Drug Overdose Morbidity and Mortality in Kentucky, 2000-2010: An Examination of Statewide Data, Including the Rising Impact of Prescription Drug Overdose on Fatality Rates, and the Parallel Rise in Associated Medical Costs

From Foreword: Kentucky has seen an explosion in fatal poisonings, particularly prescription drug related fatalities, in the last decade. In 2009, Kentucky had the 5th highest drug overdose rate in the US, increased from the 6th highest drug overdose fatality rate determined in 2008 (CDC WONDER). Kentucky also had the 5th highest nonmedical use of opioid pain relievers, and 11th highest for opioid pain reliever sales in the nation (CDC, MMWR Report November 4, 2011). These drug overdose mortality statistics are extremely startling and only begin to reveal the devastating mental, emotional, and economic toll and pain on families who will forever grieve for their lost loved one. This report was designed to gain a comprehensive understanding of the drug overdose problem in Kentucky through the analysis of multiple statewide public health data sets-- emergency department admissions of Kentucky residents in Kentucky healthcare facilities, inpatient hospitalizations of Kentucky residents in Kentucky non-federal acute care hospitals, and deaths of Kentucky residents within and outside the Commonwealth of Kentucky. The operational definitions for the underlying and multiple causes coding of drug overdose mortality within death certificates were modeled on the CDC method of Dr. Leonard Paulozzi (Morbidity and Mortality Weekly Report, Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United States, 1999 - 2008). Drug overdose morbidity definition was based on a new Safe States publication entitled “Consensus Recommendations for National and State Poisoning Surveillance”, recently produced by the Safe States Injury Surveillance Workgroup on Poisoning in April 2012. The information contained within this report is intended to inform and assist practitioners, lawmakers, and public health professionals in the development of targeted interventions for multi-pronged approaches to reduce the heavy burden of prescription drug abuse in Kentucky. It is hoped that public health professionals and lawmakers armed with the data and recommendations contained within this report on drug overdoses can better target those populations with the greatest need for substance abuse services, prevention programs, and legislation

Suicides and Suicide Attempts in Kentucky, 2001–2011

From Executive Summary: 1. There were 605 suicides among Kentucky residents in the year 2010, up 7% from the 567 recorded in the year 2009. 2. The Kentucky resident age-adjusted suicide rate increased from 12.8 per 100,000 population in 2009 to 13.5 per 100,000 population in 2010, a 5.5% increase. 3. Firearms were the primary means of completed suicide from 2001-2010. 4. Kentucky residents aged 45-54 were the age group that completed suicide most frequently in 2010. 5. The age-adjusted rate for Kentucky self-harm-related hospitalizations increased 7.6% from 2010-2011 (52.5 hospitalizations per 100,000 population in 2010 to 56.5 hospitalizations in 2011). 6. Kentucky females were the gender most often hospitalized for self-harm and most were due to poisonings, over the study period from 2001-2011. 7. Kentucky self-harm hospitalization charges totaled $42.3 million in the year 2011. 8. The age adjusted rate for Kentucky self-harm related emergency department visits was 77.2 visits per 100,000 population in 2011. 9. Kentucky females visited the emergency department for self-related harm more often than males from 2008-2011. 10. Kentucky residents aged 15-24 were the age group that most frequently visited the Kentucky emergency department related to self-harm from 2008-2011. 11. Kentucky self-harm related emergency department visit charges totaled$7.92 million in the year 2011. 12. The highest number of Kentucky emergency department visits for self-harm were due to poisonings from 2008-2011

Suicide and Suicide Attempts in Kentucky, 2001‐2012

The data sources, methods, and definitions used in this report are based on the State Injury Indicators report: Instructions for Preparing 2011 Data, Atlanta, Georgia, March 2013, a publication of the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

DEVELOPMENT OF THE ORGANIC SECTOR IN POST-SOCIALIST BULGARIA 1990-2013

The aim of the paper is to present the socio-economic and political aspects in the development of organic sector in post-socialist Bulgaria. It will question the building up of the organic concept in terms of national policies, farming practices and market forces in the country. That topic has its scientific relevance at least in three crucial dimensions. Firstly, because the legacy of the socialist system significantly affected the structure of the agricultural sector as well as the entrepreneurial behavior of the rural population under conditions of transition. Secondly, the analysis is important because it helps to identify the internal (national) and the external (out of the national context) driving forces that influence the development of the organic sector in Bulgaria. Thirdly, the organic sector comprises different economic activities, it’s not only about producing but also processing, trading, exporting, importing. In other words, economic considerations are crucial while building this new concept. Nor less of relevance is the fact that despite the unquestionable importance of the organic sector for achieving sustainable rural development, that phenomenon has not yet been subject to a lot of scientific research in Bulgaria. The paper will challenge this research gap and will present a comprehensive analysis of the development Bulgarian organic sector and the processes that influence the building up of the organic concept in a post-socialist context. The paper is supported by the Swiss Enlargement Contribution in the framework of the Bulgarian-Swiss Research Programme through the Project “Addressing socio-economic regional disparities: the potential of organic farming for strengthening rural areas in Bulgaria”. The results presented in this paper are based of qualitative and quantitative research data gathered during the first 16 months of the Project through 1) 22 semi-structures in-depth interviews with key informants working in the areas of organic farming research, organic farming associations, environmental and consumer organizations, retail, policy decision-makers, extension and administration; 2) Policy document analyses, desk-top analyses of relevant literature and other public resources and 3) network analysis of more than 20 network interviews using a semi-structured questionnaire

Motor Vehicle Injuries among Semi Truck Drivers and Sleeper Berth Passengers

Introduction: Injuries and fatalities due to large truck and other vehicle crashes have decreased over the last decade, but motor vehicle injuries remain a leading cause of death for both the working and general populations. The present study was undertaken to determine semi truck driver and sleeper berth passenger injury risk in a moving semi truck collision using a matched-pair cohort study. Method: Study data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000 - 2010. A matched-pair cohort study was used to compare the odds of injury of both drivers and sleeper berth passengers within the same semi truck controlling for variables specific to the crash or the semi truck. The crude odds ratio of injury was estimated and a statistical model for a correlated outcome using generalized estimating equations was utilized. Results: In a moving semi truck collision, the odds for an injury were increased by 2.25 times for both semi truck drivers and sleeper berth passengers who did not use occupant safety restraints compared to semi truck drivers and sleeper berth passengers who used occupant safety restraints at the time of the collision. The driver seat or sleeper berth position in the vehicle was not a significant factor (p-value= 0.31) associated with a moving semi truck collision injury. Conclusion: Nonuse of occupant safety restraints by either drivers or sleeper berth passengers significantly increased the odds of an injury in a moving semi truck collision; semi truck seating position (driver’s seat or sleeper berth) did not increase the odds for an injury in moving collisions. Impact on Industry: Trucking companies should include the mandatory use of occupant safety restraints by both semi truck drivers and sleeper berth passengers in their company safety policies

Organic Farming in Bulgaria (1990-2012). Sociological Interpretations

Contents Introduction: On the Social Reality of Organic Farming and Its Sociological Interpretations - CREATING OPPORTUNITIES FOR DEVELOPMENT OF ORGANIC ENTREPRENEURSHIP IN BULGARIA (Svetla Stoeva) - MOTIVATIONAL PROFILES FOR ENTRY INTO THE ORGANIC SECTOR IN BULGARIA (Zdravka Georgieva) - THE MARKET FOR ORGANIC PRODUCTS AS CONFIGURATIONS OF WORTHS (THE CASE OF PRODUCERS FROM BULGARIA) (Petya Slavova) - COLLECTIVE FORMS OF SOCIAL ACTION: THE CASE OF ORGANIC FARMING IN BULGARIA (Dona Pickard

Workers Compensation-Reported Injuries Among Security and Law Enforcement Personnel in the Private Versus Public Sectors

Background: Private and Public security and law enforcement (SLE) sectors perform multiple overlapping job duties. Methods: Workers’ compensation (WC) SLE first reports of injury (FROI) data (2005–2015) were analyzed to describe injuries, identify differences in awarded WC benefits, and compare the probability of a FROI resulting in awarded benefits between Public and Private SLE. A Pearson’s chi-square test was utilized and reverse selection logistic regression was performed to estimate the odds ratio that a FROI would result in an awarded benefit for Private vs. Public SLE, while adjusting for relevant covariates. Results: Private SLE had higher FROI percentages for younger and for older workers, fall injuries, and back injuries, compared to Public SLE. The adjusted odds that a FROI resulted in an awarded benefit was 1.4 times higher for Private SLE compared to Public SLE; (95% confidence interval [CI] = 1.09,1.69). Middle-aged SLE employee adjusted odds of awarded benefits was 3.3 times (95% CI [1.96, 5.39]) higher compared to younger employees. Adjusted odds of awarded benefits was 3.8 times (95% CI [1.34, 10.61]) higher for gunshots and 1.7 times (95% CI [1.22, 2.39]) higher for fractures/dislocations compared to other nature of injuries. Motor vehicle injury, fall/slip, and strain related FROIs had elevated adjusted odds of awarded benefits compared to other injury causes. Conclusions: Results highlight the importance of injury prevention education and worker safety training for Private and Public SLE sector workers on fall prevention (especially in Private SLE) and strain prevention (especially in Public SLE), as well as motor vehicle safety

Child Maltreatment Outpatient Visits to Kentucky Non-Federal Acute Care Hospitals, 2008-2010

The Kentucky Injury Prevention and Research Center (KIPRC) is a unique collaboration between th

Drug Overdose Deaths, Hospitalizations, and Emergency Department Visits in Kentucky, 2000‐2012

This report presents drug overdose morbidity and mortality data for Kentucky residents, using multiple data sources: Kentucky Death Certificate Files, Kentucky Office of Vital Statistics, 2000‐2012 (data captured as of October 21, 2013). The 2009‐2012 files are provisional and subject to change. Kentucky Inpatient Hospitalization (IH) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2000‐2012 (data for 2010‐2012 are provisional and subject to change). Kentucky Emergency Department (ED) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2008‐2012 (data for 2010‐2012 are provisional and subject to change)

Validation of ICD-10-CM Codes for Injuries Complicating Pregnancy, Childbirth and the Puerperium: A Medical Record Review

INTRODUCTION: The purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data. METHODS: A medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP. RESULTS: The estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%). DISCUSSION: The O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women