A Diverse and Inclusive Academic Membership for All

With the growing recognition that diversity and inclusion are essential for the improvement of science and innovation, this commentary provides some perspectives on three findings in the DeVilbiss et al. (2020)\u27s article and provide points of discussion on factors and strategies to consider when drafting diversity and inclusion programs for the Society for Epidemiologic Research

Mortality from motorcycle crashes: the baby-boomer cohort effect

Background Motorcyclists are known to be at substantially higher risk per mile traveled of dying from crashes than car occupants. In 2014, motorcycling made up less than 1 % of person-miles traveled but 13 % of the total mortality from motor-vehicle crashes in the United States. We assessed the cohort effect of the baby-boomers (i.e., those born between 1946 and 1964) in motorcycle crash mortality from 1975 to 2014 in the United States. Methods Using mortality data for motorcycle occupants from the Fatality Analysis Reporting System, we performed an age-period-cohort analysis using the multiphase method and the intrinsic estimator method. Results Baby-boomers experienced the highest mortality rates from motorcycle crashes at age 20-24 years and continued to experience excess mortality after age 40 years. After removing the effects of age and period, the estimated mortality risk from motorcycle crashes for baby-boomers was 48 % higher than that of the referent cohort (those born between 1930 and 1934, rate ratio 1.48; 95 % CI: 1.01, 2.18). Results from the multiphase method and the intrinsic estimator method were consistent. Conclusions The baby-boomers have experienced significantly higher mortality from motorcycle crashes than other birth cohorts. To reduce motorcycle crash mortality, intervention programs specifically tailored for the baby-boomer generation are warranted

The impact of the COVID-19 pandemic on the mental health of healthcare workers:study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study

BACKGROUND: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level. RESULTS: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00127-021-02211-9

Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful

Drink Specials, Drink Special Laws, and Fatal Motor Vehicle Crashes in the United States

The adverse health and safety consequences of excessive alcohol consumption are a leading problem around the world. Alcoholic beverages are a routine part of socializing in many societies. However, alcohol is also a significant contributor to worldwide morbidity, disability, and mortality. To lessen the harm produced by alcohol, governments have adopted different alcohol control policies. These control policies can be group into four basic strategies: deterrence, prevention, communications and outreach, and alcohol treatment. Among the prevention measures, restricting physical access to alcohol by limiting the alcohol outlets' density, raising the legal age to purchase alcohol, and reducing the affordability of alcohol through taxation have been extensively shown as cost-effective and feasible measures against alcohol-related harms. However, there are still topics related to the affordability of alcohol that have not been investigated. The role of promotional price practices at on-premises alcohol outlets on health and social outcomes, and the effects of policies enacted to prevent these practices on motor vehicle crashes remained an unexplored research topic. The main goals of this dissertation were to summarize evidence regarding the health effects of drink specials and to estimate the effects of policies restricting drink special practices as preventive tools for fatal motor vehicle crashes. Specifically, I summarized the research evidence of the effects of drink special practices on health and social outcomes (Aim 1). I examined the association between drink special laws and alcohol-related fatal motor vehicle crashes contrasting results for two methodological approaches, difference-in-difference-in-differences (Aim 2) and synthetic controls (Aim 3). This dissertation contains five chapters. The introduction in chapter one provides a background review of relevant literature that serves as the conceptual framework for this dissertation and an overview of chapters two, three, four, and five. The systematic review of the literature relevant to Aim 1 is presented in chapter two. This review included studies on the effects that drink specials and drink special laws have on alcohol consumption, binge drinking, and alcohol-related harms. Twelve studies examined the effect of drink specials in seven countries between 1978 and 2018. Consistent evidence supported associations between drink specials and increased alcohol consumption, heavy drinking, alcohol intoxication, and other alcohol-related outcomes. For aims 2 and 3, I examined 36-years of data from the U.S. Department of Transportation, Census Bureau, and NIH’s Alcohol Policy Information System and National Institute on Alcohol Abuse and Alcoholism from 1982 to 2017. In chapter three, I presented results from difference-in-difference-in-differences analyses of the effects of implementing six drink special laws on alcohol- and non-alcohol-related motor vehicle fatal crash rates in the United States (U.S.). I assessed exposure to implementation as any law, number of laws, and each law. Random effects generalized least squares regression models adjusted for the proportion of males in the state, youth involved in fatal crashes, gallons of ethanol per capita among the population age 21 years and older, and autonomy index were fitted across 24 treated and 18 non-treated states. Results revealed that the implementation of any drink special law was associated with reductions in overall and alcohol-related fatal crash rates compared to untreated states. Also, drink special laws mitigated incremental rates of non-alcohol related crashes among treated states with any drink special law compared to untreated states. In chapter four, I presented results from synthetic control analyses for single and multiple treated units. I assessed the association between drink special laws and alcohol-related fatal motor vehicle crashes and adjusted for the same covariates as in chapter three. Results in chapter four indicated that states treated with any drink special law reduced alcohol-related fatal crash rates only in years three, five, and ten post-implementation compared to the synthetic control trend. The effects of any drink special law were more consistent at different times in the post-implementation for reducing non-alcohol-related fatal crash rates than the synthetic control trend. Findings for the number of laws implemented and each drink special laws were mixed. Chapter five presents a synthesis and discussion of findings in chapters two, three, and four, as well as policy recommendations for stakeholders and future research

Additional file 1: Figure S1. of Mortality from motorcycle crashes: the baby-boomer cohort effect

Baby-boomers graphical trend compared to other birth cohorts in the United States, 1975–2014 (Red solid diamonds represent mortality rates for baby-boomers as the aged from 1975 to 2014; blue solid squares represent other birth cohorts). (DOCX 160 kb

Mental health in the Americas: an overview of the treatment gap

Objective. To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Methods. Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Results. Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% – 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. Conclusion. The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease

Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression

IntroductionThe Veterans Health Administration (VHA) supports the nation's largest primary care-mental health integration (PC-MHI) collaborative care model to increase treatment of mild to moderate common mental disorders in primary care (PC) and refer more severe-complex cases to specialty mental health (SMH) settings. It is unclear how this treatment assignment works in practice.MethodsPatients (n = 2610) who sought incident episode VHA treatment for depression completed a baseline self-report questionnaire about depression severity-complexity. Administrative data were used to determine settings and types of treatment during the next 30 days.ResultsThirty-four percent (34.2%) of depressed patients received treatment in PC settings, 65.8% in SMH settings. PC patients had less severe and fewer comorbid depressive episodes. Patients with lowest severity and/or complexity were most likely to receive PC antidepressant medication treatment; those with highest severity and/or complexity were most likely to receive combined treatment in SMH settings. Assignment of patients across settings and types of treatment was stronger than found in previous civilian studies but less pronounced than expected (cross-validated AUC = 0.50-0.68).DiscussionBy expanding access to evidence-based treatments, VHA's PC-MHI increases consistency of treatment assignment. Reasons for assignment being less pronounced than expected and implications for treatment response will require continued study