bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015
Authors: Daly Elizabeth R. , Dufault Kenneth , Swenson David J. , Lakevicius Paul , Metcalf Erin , Chan Benjamin P. 
Published: November 2017

Objectives: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. Methods: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire’s syndromic surveillance ED data system by querying for (1) chief complaint text related to the words “fentanyl,” “heroin,” “opiate,” and “opioid” and (2) opioid-related International Classification of Diseases ( ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. Results: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20 994 total opioid-related ED visits, we identified 18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being “pain” (n = 3335, 18%), “overdose” (n = 1555, 8%), “suicidal” (n = 816, 4%), “drug” (n = 803, 4%), and “detox” (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. Conclusions: Opioid-related ED encounters in New Hampshire increased substantially from 2011 to 2015. Data from New Hampshire’s ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic.
Local Public Health Surveillance of Heroin-Related Morbidity and Mortality, Orange County, Florida, 2010-2014
Authors: Hudson Toni-Marie L. , Klekamp Benjamin G. , Matthews Sarah D. 
Published: November 2017

Objectives: Heroin-related deaths have increased substantially in the past 10 years in the United States, particularly in Florida. Our objectives were to measure heroin-related morbidity and mortality rates in Orange County, Florida, and to assess trends in those rates during 2010-2014. Methods: We used 3 heroin surveillance methods, based on data from the Florida Medical Examiner, the Florida Agency for Health Care Administration (AHCA), and the Electronic Surveillance System for the Early Notification of Community-Based Epidemics–Florida (ESSENCE-FL). We conducted descriptive and geographic spatial analyses of all 3 data sets, determined heroin-related mortality and morbidity (emergency department [ED] visit) rates, and compared the timeliness of data availability from the 3 data sources. Results: Heroin-related deaths in Orange County increased by 590%, from 10 in 2010 to 69 in 2014. Heroin-related ED visits during the same period increased 12-fold (from 13 to 154) and 6-fold (from 49 to 307) when based on AHCA and ESSENCE-FL data, respectively. ESSENCE-FL identified 140% more heroin-related visits than did AHCA. Spatial analysis found geographic clustering of heroin-related morbidity and mortality. Hospitals facing the greatest burden of heroin-related ED visits were close to communities with the highest crude heroin-related ED visit rates. Of the 3 data sources, ESSENCE-FL provided the timeliest data availability. Conclusions: These 3 data sources can be considered acceptable surveillance systems for monitoring heroin-related events in Orange County. The timely availability of data from ESSENCE-FL makes it the most useful source for obtaining near–real-time data about the heroin epidemic, potentially leading to improved identification of populations most in need of interventions to reduce morbidity and mortality.
Evaluation of the Components of the North Carolina Syndromic Surveillance System Heat Syndrome Case Definition
Authors: Harduar Morano Laurel , Waller Anna E. 
Published: November 2017

Objectives: To improve heat-related illness surveillance, we evaluated and refined North Carolina’s heat syndrome case definition. Methods: We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. Results: The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: “heat ex” (n = 1674, 41.8%), “overheat” (n = 646, 16.1%), “too hot” (n = 594, 14.8%), and “heatstroke” (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: “burn,” “grease,” “liquid,” “oil,” “radiator,” “antifreeze,” “hot tub,” “hot spring,” and “sauna.” After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P < .001). Conclusions: Revising the heat syndrome case definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.
Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016
Authors: Lall Ramona , Abdelnabi Jasmine , Ngai Stephanie , Parton Hilary B. , Saunders Kelly , Sell Jessica , Wahnich Amanda , Weiss Don , Mathes Robert W. 
Published: November 2017

Introduction: The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa. Materials and Methods: The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters. Results: For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak. Practice Implications: Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.
Female infanticide in India: A review of literature
Authors: Saravanan Sheela 
Published: November 2017

In spite of the legal provisions to prevent female infanticide and foetieide, it continues to occur in many parts of the country. While infanticide was first known to be recorded in British rule, in some States like Tamil Nadu, it is essentially a post-Independence occurrence. Data from Bihar shows that it started among the high castes and now cuts across all castes and classes. In Tamil Nadu also, there are indications that the practice cuts across social groups, and also, that there has been a core area of occurrence, from where it is slowly spreading to the surrounding areas. Female infanticide is supported by sanctions and pressures from the family. It is fueled by the evil of the dowry system, which places demands on the girl's family. Sometimes, mothers kill their female babies to save them from abuse and violence later in life. Birth order also is an important factor-after two girls are born, the next girl is at high risk, according to a study from Tamil Nadu. It is believed also that killing a girl child increases the probability of a male child born in the family. Female infanticide is reported to occur also due to a lack of scanning centres, as an alternative to foetieide. Another factor implicated infanticide is the decline in the status of women due to the modernisation of agriculture. The new agricultural technology makes the traditional agricultural knowledge of women redundant, and due to the constraints on their free movement in the public space, it is the men who visit government offices to get loans and information on new varieties of seeds, pesticides and so on. In this context, women become liabilities and dowry becomes important. A change in the status of women for the worse in the wake of the modernisation of agriculture has been reported from Madurai district of Tamil Nadu, where there is a high incidence of female infanticide. Female infanticide and foeticide need to be dealt with by mobilising people to get together and work against this social evil and bring about changes in the society.
Waste-handlers and recycling in urban India: Policy, perception and the law
Authors: Chaturvedi Bharati 
Published: November 2017

All recycling in India is undertaken by (and via) the informal sector. This sector includes waste-pickers, small middlemen, transporters, larger middlemen and Anally, reprocessors. These self-employed people play a very important role in urban waste management as they provide a service which the urban municipalities cannot provide given their current institutional framework. Although the sector of informal waste managers is critical to solid waste-handling in India, the sector is unable to optimise its work due to lack of social legitimacy or legal rights over waste-processing, which makes it vulnerable to intimidation. Additionally, due to lack of awareness and specific skills, as well as very poor working conditions and poor access to basic facilities, this sector has so far been unable to make its recycling efficient and profitable. With certain changes in the policies relating to recycling and ownership of waste, there can be a synergetic relationship between the recycling sector, the existing relevant laws, and waste-handling in India that can significantly improve the efficiency of the sector and enhance financial returns to the waste-pickers and reprocessors. Such policy changes as provision of legal rights over solid waste to waste-pickers and organisation of waste-pickers into cooperative groups, can further the interests of these marginalised groups and maximise their profits, in addition to substantially improving solid waste management in the city.
Maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital
Authors: Akaba Godwin O , Ekele Bissallah A 
Published: November 2017

Our study sought to determine the maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital as well as assess reasons for these referrals. We enrolled women referred or who presented themselves to the emergency obstetric unit for management of complications of pregnancy, labour, delivery or the puerperium. The majority presented late, their mean duration of stay at the referring facility being 22.25 h. Only nine (7.3%) were transported by ambulance. Severe pre-eclampsia and eclampsia (in 33, 26.8%) were the commonest obstetric indications for referral. Stillbirths occurred in 20/122(16.4%). There were eleven maternal deaths, giving an emergency referral fatality rate of 8.9%. Both maternal and fetal outcomes of these emergency obstetric referrals were poor owing mainly to late presentation, this being the result, among other factors, of an inefficient referral system.
Screening for depression in Andean Latin America: Factor structure and reliability of the CES-D short form and the PHQ-8 among Bolivian public hospital patients
Authors: Schantz Karolina , Reighard Chelsea , Aikens James E , Aruquipa Amparo , Pinto Bismark , Valverde Helen , Piette John D. 
Published: November 2017

Objective We assessed the validity and reliability of the Center for Epidemiologic Studies-Depression scale (CES-D) short form and the Patient Health Questionnaire-8 (PHQ-8) (two measures of depressive symptoms) among urban, low-income patients from a heavily indigenous area of Andean Latin America. This is a patient population that is in many ways culturally distinct from the populations that have been included in previous Spanish language validation studies of these instruments. Methods We administered the CES-D Yale version short form and the PHQ-8 to 107 outpatients at public hospitals in La Paz and El Alto, Bolivia. We conducted exploratory factor analysis, checked internal reliability, and examined concordance between the two measures in identifying patients with clinically significant depressive symptoms. Results Internal reliability was high for both scales: PHQ-8 (Cronbach’s α = 0.808) and CES-D (α  = 0.825). A one-factor solution for the PHQ-8 was maintained after the removal of one poorly loading item. The CES-D showed a two-factor solution, with items for somatic symptoms and interpersonal problems loading on the same factor as negative affect. Using both the cutoff for depression recommended in prior studies and a sample specific cutoff of ≥1 standard deviation above the mean, the two scales demonstrated only moderate agreement (κ = 0.481–0.486). Conclusions The PHQ may be more appropriate for clinical use in the Andean region, given its greater specificity; however, lower than expected agreement between the scales suggests that they also measure different elements of depression. Irregularities with the factor structure of both scales suggest that further research with this population is needed to better understand depressive symptomology and improve screening in the region.
Racial Mixing and National Integration in Latin America: The Return of Racial Differences in Mexico and Brazil
Authors: Torre Cantalapiedra Eduardo 
Published: November 2017

The importance of racial differences in the configuration of Latin American societies has for decades been overshadowed by ideologies of racial mixing and social-class-based approaches to the analysis of the region’s societies. Since the beginning of the twenty-first century increased attention has been devoted to racial differences both in public policy and in social science research. Government affirmative action designed to reverse social inequalities due to racial differences in Brazil and the results of research on racial differences and racial mixing in Mexico indicate that, as Rodolfo Stavenhagen argued 50 years ago, racial mixing does not contribute to national integration. La transcendencia de las diferencias raciales en la configuración de las sociedades latinoamericanas ha sido poco atendida durante décadas; inicialmente, fue opacada por las ideologías del mestizaje, y posteriormente ensombrecida por el predominio de las clases sociales como forma de analizar a las sociedades de esta región. Desde a comienzos del siglo XXI, las diferencias raciales han adquirido notoriedad en Latinoamérica, tanto en las investigaciones en ciencias sociales como en las políticas públicas. Las políticas públicas de acción afirmativa conducidas por el gobierno brasileño y los hallazgos de las investigaciones más recientes en cuestiones referidas a las diferencias raciales y al mestizaje en el caso de México indican que, como dijo Rodolfo Stavenhagen hace cincuenta años, el mestizaje no contribuye a la integración nacional.
End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care
Authors: Shulman Caroline , Hudson Briony F , Low Joseph , Hewett Nigel , Daley Julian , Kennedy Peter , Davis Sarah , Brophy Niamh , Howard Diana , Vivat Bella , Stone Patrick 
Published: November 2017

Background: Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited. Aim: To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care. Design: Thematic analysis of data collected using focus groups and interviews. Participants: Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10). Results: This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues. Conclusion: Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.
Electrocardiographic alterations in patients consuming synthetic cannabinoids
Authors: Ozturk Hayriye M , Erdogan Mehmet , Alsancak Yakup , Yarlioglues Mikail , Duran Mustafa , Boztas M Hamid , Murat Sani N , Ozturk Selcuk 
Published: November 2017

Introduction: The aim of this study was to investigate the electrocardiographic parameters in patients consuming synthetic cannabinoids. Methods: Thirty-five patients who were consuming synthetic cannabinoids were enrolled to the study, prospectively. The control group included 35 healthy age and sex-matched volunteers. The standard 12-lead surface electrocardiograms of the study population were recorded. P maximum (Pmax), P minimum (Pmin), P wave dispersion, interatrial duration, P wave area in D2 derivation, abnormal P terminal force in V1 derivation, heart rate, QT interval, corrected QT, QT dispersion, PR interval duration and macrovolt T-wave alternans were evaluated by two experienced cardiologists. The intra-observer and inter-observer variations for all measurements were non-significant. Results: Pmax and Pmin duration was not different between the groups ( p=0.96, p=0.15, respectively). However, P wave dispersion was higher in the patient group compared to control group (34±9.4, 29.5±6.6, p=0.02, respectively). QT interval was significantly higher in the patient group than the control group (380.3±25, 365.6±22.8, p=0.01, respectively). Besides, corrected QT was higher in the patient group compared to control group (415±36.8, 392±15.5, p=0.001, respectively). QT dispersion was also higher in the patient group than the control group (39.8±10.0, 29.2±5.4, p<0.001, respectively). Conclusion: Altered electrocardiography parameters linked with atrial and ventricular arrhythmia development may be observed in patients consuming synthetic cannabinoids. These patients should be evaluated regularly for cardiovascular disease and arrhythmia development. The electrocardiogram, which is a cheap and easy test to apply, can be used to determine the pro-arrythmic risk in patients consuming synthetic cannabinoids.
CGRP, a target for preventive therapy in migraine and cluster headache: Systematic review of clinical data
Authors: Khan Sabrina , Olesen Astrid , Ashina Messoud 
Published: November 2017

Introduction Migraine and cluster headache are challenging to manage, with no tailored preventive medications available. Targeting the calcitonin gene-related peptide (CGRP) pathway to treat these headaches may be the first focused therapeutic option to date, with the potential for promising efficacy. Methods We systematically searched PubMed and clinicaltrials.gov for randomized controlled trials investigating the preventive potential of monoclonal antibodies against the CGRP pathway in the treatment of migraine and cluster headache. Results The literature search returned a total of 136 records, of which 32 were eligible for review. Discussion Clinical data from phase II and III trials of the four monoclonal antibodies targeting the CGRP pathway: Eptinezumab, erenumab, fremanezumab, and galcanezumab, collectively show a positive effect in the preventive treatment of episodic and chronic migraine. Multiple phase II and III trials are under way to further determine the efficacy and safety of this new drug class. It may be particularly important to assess the cardiovascular effects of long-term CGRP blockade. Phase III trials are also currently in progress for the preventive treatment of cluster headache. Conclusion Efficacy of anti-CGRP monoclonal antibodies spells a promising future for the many patients suffering from migraine, and possibly also for the smaller but severely-affected population with cluster headache.