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Krause JS, Dismuke-Greer CE, DiPiro ND, Clark JMR, Laursen-Roesler J. Relationships of Self-reported Opioid Use and Misuse and Pain Severity With Probable Major Depression Among Participants With Spinal Cord Injury. Arch Phys Med Rehabil 2024:S0003-9993(24)00890-6. [PMID: 38527688 DOI: 10.1016/j.apmr.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/24/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To examine the relations of pain intensity, opioid use, and opioid misuse with depressive symptom severity and probable major depression (PMD) among participants with spinal cord injuries (SCI), controlling for demographic, injury, and socioeconomic characteristics. STUDY DESIGN Cohort study. SETTING Medical University in the Southeastern United States (US). PARTICIPANTS Participants (N=918) were identified from 1 of 2 sources including a specialty hospital and a state-based surveillance system in the Southeastern US. Participants were a minimum of 18 years old at enrollment and had SCI with non-complete recovery. Participants were on average 57.5 years old at the time of the study and an average of 24.4 years post SCI onset. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed a self-report assessment that included frequency of prescription opioid use and misuse, based on the National Survey on Drug Use and Health (NSDUH), and the PHQ - 9 to measure depressive symptom severity and PMD. RESULTS Opioid use, opioid misuse, and pain intensity were related to elevated depressive symptom severity and higher odds of PMD. Non-Hispanic Blacks had fewer depressive symptoms and lower odds of PMD, as did those with higher incomes. Veterans had lower risk of PMD, whereas ambulatory participants had a higher risk of PMD. Age at SCI onset had a mixed pattern of significance, whereas years of education and years since injury were not significant. CONCLUSIONS The relation between pain intensity with depressive symptom severity and PMD was profound, consistent with the biopsychosocial model of pain. The greater risk of PMD and higher depressive symptom severity among those using opioids and misusing opioids raises further concern about long-term prescription opioid use. Alternative treatments are needed.
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Affiliation(s)
- James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC.
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, Palo Alto Veterans Affairs Health Care, Menlo Park, CA
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Jillian M R Clark
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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2
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Colucci M, Fonzo M, Miccolis L, Amoruso I, Mondino S, Trevisan A, Cazzaro R, Baldovin T, Bertoncello C. Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6822. [PMID: 37835091 PMCID: PMC10572455 DOI: 10.3390/ijerph20196822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Tick-borne diseases (TBD) are endemic in Europe. However, surveillance is currently incomplete. Alternative strategies need to be considered. The aim of this study was to test an Emergency Department Syndromic Surveillance (EDSyS) system as a complementary data source to describe the impact of tick bites and TBD using a small-area analysis approach and to monitor the risk of TBD to target prevention. ED databases in the Local Health Authority 8 District (Veneto, Italy) were queried for tick-bite and TBD-related visits between January 2017 and December 2022. Hospitalisations were also collected. Events involving the resident population were used to calculate incidence rates. A total of 4187 ED visits for tick-bite and 143 for TBD were recorded; in addition, 62 TBD-related hospitalisations (of which 72.6% in over 50 s and 22.6% in over 65 s). ED visits peaked in spring and in autumn, followed by a 4-week lag in the increase in hospital admissions. The small-area analysis identified two areas at higher risk of bites and TBD. The use of a EDSyS system allowed two natural foci to be identified. This approach proved useful in predicting temporal and geographic risk of TBD and in identifying local endemic areas, thus enabling an effective multidisciplinary prevention strategy.
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Affiliation(s)
- Massimiliano Colucci
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Marco Fonzo
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Liana Miccolis
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Irene Amoruso
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Sara Mondino
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Andrea Trevisan
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Romina Cazzaro
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Chiara Bertoncello
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
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Sandifer PA. Linking coastal environmental and health observations for human wellbeing. Front Public Health 2023; 11:1202118. [PMID: 37780424 PMCID: PMC10540068 DOI: 10.3389/fpubh.2023.1202118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries.
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Affiliation(s)
- Paul A. Sandifer
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC, United States
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4
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Pickens CM, Scholl L, Liu S, Smith H, Snodgrass S. Development and Validation of a Syndrome Definition for Suspected Nonfatal Unintentional/Undetermined Intent Stimulant-Involved Overdoses. Public Health Rep 2022; 137:1079-1090. [PMID: 34727510 PMCID: PMC9574309 DOI: 10.1177/00333549211054489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To monitor stimulant-involved overdose (SOD) trends, the Centers for Disease Control and Prevention (CDC) developed and evaluated the validity of a syndromic surveillance definition for suspected nonfatal, unintentional/undetermined intent stimulant-involved overdose (UUSOD). METHODS We analyzed all emergency department (ED) visits in CDC's surveillance system that met the UUSOD syndrome definition (January 2018-December 2019). We classified visits as true positive, possible, or not UUSODs after reviewing diagnosis codes and chief complaints. We first assessed whether visits were acute SODs, subsequently classifying acute SODs by intent. The percentage of true-positive UUSODs did not include intentional or possibly intentional visits. We considered all visits with UUSOD diagnosis codes to be acute SODs and reviewed them for intent. We manually reviewed and double-coded a 10% random sample of visits without UUSOD diagnosis codes using decision rules based on signs and symptoms. The overall percentage of true-positive UUSODs was a weighted average of the percentage of true-positive UUSODs based on diagnosis codes and the percentage of true-positive UUSODs determined by manually reviewing visits without codes. RESULTS During 2018-2019, 40 045 ED visits met the syndrome definition for UUSOD. Approximately half (n = 18 793; 46.9%) of 40 045 visits had UUSOD diagnosis codes, indicating acute SOD; of these, 98.6% (n = 18 534) were true-positive UUSODs. Of 2125 manually reviewed visits without UUSOD diagnosis codes, 32.6% (n = 693) were true-positive UUSODs, 54.2% (n = 1151) were possible UUSODs, and 13.2% (n = 281) were not UUSODs. Overall, 63.6% of visits were true-positive UUSODs, 29.3% were possible UUSODs, and 7.1% were not UUSODs. PRACTICE IMPLICATIONS CDC's UUSOD definition may assist in surveillance efforts with further refinement to capture data on SOD clusters and trends.
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Affiliation(s)
- Cassandra M. Pickens
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lawrence Scholl
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Liu
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Herschel Smith
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Stephanie Snodgrass
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
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5
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Anderson KN, Swedo EA, Clayton HB, Niolon PH, Shelby D, McDavid Harrison K. Building Infrastructure for Surveillance of Adverse and Positive Childhood Experiences: Integrated, Multimethod Approaches to Generate Data for Prevention Action. Am J Prev Med 2022; 62:S31-S39. [PMID: 35597581 PMCID: PMC9210215 DOI: 10.1016/j.amepre.2021.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 12/01/2022]
Abstract
Adverse and positive childhood experiences have a profound impact on lifespan health and well-being. However, their incorporation into ongoing population-based surveillance systems has been limited. This paper outlines critical steps in building a comprehensive approach to adverse and positive childhood experiences surveillance, provides examples from the Preventing Adverse Childhood Experiences: Data to Action cooperative agreement, and describes improvements needed to optimize surveillance data for action. Components of a comprehensive approach to adverse and positive childhood experiences surveillance include revisiting definitions and measurement, including generating and using uniform definitions for adverse and positive childhood experiences across data collection efforts; conducting youth-based surveillance of adverse and positive childhood experiences; using innovative methods to gather and analyze near real-time data; leveraging available data, including from administrative sources; and integrating data on community- and societal-level risk and protective factors for adverse childhood experiences, including social and health inequities such as racism and poverty, as well as policies and conditions that create healthy environments for children and families. Comprehensive surveillance data on adverse and positive childhood experiences can inform data-driven prevention and intervention efforts, including focusing prevention programming and services to populations in greatest need. Data can be used to evaluate progress in reducing the occurrence of adverse childhood experiences and bolstering the occurrence of positive childhood experiences. Through expansion and improvement in adverse and positive childhood experiences surveillance-including at federal, state, territorial, tribal, and local levels-data-driven action can reduce children's exposure to violence and other adversities and improve lifelong health and well-being.
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Affiliation(s)
- Kayla N Anderson
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Elizabeth A Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather B Clayton
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phyllis Holditch Niolon
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel Shelby
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen McDavid Harrison
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, Atlanta, Georgia
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6
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Vaidyanathan U, Sun Y, Shekel T, Chou K, Galea S, Gabrilovich E, Wellenius GA. An evaluation of Internet searches as a marker of trends in population mental health in the US. Sci Rep 2022; 12:8946. [PMID: 35624317 PMCID: PMC9136741 DOI: 10.1038/s41598-022-12952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
The absence of continuous, real-time mental health assessment has made it challenging to quantify the impacts of the COVID-19 pandemic on population mental health. We examined publicly available, anonymized, aggregated data on weekly trends in Google searches related to anxiety, depression, and suicidal ideation from 2018 to 2020 in the US. We correlated these trends with (1) emergency department (ED) visits for mental health problems and suicide attempts, and (2) surveys of self-reported symptoms of anxiety, depression, and mental health care use. Search queries related to anxiety, depression, and suicidal ideation decreased sharply around March 2020, returning to pre-pandemic levels by summer 2020. Searches related to depression were correlated with the proportion of individuals reporting receiving therapy (r = 0.73), taking medication (r = 0.62) and having unmet mental healthcare needs (r = 0.57) on US Census Household Pulse Survey and modestly correlated with rates of ED visits for mental health conditions. Results were similar when considering instead searches for anxiety. Searches for suicidal ideation did not correlate with external variables. These results suggest aggregated data on Internet searches can provide timely and continuous insights into population mental health and complement other existing tools in this domain.
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Affiliation(s)
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | | | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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7
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Zhou X, Lee EWJ, Wang X, Lin L, Xuan Z, Wu D, Lin H, Shen P. Infectious diseases prevention and control using an integrated health big data system in China. BMC Infect Dis 2022; 22:344. [PMID: 35387590 PMCID: PMC8984075 DOI: 10.1186/s12879-022-07316-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 03/28/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Yinzhou Center for Disease Prevention and Control (CDC) in China implemented an integrated health big data platform (IHBDP) that pooled health data from healthcare providers to combat the spread of infectious diseases, such as dengue fever and pulmonary tuberculosis (TB), and to identify gaps in vaccination uptake among migrant children. METHODS IHBDP is composed of medical data from clinics, electronic health records, residents' annual medical checkup and immunization records, as well as administrative data, such as student registries. We programmed IHBDP to automatically scan for and detect dengue and TB carriers, as well as identify migrant children with incomplete immunization according to a comprehensive set of screening criteria developed by public health and medical experts. We compared the effectiveness of the big data screening with existing traditional screening methods. RESULTS IHBDP successfully identified six cases of dengue out of a pool of 3972 suspected cases, whereas the traditional method only identified four cases (which were also detected by IHBDP). For TB, IHBDP identified 288 suspected cases from a total of 43,521 university students, in which three cases were eventually confirmed to be TB carriers through subsequent follow up CT or T-SPOT.TB tests. As for immunization screenings, IHBDP identified 240 migrant children with incomplete immunization, but the traditional door-to-door screening method only identified 20 ones. CONCLUSIONS Our study has demonstrated the effectiveness of using IHBDP to detect both acute and chronic infectious disease patients and identify children with incomplete immunization as compared to traditional screening methods.
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Affiliation(s)
- Xudong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China. .,Institute of Social & Family Medicine, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China.
| | - Edmund Wei Jian Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, WKWSCI Building, Singapore, 637718, Singapore
| | - Xiaomin Wang
- Institute of Social & Family Medicine, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China
| | - Leesa Lin
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Dan Wu
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hongbo Lin
- Yinzhou Center for Disease Prevention and Control, 1221 Xueshi Road, Ningbo, 315100, Zhejiang, China.
| | - Peng Shen
- Yinzhou Center for Disease Prevention and Control, 1221 Xueshi Road, Ningbo, 315100, Zhejiang, China.
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8
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Romano S, Yusuf H, Davis C, Thomas MJ, Grigorescu V. An Evaluation of Syndromic Surveillance-Related Practices Among Selected State and Local Health Agencies. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:109-115. [PMID: 32496404 DOI: 10.1097/phh.0000000000001216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONTEXT Syndromic surveillance consists of the systematic collection and use of near real-time data about health-related events for situational awareness and public health action. As syndromic surveillance programs continue to adopt new technologies and expand, it is valuable to evaluate these syndromic surveillance systems and practices to ensure that they meet public health needs. OBJECTIVE This assessment's aim is to provide recent information about syndromic surveillance systems and practice characteristics among a group of state and local health departments. DESIGN/SETTING Information was obtained between November 2017 and June 2018 through a telephone survey using an Office of Management and Budget-approved standardized data collection tool. Participants were syndromic surveillance staff from each of 31 state and local health departments participating in the National Syndromic Surveillance Program funded by the Centers for Disease Control and Prevention. Questions included jurisdictional experience, data sources and analysis systems used, syndromic system data processing characteristics, data quality verification procedures, and surveillance activities conducted with syndromic data. MEASURES Practice-specific information such as types of systems and data sources used for syndromic surveillance, data quality monitoring, and uses of data for public health situational awareness (eg, investigating occurrences of or trends in diseases). RESULTS The survey analysis revealed a wide range of experiences with syndromic surveillance. Participants reported the receipt of data daily or more frequently. Emergency department data were the primary data source; however, other data sources are being integrated into these systems. All health departments routinely monitored data quality. Syndromes of highest priority across the respondents for health events monitoring were influenza-like illness and drug-related syndromes. However, a wide variety of syndromes were reported as priorities across the health departments. CONCLUSION Overall, syndromic surveillance was relevantly integrated into the public health surveillance infrastructure. The near real-time nature of the data and its flexibility to monitor different types of health-related issues make it especially useful for public health practitioners. Despite these advances, syndromic surveillance capacity, locally and nationally, must continue to evolve and progress should be monitored to ensure that syndromic surveillance systems and data are optimally able to meet jurisdictional needs.
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Affiliation(s)
- Sebastian Romano
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Zwald ML, Holland KM, Bowen DA, Simon TR, Dahlberg LL, Stein Z, Idaikkadar N, Mercy JA. Using the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program Data to Monitor Trends in US Emergency Department Visits for Firearm Injuries, 2018 to 2019. Ann Emerg Med 2022; 79:465-473. [DOI: 10.1016/j.annemergmed.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
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10
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Rock PJ, Quesinberry D, Singleton MD, Slavova S. Emergency Medical Services and Syndromic Surveillance: A Comparison With Traditional Surveillance and Effects on Timeliness. Public Health Rep 2021; 136:72S-79S. [PMID: 34726974 DOI: 10.1177/00333549211018673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Traditional public health surveillance of nonfatal opioid overdose relies on emergency department (ED) billing data, which can be delayed substantially. We compared the timeliness of 2 new data sources for rapid drug overdose surveillance-emergency medical services (EMS) and syndromic surveillance-with ED billing data. METHODS We used data on nonfatal opioid overdoses in Kentucky captured in EMS, syndromic surveillance, and ED billing systems during 2018-2019. We evaluated the time-series relationships between EMS and ED billing data and syndromic surveillance and ED billing data by calculating cross-correlation functions, controlling for influences of autocorrelations. A case example demonstrates the usefulness of EMS and syndromic surveillance data to monitor rapid changes in opioid overdose encounters in Kentucky during the COVID-19 epidemic. RESULTS EMS and syndromic surveillance data showed moderate-to-strong correlation with ED billing data on a lag of 0 (r = 0.694; 95% CI, 0.579-0.782; t = 9.73; df = 101; P < .001; and r = 0.656; 95% CI, 0.530-0.754; t = 8.73; df = 101; P < .001; respectively) at the week-aggregated level. After the COVID-19 emergency declaration, EMS and syndromic surveillance time series had steep increases in April and May 2020, followed by declines from June through September 2020. The ED billing data were available for analysis 3 months after the end of a calendar quarter but closely followed the trends identified by the EMS and syndromic surveillance data. CONCLUSION Data from EMS and syndromic surveillance systems can be reliably used to monitor nonfatal opioid overdose trends in Kentucky in near-real time to inform timely public health response.
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Affiliation(s)
- Peter J Rock
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- 50880 Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, USA
| | - Dana Quesinberry
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Michael D Singleton
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Svetla Slavova
- 4530 Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
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11
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Affiliation(s)
- Brooke E Hoots
- 1242 Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.,United States Public Health Service, Rockville, MD, USA
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12
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Scholl L, Liu S, Vivolo-Kantor A, Board A, Stein Z, Roehler DR, McGlone L, Hoots BE, Mustaquim D, Smith H. Development and Validation of a Syndrome Definition to Identify Suspected Nonfatal Heroin-Involved Overdoses Treated in Emergency Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:369-378. [PMID: 33346583 DOI: 10.1097/phh.0000000000001271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The Centers for Disease Control and Prevention (CDC) works closely with states and local jurisdictions that are leveraging data from syndromic surveillance systems to identify meaningful changes in overdose trends. CDC developed a suspected nonfatal heroin overdose syndrome definition for use with emergency department (ED) data to help monitor trends at the national, state, and local levels. OBJECTIVE This study assesses the percentage of true-positive unintentional and undetermined intent heroin-involved overdose (UUHOD) captured by this definition. DESIGN/SETTING CDC applied the UUHOD definition to ED data available in CDC's National Syndromic Surveillance Program (NSSP). Data were analyzed from 18 states that shared access to their syndromic data in NSSP with the CDC overdose morbidity team. Data were analyzed using queries and manual reviews to identify heroin overdose diagnosis codes and text describing chief complaint reasons for ED visits. MEASURES The percentage of true-positive UUHOD was calculated as the number of true-positives divided by the number of total visits captured by the syndrome definition. RESULTS In total, 99 617 heroin overdose visits were identified by the syndrome definition. Among 95 323 visits identified as acute heroin-involved overdoses, based on reviews of chief complaint text and diagnosis codes, 967 (1.0%) were classified as possible intentional drug overdoses. Among all 99 617 visits, 94 356 (94.7%) were classified as true-positive UUHOD; 2226 (2.2%) and 3035 (3.0%) were classified as "no" and "maybe" UUHOD, respectively. CONCLUSION Analysis of the CDC heroin overdose syndrome definition determined that nearly all visits were captured accurately for patients presenting to the ED for a suspected acute UUHOD. This definition will continue to be valuable for ongoing heroin overdose surveillance and epidemiologic analysis of heroin overdose patterns. CDC will evaluate possible definition refinements as new products and terms for heroin overdose emerge.
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Affiliation(s)
- Lawrence Scholl
- Division of Overdose Prevention, National Center for Injury Prevention and Control (Drs Scholl, Liu, Vivolo-Kantor, Board, Roehler, and Hoots, Messrs McGlone and Smith, and Ms Mustaquim), Epidemic Intelligence Service (Dr Board), and Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (Mr Stein), Centers for Disease Control and Prevention, Atlanta, Georgia; ICF, Atlanta, Georgia (Mr Stein); 2M Research, Dallas/Fort Worth, Texas (Mr McGlone); and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee (Mr Smith)
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13
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Aliabadi A, Sheikhtaheri A, Ansari H. Electronic health record-based disease surveillance systems: A systematic literature review on challenges and solutions. J Am Med Inform Assoc 2021; 27:1977-1986. [PMID: 32929458 DOI: 10.1093/jamia/ocaa186] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/20/2020] [Accepted: 07/22/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Disease surveillance systems are expanding using electronic health records (EHRs). However, there are many challenges in this regard. In the present study, the solutions and challenges of implementing EHR-based disease surveillance systems (EHR-DS) have been reviewed. MATERIALS AND METHODS We searched the related keywords in ProQuest, PubMed, Web of Science, Cochrane Library, Embase, and Scopus. Then, we assessed and selected articles using the inclusion and exclusion criteria and, finally, classified the identified solutions and challenges. RESULTS Finally, 50 studies were included, and 52 unique solutions and 47 challenges were organized into 6 main themes (policy and regulatory, technical, management, standardization, financial, and data quality). The results indicate that due to the multifaceted nature of the challenges, the implementation of EHR-DS is not low cost and easy to implement and requires a variety of interventions. On the one hand, the most common challenges include the need to invest significant time and resources; the poor data quality in EHRs; difficulty in analyzing, cleaning, and accessing unstructured data; data privacy and security; and the lack of interoperability standards. On the other hand, the most common solutions are the use of natural language processing and machine learning algorithms for unstructured data; the use of appropriate technical solutions for data retrieval, extraction, identification, and visualization; the collaboration of health and clinical departments to access data; standardizing EHR content for public health; and using a unique health identifier for individuals. CONCLUSIONS EHR systems have an important role in modernizing disease surveillance systems. However, there are many problems and challenges facing the development and implementation of EHR-DS that need to be appropriately addressed.
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Affiliation(s)
- Ali Aliabadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ansari
- Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
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14
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Holland KM, Jones C, Vivolo-Kantor AM, Idaikkadar N, Zwald M, Hoots B, Yard E, D’Inverno A, Swedo E, Chen MS, Petrosky E, Board A, Martinez P, Stone DM, Law R, Coletta MA, Adjemian J, Thomas C, Puddy RW, Peacock G, Dowling NF, Houry D. Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. JAMA Psychiatry 2021; 78:372-379. [PMID: 33533876 PMCID: PMC7859873 DOI: 10.1001/jamapsychiatry.2020.4402] [Citation(s) in RCA: 360] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. OBJECTIVE To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. MAIN OUTCOMES AND MEASURES Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. RESULTS From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV. CONCLUSIONS AND RELEVANCE These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.
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Affiliation(s)
- Kristin M. Holland
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alana M. Vivolo-Kantor
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimi Idaikkadar
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa Zwald
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia,Commissioned Corps, US Public Health Service, Atlanta, Georgia
| | - Brooke Hoots
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia,Commissioned Corps, US Public Health Service, Atlanta, Georgia
| | - Ellen Yard
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia,Commissioned Corps, US Public Health Service, Atlanta, Georgia
| | - Ashley D’Inverno
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Swedo
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - May S. Chen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emiko Petrosky
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia,Commissioned Corps, US Public Health Service, Atlanta, Georgia
| | - Amy Board
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pedro Martinez
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah M. Stone
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Royal Law
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A. Coletta
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Adjemian
- Commissioned Corps, US Public Health Service, Atlanta, Georgia,Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig Thomas
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard W. Puddy
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Georgina Peacock
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole F. Dowling
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debra Houry
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Sandifer P, Knapp L, Lichtveld M, Manley R, Abramson D, Caffey R, Cochran D, Collier T, Ebi K, Engel L, Farrington J, Finucane M, Hale C, Halpern D, Harville E, Hart L, Hswen Y, Kirkpatrick B, McEwen B, Morris G, Orbach R, Palinkas L, Partyka M, Porter D, Prather AA, Rowles T, Scott G, Seeman T, Solo-Gabriele H, Svendsen E, Tincher T, Trtanj J, Walker AH, Yehuda R, Yip F, Yoskowitz D, Singer B. Framework for a Community Health Observing System for the Gulf of Mexico Region: Preparing for Future Disasters. Front Public Health 2020; 8:578463. [PMID: 33178663 PMCID: PMC7593336 DOI: 10.3389/fpubh.2020.578463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023] Open
Abstract
The Gulf of Mexico (GoM) region is prone to disasters, including recurrent oil spills, hurricanes, floods, industrial accidents, harmful algal blooms, and the current COVID-19 pandemic. The GoM and other regions of the U.S. lack sufficient baseline health information to identify, attribute, mitigate, and facilitate prevention of major health effects of disasters. Developing capacity to assess adverse human health consequences of future disasters requires establishment of a comprehensive, sustained community health observing system, similar to the extensive and well-established environmental observing systems. We propose a system that combines six levels of health data domains, beginning with three existing, national surveys and studies plus three new nested, longitudinal cohort studies. The latter are the unique and most important parts of the system and are focused on the coastal regions of the five GoM States. A statistically representative sample of participants is proposed for the new cohort studies, stratified to ensure proportional inclusion of urban and rural populations and with additional recruitment as necessary to enroll participants from particularly vulnerable or under-represented groups. Secondary data sources such as syndromic surveillance systems, electronic health records, national community surveys, environmental exposure databases, social media, and remote sensing will inform and augment the collection of primary data. Primary data sources will include participant-provided information via questionnaires, clinical measures of mental and physical health, acquisition of biological specimens, and wearable health monitoring devices. A suite of biomarkers may be derived from biological specimens for use in health assessments, including calculation of allostatic load, a measure of cumulative stress. The framework also addresses data management and sharing, participant retention, and system governance. The observing system is designed to continue indefinitely to ensure that essential pre-, during-, and post-disaster health data are collected and maintained. It could also provide a model/vehicle for effective health observation related to infectious disease pandemics such as COVID-19. To our knowledge, there is no comprehensive, disaster-focused health observing system such as the one proposed here currently in existence or planned elsewhere. Significant strengths of the GoM Community Health Observing System (CHOS) are its longitudinal cohorts and ability to adapt rapidly as needs arise and new technologies develop.
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Affiliation(s)
- Paul Sandifer
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC, United States
| | - Landon Knapp
- Center for Coastal Environmental and Human Health, College of Charleston, Charleston, SC, United States
| | - Maureen Lichtveld
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ruth Manley
- Master's Program in Environmental and Sustainability Studies, College of Charleston, Charleston, SC, United States
| | - David Abramson
- School of Global Public Health, New York University, New York, NY, United States
| | - Rex Caffey
- Department of Agricultural Economics and Agribusiness, Louisiana State University, Baton Rouge, LA, United States
| | - David Cochran
- School of Biological, Environmental, and Earth Sciences, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Tracy Collier
- Huxley College of the Environment, Western Washington University, Bellingham, WA, United States
| | - Kristie Ebi
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lawrence Engel
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - John Farrington
- Woods Hole Oceanographic Institution, Woods Hole, MA, United States
| | | | - Christine Hale
- Harte Research Institute, Texas A&M University-Corpus Christi, Corpus Christi, TX, United States
| | - David Halpern
- Scripps Institution of Oceanography, La Jolla, CA, United States
| | - Emily Harville
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Leslie Hart
- Department of Health and Human Performance, College of Charleston, Charleston, SC, United States
| | - Yulin Hswen
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Barbara Kirkpatrick
- Gulf of Mexico Coastal Ocean Observing System, Texas A&M University, College Station TX, United States
| | - Bruce McEwen
- Laboratory of Neuroendocrinology, Rockefeller University, New York, NY, United States
| | - Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Raymond Orbach
- Department of Mechanical Engineering, University of Texas, Austin, TX, United States
| | - Lawrence Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Melissa Partyka
- Mississippi-Alabama Sea Grant Consortium, Mobile, AL, United States
| | - Dwayne Porter
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Teresa Rowles
- National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Silver Spring, MD, United States
| | - Geoffrey Scott
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Teresa Seeman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Helena Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL, United States
| | - Erik Svendsen
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terry Tincher
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Juli Trtanj
- Office of Oceanic and Atmospheric Research, National Oceanic and Atmospheric Administration, Silver Spring, MD, United States
| | | | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Bronx, NY, United States
| | - Fuyuen Yip
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David Yoskowitz
- Harte Research Institute, Texas A&M University-Corpus Christi, Corpus Christi, TX, United States
| | - Burton Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
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16
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Khoury MJ, Armstrong GL, Bunnell RE, Cyril J, Iademarco MF. The intersection of genomics and big data with public health: Opportunities for precision public health. PLoS Med 2020; 17:e1003373. [PMID: 33119581 PMCID: PMC7595300 DOI: 10.1371/journal.pmed.1003373] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Muin Khoury and co-authors discuss anticipated contributions of genomics and other forms of large-scale data in public health.
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Affiliation(s)
- Muin J. Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gregory L. Armstrong
- Office of Advanced Molecular Detection, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca E. Bunnell
- Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Juliana Cyril
- Office of Technology and Innovation, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael F. Iademarco
- Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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17
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Layden JE, Ghinai I, Pray I, Kimball A, Layer M, Tenforde MW, Navon L, Hoots B, Salvatore PP, Elderbrook M, Haupt T, Kanne J, Patel MT, Saathoff-Huber L, King BA, Schier JG, Mikosz CA, Meiman J. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. N Engl J Med 2020; 382:903-916. [PMID: 31491072 DOI: 10.1056/nejmoa1911614] [Citation(s) in RCA: 536] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.
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Affiliation(s)
- Jennifer E Layden
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Isaac Ghinai
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Ian Pray
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Anne Kimball
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Mark Layer
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Mark W Tenforde
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Livia Navon
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Brooke Hoots
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Phillip P Salvatore
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Megan Elderbrook
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Thomas Haupt
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Jeffrey Kanne
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Megan T Patel
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Lori Saathoff-Huber
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Brian A King
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Josh G Schier
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Christina A Mikosz
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
| | - Jonathan Meiman
- From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison
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Hartnett KP, Kite-Powell A, Patel MT, Haag BL, Sheppard MJ, Dias TP, King BA, Melstrom PC, Ritchey MD, Stein Z, Idaikkadar N, Vivolo-Kantor AM, Rose DA, Briss PA, Layden JE, Rodgers L, Adjemian J. Syndromic Surveillance for E-Cigarette, or Vaping, Product Use-Associated Lung Injury. N Engl J Med 2020; 382:766-772. [PMID: 31860794 PMCID: PMC10613510 DOI: 10.1056/nejmsr1915313] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kathleen P Hartnett
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Aaron Kite-Powell
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Megan T Patel
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Brittani L Haag
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Michael J Sheppard
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Taylor P Dias
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Brian A King
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Paul C Melstrom
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Matthew D Ritchey
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Zachary Stein
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Nimi Idaikkadar
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Alana M Vivolo-Kantor
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Dale A Rose
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Peter A Briss
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Jennifer E Layden
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Loren Rodgers
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
| | - Jennifer Adjemian
- From the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services (K.P.H., A.K.-P., B.L.H., M.J.S., T.P.D., Z.S., N.I., L.R., J.A.), the Division of Overdose Prevention, National Center for Injury Prevention and Control (A.M.V.-K.), the Office on Smoking and Health (B.A.K., P.C.M.), Division for Heart Disease and Stroke Prevention (M.D.R.), and the Office of the Director (P.A.B.), National Center for Chronic Disease Prevention and Health Promotion, the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.A.R.), Centers for Disease Control and Prevention, Atlanta; Illinois Department of Public Health, Springfield (M.T.P., J.E.L.,); and the U.S. Public Health Service Commissioned Corps, Rockville, MD (K.P.H., M.D.R., P.C.M., L.R., J.A.)
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Zwald ML, Holland KM, Annor FB, Kite-Powell A, Sumner SA, Bowen DA, Vivolo-Kantor AM, Stone DM, Crosby AE. Syndromic Surveillance of Suicidal Ideation and Self-Directed Violence - United States, January 2017-December 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:103-108. [PMID: 31999688 PMCID: PMC7004405 DOI: 10.15585/mmwr.mm6904a3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Kupferman N, Hanlin E. Review of Emerging Infectious Disease Preparedness Measures for the State of Delaware. Dela J Public Health 2019; 5:64-67. [PMID: 34467060 PMCID: PMC8352366 DOI: 10.32481/djph.2019.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Emerging infectious diseases (EIDs) are a growing global concern as more of these pathogens or their associated illnesses are identified, and human migration continues to increase. The state of Delaware has an intricate system to monitor, prepare for, and take action against these diseases. To effectively prepare for an outbreak of an infectious disease, there is a high level of inter- and intra-organizational communication, evolutions from previous situations, and cooperation with the public. EID preparedness plans are constantly changing to adapt to the situations at hand, making collaboration with all stakeholders crucial for a sufficient outbreak response.
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Affiliation(s)
- Nikki Kupferman
- Vaccine Preventable Disease Epidemiologist, Delaware Division of Public Health
| | - Emily Hanlin
- Epidemiologist, Office of Preparedness, Delaware Division of Public Health
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Harduar Morano L, Richardson D, Proescholdbell S. Descriptive evaluation of methods for identifying work-related emergency department injury visits. Am J Ind Med 2019; 62:568-579. [PMID: 31104330 DOI: 10.1002/ajim.22984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of worker's compensation (WC) as payer underestimates work-related (WR) injuries. We evaluated three methods to identify WR injuries: WC as payer, ICD-9-CM work-status codes E000.0/E000.1, and other ICD-9-CM external cause codes. METHODS We identified injury-related emergency department visits from North Carolina's syndromic surveillance system (2010-2013). Characteristics were compared by indicator. We manually reviewed 800 admission notes to confirm if the visit was WR or non-WR; WR keywords from the review were applied to all visits. RESULTS 133 156 injury-related visits (age, 16 years or older) were identified: WC = 69%, work-status codes = 18%, other ICD-9-CM codes = 13%. Among manually reviewed visits: few visits identified by WC (0.3%) or work-status codes (2%) were non-WR, while 12% of other ICD-9-CM code identified visits were non-WR; 53%, 46%, and 31% of visits identified by WC, work-status codes, and other ICD-9-CM codes were WR, respectively. CONCLUSIONS Findings support use of WC and work-status codes to capture WR injuries; other ICD-9-CM codes should be used with caution or in combination with other indicators.
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Affiliation(s)
- Laurel Harduar Morano
- Department of Emergency Medicine, Center for Health InformaticsUniversity of North Carolina at Chapel HillChapel Hill North Carolina
| | - David Richardson
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel Hill North Carolina
| | - Scott Proescholdbell
- Injury and Violence Prevention BranchNC Division of Public HealthRaleigh North Carolina
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22
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Lee SH, Levin D, Finley PD, Heilig CM. Chief complaint classification with recurrent neural networks. J Biomed Inform 2019; 93:103158. [PMID: 30926471 PMCID: PMC10563436 DOI: 10.1016/j.jbi.2019.103158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Syndromic surveillance detects and monitors individual and population health indicators through sources such as emergency department records. Automated classification of these records can improve outbreak detection speed and diagnosis accuracy. Current syndromic systems rely on hand-coded keyword-based methods to parse written fields and may benefit from the use of modern supervised-learning classifier models. In this paper, we implement two recurrent neural network models based on long short-term memory (LSTM) and gated recurrent unit (GRU) cells and compare them to two traditional bag-of-words classifiers: multinomial naïve Bayes (MNB) and a support vector machine (SVM). The MNB classifier is one of only two machine learning algorithms currently being used for syndromic surveillance. All four models are trained to predict diagnostic code groups as defined by Clinical Classification Software, first to predict from discharge diagnosis, and then from chief complaint fields. The classifiers are trained on 3.6 million de-identified emergency department records from a single United States jurisdiction. We compare performance of these models primarily using the F1 score, and we measure absolute model performance to determine which conditions are the most amenable to surveillance based on chief complaint alone. Using discharge diagnoses, the LSTM classifier performs best, though all models exhibit an F1 score above 96.00. Using chief complaints, the GRU performs best (F1 = 47.38), and MNB with bigrams performs worst (F1 = 39.40). We also note that certain syndrome types are easier to detect than others. For example, chief complaints using the GRU model predicts alcohol-related disorders well (F1 = 78.91) but predicts influenza poorly (F1 = 14.80). In all instances, the RNN models outperformed the bag-of-words classifiers suggesting deep learning models could substantially improve the automatic classification of unstructured text for syndromic surveillance.
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Affiliation(s)
- Scott H Lee
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Drew Levin
- Sandia National Laboratories, Albuquerque, NM, United States
| | | | - Charles M Heilig
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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23
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Gould DW, Lamb E, Dearth S, Collier K. Building State and Local Public Health Capacity in Syndromic Surveillance Through an Online Community of Practice. Public Health Rep 2019; 134:223-227. [PMID: 30763205 DOI: 10.1177/0033354919828713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Deborah W Gould
- 1 Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emilie Lamb
- 2 International Society for Disease Surveillance, Braintree, MA, USA
| | - Shandy Dearth
- 2 International Society for Disease Surveillance, Braintree, MA, USA
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24
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Marx GE, Chen Y, Askenazi M, Albanese BA. Syndromic Surveillance of Emergency Department Visits for Acute Adverse Effects of Marijuana, Tri-County Health Department, Colorado, 2016-2017. Public Health Rep 2019; 134:132-140. [PMID: 30721641 DOI: 10.1177/0033354919826562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. METHODS We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider's clinical impression during the visit. RESULTS Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). CONCLUSIONS ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.
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Affiliation(s)
- Grace E Marx
- 1 Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA.,2 Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yushiuan Chen
- 1 Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
| | - Michele Askenazi
- 1 Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
| | - Bernadette A Albanese
- 1 Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
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25
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Gamache R, Kharrazi H, Weiner JP. Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities. Yearb Med Inform 2018; 27:199-206. [PMID: 30157524 PMCID: PMC6115205 DOI: 10.1055/s-0038-1667081] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective:
To summarize the recent public and population health informatics literature with a focus on the synergistic “bridging” of electronic data to benefit communities and other populations.
Methods:
The review was primarily driven by a search of the literature from July 1, 2016 to September 30, 2017. The search included articles indexed in PubMed using subject headings with (MeSH) keywords “public health informatics” and “social determinants of health”. The “social determinants of health” search was refined to include articles that contained the keywords “public health”, “population health” or “surveillance”.
Results:
Several categories were observed in the review focusing on public health's socio-technical infrastructure: evaluation of surveillance practices, surveillance methods, interoperable health information infrastructure, mobile health, social media, and population health. Common trends discussing socio-technical infrastructure included big data platforms, social determinants of health, geographical information systems, novel data sources, and new visualization techniques. A common thread connected these categories of workforce, governance, and sustainability: using clinical resources and data to bridge public and population health.
Conclusions:
Both medical care providers and public health agencies are increasingly using informatics and big data tools to create and share digital information. The intent of this “bridging” is to proactively identify, monitor, and improve a range of medical, environmental, and social factors relevant to the health of communities. These efforts show a significant growth in a range of population health-centric information exchange and analytics activities.
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Affiliation(s)
- Roland Gamache
- Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Gamache Consulting, Bethesda, USA
| | - Hadi Kharrazi
- Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Division of Health Sciences and Informatics, Johns Hopkins School of Medicine, Baltimore, USA
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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26
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Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite-Powell A, Coletta MA. Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses - United States, July 2016-September 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018. [PMID: 29518069 PMCID: PMC5844282 DOI: 10.15585/mmwr.mm6709e1] [Citation(s) in RCA: 299] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination. Methods Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016–September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics. To assess trends based on urban development, data from 16 states were analyzed by state and urbanization level. Results From July 2016 through September 2017, a total of 142,557 ED visits (15.7 per 10,000 visits) from 52 jurisdictions in 45 states were suspected opioid-involved overdoses. This rate increased on average by 5.6% per quarter. Rates increased across demographic groups and all five U.S. regions, with largest increases in the Southwest, Midwest, and West (approximately 7%–11% per quarter). In 16 states, 119,198 ED visits (26.7 per 10,000 visits) were suspected opioid-involved overdoses. Ten states (Delaware, Illinois, Indiana, Maine, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, and Wisconsin) experienced significant quarterly rate increases from third quarter 2016 to third quarter 2017, and in one state (Kentucky), rates decreased significantly. The highest rate increases occurred in large central metropolitan areas. Conclusions and Implications for Public Health Practice With continued increases in opioid overdoses, availability of timely data are important to inform actions taken by EDs and public health practitioners. Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses. Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose.
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