scholarly journals Refined assessment of associations between drinking water residence time and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia

2016 ◽  
Vol 14 (4) ◽  
pp. 672-681 ◽  
Author(s):  
Karen Levy ◽  
Mitchel Klein ◽  
Stefanie Ebelt Sarnat ◽  
Samina Panwhar ◽  
Alexandra Huttinger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Residence Time ◽  
Distribution System ◽  
Water Distribution ◽  
Disease Outbreaks ◽  
Emergency Department Visits ◽  
Water Residence Time ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Outbreak Investigations

Recent outbreak investigations suggest that a substantial proportion of waterborne disease outbreaks are attributable to water distribution system issues. In this analysis, we examine the relationship between modeled water residence time (WRT), a proxy for probability of microorganism intrusion into the distribution system, and emergency department visits for gastrointestinal (GI) illness for two water utilities in Metro Atlanta, USA during 1993–2004. We also examine the association between proximity to the nearest distribution system node, based on patients' residential address, and GI illness using logistic regression models. Comparing long (≥90th percentile) with intermediate WRTs (11th to 89th percentile), we observed a modestly increased risk for GI illness for Utility 1 (OR = 1.07, 95% CI: 1.02–1.13), which had substantially higher average WRT than Utility 2, for which we found no increased risk (OR = 0.98, 95% CI: 0.94–1.02). Examining finer, 12-hour increments of WRT, we found that exposures >48 h were associated with increased risk of GI illness, and exposures of >96 h had the strongest associations, although none of these associations was statistically significant. Our results suggest that utilities might consider reducing WRTs to <2–3 days or adding booster disinfection in areas with longer WRT, to minimize risk of GI illness from water consumption.

scholarly journals Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia

2009 ◽  
Vol 7 (2) ◽  
pp. 332-343 ◽  
Author(s):  
Sarah C. Tinker ◽  
Christine L. Moe ◽  
Mitchel Klein ◽  
W. Dana Flanders ◽  
Jim Uber ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drinking Water ◽  
Residence Time ◽  
Distribution Networks ◽  
Emergency Department Visits ◽  
Residence Times ◽  
Water Residence Time ◽  
Increased Risk ◽  
Ed Visits ◽  
Zip Code

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost 3 million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared with intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI)=1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness.

scholarly journals Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

2018 ◽  
Vol 8 (4) ◽  
pp. 166-170
Author(s):  
Jerina Nogueira ◽  
Pedro Abreu ◽  
Patrícia Guilherme ◽  
Ana Catarina Félix ◽  
Fátima Ferreira ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Intracerebral Hemorrhage ◽  
Hospital Discharge ◽  
Transitional Care ◽  
Neurological Impairment ◽  
Emergency Department Visits ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Ed Visits

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results: A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations ( P < .001) and ED visits ( P < .001) prior to the SICH, unhealthy alcohol use ( P = .049), longer period of index SICH hospitalization ( P = .032), pneumonia during hospitalization ( P = .001), and severe neurological impairment at discharge ( P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions: Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

scholarly journals Sulfur Dioxide and Emergency Department Visits for Stroke and Seizure

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Mieczysław Szyszkowicz ◽  
Eugeniusz Porada ◽  
Neil Tremblay ◽  
Eric Grafstein
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Sulfur Dioxide ◽  
Regression Models ◽  
Conditional Logistic Regression ◽  
Emergency Department Visits ◽  
Cerebrovascular Accidents ◽  
Logistic Regression Models ◽  
Female Patients ◽  
Ed Visits

The purpose of this study was to assess an association between ambient sulfur dioxide and the number of emergency department (ED) visits for ischemic stroke and seizure. The study used data collected in a Vancouver (Canada) hospital in the years 1999–2003. Daily ED visits diagnosed as ministroke, stroke, or seizure were investigated using the case-crossover technique. Conditional logistic regression models were applied to estimate the odds ratios (ORs) and their respective 95% confidence intervals (CIs). The models included temperature and relative humidity in the form of natural splines. The results were reported for an increase in interquartile range ((IQR),IQR=1.9ppb for SO2). Positive and statistically significant associations were obtained for SO2and ischemic stroke for all patients (OR=1.12; CI 1.02, 1.23; lag 3) and for female patients (OR=1.17; CI 1.01, 1.33; lag 0). In the case of ED visits for seizure, for female patients the results were also statistically significant (OR=1.15; CI 1.02, 1.28; lag 1 andOR=1.18; CI 1.05, 1.32; lag 2). These findings suggest that cases of ischemic cerebrovascular accidents are associated with acute exposure to ambient sulfur dioxide.

scholarly journals Anomalously warm weather and acute care visits in patients with multiple sclerosis: A retrospective study of privately insured individuals in the US

PLoS Medicine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. e1003580
Author(s):  
Holly Elser ◽  
Robbie M. Parks ◽  
Nuriel Moghavem ◽  
Mathew V. Kiang ◽  
Nina Bozinov ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Emergency Department ◽  
Global Climate ◽  
Emergency Department Visits ◽  
Housing Quality ◽  
Clinical Feature ◽  
Heat Sensitivity ◽  
Older Individuals ◽  
Warm Weather ◽  
Increased Risk

Background As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. Methods and findings We conducted a retrospective cohort study of individuals with MS ages 18–64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ≥1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36–55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025–1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010–1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005–1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live—and therefore the extent of their exposure to anomalously warm weather—as well as their propensity to seek treatment for neurologic symptoms. Conclusions Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.

scholarly journals Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

2020 ◽  
Vol 29 (4) ◽  
pp. 311-317
Author(s):  
Patricia S. Andrews ◽  
Sophia Wang ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Sikandar Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Health Care Utilization ◽  
Mortality Risk ◽  
Hazard Ratio ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

scholarly journals 131Spatio-temporal analysis to assess health effects of landscape fire smoke: an empirical model

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Adeleh Shirangi ◽  
Alex Xiao ◽  
Emmanuel Ongee ◽  
Ivana Ivánová ◽  
Ashraf Dewan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cardiovascular Diseases ◽  
Health Effects ◽  
Hospital Admissions ◽  
Temporal Analysis ◽  
Emergency Department Visits ◽  
Increased Risk ◽  
Wide Range ◽  
High Level

Abstract Background Understanding the health effects of smoke from landscape fires (LFs), including wildfires and prescribed burns, is limited due to lack of adequate smoke exposure measures. Methods We used the reported LFs to determine smoke plume shapes from satellite images. Daily remotely sensed fire radiative power, aerosol optical depth, smoke plumes, fire danger rating, venting index and previous day PM 2.5 were then used to estimate smoke-related particulate matter 2.5 (PM2.5). A population based time series design was used to assess associations between smoke-related PM2.5 and selected adverse health outcomes such as hospital admissions, emergency department visits and ambulance callouts. Results We found a significant dose-response relationship between increased smoke-related PM2.5 concentration and 1% to 5% increase for total emergency department attendances and total hospital admissions on the same day and the lag effects of 3 days where the PM2.5 was at medium level (95-98th percentile) and high level ( &gt; =99th percentile) compared to the low level (&lt;95th percentile). There was also 1% to 25% increased risk for individuals who were exposed to high level LF smoke with selected respiratory and cardiovascular diseases in selected health care utilisations. Conclusions Exposure to LF smoke at a high level was spatio-temporally associated with a wide range of adverse respiratory and cardiovascular diseases in selected health care utilisations. Key messages

scholarly journals Accumulation and Fate of Microorganisms and Microspheres in Biofilms Formed in a Pilot-Scale Water Distribution System

2005 ◽  
Vol 71 (2) ◽  
pp. 706-712 ◽  
Author(s):  
Jonas Långmark ◽  
Michael V. Storey ◽  
Nicholas J. Ashbolt ◽  
Thor-Axel Stenström
Keyword(s):  
In Situ Hybridization ◽  
Fluorescence In Situ Hybridization ◽  
Residence Time ◽  
Legionella Pneumophila ◽  
Distribution System ◽  
Water Distribution ◽  
Water Distribution System ◽  
Pilot Scale ◽  
Microbial Pathogens

ABSTRACT The accumulation and fate of model microbial “pathogens” within a drinking-water distribution system was investigated in naturally grown biofilms formed in a novel pilot-scale water distribution system provided with chlorinated and UV-treated water. Biofilms were exposed to 1-μm hydrophilic and hydrophobic microspheres, Salmonella bacteriophages 28B, and Legionella pneumophila bacteria, and their fate was monitored over a 38-day period. The accumulation of model pathogens was generally independent of the biofilm cell density and was shown to be dependent on particle surface properties, where hydrophilic spheres accumulated to a larger extent than hydrophobic ones. A higher accumulation of culturable legionellae was measured in the chlorinated system compared to the UV-treated system with increasing residence time. The fate of spheres and fluorescence in situ hybridization-positive legionellae was similar and independent of the primary disinfectant applied and water residence time. The more rapid loss of culturable legionellae compared to the fluorescence in situ hybridization-positive legionellae was attributed to a loss in culturability rather than physical desorption. Loss of bacteriophage 28B plaque-forming ability together with erosion may have affected their fate within biofilms in the pilot-scale distribution system. The current study has demonstrated that desorption was one of the primary mechanisms affecting the loss of microspheres, legionellae, and bacteriophage from biofilms within a pilot-scale distribution system as well as disinfection and biological grazing. In general, two primary disinfection regimens (chlorination and UV treatment) were not shown to have a measurable impact on the accumulation and fate of model microbial pathogens within a water distribution system.

scholarly journals Incidence of Hospitalizations and Emergency Department Visits for Herpes Zoster in Immunocompromised and Immunocompetent Adults in Ontario, Canada, 2002–2016

2019 ◽  
Vol 71 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Sarah A Buchan ◽  
Nick Daneman ◽  
Jun Wang ◽  
Gary Garber ◽  
Anne E Wormsbecker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Herpes Zoster ◽  
Incidence Rates ◽  
Emergency Department Visits ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Increased Risk ◽  
Rate Ratios ◽  
Immunocompetent Adults ◽  
Incident Cases

Abstract Background Immunocompromised adults are at .increased risk of herpes zoster (HZ) infection and related complications. We aimed to assess the incidence of hospital-attended HZ (ie, seen in hospital or emergency department) in immunocompromised populations and compare it to immunocompetent populations. Methods We calculated incidence rates (IRs) of hospital-attended HZ in Ontario, Canada, between 1 April 2002 and 31 August 2016 in adults ≥18 years of age categorized as immunocompromised or immunocompetent. We repeated these analyses by type of immunocompromising condition and provided incidence rate ratios (IRRs) comparing to immunocompetent adults. We also calculated IRs and IRRs of HZ complications by immunocompromised status. Results There were 135 206 incident cases of hospital-attended HZ during the study period. Immunocompromised adults accounted for 13% of these cases despite representing 3% of the population. The risk of hospital-attended HZ was higher for immunocompromised adults compared with immunocompetent adults (IRR, 2.9 [95% confidence interval {CI}, 2.9–3.0]) and ranged across type of immunocompromising conditions, from 2.6 (95% CI, 2.6–2.7) in those with a solid tumor malignancy to 12.3 (95% CI, 11.3–13.2) in those who had undergone hematopoietic stem cell transplant. The risk of any HZ complication was higher in immunocompromised adults (IRR, 3.6 [95% CI, 3.5–3.7]) and highest for disseminated zoster (IRR, 32.8 [95% CI, 27.8–38.6]). Conclusions The risk of hospital-attended HZ and related complications was higher in immunocompromised populations compared with immunocompetent populations. Our findings underscore the high-risk nature of this population and the potential benefits that may be realized through HZ vaccination.

scholarly journals Cardiac troponin I and the risk of cardiovascular or non-cardiovascular death in patients visiting the emergency department

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong Eun Park ◽  
Minseok Song ◽  
Taerim Kim ◽  
Gun Tak Lee ◽  
Sung Yeon Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Analysis ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiovascular Death ◽  
Cardiac Troponin I ◽  
Emergency Department Visits ◽  
Time Dependent ◽  
Increased Risk ◽  
The Impact

AbstractThe prognostic implication of cardiac troponin I (cTnI) values for the determination of the magnitude or duration of cause-specific death risk is limited. We included consecutive patients with maximal cTnI values within 24 h of their emergency department visits. Multivariate analyses using variables selected by the Bayesian information criterion were performed to investigate the impact of cTnI on the event rate, time-dependent risk, and dose-dependent risk of cardiovascular or non-cardiovascular death within 360 days. There were 5472 (14.9%) all-cause deaths including 881 (2.4%) cardiovascular deaths and 4591 (12.5%) non-cardiovascular deaths. In patients with positive cTnI, defined as the ≥ 99th percentile of the upper normal limit, the cumulative risk of cardiac and non-cardiac death was 4.4- and 1.4-fold higher, respectively, than that of negative cTnI, respectively. In the competing risk analysis, positive cTnI was linked to 2.4- and 1.2-fold higher risks of cardiovascular and non-cardiovascular death, respectively. The cTnI value showed a positive relationship with the risk of both cardiovascular and non-cardiovascular deaths. In the time-dependent risk analysis, the excess risk of cardiovascular death was mostly evident in the first few weeks. Higher cTnI value was associated with an increased risk of both cardiovascular and non-cardiovascular death, especially which was in the early period.

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