COVID-19 Vaccination Coverage Among People Experiencing Homelessness in a Highly Vaccinated Midwest County-Dane County, Wisconsin, 2021.

People experiencing homelessness (PEH) are at increased risk for coronavirus disease 2019 (COVID-19) infection. This study assessed COVID-19 vaccination coverage among vaccine-eligible PEH (5 years and older) stratified by demographic characteristics. PEH were less likely to complete a primary vaccination series than the Dane County population (32.0%; 95% confidence interval [CI], 30.3%-33.8% vs 82.4%; 95% CI, 82.3%-82.5%) and were less likely to have received a booster when eligible (30.8%; 95% CI, 27.8%-33.9% vs 67.2%; 95% CI, 67.1%-67.4%). Vaccination rates were lowest among young PEH and PEH of color.

Correction: Identifying COVID-19 Outbreaks From Contact-Tracing Interview Forms for Public Health Departments: Development of a Natural Language Processing Pipeline.

[This corrects the article DOI: 10.2196/36119.].

Identifying COVID-19 Outbreaks From Contact-Tracing Interview Forms for Public Health Departments: Development of a Natural Language Processing Pipeline.

BACKGROUND: In Wisconsin, COVID-19 case interview forms contain free-text fields that need to be mined to identify potential outbreaks for targeted policy making. We developed an automated pipeline to ingest the free text into a pretrained neural language model to identify businesses and facilities as outbreaks. OBJECTIVE: We aimed to examine the precision and recall of our natural language processing pipeline against existing outbreaks and potentially new clusters. METHODS: Data on cases of COVID-19 were extracted from the Wisconsin Electronic Disease Surveillance System (WEDSS) for Dane County between July 1, 2020, and June 30, 2021. Features from the case interview forms were fed into a Bidirectional Encoder Representations from Transformers (BERT) model that was fine-tuned for named entity recognition (NER). We also developed a novel location-mapping tool to provide addresses for relevant NER. Precision and recall were measured against manually verified outbreaks and valid addresses in WEDSS. RESULTS: There were 46,798 cases of COVID-19, with 4,183,273 total BERT tokens and 15,051 unique tokens. The recall and precision of the NER tool were 0.67 (95% CI 0.66-0.68) and 0.55 (95% CI 0.54-0.57), respectively. For the location-mapping tool, the recall and precision were 0.93 (95% CI 0.92-0.95) and 0.93 (95% CI 0.92-0.95), respectively. Across monthly intervals, the NER tool identified more potential clusters than were verified in WEDSS. CONCLUSIONS: We developed a novel pipeline of tools that identified existing outbreaks and novel clusters with associated addresses. Our pipeline ingests data from a statewide database and may be deployed to assist local health departments for targeted interventions.

Exposures to Opioids Among Wisconsin Children and Adolescents, 2002-2016.

BACKGROUND: Opioid overdoses and opioid-related fatalities have increased dramatically in Wisconsin over the past decade. The observed rise in morbidity and mortality parallels increased opioid prescribing and greater use of illicit drugs such as heroin. Increased availability of both prescription and illicit opioids may increase the risk of exposure and overdose among the pediatric population. METHODS: We examined demographics and temporal trends in opioid exposures among children aged 0-19 years using hospital encounter and Wisconsin Poison Control Center (WPC) data. Exposures were categorized by type of opioid. RESULTS: We identified 3,320 WPC calls and 2,725 hospital encounters involving opioids during 2002-2016. Within the hospital encounter data, the rate of opioid-involved exposures increased significantly in children aged 0-5 years and adolescents aged 13-19 years. The majority of opioid-related hospital encounters involved prescription opioids. However, the proportion of hospital encounters involving heroin increased significantly among 13-19 year olds from 2002-2016. Within WPC data, the proportion of calls involving tramadol increased among 0-5 year olds and 13-19 year olds. However, calls about opioid/acetaminophen combinations decreased significantly as a proportion of opioid exposures. DISCUSSION: These findings suggest the need for caregiver education regarding safe storage and disposal of prescription opioids to prevent unintentional or intentional exposure to these substances among young children and adolescents. Overdose rates among teens continue to rise and an increasing proportion are due to heroin; comprehensive treatment and prevention strategies targeting this demographic are needed.

Mental Health and Substance Use-Related Hospitalizations Among Women of Reproductive Age in Illinois and Wisconsin.

INTRODUCTION: Mental health and substance use are growing public health concerns, but established surveillance methods do not measure the burden of these conditions among women of reproductive age. We developed a standardized indicator from administrative data to identify inpatient hospitalizations related to mental health or substance use (MHSU) among women of reproductive age, as well as co-occurrence of mental health and substance use conditions among those hospitalizations. MATERIALS AND METHODS: We used inpatient hospital discharge data from 2012-2014 for women aged 15-44 residing in Illinois and Wisconsin. We identified MHSU-related hospitalizations through the principal International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and first-listed ICD-9-CM external cause of injury code (E code). We classified hospitalizations as related to 1 of 3 mutually exclusive categories: a mental disorder, a substance use disorder, or an acute MHSU-related event. We defined co-occurrence as the presence of both mental health and substance use codes in any available diagnosis or E-code field. RESULTS: Of 1 173 758 hospitalizations of women of reproductive age, 150 318 (12.8%) were related to a mental disorder, a substance use disorder, or an acute MHSU-related event, for a rate of 135.6 hospitalizations per 10 000 women. Of MHSU-related hospitalizations, 115 163 (76.6%) were for a principal mental disorder, 22 466 (14.9%) were for a principal substance use disorder, and 12 709 (8.5%) were for an acute MHSU-related event; 42.4% had co-occurring mental health codes and substance use codes on the discharge record. PRACTICE IMPLICATIONS: MHSU-related disorders and events are common causes of hospitalization for women of reproductive age, and nearly half of these hospitalizations involved co-occurring mental health and substance use diagnoses or events. This new indicator may improve public health surveillance by establishing a systematic and comprehensive method to measure the burden of MHSU-related hospitalizations among women of reproductive age.

Health Care Barriers to Provision of Long-Acting Reversible Contraception in Wisconsin.

INTRODUCTION: Long-acting reversible contraceptives (LARC), specifically implants and intrauterine devices (IUD), are highly effective, low maintenance forms of birth control. Practice guidelines from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics recommend that LARC be considered first-line birth control for most women; however, uptake remains low. In this study, we sought to understand practices and barriers to provision of LARC in routine and immediate postpartum settings as they differ between specialties. METHODS: We surveyed 3,000 Wisconsin physicians and advanced-practice providers in obstetrics-gynecology/women's health (Ob-gyn), family medicine, pediatrics, and midwifery to assess practices and barriers (56.5% response rate). This analysis is comprised of contraceptive care providers (n=992); statistical significance was tested using chi-square and 2-sample proportions tests. RESULTS: More providers working Ob-gyn (94.3%) and midwifery (78.7%) were skilled providers of LARC methods than those in family medicine (42.5%) and pediatrics (6.6%) (P < .0001). Lack of insertion skill was the most-cited barrier to routine provision among family medicine (31.1%) and pediatric (72.1%) providers. Among prenatal/delivery providers, over 50% across all specialties reported lack of device availability on-site as a barrier to immediate postpartum LARC provision; organizational practices also were commonly reported barriers. CONCLUSIONS: Gaps in routine and immediate postpartum LARC practice were strongly related to specialty, and providers' experience heightened barriers to immediate postpartum compared to routine insertion. Skills training targeting family medicine and pediatric providers would enable broader access to LARC. Organizational barriers to immediate postpartum LARC provision impact many providers.

Census Tract Poverty and Racial Disparities in HIV Rates in Milwaukee County, Wisconsin, 2009-2014.

Previous work has documented associations between poverty and HIV. Understanding of these relationships at local levels could help target prevention efforts; however, HIV surveillance systems do not capture individual-level poverty measures. We utilized the Public Health Disparities Geocoding Project methods to examine HIV rates by census tract poverty. HIV rates and rate ratios were computed by census tract poverty (< 5.0, 5.0-9.9, 10.0-19.9, > 20.0% of individual below the federal poverty level) for all races and stratified by Black and White race using Poisson regression. We observed higher HIV rates in the highest poverty gradient compared to the lowest poverty gradient for all races combined and among White cases. After adjustment, HIV rates were similar across poverty gradients for all comparisons. Our findings suggest that the association between poverty and HIV may differ by subpopulation, while demonstrating the potential for HIV prevention targeting residents of high poverty areas.

What about Us? Economic and Policy Changes Affecting Rural HIV/AIDS Services and Care.

Health care budgets and policies are chief drivers in the delivery and access to health services. Place is also a factor that affects patient and provider experiences within the health care system. We examine the impact of policy changes and subsequent budget cuts on rural HIV/AIDS care, support services, and prevention. We interviewed 11 social workers, case managers, and outreach workers who serve rural people living with HIV/AIDS. We conducted telephone interviews inquiring about the effect of economics and policies on direct practice with rural clients. We analyzed data using a content analysis approach. We found several themes from the data. Ryan White funding and policy changes shifted direct practice to a medical case management model. Changes in federal and state poverty levels affected client eligibility for the AIDS Drugs Assistance Program. Policy banning financial support for syringe service programs hindered prevention efforts to reduce HIV/AIDS transmission. Ancillary services were reduced, such as housing assistance, transportation, and emergency financial assistance. In conclusion, we highlight the importance of place-based policies to improve access to healthcare and services. We also provide recommendations for greater inclusion in HIV/AIDS-related policy development, care, and service planning for rural workers.

Severe Maternal Morbidity During Delivery Hospitalizations.

INTRODUCTION: Severe maternal morbidities include 25 complications resulting from, or exacerbated by, pregnancy. Nationally, in the last decade, these rates have doubled. OBJECTIVE: This study describes trends in the rates of severe maternal morbidities at the time of hospitalization for delivery among different groups of Wisconsin women. METHODS: Hospital discharge data and ICD-9-CM diagnosis and procedure codes were used to identify delivery hospitalizations and rates of severe maternal morbidity among Wisconsin women from 2000 to 2014. Subsequent analyses focused on recent years (2010-2014). Rates of severe maternal morbidity were calculated per 10,000 delivery hospitalizations for all 25 severe maternal morbidity conditions as well as 24 conditions (excluding blood transfusions). Rates and rate ratios were calculated overall and for racial/ethnic groups, age groups, public health region of residence, and hospital payer. Median hospital length of stay and median hospital charges were compared for delivery hospitalizations with increasing severe maternal morbidities. RESULTS: Severe maternal morbidity rates increased 104% from 2000 to 2014 (P for trend <0.01). After excluding blood transfusions, rates increased 15% (P for trend <0.05). From 2010 to 2014, overall rates were stable over time, but varied by maternal age, race/ethnicity, payer, and public health region of residence. Median hospital charges and length of stay increased as the number of morbidities increased. CONCLUSIONS: Monitoring severe maternal morbidities adds valuable information to understanding perinatal health and obstetric complications in order to identify opportunities for prevention of severe morbidities and improvements in the quality of maternity care.

Neonatal Abstinence Syndrome and Maternal Substance Use in Wisconsin, 2009-2014.

INTRODUCTION: Increasing rates of neonatal abstinence syndrome (NAS), most commonly linked to maternal opioid use, are a growing concern within clinical and public health domains. OBJECTIVES: The study aims to describe the statewide burden of NAS and maternal substance use, focusing on opioids in Wisconsin from 2009 to 2014. METHODS: Trends in NAS and maternal substance use diagnosis rates were calculated using Wisconsin's Hospital Discharge Data. Demographic and payer characteristics, health service utilization, and clinical outcomes were compared for newborns with and without NAS. Demographic and payer characteristics were compared between women with and without substance use identified at time of delivery. RESULTS: Rates of NAS and maternal substance use, most notably opioid use, increased significantly between 2009 and 2014. The majority of newborns diagnosed with NAS, and women identified with substance use, were non-Hispanic, white, and Medicaid-insured. Disproportionate rates of NAS and maternal opioid use were observed in American Indian/Alaska Native and Medicaid populations compared to white and privately insured groups, respectively. Women age 20-29 years had the highest rates of opioid use compared to the reference group (10-19 years). Odds of adverse clinical outcomes and levels of health service utilization were significantly higher for newborns with NAS. CONCLUSIONS: Similar to trends nationally, our findings show an increase in maternal opioid use and NAS rates in Wisconsin over time, with disproportionate effects in certain demographic groups. These findings support the need for targeted interventions in clinical and public health settings aimed at prevention and burden reduction of NAS and maternal substance use in Wisconsin.

Social network and census tract-level influences on substance use among emerging adult males: An activity spaces approach.

Social network and area level characteristics have been linked to substance use. We used snowball sampling to recruit 90 predominantly African American emerging adult men who provided typical locations visited (n=510). We used generalized estimating equations to examine social network and area level predictors of substance use. Lower social network quality was associated with days of marijuana use (B=-0.0037, p<0.0001) and problem alcohol use (B=-0.0050, p=0.0181). The influence of area characteristics on substance use differed between risky and non-risky spaces. Peer and area influences are important for substance use among men, and may differ for high and low risk places.

Mental Health Utilization Among Diverse Parenting Young Couples.

Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.

Intimate partner violence, power, and equity among adolescent parents: relation to child outcomes and parenting.

Intimate partner violence (IPV) victimization and perpetration and power imbalances in parenting partners may result in poor outcomes for parents and children. Previous work in this area has focused on the maternal experiences, neglecting to examine paternal effects. The present study aimed to elucidate the role of IPV, power, and equity in parenting and child outcomes in an urban sample of adolescent parents. 159 male and 182 female parents in a relationship were recruited through university-affiliated hospitals. Power, equity, and IPV were measured at 6 months post-partum and were used as predictors for parenting and child outcomes 12 months post-partum using general estimating equations. Gender interactions and mediation effects of depression were also assessed. Higher perceived relationship equity was related to better infant temperament (B = 0.052, SE = 0.023, p = 0.02) whereas higher partner power was related to poorer social development (B = -0.201, SE = 0.088, p = 0.02) and fine motor development (B = -0.195, SE = 0.078, p = 0.01). IPV victimization was associated with poor infant temperament (B = -2.925, SE = 1.083, p = 0.007) and lower parenting competence (B = -3.508, SE = 1.142, p = 0.002). Depression mediated the relationship between IPV and parenting and IPV and infant temperament. No gender effects were found. IPV, inequities, and power imbalances were disadvantageous for parenting and child outcomes. Our results suggest that these dynamics may negatively affect both males and females. Interventions to reduce violence in both partners and promote equity in relationships could benefit couples and their children.

Characteristics of test anxiety among medical students and congruence of strategies to address it.

INTRODUCTION: Medical students may experience test anxiety associated with 'high stakes' exams, such as Step 1 of the United States Medical Licensing Examination. METHODS: We collected qualitative responses about test anxiety at three points in time from 93 second-year medical students engaged in studying for and taking Step 1. RESULTS: Causes of test anxiety as reported by students were related to negative self-talk during preparation for the exam. Effects of anxiety had to do with emotional well-being, cognitive functioning, and physical well-being. Strategies included socializing with others and a variety of cognitive and physical approaches. Comparison of individuals' strategies with causes and effects showed some congruence, but substantial incongruence between the types of strategies chosen and the reported causes and effects of test anxiety. DISCUSSION: Students' adoption of a 'menu' of strategies rather than one or two carefully selected strategies suggest inefficiencies that might be addressed by interventions, such as advisor-directed conversations with students and incorporating student self-assessment and strategies for managing anxiety within courses on test-taking. Such interventions are in need of further study. An annotated list of evidence-based strategies would be helpful to students and educators. Most important, test anxiety should be viewed by medical educators as a 'real' experience, and students would benefit from educator support.

Enhanced divergent thinking and creativity in musicians: a behavioral and near-infrared spectroscopy study.

Empirical studies of creativity have focused on the importance of divergent thinking, which supports generating novel solutions to loosely defined problems. The present study examined creativity and frontal cortical activity in an externally-validated group of creative individuals (trained musicians) and demographically matched control participants, using behavioral tasks and near-infrared spectroscopy (NIRS). Experiment 1 examined convergent and divergent thinking with respect to intelligence and personality. Experiment 2 investigated frontal oxygenated and deoxygenated hemoglobin concentration changes during divergent thinking with NIRS. Results of Experiment 1 indicated enhanced creativity in musicians who also showed increased verbal ability and schizotypal personality but their enhanced divergent thinking remained robust after co-varying out these two factors. In Experiment 2, NIRS showed greater bilateral frontal activity in musicians during divergent thinking compared with nonmusicians. Overall, these results suggest that creative individuals are characterized by enhanced divergent thinking, which is supported by increased frontal cortical activity.

Imitation, simulation, and schizophrenia.

The social significance of imitation is that it provides internal tools for understanding the actions of others by simulating or forming internal representations of these actions. Imitation plays a central role in human social behavior by mediating diverse forms of social learning. However, imitation and simulation ability in schizophrenia has not been adequately addressed. The major aim of the present study was to investigate imitation ability in schizophrenia patients and healthy individuals by examining simple motor imitation that involved the replication of meaningless manual and oral gestures, and the imitation of emotional facial expressions, which has implications for mentalizing. A secondary aim of the present study was to investigate the relationships among imitation ability, social functioning, and working memory. Subjects were asked to mimic hand gestures, mouth movements, and facial expressions of others, online. Clinical symptoms, social competence, and working memory were also assessed. Patients with schizophrenia were significantly impaired on all imitation tasks. Imitation errors were significantly correlated with reduced social competence and increased negative symptoms. However, imitation ability was only weakly associated with working memory. To summarize, the present study examined the ability of patients with schizophrenia to imitate the behaviors demonstrated by others. The results indicate a fundamental impairment in imitation ability in schizophrenia and implicate a possible difficulty in simulation. Further research to determine the neural and developmental origins of this difficulty could be extremely helpful in elucidating the role of simulation in schizophrenia and to establish the complex relationships among mental representation, imitation, and social cognition.

Weakened center-surround interactions in visual motion processing in schizophrenia.

Schizophrenia is often accompanied by a range of visual perception deficits, with many involving impairments in motion perception. The presence of perceptual abnormalities may impair neural processes that depend on normal visual analysis, which in turn may affect overall functioning in dynamic visual environments. Here, we examine the integrity of suppressive center-surround mechanisms in motion perception of schizophrenic patients. Center-surround suppression has been implicated in a range of visual functions, including figure-ground segregation and pursuit eye movements, visual functions that are impaired in schizophrenia. In control subjects, evidence of center-surround suppression is found in a reduced ability to perceive motion of a high-contrast stimulus as its size increases. This counterintuitive finding is likely a perceptual correlate of center-surround mechanisms in cortical area MT. We now show that schizophrenic patients exhibit abnormally weak center-surround suppression in motion, an abnormality that is most pronounced in patients with severe negative symptoms. Interestingly, patients with the weakest surround suppression outperformed control subjects in motion discriminations of large high-contrast stimuli. This enhanced motion perception of large high-contrast stimuli is consistent with an MT abnormality in schizophrenia and has a potential to disrupt smooth pursuit eye movements and other visual functions that depend on unimpaired center-surround interactions in motion.