Research and Practice Integration

Cedar City, United States

Research and Practice Integration

Cedar City, United States
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Kegler S.R.,Research and Practice Integration | Stone D.M.,National Center for Injury Prevention and Control | Holland K.M.,National Center for Injury Prevention and Control
Morbidity and Mortality Weekly Report | Year: 2017

What is already known about this topic? The U.S. suicide rate has been increasing since 2000. Rates in less urban areas have been higher than rates in more urban areas, with some evidence of a growing difference. What is added by this report? During 1999-2015, suicide rates increased across all levels of urbanization, with the gap in rates between less urban and more urban areas widening over time, most conspicuously over the later part of this period. Geographic disparities in suicide rates might reflect suicide risk factors known to be prevalent in less urban areas, such as limited access to mental health care, social isolation, and the opioid overdose epidemic, because opioid misuse is associated with increased risk for suicide. That the gap in rates began to widen more noticeably after 2007-2008 might reflect the influence of the economic recession, which disproportionately affected less urban areas. What are the implications for public health practice? There is a growing need for comprehensive suicide prevention employing a broad public health approach. This might include strategies applicable for all communities (e.g., strengthening economic support during times of financial hardship and teaching coping and problem-solving skills) along with strategies that address subsets of the population at increased risk, such as rural communities (e.g., programs that address provider short­ages and promote social connectedness). CDC’s technical package of multisector policies, programs, and practices serves as a resource for states and communities to guide decision-making based on the best available evidence for preventing suicide. © 2017, Department of Health and Human Services. All rights reserved.


Levy B.,National Center for Injury Prevention and Control | Paulozzi L.,National Center for Injury Prevention and Control | Mack K.A.,Research and Practice Integration | Jones C.M.,U.S. Food and Drug Administration
American Journal of Preventive Medicine | Year: 2015

Introduction Opioid analgesic prescriptions are driving trends in drug overdoses, but little is known about prescribing patterns among medical specialties. We conducted this study to examine the opioid-prescribing patterns of the medical specialties over time. Methods IMS Health's National Prescription Audit (NPA) estimated the annual counts of pharmaceutical prescriptions dispensed in the U.S. during 2007-2012. We grouped NPA prescriber specialty data by practice type for ease of analysis, and measured the distribution of total prescriptions and opioid prescriptions by specialty. We calculated the percentage of all prescriptions dispensed that were opioids, and evaluated changes in that rate by specialty during 2007-2012. The analysis was conducted in 2013. Results In 2012, U.S. pharmacies and long-term care facilities dispensed 4.2 billion prescriptions, 289 million (6.8%) of which were opioids. Primary care specialties accounted for nearly half of all dispensed opioid prescriptions. The rate of opioid prescribing was highest for specialists in pain medicine (48.6%); surgery (36.5%); and physical medicine/rehabilitation (35.5%). The rate of opioid prescribing rose during 2007-2010 but leveled thereafter as most specialties reduced opioid use. The greatest percentage increase in opioid-prescribing rates during 2007-2012 occurred among physical medicine/rehabilitation specialists (+12.0%). The largest percentage drops in opioid-prescribing rates occurred in emergency medicine (-8.9%) and dentistry (-5.7%). Conclusions The data indicate diverging trends in opioid prescribing among medical specialties in the U.S. during 2007-2012. Engaging the medical specialties individually is critical for continued improvement in the safe and effective treatment of pain.


Bhat G.,Centers for Disease Control and Prevention | Beck L.,Centers for Disease Control and Prevention | Bergen G.,Centers for Disease Control and Prevention | Kresnow M.-J.,Research and Practice Integration
Journal of Safety Research | Year: 2015

Abstract Introduction Seat belt use reduces the risk of injuries and fatalities among motor vehicle occupants in a crash, but belt use in rear seating positions is consistently lower than front seating positions. Knowledge is limited concerning factors associated with seat belt use among adult rear seat passengers. Methods Data from the 2012 ConsumerStyles survey were used to calculate weighted percentages of self-reported rear seat belt use by demographic characteristics and type of rear seat belt use enforcement. Multivariable regression was used to calculate prevalence ratios for rear seat belt use, adjusting for person-, household- and geographic-level demographic variables as well as for type of seat belt law in place in the state. Results Rear seat belt use varied by age, race, geographic region, metropolitan status, and type of enforcement. Multivariable regression showed that respondents living in states with primary (Adjusted Prevalence Ratio (APR): 1.23) and secondary (APR: 1.11) rear seat belt use enforcement laws were significantly more likely to report always wearing a seat belt in the rear seat compared with those living in a state with no rear seat belt use enforcement law. Conclusions and practical applications Several factors were associated with self-reported seat belt use in rear seating positions. Evidence suggests that primary enforcement covering all seating positions is an effective intervention that can be employed to increase seat belt use and in turn prevent motor vehicle injuries to rear-seated occupants. © 2015 National Safety Council and Elsevier Ltd. All rights reserved.


Jones C.M.,Health-U | Baldwin G.T.,National Center for Injury Prevention and Control | Manocchio T.,Health-U | White J.O.,Health-U | Mack K.A.,Research and Practice Integration
Morbidity and Mortality Weekly Report | Year: 2016

What is already known about this topic? Use of the prescription opioid methadone for treatment of pain, rather than for treatment of opioid use disorder, has been identified as an important contributor to the rise in opioid-related overdose deaths. In recent years, a number of actions to reduce the use of methadone for pain treatment have been taken. What is added by this report? During 2002-2006, the national distribution rate of methadone increased, on average, 25.1% per year, methadone-involved drug overdose deaths increased 22.1% per year, and methadone diversion increased 24.3% per year. After 2006, methadone distribution declined 3.2% per year, and methadone-involved overdose deaths declined 6.5% per year. Rates of methadone diversion continued to increase during 2006-2009, but substantially more slowly, and then declined an average of 12.8% per year beginning in 2010. By sex, most age groups, race/ethnicity, and U.S. Census region, the methadone overdose death rate peaked during 2005-2007 and declined in subsequent years. Persons aged 25-54 years had the highest overdose death rates during the study period. There was no significant change in the overdose death rate trend among persons aged ≥65 years, who also had the lowest overdose death rate. Among persons aged 55-64 years, the rate of methadone overdose deaths continued to increase through 2014. What are the implications for public health practice? Additional clinical and public health policy changes are needed to further reduce methadone-related harm, especially among persons aged ≥55 years. © 2016, Department of Health and Human Services. All rights reserved.


Paulozzi L.J.,National Center for Injury Prevention and Control | Mack K.A.,Research and Practice Integration | Hockenberry J.M.,Emory University
Morbidity and Mortality Weekly Report | Year: 2014

Background: Overprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation.Methods: CDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines.Results: In 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone.Conclusions: Factors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety.Implications for Public Health: State policy makers might reduce the harms associated with abuse of prescription drugs by implementing changes that will make the prescribing of these drugs more cautious and more consistent with clinical recommendations. © 2014, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. All rights reserved.


Florence C.,Research and Practice Integration | Haegerich T.,National Center for Injury Prevention and Control | Simon T.,National Center for Injury Prevention and Control | Zhou C.,Research and Practice Integration | Luo F.,Research and Practice Integration
Morbidity and Mortality Weekly Report | Year: 2015

What is already known on this topic? Each year, approximately 3 million persons are hospitalized and 27 million are treated and released in emergency departments (EDs) in the United States because of violence and unintentional injuries. Medical and work-loss costs associated with these injuries create a substantial economic burden for the health care system and the general public. What is added by this report? During 2013, the rate of nonfatal injuries treated in U.S. hospital EDs that resulted in hospitalization was 951 per 100,000, and the rate of nonfatal injuries that were treated and released was 8,549 per 100,000. Nonfatal injuries accounted for approximately $456 billion in medical and work-loss costs. The vast majority of ED-treated nonfatal injuries were unintentional. The majority of medical and work-loss costs associated with ED-treated nonfatal injuries were from falls (37% of costs) and transportation-related injuries (21% of costs). What are the implications for public health practice? Injury and violence prevention strategies can reduce a substantial source of morbidity and financial burden in the United States. Understanding how the cost burden is distributed across different mechanisms and segments of the population can allow prevention interventions to be targeted where they will have the greatest impact. The concentration of costs from falls (primarily among older adults) and transportation-related injuries suggests that a substantial proportion of costs can be avoided by implementation of prevention strategies that address these mechanisms and age groups. © 2015, Department of Health and Human Services. All rights reserved.


Paulozzi L.J.,National Center for Injury Prevention and Control | Mack K.A.,Research and Practice Integration | Hockenberry J.M.,Emory University
Journal of Safety Research | Year: 2014

Introduction Overprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation. Methods CDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines. Results In 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone. Conclusions Factors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety. Implications for Public Health State policy makers might reduce the harms associated with the abuse of prescription drugs by implementing changes that will make the prescribing of these drugs more cautious and more consistent with clinical recommendations.


Florence C.,Research and Practice Integration | Simon T.,National Center for Injury Prevention and Control | Haegerich T.,National Center for Injury Prevention and Control | Luo F.,Research and Practice Integration | Zhou C.,Research and Practice Integration
Morbidity and Mortality Weekly Report | Year: 2015

What is already known on this topic? Injuries are a leading cause of death in the United States, particularly among adolescents and young adults. Intentional and unintentional injury-associated deaths result in a substantial economic burden. Injury and violence prevention strategies can save lives and reduce costs. What is added by this report? Cost of injury estimates were updated using improved methodology and the most recently available injury data. The total estimated lifetime medical and work-loss costs associated with fatal injuries in 2013 was $214 billion. Males accounted for 78% of economic costs ($166.7 billion). Approximately 61% of the total costs were attributable to unintentional injuries ($129.7 billion), followed by suicide ($50.8 billion [24%]) and homicide ($26.4 billion [12%]). Drug poisonings as a mechanism accounted for the largest share of injury costs (27%), followed by transportation (23%) and firearm-related injuries (22%). What are the implications for public health practice? Injury deaths created a substantial economic burden in the United States during 2013. Understanding the causes and mechanisms of injury death that created the largest share of this burden, such as drug overdoses, and understanding disparities among affected groups can inform public health prevention efforts. © 2015, Department of Health and Human Services. All rights reserved.


Chapin M.M.,Nationwide Childrens Hospital | Rochette L.M.,Nationwide Childrens Hospital | Rochette L.M.,U.S. Army | Annest J.L.,Research and Practice Integration | And 4 more authors.
Pediatrics | Year: 2013

OBJECTIVE: The objective of this study was to investigate the epidemiology of nonfatal choking on food among US children. METHODS: Using a nationally representative sample, nonfatal pediatric choking-related emergency department (ED) visits involving food for 2001 through 2009 were analyzed by using data from the National Electronic Injury Surveillance System-All Injury Program. Narratives abstracted from the medical record were reviewed to identify choking cases and the types of food involved. RESULTS: An estimated 111 914 (95% confidence interval: 83 975-139 854) children ages 0 to 14 years were treated in US hospital EDs from 2001 through 2009 for nonfatal food-related choking, yielding an average of 12 435 children annually and a rate of 20.4 (95% confidence interval: 15.4-25.3) visits per 100 000 population. The mean age of children treated for nonfatal food-related choking was 4.5 years. Children aged ≥1 year accounted for 37.8% of cases, and male children accounted for more than one-half (55.4%) of cases. Of all food types, hard candy was most frequently (15.5% [16 168 cases]) associated with choking, followed by other candy (12.8% [13 324]), meat (12.2% [12 671]), and bone (12.0% [12 496]). Most patients (87.3% [97 509]) were treated and released, but 10.0% (11 218) were hospitalized, and 2.6% (2911) left against medical advice. CONCLUSIONS: This is the first nationally representative study to focus solely on nonfatal pediatric food-related choking treated in US EDs over a multiyear period. Improved surveillance, food labeling and redesign, and public education are strategies that can help reduce pediatric choking on food. Pediatrics 2013;132:275-281 © 2013 by the American Academy of Pediatrics.


PubMed | Research and Practice Integration and National Center for Injury Prevention and Control
Type: Journal Article | Journal: American journal of lifestyle medicine | Year: 2015

Older adult falls are a significant cause of morbidity and mortality in the United States. This leading cause of injury in adults aged 65 and older results in $35 billion in direct medical costs.To project the number of older adult falls by 2030 and the associated lifetime medical cost. A secondary objective is to review what clinicians can do to incorporate falls screening and prevention into their practice for community-dwelling older adults.Using the CDCs Web-based Injury Statistics Query and Reporting System and the US Census Bureau data, the number of older adults in 2030, fatal falls, and medical costs associated with fall injuries was projected. In addition, evidence-based interventions that can be integrated into clinical practice were reviewed.The number of older adult fatal falls is projected to reach 100,000 per year by 2030 with an associated cost of $100 billion. By integrating screening for falls risk into clinical practice, reviewing and modifying medications, and recommending Vitamin D supplementation, physicians can reduce future falls by nearly 25%.Falls in older adults will continue to rise substantially and become a significant cost to our health care system if we do not begin to focus on prevention in the clinical setting.

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