Public Health Reports最新文献

Objective: An accurate estimate of the prevalence, demographic characteristics, and geographic distribution of thalassemia in the United States is needed to plan for the health care needs of people with this disease. We developed and evaluated the predictive value of administrative case definitions for correctly identifying people living with thalassemia.

Methods: We conducted a retrospective study of the diagnostic accuracy of 3 claims-based case definitions to identify people with thalassemia in Medicaid administrative data from 2012 through 2019. Case definition 1 was ≥5 encounters with a code for thalassemia; case definition 2 was ≥1 encounter with a code for thalassemia and ≥6 encounters with a transfusion code; and case definition 3 was ≥2 encounters with a code for thalassemia and a transfusion code occurring on the same encounters. We validated our findings by using confirmatory laboratory assessment and expert review by clinicians at thalassemia treatment centers in Georgia (Children's Healthcare of Atlanta) and California (University of California San Francisco) as the gold standard.

Results: Of the 327 people identified, thalassemia was confirmed in 173 (52.9%), excluded in 68 (20.7%), and found indeterminate in 86 (26.2%) people. Case definition 1 had the lowest positive predictive value (PPV) (range, 55%-77%). For case definition 2, the PPV range was 80% to 86%. For case definition 3, the PPV range was the highest (82%-96%) but also captured more indeterminate cases.

Conclusions: Accurately identifying patients with thalassemia using a case definition based on administrative claims data is feasible. Extending our method to other health care databases beyond Medicaid may allow for an estimate of the national prevalence of transfusion-dependent thalassemia. However, cases of nontransfusion-dependent thalassemia were difficult to define with sufficient precision.

Objectives: Illicit fentanyl exposure among US children has increased in the past 10 years. However, whether rates of prescription fentanyl exposure have changed in this population is unknown. We described prescription fentanyl exposure among young children.

Methods: We studied cases of prescription fentanyl exposure among children aged <6 years that were reported to the National Poison Data System (NPDS) from 2012 through 2024. We described the characteristics of prescription fentanyl exposure and US geographic patterns. We used binomial tests, the Pearson χ² test, and joinpoint trend analysis with a type I error rate of .05 as the threshold for significance.

Results: From 2012 through 2024, a total of 376 cases of prescription fentanyl exposure among children aged <6 years were reported to NPDS. Boys (n = 179; 47.6%) and girls (n = 196; 52.1%) were equally represented (P = .48). Significantly more children aged <2 years than aged 2 to 6 years in our study group had prescription fentanyl exposure (61.5%; P < .001), and the most common formulation was transdermal patch (n = 202; 53.7%). Joinpoint trend analysis showed a slight but not significant increase in prescription fentanyl exposure among children aged <6 years from 2012 through 2015. However, from 2015 through 2024, prescription fentanyl exposure significantly decreased (annual percentage change = -7.9; P < .05). The state with the highest annual exposure rate from prescription fentanyl was Vermont (4.3 per 1 million population).

Conclusions: From 2015 through 2024, during a time of increasing exposure to illicit fentanyl, prescription fentanyl exposure among children aged <6 years decreased. Safe disposal of transdermal patches is important, and caregiver education is needed to prevent serious medical outcomes.

Objectives: Lyme carditis is a rare, potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on clinical manifestations are not collected systematically in the United States. We developed a syndromic surveillance definition to identify patients with Lyme carditis in New York State during 2017-2021.

Methods: We developed a definition of Lyme carditis by using diagnostic codes and keywords to identify emergency department visits related to Lyme carditis through the National Syndromic Surveillance Program's BioSense Platform. We systematically abstracted information for each identified patient by reviewing medical records in New York State's regional health information exchange system. Physician reviewers independently assigned a clinical case status to each record. We mapped cases of Lyme carditis by county and described their characteristics.

Results: We identified records for 173 individuals; 32% (n = 55) were classified as confirmed, 16% (n = 27) as probable, and 53% (n = 91) as not a case of Lyme carditis. In total, we identified 82 cases of confirmed or probable Lyme carditis; the positive predictive value of the definition was 47%. Cases occurred in 49% of New York State counties and peaked annually in July and August. Among patients with confirmed and probable Lyme carditis, age distribution was bimodal, with incidence peaking at about ages 32 and 70 years; 71% were male. Eighty-four percent had positive 2-tiered serologic test results for Lyme disease, and second- or third-degree atrioventricular block was present in two-thirds of patients (67%).

Practical implications: This definition may be a useful tool to detect changing patterns of Lyme carditis in areas with a high incidence of Lyme disease.

The Dietary Supplement Health and Education Act of 1994 specified that dietary supplements must be swallowed. In this study, we investigated whether kratom-derived products are being sold to consumers in nonswallowed formulations. Kratom is the fresh or dried leaf powder of the Mitragyna speciosa tree. We identified 49 kratom-derived products being sold in the form of sublingual strips (24%), buccal pouches (8%), and vaping products (67%). Most contained 7-hydroxymitragynine (an alkaloid that the US Food and Drug Administration seeks to make a controlled substance), but we also identified mitragynine extract and mitragynine pseudoindoxyl products. The majority had flavoring or a scent, and some had mascots, pictures of fruit or mint, or formulation colors or packaging that could appeal to children. Most products were not sold in child-resistant packaging. Several kratom vaping products additionally contained intoxicating hemp cannabinoids. With no clinical, safety, or pharmacokinetic data for kratom-derived products that bypass first-pass metabolism (ie, where a chemical absorbed through the stomach or intestines is metabolized in the liver before reaching the general bloodstream), people should be advised to avoid these products, and regulatory action is needed to prevent their sale to consumers.

Despite Alzheimer disease and related dementias/disorders (ADRD) being a substantial public health concern, the Deaf community remains underrepresented in ADRD research. We examined the extent and nature of existing literature on ADRD in the Deaf community. We conducted a scoping review following Arksey and O'Malley's framework, adhering to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched 7 databases for peer-reviewed studies published in English, with no restrictions on publication date or study design. Inclusion studies addressed ADRD within the Deaf community and examined aspects such as diagnosis, care, and communication. Our search identified 435 articles, of which 16 met the inclusion criteria. Studies primarily originated from the United Kingdom and Finland, followed by the United States. Most used qualitative methodologies and explored lived experiences and communication barriers. Common themes included limited access to culturally competent care and caregiving challenges. Few studies highlighted diagnostic interventions but noted a general scarcity of resources tailored to Deaf populations. Notable gaps emerged in geographic focus, the range of studied variables, and the lack of validated sign language-based diagnostic instruments and interventions. We recommend expanding research beyond the Global North (ie, higher-income industrialized countries with greater access to resources), incorporating more longitudinal and intersectional approaches, and tailoring resources for Deaf communities. The review underscores the need for culturally competent care, improved diagnostic tools, and policy reforms to address ADRD-related disparities in the Deaf community. Future research should prioritize inclusive methodologies and community-driven interventions to enhance health outcomes and equity for Deaf individuals affected by ADRD.

Objective: In 2020, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) to ensure that communities experiencing health disparities had a voice in finding effective solutions. This mixed-methods study evaluated processes and outcomes of CEAL.

Methods: We used the National Academy of Medicine's Assessing Meaningful Community Engagement conceptual model to guide our evaluation. Data sources for the evaluation included interviews, programmatic data, community surveys, and partner surveys. We assessed the domains of strengthened partnerships, expanded knowledge, and improved health, health programs, and policies.

Results: CEAL teams built a robust partnership network that reached populations most affected by COVID-19, facilitated knowledge increases among community members and partner organizations, and positively affected COVID-19 vaccination rates.

Conclusions: This evaluation suggests that the infrastructure built by CEAL teams could be leveraged to address additional topics and populations of interest and enhance future National Institutes of Health-funded efforts in community-engaged research.