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1.
MMWR Morb Mortal Wkly Rep ; 69(4): 109-113, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31999683

RESUMO

On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release.


Assuntos
Amônia/toxicidade , Vazamento de Resíduos Químicos , Exposição Ambiental/efeitos adversos , Ferimentos e Lesões/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Illinois/epidemiologia , Lactente , Masculino , Registros Médicos , Pessoa de Meia-Idade , Inquéritos e Questionários , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 69(3): 84-89, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971930

RESUMO

In 2019, the United States experienced an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). Most EVALI patients have reported using tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products obtained from informal sources (2,3), and vitamin E acetate in these products has been closely linked with EVALI (4,5). However, some EVALI patients report using only nicotine-containing products. This study compared demographic, product use, and clinical characteristics of EVALI patients in Illinois who reported using only nicotine-containing e-cigarette, or vaping, products with those of patients who reported using any THC-containing products. Among 121 interviewed Illinois EVALI patients, 17 (14%) reported using only nicotine-containing products, including nine (7%) patients who had no indication of any THC use, based on self-report or toxicology testing. Compared with patients who used any THC-containing products, these nine patients were significantly more likely to be older and female and were less likely to experience constitutional symptoms or to have leukocytosis on initial evaluation. Although vitamin E acetate has been strongly linked with EVALI, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC- or non-THC-containing products, in some reported EVALI cases. The contributing cause or causes of EVALI for patients reporting use of only nicotine-containing products warrants further investigation.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/epidemiologia , Nicotina/administração & dosagem , Nicotina/toxicidade , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autorrelato , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 68(45): 1034-1039, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31725708

RESUMO

The United States is experiencing an unprecedented outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). All EVALI patients have used e-cigarette, or vaping, products, and most (≥85%) have reported using products containing tetrahydrocannabinol (THC) (2,3), the principal psychoactive component of cannabis. To examine whether e-cigarette, or vaping, product use behaviors differed between adult EVALI patients and adults who use these products but have not developed lung injury, the Illinois Department of Public Health (IDPH) conducted an online public survey during September-October 2019 targeting e-cigarette, or vaping, product users in Illinois. Among 4,631 survey respondents, 94% reported using any nicotine-containing e-cigarette, or vaping, products in the past 3 months; 21% used any THC-containing products; and 11% used both THC-containing products and nicotine-containing products. Prevalence of THC-containing product use was highest among survey respondents aged 18-24 years (36%) and decreased with increasing age. E-cigarette, or vaping, product use behaviors of 66 EVALI patients aged 18-44 years who were interviewed as part of the ongoing outbreak investigation were compared with a subset of 519 survey respondents aged 18-44 years who reported use of THC-containing e-cigarette, or vaping, products. Compared with these survey respondents, EVALI patients had higher odds of reporting exclusive use of THC-containing products (adjusted odds ratio [aOR] = 2.0, 95% confidence interval [CI] = 1.1-3.6); frequent use (more than five times per day) of these products (aOR = 3.1, 95% CI = 1.6-6.0), and obtaining these products from informal sources, such as a dealer, off the street, or from a friend (aOR = 9.2, 95% CI = 2.2-39.4). The odds of using Dank Vapes, a class of largely counterfeit THC-containing products, was also higher among EVALI patients (aOR = 8.5, 95% CI = 3.8-19.0). These findings reinforce current recommendations not to use e-cigarette, or vaping, products that contain THC and not to use any e-cigarette, or vaping, products obtained from informal sources. In addition, because the specific compound or ingredient causing lung injury is not yet known, CDC continues to recommend that persons consider refraining from use of all e-cigarette, or vaping, products while the outbreak investigation continues (1).


Assuntos
Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Dronabinol/efeitos adversos , Feminino , Humanos , Illinois/epidemiologia , Masculino , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 68(39): 865-869, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581166

RESUMO

In July 2019, the Illinois Department of Public Health and the Wisconsin Department of Health Services launched a coordinated epidemiologic investigation after receiving reports of several cases of lung injury in previously healthy persons who reported electronic cigarette (e-cigarette) use, or vaping (1). This report describes features of e-cigarette product use by patients in Illinois and Wisconsin. Detailed patient interviews were conducted by telephone, in person, or via the Internet with 86 (68%) of 127 patients. Overall, 75 (87%) of 86 interviewed patients reported using e-cigarette products containing tetrahydrocannabinol (THC), and 61 (71%) reported using nicotine-containing products. Numerous products and brand names were identified by patients. Nearly all (96%) THC-containing products reported were packaged, prefilled cartridges, and 89% were primarily acquired from informal sources (e.g., friends, family members, illicit dealers, or off the street). In contrast, 77% of nicotine-containing products were sold as prefilled cartridges, and 83% were obtained from commercial vendors. The precise source of this outbreak is currently unknown (2); however, the predominant use of prefilled THC-containing cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. Given the diversity of products reported and frequency of patients using both THC- and nicotine-containing e-cigarette products, additional methods such as product testing and traceback could help identify the specific cause of this outbreak.


Assuntos
Surtos de Doenças , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Dronabinol/efeitos adversos , Feminino , Humanos , Illinois/epidemiologia , Masculino , Wisconsin/epidemiologia , Adulto Jovem
5.
Matern Child Health J ; 23(12): 1621-1626, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31620951

RESUMO

OBJECTIVE: To ascertain the relation of men's lifelong class status (as measured by neighborhood income) to the rates of early (< 34 weeks) and late (34-36 weeks) preterm birth (PTB). METHODS: Stratified and multilevel, multivariable binomial regression analyses were computed on the Illinois transgenerational birth-file of infants (born 1989-1991) and their parents (born 1956-1976) with appended U.S. census income information. The median family income of men's census tract residence at two-time periods were utilized to assess lifelong class status (defined by residence in either the lower or upper half of neighborhood income distribution). RESULTS: In Cook County Illinois, the preterm rate for births (n = 8115) to men with a lifelong lower class status was twice that of births (n = 10,330) to men with a lifelong upper class status: 13% versus 6.0%, RR = 2.2 (2.0, 2.4). This differential was greatest in early PTB rates: 3.9% versus 1.4%, RR = 3.0 (2.5, 3.7). The relation of men's lifelong class status to both PTB components persisted among non-teens, married, college-educated, and non-Latina White women, respectively. The adjusted (controlling for maternal demographic characteristics) RR of early and late PTB for men with a lifelong lower (versus upper) class status were 1.4 (1.1, 1.9) and 1.2 (1.0, 1.4), respectively. The population attributable risk of early PTB for men's lifelong lower class status equaled 16%. CONCLUSIONS: Men's lifelong lower (versus upper) class status is a novel risk factor for early preterm birth regardless of maternal demographic characteristics. This intriguing finding has public health relevance.


Assuntos
Pai/psicologia , Nascimento Prematuro/epidemiologia , Características de Residência , Classe Social , Adulto , Escolaridade , Feminino , Humanos , Illinois/epidemiologia , Renda , Recém-Nascido , Masculino , Idade Materna , Gravidez , População Urbana
6.
Dis Colon Rectum ; 62(11): 1344-1351, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31596761

RESUMO

BACKGROUND: Pouchitis is the most frequent complication after IPAA in patients with ulcerative colitis. Antibiotics represent the mainstay of treatment, suggesting a crucial role of dysbiosis in the pathogenesis of this condition. Anti-tumor necrosis factor agents have been shown to adversely impact the gut microbiome and local host immunity. OBJECTIVE: The aim of this study is to assess the effect of prior exposure to biologics on the development of pouchitis in patients who have ulcerative colitis. DESIGN: This is a retrospective case-control study. SETTINGS: This study was conducted at a tertiary-care IBD center. PATIENTS: Consecutive patients with ulcerative colitis who underwent restorative proctocolectomy between 2000 and 2010 were included. MAIN OUTCOME MEASURES: The primary outcome measured was the incidence of pouchitis. RESULTS: Four hundred seventeen patients with ulcerative colitis who underwent IPAA were included. The incidence of pouchitis was 40.4%. There were no differences in patient demographics, disease-specific factors, surgical approach, and short-term postoperative complications between patients who developed pouchitis compared to those that did not. Patients exposed to anti-tumor necrosis factor agents or preoperative steroids were significantly more likely to develop pouchitis (anti-tumor necrosis factor: 47.9% vs 36.5%, p = 0.027; steroids: 41.7% vs 23.3%, p = 0.048). However, on multivariable analysis, only anti-tumor necrosis factor therapy was an independent predictor for pouchitis (p = 0.05). Pouchitis was not associated with adverse long-term outcomes. LIMITATIONS: The retrospective design was a limitation of this study. CONCLUSION: In a large cohort of patients undergoing IPAA for ulcerative colitis with at least a 5-year follow-up, anti-tumor necrosis factor exposure was the only independent risk factor for the development of pouchitis. These agents may "precondition" the pouch to develop pouchitis through alterations in the microbiome and/or local host immunity of the terminal ileum. See Video Abstract at http://links.lww.com/DCR/B19. LA EXPOSICIÓN A MEDICAMENTOS ANTI-TNF AUMENTA LA INCIDENCIA DE POUCHITIS DESPUÉS DE LA PROCTOCOLECTOMÍA RESTAURADORA EN PACIENTES CON COLITIS ULCEROSA:: La pouchitis es la complicación más frecuente después de la anastomosis anal de bolsa ileal en pacientes con colitis ulcerosa. Los antibióticos representan el pilar del tratamiento, lo que sugiere un papel crucial de la disbiosis en la patogénesis de esta afección. Se ha demostrado que los agentes anti-TNF tienen un impacto adverso en la microbiota intestinal y en la inmunidad local del huésped.El objetivo de este estudio es evaluar el efecto de la exposición previa a terapía biológica sobre el desarrollo de la pouchitis en pacientes con colitis ulcerosa.Estudio retrospectivo de casos y controles.Centro de tercer nivel de atención en enfermedades inflamatorias intestinales.Pacientes consecutivos con colitis ulcerosa que se sometieron a proctocolectomía restaurativa entre 2000-2010.Incidencia de pouchitis.Cuatrocientos diecisiete pacientes con colitis ulcerativa se sometieron a anastomosis anal de bolsa ileal. La incidencia de pouchitis fue del 40.4%. No hubo diferencias en la demografía del paciente, los factores específicos de la enfermedad, el abordaje quirúrgico y las complicaciones postoperatorias a corto plazo entre los pacientes que desarrollaron pouchitis en comparación con los que no lo hicieron. Los pacientes expuestos a agentes anti-TNF o esteroides preoperatorios fueron significativamente más propensos a desarrollar pouchitis (anti-TNF: 47.9% vs 36.5%, p = 0.027; esteroides: 41.7% vs 23.3%, p = 0.048). Sin embargo, en el análisis multivariable, solo la terapia anti-TNF fue un predictor independiente para la pouchitis (p = 0.05). La pouchitis no se asoció con resultados adversos a largo plazo.Diseño retrospectivo.En una gran cohorte de pacientes sometidos a anastomosis anal de bolsa ileal para la colitis ulcerosa con al menos 5 años de seguimiento, la exposición a terapía anti-TNF fue el único factor de riesgo independiente para el desarrollo de pouchitis. Estos agentes pueden "precondicionar" la bolsa para desarrollar una pouchitis a través de alteraciones en el microbioma y / o inmunidad local del huésped del íleon terminal. Vea el Resumen del video en http://links.lww.com/DCR/B19.


Assuntos
Anti-Inflamatórios , Colite Ulcerativa , Complicações Pós-Operatórias , Pouchite , Proctocolectomia Restauradora , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Estudos de Casos e Controles , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Illinois/epidemiologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Pouchite/diagnóstico , Pouchite/epidemiologia , Pouchite/etiologia , Período Pré-Operatório , Proctocolectomia Restauradora/efeitos adversos , Proctocolectomia Restauradora/métodos , Medição de Risco , Fatores de Risco
7.
Comput Methods Programs Biomed ; 178: 145-153, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416543

RESUMO

BACKGROUND: Southern Illinois University School of Medicine (SIUSOM) collects large amounts of data every day. SIUSOM and other similar healthcare systems are always looking for better ways to use the data to understand and address population level problems. The purpose of this study is to analyze the administrative dataset for pediatric patients served by Southern Illinois University School of Medicine (SIUSOM) to uncover patterns that correlate specific demographic information to diagnoses of pediatric diseases. The study uses a cross-sectional database of medical billing information for all pediatric patients served by SIUSOM between June 2013 and December 2016. The dataset consists of about 980.9K clinical visits for 65.4K unique patients and includes patient demographic identifiers such as their sex, date of birth, race, anonymous zipcode and primary and secondary insurance plan as well as the related pediatric diagnosis codes. The goal is to find unknown correlations in this database. METHOD: We proposed a two step methodology to derive unknown correlations in SIUSOM administrative database. First, Class association rule mining was used as a well-established data mining method to generate hypothesis and derive associations of the form D → M, where D is diagnosis code of a pediatric disease and M is a patient demographic identifier (age,sex, anonymous zipcode, insurance plan, or race). The resulting associations were pruned and filtered using measures such as lift, odds ratio, relative risk, and confidence. The final associations were selected by a pediatric doctor based on their clinical significance. Second,each association rule in the final set was further validated and adjusted odds ratios were obtained using multiple logistic regression. RESULTS: Several associations were found correlating specific patients' residential zip codes with the diagnosis codes for viral hepatitis carrier, exposure to communicable diseases, screening for mental and developmental disorder in childhood, history allergy to medications, disturbance of emotions specific to childhood, and acute sinusitis. In addition, the results show that African American patients are more likely to be screened for mental and developmental disorders compared to White patients for SIUSOM pediatric population (Odds Ratio (OR):3.56, 95% Confidence Interval (CI):[3.29,3.85]). CONCLUSION: Class association rule mining is an effective method for detecting signals in a large patient administrative database and generating hypotheses which correlate patients' demographics with diagnosis of pediatric diseases. A post processing of the hypotheses generated by this method is necessary to prune spurious associations and select a set of clinically relevant hypotheses.


Assuntos
Mineração de Dados/métodos , Pediatria/organização & administração , Adolescente , Algoritmos , Criança , Pré-Escolar , Doenças Transmissíveis/epidemiologia , Estudos Transversais , Interpretação Estatística de Dados , Bases de Dados Factuais , Deficiências do Desenvolvimento/epidemiologia , Grupos Étnicos , Feminino , Hepatite/epidemiologia , Humanos , Illinois/epidemiologia , Lactente , Recém-Nascido , Masculino , Transtornos Mentais/epidemiologia , Análise de Regressão , Características de Residência , Estudos Retrospectivos
8.
BMC Public Health ; 19(1): 1010, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357967

RESUMO

BACKGROUND: Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. METHODS: A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. RESULTS: After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. CONCLUSIONS: Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.


Assuntos
Acidentes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/terapia , Comércio/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Menores de Idade/legislação & jurisprudência , Consumo de Álcool por Menores/legislação & jurisprudência , Ferimentos e Lesões/terapia , Adolescente , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Concentração Alcoólica no Sangue , Criança , Feminino , Humanos , Illinois/epidemiologia , Masculino , Menores de Idade/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
9.
Emerg Infect Dis ; 25(8): 1445-1451, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310217

RESUMO

In the United States, fatal transfusion-transmitted infections from red blood cell units are rare. Although this pattern mostly reflects how inhospitable refrigerated red blood cell units are to contaminant growth, fatalities caused by microorganisms that can grow at storage temperature (4°C), but not in standard clinical blood cultures at 37°C, are probably underestimated. We analyzed a fatal red blood cell transfusion in Peoria, Illinois, USA, that occurred in 2017. Samples from the patient's whole blood and the red blood cell unit remained culture-negative during the investigation, despite direct visualization of gram-negative bacilli within the unit immediately after transfusion. We identified the bacteria as Pseudomonas poae, a nonpathogenic pseudomonad carrying multiple cold-shock domain protein genes, and confirmed its cold tolerance and inability to grow at 37°C. Our work indicates transfusion reaction workups need to include testing for psychrophilic organisms, which could explain the cause of other apparently culture-negative transfusion reactions.


Assuntos
Transfusão de Sangue , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etiologia , Pseudomonas , Sepse/diagnóstico , Sepse/etiologia , Reação Transfusional/diagnóstico , Transfusão de Eritrócitos/efeitos adversos , Evolução Fatal , Feminino , Humanos , Illinois/epidemiologia , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Filogenia , Pseudomonas/classificação , Pseudomonas/genética , Pseudomonas/isolamento & purificação , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/transmissão , RNA Ribossômico 16S/genética , Sepse/epidemiologia , Sepse/transmissão , Reação Transfusional/epidemiologia
10.
J Forensic Sci ; 64(6): 1735-1742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216059

RESUMO

The National Institute on Drug Abuse has observed an increase in fentanyl deaths in the United States. One epidemic related to the abuse of fentanyl happened in Cook County in 2005-2007 (350 deaths). Another outbreak of fentanyl deaths occurred in 2015-2017 in the same area. The database of the Cook County Medical Examiner's Office was searched for cases of fentanyl deaths between 2015 and 2017: 1244 deaths were found. A comparison was performed with the previous data: an increase in the number of females was observed in 2015-2017. Also, in 2005-2007, the majority of deaths occurred among African American, while in 2015-2017, Caucasians were more involved. Within our population, some drug combinations were more common in specific demographic subgroups (male/females; Caucasian/African American; and certain age groups). The epidemiology and the most significant drug associations found at the toxicology are discussed, highlighting the usefulness of the knowledge about this outbreak for public health.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Fentanila/envenenamento , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Analgésicos Opioides/análise , Depressores do Sistema Nervoso Central/análise , Médicos Legistas , Etanol/análise , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Fentanila/análogos & derivados , Fentanila/análise , Humanos , Illinois/epidemiologia , Rim/química , Fígado/química , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/química , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
11.
Cancer Causes Control ; 30(9): 967-978, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236792

RESUMO

PURPOSE: Although the incidence rate of epithelial ovarian cancer (EOC) is somewhat lower in African American (AA) than white women, survival is worse. The Ovarian Cancer in Women of African Ancestry (OCWAA) consortium will overcome small, study-specific sample sizes to better understand racial differences in EOC risk and outcomes. METHODS: We harmonized risk factors and prognostic characteristics from eight U.S. STUDIES: the North Carolina Ovarian Cancer Study (NCOCS), the Los Angeles County Ovarian Cancer Study (LACOCS), the African American Cancer Epidemiology Study (AACES), the Cook County Case-Control Study (CCCCS), the Black Women's Health Study (BWHS), the Women's Health Initiative (WHI), the Multiethnic Cohort Study (MEC), and the Southern Community Cohort Study (SCCS). RESULTS: Determinants of disparities for risk and survival in 1,146 AA EOC cases and 2,922 AA controls will be compared to 3,368 white EOC cases and 10,270 white controls. Analyses include estimation of population-attributable risk percent (PAR%) by race. CONCLUSION: OCWAA is uniquely positioned to study the epidemiology of EOC in AA women compared with white women to address disparities. Studies of EOC have been underpowered to address factors that may explain AA-white differences in the incidence and survival. OCWAA promises to provide novel insight into disparities in ovarian cancer.


Assuntos
Neoplasias Ovarianas/etnologia , Neoplasias Ovarianas/epidemiologia , Adulto , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Illinois/epidemiologia , Incidência , Pessoa de Meia-Idade , North Carolina/epidemiologia , Fatores de Risco , Estados Unidos , Adulto Jovem
12.
Ticks Tick Borne Dis ; 10(5): 1162-1167, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31248821

RESUMO

Lyme borreliosis is the most commonly reported vector-borne disease in the United States and Europe. It is caused by a group of spirochete bacteria belonging to the Borrelia burgdorferi sensu lato complex. These pathogens are transmitted among vertebrate reservoir hosts through the bite of hard-bodied ticks. While the enzootic cycle of Borrelia transmission is well understood in its primary reservoir, the white-footed mouse, Peromyscus leucopus, far less is known about other reservoir hosts, particularly in grassland ecosystems. This study assessed the prevalence of B. burgdorferi s. l. among four non-Peromyscus rodents in a prairie ecosystem in the Midwestern United States over a four-year period. We found high prevalences of the bacteria in all four species studied. Our results help to support the roles of Microtus species as reservoirs of B. burgdorferi and add to the literature that suggests Zapus hudsonius may also be a reservoir. Additionally, we identified a previously unknown possible reservoir, Ictidomys tridecemlineatus. Our study also identifies the need to study the dynamics of Lyme borreliosis in habitats and areas outside of the typical range of P. leucopus.


Assuntos
Borrelia burgdorferi/fisiologia , Reservatórios de Doenças/veterinária , Doença de Lyme/veterinária , Doenças dos Roedores/epidemiologia , Roedores , Infestações por Carrapato/veterinária , Animais , Arvicolinae , Reservatórios de Doenças/microbiologia , Pradaria , Illinois/epidemiologia , Doença de Lyme/epidemiologia , Doença de Lyme/microbiologia , Doenças dos Roedores/microbiologia , Doenças dos Roedores/parasitologia , Sciuridae , Infestações por Carrapato/epidemiologia , Infestações por Carrapato/parasitologia
14.
Ann Thorac Surg ; 108(2): 552-557, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30928551

RESUMO

BACKGROUND: The 15-mm mechanical valve was approved by the US Food and Drug Administration in March 2018. We review our experience in infants with this valve in the mitral position (MV), focusing on outcomes and timing to repeat MV replacement (MVR). METHODS: Between 2006 and 2017 7 patients underwent eight MVRs (one repeat) with a 15-mm mechanical valve. Retrospective chart review was performed to examine short- and long-term outcomes. RESULTS: There were no operative deaths. Mean follow-up was 5.8 ± 4.8 years (range, 0.72 to 11.1). Six patients underwent an MV operation 53 ± 39 days (range, 9 to 118) before MVR with the 15-mm valve. All patients were on mechanical ventilatory support at the time of operation. Mean age, body weight, and body surface area at time of 15-mm MVR were 0.5 ± 0.3 years (range, 0.2 to 0.9), 5.6 ± 0.8 kg (range, 4.8 to 6.6), and 0.29 ± 0.03 m2 (range, 0.27 to 0.32), respectively. Two patients required pacemaker implantation for atrioventricular block, both after their second MVR. Two patients are well at 16 and 24 months. Four patients underwent repeat MVR because of somatic growth and patient-prosthesis mismatch. Mean time to repeat MVR was 23 months (range, 6 to 40). There were two late deaths, one at 10 months unrelated to the valve in a child with a chromosomal abnormality. The other child had a congenital diaphragmatic hernia, early valve thrombosis, and died of multiple complications after a fourth MVR. CONCLUSIONS: The 15-mm mechanical valve was useful in treating MV disease in infants 2 to 12 months of age. This newly approved smallest available mechanical valve has a predicted mean time to replacement of 23 months in the mitral position.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Ecocardiografia , Feminino , Humanos , Illinois/epidemiologia , Incidência , Lactente , Masculino , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/congênito , Insuficiência da Valva Mitral/diagnóstico , Estenose da Valva Mitral/congênito , Estenose da Valva Mitral/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
15.
Artigo em Inglês | MEDLINE | ID: mdl-30893862

RESUMO

Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings. Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prática de Saúde Pública , População Rural , Sistemas de Informação Geográfica , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Illinois/epidemiologia
16.
Int J Health Serv ; 49(3): 606-622, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30898002

RESUMO

There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement-related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.


Assuntos
Aplicação da Lei , Violência , Ferimentos e Lesões/epidemiologia , Adulto , Fatores Etários , Grupos Étnicos , Feminino , Humanos , Illinois/epidemiologia , Masculino , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Ferimentos e Lesões/etnologia , Ferimentos e Lesões/mortalidade
17.
J Parasitol ; 105(2): 232-236, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30908117

RESUMO

Haemosporidian parasites are widespread in birds and are commonly used to evaluate ecological, evolutionary, and behavioral consequences of pathogen infection. While haemosporidian parasites may be important agents of selection, information on the incidence and outcomes of infection in many wild birds remains incomplete and warrants further inquiry. We examined the prevalence and costs of haemosporidian parasites in a wild population of dickcissels ( Spiza americana; n = 170) breeding in central Illinois. Over 2 breeding seasons, prevalence of haemosporidian parasites was 41% and was similar between sexes and years. Within each sex, there was no association between proxies of fitness (body condition and number of fledglings produced) and infection status. While we found no evidence that haemosporidian parasites have a direct, negative impact on dickcissels, we discuss how extra-pair paternity and changes across the life cycle of dickcissels and haemosporidian parasites may have masked or prevented detection of negative effects in our study. Ultimately our findings contribute to a growing literature providing improved clarity on how and when parasite infections can negatively impact wild host organisms and can aid in guiding future work examining such associations.


Assuntos
Doenças das Aves/parasitologia , Haemosporida/fisiologia , Passeriformes/parasitologia , Infecções Protozoárias em Animais/epidemiologia , Animais , Feminino , Illinois/epidemiologia , Masculino
18.
PLoS One ; 14(2): e0212087, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30742677

RESUMO

Youth gambling is an increasing concern. As a response, the "Don't Gamble Away our Future (DGAOF)" program has been implemented among children in central Illinois. We aim to assess the long-term effectiveness of this school-based youth gambling prevention program in Illinois using the data from 2005 to 2009. The intervention included interactive PowerPoint presentations and prevention materials in parent packets. Students aged 8 to 18 years were eligible to participate in the intervention and the questionnaire pre-post knowledge tests (total score 0-9). Students in 5th grade and above also received a gambling behavior screen test using the Modified South Oaks Gambling Screening for Teens (MSOGST) for identifying probable gamblers. Multivariable generalized mixed models were conducted to detect the effects of a 5-year youth gambling prevention program as controlling potential confounders. A total of 16,262 and 16,421 students completed pre-post tests and MSOGST tests, respectively. Of 16,262, half were female, the majority (76.1%) were from senior high school, and 21.3% received the intervention at least twice. The median gap between interventions was 368 days. Students receiving multiple interventions had higher scores on the pre-test as compared to those receiving a single intervention (P<0.001 for all comparisons among groups), and they demonstrated an increasing trend of awareness about gambling over time (P<0.001 for multiple interventions; P = 0.538 for single intervention). The prevalence of problem gambling had decreased among students receiving the intervention twice as compared to receiving the intervention once (7.9% versus 9.4%; OR = 0.89, 95% CL: 0.82-0.97). However, this effect was not confirmed among students receiving the intervention three or more times. In conclusion, the DGAOF program has demonstrated a positive long-term impact on increasing gambling knowledge and partially reducing pathological gamblers through direct training. It suggests that multiple repeated interventions are important for youth gambling prevention.


Assuntos
Terapia Comportamental , Jogo de Azar/terapia , Adolescente , Comportamento do Adolescente/fisiologia , Terapia Comportamental/métodos , Terapia Comportamental/organização & administração , Criança , Aconselhamento/métodos , Aconselhamento/organização & administração , Eficiência Organizacional , Feminino , Seguimentos , Jogo de Azar/epidemiologia , Jogo de Azar/prevenção & controle , Humanos , Illinois/epidemiologia , Masculino , Serviços de Saúde Escolar/organização & administração , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
19.
MMWR Morb Mortal Wkly Rep ; 68(7): 177-180, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30789880

RESUMO

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that can occur following prenatal exposure to opioids (1). NAS surveillance in the United States is based largely on diagnosis codes in hospital discharge data, without validation of these codes or case confirmation. During 2004-2014, reported NAS incidence increased from 1.5 to 8.0 per 1,000 U.S. hospital births (2), based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes identified in hospital discharge data, without case confirmation. However, little is known about how well these codes identify NAS or how the October 1, 2015, transition from ICD-9-CM to the tenth revision of ICD-CM (ICD-10-CM) codes affected estimated NAS incidence. This report describes a pilot project in Illinois, New Mexico, and Vermont to use birth defects surveillance infrastructure to obtain state-level, population-based estimates of NAS incidence among births in 2015 (all three states) and 2016 (Illinois) using hospital discharge records and other sources (varied by state) with case confirmation, and to evaluate the validity of NAS diagnosis codes used by each state. Wide variation in NAS incidence was observed across the three states. In 2015, NAS incidence for Illinois, New Mexico, and Vermont was 3.0, 7.5, and 30.8 per 1,000 births, respectively. Among evaluated diagnosis codes, those with the highest positive predictive values (PPVs) for identifying confirmed cases of NAS, based on a uniform case definition, were drug withdrawal syndrome in a newborn (ICD-9-CM code 779.5; state range = 58.6%-80.2%) and drug withdrawal, infant of dependent mother (ICD-10-CM code P96.1; state range = 58.5%-80.2%). The methods used to assess NAS incidence in this pilot project might help inform other states' NAS surveillance efforts.


Assuntos
Anormalidades Congênitas/epidemiologia , Síndrome de Abstinência Neonatal/epidemiologia , Vigilância da População/métodos , Humanos , Illinois/epidemiologia , Recém-Nascido , New Mexico/epidemiologia , Vermont/epidemiologia
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