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1.
J Addict Dis ; : 1-9, 2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35238283

RESUMO

INTRODUCTION: Opioid and other substance use disorders (OUD/SUDs) have been and continue to be significant public health issues. The standard of care for OUD is the use of medication for opioid use disorder (MOUD) in conjunction with counseling or behavioral therapies, yet research has indicated that barriers exist for patients accessing MOUD as well as for physicians prescribing MOUD due to requirements associated with the DATA 2000 waiver. METHODS: A pilot cross-sectional survey was conducted among Kentucky physicians in order to reassess common barriers as well as to explore barriers that non-waivered providers face to becoming waivered. Barriers were compared by waiver status (waiver vs. non-waivered) as well as geographic location (rural vs. non-rural). RESULTS: Compared to waivered physicians, non-waivered physicians were significantly less likely to report positive personal beliefs related to the use of MOUD for OUD and reported significantly more barriers to treating OUD patients in the areas of physicians' practice and culture, auditing, and institutional support and resources (p < .05). The majority (69%) of all physicians indicated they would benefit from a tool kit with evidence-based clinical guidelines. CONCLUSIONS: The barriers and beliefs identified in this pilot study indicate the need for policy action at the federal level to reduce barriers and incentivize more physicians to obtain waivers to treat OUD. Further, the development of brief educational resources tailored to physicians to treat OUD patients including pregnant patients with OUD is recommended.

2.
Am J Ind Med ; 65(6): 483-491, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35338513

RESUMO

BACKGROUND: The objective of this study was to identify the most frequent type, nature, and cause of work-related injuries among distillery workers and the contributing factors for these events to target interventions to reduce injuries. METHODS: Workers' compensation first reports of injury (FROI) from the years 2010 through 2019 were obtained. Variables were created for "occupational category" and "cause of injury" for evaluation of the injurious events. The ratchet circular scan test was used to assess seasonal variation in injury, and kernel density estimation to assess rates of injury by calendar year. RESULTS: A total of 974 FROIs were recorded over these 10 years; 908 of the injuries resulted in lost time, 65 resulted in no lost time, and 1 resulted in a fatality. The most common injuries reported were strains or tears, lacerations, and contusions (33.4%, 14.7%, and 13.5%, respectively). The most frequent anatomical sites of injury were the shoulders, fingers, and low back area (11.8%, 11.4%, and 8.9%, respectively). Barreling operation activities experienced the greatest frequency of work-related injury at 28.5% of all FROIs. A seasonal peak of injuries was observed during May and June. CONCLUSIONS: Implementing ergonomic and safety solutions for transportation and work tasks associated with barreling operations may significantly reduce the rate of work-related injuries in distillery workers. Injury prevention interventions should particularly target strain or tear injuries caused by repetitive motion or bodily reaction and overexertion. Contact with objects or machinery accounted for one-third of distillery industry FROIs.


Assuntos
Traumatismos Ocupacionais , Indenização aos Trabalhadores , Humanos , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/etiologia
3.
Health Sci Rep ; 4(3): e335, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34401522

RESUMO

BACKGROUND: Opioid use has risen dramatically in recent years, and its illegal use puts first responders at risk when intervening in overdoses. Synthetic opioids, like fentanyl with a potency 50 to 100 times greater than morphine, pose a great risk and accidental exposure via ingestion, inhalation, mucosal, or percutaneous routes, can potentially lead to fatal outcomes. Anecdotal media accounts in early 2017 of accidental occupational opioid exposure among first responders generated a national concern. METHODS: To identify first responders' recollections, beliefs, and concerns about possible occupational exposure to opioids and other drugs, researchers in Kentucky, Virginia, Mississippi, and Georgia administered an emailed, anonymous convenience sample survey. RESULTS: A total of 5955 surveys were analyzed with 15% of respondents reporting they believed they had been exposed to opioids, and of those, less than 1% reported experiencing health effects from perceived exposure. Over half (51%) of respondents reported being "very or somewhat concerned" about developing health effects from exposure to opioids. Half of respondents reported being unaware of Centers for Disease Control and Prevention (CDC)/National Institutes for Occupational Safety and Health (NIOSH) guidelines for preventing occupational-related opioid exposures. CONCLUSIONS: Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls, but half were concerned about potential exposures and half were unaware of the educational guidance on prevention available. The high level of concern regarding potential exposure warrants the need for the development and or enhancement of targeted educational training interventions and further dissemination of pre-existing training interventions to ensure first responders have the knowledge and understanding of occupational opioid exposures and minimize stress associated with the potential rare exposures.

4.
J Psychoactive Drugs ; : 1-8, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34269163

RESUMO

Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.

5.
Inj Prev ; 27(S1): i3-i8, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33674326

RESUMO

INTRODUCTION: Emergency department (ED) visit discharge data are a less explored population-based data source used to identify work-related injuries. When using discharge data, work-relatedness is often determined by the expected payer of workers' compensation (WC). In October 2015, healthcare discharge data coding systems transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). ICD-10-CM's structure offers potential new work-related codes to enhance work-related injury surveillance. This study identified work-related ED visits using relevant ICD-10-CM work-related injury codes. Cases identified using this method were compared with those identified using the WC expected payer approach. METHODS: State ED visit discharge data (2016-2019) were analysed using the CDC's discharge data surveillance definition. Injuries were identified using a diagnosis code or an external cause-of-injury code in any field. Injuries were assessed by mechanism and expected payer. Literature searches and manual review of ICD-10-CM codes were conducted to identify possible work-related injury codes. Descriptive statistics were performed and assessed by expected payer. RESULTS: WC was billed for 87 361 injury ED visits from 2016 to 2019. Falls were the most frequent injury mechanism. The 246 ICD-10-CM work-related codes identified 36% more work-related ED injury visits than using WC as the expected payer alone. CONCLUSION: This study identified potential ICD-10-CM codes to expand occupational injury surveillance using discharge data beyond the traditional WC expected payer approach. Further studies are needed to validate the work-related injury codes and support the development of a work-related injury surveillance case definition.


Assuntos
Classificação Internacional de Doenças , Traumatismos Ocupacionais , Serviço Hospitalar de Emergência , Humanos , Alta do Paciente , Indenização aos Trabalhadores
6.
Geohealth ; 4(8): e2019GH000241, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32821873

RESUMO

The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having "lower" or "moderate" heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States.

7.
Public Health Rep ; 135(2): 262-269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040923

RESUMO

OBJECTIVES: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. METHODS: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). RESULTS: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. CONCLUSIONS: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Heroína/envenenamento , Adolescente , Adulto , Criança , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Classificação Internacional de Doenças , Kentucky , Masculino , Naloxona/administração & dosagem
8.
J Safety Res ; 71: 191-200, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31862030

RESUMO

OBJECTIVES: National fatality rates for commercial tow truck operators exceed those of other first responders who also perform traffic incident management services. The objectives of the current study are to (1) characterize causal factors associated with injuries among commercial tow truck operators engaged in roadside assistance through analysis of coded and free text data obtained from U.S. Occupational Safety and Health Administration (OSHA) investigation files, and (2) utilize supplemental data sources to analyze environmental factors for injuries in which commercial tow truck operators were struck by roadway traffic. METHODS: Searches of OSHA's online IMIS database were performed to identify investigations of incidents in which tow truck operators were injured while performing roadside assistance duties. Freedom of Information Act (FOIA) requests were submitted to obtain full investigation files for each case. Coded and narrative text analyses were performed to identify causal themes across the identified cases. RESULTS: One-hundred and six cases of tow truck operators being killed or severely injured were identified in IMIS; 41 FOIA requests for related investigation documents were fulfilled. Two major event type themes were identified which accounted for 9 in 10 of the cases identified. These were (1) 'struck-by' incidents, which were primarily injuries resulting from contact with roadway traffic, rolling vehicles and equipment or other non-motorized objects; and (2) 'caught-in or -between' incidents, which were primarily injuries resulting from being pinned beneath and between vehicles and being caught in moving parts. CONCLUSIONS: The towing industry should provide initial and refresher safety training on vehicle loading and unloading, defensive techniques when exposed to traffic on roadways, and proper wheel chocking and braking procedures. States should include tow trucks as a first responder vehicle type in their "Move Over" laws and implement public awareness campaigns to protect all first responders, including tow truck operators.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Veículos Automotores , Segurança/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/etiologia
9.
PLoS One ; 14(10): e0223318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618226

RESUMO

BACKGROUND: Timely data is key to effective public health responses to epidemics. Drug overdose deaths are identified in surveillance systems through ICD-10 codes present on death certificates. ICD-10 coding takes time, but free-text information is available on death certificates prior to ICD-10 coding. The objective of this study was to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance. METHODS: Using 2017-2018 Kentucky death certificate data, free-text fields were tokenized and features were created from these tokens using natural language processing (NLP). Word, bigram, and trigram features were created as well as features indicating the part-of-speech of each word. These features were then used to train machine learning classifiers on 2017 data. The resulting models were tested on 2018 Kentucky data and compared to a simple rule-based classification approach. Documented code for this method is available for reuse and extensions: https://github.com/pjward5656/dcnlp. RESULTS: The top scoring machine learning model achieved 0.96 positive predictive value (PPV) and 0.98 sensitivity for an F-score of 0.97 in identification of fatal drug overdoses on test data. This machine learning model achieved significantly higher performance for sensitivity (p<0.001) than the rule-based approach. Additional feature engineering may improve the model's prediction. This model can be deployed on death certificates as soon as the free-text is available, eliminating the time needed to code the death certificates. CONCLUSION: Machine learning using natural language processing is a relatively new approach in the context of surveillance of health conditions. This method presents an accessible application of machine learning that improves the timeliness of drug overdose mortality surveillance. As such, it can be employed to inform public health responses to the drug overdose epidemic in near-real time as opposed to several weeks following events.


Assuntos
Overdose de Drogas/mortalidade , Causas de Morte , Overdose de Drogas/diagnóstico , Overdose de Drogas/epidemiologia , Humanos , Classificação Internacional de Doenças , Kentucky/epidemiologia , Aprendizado de Máquina , Vigilância em Saúde Pública
10.
Curr Epidemiol Rep ; 6(2): 263-274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31259141

RESUMO

Purpose of Review: Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality. Recent Findings: Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality. Summary: The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation's overdose crisis continues to evolve.

11.
BMC Public Health ; 19(1): 177, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744608

RESUMO

BACKGROUND: Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. METHODS: Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. RESULTS: Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. CONCLUSIONS: FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment.


Assuntos
Internet , Transtornos Relacionados ao Uso de Substâncias/terapia , Tempo para o Tratamento , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Kentucky
12.
Acad Forensic Pathol ; 9(1-2): 66-80, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34394792

RESUMO

Objective: To (a) determine the impact of Kentucky's (KY's) mandate requiring postmortem toxicology testing of coroner cases; (b) identify the influence of coroner experience and training, jurisdiction size, budget, and location on postmortem testing requests; (c) identify facilitators/barriers for postmortem toxicology testing requests and listing the specific drugs involved in drug-poisoning deaths on death certificates. Methods: A modified Dillman approach was used to deliver the survey to KY's elected coroners between April and May 2016. Responses stratified by identified influence factors were compared using χ2 tests and Fisher exact tests. Results: Fifty-eight percent of coroners reported that drug overdose investigations had changed since the mandate was enacted. Statistically significant differences in responses were found when stratified. Sixty-three percent of coroners reported always using testing results to complete death certificates. Conclusions: Uptake of the mandate for postmortem toxicology testing of all decedents is not yet complete. Policy Implication: Without uptake of the mandate, surveillance efforts may result in undercounting of drug overdose deaths and the involvement of specific drugs. Mandates for enhanced training and modification of funding structure for medico-legal death investigations could facilitate uptake.

13.
Accid Anal Prev ; 126: 3-9, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29174330

RESUMO

INTRODUCTION: There is ongoing concern at the national level about the availability of adequate commercial vehicle rest areas and truck stops for commercial vehicle drivers to rest or to wait for a delivery window. METHODS: A retrospective case-control study was conducted to determine the association between the occurrence of sleepiness/fatigue-related (cases) vs. all other human factor-related commercial vehicle driver at-fault crashes (controls) and proximity to rest areas, weigh stations with rest havens, and truck stops. RESULTS: Commercial vehicle driver at-fault crashes involving sleepiness/fatigue were more likely to occur on roadways where the nearest rest areas/weigh stations with rest havens/truck stops were located 20 miles or more from the commercial vehicle crash site (Odds Ratio [OR]=2.32; Confidence Interval [CI] 1.615, 3.335] for 20-39.9 miles vs. <20 miles; and OR=6.788 [CI 2.112, 21.812] for 40+ miles) compared to commercial vehicle at-fault driver crashes with human factors other than sleepiness/fatigue cited in crash reports. Commercial vehicle driver at-fault crashes involving sleepiness/fatigue also were more likely to occur on parkways compared to interstates (adjusted OR=3.747 [CI 2.83, 4.95]), during nighttime hours (adjusted OR=6.199 [CI 4.733, 8.119]), and on dry pavement (adjusted OR 1.909, [CI 1.373, 2.655]). CONCLUSIONS: The use of statewide crash data analysis coupled with ArcGIS mapping capabilities provided the opportunity to both statistically determine and to visualize the association between rest area/weigh station with rest haven/truck stop distance and the occurrence of commercial vehicle driver at-fault crashes involving sleepiness/fatigue. Implementation and evaluation of commercial vehicle employer policies and interventions such as the use of commercial vehicle driver fatigue alert systems may help to reduce fatigue and sleepiness in commercial vehicle drivers. These results can be used by state and local highway transportation officials to inform and increase truck parking availability, especially on parkways.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Fadiga/epidemiologia , Descanso/fisiologia , Sonolência , Adulto , Condução de Veículo/estatística & dados numéricos , Estudos de Casos e Controles , Planejamento Ambiental , Fadiga/prevenção & controle , Humanos , Kentucky , Pessoa de Meia-Idade , Veículos Automotores , Razão de Chances , Estudos Retrospectivos , Fatores de Risco
14.
Inj Epidemiol ; 5(1): 36, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30270412

RESUMO

BACKGROUND: Implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) in the U.S. on October 1, 2015 was a significant policy change with the potential to affect established injury morbidity trends. This study used data from a single state to demonstrate 1) the use of a statistical method to estimate the effect of this coding transition on injury hospitalization trends, and 2) interpretation of significant changes in injury trends in the context of the structural and conceptual differences between ICD-9-CM and ICD-10-CM, the new ICD-10-CM-specific coding guidelines, and proposed ICD-10-CM-based framework for reporting of injuries by intent and mechanism. Segmented regression analysis was used for statistical modeling of interrupted time series monthly data to evaluate the effect of the transition to ICD-10-CM on Kentucky hospitalizations' external-cause-of-injury completeness (percentage of records with principal injury diagnoses supplemented with external-cause-of-injury codes), as well as injury hospitalization trends by intent or mechanism, January 2012-December 2017. RESULTS: The segmented regression analysis showed an immediate significant drop in external-cause-of-injury completeness during the transition month, but returned to its pre-transition levels in November 2015. There was a significant immediate change in the percentage of injury hospitalizations coded for unintentional (3.34%) and undetermined intent (- 3.39%). There were immediate significant changes in the level of injury hospitalization rates due to poisoning, suffocation, struck by/against, other transportation, unspecified mechanism, and other specified not elsewhere classifiable mechanism. Significant change in slope after the transition (without immediate level change) was identified for assault, firearm, cut/pierce, and motor vehicle traffic injury rates. The observed trend changes reflected structural and conceptual features of ICD-10-CM coding (e.g., poisoning and suffocations are now captured via diagnosis codes only), new coding guidelines (e.g., requiring coding of injury intent as "accidental" if it is unknown or unspecified), and CDC proposed external-cause-of-injury code groupings by injury intent and mechanism. Researchers can replicate this methodology assessing trends in injuries or other ICD-10-CM-coded conditions using administrative billing data sets. CONCLUSIONS: The CDC 's Proposed Framework for Presenting Injury Data Using ICD-10-CM External Cause of Injury Codes provided a logical transition from the ICD-9-CM-based matrix on injury hospitalization trends by intent and mechanism. Our findings are intended to raise awareness that changes in the ICD-10-CM coding system must be understood to assure accurate interpretation of injury trends.

15.
Ann Epidemiol ; 28(9): 629-634.e1, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30033036

RESUMO

PURPOSE: American football is played by over 1 million high school athletes in the United States, and knee injuries are the third most common injury. The purpose of this study is to identify factors that influence return to play after knee injuries in high school football athletes and whether return to play differs for varsity and nonvarsity football players. METHODS: We used academic year 2006-2007 through 2009-2010 data from the National High School Sports-Related Injury Surveillance Study. Polytomous logistic regression was used to assess factors influencing return to play. RESULTS: Thirty-one percent returned to play in more than 3 weeks or not at all. After adjusting for injury severity, a difference in time to return to play persisted for injuries occurring in the regular or postseason compared to pre-season (OR 0.5, CI: 0.3-0.9), and injuries occurring to varsity players compared with nonvarsity players (OR 0.7, CI: 0.4-1.0). CONCLUSIONS: Time in season, method of injury assessment, and the need for surgery were the main predictors of return to play for football athletes. As more factors were influential for varsity athletes than nonvarsity athletes, future studies should separate the groups of athletes to better identify their specific factors for time to return.


Assuntos
Atletas/psicologia , Futebol Americano/lesões , Traumatismos do Joelho , Volta ao Esporte , Adolescente , Traumatismos em Atletas/prevenção & controle , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Masculino , Vigilância em Saúde Pública , Recuperação de Função Fisiológica , Instituições Acadêmicas , Fatores de Tempo , Estados Unidos
17.
Drug Alcohol Depend ; 186: 80-85, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29554591

RESUMO

BACKGROUND: The goal of this study was to establish and compare baseline data on the prevalence of gabapentin identified through postmortem toxicology testing among drug overdose decedents in several geographically diverse states/jurisdictions with differing levels of drug overdose fatality burdens in 2015. METHODS: Death certificates and postmortem toxicology result reports from five U.S. jurisdictions were used to identify residents who died from drug overdoses in year 2015 and to calculate prevalence rates of gabapentin in postmortem toxicology by jurisdiction. RESULTS: On average, 22% of all drug overdose decedents in our study tested positive for gabapentin. The percentage of gabapentin-positive overdose deaths varied significantly among jurisdictions: 4% in Northeast Tennessee, 7% in Maricopa County, 15% in West Virginia, 20% in North Carolina, and 41% in Kentucky (p < 0.0001). Among the drug overdose decedents who tested positive for opioids (including heroin), 26% also tested positive for gabapentin, with significant variation among states/jurisdictions (p < 0.0001). There was a significant difference in the gender distribution among drug overdose decedents who tested positive for gabapentin (46% male) vs. those who tested negative for gabapentin (65% male) (p < 0.0001). In Kentucky, gabapentin was listed as a contributing drug on the death certificate in 40% of the overdose deaths with gabapentin-positive toxicology; in North Carolina this percentage was 57%. CONCLUSIONS: Routine gabapentin postmortem testing and linking of death certificate, medical examiner, coroner, toxicology, and prescription history data will provide more reliable information on the extent of gabapentin misuse, diversion, and implications for clinical care.


Assuntos
Aminas/sangue , Ácidos Cicloexanocarboxílicos/sangue , Overdose de Drogas/epidemiologia , Overdose de Drogas/mortalidade , Antagonistas de Aminoácidos Excitatórios , Ácido gama-Aminobutírico/sangue , Adulto , Analgésicos Opioides/sangue , Feminino , Gabapentina , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Caracteres Sexuais , Estados Unidos/epidemiologia
18.
J Immigr Minor Health ; 20(2): 448-455, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28197863

RESUMO

Information on foreign-born worker (FBW) and native-born worker (NBW) fatal injuries is scarce. The Kentucky Fatality Assessment and Control Evaluation program analyzed 2001-2014 worker fatality data. The Kentucky FBW fatality rate was double the US FBW and NBW rates, and 50% higher than the Kentucky NBW fatality rate. FBW average age at death was 38 years; NBW age was 47 years. FBW deaths occurred in construction (26%) and services (22%) industries, and transportation [28% (54% due to semi truck crashes)] and construction [26%(48% due to roofing, scaffolding, and ladder-related falls)] occupations; in contrast, NBW deaths occurred in services (22%), and transportation (18%) industries, and transportation (25%) and management (20%) occupations, and were due to exposures to inanimate mechanical forces (38%), and transport accidents (30%). Enhanced FBW cultural competent interventions and policies are needed to prevent FBW occupational injuries, and improve FBW workplace safety and health.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Traumatismos Ocupacionais/etnologia , Traumatismos Ocupacionais/mortalidade , Acidentes de Trabalho/mortalidade , Acidentes de Trabalho/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos
19.
Inj Prev ; 24(1): 60-67, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28739777

RESUMO

BACKGROUND: According to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population. OBJECTIVE: The elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS). METHODS: DOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths. RESULTS: DOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013-2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids. CONCLUSIONS: A comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.


Assuntos
Prevenção de Acidentes , Acidentes/mortalidade , Analgésicos Opioides/envenenamento , Pessoas com Deficiência/estatística & dados numéricos , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Gabapentina/envenenamento , Adulto , Benchmarking , Atestado de Óbito , Monitoramento Epidemiológico , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prevalência , Caracteres Sexuais
20.
Int J Drug Policy ; 46: 120-129, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28735777

RESUMO

BACKGROUND: The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS: The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. RESULTS: Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. CONCLUSIONS: The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.


Assuntos
Overdose de Drogas/epidemiologia , Fentanila/envenenamento , Dependência de Heroína/complicações , Transtornos Relacionados ao Uso de Opioides/complicações , Adolescente , Adulto , Idoso , Analgésicos Opioides/envenenamento , Contaminação de Medicamentos , Overdose de Drogas/mortalidade , Feminino , Heroína/envenenamento , Dependência de Heroína/epidemiologia , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
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