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Introduction: Alcohol-related mortality is increasing nationally, but state-specific trends still need to be explored. This paper reviews the patterning of alcohol-related deaths among Wisconsin residents in the 2 decades prior to the COVID-19 pandemic., Methods: Data are from death certificates for state residents from 2000 through 2019. We used underlying cause of death codes (ICD-10) to classify deaths as 100% attributable to alcohol (ie, acute, chronic liver, and other chronic). Demographic characteristics were available for the most recent decedents (2015-2019). We assess trends in alcohol-related mortality and used chi-square tests to assess demographic differences compared to deaths from all other causes., Results: The number of alcohol-related deaths more than doubled from 2000 through 2019 in Wisconsin, rising from 394 in 2000 to 857 in 2019. In the 5 most recent years (2015-2019), the populations with significantly higher rates of alcohol-related deaths included men, middle-aged adults, Black residents, and those of Hispanic descent. Education level also was significantly related to alcohol-attributable mortality, as those with the highest and lowest education levels were the least likely to die from this cause., Discussion/conclusions: Results of these analyses show that the number of deaths due to alcohol-related diseases has risen significantly since 2000, and this trend preceded the COVID-19 pandemic. These rising mortality rates deserve the attention of the medical and public health communities. Our findings show that, in recent years, Hispanic individuals, men, and middle-aged adults are at a higher risk for alcohol-related deaths. Stakeholders may wish to consider interventions targeted to these groups., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Background: The COVID-19 pandemic has forced many practices to completely change the interface between health care providers and patients. Patients presenting with facial trauma present a special risk for COVID-19 transmission, as contact with respiratory and ocular secretions is common, and so special precautions must be taken in managing them., Methods: We created guidelines and a triage/management algorithm for patients presenting with facial trauma to decrease the risk of COVID-19 transmission., Conclusions: In this paper, we present a set of guidelines and a triage algorithm we have successfully implemented to mitigate the spread of COVID-19 while managing facial trauma. We believe that these guidelines can help other providers restructure their practices during this pandemic., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Background: Wisconsin's health ranking dropped from 7th healthiest in 1990 to 23rd in 2018. The purpose of this paper is to identify the contributory factors to this decline., Methods: Trends in Wisconsin's health rank for 1990 to 2018 were compared overall and for only identical measures used in both years., Results: Of the identical measures used in both years (n=10), the median rank declined from 8.5 (range 6-21) in 1990 to 19 (range 9-43) in 2018, with the greatest declines for infectious diseases, infant mortality, and smoking. The ranks were lower in 2018 for the similar measures used and for measures used only in 2018 compared to measures used only in 1990., Discussion: Wisconsin's drop in health ranking is real and calls for action to address the root causes., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: The coronavirus pandemic has placed enormous stresses on health care systems across the United States and internationally. Predictive modeling has been an important tool for projecting utilization rates and surge planning. As the initial outbreak begins to slow, questions are being raised regarding long-term coronavirus mitigation plans. This paper examines the current status of the coronavirus outbreak in Milwaukee County, Wisconsin, and simulates several scenarios where physical distancing measures are removed., Methods: The outbreak's doubling time, reproductive numbers at several points, and incidence curve were calculated to assess outbreak progression. Compartmental models were used to estimate the number of hospitalizations and critically ill patients in Milwaukee County if distancing policies were removed., Results: The compartmental models predict a substantial spike in cases and overwhelming medical resource utilization with an abrupt end to social distancing. Partial reduction in social distancing policies would likely result in a smaller spike, with less severe strain on available medical resources., Conclusions: Milwaukee County remains very susceptible to a resurgence of COVID-19 cases. Removing physical distancing policies poses significant risks with regard to resource management., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: Emergency departments have seen increasing numbers of patients presenting with acute mental illness. Currently, there is not a standard for assessing the medical stability of these patients prior to transfer to inpatient psychiatric services, which causes unnecessary delays in patient care., Objective: Provide a literature review and multidisciplinary expert consensus recommendations to simplify and expedite the medical evaluation of patients requiring admission to inpatient psychiatric facilities., Methods: A task force with representation from emergency physicians (Wisconsin Chapter of the American College of Emergency Physicians) and psychiatrists (Wisconsin Psychiatric Association) met to create this position statement. The members reviewed clinical practice guidelines and primary literature sources to develop evidence-based recommendations., Results: Five categories of recommendations were developed: (1) A detailed history and physical exam should constitute the minimum necessary information required for most medical assessments. (2) Clinical information should guide further diagnostic testing; therefore, receiving facility blanket requirements for routine testing should be abandoned. (3) Emergency physicians should understand the limited medical capabilities of institutes of mental disease. Obtaining reasonable diagnostic testing that is not available at these facilities may be appropriate, though this should not delay patient transfer. (4) Structured medical evaluation algorithms should be used to enhance the uniformity of medical assessments for these patients. This task force recommends the Wisconsin SMART Form. (5) Emergency physicians and psychiatrists should communicate more regularly without intermediaries, both at the clinical encounter and beyond., Conclusion: The recommendations in this paper are endorsed by the Wisconsin Chapter of the American College of Emergency Physicians and the Wisconsin Psychiatric Association, which strongly urge affected medical providers to adopt them into routine practice., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: Milwaukee, a city characterized by high rates of racial segregation and a growing immigrant population, has large race-based breast cancer survival disparities. To address these disparities, breast health education workshops were offered through a community-academic partnership (CAP) to women from various ethnic backgrounds. This paper explores attendance, satisfaction, and rates of screening mammography among workshop attendees., Methods: Partnerships were formed with community-based organizations, a mobile mammography unit, and the Wisconsin Well Woman Program, a state-supported program providing free mammograms. Multilingual staff provided monthly breast health education workshops at community settings and coordinated transportation. Participants completed surveys that included demographics, prior screening history, barriers to screening, and program evaluation. Descriptive statistics were used to summarize and analyze data., Results: Over a 24-month period, 493 women-most of whom sought services at partnering organizations that serve primarily immigrants, refugees, and racial minorities-attended breast health workshops, with 374 participants completing surveys (mean age = 45 years). A total of 360 were ≥ 40 years old. Among these women, 188 (113 insured [60%], 75 uninsured [40%]) reported no prior mammogram in the past 2 to 5 years. After attending the workshop, mammogram uptake was 100% among the insured and 80% among the uninsured. Satisfaction with the workshops was high; 73% of attendees rated them highly informative., Conclusions: Our CAP offered culturally tailored breast health education and access to screening via a mobile unit that was well attended, highly rated, and increased screening mammography., (Copyright© Wisconsin Medical Society.)

Background: Adequate physical activity and cardiorespiratory fitness aid in the prevention of type 2 diabetes mellitus and obesity. Large sociodemographic/economic disparities exist for these conditions, which develop over time beginning in childhood. This paper examines disparities in both activity and fitness levels among children and adolescents in Wisconsin., Methods: The Wisconsin Partnership for Childhood Fitness collected cardiorespiratory fitness and physical activity data on 3,798 6th grade students in 37 schools in fall 2011. Fitness data were collected via testing in physical education classes. Activity data were collected via self-report, 1-day activity logs administered during school. Using hierarchical linear models, disparities in fitness and physical activity by race/ethnicity and school-level characteristics were investigated., Results: Widespread race and ethnic disparities exist in aerobic fitness, as well as more limited disparities in physical activity levels. In addition, students from schools with higher overall socioeconomic status (SES) were more active and had higher fitness levels than those from schools with overall lower SES levels., Conclusions: Among Wisconsin adolescents, race/ethnicity and school-level SES contribute to significant differences in both fitness and physical activity levels. Modifiable elements of the school environment to increase physical activity, and potentially fitness, may provide opportunities to reduce health disparities among children, contributing to improved long-term health outcomes among Wisconsin adults.

Background: Cancer health disparities by race, ethnicity, socioeconomic status, and geography are a top public health priority. Breast and colorectal cancer, in particular, have been shown to exhibit significant disparities and contribute a large proportion of morbidity and mortality from cancer. In addition, breast and colorectal cancer offer targets for prevention and control, including nutrition, physical activity, screening, and effective treatments to prolong and enhance the quality of survival. However, despite the investment of significant time and resources over many years, breast and colorectal cancer disparities persist, and in some cases, may be growing., Methods: This paper examines breast and colorectal cancer survival disparities in an 8-county region in southeastern Wisconsin, including the City of Milwaukee. Cox proportional hazards models were used to examine survival trends, and a new adaptation of adaptive spatial filtering--a disease mapping method--was used to examine spatial patterns of survival., Results: Disparities by race and ethnicity are revealed, and spatial analyses identify specific areas within the study region that have lower than expected survival rates., Conclusions: Cancer control efforts in southeastern Wisconsin should focus on black/African American and Hispanic/Latina women to reduce breast cancer survival disparities, and black/African American populations to reduce colorectal cancer disparities. Evidence indicates that targeted interventions may be needed to serve populations in the Milwaukee and Kenosha metropolitan areas, as well as areas of Walworth, Ozaukee, and Waukesha counties.

Background: Safe hospital discharges have become a major focus in the national discussion on transitions of care and care coordination. Education on the hospital discharge process is evolving as the needs of trainees are better understood., Purpose: This study is a cross-sectional survey of residents in a Midwestern residency program about their confidence in safely discharging patients from the hospital, including how they have or have not learned to do so., Methods: An anonymous paper questionnaire was distributed to a convenience sample of interns and residents at a weekly meeting of the residency program., Results: Most residents reported a general confidence in their abilities to safely discharge patients from the hospital; however, further probing revealed that their confidence breaks down when required to competently perform specific tasks of the discharge process such as activity restrictions or facilitation of home care. More than 50% of house staff surveyed responded that their education in many specific aspects of the discharge process are lacking., Conclusion: Interdisciplinary care education, and the discharge summary in particular, warrant further scrutiny as a care transition tool and means of teaching safe hospital discharge to trainees. We present a questionnaire that may serve useful as an anonymous tool to gauge residents' educational needs.