Benefits of Understanding Systemic Racism in Forming Clinician-Patient Relationships to Reduce Black Infant Mortality

Background: The United States lags far behind other developed nations in our overall infant mortality rate. Public health researcher Arline Geronimus has described a "weathering" effect of chronic racial stress among Black women that contributes to high rates of preterm birth, the leading cause of infant death. Trusting relationships between clinicians and patients may play a role in reducing infant mortality for Black mothers. Based on a social-ecological model of health care communication around infant mortality, we focus here on doctor-patient communication and correlations between clinicians' understandings of systemic racism and their communication with Black pregnant patients.Methods: This paper reports the findings from interviews with 5 maternal health clinicians (prior to recruitment being temporarily paused due to COVID-19) practicing at Cuyahoga County hospitals that serve large populations of Black women. Qualitative coding methods based in grounded theory were used to draw out themes from interview transcripts.Results: Doctor-patient communication was an emergent theme in these interviews. Results suggest an association between clinicians' understanding of the impact of systemic racism and their ability to communicate successfully and form positive bonds with pregnant mothers who are at higher risk of infant mortality.Conclusion: Acknowledging systemic racism as the cause of poor social determinants of health, which in turn contribute to higher rates of infant mortality, may provide clinicians a pathway to more positive communication and higher levels of trust with their patients, which in turn may play a role in reducing infant mortality in the Black community. Further research should investigate these associations.

The H in WASH: a reflection on the contribution, style and legacy of Professor Val Curtis

In this paper we reflect on the contribution, style and legacy of Professor Val Curtis, an important, and sometimes controversial, figure in the water, sanitation and hygiene (WASH) sector who sadly passed away on October 19, 2020. Across numerous scientific articles, and several books, and operational programmes, she established herself as a world-renowned scientific expert in the field of hygiene and behaviour change, as well as a major thought-leader in the WASH sector. We identify four major scientific contributions which she made over three decades of research that spanned multiple fields, including engineering, epidemiology, and psychology. Beyond her research, she tirelessly championed hygiene as a public health priority, using her talents as a communicator to secure concrete changes in relevant policy and practice. We are confident that her example, as both a public health researcher, and as a hygiene champion, will inspire future generations of WASH researchers and practitioners to be bold and ambitious.

Privacy, security, and the public health researcher in the era of electronic health record research

Health data derived from electronic health records are increasingly utilized in large-scale population health analyses. Going hand in hand with this increase in data is an increasing number of data breaches. Ensuring privacy and security of these data is a shared responsibility between the public health researcher, collaborators, and their institutions. In this article, we review the requirements of data privacy and security and discuss epidemiologic implications of emerging technologies from the computer science community that can be used for health data. In order to ensure that our needs as researchers are captured in these technologies, we must engage in the dialogue surrounding the development of these tools.

Abstract P147: Sexual Problems Experienced by Women After an MI

Objective: Describe sexual problems experienced by female patients following an MI to inform best practices for prevention and treatment. Methods: Women in the U.S. TRIUMPH MI registry who reported being sexually active before and 12 months after their MI were randomly selected. In-depth telephone interviews 18-24 months post-MI were conducted until thematic saturation occurred. Transcripts were coded and content analyzed by a multidisciplinary team including a nurse, psychologist, public health researcher, anthropologist, and gynecologist. Findings: Mean age was 58 years (range 43 to 75). Most subjects (13/17) said sexual activity was important before and after the MI. Although frequency of sexual activity was generally lower, the majority had resumed sexual activity by 6 months post-MI. Three women had resumed sexual activity within 3 weeks of the MI. Common, bothersome sexual problems after MI included: 1) low desire and arousal: “Since I had my heart attack the desire is not there anymore, not like it was. And I don't get the same feeling that I used to get from it.”, 2) vaginal dryness: “It's so bad. But I don't know what to do with that.” and 3) fear or worry that sex will trigger another MI: “My first experience, I was trying so hard, I had a real heart palpitation. You know, real strong and my heart beat real fast and it scared me.” Patients described their own and their partner's fear about sex as a hindrance: “I had to convince my husband that I wasn't going to die in bed.” Women indicated that physician-initiated attention to sexual concerns following an MI is lacking. Some attributed their sexual problems to medications that were initiated after the MI. Despite sexual problems experienced by MI patients and their partners, several women reported pleasure, physical closeness, normalcy, and “living life to the fullest” in the face of a life-threatening condition as motivations for continued sexual activity. Conclusions: Many women continue to be sexually active following an MI, in spite of bothersome sexual problems and worry about MI recurrence triggered by sex. Sexual activity, including fear of recurrent MI, should be addressed during post-MI care. These findings are being used to develop an intervention to improve sexual outcomes in women following MI.