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BACKGROUND Caregivers without behavioral health expertise struggle to manage behaviorally challenging patients while providing continuous observation (CO) care. PROBLEM A gap in knowledge exists concerning effective CO interventions to reduce patient violence with limited psychiatric resources. The objectives of this project were to improve safety and engagement among staff providing in-person 1:1 CO for patients and optimize acute care CO utilization. METHODS OR INTERVENTIONS Nurse leaders rounded regularly on CO staff and patients requiring CO and provided the safety, technology, activity, relief, and surroundings interventions tool kit for CO staff, patients, and families. Patient readiness to trial remote video monitoring CO was assessed, and violence prevention and assault reporting education to CO staff was reinforced. RESULTS A survey of 46 CO staff demonstrated positive responses to perceptions of: (1) improved safety (p

There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today's midlife Americans have had more pain throughout adulthood than did today's elderly. Disaggregating the cross-section of ages by year of birth and completion of a bachelor's degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age-a result not found for those with a bachelor's degree. Thus, the gap in pain between the more and less educated has widened in each successive birth cohort. The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950. If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow's elderly will be sicker than today's elderly, with potentially serious implications for healthcare.

It is now established that mortality and excess mortality from COVID-19 differed across racial and ethnic groups in 2020. Less is known about educational differences in mortality during the pandemic. We examine mortality rates by BA status within sex, age, and race/ethnic groups comparing 2020 with 2019. Mortality rates have increasingly differed by BA status in the US in recent years and there are good reasons to expect the gap to have widened further during the pandemic. Using publicly available provisional data from the National Center for Health Statistics we find that mortality rates increased in 2020 over 2019 for those with and without a BA, irrespective of age, sex, or race/ethnicity. Although mortality rates increased by more for those without a BA, the ratio of mortality rates for those with and without a BA changed surprisingly little from 2019 to 2020. Among 60 groups (sex by race/ethnicity by age) that are available in the data, the ratio of mortality rates of those without a BA to those with a BA fell for more than half of the groups. Our results suggest that differences in the risk of infection were less important in structuring mortality by education than differences in the risk of death conditional on infection.

Deaths of despair, morbidity and emotional distress continue to rise in the US. The increases are largely borne by those without a four-year college degree—the majority of American adults. For many less-educated Americans, the economy and society are no longer providing the basis for a good life. Concurrently, all-cause mortality in the US is diverging by education—falling for the college-educated and rising for those without a degree—something not seen in other rich countries. We review the rising prevalence of pain, despair, and suicide among Americans without a BA. Pain and despair created a baseline demand for opioids, but the escalation of addiction came from pharma and its political enablers. We examine “the politics of despair,” how less-educated people have abandoned and been abandoned by the Democratic Party. While healthier states once voted Republican in presidential elections, now the least-healthy states do. We review the evidence on whether or not deaths of despair have risen during the COVID pandemic. More broadly, excess mortality from COVID has not increased the ratio of all-cause mortality rates for those with and without a four-year degree, but has instead replicated the pre-existing mortality ratio.

This essay traces the Vatican’s decades-long, worldwide, multifront war on what it has come to call “gender ideology” from its very recent incarnation in Donald Trump’s United States back t...

American mortality rates have diverged in recent years between those with and without a four-year college degree, and there are many reasons to expect the education-mortality gradient to have steepened during the pandemic. Those without a BA are more likely to work in frontline occupations, to rely on public transportation, and to live in crowded quarters, all of which are associated with an increase in infection risk, a risk that was zero prior to the pandemic. We use publicly available data from the National Center for Health Statistics on deaths by age, sex, education and race/ethnicity to assess the protective effect of a BA in 2020 compared to 2019. While the BA was strongly protective during 2020, the ratio of mortality rates between those with and without a degree was little changed relative to pre-pandemic years. Among 60 groups (gender by race/ethnicity by age) that are available in the data, the relative risk reduction associated with a BA fell for more than half the groups between 2019 and 2020, and increased by more than 5 percentage points for only five groups. Our main finding is not that the BA was protective against death in 2020, which has long been the case, but that the protective effect was little different than in 2019 and earlier years, in spite of the change in the pattern of risk by occupation and income. The virus maintained the mortality-education gradient that existed pre-pandemic, at least through the end of 2020. Our results suggest that changes in the risk of infection were less important in structuring mortality than changes in the risk of death conditional on infection.

Significance Without a 4-y college diploma, it is increasingly difficult to build a meaningful and successful life in the United States. We explore what the BA divide has done to longevity, focusing on a measure of expected years lived between ages 25 and 75. In the richest large country in the world, with frontier medical technology, expected years lived between 25 and 75 declined for most of a decade for men and women without a 4-y degree, even prior to the arrival of COVID-19. For those with and without a BA, racial divides narrowed by 70% between 1990 and 2018, while educational divides more than doubled for both Black and White people., A 4-y college degree is increasingly the key to good jobs and, ultimately, to good lives in an ever-more meritocratic and unequal society. The bachelor’s degree (BA) is increasingly dividing Americans; the one-third with a BA or more live longer and more prosperous lives, while the two-thirds without face rising mortality and declining prospects. We construct a time series, from 1990 to 2018, of a summary of each year’s mortality rates and expected years lived from 25 to 75 at the fixed mortality rates of that year. Our measure excludes those over 75 who have done relatively well over the last three decades and focuses on the years when deaths rose rapidly through drug overdoses, suicides, and alcoholic liver disease and when the decline in mortality from cardiovascular disease slowed and reversed. The BA/no-BA gap in our measure widened steadily from 1990 to 2018. Beyond 2010, as those with a BA continued to see increases in our period measure of expected life, those without saw declines. This is true for the population as a whole, for men and for women, and for Black and White people. In contrast to growing education gaps, gaps between Black and White people diminished but did not vanish. By 2018, intraracial college divides were larger than interracial divides conditional on college; by our measure, those with a college diploma are more alike one another irrespective of race than they are like those of the same race who do not have a BA.