Mental Health Status of Rhode Island Middle School and High School Students Before Versus During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic negatively affected adolescent mental health due to school closures, isolation, family loss/hardships, and reduced health care access. METHODS: We compared adolescent mental health in Rhode Island before versus during the pandemic, separately among middle and high schoolers. This serial cross-sectional study used Youth Risk Behavior Survey data from 2019 and 2021 (N = 7403). Multivariable logistic regression models estimated the association between year and mental health status, adjusting for sociodemographics. RESULTS: Middle schoolers in 2021 had higher odds of ever seriously considering suicide (22.6% vs 16.7%) and ever attempting suicide (9.3% vs 6.1%) compared to 2019. Among high schoolers, those in 2021 had higher odds of experiencing persistent sadness/hopelessness in the past year (37.4% vs 32.0%). However, high schoolers in 2019 and 2021 had similar odds of considering suicide in the past year, while those in 2021 had lower odds of having attempted suicide in the past year (8.5% vs 14.6%). CONCLUSION: The COVID-19 pandemic may have worsened multiple aspects of adolescent mental health in Rhode Island, particularly among middle schoolers. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Promoting school connectedness, creating supportive environments, and diversifying the mental health workforce may help overcome adverse pandemic effects.

Intrauterine Postpartum Hemorrhage-Control Devices.

Postpartum hemorrhage , defined as a cumulative blood loss of 1,000 mL or more or blood loss associated with signs or symptoms of hypovolemia regardless of the route of delivery, is the leading cause of preventable maternal death worldwide. The United States has one of the highest maternal mortality rates among developed countries, with about 14% of all maternal deaths associated with postpartum hemorrhage. Although postpartum hemorrhage has multiple causes, the most common is uterine atony-when the uterus fails to adequately contract after childbirth-accounting for 80% of all postpartum hemorrhages. When postpartum hemorrhage occurs despite preventive measures, therapeutic measures are used. Intrauterine hemorrhage-control devices are often the second-line therapy when medical management is unsuccessful. Despite its widespread use in current obstetric practice, the mechanism of intrauterine balloon tamponade, such as the Bakri balloon, is counterintuitive to the physiologic uterine contraction that occurs after delivery to control bleeding, and data on its effectiveness are mixed. Vacuum-induced hemorrhage control, such as with the Jada System, cleared by the U.S. Food and Drug Administration in 2020, is a novel modality for control of postpartum bleeding. It mimics postpartum physiology by applying low-level intrauterine negative pressure to facilitate uterine compressive forces, thereby constricting blood vessels to achieve hemostasis. Preliminary data from four studies are promising but are limited by a lack of control groups, selection bias, or modest sample sizes. The results of ongoing and planned randomized controlled trials will clarify the role of the Jada System for reducing morbidity from postpartum hemorrhage.

Protocol for a multicenter, double-blinded placebo-controlled randomized controlled trial comparing intravenous ferric derisomaltose to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy: The IVIDA2 trial.

BACKGROUND: Iron deficiency anemia (IDA) is common during pregnancy and associated with adverse maternal and neonatal outcomes. Treatment with iron supplementation is recommended during pregnancy, but the optimal delivery route is unclear. Oral iron risks has high risk of gastrointestinal side effects and low absorption. Intravenous iron is infused directly but is expensive. The American College of Obstetricians and Gynecologists currently recommends oral iron to treat IDA in pregnancy with intravenous iron reserved as second-line therapy, if needed. This approach is associated with persistent anemia, increasing the risk of peripartum blood transfusion. We aim to provide data on optimal route of iron repletion for IDA in pregnancy. METHODS: In IVIDA2, a double-blind, placebo controlled, multicenter randomized trial in the United States, 746 pregnant people with moderate-to-severe IDA (hemoglobin <10 g/dL and ferritin <30 ng/mL) at 24-28 weeks' gestation will be randomized 1:1 to either a single 1000 mg dose of intravenous ferric derisomaltose and oral placebo (1-3 times daily) or a single placebo infusion with 1-3 times daily 325 mg ferrous sulfate (65 mg elemental iron) tablet. The primary outcome is peripartum blood transfusion (blood transfusion from delivery to 7 days postpartum). Secondary outcomes include adverse medication reactions, maternal and neonatal hematologic indices, and offspring neurodevelopment. ETHICS AND DISSEMINATION: A central ethical review board-Advarra-granted ethical approval (Pro00060930). Participating centers-Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of Ethics and dissemination: A central ethical review board-Advarra-granted ethical approval (Pro00060930). Participating centers-Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of.

Statewide Evaluation of SARS-CoV-2 Diagnoses and Sexual Orientation and Gender Identity.

OBJECTIVE: Understanding and identifying disparities in COVID-19 testing outcomes can help allocate resources to where they are most needed. The objective of this study was to estimate the association between lesbian, gay, bisexual, transgender, and queer (LGBTQ+) identity and SARS-CoV-2 test positivity. METHODS: Data were from the Rhode Island SARS-CoV-2 surveillance database and included tests scheduled from June 8, 2020, through January 15, 2021. We used multivariable generalized estimating equations accounting for repeat testing to estimate the odds of receiving a positive test result for SARS-CoV-2 by LGBTQ+ identity and race/ethnicity, adjusting for sociodemographic and temporal confounders. RESULTS: In multivariable analysis of 232 025 tests, LGBTQ+ people had lower odds of receiving a positive test result than cisgender heterosexual people (5.4% vs 8.7%; adjusted odds ratio [aOR] = 0.63; 95% CI, 0.59-0.68). Compared with cisgender heterosexual White people, LGBTQ+ White people were significantly less likely (aOR = 0.67; 95% CI, 0.61-0.73) and cisgender heterosexual people of color were significantly more likely (aOR = 1.71; 95% CI, 1.64-1.78) to receive a positive test result. LGBTQ+ people of color had similar test positivity (aOR = 0.90; 95% CI, 0.79-1.02) as cisgender heterosexual White people. People in sexual minority groups were significantly less likely than heterosexual people to receive a positive test result, but we found no significant differences in test results among cisgender, transgender, and gender nonconforming people. CONCLUSIONS: LGBTQ+ people may be less likely than heterosexual people to receive a positive test result for SARS-CoV-2, potentially related to protective health practices and greater social isolation. Addressing racial and ethnic disparities among both LGBTQ+ people and cisgender heterosexual people should be a priority of the public health workforce.

Health of Caregivers in Rhode Island.

[Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].

Hysteroscopic tissue removal system (MyoSure) for the resection of polyps, sub-mucosal leiomyomas and retained products of conception in an out-patient setting: A single UK institution experience.

PURPOSE: The present study aimed to elucidate the hysteroscopic tissue removal system (MyoSure) efficacy and safety amongst uterine cavity pathologies (UCPs), and to determine its feasibility in an outpatient setting. We also sought to identify possible factors that could adversely affect complete lesion excision. METHODS: 124 women underwent MyoSure procedure and 135 UCPs were excised, between January 2017 and January 2018. The MyoSure efficacy was evaluated, and potential factors correlated with increased incomplete excision rate were assessed, using both univariate and multivariate analysis. RESULTS: The overall MyoSure excision rate was 94.8%. 107/109 polyps and 14/19 leiomyomas were completely resected with a success rate of 98.1% and 73.7% respectively. The complete excision rate amongst retained products of conception (RPOC) cases was 100%. A significant correlation between leiomyomas and incomplete excision was found when compared to polyps and RPOC (p < 0.001). In this cohort, type II leiomyomas (OR = 1.8, p = 0.01) and maximal diameter > 4 cm (OR = 1.6, p = 0.02) were independently correlated with incomplete leiomyomas excision. Nine out of 124 women (7.3%) experienced severe pain during the procedure, while 17% and 73% reported moderate and mild pain respectively. Furthermore, 99% of women (123/124) would undergo the procedure again in the future or recommend it to a friend, for a similar pathology removal. CONCLUSIONS: MyoSure is an efficient, safe and feasible operative hysteroscopic procedure in an office-outpatient setting. It is associated with high patient acceptability and, it is highly recommended by the vast majority of the women. Large, and type II leiomyomas are seemingly procedure limitations.

A Behavioral Health Survey of Primary Care Integration in Rhode Island.

BACKGROUND: Integrating behavioral and primary care practices improves quality of care, but limited data exists regarding the extent or attributes of such integration. We conducted a baseline evaluation of the level and characteristics of integrated practices in Rhode Island. METHODS: The Rhode Island Department of Health 2015 Statewide Health Inventory Behavioral Health Survey was sent to behavioral health clinics and outpatient psychiatry and psychology practices. Survey questions assessed indicators of integration, including colocation, shared electronic medical records (EMRs), and shared communication systems. RESULTS: Only 19%, 9%, and 17% of behavioral health clinics, psychiatrists, and psychologists, respectively reported any integration with primary care practices. Compared to psychology (3.5%) and psychiatry (0.0%) practices, behavioral health clinics reported the highest level of practice colocation (10.4%, P<0.05). Compared to non-colocated practices, colocated behavioral health clinics reported higher levels of integration by other indicators, including shared EMRs (33.0% vs 0.0%, P=0.01). CONCLUSION: This statewide survey demonstrated that limited integration exists between behavioral health and primary care practices in Rhode Island, and that such integration has a range of characteristics and levels. More practice integration is needed to ensure the delivery of high-quality, evidence-based care to the millions of individuals living with cooccurring behavioral and physical health needs.

Calculating State-Level Estimates of Upcoming Older Adult Health Needs.

OBJECTIVES: Census demographers have provided projections of the increased numbers of older adults in upcoming decades, but it is less clear whether they will also be any more or less healthy than current seniors. This is critical information for state planners, as the majority of older adults will need assistance with activities of daily living to remain in their homes. Previous longitudinal and cohort studies have yielded national estimates, but those more costly sources are generally beyond the resources of state public health agencies. We provide a more practicable model for assessing state-level changes in health-related quality of life (HRQOL) among middle-aged versus older adults as a guide to probable upcoming home- and community-based service needs. METHODS: We used 2 sets of state Behavioral Risk Factor Surveillance System data 15 years apart to calculate and compare adjusted odds ratios of 8 poor HRQOL measures for middle-aged and older adults. RESULTS: Compared with their peers only 15 years earlier, recent middle-aged adults had higher odds of poor outcomes across all HRQOL measures, whereas adults 65-74 years had higher odds of poor outcomes for far fewer of the measures. Among adults 75 years and older, odds were higher compared with 15 years ago for only 1 measure (multiple days of poor mental health). CONCLUSIONS: Compared with older adults, the health profile of middle-aged adults in this state appears to have worsened much more rapidly in the past 15 years, indicating that these adults will have many more health-related needs when they become seniors. While this model is less sophisticated than others using longitudinal data, it provides the state-level data that are often more compelling to state policy makers.

Health profile of Rhode Island healthcare workers.

[Full article available at http://rimed.org/rimedicaljournal-2017-12.asp].

The relationship between early childhood head injury and later life criminal behaviour: a longitudinal cohort study.

BACKGROUND: Childhood head injury has been associated with the development of behavioural and psychological problems. This study examined the relationship between head injury in young childhood and subsequent criminal behaviour. METHODS: Data were from the Providence cohort of the Collaborative Perinatal Project, a multicentre longitudinal study aimed at identifying the role of perinatal and prenatal factors on child health. History of head injury between ages 0 and 7 years was ascertained from health records of 2893 children. In total, 120 (4%) of children had a head injury. Propensity score matching was used to match each head injury case to five controls. Negative binomial regression was used to estimate the relationship between head injury and number of arrests, and log binomial regression was used to estimate risk of conduct problems. RESULTS: Those who suffered any head injury from ages 0 to 7 years had approximately 1.5 times the rate of arrests and risk of conduct problems compared with uninjured controls, though results did not meet the p<0.05 threshold for statistical significance. Severe head injury was associated with a twofold increased rate of juvenile arrests (incident rate ratio=2.44, 95% CI 0.93 to 6.46) and risk of conduct problems (risk ratio=2.47, 95% CI 0.90 to 6.74) that approached statistical significance. CONCLUSIONS: Head injury in childhood was associated with increased criminality and conduct problems. Future work should identify mechanisms of this association in order to develop interventions to prevent criminal behaviour resulting from head injury.

Correlates of smoking during an economic recession among parents of children with asthma.

OBJECTIVE: We describe the correlates of smoking among parents who have a child with asthma and examine whether the correlates changed from 2008 to 2010, when the United States experienced a severe recession and a sharp increase in unemployment, a stressor that could influence smoking behavior. METHODS: Data are from the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey of U.S. adults age 18 and older. Separate logistic regressions estimated the association between unemployment and smoking in 2008 and 2010, adjusting for sociodemographic and other characteristics of parents of a child with asthma. RESULTS: Being unemployed was a significant predictor of smoking in 2010 (AOR = 1.80; 95% CI: 1.24-2.61), but was not a significant predictor in 2008 (AOR = 1.26, 95% CI: 0.82-1.95). One central component of well-being, as measured by being dissatisfied with one's life, was significantly associated with parental smoking in 2010 (AOR = 2.06, 95% CI: 1.00-4.27), but not in 2008 (AOR = 1.62, 95% CI: 0.85-3.11). Several covariates had similar associations with parental smoking in both survey years, including low education, not being currently married, not having health insurance, and binge drinking. CONCLUSIONS: Our results support the idea that during hard economic times unemployment and related stressors may be strong determinants of parental smoking when a child in the home has asthma. Given that the BFRSS is a cross-sectional survey, definitive conclusions cannot be drawn regarding the causal pathway connecting unemployment, global well-being, and parental smoking.

Injury patterns and severity among motorcyclists treated in US emergency departments, 2001-2008: a comparison of younger and older riders.

OBJECTIVE: To examine differences across age groups in patterns of injuries sustained from motorcycle crashes. METHODS: Cross-sectional data from the National Electronic Injury Surveillance System-All Injury Program were used to assess emergency department-treated injuries resulting from motorcycle crashes in the USA from 2001 to 2008. Trends in injury frequency, the types of injuries and severity of injuries sustained among those aged 20-39 years, 40-59 years, and 60 years and older were compared. RESULTS: An estimated 65 660 patients 60 years and older, 466 125 patients aged 40-59 years and 921 229 patients aged 20-39 years were treated in US emergency rooms for injuries sustained in motorcycle crashes from 2001 to 2008. The number of injuries increased in all groups from 2001 to 2008, with the greatest rate of increase occurring in the oldest age group. Older adults had the greatest odds of hospitalisation with a threefold increased rate of hospitalisation (OR=3.05; 95% CI 2.58 to 3.59) compared with younger adults. Middle age adults had a nearly twofold increased odds of hospitalisation (OR=1.89; 95% CI 1.70 to 2.11; p<0.0001) compared with younger adults. Analysis of injury severity showed a similar pattern with both older adults (OR=2.46; 95% CI 2.02 to 3.01) and middle age adults (OR=1.66, 95% CI 1.52 to 1.82) having significantly increased odds of severe injury compared with young adults. CONCLUSIONS: Older adults involved in motorcycle crashes are prone to more severe injuries than younger adults. The increased number of older adults riding motorcycles should put further focus on risk of injury to this population.