scholarly journals Xylazine Spreads Across the US: A Growing Component of the Increasingly Synthetic and Polysubstance Overdose Crisis

2021 ◽  
Author(s):  
Joseph Friedman ◽  
Fernando Montero Castillo ◽  
Phillippe Bourgois ◽  
Rafik Wahbi ◽  
Daniel Dye ◽  
...  
Keyword(s):  
Participant Observation ◽  
Risk Environment ◽  
Polysubstance Use ◽  
Drug Classes ◽  
Sequential Mixed Methods ◽  
Increased Risk ◽  
The Us ◽  
Overdose Mortality ◽  
Us Census ◽  
Overdose Deaths

Background: Recent sharp exacerbations of the US overdose crisis have been linked to systemic polysubstance use and potent synthetic compounds in numerous drug classes. Xylazine is a veterinary tranquilizer, long noted in the opioid supply of Puerto Rico, and more recently Philadelphia. Yet it's national relevance and potential role in the shifting US overdose risk environment are poorly characterized. Methods: In this sequential mixed methods study, xylazine was increasingly observed by our ethnographic team over many years of intensive participant observation fieldwork in Philadelphia among drug sellers and people who inject drugs (PWID). Subsequently, we systematically searched for records describing xylazine-involved overdose mortality across the US and assessed time trends and overlap with other drugs. Results: In 10 jurisdictions--representing all 4 US Census Regions--xylazine was found to be increasingly implicated in overdose mortality, rising from 0.36% of deaths in 2015 to 6.7% in 2020. The highest xylazine prevalence in the most recent data was observed in Philadelphia, (25.8% of deaths), followed by Maryland (19.3%) and Connecticut (10.2%). Illicitly-manufactured-fentanyls were present in 98.4% of xylazine-involved-overdose-deaths--suggesting a strong ecological link--as well as cocaine (45.4%), benzodiazepines (28.4%), heroin (23.3%), and alcohol (19.7%). PWID in Philadelphia described xylazine as a sought-after adulterant that improves euphoria and lengthens the short duration of fentanyl injections, in particular. They also linked it to increased risk of soft tissue infection and overdose. Conclusions: We summarize evidence that xylazine is increasingly implicated in overdose deaths across the US and is linked to the proliferation of illicitly-manufactured-fentanyls. We document hypothesis-generating ethnographic accounts linking it to health risks for PWID. Nevertheless, many jurisdictions do not routinely test for xylazine, and it is not tracked in federal overdose statistics. Further efforts are needed to provide PWID with services that can help to minimize additional risks associated with a shifting drug supply.

scholarly journals Evaluating Satellite Imagery‐Based Land Use Data for Describing Forestland Development in Western Washington

2009 ◽  
Vol 24 (4) ◽  
pp. 214-222 ◽  
Author(s):  
Jeffrey D. Kline ◽  
Alissa Moses ◽  
David Azuma ◽  
Andrew Gray
Keyword(s):  
Land Use ◽  
Satellite Imagery ◽  
Econometric Model ◽  
Landsat Imagery ◽  
Forest Inventory And Analysis ◽  
The Us ◽  
Western Washington ◽  
Us Census ◽  
The Impact ◽  
Density Development

Abstract Forestry professionals are concerned about how forestlands are affected by residential and other development. To address those concerns, researchers must find appropriate data with which to describe and evaluate rates and patterns of forestland development and the impact of development on the management of remaining forestlands. We examine land use data gathered from Landsat imagery for western Washington and evaluate its usefulness for characterizing low-density development of forestland. We evaluate the accuracy of the satellite imagery‐based land use classifications by comparing them with other data from US Forest Service's Forest Inventory and Analysis inventories and the US census. We then use the data to estimate an econometric model describing development as a function of socioeconomic and topographic factors and project future rates of development and forestland loss to 2020. We conclude by discussing how best to meet the land use data needs of researchers, forestry policymakers, and managers.

scholarly journals POS1143 GOUT AND JOINT REPLACEMENTS IN THE US

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 851.1-851
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Knee Joint ◽  
Confidence Intervals ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Economic Burden ◽  
Hip Replacement ◽  
Average Charge ◽  
Joint Replacements ◽  
Increased Risk ◽  
The Us

Background:Irreversible joint damage in gout has been linked to a possible increase in knee and hip joint replacements1. In addition, the strong association between gout and osteoarthritis2,3 could also lead to an increased risk of joint replacements in patients with gout. Population-based data from the UK and Taiwan have shown hazard rates of 1.14 and 1.16 respectively for knee replacements in patients with gout compared to age and gender matched controls1. However, there is little national data in the US on clinical and economic burden of joint replacements in patients with gout.Objectives:To evaluate total or partial hip and knee joint replacements in patients with gout in the US and to estimate their economic impactMethods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD)10 diagnosis and procedure codes, age, gender, length of stay, payer, charges, comorbidities etc. is available. We examined hospitalizations in patients with gout with hip and knee joint replacements in NIS 2018, the most recent year of data.Results:In 2018, there were 914,510 hospitalizations with primary or secondary diagnosis of gout in the US. Of these 43,615 were for joint replacement surgeries (knee (24,840) and hip (18,755)). Patients with knee replacement were on an average 68.5 years old (95% confidence intervals 68.2 years -68.8 years). Patients with hip replacement were slightly older (mean age 70.3 years, 95% confidence intervals 69.8 years -70.7 years). Unlike general population statistics, men formed a majority of these joint replacements (68% for the knee and 72% for the hip). The average charge per hospitalization was $69,279 and $72,944 for knee and hip replacement respectively. The total annual national cost estimate was $3.09 billion, with government insurances (Medicare and Medicaid) responsible for 67% of knee replacement and 70% of hip replacement costs.Conclusion:Joint replacements in gout patients have a large clinical and economic burden in the US. This calls for an increased awareness and management of associated hip and knee arthritis in patients with gout.References:[1]Kuo CF, Chou IJ, See LC, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. Dec 1 2018;57(12):2129-2139.[2]Howard RG, Samuels J, Gyftopoulos S, et al. Presence of gout is associated with increased prevalence and severity of knee osteoarthritis among older men: results of a pilot study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. Mar 2015;21(2):63-71.[3]Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Annals of the rheumatic diseases. Oct 2007;66(10):1374-1377.Disclosure of Interests:Gurkirpal Singh Shareholder of: Pfizer, Merck, Sanofi, Grant/research support from: Horizon, Maanek Sehgal: None declared, Alka Mithal: None declared.

scholarly journals Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

2021 ◽  
Author(s):  
Gayathri S. Kumar ◽  
Jenna A. Beeler ◽  
Emma E. Seagle ◽  
Emily S. Jentes
Keyword(s):  
Health Outcomes ◽  
Physical Health ◽  
Public Health Practice ◽  
The United States ◽  
Inclusion Criteria ◽  
Physical Health Outcomes ◽  
Increased Risk ◽  
The Us ◽  
Bhutanese Refugee

AbstractSeveral studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

scholarly journals Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

2020 ◽  
Author(s):  
Kosuke Inoue ◽  
Roch Nianogo ◽  
Donatello Telesca ◽  
Atsushi Goto ◽  
Vahe Khachadourian ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Regression Models ◽  
Machine Learning Algorithms ◽  
Logistic Regression Models ◽  
Health And Nutrition ◽  
Increased Risk ◽  
The Us ◽  
All Cause Mortality ◽  
Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

scholarly journals Sleep Duration and Waking Activities in Relation to the National Sleep Foundation’s Recommendations: An Analysis of US Population Sleep Patterns from 2015 to 2017

2021 ◽  
Vol 18 (11) ◽  
pp. 6154
Author(s):  
Michael Osei Mireku ◽  
Alina Rodriguez
Keyword(s):  
Sleep Duration ◽  
Time Use ◽  
Variance Estimation ◽  
Estimation Method ◽  
Short Sleep Duration ◽  
Weighted Estimates ◽  
American Time Use Survey ◽  
Increased Risk ◽  
The Us ◽  
Time Use Survey

The objective was to investigate the association between time spent on waking activities and nonaligned sleep duration in a representative sample of the US population. We analysed time use data from the American Time Use Survey (ATUS), 2015–2017 (N = 31,621). National Sleep Foundation (NSF) age-specific sleep recommendations were used to define recommended (aligned) sleep duration. The balanced, repeated, replicate variance estimation method was applied to the ATUS data to calculate weighted estimates. Less than half of the US population had a sleep duration that mapped onto the NSF recommendations, and alignment was higher on weekdays (45%) than at weekends (33%). The proportion sleeping longer than the recommended duration was higher than those sleeping shorter on both weekdays and weekends (p < 0.001). Time spent on work, personal care, socialising, travel, TV watching, education, and total screen time was associated with nonalignment to the sleep recommendations. In comparison to the appropriate recommended sleep group, those with a too-short sleep duration spent more time on work, travel, socialising, relaxing, and leisure. By contrast, those who slept too long spent relatively less time on each of these activities. The findings indicate that sleep duration among the US population does not map onto the NSF sleep recommendations, mostly because of a higher proportion of long sleepers compared to short sleepers. More time spent on work, travel, and socialising and relaxing activities is strongly associated with an increased risk of nonalignment to NSF sleep duration recommendations.

scholarly journals Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul M. McKeigue ◽  
◽  
Sharon Kennedy ◽  
Amanda Weir ◽  
Jen Bishop ◽  
...  
Keyword(s):  
Primary Care ◽  
Rate Ratio ◽  
Case Control Study ◽  
Fatal Outcome ◽  
Case Control ◽  
Care Practice ◽  
Drug Classes ◽  
Increased Risk ◽  
Co Morbidity ◽  
Control Study

Abstract Background The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. Methods Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. Results Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be “medications compromising COVID”, all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. Conclusions Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. Registration ENCEPP number https://EUPAS35558

scholarly journals COVID-19 positivity associated with traumatic stress response to childbirth and no visitors and infant separation in the hospital

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gus A. Mayopoulos ◽  
Tsachi Ein-Dor ◽  
Kevin G. Li ◽  
Sabrina J. Chan ◽  
Sharon Dekel
Keyword(s):  
Traumatic Stress ◽  
Neonatal Intensive Care ◽  
Acute Stress ◽  
Psychiatric Morbidity ◽  
Neonatal Intensive Care Units ◽  
Stress Symptoms ◽  
Increased Risk ◽  
The Us ◽  
Control Survey ◽  
Novel Coronavirus

AbstractAs the novel coronavirus (COVID-19) has spread globally, a significant portion of pregnant and delivering women were infected with COVID-19. While emerging studies examined birth outcomes in COVID-19 positive women, knowledge of the psychological experience of childbirth and maternal wellness remains lacking. This matched-control survey-based study included a sample of women recruited during the first wave of the pandemic in the US who gave birth in the previous six months. Women reporting confirmed/suspected COVID-19 (n = 68) during pregnancy or childbirth were matched on background factors with women reporting COVID-19 negativity (n = 2,276). We found nearly 50% of COVID positive women endorsed acute traumatic stress symptoms at a clinical level in response to childbirth. This group was more than twice as likely to endorse acute stress and to have no visitors during maternity hospitalization than COVID negative women; they were also less likely to room-in with newborns. The COVID positive group reported higher levels of pain in delivery, lower newborn weights, and more infant admission to neonatal intensive care units. Our findings suggest COVID-19 affected populations are at increased risk for traumatic childbirth and associated risk for psychiatric morbidity. Attention to delivering women’s wellbeing is warranted during the pandemic.

scholarly journals Frequency of Antimicrobial Resistance in Shiga Toxin-Producing Escherichia coli (STEC) and Non-Typhoidal Salmonella (NTS) Clinical Infections and Association with Epidemiological Factors

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S366-S366
Author(s):  
Sanjana Mukherjee ◽  
Rebekah Mosci ◽  
Chase Anderson ◽  
Brian Snyder ◽  
James Collins ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Antibiotic Prescription ◽  
Epidemiological Data ◽  
Chi Square ◽  
Surveillance Network ◽  
High Frequencies ◽  
Drug Classes ◽  
The Us ◽  
Prescription Rates ◽  
Foodborne Infections

Abstract Background STEC and NTS are leading causes of foodborne infections in the US. Monitoring resistance in these pathogens is essential to understand the distribution of resistance profiles and because of the high likelihood of horizontal transfer of resistance genes to other pathogens. Data involving resistance in clinical STEC and NTS isolates from Michigan is lacking. Methods Clinical STEC (n = 353) and NTS (n = 148) isolates from the MDHHS (2010–2014) were examined for resistance using disk diffusion, E-test or broth microdilution. Case information and epidemiological data for STEC isolates was extracted and associations with resistant infections were determined using chi square tests in SAS 9.3 and EpiInfo™ 7. Results Overall, 31 (8.8%, n = 353) STEC isolates were resistant to at least one antibiotic; high frequencies of resistance were observed for ampicillin (7.4%) and trimethoprim-sulfamethoxazole (4.0%). Resistance to ciprofloxacin (0.28%) and all three drug classes (0.28%) was less common. Preliminary results indicate that O157 resistance to ampicillin (4.8%) and trimethoprim-sulfamethoxazole (3.4%) was higher in Michigan compared with national frequencies (ampicillin = 2.7%, trimethoprim-sulfamethoxazole= 1.5%). Higher resistance frequencies were also observed in counties with high (11.3%) vs. low (7.7%) antibiotic prescription rates. For NTS, 23 (15.5%) isolates were resistant to ≥1 antibiotic. Resistance varied by serotype with high frequencies in Typhimurium (20%, n = 20), Newport (17.6%, n = 17) and Enteritidis (4.8%, n = 42); 11 (7.4%) NTS isolates were resistant to ≥3 antimicrobial classes. Conclusion Continuous monitoring of resistance in clinical STEC and NTS is warranted due to their importance as food pathogens. The identification of risk factors for resistance is crucial to develop alternative prevention practices to reduce the health burden of resistant infections in Michigan, which is not part of the FoodNet surveillance network. Disclosures All authors: No reported disclosures.

scholarly journals Why the Economics Profession Must Actively Participate in the Privacy Protection Debate

2019 ◽  
Vol 109 ◽  
pp. 397-402 ◽  
Author(s):  
John M. Abowd ◽  
Ian M. Schmutte ◽  
William N. Sexton ◽  
Lars Vilhuber
Keyword(s):  
Privacy Protection ◽  
Public Information ◽  
Census Bureau ◽  
Economic Research ◽  
Technical Problems ◽  
Public Data ◽  
The Us ◽  
Economics Profession ◽  
Computer Scientists ◽  
Us Census

When Google or the US Census Bureau publishes detailed statistics on browsing habits or neighborhood characteristics, some privacy is lost for everybody while supplying public information. To date, economists have not focused on the privacy loss inherent in data publication. In their stead, these issues have been advanced almost exclusively by computer scientists who are primarily interested in technical problems associated with protecting privacy. Economists should join the discussion, first to determine where to balance privacy protection against data quality--a social choice problem. Furthermore, economists must ensure new privacy models preserve the validity of public data for economic research.

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