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Chronic Disease or Injury

Description

Mirroring public health response to infectious disease outbreaks, many public health departments are taking an outbreak management approach to respond to drug overdose surges 1-3. The Marion County Public Health Department (MCPHD) has developed an overdose response plan (ORP) integrating drug overdose surveillance and community stakeholder response strategies. Effective drug overdose surveillance requires accurate and reliable data streams. This work assessed data sources utilized for county overdose surveillance and provided recommendations to improve overdose surveillance.

Objective: To assess the data sources used to monitor overdose events in Marion County and improve community overdose surveillance.

Submitted by elamb on
Description

The number of overdose deaths involving illicit opioids such as heroin and illicitly-manufactured fentanyl (IMF) is now higher than deaths involving prescription opioids. Adolescents misusing prescription opioids are more likely to use heroin. Although nonmedical use of prescription opioids (NUPO) among adolescents is decreasing, there is still relatively high prevalence of this behavior. Such high prevalence, along with the evolving epidemiology of the drug overdose epidemic as well as the association between NUPO and heroin use, signal that NUPO in adolescents is still an important issue. Understanding the interrelationships between NUPO and illicit opioid use in adolescents can inform prevention efforts. The purpose of this study is to: 1) present the magnitude of the drug overdose problem in adolescents, 2) compare the prevalence of heroin use and injection drug use (IDU) between students reporting NUPO and those not reporting NUPO, and 3) determine whether a dose-response relationship exists between these behaviors among adolescents. This information will be beneficial when focusing on adolescents at risk for heroin use by helping to determine whether any NUPO is associated with heroin use or if such risk is only noted at a higher frequency of NUPO behavior.

Objective: Given the evolving opioid overdose epidemic, we examined the interrelationships between nonmedical use of prescription opioids and illicit opioid use in adolescents.

Submitted by elamb on
Description

Clark County, Indiana is geographically located in between the urban area of Louisville, Kentucky and Scott County, Indiana. Scott County is the site for the largest HIV outbreak in the history of the United States, directly related to high rates of IV drug abuse. The unique geographic location of Clark County in combination with the recent HIV and Hepatitis C outbreaks in Clark and neighboring counties has greatly informed the development of an effective response to overdoses and the opioid epidemic in general. Furthermore, Clark County has a unique population distribution, with a population of over 125,000 and a land area of over 300 square miles. Despite this large area, over 80% of the population lives within 9 miles of the southern border of the county. This leads to a mix of both urban and rural challenges. There are several areas of the county that have greater than 15 minute emergency response times, which is often the difference between life and death in an overdose situation. These factors led to the development of the Clark County Rapid Response Project. The rapid response project is a community-based, multidisciplinary framework to address the opioid addicted patient, from initial use to successful recovery. The project uses data driven technology to initiate the care of opiate overdose patients and administer lifesaving interventions.

Objective: To use novel technologies to develop a rapid response framework to reach opioid overdose patients in an area which is challenging from both a geography and population distribution standpoint.

Submitted by elamb on
Description

In North Carolina there has been an escalation of poisoning deaths. In 2011, the number of fatal poisonings was 1,368 deaths, with 91% classified as drug overdoses with the majority of those due to opioid analgesics.[1] Far greater numbers of drug overdoses result in hospitalization, emergency department (ED) or outpatient clinic visits, or resolve without the individual seeking medical attention. Although public health authorities have long employed death data for drug overdose surveillance in NC, little attention has been paid to the use of ED data for this purpose. Through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC collects information on 99.5% of all acute-care ED visits across the state, primarily for syndromic surveillance purposes. Despite the timeliness and completeness of this data system, drug overdose surveillance is a challenge due to lack of a standardized definition for the positive identification of opioid overdoses. In this study we used NC DETECT ED data to describe visits due to drug, and more specifically, opioid overdoses. Objective: To describe the epidemiologic characteristics for emergency department visits due to drug overdoses in North Carolina.

Submitted by elamb on
Description

In Reunion Island, alcohol is the most experienced psychoactive substance [1]. Alcohol consumption is characterized by a massive ingestion of hard liquor and an early experimentation. Health consequences are significant: a high annual incidence of fetal alcohol syndromes [2] and a higher premature mortality than in France mainland [1]. Reunion island is one the French regions most affected by addictive behaviors related to alcohol. However, existing data are insufficient concerning the current health impact and associated factors.

Objective

Describe the emergency departments' visits for alcohol intoxication (AI) in Reunion Island and factors associated with their variations.

Submitted by elamb on
Description

Syndromic surveillance is usually presented as relevant for event detection. As the data collected automatically from data sources is detailed enough (e.g. ICD10 codes), it may contribute to assess and quantify the burden of health events and describe their main epidemiological features. In France, besides the national liver transplant data, no surveillance data are available for ALF. Since ALF is severe, threatens the vital prognosis in absence of intensive care, may require liver transplantation and is quite well characterized clinically, patients are very likely to be diagnosed with ALF in ED at the onset phase. ALF is caused by viral infections (hepatitis A, B, C, D or E viruses), drug or toxic exposures, autoimmune or metabolic disorders (Wilson's disease), some of which have public health implications (viral hepatitis, drug or toxicological adverse effects). We therefore hypothesized that surveillance of ALF through an ED syndromic surveillance system would be feasible. The aim of our work was to explore the relevance of ED data to describe the main features and assess the burden of ALF.

Objective

The objective of this study was to assess the interest and feasibility of using syndromic surveillance data from emergency departments (ED) for the description of clinical and epidemiological characteristics of patients with acute liver failure (ALF) during the 2010-2012 period in France.

Submitted by elamb on
Description

Many studies have shown relationships between race/ethnicity and some birth defects. For example, white teenagers have higher rates of gastroschisis than African-American teenagers 1 , and transposition of great arteries is more prevalent in white than non-white children 2 .The Louisiana Birth Defects Monitoring Network (LBDMN) is a population-based surveillance system created in 2005. LBDMN actively collects information from multiple sources to track babies born with birth defects up to three years old in the state. Racial disparity in birth defects has never been evaluated using birth defects surveillance data in Louisiana. Findings from this study are expected to help LBDMN and Louisiana Children and Youth with Special Health Needs Program better understand variations in the prevalence of some birth defects among certain racial/ethnic groups in the state.

Objective

This study aimed to evaluate relationships between race/ethnicity and selected major birth defects using 2006-2008 Louisiana birth defects surveillance data.

Submitted by elamb on
Description

The nature of Emergency Room services makes the patients' visits hard to predict and control and the services incur high costs. Chronic patients should not require urgent care to treat their chronic illness, if they were properly managed in primary care. We track frequency of emergency room visits by chronically ill when the primary complaint of record is their chronic condition. We use a record of institutional insurance claims collected in over 400 hospitals in California between 2006 and 2010. We identify dimensions of data that provide statistically significant differences of utilization between strata. We found particularly significant differences in resource utilization subject to type of insurance coverage carried by the patient, and subject to patient's age. We studied Diabetes, Asthma, and Arthritis patients from 8 age groups spanning ages 5 to 85, and 13 insurance payer types.

Objective

To study patterns of utilization of emergency care resources by chronically ill in order to identify efficiency and quality of care improvement opportunities.

Submitted by elamb on
Description

In May of 2001, Boston released a strategic transportation plan to improve bicycle access and safety. [1] According to the Boston Transportation Department, ridership has increased 122% between 2007 and 2009. [2] A collaborative public health and public safety task force was initiated in 2010 to foster a safe and healthy bicycling environment.

Objective

To quantify the injury burden and identify possible risk factors using bicycle related injury (BRI) visits at Boston emergency departments (ED).

Submitted by elamb on
Description

Although heat illness is preventable, it is a leading cause of death among U.S. high school and college athletes (1). Despite this, the total burden of heat illness during sports and recreation is unknown. With over 250 million U.S. residents reporting occasional participation in sports or recreational activities (2), there is a large population at risk.

Objective

To examine the incidence and characteristics of heat illness during sports and recreation.

Submitted by elamb on