Maximizing the Value of Electronic Prescription Monitoring Programs

2003 ◽  
Vol 31 (1) ◽  
pp. 41-54 ◽  
Author(s):  
David B. Brushwood
Keyword(s):  
United States ◽  
Pain Management ◽  
Public Health Problem ◽  
Opioid Analgesics ◽  
The United States ◽  
Deterrent Effect ◽  
Electronic Prescription ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Controlled Substance

There is general agreement that the “principle of balance” should guide controlled substance policy and regulation in the United States. Although the diversion of controlled substances from medical to nonmedical purposes is a significant public health problem, overly aggressive controlled substance regulation has been shown to have an unintended deterrent effect on appropriate controlled substance use, including pain management with opioid analgesics. The promotion of effective pain management and the reduction of substance abuse are equally important regulatory objectives. Neither regulatory objective need be sacrificed to achieve the other. Rather, the two objectives must be balanced with each other to assure that necessary pain management is encouraged while drug abuse is curtailed.Approximately 75 million people in the United States suffer from severe pain. Fifty million of these suffer chronic pain, and 25 million suffer acute pain from trauma or surgery. Pain is not merely an uncomfortable symptom.

scholarly journals Solar and Climate Effects Explain the Wide Variation in Legionellosis Incidence Rates in the United States

2019 ◽  
Vol 85 (22) ◽  
Author(s):  
Xiang Y. Han
Keyword(s):  
United States ◽  
Public Health Problem ◽  
The United States ◽  
Incidence Rates ◽  
Sunshine Hours ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Solar Uv ◽  
Environmental Bacteria

ABSTRACTLegionellosis, an infection caused by the environmental bacteriaLegionellaspp., has become a significant public health problem in the United States in recent years; however, among the states, the incidence rates vary widely without a clear explanation. This study examined environmental effects on the 2014-to-2016 average annual legionellosis incidence rates in the U.S. states through correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours. The continental states west of ∼95°W showed low incidence rates of 0.51 to 1.20 cases per 100,000 population, which corresponded to low precipitation, below 750 mm annually. For the eastern states, where precipitation was higher, solar effects were prominent and mixed, leading to wide incidence variation. Robust regressions suggested a dividing line at 40°N: north of this line, rising temperature, mainly from solar heat, raised legionellosis incidence to a peak of 4.25/100,000 in Ohio; south of the line, intensifying sunlight in terms of high UV indices and long sunshine hours prevailed to limit incidence gradually to 0.99/100,000 in Louisiana. On or near the 40°N line were 15 eastern states that had leading legionellosis incidence rates of >2.0/100,000. These states all showed modest environmental parameters. In contrast, the frigid climate in Alaska and the strong year-round solar UV in Hawaii explained the lowest U.S. incidences, 0.14/100,000 and 0.47/100,000, respectively, in these states. The findings of solar and climate effects explain the wide variation of legionellosis incidence rates in the United States and may offer insights into the potential exposure to and prevention of infection.IMPORTANCELegionellosis, caused by the environmental bacteriaLegionellaspp., has become a significant public health problem in the United States in recent years, with ∼6,000 cases annually. The present study showed, through a series of correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours, that these environmental conditions strongly influence the legionellosis incidence rates across the United States in mixed and dynamic fashions. The incidence rates varied remarkably by region, with the highest in Ohio and New York and the lowest in Alaska. A precipitation threshold above 750 mm was required for elevated legionellosis activity. Regression models and dividing lines between regions were established to show the promotive effect of temperature, as well as the inhibitive effects of solar UV and sunshine hours. These findings explain the wide variation of legionellosis incidence rates in the United States. They may also offer insights into potential exposure to and prevention of infection.

scholarly journals Promising Agents for Chemoprevention of Skin Cancer

2006 ◽  
Vol 13 (5) ◽  
pp. 185-186
Author(s):  
S. P. Stratton ◽  
M. S. Stratton ◽  
D. S. Alberts
Keyword(s):  
Public Health ◽  
United States ◽  
Skin Cancer ◽  
Health Problem ◽  
Public Health Problem ◽  
The United States ◽  
Northern Europe ◽  
Significant Public Health Problem ◽  
The World ◽  
Significant Public Health

Skin cancer presents a significant public health problem because of its increasing incidence in the United States, Australia, Northern Europe, and other temperate climates around the world. [...]

Contrasting Crash- and Non-Crash-Involved Riders: Analysis of Data from the Motorcycle Crash Causation Study

2019 ◽  
Vol 2673 (7) ◽  
pp. 122-131 ◽  
Author(s):  
Hitesh Chawla ◽  
Ilker Karaca ◽  
Peter T. Savolainen
Keyword(s):  
Risk Factors ◽  
Public Health Problem ◽  
The United States ◽  
Crash Risk ◽  
Volume Data ◽  
Logistic Regression Models ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Paired Control ◽  
Motorcycle Crashes

Motorcycle crashes and fatalities remain a significant public health problem as fatality rates have increased substantially as compared to other vehicle types in the United States. Analysis of causal factors for motorcycle crashes is often challenging given a lack of reliable traffic volume data and the fact that such crashes comprise a relatively small portion of all traffic crashes. Given these limitations, on-scene crash investigations represent an ideal setting through which to investigate the precipitating factors for motorcycle-involved crashes. This study examines motorcycle crash risk factors by employing data recently made available from the Federal Highway Administration Motorcycle Crash Causation Study (MCCS). The MCCS represents a comprehensive investigative effort to determine the causes of motorcycle crashes and involved the collection of in-depth data from 351 crashes, as well as the collection of comparison data from 702 paired control observations in Orange County, California. This dataset provides a unique opportunity to understand how the risk of crash involvement varies across different segments of the riding population. Logistic regression models are estimated to identify the rider and vehicle attributes associated with motorcycle crashes. The results of the study suggest that motorcycle crash risks are related to rider age, physical status, and educational attainment. In addition to such factors outside of the rider’s control, several modifiable risk factors, which arguably affect the riders’ proclivity to take risks, were also found to be significantly associated with motorcycle crash risk, including motorcycle type, helmet coverage, motorcycle ownership, speed, trip destination, and traffic violation history.

Maximizing the Value of Electronic Prescription Monitoring Programs

2003 ◽  
Vol 31 (1) ◽  
pp. 8-9
Author(s):  
David B. Brushwood
Keyword(s):  
Inappropriate Prescribing ◽  
Public Health Problem ◽  
Electronic Prescription ◽  
Controlled Substances ◽  
Drug Enforcement Administration ◽  
Prescription Monitoring ◽  
Monitoring Programs ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Great Fear

Diversion of controlled substances from medical to nonmedical purposes is a significant public health problem. However, there is great fear that regulatory efforts to curb this activity could have a chilling effect on appropriate and necessary pain management.To track the extent to which there is inappropriate prescribing and dispensing of controlled substances, seventeen states have adopted prescription monitoring programs. Although earlier programs relied on ink-on-paper multiple copy or serialized prescriptions, the recent trend has been the development of electronic-based programs that can link to computerized pharmacy systems. Although these programs have not been thoroughly analyzed for their safety or efficacy, there is growing enthusiasm for them. The Drug Enforcement Administration (DEA) backs the development of state-based electronic prescription monitoring programs and a bill is pending in Congress that would create a national program.

Basics of Pediatric Pain Management

2019 ◽  
pp. 306-318
Author(s):  
Tommy Rappold ◽  
Matthew Digiusto ◽  
M-Irfan Suleman
Keyword(s):  
Public Health ◽  
Pain Management ◽  
Side Effects ◽  
Health Problem ◽  
Coping Skills ◽  
Public Health Problem ◽  
Pediatric Pain ◽  
Significant Public Health Problem ◽  
Common Causes ◽  
Significant Public Health

Chapter 18 covers the basics of pediatric pain management. Pediatric pain is a significant public health problem leading to lost days of school, increased use of the healthcare system, and multifactorial impact on all aspects of a child’s life. Pediatric patients present special clinical challenges because of variabilities in metabolism, susceptibility to disease and side effects, ability to communicate, developmental stage, coping skills, and support systems. This chapter serves as an introduction to the main features of pediatric pain management and reviews pain assessment, common causes of pain both acute and chronic, and basic nonpharmacologic and pharmacologic strategies in patients ranging from neonates to adolescents.

scholarly journals The Metabolomics of Chronic Pain Conditions: A Systematic Review

2020 ◽  
Vol 22 (4) ◽  
pp. 458-471
Author(s):  
Edwin N. Aroke ◽  
Keesha L. Powell-Roach
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Public Health Problem ◽  
The United States ◽  
High Quality Research ◽  
Downstream Effects ◽  
Significant Public Health Problem ◽  
Significant Public Health ◽  
Chronic Pain Conditions ◽  
Metabolomic Approach

Background: Chronic pain is a significant public health problem in the United States, affecting approximately 100 million people. Yet there is a lack of robust biomarkers for clinical use in chronic pain conditions. Downstream effects of environmental, genomic, and proteomic variations in individuals with chronic pain conditions can be identified and quantified using a metabolomic approach. Aim/Design: The purpose of this systematic review was to examine the literature for reports of potential metabolomic signatures associated with chronic pain conditions. Methods: We searched relevant electronic databases for published studies that used various metabolomic approaches to investigate chronic pain conditions among subjects of all ages. Results: Our search identified a total of 586 articles, 18 of which are included in this review. The reviewed studies used metabolomics to investigate fibromyalgia ( n = 5), osteoarthritis ( n = 4), migraine ( n = 3), musculoskeletal pain ( n = 2), and other chronic pain conditions ( n = 1/condition). Results show that several known and newly identified metabolites differ in individuals with chronic pain conditions compared to those without these conditions. These include amino acids (e.g., glutamine, serine, and phenylalanine) and intermediate products (e.g., succinate, citrate, acetylcarnitine, and N-acetylornithine) of pathways that metabolize various macromolecules. Conclusion: Though more high-quality research is needed, this review provides insights into potential biomarkers for future metabolomics studies in people with chronic pain conditions.

scholarly journals De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions (DIODE): Trial rationale, protocol, and progress to date (Preprint)

2020 ◽  
Author(s):  
D. Brad Rindal ◽  
Stephen E. Asche ◽  
Jan Gryczynski ◽  
Sheryl M. Kane ◽  
Anjali R. Truitt ◽  
...  
Keyword(s):  
United States ◽  
Pain Management ◽  
Patient Education ◽  
Randomized Trial ◽  
Primary Outcome ◽  
Opioid Analgesics ◽  
The United States ◽  
Prescribing Patterns ◽  
Opioid Prescribing ◽  
Patient Level

BACKGROUND Overdose deaths from prescription opioid analgesics are a continuing crisis in the United States. Opioid analgesics are among the most frequently prescribed drugs by dentists. An estimated 5 million people undergo third-molar extractions in the United States each year, resulting in postoperative pain. Studies show that in most cases the combination of ibuprofen and acetaminophen is an effective alternative to commonly-prescribed opioid analgesics for the management of post-extraction pain. Nevertheless, many dentists routinely prescribe opioids after dental extractions. OBJECTIVE We describe the rationale, design, and methods for a randomized trial of interventions designed to de-implement opioid prescribing by dentists while implementing effective non-opioid analgesics following dental extractions. METHODS Using a prospective, 3-arm cluster randomized trial design with dentists as the unit randomized and patient-level prescribing data as the primary outcome, we will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients. The study will test the efficacy of two interventions to decrease opioid prescribing following dental extractions: Clinical Decision Support (CDS), and CDS with Patient Education (CDS-E). Providers will be randomized to CDS, CDS-E, or standard practice. Patient-level outcomes will be determined via review of comprehensive electronic health records. We will compare study arms on differential change in prescribing patterns from pre- to post-implementation of the intervention. The primary outcome of interest is a binary indicator of whether or not the patient received an opioid prescription on the day of the extraction encounter. We will also examine recommendations or prescriptions for non-opioid analgesics, patients’ perception of shared decision making, and patients’ pain experiences following the extraction. RESULTS The HealthPartners Institutional Review Board has approved the study. All study materials including the CDS and patient education materials have been developed and pilot tested and the protocol has been approved by National Institute of Dental and Craniofacial Research (NIDCR). The intervention was implemented in February 2020 and data collection has begun. CONCLUSIONS If the intervention strategies are shown to be effective, they could be implemented more broadly in dental settings with high levels of opioid prescribing. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03584789

scholarly journals Self-neglect: a survey of old age psychiatrists in Ireland

2013 ◽  
Vol 25 (12) ◽  
pp. 2088-2090 ◽  
Author(s):  
James G. O’Brien ◽  
Colm Cooney ◽  
Mairead Bartley ◽  
Desmond O’Neill
Keyword(s):  
Old Age ◽  
Elderly Person ◽  
Public Health Problem ◽  
The United States ◽  
Personal Hygiene ◽  
Protective Services ◽  
Adult Protective Services ◽  
Adequate Food ◽  
Significant Public Health Problem ◽  
Significant Public Health

Self-neglect in old age is complex, challenging, and likely to increase in the future. Self-neglect is characterized as the behavior of an elderly person that threatens his or her own safety. Self-neglect is the most common form of abuse and neglect reported to Adult Protective Services in the United States (see Teaster, 2000). Self-neglect is also associated with a significantly increased mortality in victims (Dong et al., 2009). Self-neglect has become a significant public health problem affecting not just the victims but also family members, friends, and frequently the community at large. Characteristics of self-neglect include a failure to provide oneself with adequate food, water, clothing, shelter, or a safe environment and neglect of personal hygiene and medical treatment (O’Brien, 2011).

Crowdsourced Tick Image-Informed Updates to U.S. County Records of Three Medically Important Tick Species

2021 ◽  
Author(s):  
Heather L Kopsco ◽  
Roland J Duhaime ◽  
Thomas N Mather
Keyword(s):  
Tick Species ◽  
Ixodes Scapularis ◽  
Public Health Problem ◽  
The United States ◽  
Amblyomma Americanum ◽  
Distribution Data ◽  
Ixodes Pacificus ◽  
Prevention Education ◽  
Significant Public Health Problem ◽  
Significant Public Health

Abstract Burgeoning cases of tick-borne disease present a significant public health problem in the United States. Passive tick surveillance gained traction as an effective way to collect epidemiologic data, and in particular, photograph-based tick surveillance can complement in-hand tick specimen identification to amass distribution data and related encounter demographics. We compared the Federal Information Processing Standards (FIPS) code of tick photos submitted to a free public identification service (TickSpotters) from 2014 to 2019 to published nationwide county reports for three tick species of medical concern: Ixodes scapularis Say (Ixodida: Ixodidae), Ixodes pacificus Cooley and Kohls (Ixodida: Ixodidae), and Amblyomma americanum Linneaus (Ixodida: Ixodidae). We tallied the number of TickSpotters submissions for each tick species according to “Reported” or “Established” criteria per county, and found that TickSpotters submissions represented more than half of the reported counties of documented occurrence, and potentially identified hundreds of new counties with the occurrence of these species. We detected the largest number of new county reports of I. scapularis presence in Michigan, North Carolina, and Texas. Tick image submissions revealed potentially nine new counties of occurrence for I. pacificus, and we documented the largest increase in new county reports of A. americanum in Kentucky, Illinois, Indiana, and Ohio. These findings demonstrate the utility of crowdsourced photograph-based tick surveillance as a complement to other tick surveillance strategies in documenting tick distributions on a nationwide scale, its potential for identifying new foci, and its ability to highlight at-risk localities that might benefit from tick-bite prevention education.

Understanding Characteristics Of Users With Signs Of Opioid Misuse On Twitter (Preprint)

2020 ◽  
Author(s):  
Haya Jarad ◽  
Junhua Yang ◽  
Abeed Sarker
Keyword(s):  
United States ◽  
Pain Management ◽  
Religious Orientation ◽  
The United States ◽  
Opioid Abuse ◽  
Management Tool ◽  
Opioid Misuse ◽  
Major Health Problem ◽  
Personal Traits ◽  
And Behaviors

BACKGROUND Opioid misuse is a major health problem in the United States, and can lead to addiction and fatal overdose. The United States is in the midst of an opioid epidemic; in 2018, an average of approximately 130 Americans died daily from an opioid overdose and 2.1 million have an opioid use disorder (OUD). In addition to electronic health records (EHRs), social media have also been harnessed for studying and predicting physical and behavioral outcomes of OUD. Specifically, it has been shown that on Twitter the use of certain language patterns and their frequencies in subjects’ tweets are indicative of significant healthcare outcomes such as opioid misuse/use and suicide ideation. We sought to understand personal traits and behaviors of Twitter chatters relative to the motive of opioid misuse; pain or recreational. OBJECTIVE . METHODS We collected tweets using the Twitter public developer application programming interface (API) between April 13, 2018 – and May 21, 2018. A list of opioid-related keywords were searched for such as methadone, codeine, fentanyl, hydrocodone, vicodin, heroin and oxycodone. We manually annotated tweets into three classes: no-opioid misuse, pain-misuse and recreational-misuse, the latter two representing misuse for pain or recreation/addiction. We computed the coding agreement between the two annotators using the Cohen’s Kappa statistic. We applied the Linguistic Inquiry and Word Count (LIWC) tool on historical tweets, with at least 500 words, of users in the dataset to analyze their language use and learn about their personality raits and behaviors. LIWC is a text processing software that analyzes text narratives and produces approximately 90 variables scored based on word use that pertain to phsycological, emotional, behavioral, and linguistic processes. A multiclass logistic regression model with backward selection based on the BIC criterion was used to identify variables associated with pain and recreational opioid misuse compared to the base class; no-opioid misuse.. The goal was to understand whether personal traits or behaviors differ across different classes. We reported the odd ratios of different variables in both pain and recreational related opioid misuse classes with respect to the no-opioid misuse class. RESULTS The manual annotation resulted in a total of 1,164 opioid related tweets. 229 tweets were assigned to the pain-related class, 769 were in the recreational class, and 166 tweets were tagged with no opioid misuse class. The overall inter-annotator agreement (IAA) was 0.79. Running LIWC on the tweets resulted in 55 variables. We selected the best model based on BIC. We examined the variables with the highest odd ratios to determine those associated with both pain and recreational opioid misuse as compared to the base class. Certain traits such as depression, stress, and melancholy are established in the literature as commonplace amongst opiod abuse indiviuals. In our analysis, these same characteristics, amongst others, were identified as significantly positively associated with both the Pain and Recreational groups compared to the no-opioid misuse group. Despite the different motivaions for opiod abuse, both groups present the same core personality traits. Interestingly, individuals who misuse opioids as a pain management tool exhibited higher odds ratios for psychological processees and personal traits based on their tweet language. These include a strong focus on discipline, as demonstrated by the variables “disciplined”, “cautious” and “work_oriented”. Their tweet language is also indicative of cheerfulness, a variable absent in the recreational misuse group. Variables associated with the reacreational misuse group revolve around external factors. They are generous and motivated by reward, while maintaining a religious orientation. Based on their tweet language, this group is also characterized as “active”; we understand that these individuals are more social and community focused . CONCLUSIONS To our best knowledge, this is the first study to investigate motivations of opioid abuse as it relates to tweet language. Previous studies utilizing Twitter data were limited to simply detecting opiod abuse likelihood through tweets. By delving deeper into the classes of opioid abuse and its motivation, we offer greater insight into opioid abuse behavior. This insight extends beyond simple identification, and explores patterns in motivation. We conclude that user language on Twitter is indicative of significant differences in personal traits and behaviors depending on abuse motivation: pain management or recreation.

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