Factors Associated With State Mandate of Nursing Home Staff Testing During COVID-19

COVID-19 has presented challenges for nursing homes (NHs) and other congregate living settings which serve older adults at high risk for morbidity and death from the virus. This study identified factors associated with states’ adopting a mandate for regular staff testing for COVID-19 in NHs. Potential correlates included state government ideology and capacity, NH supply and demand, prevailing economic conditions, existing state policies, and NH characteristics. Findings indicate that percent for profit NHs is most strongly associated with adoption of a state staff testing mandate. Governing capacity (average legislative salary), percent population at risk for COVID-19, and existing public policy (percent Medicaid spending devoted to long-term services and supports (LTSS) were also associated with the probability of adoption. Based on these results, states with more proprietary facilities and greater capacities for government action, investment in Medicaid LTSS, and at-risk populations were more likely to mandate regular staff testing in NHs.

Implications of the COVID-19 Pandemic on Adult Day Services and the Families They Serve

The COVID-19 pandemic forced adult day services (ADS) to close and abruptly end in-person services to clients. To understand the effect of the pandemic on ADS, a 20-item survey was used to examine services provided, staffing, finances, and plans to reopen. Data came from 22 sites participating in the Adult Day Service Plus a national randomized controlled trial. Of the 22 ADS sites responding to the survey, most (86.4%, n = 19) closed due to COVID-19 with nearly half closing due to a state mandate (52.6%, n = 10). Most sites reported the need to furlough or terminate staff (63.6%, n = 14). Services that sites continued to provide included telephone support (n = 22, 100%), delivery of food (n = 8, 36.4%), medical check-ins (n = 9, 40.1%), and activity via Zoom or YouTube (n = 14, 63.6%). Most of these services were provided without reimbursement. Adult day services have considerable potential as a platform for service innovation in community-based services.

COVID-19 and Vision Therapy: An Academic Experience

Background: The COVID-19 pandemic required unprecedented changes to health care delivery. The University Eye Center (UEC) at the State University of New York College of Optometry has a robust vision rehabilitation practice. However, during the pandemic via state mandate, it could no longer provide in-office care. Development of novel approaches to manage patients with binocular vision disorders, especially to care for the vulnerable traumatic brain injury and pediatric patient populations, was essential and required rapid response. This included a combination of launching telehealth visits and a home-based vision therapy app, as well as innovative programs developed internally. While telehealth is not a substitute for in-office vision therapy, the combination of multiple platforms enabled the UEC to continue patient care despite a stay-at-home order during the pandemic.

Secular trends in testosterone- findings from a large state-mandate care provider

Background Several studies from the US and Europe have shown a population-level decline in serum testosterone in men from 1970's to early 2000's. However, to the best of our knowledge, no study examining population-level decline in testosterone has been published in more recent years. The study objective was therefore to examine secular trends in testosterone levels among Israeli men in the first and second decades of the 21 st century,Methods All incident total testosterone performed between1/2006 and 3/2019 among 102,334 male members of a large health organization.Results A prominent trend of age-independent decline in the testosterone levels for most age groups. The results were highly significant ( Common.EditSubmissionSteps.Transform.EquationText )Conclusions The results show a highly significant age-independent decline in total testosterone that is unlikely to be explained by increasing rates of obesity.

Factors Leading to Discrepancies in Accumulated Physical Activity During School Hours in Elementary School Students

Purpose: Current in-school physical activity (PA) policies lack regulation, which testifies to the urgency of monitoring in-school moderate to vigorous PA (MVPA). This study quantifies the demographical differences of in-school PA among elementary students. Methods: Fourth-grade students wore accelerometers during school for 1 week. The teachers logged information for PA setting and duration of opportunity. Results: The accelerometry data (N = 148) showed alarming results in the lack of MVPA during in-school PA opportunity times. Significant sex differences showed boys to accumulate more minutes MVPA per day in recess than girls (7.62 ± 5.87 and 5.19 ± 3.03, respectively). Racial differences showed that non-White students accumulated significantly more minutes of MVPA per week during the school day than White students (30.82 ± 19.09 and 23.44 ± 18.41, respectively). Conclusions: The students fell short of the recommended 30 min of MVPA per day during school hours, as advised by a state mandate. Significant differences were seen in PA levels across sex and race, supporting the need for enhanced attention to influential factors on PA engagement.

Exertional Heat-Stroke Preparedness in High School Football by Region and State Mandate Presence

Context Exertional heat stroke (EHS) is a leading cause of sudden death in high school football players. Preparedness strategies can mitigate EHS incidence and severity. Objective To examine EHS preparedness among high school football programs and its association with regional and state preseason heat-acclimatization mandates. Design Cross-sectional study. Setting Preseason high school football programs, 2017. Patients or Other Participants A total of 910 athletic trainers (ATs) working with high school football (12.7% completion rate). Main Outcome Measure(s) We acquired data on high school football programs' EHS preparedness strategies in the 2017 preseason via an online questionnaire, looking at (1) whether schools' state high school athletic associations mandated preseason heat-acclimatization guidelines and (2) heat safety region based on warm-season wet-bulb globe temperature, ranging from the milder region 1 to the hotter region 3. Six EHS-preparedness strategies were assessed: EHS recognition and treatment education; policy for initiating emergency medical services response; emergency response plan enactment; immersion tub filled with ice water before practice; wet-bulb globe temperature monitoring; and hydration access. Multivariable binomial regression models estimated the prevalence of reporting all 6 strategies. Results Overall, 27.5% of ATs described their schools as using all 6 EHS-preparedness strategies. The highest prevalence was in region 3 schools with state mandates (52.9%). The multivariable model demonstrated an interaction in which the combination of higher heat safety region and presence of a state mandate was associated with a higher prevalence of reporting all 6 strategies (P = .05). Controlling for AT and high school characteristics, the use of all 6 strategies was higher in region 3 schools with state mandates compared with region 1 schools without state mandates (52.9% versus 17.8%; prevalence ratio = 2.68; 95% confidence interval = 1.81, 3.95). Conclusions Our findings suggest a greater use of EHS-preparedness strategies in environmentally warmer regions with state-level mandates for preseason heat acclimatization. Future researchers should identify factors influencing EHS preparedness, particularly in regions 1 and 2 and in states without mandates.

Efua Sutherland, Ama Ata Aidoo, the State, and the Stage

Shortly after its independence from Britain, Ghana became a transnational center for emerging political projects of black liberation. Its president, Kwame Nkrumah, sought to integrate a Marxist ideology with local knowledge in the context of the new nation-state, and proposed cultural initiatives that would support this synthesis. The plays of Efua Sutherland, a leading member of Ghana’s independence-era cultural elite, and Ama Ata Aidoo, who has come to be seen as an important figure of African post-colonial writing, reveal the ambitions and the difficulties of African modernity. Both writers situate a colonial legacy against Ghanaian cultural life and a black transnational influence. While fulfilling a state mandate for original productions, their plays (in particular, Sutherland’s Edufa and Foriwa, and Aidoo’s The Dilemma of a Ghost) complicate the statist ideology with an emergent African feminism that disallows synthesis, and shows the critical power of difference.