVID-19 pandemic and to outline future preferences and needs for continued telehealth use. This study also aimed to delineate telehealth use among rural and micropolitan and metropolitan practices to better understand if telehealth use varied by practice location. A web-based survey was distributed to practice managers of obstetrical practices in North Carolina from June 14, 2020 to September 14, 2020. Practice managers were contacted through assistance of the Community Care of North Carolina Pregnancy Medical Home program. Practice location was defined as rural, micropolitan, or metropolitan based on the county population. The survey assessed telehealth use before and during the COVID-19 pandemic, types of modalities used, and preferences for future use. Descriptive statistics were performed to describe survey responses and compare them by practice location. A total of 295 practice managers were sent a web-based survey and 98 practice managers responded. Responding practices represented 66 of 100 counties in North Carolina with 50 practices from rural and micropolitan counties and 48 practices from metropolitan counties. The most common type of provider reported by practice managers were general obstetrician and gynecologists (85%), and the most common practice type was county health departments (38%). Overall, 9% of practices reported telehealth use before the pandemic and 60% reported telehealth use during the pandemic. The most common type of telehealth modality was telephone visits. There were no significant differences in the uptake of telehealth or in the modalities used by practice location. A total of 40% of practices endorsed a preference for continued telehealth use beyond the COVID-19 pandemic. The most commonly reported need for continuation of telehealth use was assistance with patient access to telehealth technologies (54%). There were no significant differences in the preferences for telehealth continuation or future needs by practice location. Telehealth use increased among a variety of practice types during the pandemic with no variation observed by practice location in terms of modalities used, future preferences, or needs. This study assessed statewide uptake of and differences in obstetrical telehealth use during the early COVID-19 pandemic. With telehealth becoming an integral part of obstetrical care delivery, this survey has implications for anticipating the needs of practices and designing innovative solutions for providers and pregnant people beyond the COVID-19 pandemic.

Comparison of Trauma and Burn Evaluations in a Pediatric Emergency Department During Pre, Early and Late COVID-19 Pandemic

BackgroundPediatric trauma epidemiology altered during early COVID-19 pandemic period but the impact of the ongoing pandemic is unknown. ObjectivesTo compare pediatric trauma epidemiology between the pre, early and late pandemic periods and to evaluate the association of race and ethnicity on injury severity during the pandemic. MethodsWe performed a retrospective study of trauma consults for an injury/burn in children ≤16 years between January 1, 2019 and December 31, 2021. Study period was categorized into pre (January 1, 2019–February 28, 2020), early (March 1, 2020–December 31, 2020), and late (January 1, 2021–December 31, 2021) pandemic. Demographics, etiology, injury/burn severity, interventions and outcomes were noted. ResultsA total of 4940 patients underwent trauma evaluation. Compared to pre-pandemic, trauma evaluations for injuries and burns increased during both the early (RR: 2.13, 95% CI: 1.6–2.82 and RR: 2.24, 95% CI: 1.39–3.63, respectively) and late pandemic periods (RR: 1.42, 95% CI: 1.09–1.86 and RR: 2.44, 95% CI: 1.55–3.83, respectively). Severe injuries, hospital admissions, operations and death were higher in the early pandemic but reverted to pre-pandemic levels during late pandemic. Non-Hispanic Blacks had an approximately 40% increase in mean ISS during both pandemic periods though they had lower odds of severe injury during both pandemic periods. ConclusionsTrauma evaluations for injuries and burns increased during the pandemic periods. There was a significant association of race and ethnicity with injury severity which varied with pandemic periods. Level of evidenceRetrospective comparative study, Level III.

Provider and Patient Experiences of Delays in Primary Care During the Early COVID-19 Pandemic.

The necessary suspension of nonacute services by healthcare systems early in the COVID-19 pandemic was predicted to cause delays in routine care in the United States, with potentially serious consequences for chronic disease management. However, limited work has examined provider or patient perspectives about care delays and their implications for care quality in future healthcare emergencies. This study explores primary care provider (PCP) and patient experiences with healthcare delays during the COVID-19 pandemic. PCPs and patients were recruited from four large healthcare systems in three states. Participants underwent semistructured interviews asking about their experiences with primary care and telemedicine. Data were analyzed using interpretive description. Twenty-one PCPs and 65 patients participated in interviews. Four main topics were identified: (1) types of care delayed, (2) causes for delays, (3) miscommunication contributing to delays, and (4) patient solutions to unmet care needs. Both patients and providers reported delays in preventive and routine care early in the pandemic, driven by healthcare system changes and patient concerns about infection risk. Primary care practices should develop plans for care continuity and consider new strategies for assessing care quality for effective chronic disease management in future healthcare system disruptions.

Trends in Language Use During the COVID-19 Pandemic and Relationship Between Language Use and Mental Health: Text Analysis Based on Free Responses From a Longitudinal Study.

The COVID-19 pandemic and its associated restrictions have been a major stressor that has exacerbated mental health worldwide. Qualitative data play a unique role in documenting mental states through both language features and content. Text analysis methods can provide insights into the associations between language use and mental health and reveal relevant themes that emerge organically in open-ended responses. The aim of this web-based longitudinal study on mental health during the early COVID-19 pandemic was to use text analysis methods to analyze free responses to the question, "Is there anything else you would like to tell us that might be important that we did not ask about?" Our goals were to determine whether individuals who responded to the item differed from nonresponders, to determine whether there were associations between language use and psychological status, and to characterize the content of responses and how responses changed over time. A total of 3655 individuals enrolled in the study were asked to complete self-reported measures of mental health and COVID-19 pandemic-related questions every 2 weeks for 6 months. Of these 3655 participants, 2497 (68.32%) provided at least 1 free response (9741 total responses). We used various text analysis methods to measure the links between language use and mental health and to characterize response themes over the first year of the pandemic. Response likelihood was influenced by demographic factors and health status: those who were male, Asian, Black, or Hispanic were less likely to respond, and the odds of responding increased with age and education as well as with a history of physical health conditions. Although mental health treatment history did not influence the overall likelihood of responding, it was associated with more negative sentiment, negative word use, and higher use of first-person singular pronouns. Responses were dynamically influenced by psychological status such that distress and loneliness were positively associated with an individual's likelihood to respond at a given time point and were associated with more negativity. Finally, the responses were negative in valence overall and exhibited fluctuations linked with external events. The responses covered a variety of topics, with the most common being mental health and emotion, social or physical distancing, and policy and government. Our results identify trends in language use during the first year of the pandemic and suggest that both the content of responses and overall sentiments are linked to mental health.

Daily associations between affect, drinking motives, and drinking intensity among U.S. young adults.

We investigated the relationships between daily affect, drinking motives, likelihood of drinking, and intensity of drinking, particularly high-intensity drinking (HID), in a sample of young adults. We also explored differences in our outcomes before versus during the early coronavirus disease (COVID-19) pandemic. In the springs of 2019 and 2020, young adult drinkers (N = 633) completed 14 consecutive morning surveys (each year) characterizing the prior day's affect, motives, and alcohol use. We examined between-person and within-person associations of affect and motives with two outcomes: any drinking and drinking intensity on drinking days (1 = moderate drinking [1-3 drinks for women, 1-4 drinks for men], 2 = binge drinking [4-7 for women, 5-9 for men], and 3 = HID [8 + for women, 10 + for men]). Young adults reported higher positive affect on drinking days and higher negative affect on nondrinking days. On days when young adults reported greater enhancement motives, positive affect was strongly related to HID. During the early COVID-19 pandemic, young adults were more likely to report drinking, but did not drink more heavily unless they also reported drinking for social motives. These results suggest that heightened social, coping, and enhancement motives are risk factors for drinking in young adults. They also suggest that young adults perceive their mood to be better on drinking days, particularly when they were drinking to enhance positive affect. Results are consistent with a positive affect regulation model (i.e., drinking to increase positive affect), but not a negative affect regulation model (i.e., drinking to cope with negative affect). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Incidence of Guillain-Barré syndrome in South Korea during the early COVID-19 pandemic.

Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, often triggered by infection. We aimed to investigate how the incidence of GBS changed in the early stages of the coronavirus 2019 (COVID-19) pandemic when nationwide infections declined due to non-pharmaceutical interventions. We conducted a nationwide population-based retrospective GBS cohort study using data from the Health Insurance Review and Assessment Service of Korea. Patients with new-onset GBS were defined as those who were first hospitalized between 1 January 2016 and 31 December 2020 with an International Classification of Disease, 10th Revision code, for GBS (G61.0) as a primary diagnosis. The incidence of GBS in the pre-pandemic years (2016-2019) was compared with that in the first pandemic year (2020). Nationwide epidemiological data for infections were collected from the national infectious disease surveillance system. A correlation analysis was performed to determine the incidence of GBS and nationwide trends of various infections. Overall, 3,637 new-onset GBS cases were identified. The age-standardized incidence of GBS in the first pandemic year was 1.10 (95% confidence interval, 1.01-1.19) per 100,000 persons. Compared to the first pandemic year, the incidence of GBS during the pre-pandemic years (1.33-1.68/100,000 persons/year) was significantly higher, with incidence rate ratios of 1.21-1.53 (P < 0.001). Nationwide cases of upper respiratory viral infections were significantly reduced in the first pandemic year; however, Campylobacter infections peaked in the summer of the pandemic. The nationwide epidemiology of parainfluenza virus, enterovirus, and Campylobacter infections correlated positively with GBS incidence. The overall GBS incidence decreased in the early stages of the COVID-19 pandemic, which can be attributed to the dramatic reduction in viral illnesses due to public measures.

The Impact of the COVID-19 Pandemic on Female Sexual Function in Jordan: Cross-sectional Study.

Sexual function is a complex physiological process controlled by neurovascular and endocrine mechanisms that are affected by stressful events. The sexual response cycle consists of four main phases, which are sexual desire or libido, arousal or excitement, orgasm, and resolution. The COVID-19 outbreak is one of the most stressful events historically, causing several unpleasant consequences, including major physical and mental disorders, and sexual dysfunction and alteration in sexual behavior are possible anticipated consequences of the pandemic. Moreover, there are social taboos related to sexual behavior in Jordan, and the current knowledge on changes in Jordanian female sexual function during COVID-19 pandemic is limited. This study aims to evaluate the impact of COVID-19 on women's sexual function during the early COVID-19 pandemic in Jordan. This is a cross-sectional study that employed a web-based survey to follow 200 female individuals from the general population in Jordan. The survey evaluated sexual function both during COVID-19 and 6 months prior to the pandemic. The primary outcomes investigated in this study were the changes in sexual intercourse frequency and sexual function aspects, including desire, arousal, satisfaction, orgasm, lubrication, and pain during sexual activity. Data were analyzed using paired t test, McNemar test, Pearson correlations, and multiple linear regression using SPSS 25. During the COVID-19 pandemic, the participants' sexual intercourse frequency increased while their sexual satisfaction was significantly changed. The proportion of participants who had 0-2 times per week of sexual intercourse was decreased during the COVID-19 pandemic compared with that before the pandemic (n=90, 45% vs n=103, 51.5%; P=.02). Conversely, the number of female individuals with 3-7 times per week of sexual intercourse increased after the pandemic compared with the prepandemic state (n=103, 51.5% vs n=91, 45.5%; P=.04). Female sexual satisfaction was significantly reduced after the COVID-19 pandemic compared with that before the pandemic (3.39 vs 3.30; P=.049). The other categories of sexual function, including desire, arousal, satisfaction, orgasm, lubrication, and dyspareunia showed no significant changes during the COVID-19 pandemic compared with the previous 6 months. There were no significant differences between the total sexual function mean scores during COVID-19 (15.73) compared with the prepandemic scores (15.85; P=.41). The total score of female sexual function during the pandemic was negatively associated with the participants' age and education level. Correlations between various demographics and sexual function categories during the COVID-19 pandemic were identified. This is the first study exploring female sexual function during the COVID-19 outbreak in Jordan. The results suggest that COVID-19-associated stress is influencing women's sexual function, necessitating the provision of adequate emotional and physiological well-being support for women during similar crises.

Children's rates of BMI change during pre-pandemic and two COVID-19 pandemic periods, IQVIA Ambulatory Electronic Medical Record, January 2018 Through November 2021.

Many US youth experienced accelerated weight gain during the early COVID-19 pandemic. Using an ambulatory electronic health record data set, the authors compared children's rates of BMI change in three periods: pre-pandemic (January 2018-February 2020), early pandemic (March-December 2020), and later pandemic (January-November 2021). This study used mixed-effects models to examine differences in rates of change in BMI, weight, and obesity prevalence among the three periods. Covariates included time as a continuous variable, a variable indicating in which period each BMI was taken, sex, age, and initial BMI category. In a longitudinal cohort of 241,600 children aged 2 through 19 years with ≥4 BMI measurements, the monthly rates of BMI change (kilograms per meters squared) were 0.056 (95% CI: 0.056-0.057) in the pre-pandemic period, 0.104 (95% CI: 0.102-0.106) in the early pandemic, and 0.035 (95% CI: 0.033-0.036) in the later pandemic. The estimated prevalence of obesity in this cohort was 22.5% by November 2021. In this large, geographically diverse cohort of US youth, accelerated rates of BMI change observed during 2020 were largely attenuated in 2021. Positive rates indicate continued weight gain rather than loss, albeit at a slower rate. Childhood obesity prevalence remained high, which raises concern about long-term consequences of excess weight and underscores the importance of healthy lifestyle interventions.

Rates of Follow-up Colonoscopy After a Positive Stool-Based Screening Test Result for Colorectal Cancer Among Health Care Organizations in the US, 2017-2020

Noninvasive stool-based screening tests (SBTs) are effective alternatives to colonoscopy. However, a positive SBT result requires timely follow-up colonoscopy (FU-CY) to complete the colorectal cancer screening paradigm. To evaluate FU-CY rates after a positive SBT result and to assess the association of the early COVID-19 pandemic with FU-CY rates. This mixed-methods cohort study included retrospective analysis of deidentified administrative claims and electronic health records data between June 1, 2015, and June 30, 2021, from the Optum Labs Data Warehouse and qualitative, semistructured interviews with clinicians from 5 health care organizations (HCOs). The study population included data from average-risk primary care patients aged 50 to 75 years with a positive SBT result between January 1, 2017, and June 30, 2020, at 39 HCOs. The primary outcome was the FU-CY rate within 1 year of a positive SBT result according to patient age, sex, race, ethnicity, insurance type, Charlson Comorbidity Index (CCI), and prior SBT use. This cohort study included 32 769 individuals (16 929 [51.7%] female; mean [SD] age, 63.1 [7.1] years; 2092 [6.4%] of Black and 28 832 [88.0%] of White race; and 825 [2.5%] of Hispanic ethnicity). The FU-CY rates were 43.3% within 90 days of the positive SBT result, 51.4% within 180 days, and 56.1% within 360 days (n = 32 769). In interviews, clinicians were uniformly surprised by the low FU-CY rates. Rates varied by race, ethnicity, insurance type, presence of comorbidities, and SBT used. In the Cox proportional hazards regression model, the strongest positive association was with multitarget stool DNA use (hazard ratio, 1.63 [95% CI, 1.57-1.68] relative to fecal immunochemical tests; P < .001), and the strongest negative association was with the presence of comorbidities (hazard ratio, 0.64 [95% CI, 0.59-0.71] for a CCI of >4 relative to 0; P < .001). The early COVID-19 pandemic was associated with lower FU-CY rates. This study found that FU-CY rates after a positive SBT result for colorectal cancer screening were low among an average-risk population, with the median HCO achieving a 53.4% FU-CY rate within 1 year. Socioeconomic factors and the COVID-19 pandemic were associated with lower FU-CY rates, presenting opportunities for targeted intervention by clinicians and health care systems.

Exploring U.S. Food System Workers' Intentions to Work While Ill during the Early COVID-19 Pandemic: A National Survey.

With "stay at home" orders in effect during early COVID-19, many United States (U.S.) food system workers attended in-person work to maintain national food supply chain operations. Anecdotally, many encountered barriers to staying home despite symptomatic COVID-19 illness. We conducted a national, cross-sectional, online survey between 31 July and 2 October 2020 among 2535 respondents. Using multivariable regression and free-text analyses, we investigated factors associated with workers' intentions to attend work while ill (i.e., presenteeism intentions) during the early COVID-19 pandemic. Overall, 8.8% of respondents intended to attend work with COVID-19 disease symptoms. Almost half (41.1%) reported low or very low household food security. Workers reporting a higher workplace safety climate score were half as likely to report presenteeism intentions (adjusted odds ratio [aOR] 0.52, 95% confidence interval (CI) 0.37, 0.75) relative to those reporting lower scores. Workers reporting low (aOR 2.06, 95% CI 1.35, 3.13) or very low (aOR 2.31, 95% CI 1.50, 3.13) household food security levels had twice the odds of reporting presenteeism intentions relative to those reporting high/marginal food security. Workplace culture and safety climate could enable employees to feel like they can take leave when sick during a pandemic, which is critical to maintaining individual and workplace health. We stress the need for strategies which address vulnerabilities and empower food workers to make health-protective decisions.

Psychosocial work stress and parent-child bonding during the COVID-19 pandemic: clarifying the role of parental symptoms of depression and aggressiveness

BackgroundParental work stress and impaired mental health seem to have intensified during the current COVID-19 pandemic. Both can have a negative impact on parent-child bonding: psychosocial work stress in the course of a spillover effect from work to family and symptoms of impaired mental health as part of a crossover effect from parent to child. This potentially affects the child’s development in the long term.MethodThis cross-sectional study examined the relationship between psychosocial work stress and parent-child bonding during the early COVID-19 pandemic (May–June 2020). Symptoms of depression and aggressiveness were considered as mediators of this relationship. The sample consisted of employees in Eastern Germany (n = 380; 42.9% mothers, 57.1% fathers), aged 24–55 years, with children aged 0–36 months.ResultsIn the total sample, an association was only found after adjusting for potential confounders, indicating that higher psychosocial work stress is associated with weaker bonding between the parent and child (β = 0.148, p = .017, 95% CI [0.566, 5.614]). The separate analyses for mothers and fathers did not reveal a statistically significant relationship between psychosocial work stress and parent-child bonding. In the total sample, the higher the psychosocial work stress was, the higher were the parental symptoms of depression (β = 0.372, p < .001, 95% CI [3.417, 5.696]) and aggressiveness β = 0.254, p < .001, 95% CI [1.008, 3.208]). The mental health symptoms in turn were related to weaker parent-child bonding (symptoms of depression β = 0.320, p < .001, 95% CI [0.345, 0.749]; symptoms of aggressiveness β = 0.394, p < .001, 95% CI [0.697, 1.287]). The results furthermore suggested that parental mental health symptoms mediate the association between psychosocial work stress and parent-child bonding (symptoms of depression, ab = 2.491, 95% CI [1.472, 3.577] and of aggressiveness, ab = 2.091, 95% CI [1.147, 3.279]). The mediation effect was also found in the separate analyses for the mothers and fathers.DiscussionThe results of this study during the early COVID-19 pandemic in Germany highlight the importance of prevention as well as intervention measures in relation to psychosocial work stress that may play a debilitating role in the context of family relationships. In addition, the results suggest that both employers and employees should be made aware of the importance of psychosocial work stress, as it can have a negative impact on mental health, which in turn may have a major influence on family relationships.

Disparities in Use of Virtual Primary Care During the Early COVID-19 Pandemic.

Background: The COVID-19 pandemic increased the use of virtual health care. However, certain factors may disparately affect some patients' utilization of virtual care. Associations between age, racial categories (White or Black), and socioeconomic disadvantage were evaluated during the early COVID-19 pandemic. Methods: This cross-sectional retrospective study included adult patients with virtual or in-person primary care encounters at a large, midwestern hospital system with widespread urban and suburban offices between March 1, 2020, and June 30, 2020. Virtual visits included synchronous video and telephone visits and asynchronous patient portal E-visits. Chi-squared tests and multivariable logistic analysis assessed the associations between ages and racial categories, and area deprivation index with the use of virtual versus in-person primary care. Results: Of 72,153 patient encounters, 43.0% were virtual visits, 54.6% were White patients, and 45.4% were Black. Across equivalent age ranges, black patients were slightly less likely to utilize virtual care than similarly aged White patients, but not consistently across virtual modalities. Women were more likely to use virtual care across all modalities, and individuals >65 years were more likely to use telephone visits and less likely to use video and E-visits, regardless of race. Patients residing in areas with the greatest socioeconomic advantage were more likely to utilize video and E-visits. Conclusions: Differential patterns of utilization emerged across racial categories and age ranges, suggesting that racial disparities are exacerbated depending upon patient age and mode of utilization.

Cannabis use during the early COVID-19 pandemic: Use patterns, predictors, and subjective experiences.

Even in the early stages, global crises such as the COVID-19 pandemic lead to serious dislocations of social life, secondary adjustment reactions to external restrictions and individual concerns. Coping mechanisms may also include dysfunctional strategies like an increase of drug use. Considering the wide-spread use of cannabis, the aim of this study was to elucidate the interplay of social restrictions, psychopathology, concerns related to the pandemic in addition to the users' experiences, motivations and consumption quantities during the early COVID-19 pandemic. It was presumed that cannabis intake would increase during the early phase of the crisis and that consumption quantities would be related to corona-related restrictions, concerns as well as subjective substance effects and psychopathology. As part of an international, cross-sectional, internet-based survey (N = 5,049) available in five languages, consumption quantities and patterns of cannabis use in the early phase of the pandemic from April to August 2020 were examined. Participants retrospectively rated restrictions and concerns related to the pandemic, motives of cannabis use prior to and during 1 month the pandemic, and subjective consumption effects. Cannabis use behavior showed no significant differences when consumption quantities prior and during 1 month after the COVID-19 outbreak were compared. Higher quantities of cannabis intake prior and during 1 month of the pandemic as well as more corona-related concern were associated with an increased perception of positive effects of cannabis during the pandemic. Predictors of its use during 1 month of pandemic were higher pre-pandemic consumption quantity, older age, quarantinization, a lesser degree of being affected by negative effects of the pandemic and a stronger subjective experience of corona-related positive effects of cannabis. Comparisons of the motives for cannabis intake in the pre-pandemic versus the pandemic period showed that all rationales for consumption were reported less frequently, except boredom. Frequencies of cannabis intake remained relatively stable in the early pandemic phase. Risk factors for increased use seem related to habitual consumption patterns that become more prominent under quarantinization. The use of cannabis as a dysfunctional coping strategy might not be amenable via self-report and should therefore receive special attention in clinical contexts.