Chronic Disease or Injury

Suicide is a growing public health problem in the United States. From 2001 to 2016, ED visit rates for nonfatal self-harm, a common risk factor for suicide, increased 42%. To improve public health surveillance of suicide-related problems, including SI and SA, the Data and Surveillance Task Force within the National Action Alliance for Suicide Prevention recommended the use of real-time data from hospital ED visits. The collection and use of real-time ED visit data on SI and SA could support a more targeted and timely public health response to prevent suicide. Therefore, this investigation aimed to monitor ED visits for SI or SA and to identify temporal, demographic, and geographic patterns using data from CDC's National Syndromic Surveillance Program (NSSP).

Objective: To describe epidemiological characteristics of emergency department (ED) visits related to suicidal ideation (SI) or suicidal attempt (SA) using syndromic surveillance data.

Although sexual violence is a pressing public health and safety issue, it has historically been challenging to monitor population trends with precision. Approximately 31% of incidents of sexual violence are reported to law enforcement and only 5% lead to an arrest1, making the use of law enforcement data challenging. Syndromic surveillance data from emergency departments provides an opportunity to use care-seeking to more accurately surveil sexual violence without introducing additional burdens on either patients or healthcare providers.

Objective: To describe characteristics of sexual violence emergency department visits in Washington State.

LAC experienced several days of record-breaking temperatures during the summer of 2018. Downtown Los Angeles temperatures soared to 108°F in July with an average daily maximum of 92°F. Extreme heat events such as these can pose major risks to human health. Syndromic surveillance can be a useful tool in providing near real-time surveillance of HRI. In 2014, a working group was formed within the CSTE Climate Change Subcommittee to define and analyze HRI. The workgroup's goal was to provide guidance to public health professionals in adapting and implementing an HRI syndrome surveillance query. The Acute Communicable Disease Control Program's (ACDC) Syndromic Surveillance Unit utilized CSTE's HRI query to provide surveillance during the extreme heat season in 2018 in LAC. Additional modifications to the CSTE query were evaluated for potential improvements towards characterizing HRI trends.

Objective: To analyze Los Angeles County'™s (LAC) extreme heat season in 2018 and evaluate the Council of State and Territorial Epidemiologists' (CSTE) syndrome query for heat-related-illness (HRI) in Los Angeles County (LAC)

The National Institute for Drug Abuse Report, Common Comorbidities with Substance Use Disorders, states there are many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.(1) Prescription opioids are amongst the most commonly used drugs that lead to illicit drug use.(2)Much of the data about the starting point of the prescription opioid addiction is in the patient health history and is recorded within the provider electronic health record and administrative systems.Description: There are a variety of addiction and misuse risk screening tools available and selecting appropriate tools screening can be confusing for providers. Examples of common screening tools: Opioid Abuse Risk Screener (OARS), Opioid Risk Tool (ORT), Screener and Opioid Assessment for Patients with Pain (SOAPP), Current Opioid Misuse Measure (COMM), Diagnosis, Intractability, Risk, and Efficacy (DIRE). These opioid risk screening tools are interview based and vary in how they survey for psychosocial factors. The screening tools are useful, but are meant only to alert the provider to conduct further investigation.(3) Understanding how the comorbidities recorded in the patient's clinical interactions may help improve risk assessment investigations and ongoing monitoring programs. Studying the chronic pain patients' longitudinal clinical, operational, and laboratory records provides the basis for better study controls than those using population based on emergency department admission and mortality events.

Objective: Assessing mental health and opioid addiction comorbidities among chronic pain patients using a large longitudinal clinical, operational, and laboratory data set.

Opioid abuse has increased exponentially in recent years throughout the United States, leading to an increase in the incidence of emergency response activities, hospitalization, and mortality related to opioid overdose. As a result, states that have been hit particularly hard during this period such as Wisconsin have allocated considerable resources to addressing this crisis via enhanced public health surveillance and outreach, procurement and administration of medical countermeasures, prescription drug monitoring programs, targeted preventive and acute treatment, first responder and hospital staff training, cross-agency collaboration, and Incident Management System activities. Central to these efforts is the identification of the primary drivers of opioid overdose and death to improve the precision and efficacy of targeted public health interventions to address the opioid crisis. The present study sought to accomplish this end by syncing rich data sources at the point of emergency response (EMS ambulance runs) to ultimate mortality outcomes (vital death records).

Objective: To identify the correlates of opioids as an underlying cause of death by linking coroner/medical examiner vital death records with emergency medical service (EMS) ambulance run data. By combining death data to EMS ambulance runs, the goal was to determine characteristics of the emergency response particularly for opioid overdose events that may connect to increased mortality.

Using death certificates alone to identify contributing substances in drug overdose deaths may result in misclassification and underestimation of the burden of illicit and prescription opioids and other drugs in drug-related deaths. To enable timely and targeted prevention in Tennessee (TN), the identification and monitoring of new drugs and trends in use should utilize toxicology and medicolegal death investigation data directly, as recommended by others 1-3. These data can inform mortality outcome definitions for improved surveillance and risk factor identification 4-7. To our knowledge, this is the first analysis to use statewide linked toxicology and death certificate data in TN.

Objective: To examine specific drugs present based on postmortem toxicology for prescription opioid, heroin, and fentanyl overdoses classified based on ICD-10 coding. To compare drugs identified from postmortem toxicology with those listed on the death certificate for opioid overdoses.

Extreme heat and related illnesses are a critical concern in Arizona from May to September each year. From 2008 to 2016, Arizona medical facilities had an average of 1,790 emergency visits and 442 hospital admissions for heat-related illnesses (HRI) during the summer months. In 2016 alone, Arizona Emergency Departments (EDs) received a total of 2,484 visits for HRI and 527 of these cases were admitted as inpatients1. Pinal County, which has an estimated population of 430,237 individuals, contributes to the number of HRI visits to Arizona Emergency Departments that occur each year. In order to determine the burden of HRIs within the county, Pinal County Public Health Services District (PCPHSD) began to conduct heat-related illness surveillance in 2017 and found that 149 HRI cases had been reported that year3. PCPHSD continued to conduct HRI surveillance through summer 2018 to build on surveillance activities from 2017 and meet the following goals: 1) improve HRI case identification and assessment through enhanced HRI surveillance and interview processes, 2) determine risk factors and risk populations for HRIs in Pinal County, and 3) recommend and implement practical interventions to prevent HRIs among Pinal residents.

Objective: Determine risk factors and risk populations for heat-related illnesses in Pinal County, AZ by improving HRI case identification and assessment.

The rate of drug overdose deaths in the United States has increased steadily since 2000. Injection drug use, a practice associated with infectious disease transmission, has likely increased along with this upward trend in drug overdoses. Injection drug use surveillance is difficult to conduct at a public health department because there are no specific Internal Classification of Diseases codes to identify this risk behavior in hospital discharge or vital registration data. Maricopa County Department of Public Health Office of Epidemiology aimed to identify indications of injection drug use within data from the Office of the Medical Examiner.

Objective: To determine whether data from the Office of the Medical Examiner are useful for conducting injection drug use surveillance in Maricopa County, Arizona, and to describe the characteristics of decedents who died from a drug overdose, were investigated by the county's medical examiner, and had an indication of injection drug use.

Suicide is a leading cause of mortality in the United States, causing about 45,000 deaths annually. Research suggests that universal screening in health care settings may be beneficial for prevention, but few studies have combined detailed suicide circumstances with ED encounter data to better understand care-seeking behavior prior to death.

Objective: To identify potential emergency department (ED) visits prior to suicide deaths in North Carolina (NC) and describe pre-suicide care-seeking in EDs.

Children with special health care needs (CSHCN) are defined as: “those who have or are at increased risk for a chronic physical, developmental, behavioural, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” The care of CSHCN is a significant public health issue. These children are medically complex, require services and supports well beyond those that typically developing children require, and command a considerable proportion of the pediatric health care budget. Different tools were used to identify CSHCN. One of them is the CSHCN screener which uses a non-condition specific approach that identifies children across a range and diversity of childhood chronic conditions and special needs. It identifies children with elevated or unusual needs for health care or educational services due to a chronic health condition. It focuses on health consequences a child experiences as a result of having an ongoing health condition rather than on the presence of a specific diagnosis or type of disability. It allows a more comprehensive assessment of the performance of the health care system than is attainable by focusing on a single diagnosis. The CSHCN screener is only available in English and Spanish. In developing countries, obtaining reliable prevalence rates for CSHCN is challenging. Sophisticated datasets associated with governmental services and high quality research studies are less common due to fewer resources. Egypt has no screening or surveillance systems for identifying CSHCN.

Objective: To test the feasibility of using an Arabic version of CSHCN Screener in identifying CSHCN in the Egyptian setup and to estimate the prevalence of CSHCN among children aged 6-14 years in Alexandria, Egypt using the Arabic version of the CSHCN Screener.