scholarly journals Decreased Incidence of Michigan Emergency Department Visits for Febrile Neutropenia Observed After Public Health Measures for the COVID-19 Pandemic

2021 ◽  
Author(s):  
Michael Baracy ◽  
Karen Hagglund ◽  
Logan Corey
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Febrile Neutropenia ◽  
Hematologic Malignancy ◽  
Population Based ◽  
Primary Study ◽  
Executive Orders ◽  
Social Distancing ◽  
The Public ◽  
Ed Visits

Abstract Importance: Masking and social distancing appear to decrease the of febrile neutropenia in susceptible populations, especially among patients with hematologic malignancies.Objective: To determine whether COVID-19 infection mitigation efforts, namely masking and social distancing, results in a reduction in the incidence of febrile neutropenia.Design: This was a retrospective cohort study comparing the incidence of FN in the 13 months prior to (Year 0) and 13 months following (Year 1) the public health executive orders (PHEO) in Michigan. Data voluntarily submitted by Michigan emergency departments to the National Syndromic Surveillance Program (NSSP) was queried for all ED visits from April 1st, 2019 to March 31st, 2021.Setting: Population based study.Participants: A population-based sample of patients who reported to a Michigan emergency department and on whom data was captured.Intervention(s): Population based masking and social distancing.Main Outcome(s) and Measure(s): The primary study outcome was the incidence of FN as a proportion of emergency visits in the 13-months before and after COVID-19 mitigations efforts, namely masking and social distancing. We hypothesized that there would be a significant decrease in the incidence of FN in the period following the public health executive orders aimed at reducing the spread of the COVID-19 virus.Results: There was a total of 8,979,221 total ED visits captured during the study period. In Year 0 there were 5,073,081 recorded ED visits and 3,906,140 in Year 1, a decrease of 23%. There was a significant reduction in the proportion of total ED visits with a diagnosis of FN, decreasing 13.3% across periods (0.15% vs. 0.13%, p=0.036). In patients with a hematologic malignancy the incidence of FN was significantly lower in the period following PHEO (22% vs 17%, p=0.02, Table 2).Conclusions and Relevance: Our study found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN, particularly in those with a hematologic malignancy. These findings may be useful in the design of clinical trials as well as informing future recommendations for the prevention of FN.

scholarly journals The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252441
Author(s):  
Elissa Rennert-May ◽  
Jenine Leal ◽  
Nguyen Xuan Thanh ◽  
Eddy Lang ◽  
Shawn Dowling ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Population Based ◽  
Emergency Department Visits ◽  
System Capacity ◽  
Population Based Study ◽  
Health Measures ◽  
Ed Visits ◽  
The Impact

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

Assessing the quality of public health in the Russian Federation and Israel: Main problems and solutions

2020 ◽  
Vol 19 (4) ◽  
pp. 618-632
Author(s):  
A.S. Panchenko
Keyword(s):  
Public Health ◽  
Russian Federation ◽  
Population Based ◽  
The Public ◽  
Disability Adjusted Life ◽  
Problems And Solutions ◽  
The Russian Federation ◽  
Disability Adjusted Life Year ◽  
Practical Recommendations

Subject. The article addresses the public health in the Russian Federation and Israel. Objectives. The focus is on researching the state of public health in Russia and Israel, using the Global Burden of Disease (GBD) project methodology, identifying problem areas and searching for possible ways to improve the quality of health of the Russian population based on the experience of Israel. Methods. The study draws on the ideology of the GBD project, which is based on the Disability-Adjusted Life-Year (DALY) metric. Results. The paper reveals the main causes of DALY losses and important risk factors for cancer for Russia and Israel. The findings show that the total DALY losses for Russia exceed Israeli values. The same is true for cancer diseases. Conclusions. Activities in Israel aimed at improving the quality of public health, the effectiveness of which has been proven, can serve as practical recommendations for Russia. The method of analysis, using the ideology of the GBD project, can be used as a tool for quantitative and comparative assessment of the public health.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

2020 ◽  
pp. 1-10
Author(s):  
Brittany M. Stopa ◽  
Maya Harary ◽  
Ray Jhun ◽  
Arun Job ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Data Bank ◽  
The United States ◽  
National Sample ◽  
Population Based ◽  
Weighted Estimates ◽  
True Incidence ◽  
Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

scholarly journals The effect of social distancing on the reach of an epidemic in social networks

2021 ◽  
Author(s):  
Gregory Gutin ◽  
Tomohiro Hirano ◽  
Sung-Ha Hwang ◽  
Philip R. Neary ◽  
Alexis Akira Toda
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Social Networks ◽  
Monte Carlo Simulation ◽  
Monte Carlo ◽  
Disease Transmission ◽  
Global Level ◽  
Social Distancing ◽  
The Public ◽  
Simulation Results

AbstractHow does social distancing affect the reach of an epidemic in social networks? We present Monte Carlo simulation results of a susceptible–infected–removed with social distancing model. The key feature of the model is that individuals are limited in the number of acquaintances that they can interact with, thereby constraining disease transmission to an infectious subnetwork of the original social network. While increased social distancing typically reduces the spread of an infectious disease, the magnitude varies greatly depending on the topology of the network, indicating the need for policies that are network dependent. Our results also reveal the importance of coordinating policies at the ‘global’ level. In particular, the public health benefits from social distancing to a group (e.g. a country) may be completely undone if that group maintains connections with outside groups that are not following suit.

scholarly journals Epidemiological modelling of the health and economic effects of COVID-19 control in Australia’s second wave

2021 ◽  
Author(s):  
R. Quentin Grafton ◽  
John Parslow ◽  
Tom Kompas ◽  
Kathryn Glass ◽  
Emily Banks
Keyword(s):  
Public Health ◽  
Health Outcomes ◽  
Health Management ◽  
Economic Effects ◽  
Social Distancing ◽  
The Public ◽  
Long Duration ◽  
Community Transmission ◽  
Second Wave ◽  
Detection Strategies

Abstract Background We investigated the public health and economy outcomes of different levels of social distancing to control a ‘second wave’ outbreak in Australia and identify implications for public health management of COVID-19. Methods Individual-based and compartment models were used to simulate the effects of different social distancing and detection strategies on Australian COVID-19 infections and the economy from March to July 2020. These models were used to evaluate the effects of different social distancing levels and the early relaxation of suppression measures, in terms of public health and economy outcomes. Results The models, fitted to observations up to July 2020, yielded projections consistent with subsequent cases and showed that better public health outcomes and lower economy costs occur when social distancing measures are more stringent, implemented earlier and implemented for a sufficiently long duration. Early relaxation of suppression results in worse public health outcomes and higher economy costs. Conclusions Better public health outcomes (reduced COVID-19 fatalities) are positively associated with lower economy costs and higher levels of social distancing; achieving zero community transmission lowers both public health and economy costs compared to allowing community transmission to continue; and early relaxation of social distancing increases both public health and economy costs.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

Triage Management, Survival, and the Law in the Age of Ebola

2014 ◽  
Vol 9 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Frederick M Burkle ◽  
Christopher M Burkle
Keyword(s):  
Public Health ◽  
International Health ◽  
Epidemiological Data ◽  
Population Based ◽  
World Health ◽  
Economic Stability ◽  
Budget Cuts ◽  
The Public ◽  
Level 3 ◽  
Health Organization

AbstractLiberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. (Disaster Med Public Health Preparedness. 2014;0:1-6)

scholarly journals Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions

2021 ◽  
Vol 42 (3) ◽  
pp. 247-256
Author(s):  
Lacey B. Robinson ◽  
Anna Chen Arroyo ◽  
Rebecca E. Cash ◽  
Susan A. Rudders ◽  
Carlos A. Camargo
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
New York ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization ◽  
Allergic Reactions ◽  
Infants And Toddlers ◽  
Ed Visits ◽  
Total Charges

Background and Objective: Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). Methods: We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Results: Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (Ptrend < 0.001), whereas hospitalizations for AAR remained stable (Ptrend = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009‐2015) and hospitalizations (2011‐2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Conclusion: Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.

scholarly journals ABO Blood Groups and the Incidence of Complications in COVID-19 Patients: A Population-Based Prospective Cohort Study

2021 ◽  
Vol 18 (19) ◽  
pp. 10039
Author(s):  
Salvador Domènech-Montoliu ◽  
Joan Puig-Barberà ◽  
Maria Rosario Pac-Sa ◽  
Paula Vidal-Utrillas ◽  
Marta Latorre-Poveda ◽  
...  
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Relative Risk ◽  
Clinical Analysis ◽  
Population Based ◽  
Blood Groups ◽  
Adjusted Relative Risk ◽  
Abo Blood Groups ◽  
The Public ◽  
Telephone Interviews

After a COVID-19 outbreak in the Falles festival of Borriana (Spain) during March 2020, a cohort of patients were followed until October 2020 to estimate complications post-COVID-19, considering ABO blood groups (ABO). From 536 laboratory-confirmed cases, 483 completed the study (90.1%) carried by the Public Health Center of Castelló and the Emergency and Microbiology and Clinical Analysis of Hospital de la Plana Vila-real. The study included ABO determination and telephone interviews of patients. The participants had a mean age of 37.2 ± 17.1 years, 300 females (62.1%). ABO were O (41.4%), A (45.5%), B (9.1%), and AB (3.9%). We found no difference in the incidence of COVID-19 infections. A total of 159 (32.9%) patients reported one or more post-COVID-19 complications with divergent incidences after adjustment: O (32.3%), A (32.6%), B (54.1%), and AB (27.6%); B groups had more complications post-COVID-19 when compared with O group (adjusted relative risk [aRR] 95% confidence interval [CI] 1.68, 95% CI 1.24–2.27), and symptoms of fatigue (1.79, 95% CI 1.08–2.95), myalgia (2.06, 95% CI 1.10–3.84), headache (2.61, 95% CI 1.58–4.31), and disorder of vision (4.26 95% CI 1.33–13.60). In conclusion, we observed significant differences in post-COVID-19 complications by ABO, with a higher incidence in B group. Additional research is justified to confirm our results.

scholarly journals Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Julio García-Suárez ◽  
◽  
Javier de la Cruz ◽  
Ángel Cedillo ◽  
Pilar Llamas ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cancer Therapy ◽  
Hematologic Malignancy ◽  
Large Population ◽  
Hematologic Malignancies ◽  
Population Based ◽  
Clinical Severity ◽  
Primary Study ◽  
Registry Study ◽  
Population Based Registry

Abstract Background Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. Methods In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. Results Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17–10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). Conclusions In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.

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