Impact of a Large Fire and Subsequent Pollution Control Failure at a Coke Works on Acute Asthma Exacerbations in Nearby Adult Residents

Clairton, Pennsylvania, is home to the largest coke works facility in the United States (US). On 24 December 2018, a large fire occurred at this facility and damaged pollution control equipment. Although repairs were not completed for several months, production continued at pre-fire capacity and daily emissions increased by 24 to 35 times, with multiple exceedances of monitored levels of outdoor air pollution (OAP). The aim of this study was to objectively evaluate the impact of this industrial incident and resultant OAP exceedances on asthma morbidity. We assessed pre-fire and post-fire rate ratios (RR) of outpatient and emergency department (ED) visits for asthma exacerbations among nearby adult residents. Pre-fire versus post-fire RRs increased for both visit types: RR = 1.82 (95% CI: 1.30, 2.53; p < 0.001) and 1.84 (95% CI: 1.05, 3.22; p = 0.032) for outpatient and ED visits, respectively. Additionally, total visit rates increased on days with OAP exceedances: RR = 2.47 (95% CI: 1.52, 4.01; p < 0.0001), 1.58 (95% CI: 1.00, 2.48; p = 0.048) and 1.79 (95% CI: 1.27, 2.54; p = 0.001) for PM2.5, SO2, and H2S exceedance days, respectively. These results show a near doubling of acute visits for asthma exacerbations in nearby adult residents during this industrial incident and underscore the need for prompt remediation and public notification of OAP exceedances to prevent adverse health impacts.

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Impact of the first COVID-19 shelter-in-place order in the United States on emergency department utilization, Marin County, California

10.1101/2020.07.01.20144691 ◽

2020 ◽

Author(s):

Brett R. Bayles ◽

Michaela F George ◽

Haylea Hannah ◽

Patti Culross ◽

Rochelle R. Ereman ◽

...

Keyword(s):

United States ◽

San Francisco ◽

Large Scale ◽

Temporal Dynamics ◽

The United States ◽

Emergency Department Utilization ◽

Marin County ◽

Before And After ◽

Ed Visits ◽

The Impact

Background: The first shelter-in-place (SIP) order in the United States was issued across six counties in the San Francisco Bay Area to reduce the impact of COVID-19 on critical care resources. We sought to assess the impact of this large-scale intervention on emergency departments (ED) in Marin County, California. Methods: We conducted a retrospective descriptive and trend analysis of all ED visits in Marin County, California from January 1, 2018 to May 4, 2020 to quantify the temporal dynamics of ED utilization before and after the March 17, 2020 SIP order. Results: The average number of ED visits per day decreased by 52.3% following the SIP order compared to corresponding time periods in 2018 and 2019. Both respiratory and non-respiratory visits declined, but this negative trend was most pronounced for non-respiratory admissions. Conclusions: The first SIP order to be issued in the United States in response to COVID-19 was associated with a significant reduction in ED utilization in Marin County.

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Cockroach exposure and childhood asthma: Is the effect an artifact of confounding by stress?

10.21203/rs.3.rs-44826/v1 ◽

2020 ◽

Author(s):

Felicia Rabito ◽

Derek Werthmann ◽

Hua He ◽

Aubrey S. Madkour ◽

Whitney D. Arroyave ◽

...

Keyword(s):

Strong Association ◽

High Stress ◽

Asthma Management ◽

Stress Path ◽

Mediation Effect ◽

Asthma Morbidity ◽

Modifiable Factors ◽

Children With Asthma ◽

Ed Visits ◽

The Impact

Abstract Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure. Conclusion The strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.

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Continued Evidence of the Impact of Rotavirus Vaccine in Children Less Than 3 Years of Age From the United States New Vaccine Surveillance Network: A Multisite Active Surveillance Program, 2006–2016

Clinical Infectious Diseases ◽

10.1093/cid/ciaa150 ◽

2020 ◽

Author(s):

Mary Allen Staat ◽

Daniel C Payne ◽

Natasha Halasa ◽

Geoffrey A Weinberg ◽

Stephanie Donauer ◽

...

Keyword(s):

United States ◽

Disease Burden ◽

The United States ◽

Population Based ◽

Surveillance Program ◽

Surveillance Network ◽

Rotavirus Vaccination ◽

Ed Visits ◽

The Impact ◽

Vaccine Surveillance

Abstract Background Since 2006, the New Vaccine Surveillance Network has conducted active, population-based surveillance for acute gastroenteritis (AGE) hospitalizations and emergency department (ED) visits in 3 United States counties. Trends in the epidemiology and disease burden of rotavirus hospitalizations and ED visits were examined from 2006 to 2016. Methods Children < 3 years of age hospitalized or visiting the ED with AGE were enrolled from January 2006 through June 2016. Bulk stool specimens were collected and tested for rotavirus. Rotavirus-associated hospitalization and ED visit rates were calculated annually with 2006–2007 defined as the prevaccine period and 2008–2016 as the postvaccine period. Rotavirus genotype trends were compared over time. Results Over 11 seasons, 6954 children with AGE were enrolled and submitted a stool specimen (2187 hospitalized and 4767 in the ED). Comparing pre- and postvaccine periods, the proportion of children with rotavirus dramatically declined for hospitalization (49% vs 10%) and ED visits (49% vs 8%). In the postvaccine era, a biennial pattern of rotavirus rates was observed, with a trend toward an older median age. G1P[8] (63%) was the predominant genotype in the prevaccine period with a significantly lower proportion (7%) in the postvaccine period (P < .001). G2P[4] remained stable (8% to 14%) in both periods, whereas G3P[8] and G12P[8] increased in proportion from pre- to postvaccine periods (1% to 25% and 17% to 40%), respectively. Conclusions The epidemiology and disease burden of rotavirus has been altered by rotavirus vaccination with a biennial disease pattern, sustained low rates of rotavirus in children < 3 years of age, and a shift in the residual genotypes from G1P[8] to other genotypes.

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Eliminating Central Line–Associated Bloodstream Infections: A National Patient Safety Imperative

Infection Control and Hospital Epidemiology ◽

10.1086/674384 ◽

2014 ◽

Vol 35 (1) ◽

pp. 56-62 ◽

Cited By ~ 78

Author(s):

Sean M. Berenholtz ◽

Lisa H. Lubomski ◽

Kristina Weeks ◽

Christine A. Goeschel ◽

Jill A. Marsteller ◽

...

Keyword(s):

Bloodstream Infections ◽

The United States ◽

Central Line ◽

Program Goal ◽

National Patient ◽

National Initiative ◽

Adjusted Incidence Rate ◽

Rate Ratios ◽

The Impact ◽

Clabsi Rate

Background.Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.Methods.We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.Results.A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.Conclusion.Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.

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Regional variation in high-resource utilization among lung cancer-related emergency department visits in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e20038 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e20038-e20038

Author(s):

Cynthiya Ruban ◽

Marc Kowalkowski ◽

Christopher Michael Blanchette

Keyword(s):

Lung Cancer ◽

Emergency Department ◽

Regional Variation ◽

The United States ◽

Emergency Department Visits ◽

Factors Associated ◽

High Resource ◽

Ed Visits ◽

Hospital Factors ◽

The Impact

e20038 Background: Regional variation is common in oncology care but is not defined for emergency department (ED) care for cancer patients, particularly patients with lung cancer (LC) who regularly utilize EDs for management of acute cancer or treatment related illness. This study analyzed regional variation and other factors associated with high total episodic charge (≥75th percentile; HTC) among LC patients evaluated in the ED in relation to discharge or admission. Methods: A retrospective study of LC-related ED visits in the US was conducted using the 2013 Nationwide ED Sample. LC-related ED visits among adults were identified by LC-specific Clinical Classification Software codes (CCS = 19; mapping to ICD-9 = 162.x, 209.21, 231.2, V10.11). Multivariable logistic regression analyzed the association between patient and hospital factors and HTC, weighted to represent ED visits nationwide. Results: Among 373,761 LC-related ED visits, 134,838 (36%) were treated and discharged and 238,923 (64%) were admitted (ranging from 51% (West [W]) to 76% (South [S]). HTC was ≥$5,655 (median = $2,993) for ED discharges and ≥$54,760 (median = $29,590) for admissions. The proportion of visits with HTC differed by region and admission status (discharged: 7% [W] to 27% [S]; admitted: 20% [Midwest] to 39% [W]). After adjusting for clinical and hospital factors associated with increased HTC odds (metastases, common acute comorbid disorder [chest and abdominal pain, pneumonia, sepsis, respiratory failure], diagnostic radiology use, thoracic/other surgery, chemo/radiotherapy, length of stay, primary payer, and hospital ownership, location and teaching status), significant HTC variation remained by hospital region with opposing relative HTC odds among discharged and admitted patients (discharged: W v S OR = 0.3 95%CI = 0.2-0.6, Northeast v S OR = 0.5 95%CI = 0.3-0.7; admitted: W v S OR = 3.8 95%CI = 2.5-5.7). Conclusions: Regional variation in HTC suggest differences in ED use and management patterns for LC and may reflect quality of care concerns. Clinical outcome linkage (including ED revisit tracking) is needed to better define the impact of variation and develop strategies to improve care for patients with LC.

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Assessing the impact of the Good Samaritan Law in the state of Connecticut: a system dynamics approach

Health Research Policy and Systems ◽

10.1186/s12961-021-00807-w ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Nasim S. Sabounchi ◽

Rebekah Heckmann ◽

Gail D’Onofrio ◽

Jennifer Walker ◽

Robert Heimer

Keyword(s):

Public Health ◽

System Dynamics ◽

The United States ◽

Opioid Use Disorder ◽

Behavioral Changes ◽

Opioid Use ◽

Good Samaritan ◽

Ed Visits ◽

The Impact ◽

Overdose Deaths

Abstract Background Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. Methods Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. Results The simulation model suggests that Connecticut’s GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. Conclusions The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.

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Cockroach exposure and perceived stress interact to predict clinical outcomes in childhood asthma

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01447-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Felicia A. Rabito ◽

Derek Werthmann ◽

Hua He ◽

Aubrey S. Madkour ◽

Whitney D. Arroyave ◽

...

Keyword(s):

Perceived Stress ◽

Strong Association ◽

High Stress ◽

Asthma Management ◽

Stress Path ◽

Mediation Effect ◽

Asthma Morbidity ◽

Modifiable Factors ◽

Ed Visits ◽

The Impact

Abstract Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure. Conclusion The strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.

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The Impact of Changing Demographic Composition on Aggravated Assault Victimization During the Great American Crime Decline

Criminal Justice Review ◽

10.1177/0734016817724503 ◽

2017 ◽

Vol 42 (3) ◽

pp. 291-314 ◽

Cited By ~ 3

Author(s):

Maria Kaylen ◽

William Alex Pridemore ◽

Sean Patrick Roche

Keyword(s):

Rural Areas ◽

Interpersonal Violence ◽

The United States ◽

Demographic Composition ◽

Aggravated Assault ◽

Victimization Rate ◽

Urban Rural ◽

Rate Ratios ◽

The Impact ◽

Victimization Rates

The United States experienced a dramatic decline in interpersonal violence rates between the early 1990s and mid-2000s. This decline, however, was much steeper in urban and suburban relative to rural areas. Prior research showed changing demographic composition can account for a substantial amount of change in inequality in victimization rates. We employed National Crime Victimization Survey data and counterfactual modeling to determine if changes in demographic composition—including proportion of population young, unmarried, male, unemployed, and in several income groups—of urban, suburban, and rural areas were partially responsible for changes between 1993 and 2005 in (1) area-specific aggravated assault victimization rates and (2) urban–suburban, urban–rural, and suburban–rural victimization rate ratios. Results showed changes in individual demographic characteristics played a very minor role in changes in area-specific assault rates. The one exception was income, which explained a substantial amount of change in victimization rates across all three areas. Changes in demographic composition explained a greater amount of change in rural relative to urban and suburban victimization rates. Changes in demographic composition across these three area types were also responsible for a small proportion of the large changes in the urban–rural and suburban–rural victimization rate ratios over time.

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Modeling the Impact of COVID-19 on Dental Insurance Coverage and Utilization

Journal of Dental Research ◽

10.1177/0022034520954126 ◽

2020 ◽

Vol 100 (1) ◽

pp. 50-57

Author(s):

S.E. Choi ◽

L. Simon ◽

C.A. Riedy ◽

J.R. Barrow

Keyword(s):

United States ◽

Dental Care ◽

Insurance Coverage ◽

The United States ◽

Sensitivity Analyses ◽

Dental Insurance ◽

Unemployment Rates ◽

Access To Dental Care ◽

Ed Visits ◽

The Impact

Unemployment rates in the United States are rapidly increasing as a result of the COVID-19 pandemic and attendant economic disruption. As employees lose their jobs, many will lose their employer-sponsored dental insurance (ESDI). Changes in insurance coverage are directly related to the oral health of the population, with many at risk of losing access to dental care. We assessed the impact of recent unemployment rates on insurance coverage and dental utilization. We estimated changes in dental insurance coverage at the state level, using previously applied econometric estimates. Expected changes in types of dental procedures performed at dental practices nationwide were assessed using a microsimulation model, using national practice survey data. Changes in emergency department (ED) visits for dental problems were estimated by fitting trendlines to ED visit patterns by payer type. Sensitivity analyses were conducted to assess how variations in unemployment rates and rates of ESDI in response to unemployment could alter the results. Since March 2020, the national unemployment rate has increased by 8.40 percentage points, an increase expected to result in more than 16 million individuals losing ESDI in the United States. Of these individuals, 45.0% are likely to enroll in their state’s Medicaid and Children’s Health Insurance Program, and 47.0% are expected to become uninsured. With these expected changes in dental insurance coverage, the average dental practice would experience decreases in routine checkup visits but increases in tooth extraction, a procedure that is highly used by publicly insured or uninsured patients. In addition, dental-related ED visits would be expected to grow by 4.0%. Losses of employment caused by the COVID-19 in the United States can have countervailing effects on people’s health by impeding access to dental care. Lack of dental insurance is expected to be more pronounced in states that have not expanded Medicaid or do not provide Medicaid dental benefits for adults.

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