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Introduction Water infrastructure is critical to the health of communities, and its condition is connected to environmental justice (Schaider et al., 2019). By 2027, more than $300 billion will be [...], Cured-in-place pipes (CIPPs) are plastic liners manufactured inside existing damaged sanitary sewer, storm sewer, and water pipes that extend the service life of host pipes. This process often is conducted in neighborhoods and near roadways. Before, during, and after plastic manufacture, waste materials that include volatile materials are released into the air. Emissions from this manufacturing process can affect outdoor air quality and indoor air quality for buildings connected to the sewer system. We identified key issues and solicited stakeholder feedback to estimate and manage public health risks of CIPP-generated chemical air pollution. A work group representing 13 U.S. agencies and public health associations provided feedback and prioritized public health issues for action. To mitigate potential public and occupational health risks, additional testing and public health educational efforts were recommended. An improved understanding of CIPP chemical exposure pathways, as well as stakeholder needs and interests, is essential.

Author(s): Masaaki Takizawa [sup.1] , Ichiro Kawachi [sup.2] , Takeo Fujiwara [sup.1] , Masashi Kizuki [sup.1] , Nobutoshi Nawa [sup.1] , Shiho Kino [sup.2] Author Affiliations: (1) grid.265073.5, 0000 0001 [...], Objectives Globally, unintentional injuries are one of the leading causes of infant death. Established risk factors for injuries during infancy include single parent households, socioeconomic disadvantage and maternal postpartum depression. We sought to examine whether maternal working status is associated with unintentional injury among infants in Japan. Methods We used data from an original questionnaire targeting mothers who participated in a 3 or 4-month health check-up program in Aichi prefecture, Japan. Experience of any type of unintentional injury was used as the primary outcome, and we also examined the experience of "falls" and "near-drowning" as secondary outcomes. We conducted multivariable logistic regression analysis, adjusting for covariates. We also performed propensity score matching in order to balance covariates between paid employment and unpaid employment groups. Results Among 6,465 valid responses (response rate, 67%), 9.8% of infants experienced unintentional injuries. After matching on propensity for maternal employment (based on 26 covariates), we found that infants of mothers in paid employment were 1.35 times (95% CI: 1.04-1.74) more likely to experience injures, including 1.60 times higher likelihood of falls (95% CI: 1.14-2.24). Near-drowning was not significantly associated with maternal employment. We also found that father's employment status was positively associated with risk of falls. Conclusion Both multivariable logistic analysis and propensity score matching analysis revealed that maternal paid employment status was associated with unintentional injuries among Japanese infants. To prevent infant injuries, comprehensive support for working families should be considered.

Author(s): N. J. Scheers [sup.1] , Chauncey Dayton [sup.2] , Mary Batcher [sup.1] , Bradley T. Thach [sup.3] Author Affiliations: (1) BDS Data Analytics, , 5823 Jane Way, 22310, Alexandria, [...], Objective Compare mothers' reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices. Methods A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers' choices. Results Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because "There is no suffocation risk" (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because "I was concerned about suffocation risk." Conclusions for Practice Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers' use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers.

Author(s): Cheng Chen 1, Almut G. Winterstein 1,2,3, Wei-Hsuan Lo-Ciganic 1,2, Patrick J. Tighe 4, Yu-Jung Jenny Wei 1,2,* Introduction Amid the opioid epidemic in the US, the proportion of [...], Background Gabapentinoids are increasingly prescribed to manage chronic noncancer pain (CNCP) in older adults. When used concurrently with opioids, gabapentinoids may potentiate central nervous system (CNS) depression and increase the risks for fall. We aimed to investigate whether concurrent use of gabapentinoids with opioids compared with use of opioids alone is associated with an increased risk of fall-related injury among older adults with CNCP. Methods and findings We conducted a population-based cohort study using a 5% national sample of Medicare beneficiaries in the United States between 2011 and 2018. Study sample consisted of fee-for-service (FFS) beneficiaries aged [greater than or equal to]65 years with CNCP diagnosis who initiated opioids. We identified concurrent users with gabapentinoids and opioids days' supply overlapping for [greater than or equal to]1 day and designated first day of concurrency as the index date. We created 2 cohorts based on whether concurrent users initiated gabapentinoids on the day of opioid initiation (Cohort 1) or after opioid initiation (Cohort 2). Each concurrent user was matched to up to 4 opioid-only users on opioid initiation date and index date using risk set sampling. We followed patients from index date to first fall-related injury event ascertained using a validated claims-based algorithm, treatment discontinuation or switching, death, Medicare disenrollment, hospitalization or nursing home admission, or end of study, whichever occurred first. In each cohort, we used propensity score (PS) weighted Cox models to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of fall-related injury, adjusting for year of the index date, sociodemographics, types of chronic pain, comorbidities, frailty, polypharmacy, healthcare utilization, use of nonopioid medications, and opioid use on and before the index date. We identified 6,733 concurrent users and 27,092 matched opioid-only users in Cohort 1 and 5,709 concurrent users and 22,388 matched opioid-only users in Cohort 2. The incidence rate of fall-related injury was 24.5 per 100 person-years during follow-up (median, 9 days; interquartile range [IQR], 5 to 18 days) in Cohort 1 and was 18.0 per 100 person-years during follow-up (median, 9 days; IQR, 4 to 22 days) in Cohort 2. Concurrent users had similar risk of fall-related injury as opioid-only users in Cohort 1(aHR = 0.97, 95% CI 0.71 to 1.34, p = 0.874), but had higher risk for fall-related injury than opioid-only users in Cohort 2 (aHR = 1.69, 95% CI 1.17 to 2.44, p = 0.005). Limitations of this study included confounding due to unmeasured factors, unavailable information on gabapentinoids' indication, potential misclassification, and limited generalizability beyond older adults insured by Medicare FFS program. Conclusions In this sample of older Medicare beneficiaries with CNCP, initiating gabapentinoids and opioids simultaneously compared with initiating opioids only was not significantly associated with risk for fall-related injury. However, addition of gabapentinoids to an existing opioid regimen was associated with increased risks for fall. Mechanisms for the observed excess risk, whether pharmacological or because of channeling of combination therapy to high-risk patients, require further investigation. Clinicians should consider the risk-benefit of combination therapy when prescribing gabapentinoids concurrently with opioids.

Author(s): Carolyn DiGuiseppi [sup.1] , Susan E. Levy [sup.2] , Katherine R. Sabourin [sup.1] , Gnakub N. Soke [sup.1] [sup.3] , Steven Rosenberg [sup.4] , Li-Ching Lee [sup.5] , Eric [...], This study examined caregiver-reported medically-attended injuries among 30-68 month old children with autism spectrum disorder (ASD) compared to general population (POP) and non-ASD developmental disorders (DD) controls in the Study to Explore Early Development. Injuries were common in ASD cases (32.3%) as well as POP (30.2%) and DD (27.8%) controls; most resulted in an emergency visit or hospitalization. After accounting for sociodemographic, health, IQ and behavior differences, odds of injury in ASD cases were significantly higher than DD controls but similar to POP controls. Attention problems mediated the relationships. Clinicians caring for children with both ASD and attention problems should consider providing targeted safety advice. Differences in injury risk between children with ASD vs. other developmental disorders need further study.

Author(s): Wesley Hayes [sup.1] [sup.2] Author Affiliations: (1) Great Ormond Street Hospital for Children, 0000 0004 0426 7394, grid.424537.3, , London, UK (2) University College London, 0000000121901201, grid.83440.3b, , London, [...], Acute kidney injury (AKI) is common in children admitted to hospital. Whilst some recover normal kidney function following an acute kidney insult, a significant proportion experience long-term sequelae. The aim of this review is to summarize current understanding of the processes that can lead to sequelae following AKI. Kidney injury, repair, recovery and progression are described. Risk factors for progression are outlined, and potential strategies to stratify the risk of progression in children with AKI are discussed. Clinical management priorities to minimize sequelae are suggested. Looking ahead, novel therapeutic targets are discussed with the potential to accelerate adaptive repair and ameliorate the progression and sequelae of AKI in the future.

Among the many organ systems affected by harmful alcohol use, the lungs are particularly susceptible to infections and injury. The mechanisms responsible for rendering people with alcohol use disorder (AUD) [...]

Excessive alcohol consumption is a global healthcare problem. The liver sustains the greatest degree of tissue injury by heavy drinking because it is the primary site of ethanol metabolism. Chronic [...]

Background Ischemic heart disease is the leading cause of cardiovascular death in the US (1). Current revascularization strategies, including percutaneous and surgical interventions, have dramatically improved ischemic heart disease-related mortality. [...], Coronary revascularization is an effective means of treating ischemic heart disease; however, current therapeutic revascularization strategies are limited to large caliber vessels. Because the mammalian heart scars following cardiac injury, recent work showing that cardiac fibroblasts can transdifferentiate into new coronary endothelium raises a new and exciting approach to promoting endogenous revascularization following cardiac injury. In this issue of the JCI, He et al. report on their employment of a battery of lineage-tracing tools to address the developmental origins of fibroblasts that give rise to new endothelial cells. Surprisingly, cardiac fibroblasts did not appear to contribute appreciably to regeneration of cardiac endothelium. Instead, cardiac endothelial cells were likely to proliferate and generate new endothelium following injury. As these conclusions diverge from prior findings, additional work will be required to understand the sources that generate cardiac endothelium in new blood vessels after injury. Clarification of the origins of coronary endothelial cells during cardiac repair is essential for identifying improved approaches to revascularizing damaged myocardium in patients with ischemic heart disease.

INJURIES are major sources of morbidity and mortality (McCaig and Burt, 2001), and many are associated with alcohol use (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2000a). Case-control and [...], Objective: Alcohol is associated with intentional injury, but most studies have operationalized it as alcoholism and have not examined acute exposure. The study aimed to clarify the relative contributions of drinking over a few hours and of alcohol use disorders to the risk of intentional injury inflicted by another person. Method: The study used a case-control design with two control groups: (1) Community controls matched to cases, and (2) the cases themselves, comparing consumption on the day of injury with consumption on previous days, in a case-crossover comparison. Cases were patients with an acute injury presenting to any of the three emergency departments in one county; 102 had an intentional injury. Community controls (N = 1,856) were recruited by random-digit dialing. Recent alcohol consumption was recorded in self-reported standard drinks. Current alcohol use disorders were defined using DSM-IV criteria. Results: In the case-control analysis, drinking in a 6-hour window was associated with risk of intentional injury (odds ratio [OR] = 10, 95% confidence interval [CI]: 4.7-22). In case-crossover comparison of the cases' own drinking in the 6 hours prior to injury with their own drinking the day before, the OR was 34 (95% CI: 4.7-250). In case-control analyses, alcohol dependence was associated with intentional injury (OR = 6.0, 95% CI: 3.5-10), but alcohol abuse was not (OR = 0.7, 95% CI: 0.4-1.3). Conclusions: Drinking over a few hours is strongly associated with intentional injury. Current alcohol dependence is also, but with a lower OR. The findings may have implications for efforts to prevent intentional injury. (J Stud. Alcohol 64: 350-357, 2003)

ABBREVIATIONS. BCC, behavioral change counseling; ED, emergency department; CI, confidence interval. Injuries are the leading cause of death and disability among adolescents and young adults in the developed world. (1,2) [...], Objective. To determine whether a brief session of behavior change counseling (BCC), offered to injured adolescents in the emergency department (ED) as a therapeutic intervention, could be used to change injury-related risk behaviors and the risk of reinjury. Study Design. A randomized, controlled trial. Participants. Adolescents between 12 and 20 years old who were undergoing treatment for an injury in the ED and who were cognitively able to participate in the intervention. Setting. An urban ED at a level 1 pediatric trauma center. Intervention. Study participants completed a baseline risk behavior prevalence assessment. Participants were then randomly assigned to receive BCC or routine ED care. Those in the treatment group underwent a brief session of BCC with a study social worker focused on changing an identified injury-related risk behavior (seatbelt use, bicycle helmet use, driving after drinking, riding with an impaired driver, binge drinking, or carrying a weapon). Participants were recontacted 3 months and 6 months after enrollment to assess the prevalence of positive behavior change and the interim occurrence of medically treated injuries. Results. We enrolled 631 participants (78% of those eligible) and obtained follow-up for 76% at 3 months and 75% at 6 months. The relative risk of a positive behavior change with respect to seatbelt use was 1.34 (95% confidence interval [CI]: 1.00, 1.79) at 3 months, favoring the intervention group. The relative risk for the same outcome was 1.47 (95% CI: 1.09, 1.96) at 6 months. A positive change in bicycle helmet use was 1.81 (95% CI: 1.02, 3.18) times more likely at 3 months and 2.00 (95% CI: 1.00, 4.00) times more likely at 6 months in the intervention group. There was no effect of the intervention on changes in other target behaviors. Over the 6-month follow-up period, the risk of reinjury requiring medical attention did not differ between treatment groups. Conclusions. Brief BCC can be delivered to adolescents undergoing treatment for injury in the ED and can be used to address injury-related risk behaviors. The intervention was associated with a greater likelihood of positive behavior change in seatbelt and bicycle helmet use. This effect lasted over 6 months of follow-up. BCC was not associated with changes in other risk behaviors and could not be shown to significantly reduce the risk of reinjury.