SLEEP DISORDERED BREATHING (SDB) IN YOUNG CHILDREN HAS BEEN ASSOCIATED WITH POORACADEMIC PERFORMANCE AND BEHAVIORAL abnormalities, especially inattention, hyperactivity, and other "externalizing" behaviors (e.g., oppositionality, conduct problems).1 Cognitive test findings have been less consistent, but young children with SDB have generally shown diminished scores on tests of intelligence (IQ), attention, and executive functioning.1 Adults with SDB also display inattention, but they rarely show IQ deficits, hyperactivity, or externalizing behaviors.2,3 SDB in middle to late childhood has received much less research attention. Of the 60 published papers reviewed in 2006 by Beebe, 1 most enrolled only children aged ≤ 11 years. This emphasis on younger populations has remained true in more recent publications. 4 Studies that have examined a broader age range have enrolled primarily young children due to their recruitment strategies (e.g., recruiting from otolaryngology clinics) or have relied solely upon parent report of both clinical symptoms of SDB and behavioral disturbances, which can artificially inflate correlations.1 To our knowledge, only one published study has independently measured SDB and cognitive, behavioral, or scholastic functioning exclusively during middle to late childhood. Rhodes and colleagues 5 reported cognitive deficits in 5 children with OSA with a mean age of 13 years. Despite the fact that SDB has been associated with cognitive, behavioral, and functional deficits in studies of thousands of young children and adults, clinicians working with older children and adolescents have extremely limited data to inform evidence-based care.To some degree, findings from younger children and adults might be extrapolated to middle or late childhood. However, the nature of the cognitive and behavioral dysfunction that has been associated with SDB appears to differ in young children versus adults, and it is not clear when or how this developmental shift occurs.2 The risk factors for SDB also differ with age and may confound or moderate the impact of SDB. Further, the adaptive challenges faced by older children and adolescents differ substantially from those faced by young children and adults, 6 so the functional impact of sleep pathology in this understudied population may be unique. Finally, older children and adolescents tend to show greater sleep restriction on school nights than do their younger counterparts, and data suggest that, even among Study Objectives: (1) to determine the associations of sleep disordered breathing (SDB) with behavioral functioning, cognitive test scores, and school grades during middle-to late-childhood, an under-researched developmental period in the SDB literature, and (2) to clarify whether associations between SDB and school grades are mediated by deficits in cognitive or behavioral functioning. Design: Cross-sectional correlative study. Setting: Office/hospital, plus reported functioning at home and at school. Participants: 163 overweight subjects aged 10-16.9 years wer...

Background Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities.Methods We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days.Findings If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23-74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2-54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced.Interpretation Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable.

IMPORTANCEPrisons and jails are high-risk environments for COVID-19. Vaccination levels among workers in many such settings remain markedly lower than those of residents and members of surrounding communities. The situation is troubling because prison staff are a key vector for COVID-19 transmission. OBJECTIVE To assess patterns and timing of staff vaccination in California state prisons and identify individual-level and community-level factors associated with remaining unvaccinated. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from December 22, 2020, through June 30, 2021, to quantify the fractions of staff and incarcerated residents who remained unvaccinated among 23 472 custody and 7617 health care staff who worked in roles requiring direct contact with residents at 33 of the 35 prisons operated by the California Department of Corrections and Rehabilitation. Multivariable probit regressions assessed demographic, community, and peer factors associated with staff vaccination uptake. MAIN OUTCOMES AND MEASURES Remaining unvaccinated throughout the study period. RESULTS Of 23 472 custody staff, 3751 (16%) were women, and 1454 (6%) were Asian/Pacific Islander individuals, 1571 (7%) Black individuals, 9008 (38%) Hispanic individuals, and 6666 (28%) White individuals. Of 7617 health care staff, 5434 (71%) were women, and 2148 (28%) were Asian/ Pacific Islander individuals, 1201 (16%) Black individuals, 1409 (18%) Hispanic individuals, and 1771 (23%) White individuals. A total of 6103 custody staff (26%) and 3961 health care staff (52%) received 1 or more doses of a COVID-19 vaccine during the first 2 months vaccines were offered, but vaccination rates stagnated thereafter. By June 30, 2021, 14 317 custody staff (61%) and 2819 health care staff (37%) remained unvaccinated. In adjusted analyses, remaining unvaccinated was positively associated with younger age (custody staff: age, 18-29 years vs Ն60 years

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Background Prisons and jails are high-risk settings for COVID-19 transmission, morbidity, and mortality. COVID-19 vaccines may substantially reduce these risks, but evidence is needed of their effectiveness for incarcerated people, who are confined in large, risky congregate settings. Methods We conducted a retrospective cohort study to estimate effectiveness of mRNA vaccines, BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), against confirmed SARS-CoV-2 infections among incarcerated people in California prisons from December 22, 2020 through March 1, 2021. The California Department of Corrections and Rehabilitation provided daily data for all prison residents including demographic, clinical, and carceral characteristics, as well as COVID-19 testing, vaccination status, and outcomes. We estimated vaccine effectiveness using multivariable Cox models with time-varying covariates that adjusted for resident characteristics and infection rates across prisons. Findings Among 60,707 residents in the cohort, 49% received at least one BNT162b2 or mRNA-1273 dose during the study period. Estimated vaccine effectiveness was 74% (95% confidence interval [CI], 64-82%) from day 14 after first dose until receipt of second dose and 97% (95% CI, 88-99%) from day 14 after second dose. Effectiveness was similar among the subset of residents who were medically vulnerable (74% [95% CI, 62-82%] and 92% [95% CI, 74-98%] from 14 days after first and second doses, respectively), as well as among the subset of residents who received the mRNA-1273 vaccine (71% [95% CI, 58-80%] and 96% [95% CI, 67-99%]). Conclusions Consistent with results from randomized trials and observational studies in other populations, mRNA vaccines were highly effective in preventing SARS-CoV-2 infections among incarcerated people. Prioritizing incarcerated people for vaccination, redoubling efforts to boost vaccination and continuing other ongoing mitigation practices are essential in preventing COVID-19 in this disproportionately affected population.