public health

Intranasal Naloxone for Opioid Overdose

Author/s: 
Jessica L Taylor, Karen E Lasser

In 2021, opioid overdose deaths exceeded 80 000 in the US.1 Naloxone, a competitive opioid receptor antagonist that reverses symptoms of opioid intoxication and overdose by displacing opioids from μ-opioid receptors, is a safe and effective medication for preventing opioid overdose death. Naloxone meets US Food and Drug Administration (FDA) criteria for approval without a prescription: its benefits outweigh risks, it treats a condition that can be identified by people in the community, it has a low potential for misuse, and it can be labeled to facilitate correct administration.

Suicide Prevention in Primary Care: A Toolkit for Primary Care Clinicians and Leaders

Author/s: 
Institute of Family Health, Little, V.

Suicide prevention has been named a national priority and much work has been done to review existing evidence and identify gaps in how our nation’s mental health and health care systems address this public health challenge. A national task force that was part of the effort to update the national suicide prevention strategy reviewed research and best practices from the field and
concluded that suicide prevention could be improved in health care. The task force found three common characteristics among successful suicide prevention programs in health care settings. Health care staff in these organizations:
Believed that suicide can be prevented in the population they serve through improvements in service access and quality, and through systems of continuous improvement;
Created a culture that finds suicide unacceptable and sets and monitors ambitious goals to prevent suicide; and
Employed evidence-based clinical care practice, including standardized risk stratification, evidence-based interventions, and patient engagement approaches1.

The task force’s recommendations formed the foundation of the Zero Suicide Approach for health care organizations. The recommendations contained in this guide are based on those offered in the comprehensive Zero Suicide in Health and Behavioral Health Care Toolkit [http://zerosuicide.sprc.org/toolkit]. Here they have been adapted specifically for primary care organizations and clinicians who care for underserved populations.
The guide focuses on two core components:
1. Screening and assessment
2. Care management and referral processes
The final section contains some additional information on administrative and legal issues providers and leaders may find helpful to support integration of safer suicide care in practice. Many providers and clinical leaders erroneously assume if they discuss suicide with a patient they open up themselves to liability. Utilizing a patient safety approach, primary care organizations can
establish safer suicide care practices that deliver high quality care to patients and reduce risk to the organization.
In each section of this guide you will find:
Information summarized for providers, including some helpful provider communication tips.
A list of recommended trainings and resources to learn more.
Leadership actions organizations may wish to undertake to help providers reduce suicide in their organization’s
patient population, and
Relevant tools, templates and case studies.
This toolkit begins with a brief background on the impact of suicide and offers a case study illustrating how one federally qualified health center adopted a safer suicide care model.

Understanding Suicide Risk And Prevention

Author/s: 
Miller, Benjamin F., Coffey, M. J.

KEY POINTS:

  • Suicide rates have been rising during the past several years, but suicide is preventable.
  • There are many known risk factors for suicide, but the predictive utility of any single risk factor is low, requiring a focus on population-level rather than individual-level prevention.
  • There are proven processes for identifying suicide risk and intervening in health care, criminal justice, and education settings.
  • There is also a need for an enhanced data infrastructure to support suicide and self-harm surveillance systems.
  • Additional policy intervention is needed to scale and spread successful prevention approaches and to identify others. For example, policies should support removal of lethal means, increased funding for help lines and school-based programs, and integration of mental health care into routine health care.

 

Foodborne illness source attribution estimates for 2018 for Salmonella, Escherichia coli O157, Listeria monocytogenes, and Campylobacter using multi-year outbreak surveillance data, United States

Each year in the United States an estimated 9 million people get sick, 56,000 are hospitalized, and 1,300 die of foodborne disease caused by known pathogens. These estimates help us understand the scope of this public health problem. However, to develop effective prevention measures, we need to understand the types of foods contributing to the problem. The Interagency Food Safety Analytics Collaboration (IFSAC) is a tri-agency group created by the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS). IFSAC developed a method to estimate the percentages of foodborne illness attributed to certain sources using outbreak data from 1998 through the most recent year for four priority pathogens: Salmonella, Escherichia coli O157, Listeria monocytogenes, and Campylobacter. IFSAC described this method and the estimates for 2012 in a report, peer-reviewed journal article, and at a public meeting. IFSAC derived the estimates for 2018 using the same method used for the 2012 estimates, with some modifications. The data came from 1,459 foodborne disease outbreaks that occurred from 1998 through 2018 and for which each confirmed or suspected implicated food was assigned to a single food category. The method relies most heavily on the most recent five years of outbreak data (2014 – 2018). Foods are categorized using a scheme IFSAC created that classifies foods into 17 categories that closely align with the U.S. food regulatory agencies’ classification needs

Health Policy Brief: Understanding Suicide Risk and Prevention

Author/s: 
Miller, Benjamin F., Coffery, M. J.
  • Suicide rates have been rising during the past several years, but suicide is preventable.
  • There are many known risk factors for suicide, but the predictive utility of any single risk factor is low, requiring a focus on population-level rather than individual-level prevention.
  • There are proven processes for identifying suicide risk and intervening in health care, criminal justice, and education settings.
  • There is also a need for an enhanced data infrastructure to support suicide and self-harm surveillance systems.
  • Additional policy intervention is needed to scale and spread successful prevention approaches and to identify others. For example, policies should support removal of lethal means, increased funding for help lines and school-based programs, and integration of mental health care into routine health care.

Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis

Author/s: 
Ebell, M.H., Bentivegna, M., Hulme, C.

Abstract

Purpose: Benefit of lung cancer screening using low-dose computed tomography (LDCT) in reducing lung cancer-specific and all-cause mortality is unclear. We undertook a meta-analysis to assess its associations with outcomes.

Methods: We searched the literature and previous systematic reviews to identify randomized controlled trials comparing LDCT screening with usual care or chest radiography. We performed meta-analysis using a random effects model. The primary outcomes were lung cancer-specific mortality, all-cause mortality, and the cumulative incidence ratio of lung cancer between screened and unscreened groups as a measure of overdiagnosis.

Results: Meta-analysis was based on 8 trials with 90,475 patients that had a low risk of bias. There was a significant reduction in lung cancer-specific mortality with LDCT screening (relative risk = 0.81; 95% CI, 0.74-0.89); the estimated absolute risk reduction was 0.4% (number needed to screen = 250). The reduction in all-cause mortality was not statistically significant (relative risk = 0.96; 95% CI, 0.92-1.01), but the absolute reduction was consistent with that for lung cancer-specific mortality (0.34%; number needed to screen = 294). In the studies with the longest duration of follow-up, the incidence of lung cancer was 25% higher in the screened group, corresponding to a 20% rate of overdiagnosis.

Conclusions: This meta-analysis showing a significant reduction in lung cancer-specific mortality, albeit with a tradeoff of likely overdiagnosis, supports recommendations to screen individuals at elevated risk for lung cancer with LDCT.

Keywords: cancer screening; health services; low-dose computed tomography; lung cancer; mass screening; overdiagnosis; preventive medicine; public health.

© 2020 Annals of Family Medicine, Inc.

Candida auris: A Drug-resistant Germ That Spreads in Healthcare Facilities

Candida auris (also called C. auris) is a fungus that causes serious infections. Patients with C. auris infection, their family members and other close contacts, public health officials, laboratory staff, and healthcare personnel can all help stop it from spreading.

Preventing Firearm-Related Death and Injury

Author/s: 
Pallin, R., Spitzer, S.A., Ranney, M.L., Betz, M.E., Wintemute, G.J.

Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.

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