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AMCP Partnership Forum: Racial health disparities-a closer look at benefit design
No full textAs part of its stand against racial injustice and its commitment to action, AMCP dedicated a partnership forum to discussion of potential sources of racial health disparities and inequities in benefit design because these are primary drivers of medication use. This forum, held virtually March 23-24, 2021, convened more than 40 experts representing key stakeholders from managed care settings. Key principles that emerged from the forum discussion as means to mitigate racial health disparities were to acknowledge that structural racism exists and that it can impact the provision of health care, including but not limited to formulary development and benefit design processes; to integrate proactive strategies to improve equity, beginning with education and training, into all aspects of health care; and to view patients holistically with an understanding of the compounding effect of social determinants of health on their personal wellness. With these principles in mind, participants highlighted several priority considerations including improving existing gaps in data, addressing diversity and equity as they relate to formulary development, evaluating systems such as benefit offerings through a lens of increasing equity, recognizing cost-related factors that affect equity, considering patients\u27 interactions with and their ability to access the system, and committing to patient-centered care. Participants also suggested areas for policy-related focus and noted the need to develop and deploy specific education and training
Network-Based Analysis of Prescription Opioids Dispensing Using Exponential Random Graph Models (ERGMs)
No full textThe United States has been experiencing an unprecedented level of opioid overdose-related mortality due in part to excessive use of prescription opioids. Peer-driven network interventions may be beneficial. A key assumption of social network interventions is that of some members of the network act as key players and can influence the behavior of others in the network. We used opioid prescription records to create a social network of patients who use prescription opioid in the state of Rhode Island. The study population was restricted to patients on stable opioid regimens who used one source of payment and received the same opioid medication from ≥3 prescribers and pharmacies. An exponential random graph model (ERGM) was employed to examine the relationship between patient attributes and the likelihood of tie formation and modularity was used to assess for homophily (the tendency of individuals to associate with similar people). We used multivariable logistic regression to assess predictors of high betweenness centrality, a measure of influence within the network. 372 patients were included in the analysis; average age was 51 years; 53% were female; 57% were prescribed oxycodone, 34% were prescribed hydrocodone and 9% were prescribed buprenorphine/naloxone. After controlling for the main effects in the ERGM model, homophily was associated with age group, method of payment, number and type of opioid prescriptions filled, mean daily dose, and number of providers seen. Type of opioid and number of prescribers were identified as significant predictors of high betweenness centrality. We conclude that patients who use multiple prescribers or have a diagnosis of opioid use disorder may help promote positive health behaviors or disrupt harmful behaviors in an opioid prescription network
A High-Resolution Earth Observations and Machine Learning-Based Approach to Forecast Waterborne Disease Risk in Post-Disaster Settings
Get PDFResponding to infrastructural damage in the aftermath of natural disasters at a national, regional, and local level poses a significant challenge. Damage to road networks, clean water supply, and sanitation infrastructures, as well as social amenities like schools and hospitals, exacerbates the circumstances. As safe water sources are destroyed or mixed with contaminated water during a disaster, the risk of a waterborne disease outbreak is elevated in those disaster-affected locations. A country such as Haiti, where a large quantity of the population is deprived of safe water and basic sanitation facilities, would suffer more in post-disaster scenarios. Early warning of waterborne diseases like cholera would be of great help for humanitarian aid, and the management of disease outbreak perspectives. The challenging task in disease forecasting is to identify the suitable variables that would better predict a potential outbreak. In this study, we developed five (5) models including a machine learning approach, to identify and determine the impact of the environmental and social variables that play a significant role in post-disaster cholera outbreaks. We implemented the model setup with cholera outbreak data in Haiti after the landfall of Hurricane Matthew in October 2016. Our results demonstrate that adding high-resolution data in combination with appropriate social and environmental variables is helpful for better cholera forecasting in a post-disaster scenario. In addition, using a machine learning approach in combination with existing statistical or mechanistic models provides important insights into the selection of variables and identification of cholera risk hotspots, which can address the shortcomings of existing approaches
How Do Risky Behaviors and Mental Health Differ Among Students Based on Undergraduate Class Status?
No full textObjective: The purpose of this study was to examine the relationships among undergraduate class status, risky behaviors (i.e., alcohol and marijuana use, sexual activity), life satisfaction, and ability to cope. Methods: Undergraduate students (N = 2,961) completed an electronic survey to assess for mental health status and risky behaviors. Results: Compared with others, first-year students reported fewer days of having at least one alcoholic drink, fewer days of having five or more alcoholic drinks in a row, and less frequency of marijuana use. First-year students reported fewer sexual partners and less frequency of sexual activity compared with others. First-year students were more likely to report greater life satisfaction, being able to cope with difficult situations, and greater self-worth, compared with others. Conclusions: As undergraduate students progress through their academic career, they are more likely to engage in risky behaviors and experience life dissatisfaction
Maternal Stress and Excessive Weight Gain in Infancy
Get PDFRapid weight gain in infancy increases the risk of developing obesity early in life and contributes significantly to racial and ethnic disparities in childhood obesity. While maternal perceived stress is associated with childhood obesity, little is known about the impact it has on infant weight gain. Therefore, this study explores the impact of maternal perceived stress on change in weight-for-length (WFL) z-scores and the risk of rapid weight gain in infancy. We conducted a secondary data analysis of the longitudinal Nurture birth cohort (n = 666). Most mothers in the cohort were non-Hispanic/Latinx Black (71.6%). About one-half of mothers had a body mass index (BMI) greater than 25 prior to pregnancy, were unemployed, and had a low income. Most infants in the cohort were born full-term and were of normal weight. Data were collected at 3-, 6-, 9-, and 12-months postpartum. At each assessment, mothers completed the Cohen’s Perceived Stress Scale (PSS), and research assistants weighed and measured each infant. Tertiles were used to compare mothers with high and low perceived stress. A mixed model analysis of repeated measures assessed the associations between baseline perceived stress and the change in infant WFL z-scores over time. Log-binomial models assessed the association between baseline perceived stress and rapid weight gain, defined as a change in WFL z-score \u3e 0.67 standard deviations from three to twelve months. Just under one-half of the infants (47%) experienced rapid weight gain between three and twelve months of age. Birthweight for gestational age (RR = 1.18, 95% CI = 1.08–1.29, p-value = 0.004), gestational age at birth (RR = 1.07, 95% CI = 1.01–1.14, p-value = 0.031), and weeks breastfed (0.99, 95% CI 0.99–1.00, p-value 0.044) were associated with risk of rapid weight gain in unadjusted analyses. WFL z-scores increased significantly over time, with no effect of perceived stress on change in WFL z-score or risk of rapid weight gain. Rapid weight gain in infancy was prevalent in this sample of predominately Black infants in the Southeastern US. We did not find evidence to support the hypothesis that maternal perceived stress influenced the risk of rapid weight gain. More work is needed to identify and assess the risk factors for rapid weight gain in infancy and to understand the role that maternal stress plays in the risk of childhood obesity so that prevention efforts can be targeted
Pedagogies of the “Irresistible”: Imaginative Elsewheres of Black Feminist Learning.
Get PDFIn her foreword to the groundbreaking anthology, This Bridge Called My Back: Writings by Radical Women of Color, Toni Cade Bambara (1983) famously argues that the great work of feminist writing is “to make revolution irresistible.” This statement is often read as a founding call of women-of-color feminism, and of feminist literary expression in particular. Yet Bambara’s notion of the “irresistible” extends beyond the page; throughout her works, she also uses the term as a key descriptor of her pedagogy, and her vision of the classroom. Bambara joins Audre Lorde and other Black feminist writer/teachers in insisting on a crucial nexus of joy, pleasure, and creative expression in radical feminist pedagogy. This paper explores the possibilities of poetic imagination as a site for intersectional pedagogy. How do Black feminist writers mobilize shared feeling and intimacy to reimagine power in the classroom space? Exploring scenes of teaching and learning in Black feminist literary works including Bambara’s short story “The Lesson” (1972), Jamaica Kincaid’s Annie John (1983) and Lucy (1990), and rapper Missy Elliott’s single “Gossip Folks” (2002), I examine how Black feminist literature opens pathways for critiquing race, gender, class, sexuality and related power structures by reimagining the site of the classroom. I consider these scenes alongside critical and personal reflections on Black feminist pedagogy by Bambara, Lorde, and other Black feminist teacher/artists. Reading these texts through an interdisciplinary lens, I argue that Black feminist literary imagination allows us to re-think the site of the classroom through a Black queer feminist perspective that can shift our approaches to social transformation in academic spheres and beyond
Treatment, Clinical Outcomes, and Predictors of Mortality among a National Cohort of Admitted Patients with Acinetobacter baumannii Infection
Get PDFThe objectives were to analyze treatment, clinical outcomes, and predictors of mortality in hospitalized patients with Acinetobacter baumannii infection. This was a retrospective cohort study of inpatients with A. baumannii cultures and treatment from 2010 to 2019. Patients who died during admission were compared to those who survived, to identify predictors of inpatient mortality, using multivariable unconditional logistic regression models. We identified 4,599 inpatients with A. baumannii infection; 13.6% died during admission. Fluoroquinolones (26.8%), piperacillin-tazobactam (24%), and carbapenems (15.6%) were used for treatment. Tigecycline (3%) and polymyxins (3.7%) were not used often. Predictors of inpatient mortality included current acute respiratory failure (adjusted odds ratio [aOR] 3.94), shock (aOR 3.05), and acute renal failure (aOR 2.01); blood (aOR 1.94) and respiratory (aOR 1.64) infectious source; multidrug-resistant A. baumannii (MDRAB) infection (aOR 1.66); liver disease (aOR 2.15); and inadequate initial treatment (aOR 1.30). Inpatient mortality was higher in those with MDRAB versus non-MDRAB (aOR 1.61) and in those with CRAB versus non-CRAB infection (aOR 1.68). Length of stay \u3e10 days was higher among those with MDRAB versus non-MDRAB (aOR 1.25) and in those with CRAB versus non-CRAB infection (aOR 1.31). In our national cohort of inpatients with A. baumannii infection, clinical outcomes were worse among those with MDRAB and/or CRAB infection. Predictors of inpatient mortality included several current conditions associated with severity, infectious source, underlying illness, and inappropriate treatment. Our study may assist health care providers in the early identification of admitted patients with A. baumannii infection who are at higher risk of death