Lifetime Revictimization: Evidence From the Wisconsin Longitudinal Study.

Despite the documented increasing prevalence of elder abuse victimization and its devastating health effects, a life-course view of the victimization experiences of older adults has rarely been adopted in the elder abuse literature. The current study investigated lifetime links between victimization experiences by examining the indirect effect of adverse childhood experiences (ACE) on elder abuse victimization via intimate partner violence (IPV) victimization in middle adulthood, and whether this indirect association would differ by gender. Using data from the Wisconsin Longitudinal Study, we analyzed the previous and current victimization experiences of a total of 5,391 older adults in their early 70s and estimated mediational and moderated mediation models. The key results indicated that a higher ACE score was associated with exposure to IPV victimization in middle adulthood, which was in turn associated with exposure to elder abuse victimization. This indirect association was stronger for women than for men. Regarding specific types of childhood victimization, parental physical abuse, sexual abuse, and witnessing domestic violence significantly predicted elder abuse victimization via IPV victimization. Our results support the phenomenon of lifetime victimization, whereby an individual experiences reoccurring forms of victimization across the life course from childhood to late adulthood. Findings highlight the compelling need for the assessment of cumulative victimization experiences and their impact on elder abuse victims. A life-course-based, trauma-informed approach would greatly enhance prevention and intervention services for elder abuse.

Differences in Injury Patterns and Delays in Care-Seeking Behaviors in the Anabaptist Population.

BACKGROUND: The lifestyle differences of Anabaptists and their views on health care may yield different injury patterns than standard populations and require a customized approach to injury prevention and health care delivery. OBJECTIVE: To identify differences in injury patterns and delays in care-seeking behaviors among the Anabaptists in Wisconsin. METHODS: This single-center retrospective cohort study was conducted from (23 years) January 1, 2000, to December 31, 2023. Local Trauma Registry data collected patient demographics, injury details, morbidity outcomes, in-hospital mortality, and preexisting comorbidity. Anabaptist trauma patients were isolated by confirmed identification in the Trauma Registry. The analysis utilized both descriptive statistics and a logistic regression model with the outcome of Anabaptist. RESULTS: A total of 14,431 patients were included in the analysis; 81 (0.4%) were confirmed as Anabaptist. The Anabaptist population showed a higher likelihood of helicopter transportation (odds ratio [OR] 4.64, p < .01) and an activation of Pediatric Level I (OR 4.07, p < .01). As the emergency department shock index increased by one unit, the odds of being Anabaptist increased by 9.87 (p < .01). The injury mechanisms that were associated with the Anabaptist population included buggy collisions (OR 312.58, p < .01), caught or crushed (OR 5.21, p = .01), machinery (OR 5.38, p < .01), near drowning (OR 14.09, p < .01), scooter (OR 13.93, p = .04), and woodworking (OR 12.81, p = .01). CONCLUSIONS: This study identified differences in injury patterns and delays in care-seeking behaviors in the Anabaptist population.

Identifying Local Facilitators and Barriers to Screening Mammography Within a Rural Acute Care Hospital Service Area.

INTRODUCTION: Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital. METHODS: We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively. FINDINGS: Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%). CONCLUSIONS: Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.

Exploring Expressive Writing with Patients With Chronic Pain During Primary Care Visits.

BACKGROUND: Patients living with chronic pain may feel frustrated with and neglected by clinicians who care for them, leading to negative health care experiences. Clinicians may struggle to find new ways to engage and connect with patients experiencing chronic pain. Both patients and clinicians may benefit from expressive writing by potentially improving communication and creating a deeper sense of connection within medical visits. METHODS: An expressive writing activity, the Three-Minute Mental Makeover (3MMM), was conducted with 15 patients living with chronic pain during primary care visits with 5 UW Health family medicine physicians. Patient and physician experience using the 3MMM was measured using pre- and post-visit surveys and individual interviews. RESULTS: Both physicians and patients viewed the experience of doing the 3MMM together positively. We identified 8 key themes from individual follow-up interviews with patients and physicians: (1) opening the door, (2) insight into the doctor/patient as a person, (3) peer-to-peer communication, (4) closeness and connection, (5) comfort and relaxation, (6) unexpected learning, (7) unexpected value to patients, and (8) vulnerability and self-disclosure. The most commonly reported barriers to physicians using the activity in practice were lack of time and persuading other physicians to do the activity. DSICUSSION: Patients with chronic pain and the clinicians who care for them may benefit from an expressive writing exercise, such as the 3MMM, in the key realms of building relationships, communication, and trust.

Community Agency Preferences for and Perceptions of Disseminating and Implementing a Continence Promotion Program.

BACKGROUND: This study sought to assess the perceived value of in-person and online implementation of a community-based continence promotion program among Wisconsin community agencies serving older adults. METHODS: Electronic surveys were administered to representatives of organizations that serve older adults and assessed their preferences and perceptions of disseminating and implementing a continence promotion program to members of their organization. RESULTS: Among 101 participants, most (68%) reported an online program would appeal to their organization, while fewer noted the appeal of an in-person program. Many considered technology a barrier but indicated the online format could improve program reach and provide privacy to women with incontinence. CONCLUSIONS: Community organizations perceived incontinence as a prevalent and important issue and see advantages of in-person and online program implementation.

Lead Poisoning in Milwaukee: A Medical and Public Health Update.

INTRODUCTION: Every year, children are poisoned with lead with irreversible effects. This exposure most often occurs in older housing built before 1978 with chipping paint from windowsills where children play and ingest the lead particulates. Exposure to lead can cause neurological and psychological dysfunction, among other health issues. OBJECTIVE: This quality improvement study aims to evaluate our knowledge of at-risk children through a public health approach by analyzing the current public health data and possible barriers to lead screening, testing follow-up, and identifying at-risk children. METHODS: We received data on lead-poisoned children and inspected properties from the City of Milwaukee Health Department. We analyzed each child's initial blood lead level, as well as follow-up tests recorded, ZIP code of residence, and family renter versus home ownership. RESULTS: Over 90% of children in the database had recorded follow-up blood lead testing following an initial elevated blood lead level. There was no difference in initial recorded blood lead levels between children with recorded follow-up blood lead levels and children without (21.40, SD = 11.26); t[1.17], P = 0.24). Most affected children were from economically disadvantaged ZIP codes (53206, 53208, 53215), and 94% lived in rented properties. CONCLUSIONS: Over 90% of children in the database had recorded follow-up blood lead testing following an initial elevated blood lead level. There was no difference in initial recorded blood lead levels between children with recorded follow-up blood lead levels and children without (21.40, SD = 11.26); t[1.17], P = 0.24). Most affected children were from economically disadvantaged ZIP codes (53206, 53208, 53215), and 94% lived in rented properties.

Scrotal Trauma Treatment and Outcomes.

INTRODUCTION: Genitourinary tract injuries have been reported to account for 3% to 10% of trauma patients, and scrotal injuries have been reported to comprise 71% of male genital trauma. Scrotal trauma is particularly prevalent in males 10 to 30 years of age, thus posing a potential threat to fertility. Scrotal trauma can be blunt or penetrating in nature, and the mechanism of trauma can have an impact on the management and outcomes of this type of injury. METHODS: A retrospective chart review of adult patients who presented with scrotal trauma to a single large level I trauma center from January 1, 2000, to June 1, 2022, was conducted to assess the relative occurrence and type of trauma (blunt vs penetrating), as well as differences in the management, duration of hospital stay, and need for orchiectomy between these 2 types of injury. RESULTS: There were 102 patients included in this study, with an average age of 39.5 years (18.7-77.2 years). Fifty-six patients had blunt scrotal trauma, and 46 had penetrating scrotal injury. There was not a statistically significant difference in the percentages of blunt versus penetrating trauma (P < = 0.3729). Patients with penetrating trauma were more likely to be inpatient than those with blunt trauma (69.6% vs 42.9%; P < = 0.013; 95% CI, 0.062-0.473). A total of 61 patients were treated conservatively (44 and 17 patients in the blunt and penetrating trauma groups, respectively). Overall, 41 patients required surgical intervention: 12 who had blunt trauma and 29 who suffered penetrating injury. Surgical treatment was more common for penetrating trauma than for blunt trauma (63.0% vs 21.4%; P <0.0001; 95% CI, 0.220-0.612). Eleven patients underwent orchiectomy - 4 from the blunt trauma group and 7 from the penetrating trauma group; the rate of orchiectomy was not significantly different between the 2 groups. CONCLUSIONS: In this study, blunt scrotal trauma was slightly more common than penetrating injury, but the difference did not reach statistical significance. Blunt scrotal trauma was associated with a higher rate of conservative treatment. Further study is needed to better understand the impact of scrotal trauma on future fertility.

Transition Practices in Wisconsin Health Care Systems: What Do We Know?

BACKGROUND: The transition from youth to adult health care is a complex process, and only 25% of all youth and less than 35% of youth with special health care needs in Wisconsin receive support. OBJECTIVES: This article describes the process and results from the Wisconsin Youth Health Transition Initiative's assessment of transition support provided in health care. METHODS: Key informant interviews were undertaken with clinicians from several Wisconsin health care systems. RESULTS: Fifty percent of health care systems interviewed had a formal policy or guideline supporting health care transition. Additionally, several barriers consistent with national trends were confirmed. CONCLUSIONS: Health care transition for Wisconsin youth remains suboptimally supported in practice. Continued funding and work towards this important maternal and child health objective are needed.

Delta-8 Tetrahydrocannabinol in the Emergency Department: A Case Series.

INTRODUCTION: "Delta-8," or delta-8 tetrahydrocannabinol (delta-8 THC), is a cannabinoid product that is growing in popularity for recreational use across the nation. This report aims to characterize the clinical presentation of acute delta-8 ingestions presenting to the emergency department. CASE SERIES: This is a case series of 6 patients who presented to a regional network of small- and medium-volume emergency departments in northwest Wisconsin. Patient histories confirmed that all patients had delta-8 exposure. Patient ages ranged from 5 to 57 years old. Amounts ingested and routes of ingestions varied from patient to patient. The most common symptoms reported were respiratory depression, unresponsiveness, altered mental status, tachycardia, and chest pressure. CONCLUSIONS: This case series is a snapshot of the burden experienced by emergency departments because of delta-8 availability. Clinicians should maintain a high index of suspicion for delta-8 use, especially in patients with altered mental status, anxiety, or cardiac.

Tropical Myositis: A Not-So-Tropical Diagnosis in a Febrile Type 1 Diabetic Patient.

INTRODUCTION: Tropical myositis - also known as pyomyositis - is a subacute, primary infection of skeletal muscle. Long considered a diagnosis exclusive to tropical climates, recently it has been reported increasingly in historically nontropical climates. We present a case of tropical myositis in Madison, Wisconsin, occurring in a febrile type 1 diabetic patient without travel or known exposure. CASE PRESENTATION: A 35-year-old male with a history of von Willebrand disease, type 1 diabetes, and financial insecurity resulting in insulin rationing presented with 2 weeks of generalized weakness. On exam, he had a multitude of large, erythematous "bumps" across his body, which had been increasing in size for more than 2 weeks. His blood glucose was 518, with leukocytosis and labs supportive of diabetic ketoacidosis. Computed tomography revealed extensive intramuscular and subcutaneous abscesses of the left chest, bilateral erector spinae, right gluteal muscles, bilateral thighs, left leg, and left upper and lower arm. Broad-spectrum antibiotics were initiated, as was treatment for diabetic ketoacidosis. Blood and urine cultures revealed oxacillin-susceptible Staphylococcus aureus. After clinical stabilization, he underwent initial incision and drainage of the abscesses. His condition would require 14 more operative incision and drainage procedures and wound closure attempts before he was discharged to a rehab facility after more than a month-long hospitalization. DISCUSSION: Severe tropical myositis is associated with high morbidity and high use of health care resources. The exponential rise in cases in the United States in recent years risks further stressing an already-burdened health care system. We explore potential causes of the increase in cases of tropical myositis in nontropical regions, including increasing rates of diabetes and poverty and climate change. Recent data suggest that the large majority of tropical myositis cases are caused by Panton-Valentine leukocidin toxin-producing Staphylococcus aureus strains. There is a theoretical mitigation of disease severity when patients receive early protein synthesis inhibitor antibiotic treatment, though these findings are limited to case reports and observational studies and lack controlled clinical trials. This case highlights the need for early identification, antibiotic administration, and surgical source control in suspected cases of tropical myositis.

AVIAN HAEMOSPORIDIANS IN GREATER SCAUP (AYTHYA MARILA) AND LESSER SCAUP (AYTHYA AFFINIS) FROM WISCONSIN.

Avian haemosporidians are a diverse group of protozoan parasites that infect a wide range of host species. Waterfowl are an ecologically and economically important group of hosts that have been underrepresented in studies of haemosporidians. Diving ducks have unique life history traits, and morphological, behavioral, and dietary differences separate them from more common dabbling ducks. Greater scaup (Aythya marila) and lesser scaup (Aythya affinis) are closely related diving ducks with declining population trends in North America. To better understand the diversity of haemosporidians within diving ducks and factors related to host infections in scaup, we surveyed 82 hunter-donated waterfowl from 8 species of divers, sea ducks, and dabblers from Green Bay, Wisconsin from 2019 to 2021. We used molecular detection methods and phylogenetic and statistical analyses to describe the diversity, host associations, and prevalence of haemosporidians. We detected 14 unique genetic lineages of haemosporidians, including 4 novel lineages. We identified at least 1 lineage of haemosporidian in each of the 8 host species of divers, sea ducks, and dabblers examined. Lesser scaup had more diverse haemosporidian communities than did greater scaup, but lineages showed no clustering among these hosts when incorporated in phylogenetic analyses with lineages from other Nearctic waterfowl. Female lesser scaup had the highest infection prevalence, but there was no effect of host age or year of sampling. Our findings underscore the importance of species and sex differences that could lead to a higher risk of infections. Our results also fill an important geographical sampling gap for haemosporidians along a key migratory route. Increased monitoring of haemosporidians in waterfowl could contribute to insights into parasite evolution and ecology and the conservation and management of host populations.

Closing the gap in access to child mental health care: provider feedback from the Wisconsin Child Psychiatry Consultation Program.

BACKGROUND: Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics. OBJECTIVES: The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care. METHODS: A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann-Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach. RESULTS: Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage. CONCLUSIONS: This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.

Harm Reduction and Treatment Among People at High Risk of Overdose.

Importance: Rates of overdose deaths involving synthetic opioids remain high, increasingly involve stimulants combined with opioids, and are increasing rapidly in racially and ethnically minoritized communities, yet little is known about access to harm reduction and treatment services in these groups. Objective: To characterize access and barriers to harm reduction and treatment in a racially and ethnically diverse population of people who use drugs. Design, Setting, and Participants: A cross-sectional telephone survey of people recruited from 39 treatment, harm reduction, and social service organizations in Milwaukee County, Wisconsin; Flint and Detroit, Michigan; and statewide in New Jersey was conducted from January 30 to July 28, 2023. Adults who used cocaine, methamphetamine, or opioids in the past 30 days called a study hotline and completed an interview in English or Spanish. Exposures: Overdose experience, drug types used (opioids only, stimulants only, and polysubstance), and social risk factors (eg, financial instability and criminal legal involvement). Main Outcomes and Measures: Recent use of any harm reduction services, fentanyl test strips, naloxone possession, treatment, and self-reported barriers to services. Results: Of the total sample of 1240 adults, 486 (39.2%) were Black non-Hispanic, 183 (14.8%) were Hispanic, and 464 (37.4%) were White non-Hispanic. In the past 30 days, 826 individuals (66.6%) were polysubstance users, 135 (10.9%) used only opioids, and 279 (22.5%) used only stimulants. A total of 349 respondents (28.1%) experienced a prior-year overdose. Compared with those without a prior-year overdose, people with overdose were more likely to possess naloxone (80.7% vs 68.2%; P < .001), possess fentanyl test strips (36.8% vs 23.5%; P < .001), and use harm reduction services (63.4% vs 53.0%; P = .003), while differences in treatment use were nonsignificant (52.0% vs 46.6%; P = .24). Among stimulant-only users, 51.4% possessed naloxone compared with 77.3% of opioid-only users (P < .001) and 77.6% of polysubstance users (P < .001), with similar disparities in fentanyl test strip possession. Conclusions and Relevance: In this cross-sectional study of people who used drugs in the past 30 days, findings highlighted low use of harm reduction and treatment services among people who use stimulants. Additional communication regarding their importance may help increase the use of the services amidst a rapidly changing drug supply.