Public Health Reports最新文献

Objectives: Suicidal behaviors present public health challenges worldwide. Surveillance and research aimed at preventing suicidal behaviors often rely on administrative data. Existing systematic reviews examine the validity of methods for identifying suicidal outcomes in administrative datasets but do not include codes based on the International Classification of Diseases, Tenth Revision (ICD-10), despite their widespread use for >2 decades. This rapid review evaluates methods for identifying suicidal behaviors using ICD-10 codes.

Methods: We searched PubMed and PsycINFO to identify relevant studies worldwide. Studies were included if they measured suicidal behaviors, used ICD-10 codes, validated the behaviors against a gold standard, and provided measures of accuracy (eg, specificity, sensitivity). We extracted data on study populations, data sources, ICD-10 codes used, gold-standard comparators, and accuracy measures from included studies.

Results: Of 2246 studies identified, 9 met our inclusion criteria. For methods identifying suicide attempts, sensitivity ranged from 19% to 45%, specificity from 47% to 99%, positive predictive value from 21% to 82%, and negative predictive value from 65% to 92%. For methods identifying self-harm, sensitivity ranged from 12% to 85%, specificity from 98% to 100%, positive predictive value from 64% to 100%, and negative predictive value from 86% to 87%. Only sensitivity was reported for suicide death (range, 78%-97%).

Conclusions: Findings indicate that sensitivity and positive predictive value for identifying suicide attempts using ICD-10 codes are low. Studies and surveillance methods relying on these codes might substantially underestimate rates of suicidal behaviors. ICD-10 codes may provide higher accuracy for identifying self-harm and other nonfatal suicidal behaviors than codes from the International Classification of Diseases, Ninth Revision.

Rapid initiation of antiretroviral therapy (rapid ART) is a clinical strategy where HIV treatment is initiated on day of HIV diagnosis, resulting in improved retention in care and virologic suppression. HIV specialists historically have prescribed ART, but recent efforts have increased prescribing among primary care providers. Justice-involved individuals have lower rates of engagement in care along the HIV care continuum compared with the general population; evaluating the effect of rapid ART prescribing by provider type can aid in improving outcomes among this population. The purpose of this case study was to compare rates of offering rapid ART to those newly diagnosed with HIV in a California county jail following an educational intervention that aimed to increase prescribing by primary care providers in the jail. The educational intervention included an educational session, creation of an electronic health record (EHR) note template containing prompts for the offering of rapid ART, and the creation of an EHR order set for relevant laboratory tests. Forty-two individuals were newly diagnosed with HIV in the jail from May 2017 through December 2023. Medical record review indicated that rapid ART offering increased by 36% (56% [9 of 16] vs 92% [24 of 26]) after the intervention versus preintervention, with 50% (13 of 26) offered by primary care physicians following the intervention, compared with 7% (1 of 16) offered by primary care providers preintervention. This intervention serves as a test case that highlights the ability to expand rapid ART offering by primary care providers in resource-limited settings such as jails.

We investigated the proportion of mpox hospitalizations for medical indications versus infection control isolation at New York University Langone Health and NYC Health + Hospitals from May 1, 2022, through April 28, 2023. We reviewed the electronic medical records of people with a positive mpox nucleic acid amplification test independently. We collected demographic and clinical data on those who met our inclusion criteria, and we stratified patients by medical indication or infection control isolation based on their reason for hospitalization. This observational cohort study included 66 patients admitted for mpox, of whom 8 (12.1%) were admitted primarily for infection control isolation and 58 (87.9%) were admitted primarily for medical indications. Those hospitalized primarily for isolation (vs medical indications) were significantly less likely to have a private residence (25.0% vs 79.3%; P < .001). Those hospitalized for medical indications (vs isolation) were significantly more likely to be HIV positive (63.8% vs 12.5%; P = .006), to have secondary bacterial infections (65.5% vs 25.0%; P = .03), and to receive antibiotics (81.0% vs 25.0%; P < .001). We found no significant differences in the median cumulative length of stay per patient or the proportion of tecovirimat receipt between the 2 groups. While the small size of the isolation cohort was a limitation of this analysis, our findings argue for increased capacity for community-based isolation, which may reduce the use of hospital admissions primarily for infection control isolation in future outbreaks.

Objectives: Public health nurses (PHNs) are one of the largest public health occupation groups, bringing important expertise to the activities of public health; however, their roles and distribution differ across the country. The objective of this study was to estimate the relative need for, supply of, and priority areas for PHNs at the county level.

Methods: We used a cross-sectional design with national data sources available at the county level to measure the local need for, supply of, and priority areas for PHNs. We estimated need through a newly developed index based on 4 domains: demographic characteristics, economic characteristics, health care context, and health outcomes within the county. We estimated supply by using registered nurse staffing data from local health departments. We identified priority tiers of PHN deserts as counties with relatively high need and low supply. We conducted the study in 2024-2025.

Results: The need for and supply of PHNs varied across the country, with little correlation (+0.26). For example, average need was highest in the southeastern United States (mean need score, 68.3 of 100; median need score, 76.0 of 100) and lowest in the upper northeastern United States (mean need score, 19.8 of 100; median need score, 13.5 of 100).

Conclusions: The combination of local-level PHN need and supply can be used to identify potential gaps in PHN availability and can inform investment, recruitment, training, or allocation of other resources to address the PHN workforce needs of local health departments.

The essential public health services of community health assessment (CHA) and community health improvement planning (CHIP) entailed in Healthy People 2030 and Public Health Accreditation Board standards and measures for local health departments are underused in practice-based research. Innovative approaches are particularly needed to improve access to evidence-based behavioral health prevention and treatment services, given the persistent stigmatization of behavioral health conditions. We present a new way of thinking about community development in which other public health agencies can leverage their own CHA and CHIP processes for cross-sector, participatory codesign with behavioral health service providers and users to improve access to support, resources, and treatment. Codesign entails collaborative inquiry with providers and users to frame and reframe their collective understanding of challenges to accessing services and iteratively test solutions. In 2023-2024, we implemented the codesign process using photovoice to engage community members in Lexington, Kentucky, including those who had received behavioral health services, in identifying barriers (eg, stigma, transportation, financial constraints) to accessing behavioral health services. Photovoice insights led to the development of a comprehensive, coalition-sourced directory of local behavioral health resources and strategies to connect people in need with local services and promote cross-sector collaboration. These strategies included the design of media campaigns and training programs targeting the priority areas of financial stability, mental well-being, knowledge empowerment, and access to care. This study provides preliminary evidence that situating codesign methods and tools in CHA/CHIP processes is a feasible, effective, and replicable way to improve access to behavioral health services.

Objective: Teenage pregnancy rates are high in the United States. Teenagers with epilepsy are at a particular health risk due to challenging transitions of care and unique considerations for contraception as well as at increased risk for fetal and maternal complications in pregnancy. The objective of this study was to explore the live birth rate among teenaged girls with epilepsy in Michigan.

Methods: In this retrospective open-cohort epidemiological study, we estimated the live birth rate and identified predictors for births among Medicaid-insured teenaged girls (aged 15-19 y) with epilepsy in Michigan, using administrative data from the Michigan Children's Special Health Care Services Program from 2016-2022.

Results: Among teenaged girls with epilepsy in Michigan, the birth rate was 1.6 per 100 population. Significant factors associated with giving birth (vs not) included use of fewer antiseizure medications, lack of contraceptive use, and low annual household income.

Conclusion: Given the risk factors identified (eg, no use of contraceptives, low income), teenaged girls with epilepsy may need greater access to care, resources, and/or support than teenaged girls without epilepsy. Our data suggest that targeted interventions to facilitate access to contraceptives could be beneficial. Improving data tracking and diagnosis coding practices will be important for the future study of the birth rate among teenaged girls with epilepsy.

Objectives: The Centers for Disease Control and Prevention (CDC) supports health departments in meeting public health accreditation standards, but how cumulative investments in these activities are related to growth in accreditation nationwide has not been documented. We analyzed CDC funding for accreditation activities for an 18-year period to determine cumulative investment relative to reach and coverage of the US population by accredited health departments.

Methods: We conducted a secondary analysis of Public Health Accreditation Board (PHAB) data to examine changes in the percentage of state health departments (SHDs) and local health departments (LHDs) that were accredited during 2005-2023.

Results: During 2005-2023, CDC distributed $248 million to 3 recipient types for accreditation activities, including health departments, PHAB, and other partner organizations. During this time, the number of accredited SHDs increased from 2 of 51 (4%) in 2013 to 41 of 51 (80%) in 2023, and the number of accredited LHDs increased from 20 of 2297 (1%) in 2013 to 395 of 2297 (17%) in 2023. In 2023, 83% of the US population was served by an accredited SHD and 43% by an accredited LHD. Among the 395 accredited LHDs nationwide, 322 (82%) were in states that provided funds to localities for accreditation activities from investments we analyzed.

Conclusions: Sustained funding for multicomponent accreditation activities was followed by growth in accredited SHDs and LHDs. States that allocated CDC funding to support local accreditation had more accredited LHDs than states that did not allocate such funding. Further research is needed to understand how accreditation of health departments changes in relation to other funding sources and supports.

Objectives: Ingesting raw water can cause illness. This study aimed to (1) assess beliefs about raw water and water practices among US adults while hiking or camping and (2) identify differences among demographic groups in those beliefs and practices.

Methods: In fall 2021, Porter Novelli Public Services and ENGINE Insights administered the PN View 360+ survey (N = 1004 US panel members aged ≥18 y), which was weighted to be representative of the US population by sex, age, region, race and ethnicity, and education. We analyzed data on 4 survey questions using Wald χ² tests and post hoc Wald F tests to compare subgroups for demographic variables with ≥3 levels.

Results: A significantly greater percentage of men (vs women) and respondents aged ≤34 years (vs ≥35 y) agreed or strongly agreed that raw water is safe to drink (59% vs 41%; 40% vs 12%-30%, respectively), contains probiotics (62% vs 38%; 49% vs 6%-30%), and is regulated by a federal agency (60% vs 40%; 43% vs 12%-29%). Among respondents (166 of 958; 17%) who reported drinking raw water in the past year, a significantly greater percentage were men than women (60% vs 40%), non-Hispanic than Hispanic (77% vs 23%), or aged ≤34 years than ≥35 years (41% vs 22%-26%).

Conclusion: These results can inform communication materials to reduce the consequences of ingesting insufficiently treated raw water. Clear messaging and educational campaigns could improve public knowledge and help health care providers communicate recommendations.

Characterizing high-volume co-prescribing of antibiotics and opioids can inform interventions that improve prescribing practices. Using 2021 Medicare Part D data, we conducted a cross-sectional analysis to assess concordance between high-volume prescribing of antibiotics and opioids and characterize associations between prescriber-level factors and high-volume co-prescribing of antibiotics and opioids. High-volume antibiotic prescribers accounted for 12.5 million (36.0%) antibiotic prescriptions, and high-volume opioid prescribers accounted for 22.3 million (51.9%) opioid prescriptions. We found fair concordance between being a high-volume prescriber of antibiotics and a high-volume prescriber of opioids (κ = 0.30). Prescribers in the South (adjusted odds ratio [AOR] = 3.67; 95% CI, 3.46-3.90) and in rural areas (AOR = 2.32; 95% CI, 2.12-2.54) were more likely to be high-volume co-prescribers of antibiotics and opioids than prescribers in the West and in urban areas, respectively. Public health and professional organizations can partner to provide support to optimize antibiotic and opioid prescribing practices and improve patient safety.