Person-centered hospital discharge data: Essential existing infrastructure to enhance public health surveillance of maternal substance use disorders in the midst of a national maternal overdose crisis

OBJECTIVES

As crises of drug-related maternal harms escalate, US public health surveillance capacity remains suboptimal for drug-related maternal morbidities. Most state hospital discharge databases (HDDs) are encounter-based, and thus limit ascertainment of morbidities to delivery visits and ignoring those occurring during the 21 months spanning pregnancy and postpartum year. This study analyzes data from a state that curates person-centered HDD to compare patterns of substance use disorder (SUD) diagnoses at delivery vs. the full 21 pregnancy/postpartum months, overall and by maternal social position.

METHODS

Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated SUD diagnosis (e.g., opioids, stimulants, benzodiazepines, cannabis) prevalence at delivery; across the full 9 months of pregnancy and 12 postpartum months; and by trimester and postpartum quarter. Risk ratio and risk difference estimated disparities by race/ethnicity, age, rurality, and payor.

RESULTS

The 21-month SUD prevalence rate per 100,000 was 2671 (95% CI 2616-2726), with 31% (29.5%-31.5%) missing SUD indication when ascertained at delivery only (1866; 95% CI 1820-1912). Quarterly rates followed a roughly J-shaped trajectory. Structurally marginalized individuals suffered the highest 21-month SUD prevalence (e.g., Black:White risk ratio=1.80 [CI:1.73-1.88]).

CONCLUSION

By spanning the full 21 months of pregnancy/postpartum, person-centered HDD reveal than the maternal SUD crisis is far greater than encounter-based delivery estimates had revealed. Generating person-centered HDD will improve efforts to tailor interventions to help people who use drugs survive while pregnant and postpartum, and eliminate inequities.

Racial differences in the association of undetectable HIV viral load and transportation to an HIV provider among men who have sex with men in Atlanta, Georgia: a health equity perspective

There are inequities in HIV outcomes among Black gay, bisexual, and other sexual minority men who have sex with men (GBMSM) compared to GBMSM overall, including access to transportation to HIV care. It is unclear if the relationship between transportation and clinical outcomes extends to viral load. We assessed the relationship between transportation dependence to an HIV provider and undetectable viral load among Black and White GBMSM in Atlanta. We collected transportation and viral load information from GBMSM with HIV from 2016-2017 (n = 345). More Black than White GBMSM had a detectable viral load (25% vs. 15%) and took dependent (e.g. public) transportation (37% vs. 18%). Independent (e.g. car) transportation was associated with undetectable viral load for White GBMSM (cOR 3.61, 95% CI 1.45, 8.97) but was attenuated by income (aOR. 2.29, 95% CI 0.78, 6.71), and not associated for Black GBMSM (cOR 1.18, 95% CI 0.58, 2.24). One possible explanation for no association for Black GBMSM is that there are more competing barriers to HIV care for Black GBMSM than White GBMSM. Further investigation is needed to confirm whether 1) transportation is unimportant for Black GBMSM or 2) transportation interacts with additional factors not considered in this analysis.

Structural racism theory, measurement, and methods: A scoping review

Introduction

Epidemiologic and public health interest in structural racism has grown dramatically, producing both increasingly sophisticated questions, methods, and findings, coupled with concerns of atheoretical and ahistorical approaches that often leave the actual production of health or disease ambiguous. This trajectory raises concerns as investigators adopt the term "structural racism" without engaging with theories and scholars with a long history in this area. This scoping review aims to build upon recent work by identifying current themes about the incorporation of structural racism into (social) epidemiologic research and practice with respect to theory, measurement, and practices and methods for trainees and public health researchers who are not already deeply grounded in this work.

Methods

This review uses methodological framework and includes peer-review articles written in English published between January 2000-August 2022.

Results

A search of Google Scholar, manual collection, and referenced lists identified a total of 235 articles; 138 met the inclusion criteria after duplicates were removed. Results were extracted by, and organized into, three broad sections: theory, construct measurement, and study practice and methods, with several themes summarized in each section.

Discussion

This review concludes with a summary of recommendations derived from our scoping review and a call to action echoing previous literature to resist an uncritical and superficial adoption of "structural racism" without attention to already existing scholarship and recommendations put forth by experts in the field.

Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis

BACKGROUND

Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations.

METHODS AND FINDINGS

This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively.

CONCLUSION

In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage.

[Coating material of parlene C as encapsulation material for biomedical micro-implants]

Biomedical microsystems attain to contact with environments like blood, ephitHelium and saline solutions therefore they need an encapsulation. Parylene seems to be a suitable polymer to cover the implants and protect them against moisture and aggressive environment. This paper describes the characterisation of Parylene C coatings and its possibilities to protect implants. Beside the encapsulation of biomedical microsystems the manufacturing of fexible electrodes and the cytotoxicity behavior of RIE etched Parylene layers was investigated.

Purified chicken growth hormone (GH) and a human pancreatic GH-releasing hormone increase body weight gain in chickens

Purified chicken GH (cGH) and a synthetic human GH-releasing hormone (hpGRF) were tested for the ability to improve growth performance in chickens. Purified cGH was given to 4-week-old cockerels at 5, 10, and 50 micrograms/day for 14 days via daily iv injection. Body weights of chickens receiving 5 and 10 micrograms/day cGH were significantly increased at 6 days by 13.5% and 11.2%, respectively, relative to control values. At 14 days, body weights averaged 8.1% and 7.7% greater than controls, but these values were not statistically significant. There was a slight stimulation of body weight gain in chickens receiving 50 micrograms/day cGH. In general, cGH produces a transient stimulation of body weight gain in chickens. hpGRF was also given to 4-week-old cockerels for 14 days via daily iv injection at 0.1, 1.0, and 10.0 micrograms/day. hpGRF at 0.1 microgram/bird daily increased body weight on day 14 (9.1% over the control value). The stimulating effects of hpGRF on body weight are also transient. The effects of cGH on serum somatomedin-C (SM-C) were examined. Serum SM-C concentrations were significantly elevated 24 and 36 h after injection of cGH. In conclusion, purified cGH and hpGRF appear to have some growth-promoting activity. The stimulatory effect of hpGRF on weight gain may be mediated via GH, and the stimulatory effect of cGH could be mediated through SM-C.

Effects of thyrotropin-releasing hormone and a thyrotropin releasing hormone analog on growth and selected plasma hormones in lambs

An 8-wk growth trial was conducted to assess the effects of continuous infusion of thyrotropin-releasing hormone (TRH) and an active TRH analog less than Aad-His-Pro-NH2 (the less than Aad is L-pyro-alpha-aminoadipic acid) on growth trial performance, carcass composition and hormone profiles of growing lambs. Both drugs were infused at 600 micrograms X lamb -1 X d -1 with 16 lambs/treatment. Both TRH and less than Aad-His-Pro-NH2 decreased average daily gain (ADG; P less than .01) and increased feed conversion (FC; P less than .01) compared with saline infused controls. Average daily feed intake was not altered. Carcasses of lambs given TRH or less than Aad-His-Pro-NH2 contained fewer kilograms of moisture (P less than .05) and appeared to contain fewer kilograms of protein. Thyrotropin-releasing hormone and less than Aad-His-Pro-NH2 increased thyroid gland weights (P less than .05), but pituitary gland weights were not different. Plasma thyrotropin (TSH) concentrations were increased by both drugs compared with control lambs, peaking at 4 to 7 d after initiating infusion. However, by 14 d, TSH concentrations returned to control levels. Triiodothyronine (T3) and thyroxine (T4) were elevated by both drugs over the entire 8-wk trial, with peak levels reached at 10 d and maintained for the duration of the study. Both TRH and less than Aad-His-Pro-NH2 increased prolactin over the entire period. Growth hormone levels were not altered by either drug. The effects of less than Aad-His-Pro-NH2 infusion on growth trial performance, carcass composition and hormone profiles of growing lambs were very similar to TRH. The negative effects of TRH and less than Aad-His-Pro-NH2 infusion on ADG, FC and carcass protein appear to be the result of elevated T3 and T4 levels.

Effects of exogenous growth hormone and diethylstilbestrol on growth and carcass composition of growing lambs

An 8-wk growth trial was conducted to assess the effects of ovine growth hormone (oGH; 7 mg/d, sc) on growth performance and carcass composition of normal, growing wether lambs. Diethylstilbestrol (DES; .1 mg/d, sc) and control lambs were included for comparisons. Plasma oGH levels at 8 wk were 1.9, 5.5 (P less than .05) and 138.1 ng/ml (P less than .001) for controls, DES and oGH lambs, respectively. Diethylstilbestrol did not increase plasma oGH until the fourth week. The oGH improved feed conversion 7.4% (FC; P less than .05), but did not alter average daily gain (ADG) or feed intake (ADF). Diethylstilbestrol increased ADG 15.3% (P less than .05) and improved FC 16.1% (P less than .01), with no effect on ADF. The primary effect of oGH on carcass composition was to decrease the quantity of fat 8.9% (P less than .05). In addition, oGH may have increased protein 6.5% (P less than .10) and moisture 4.0% (not significant). Diethylstilbestrol increased the quantity of carcass protein 10% (P less than .01) and moisture 8.7% (P less than .05), with no effect on fat. In these studies, the primary effect of exogenous oGH on normal, growing lambs was to reduce carcass fat, which may account for the observed improvement in FC. Diethylstilbestrol, at 1/70th of the oGH dose, was superior to oGH for improving FC (P less than .05) and ADG (P less than .10). Improvements in body weight of the lambs given DES were observed 2 wk before an increase in plasma oGH. In addition, DES, unlike exogenous oGH, did not alter the quantity of carcass fat. These observations do not support the concept that the mode of action of DES is through increased GH secretion.