Search

To estimate the independent and combined effects of in utero exposures on birth outcomes in a rural population.The study used population-level data (2020-2022) from a state-wide surveillance tool (Project WATCH) in West Virginia. Outcomes included low birth weight (LBW), preterm birth, small for gestational age (SGA), and birth weight in grams. Exposure included a composite variable with 8-levels of three exposure (opioids, stimulants, and cannabis) categories. Analyses were adjusted for sociodemographic covariates using multiple logistic and linear regression analyses.Of the 34,412 singleton live births, 1-in-8 newborns (12.2%) had in utero exposure(s) to opioids, stimulants, and/or cannabis, 11.5% were preterm, 7.9% had LBW, 9.6% were SGA, and mean birth weight was 3249g (SD=563.6). Preterm birth was associated with stimulant alone exposure [aOR=1.40 (1.03, 1.89)] and 'stimulant and cannabis' concurrent exposure [aOR =1.69 (1.16, 2.47)]. LBW was associated with opioids alone [aOR=1.34 (1.10, 1.63)], cannabis alone [aOR=1.31 (1.13, -1.52)], 'opioid and cannabis' [aOR=1.61 (1.12, -2.31)], and 'opioids, stimulants, and cannabis' concurrent exposures [aOR=2.27 (1.43, 3.61)]. Five exposure categories were associated with lower birth weights [adjusted mean difference (aMD) range -72g. to -211g)]. SGA was associated with opioids alone [aOR=1.48 (1.24, 1.78)], cannabis alone [aOR=1.49 (1.31, 1.69)], and 'opioids and cannabis' concurrent exposures [aOR=1.91 (1.36, 2.67)].We showed complex associations between in utero substance exposures, preterm birth, birth weight, and sociodemographic factors in a rural population. The results may inform policy efforts to improve maternal and child health in socioeconomically disadvantaged and underserved rural populations.

Autism spectrum disorder (ASD) is a consortium of developmental conditions. As scientists have not yet identified the exact underlying cause for these disorders, it is not easy to narrow down a singular therapy to propose a reliable cure. The preponderance of research suggests that stem-cell therapy improves aspects of outcome measure scales in patients with ASD; therefore, future studies should give us more confidence in the results. This overview considers the data that have emerged from the small set of published trials conducted using different approaches in stem-cell therapy for ASD, evaluates their results and proposes additional steps that could be taken if this field of endeavor is to be pursued further.

BACKGROUND: Previous research indicated that diabetes during pregnancy results in a more permeable placenta. Based on this data, we hypothesized that women with maternal diabetes were more likely to have infants who developed neonatal abstinence syndrome (NAS). PURPOSE: The purpose of the study was to examine the association between maternal diabetes and NAS in a cohort of women reporting substance use during pregnancy. METHODS: This study used data from a population-based cohort of all newborns born in 2017 and 2018 (N = 36,974) in the state of West Virginia and restricted the analysis to those infants with intrauterine substance exposure (14%, n = 5188). Multiple logistic regression was performed to analyze the adjusted relationship between maternal diabetes and NAS while controlling for maternal and infant covariates. RESULTS: Just over 28% of women with diabetes had an infant who developed NAS, whereas 34.8% of women without diabetes had an infant who developed NAS. The adjusted odds ratio of infants developing NAS born to women with diabetes was 0.70 (95% confidence interval: 0.51, 0.94) compared with those born to mothers without diabetes after controlling for covariates. Contrary to our hypothesis, the study suggests that maternal diabetes during pregnancy is associated with a decreased risk of an infant developing NAS. IMPLICATIONS FOR PRACTICE: Future research generating from this hypothesis may lead to potential implications for practice for infants born to mothers with substance use during pregnancy and diabetes. IMPLICATIONS FOR RESEARCH: More research should be conducted to investigate the relationship between glucose metabolism and NAS.

Diabetes mellitus (DM) often causes chronic kidney damage despite best medical practices. Diabetic kidney disease (DKD) arises from a complex interaction of factors within the kidney and the whole body. Targeting specific disease-causing agents using drugs has not been effective in treating DKD. However, stem cell therapies offer a promising alternative by addressing multiple disease pathways and promoting kidney regeneration. Mesenchymal stem cells (MSCs) offer great promise due to their superior accessibility ratio from adult tissues and remarkable modes of action, such as the production of paracrine anti-inflammatory and cytoprotective substances. This review critically evaluates the development of MSC treatment for DKD as it moves closer to clinical application. Results from animal models suggest that systemic MSC infusion may positively impact DKD progression. However, few registered and completed clinical trials exist, and whether the treatments are effective in humans is still being determined. Significant knowledge gaps and research opportunities exist, including establishing the ideal source, dose, and timing of MSC delivery, better understanding of in vivo mechanisms, and developing quantitative indicators to obtain a more significant therapeutic response. This paper reviews recent literature on using MSCs in preclinical and clinical trials in DKD. Potent biomarkers related to DKD are also highlighted, which may help better understand MSCs’ action in this disease progression.

PurposeEmployee work engagement has become a major concern for managers as hardly 21% of employees are engaged in their work. Therefore, this study aims to unveil the association between ethical leadership and employee engagement. Specifically, the study explores the mediating role of trust in leader between ethical leadership and employee work engagement and moderating role of harmonious work passion in the association between trust in leader and employee work engagement.Design/methodology/approachThis study collected data from 491 employees and their immediate supervisors working in various organizations (in Pakistan) through “Google Forms”. The data were analyzed through analysis of moment structure (AMOS) and structural equation modeling (SEM) was applied to examine measurement model (for unidimensionality) and structural model (for hypotheses testing).FindingsThe study noted that ethical leaders positively influence their subordinates to engage in their work. In addition, employees' trust in leader was noted to mediate the association between ethical leadership and employee work engagement. Finally, employees high in harmonious work passion are more likely to engage in their work when perceived their leaders ethical style.Practical implicationsThe study suggests to management that fair dealing and involvement in decision-making (ethical leadership) improve employee work engagement as such practices build employees' level of trust in their leaders. In addition, management is suggested to give freedom to employees while selecting their tasks as it positively contributes to their harmonious work passion which ultimately benefits the organization.Originality/valueDrawing upon social exchange and self-determination theory, this study is the first of its kind that explored the moderating role of harmonious work passion and mediating role of trust in leader between ethical leadership and employee work engagement.

This paper theorizes the use of water imagery in Elizabeth Bishop’s selected postmodern poetry namely, “The Map”, “The Imaginary Iceberg” and “The Man-Moth”. Speaking in the language of tears, lake, bay, river, strait, sea and ocean, Bishop personifies water for culture and its language. It is on this basis that Bishop comes close to the French psychoanalyst and linguist, Julia Kristeva’s concept of the semiotic chora. Kristeva calls it a space of maternal discourse, where the fluid realm of mother’s body called chora celebrates the fluidity of semiotic desires and expresses them through the symbolic language of the world outside her body. Bishop revisits this bodily space, time and again, to acquire subjectivity through the mother/child bond. Bishop’s poetic language celebrates this relationship between the semiotic (maternal) and symbolic (paternal) realm of language. The symbolic enables the semiotic to express itself, and the semiotic shatters the rigidity of the symbolic meanings through an ongoing process of signification. This reciprocity, through the semiotic chora, makes Bishop’s identity fluid and always in motion towards multiplicity. This plurality brings newness to Bishop’s poetry and engages the researcher with fresh perspectives of outer vision, inner perception, structural patterns and make her poetry eventful.

This article establishes Elizabeth Bishop’s relationship with art historian Heinrich Wölfflin through an in-depth analysis of the former’s landscape poems, “Questions of Travel,” “Cape Breton” and “The End of March.” Bishop’s poetry is shown to exercise Wölfflin’s “painterly” geometry to soften stationary shapes and enhance her language’s ability to paint her poetic environment. This study focuses on Bishop’s geometry of indeterminate lines as incomplete and unclear dimensions of vision, where their preference for diagonal motion references Wölfflin’s description of the “painterly […] depreciation of line” in baroque art. Bishop’s painterly lines of perception help to differentiate her spatial poetics from plastic tendencies. Her poems are not tangible facts, but spaces of dialogue. This article thus proposes that Bishop’s landscape poems show strategies of painterly paintings read as verse.

Background Nosocomial Bloodstream infection (nBSI) in COVID 19 patients is an emerging clinical concern for physicians. In this study, we aimed to assess the prevalence of BSI in COVID-19 patients admitted to our hospital, The Indus Hospital, Karachi, Pakistan. Methods This retrospective study included the RT-PCR confirmed COVID-19 patients admitted to our hospital from March 2020 to December 2021. Demographics, the incidence of BSI, frequency of pathogens from the positive blood cultures, antibiotics resistance pattern, and frequency of Multidrug-Resistant Organisms (MDROs) were obtained from the hospital’s electronic medical record. Blood cultures were performed using BD BACTEC. Bacterial identification was done by using Analytical Profile Index(API) whereas antimicrobial susceptibility testing of isolates was performed by the Kirby-Baur disk diffusion method and VITEK® 2 COMPACT. Results Our data showed that 25% of the patients admitted to our hospital developed BSI. The incidence of BSI was higher in males than in females (62.6% vs 37.4%) and most of the patients were in the age group of 46-60 years (n=93). Gram-negative pathogens were pre-dominantly identified, (50.67%), followed by yeast (12.9%), and Gram-positive pathogens (11.8%). Among these isolates, Acinetobacter sp. was the most commonly identified pathogen. Figure 1 shows the incidence of BSI and Figure 2 shows the distribution of all the pathogens identified from the positive blood cultures. Antibiotics resistance pattern showed a higher prevalence of MDROs. Among the MDROs, Acinetobacter sp. was highest in number (97.6%), followed by 66.6% of Pseudomonas, 63% of E.coli, 62% of S. aureus, 61.5% of Enterococcus, and 50% of Klebsiella sp. Conclusion Our findings indicated the incidence of BSI in 25% of COVID-19 in-patients. There is a significant prevalence of MDROs among which compelling prevalence of Acinetobacter sp. was observed. The COVID-19 pandemic overburdened the already vulnerable health care systems and made it difficult to adhere to infection control practices leading to the emergence of MDROs. Moreover, timely initiation of empirical antibiotics could also reduce the incidence of BSI in patients. Lastly, further multi-centered studies are needed for the evaluation of the incidence of BSI in our region. Disclosures All Authors: No reported disclosures.

ObjectiveMultimorbidity and non-cancer chronic pain conditions (NCPC) are independently linked to elevated risk for cognitive impairment and incident Alzheimer’s Disease and Related Dementias (ADRD)-both - We present the study of potential joint and interactive effects of these conditions on the risk of incident ADRD in older population.MethodsThis retrospective-cohort study drew baseline and 2-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey (MCBS). Baseline multimorbidity and NCPC were ascertained using claims data. ADRD was ascertained at baseline and follow-up.ResultsNCPC accompanied by multimorbidity (vs. absence of NCPC or multimorbidity) had a significant and upward association with incident ADRD (adjusted odds ratio (AOR): 1.72, 95% CI 1.38, 2.13, p<0.0001). Secondary analysis by number of comorbid conditions suggested that the joint effects of NCPC and multimorbidity on ADRD risk may increase with rising number contributing chronic conditions. Interaction analyses indicated significantly elevated excess risk for incident ADRD.

This research is an attempt to explore the formation of the assemblage of justice in Tawfiq al-Hakim’s The Song of Death (Ughniyat al- Mawt) (2008). The play is Al-Hakim’s rendition of a rural tragedy. Alwan, the son returning from the metropolis, remains caught up in a centuries’ long tribal blood feud. Urged on avenging his father’s murder, and failing to do so, Alwan dampens his mother’s thirst for blood with his own. This paper looks at the play with reference to K. M. Clarke’s merging of the affective theory with the fabric of justice. In this way, the portrayal of both tribal and new formations of systemic justice rising in Nasser’s Egypt will be explored within the play. Furthermore, this research investigates the role past traces and remnants of encounters with justice play in the structuring of justice within the rural scape of modern Egypt. The paper explores and dismantles various binaries presented in the text: tribal and modern, justice and vengeance, and shame and honour. It analyzes the ways in which emotional expressions and affects are articulated and institutionalized by the characters. In addition, the possibility of new imaginaries and cartographies of justice will be explored in order to reframe the debate around the binary of tribal and modern judicialization of violence.

OBJECTIVE: This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women. METHODS: In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543 women who had birth during 2016–17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief. RESULTS: Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4–1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3–1.5); cannabis (AOR: 1.9, 95% CI: 1.5–2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2–2.4), prescription opioids (AOR:1.4, 95% CI: 1.02–1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1–3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results. CONCLUSIONS: Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.

PurposeThis study explores the service quality dimensions in Internet banking and their impact on e-customer’s satisfaction and e-customer’s loyalty. This study tries to inspect the structural association between Internet banking service quality, electronic customer satisfaction and electronic customer loyalty based on separate constructs.Design/methodology/approachIn this present research, quantitative approach is applied. The data is gathered from 500 bank clients in Pakistan by using structured questionnaires, and the theoretical model is tested by partial least square structured equation modeling (PLS-SEM). Moreover, convergent validity and discriminant validity were assessed.FindingsResults show that all the dimensions are found to have a positive and significant influence on customer satisfaction while customer’s satisfaction has a significant and positive impact on customer’s loyalty. Findings indicate that service quality plays a very important role in every society, as it has become the basis for how customers interpret online banking and, in the end, how it interacts and operates with online services.Practical implicationsThis research adds up considerably to the literature of bank marketing, and it is also fruitful for the academicians since it demonstrates the way Internet banking service quality determinants predict e-satisfaction of clients which ultimately raises the e-loyalty of clients. This study is useful for those E-retailers and managers who want to grab e-retailing market.Originality/valueThis research suggests a model which ultimately enhances customer loyalty towards Internet banking service quality through customer satisfaction in Pakistan. It involves modified model of E-SERVQUAL (user friendliness, efficiency of websites, personal need, and site organization) which connects it to electronic customer satisfaction and electronic customer loyalty. Therefore, it will assist the Internet banking sector in building effective marketing tactics, establishing long lasting relationships with clients and acquiring the competitive edge in the market.

Cryptococcus neoformans is an opportunistic pathogen, mainly responsible for meningitis in immunodeficient individuals. We report a rare case of dessiminated cryptococcosis in a six years old boy, patient was being evaluated for lymphoma. In the present case the causative agent was Cryptococcus neoformans. It was diagnosed through Bactec, aerobic blood culture bottle. The cause of hospitalization of the patient was fever with abdominal pain. Blood and CSF culture revealed the presence of Cryptococcus neoformans which was further confirmed by urease test and corn meal tween agar (CMT). In the present case fungus was unusually isolated earlier from blood culture rather than cerebrospinal fluid. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5784 How to cite this:Khursheed N, Umer A, Adnan F. Disseminated cryptococcal infection in a lymphoma suspected patient. Pak J Med Sci. 2022;38(2):430-432. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5784 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Rural people with Multiple Sclerosis (PwMS) face distinctive challenges in the COVID-19 pandemic. The purpose of this study was to determine the COVID-19 vaccine intent and factors associated with vaccine hesitancy among Appalachian adults with MS. Method: We conducted a cross sectional phone and in-person survey of PwMS in a large academic center in West Virginia (WV) from February to May 2021. The study sample consists of 306 adult participants. Results: Among the 306 participants, 104 (33.99%) indicated vaccine hesitancy. Statistically significant factors (p

Background There is a growing concern regarding the increasing prevalence of common non-cancer chronic pain conditions (NCPCs) and their possible association with Alzheimer’s disease and related dementias (ADRD). However, large population-based studies are limited, especially in Appalachian and other predominantly rural, underserved populations who suffer elevated prevalence of both NCPCs and known ADRD risk factors. Objectives We investigated the relation of NCPC to risk of incident ADRD in older Appalachian Medicare beneficiaries and explored the potential mediating effects of mood and sleep disorders. Methods Using a retrospective cohort design, we assessed the overall and cumulative association of common diagnosed NCPCs at baseline to incident ADRD in 161,573 elders ≥65 years, Medicare fee-for-service enrollees, 2013–2015. NCPCs and ADRD were ascertained using claims data. Additional competing risk for death analyses accounted for potential survival bias. Main Findings Presence of any NCPC at baseline was associated with significantly increased odds for incident ADRD after adjustment for covariates [adjusted odds ratio (AOR) = 1.26 (1.20, 1.32), p < .0001]. The magnitude and strength of this association increased significantly with rising burden of NCPCs at baseline [AOR for ≥4 vs. no NCPC = 1.65 (1.34, 2.03), p-trend = .01]. The addition of depression and anxiety, but not sleep disorders, modestly attenuated these associations [AORs for any NCPC and ≥4 NCPCs, respectively = 1.16 (1.10, 1.22) and 1.39 (1.13, 1.71)], suggesting a partial mediating role of mood impairment. Sensitivity analyses, multinomial logistic regressions accounting for risk of death, yielded comparable findings. Conclusion In this large cohort of older Appalachian Medicare beneficiaries, baseline NCPCs showed a strong, positive, dose–response relationship to odds for incident ADRD; this association appeared partially mediated by depression and anxiety. Further longitudinal research in this and other high-risk, rural populations are needed to evaluate the causal relation between NCPC and ADRD.

Chronic Kidney Disease (CKD) affects approximately 10% of the general population. CKD itself is a risk factor for cardiovascular mortality and morbidity. Large epidemiological studies have clearly established a clear relationship between severity of CKD and cardiovascular event rates. Sudden cardiac death accounts for approximately 40% mortality in dialysis patients and it is usually secondary to an underlying cardiomyopathy, with left ventricular hypertrophy mostly evident on echocardiography. Several risk factors play an important role in pathogenesis of uremic cardiomyopathy including vitamin D deficiency, secondary hyperparathyroidism, phosphate retention, increased FGF23 and decreased Klotho levels. The mortality due to cardiovascular events in early stage CKD is relatively higher in comparison to progression to ESRD, so early diagnosis and treatment with dialysis should be focused.

The reported associations between birth weight and childhood cardiovascular disease (CVD) risk factors have been inconsistent. In this study, we investigated the relationship between birth weight and CVD risk factors at 11 years of age. This study used longitudinally linked data from three cross-sectional datasets (N= 22,136) in West Virginia; analysis was restricted to children born full-term (N= 19,583). The outcome variables included resting blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and lipid profile [total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL, and triglycerides (TG)]. Multiple regression analyses were performed, adjusting for child’s body mass index (BMI), sociodemographics, and lifestyle characteristics. Unadjusted analyses showed a statistically significant association between birth weight and SBP, DBP, HDL, and TG. When adjusted for the child’s BMI, the association between birth weight and HDL [b= 0.14 (95% CI: 0.11, 0.18) mg/dl per 1000 g increase] and between birth weight and TG [b= –0.007 (–0.008, –0.005) mg/dl per 1000 g increase] remained statistically significant. In the fully adjusted model, low birth weight was associated with higher LDL, non-HDL, and TGs, and lower HDL levels. The child’s current BMI at 11 years of age partially (for HDL, non-HDL, and TG) and fully mediated (for SBP and DBP) the relationship between birth weight and select CVD risk factors. While effects were modest, these risk factors may persist and amplify with age, leading to potentially unfavorable consequences in later adulthood.

INTRODUCTION: The immediate benefits of breastfeeding are well-established but the long-term health benefits are less well-known. West Virginia (WV) has a higher prevalence of cardiovascular disease (CVD) and lower breastfeeding rates compared to national averages. There is a paucity of research examining the relationship between breastfeeding and subsequent childhood CVD risk factors, an issue of particular relevance in WV. METHODS: This study used longitudinally linked data from three cross-sectional datasets in WV (N = 11,980). The information on breastfeeding was obtained retrospectively via parental recall when the child was in the fifth grade. The outcome variables included blood pressure measures [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), non-HDL, and triglycerides (TG)]. Multiple regression analyses were performed, adjusting for childhood body mass index (BMI) and additional covariates. RESULTS: Only 43% of mothers selfreported ever breastfeeding. The unadjusted analysis showed that children who were ever vs. never breastfed had significantly lower SBP (b = − 1.39 mmHg; 95% CI − 1.97, − 0.81), DBP (b = − 0.79 mmHg; 95% CI − 1.26, − 0.33), log-TG (b = − 0.08; 95% CI − 0.1, − 0.05), and higher HDL (b = 0.95 mg/dL; 95% CI 0.33, 1.56). After adjustment for the child’s BMI, socio-demographic and lifestyle factors, log-TG remained significantly associated with breastfeeding (b = − 0.04; 95% CI − 0.06, − 0.01; p = 0.01). CONCLUSION: The observed protective effect of any breastfeeding on childhood TG level was small but significant. This finding provides some support for a protective effect of breastfeeding on later CVD risk.

ObjectiveTo determine whether increased patient interaction, exposure to the neurologic examination, and access to positive neurology mentors increase interest in neurology for first-year medical students.MethodsNeuro Day was a 2-part experience for first-year medical students. The first part consisted of a flipped classroom to teach the standard neurologic examination. The second part involved patient encounters modeled off of the traditional patient rounds. Students rotated from room to room, listening to patients' experiences with different neurologic diseases and eliciting pathologic neurologic examinations. Students were surveyed before and after Neuro Day.ResultsThe result of the binomial test indicated that the proportion of medical students interested in neurology significantly increased from 78% to 85% (95% confidence interval [CI] 0.79–0.92; p = 0.034) after participating in Neuro Day. The proportion of students' knowledge of clinical neurology increased from 45% to 63.1% (95% CI 0.54–0.72; p < 0.0001), comfort with performing a neurologic examination increased from 30% to 78.4% (95% CI 0.70–0.86; p < 0.0001), and fear of studying neurology decreased from 46% to 26% (95% CI 0.17–0.34; p < 0.0001) following Neuro Day. One hundred percent of students indicated that they would recommend Neuro Day to their peers.ConclusionNeuro Day is a feasible and effective model to incorporate into medical education. There was increased interest in and decreased fear of neurology. We anticipate that this paradigm can be used in the future to encourage students to consider a career in neurology.

BACKGROUND: Most studies examining the relationship between neonatal abstinence syndrome (NAS) and health insurance status in the United States (USA) have used administrative insurance claims data, which is subject to myriad limitations. We examined the association between NAS and health insurance status in a large geographically defined rural population in the United States, using non–claims data. METHODS: We utilized data from a population-based cohort of all newborns born in 2017–2019 in the rural state of West Virginia (WV) and restricted analyses to WV residents’ births (n = 46 213). NAS was defined as neonatal withdrawal from many substances, including opiates and not limited to those cases that require pharmacological treatment. RESULTS: Medicaid covered more than half (52.6%) of all infants’ births in the state of WV. The incidence of NAS was 85.8 and 12.7 per 1000 livebirths in the Medicaid and privately insured groups, respectively. Among all infants diagnosed with NAS, 86.1% were enrolled in the state’s Medicaid programme. The risk of NAS in the Medicaid-insured newborns was higher than privately insured newborns in the unadjusted analysis (risk ratio (RR) 6.76, 95% confidence interval (CI) 5.95, 7.68) and the adjusted analysis (RR 3.00, 95% CI 2.01, 4.49); adjusted risk difference 20.3 (95% CI 17.5, 23.1 cases per 1000 livebirths). CONCLUSIONS: NAS is an important indicator of the immediate effect of the opioid crisis. This study shows the disparity in NAS by health insurance status for a large rural population in the United States, and its burden on the state’s Medicaid programme. Providing timely and accurate estimates of NAS is important for public health policies and decision making.

Introduction: Research on cardiovascular health (CVH) and risk factors among immigrants has been well-documented. Less is known about social influences on CVH, among black immigrants. Despite having the largest population of black immigrants in the U.S., Afro-Caribbean (AC) immigrants have been underrepresented in health research. We examined the social determinants of CVH among AC immigrants (Guyanese, Haitian and Jamaican) in New York City (NYC). Hypothesis: We hypothesized that social determinants of CVH will vary among the three ethnic sub-groups of AC immigrants. Methods: We included 1691 AC immigrants who reported their race as non-Hispanic Black and country of birth (COB) as Guyana (n= 369), Haiti (n= 291) or Jamaica (n= 1031) in the 2010-2014 administrations of the New York City Community Health Survey. Logistic regression analysis was performed to assess the association between social determinants and CVH (ideal vs intermediate/poor) using AHA’s CVH metrics. Results: The majority of the sample was female (59.2%) and reported high school education or less (53.9%). Most AC immigrants reported to have ideal CVH (71.3%). Education was significantly associated with CVH only among Jamaican immigrants. Jamaican immigrants with ≤ high school education were more likely to have intermediate/poor CVH compared to those with ≥ some college education. Conclusions: These findings suggest that social determinants influencing CVH differ among AC immigrant sub-groups in NYC. These findings suggest that social determinants influencing CVH differ among AC immigrant sub-groups in NYC. National surveillance efforts should obtain more complete data on country of origin and oversample racial/ethnic minority groups in order to better understand their CVH outcomes. Future research should examine other social factors that may influence CVH among black immigrants.