[ad_1]
Stephen W. Patrick
US counties that have shortages of mental health providers and higher long-term unemployment rates also have higher rates of Neonatal Abstinence Syndrome, or NAS, according to a study published in JAMA.
"What is clear when I take care of infants and talk to their mother, is that even though the NAS is not particularly complex clinically, it can be complex on the social plan", Stephen W. Patrick, MD, MPH, Assistant Professor of Pediatrics and Health Policy at the University of Vanderbilt and Director of the Vanderbilt Center for Child Health Policy, has Infectious Diseases in Children. "The stories of pregnant women that I tell are long stories of trauma and violence. This study was our first attempt to try to see what was happening beyond the walls of the hospital. Sometimes we focus on what's going on in bed, but a lot of the NAS happens outside of the hospital. "
Patrick and his colleagues conducted a cross-sectional, retrospective cross-sectional study of birth and economic data collected between 2009 and 2015 in 580 counties in Florida, Kentucky, Mbadachusetts, Michigan, New York, North Carolina, and Tennessee and Washington. In addition, the researchers examined the 10-year unemployment rate at the county level and the availability of mental health and primary care clinicians.
During the study period, 6,302,497 children were born and 47,224 diagnoses were established (median rate = 7.1 cases per 1,000 hospital births, interquartile range [IQR] = 2.2-15.8).
Patrick and his colleagues calculated that the 10-year unemployment rate was 7.6% (IQR = 6.4% to 9%) and that almost every year, in every county (83.9%), there was a partial or total shortage of health care providers.
Subsequent badyzes revealed that rates of SAR were higher in counties with shortages of mental health providers (unadjusted rates = 14 per 1,000 live births versus 10.6 per 1,000 live births; 39, adjusted incidence [IRR] = 1.17; 95% CI, 1.07-1.27). The shortage of mental health providers was most affected by the rate of diagnosed ANS cases in metropolitan counties (aIRR = 1.28, 95% CI, 1.16-1.40).
Patrick said that there was a known correlation between untreated mental health disorders and opioid use. He suggested that improving access to mental health providers could be "a way to help prevent the SIN for years to come."
The researchers said there was no relationship between SIN rates and shortages of primary health care providers, but found that SIN rates were correlated with long-term unemployment. (Unadjusted rate = 20.1 per 1,000 births vs. 7.8 per 1,000 live births, ARR = 1.34, 95% CI, 1-1.23). This badociation had the greatest impact on remote and rural counties (aIRR = 1.34, 95% CI, 1.05-1.70).
"For clinicians, I think we need to step back and not just think about opioids or the mother's drug exposure, but in the broader context," said Patrick. "For me, it makes sense when I think about how to take care of pregnant women, taking into account their trauma and how I can connect them to other resources that might be beneficial. It may sound overwhelming, and I think one of the goals of our paper was not just to focus on drugs, but to start the conversation by thinking about the social determinants of health care. "- by Katherine Bortz
Disclosure: Patrick does not report any relevant financial information.
[ad_2]
Source link
