Opt-out of Stop Smoking Service referral via SMS: a controlled interrupted time series analysis.

Septoplasty opioid prescription trends following the publication of opioid prescribing clinical practice guidelines.

The short-term impacts of the decriminalization of illegal drug possession on clients dispensed opioid agonist treatment medications and visits to supervised consumption services and overdose prevention services in British Columbia, Canada (2015-2023).

Association of respiratory diseases with humidifier disinfectants exposure and its latency: A study of health damage reporter cohort in South Korea.

Breaking barriers: evaluating access models for harm reduction vending machines.

Impact of timing in prospective audit and feedback on broad-spectrum antibiotic use: a comparison between third-day and seventh-day interventions.

Consumption and expenditure on fidaxomicin and oral vancomycin for Clostridioides difficile infection: A 12-year longitudinal study of 43 countries and regions.

Monitoring prescription medication utilization can serve as a powerful indicator of health system resilience and vulnerabilities during public health emergencies. By examining shifts in medication fills, policymakers and stakeholders can identify both strengths and weaknesses in access to care for vulnerable populations. To evaluate health system responses during the COVID-19 pandemic and inform future preparedness strategies during public health crises using trends in prescription medication utilization. Using data from the Colorado All Payer Claims Database (CO APCD), we conducted an interrupted time-series analysis of monthly prescription fills among insured adults from January 2019 to December 2021. Therapeutic categories included opioids, psychotropics, antibiotics, antivirals, cardiometabolic drugs, and oncology medications. Interventional autoregressive integrated moving average models assessed immediate and trend-level changes in utilization following the pandemic onset in March 2020. We separately evaluated prescriptions dispensed by retail pharmacies, including mail order, and physician-administered medications, highlighting differences in how each modality adapted to system-level disruptions. The pandemic led to an immediate decrease in prescription fills, with 3.3 fewer fills per 100 insured adults (95% CI = -0.049 to -0.016; P < 0.001). Retail pharmacy prescriptions rebounded over time, supported by telehealth and mail-order options, whereas physician-administered therapies faced sustained declines. Specific therapeutic classes showed varied responses. Opioid prescriptions decreased by 0.4 fills per 100 adults (95% CI = -0.0058 to -0.0026; P < 0.001), whereas psychotropic medication use increased by 0.8 fills per 100 insured adults (95% CI = 0.0037-0.0123; P < 0.001). Antibiotic and antiviral prescriptions declined significantly. Cardiometabolic and oncology medication utilization remained stable throughout the study period. The rebound in retail pharmacy prescriptions during the COVID-19 pandemic highlights the role of telehealth and mail-order services in mitigating care disruptions. However, the persistent declines in physician-administered therapies reveal structural vulnerabilities, particularly for populations requiring complex or injectable treatments. Policymakers should build on strengths such as telehealth expansion and existing successful overprescribing management programs for opioids and antibiotics and should also address gaps in access to safe in-person care, particularly for vulnerable populations. Emergency preparedness measures should also prioritize promoting mental health support to ensure comprehensive resilience in future public health crises. By incorporating prescription utilization surveillance into routine health system monitoring, stakeholders can respond proactively to emerging challenges and promote more equitable access to essential therapies during public health emergencies.

Local Cannabis Policy and Cannabis Use by California High School Students Before and After Statewide Retail Legalization.

The deep inferior epigastric perforator (DIEP) flap is a favored option for autologous breast reconstruction. However, complications related to insufficient perfusion, such as flap loss and fat necrosis, remain significant concerns. SPY Elite Fluorescence Imaging enables real-time tissue perfusion assessment during surgery, potentially reducing complications through superior visualization compared with clinical assessment alone. This study evaluates surgical outcomes and healthcare utilization patterns before and after the implementation of SPY imaging for DIEP flap breast reconstruction. This retrospective study examined 271 breast cancer patients undergoing DIEP flap reconstruction at Rigshospitalet, Copenhagen (November 2016-June 2024), with 164 in the SPY group and 107 in the non-SPY group. Outcomes included flap complications and frequency of postoperative visits. The interrupted time series revealed a significant decrease in complications over time (β = -0.110, p < 0.001) with SPY implementation. Overall rate of flap complications saw a relative risk reduction of 21.3%, explained by a reduction in rates of flap infection, flap loss, and seroma. Healthcare utilization decreased across all categories: hospital visits (-21.6%), doctor visits (-17.4%), and nurse visits (-23.6%). The number needed to treat to prevent one complication was 6.0. SPY imaging implementation was associated with significant reductions in flap complications and healthcare utilization. While our interrupted time series design strengthens causal inference by accounting for temporal trends and learning curves, the observational nature precludes definitive causal claims. The technology shows potential clinical and economic value. Prospective studies are needed to validate these findings and establish standardized protocols for optimal application.

ABSTRACT There is limited information on the association between burden of pneumococcal disease and vaccination. This study aimed to assess pneumococcal disease burden among adults in Hong Kong by estimating incidence rate (IR), case fatality rate (CFR), healthcare resource utilization and costs before and after the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into Hong Kong’s childhood immunization program (CIP) in 2011. Adults ≥18 years hospitalized with invasive pneumococcal disease (IPD) and pneumonia from 2005 to 2019 were identified from the Clinical Data Analysis and Reporting System (CDARS). Interrupted time series analysis (ITSA) was performed and incidence rate ratio (IRR) was computed to compare baseline and trend of IRs between pre-introduction (2005–2010) and post-introduction (2012–2019) of PCV13. Overall IPD and pneumonia IRs were 0.78 and 5.34 episodes per 100,000 person-years, respectively. ITSA showed no changes in baseline IPD IR (IRR = 0.82; P value = .447) and trend of IR (IRR = 0.98; P value = .112). There was no difference in baseline pneumonia IR (IRR = 0.81; P value = .075), but a marginal (small but statistically significant) reduction in trend was observed in the post-PCV13 period (IRR = 0.98; P value = .019). CFR was 24.12% for IPD and higher at 30.06% for pneumonia. The average total costs per pneumonia episode were higher in the post-PCV13 period (2,975 vs. 2,810 Hong Kong Dollar). IPD and pneumonia incidence fluctuated over the study period. After PCV13 introduction into Hong Kong’s CIP, there was only a marginal reduction in trend of pneumonia among adults. CFRs of IPD and pneumonia were high, and disease burden remained substantial.

ABSTRACT Background People with disabilities (PWD) face persistent barriers to healthcare, often exacerbated during public health emergencies. In Indonesia, 10.8% of adults with disabilities have chronic disease, yet how the National Health Insurance (JKN) addresses disparities remains unclear. Objective To assess the COVID-19 pandemic’s impact on disability-based disparities in chronic healthcare utilization under JKN, and whether these were modified by gender or geographic disadvantage. Methods A panel-based interrupted time series analysis using generalized estimating equations was conducted on the JKN sample dataset (1% of national enrollees). The sample included 108,762 adults aged 19–65 with chronic conditions, with monthly primary care records from September 2019 to August 2020. Outcomes were preventive and curative visits, modeled by disability status, gender, and residence district. Results The sample averaged 48.3 years, 61.2% were women, 15.5% had a disability, and 1.2% lived in underdeveloped districts. Preventive visits declined 25.6% and curative visits 40.5% in the first two months of the pandemic. PWD had higher curative care use (IRR = 1.05; 95% CI: 1.02–1.07), but women with disabilities had fewer curative visits than men with disabilities (IRR = 0.92; 95% CI: 0.86–0.98). Residence in underdeveloped districts reduced preventive (IRR = 0.34; 95% CI: 0.19–0.60) and curative (IRR = 0.83; 95% CI: 0.70–0.99) visits. Conclusions The pandemic worsened disparities. Gender compounded disability-related inequities in curative use, while geographic disadvantage limited access for all. Future research should examine longer-term trends. Integrating disability- and gender-inclusivetuy approaches is essential for equitable UHC during and beyond crises.

Currently, the world has entered the post-COVID-19 era. Since January 8, 2023, China has implemented the "Class B infectious disease Class B management" policy, which is a major shift in China's epidemic prevention and control measures. It is imperative to assess whether the policy will have an impact on the spread of other notifiable infectious diseases in China. The "Class B infectious disease Class B management" policy is regarded as an intervention. We extracted monthly data on cases and deaths of the 39 notifiable infectious diseases (nine diseases are transmitted through contact, twelve through air, seven through water and food, seven through insect, and four through blood and sex) between December 2019 and May 2024 from the National Disease Control and Prevention Administration of the People's Republic of China. Based on an interrupted time series design, we applied quasi-Poisson regression models to examine the immediate and sustained effects of the intervention on the number of cases and deaths of the 39 notifiable infectious diseases in China. During the intervention period from January 2023 to May 2024, the total number of cases and deaths of the 39 notifiable infectious diseases increased by 230.69% and 14.20% respectively compared to the same period had no intervention been implemented. Surprisingly, the number of dengue fever cases increased tremendously by 12,495.57%, while the number of cases of brucellosis and the number of deaths from tuberculosis and infectious diarrhea decreased rather than increased. We found a significant immediate increase in the total number of cases and deaths of the 39 notifiable infectious diseases and the number of cases of airborne and insect-borne infectious diseases at the beginning of the policy. In the long run, the policy had a significant positive sustained effect on the number of cases of blood-borne and sexual infectious diseases and a significant negative sustained effect on the number of deaths from tuberculosis. If China or other regions relax their prevention and control measures against coronavirus infectious diseases similar to SARS in the future, health authorities should, on the one hand, remain vigilant immediately to prevent a sudden increase in the number of cases of airborne and insect-borne infectious diseases, and on the other hand, maintain long term close monitoring of the trend of cases of blood-borne and sexual infectious diseases. This is crucial for the sustainable control of notifiable infectious diseases and the maintenance of social stability. Furthermore, when evaluating the effectiveness of policies (interventions) in the future, it is recommended to adopt an interrupted time series design.

In southern Brazil, dengue transmission in the state of Paraná has shown a significant increase in the number of cases since the first recorded occurrence in 1995, with more frequent outbreaks in the west, northwest, and north of the state. We evaluated the impact of a campaign of dengue vaccination administered to a fraction of the population in 30 municipalities in the state by conducting a 15-year interrupted time-series ecological study using data obtained from an official Brazilian data register. We modeled dengue incidence using Poisson regression adjusted by covariates (demographic, climate, and epidemiological factors), allowing for specific temporal variation for each site. A reduction of 18.7% in dengue incidence rate was estimated for a vaccination coverage of 100%. Although there was an increase in the crude dengue incidence rate, considering the three-dose coverage achieved in the municipalities, we estimated an 8.2% relative reduction in the incidence rate. This reduction would increase to 17% with a hypothetical coverage of 90%. The campaign was more effective in small municipalities since they had higher vaccination coverage. These findings underscore the significant impact of the vaccination campaign on reducing dengue incidence trends across the targeted municipalities.

Tobacco taxation is a proven strategy to reduce cigarette consumption, but its impact may be reduced by industry pricing tactics. Relatively few studies have examined the extent to which tobacco industry pricing strategies attenuate the impact of taxes on cigarette demand. This study compared the impacts of the 2018 and 2023 tobacco taxes in Singapore, focusing on changes in cigarette demand and industry pricing responses. We analysed brand-level recommended retail pricing (RRP) and monthly sales volume data from 2016 to 2023. We grouped brands into five price tiers, using weighted averages to assess changes in RRP and interrupted time series analyses to assess changes in cigarette demand and calculated price elasticity of demand (PED) before and after each tax increase. The 10% tax increase in 2018 raised average RRP by 4.6% and reduced cigarette demand by 4.0% (PED=-0.22). The 15% tax increase in 2023 raised average RRP by 13.8% and reduced demand by 7.5% (PED=-0.86). In 2018, tobacco companies used price smoothing and undershifting to protect cheaper brands, whereas in 2023, price increases were more uniform across all price tiers. Singapore's 2023 tobacco tax increase was predictably more impactful than the 2018 increase, both in terms of price change and demand reduction. Industry pricing tactics blunted the effect of the 2018 tax but were less protective in 2023. Repeated, substantial tax increases, coupled with regulatory oversight of pricing practices, are important to maximise public health impacts.

Impact of drink-driving penalty enhancement policies on road traffic injury deaths among vulnerable road users in Shandong Province: an interrupted time series study.

SYSTEMATIC REVIEWS OF QUASI-EXPERIMENTAL STUDIES: CHALLENGES AND CONSIDERATIONS.

Falls are a leading cause of injury and death in older adults (age ≥ 65 years). The onset of the COVID-19 pandemic in the United States (US) marked a transition into a period of greater social isolation to curb the spread of disease. The pandemic additionally greatly strained the US healthcare system. As a result, older adults participated in less physical activity and experienced greater hesitancy to seek medical care in an effort to minimize their risk of infection. They additionally may have experienced delays and incomplete access to such care. It is possible that such changes worsened frailty and increased vulnerability to falls and fall-related sequelae among this population. We hypothesized that the COVID-19 pandemic led to an increase in fall-related fatalities generally and an increase in fall-related fatalities that occurred in the home. We conducted an interrupted time series analysis using a regression model on monthly fall fatalities among older adults from January 2015 through December 2020. Fall fatality data were extracted from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), along with the estimated annual population of US residents aged ≥ 65. The COVID-19 pandemic, defined as starting in the US in March 2020, was the interruption variable. There were 192,586 fall fatalities among older adults in the study period, with a mean of 2614 deaths per month ( = 228.4) pre-pandemic, and 3051 deaths per month ( = 215.1) post-pandemic onset. There was no statistically significant change in the incidence of all fall-related fatalities following pandemic onset. However, there was a 25% increase in incidence of fall-related fatalities that occurred within fall victims' homes, specifically (IRR = 1.25, 95% CI 1.14, 1.36). There was a significant increase in fall-related fatalities within homes among older adults in the US after the onset of the COVID-19 pandemic. During pandemic type situations and times of social distancing, increased social supports and resources must be maintained for older adults to reduce the incidence of falls within the home and fall-related injuries.

Assessing the Effect of the COVID-19 Pandemic on Abortion Care Utilization and Delays and Whether There Was a Differential Impact Among Latinas in North Carolina.

Many older adults living in a seniors' residence (SR), especially those living with dementia, will have to be relocated in long-term care (LTC) despite the negative impact of these care transitions on physical and psychological well-being. Using a living lab methodology and focus group methods, a care approach was co-developed in collaboration with a SR and public home care services, to promote aging-in-place and delay relocations in LTC. Outcomes were assessed using Interrupted Time Series Analysis. Integrating best practices like staff training, care reorganization, personalized care based on the residents' life stories, and stronger collaborations with the home care services, this approach allowed older adults with higher assistance needs to remain within their home. Relocations to LTC were delayed by approximately 3months. Ultimately, aging-in-place was found to be relevant in providing evolving care to older adults living in a SR, though further studies are needed to document its financial impact.