Child Care in the Time of Coronavirus Disease-19: A Period of Challenge and Opportunity

Consensus-Driven Recommendations to Support Physician Pregnancy, Adoption, Surrogacy, Parental Leave, and Lactation in Emergency Medicine

The emergency department clinical environment is unique, and guidelines for promoting supportive and equitable workplace cultures ensure success and longevity for pregnant persons and parents in emergency medicine. There is paucity, variability, and dissatisfaction with current parental (historically referred to as maternity and paternity) leave policies. This paper describes the development of consensus-derived recommendations to serve as a framework for emergency departments across the country for incorporating family-friendly policies. Policies that foster a family-inclusive workplace by allowing for professional advancement without sacrificing personal values regardless of sex, gender, and gender identity are critical for emergency medicine recruitment and retention.

Socioeconomic status and pediatric cochlear implant usage during COVID-19

OBJECTIVE

COVID-19 (COVID) delayed access to speech and hearing services. The objective of this study was to identify interactions between socioeconomic status (SES) and cochlear implant (CI) usage during COVID.

METHODS

Consecutive pediatric patients (age 0-17) with CI and audiology visits between 2019 and 2022 at a tertiary care children's hospital were reviewed. Age, sex, race, insurance type, and proxy measures for SES using zip code were recorded. Hours spent with CI on and in different listening environments were compared between pre-COVID (1/1/2019-12/31/2019), COVID (4/1/2020-3/31/2021), and most recent (6/1/2021-5/31/2022) time periods.

RESULTS

Most patients were male (32/59, 54 % ears of 48 patients) and White, non-Hispanic (45/59, 76 %). Median age at implant was 2.0 years (range:0.6-12.2). There were no significant differences in hours spent with CI on during COVID compared with pre-COVID. However, children spent more time listening to louder noises (70-79 dB and ≥80 dB) recently compared with during COVID (p = 0.01 and 0.006, respectively). During COVID, children living in areas with greater educational attainment showed smaller reductions in total hours with CI on (β = 0.1, p = 0.02) and hours listening to speech in noise (β = 0.03, p = 0.005) compared with pre-COVID. In the most recent time period, children of minority race (β = -3.94 p = 0.008) and those who were older at implant (β = -0.630, p = 0.02) were more likely to experience reductions in total hours with CI on compared with during COVID.

CONCLUSION

Interventions which mitigate barriers of implant use and promote rich listening home-environments for at risk populations should be implemented during challenging future social and environmental conditions.

Incidence and Transmission of SARS-CoV-2 in US Child Care Centers After COVID-19 Vaccines

Importance

SARS-CoV-2 surveillance studies in US child care centers (CCCs) in the post-COVID-19 vaccine era are needed to provide information on incidence and transmission in this setting.

Objective

To characterize SARS-CoV-2 incidence and transmission in children attending CCCs (students) and their child care providers (CCPs) and household contacts.

Design, Setting, and Participants

This prospective surveillance cohort study was conducted from April 22, 2021, through March 31, 2022, and included 11 CCCs in 2 cities. A subset (surveillance group) of CCPs and students participated in active surveillance (weekly reverse transcription-polymerase chain reaction [RT-PCR] swabs, symptom diaries, and optional baseline and end-of-study SARS-CoV-2 serologic testing), as well as all household contacts of surveillance students. Child care center directors reported weekly deidentified self-reported COVID-19 cases from all CCPs and students (self-report group).

Exposure

SARS-CoV-2 infection in CCC students.

Main Outcomes and Measures

SARS-CoV-2 incidence, secondary attack rates, and transmission patterns were determined from diary entries, self-reports to CCC directors, and case logs. Incidence rate ratios were measured using Poisson regression clustering on centers with a random intercept and unstructured matrix.

Results

From a total population of 1154 students and 402 CCPs who self-reported cases to center directors, 83 students (7.2%; mean [SD] age, 3.86 [1.64] years; 55 male [66%]), their 134 household contacts (118 adults [mean (SD) age, 38.39 (5.07) years; 62 female (53%)], 16 children [mean (SD) age, 4.73 (3.37) years; 8 female (50%)]), and 21 CCPs (5.2%; mean [SD] age, 38.5 [12.9] years; 18 female [86%]) participated in weekly active surveillance. There were 154 student cases (13%) and 87 CCP cases (22%), as defined by positive SARS-CoV-2 RT-PCR or home antigen results. Surveillance students had a higher incidence rate than self-report students (incidence rate ratio, 1.9; 95% CI, 1.1-3.3; P = .01). Students were more likely than CCPs to have asymptomatic infection (34% vs 8%, P < .001). The CCC secondary attack rate was 2.7% to 3.0%, with the upper range representing possible but not definite secondary cases. Whether the index case was a student or CCP, transmission within the CCC was not significantly different. Household cumulative incidence was 20.5%, with no significant difference in incidence rate ratio between adults and children. Household secondary attack rates were 50% for children and 67% for adults. Of 30 household cases, only 5 (17%) represented secondary infections caused by 3 students who acquired SARS-CoV-2 from their CCC. Pre- and poststudy seroprevalence rates were 3% and 22%, respectively, with 90% concordance with antigen or RT-PCR results.

Conclusions and Relevance

In this study of SARS-CoV-2 incidence and transmission in CCCs and students' households, transmission within CCCs and from children infected at CCCs into households was low. These findings suggest that current testing and exclusion recommendations for SARS-CoV-2 in CCCs should be aligned with those for other respiratory viruses with similar morbidity and greater transmission to households.

Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality

OBJECTIVE

To examine the relationship between the diet quality of children aged 2-5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices.

DESIGN

Cross-sectional analysis.

PARTICIPANTS

Family child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial.

MAIN OUTCOME MEASURES

Data were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index-2015.

ANALYSIS

Multilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons.

RESULTS

Children in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12-1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02-34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29-12.23; P = 0.001) had higher total Healthy Eating Index scores.

CONCLUSIONS AND IMPLICATIONS

Future interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.

Measuring the Impact of a Delay in Care on Pediatric Otolaryngologic Surgery Completion

Objective: To determine if postponement of elective pediatric otorhinolaryngology surgeries results in a change in overall healthcare utilization and if there is any commensurate impact on disease progression. Methods: We identified patients ≤18 years of age whose surgeries were postponed at the onset of the COVID-19 pandemic-related shutdown. We then tracked patients' rate of and patterns of rescheduling surgery. Surveys were also sent to caregivers to better characterize his/her decision regarding moving forward with his/her child's surgery during COVID-19. Results: A total of 1915 pediatric patients had elective surgeries canceled, of which 992 (51.8%) were rescheduled within 4 months. No difference in rates of rescheduling was identified based on race or ethnicity. Patients who were scheduled for tonsillectomies and/or adenoidectomies were 1.22 times more likely to reschedule compared to those patients with other planned procedures (CI: 1.02-1.46). A total of 95 caregivers at two hospitals completed surveys: 44 (47.4%) rescheduled their child's surgery. Most caregivers who rescheduled were concerned their child's disease could impact their future (n = 14, 32%). Conclusions: Just over half of patients who had pediatric otolaryngologic surgery canceled during a period of social distancing went on to have surgery within a 4-month timeframe. This reflects the dependence of pediatric otolaryngologic surgery on environmental exposures and may represent a potential target for prevention and management of some pediatric otolaryngology diseases.

Challenges to infection control in early communication intervention: A scoping review

Background: Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech–language therapists (SLTs) use IPC measures for providing early communication intervention (ECI).Objectives: To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1–5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review).Method: A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis.Results: Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies.Conclusion: This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.

Early childhood educators' psychological distress and wellbeing during the COVID-19 pandemic

There is growing awareness of the impacts of COVID-19 on children, families, and more recently, early childhood educators. This study aimed to add to this research and explore Australian early childhood educators' psychological distress and wellbeing in relation to COVID-19. Accordingly, 205 educators (117 early childhood educators, 86 leaders and 2 others) completed the Impact of Event Scale-Revised, measuring levels of post-traumatic distress, and an open-ended question on wellbeing, both in relation to COVID-19. Educators' responses to the open-ended question were matched to those who scored high, medium, and low on the Impact of Events Scale-Revised. Results demonstrated 66.8% of educators scored in the low range for post-traumatic distress, 11.7% scored in the moderate range, and 21.5% scored in the high range for post-traumatic distress on the Impact of Events Scale-Revised. Participants scoring in the low range on the Impact of Events Scale-Revised provided fewer comments regarding the emotional impacts of COVID-19. There were no differences between the groups in terms of fear of COVID-19 infection, challenges related to increased workload during the pandemic, and frustration with the Australian government response to COVID-19. Educators and early childhood leaders reported comparable wellbeing challenges during the pandemic. This research has implications for the types of support provided to educators during future pandemics.

The Impact of the Implementation of Preventive Measures Due to COVID-19 on Work Design and Early Childhood Professionals' Well-Being-A Qualitative Study

The reopening of child-care programs during COVID-19 demanded comprehensive preventive measures. Research to date has overlooked this reopening process as well as early childhood professionals’ (ECPs) implementation efforts and resulting changes in their work practices and well-being. As a result, this study sought insights into (1) the practical implementation of measures, (2) perceptions and evaluations of measures, (3) changes in work characteristics, and (4) its impact on well-being. Qualitative interviews were conducted with German child-care managers (N = 27) between June and August 2020. The semi-structured interviews were audio-recorded, transcribed, and content-analyzed using MAXQDA. ECPs, through a combination of high effort and engagement, ensured the feasibility of most preventive measures. This included practices which were perceived to be unreasonable or ones which were stricter than practices required for the public. This exacerbated the critical work characteristics (e.g., high workload, overtime, and multitasking) from pre-pandemic scenarios and led to new work demands (e.g., changes in work content and social interactions). ECPs maintained intensive work demands and consequently suffered from broad strain outcomes (e.g., worry, exhaustion, anger, fear of infection, and reduced psychological sense of community). This study highlights the adverse psychosocial work environment of ECPs despite the necessity of ensuring health and safety at work.

Expanding Surveillance Toward Sharing Data with the Community: Qualitative Insights from a Childcare Center Illness Surveillance Program

Childcare attendance is a recognized independent risk factor for pediatric infectious diseases due to the pathogen-sharing behaviors of young children and the crowded environments of childcare programs. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is a novel online illness surveillance network used by community childcare centers to track disease incidence. It has been used to warn local public health departments about emerging outbreaks. The flow of data from MCRISP, however, remains largely unidirectional-from data reporter to public health researchers. With the intent to ultimately improve the system for users, we wanted to better understand how community illness data collected by MCRISP might best benefit childcare stakeholders themselves. Using a ground-up design approach, we conducted a series of focus groups among childcare directors participating in MCRISP. All primary data reporters from each of the 30 MCRISP-affiliated childcare centers were eligible to participate in the focus groups. A thematic assessment from the focus groups revealed that participants wanted surveillance system improvements that would (1) support subjective experiences with objective data, (2) assist with program decision making, (3) provide educational resources, and (4) prioritize the user's experience. Our findings support a framework by which community disease surveillance networks can move toward greater transparency and 2-way data flow. Ultimately, a more mutually beneficial surveillance system improves stakeholder engagement, provides opportunities for rapid mitigation strategies, and can help allocate timely resources in responding to emerging outbreaks and pandemics.

Associations Between Change in Outside Time Pre- and Post-COVID-19 Public Health Restrictions and Mental Health: Brief Research Report

The novel coronavirus disease 2019 (COVID-19) and associated pandemic has resulted in systemic changes to much of life, affecting both physical and mental health. Time spent outside is associated with positive mental health; however, opportunities to be outside were likely affected by the COVID-19 public health restrictions that encouraged people not to leave their homes unless it was required. This study investigated the impact of acute COVID-19 public health restrictions on outside time in April 2020, and quantified the association between outside time and both stress and positive mental health, using secondary analyses of cross-sectional data from the COVID and Well-being Study. Participants (n = 3,291) reported demographics, health behaviors, amount of time they spent outside pre/post COVID-19 public health restrictions (categorized as increased, maintained, or decreased), current stress (Perceived Stress Scale-4), and positive mental health (Short Warwick-Edinburgh Mental Well-being Scale). Outside time was lower following COVID-19 restrictions (p < 0.001; Cohen's d = −0.19). Participants who increased or maintained outside time following COVID-19 restrictions reported lower stress (p < 0.001, 5.93 [5.74–6.12], Hedges' g = −0.18; p < 0.001, mean = 5.85 [5.67–6.02], Hedges' g = −0.21; respectively) and higher positive mental health (p < 0.001, 24.49 [24.20–24.77], Hedges' g = 0.21; p < 0.001, 24.78 [24.52–25.03], Hedges' g = 0.28) compared to those who decreased outside time. These findings indicate that there are likely to be negative stress and mental health implications if strategies are not implemented to encourage and maintain safe time outside during large-scale workplace and societal changes (e.g., during a pandemic).

Impacts of the COVID-19 Pandemic on Life of Higher Education Students: A Global Perspective

The paper presents the most comprehensive and large-scale study to date on how students perceive the impacts of the first wave of COVID-19 crisis in early 2020 on various aspects of their lives on a global level. With a sample of 30,383 students from 62 countries, the study reveals that amid the worldwide lockdown and transition to online learning students were most satisfied with the support provided by teaching staff and their universities’ public relations. Still, deficient computer skills and the perception of a higher workload prevented them from perceiving their own improved performance in the new teaching environment. Students were mainly concerned about issues to do with their future professional career and studies, and experienced boredom, anxiety, and frustration. The pandemic has led to the adoption of particular hygienic behaviours (e.g., wearing masks, washing hands) and discouraged certain daily practices (e.g., leaving home, shaking hands). Students were also more satisfied with the role played by hospitals and universities during the epidemic compared to the governments and banks. The findings also show that students with certain socio-demographic characteristics (male, part-time, first-level, applied sciences, a lower living standard, from Africa or Asia) were significantly less satisfied with their academic work/life during the crisis, whereas female, full-time, first-level students and students faced with financial problems were generally affected more by the pandemic in terms of their emotional life and personal circumstances. Key factors influencing students’ satisfaction with the role of their university are also identified. Policymakers and higher education institutions around the world may benefit from these findings while formulating policy recommendations and strategies to support students during this and any future pandemics.