An exploratory study of the prevalence and adverse associations of in-school traditional bullying and cyberbullying among adolescents in Connecticut.

Bullying, traditional or cyber, among adolescents, is a public health concern. In this study, we explored frequencies and correlates of different forms of bullying among Connecticut high-school students. Youth Risk Behavior Survey data from 2019 from Connecticut adolescents (N = 1814) were used. χ2 tests and survey-weighted logistic regressions examined relationships between bullying subgroups (in-school traditional bullying (ISTB) only, cyberbullying only, and both) and mental concerns, risk behaviors, academic performance, physical health, and receipt of social support, with the logistic regressions adjusted for demographics. The past-12-month frequency of having experienced only cyberbullying was 5.6%, only ISTB was 9.1%, and both forms was 8.7%. Between-group differences were observed by bullying status in terms of sex and race/ethnicity. In adjusted models, bullying status was associated with suicide attempts, suicidal ideation, self-harm, depression/dysphoria, mental health, use of alcohol, marijuana, injection drugs, tobacco, and e-vapor, gambling, driving under influence of alcohol, high-risk sexual behavior, physical fights, weapon-carrying, injuries/threats at school, feeling unsafe at school, dating violence, obesity, poor general health, insecure housing, less perceived family support, and poor academic performance. People experiencing both types of bullying were typically more likely to report adverse measures. High-school students commonly report bullying. The findings that both forms (traditional and cyber) were more robustly linked to negative experiences highlight the need for examining further relationships between types and patterns of bullying and mental health and functioning. Better understanding may help improve preventive anti-bullying interventions.

A 16-Year Chronicle of Developing a Healthy Workplace Participatory Program for Total Worker Health® in the Connecticut Department of Correction: The Health Improvement through Employee Control (HITEC) Program.

Health Improvement Through Employee Control (HITEC) is a 16-year program directed toward the health of corrections personnel and developed through the application of the principles of Participatory Action Research (PAR) and participatory ergonomics. Its impetus has always been the adverse health status of the corrections workforce: early mortality, depression, obesity, and hypertension. The HITEC program trained small "Design Teams" (DTs) of front-line personnel in participatory methods for intervention design for health improvement and organizational change in line with the Total Worker Health® principles. Periodic surveys and physical testing were introduced for longitudinal assessments. Comparative interventions at comparable sites included DTs without a priori assignation, problem-focused kaizen effectiveness teams (KETs), and bargaining unit-centered DTs. DT resilience and the replacement of members who transferred facilities or retired was aided by novel cooperative administrative structures. DT-generated interventions included stress lounges, changes in critical event report writing, a joint program with trained inmates to improve air quality, and training in staff mental health and sleep behavior. A specialized peer-to-peer Health Mentoring Program (HMP) paired new officers with trained peers. Many interventions and program features were institutionalized, thus improving prospects for self-supporting program longevity. Participatory interventions designed and supported by the corrections workforce were found to be both feasible and exceptionally effective.

Using Data-To-Care Strategies to Optimize the HIV Care Continuum in Connecticut: Results From a Randomized Controlled Trial.

BACKGROUND: Re-engaging people with HIV who are newly out-of-care remains challenging. Data-to-care (D2C) is a potential strategy to re-engage such individuals. METHODS: A prospective randomized controlled trial compared a D2C strategy using a disease intervention specialist (DIS) vs standard of care where 23 HIV clinics in 3 counties in Connecticut could re-engage clients using existing methods. Using a data reconciliation process to confirm being newly out-of-care, 655 participants were randomized to DIS (N = 333) or standard of care (N = 322). HIV care continuum outcomes included re-engagement at 90 days, retention in care, and viral suppression by 12 months. Multivariable regression models were used to assess factors predictive of attaining HIV care continuum outcomes. RESULTS: Participants randomized to DIS were more likely to be re-engaged at 90 days (adjusted odds ratios [aOR] = 1.42, P = 0.045). Independent predictors of re-engagement at 90 days were age older than 40 years (aOR = 1.84, P = 0.012) and perinatal HIV risk category (aOR = 3.19, P = 0.030). Predictors of retention at 12 months included re-engagement at 90 days (aOR = 10.31, P < 0.001), drug injection HIV risk category (aOR = 1.83, P = 0.032), detectable HIV-1 RNA before randomization (aOR = 0.40, P = 0.003), and county (Hartford aOR = 1.74, P = 0.049; New Haven aOR = 1.80, P = 0.030). Predictors of viral suppression included re-engagement at 90 days (aOR = 2.85, P < 0.001), retention in HIV care (aOR = 7.07, P < 0.001), and detectable HIV-1 RNA prerandomization (aOR = 0.23, P < 0.001). CONCLUSIONS: A D2C strategy significantly improved re-engagement at 90 days. Early re-engagement improved downstream benefits along the HIV care continuum like retention in care and viral suppression at 12 months. Moreover, other factors predictive of care continuum outcomes can be used to improve D2C strategies.

Evaluation of landscaping and vegetation management to suppress host-seeking Ixodes scapularis (Ixodida: Ixodidae) nymphs on residential properties in Connecticut, USA.

Ticks and tick-borne diseases are of increasing concern across the United States, particularly in the Northeast. Ixodes scapularis Say (Ixodida: Ixodidae) remains the primary vector for the Lyme disease spirochete, Borrelia burgdorferi (Johnson, Schmid, Hyde, Steigerwalt, and Brenner). Prior studies established that I. scapularis can be found in greatest abundance in the 1-m forested ecotone surrounding the lawn edge in residential backyards. Our study was conducted on 42 properties in Guilford, CT, and sought to expand upon this premise by determining which key habitat features were associated with increased densities of host-seeking I. scapularis nymphs. We quantified nymphal abundances in 19 different habitat types that were posited to influence densities. We determined that nymphal I. scapularis densities were greatest in forested areas closest to lawn edges with leaf litter or understory vegetation present, as well as short lawns adjacent to woodland edges. Additionally, we determined that there were no significant declines in nymphal I. scapularis density where leaf litter was removed, lawns were left unmowed, or woodchip barriers were installed. Bird feeders and woodpiles were not associated with increased nymphal I. scapularis densities. However, areas adjacent to stone walls did have nearly 3 times the density of I. scapularis nymphs present compared with habitats without stone walls. The culmination of the results from this study can be utilized to create more targeted acaricide applications rather than broadcast spraying, as well as increase homeowner awareness for areas with heightened risk for exposure to nymphal I. scapularis, which are deemed the most epidemiologically important species and stage for pathogen transfer to humans.

Phytoplankton assemblage responses to nitrogen following COVID-19 stay-in-place orders in western Long Island Sound (New York/Connecticut).

This study evaluated water quality, nitrogen (N), and phytoplankton assemblage linkages along the western Long Island Sound (USA) shoreline (Nov. 2020-Dec. 2021) following COVID-19 stay-in-place (SIP) orders through monthly surveys and N-addition bioassays. Ammonia-N (AmN; NH3+NH4+) negatively correlated with total chlorophyll-a (chl-a) at all sites; this was significant at Alley Creek, adjacent to urban wastewater inputs, and at Calf Pasture, by the Norwalk River (Spearman rank correlation, p < 0.01 and 0.02). Diatoms were abundant throughout the study, though dinoflagellates (Heterocapsa, Prorocentrum), euglenoids/cryptophytes, and both nano- and picoplankton biomass increased during summer. In field and experimental assessments, high nitrite + nitrate (N + N) and low AmN increased diatom abundances while AmN was positively linked to cryptophyte concentrations. Likely N + N decreases with presumably minimal changes in AmN and organic N during COVID-19 SIP resulted in phytoplankton assemblage shifts (decreased diatoms, increased euglenoids/cryptophytes), highlighting the ecological impacts of N-form delivered by wastewater to urban estuaries.

Linking crash and breathalyzer data in Connecticut.

OBJECTIVES: To document the process of linking breathalyzer and motor vehicle crash (MVC) data for the State of Connecticut using a unique identifier in the place of personal and private information. METHODS: Deterministic linkage methodologies were utilized in Microsoft SQL Server to join 5,634 (of 6,650) breathalyzer records to corresponding MVC driver records for the period of January 1, 2017 to December 31, 2022. Differences between the linked and original datasets were documented by comparing the consistency of frequency and proportion distributions of key variables. RESULTS: Proportions of annual records, alcohol breath tests, and refusals were nearly unchanged when comparing linked and original breathalyzer data. When examining variables in the original MVC driver records, there were differences in the within-group proportions for sex and age, with an overrepresentation of males and drivers aged 26-to-40 years old. For crash and injury severity, the linked dataset had lower proportions of more severe injury records when compared to the original MVC data. Additionally, 1,007 breathalyzer records were not matched with an associated MVC record. CONCLUSIONS: Linkage methodology is sound and produced quality matches. The use of a unique identifier provided a strong match qualifier in the absence of personal and private data. Changes in proportions for age, sex, crash and injury severity align with previous research. Potential missed matches may be attributed to several factors outside of the linkage process, including data discrepancies and varied reporting practices. Future studies will further explore these differences and incorporate additional toxicology data as part of a continued effort to fuze crash, citation, toxicology, and public health data. The end result will be a holistic, comprehensive, and multifaceted database for transportation research and education.

Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022.

Importance: Xylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses. Objective: To gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023. Exposure: State. Main Outcomes and Measures: Yearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories). Results: A total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine's representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states. Conclusions and Relevance: In this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine's reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine's geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.

Implementing a Surveillance-Based Approach to Create a Statewide Viral Clearance Cascade for Hepatitis C Among People With HIV and HCV Coinfection in Connecticut.

OBJECTIVES: Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance-based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. METHODS: We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. RESULTS: Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P = .02). CONCLUSIONS: A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies.

Workforce Survey of Connecticut Midwives.

INTRODUCTION: Midwives in Connecticut lack resources for current, state-specific data regarding compensation, benefits, work hours, and scope of practice. The primary purpose of this study was to provide detailed information about the work and services provided by midwives in Connecticut and how they are compensated. METHODS: Certified nurse-midwives (CNMs) licensed in Connecticut were recruited for a 53-question online survey between October 2021 and February 2022. The survey included topics such as compensation, benefits, practice patterns, and precepting. RESULTS: For full-time salaried CNMs in Connecticut, compensation was higher than the national average for midwives. A majority of CNMs in the state work 40 hours per week or less in physician-owned private practices and are preceptors. DISCUSSION: For midwives planning to negotiate contracts in Connecticut, this report provides important information to ensure fair compensation and work hours. The survey also serves as a roadmap for midwives in other states who wish to collect and disseminate similar workforce data.

Human Papillomavirus Vaccination Status and Correlates Among Mid-Adult Women: Connecticut, USA, 2016-2019.

Background: In 2019, the CDC expanded their recommendations for human papillomavirus (HPV) vaccination beyond age 26 years to include shared clinical decision-making (SCDM) among adults aged 27-45 years ("mid-adults"). The purpose of this study was to describe HPV vaccination status among mid-adult women before the implementation of SCDM for HPV vaccination. Methods: A cross-sectional survey was conducted during 2016-2019 in Connecticut, United States, and enrolled women born in 1981 or later (birth cohorts eligible for HPV vaccination). This analysis was restricted to participants aged 27 years and older at the time of the survey. Correlates of vaccination status, sources of vaccine information, and reasons for not receiving the vaccine were examined. Results: Among 298 participants, 64.4% had not received HPV vaccine. Other than age (younger age was associated with being vaccinated), no other demographic or behavioral correlates were associated with vaccination. Compared with unvaccinated women, vaccinated women were more likely to have heard about the HPV vaccine from a doctor (odds ratio [OR] = 3.45, 95% confidence interval [CI]: 2.00-5.88) and less likely to have heard about it from television (OR = 0.23, 95% CI: 0.13-0.41). The main reasons for not being vaccinated were "vaccine not offered" (48%) and "too old" (40%). Conclusions: A majority of mid-adult women in this study were not previously vaccinated against HPV, signaling the large opportunity for SCDM with this population. This may be facilitated by ensuring health care providers and mid-adult women know about the availability and potential benefits of HPV vaccination to inform decision making.

Suburban Population of Bobcats (Lynx rufus) in Connecticut, USA, Tested Negative for SARS-CoV-2, November 2021-February 2022.

A SARS-CoV-2 genomic and serologic survey was performed in a population of bobcats (Lynx rufus) inhabiting the state of Connecticut, USA. Wild animal populations are becoming established in densely populated cities with increased likelihood of direct or indirect contact with humans, as well as with household cats and dogs. Wild-caught bobcats (n=38) tested negative for SARS-CoV-2 genomic RNA by reverse-transcription quantitative PCR and for virus-neutralizing antibodies by ELISA, suggesting that either the species is not susceptible to SARS-CoV-2 or that the surveyed population has not yet been exposed to a source of infectious virus. However, this limited survey cannot rule out that human-to-bobcat or unknown reservoir-to-bobcat transmission of the virus occurs in nature.

Association Between Lifetime Sexual Violence and Recent Traumatic Brain Injury Among Adults: 2017 Connecticut Behavioral Risk Factor Surveillance System.

Sexual violence (SV) is a critical public health problem that is associated with numerous negative health consequences, including immediate- and long-term physical and mental health conditions and health-risk behaviors. Some of these health-risk behaviors (e.g., substance use, unsafe driving practices, poor mental health, lower impulse control, and abnormal brain circuitry) might increase the risk for sustaining a traumatic brain injury (TBI). A TBI causes neurological or neuropsychological changes and may also lead to various symptoms that affect a person's cognition, mobility, behavior, and mental health. Determining if those who have experienced SV are at increased risk of sustaining a TBI in their lifetime is critical given the high prevalence and health impacts of SV, the potential vulnerability to TBI after SV, and the known detrimental effects of TBI. This exploratory study examined data from the 2017 Connecticut behavioral risk factor surveillance system and found that lifetime SV victimization (controlling for age and sex) was associated with increased odds of reporting a recent TBI in the past 12 months (adjusted odds ratio [AOR] = 2.1; 95% confidence interval [CI] [1.03, 4.21]). Further research is needed to better understand how SV history is related to the risk of sustaining a TBI. Healthcare professionals can support patients who experience SV by providing resources to help reduce associated physical and mental health conditions and health-risk behaviors.

Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016-17.

OBJECTIVE: To determine the relative risk of death following exposure to treatments for OUD compared to no treatment. METHODS: In this retrospective cohort study we compiled and merged state agency data on accidental and undetermined opioid overdose deaths in 2017 and exposures to OUD treatment in the prior six months to determine incidence rates following exposure to different treatment modalities. These rates were compared to the estimated incidence among those exposed to no treatment to determine relative risk of death for each treatment exposure. RESULTS: Incidence rates for opioid poisoning deaths for those exposed to treatment ranged from 6.06±1.40 per 1000 persons exposed to methadone to 17.36±3.22 per 1000 persons exposed to any non-medication treatment. The estimated incidence rate for those not exposed to treatment was 9.80±0.72 per 1000 persons. With no exposure to treatment as referent, exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively; the relative risk of non-medication treatments was equal to or worse than no exposure to treatment (RR = 1.27-1.77). PRINCIPAL CONCLUSIONS: Exposure to non-MOUD treatments provided no protection against fatal opioid poisoning whereas the relative risk was reduced following exposures to MOUD treatment, even if treatment was not continued. Population level efforts to reduce opioid overdose deaths need to focus on expanding access to agonist-based MOUD treatments and are unlikely to succeed if access to non-MOUD treatments is made more available.

Transit and treatment: Aligning systems to address substance use in Connecticut.

OBJECTIVE: Test hypotheses that proximity to new transit improves substance use disorder treatment provider cost efficiency (i.e., economies of scale and scope). DATA SOURCES AND STUDY SETTING: Connecticut substance uses disorder treatment providers/programs. A 2015 rapid transit line opening with 10 stations, near some providers/programs. Providers' annual operating costs from publicly available federal tax forms (2013-2018). Annual client counts, service-type (including substance use disorder and/or mental health, among others), and location data, for 50 providers and their programs, from Department of Mental Health and Addiction Services, with an unbalanced panel of 285 provider-years. STUDY DESIGN: Economies of scale occur when the percent change in operating costs is less than the percentage change in clients. Economies of scope occur when operating costs fall as providers treat clients with multiple service needs. With our quasi-experimental, multivariate regressions approach, we test hypotheses that proximity to a new transit line enhances economies of scale and scope (i.e., lowers unit operating costs). DATA COLLECTION/EXTRACTION METHODS: Annual provider-level operating costs merged with new transit station locations and Department of Mental Health and Addiction Services program/provider-level secondary data (locations, client counts/completions/dates, service types, and average demographics). PRINCIPAL FINDINGS: For providers with programs within 1-mile of new transit (compared with a "control" sample beyond 1-mile of new transit), (i) a 10% increase in clients leads to a 0.12% lower operating costs per client; (ii) a 10% increase in clients completing treatment results in a 1.5% decrease in operating costs per client; (iii) a 10% increase in clients receiving treatment for multiple services causes a 0.81% lower operating costs per client; (iv) offering multiple services leads to 6.3% lower operating costs. CONCLUSIONS: New transit proximity causes operating cost savings for substance use disorder/mental health treatment providers. System alignment may benefit transit and health care sectors.

Uptake of toxic and nutrient elements by foraged edible and medicinal mushrooms (sporocarps) throughout Connecticut River Valley, New England, USA.

Foraging for edible and medicinal mushrooms is a cultural and social practice both globally and in the United States. Determining the toxic and nutrient element concentrations of edible and medicinal mushrooms is needed to ensure the safe consumption of this food source. Our research examined wild, foraged mushrooms in New England, USA to assess nutrient (Ca, K, Mg, P) and toxic (As, Hg, Pb, Cd) element relationships between mushrooms, substrates, and soils. We examined a gradient in nutrient and toxic elements from more rural Mountain and Hill Zones in Massachusetts, Vermont, and New Hampshire to more developed and urban Valley and Coastal Zones in Connecticut. Substrates and mineral soils were moderate to weak predictors of mushroom tissue concentrations. We found significant differences in nutrient and toxic element concentration among the five common genera: Ganoderma, Megacollybia, Pluteus, Pleurotus, and Russula. In particular, Pluteus had consistently higher toxic element concentrations while Pleurotus and Russula had the highest Bioaccumulation Factors (BAFs). We found that the urban areas of the Valley and Coastal zones of Connecticut had Cd Target Hazard Quotient (THQ) values and ΣTHQ values > 1.0, indicating potential non-carcinogenic health hazard. However, the trend was largely driven by the > 2.0 Cd THQ for Pluteus. Our results suggest that foraging in more urban areas can still yield mushrooms with safe concentrations of toxic elements and abundant nutrients. Further research of this kind needs to be conducted within this region and globally to ensure humans are consuming safe, foraged mushrooms.

Understanding Shield Laws.

In anticipation of extraterritorial application of antiabortion laws, many states have enacted laws that attempt to shield abortion providers, helpers, and patients from civil, professional, or criminal liability associated with legal abortion care. This essay analyzes and compares the statutory schemes of the seven early adopting shield states: California, Connecticut, Delaware, Illinois, Massachusetts, New Jersey, and New York. After describing what the laws do and how they operate, we offer reflections on coming disputes, areas of legal uncertainty, and ways to improve future shield laws.

Introduction of the ectoparasite Rhipicephalus pulchellus (Ixodida: Ixodidae) into Connecticut with a human traveler from Tanzania, and a review of its importation records into the United States.

Globalization, increased frequency of travel, and a rise in legal and illegal animal trades can introduce exotic ticks into the United States. We herein report the importation of a male Rhipicephalus pulchellus (Gerstäcker) on a human traveler returning to Connecticut from Tanzania, Africa, and review historical importation records of this species into the United States. This common tick is broadly distributed throughout East Africa, from Eritrea to Tanzania, has a wide host range on domestic animals and wildlife, and has been most frequently introduced into the United States on tick-infested wild animal hosts and animal trophies, but documentation of importation on humans has been rare. Archival records at the United States Department of Agriculture's National Veterinary Services Laboratories show R. pulchellus has been introduced into the United States at least 40 times over the last 62 yr. Rhipicephalus pulchellus has been linked to Rickettsia conorii, the agent of boutonneuse fever in humans, Crimean-Congo hemorrhagic fever orthonairovirus, and Nairobi sheep disease orthonairovirus. Given the potential for this exotic tick to introduce animal or human pathogens, proper surveillance, interception, identification, and reporting of these ticks are vital in protecting human and animal health.

Recognition and Treatment of Wounds in Persons Using Xylazine: A Case Report From New Haven, Connecticut.

BACKGROUND: Xylazine is an α 2 -adrenergic agonist that is commonly used as a veterinary tranquilizer and is increasingly present in the unregulated US drug supply since at least 2019. There are many suspected clinical complications of xylazine use, including unusual skin wounds, atypical overdose presentations, and possible dependence and withdrawal syndromes. However, there are few reports of cutaneous manifestations of xylazine in patients who inject drugs that can guide diagnosis and management in patients with confirmed xylazine toxicology. CASE SUMMARY: We present the cases of 3 stably housed patients in Connecticut with opioid use disorder and intravenous use of fentanyl who presented with atypical, chronic wounds at the site of injection drug use. Xylazine toxicology sent on all 3 patients was positive. All patients were seen by wound care and dermatology, and 1 patient was followed by infectious diseases. Wound care management strategies are discussed as well as harm reduction strategies. For all patients, the dose of their medication for opioid use disorder was increased to decrease frequency of drug use given concern that patients were exposed to a drug supply containing xylazine. CLINICAL SIGNIFICANCE: This case report presents wound characteristics that raise the index of suspicion for xylazine-involved injection wounds and might assist in their diagnosis and management. There is urgent need for more reporting of such cases as well as rigorous research to understand the potential impact of xylazine on people who use drugs. Multidisciplinary best practices should be established.

"It's starting to weigh on me": Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model.

BACKGROUND: The experiences and perceived support needs of harm reduction workers in the USA have been understudied. While previous research has explored staff burnout and role-related stress, there is a research gap around potential supports for staff wellbeing and individual longevity in their roles. This is especially critical given the growing overdose crisis and the need for sustainable harm reduction programming. Thus, we sought to describe the experiences of harm reduction staff and identify the perceived support that could empower harm reduction staff to successfully navigate their roles. METHODS: Purposive sampling methods were used to recruit harm reduction staff working in Connecticut. Seventeen semi-structured, one-on-one interviews were conducted between December 2022 and March 2023. Participants were asked about their experiences with role-related stressors and supports. Informed by the Social-Ecological Model, transcripts were coded using both inductive and deductive codes, and themes were developed using thematic analysis approaches. RESULTS: Study participants described their experiences working in harm reduction and the numerous ways they already are or could be receiving support in their roles. These experiences were organized into eight themes according to the levels of the Social-Ecological Model. At the individual level, participants explained that support could help them navigate the variability of the physical environment, boundary setting, and self-care. Relationships between clients and co-workers were both identified as means of support at the interpersonal level, helping participants navigate difficult situations and feelings of stress. At the organizational level, study participants explained how they look to their organization to provide sufficient support by way of training, staffing, compensation, and benefits. Additionally, participants stressed the importance of having supervisors who valued their work and provided emotional support. Lastly, at the community level, participants discussed how support was needed to help them navigate complex systems while working with a stigmatized population in an often-stigmatized field. CONCLUSIONS: To best support harm reduction staff in their day-to-day roles, our findings underscore the need for support on multiple levels. Future research could explore how the provision of support to harm reduction staff impacts not only staff perceptions of support but also the success of clients accessing harm reduction services.

Thrombocytopenia Associated with Elemental Mercury Poisoning in Two Siblings - Connecticut, July 2022.

Two siblings aged 5 and 15 years from Connecticut were hospitalized with petechial rash, oral mucositis, and severe thrombocytopenia approximately 10 days after they played with a jar of elemental mercury they found in their home. Before the mercury exposure was disclosed, the siblings were treated with platelet transfusions, intravenous immune globulin (IVIG) for possible immune thrombocytopenic purpura, and antibiotics for possible infectious causes. When their conditions did not improve after 6 days, poison control facilitated further questioning about toxic exposures including mercury, testing for mercury, and chelation with dimercaptosuccinic acid. The older sibling soon recovered, but the younger child required a prolonged hospitalization for severe thrombocytopenia, ultimately receiving repeated doses of IVIG, steroids, and romiplostim, a thrombopoietin receptor agonist. Close collaboration among multiple agencies was required to identify the extent of mercury contamination, evaluate and treat the other family members, and decontaminate the home. These cases demonstrate the importance of ongoing public health outreach to promote early detection of elemental mercury toxicity, and the need to evaluate for environmental exposures when multiple close contacts experience similar signs and symptoms.