Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Navon L[original query] |
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Advancing ethical considerations for data science in injury and violence prevention
Idaikkadar N , Bodin E , Cholli P , Navon L , Ortmann L , Banja J , Waller LA , Alic A , Yuan K , Law R . Public Health Rep 2025 333549241312055 ![]() ![]() Data science is an emerging field that provides new analytical methods. It incorporates novel data sources (eg, internet data) and methods (eg, machine learning) that offer valuable and timely insights into public health issues, including injury and violence prevention. The objective of this research was to describe ethical considerations for public health data scientists conducting injury and violence prevention-related data science projects to prevent unintended ethical, legal, and social consequences, such as loss of privacy or loss of public trust. We first reviewed foundational bioethics and public health ethics literature to identify key ethical concepts relevant to public health data science. After identifying these ethics concepts, we held a series of discussions to organize them under broad ethical domains. Within each domain, we examined relevant ethics concepts from our review of the primary literature. Lastly, we developed questions for each ethical domain to facilitate the early conceptualization stage of the ethical analysis of injury and violence prevention projects. We identified 4 ethical domains: privacy, responsible stewardship, justice as fairness, and inclusivity and engagement. We determined that each domain carries equal weight, with no consideration bearing more importance than the others. Examples of ethical considerations are clearly identifying project goals, determining whether people included in projects are at risk of reidentification through external sources or linkages, and evaluating and minimizing the potential for bias in data sources used. As data science methodologies are incorporated into public health research to work toward reducing the effect of injury and violence on individuals, families, and communities in the United States, we recommend that relevant ethical issues be identified, considered, and addressed. |
Tobacco product use among middle and high school students - National Youth Tobacco Survey, United States, 2024
Jamal A , Park-Lee E , Birdsey J , West A , Cornelius M , Cooper MR , Cowan H , Wang J , Sawdey MD , Cullen KA , Navon L . MMWR Morb Mortal Wkly Rep 2024 73 (41) 917-924 Use of tobacco products in any form is unsafe, and nearly all tobacco product use begins during adolescence. CDC and the Food and Drug Administration (FDA) analyzed data from the 2024 National Youth Tobacco Survey to determine tobacco product use among U.S. middle school (grades 6-8) and high school (grades 9-12) students. In 2024, current (previous 30-day) use of any tobacco product was reported by 10.1% of high school students (representing 1.58 million students) and 5.4% of middle school students (representing 640,000 students). Among all students, e-cigarettes were the most commonly reported tobacco product currently used (5.9%), followed by nicotine pouches (1.8%), cigarettes (1.4%), cigars (1.2%), smokeless tobacco (1.2%), other oral nicotine products (1.2%), heated tobacco products (0.8%), hookahs (0.7%), and pipe tobacco (0.5%). During 2023-2024, among all students, the estimated number who reported current use of any tobacco product decreased from 2.80 to 2.25 million students; e-cigarette use decreased (from 2.13 to 1.63 million students); and hookah use decreased (from 290,000 to 190,000 students). Among high school students, current use of any tobacco product decreased from 12.6% to 10.1% of students, and e-cigarette use decreased from 10.0% to 7.8%. Among middle school students, no statistically significant changes occurred. Evidence-based strategies can help prevent initiation and promote cessation of tobacco product use among U.S. youths. |
Two decades of nonfatal injury data: a scoping review of the National Electronic Injury Surveillance System-All Injury Program, 2001-2021
Navon L , Chen LH , Cowhig M , Wolkin AF . Inj Epidemiol 2023 10 (1) 44 BACKGROUND: Injury is a leading cause of preventable morbidity and mortality in the USA. Ongoing surveillance is needed to understand changing injury patterns to effectively target prevention efforts. Launched jointly in 2000 by the Consumer Product Safety Commission (CPSC) and the Centers for Disease Control and Prevention (CDC), the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) provides national-level estimates of US emergency department visits for nonfatal injuries. A scoping review of peer-reviewed articles was conducted to characterize how NEISS-AIP data have been used for injury surveillance in the USA. MAIN BODY: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three bibliographic databases (PubMed, Scopus, and Google Scholar) were systematically searched for English language peer-reviewed articles that used NEISS-AIP data as the primary data source during 2001-2021. Key article characteristics from included articles were abstracted to generate descriptive summary statistics to understand the use and limitations of NEISS-AIP for injury surveillance. Database queries returned 6944 citations; 594 citations were manually reviewed, and 167 non-duplicate journal articles were identified. An average of 8.0 articles (range: 1-14) were published annually during 2001-2021. Articles appeared in 72 different journals representing a diverse audience with the majority of articles written by CDC authors. Starting in 2013, a higher proportion of articles were published by non-CDC authors. The largest number of articles examined injury among all age groups (n = 71); however, the pediatric population was the specific age group of greatest interest (n = 48), followed by older adults (n = 23). Falls (n = 20) and motor-vehicle-related injuries (n = 10) were the most studied injury mechanisms. The most commonly identified limitation identified by authors of reviewed articles was that NEISS-AIP only produces national estimates and therefore, cannot be used for state- or county-level injury surveillance (n = 38). CONCLUSIONS: NEISS-AIP has contributed to nonfatal injury surveillance in the USA. CDC and CPSC continue to work together to expand and enhance NEISS-AIP data collection. Researchers are encouraged to continue using this publicly available dataset for injury surveillance. |
Notes from the field: Emergency department visits for nonfatal pedal cyclist injuries before and during the COVID-19 pandemic, United States, 2019-2020
Navon L , Yuan K , Beck L . MMWR Morb Mortal Wkly Rep 2023 72 (28) 769-771 During the early months of the COVID-19 pandemic, many jurisdictions implemented stay-at-home orders (1). Vehicle miles traveled (VMT)* in April 2020 declined by 40% compared with VMT in April 2019; annual VMT in 2020 declined by 13% compared with those in 2019 (2). Despite decreased VMT, pedal cyclist traffic crash fatalities increased by 10% from 859 in 2019 to 948 in 2020 (3). In 2021, pedal cyclist fatalities increased to 966, the highest number reported since 1975 (3,4). Given the increase in pedal cyclist fatalities despite the decline in VMT in 2020, emergency department (ED) visits for nonfatal pedal cyclist injuries in 2019 and 2020 were compared. |
Emergency department visits for alcohol-associated falls among older adults inthe United States, 2011 to 2020
Yuan K , Haddad Y , Law R , Shakya I , Haileyesus T , Navon L , Zhang L , Liu Y , Bergen G . Ann Emerg Med 2023 82 (6) 666-677 STUDY OBJECTIVE: The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States. METHODS: We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults. RESULTS: There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups. CONCLUSION: Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk. |
Emergency department visits by incarcerated adults for nonfatal injuries - United States, 2010-2019
Wulz A , Miller G , Navon L , Daugherty J . MMWR Morb Mortal Wkly Rep 2023 72 (11) 278-282 During 2010-2019, U.S. correctional authorities held 1.4-1.6 million persons in state and federal prisons annually, and 10.3-12.9 million persons were admitted to local jails each year (1,2). Incarcerated persons experience a disproportionate burden of negative health outcomes, including unintentional and violence-related injuries (3,4). No national studies on injury-related emergency department (ED) visits by incarcerated persons have been conducted, but a previous study demonstrated a high rate of such visits among a Seattle, Washington jail population (5). To examine nonfatal injury-related ED visits among incarcerated adults, CDC analyzed 2010-2019 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) data. During 2010-2019, an estimated 733,547 ED visits by incarcerated adults occurred in the United States. The proportion of ED visits resulting from assault* and self-harm among incarcerated adults was five times as high as those among nonincarcerated adults. Among incarcerated adults, men and adult persons aged <65 years had the highest proportion of assault-related ED visits. Falls accounted for the most ED visits among incarcerated adults aged ≥65 years. A higher proportion of ED visits by incarcerated women than incarcerated men were for overdose or poisoning. These findings suggest that injuries among incarcerated adults differ from those among nonincarcerated adults and might require development and implementation of age- and sex-specific prevention strategies for this population. |
Notes from the field: Characteristics of tetrahydrocannabinol-containing e-cigarette, or vaping, products used by adults - Illinois, September-October 2019
Navon L , Ghinai I , Layden J . MMWR Morb Mortal Wkly Rep 2020 69 (29) 973-975 As of February 18, 2020, 2,807 patients hospitalized with e-cigarette, or vaping, product use–associated lung injury (EVALI) had been reported to CDC (1). Nationwide, and in Illinois, approximately 80% of EVALI patients reported use of tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products (2,3). The recent EVALI outbreak highlighted the limited availability of data on the characteristics of THC-containing e-cigarette, or vaping, products used in the United States. |
Characteristics of persons who report using only nicotine-containing products among interviewed patients with e-cigarette, or vaping, product use-associated lung injury - Illinois, August-December 2019
Ghinai I , Navon L , Gunn JKL , Duca LM , Brister S , Love S , Brink R , Fajardo G , Johnson J , Saathoff-Huber L , King BA , Jones CM , Krishnasamy VP , Layden JE . MMWR Morb Mortal Wkly Rep 2020 69 (3) 84-89 In 2019, the United States experienced an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). Most EVALI patients have reported using tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products obtained from informal sources (2,3), and vitamin E acetate in these products has been closely linked with EVALI (4,5). However, some EVALI patients report using only nicotine-containing products. This study compared demographic, product use, and clinical characteristics of EVALI patients in Illinois who reported using only nicotine-containing e-cigarette, or vaping, products with those of patients who reported using any THC-containing products. Among 121 interviewed Illinois EVALI patients, 17 (14%) reported using only nicotine-containing products, including nine (7%) patients who had no indication of any THC use, based on self-report or toxicology testing. Compared with patients who used any THC-containing products, these nine patients were significantly more likely to be older and female and were less likely to experience constitutional symptoms or to have leukocytosis on initial evaluation. Although vitamin E acetate has been strongly linked with EVALI, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC- or non-THC-containing products, in some reported EVALI cases. The contributing cause or causes of EVALI for patients reporting use of only nicotine-containing products warrants further investigation. |
Risk factors for e-cigarette, or vaping, product use-associated lung injury (EVALI) among adults who use e-cigarette, or vaping, products - Illinois, July-October 2019
Navon L , Jones CM , Ghinai I , King BA , Briss PA , Hacker KA , Layden JE . MMWR Morb Mortal Wkly Rep 2019 68 (45) 1034-1039 The United States is experiencing an unprecedented outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). All EVALI patients have used e-cigarette, or vaping, products, and most (>/=85%) have reported using products containing tetrahydrocannabinol (THC) (2,3), the principal psychoactive component of cannabis. To examine whether e-cigarette, or vaping, product use behaviors differed between adult EVALI patients and adults who use these products but have not developed lung injury, the Illinois Department of Public Health (IDPH) conducted an online public survey during September-October 2019 targeting e-cigarette, or vaping, product users in Illinois. Among 4,631 survey respondents, 94% reported using any nicotine-containing e-cigarette, or vaping, products in the past 3 months; 21% used any THC-containing products; and 11% used both THC-containing products and nicotine-containing products. Prevalence of THC-containing product use was highest among survey respondents aged 18-24 years (36%) and decreased with increasing age. E-cigarette, or vaping, product use behaviors of 66 EVALI patients aged 18-44 years who were interviewed as part of the ongoing outbreak investigation were compared with a subset of 519 survey respondents aged 18-44 years who reported use of THC-containing e-cigarette, or vaping, products. Compared with these survey respondents, EVALI patients had higher odds of reporting exclusive use of THC-containing products (adjusted odds ratio [aOR] = 2.0, 95% confidence interval [CI] = 1.1-3.6); frequent use (more than five times per day) of these products (aOR = 3.1, 95% CI = 1.6-6.0), and obtaining these products from informal sources, such as a dealer, off the street, or from a friend (aOR = 9.2, 95% CI = 2.2-39.4). The odds of using Dank Vapes, a class of largely counterfeit THC-containing products, was also higher among EVALI patients (aOR = 8.5, 95% CI = 3.8-19.0). These findings reinforce current recommendations not to use e-cigarette, or vaping, products that contain THC and not to use any e-cigarette, or vaping, products obtained from informal sources. In addition, because the specific compound or ingredient causing lung injury is not yet known, CDC continues to recommend that persons consider refraining from use of all e-cigarette, or vaping, products while the outbreak investigation continues (1). |
E-cigarette product use, or vaping, among persons with associated lung injury - Illinois and Wisconsin, April-September 2019
Ghinai I , Pray IW , Navon L , O'Laughlin K , Saathoff-Huber L , Hoots B , Kimball A , Tenforde MW , Chevinsky JR , Layer M , Ezike N , Meiman J , Layden JE . MMWR Morb Mortal Wkly Rep 2019 68 (39) 865-869 In July 2019, the Illinois Department of Public Health and the Wisconsin Department of Health Services launched a coordinated epidemiologic investigation after receiving reports of several cases of lung injury in previously healthy persons who reported electronic cigarette (e-cigarette) use, or vaping (1). This report describes features of e-cigarette product use by patients in Illinois and Wisconsin. Detailed patient interviews were conducted by telephone, in person, or via the Internet with 86 (68%) of 127 patients. Overall, 75 (87%) of 86 interviewed patients reported using e-cigarette products containing tetrahydrocannabinol (THC), and 61 (71%) reported using nicotine-containing products. Numerous products and brand names were identified by patients. Nearly all (96%) THC-containing products reported were packaged, prefilled cartridges, and 89% were primarily acquired from informal sources (e.g., friends, family members, illicit dealers, or off the street). In contrast, 77% of nicotine-containing products were sold as prefilled cartridges, and 83% were obtained from commercial vendors. The precise source of this outbreak is currently unknown (2); however, the predominant use of prefilled THC-containing cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. Given the diversity of products reported and frequency of patients using both THC- and nicotine-containing e-cigarette products, additional methods such as product testing and traceback could help identify the specific cause of this outbreak. |
Pulmonary illness related to e-cigarette use in Illinois and Wisconsin - preliminary report
Layden JE , Ghinai I , Pray I , Kimball A , Layer M , Tenforde M , Navon L , Hoots B , Salvatore PP , Elderbrook M , Haupt T , Kanne J , Patel MT , Saathoff-Huber L , King BA , Schier JG , Mikosz CA , Meiman J . N Engl J Med 2019 382 (10) 903-916 BACKGROUND: E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS: We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS: There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS: Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes. |
Identifying areas with disproportionate local health department services relative to opioid overdose, HIV and hepatitis C diagnosis rates: A study of rural Illinois
McLuckie C , Pho MT , Ellis K , Navon L , Walblay K , Jenkins WD , Rodriguez C , Kolak MA , Chen YT , Schneider JA , Zahnd WE . Int J Environ Res Public Health 2019 16 (6) Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings. Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden. |
The public health response to a large poisoning outbreak involving an illicit substance: Synthetic cannabinoids contaminated with a long-acting anticoagulant rodenticide, Illinois, March-July, 2018
Navon L , Moritz E , Austin C , Wahl M , Aks S , Layden J . J Public Health Manag Pract 2019 26 (6) E1-E7 During March-July 2018, the Illinois Department of Public Health responded to an acute outbreak of severe coagulopathy among patients with recent synthetic cannabinoid use. Toxicological testing indicated that cases were exposed to brodifacoum, a long-acting anticoagulant rodenticide. A total of 174 confirmed and probable cases, including 5 deaths, were linked to this outbreak. On the basis of the experience of responding to this complex outbreak, we recommend several steps for consideration to improve health department preparation for acute outbreaks involving illicit substances including strengthening communication between public health and law enforcement agencies, reviewing legal authority to investigate noninfectious acute disease outbreaks, continuing strong partnerships with state poison control centers, partnering with substance abuse and mental health agencies to provide services to patients, and determining health department ability to rapidly enter into public-private partnership agreements. |
Job autonomy & safety climate: examining associations in the mining industry
Haas E , Ryan M , Hoebbel C . Prof Saf 2018 63 (12) 30-34 Perceptions of safety climate pertain to an organization's prioritization of safety relative to other concerns, such as productivity or quality control (Naveh, Katz-Navon & Stern, 2011; Zohar, 2000). Relating to what organizations may prioritize, safety climate also entails the kind of behaviors that are expected, supported and rewarded (Schneider, 1990). Characteristics of safety climate can impact workers' own safety values, which, in turn, influence their behaviors (Naveh, et al., 2011). Further, a positive safety climate has been linked to less burnout and fewer errors, near-hits and incidents that result in lost time from work (Christian, Bradley, Wallace, et al., 2009; Nahrgang, Morgesun & Hofmann, 2011). In this sense, not only has safety climate been identified as a potential leading indicator of incident occurrence, but also evidence exists that a positive safety climate might strengthen the impact of job factors (e.g., job autonomy, supervisor support, coworker support) on workers' proactive behavior (Bronkhorst, 2015), although these factors are not well understood (Parker, Axtell & Turner, 2001). To that end, this article examines what role job autonomy, in particular, may have in forming workers' perceptions and subsequent OSH performance on the job. The authors begin by defining autonomy in the workplace to provide a consistent platform for studying the term. Key Takeaways: 1. Job autonomy is among the most important features of organizational design that ensures job satisfaction and motivation. It is important to understand how job autonomy may support the safety climate and subsequent behaviors executed by workers. 2. The authors used two mine companies to compare workers' perceptions of safety climate and personal levels of proactivity and compliance on the job, one that incorporated autonomous work processes and practices, and one that did not. 3. Job autonomy played a significant role in worker perceptions of their own proactive and compliant behaviors on the job, including taking initiative to address OSH problems, voicing concerns about OSH, and following rules and procedures. 4. The discussion provides insights into specific autonomous work processes to provide direction for companies that want to improve aspects of their organizational management of safety, health and risks on the job. |
Hospitalization trends and comorbidities among people with HIV/AIDS compared with the overall hospitalized population, Illinois, 2008-2014
Navon L . Public Health Rep 2018 133 (4) 33354918777254 OBJECTIVES: To understand trends in health care use among people living with HIV/AIDS (PLWHA), this study compared trends in hospitalization rates, comorbidities, and hospital death rates of hospitalized PLWHA with the overall hospitalized population in Illinois during 2008-2014. METHODS: This study identified principal hospitalizations (the principal discharge diagnosis coded with an HIV-related billing code) and secondary HIV hospitalizations (a non-principal discharge diagnosis coded with an HIV-related billing code) from 2008-2014 Illinois hospital discharge data. Hospitalization rates among PLWHA were calculated using prevalence data from the Illinois Electronic HIV/AIDS Registry; US Census population estimates were used to calculate overall Illinois hospitalization rates. Joinpoint regression analysis was used to assess trends overall and among demographic subgroups. Comorbidities and discharge status for all hospitalizations were identified. RESULTS: In 2014, the hospitalization rate was 2.2 times higher among PLWHA than among the overall Illinois hospitalized population. From 2008 to 2014, principal HIV hospitalization rates per 1000 PLWHA decreased by 48% (from 71 to 37) and secondary HIV hospitalization rates declined by 26% (from 296 to 218). The decline in the principal HIV hospitalization rate was steepest from 2008 to 2011 (annual percentage change = -16.0%; P = .003). Mood disorders, substance-related diagnoses, and schizophrenia accounted for 18% to 22% of principal hospitalizations among PLWHA compared with 7% to 8% of overall Illinois hospitalizations. Hepatitis as a comorbidity was more common among hospitalized PLWHA (18%-22%) than among the overall Illinois hospitalized population (1.4%-1.5%). Hospitalized PLWHA were 3 times more likely than the overall Illinois hospitalized population to die while hospitalized. CONCLUSIONS: HIV hospitalizations are largely preventable with appropriate treatment and adherence. Additional efforts to improve retention in HIV care that address comorbidities of PLWHA are needed. |
Notes from the Field: Outbreak of severe illness linked to the vitamin K antagonist brodifacoum and use of synthetic cannabinoids - Illinois, March-April 2018
Moritz E , Austin C , Wahl M , DesLauriers C , Navon L , Walblay K , Hendrickson M , Phillips A , Kerins J , Pennington AF , Lavery AM , El Zahran T , Kauerauf J , Yip L , Thomas J , Layden J . MMWR Morb Mortal Wkly Rep 2018 67 (21) 607-608 Synthetic cannabinoids, also known as K2 and spice, are heterogeneous psychoactive compounds identified as substances of abuse (1,2). On March 22, 2018, the Illinois Department of Public Health was notified by the Illinois Poison Center of four patients seen in emergency departments (EDs) during the preceding 2 weeks with unexplained bleeding and high international normalized ratios (INRs; range from 5 to >20 [normal <1.1]), indicating a clotting disorder, and reported synthetic cannabinoid use during the previous 3 days. None reported taking prescription anticoagulants or exposure to anticoagulant rodenticides. An investigation by the Illinois Department of Public Health, the Illinois Poison Center, CDC, local health departments, and law enforcement agencies was initiated to identify additional cases, ascertain epidemiologic links among patients, and implement control measures. |
Hospitalizations for heat-stress illness varies between rural and urban areas: an analysis of Illinois data, 1987-2014
Jagai JS , Grossman E , Navon L , Sambanis A , Dorevitch S . Environ Health 2017 16 (1) 38 BACKGROUND: The disease burden due to heat-stress illness (HSI), which can result in significant morbidity and mortality, is expected to increase as the climate continues to warm. In the United States (U.S.) much of what is known about HSI epidemiology is from analyses of urban heat waves. There is limited research addressing whether HSI hospitalization risk varies between urban and rural areas, nor is much known about additional diagnoses of patients hospitalized for HSI. METHODS: Hospitalizations in Illinois for HSI (ICD-9-CM codes 992.x or E900) in the months of May through September from 1987 to 2014 (n = 8667) were examined. Age-adjusted mean monthly hospitalization rates were calculated for each county using U.S. Census population data. Counties were categorized into five urban-rural strata using Rural Urban Continuum Codes (RUCC) (RUCC1, most urbanized to RUCC5, thinly populated). Average maximum monthly temperature ( degrees C) was calculated for each county using daily data. Multi-level linear regression models were used, with county as the fixed effect and temperature as random effect, to model monthly hospitalization rates, adjusting for the percent of county population below the poverty line, percent of population that is Non-Hispanic Black, and percent of the population that is Hispanic. All analyses were stratified by county RUCC. Additional diagnoses of patients hospitalized for HSI and charges for hospitalization were summarized. RESULTS: Highest rates of HSI hospitalizations were seen in the most rural, thinly populated stratum (mean annual summer hospitalization rate of 1.16 hospitalizations per 100,000 population in the thinly populated strata vs. 0.45 per 100,000 in the metropolitan urban strata). A one-degree Celsius increase in maximum monthly average temperature was associated with a 0.34 increase in HSI hospitalization rate per 100,000 population in the thinly populated counties compared with 0.02 per 100,000 in highly urbanized counties. The most common additional diagnoses of patients hospitalized with HSI were dehydration, electrolyte abnormalities, and acute renal disorders. Total and mean hospital charges for HSI cases were $167.7 million and $20,500 (in 2014 US dollars). CONCLUSION: Elevated temperatures appear to have different impacts on HSI hospitalization rates as function of urbanization. The most rural and the most urbanized counties of Illinois had the largest increases in monthly hospitalization rates for HSI per unit increase in the average monthly maximum temperature. This suggests that vulnerability of communities to heat is complex and strategies to reduce HSI may need to be tailored to the degree of urbanization of a county. |
Notes from the Field: Investigation of Elizabethkingia anophelis Cluster - Illinois, 2014-2016.
Navon L , Clegg WJ , Morgan J , Austin C , McQuiston JR , Blaney DD , Walters MS , Moulton-Meissner H , Nicholson A . MMWR Morb Mortal Wkly Rep 2016 65 (48) 1380-1381 ![]() Elizabethkingia spp., formerly known as Flavobacterium and Chryseobacterium, are multidrug-resistant, Gram negative bacilli found in the environment that can cause health care–associated outbreaks (1). Elizabethkingia meningoseptica was first identified by Elizabeth King in 1959 as a cause of meningitis outbreaks among hospitalized newborns (2). Elizabethkingia anophelis (EKA) was first identified in 2011 from the midgut of a mosquito (3); a recent series of cases from Hong Kong indicate that EKA health care–associated infections cause significant morbidity and have a high case-fatality rate (23.5%) (4). | In February 2016, the Wisconsin Department of Health Services notified the Illinois Department of Public Health (IDPH) and other neighboring health departments of an ongoing outbreak of EKA among Wisconsin residents. To determine if Illinois had related cases, IDPH sent memos on February 10 and March 29, 2016 to Illinois health care providers, infection preventionists and laboratories, requesting all available isolates of Elizabethkingia spp. dating back 2 years, to January 1, 2014. Twelve isolates from 11 patients were sent to CDC for testing; specimen collection dates ranged from June 23, 2014 to March 31, 2016. | On April 14, 2016, CDC informed IDPH that all submitted isolates were identified as EKA and that a genetic cluster (11 isolates from 10 patients) distinct from the Wisconsin outbreak strain had been identified, based on pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). The eleven isolates were an average of 39.6 single nucleotide polymorphisms (SNPs) apart by WGS, with a range of 9–60 SNPs in the core of the genomic sequence shared across the isolates (80% of the genome). This SNP range corresponded to PFGE patterns with zero (indistinguishable) to three (closely related) band pattern differences. By comparison, some historic EKA isolates tested by CDC have differed by approximately 1,000 SNPs, with the more distantly related EKA strains differing by tens of thousands of SNPs. Phylogenetic analysis followed by bootstrapping statistical analysis provided strong support that these Illinois isolates clustered together and were genetically distinct from other EKA isolates submitted to CDC. |
Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258
Kitchel B , Rasheed JK , Patel JB , Srinivasan A , Navon-Venezia S , Carmeli Y , Brolund A , Giske CG . Antimicrob Agents Chemother 2009 53 (8) 3365-70 ![]() Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have become more common in the United States and throughout the world. We used pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) to examine the molecular epidemiology of KPC-producing K. pneumoniae isolates sent to the Centers for Disease Control and Prevention (CDC) for reference testing from 1996 to 2008. A dominant strain, sequence type 258 (ST 258), was found and likely accounts for 70% of the CDC's K. pneumoniae PFGE database. Isolates with PFGE patterns related to ST 258 were identified in 10 of the 19 U.S. states currently reporting KPC-producing K. pneumoniae, in addition to one isolate from Israel. KPC subtyping and analysis of the surrounding genetic environment were subsequently performed on 23 representative isolates. Thirteen isolates identified as ST 258 possessed either bla(KPC-2) or bla(KPC-3) and some variability in the Tn4401 element upstream of the bla(KPC) gene. Escherichia coli DH10B was successfully transformed by electroporation with KPC-encoding plasmid DNA from 20 of the 23 isolates. Restriction analysis of plasmid DNA prepared from transformants revealed a diversity of band patterns, suggesting the presence of different plasmids harboring the bla(KPC) gene, even among isolates of the same ST. |
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