Barriers and Promoters of Retention of Direct Care Workers in Community Mental Health Agencies

Demand for behavioral health direct-care providers is increasing due to shortage of licensed behavioral health providers. However, high turnover has been reported among them with limited exploratory research. The present study aimed to identify a wide variety of barriers and promoters of retention and strategies to retain direct care workers. An online, self-administered survey designed to measure demographics, job satisfaction, perceived importance of various job aspects, intention to leave, perceived stress and sources of stress was administered among 179 direct care workers from four agencies. Multiple logistic regression exhibited higher odds of intending to leave for those who had higher general perceived stress (OR=1.3, CI=1.1-1.7) and those who experienced stress from supervisor (OR=5.0, CI=1.7-14.4) and organizational culture (OR=4.2, CI=1.1-18.4). Work-related stress is a prevalent issue among direct-care providers and may be associated with turnover. Policy formulation and implementation directed at strategies to reduce stress may be warranted to improve retention.https://digitalcommons.unmc.edu/bhecn_report/1000/thumbnail.jp

Improving Behavioral Health Workforce Supply and Needs Estimates Using Active Surveillance Data

INTRODUCTION: Previous studies show that supply of behavioral health professionals in rural areas is inadequate to meet the need. Measuring shortage using licensure data on psychiatrists is a common approach. Although inexpensive, the licensure data have many limitations. An alternative is to implement an active surveillance system, which uses licensure data in addition to active data collection to obtain timely and detailed information. METHODS: Nebraska Health Professions Tracking Service (HPTS) data were used to examine differences in workforce supply estimates between the passive (licensure data only) and active (HPTS data) surveillance systems. The impact of these differences on the designation of psychiatric professional shortage areas has been described. Information regarding the number of psychiatrists, advanced practice registered nurses and physician assistants specializing in psychiatry was not available from the licensure database, unlike HPTS. RESULTS: Using licensure data versus HPTS data to estimate workforce, the counts of professionals actively practicing in psychiatry and behavioral health were overestimated by 24.1-57.1%. Ignoring work status, the workforce was overestimated by 10.0-17.4%. Providers spent 54-78% of time seeing patients. Based on primary practice location, 87% of counties did not have a psychiatrist and 9.6% were at or above the Health Professional Shortage Area designation ratio of psychiatrists to population. CONCLUSION: Enumeration methods such as ongoing surveillance, in addition to licensure data, curtails the issues and improves identification of shortage areas and future behavioral workforce related planning and implementation strategies

Provisional behavioral health licenses to full licenses: Analysis of Nebraska behavioral workforce data 2009–2019

There is a need to recruit and to retain behavioral health providers especially when providers are moving from the provisional licensing status to a full licensure status. This study estimated the rates of conversion of provisional licenses to full licenses among provisionally licensed psychologists, mental health practitioners, master social workers, and alcohol and drug counselors (ADCs) in Nebraska and examined potential associations among demographic characteristics and license conversion rates. Nebraska’s behavioral health licensure data (2009–2019) was obtained from the Health Professional Tracking Service (HPTS) program that was established as a joint effort between Nebraska Department of Health and Human Services, Human Services Office of Rural Health and University of Nebraska Medical Center. The rate of conversion from provisional to full license during the most recent years ranged from 44% for ADCs to 75% among social workers. Compared to individuals of older age, individuals of younger age are more likely to convert among ADCs (p = .0028). Moreover, compared to individuals living in urban areas, rural practitioners are more likely to convert among social workers (p \u3c .0001). With behavioral health problems on the rise across the country, it is urgent that behavioral health professional shortage areas begin to close the workforce gap. Increasing conversion rates from provisional to full licenses will be a part of this solution

Low-Level Groundwater Atrazine in High Atrazine Usage Nebraska Counties: Likely Effects of Excessive Groundwater Abstraction

Recent studies observed a correlation between estrogen-related cancers and groundwater atrazine in eastern Nebraska counties. However, the mechanisms of human exposure to atrazine are unclear because low groundwater atrazine concentration was observed in counties with high cancer incidence despite having the highest atrazine usage. We studied groundwater atrazine fate in high atrazine usage Nebraska counties. Data were collected from Quality Assessed Agrichemical Contaminant Nebraska Groundwater, Parameter–Elevation Regressions on Independent Slopes Model (PRISM), and water use databases. Descriptive statistics and cluster analysis were performed. Domestic wells (59%) were the predominant well type. Groundwater atrazine was affected by well depth. Clusters consisting of wells with low atrazine were characterized by excessive groundwater abstraction, reduced precipitation, high population, discharge areas, and metropolitan counties. Hence, low groundwater atrazine may be due to excessive groundwater abstraction accompanied by atrazine. Human exposure to atrazine in abstracted groundwater may be higher than the estimated amount in groundwater

Cohort profile: the British Columbia COVID-19 Cohort (BCC19C)—a dynamic, linked population-based cohort

PurposeThe British Columbia COVID-19 Cohort (BCC19C) was developed from an innovative, dynamic surveillance platform and is accessed/analyzed through a cloud-based environment. The platform integrates recently developed provincial COVID-19 datasets (refreshed daily) with existing administrative holdings and provincial registries (refreshed weekly/monthly). The platform/cohort were established to inform the COVID-19 response in near “real-time” and to answer more in-depth epidemiologic questions.ParticipantsThe surveillance platform facilitates the creation of large, up-to-date analytic cohorts of people accessing COVID-19 related services and their linked medical histories. The program of work focused on creating/analyzing these cohorts is referred to as the BCC19C. The administrative/registry datasets integrated within the platform are not specific to COVID-19 and allow for selection of “control” individuals who have not accessed COVID-19 services.Findings to dateThe platform has vastly broadened the range of COVID-19 analyses possible, and outputs from BCC19C analyses have been used to create dashboards, support routine reporting and contribute to the peer-reviewed literature. Published manuscripts (total of 15 as of July, 2023) have appeared in high-profile publications, generated significant media attention and informed policy and programming. In this paper, we conducted an analysis to identify sociodemographic and health characteristics associated with receiving SARS-CoV-2 laboratory testing, testing positive, and being fully vaccinated. Other published analyses have compared the relative clinical severity of different variants of concern; quantified the high “real-world” effectiveness of vaccines in addition to the higher risk of myocarditis among younger males following a 2nd dose of an mRNA vaccine; developed and validated an algorithm for identifying long-COVID patients in administrative data; identified a higher rate of diabetes and healthcare utilization among people with long-COVID; and measured the impact of the pandemic on mental health, among other analyses.Future plansWhile the global COVID-19 health emergency has ended, our program of work remains robust. We plan to integrate additional datasets into the surveillance platform to further improve and expand covariate measurement and scope of analyses. Our analyses continue to focus on retrospective studies of various aspects of the COVID-19 pandemic, as well as prospective assessment of post-acute COVID-19 conditions and other impacts of the pandemic

Neurocognitive impairment in people living with human immunodeficiency virus (HIV): Risk factors and mortality

Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH) with clinical and public health implications. Studies have generated inconsistent results regarding etiological factors for NCI in PLWH and a brief user-friendly predictive tool is desirable in clinical practice to assess the probability of having NCI in PLWH. Furthermore, factors associated with clinically meaningful decline in neurocognitive status and survival disadvantage for patients with NCI are understudied in the post-cART era. The goal of this dissertation was to investigate factors associated with baseline NCI and neurocognitive decline and the association of baseline NCI with mortality in PLWH. Further, we aimed to construct a predictive tool for NCI and to examine the association between longitudinal changes in neurocognitive status and mortality in PLWH. We used two large databases, the National NeuroAIDS Tissue Consortium (NNTC) and the CNS HIV Antiretroviral Therapy Effects Research (CHARTER), to carry out this research project. Statistical procedures such as Bayesian network analysis, multiple logistic regression, joint modeling, and multivariable Cox proportional hazards modeling were employed. Results of first study indicated that neurocognitive impairment had positive associations with older age, current unemployment, difficulty in bathing, dressing, eating, or using the toilet, impaired use of hands, history of high cholesterol, current psychotropic medication use, presence of any AIDS-defining illness and lifetime history of stroke. In the second study we noted that lifetime depression, hepatitis-C infection, lifetime methamphetamine and cannabis use Hispanic ethnicity, no baseline ARV use, and difficulty eating, dressing, bathing, or using the toilet were positively associated with neurocognitive decline. Finally, the third study exhibited a significant interaction between age and neurocognitive status in relation to mortality. Also, non-Hispanic ethnicity, lower baseline serum hemoglobin and higher baseline plasma viral load were positively associated with higher hazard of death. By knowing associated factors, the results of this study could assist clinicians identify patients needing comprehensive neuropsychological examination resulting in timely diagnosis and appropriate management. Furthermore, through targeted interventions, the results of this study may assist in improving the quality of life and disease outcomes (decline and mortality) among PLWH

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes

Estrogen Disrupting Pesticides in Nebraska Groundwater: Trends between Pesticide-contaminated Water and Estrogen-related Cancers in An Ecological Observational Study

Estrogen disrupting pesticides (EDP) are pesticides that modify estrogen activities in estrogen-producing vertebrates. A substantial amount of these pesticides has been detected in human tissues, and they function directly to disrupt estrogen synthesis or effector cells. This study examines EDP’s ecological distribution across Nebraska counties and its association with estrogen-related cancers (ERC). To determine the ecological distribution of selected EDP, county-level choropleth maps were created. Moreover, EDP was tested in separate linear models with different ERC to determine the association between ERC and EDP across Nebraska counties. Exposure data for this county-level study was obtained from the quality assessed agrichemical contaminant Nebraska groundwater database between 1 January 1974 and 31 December 2012. Acetochlor, atrazine, and its metabolites, deethylatrazine (DEA), and de-isopropyl atrazine (DIA) were the most frequently detected EDP in Nebraska groundwater. Moreover, Nebraska county-level potential confounder for ERC such as physically unhealthy days, % adult smoking, % obese adult, % uninsured, and % binge drinking were obtained from County Health Rankings 2010. ERC, which is the outcome variable (breast cancer, uterine cancer, and prostate cancer), were obtained from the Nebraska State profile of the National Cancer Institute. This was expressed as county-level age-standardized incidence cancer rates between 1 January 2013 and 31 December 2017. Data characteristics were determined using percentages, mean, median, 25th and 75th percentile, minimum and maximum values. The relationship between county-level cancer rates and % wells positive for pesticides after adjusting for the county level potential confounders were analyzed in a linear regression model. Water supply wells positive for atrazine and DEA were observed to cluster in the South and South East counties of Nebraska. Furthermore, breast cancer and prostate cancer incidence rates were higher in the southeast of Nebraska with more atrazine and DEA. However, breast cancer and prostate cancer were not significantly associated in a linear regression model with any of the observed EDP. In contrast, uterine cancer was statistically associated with % water supply wells positive for acetochlor (β = 4.01, p = 0.04). While consistent associations were not observed between ERC and EDP from the GIS and the linear regression model, this study’s results can drive future conversation concerning the potential estrogenic effects of acetochlor, atrazine, and its metabolites on the incidence of breast, uterine and prostate cancer in the State of Nebraska

A population-based assessment of myocarditis after messenger RNA COVID-19 booster vaccination among adult recipients

Objectives: We aimed to estimate the rate of myocarditis after the messenger RNA (mRNA) COVID-19 booster vaccination by vaccine type, age, and sex. Methods: We used data from the British Columbia COVID-19 Cohort, a population-based cohort surveillance platform. The exposure was a booster dose of an mRNA vaccine. The outcome was diagnosis of myocarditis during hospitalization or an emergency department visit within 7-21 days of booster vaccination. Results: The overall rate of myocarditis was lower for the booster dose (6.41, 95% confidence interval [CI]: 3.50-10.75) than the second dose (17.97, 95% CI: 13.78-23.04); (Rate ratiobooster vs dose-2 = 0.34, 95% CI: 0.17-0.61). This difference was more apparent for the mRNA-1273 vaccine type. After the second dose, the myocarditis rate in males was significantly lower for BNT162b2 than mRNA-1273 overall and among those aged 18-39 years. In contrast, after the booster dose, no significant differences between myocarditis and vaccine type was observed overall or within the specific age groups among males or females. Conclusion: Myocarditis after mRNA COVID-19 vaccines is a rare event. A lower absolute risk of myocarditis was observed after a booster dose of mRNA vaccine than the primary series second dose

Neurocognitive impairment and health-related quality of life among people living with Human Immunodeficiency Virus (HIV).

The association between HIV-associated neurocognitive impairment (NCI) and health-related quality of life (HRQoL) is not well known. We investigated this association among the CNS (Central Nervous System) HIV Antiretroviral Therapy Effects Research (CHARTER) study participants. We performed factor analysis to distinguish physical and mental HRQoL, followed by general linear models. We analyzed 1,340 HIV participants, including 35.6% with NCI, 77.2% males, 70.5% unemployed, and 42.2% with depression. Impaired participants had lower (worse) mental and physical HRQoL mean scores compared to unimpaired participants. NCI was negatively associated with mental HRQoL in crude (mean difference: -4.38; 95% CI: -6.70 to -2.06) and adjusted analysis (-2.56, -4.83 to -0.30). NCI was also negatively associated with physical HRQoL in unadjusted analysis (-4.62, -7.45 to -1.78), though the association weakened in the adjusted analysis (-2.20, -4.81 to 0.40). The association between NCI and HRQoL was confounded mainly by employment and was partially mediated by depression. These findings suggest that future strategies aimed at improving HRQoL among HIV-infected patients with NCI might benefit from concurrent management of depression