Physical activity (PA) and limited screen media use are key behaviors for healthy development in early childhood. This study aimed to investigate 12-month trajectories of PA and screen time among toddlers, and to examine their associations with parenting practices. This study used data from the Child and Mother PA Study (CAMPAS) collected at approximately 12, 18, and 24 months of age (waves 1–3). CAMPAS included 139 toddler-mother dyads residing in the Chicago area who were recruited between 2022 and 2024. Toddlers’ PA was measured using hip-worn ActiGraph accelerometers and their screen time was reported by mothers. The Preschooler PA Parenting Practices (PPAPP) questionnaire was used to assess PA-encouraging and screen time-limiting parenting practices. Mixed-effects models were fit to model trajectories of moderate- and vigorous-intensity PA (MVPA) and screen time over age. Multivariable mixed-effects regression models examined the associations between toddlers’ MVPA and screen time and their parents’ parenting practice scores. Analyses included 139 toddler-mother dyads (53.2

BACKGROUND: Teaching in Health Professions Education (HPE) is complex, with educators balancing teaching, clinical, and scholarly responsibilities. Medical, nursing, and other health professional schools have created units to move HPE forward. However, little is known about how these units have evolved over the past 15 years. This study explored the landscape of HPE units in Eastern, Southern, and Western Africa, their evolution, functions, challenges, and opportunities for continued growth. METHODS: This exploratory qualitative study used purposive sampling to recruit HPE professionals from educational institutions across ESWA. Recruitment methods included self-identification on a survey, snowball sampling, and direct outreach by the research team which included HPE professionals from ESWA. This team co-developed a semi-structured interview guide and conducted interviews via Zoom. This project used a content analysis approach to understand the functions, challenges and opportunities of these units. Transcripts were coded in Dedoose and exported by code for review, discussion, and categorization. RESULTS: We conducted 22 interviews from 21 institutions in 9 countries. Most units are approximately 20 years old. Units sit in various locations within institutions, for example at a faculty-level, within the Dean’s office, or as a stand-alone department. There is also heterogeneity in funding sources and staff size. The most common activities are Faculty development; Research in health professions education; Curriculum development, review, renewal, and implementation; and Teaching and training. Noted challenges HPE units face are human resource issues due to lack of adequately trained faculty and the inability to hire them; tension between clinical and educator identities; and institutional incentives that are not aligned to quality teaching. Despite these challenges, units are experiencing major successes such as reshaping perspectives on thinking and learning within their institutions, influencing curricula, and creating graduate programs in HPE. CONCLUSIONS: The charge of HPE units in ESWA remains much the same as it was in prior studies with similar functions, challenges and opportunities. This study adds important context around these activities, helping to understand opportunities for growth, such as establishing and entrenching an HPE professional identity and promoting collaborations as ways to strengthen and accelerate HPE units in ESWA.

Early childhood is a critical window of rapid neurocognitive and social-emotional development. Toddlerhood (age 1–2 years), in particular, is characterized by rapid changes in both screen media exposure and movement behaviors. This study examined associations between changes in daily screen time and moderate- to vigorous-intensity physical activity (MVPA) from ages 1.5 to 2.5 years and social-emotional functioning at age 2.5 years. This study analyzed data from the Child and Mother Physical Activity Study (CAMPAS). Daily screen time was proxy-reported by mothers, and MVPA was measured using hip-worn ActiGraph accelerometers. Social-emotional functioning at age 2.5 years was assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression models predicted SDQ scores at age 2.5 years, including annualized changes in screen time and MVPA as primary predictors, adjusting for age, sex, neighborhood resources, and baseline SDQ scores. Analysis included 116 children (53

BACKGROUND:Both suicides and unintentional drug overdose deaths have risen dramatically over the last two decades in the USA. However, the classification of death manner intent can be a challenge for death investigators in drug poisoning deaths. This study assessed whether county death investigation system type was a predictive factor in the likelihood of 'undetermined' intent death classifications. METHODS:This study examines the association between undetermined intent classifications and death investigation systems among drug poisoning deaths in the USA. With novel data from the Centres for Disease Control and Prevention and from the State Unintentional Drug Overdose Reporting System in nine states, we used logistic regression models to analyse whether county coroner systems were differentially associated with 'undetermined' intent death classifications as compared with county medical examiner systems. RESULTS:County coroner systems were associated with increased odds of undetermined intent classifications in drug poisoning deaths as compared with county medical examiner systems (OR: 1.79; 95% CI 1.43 to 2.27). Even after a full set of county and individual decedent controls, the association remained (adjusted OR: 1.60; 95% CI 1.25 to 2.05). CONCLUSIONS:Future work should examine ways to identify suicides in drug poisoning deaths, as the consequences of misclassification echo forward into data used for prevention. The type of death investigation system may be an important factor in how drug poisoning deaths are classified.

Background:The Movement Behavior Questionnaire-Child (MBQ-C) is a caregiver-reported tool designed to assess 24-hour movement behaviors (physical activity [PA], sleep, and screen time) in children under age 5 years who are able to walk. This study evaluated the test-retest reliability and convergent validity of the MBQ-C PA domain among toddlers aged 1-2 years. Method:This ancillary study was conducted within the Child and Mother Physical Activity Study (CAMPAS), a longitudinal cohort examining early childhood PA development. Toddlers aged 1-2 years wore an ActiGraph wGT3X-BT accelerometer on the hip for 7 consecutive days. Mothers completed the MBQ-C PA domain twice, once before and once after the wear. The domain included four items assessing time spent in active play (categorical responses from 0 minutes to > 4 hours per day) and energetic play (categorical responses from 0 minutes to > 2 hours per day) on a typical weekday and weekend day. Responses were converted to minutes per day using the midpoints of categorical ranges. Test-retest reliability was evaluated using intraclass correlation coefficients (ICCs). Convergent validity was examined using Spearman correlations between MBQ-C-derived and accelerometer-derived PA metrics. Results:A total of 71 toddler-mother dyads were included in analysis (child age = 24 ± 4 months; range = 16-34 months). The proportions of respondents reporting "0 minutes" on the four MBQ-C PA items ranged from 0-10%. No respondents reported the highest response to any MBQ-C PA items, indicating no to minimal floor and ceiling effects. Accelerometer-derived mean acceleration was 21.0 ± 4.5 mg. Accelerometer-derived total PA and moderate- and vigorous-intensity PA were 245 ± 42 and 79 ± 23 minutes/day, respectively. Test-retest reliability was poor for active play (ICC = 0.45; 95% CI = 0.20, 0.64) and moderate for energetic play (ICC = 0.57; 95% CI = 0.38, 0.76), respectively. MBQ-C-derived PA estimates were not correlated with accelerometer-derived PA estimates (ρ=-0.18 to 0.07; all p > 0.05). Conclusion:Among toddlers aged 1-2 years, the MBQ-C PA domain demonstrated poor to moderate test-retest reliability and very low convergent validity relative to accelerometer-derived PA measures. These findings underscore the challenges of accurately capturing toddlers' PA through caregiver report, given the highly sporadic and unstructured nature of movement at this age.

BACKGROUND:This study updates the COVID-19 pandemic surveillance in East Asia and the Pacific region that we first conducted in 2020 with 2 additional years of data for the region. OBJECTIVE:First, we aimed to measure whether there was an expansion or contraction of the pandemic in East Asia and the Pacific region when the World Health Organization (WHO) declared the end of the COVID-19 public health emergency of international concern on May 5, 2023. Second, we used dynamic and genomic surveillance methods to describe the dynamic history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Finally, we aimed to provide historical context for the course of the pandemic in East Asia and the Pacific region. METHODS:In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether the regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. RESULTS:Several countries in East Asia and the Pacific region had COVID-19 transmission rates above an outbreak threshold at the point of the WHO declaration (Brunei, New Zealand, Australia, and South Korea). However, the regional transmission rate had remained below the outbreak threshold for 4 months. In the rolling 6-month window t test for regional outbreak status, the final P value ≤.10 implies a rejection of the null hypothesis (at the α=.10 level) that the region as a whole was not in an outbreak for the period from November 5, 2022, to May 5, 2023. From January 2022 onward, nearly every sequenced SARS-CoV-2 specimen in the region was identified as the Omicron variant. CONCLUSIONS:While COVID-19 continued to circulate in East Asia and the Pacific region, transmission rates had fallen below outbreak status by the time of the WHO declaration. Compared to other global regions, East Asia and the Pacific region had the latest outbreaks driven by the Omicron variant. COVID-19 appears to be endemic in the region, no longer reaching the threshold for a pandemic definition. However, the late outbreaks raise uncertainty about whether the pandemic was truly over in the region at the time of the WHO declaration.

Background: This study updates the initial COVID-19 pandemic surveillance in sub-Saharan Africa (SSA) from 2020 byproviding 2 additional years of data for the region. Objective: First, we aimed to measure whether there was an expansion or contraction in the pandemic in SSA when the WorldHealth Organization (WHO) declared an end to the public health emergency for the COVID-19 pandemic on May 5, 2023. Second,we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the windowof the WHO declaration within the broader history. Third, we aimed to provide historical context for the course of the pandemicin SSA. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study by Postet al (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data(GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect cladedesignations from sequences and used Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducteda 1-sided t-test to assess whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iterativelywith a rolling 6-month window of data across the sample period. Results: Speed for the region remained well below the outbreak threshold before and after the WHO declaration. Accelerationand jerk were also low and stable. The 7-day persistence coefficient remained somewhat large (1.11) and statistically significant.However, both shift parameters for the weeks around the WHO declaration were negative, meaning the clustering effect of new COVID-19 cases had become recently smaller. From November 2021 onward, Omicron was the predominant variant of concernin sequenced viral samples. The rolling t-test of speed equal to 10 was insignificant for the entire sample period. Conclusions: While COVID-19 continues to circulate in SSA, the region never reached outbreak status, and the weeklytransmission rate remained below 1 case per 100,000 population for well over 1 year ahead of the WHO declaration. COVID-19is endemic in the region and no longer reaches the threshold for its classification as a pandemic. Both standard and enhancedsurveillance metrics confirm that the pandemic ended in SSA by the time the WHO made its declaration. (JMIR Public Health Surveill 2024;10:e53409) doi: 10.2196/53409

BACKGROUND:This study updates the COVID-19 pandemic surveillance in the Middle East and North Africa (MENA) we first conducted in 2020 with 2 additional years of data for the region. OBJECTIVE:The objective of this study is to determine whether the MENA region meets the criteria for moving from a pandemic to endemic. In doing so, this study considers pandemic trends, dynamic and genomic surveillance methods, and region-specific historical context for the pandemic. These considerations continue through the World Health Organization (WHO) declaration of the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. METHODS:In addition to updates to traditional surveillance data and dynamic panel estimates from the original study by Post et al, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional weekly speed of COVID-19 spread was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data from September 4, 2020, to May 12, 2023. RESULTS:The speed of COVID-19 spread for the region had remained below the outbreak threshold for 7 continuous months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant and positive, the weekly shift parameters suggested the coefficients had most recently turned negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of the speed of spread equal to 10 became entirely insignificant from October 2022 onward. CONCLUSIONS:The COVID-19 pandemic had far-reaching effects on MENA, impacting health care systems, economies, and social well-being. Although COVID-19 continues to circulate in the MENA region, the rate of transmission remained well below the threshold of an outbreak for over 1 year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. Both standard and enhanced surveillance metrics confirm that the pandemic had transitioned to endemic by the time of the WHO declaration.

Background Human mobility data have been used as a potential novel data source to guide policies and response planning during the COVID-19 global pandemic. The COVID-19 Mobility Data Network (CMDN) facilitated the use of human mobility data around the world. Both researchers and policy makers assumed that mobility data would provide insights to help policy makers and response planners. However, evidence that human mobility data were operationally useful and provided added value for public health response planners remains largely unknown. Objective This exploratory study focuses on advancing the understanding of the use of human mobility data during the early phase of the COVID-19 pandemic. The study explored how researchers and practitioners around the world used these data in response planning and policy making, focusing on processing data and human factors enabling or hindering use of the data. Methods Our project was based on phenomenology and used an inductive approach to thematic analysis. Transcripts were open-coded to create the codebook that was then applied by 2 team members who blind-coded all transcripts. Consensus coding was used for coding discrepancies. Results Interviews were conducted with 45 individuals during the early period of the COVID-19 pandemic. Although some teams used mobility data for response planning, few were able to describe their uses in policy making, and there were no standardized ways that teams used mobility data. Mobility data played a larger role in providing situational awareness for government partners, helping to understand where people were moving in relation to the spread of COVID-19 variants and reactions to stay-at-home orders. Interviewees who felt they were more successful using mobility data often cited an individual who was able to answer general questions about mobility data; provide interactive feedback on results; and enable a 2-way communication exchange about data, meaning, value, and potential use. Conclusions Human mobility data were used as a novel data source in the COVID-19 pandemic by a network of academic researchers and practitioners using privacy-preserving and anonymized mobility data. This study reflects the processes in analyzing and communicating human mobility data, as well as how these data were used in response planning and how the data were intended for use in policy making. The study reveals several valuable use cases. Ultimately, the role of a data translator was crucial in understanding the complexities of this novel data source. With this role, teams were able to adapt workflows, visualizations, and reports to align with end users and decision makers while communicating this information meaningfully to address the goals of responders and policy makers.

Background With the rapid growth of Nigeria’s older population, it has become important to establish age-friendly healthcare systems that support care for older people. This study aimed to explore the barriers and facilitators to the delivery of age-friendly health services from the perspectives of primary healthcare managers in Lagos State, Nigeria. Method We conducted 13 key informant interviews including medical officers of health, principal officers of the (Primary Health Care) PHC Board and board members at the state level. Using a grounded theory approach, qualitative data analysis was initially done by rapid thematic analysis followed by constant comparative analysis using Dedoose software to create a codebook. Three teams of two coders each blind-coded the interviews, resolved coding discrepancies, and reviewed excerpts by code to extract themes. Results The main barriers to the delivery of age-friendly services included the lack of recognition of older adults as a priority population group; absence of PHC policies targeted to serve older adults specifically; limited training in care of older adults; lack of dedicated funding for care services for older adults and data disaggregated by age to drive decision-making. Key facilitators included an acknowledged mission of the PHCs to provide services for all ages; opportunities for the enhancement of older adult care; availability of a new building template that supports facility design which is more age-friendly; access to basic health care funds; and a positive attitude towards capacity building for existing workforce. Conclusion While we identified a number of challenges, these offer opportunities to strengthen and prioritize services for older adults in PHCs and build on existing facilitators. Work is needed to identify and test interventions to overcome these challenges and improve the responsiveness of the PHC system to older adults through the delivery of age-friendly health services in PHCs in Lagos, Nigeria.

Abstract Background: The United States has the unfortunate distinction of spending much more on healthcare than other countries around the world while also having poorer health outcomes.Understanding the economic and social impacts of solutions to the current state of high healthcare costs and poor outcomes is critical both from an economic and social perspective. A detailed investigation into the costs and benefits, both economic and social, is needed to understand the impact of implementing a universal healthcare model in the US. Methods: We conducted a rapid scoping review of recent literature related to universal healthcare in the United States to identify its potential economic and social impacts. We searched PubMed and Google Scholar articles published between 2020-2023, in English, and focused on universal healthcare in the US. Exclusion criteria included discussions of medical conditions without a specific tie to universal coverage, books, political think tank publications, graduate student scholarship, reference chapters in encyclopedias, and duplicate articles. Two researchers reviewed, summarized, and coded the sources. Results: Our search yielded 2070 results with 67 documents included in the final scoping review. Analysis uncovered five themes related to the economic impact of implementing a universal healthcare model in the US: 1) government spending, 2) individual spending and income, 3) national health expenditures, 4) impact on the US’s gross domestic product and economy, and 5) impacts on specific costs and cost-controls. Identified social impacts included 1) healthcare access, utilization, and health outcomes, 2) quality of care, 3) patient and provider experience, 4) individual and societal externalities, 5) potential opposition and support, and 6) equity. Conclusions: On balance, the economic and social impacts of implementing a universal healthcare system in the US are overwhelmingly positive. To be sure, there will be some sectors that will not benefit from this change, many political hurdles to overcome, and valid concerns remain about ensuring the system does not duplicate and perpetuate the current system’s inequalities and inefficiencies. When looked at overall however, a universal healthcare system in the US will be vastly superior to the current system and will improve health for less money.

Background Adolescences/youth (A/Y) make the transition to adulthood in good health, but there are particular public health challenges within this age group, such as injuries from accidents or violence, mental health problems, problems from substance use, problems from undernutrition and overnutrition, endemic diseases (e.g. malaria), and sexual and reproductive health (SRH) problems. Adolescent and youth-friendly health services (AYFHSs) provide access to information and services on prevention, diagnosis, counselling, treatment, and care and allow all people to safely reach services without travelling long distances. This study aimed to describe the existing services provided for A/Y at PHCs, assess the knowledge, perceptions, and practices of AYFHS among the healthcare providers (HCPs), and understand the medical officers of health (MOHs) perceived facilitators and barriers to integration of AYFHS at PHCs in Ogun State. Methods The study was a descriptive cross-sectional with a mixed-method approach. A checklist, questionnaire, and interview guide were used to collect data from the PHCs, HCPs and MOHs, respectively. The quantitative data were analysed via SPSS version 27. Qualitative data were transcribed verbatim, analysed manually and presented in narrations using rapid, deductive thematic analysis. The level of significance was set at a P-value < 0.05. Results Ten model PHCs, 32 HCPs, and ten MOHs participated in the study. In the assessment of the facility readiness for AYFHSs, basic amenities, medical equipment, etc., were available or adequate, but there was a lack or absence of clearly visible signboards, comfortable waiting areas, displays of IEC materials, and confidentiality procedures and practices. More than 80% and 62.5% of the HCPs had good knowledge and positive perceptions of providing AYFHS, respectively. There were statistically significant associations between the overall perception scores of the respondents and the practices of some AYFHSs, such as A/Y having a consultation without an appointment (p=0.020). In the interviews with the MOHs, some factors were identified as facilitators (e.g. existing relationships with NGOs for support) and barriers (e.g. inadequate staffing) to the AYFHS. Conclusion Most of the PHCs in this study are inadequately prepared to provide AYFHSs and fall short of national recommendations. Most of the identified barriers to AYFHS integration were health system-related.

BackgroundHarm reduction for people who use drugs (PWUD) is an established evidence-based practice that encompasses a wide variety of services, delivery formats, and settings and has been named a priority in US drug policy. Harm reduction is focused on planning with communities and meeting PWUD where they are and encompasses a wide variety of interventions. We describe and report the feasibility, acceptability, and process implementation outcomes for an innovative pilot drug overdose harm reduction intervention, Block-by-Block (BXB), focused on training for and distribution of naloxone and test strips in areas identified as high risk for fatal overdoses.Case presentationBeginning operations in 2022, BXB operates in five pilot sites in four Illinois counties. Through partnerships with local organizations, BXB delivers harm reduction services in a private setting (home) or in a setting not specifically focused on serving PWUD (businesses, libraries, faith-based organizations, etc.) to reach PWUD and their friends, family and neighbors living in areas disproportionately affected by opioid overdose death. The intervention theory is based on acknowledgement that harm reduction services that require PWUD to visit a mobile unit, van or community organization, may not reach those in need or their friends, neighbors, and family for a variety of reasons including stigma associated with drug use, lack of awareness about these services, or where to locate them. Services delivered include education and training in the use of naloxone and fentanyl, xylazine and benzodiazepine test strips. Leave behind materials include naloxone, test strips and handouts with information on the intervention and local resources.ConclusionsResults to date indicate that this intervention is feasible -over half (55%) of the doors approached were answered. Acceptability of the intervention as delivered is high --people at 75% of doors that were answered were interested in and received training and/or supplies. BXB is flexible in that it has been quickly adapted to changes in community conditions, the drug supply, and shifting high risk areas as they developed. This is a promising intervention that leverages available data and resources and is readily implementable in communities with support from a central program administrator and access to geo-coded data.

OBJECTIVE To develop guidance for pediatric clinicians on how to discuss race and racism in pediatric clinical settings. METHODS We conducted a modified Delphi study from 2021 to 2022 with a panel of pediatric clinicians, psychologists, parents, and adolescents with expertise in racism and child health through scholarship or lived experience. Panelists responded to an initial survey with open-ended questions about how to talk to youth about race and racism. We coded the responses using qualitative methods and presented them back to the panelists. In iterative surveys, panelists reached a consensus on which themes were most important for the conversation. RESULTS A total of 29 of 33 panelists completed the surveys and a consensus was reached about the concepts pediatric clinicians should consider before, during, and after conversations about race and racism and impediments clinicians may face while having these discussions. Panelists agreed that it was within the pediatric clinician’s role to have these conversations. An overarching theme was the importance of having background knowledge about the systemic nature of racism. Panelists agreed that being active listeners, learning from patients, and addressing intersectionality were important for pediatric clinicians during conversations. Panelists also agreed that short- and long-term benefits may result from these conversations; however, harm could be done if pediatric clinicians do not have adequate training to conduct the conversations. CONCLUSIONS These principles can help guide conversations about race and racism in the pediatric clinical setting, equipping clinicians with tools to offer care that acknowledges and addresses the racism many of their patients face.

There is a growing focus on interventions at the health system level to promote healthy aging and provide age-friendly health services (AFHS) in low- and middle-income countries where populations are aging. This study aimed to determine the provider and facility readiness for AFHS. We developed and implemented surveys to collect PHC facility capacity and readiness to deliver AFHS and a KAP survey for facility healthcare workers based on guidelines from the WHO age-friendly tool kit and questionnaires from other studies. Direct observation and structured interviews of facility heads were conducted in a stratified random sample of 15 out of the 57 comprehensive PHC facilities in Lagos, Nigeria. One hundred and twenty providers were conveniently sampled for the KAP survey. Statistical analysis was conducted using STATA version 15 (StataCorp, College Station, Texas, USA). For facility readiness, only 13.3% of PHCs sometimes offered hearing assessment and none of the PHCs offered colorectal cancer assessment. Few (20.0%) facilities offered home services and only 1 (0.7%) had dedicated funding for care of older people. Ramps were at the entrance in 60.0% of facilities and almost half (43.3%) of the PHCs had wheelchair accessible entrances to the public toilets. The majority of HCWs (81.7%) had heard about healthy aging but only 5.0% about AFHS, only 10.8% reported formal training. Around a third knew about specific conditions which affect people as they age, including; depression (37.5%), urinary incontinence (35.0%), and falls/immobility (33.3%). Over half of the providers (54.2%) screened for malnutrition in older patients, 25.8% screened for suspected elder abuse and much less (19.2%) for delirium. This study found some areas of strength but also gaps in facility readiness as well as knowledge and training needed to support AFHS care. We recommend identifying interventions to improve the availability and delivery of care for older adults.

Background Physical activity (PA) development in toddlers (age 1 and 2 years) is not well understood, partly because of a lack of analytic tools for accelerometer-based data processing that can accurately evaluate PA among toddlers. This has led to a knowledge gap regarding how parenting practices around PA, mothers’ PA level, mothers’ parenting stress, and child developmental and behavioral problems influence PA development in early childhood. Methods The Child and Mother Physical Activity Study is a longitudinal study to observe PA development in toddlerhood and examine the influence of personal and parental characteristics on PA development. The study is designed to refine and validate an accelerometer-based machine learning algorithm for toddler activity recognition (Aim 1), apply the algorithm to compare the trajectories of toddler PA levels in males and females age 1–3 years (Aim 2), and explore the association between gross motor development and PA development in toddlerhood, as well as how parenting practices around PA, mothers’ PA, mothers’ parenting stress, and child developmental and behavioral problems are associated with toddlerhood PA development (Exploratory Aims 3a-c). Discussion This study will be one of the first to use longitudinal data to validate a machine learning activity recognition algorithm and apply the algorithm to quantify free-living ambulatory movement in toddlers. The study findings will help fill a significant methodological gap in toddler PA measurement and expand the body of knowledge on the factors influencing early childhood PA development.

This study updates the COVID-19 pandemic surveillance in Central Asia we first conducted in 2020 by providing two additional years of data for the region. The historical context provided through additional data can inform regional preparedness and early responses to infectious outbreaks of either the SARS-CoV-2 virus or future pathogens in Central Asia.

Early childhood is an important development period for establishing healthy physical activity (PA) habits. The objective of this study was to evaluate PA levels in a representative sample of U.S. preschool-aged children. The study sample included 301 participants (149 girls, 3–5 years of age) in the 2012 U.S. National Health and Examination Survey National Youth Fitness Survey. Participants were asked to wear an ActiGraph accelerometer on their wrist for 7 days. A machine learning random forest classification algorithm was applied to accelerometer data to estimate daily time spent in moderate- and vigorous-intensity PA (MVPA; the sum of minutes spent in running, walking, and other moderate- and vigorous-intensity PA) and total PA (the sum of MVPA and light-intensity PA). We estimated that U.S. preschool-aged children engaged in 28 min/day of MVPA and 361 min/day of total PA, on average. MVPA and total PA levels were not significantly different between males and females. This study revealed that U.S. preschool-aged children engage in lower levels of MVPA and higher levels of total PA than the minimum recommended by the World Health Organization.

Background:Effective cultural competency (CC) training for future health professionals is an important first step towards improving healthcare disparities (HCD). The Accreditation Council for Graduate Medical Education (ACGME) now requires that institutions train residents and faculty members in CC relevant to the patient population they serve. Methods:Using Kern's Model, we created and implemented a novel CC curriculum tailored to specific program needs in an emergency medicine residency program. Results:At the end of the curriculum, respondents reported having a better understanding of the importance of CC for their practice (p = 0.004) and of how a patient's personal and historical context affects treatment (p = 0.002). They also reported an increase in the frequency of practicing strategies to reduce bias in themselves (p < 0.001) and others (p < 0.001), as well as comfort interacting with and treating patients from different backgrounds (p < 0.001). Lastly, they reported improved preparedness to collaborate with communities to address HCD (p = 0.004) and to identify community leaders to do so (p < 0.001). Conclusions:The challenges of CC training demonstrate the need for a standard yet adaptable framework. We have designed, implemented, and evaluated a novel curriculum tailored to the specific needs of our EM residency program. The curriculum improved participants' attitudes, preparedness, and self-reported behaviors regarding CC and HCD. This framework represents an example of a successful model to meet ACGME requirements.

BACKGROUNDThe Omicron variant of SARS-CoV-2 is more transmissible than prior variants of concern (VOCs). It has caused the largest outbreaks in the pandemic, with increases in mortality and hospital hospitalizations. Early data on the spread of Omicron were captured in countries with relatively low case counts, so it was unclear how the arrival of Omicron would impact the trajectory of the pandemic in countries already experiencing high levels of community transmission of Delta.OBJECTIVEThe objective of this study is to quantify and explain the impact of Omicron on pandemic trajectories and how they differ between countries who were or were not in a Delta outbreak at the time Omicron occurred.METHODSWe used SARS-CoV-2 surveillance and genetic sequence data to classify countries into two groups: those that were in a Delta outbreak (defined by at least ten novel daily transmissions per 100,000 population) when Omicron was first sequenced in the country, and those that were not. We used trend analysis, survival curves, and dynamic panel regression models to compare outbreaks in the two groups over the period from November 1, 2021 to February 11, 2022. We summarized the outbreaks in terms of their peak rate of SARS-CoV-2 infections and the duration of time the outbreaks took to reach the peak rate.RESULTSCountries that were already in an outbreak with predominantly Delta lineages when Omicron arrived took longer to reach their peak rate and saw greater than a two-fold increase (2.04) in the average apex of the Omicron outbreak compared to countries that were not yet in outbreak.CONCLUSIONSThese results suggest that high community transmission of Delta at the time of the first detection of Omicron was not protective, but rather precluded larger outbreaks in those countries. Outbreak status may reflect a generally susceptible population, due to overlapping factors including climate, policy, and individual behavior. In the absence of strong mitigation measures, arrival of a new, more transmissible variant in these countries is therefore more likely to lead to larger outbreaks. Alternately, countries with enhanced surveillance programs and incentives may be more likely to both exist in an outbreak status and detect more cases during an outbreak, resulting in a spurious relationship. Either way, these data argue against herd immunity mitigating future outbreaks with variants that have undergone significant antigenic shifts.CLINICALTRIALNot applicable.