Wisconsin Department of Health Services

Severe rhinovirus (RV)/enterovirus (EV) respiratory infections in pediatric patients increased in the US during 2022-2023. This study aimed to characterize RV/EV genetic diversity among hospitalized children in Wisconsin and describe demographic and clinical factors of patients by RV/EV type. During September 2022-April 2023, five Wisconsin pediatric hospitals submitted five RV/EV-positive specimens weekly to CDC. Viral typing was performed using partial viral protein (VP) 4/VP2 (RV) and VP1 (EV) sequencing. Wisconsin Department of Health Services abstracted demographic, comorbid condition, and hospitalization course information from patient medical records. Ninety-six patients were included in this investigation. RV-C (n = 40, 42%) and RV-A (n = 31, 32%) were the most frequently detected species, with 46 RV and 5 EV types identified. The median age was 2.5 (IQR: 0.7-5.5) years. Seventy-one (74%) children had at least one comorbid condition. Asthma was more common among children with RV-C infections (n = 12, 30%) compared with other RVs (n = 3, 9%) (p = 0.02). RV-A and RV-C were important contributors to severe pediatric respiratory infection in Wisconsin. Molecular typing showed virus divergence typically observed during season-long investigations. Year-round molecular characterization is needed to better understand the contribution of RV/EV types to severe pediatric respiratory illness.

Denominator inflation (DI) can burden long-standing immunization information systems (IIS), evident through a system having more client records than population estimates. DI underestimates IIS vaccination coverages compared to National Immunization Surveys (NIS) data. To mitigate DI, the Wisconsin Immunization Registry (WIR) implemented a dormant indicator in June 2020. Clients are presumed to have left the jurisdiction and are placed in the dormant state if they meet the following criteria: client age is at least 11 years old, no updates to the client record in at least 10 years, and the record has not been queried in the last five years. The querying component is a novel approach when compared to American Immunization Registry Association recommendations for the Patient Active/Inactive Status. The study purpose was to quantify how incorporating the dormant state in an adolescent population assessment impacts Wisconsin's vaccination coverage rates compared to the NIS-Teen estimates. This study also addressed the population characteristics of adolescent dormant state and non-dormant state client records. The study population included all Wisconsin adolescents, aged 13-18 years, and assessed vaccine uptake for Meningococcal ACWY , Tdap, HPV initiation, and HPV Complete. Vaccination coverage was assessed, with and without the dormant clients, and then compared to the NIS-Teen estimates. Descriptive statistics were assessed among dormant and non-dormant clients, including a regional variation assessment. Initial results showed an increase in adolescent vaccination rates for all vaccines and series when excluding dormant clients and suggest a more accurate assessment in line with NIS-Teen estimates. Dormant clients had a higher proportion of unknown and missing data fields for race, sex, and ethnicity. At this time, removing dormant client records is an effective strategy for reducing DI in WIR, with opportunities for further refinement.

Abstract Mindfulness digital health interventions (DHIs) can reduce stress among caregivers of persons living with dementia (PLWD). Little is known about how mindfulness DHI utilization relates to stress reduction. This study is a secondary analysis of a feasibility pilot RCT of Healthy Minds Program for Caregivers (HMP-C), a mindfulness stress-reduction DHI for caregivers of PLWD. Forty-seven participants randomized to the intervention condition (HMP-C) in the primary trial were included the secondary analysis. Participants were instructed to use HMP-C for a minimum of 52.5 minutes per week. We describe HMP-C utilization and the association between HMP-C usage and reductions in perceived stress (PSS-10) between baseline and post-test using linear and logistic regression. Median usage of HMP-C was 30 minutes per week (IQR = 30; Range= 1-110). Every 10 additional minutes of HMP-C usage per week was associated with a 1.2 (CI = 0.4,1.9) point decrease in perceived stress. Using HMP-C for 52.5 minutes or more was associated with an 8-point reduction in stress (CI = 3.2,13.2). These findings suggest that utilization of HMP-C is related to reductions in perceived stress. However, there was significant variability in utilization, with few caregivers sufficiently using HMP-C to see clinical reductions in perceived stress. Future research is needed to explore strategies for improving utilization among low-usage caregivers and to identify the optimal balance of feasibility and clinical benefit for mindfulness DHIs among caregivers.

Uniform guidance has not been established regarding the inclusion of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code R45.88 (non-suicidal self-harm), with or without the presence of an injury code, as a self-harm case. This study explores the differences between discharge patients identified with self-harm and co-occurring injury, and those identified with self-harm and no co-occurring injury. Analyses were conducted using Wisconsin and Oregon discharge records from 2022 to 2023. Two mutually exclusive groups were created based on ICD-10-CM codes: Group A) patients with a self-harm injury code, or R45.88 with another injury diagnosis or e-code and, Group B) patients with R45.88 and no other injury code. Hospital and emergency department (ED) patients were analysed separately by jurisdiction. Univariate analyses were conducted, and logistic regression models were run separately for each patient type. The models analysed differences between patients in Groups A and B. For both jurisdictions and patient type, Group B was significantly younger: mean of 14 and 5 years younger among Wisconsin and Oregon hospital patients and 5 and 3 years younger among Wisconsin and Oregon ED patients, respectively. Age remained significant in the models for both types of patients in both jurisdictions. Comorbidities, such as suicidal ideation and mental health disorders, and some demographics, were significantly different between groups, and this varied by jurisdiction. Surveillance of self-harm that incorporates all instances of R45.88 is more inclusive of all self-harm behaviours, whether resulting in injury or not. This will support a more accurate representation of self-harm burden, and the populations impacted.

Background: Telehealth care is now a key element of mainstream health care since the COVID-19 pandemic, with all types of health care providers joining the digital revolution. As a population experiencing health care disparities, adults with developmental disabilities and their supporters have described variable experiences with telehealth care that contribute to overall care quality and health outcomes. Methods: This e-Delphi study established consensus on best practices in telehealth care for adults with developmental disabilities in the United States. Online surveys and videoconferencing interviews were conducted with 44 expert panelists with experience with telehealth care and developmental disabilities, including adults with developmental disabilities, family members, direct support professionals, nurses, and health care providers. Results: Three rounds of surveys resulted in a set of 9 guidelines consisting of 42 items. The guidelines addressed 1) appropriate situations for telehealth care, 2) communication needs and preferences, 3) support person collaboration, 4) education and anticipatory guidance, 5) reminders, 6) coordination of care, 7) equitable and fair access, 8) privacy and safety, and 9) evidence-based practice. Conclusion: Health care providers can adopt these best practice guidelines to ensure telehealth care is provided equitably and safely to adults with developmental disabilities. Policy advocacy is needed for the uptake of these guidelines and for health care providers and adults with developmental disabilities to access the resources needed for safe and effective telehealth care use.

Non-Hodgkin's Lymphoma (NHL) accounts for a substantial number of cancer cases in the United States, with a significant prevalence and mortality rate. The implementation of the Affordable Care Act (ACA) has the potential to impact cancer-specific survival among NHL patients by improving access to healthcare services and treatments. This study aims to assess the impact of the implementation of the ACAon cancer-specific survival among patients diagnosed with NHL. In this retrospective analysis, we leveraged data from the Surveillance, Epidemiology, and End Results (SEER) registry to assess the impact of the ACAon cancer-specific survival among NHL patients. The study covered the years 2000-2020, divided into pre-ACA (2000-2013) and post-ACA (2017-2020) periods, with a three-year washout (2014-2016). Using a Difference-in-Differences approach, we compared Georgia (a non-expansion state) to New Jersey (an expansion state since 2014). We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities. Among 74,762 patients, 56.2% were in New Jersey (42,005), while 43.8% were in Georgia (32,757). The pre-ACA period included 32,851 patients (51.7% in Georgia and 56.7% in New Jersey), and 27,447 patients were in the post-ACA period (48.3% in Georgia and 43.4% in New Jersey). The post-ACA period exhibited a 34% survival improvement (OR=0.66, 95% CI 0.58-0.75). ACA implementation was associated with a 16% survival boost among NHL patients in New Jersey (OR=0.84, 95% CI 0.74-0.95). Other factors linked to improved survival included surgery (OR=0.86, 95% CI 0.81-0.91), radiotherapy (OR=0.77, 95% CI 0.72-0.82), and married status (OR=0.67, 95% CI 0.64-0.71). The study underscores the ACA's potential positive impact on cancer-specific survival among NHL patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.