Sentinel surveillance of suspected opioid-related poisonings and injuries: trends and context derived from the electronic
Canadian Hospitals Injury Reporting and Prevention Program, March 2011 to June 2017

Introduction The opioid epidemic is currently a major public health problem in Canada. As such, knowledge of upstream risk factors associated with opioid use is needed to inform injury prevention, health promotion and harm reduction efforts. Methods We analyzed data extracted from 11 pediatric and 6 general hospital emergency departments (EDs) as part of the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from March 2011 to June 2017. We identified suspected opioid-related injuries using search strings and manually verified them. We computed age-adjusted and sex-stratified proportionate injury ratios (PIRs) and 95% confidence intervals (CIs) to compare opioid-related injuries to all injuries in eCHIRPP. Negative binomial regression was used to determine trends over time. We conducted qualitative analyses of narratives to identify common themes across life stages. Results Between March 2011 and June 2017, 583 suspected opioid-related poisoning/ injury cases were identified from eCHIRPP. Most of the cases were females (55%). Many of the injuries occurred in patients’ own homes (51%). Forty-five percent of the injuries were intentional self-harm. Among children (aged 1–9 years), most injuries were caused by inadvertent consumption of opioids left unattended. Among youth (aged 10–19 years) and adults (aged 20–49 years), opioid use was associated with underlying mental illness. Overall, the average annual percent change (AAPC) in the rate of injuries (per 100 000 eCHIRPP cases) has been increasing since 2012 (AAPC = 11.9%, p $lt; .05). The increase is particularly evident for males (AAPC = 16.3%, p $lt; .05). Compared to other injuries, people with suspected opioid-related injuries were more likely to be admitted to hospital (PIR = 5.3, 95% CI: 4.6–6.2). Conclusion The upstream determinants of opioid-related injuries are complex and likely vary by subpopulations. Therefore, continued monitoring of risk factors is important in providing the evidence necessary to prevent future overdoses and deaths.

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Substance Abuse and Drug-Related Death, Suicidal Ideation, and Suicide: A Review

Crisis ◽

10.1027//0227-5910.20.1.28 ◽

1999 ◽

Vol 20 (1) ◽

pp. 28-35 ◽

Cited By ~ 29

Author(s):

Annie Mino ◽

Arnaud Bousquet ◽

Barbara Broers

Keyword(s):

Public Health ◽

Risk Factors ◽

Substance Abuse ◽

Suicidal Ideation ◽

Family Support ◽

Drug Users ◽

Suicide Attempts ◽

Public Health Problem ◽

Major Public Health Problem ◽

Hiv Epidemic

The high mortality rate among drug users, which is partly due to the HIV epidemic and partly due to drug-related accidental deaths and suicides, presents a major public health problem. Knowing more about prevalence, incidence, and risk factors is important for the development of rational preventive and therapeutic programs. This article attempts to give an overview of studies of the relations between substance abuse, suicidal ideation, suicide, and drug-related death. Research in this field is hampered by the absence of clear definitions, and results of studies are rarely comparable. There is, however, consensus about suicidal ideation being a risk factor for suicide attempts and suicide. Suicidal ideation is also a predictor of suicide, especially among drug users. It is correlated with an absence of family support, with the severity of the psychosocial dysfunctioning, and with multi-drug abuse, but also with requests for treatment. Every clinical examination of a drug user, not only of those who are depressed, should address the possible presence of suicidal ideation, as well as its intensity and duration.

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MEASLES OUTBREAK IN A RURAL AREA OF A DEVELOPING COUNTRY: A CASE CONTROL STUDY

Pakistan Journal of Public Health ◽

10.32413/pjph.v7i4.78 ◽

2018 ◽

Vol 7 (4) ◽

pp. 197-201

Author(s):

Mir M Hassan Bullo ◽

Mirza Amir Baig ◽

Jawad Faisal Malik ◽

Ejaz Ahmad Khan ◽

Muazam Abbas Ranjha ◽

...

Keyword(s):

Risk Factors ◽

Vaccine Coverage ◽

Significant Risk ◽

Public Health Problem ◽

Maculopapular Rash ◽

Healthcare Facility ◽

Control Measures ◽

Major Public Health Problem ◽

District Health ◽

Active Case

Background: Measles is highly contagious vaccine preventable disease (VPD), and a major public health problem considered as leading cause of morbidity and mortality in developing countries like Pakistan. An outbreak of measles was reported in Sharifabad Islamabad on 15th of April 2017, and an investigation was launched to assess the magnitude of outbreak, evaluate risk factors and recommend control measures. Methods: A comprehensive house to house active case search along with vaccine coverage survey was conducted from April 19-22, 2017. A case was defined as "onset of maculopapular rash with fever in a resident of Sharifabad with at least one of the following signs/ symptoms, Coryza, Conjunctivitis, Cough, Otitis media or Pneumonia present in between 19 March to 22nd April 2017". Four age & sex matched controls were selected from the neighborhood. Data was collected through interview method using structured questionnaire and vaccination coverage was determined by using Epi survey form. Blood samples were sent for laboratory confirmation. Results: A total of eight cases were identified through active case finding while three were reported by local practitioner. Mean age of cases were 20 months (range 8-36 months). Severely affected age-group was 1-2 years with attack rate of 46%. Around two-third (64%) of cases and a few (16%) of controls were unvaccinated against measles. Contact with measles patient [OR 25.2, CI 3.9-160.1, P=0.00], unvaccinated children [OR 9.2 CI 2.12-40.4, P=0.000], social misconception regarding vaccination [OR 7.8 CI 1.42-42.6, P=0.00], and distance from healthcare facility [OR 5.7 CI 1.15-28.35, P=0.02] were significant risk factors. Vaccine efficacy was 90%. Conclusion: Main reasons of the outbreak were contact with the cases, and low vaccination status. We recommended comprehensive measles vaccination and community awareness sessions. On our recommendations district health authority Islamabad carried out mop up of whole area.

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Predictive risk factors towards liver fluke infection among the people in Kamalasai District, Kalasin Province, Thailand

SAGE Open Medicine ◽

10.1177/2050312119840201 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984020 ◽

Cited By ~ 1

Author(s):

Woragon Wichaiyo ◽

Wirat Parnsila ◽

Wisit Chaveepojnkamjorn ◽

Banchob Sripa

Keyword(s):

Risk Factors ◽

Liver Fluke ◽

Public Health Problem ◽

Major Public Health Problem ◽

Cross Sectional ◽

The People ◽

Fluke Infection ◽

Raw Fish ◽

Predictive Risk ◽

Liver Fluke Infection

Background: Liver fluke disease caused by Opisthorchis viverrini remains a major public health problem with its crucial risk factors caused by some individual habits or false beliefs among the people in northeastern Thailand concerning the consumption of raw fish meat dishes. Objectives: This study explores the predictive risk factors for the infection of liver fluke disease. Methods: The sample consisted of 400 people aged 30 years and above in Thanya sub-district, Kamalasai district, Kalasin province. A cross-sectional analytic study, using the χ2 test, odds ratio and 95% confidence interval, was used to find the influence of each variable, along with the use of multiple logistic regression (p = 0.05). A questionnaire form was used as the research instrument. Results: Factors found in the results are as follows: households with a cat were 7.00 times more at risk than households without a cat; eating raw fish dishes prepared by themselves increases the risk of infection by 2.58 times; eating raw fish dishes prepared by family members increases the risk by 4.74 times; and raw fish dishes bought from a community market increases the risk by 2.33 times. Conclusion: A campaign should be launched to educate people not to eat raw or undercooked fish dishes, but to fully cook fish dishes before eating, as the food is still delicious, but also safe, healthy, and free from liver fluke infection.

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Effect of a Fall Prevention Program on Balance Maintenance Using a Quasi-experimental Design in Real-World Settings

Journal of Aging and Health ◽

10.1177/0898264312436713 ◽

2012 ◽

Vol 24 (5) ◽

pp. 827-845 ◽

Cited By ~ 5

Author(s):

Yvonne Robitaille ◽

Michel Fournier ◽

Sophie Laforest ◽

Lise Gauvin ◽

Johanne Filiatrault ◽

...

Keyword(s):

Real World ◽

Fall Prevention ◽

Prevention Program ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Community Dwelling ◽

Balance Performance ◽

Community Based ◽

Fall Prevention Program ◽

Quasi Experimental

Objectives: To examine the effect of a fall prevention program offered under real-world conditions on balance maintenance several months after the program. To explore the program’s impact on falls. Method: A quasi-experimental study was conducted among community-dwelling seniors, with pre- and postintervention measures of balance performance and self-reported falls. Ten community-based organizations offered the intervention (98 participants) and 7 recruited participants to the study’s control arm (102 participants). An earlier study examined balance immediately after the 12-week program. The present study focuses on the 12-month effect. Linear regression (balance) and negative binomial regression (falls) procedures were performed.falls. Results: During the 12-month study period, experimental participants improved and maintained their balance as reflected by their scores on three performance tests. There was no evidence of an effect on falls.falls. Discussion: Structured group exercise programs offered in community-based settings can maintain selected components of balance for several months after the program’s end.

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A review of the evidence to explain pharmacological basis of injection (ab)use of buprenorphine–naloxone tablets

Journal of Opioid Management ◽

10.5055/jom.2021.0651 ◽

2021 ◽

Vol 17 (7) ◽

pp. 141-152

Author(s):

Tamoud Modak, MD, DM ◽

Siddharth Sarkar, MD, MRCPsych ◽

Yatan Pal Singh Balhara, MD

Keyword(s):

Public Health Problem ◽

Opioid Use Disorder ◽

Critical Examination ◽

Evidence Based ◽

Major Public Health Problem ◽

Opioid Use ◽

Evidence Based Treatment ◽

Opioid Replacement Therapy ◽

Pharmacological Basis

Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.

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Sero-epidemiology and risk factors of syphilis in Makassar, Indonesia

Serbian Journal of Dermatology and Venerology ◽

10.2478/sjdv-2019-0006 ◽

2019 ◽

Vol 11 (2) ◽

pp. 43-49

Author(s):

Maryam Kusumawaty ◽

Khairuddin Djawad ◽

Muh Nasrum Massi ◽

Andi Muhammad Adam ◽

Siswanto Wahab ◽

...

Keyword(s):

Risk Factors ◽

Hiv Transmission ◽

Treponema Pallidum ◽

Public Health Problem ◽

Sexual Relationships ◽

Capital City ◽

Major Public Health Problem ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Increased Risk

Abstract Introduction. Syphilis is an infectious disease caused by Treponema pallidum spirochete and is mainly transmitted by sexual contact. Syphilis has the potential to cause serious complications and is closely related to human immunodeficiency virus (HIV) infection thus making syphilis still a major public health problem. In Indonesia, surveys of high-risk populations in 2007 and 2011 reported an increase in the prevalence of syphilis, especially in men who have sexual relationships with other men (MSM). Moreover, studies have described risk factors for HIV transmission including MSM, heterosexual contacts, Intravenous (IV) drug use, and infected partners. Objectives. To assess the epidemiological aspects and risk factors for syphilis in Makassar, as well as the correlation with a coinfection of other sexually transmitted infections. Material and Methods. This study is a multi-centre cross-sectional descriptive study with consecutive sampling. We evaluated cases for eligibility by confirming the diagnosis based on the serological result using rapid plasma reagin assay (RPR), Treponema pallidum haemagglutination (TPHA), and HIV screening kit. The cases were analyzed based on epidemiological features, risk factors and clinical findings, co-infection with other sexually transmitted infection (ST), and stadium of the disease. Results. A total of 79 serologically confirmed syphilis cases were collected between January 2017 and December 2018 in Makassar, the capital city of South Sulawesi province in Indonesia. Of the 63 male subjects (79.7%), 38 (48.1%) were homosexual/MSM, and in 41 cases of HIV-infected subjects, 25 (60.9%) of them were also MSM. Conclusion. Our study showed there was a significant correlation between syphilis and an increased risk of HIV transmission in MSM groups. The higher number of cases of syphilis and HIV co-infection among MSM can increase transmission of both infections and should be considered a major risk factor for syphilis in Makassar.

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Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006–2019: an in-depth assessment

Archives of Public Health ◽

10.1186/s13690-021-00759-1 ◽

2022 ◽

Vol 80 (1) ◽

Author(s):

Samuel Kwaku Essien ◽

David Kopriva ◽

A. Gary Linassi ◽

Audrey Zucker-Levin

Keyword(s):

Negative Binomial ◽

Negative Binomial Regression ◽

Limb Amputation ◽

Annual Percent Change ◽

Discharge Data ◽

Resident Population ◽

True Incidence ◽

Depth Analysis ◽

The Impact ◽

Extremity Amputation

Abstract Background Most epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada. Methods We calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age. Results Incidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period. Conclusion The rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

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Obesity and Overweight in Relation to Hypertension and Associated Risk in School Children

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i431174 ◽

2021 ◽

pp. 80-86

Author(s):

Gorantla Naresh Babu ◽

P. Jameela ◽

S. Jafar Sharif ◽

A. Ramya ◽

K. Ziyaul Haq ◽

...

Keyword(s):

Risk Factors ◽

School Children ◽

Public Health Problem ◽

Overweight And Obesity ◽

Physical Activities ◽

Major Public Health Problem ◽

Healthy Weight ◽

Cardiovascular Risks ◽

Obesity And Overweight ◽

Associated Risk Factors

Aim: Hypertension is a major public health problem worldwide and is associated with high mortality and morbidity. The main aim of this study is to assess obesity and overweight in school children and their relationship to hypertension and associated risk factors. Study Design: Population based cross sectional study. Results and Discussion: A total number of 712 students with age group between 7-12 years from different school were screened for their height, weight and body mass index. The present study was aimed to assess obesity and overweight in school children and their relationship to hypertension and associated risk factors. Under weight and healthy weight children are engaged in physical activities like playing in ground and thus they are healthy where the children who found as overweight and obese were not engaged in physical activities regularly and thus this might be the reason for their overweight and obesity. At the same time the children who found as obese and overweight were said that they were having fast foods twice a day. Conclusion: In order to get rid of these risks and their associated cardiovascular risks, their food habits must be changed and physical activities needs to be improved.

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A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

Frontiers in Sociology ◽

10.3389/fsoc.2021.652672 ◽

2021 ◽

Vol 6 ◽

Author(s):

Cara Jane Bergo ◽

Jennifer R. Epstein ◽

Stacey Hoferka ◽

Marynia Aniela Kolak ◽

Mai T. Pho

Keyword(s):

Risk Factors ◽

High Risk ◽

Drug Use ◽

Injection Drug Use ◽

Negative Binomial ◽

Cook County ◽

Injection Drug ◽

County Level ◽

Opioid Use ◽

Zip Code

The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons <40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

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Assessment of Extrapulmonary Tuberculosis Using Gene Xpert MTB/RIF Assay and Fluorescent Microscopy and Its Risk Factors at Dessie Referral Hospital, Northeast Ethiopia

BioMed Research International ◽

10.1155/2018/8207098 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Yeshi Metaferia ◽

Abdurahaman Seid ◽

Genet Mola Fenta ◽

Daniel Gebretsadik

Keyword(s):

Risk Factors ◽

Extrapulmonary Tuberculosis ◽

Fluorescent Microscopy ◽

Significant Proportion ◽

Previous History ◽

Public Health Problem ◽

Referral Hospital ◽

Major Public Health Problem ◽

Dessie Referral Hospital ◽

Xpert Assay

Background.Tuberculosis is a major public health problem and extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide.Objective.To determine the magnitude of EPTB, associated risk factors, and agreement of diagnostic techniques at Dessie Referral Hospital.Methods.A cross-sectional study was conducted on consecutive presumptive EPTB cases from March 1 to June 30, 2017. Sociodemographic characteristics and other variables were collected using a structured questionnaire. Clinical specimens were collected and processed using fluorescent microscopy and Gene Xpert assay. Data was analyzed using SPSS version 20. Chi-square test and logistic regression were done and a P value of ≤0.05 was taken as statistically significant.Results.From a total of 353 presumptive EPTB cases the overall prevalence of Gene Xpert assay and smear confirmed patients was 8.8% and 2.5%, respectively. Tuberculosis lymphadenitis was the predominant (33.3%) type followed by pleural (11.9%) and peritoneal (6.7%) tuberculosis. Previous history of pulmonary tuberculosis was significantly associated with extrapulmonary infection (AOR:2.8; 95%CI: 1.05-7.54; p=0.04); however, other variables such as age, residence, sex, marital status, occupation, level of education, and monthly income did not show any association.Conclusion.High proportions (71%) of Gene Xpert assay confirmed EPTB patients were smear-negative. Sensitivity of microscopy should be enhanced in resource limited countries like Ethiopia where Gene Xpert machine is not easily accessible.

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