Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic.

PURPOSE: This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. METHODS: We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. RESULTS: The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (ß = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (ß = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. CONCLUSIONS: We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.

Risk factors associated with indicators of dehydration among migrant farmworkers.

OBJECTIVE: Farmworkers are at increased risk of adverse health outcomes related to occupational heat exposure and inadequate access to water, shade, or rest breaks. Presently, there is a dearth of studies examining the prevalence of dehydration and related factors in U.S. farmworkers. Our objectives were to characterize hydration status during typical workdays and to identify risk factors associated with increased dehydration in migrant farmworkers employed in Florida. METHODS: Urine samples were collected and analyzed for urine specific gravity (USG) 2-3 times per person per day over five days in May 2021 and 2022. Data collection included demographic characteristics, wet-bulb-globe-temperature (WBGT), and information on working conditions (task type, duration, and crop units harvested), fluid intake, clothing worn, and heat safety behaviors. Multivariable mixed regression models were used to evaluate risk factors associated with change in USG levels (continuous) during a work shift. RESULTS: A total of 111 farmworkers participated in this study providing 1020 cumulative USG measurements, of which 96.8% of end-of-shift USG samples were above 1.020 indicating potential dehydration. In multivariable models, dehydration assessed using change in USG levels significantly declined with age (ß = -0.078; 95%CI: 0.150, -0.006) but showed significant increase with body mass index (ß = 0.016; 95%CI: 0.003, 0.028), WGBT (ß = 0.054; 95%CI:0.044, 0.064), mean shift duration, and state of primary residence. We did not find significant associations of dehydration with type of clothing worn, intake of employer-provided water, or crop units harvested during a shift in this sample of farmworkers. CONCLUSION: Our findings underscore the need for additional research to evaluate adverse outcomes related to dehydration and to better understand recovery patterns from chronic dehydration across workweeks and harvest seasons in migrant farmworkers.

Injuries Among Hispanic/Latinx Agricultural Workers Seen in Illinois Hospitals.

OBJECTIVE: Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs. METHODS: Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care. RESULTS: We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons. CONCLUSION: The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.

Disparities in fatal and non-fatal opioid-involved overdoses among middle-aged non-Hispanic Black Men and Women.

The gap in fatal opioid overdose rates has been closing between non-Hispanic Black and non-Hispanic White individuals. The rising opioid-involved mortality rates among non-Hispanic Black adults has been identified by SAMHSA as a critical public health issue. However, further research is needed that utilizes comprehensive surveillance data on both fatal and non-fatal opioid-involved overdoses to better assess the changing trends and evaluate factors contributing to changing disparities. We conducted an analysis of medical examiner and hospital data for years 2016-2021 from the largest county in Illinois (Cook) to (1) evaluate disparities in non-fatal and fatal opioid-involved overdoses between middle-aged non-Hispanic Black adults and Black adults of other age groups stratified by sex, (2) to assess if disparities exist across middle-aged adults of different race-ethnicities specifically non-Hispanic White and Hispanic-Latino adults, and (3) evaluate factors contributing to the disparities. Fatal opioid overdose rates among middle-aged Black men 45-64 years old were on average 5.3 times higher than Black men of other age groups, and 6.2 times higher than middle-aged non-Black men. Similarly, fatal opioid overdose rates among middle-aged Black women were on average 5.0 times higher than Black women of other age groups, and 4.9 times higher than middle-aged non-Black women. Hospital utilization rates for opioid-involved overdoses showed similar disparities between age groups and race-ethnicities. Findings indicate that stark disparities in rates of opioid-involved overdoses among middle-aged Black men and women are likely attributed to exposure to more lethal opioids, drug variability in local markets, differences in concurrent drug exposures, and lower access to harm reduction, emergent and preventative health services.

Poor adherence to dust, noise and safety regulations predict injury rates in underground coal mines.

BACKGROUND: While safety in US coal mining has improved over the past two decades, general occupational health research shows that risk of injury varies across individual worksites and is influenced by worksite safety cultures and practices. METHODS: In this longitudinal study, we evaluated whether mine-level characteristics reflecting poor adherence to health and safety regulations in underground coal mines are associated with higher acute injury rates. We aggregated Mine Safety and Health Administration (MSHA) data by year for each underground coal mine for the period 2000-2019. Data included part-50 injuries, mine characteristics, employment and production, dust sampling, noise sampling, and violations. Multivariable hierarchical generalised estimating equations (GEE) models were developed. RESULTS: Based on the final GEE model, despite an average annual decline in injury rates by 5.5%, the following indicators of inadequate adherence to health and safety regulations were associated with increased average annual injury rates: +2.9% for each 10% increase in dust samples exceeding the permissible exposure limit; +0.6% for each 10% increase of permitted 90 dBA 8-hour noise exposure dose; +2.0% for every 10 substantial-significant MSHA violations in a year; +1.8% for each rescue/recovery procedure violation; +2.6% for each safeguard violation. If a fatality occurred in a mine, injury rates increased by 11.9% in the same year, but declined by 10.4% in the following year. The presence of safety committees was associated with a 14.5% decline in injury rates. DISCUSSION: In US underground coal mines, injury rates are associated with poor adherence to dust, noise and safety regulations.

Trends in assault-related hospitalizations during the SARS-CoV-2 pandemic.

INTRODUCTION: Violence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy. MATERIAL AND METHODS: Outpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables. RESULTS: The annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15-34-year-olds, and Chicago residents. CONCLUSION: During SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.

Increased odds of mortality from non-malignant respiratory disease and lung cancer are highest among US coal miners born after 1939.

OBJECTIVES: Coal miners suffer increased mortality from non-malignant respiratory diseases (NMRD), including pneumoconioses and chronic obstructive pulmonary disease, compared with the US population. We characterised mortality trends from NMRD, lung cancer and ischaemic heart disease (IHD) using data from the Federal Black Lung Program, National Coal Workers' Health Surveillance Program and the National Death Index. METHODS: We compared mortality ORs (MORs) for NMRD, lung cancer and IHD in former US coal miners to US white males. MORs were computed for the study period 1979-2017 by birth cohort (<1920, 1920-1929, 1930-1939, ≥1940), with a subanalysis restricted to Central Appalachia. RESULTS: The study population totalled 235 550 deceased miners, aged >45 years. Odds of death from NMRD and lung cancer across all miner birth cohorts averaged twice those of US males. In Central Appalachia, MORs significantly increased across birth cohorts. There was an eightfold increase in odds of death from NMRD among miners born after 1940 (MORBC≥1940 8.25; 95% CI 7.67 to 8.87). Miners with progressive massive fibrosis (PMF) were younger at death than those without PMF (74 vs 78 years; p<0.0001). We observed a pattern of reduced MORs from IHD in coal miners compared with national and regional counterparts. CONCLUSION: US coal miners have excess mortality from NMRD and lung cancer compared with total US and Appalachian populations. Mortality is highest in the most recent birth cohorts, perhaps reflecting increased rates of severe pneumoconiosis.

Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy.

BACKGROUND: Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine potential undercount of opioid-involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount. METHODS: A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid-involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose. RESULTS: Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR = 3.7: 2.1, 6.5), hospitalized for 4+ days (aOR = 2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR = 4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR = 0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR = 0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6% to 15%. CONCLUSIONS: Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20%-40% undercount reported elsewhere. See video abstract at, http://links.lww.com/EDE/B990 .

Barriers and Facilitators of Implementing Injury Prevention Practices by Massage Therapists.

OBJECTIVE: Massage therapy involves pervasive ergonomic hazards with the majority of massage therapists (MTs) experiencing adverse musculoskeletal health issues. A variety of barriers and facilitators exist that can impact the efficacy of safety programs. METHODS: A longitudinal study to characterize individual and organizational barriers and facilitators that influence the implementation of self-care techniques designed to reduce musculoskeletal health issues. RESULTS: MTs who reported time as abarrier implemented 0.9 fewer selfcare items despite wanting to make these changes (P  = 0.003) and 1.4 fewer self-care items when management was identified as a barrier (P < 0.001). Almost 20% of the MTs reported switching jobs which was associated with implementing 1.1 fewer self-care items (P = 0.002). CONCLUSIONS: Our findings show that organizational factors plays a critical role in workplace safety which can be used to improve working conditions faced by MTs.

Prevalence and severity of abnormal lung function among US former coal miners with and without radiographic coal workers' pneumoconiosis.

OBJECTIVES: Examination of lung function abnormalities among coal miners has historically focused on actively working miners. This likely underestimates the true burden of chronic respiratory disease. The objective of this study was to characterise patterns and severity of lung function impairment among a population of former coal miners. METHODS: Cross-sectional data from 2568 former coal miners evaluated at eight US Black Lung clinics in a 12-month period were retrospectively analysed for patterns of prebronchodilator spirometric abnormality and severity of lung function impairment. Spirometry data from a subset of former miners with chest radiographs were analysed based on the presence and severity of coal workers' pneumoconiosis (CWP). RESULTS: Abnormal spirometry was identified in 56.6% of subjects. The age-standardised prevalence of airflow obstruction among miners aged ≥45 years was 18.9% overall and 12.2% among never smokers. Among 1624 subjects who underwent chest radiography, the prevalence and severity of abnormal spirometry increased with worsening radiographic category for pneumoconiosis. Of never-smoking former miners without radiographic CWP, 39.0% had abnormal spirometry; 25.1% had abnormally low forced expiratory volume in 1 s (FEV1), and 17.1% had moderate to severe FEV1 impairment. CONCLUSIONS: Abnormal spirometry is common among former coal miners. While ever-smoking former miners had higher rates of airflow obstruction, never-smoking former miners also demonstrated clinically significant airflow obstruction, including those without radiographic pneumoconiosis. These findings demonstrate the importance of recognising physiological as well as imaging manifestations of coal mine dust lung diseases in former miners.

Comparison of health outcomes from heat-related injuries by National Weather Service reported heat wave days and non-heat wave days - Illinois, 2013-2019.

It is predicted that heat waves will increase as climate changes. Related public health interventions have expanded over the past decades but are primarily targeted at health outcomes occurring during heat waves. However, heat adaptation is dynamic and adverse outcomes related to heat injuries occur with moderate increases in temperature throughout the summertime. We analyzed outpatient and inpatient heat related injuries from 2013 to 2019. National Weather Service event summaries were used to characterize reported heat wave days and weather data was linked to individual cases. Despite the higher rate of heat injury on heat wave days, only 12.7% of the 17,662 heat-related injuries diagnosed from 2013 to 2019 occurred during reported heat waves. In addition, the National Weather Service surveillance system monitoring heat related injuries only captured 2.1% of all heat related injuries and 30.6% of heat related deaths. As climate changes and warmer conditions become more common, public health response to moderate increases in temperature during summertime needs to be strengthened as do the surveillance systems used to monitor adverse heat related health events. Improved surveillance systems, long-term interventions and strategies addressing climate change may help mitigate adverse health outcomes attributable to heat related injuries over the summertime.

Health Care Utilization of Individuals Affected by Homelessness: Illinois, 2011-2018.

OBJECTIVES: To describe individuals coded as homeless in state-level data comprising of outpatient and inpatient cases over a multi-year period to provide public health surveillance data on the health care utilization and needs of this population. RESEARCH DESIGN: In this cross-sectional study, outpatient and inpatient visits coded for homelessness were identified from the Illinois Hospital Discharge Database from January 1, 2011 through December 31, 2018. Demographic characteristics, primary diagnosis and comorbid conditions, and hospital course of treatment were described. Predictors of discharge to a health care facility versus routine discharge to home or self-care were evaluated using multivariable logistic regression. RESULTS: There were 154,173 patient visits predominantly involving males, those aged 25-64 years, and non-Hispanic Whites and African Americans. The majority had comorbidities of depression, psychosis, and/or substance abuse (70.2%) and a routine discharge to home or self-care (81.9%). Discharge to home or self-care relative to another health care institution was associated with having charity coverage and being Black/African American. CONCLUSIONS: Those experiencing homelessness experience a high burden of health concerns. Hospital billing records can be used to prioritize the distribution of limited public health resources for health care programs and interventions among those experiencing homelessness.

Association between Financial Conflicts of Interest and International Labor Office Classifications for Black Lung Disease.

Rationale: The U.S. Department of Labor administers the Federal Black Lung Program (FBLP), an administrative system charged with managing claims by coal miners for workers' compensation for totally disabling coal mine dust lung disease. Specific case reports have raised concern that financial conflicts of interest (COIs) may systematically bias physicians when they are classifying chest X-rays (CXRs) for the absence, presence, and severity of pneumoconiosis. Objectives: To evaluate the direction and magnitude of association between financial COIs of physicians participating in the FBLP and international standards for the classification of radiographs of pneumoconiosis. Methods: An epidemiologic assessment of black lung claims filed to the FBLP from 2000 to 2013 was conducted to determine physician classifications of radiographs. FBLP court decisions from 2002 to 2019 (n = 7,656) were used to evaluate financial COIs of each physician. The main outcome measures used were classifications of radiographs for the absence of pneumoconiosis (small opacity classifications of 0/0 or 0/1), simple pneumoconiosis (small opacity classifications of 1/0 through 3/+), and progressive massive fibrosis (PMF) (large opacities with classifications of A, B, or C). Results: Of 63,780 radiograph classifications made by 264 physicians, 31.4% were read positive for simple pneumoconiosis and 3.6% were read as having PMF. There were 52 physicians who classified CXRs as having no evidence of pneumoconiosis in 99%+ of their readings and 18 physicians who classified CXRs as positive for simple pneumoconiosis in 99%+ of their readings. The adjusted odds of a negative classification of pneumoconiosis was 1.46 (95% confidence interval [CI], 1.44-1.47) per 10% increase in the proportion of court records demonstrating that a physician was hired by the employer. Per 10% increase in court records indicating a physician was hired by the miner/claimant, the adjusted odds ratio for classifying simple pneumoconiosis was 1.51 (95% CI, 1.49-1.52), and the adjusted odds ratio for finding PMF was 1.28 (95% CI, 1.26-1.30). Conclusions: There was a strong association between source of payment and radiograph classification, suggesting the importance of eliminating financial COIs in what should be an objective determination of eligibility for Black Lung Workers' compensation benefits.

Burn Center Referral Practice Evaluation and Treatment Outcomes Comparison Among Verified, Nonverified Burn Centers, and Nonburn Centers: A Statewide Perspective.

The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.4-0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4-0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4-0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6-0.9), shorter length of hospitalization (VB vs OF: ß: -0.4, P < .001; NVB vs OF: ß: -0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97-1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7-1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.

Attitudes and behaviors of chiropractic interns toward occupational history taking.

OBJECTIVE: This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking. METHODS: All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study. RESULTS: The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was "very important." Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). CONCLUSION: Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.

Injuries during the first hour at work in the U.S. mining industry.

BACKGROUND: The first hour of a shift in a mine is characterized by a large movement of miners from incoming and outgoing shifts, in addition to safety and maintenance checks of mining equipment. These activities rely on communication to ensure a safe transition between shifts. This study aims to identify risk factors for injury among miners during the first hour of a work shift and to characterize injury outcomes. METHODS: Data from U.S. Mine Safety and Health Administration Part 50 reports, 1983-2015, were used to identify injuries occurring within the first hour of a shift. Multivariable logistic regression was used to evaluate predictors of injuries occurring during the first shift-hour and to assess the outcome of these injuries. RESULTS: Out of the 545,537 cases included in the analysis, 16,446 injuries occurred during the first hour of a shift. Risk factors associated with these injuries included being female, being older, working on Sunday and Monday, having an irregular shift start, working night shifts, employed in surface mining operations, and mine operations with <200 employees, and mechanisms of injury related to falls, movement of equipment and personnel, and being struck by or caught between boxes and containers. Injurious incidents occurring during the first hour of work were associated with mass injury events involving five or more workers (aOR = 3.58; 95% CI: 2.77, 4.64). CONCLUSIONS: Although injury rates were substantially lower during the first hour of work compared to all other work hours, this study identified risk factors and mechanisms of injury that are highly preventable during the first hour of work.

Progression of coal workers' pneumoconiosis absent further exposure.

OBJECTIVES: The natural history of coal workers' pneumoconiosis (CWP) after cessation of exposure remains poorly understood. METHODS: We characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression. RESULTS: A total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR. CONCLUSIONS: This study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.

Clinical outcomes of temperature related injuries treated in the hospital setting, 2011-2018.

BACKGROUND: Concerns over climate change have prompted substantial interest in temperature related injuries resulting from extreme weather conditions. Climate models predict that as global temperatures increase, the frequency and severity of extreme heat and cold weather events will grow which will likely increase the incidence of temperature related injury. The aim of this study was to analyze the healthcare impacts of temperature related injuries in the state of Illinois in order to serve as a model to guide future public health policy. METHODS: Outpatient and inpatient heat and cold related injuries treated in Illinois hospitals from 2011 to 2018 were analyzed. Weather data was linked to individual cases. RESULTS: The crude annual total hospital utilization incidence rate for heat injuries was 23.6 per 100,000 residents compared to 23.2 per 100,000 residents for cold injuries, however, the crude annual inpatient admission incidence rate was more than four-fold higher for cold injuries compared to heat injuries (10.2 vs 2.4 per 100,000). Although hypothermia made up 27.0% of all temperature related injuries, it comprised 94.0% of all deaths. In the multivariable models, we identified demographic characteristics, temperature conditions and comorbidities strongly associated with both heat and cold related in-hospital mortality. CONCLUSIONS: While climate change is increasing the number of extreme heat days, it may also impact cold adaptation resulting in more serious adverse health outcomes when severe cold weather events do occur. As electronic health records become more widely available, they can prove to be a valuable resource to monitor, treat and predict temperature related injuries in the near future. Our findings regarding the substantially elevated mortality among cold related injuries, demonstrate the need to tailor public health messages to different climate zones in the United States.

Comparison of State Hospital Visits With Housing and Urban Development Estimates of Homeless: Illinois, 2011-2018.

Objectives. To assess the value of hospital records in augmenting information on homelessness counts at a state level.Methods. We used data from the Illinois Hospital Discharge Database (2011-2018) to identify outpatients and inpatients identified as affected by homelessness. We used probabilistic linkage methodology to estimate unique individuals rather than visits and compared them with US Department of Housing and Urban Development annual estimates of homelessness based on point-in-time counts.Results. Department of Housing and Urban Development point-in-time estimates indicate a substantial decline of approximately 24% in homelessness in Illinois; however, estimates of unique individuals visiting the hospital with a code for homelessness more than doubled in this same period.Conclusions. Other data sources, such as hospital records, are increasingly able to identify and report information related to homelessness. Using these additional data sources may help to augment the Department of Housing and Urban Development point-in-time estimates to provide more accurate estimates of homelessness that are used to direct resources and assess policy and support services for those affected by homelessness.