Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions.

Effective screening and referral practices for perinatal mental health disorders, perinatal substance use disorders (SUDs), and intimate partner violence are greatly needed to reduce maternal morbidity and mortality. We conducted a randomized controlled trial from January 2021 to April 2023 comparing outcomes between Listening to Women and Pregnant and Postpartum People (LTWP), a text- and telephone-based screening and referral program, and usual care in-person screening and referral within the perinatal care setting. Participants assigned to LTWP were three times more likely to be screened compared with those assigned to usual care. Among participants completing a screen, those assigned to LTWP were 3.1 times more likely to screen positive, 4.4 times more likely to be referred to treatment, and 5.7 times more likely to attend treatment compared with those assigned to usual care. This study demonstrates that text- and telephone-based screening and referral systems may improve rates of screening, identification, and attendance to treatment for perinatal mental health disorders and perinatal SUDs compared with traditional in-person screening and referral systems. System-level changes and complementary policies and insurance payments to support adoption of effective text- and telephone-based screening and referral programs are needed.

Persistent Opioid Use Following Pediatric Nonfatal Firearm Injury.

OBJECTIVE: Firearms are a major cause of pediatric injury. An analysis of opioid use following pediatric firearm injury has not previously been reported. Our objective was to determine the prevalence and factors associated with persistent opioid use among pediatric nonfatal firearm injury victims. METHODS: We performed a retrospective cohort study using 2015-18 claims data from the Merative MarketScan Multi-State Medicaid and Commercial Databases, utilizing International Classification of Diseases, Tenth Revision codes for firearm injury and National Drug Codes for opioids. Dispensed opioid claims were used as a proxy for opioid use. Opioid exposure was defined both dichotomously and continuously (by the total number of opioid days prescribed) in the 30 days following discharge from firearm injury index encounter. Persistent opioid use was defined as ≥1 opioid claim(s) in the 90 to 270 days following index encounter. Multivariable logistic regression analysis was performed to determine whether covariates of interest were associated with greater odds of persistent opioid use. RESULTS: Our cohort consisted of 2110 children who experienced nonfatal firearm injury (mean age 13.5, 80.9% male, 79.5% Medicaid) with 608 children (28.8%) exposed to opioids. Of patients exposed to opioids, 10.4% developed persistent opioid use. In adjusted analyses, each opioid day dispensed during the exposure period represented 5% greater odds of experiencing persistent opioid use. CONCLUSIONS: Clinicians caring for children injured by firearms should be aware of the risk of developing persistent opioid use and balance that risk with the need to sufficiently control pain.

Health Care Utilization After Nonfatal Firearm Injuries.

OBJECTIVES: Despite the high incidence of firearm injuries, little is known about health care utilization after nonfatal childhood firearm injuries. This study aimed to describe health care utilization and costs after a nonfatal firearm injury among Medicaid and commercially insured youth using a propensity score matched analysis. METHODS: We conducted a propensity score matched cohort analysis using 2015 to 2018 Medicaid and Commercial Marketscan data comparing utilization in the 12-months post firearm injury for youth aged 0 to 17. We matched youth with a nonfatal firearm injury 1:1 to comparison noninjured youth on demographic and preindex variables. Outcomes included inpatient hospitalizations, emergency department (ED) visits, and outpatient visits as well as health care costs. Following propensity score matching, regression models estimated relative risks of the health care utilization outcomes, adjusting for demographic and clinical covariates. RESULTS: We identified 2110 youth with nonfatal firearm injury. Compared with matched noninjured youth, firearm injured youth had a 5.31-fold increased risk of inpatient hospitalization (95% confidence interval [CI] 3.93-7.20), 1.49-fold increased risk of ED visit (95% CI 1.37-1.62), and 1.06-fold increased risk of outpatient visit (95% CI 1.03-1.10) 12-months postinjury. Adjusted 12-month postindex costs were $7581 (95% CI $7581-$8092) for injured youth compared with $1990 (95% CI $1862-2127) for comparison noninjured youth. CONCLUSIONS: Youth who suffer nonfatal firearm injury have a significantly increased risk of hospitalizations, ED visits, outpatient visits, and costs in the 12 months after injury when compared with matched youth. Applied to the 11 258 US youth with nonfatal firearm injuries in 2020, estimates represent potential population health care savings of $62.9 million.

Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury.

Importance: Firearm injuries are a leading cause of morbidity and mortality among US children and adolescents. Despite evidence demonstrating mental health sequelae for children and adolescents who have experienced a firearm injury, little is known about mental health care utilization after a firearm injury. Objective: To evaluate mental health care utilization in the 12 months after a firearm injury among Medicaid-insured and commercially insured children and adolescents compared with propensity score-matched controls. Design, Setting, and Participants: This propensity score-matched retrospective cohort analysis assessed 2127 children and adolescents, aged 0 to 17 years, with a firearm injury that occurred between January 1, 2016, and December 31, 2017, compared with 2127 matched controls using MarketScan Medicaid and commercial claims data. Claims data were analyzed 12 months before and after injury, with the total study period spanning from January 1, 2015, to December 31, 2018. Exposure: Nonfatal firearm injury. Main Outcomes and Measures: The primary outcome of interest was a dichotomous variable representing any mental health care utilization in the 12 months after injury. Secondary outcomes included psychotherapy utilization, substance use-related utilization, and a psychotropic medication prescription. Logistic regression modeling was used to estimate relative risks with adjusted analyses of dichotomous outcomes. Results: The overall cohort consisted of 4254 children and adolescents, of whom 2127 (mean [SD] age, 13.5 [4.1] years; 1722 [81.0%] male) had an initial encounter for a firearm injury and an equal number of matched controls (mean [SD] age, 13.5 [4.1] years; 1720 [80.9%] male). Children and adolescents with a firearm injury had a 1.40 times greater risk (95% CI, 1.25-1.56; P < .001) of utilizing mental health services in the 12 months after their injury compared with children and adolescents without a firearm injury, after controlling for potential confounders. Children and adolescents with a firearm injury had a 1.23 times greater risk (95% CI, 1.06-1.43; P = .007) of utilizing psychotherapy and a 1.40 times greater risk (95% CI, 1.19-1.64; P < .001) of substance use-related utilization. Among those who experienced a firearm injury, Black children and adolescents were 1.64 times more likely (95% CI, 1.23-2.19; P < .001) to utilize mental health care compared with White children and adolescents. Conclusions and Relevance: This propensity score-matched cohort study found that children and adolescents with a firearm injury had a greater risk of utilizing mental health services in the 12 months after their injury compared with those without an injury, and significant racial disparities were associated with use of mental health services. The findings suggest that health care practitioners should be aware of this increased risk and ensure adequate mental health follow-up for these patients.

Increase in Mental Health Diagnoses Among Youth With Nonfatal Firearm Injuries.

BACKGROUND AND OBJECTIVES: Firearm injury is a leading cause of mortality for US youth. For every youth who dies from a firearm injury, at least 4 more survive. Little is known about the mental health consequences of non-fatal firearm injury in youth. Our objective was to quantify new mental health diagnoses after nonfatal firearm injury. METHODS: MarketScan Medicaid and commercial data were used to identify youth age 0 to 17 years with an initial encounter for a nonfatal firearm injury in 2016 to 2017. The International Classification of Diseases, Tenth Revision codes determined the presence of mental health conditions in the 12 months preinjury, during the index encounter, and in the 12 months postinjury. Logistic regression analysis was performed to determine factors associated with new mental health diagnoses during the 12 months postinjury. RESULTS: About 2178 patients (1769 Medicaid, 409 commercial) were identified for inclusion. 844 (38.8%) patients had a mental health diagnosis identified during the 12-month preinjury period. During the index encounter, 184 (8.5%) patients had a newly diagnosed mental health disorder. In the 12 months postinjury, 559 (25.7%) patients had a newly diagnosed mental health disorder. The most common new diagnosis categories were trauma disorders, substance abuse, and disruptive disorders. Medicaid insurance and a prior complex chronic condition were predictors of new mental health diagnosis. CONCLUSION: Over a quarter of youth with nonfatal firearm injury were diagnosed with a new mental health condition in the 12 months after their injury. Health care providers should be vigilant about mental health screening and ensuring access to mental health care services in this population.

A Non-Randomized Trial of In-Person Versus Text/Telephone Screening, Brief Intervention and Referral to Treatment for Pregnant and Postpartum Women.

Background: Systems of care that improve mental health and substance use disorder Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant and postpartum women are needed. Aims: The aim of this study is to determine if women receiving prenatal care from January 2020 to April 2021 are more likely to be screened, screen positive, be referred for treatment and attend treatment with technology facilitated SBIRT, compared to women receiving prenatal care and in-person SBIRT January 2017 to December 2019. Materials & Methods: Technology facilitated SBIRT, designated Listening to Women (LTW), includes text message-based screening, phone-based brief intervention, and referral to treatment by a remote care coordinator. A total of 3535 pregnant and postpartum women were included in the quasi-experimental study and data were collected via text message and Electronic Health Record. Results: In-person SBIRT was completed by 65.2% (1947/2988) of women while 98.9% (547/553) of women approached agreed to take part in LTW and 71.9% (393/547) completed SBIRT via LTW. After controlling for potentially confounding variables, women enrolled in LTW were significantly more likely to be screened (relative risk [RR]: 1.10, 95% CI 1.03-1.16), screen positive (RR 1.91, 95% CI 1.72-2.10), referred to treatment (RR 1.55, 95% CI 1.43-1.69) and receive treatment (RR 4.95, 95% CI 3.93-6.23), compared to women receiving in-person SBIRT. Black women enrolled in LTW were significantly more likely to screen positive (RR 1.65, 95% CI 1.35-2.01), be referred to treatment (RR 1.54, 95% CI 1.35-1.76) and attend treatment (RR 5.49, 95% CI 3.69-8.17), compared to Black women receiving in-person SBIRT. Discussion: LTW appears to increase the proportion of pregnant and postpartum women receiving key elements of SBIRT.

Overlap between Parkinson disease and Alzheimer disease in ABCA7 functional variants.

OBJECTIVE: Given their reported function in phagocytosis and clearance of protein aggregates in Alzheimer disease (AD), we hypothesized that variants in ATP-binding cassette transporter A7 (ABCA7) might be involved in Parkinson disease (PD). METHODS: ABCA7 variants were identified using whole-exome sequencing (WES) on 396 unrelated patients with PD and 222 healthy controls. In addition, we used the publicly available WES data from the Parkinson's Progression Markers Initiative (444 patients and 153 healthy controls) as a second, independent data set. RESULTS: We observed a higher frequency of loss-of-function (LOF) variants and rare putative highly functional variants (Combined Annotation Dependent Depletion [CADD] >20) in clinically diagnosed patients with PD than in healthy controls in both data sets. Overall, we identified LOF variants in 11 patients and 1 healthy control (odds ratio [OR] 4.94, Fisher exact p = 0.07). Four of these variants have been previously implicated in AD risk (p.E709AfsX86, p.W1214X, p.L1403RfsX7, and rs113809142). In addition, rare variants with CADD >20 were observed in 19 patients vs 3 healthy controls (OR 2.85, Fisher exact p = 0.06). CONCLUSION: The presence of ABCA7 LOF variants in clinically defined PD suggests that they might be risk factors for neurodegeneration in general, especially those variants hallmarked by protein aggregation. More studies will be needed to evaluate the overall impact of this transporter in neurodegenerative disease.

DNA variants in CACNA1C modify Parkinson disease risk only when vitamin D level is deficient.

OBJECTIVE: To evaluate the association between the genetic variants in CACNA1C, which encodes the α1 subunit of the L-type voltage-sensitive calcium channel (LVSCC) and Parkinson disease (PD) while accounting for interactions with vitamin D concentration. METHODS: Two independent case-control data sets (478 cases and 431 controls; 482 cases and 412 controls) were used. Joint effects of single nucleotide polymorphisms (SNPs) and SNP-vitamin D interaction were analyzed by comparing models containing vitamin D deficiency, SNP genotypes, SNP-vitamin D interaction, and covariates to a restricted model with only vitamin D deficiency and covariates. Meta-analysis was used to combine the joint effects in the 2 data sets. Analysis was stratified by vitamin D deficiency to demonstrate the pattern of SNP-vitamin D interaction. RESULTS: Vitamin D deficiency was associated with PD in both data sets (odds ratio [OR] = 1.9-2.7, p ≤ 0.009). SNP rs34621387 demonstrated a significant joint effect (meta-analysis, p = 7.5 × 10(-5); Bonferroni corrected, p = 0.02). The G allele at rs34621387 is associated with PD in vitamin D-deficient individuals in both data sets (OR = 2.0-2.1, confidence interval = 1.3-3.5, p = 0.002) but is not associated with PD in vitamin D-nondeficient individuals (p > 0.8 in both data sets). CONCLUSIONS: Previous studies suggest that vitamin D deficiency is associated with PD and sustained opening of LVSCC contributes to the selective vulnerability of dopaminergic neurons in PD. Our data demonstrate that the association between genetic variations in CACNA1C and PD depends on vitamin D deficiency, providing one potential mechanism underlying the association between vitamin D deficiency and PD.

Vitamin D from different sources is inversely associated with Parkinson disease.

An inverse association between Parkinson disease (PD) and total vitamin D levels has been reported, but whether vitamin D from different sources, that is, 25(OH)D2 (from diet and supplements) and 25(OH)D3 (mainly from sunlight exposure), all contribute to the association is unknown. Plasma total 25(OH)D, 25(OH)D2, and 25(OH)D3 levels were measured by liquid chromatography-tandem mass spectrometry in PD patients (n = 478) and controls (n = 431). Total 25(OH)D was categorized by clinical insufficiency or deficiency; 25(OH)D2 and 25(OH)D3 were analyzed in quartiles. Vitamin D deficiency (total 25[OH]D < 20 ng/mL) and vitamin D insufficiency (total 25[OH]D < 30 ng/mL) are associated with PD risk (odds ratio [OR] = 2.6 [deficiency] and 2.1 [insufficiency]; P < 0.0001), adjusting for age, sex, and sampling season. Both 25(OH)D2 and 25(OH)D3 levels are inversely associated with PD (P(trend) < 0.0001). The association between 25(OH)D2 and PD risk is largely confined to individuals with low 25(OH)D3 levels (P(trend) = 0.0008 and 0.12 in individuals with 25[OH]D3 < 20 ng/mL and 25[OH]D3 ≥ 20 ng/mL, respectively). Our data confirm the association between vitamin D deficiency and PD, and for the first time demonstrate an inverse association of 25(OH)D2 with PD. Given that 25(OH)D2 concentration is independent of sunlight exposure, this new finding suggests that the inverse association between vitamin D levels and PD is not simply attributable to lack of sunlight exposure in PD patients with impaired mobility. The current study, however, cannot exclude the possibility that gastrointestinal dysfunction, a non-motor PD symptom, contributes to the lower vitamin D2 levels in PD patients.

Case study of landfill leachate recirculation using small-diameter vertical wells.

A case study of landfill liquids addition using small diameter (5 cm) vertical wells is reported. More than 25,000 m(3) of leachate was added via 134 vertical wells installed 3 m, 12 m, and 18 m deep over five years in a landfill in Florida, US. Liquids addition performance (flow rate per unit screen length per unit liquid head) ranged from 5.6×10(-8) to 3.6×10(-6) m(3) s(-1) per m screen length per m liquid head. The estimated radial hydraulic conductivity ranged from 3.5×10(-6) to 4.2×10(-4) m s(-1). The extent of lateral moisture movement ranged from 8 to 10 m based on the responses of moisture sensors installed around vertical well clusters, and surface seeps were found to limit the achievable liquids addition rates, despite the use of concrete collars under a pressurized liquids addition scenario. The average moisture content before (51 samples) and after (272 samples) the recirculation experiments were 23% (wet weight basis) and 45% (wet weight basis), respectively, and biochemical methane potential measurements of excavated waste indicated significant (p<0.025) decomposition.

The efficacy of religious service attendance in reducing depressive symptoms.

PURPOSE: To examine whether religiosity may help people ward off depression, we investigated the association between religious service attendance and depressive symptom scores in a community-based 30-year follow-up longitudinal study. METHODS: This study used data on 754 subjects followed over 30 years and evaluated at four time points. Linear mixed effects models were used to assess the association between religious service attendance and depressive symptoms development; frequency of attendance and age also were used as predictors. Demographic factors, life-time trauma, family socioeconomic status, and recent negative events were considered as control variables. RESULTS: Depressive symptom scores were reduced by an average of 0.518 units (95 % CI from -0.855 to -0.180, p < 0.005) each year in subjects who attended religious services as compared with subjects who did not. The more frequent the religious service attendance, the stronger the influence on depressive symptoms when compared with non-attendance. Yearly, monthly, and weekly religious service attendance reduced depression scores by 0.474 (95 % CI from -0.841 to -0.106, p < 0.01), 0.495 (95 % CI from -0.933 to -0.057, p < 0.05) and 0.634 (95 % CI from -1.056 to -0.212, p < 0.005) units on average, respectively, when compared with non-attendance after controlling for other covariates. CONCLUSION: Religious service attendance may reduce depressive symptoms significantly, with more frequent attendance having an increasingly greater impact on symptom reduction in this 30-year community-based longitudinal study.

Impact of early adolescent anxiety disorders on self-esteem development from adolescence to young adulthood.

PURPOSE: To examine the association between early adolescent anxiety disorders and self-esteem development from early adolescence through young adulthood. METHODS: Self-esteem was measured at mean ages 13, 16, and 22 for 821 participants from the Children in the Community Study, a population-based longitudinal cohort. Anxiety disorders were measured at mean age 13 years. Multilevel growth models were employed to analyze the change in self-esteem from early adolescence to young adulthood and to evaluate whether adolescent anxiety disorders predict both average and slope of self-esteem development. RESULTS: Self-esteem increased during adolescence and continued to increase in young adulthood. Girls had lower average self-esteem than boys, but this difference disappeared when examining the effect of anxiety. Adolescents with anxiety disorder had lower self-esteem, on average, compared with healthy adolescents (effect size [ES] = -.35, p < .01). Social phobia was found to have the greatest relative impact on average self-esteem (ES = -.30, p < .01), followed by overanxious disorder (ES = -.17, p < .05), and simple phobia (ES = -.17, p < .05). Obsessive compulsive-disorder (OCD) predicted a significant decline in self-esteem from adolescence to young adulthood (ß = -.1, p < .05). Separation anxiety disorder was not found to have any significant impact on self-esteem development. CONCLUSIONS: All but one of the assessed adolescent anxiety disorders were related to lower self-esteem, with social phobia having the greatest impact. OCD predicted a decline in self-esteem trajectory with age. The importance of raising self-esteem in adolescents with anxiety and other mental disorders is discussed.