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  • 1
    Online Resource
    Online Resource
    Utilization and Impact of Symptomatic and Exposure SARS-CoV-2 Testing in K-12 Schools
    American Academy of Pediatrics (AAP) ; 2023
    In:  Pediatrics Vol. 152, No. Supplement 1 ( 2023-07-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 152, No. Supplement 1 ( 2023-07-01)
    Abstract: The Centers for Disease Control and Prevention recommend that schools can offer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic (on-demand) testing for students and staff with coronavirus disease 2019 symptoms or exposures. Data related to the uptake, implementation, and effect of school-associated on-demand diagnostic testing have not been described. METHODS The Rapid Acceleration of Diagnostics Underserved Populations Return to School program provided resources to researchers to implement on-demand SARS-CoV-2 testing in schools. This study describes the strategies used and uptake among the different testing programs. Risk of positivity was compared for symptomatic and exposure testing during the δ and ο variant periods. We estimated the number of school absence days saved with school-based diagnostic testing. RESULTS Of the 16 eligible programs, 7 provided school-based on-demand testing. The number of persons that participated in these testing programs is 8281, with 4134 (49.9%) receiving & gt;1 test during the school year. Risk of positivity was higher for symptomatic testing compared with exposure testing and higher during the ο variant predominant period compared with the δ variant predominant period. Overall, access to testing saved an estimated 13 806 absent school days. CONCLUSIONS School-based on-demand SARS-CoV-2 testing was used throughout the school year, and nearly half the participants accessed testing on more than 1 occasion. Future studies should work to understand participant preferences around school-based testing and how these strategies can be used both during and outside of pandemics.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2022-060352I
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2023
    detail.hit.zdb_id: 1477004-0
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  • 2
    Online Resource
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    A Multi-Study Synthesis of Facilitators and Barriers to SARS-CoV-2 Testing Enrollment in School Settings
    American Academy of Pediatrics (AAP) ; 2023
    In:  Pediatrics Vol. 152, No. Supplement 1 ( 2023-07-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 152, No. Supplement 1 ( 2023-07-01)
    Abstract: Understanding the motivators and barriers to testing enrollment from different stakeholder perspectives is essential to increasing participation in school-based testing programs, particularly among underserved populations. This multistudy analysis aimed to identify facilitators and barriers to enrollment in school-based testing for coronavirus disease 2019 (COVID-19). METHODS Four independent studies collected and analyzed qualitative data from study participants regarding: (1) motivators, benefits, and/or reasons for enrolling and/or participating in COVID-19 testing in schools; and/or (2) concerns, barriers, and/or negative outcomes related to COVID-19 testing in schools. Study authors conducted a retrospective review of findings from the independent studies to identify themes related to testing motivators and concerns that emerged across the studies. RESULTS The analysis identified 10 distinct themes regarding the perceived motivators of COVID-19 testing in schools and 15 distinct themes regarding concerns and barriers to COVID-19 testing in schools. Common motivators across multiple studies included convenience of testing in school and the desire to keep self and others safe from COVID-19. Concerns about the implications of receiving a positive test result was a barrier identified by multiple studies. CONCLUSIONS Themes from 4 independent studies revealed insights about the motivations and barriers to enrolling and participating in COVID-19 testing programs in kindergarten through 12th grade school settings. Study findings can be used to improve enrollment and participation in new and existing school-based testing programs to reduce transmission of COVID-19 and other infectious diseases in schools.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2022-060352J
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2023
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  • 3
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    Abstract 19: Assessing The Impact Of Stroke Systems Of Care Policies On Stroke-related Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 15, No. Suppl_1 ( 2022-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. Suppl_1 ( 2022-05)
    Abstract: Introduction: Stroke systems of care (SSOC) laws have been adopted across the US as early as 2002 to improve access to time- sensitive, life-saving treatments and care for stroke patients. However, the impact of these laws on stroke care delivery and patient outcomes remains largely unknown. The study goal was to determine whether the policy interventions are associated with improved stroke outcomes by examining SSOC laws implemented by states. Methods: We developed a policy surveillance dataset of the 50 states and D.C. SSOC laws in effect at any time from 2002-2018. A stakeholder group of federal, state, and local SSOC experts informed the study. Based on an evidence-informed conceptual model, the study linked the policy surveillance dataset with three state-level outcomes: 1) age-adjusted overall stroke mortality rates; 2) percentage of hospitals certified as primary stroke centers (PSC); and 3) percentage of patients who received brain scan results within 45 minutes of arrival at a stroke center. To estimate policy effectiveness, we used Bayesian Additive Regression Trees to predict outcomes as if no policies were in effect and compared them to the actual observed outcomes in each state that put at least one policy into effect. For each modeled outcome, we controlled for state-level contextual factors such as stroke prevalence, percent rural population, non-white population, density of hospital closure, Paul Coverdell National Acute Stroke Program participation, and Medicaid expansion status. Results: Results identified 38 states with at least one SSOC law in effect during the study period. Of these states, 11 states had lower and 3 had higher overall stroke mortality rates than predicted; 9 states had a higher and 4 had a lower proportion of PSCs than predicted; and 12 states had higher and 2 had lower brain scan rates within 45 minutes than predicted. Conclusion: Having one or more SSOC laws in effect is associated with improved stroke outcomes. This information can inform national chronic disease organizations and state decisionmaker efforts to improve SSOC at state and regional levels.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.15.suppl_1.19
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2453882-6
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  • 4
    Online Resource
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    SARS-CoV-2 Screening Testing Programs for Safe In-person Learning in K–12 Schools
    Oxford University Press (OUP) ; 2023
    In:  Journal of the Pediatric Infectious Diseases Society Vol. 12, No. 2 ( 2023-02-27), p. 64-72
    Details
    In: Journal of the Pediatric Infectious Diseases Society, Oxford University Press (OUP), Vol. 12, No. 2 ( 2023-02-27), p. 64-72
    Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening testing is a recommended mitigation strategy for schools, although few descriptions of program implementation are available. Methods Kindergarten through 12th grade (K–12) students and staff practicing universal masking during the delta and omicron variant waves from five schools in Durham, North Carolina and eight schools in Kansas City, Missouri participated; Durham’s program was structured as a public health initiative facilitated by school staff, and Kansas City’s as a research study facilitated by a research team. Tests included school-based rapid antigen or polymerase chain reaction testing, at-home rapid antigen testing, and off-site nucleic acid amplification testing. Results We performed nearly 5700 screening tests on more than 1600 K–12 school students and staff members. The total cost for the Durham testing program in 5 public charter K–12 schools, each with 500–1000 students, was $246 587 and approximately 752 h per semester; cost per test was $70 and cost per positive result was $7076. The total cost for the Kansas City program in eight public K–12 schools was $292 591 and required approximately 537 h in personnel time for school-based testing; cost per test was $132 and cost per positive result was $4818. SARS-CoV-2 positivity rates were generally lower (0–16.16%) than rates in the community (2.7–36.47%) throughout all testing weeks. Conclusions and Relevance Voluntary screening testing programs in K–12 schools are costly and rarely detect asymptomatic positive persons, particularly in universally masked settings. Clinical Trial Registration NCT04831866.
    Type of Medium: Online Resource
    ISSN: 2048-7207
    URL: Article
    DOI: 10.1093/jpids/piac119
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2668791-4
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  • 5
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    Pairing Project ECHO and patient navigation as an innovative approach to improving the health and wellness of cancer survivors in rural settings
    Wiley ; 2022
    In:  The Journal of Rural Health Vol. 38, No. 4 ( 2022-09), p. 855-864
    Details
    In: The Journal of Rural Health, Wiley, Vol. 38, No. 4 ( 2022-09), p. 855-864
    Abstract: We conducted a 12‐month pilot study of 2 complementary strategies for improving rural cancer survivorship outcomes: (1) Project ECHO, a telementoring model to increase knowledge and skills about cancer survivorship among multidisciplinary health care provider teams in rural areas and (2) patient navigation (PN) services to connect rural cancer survivors with resources for enhancing health and wellness. Methods We recruited 4 CDC‐funded National Comprehensive Cancer Control Program sites to implement Project ECHO and PN interventions for a defined rural population in each of their jurisdictions. Sites received ongoing technical assistance and a stipend to support implementation. We conducted a mixed‐methods evaluation consisting of quantitative performance monitoring data and qualitative interviews with site staff to assess implementation. Findings Site teams delivered 21 cancer survivorship ECHO sessions to rural providers resulting in 329 participant encounters. Almost all (93%) ECHO participants reported enhanced knowledge of cancer survivorship issues, and 80% reported intent to apply learnings to their practices. Site teams engaged 16 patient navigators who navigated 164 cancer survivors during the study period. Successful implementation required strong partnerships, clear avenues for recruitment of rural providers and cancer survivors, and activities tailored to local needs. Fostering ongoing relationships among sites through community of practice calls also enhanced implementation. Conclusions Sites successfully implemented a novel approach for enhancing care for cancer survivors in rural communities. Pairing Project ECHO to address structural barriers and PN to address individual factors affecting survivorship may help bridge the health equity gap experienced by cancer survivors in rural communities.
    Type of Medium: Online Resource
    ISSN: 0890-765X , 1748-0361
    URL: Issue
    URL: Article
    DOI: 10.1111/jrh.v38.4
    DOI: 10.1111/jrh.12682
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2159889-7
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  • 6
    Online Resource
    Online Resource
    A COVID-19 Testing Preference Study in Schools
    American Academy of Pediatrics (AAP) ; 2023
    In:  Pediatrics Vol. 152, No. Supplement 1 ( 2023-07-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 152, No. Supplement 1 ( 2023-07-01)
    Abstract: The Centers for Disease Control and Prevention identifies in-school COVID-19 testing as a key mitigation strategy to protect students and staff during the COVID-19 pandemic. Both nasal and saliva samples are acceptable, but existing school guidance does not state a preferred test method. METHODS From May 2021 through July 2021, we performed a randomized, crossover study in kindergarten through 12th grade (K-12) schools to evaluate student and staff preference for self-collected nasal or saliva testing. Participants performed both collection types and participated in a standardized questionnaire assessing the preferred method. RESULTS A total of 135 students and staff participated. Staff, middle school, and high school students preferred the nasal swab (80/96, 83%), whereas elementary students were mixed (20/39, 51% preferred saliva). Reasons reported for preferring the nasal swab included being faster and easier. Reasons reported for preferring saliva included being easier and more fun. Despite their preference, 126 (93%) and 109 (81%) participants would take the nasal swab or saliva test again, respectively. CONCLUSIONS The anterior nasal test was the preferred testing method by students and staff, although preference varied by age group. Willingness to perform both tests again in the future was high. Identifying the preferred testing modality is important to increase acceptance and participation in COVID-19 in-school testing programs.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2022-060352H
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2023
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  • 7
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    Implementation of School-Based COVID-19 Testing Programs in Underserved Populations
    American Academy of Pediatrics (AAP) ; 2022
    In:  Pediatrics Vol. 149, No. Supplement_2 ( 2022-02-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 149, No. Supplement_2 ( 2022-02-01)
    Abstract: Evidence suggests that coronavirus disease 2019 (COVID-19) testing in schools can add a layer of protection to reduce the spread of Severe Acute Respiratory Syndrome Coronavirus 2 and facilitate a safer return to in-person learning. Despite this evidence, implementation of testing in school settings has been challenging initially because of a lack of funding and limited availability of testing, but, as the pandemic has progressed and more funding and resources have been devoted to testing, other implementation challenges have arisen. We describe key implementation barriers and strategies that have been operationalized across 5 projects working to help schools with predominantly underserved populations who have faced significant COVID-19–related health disparities. We leveraged a key framework from the implementation science field to identify the challenges and used a matching tool to align implementation strategies to these challenges. Our findings suggest that the biggest obstacles to COVID-19 testing were the perceived relative advantages versus burden of COVID-19 testing, limited engagement with the target beneficiaries (eg, families, students, staff), and innovation complexity. Common strategies to overcome these challenges included identifying and preparing testing champions, altering incentive and allowance structures, assessing for readiness, and identifying barriers and facilitators. We aim to augment existing implementation guidance for schools by describing common barriers and recommended solutions from the implementation science field. Our results indicate a clear need to provide implementation support to schools to facilitate COVID-19 testing as an added layered mitigation strategy.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2021-054268G
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
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  • 8
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    Online Resource
    Strategies for Identifying Students in Need of School-Based Asthma Services : Challenges and Questions That Emerged From a Rapid Evaluation of a School-Based Asthma Program
    SAGE Publications ; 2010
    In:  Journal of Asthma & Allergy Educators Vol. 1, No. 3 ( 2010-06), p. 109-116
    Details
    In: Journal of Asthma & Allergy Educators, SAGE Publications, Vol. 1, No. 3 ( 2010-06), p. 109-116
    Abstract: Charlotte-Mecklenburg Schools (CMS), with assistance from the Centers for Disease Control and Prevention (CDC), conducted an evaluation of the CMS Asthma Program. Data were collected during the 2007-2008 school year through surveys of students with asthma (n = 286), interviews with school nurses (n = 11), and reviews of administrative records that included service provision and nurse ratings of the need for asthma services (based on a set of clinical indicators and symptom frequencies) for each student with asthma. Ninety percent of high-need students, 75.8% of medium-need students, 45.3% of low-need students, and 21.4% of nonrated students were enrolled in student-level services. Given the large number of students without a nurse rating for need, asthma management difficulties (AMD; a set of questions completed by all students on the student survey) were examined as a proxy indicator of need for student-level services. When looking only at need based on AMD, 46.0% of high-need students, 48.0% of medium-need students, and 35.2% of low-need students were enrolled in any student-level service. A Pearson χ 2 revealed that nurse ratings of need and need based on AMD were not significantly related (χ 2 = 4.1888, df = 4, P = .381); of students with nurse ratings for need, more were classified as medium and high need based on AMD than were rated medium and high need by school nurses. This suggests that many students were experiencing AMD but not coming to the attention of school nurses. Among students with asthma, additional resources and systematic procedures are needed to identify those who need student-level services, particularly for students who do not otherwise present with symptoms to the school nurse.
    Type of Medium: Online Resource
    ISSN: 2150-1297 , 2150-1300
    URL: Article
    DOI: 10.1177/2150129710372397
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2540944-X
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  • 9
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    Secondhand Tobacco Smoke Exposure Among School-Aged Youth Enrolled in School-Based Asthma Management Programs : A Mixed Methods Analysis
    SAGE Publications ; 2011
    In:  Journal of Asthma & Allergy Educators Vol. 2, No. 4 ( 2011-08), p. 173-180
    Details
    In: Journal of Asthma & Allergy Educators, SAGE Publications, Vol. 2, No. 4 ( 2011-08), p. 173-180
    Abstract: The high prevalence of asthma among school-aged youth places a significant burden on students, families, and communities. Secondhand smoke (SHS) exacerbates asthma symptoms and attacks. Parental smoking is likely the most common and recurring source of SHS exposure among children. School-based asthma management programs can play a major role in educating students and their families about how to reduce, eliminate, and cope with SHS exposure. Between January 2007 and May 2008, a total of 121 middle and 248 elementary school students who participated in school-based asthma management programs in elementary school completed pretest and posttest surveys assessing asthma behaviors and management difficulties. Subgroups of 40 middle and 54 elementary school students participated in 15 focus groups. Quantitative data were analyzed using descriptive statistics and independent sample t tests. Thematic analysis was used to identify and interpret prominent themes within qualitative data. Quantitative analysis of elementary school student data revealed students exposed to SHS had significantly higher asthma management difficulties at pretest (2.79 vs 1.98, respectively; t = 3.4, P = .001) and posttest (2.56 vs 1.74, respectively; t = 3.8, P 〈 .001) compared with those without SHS exposure. Qualitative results from elementary and middle school students revealed that many students reported SHS exposure resulting from family members smoking at home or in cars. Students and their families reported using ineffective methods (eg, opening a window, drinking water, holding their breath) for reducing, eliminating, and coping with SHS exposure. School-based asthma management programs should provide education to students and their families on the lasting effects of SHS on asthma symptoms and effective strategies for reducing, eliminating, and coping with SHS exposure in homes and cars. A focus on parent and community involvement can play a key role in addressing students’ asthma management needs outside of school.
    Type of Medium: Online Resource
    ISSN: 2150-1297 , 2150-1300
    URL: Article
    DOI: 10.1177/2150129711408305
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 10
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    Increasing Community Readiness for Childhood Obesity Prevention: A Case Study of Four Communities in Georgia
    SAGE Publications ; 2021
    In:  Health Promotion Practice Vol. 22, No. 5 ( 2021-09), p. 676-684
    Details
    In: Health Promotion Practice, SAGE Publications, Vol. 22, No. 5 ( 2021-09), p. 676-684
    Abstract: The community readiness model (CRM) was used to assess changes in community readiness across four counties in Georgia that were targeted as part of a 3-year Childhood Obesity Prevention Program. Key respondent interviews were conducted with community stakeholders in 2012 (n = 20) and 2017 (n = 18) using a semistructured questionnaire assessing six dimensions of community readiness (i.e., community efforts, community knowledge of efforts, leadership, community climate, community knowledge about the issue, and resources available to support efforts). Interviews were analyzed using the CRM scoring protocol and qualitative methods. Paired t tests were used to compare mean score differences between baseline and follow-up assessments. At baseline, overall mean readiness scores for the four counties ranged from 4.52 to 5.05 on the CRM 9-point scale. At follow-up, overall readiness scores ranged from 6.01 to 6.97 out of 9.00. Data revealed a statistically significant improvement in scores across all communities (+1.70, p = .007; 95% confidence interval [0.87, 2.51] ). Data also revealed statistically significant improvements in every dimension of readiness, except community knowledge of the issue. Information gleaned from interviews suggested that investing in staff to support efforts, building awareness to shift the community climate, and cross sector collaboration contributed to improved community readiness among the study communities. The provision of technical assistance, peer learning opportunities, and financial support as part of a cooperative grant initiative holds promise for increasing the capacity of community coalitions to advance childhood obesity prevention efforts in their local communities.
    Type of Medium: Online Resource
    ISSN: 1524-8399 , 1552-6372
    URL: Article
    DOI: 10.1177/1524839920917127
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2036801-X
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