Health SPHere

Alumni magazine of the Boston University School of Public Healt

Health SPHere

Alumni magazine of the Boston University School of Public Healt

Fatal & Non-Fatal Opioid Overdoses in Marin County: Using EMS and county data to locate the presence of fentanyl, naloxone distribution, repeated overdoses, and demographics

Background. In recent years, the United States has been greatly affected by prescription drug overdose deaths, 68% of which are caused by opioids. Like many communities nationwide, Marin County in California is deeply affected by the opioid epidemic with accidental overdose being one of the leading causes of injury-related death. This study examines how fatal and non-fatal opioid overdoses in Marin County are associated with factors such as suspected fentanyl involvement, naloxone administration (EMS), and repeat overdose events. Methods. A cross-sectional study was conducted by Marin County’s Health and Human Services using data collected from EMS dispatch calls and vital statistical records. Logistic regression was used to study the relationship between fatal and non-fatal overdoses and factors associated with the EMS event such as suspected fentanyl involvement, use of naloxone, and repeat suspect overdose. A spatial analysis was conducted using a Geographical Information System software examining the distribution of fatal and non-fatal overdoses in Marin County in relation to three variables: suspected fentanyl involvement, presence of naloxone, and whether the incident was a repeat overdose. Results. This multivariate regression model shows that individuals who are 45 years old and over are 6 times more likely to die from any overdose (OR=6.19, 95% CI=3.99-9.60). Individuals who did not receive naloxone at the time of the EMS event were more likely to die from an opioid overdose (OR=0.51. 95% CI=0.33-0.79). Lastly, individuals were 3 times more likely to die from their first overdose compared to individuals who had already experienced an overdose in the past (OR=3.1, 95% CI=1.19-8.20). Discussion. EMS and death county data are helpful in examining fatal and non-fatal overdoses. The statistically significant findings show that fatal overdoses are associated with older age, first-time overdoses, and naloxone administration

Individual EMS Disposition in the Prehospital Setting to Predict Future Opioid Overdose and Mortality

Introduction There have been over 400,000 deaths related to prescription opioids in the US since 1999, with the highest prevalence among individuals aged 45-54 years old. However, adults between the ages of 18 and 34 have the highest prevalence of misuse of prescription opioids. With accidental overdoses as a leading cause of death, Marin County is just one community that is heavily impacted by this ongoing epidemic. Statistics related to non-fatal and fatal opioid overdoses are difficult to accurately count due to the differing ways counties may categorize cause of death, diagnoses, and other contributing factors. However, looking at 911 calls gives us a baseline for community-based non-fatal opioid overdoses encountered by Emergency Medical Services (EMS) to further characterize the burden of opioid overdoses. Methods A cross-sectional study was conducted by Marin County’s Health and Human Services using EMS data and death records. This study determined if an individual\u27s disposition from EMS can be used to predict future outcomes for individuals with opioid use disorder. Whether the patient refuses treatment/transport or accepts treatment/transport may allow us to find patterns that will predict outcomes such as experiencing another overdose or being at a higher risk for all-cause or overdose mortality. Results The bivariate analysis outcomes showed that age, year, repeat overdose, and disposition were all statistically significant for higher incidence of mortality. On average, individuals who were transported to the ER with lights and sirens had 1.59 times the odds of dying than individuals who were not transported to the ER with lights and sirens, after controlling for age, year of overdose and whether or not it was a repeat overdose event (95% CI = 1.052- 2.406). Additionally, individuals who were transported had 0.516 times the odds of dying than individuals who were not transported, after controlling for age, year of overdose and whether or not it was a repeat overdose event (95% CI = 0.271-0.984). Discussion In addition to the overdose prevention and education programs already in place, programs specifically aimed at the at risk groups established in this study could help combat this crisis. Extending resources and educational services specifically to the 46+ population could help raise awareness and protect this group. Preventing first time overdoses from occuring in the first place could be achieved by openly discussing harm reduction strategies and making Narcan more readily available. Another step that can be taken to reach more individuals and ultimately combat the opioid crisis would be to implement a plan that allows EMS to connect patients to resources such as counseling, rehab centers, and harm reduction strategies

Innovations in Public Health: Understanding State Public Health

Provides an overview of state public health services -- services provided and outsourced, organizational and accountability structures, and key statutes -- and offers a framework for exploring the scope of the state's role and responsibilities

Matching Methods for Causal Inference: A Review and a Look Forward

When estimating causal effects using observational data, it is desirable to replicate a randomized experiment as closely as possible by obtaining treated and control groups with similar covariate distributions. This goal can often be achieved by choosing well-matched samples of the original treated and control groups, thereby reducing bias due to the covariates. Since the 1970s, work on matching methods has examined how to best choose treated and control subjects for comparison. Matching methods are gaining popularity in fields such as economics, epidemiology, medicine and political science. However, until now the literature and related advice has been scattered across disciplines. Researchers who are interested in using matching methods---or developing methods related to matching---do not have a single place to turn to learn about past and current research. This paper provides a structure for thinking about matching methods and guidance on their use, coalescing the existing research (both old and new) and providing a summary of where the literature on matching methods is now and where it should be headed.Comment: Published in at http://dx.doi.org/10.1214/09-STS313 the Statistical Science (http://www.imstat.org/sts/) by the Institute of Mathematical Statistics (http://www.imstat.org

Spatiotemporal trends of cutaneous leishmaniasis in Costa Rica.

BACKGROUND: Cutaneous leishmaniasis (CL) remains an important neglected tropical disease in Costa Rica, which has one of the largest burdens of this disease in Latin America. METHODS: We identified district-level hotspots of CL from 2006 to 2017 and conducted temporal analysis to identify where hotspots were increasing across the country. RESULTS: Clear patterns of CL risk were detected, with persistent hotspots located in the Caribbean region, where risk was also found to be increasing over time in some areas. CONCLUSIONS: We identify spatiotemporal hotspots, which may be used in support of the leishmaniasis plan of action for the Americas

Recommendations for core competencies for local environmental health practitioners

In February 2000, environmental health experts from 13 national environmental/health organizations came together in Washington to begin the work of defining core competencies for local level environmental health practitioners. APHA's Public Health Innovations Project, with funding from the National Center for Environmental Health (NCEH) at the Centers for Disease Control and Prevention (CDC), convened the meeting. The expert panel members and several federal agency representatives met for two days to identify the core competencies local environmental health practitioners needed to be effective in their work.Executive Summary -- -- Part I: Setting the Stage -- -- A. Introduction -- B. Background -- C. Terms and target audience -- D. Definitions of competencies -- E. Basic assumptions -- -- Part II: Recommended Competencies -- A. Assessment -- B. Management -- C. Communication -- -- Part III: Traits and Characteristics of an Effective Environmental Health Practitioner -- -- Part IV: Next Steps -- -- Part V: Appendices A-G -- Appendix A: Expert panel members -- Appendix B: Summary of expert panel discussion -- Appendix C: Typical responsibilities of environmental health and protection programs -- Appendix D: Technical competencies covered in NEHA's Registered Environmental Health Specialist/Registered Sanitarian (REHS/RS) exam -- Appendix E: Content areas of NEHA's REHS/RS exam -- Appendix F: Setting the context: environmental health practitioner competencies -- Appendix G: Resources"May 2001.""Revised June 27, 2001."Mode of access: Internet as an Acrobat .pdf file (313 KB, 48 p.).Includes bibliographical references (p. 44-47)

Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales

Making a Difference: Investing in Sustainable Health and Well-being for the People of Wale