Quality Rated Childcare Programs and Social Determinants of Health in Rural and Non-Rural Georgia

Background: Early childhood is linked to school readiness and early school achievement. Through its Quality Rated (QR) program, which was designed to improve the quality of care in early childhood programs, the state of Georgia has been a trailblazer in funding universal preschool and in improving the quality of childcare programs. We have assessed differences in the availability of QR childcare programs in Georgia to learn if, in rural versus non-rural counties, there is a relationship between QR childcare programs and health-related outcomes. Methods: This cross-sectional study evaluated county-level data to evaluate the relationship between QR childcare programs and social determinants of health. County-level data for Georgia were extracted from the Georgia Department of Early Care and Learning, County Health Rankings and Roadmaps, and the Georgia Juvenile Justice Data Clearinghouse. Results: Counties without QR childcare programs had child mortality rates 3.5 times higher than those for the state overall. Other differences in health-related outcomes included, but were not limited to, teen birth rates, low birth-weight babies, children in poverty, housing problems, and food insecurity. Conclusions: It is now appropriate to address the prevalence of health disparities in rural areas of Georgia and focus on some of the disparities through the QR early childhood programs and other state agencies. Empowering rural communities to address health disparities may be the most favorable path toward diminishing these inequalities

Brain development: A look at four programs in Georgia that support optimal brain development

Background: Georgia is making strides to improve its early care and education system through program development within state agencies and alliances. These timely, statewide programs are focused on improving understanding of the importance of brain development. Methods: We reviewed the mission and information provided by four Georgia agencies with the aim of developing and improving programs and educational opportunities to instruct educators, policy makers, the general public, and others about child development in the context of brain development. Results: For young children in Georgia, the four organizations are committed to ensuring opportunities for well-being. Georgia is moving forward in its quest to improve resources and environments for young children, families, and citizens. The agencies and activities include Better Brains for Babies; the Georgia Department of Early Care and Learning; Georgia Early Education Alliance for Ready Students; and the Talk With Me Baby program. Conclusions: Georgia is making substantial efforts to provide and support early education environments based on emerging research on how brain development affects various aspects of a child’s development, including those that are social, cognitive, emotional, physical, and linguistic

Sexual Health Education in Georgia: A Role for Reducing Sexually Transmitted Infections Among Adolescents

Background: In Georgia, sexually transmitted infections (STIs) are a substantial health issue, particularly among young adults in vulnerable and minority populations. The United States Preventive Services Task Force recommends that sexually active adolescents and at-risk adults receive behavioral counseling and education in primary care settings, community organizations, departments of health, and schools. Methods: The present approach used in Georgia for educating adolescents at high risk for STIs about these diseases was assessed. The data collected included standards for sexual health education, survey results from educators and students, and observations from a pilot study with adolescents detained by the juvenile justice system. Results: In Georgia, most health educators for middle (87.3%) and high (93.8%) schools have health and/or physical education backgrounds. They indicated a need for further education about STIs. For grades 6-12, 24% of students reported that they had not received HIV/AIDS education during the academic year. Preliminary observations from a study with juvenile detainees indicate that this population has limited knowledge about STIs, their effects and modes of transmission. Conclusion: Sexual health education, including that for HIV/AIDS, is essential to curtail the STI crisis, and educational endeavors should be culturally sensitive and evidence-based. In Georgia, many citizens, including teachers, are not adequately equipped to make informed decisions regarding STI risk. Georgia, home to the Centers for Disease Control and Prevention, is in a unique position to adapt evidence-based sexual health interventions for its population

Psychotropic Medications, Weight Gain and Chronic Diseases in a Correctional Setting: Impact on Women’s Health

Background: Studies with non-incarcerated populations have found a relationship between psychotropic medications and metabolic side effects, such as weight gain. Few studies have investigated the relationship between psychotropic medications associated with weight gain in prisoners, despite data showing that 73% of female and 55% of male offenders have a mental health problem and 15% have had medications prescribed. Methods: This longitudinal study investigated the relationship among psychotropic medications and weight gain in prisoners. We hypothesized that women prescribed psychotropic medications gain more weight than men. Data were extracted from Department of Corrections’ electronic health records. All prisoners with active records that included weight pre and post initiation of psychotropic medication were included in the study. Results: Women were prescribed antidepressants in higher proportions compared to men (χ2 = 58.3, p \u3c .01). The differences for antipsychotics were not significant (χ2 = 2.3, p = .13). There were no significant gender differences regarding the percentage of inmates who gained weight. In regard to changes in weight (kg), women on antidepressants gained more weight (mean 6.4 kg) compared to men (mean 2.0 kg), which was significant (p \u3c .01). Although women prescribed antipsychotics gained an average of 8.8 kg compared to men prescribed antipsychotics, who gained an average of 1.6 kg, this difference was not significant (p = .12). Further, there were no weight gain differences in terms of race or age in contrast to non-incarcerated populations. Conclusions: The significant weight gain among women prisoners raises important questions about the effects of incarceration on women’s health. Despite the significantly greater weight gain among women prisoners, other correlates of weight gain found in non-incarcerated populations are not evident in corrections

Gender Disparities in Weight Gain Among Offenders Who Are Obese Upon Entering Correctional Facilities

Background: Obesity is a significant health issue for offenders, who have a higher prevalence of obesity-related conditions, such as diabetes, compared to non-incarcerated populations. Within incarcerated populations, there are obesity disparities in terms of race, gender, and age, as well as excess weight gain during incarceration. Methods: This longitudinal study was conducted for 2005 – 2010 in collaboration with a Department of Corrections in the east south central region of the United States. From electronic health records of 10,841 offenders, weight, height, and demographic data were extracted. As determined from these data, 2,622 offenders met the inclusion criteria (two or more valid weight and height measurements and length of incarceration \u3e zero). Results: Women offenders who entered corrections as obese had a mean (and standard deviation) body mass index (BMI) of 36.2 (5.3) at baseline; the mean for men was 34.2 (4.4). For women who were obese at baseline, their BMI increased by 1.0 (3.3); for men their BMI decreased by 0.7 (3.1). Gender differences for changes in BMI among the obese population were significant (χ2 = 15.8, p \u3c 0.001). Women and men also differed in regard to weight gain (χ2 = 34.0, p \u3c 0.001). Further, those women and men who were not obese at baseline had an increase in BMI that was greater than the increase for the group that entered corrections as obese (p \u3e 0.001). Conclusions: Women offenders, obese or not at baseline, had greater gains in weight in comparison to men. However, there were no significant differences in BMI changes for race or correlations with age or length of incarceration. The findings related to gender warrant further investigations to explain these disparities and to evaluate the capacity of the corrections system to meet the health needs of women

Tapping the “Town and Gown” Potential for Correctional Health Research Collaborations

Background: Collaborations between juvenile justice systems (town) and academia (gown) promise to significantly enhance what we understand about high rates of sexually transmitted infections (STIs) found among detained populations, particularly African American young women. However, research related to the sexual health of adolescent detainees has not occurred in proportion to the magnitude of issues found in the population. While there are many challenges to conducting research with this population, there are also lessons learned and best practices from other studies that may provide guidance. Methods: In 2015, we implemented a pilot project with young women in a detention center to understand the association between STIs and relationship dynamics. Using a formative assessment-based approach, the team periodically compared expectations to actual milestones and outcomes. This approach has provided feedback, guidance and lessons learned that we will use to adjust our pilot project. Results: Three challenges emerged from our review: concerns related to different agendas, bureaucratic difficulties and human protection. In addressing these challenges, we identified study procedures to revise and to incorporate into future works. Conclusions: Juvenile justice and academic partnerships require extensive pre-research work to account for the many challenges to implementing and conducting projects with this population. However, “town and gown” approaches to understanding and improving the sexual health of detainees can result in a more complete assessment of these issues compared to either a solely academic or juvenile justice investigation

Exploration of barriers and facilitators to publishing local public health findings: A mixed methods protocol

Background: Worldwide, the US accounts for a large proportion of journals related to public health. Although the American Public Health Association (APHA) includes 54 affiliated regional and state associations, little is known about their capacity to support public health scholarship. The aim of this study is to assess barriers and facilitators to operation of state journals for the dissemination of local public health research and practices. Methods: A mixed methods approach will be used to complete the 12-month study. Affiliate websites will be accessed through the APHA membership portal to evaluate organizational infrastructure and ascertain the presence/absence of a journal. The leader of each affiliate will be contacted via email containing a link to a 12-question on-line survey to collect his/her perceptions of scholarly journals and the publication of local health data. To determine barriers and facilitators to publication of local public health findings, 30-minute semi-structured telephone interviews will focus on the infrastructure of the association, perceptions of the leader about the journal (if in place), and its operation. Results: We anticipate that 54 affiliate websites will be reviewed to complete the extraction checklist, that 74% of affiliate leaders will respond to the survey, and that 11 semi-structured interviews will be conducted. A limited number of state/regional public health associations will operate journals and a small percentage of those without journals may express an interest in implementing them. Barriers to operation of journals may include lack of resources (i.e., personnel, funding), and low prioritization of publication of state and local public health findings. Facilitators may include strong affiliate-academic relationships, affiliate leadership with experience in publications, and affiliate relationships with state and local departments of health. Conclusions: The research proposed in this protocol may stimulate other state public health associations and other academic public health programs to follow suit; it would not be the first time that an observational research study served as an intervention

Impact of Opioid-Free Anesthesia Versus Opioid-Based Anesthesia on Time to Extubation: A Scoping Review

Purpose/Background Opioids during surgery have been clinically proven to lengthen the time between intubation and post-op extubation. Increased time to extubation is associated with negative patient outcomes. This scoping review aims to evaluate the use of ketamine with opioid free analgesia (OFA) versus traditional opioid usage and its outcomes on extubation times. Methods From September 2021 to November 2021, we conducted a literature search using the University of Tennessee Health Science Center’s (UTHSC) online library. Through the PubMed, CINAHL, Medline, and Cochrane databases, we identified seventy-one articles that matched our criteria. Of those articles, we selected twenty-five to undergo rapid critical appraisal (RCA). We then chose ten articles that were critically appraised and were from peer-reviewed sources. Finally, we constructed an outcome synthesis table and level of evidence table to synthesize the results of those ten articles. Results Ten articles were chosen for this scoping review. Nine articles show that the use of ketamine decreases the time to extubation, with five proving to be statistically significant. Four articles demonstrated a decrease in ICU length of stay in days with the ketamine-based anesthesia group. Five articles found a significant decrease in postoperative opioid consumption in the ketamine-based anesthesia group. The results demonstrate that there is evidence favoring the use of ketamine and opioid free anesthesia to decrease extubation times, decrease ICU lengths of stay, and decrease postoperative opioid consumption. Implications for Nursing Practice This scoping review has demonstrated that ketamine, when used as a perioperative adjunct for pain control, will reduce opioid usage and times to extubation. Implementation of routine ketamine administration should be considered in populations that may have prolonged intubation times

Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt

Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings