Suicide Risk in Adolescents During the COVID-19 Pandemic

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic created high levels of psychological distress and may have increased suicide risk. METHODS: We used the 4-item Ask Suicide-Screening Questions (ASQ) to assess suicide risk among all patients 12 to 24 years of age at a children’s hospital. We compared demographics, encounter type (telehealth or face-to-face [F2F]), and screening results from April to June 2020 (T2) to those from April to June 2019 (T1). RESULTS: Fewer patients were seen at T2 than T1 (17 986 vs 24 863). A greater proportion of visits at T2 were by telehealth (0% vs 43%). The rate of positive suicide screens was higher in T2 than in T1 (12.2% vs 11.1%, adjusted odds ration [aOR], 1.24; 95% confidence interval [CI], 1.15–1.35). The odds of a positive screen were greater for older patients (aOR of 1.12 for age in years; 95% CI, 1.10–1.14), female patients (aOR, 2.23; 95% CI, 2.00–2.48), patients with public versus private insurance (aOR, 1.88; 95% CI, 1.72–2.07), and lower for Black versus White patients (aOR, 0.85; 95% CI, 0.77–0.95). Rates of positive screens were highest among inpatients (20.0%), intermediate for emergency department patients (14.4%), and lowest in outpatient clinics (9.9%) (P < .05). CONCLUSIONS: Rates of positive suicide risk screens among adolescents rose in the pandemic’s early months with differences related to sociodemographics and visit type. Changes in health care delivery highlight the complexities of assessing and responding to mental health needs of adolescents. Additional research might determine the effects of screening methods and patient populations on screening results.

THE CONCEPT OF TEACHING MATHEMATICS IN THE 1ST GRADE OF A GENERAL EDUCATION SCHOOL

The teaching of mathematics should reflect the global trends in the development of mathematical and pedagogical scientific thought. The authors develop guidelines for studying mathematics in the 1st grade based on the Federal State Educational Standard. Thus, the structure and the form of the textbook content are described by chapter. The theoretical part should allow students to complete screening questions, univariate and multivariate tests, problems, and exercises. Each chapter of the developed textbook is divided into paragraphs, and each paragraph is divided into items. One item of theoretical material contains either a new idea to study or a set of interrelated concepts that define a new idea. According to this, it is possible to form mathematical knowledge trajectories. So, there are broad opportunities to transform knowledge elements into multimedia forms, including presentations, videos, test modules, and other newly emerging means of representation and visualization, using the achievements of artificial intelligence. It is possible to define main themes such as natural numbers counting, acquaintance with geometric shapes, comparison of objects in the value and quantity, acquaintance with a squared paper and measurement standards, the study of objects position, the sets consideration, introduction to the algorithm concept can. The authors’ conceptual directions of teaching mathematics in the 1st grade provide the foundation for mathematical education in general education schools for all the years of study.

Evaluation of A Breastfeeding Promotion Film Among A Racially Minoritized Sample

Background: In Los Angeles County (LAC), disparities in breastfeeding rates vary by race and region. Black persons are more affected by social and environmental factors than other racial/ethnic groups, leading to lower breast/chestfeeding rates. This study aims to evaluate the community’s knowledge, perceptions, experiences, barriers, and solutions regarding breast/chestfeeding among Black persons. Methods: Participant responses were collected anonymously through an online survey (via QR code) pre-and post-viewing with open- and closed-ended questions. There were 15 pre-screening questions and 24 post-screening questions. Questions included four main areas in breast/chestfeeding: current/past experiences, support, awareness of laws, and solutions. Central tendency, variance, and paired differences were calculated from evaluation responses. Results: There were 185 participants who completed the pre-screening evaluation and 57 participants who completed the post-screening evaluation. Racial/ethnic differences were found for stated reasons for attendance, and perceptions of breastfeeding being challenging after viewing the video. Most participants felt the video was relevant (median response = “2-relevant”; IQR = “3-neutral”, “1-very relevant”), learned something new (81.4%) and knew how to access breast/chestfeeding support after viewing the video (93.2%). Conclusions: Current media is a way to alter perceptions and opinions, and provides information. Additionally, it can be a way of increasing awareness of issues that Black breast/chestfeeding persons encounter. Strategic marketing efforts for future film screenings may increase attendance from those that can gain insight into breast/chestfeeding support (youth/young adults and males). Supportive breast/chestfeeding environments can also be a reality with a readily accessible, unified, and encouraging personal and professional networks.

486. Characteristics Associated with SARS-CoV-2 Infection in Children

Background We sought to describe the range of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children. Methods Patients < 18 years of age who had a positive nasopharyngeal polymerase chain reaction (PCR) for SARS-CoV-2 at a single health system in central Pennsylvania from 3/19/2020-12/31/2020 were identified. Using a random number generator, 150 additional patients < 18 years of age who had a negative PCR test were also identified. Asymptomatic patients and those without clinical data in the electronic medical record were excluded from analysis. Demographic characteristics, symptoms present at the time of testing, and outcomes were compared between PCR-positive and negative patients. Odds ratios were calculated using univariable and multivariable logistic regression models to patients with positive vs. negative PCR tests. Results We included 544 patients in analysis, 412 (76%) of which had a positive SARS-CoV-2 PCR. PCR-positive patients were statistically more likely to have a known contact, no comorbidities, and to present with cough, cold-like symptoms, headache, or loss of taste and smell. All patients who presented with loss of taste and smell were PCR positive at time of presentation. Positive patients were statistically less likely to present with fever or emesis than negative patients. Multivariable regression identified increased age, cough, cold symptoms, headache, and non-white race as predictive of PCR positivity. Patients who tested positive were statistically less likely to be admitted to the hospital and less likely to require respiratory support than negative patients. Conclusion Loss of taste and smell is a specific, though uncommon, indicator of SARS-CoV-2 infection in the pediatric population. Headache, cough, and cold-like symptoms are also suggestive of SARS-CoV-2 infection, while fever and gastrointestinal symptoms appear less common. This data suggests that screening questions developed for adults may be less applicable in children. Future research, including more dedicated and prospective studies, is warranted to identify patients in whom a positive SARS-CoV-2 test is sufficiently likely to warrant isolation and testing. Disclosures All Authors: No reported disclosures

A Questionnaire-based Survey on Depression and Anxiety among Rheumatology Patients during the COVID-19 Pandemic: Patient’s Perspective

Objectives: The Coronavirus Disease 2019 (COVID-19) outbreak is a global pandemic and has caught the attention of the rheumatology fraternity, where patients are thought to be at higher risk of infection. We aimed to study the incidence of COVID-19 infection and depression and anxiety symptoms among patients with rheumatic disease (RD) in Hospital Selayang, Malaysia, during the COVID-19 pandemic. Methods: A crosssectional study was conducted via phone interview using a structured questionnaire in patients with RD aged > 18 years old scheduled for clinic appointments from 4 to 28 May 2020, which coincided with the second wave of COVID-19 cases in Malaysia. The questionnaire included demographics, COVID-19 screening questions, depression and anxiety symptoms screening using questions derived from the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Results: Among the 361 patients enrolled, the majority were females (83.1%), and over half (54.3%) were ethnic Malays, 41.6% had rheumatoid arthritis, 34.6% had systemic lupus erythematosus, 12.2% had spondyloarthropathy, and only one (0.3%) patient had COVID-19 infection. The mean age of patients was 48.2 years (range: 16–80 years). The frequency of patients with depression and anxiety symptoms was 8.6% and 6.9%, respectively. Married patients reported feeling more anxious (p = 0.013), while patients with tertiary education levels reported feeling more depressed (p = 0.012). Conclusions: The incidence of COVID-19 infection is low, probably due to the low rate of testing. Depression and anxiety symptoms reported by patients in our cohort were modest. Our findings suggest that the COVID-19 pandemic has a greater impact on married patients with RD and those with a higher education level.

Study of incidence of allergic conjunctivitis in patients with allergic rhinitis

Background: Allergic conjunctivitis (AC) accounts for 15% of eye related consultations in primary care centers. AC is commonly manifesting as itchy or watering or red eye, comprising the symptoms of the total ocular symptom scores (TOSS). Recognition of AC is unreported even in patients with recognized AR (allergic rhinitis). Therefore, the objective of the present study was to identify the incidence of AC in patients with AR.Methods: This randomized observational study was conducted on 110 patients for a 6 month period from February to July 2019, having diagnosed AR and attending the outpatient clinic in CHC Chenani, district Udhampur, Jammu and Kashmir. The patients were directly questioned if they had AC, clarified by using standard screening questions of red, itchy and watery eyes and quantified by TOSS and were asked about indirect symptoms that may be attributable to AC.Results: Among the 110 patients, 50.9% of patients identified AC on direct questioning; additional symptoms were squint at 47.3% and blinking at 51.2%. Olopatadine, significantly reduced TOSS scores within 5 minutes of treatment and 80.9% showed improvement, which identified 39% silent sufferers of AC. A total of 90% AC subjects were identified through TOSS symptoms and totally 95.5%, detecting additional symptoms. The other co-morbidity that was associated with allergic conjunctivitis was allergic dermatitis.Conclusions: The screening questions could identify only about 56% of the patients with AC. Additional specific questioning and a therapeutic challenge in suspected patients can help identify patients who may benefit from treatment of AC.

Challenges of Diabetes Self-Management in Adults Affected by Food Insecurity in a Large Urban Centre of Ontario, Canada

Objective. To explore how food insecurity affects individuals’ ability to manage their diabetes, as narrated by participants living in a large, culturally diverse urban centre. Design. Qualitative study comprising of in-depth interviews, using a semistructured interview guide. Setting. Participants were recruited from the local community, three community health centres, and a community-based diabetes education centre servicing a low-income population in Toronto, Ontario, Canada. Participants. Twenty-one English-speaking adults with a diagnosis of diabetes and having experienced food insecurity in the past year (based on three screening questions). Method. Using six phases of analysis, we used qualitative, deductive thematic analysis to transcribe, code, and analyze participant interviews. Main Findings. Three themes emerged from our analysis of participants’ experiences of living with food insecurity and diabetes: (1) barriers to accessing and preparing food, (2) social isolation, and (3) enhancing agency and resilience. Conclusion. Food insecurity appears to negatively impact diabetes self-management. Healthcare professionals need to be cognizant of resources, skills, and supports appropriate for people with diabetes affected by food insecurity. Study findings suggest foci for enhancing diabetes self-management support.