Supersized alcopop related calls in the National Poison Data System, 2010-2019.

BACKGROUND: Supersized alcopops are single-serving high-alcohol-content beverages frequently consumed by underage drinkers. However, little data exist regarding the public health burden of supersized alcopops during the last decade. The current study examined the characteristics of calls to U.S. poison control centers involving supersized alcopops. This study also compared the proportion of calls for underage consumers between calls involving consumption of supersized alcopops and calls involving other types of alcohol (e.g., liquor, beer, wine). METHODS: Data from the National Poison Data System (NPDS) repository of calls to U.S. poison control centers were analyzed. RESULTS: Between 2010 and 2019, poison control centers received 1719 calls for exposures to supersized alcopops. Nearly one-half of calls involving supersized alcopop consumption (46.3 %) were made for consumers who were below the legal drinking age. In all years, the proportion of calls for supersized alcopops that were for underage exposures greatly exceeded the proportion of calls that were for underage exposures for other types of alcohol. For those 0-11 years of age, 91 % of supersized alcopop exposures were unintentional; however, for each other age group, at least 84 % of exposures were intentional. Supersized alcopop exposures involved a co-ingested product in more than 80 % of cases among patients of legal drinking age and less than 50 % of cases among patient under legal drinking age. CONCLUSIONS: Compared to other alcohol products, calls to U.S poison control centers for supersized alcopops disproportionately involved underage drinkers. To protect youth, improved regulation of supersized alcopop products is urgently needed.

Barriers to the Treatment of Hepatitis C among Predominantly African American Patients Seeking Care in an Urban Teaching Hospital in Washington, D.C.

BACKGROUND: In the United States, it is estimated that 2.4 million people are currently infected with the hepatitis C virus (HCV). In order to address HCV infection management in the U.S., several government entities collaborated to develop and release a multistep plan for the prevention, care, and treatment of viral hepatitis. Optimal health outcomes from the plan are contingent upon addressing each of the several steps in the HCV care cascade. Among the critical challenging steps is linkage to care and access to treatment. Of the nearly three million people in the U.S. infected with HCV, only 43% have been linked to care, 16% have received treatment, and 9% have had their infection resolved. OBJECTIVE: This retrospective study aims to identify predictors within the HCV treatment cascade that contribute to failures in care of HCV-infected patients in an urban hospital setting located in the District of Columbia. SETTING: The outpatient clinics of a tertiary-care urban teaching hospital. METHODS: A retrospective study was conducted using electronic medical records of persons 18 years and older who were HCV antibody positive and had at least one visit at any of the outpatient clinics from August 1, 2015 to August 1, 2016. Descriptive analysis of HCV positive persons was conducted, and predictors of HCV treatment were assessed. RESULTS: A total of 252 patients were included in the study. Overall, patients were predominantly male (63.1%), African American (97.6%), under the age of 65 (71.4%), covered by public insurance (89.3%), and were diagnosed with HCV after the year 2001 (53.2%). Additionally, majority of patients had not been treated for their HCV infection (58%). Multiple barriers resulted in HCV infected patients not obtaining access to treatment. Fibrosis stage (p < 0.001) and prior insurance denial (p < 0.05) were significant predictors of HCV treatment. Age, gender, insurance type, substance abuse, alcohol abuse, and year of HCV diagnosis were not associated with limited access of HCV treatment. CONCLUSION: HCV infections remain a major public health concern among patients in the District of Columbia. This study identified fibrosis stage and prior insurance denial as primary barriers to access of HCV treatment. While there are many points in the hepatitis cascade of care in which patients can lose access to or fail treatment completion, the primary point of intervention in our patient population appears to be during the initiation of treatment and insurance prior authorization process.

Adult lead exposure from ammunition reloading and indoor residential shooting.

The use and maintenance of firearms is a common and often preventable source of adult lead exposure that is often poorly understood by medical professionals. This case describes an elevated blood lead level (BLL) in an adult man due to the exposure sources of ammunition reloading and indoor target shooting in the basement of his home and details the challenges involved in the diagnosis and management of such cases. The elevated BLL was reduced through strict attention to personal hygiene during the reloading process and while shooting, improved ventilation and cleaning of the basement, and avoidance of vacuuming and use of dry cleaning techniques. Medical providers may be unfamiliar with the risks of indoor residential shooting and how to ameliorate them; this knowledge deficit may result in delays in diagnosis as well as an inability to successfully mitigate the risks for exposure. Time-sensitive diagnosis and treatment, comprehensive risk assessments, and reduction of exposure sources are important facets in the care of adult patients who are exposed to lead through recreational activities. Health care professionals should be aware of the potential dangers of ammunition reloading and indoor shooting, be familiar with ways to reduce lead exposure during these activities, and understand the resources that are available for the management of lead-exposed patients.