402: Adverse outcomes of low risk pregnancies in the united states

Abstract Tick-borne diseases are a growing threat to public health in the United States, especially among outdoor workers who experience high occupational exposure to ticks. Long-lasting permethrin-impregnated clothing has demonstrated high initial protection against bites from blacklegged ticks, Ixodes scapularis Say (Acari: Ixodidae), in laboratory settings, and sustained protection against bites from the lone star tick, Amblyomma americanum (L.) (Acari: Ixodidae), in field tests. However, long-lasting permethrin impregnation of clothing has not been field tested among outdoor workers who are frequently exposed to blacklegged ticks. We conducted a 2-yr randomized, placebo-controlled, double-blinded trial among 82 outdoor workers in Rhode Island and southern Massachusetts. Participants in the treatment arm wore factory-impregnated permethrin clothing, and the control group wore sham-treated clothing. Outdoor working hours, tick encounters, and bites were recorded weekly to assess protective effectiveness of long-lasting permethrin-impregnated garments. Factory-impregnated clothing significantly reduced tick bites by 65% in the first study year and by 50% in the second year for a 2-yr protective effect of 58%. No significant difference in other tick bite prevention method utilization occurred between treatment and control groups, and no treatment-related adverse outcomes were reported. Factory permethrin impregnation of clothing is safe and effective for the prevention of tick bites among outdoor workers whose primary exposure is to blacklegged ticks in the northeastern United States.

Download Full-text

1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1610 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S720-S720

Author(s):

Amy M Beeson ◽

Grace E Marx ◽

Amy M Schwartz ◽

Alison F Hinckley

Keyword(s):

United States ◽

Lyme Disease ◽

Standard Treatment ◽

Age Distribution ◽

Public Health Problem ◽

The United States ◽

Adverse Outcomes ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p< 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p< 0.0001) and during non-summer months (OR 2.2, p< 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

Download Full-text

Associations of Community Water Lead Concentrations with Hemoglobin Concentrations and Erythropoietin-Stimulating Agent Use among Patients with Advanced CKD

Journal of the American Society of Nephrology ◽

10.1681/asn.2020091281 ◽

2021 ◽

pp. ASN.2020091281

Author(s):

John Danziger ◽

Kenneth J. Mukamal ◽

Eric Weinhandl

Keyword(s):

United States ◽

Drinking Water ◽

Kidney Disease ◽

The United States ◽

Water Systems ◽

Adverse Outcomes ◽

Content Type ◽

Community Water Systems ◽

Community Water ◽

Lead Levels

BackgroundAlthough patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known.MethodsTo investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90th percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System.ResultsAmong 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90th percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients.ConclusionsThis first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

Download Full-text

Cost Implications and Complications of Overtreatment of Low-Risk Prostate Cancer in the United States

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2015.0009 ◽

2015 ◽

Vol 13 (1) ◽

pp. 61-68 ◽

Cited By ~ 40

Author(s):

Ayal A. Aizer ◽

Xiangmei Gu ◽

Ming-Hui Chen ◽

Toni K. Choueiri ◽

Neil E. Martin ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

The United States ◽

Low Risk ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Cost Implications

Download Full-text

Newly Approved Novel Dosage Forms of Glucagon for Management of Severe Hypoglycemia

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.176 ◽

2020 ◽

Vol 35 (4) ◽

pp. 176-181

Author(s):

Thomas J. Borden ◽

Danial E. Baker ◽

Terri L. Levien ◽

Brian J. Gates

Keyword(s):

United States ◽

Older People ◽

Severe Hypoglycemia ◽

The United States ◽

Medical Intervention ◽

Dosage Forms ◽

Adverse Outcomes ◽

Oral Glucose ◽

Term Care ◽

Increased Risk

The prevalence and clinical impact of diabetes mellitus (DM) continues to increase in the United States and throughout the world. Older adults are at increased risk for adverse outcomes associated with hypoglycemia, particularly in situations where a lack of awareness may arise because typical symptoms are not necessarily present, serve to prompt medical intervention with oral glucose. Glucagon emergency kits that have been available to date require multiple-step reconstitution that may compromise timely and appropriate administration of lifesaving glucagon treatment during episodes of severe hypoglycemia. In settings such as long-term care facilities, trained medical professionals may not be readily available, meaning that glucagon must be administered by laypersons. Novel dosage forms of glucagon that have recently been approved for marketing in the United States allow glucagon to be delivered more easily, which may positively impact effective treatment of severe hypoglycemia among older people. Nasal glucagon and glucagon autoinjection "pens" are as effective as glucagon kits and increase the likelihood glucagon will be appropriately used by patient caregivers. The safety, efficacy, and convenience of these new devices may improve outcomes and reduce health care costs of older people with diabetes.

Download Full-text

Factors contributing to high and low risk fires in the United States: an analysis of the relative risk assessment

Advances in forest fire research 2018 ◽

10.14195/978-989-26-16-506_110 ◽

2018 ◽

pp. 1002-1008

Author(s):

Erin Noonan-Wright ◽

Carl Seielstad

Keyword(s):

United States ◽

Risk Assessment ◽

Relative Risk ◽

The United States ◽

Low Risk ◽

Relative Risk Assessment

Download Full-text

More Blood Transfusions for Rural Women Delivering Low Risk Infants in the United States [37N]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000559343.12931.9b ◽

2019 ◽

Vol 133 (1) ◽

pp. 160S-160S

Author(s):

Ellen Hartenbach ◽

Daphne Kuo Hsiang-Hui ◽

Madelyne Greene ◽

Emily Shrider ◽

Kathleen M. Antony ◽

...

Keyword(s):

United States ◽

Rural Women ◽

The United States ◽

Low Risk ◽

Blood Transfusions

Download Full-text

Adverse Staff Health Outcomes Associated with Endoscope Reprocessing

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-47.2.172 ◽

2013 ◽

Vol 47 (2) ◽

pp. 172-179 ◽

Cited By ~ 2

Author(s):

Elane Gutterman ◽

Lindsay Jorgensen ◽

Amber Mitchell ◽

Sherry Fua

Keyword(s):

United States ◽

Health Outcomes ◽

Health Workers ◽

The United States ◽

Adverse Outcomes ◽

Healthcare Personnel ◽

Health Administration ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Pubmed Database

Abstract There are occupational challenges associated with cleaning, disinfecting, storing, and transporting flexible endoscopes. Although the Occupational Safety and Health Administration (OSHA) has set standards to protect the safety of health workers in the United States, the standards are not specific to endoscope reprocessing, and the general standards that are in place are not fully implemented. Furthermore, adverse staff outcomes may not be fully preventable. To assess the evidence for adverse outcomes in staff associated with endoscope reprocessing, a literature review was performed in the PubMed database for articles on this topic published between Jan. 1, 2007 and March 7, 2012. Eight studies were identified, mainly European, which reported numerous adverse outcomes to healthcare personnel associated with endoscope reprocessing including respiratory ailments and physical discomfort. More scientifically rigorous studies are required to comprehensively describe adverse health outcomes in personnel engaged in reprocessing, particularly in the United States, and examine whether increased automation of the reprocessing process leads to decreased adverse health outcomes for staff.

Download Full-text