Using Hospital Discharge Data to Assess Trends of Carbapenem-resistant Enterobacteriaceae in Rhode Island

In 2017, Carbapenem-resistant Enterobacteriaceae (CRE) will become a reportable infectious disease in Rhode Island. To prepare for this updated regulation, the Center for Acute Infectious Disease Epidemiology (CAIDE) analyzed Rhode Island Hospital Discharge Data (HDD), internal epidemiologic line lists, as well as antibiograms from local laboratories to gauge past incidence of CRE in Rhode Island healthcare facilities. CAIDE used the HDD for a retrospective assessment of statewide CRE incidence in acute care hospitals from 2011-2015 using SAS 9.3 (SAS Institute, Cary, NC). Epidemiologists compiled lists of ICD-9/ICD-10 diagnosis codes that when combined indicate CRE. Codes included specific infections, antimicrobial resistance, and different specified sites (e.g. blood, urinary tract, lungs). The results of HDD inpatient population data analysis included annual counts of potential CRE diagnoses, which were used to calculate corresponding annual inpatient rates of CRE. The results from this research inform CAIDE’s development strategy for both a statewide surveillance system and registry for CRE. Moreover, CAIDE has an enhanced understanding of annual trends to predict more accurately the potential burden of the mandatory CRE reporting on the Rhode Island Department of Health

Changes in Depression and Stress after Release from a Tobacco-Free Prison in the United States

Prior research has found high levels of depression and stress among persons who are incarcerated in the United States (U.S.). However, little is known about changes in depression and stress levels among inmates post-incarceration. The aim of this study was to examine changes in levels of depression and stress during and after incarceration in a tobacco-free facility. Questionnaires that included valid and reliable measures of depression and stress were completed by 208 male and female inmates approximately eight weeks before and three weeks after release from a northeastern U.S. prison. Although most inmates improved after prison, 30.8% had a worsening in levels of depression between baseline and the three-week follow-up. In addition, 29.8% had a worsening in levels of stress after release than during incarceration. While it is not surprising that the majority of inmates reported lower levels of depression and stress post-incarceration, a sizable minority had an increase in symptoms, suggesting that environmental stressors may be worse in the community than in prison for some inmates. Further research is needed to address depression and stress levels during and after incarceration in order for inmates to have a healthier transition back into the community and to prevent repeat incarcerations

HIV testing among non-incarcerated substance-abusing juvenile offenders

Juvenile offenders are a subgroup of adolescents at particular risk for HIV/STI infection. Although HIV prevalence among these youth is low (<1%) in the US, rates of other STIs, unprotected sexual activity, multiple partners, and incidents of substance use during sex are high compared with other adolescent populations. Many of these youth will enter the adult criminal justice system, which is known to have an extremely high rate of HIV infection. US constitutional mandates provide HIV/STI testing for incarcerated juveniles, but close to 80% of juvenile arrestees are never detained. Moreover, although they engage in similar HIV risk behaviors as those detained, they have limited access to available HIV/STI testing services. Thus, our study examined rates of lifetime HIV testing among a pilot sample of 60 court-involved, substance-using juveniles monitored in the community to explore rates of testing and the reasons related to lifetime testing among a high-risk, yet understudied US juvenile population

Bringing Personality Into the Public Health Conversation: Evidence From a Correctional Population

Incarceration provides an opportunity for public health interventions, but communication and the delivery of services are complicated by considerable variability even within this generally high-needs population. Public health practitioners have relied heavily on social determinants of health data in their work, but this does not fully explain key patterns in responses and success. Psychometric work related to the “big five” or “five-factor” personality domains may provide important additional guidance to health communications and interventions. The Contraceptive Awareness and Reproductive Education clinical trial provided health risk factor and personality data on 257 incarcerated women aged 18–35. Of the study population, 85.9% reported at least one of the five forms of childhood trauma. Three of the five personality domains were associated with multiple health risk factors and four of the five were associated with fair or poor general health. Personality data provide important guidance in understanding variability in responses to public health interventions in the correctional setting