IMPORTANCE: Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are ...unclear. OBJECTIVE: To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. DESIGN, SETTING, AND PARTICIPANTS: Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021. EXPOSURES: Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). MAIN OUTCOMES AND MEASURES: Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes. RESULTS: Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%). CONCLUSIONS AND RELEVANCE: Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.
Placing full-service supermarkets in food deserts--areas with limited access to healthy food--has been promoted as a way to reduce inequalities in access to healthy food, improve diet, and reduce the ...risk of obesity. However, previous studies provide scant evidence of such impacts. We surveyed households in two Pittsburgh, Pennsylvania, neighborhoods in 2011 and 2014, one of which received a new supermarket in 2013. Comparing trends in the two neighborhoods, we obtained evidence of multiple positive impacts from new supermarket placement. In the new supermarket neighborhood we found net positive changes in overall dietary quality; average daily intakes of kilocalories and added sugars; and percentage of kilocalories from solid fats, added sugars, and alcohol. However, the only positive outcome in the recipient neighborhood specifically associated with regular use of the new supermarket was improved perceived access to healthy food. We did not observe differential improvement between the neighborhoods in fruit and vegetable intake, whole grain consumption, or body mass index. Incentivizing supermarkets to locate in food deserts is appropriate. However, efforts should proceed with caution, until the mechanisms by which the stores affect diet and their ability to influence weight status are better understood.
To provide a richer understanding of food access and purchasing practices among US urban food desert residents and their association with diet and BMI.
Data on food purchasing practices, dietary ...intake, height and weight from the primary food shopper in randomly selected households (n 1372) were collected. Audits of all neighbourhood food stores (n 24) and the most-frequented stores outside the neighbourhood (n 16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and BMI were conducted.
Two low-income, predominantly African-American neighbourhoods with limited access to healthy food in Pittsburgh, PA, USA.
Household food shoppers.
Only one neighbourhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighbourhood. Although the nearest full-service supermarket was an average of 2·6 km from their home, respondents shopped an average of 6·0 km from home. The average trip was by car, took approximately 2 h for the round trip, and occurred two to four times per month. Respondents spent approximately $US 37 per person per week on food. Those who made longer trips had access to cars, shopped less often and spent less money per person. Those who travelled further when they shopped had higher BMI, but most residents already shopped where healthy foods were available, and physical distance from full-service supermarkets was unrelated to weight or dietary quality.
Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought, and thus policy and interventions that focus merely on improving access may not be effective.
Objective
To examine perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to ...assess whether these barriers and strategies varied by locality.
Methods
We developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. We compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs. rural; suburban vs. rural and city vs. suburban).
Results
More than half of schools located in cities expected nine of ten potential barriers to affect the delivery of school-based health services during Fall 2021. More than 50% of responding schools located in urban, suburban and rural area indicated that external barriers outside of their control, including insufficient funding and families not able to bring students to school, were likely to be barriers to delivering care. Strategies identified as “very effective” did not vary by locality. Across all localities, more schools reported virtual strategies were less effective than in-person strategies.
Conclusions for Practice
Lessons from the early stages of the COVID-19 pandemic provide critical information for natural disaster and public health emergency preparedness. School locality should be considered in the development of plans to continue the delivery of school-based health services after natural disasters or during public health emergencies.
Significance
What is already known on this subject?
Little is known about the impact of the COVID-19 pandemic on the provision of school-based health services and whether geographic locality of schools was associated with the ability of schools to continue to deliver health services on-site.
What this study adds?
Geographic locality was associated with barriers to deliver school-based health services during the Fall 2021 but not strategies used to deliver services. More schools in cities reported higher rates of anticipated barriers than schools located in suburban and rural areas. Strategies used and deemed to be effective did not vary across locality. In-person strategies were more likely than virtual strategies to be reported as very effective.
ABSTRACT
BACKGROUND
Schools have a long history of delivering health services, but it is unclear how the COVID‐19 pandemic may have disrupted this. This study examined changes in school‐based health ...services and student needs before and during the pandemic and the factors important for delivering school‐based health services.
METHODS
A web‐based survey regarding the impact of the pandemic on school‐based health services was distributed via email to all 1178 Virginia public elementary schools during May 2021.
RESULTS
Responding schools (N = 767, response rate = 65%) reported providing fewer school‐based health services during the 2020‐2021 school year than before the pandemic, with the largest declines reported for dental screenings (51% vs 15%) and dental services (40% vs 12%). Reports show that mental health was a top concern for students increased from 15% before the pandemic to 27% (P < .001). Support from families and school staff were identified by most respondents (86% and 83%, respectively) as very important for the delivery of school‐based health services.
CONCLUSIONS
Schools reported delivering fewer health services to students during the 2020‐2021 school year and heightened concern about students' mental health. Understanding what schools need to deliver health services can assist state and local education and health officials and promote child health.
This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease.
A comprehensive ...literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. Structure: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.
Purpose: This study examines school climate and student achievement trends under an ambitious school leadership residency program in an urban school district. The 2-year leadership residencies were ...intensive, combining at least 370 hours of professional development with on-the-job training, in which aspiring school principals held either assistant-level administrative or teacher leadership roles. Research Design: Using a difference-in-differences framework with school fixed effects, we estimate the relationship between schools’ cumulative exposure to program residents and measures of school climate and student performance. We measure school climate using school-by-semester teacher survey composites. Student performance is captured using school-by-year data on language arts and math scale scores, chronic absence rates, suspension rates, and graduation rates. Findings: In models that allow average time trends to vary between the state and the treatment city, an additional resident-by-year in an administrative role in high schools is linked to an additional 15% of a school-level standard deviation in math scale scores and an additional 3.6 percentage points in graduation rates, but also to an additional 10 percentage points in suspension rates. Results are sensitive to model specification, school level, and to residents’ placement in administrative or teacher leader roles. Implications: Due to the contracting nature of the district, only one of 30 entering residents became a school principal within 3 years of program inception. In some models, the estimates suggest potential for aspiring leaders to effect change from nonprincipal administrative roles. Potential for teacher leadership roles is less clear.
In the current educational context, school models that leverage technology to personalize instruction have proliferated, as has student enrollment in, and funding of, such school models. However, ...even the best laid plans are subject to challenges in design and practice, particularly in the dynamic context of a school. In this collective case study, we identify challenges, disruptions, and contradictions as they occur across schools engaged in implementing technology-mediated personalized learning. Using cultural historical activity theory—a theoretical framework concerned with the individual and contextual factors influencing school change—to frame the analysis, we also examine some of the structural and contextual sources of these disruptions and contradictions. Our findings enable us to offer recommendations for policymakers and for practitioners engaged in implementing personalized learning models, as well as directions for future research on this topic.
Local health departments (LHDs) play an important role in ensuring essential public health services. Geographic information system (GIS) technology offers a promising means for LHDs to identify ...geographic gaps between areas of need and the reach of public health services. We examined how large LHDs could better inform planning and investments by using GIS-based methodologies to align community needs and health outcomes with public health programs. We present a framework to drive LHDs in identifying and addressing gaps or mismatches in services or health outcomes.
This report examines achievement in 62 schools pursuing a variety of personalized learning practices, and implementation details in 32 of the schools. It uses data from site visits, interviews, and ...surveys to create a broad picture of efforts to implement personalized learning and the perceptions of teachers and students. Achievement data for personalized learning students are compared to a matched group of students attending other schools.
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