Trends in Initiate Pediatric Opioid Prescriptions in Rhode Island: 2017-2021

OBJECTIVE

To analyze recent trends in initiate pediatric opioid prescriptions dispensed in Rhode Island.

METHODS

All Rhode Island residents aged 0-17 years with an initiate opioid prescription dispensed between January 1, 2017 and December 31, 2021 were obtained from the Rhode Island Prescription Drug Monitoring Program. Analyses were conducted to investigate trends related to patient demographics, prescription characteristics, diagnosis codes, and prescriber type.

RESULTS

From 2017-2021, there was a decrease in the number of unique pediatric patients dispensed an initiate prescription, the number of initiate pediatric opioid prescriptions, and the initiate prescription dosage. Initiate opioid prescriptions were primarily related to dental-related diagnoses, and dentists and oral and maxillofacial (OMF) surgeons comprised the largest category of prescriber type.

CONCLUSION

Initiate pediatric opioid prescriptions have decreased in Rhode Island in recent years. However, there remain opportunities to educate prescribers on reducing opioid exposure to vulnerable populations, including the use of alternate analgesics.

Smartphone Addiction and Mental Illness In Rhode Island Young Adults

BACKGROUND

Smartphone addiction is a rising problem in the United States. The current study estimated the prevalence of smartphone addiction in Rhode Island young adults and its associations with mental illness.

METHODS

The 2022 Rhode Island Young Adult Survey measured smartphone addiction, depression, anxiety, and suicide ideation. Covariates included age, sex/gender minority status, race/ethnicity, and social status.

RESULTS

The prevalence of smartphone addiction was 34%. Odds of experiencing depression (OR[95%CI]=2.69 [2.05,3.52]), anxiety (OR[95%CI]=2.06 [1.58,2.69]), and suicide ideation (OR[95%CI]=1.55 [1.08,2.20]) were greater in participants with smartphone addiction. The relationship between smartphone addiction and depression was strongest in heterosexual cis-males (OR[95%CI] = 8.45 [3.53, 20.3]).

DISCUSSION

Smartphone addiction is prevalent among Rhode Island's young adults and may be associated with depression, anxiety, and suicide ideation. Heterosexual cis-males may be particularly vulnerable. Screening programs and interventions to reduce smartphone use for all young adults, and particularly young men, should be considered.

Brain Injury and Substance Use in Young Adults: The Need for Integrating Care

OBJECTIVES

This study examined sociodemographic disparities in traumatic brain injury (TBI), and the association between TBI and substance misuse among young adults in Rhode Island.

METHODS

Among this sample of N=1,022 from the 2022 Rhode Island Young Adult Survey, multivariable logistic regressions were used to examine both study objectives.

RESULTS

Black, Asian, and Hispanic young adults had 77% (95%CI: 26%, 93%), 79% (95%CI: 32%, 94%), and 58% (95%CI: 31%, 75%) lower odds of brain injury, respectively, compared to White, non-Hispanic young adults. Those having experienced brain injury were more likely to engage in hazardous alcohol use (p = 0.003), hazardous marijuana use (p < 0.001), and illicit drug use (p = 0.003), but not OTC or prescription drug misuse.

CONCLUSIONS

There is a pressing need for integrated, large-scale, multidisciplinary programs with a well-trained workforce to address TBI and substance misuse in various medical settings for behavioral health and emergency care.

Dispensed Opioid, Buprenorphine, Benzodiazepine, and Stimulant Prescriptions among Rhode Island Residents, 2017-2021

The Rhode Island Prescription Drug Monitoring Program (PDMP) requires dispensers with an active Controlled Substance Registration to report Schedule II-V substances and opioid antagonists within 24 hours of dispensing. This database was designed to surveille diversion and identify high-risk prescribing to prevent drug related harms. Using PDMP data from January 1, 2017, to December 31, 2021, opioid, buprenorphine, stimulant, and benzodiazepine dispensing trends were explored. During this time, opioid prescriptions dispensed annually decreased by 27.3% (from 576,421 to 419,220), and benzodiazepine prescriptions dispensed annually decreased by 12.3% (552,430 to 484,496). High-risk prescribing also decreased with opioids prescriptions > 90 daily MME decreasing by 52.1% and instances of overlapping benzodiazepine and opioid prescriptions decreasing by 34.1%. Buprenorphine and stimulant dispensing have increased by 11.1% and 20.7%, respectively. Prevention interventions will continue to educate providers on appropriate prescribing practices and work to further reduce unnecessary prescribing within the state.

Robotic Spine Surgery in Rhode Island

Surgical robots were first proposed in the 1960s with subsequent development and clinical implementation in the 1980s and 1990s. Recent advances in technology have led to widespread utilization of robots in many surgical subspecialties. In spine surgery, robots are primarily utilized for pedicle screw placement, with several studies highlighting the potential benefits of improved accuracy and reduction in radiation exposure. Once streamlined, robotic spine surgery (RSS) can provide financial renumeration through potential cost savings and marketing benefits, and in the future will likely aid in more complex surgeries. In Rhode Island, this technology has been implemented and has the potential to deliver optimized outcomes for patients. Robotic spine surgery is not a substitute for a skilled spine surgeon however, and careful diagnosis, care planning, and surgical execution are still mandatory to deliver the best possible patient outcomes. In this review, we chronicle the history of RSS, outline currently available RSS platforms, describe the efficacy, risks, and complications of RSS procedures, and explain the current and future utilization of RSS in Rhode Island.

Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska

BACKGROUND

Three current and former awardees of the Centers for Disease Control and Prevention's Colorectal Cancer Control Program launched integrated cancer screening strategies to better coordinate multiple cancer screenings (e.g., breast, cervical, colorectal). By integrating the strategies, efficiencies of administration and provision of screenings can be increased and costs can be reduced. This paper shares findings from these strategies and describes their effects.

METHODS

The Idaho Department of Health and Welfare developed a Baseline Assessment Checklist for six health systems to assess the current state of policies regarding cancer screening. We analyzed the checklist and reported the percentage of checklist components completed. In Rhode Island, we collaborated with a nurse-patient navigator, who promoted cancer screening, to collect details on patient navigation activities and program costs. We then described the program and reported total costs and cost per activity. In Nebraska, we described the experience of the state in administering an integrated contracts payment model across colorectal, breast, and cervical cancer screening and reported cost per person screened. Across all awardees, we interviewed key stakeholders.

RESULTS

In Idaho, results from the checklist offered guidance on areas for enhancement before integrated cancer screening strategies, but identified challenges, including lack of capacity, limited staff availability, and staff turnover. In Rhode Island, 76.1% of 1023 patient navigation activities were for colorectal cancer screening only, with a much smaller proportion devoted to breast and cervical cancer screening. Although the patient navigator found the discussions around multiple cancer screening efficient, patients were not always willing to discuss all cancer screenings. Nebraska changed its payment system from fee-for-service to fixed cost subawards with its local health departments, which integrated cancer screening funding. Screening uptake improved for breast and cervical cancer but was mixed for colorectal cancer screening.

CONCLUSIONS

The results from the case studies show that there are barriers and facilitators to integrating approaches to increasing cancer screening among primary care facilities. However, more research could further elucidate the viability and practicality of integrated cancer screening programs.

SARS-CoV-2 Variants in Rhode Island; May 2022 Update

BACKGROUND

Genomic surveillance allows identification of circulating SARS-CoV-2 variants. We provide an update on the evolution of SARS-CoV-2 in Rhode Island (RI).

METHODS

All publicly available SARS-CoV-2 RI sequences were retrieved from https://www.gisaid.org. Genomic analyses were conducted to identify variants of concern (VOC), variants being monitored (VBM), or non-VOC/non-VBM, and investigate their evolution.

RESULTS

Overall, 17,340 SARS-CoV-2 RI sequences were available between 2/2020-5/2022 across five (globally recognized) major waves, including 1,462 (8%) sequences from 36 non-VOC/non-VBM until 5/2021; 10,565 (61%) sequences from 8 VBM between 5/2021-12/2021, most commonly Delta; and 5,313 (31%) sequences from the VOC Omicron from 12/2021 onwards. Genomic analyses demonstrated 71 Delta and 44 Omicron sub-lineages, with occurrence of variant-defining mutations in other variants.

CONCLUSION

Statewide SARS-CoV-2 genomic surveillance allows for continued characterization of circulating variants and monitoring of viral evolution, which inform the local health force and guide public health on mitigation efforts against COVID-19.

Receipt of Physical Therapy and Chiropractic Care by Adults Diagnosed with Chronic Pain: Analysis of the 2016-2018 Rhode Island All Payer Claims Database

OBJECTIVE

To examine trends and factors associated with physical therapy (PT) and chiropractic care use among Rhode Islanders with private or publicly-funded health insurance who were diagnosed with chronic pain from 2016-2018.

METHODS

We measured monthly PT and chiropractic care use from the RI All Payer Claims Database, and conducted logistic regression to identify factors associated with utilization.

RESULTS

There were 284,942 unique adults with chronic pain representing over one-quarter of insured persons in the state. Chiropractic care use remained unchanged but was more prevalent (7.2%) than PT whose use increased minimally from 4.0% (2016) to 4.5% (2018). Traditional Medicare or Medicaid enrollment was associated with lower odds of receiving PT and chiropractic care than in private plans.

CONCLUSIONS

PT and chiropractic care use varied across payers; however, there were little to no changes in their use over time despite clinical guidelines that encourage non-pharmacologic options to manage chronic pain.

Trends and Risk Factors for Overlapping Stimulant and Opioid Prescriptions - Rhode Island, April 1, 2016-March 31, 2020

OBJECTIVE

To investigate possible trends and risk factors for overlapping stimulant and opioid prescriptions in Rhode Island (RI).

METHODS

All RI residents with a stimulant prescription dispensed between April 1, 2016 and March 31, 2020 were obtained from the RI Prescription Drug Monitoring Program (PDMP). Individuals were stratified by overlapping stimulant/opioid exposure and compared by demographic and prescription characteristics.

RESULTS

While stimulant prescribing remained relatively constant, the percent of individuals with an overlapping opioid prescription declined. Individuals prescribed overlapping stimulant/opioid prescriptions differed significantly as a function of age, sex, payment method, type of stimulant prescribed, and prescriber type.

CONCLUSIONS

Among residents who were dispensed at least one stimulant prescription, individuals who were older, female, and on Medicare insurance were more likely to have an overlapping stimulant/opioid prescription. The RI PDMP can be used to identify trends and risk factors regarding prescribing patterns, which can inform future health policy and practice.

Gambling: A Ubiquitous Behavior Among Rhode Island's Young Adults

OBJECTIVES

Gambling is a prevalent behavior associated with numerous consequences. The purpose of the current study was to assess the prevalence of gambling and problem gambling in Rhode Island young adults and to identify sociodemographic correlates of gambling.

METHODS

Data from n=546 participants of the Rhode Island Young Adult Survey were used. Twelve types of gambling behaviors, and problem gambling, were assessed. Sociodemographic variables included age, race/ethnicity, gender, sexual orientation, social status, education, employment, and essential worker status.

RESULTS

The prevalence of any gambling was 62.3%, and odds of any gambling was 57% higher (95%CI = 1.08,2.27) among essential workers. The prevalence of problem gambling was 11.4%, and the odds were 3.6 times higher (95%CI = 1.32, 9.86) among persons who are transgender.

CONCLUSIONS

The prevalence of gambling and problem gambling are high among Rhode Island's young adults. Implementing programmatic and regulatory measures to prevent and treat problem gambling are vital.

Eliminating Disparities in Young Adult Tobacco Use: The Need for Integrated Behavioral Healthcare

OBJECTIVES

There is limited data available specific to young adult tobacco use in Rhode Island. This study examines whether young adult cigarette and e-cigarette use varies by sociodemographics, mental health, and use of other substances.

METHODS

This cross-sectional web-based survey was administered during the COVID-19 pandemic, from May to October 2020.

RESULTS

A total of 12.9% of young adults reported current cigarette or e-cigarette use. Young adults who currently used cigarettes or e-cigarettes were more likely to be white, non-Hispanic, younger, and have depressive symptoms, a depression diagnosis, suicide ideation, engage in harmful drinking, alcohol dependence, current marijuana use, and frequent marijuana use.

CONCLUSIONS

To address the needs of disproportionately affected young adults, steps must be taken to integrate comprehensive, barrier-free, widely promoted coverage of tobacco cessation treatment in all behavioral healthcare settings.

Breaking Down Barriers: Young Adult Interest and Use of Telehealth for Behavioral Health Services

OBJECTIVES

Use of telehealth for behavioral health services has increased since the start of the COVID-19 pandemic. This study examines which young adults in Rhode Island were using these telehealth services and are interested in its use.

METHODS

This cross-sectional web-based survey was administered in the midst of the COVID-19 pandemic, from May to October 2020.

RESULTS

Results suggest sexual and gender minorities and those with low social status were more likely to access these services, highlighting its effectiveness at reaching disadvantaged young adults. Those with mental health symptoms were more likely to utilize telehealth, but those with substance use were not.

CONCLUSIONS

There is a missed opportunity to target substance use telehealth services to this willing and interested population. Continued coverage and use of telehealth for mental health and substance use services is essential in breaking down barriers to care for young adults in Rhode Island.

Quantification of microplastics in sediments from Narragansett Bay, Rhode Island USA using a novel isolation and extraction method

Microplastics are small plastic particles found ubiquitously in marine environments. In this study, a hybridized method was developed for the extraction of microplastics (45-1000 μm) from sediments using sodium bromide solution for density separation. Method development was tested using spiked microplastics as internal standards. The method was then used to extract microplastics from sediments in Narragansett Bay, Rhode Island, USA. Suspect microplastics were analyzed with Raman spectroscopy. Microplastic abundance ranged from 40 particles/100 g sediment to 4.6 million particles/100 g sediment (wet weight). Cellulose acetate fibers were the most abundant microplastic. These results are some of the first data for microplastics in Rhode Island sediments.

Controlled Substance Prescription History among Individuals Who Died of an Accidental Opioid-Involved Drug Overdose in Rhode Island

Background: Accidental opioid-involved overdose deaths are increasing nationally in the wake of the COVID-19 pandemic, but it is unclear if this reflects a change in populations most at risk. Objective: To determine whether the demographic characteristics and controlled substance prescription history of accidental opioid-involved drug overdose decedents in 2020 differed from prior years. Methods: We identified accidental opioid-involved overdose decedents using Rhode Island (RI) State Medical Examiner's Office data. Decedents were linked to the RI Prescription Drug Monitoring Program database. We compared demographic characteristics and prescription history by year of death. Results: From 2018 to 2020, 763 RI residents died from accidental opioid-involved overdose in RI. From 2018 to 2019, deaths decreased by 7%, but then increased by 31% from 2019 to 2020. Demographic characteristics were similar by year of death (all p > 0.05). The percentage of decedents with a prior opioid prescription and a prior benzodiazepine prescription declined from 2018 to 2020 (p < 0.01 and p = 0.03). Conclusions: We found that opioid-involved overdose deaths in RI are increasing overall, but without significant changes in demographics. While prior exposure to some controlled substances did decline over time, it is not clear if these changes reflect more responsible prescribing practices, or a more concerning pattern such as patient abandonment or decreased healthcare access. More studies are needed to better describe the current trend of increasing opioid-involved deaths while also pursuing current evidence-based interventions.

Inequities Laid Bare: The Mental Health of Young Adults in Rhode Island During the COVID-19 Pandemic

This study documents disparities in the mental health burden of young adults in Rhode Island during the COVID-19 pandemic as it pertains to essential worker status, sexual orientation, gender identity, and childhood trauma. A cross-sectional web-based survey of young adults aged 18 to 25 years conducted between May and October of 2020 assessed anxiety symptoms, depressive symptoms, and thoughts of suicide. In fully adjusted regression models, (n =528 young adults) being an essential worker, a sexual minority, having lower relative SES, and having more adverse childhood experiences were significantly associated with negative mental health outcomes. In models adjusted for individual ACEs, exposure to mental illness in the household, physical violence between adults in the household, emotional abuse, and sexual abuse were independently associated with all three outcomes. Young adults most vulnerable and stigmatized in the community are also those who are most severely affected in terms of mental health.

Increased Temperatures Are Associated with Increased Utilization of Emergency Medical Services in Rhode Island

BACKGROUND

Increasing temperatures negatively impact health and increases demands on healthcare systems. However, this has been poorly studied in Rhode Island (RI). Here we characterize the impact of heat on emergency medical services (EMS) utilization in RI.

METHODS

The Rhode Island National Emergency Services Information System V3 dataset was merged with data from the National Center for Environmental Information of the National Oceanic and Atmospheric Administration from the summers of 2018 and 2019. The outcome of daily mean EMS runs were compared against the exposure increasing daily temperatures, measured as daily maximum, minimum and daily average °F, using Poisson regressions. Patient characteristics were included across temperature models.

RESULTS

Increasing daily temperatures were associated with increasing EMS encounters. The adjusted incident rate ratio (IRR) for mean daily EMS encounters by increasing maximum daily temperature was 1.006 (95% CI 1.004-1.007, Table 3). This resulted in a projected 17.2% increase in EMS runs on days with a maximum temperature of 65°F compared to days with a maximum temperature of 95°F. The adjusted IRR for mean daily EMS encounters by the daily minimum temperature was 1.004 (1.003-1.006) and the adjusted IRR for the mean daily EMS encounters by the daily average temperature was 1.006 (1.005-1.008).

CONCLUSIONS

Increasing minimum, maximum, and average daily temperatures were associated with increasing EMS utilization across Rhode Island in the summers of 2018 and 2019. Further research into these trends may help with planning and resource allocation as summer temperatures continue to rise.

Recreational users' perceptions of coastal water quality in Rhode Island (USA): Implications for policy development and management

Stakeholders' understanding of water quality influences how they approach water policy problems and their support for potential solutions. This study explores how resource policy in the United States accounts for different water quality meanings held by recreational users. In-person surveys were conducted along the shoreline in Rhode Island (USA) to examine how recreational users make sense of coastal water quality. Findings indicate that recreational users' understanding of water quality is constructed from an array of environmental conditions (e.g., chl a, phosphates) and attitudinal factors (e.g., perceived problems associated with sewage, algae, or trash), and the meanings ascribed to water quality extend beyond the biophysical indicators typically employed by water resource managers. Potential management strategies based on these findings include expanding current definitions of water quality and monitoring a broader suite of factors, conducting research that captures nuanced meanings of water quality held by different users, and developing outreach programs that clarify the potential impacts of water quality components on human health and well-being.

Low Seroprevalence of SARS-CoV-2 in Rhode Island blood donors during may 2020 as determined using multiple serological assay formats

BACKGROUND

Epidemic projections and public health policies addressing Coronavirus disease (COVID)-19 have been implemented without data reporting on the seroconversion of the population since scalable antibody testing has only recently become available.

METHODS

We measured the percentage of severe acute respiratory syndrome- Coronavirus-2 (SARS-CoV-2) seropositive individuals from 2008 blood donors drawn in the state of Rhode Island (RI). We utilized multiple antibody testing platforms, including lateral flow immunoassays (LFAs), enzyme-linked immunosorbent assays (ELISAs) and high throughput serological assays (HTSAs). To estimate seroprevalence, we utilized the Bayesian statistical method to adjust for sensitivity and specificity of the commercial tests used.

RESULTS

We report than an estimated seropositive rate of RI blood donors of approximately 0.6% existed in April-May of 2020. Daily new case rates peaked in RI in late April 2020. We found HTSAs and LFAs were positively correlated with ELISA assays to detect antibodies specific to SARS-CoV-2 in blood donors.

CONCLUSIONS

These data imply that seroconversion, and thus infection, is likely not widespread within this population. We conclude that IgG LFAs and HTSAs are suitable to conduct seroprevalence assays in random populations. More studies will be needed using validated serological tests to improve the precision and report the kinetic progression of seroprevalence estimates.

Low Seroprevalence of SARS-CoV-2 in Rhode Island blood donors during may 2020 as determined using multiple serological assay formats

BACKGROUND

Epidemic projections and public health policies addressing Coronavirus disease (COVID)-19 have been implemented without data reporting on the seroconversion of the population since scalable antibody testing has only recently become available.

METHODS

We measured the percentage of severe acute respiratory syndrome- Coronavirus-2 (SARS-CoV-2) seropositive individuals from 2008 blood donors drawn in the state of Rhode Island (RI). We utilized multiple antibody testing platforms, including lateral flow immunoassays (LFAs), enzyme-linked immunosorbent assays (ELISAs) and high throughput serological assays (HTSAs). To estimate seroprevalence, we utilized the Bayesian statistical method to adjust for sensitivity and specificity of the commercial tests used.

RESULTS

We report than an estimated seropositive rate of RI blood donors of approximately 0.6% existed in April-May of 2020. Daily new case rates peaked in RI in late April 2020. We found HTSAs and LFAs were positively correlated with ELISA assays to detect antibodies specific to SARS-CoV-2 in blood donors.

CONCLUSIONS

These data imply that seroconversion, and thus infection, is likely not widespread within this population. We conclude that IgG LFAs and HTSAs are suitable to conduct seroprevalence assays in random populations. More studies will be needed using validated serological tests to improve the precision and report the kinetic progression of seroprevalence estimates.

A Community-Adapted Approach to SARS-CoV-2 Testing for Medically Underserved Populations, Rhode Island, USA

We developed a testing program for severe acute respiratory syndrome coronavirus 2 in an urban Latinx neighborhood in Providence, Rhode Island, USA. Approximately 11% of Latinx participants (n = 180) tested positive. Culturally tailored, community-based programs that reduce barriers to testing help identify persons at highest risk for coronavirus disease.

Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July-August 2020

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17–August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%–5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%–3.5%) and nursing home personnel (13.1%, 95% CI 11.5%–14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%–27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.

Physical Medicine and Rehabilitation in Rhode Island during the COVID-19 Pandemic

The COVID-19 pandemic has transformed the practice of medicine. We interviewed Physical Medicine and Rehabilitation (PM&R) specialist physicians providing rehabilitation services throughout Rhode Island to organize a narrative assessing the pandemic's impact on the state's rehabilitation community and the responses of its leaders. Almost half of rehabilitation providers needed to suspend their services during the initial peak of the pandemic. Most experienced reductions in the size of their practices, as well as personnel issues that contributed to burnout. All physicians used telemedicine to connect with patients. Many reported issues with accessing personal protective equipment and providing clinical opportunities for trainees. Inpatient rehabilitation policies and practices helped to maintain access for COVID-positive and negative patients, yet challenges were faced when configuring physical space to abide by CDC social distancing guidelines and providing care without patient visitors. Despite setbacks, the pandemic outlined opportunities for improvement of healthcare organization and delivery.

Public Health Approaches Toward Eliminating Hepatitis C Virus in Rhode Island

Hepatitis C Virus (HCV) continues to be a cause of significant morbidity and mortality around the world surpassing HIV, Tuberculosis and Malaria as the leading cause of death by an infectious disease. In the United States, advances in screening, testing and treatment have put the goal set by the World Health Organization (WHO) to HCV elimination within reach. Rhode Island has taken an innovative public health approach to eliminating HCV by improving disease surveillance activities, supporting disease reduction strategies and removing barriers across the continuum of care, particularly for populations that are disproportionately impacted by the disease. Through the coordination of the Rhode Island Hepatitis C Action Coalition, the Rhode Island Department of Health (RIDOH), the Executive Office of Health and Human Services (EOHHS), community organizations, and clinical leaders, important steps have been taken to reduce transmission of the disease and work toward HCV elimination.

The Health and Socioeconomic Outcomes of Abortion Denial in Rhode Island: A Health Impact Assessment

OBJECTIVES

To determine the health and socioeconomic consequences of comprehensive abortion denial in Rhode Island.

METHODS

Using Turnaway Study findings and RI abortion data from 2013-2016, we project the burden of negative outcomes for women and their families under 100% abortion denial conditions.

RESULTS

Findings suggest negative impacts on the health and socioeconomic well-being of RI women and their families. 982 and 910 women, who would have otherwise received an abortion, will report anxiety and depression, respectively, at one-week post abortion denial, and 1,499 will report receiving Temporary Assistance for Needy Families funding at six months post denial.

CONCLUSIONS

If women who would seek a safe and legal abortion in RI are denied one, clear and undue burden will exist for those who carry to term and raise the child, as well as affecting existing children.

Multilevel Barriers to Engagement in the HIV Care Continuum Among Residents of the State of Rhode Island Living with HIV

An estimated 1.2 million people in the United States are living with HIV. Of those living with HIV, only 40% are engaged in HIV care, 37% are prescribed antiretroviral therapy (ART), and 30% are virally suppressed. Individual-, interpersonal-, and structural-level factors that represent barriers to engagement along the HIV care continuum are important to identify in order to inform priority areas and interventions. 296 adult residents of Rhode Island living with HIV between November 2015 and January 2016 were asked to participate in an observational study (Ryan White Part B Health Resources and Services Administration-funded consumer needs assessment) to identify the multilevel factors associated with engagement in the HIV care continuum outcomes (i.e., being retained in care, being prescribed ART, adhering to ART, and achieving viral suppression-all in the past 12 months). Multivariable logistic regression models were fit to model the four HIV care continuum outcomes. The majority of participants were over age 30 (92.5%), racial/ethnic minorities (67.1%), cisgender men (56.9%), and identified as straight/heterosexual (60.5%). Overall, 95.2% of participants were retained in care in the past 12 months, 93.0% were prescribed ART, 87.1% were currently adherent to ART, and 68.2% were virally suppressed. Factors positively associated with not being retained in HIV care in the past 12 months included having no income and challenges navigating the HIV care system. Being age 18-29 and having a provider who does not know how to treat people with HIV/AIDS were each positively associated with not being prescribed ART. Factors positively associated with not being adherent to ART included being age 18-29 and substance use in the past 12 months. Finally, having private insurance and having a provider who is not trustworthy were each positively associated with not being virally suppressed. Regardless of the fact that many of the individuals living with HIV in this sample are able to achieve an undetectable viral load, challenges with retention in HIV care and ART adherence threaten to undermine the clinical and public health benefits of treatment as prevention. Future longitudinal research conducted to better understand how to boost the effectiveness of treatment as prevention in this population should focus on examining the unique multilevel factors, polymorbidities, and conditions (mostly social determinants of health including housing, socioeconomic position, etc.) associated with suboptimal engagement across the stages of the HIV care continuum.

Rhode Island Department of Health Foodborne Illness Complaint System: A Descriptive and Performance Analysis

Foodborne illnesses create a large impact on both the health and economy of the United States. Early detection of an outbreak is essential to preventing additional illnesses. Foodborne illnesses are commonly identified through foodborne illness complaint systems, and it is vital that public health agencies ensure their systems are functioning effectively for successful detection of foodborne outbreaks. The purpose of this study was to provide a descriptive summary of foodborne illness complaint data in Rhode Island and to evaluate the Rhode Island Department of Health (RIDOH) foodborne illness complaint system's ability to detect foodborne outbreaks using the Council to Improve Foodborne Outbreak Response (CIFOR) target performance measures. Data were collected from all foodborne illness complaints reported to RIDOH by the public from 1 January 2010 to 31 December 2017. During this period, 1,218 foodborne illness complaints in total were reported to RIDOH; 85% of complainants reported their illness within 7 days of symptom onset. Most complainants (73%) did not seek medical attention. There were 54 outbreaks, 80% of which were identified by the complaint system. Most pathogens that were identified during an outbreak detected by the complaint system were nonreportable (69%). CIFOR metrics indicate that the complaint system is functioning (i) at an acceptable level of illness complaints expected based on population size and (ii) at preferable levels for metrics related to outbreak detection. This review of the RIDOH foodborne illness complaint system provides evidence for the vital role of complaint systems in detecting foodborne illness outbreaks. In addition, it demonstrates that complaint systems can detect illnesses in a timely manner, likely preventing further illnesses. This was the first multiyear evaluation of Rhode Island's illness complaint surveillance system and will serve as a baseline for future analyses to monitor trends in performance.

Increasing Syphilis in Rhode Island: Return of an Old Foe

The number of people diagnosed with syphilis has increased significantly in the United States over the last decade. In Rhode Island, the number of new diagnoses has increased more than four-fold since 2008. Syphilis disproportionately impacts gay, bisexual, and other men who have sex with men (MSM), with those from African American and Hispanic/Latino communities most affected. Given these trends, physicians need to be aware of current prevention, diagnosis, and treatment practices for syphilis, especially when working with populations who are most at risk. [Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].

Helping Ambulatory Practices Succeed: Reflections from Practice Transformation Facilitators

Healthcare reform efforts implemented to optimize primary and specialty care delivery require practices to undertake considerable transformation. To support change efforts, many private insurers and federal and state health-reform efforts provide practices and clinicians with access to practice-transformation facilitators. Healthcentric Advisors provides practice-transformation support and technical assistance to practices in Rhode Island and across New England. From this work we know that strategies and approaches to support transformation and achievement of program recognitions differ by practice characteristics, resource access, and patient panels. Understanding practice attitudes and beliefs about change, recognizing that change occurs on a spectrum, acknowledging that program recognition is only the beginning, and aligning quality-improvement initiatives, are domains that support success regardless of practice type. However, working with a facilitator who engages your entire care team to integrate a culture of quality improvement and process ownership, has the greatest impact on overall transformation.

Distribution of Preventive Dental Care during Pregnancy in Rhode Island, 2012 to 2015

AIMS

To examine the distribution of preventive dental care for pregnant women in Rhode Island.

METHODS

The data used were obtained from the 2012 to 2015 Rhode Island Pregnancy Risk Assessment Monitoring System (RIPRAMS). Statistical analyses were conducted for respondents who had valid information for both preventive dental care receipt and race/ethnicity to examine population differences in the receipt of preventive dental care.

RESULTS

Respondents who identified as Hispanic and had more than 12 years of education had higher odds for preventive dental care receipt in Rhode Island between 2012 to 2015 compared to non-Hispanic whites. Furthermore, respondents with lower household income were the least likely to have received preventive dental care. This was especially true for black and non-Hispanic women who reported being neither black nor white.

CONCLUSION

Preventive dental care in Rhode Island between 2012 and 2015 did not meet the perinatal and Infant Oral Health Quality Improvement (PIOHQI) target of 60% in minority populations.

State Unintentional Drug Overdose Reporting Surveillance: Opioid Overdose Deaths and Characteristics in Rhode Island

Unintentional opioid overdoses are a growing public health epidemic in the United States. Rhode Island is also faced with a challenging crisis of drug overdose deaths. The State Unintentional Drug Overdose Reporting Surveillance (SUDORS) data from the second half of 2016 were used to present opioid overdose deaths and characteristics in Rhode Island. During July-December 2016, 142 individuals died of opioid overdose in Rhode Island. People who died by opioid overdose were more likely to be 25-65 years old, male, and non-Hispanic white. The most common precipitating circumstances were substance abuse (88%), current mental health problems (43%), and physical health problems (27.5%). Over 83% of decedents had 2 or more substances attribute to causing their death, with fentanyl (71.1%) as the most common substance. Only 36.6% of decedents had naloxone administered. Fatal opioid overdose data are important for understanding this public health crisis and can guide overdose intervention efforts.

Overview of Antimicrobial Stewardship Activities in Rhode Island

Due to the rise of antibiotic resistance, and the decrease of novel antibiotics coming to market, the Centers for Disease Control and Prevention (CDC) has formally recognized that action must take place to ensure appropriate antibiotic use, and maintain public health. The RI Department of Health (RIDOH) Director responded by initiating the RI Antimicrobial Stewardship and Environmental Cleaning Task Force (RIAMSEC), a multidisciplinary team that set in motion a set of tasks for RIDOH. As a result, a survey of antibiotic stewardship programs (ASP) at the RI acute care hospitals (ACHs) and long-term care (LTC) facilities revealed gaps in addressing HAI prevention and AMS goals for the state. RIDOH has therefore expanded statewide coordination efforts to form the RI Healthcare-Associated Infection Prevention and Antimicrobial Stewardship Coalition which is intended to effectively prevent HAI and ultimate improve the Centers for Medicare and Medicaid Services Hospital-acquired Condition (HAC) Reduction scores in Rhode Island.[Full article available at http://rimed.org/rimedicaljournal-2018-06.asp].

Respiratory viral testing in laboratories serving acute care hospitals in Rhode Island

BACKGROUND

The rapid detection of respiratory viral infections is associated with several positive health outcomes. However, little is known about the availability of rapid respiratory viral testing in acute care hospital laboratories.

METHODS

A survey was sent to 13 hospital laboratories assessing results' turnaround time, the number of ordered tests and positive results.

RESULTS

Rapid viral panel (RVP), respiratory syncytial virus (RSV), and rapid influenza testing was available in 9 of 13, 13 of 13, and 13 of 13 hospitals, respectively. Results were available within 24 hours of specimen collection in 1 of 9 hospitals for RVP; RSV and rapid influenza results were available within 12 hours in 8 of 13 and 13 of 13 hospitals, respectively.

CONCLUSIONS

Rapid diagnosis of respiratory viral infections in RI acute care hospitals can be made for influenza and RSV. However, rapid results for other respiratory viruses are unavailable in most of RI hospitals. [Full article available at http://rimed.org/rimedicaljournal-2017-09.asp].

Retrospective analysis of heavy metal contamination in Rhode Island based on old and new herbarium specimens

PREMISE OF THE STUDY

Herbarium specimens may provide a record of past environmental conditions, including heavy metal pollution. To explore this potential, we compared concentrations of copper, lead, and zinc in historical and new collections from four sites in Rhode Island, USA.

METHODS

We compared historical specimens (1846 to 1916) to congener specimens collected in 2015 at three former industrial sites in Providence, Rhode Island, and one nonindustrial site on Block Island. Leaf material was prepared by UltraWAVE SRC Microwave Digestion, and heavy metal concentrations were measured by inductively coupled plasma-atomic emission spectroscopy.

RESULTS

Heavy metal concentrations in the historical and new specimens were measurable for all elements tested, and levels of copper and zinc were comparable in the historical and 2015 collections. By contrast, the concentration of lead declined at all sites over time. Significant variability in heavy metal concentration was observed between taxa, reflecting their varied potential for elemental accumulation.

DISCUSSION

It seems clear that herbarium specimens can be used to evaluate past levels of pollution and assess local environmental changes. With careful sampling effort, these specimens can be a valuable part of environmental science research. Broadening the possible applications for herbarium collections in this way increases their relevance in an era of reduced funding for collections-based research.

Preventing Foodborne and Enteric Illnesses Among At-Risk Populations in the United States and Rhode Island

One out of every six people in the United States is estimated to become sick each year from pathogens that can cause foodborne illness. The groups at greatest risk for serious illness, hospitalization, or death include young children, older adults, people with chronic conditions, and pregnant women. Such health disparities must be considered along with those disparities that may exist among racial and ethnic groups and among groups of varying socioeconomic status. We analyzed risk profiles for enteric disease using data from Rhode Island and the nation as a whole, exploring disparities among groups defined by demographic and health characteristics. As expected, disparities in the burden of enteric illnesses are not limited to racial or ethnic differences in disease burden, or in differences otherwise attributable to socioeconomic status. Age is an especially important determinant of risk, as is residential status. Other groups found to be especially vulnerable to foodborne and enteric illnesses in Rhode Island include pregnant women and those with certain health conditions (e.g., cancer, liver disease or immunosuppression). By understanding what groups are at increased risk, providers can more effectively counsel their patients to mitigate risk and effectively treat these conditions. [Full article available at http://rimed.org/rimedicaljournal-2016-11.asp].

Diabetes and BMI: Health Equity through Early Intervention on Dysglycemia, and How Providers Can Help

Like most states in the U.S., Rhode Island's rate of type 2 Diabetes Mellitus (DM) is rising as its population has both aged and become heavier. Risk of both BMI>=30 and DM has risen across almost all demographics, but disparities continue to exist in both conditions. We analyzed state health survey data to assess race/ethnicity-stratified DM and BMI and the age-adjusted rate of DM by weight status relative to the late 1990s. The prevalence of obesity increased across almost all demographic groups relative to 15 years ago, but the rise was greatest among non-Hispanic whites. The age-adjusted rate of DM had a similar increase across racial/ethnic categories where BMI>=30, but black adults were still at higher risk of DM even at a BMI<30. In sum, non-Hispanic whites and Hispanics are "catching up" to blacks' historically higher prevalence of obesity and DM, but disparities remain in both conditions. We describe two ways providers can collaborate with the Department of Health to address these growing health problems. [Full article available at http://rimed.org/rimedicaljournal-2016-11.asp].

Health Equity, Social Justice, and HIV in Rhode Island: A Contemporary Challenge

From its beginning, HIV has primarily affected marginalized populations, such as injection drug users, gay, bisexual and other men who have sex with men (GBMSM), and minority racial and ethnic groups. HIV is a disease that, from the start, has been strongly influenced by issues related to social justice and health equity due to its intersection with behaviors among at-risk populations. While some of the risks associated with HIV have been successfully mitigated through social justice initiatives related to needle exchange programs and routine HIV testing of pregnant women, Rhode Island remains confronted with the health equity challenges of preventing HIV transmission and ensuring access to HIV care/treatment, especially for Black/African Americans, Hispanics, and GBMSM. [Full article available at http://rimed.org/rimedicaljournal-2016-11.asp].

Clinical presentation, pathophysiology, diagnosis, and treatment of acquired and hereditary angioedema: Exploring state-of-the-art therapies in RI

Hereditary and acquired angioedema are potentially life-threatening diseases characterized by spontaneous episodes of subcutaneous and submucosal swelling of face, lips, oral cavity, larynx, and GI tract. Hereditary angioedema (HAE) usually presents within the first and second decades of life, whereas acquired angioedema presents in adults after 40 years of age. These clinical symptoms together with reduced C1 inhibitor levels and/or activity can usually confirm the diagnosis. In recent years, multiple novel therapies for treating hereditary angioedema have emerged including C1 inhibitor concentrates, ecallantide/kallikrein inhibitor, and icatibant/bradykinin receptor antagonist. This article reviews the clinical presentation, diagnosis, treatment, and prophylaxis of HAE. Lastly, this article takes into consideration that, in reality, acute care treatment can often be limited by each hospital's formulary, included is a review of HAE treatments available at the nine major hospitals in Rhode Island. [Full article available at http://rimed.org/rimedicaljournal-2016-06.asp, free with no login].

Cancer and Obesity in Rhode Island

There is growing evidence that obesity increases the risk of certain cancers and cancer mortality. As obesity rates are projected to rise over the next decade, associated cancer morbidity and mortality present a significant public health concern. This is particularly striking in the state of Rhode Island, where nearly a third of the population is obese. Interventions such as taxation of obesity-associated foods or insurance incentive programs promoting positive health behaviors could decrease obesity-associated cancer incidence and mortality over time. Public health programs could be deployed at both the local and national levels. We provide a background on obesity-related cancer, discuss existing evidence to support these ideas, and make recommendations regarding individual and societal factors when considering public policy, health-care delivery, taxation structure, and insurance.

Concordance between Activated Partial Thromboplastin Time and Antifactor Xa Assay for Monitoring Unfractionated Heparin in Hospitalized Hyperbilirubinemic Patients

BACKGROUND

Activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) monitoring methods for unfractionated heparin (UFH) often disagree. The extent of discordance for those with elevated bilirubin remains unclear. Our objective was to evaluate concordance between activated aPTT and anti-Xa methods for hyperbilirubinemic patients on UFH.

METHODS

This was a retrospective cohort study of 26 patients hospitalized at Rhode Island Hospital between August 2014 and September 2014. Patients had at least one bilirubin measurement >5 mg/dL. After categorizing lab values, percent agreement and kappa were used to examine concordance between aPTT and anti-Xa.

RESULTS

Overall percent agreement between aPTT and anti-Xa was 50%. A nontherapeutic aPTT and therapeutic anti-Xa accounted for 98% of all disagreement. Specifically, 76.7% of disagreement was due to a subtherapeutic aPTT and a therapeutic anti-Xa. Unweighted kappa was 0.141 (95%CI: 0.048-0.235).

CONCLUSION

Concordance between aPTT and anti-Xa values was poor in hyperbilirubinemic patients.

Snakebite! Crotalinae Envenomation of a Man in Rhode Island

The incidence of poisonous snakebites has regional variance. Health care providers' knowledge and comfort in treating these envenomated patients depends on the density of poisonous snakes in their environment, with practitioners in the southern U.S. typically treating more exposed patients than those in colder regions in the North. We present a rare case of a confirmed copperhead snakebite that occurred in Rhode Island. We will review Copperhead bites, clinical management and treatment options.

Profiles of medicinal cannabis patients attending compassion centers in rhode island

Little is understood regarding medicinal marijuana dispensary users. We sought to characterize socio-demographics and reasons for medicinal marijuana use among medical cannabis dispensary patients in Rhode Island. Participants (n=200) were recruited from one of two Compassion Centers in Rhode Island and asked to participate in a short survey, which included assessment of pain interference using the Brief Pain Inventory (BPI). The majority of participants were male (73%), Caucasian (80%), college educated (68%), and had health insurance (89%). The most common reason for medicinal marijuana use was determined to be chronic pain management. Participants were more likely to have BPI pain interference scores of > 5 if they were older (OR: 1.36, 95% CI: 1.04-1.78) or reported using cannabis as a substitute for prescription medications (OR: 2.47, 95% CI: 1.23-4.95), and were less likely to have interference scores of >5 if they had higher income levels (OR: 0.53, 95% CI: 0.40-0.70) or reported having ever received treatment for an alcohol use disorder. One-fifth of participants had a history of a drug or alcohol use disorder. Most participants report that medicinal cannabis improves their pain symptomology, and are interested in alternative treatment options to opioid-based treatment regimens.

The Nuts and Bolts of Long-term Care In Rhode Island: Demographics, Services and Costs

Nearly 8,000 people reside in Rhode Island's (RI's) 84 nursing homes at any single point in time. Many of these people are highly vulnerable because of illness or frailty. In this article, we describe the reasons that RI residents seek care from nursing homes, the associated costs (with a focus on Medicare and Medicaid payment), and different ways to assess nursing home quality. We also describe the home- and community-based services that can help people remain in the community. A resource list provides additional information for those seeking to better understand RI nursing homes and long-term care supports and services.

Hepatitis C Prevention and Needle Exchange Programs in Rhode Island: ENCORE

As Rhode Island's only needle exchange program, ENCORE (Education, Needle Exchange, Counseling, Outreach, and REferrals) serves a wide range of clients infected or at risk for infection with hepatitis C virus (HCV). Through its on-site and outreach platforms across Rhode Island, ENCORE is in a unique position to serve at-risk individuals who may not otherwise present for prevention, testing and care for HCV, as well as human immunodeficiency virus (HIV). In this article, we discuss the role of needle exchange programs in preventing HCV transmission, and provide an overview of the history and current operations of ENCORE.

Estimating the true prevalence of hepatitis C in rhode island

Although there is a large health, social, and economic burden of hepatitis C virus (HCV) infection in the United States, the number of persons infected with HCV in Rhode Island (RI) is unknown. To inform the expansion of HCV-related public health efforts in RI, and because surveillance data are lacking and national surveys, including the National Health and Nutrition Examination Survey (NHANES), likely underestimate true HCV prevalence, we reviewed published peer-reviewed and grey literature to more accurately estimate the prevalence of HCV in RI. The results of our review suggest that between 16,603 and 22,660 (1.7%-2.3%) persons in RI have ever been infected with HCV. Assuming a spontaneous clearance rate of 26%, we estimate that between 12,286 and 16,768 (1.2%-1.7%) have ever been or are currently chronically infected with HCV. Findings suggest the urgent need for improved HCV screening in RI, and that reducing morbidity and mortality from HCV will require a dramatic scale-up of testing, linkage to care, treatment and cure.

Prevention and control of hepatitis C in rhode island

Concern about the morbidity and mortality of hepatitis C infection is increasing. Persons born from 1945 to 1965 are most significantly affected, with the majority unaware of their infection, and will otherwise go untreated. Up to three-fourths of hepatitis C-related deaths occur in this population of "baby boomers." Since 2007, mortality from hepatitis C has exceeded that from HIV, nationally and in Rhode Island. New treatment options for hepatitis C emphasize the potential for cure of hepatitis C that is distinct from HIV. Financial resources and integration of hepatitis C partners and services in Rhode Island will be instrumental in reducing hepatitis C infections and increasing the number of cases cured. We describe public health investments in the past, present, and future to implement strategies for effectively addressing hepatitis C in the state.

Hepatitis C virus infection: from margin to center in rhode island and beyond

Physicians, Research Scientists and Public Health Experts Collaborate to Combat Rhode Island’s Hepatitis C Epidemic

The Rhode Island Consortium for Autism Research and Treatment (RI-CART): a new statewide autism collaborative

Autism is a neurodevelopmental disorder characterized by core deficits in social interaction, language and repetitive behaviors. The need for services is rising sharply as the number of children identified with autism increases. The Rhode Island Consortium for Autism Research and Treatment (RI-CART) was founded in 2009 with the goal of increasing communication among autism researchers throughout the state and improving treatment for children with autism. RI-CART members have several exciting projects in progress, with its larger aim being the creation of a statewide research registry. A statewide registry would benefit research in Rhode Island and allow for larger collaborations nationally.

Outpatient parenteral antibiotic therapy in an academic practice in Rhode Island

Outpatient parenteral antimicrobial therapy (OPAT) is an increasingly utilized treatment modality that has been proven to be safe and cost effective for treating infections that require prolonged antimicrobial treatment. Adequate patient selection, a structured OPAT team with an effective communication system, and routine clinical monitoring are key elements to establish a successful OPAT program. The Miriam Hospital Infectious Diseases Clinic offers a multidisciplinary OPAT model coordinated by infectious diseases specialists and serves as a major referral center in Rhode Island.