Understanding Local Alcohol Control in Wisconsin: Building a Database of Local Municipal Alcohol Policies.

In Wisconsin, many alcohol policies are regulated at the local level. To examine the relationship between local policies, alcohol use and health outcomes, our team developed a database to collect local alcohol policies. Initial results highlight differences in how policies are defined, enforced, and made available to the public.

Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study.

BACKGROUND: Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse. METHODS: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status. RESULTS: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 - 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events. CONCLUSIONS: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

Antibody response to sequential vaccination with cell culture, recombinant, or egg-based influenza vaccines among U.S. adults.

The immune response to inactivated influenza vaccines (IIV) is influenced by multiple factors, including hemagglutinin content and egg-based manufacturing. Only two US-licensed vaccines are manufactured without egg passage: cell culture-based inactivated vaccine (ccIIV) and recombinant vaccine (RIV). We conducted a randomized open-label trial in central Wisconsin during the 2018-19 and 2019-20 seasons to compare immunogenicity of sequential vaccination. Participants 18-64 years old were randomized 1:1:1 to receive RIV, ccIIV or IIV in strata defined by number of influenza vaccine doses in the prior 3 years. They were revaccinated with the same product in year two. Paired serum samples were tested by hemagglutination inhibition against egg-adapted and cell-grown vaccine viruses. Serologic endpoints included geometric mean titer (GMT), mean fold rise, and percent seroconversion. There were 373 participants randomized and vaccinated in 2018-19; 332 were revaccinated in 2019-20. In 2018-19, RIV and ccIIV were not more immunogenic than IIV against A/H1N1. The post-vaccination GMT against the cell-grown 3C.2a A/H3N2 vaccine virus was higher for RIV vs IIV (p = .001) and RIV vs ccIIV (p = .001). The antibody response to influenza B viruses was similar across study arms. In 2019-20, GMT against the cell-grown 3C.3a A/H3N2 vaccine virus was higher for RIV vs IIV (p = .03) and for RIV vs ccIIV (p = .001). RIV revaccination generated significantly greater backboosting to the antigenically distinct 3C.2a A/H3N2 virus (2018-19 vaccine strain) compared to ccIIV or IIV. This study adds to the evidence that RIV elicits a superior immunologic response against A/H3N2 viruses compared to other licensed influenza vaccine products.

Mapping Milwaukee's Blueprint for Peace: Evaluating the Geospatial Reach of a Cure Violence Implementation, 414LIFE.

BACKGROUND: Cure Violence interruption programs are evidence-based interventions aimed at reducing the transmission of gun violence and its related injuries. Assessing the implementation of these programs can include the metric of "reach." This study evaluated one such program - 414LIFE - in Milwaukee, Wisconsin. The evaluation reconceptualized "reach" as a metric for reaching the individuals and neighborhoods at greatest risk for gun violence. METHODS: 414LIFE's reach was analyzed descriptively and geospatially through its program evaluation dataset from May 2019 through September 2020 using a cross-sectional design. Program referral criteria includes patients who sustained a gunshot wound, are less than 36 years old, and a resident of, or injured in, the city of Milwaukee. A choropleth map visualized location of participants' residence, which justified a global Moran's I, and then a local Moran's I calculation to identify statistically significant clustering of referrals. RESULTS: In the first 1.5 years of the program's partnership with the local level I trauma center and affiliated academic medical institution, 398 patients were referred. Three hundred referrals (75.4%) met program criteria; 53.8% were Black men. Statistically significant clusters were identified and mapped. Half of the top 10 neighborhoods with referrals were the city's identified priority neighborhoods. CONCLUSIONS: 414LIFE successfully reaches its intended population and geographic locations. Geospatial reach should be considered routinely in program evaluations of Cure Violence programs to track growth and reach over time.

Abortion Attitudes and Behavioral Intentions of Obstetrics and Gynecology Residents at Four Midwestern Residency Programs Prior to Dobbs v Jackson Women's Health.

INTRODUCTION: In June 2022, the United States Supreme Court announced its decision in Dobbs v Jackson Women's Health Organization to overturn Roe v Wade. As a result, half of US states now face proposed or in-effect abortion bans, which affect the ability of obstetrics and gynecology (ObGyn) residency programs to provide abortion training. We sought to establish ObGyn residents' pre-Dobbs attitudes toward abortion, desire to learn about abortion, and intentions about providing abortion care in their future practice. METHODS: From January through December 2021, we surveyed 70 ObGyn residents at 4 programs in Wisconsin and Minnesota to assess their attitudes toward abortion, desire to learn about abortion, and intentions about providing abortion care in their future practice. RESULTS: Fifty-five out of 70 (79%) ObGyn residents completed the survey. Most reported highly favorable attitudes toward abortion, nearly all found the issue of abortion important, and the majority planned to incorporate abortion care into their future work. There were no differences in median attitude scores or behavioral intentions among institutions. CONCLUSIONS: Prior to the Dobbs decision, ObGyn residents in Minnesota and Wisconsin viewed abortion as important health care and intended to provide this care after graduation.

The Burden of Burnout and Importance of Mentorship for Preclinical Medical Students: Perspectives From a Public University Medical School.

BACKGROUND: Physician burnout often stems from burnout in medical students that began during the first year of medical education. Individual factors contributing to burnout must be considered within the demands of rigorous curricula and personal ambitions. This study focused on understanding how burnout is perceived by students and the impact mentorship had on its incidence and onset. METHODS: A literature review guided the development of a facilitator guide that outlined factors causing burnout. Preclinical medical students from the University of Wisconsin School of Medicine and Public Health were recruited for online focus groups. Responses were analyzed using hierarchical inductive coding, and identified themes were utilized to create a 2-part electronic Qualtrics survey focused on key aspects and timepoints of burnout. Part A of the survey was sent the summer after the first year of medical school (M1), and Part B was sent after the final course of the second year (M2). RESULTS: Nineteen percent of students agreed they entered medical school burnt out. The percentage of survey respondents who were not burnt out at each consecutive block in their first year decreased from 80% during the first block to 20% at the beginning of the last block. Focus group and survey results found that mentorship had positive effects on burnout, and students noted increased needs for mental health services. CONCLUSIONS: Understanding key pressure points and essential resources for addressing student burnout allows for improved education and personal outcomes. Alleviating factors were strong mentorship, mental health resources, and streamlined faculty communication. Increasing burnout highlights the importance of interventions to reduce long-lasting effects on student performance and well-being.

Qualitative Pilot Study: Longitudinal Perspectives From People Who Had Second Trimester Abortions for Fetal Anomaly.

BACKGROUND: We investigated patient experience with abortion for fetal anomaly, about which little is known. METHODS: This qualitative, longitudinal pilot study surveyed 7 patients twice after abortion for fetal anomaly, initially 4 to 5 days after the abortion and a follow-up 3 months post-abortion, at a single Wisconsin hospital from July 2012 to February 2014. RESULTS: Patients indicated that having a choice to have an abortion and choose the modality is imperative, and they remained certain in their decision-making over time. They also described initially strong, then lacking, social support; processed grief; and identified resource constraints. DISCUSSION: Patients emphasized the importance of having the choice to choose abortion and the abortion modality, remaining confident in their decision-making over time. This qualitative pilot study provides areas for future intervention to improve care for people undergoing abortion for fetal anomaly.

'I'm So Proud of How Hard You're Trying': A Photovoice Analysis of Youth Mental Health and Wellness in Wisconsin.

Understanding youth and young adult mental health and well-being is critical to addressing rates of suicide among this population. This qualitative study sought to gather additional perspectives of students across Wisconsin using photovoice methods to enhance understanding of their experiences and to inform future policies and programs. A total of 11 youth and young adults ages 14 to 26 participated by taking pictures in response to given prompts and then discussing those pictures within a virtual focus group. Spanning the social-ecological framework, 4 themes emerged from the photographs and discussion: (1) individual-level factors drive mental health and well-being; (2) the support of interpersonal relationships is crucial; (3) school-related factors are predominant sources of stress; (4) policies, culture, and systems influence well-being. This study highlights the unique experiences of youth and young adults and underscores the impact of systems and structures on their mental health and well-being.

Assessment of a Pilot Peer Support Program for Suicide Prevention on a Medical School Campus: Impact on Awareness, Stigma, and Self-Efficacy for Outreach.

With the continued rise in mental health concerns, including suicide on college campuses nationwide, many academic institutions have developed peer-support programs. Correspondingly, the Medical College of Wisconsin developed and evaluated Seeking Peer Outreach* as its pioneer suicide prevention initiative. Seeking Peer Outreach* is an innovative approach to provide all medical students near-peer support and outreach encouraging engagement and conversations in effort to reduce the stigma and isolation often associated with mental health concerns in professional education. This study explores the effectiveness and efficacy of Seeking Peer Outreach* - a 3-tiered peer-support system. A survey of medical students, faculty, and staff demonstrated that the program increased knowledge on suicidal thoughts and behaviors and improved self-efficacy in talking about mental health with peers. It also showed that effective training helps individuals gain confidence with mental health interventions and suicide prevention.

Knowledge, Attitudes, and Behaviors Regarding Pneumococcal Vaccines in Adults 65 Years and Older in Primary Care in Wisconsin.

INTRODUCTION: Although shared decision-making is highly valued, its implementation in clinical practice is suboptimal. Shared decision-making was included in the Centers for Disease Control and Prevention (CDC) recommendations for the pneumococcal conjugate vaccine 13 valent for older adults. As a first step to develop and test clinician educational resources to facilitate shared decision-making for pneumococcal vaccines for older adults, we completed a needs assessment to identify knowledge gaps, attitudes, and behaviors. METHODS: Primary care clinicians, pharmacists, and patient care staff completed a questionnaire on shared decision-making and pneumococcal vaccines. After the CDC recommended new pneumococcal vaccines and eliminated the role of shared decision-making, a revised questionnaire was distributed to additional clinicians in an effort to increase the sample size. RESULTS: Knowledge of pneumococcal vaccine recommendations was high among those who responded to knowledge questions (48 of 75 respondents). Although 96% of respondents believed shared decision-making for use of pneumococcal vaccines in adults 65 years or older was feasible, 25% responded that it would be "somewhat difficult" to explain potential harms and benefits of PCV13. DISCUSSION: Although shared decision-making was reported to be feasible, challenges implementing it are ongoing. Knowledge gaps regarding pneumococcal vaccines were observed, highlighting the need for ongoing medical education with changing vaccine recommendations.

"It is like a curse". The lived experiences of the intersection of intergenerational violence, pregnancy, and intimate partner violence among urban Wisconsin Indigenous women.

BACKGROUND: Intimate Partner Violence (IPV) is a significant public health concern that disproportionately impacts Indigenous American women more than any other ethnic/racial group in the United States. PURPOSE: This study aims to inform the work of nurses and allied health professionals by providing insight into the lived realities of Indigenous women in urban areas and how IPV manifests in the lives of Indigenous women. METHODS: Postcolonial and Indigenous feminist frameworks informed this qualitative study. Using thematic analysis, we analyzed data from semi-structured individual interviews with 34 Indigenous women in large urban areas in the upper Midwest. FINDINGS: This manuscript discusses one broad theme: experiences of IPV during pregnancy and the devastating impacts on women and their children in the form of intergenerational trauma. Under this broad theme, we identified two sub-themes: impacts of IPV on individual pregnancy experiences and linkages to adverse pregnancy-related outcomes related to physical IPV during the childbearing years. CONCLUSION: This Indigenous-led study informs the development of effective Indigenous-specific interventions to minimize barriers to accessing prenatal care and help-seeking when experiencing IPV to reduce the devastating consequences for Indigenous women and their families.

Outcomes from Partner2Lose: a randomized controlled trial to evaluate 24-month weight loss in a partner-assisted intervention.

BACKGROUND: Partner support is associated with better weight loss outcomes in observational studies, but randomized trials show mixed results for including partners. Unclear is whether teaching communication skills to couples will improve weight loss in a person attempting weight loss (index participant). PURPOSE: To compare the efficacy of a partner-assisted intervention versus participant-only weight management program on 24-month weight loss. METHODS: This community-based study took place in Madison, WI. Index participants were eligible if they met obesity guideline criteria to receive weight loss counseling, were aged 18-74 years, lived with a partner, and had no medical contraindications to weight loss; partners were aged 18-74 years and not underweight. Couples were randomized 1:1 to a partner-assisted or participant-only intervention. Index participants in both arms received an evidence-based weight management program. In the partner-assisted arm, partners attended half of the intervention sessions, and couples were trained in communication skills. The primary outcome was index participant weight at 24 months, assessed by masked personnel; secondary outcomes were 24-month self-reported caloric intake and average daily steps assessed by an activity tracker. General linear mixed models were used to compare group differences in these outcomes following intent-to-treat principles. RESULTS: Among couples assigned to partner-assisted (n = 115) or participant-only intervention (n = 116), most index participants identified as female (67%) and non-Hispanic White (87%). Average baseline age was 47.27 years (SD 11.51 years) and weight was 106.55 kg (SD 19.41 kg). The estimated mean 24-month weight loss was similar in the partner-assisted (2.66 kg) and participant-only arms (2.89 kg) (estimated mean difference, 0.23 kg [95% CI, -1.58, 2.04 kg], p=0.80). There were no differences in 24-month average daily caloric intake (estimated mean difference 50 cal [95% CI: -233, 132 cal], p=0.59) or steps (estimated mean difference 806 steps [95% CI: -1675, 64 steps], p=0.07). The percentage of participants reporting an adverse event with at least possible attribution to the intervention did not differ by arm (partner-assisted: 9%, participant-only, 3%, p = 0.11). CONCLUSIONS: Partner-assisted and individual weight management interventions led to similar outcomes in index participants. TRIAL REGISTRATION: Clinicaltrials.gov NCT03801174, January 11, 2019.