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Abstract Background The primary strategy for achieving the second goal of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is morbidity management and disability prevention (MMDP), aimed at alleviating the suffering of affected populations. A significant challenge in many LF-endemic areas is the effective registration and identification of individuals with LF, which is crucial for planning and ensuring access to MMDP services. This study seeks to map the geographical distribution of LF-related morbidities across 24 endemic districts in Ethiopia. Methods A community-based cross-sectional study was conducted to identify individuals affected by LF in 24 endemic districts using primary health care units (PHCUs). The study involved 946 trained health extension workers (HEWs) conducting house-to-house visits to identify and register cases of lymphedema and hydrocele, with support from 77 trained supervisors and 87 team leaders coordinating the morbidity mapping. Certified surgeons performed confirmatory evaluations through clinical assessments on a randomly selected sample of cases to validate HEW diagnoses, ensuring accurate identification of lymphedema and hydrocele. Statistical analysis of the data, including the severity of lymphedema and acute attacks, was conducted using STATA 17. Results This study involved 300,000 households with nearly 1.2 million individuals, leading to the identification of 15,527 LF cases—14,946 (96.3%) with limb lymphedema and 581 (3.7%) with hydrocele. Among those with lymphedema, 8396 (54.1%) were women. Additionally, 13,731 (88.4%) patients resided in rural areas. Of the 14,591 cases whose acute attack information was recorded, 10,710 (73.4%) reported experiencing at least one acute attack related to their lymphedema in the past 6 months, with a notable percentage of males (74.5%; n = 4981/6686). Among the 12,680 recorded cases of leg lymphedema, the percentage of acute attacks increased with severity: 64% (n = 5618) mild cases, 68% (n = 5169) moderate cases and 70% (n = 1893) severe cases. Conclusion This study successfully mapped the geographical distribution of LF morbidities across 24 LF-endemic districts in Ethiopia, identifying a substantial number of lymphedema and hydrocele cases, particularly in rural areas where healthcare access is limited. The findings underscore the potential of Ethiopia’s health extension program to identify affected individuals and ensure they receive necessary care. The findings inform targeted interventions and access to MMDP services, contributing to Ethiopia’s goal of eliminating LF by 2027.

Abstract Background Heart failure is a rare manifestation of metastatic disease of the carcinoma of an unknown primary, malignancy that requires extensive work-up to identify the primary site. Initial consideration of rare etiologies in patients presented with a common clinical syndrome is challenging. Case presentation A 35-year-old Black woman presented with shortness of breath at rest, orthopnea, paroxysmal nocturnal dyspnea, chest pain, a blood-tinged productive cough, and fever for 2 weeks. She also had progressive body swelling, easy fatigability, loss of appetite, and abdominal pain during the same week’s duration. Body imaging revealed large pleural and pericardial effusions, metastatic liver lesions, and bilateral pulmonary vascular segmental and subsegmental filling defects. Pericardial and pleural fluid cytology suggest malignant effusion. Liver lesions and core needle biopsy indicated adenocarcinoma of unknown origin, and the carcinoembryonic antigen level also increased significantly. Conclusion Carcinoma of unknown primary origin commonly presents in an advanced stage and is often accompanied by clinical features of site metastasis. This case highlights heart failure as an unusual first manifestation of adenocarcinoma with an unknown primary origin.

Abstract Faba bean is one of the most important grown plants worldwide for human and animal. Despite its various importance, the productivity of faba bean has been constrained by several biotic and abiotic factors. Many faba bean pathogens have been reported so far, of which the most important yield limiting disease is Chocolate Spot Disease (Botrytis fabae). The dynamics of disease transmission and decision-making processes for intervention programs for disease control are now better understood through the use of mathematical modeling. In this paper a deterministic mathematical model for Chocolate Spot disease (CSD) on faba bean plant with an optimal control model was developed and analyzed to examine the best strategy in controlling CSD. The optimal control model is developed with three control interventions, namely prevention ( $$u_{1}$$ u 1 ), quarantine ( $$u_{2}$$ u 2 ) and chemical control ( $$u_{3}$$ u 3 ). The Pontryagin’€™s maximum principle isused to derive the Hamiltonian, the adjoint variables, the characterization of the controls and the optimality system. A cost-effective approach is chosen from a set of possible integrated strategies using the incremental cost-effectiveness ratio (ICER). The forward-backward sweep iterative approach is used to run numerical simulations. We obtained the Hamiltonian, the adjoint variables, the characterization of the controls and the optimality system. The numerical results demonstrate that each integrated strategy can reduce the diseases within the specified period. However due to limited resources, an integrated strategy prevention and uprooting was found to be a best cost-effective strategy to combat CSD. Therefore, attention should be given for the integrated cost-effective and environmentally eco-friendly strategy by stake holders and policy makers to control CSD and disseminate the integrated intervention to the farmers in order to fight the spread of CSD in the Faba bean population and produce the expected yield from the field.

In this work, a compartmental model for the coinfection of bacterial meningitis and Hepatitis B was formulated and analyzed. The most sensitive parameters were identified, including the contact rates for Hepatitis B virus (HBV) and bacterial meningitis, the progression rate of bacterial meningitis, and the recruitment rate. Based on the results of the sensitivity analysis, the system was extended into an optimal control model by incorporating four intervention strategies: bacterial meningitis prevention, Hepatitis B vaccination for susceptible individuals, and treatments for individuals infected with bacterial meningitis, those with chronic Hepatitis B, and those who are coinfected. The controls are characterized using Pontryagin’s maximum principle. The optimality system is simulated using the forward–backward sweep Runge–Kutta scheme. Subsequently, the incremental cost-effectiveness ratio (ICER) analysis method is applied to determine the most cost-effective strategy. The results indicate that combining bacterial meningitis prevention efforts with Hepatitis B vaccination represents the most cost-effective intervention.

Peste des Petits Ruminants (PPR) is a highly contagious transboundary viral disease of small ruminants with significant economic implications caused by the Peste des Petits Ruminants virus. This study employs mathematical modeling to investigate the impact of imperfect PPR vaccines and restocked small ruminants on the transmission dynamics of PPR. A deterministic mathematical model is developed by incorporating vaccinated and restocked subpopulations into the classical SEIR model. The influence of infected animals introduced through restocking on vaccination efficacy in preventing PPR spread is examined. The global dynamics of equilibrium points in the model are analyzed using the Lyapunov-LaSalle invariance principle. Parameter values for numerical simulations are estimated based on monthly PPR data from the Amhara regional state in Ethiopia, obtained from the Ministry of Agriculture. The basic reproduction number (Rv) is calculated to assess the level of PPR in the small ruminant population, and sensitivity analysis of parameters is performed on Rv. The analytical and numerical results reveal that infected restocked small ruminants significantly facilitate the spread of PPR in the population. Moreover, even with high efficacy vaccination, the system exhibits a unique asymptotically stable endemic equilibrium. These findings emphasize that appropriate vaccination alone is insufficient to control and eradicate PPR in the region. Implementing strict movement restrictions and biosecurity measures are necessary. These findings provide valuable insights for national policymakers in achieving the regional and national targets for PPR eradication by 2027.

Organic-based pollutants are extensively released from various industries and they potentially harm the environment and human health. Photocatalysis is regarded as one of the most promising techniques for removal of organic contaminants from wastewater. Therefore, in this study, iron oxide-based nanocomposites were synthesized by an emerging green and sustainable method using Ethiopian endemic plant extract, Echinops kebericho M. as a capping and stabilizing agent. The phytoextract-assisted synthesized nanoparticles (NPs) α-Fe2O3 and nanocomposites (NCs) α-Fe2O3/MgO calcinated at a temperature of 400°C were characterized and used for their photocatalytic activities toward gentian violet (GV) dye degradation using ultraviolet–visible spectroscopy (UV-vis) at optimized catalyst dose, initial GV concentration, pH, and time conditions. The X-ray diffraction (XRD) analysis result revealed that the mean crystal size of α-Fe2O3 and α-Fe2O3/MgO is 11.2 and 15.4 nm, respectively. Characterization results of scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM-EDS), transmission electron microscopy (TEM), high-resolution transmission electron microscopy (HRTEM), and X-ray photoelectron spectroscopy (XPS) clearly showed the successful deposition of MgO on α-Fe2O3. The maximum degradation of GV, 96.2%, was observed by using α-Fe2O3/MgO after 60 min under visible light irradiation. Thus, synthesized NCs were shown to have better GV degradation efficiency in a shorter time as compared to the previously reported nanomaterials. The results revealed photocatalytic degradation using endemic plant extract-assisted synthesized NCs, α-Fe2O3/MgO, is considered a greener, simple, and more efficient method for the removal of organic dyes.

In this study, we developed an optimal control deterministic model for the dynamics of bacterial meningitis disease. The objective was to investigate the efficiency and cost-effectiveness of the three controls (prevention, treatment, and screening) in curtailing the spread of bacterial meningitis. To accomplish this, we applied Pontryagin's maximum principle to derive the optimality system. We examined different combination strategies to investigate the effect of the interventions on the spread of bacterial meningitis. We used an incremental cost-effectiveness ratio (ICER) to examine which control technique was the most successful. The simulation results show that combining prevention and screening is the most cost-effective strategy. The objective function and the incremental cost-effectiveness ratio further support this result, indicating that maximum utilization of prevention and screening is required for the entire period.

A deterministic model with an optimal control framework is formulated to analyse the cost-effectiveness of intervention measures used to control Fasciola hepatica in cattle populations. Using the Volterra-Lyapunov stability method, it is noted that the model is globally stable at the endemic equilibrium point. The Pontryagin maximum principle has been applied to determine optimal disease control conditions, including strategies such as pasture management, treatment of infected cattle, and molluscicide use. Numerical simulations for the optimum problem show that double and triple controls have significant effects on reducing disease transmission. The results indicate that for optimal impact, the molluscicide control parameter should always be at its highest possible value. The incremental cost-effectiveness ratio (ICER) analysis of strategies to reduce the disease shows that pasture management combined with molluscicide use will be the most effective and least expensive option. The molluscicide intervention rate should always be at its maximum value for better control of the disease. Educational programs for proper pasture management conditions and sufficient use of molluscicides can significantly reduce the spread of Fasciola hepatica among cattle and humans.

Cholera is a disease of poverty affecting people with inadequate access to safe water and basic sanitation. Conflict, unplanned urbanization and climate change all increase the risk of cholera. In this article, an optimal control deterministic mathematical model of cholera disease with cost-effectiveness analysis is developed and analyzed considering both direct and indirect contact transmission pathways. The model qualitative behaviors, such as the invariant region, the existence of a positive invariant solution, the two equilibrium points (disease-free and endemic equilibrium), and their stabilities (local as well as global stability) of the model are studied. Moreover, the basic reproduction number of the model is obtained. We also performed sensitivity analysis of the basic parameters of the model. Then an optimal control problem is designed with a control functional having five controls: vaccination, treatment, environment sanitation and personal hygiene, and water quality improvement program. We examined the existence and uniqueness of the optimal controls of the system. Through the implementation of Pontryagin's maximum principle, the characterization of the optimal controls optimality system is established. The numerical simulation results the integrated control strategies demonstrated that strategy 2, 7, and 12 are effective programs to combat cholera disease from the community. Based on the local circumstances, available funds, and resources, it is recommended to the government stakeholders and policymakers to execute any one of the three integrated intervention programs.

We report 4 cases of human African trypanosomiasis that occurred in Ethiopia in 2022, thirty years after the last previously reported case in the country. Two of 4 patients died before medicine became available. We identified the infecting parasite as Trypanosoma brucei rhodesiense. Those cases imply human African trypanosomiasis has reemerged.

In this paper, a mathematical model for the transmission dynamics of Fasciola hepatica in cattle and snail populations is formulated and analyzed. The snail mortality rate (μs) is the most important factor that indirectly impacts the basic reproduction number (R0). A 50% change, either an increase or decrease, in the snail mortality rate will result in an approximate 50% change in the opposite direction in the value of R0. The model shows a forward bifurcation at R0=1, indicating that the disease dynamics undergo a critical transition at this threshold. This change signifies a transition from a disease-free state to a persistent infection, highlighting the possibility of a continuous disease presence given specific epidemiological conditions. Simulations show that reducing miracidia, metacercariae, and snail populations, improving treatment, and lowering pathogen transfer between cattle and snails significantly decrease disease prevalence in cattle. To control the disease, transmission rates for cattle and snails must be reduced below γc=1.4338×10−7 and γs=1.1473×10−8, respectively. Current treatments are insufficient, and a combination of improved treatments reduced transmission rates, and increased snail mortality is recommended for better disease control.

Abstract Hepatitis B is one of the world’s most common and severe infectious diseases. Worldwide, over 350 million people are currently estimated to be persistent carriers of the hepatitis B virus (HBV), with the death of 1 million people from the chronic stage of HBV infection. In this work, developed a nonlinear mathematical model for the transmission dynamics of HBV. We constructed the mathematical model by considering vaccination, treatment, migration, and screening effects. We calculated both disease-free and endemic equilibrium points for our model. Using the next-generation matrix, an effective reproduction number for the model is calculated. We also proved the asymptotic stability of both local and global asymptotically stability of disease-free and endemic equilibrium points. By calculating the sensitivity indices, the most sensitive parameters that are most likely to affect the disease’s endemicity are identified. From the findings of this work, we recommend vaccination of the entire population and screening all the exposed and migrants. Additionally, early treatment of both the exposed class after screening and the chronically infected class is vital to decreasing the transmission of HBV in the community.

In this investigation, we developed a deterministic SCHRS mathematical model of corruption transmission dynamics and its extended stochastic model after incorporating stochastic factors and Brownian motion. We presented both model analyses in their respective order. The positivity, invariant region, corruption-free equilibrium point, basic reproduction numbers, both local and global stabilities of corruption-free equilibrium, and endemic equilibrium with their stabilities were discussed. The basic reproduction numbers of both deterministic and stochastic approaches are obtained using the next-generation matrix method and twice Itô’s differentiable formula. Sensitivity analyses of the impact of relevant parameters are performed. Furthermore, the outcomes of numerical simulations were presented by comparing the deterministic and stochastic approaches to the model's relevant parameters. We observed that as the rate at which the corrupted population interacts with the susceptible population increases, so does the number of corrupted individuals in the community. Moreover, when individuals recover more through education or punishment, the number of corrupted individuals decreases.

Measles is one of the top communicable diseases, which is still responsible for 2.6 million deaths every year. Due to this reason, the paper focuses on measles transmission dynamics concerning the impact of indirect contact rate (transmitted from the host of the virus to the healthy individual) and improving the SEVIR model into the SVIRP model. From the model, we first estimated the disease-free equilibrium, calculated the effective reproduction number REff, and established the stability analysis. The Castillo–Chavez stability criterion is used to demonstrate the global stability of the disease-free equilibrium point, while the linearization method is used to justify its local stability analysis and gives a result REff 1. To identify the effect of parameters on the transmission dynamics, we performed sensitivity index and numerical simulation. From the result, we obtained that the indirect contact rate has the highest impact in maximizing the transmission dynamics of measles. Also, we found that working on prevention and treatment strategies brings a significant contribution in reducing the disease effect in the community.

Abstract HIV patients are vulnerable to developing active visceral leishmaniasis (VL). To understand this complication, we studied a mathematical model for HIV and visceral leishmaniasis coinfection. In this approach, we reckoned two distinct equilibria: the disease-free and the endemic equilibria. The local and global stability of the disease-free equilibrium were thoroughly investigated. To further support the qualitative findings, we performed simulations to quantify the changes of the dynamical behavior of the full model for variation of relevant parameters. Increasing the rate of VL recovery ( ϕ 1 $\phi _{1}$ ), the recovery rate for VL–HIV Co-infection ( ϕ 2 $\phi _{2}$ ), removing reservoirs ( c 1 $c_{1}$ ), minimizing the contact rate ( β h $\beta _{h}$ ) are important in controlling the transmission of individual and co-infection disease of VL and HIV. In conclusion, possible measures should be implemented to reduce the number of infected individuals. Therefore, we recommend that policy makers and stakeholders incorporate these measures during planing and implementation phases to control the transmission of VL–HIV co-infection.

In this paper, we develop and examine a mathematical model of human melioidosis transmission with asymptomatic cases to describe the dynamics of the epidemic. The basic reproduction number (R0) of the model is obtained. Disease-free equilibrium of the model is proven to be globally asymptotically stable when R0 is less than the unity, while the endemic equilibrium of the model is shown to be locally asymptotically stable if R0 is greater than unity. Sensitivity analysis is performed to illustrate the effect of the model parameters influencing on the disease dynamics. Furthermore, numerical experiments of the model are conducted to validate the theoretical findings.

In this paper we formulated and analyzed an optimal deterministic eco-epidemiological model for the dynamics of maize streak virus (MSV) and examine the best strategy to fight maize population from maize streak disease (MSD). The optimal control model is developed with three control interventions, namely prevention (u1), quarantine (u2) and chemical control (u3). To achieve an optimal control strategy, we used the Pontryagin’s maximum principle obtain the Hamiltonian, the adjoint variables, the characterization of the controls and the optimality system. Numerical simulations are performed using Forward-backward sweep iterative method. The findings show that each integrated strategy is able to mitigate the disease in the specified time. However due to limited resources, it is important to find a cost-effective strategy. Using Incremental Cost-Effectiveness Ratio(ICER) a cost-effectiveness analysis is investigated and determined that the combination of prevention and quarantine is the best cost-effective strategy from the other integrated strategies. Therefore, policymakers and stakeholders should apply the integrated intervention to stop the spread of MSV in the maize population.

In this paper, we developed a deterministic mathematical model of social media addiction (SMA) with an optimal control strategy. Major qualitative analysis like the social media addiction free equilibrium point (E0), endemic equilibrium point (E∗), basic reproduction number (R0), were computed. From the stability analysis, we found that the social media addiction free equilibrium point (SMAFEP) is locally asymptotically stable if R01 the unique endemic equilibruim is locally assymptotically stable. Also using Center Manifold theorem, the model exhabits a forward bifurcation at R0=1. The sensitivity of model parameters is done using the normalized forward sensitivity index definition. Secondly, we introduced two time dependent controls on the basic model and formulated an optimal control model. Then, we used the Pontryagin’s maximum principle to find the optimal system of the model. Numerical simulations, on the optimal control problem using the fourth-order Range-Kutta forward-backward sweep method, on the suggested strategies for SMA is performed. We found that to effectively control SMA at a specified period of time, stakeholders and policymakers must apply the integrated control strategies C.

In the present paper, we formulate a new mathematical model for the dynamics of moral corruption with comprehensive age-appropriate sexual information and provision of guidance and counselling. The population is subdivided into three (3) different compartments according to their level of information on sexual matters. The model is proved to be both epidemiologically and mathematically well posed. The existence of unique morally corrupt-free and endemic equilibrium points is investigated. The basic reproduction number with respect to morally corrupt-free equilibrium is obtained using next generation matrix approach to monitor the dynamics of corrupt morals and ascertain its level in order to suggest effective intervention strategies to control this problem. The local as well as global asymptotic stability of these equilibrium points is studied. The analysis reveals a globally asymptotically stable morally corrupt-free equilibrium whenever ℛ0≤1 and a globally asymptotically stable endemic equilibrium if otherwise. Further analysis, using center manifold theory, shows that the model exhibits forward bifurcation insinuating that the classical epidemiological requirement of ℛ0≤1 is necessary and sufficient for elimination of moral corruption. A brief discussion on the graphical results using the available numerical procedures is shown. From numerical simulations, it was ascertain that integrated control strategy is the best approach to fight against moral corruption transmission. Lastly, some key parameters that show significance in the moral corruption elimination from the society are also exploited.

The article focuses on the High School Sports-Related Injury Surveillance Study conducted by the Center for Injury Research and Policy Nationwide Children's Hospital in Columbus, Ohio, which examined heat illness among high school athletes in the U.S. for the 2005-2009 period. During the said period, a total of 118 time-loss heat illnesses were reported by the 100 participating schools in the nine sports studied. The study observed that the highest rate of time-loss heat illness was among football players at 4.5% per 100,000 athlete-exposures. Study findings indicate that obesity is a risk factor for heat illness because fat decreases heat loss. INSET: What is already known on this topic?.

In this paper, a nonlinear deterministic model for the dynamics of corruption is proposed and analysed qualitatively using the stability theory of differential equations. The basic reproduction number with respect to the corruption-free equilibrium is obtained using next-generation matrix method. The conditions for local and global asymptotic stability of corruption-free and endemic equilibria are established. From the analysis using center manifold theory, the model exhibits forward bifurcation. Then, the model was extended by reformulating it as an optimal control problem, with the use of two time-dependent controls to assess the impact of corruption on human population, namely, campaigning about corruption through media and advertisement and exposing corrupted individuals to jail and giving punishment. By using Pontryagin’s maximum principle, necessary conditions for the optimal control of the transmission of corruption were derived. From the numerical simulation, it was found that the integrated control strategy must be taken to fight against corruption.

In this paper, an ecoepidemiological deterministic model for the transmission dynamics of maize streak virus (MSV) disease in maize plant is proposed and analysed qualitatively using the stability theory of differential equations.The basic reproduction number with respect to the MSV free equilibrium is obtained using next generation matrix approach. The conditions for local and global asymptotic stability of MSV free and endemic equilibria are established. The model exhibits forward bifurcation and the sensitivity indices of various embedded parameters with respect to the MSV eradication or spreading are determined. Numerical simulation is performed and dispalyed graphically to justify the analytical results.

Hydride fuels have features which could make their use attractive in future advanced power reactors. The potential benefit of use of hydride fuel in HPLWR without introducing significant modification in the current core design concept of the high-performance light water reactor (HPLWR) has been evaluated. Neutronics and thermal hydraulic analyses were performed for a single assembly model of HPLWR with oxide and hydride fuels. The hydride assembly shows higher moderation with softer neutron spectrum and slightly more uniform axial power distribution. It achieves a cycle length of 18 months with sufficient excess reactivity. At Beginning of Cycle the fuel temperature coefficient of the hydride assembly is higher whereas the moderator and void coefficients are lower. The thermal hydraulic results show that the achievable fuel temperature in the hydride assembly is well below the design limits. The potential benefits of the use of hydride fuel in the current design of the HPLWR with the achieved improvements in the core neutronics characteristics are not sufficient to justify the replacement of the oxide fuel. Therefore for a final evaluation of the use of hydride fuels in HPLWR concepts additional studies which include modification of subassembly and core layout designs are required.

Background: Children aged 0-4 years have the highest rate of emergency department (ED) visits for traumatic brain injury (TBI); falls are the leading cause. Infants younger than 2 years are more likely to sustain a fractured skull after a fall., Objective: This study examined caregiver actions and products associated with ED visits for fall-related fractured skulls in infants aged 0-4 months., Methods: Data were analyzed from the 2001-2017 National Electronic Injury Surveillance System-All Injury Program. Case narratives of infants aged 0-4 months who visited an ED for a fall-related skull fracture were examined to code caregiver actions preceding the fall. Product codes determined fall location and product type involved (e.g., flooring, bed, or stairs). All national estimates were weighted., Results: There were more than 27,000 ED visits (weighted estimate) of infants aged 0-4 months for a nonfatal fall-related fractured skull between 2001 and 2017. Most were younger than 2 months (46.7%) and male (54.4%). Falls occurred primarily in the home (69.9%) and required hospitalization (76.4%). Primary caregiver actions coded involved placing (58.6%), dropping (22.7%), and carrying an infant (16.6%). Floor surfaces were the most common product (mentioned in 24.0% of the cases)., Conclusions: Fall-related fractured skulls are a health and developmental concern for infants, highlighting the importance of a comprehensive assessment at the time of the injury to better understand adult actions. Findings indicated the need to develop prevention messages that include safe carrying and placement of infants., Competing Interests: Declaration of competing interest None., (Published by Elsevier Inc.)

Introduction: The U.S. age-adjusted suicide rate is 35% higher than two decades ago and the COVID-19 pandemic era highlighted the urgent need to address nonfatal self-harm, particularly among youth. This study aimed to report the estimated annual economic cost of U.S. suicide and nonfatal self-harm., Methods: In 2023 CDC's WISQARS Cost of Injury provided the retrospective number of suicides and nonfatal self-harm injury emergency department (ED) visits from national surveillance sources by sex and age group, as well as the estimated annual economic cost of associated medical spending, lost work productivity, reduced quality of life from injury morbidity, and avoidable mortality based on the value of statistical life during 2015-2020., Results: The economic cost of suicide and nonfatal self-harm averaged $510 billion (2020 USD) annually, the majority from life years lost to suicide. Working-aged adults (aged 25-64 years) comprised nearly 75% of the average annual economic cost of suicide ($356B of $484B) and children and younger adults (aged 10-44 years) comprised nearly 75% of the average annual economic cost of nonfatal self-harm injuries ($19B of $26B)., Conclusions: Suicide and self-harm have substantial societal costs. Measuring the consequences in terms of comprehensive economic cost can inform investments in suicide prevention strategies., (Published by Elsevier Inc.)

Introduction: Violence is a leading cause of morbidity and mortality among U.S. youth. More information on the health and economic burden of the most frequent assault mechanisms-or, causes (e.g., firearms, cut/pierce)-can support the development and implementation of effective public health strategies. Using nationally representative data sources, this study estimated the annual health and economic burden of U.S. youth violence by injury mechanism., Methods: In 2023, CDC's WISQARS provided the number of homicides and nonfatal assault ED visits by injury mechanism among U.S. youth aged 10-24 years in 2020, as well as the associated average economic costs of medical care, lost work, morbidity-related reduced quality of life, and value of statistical life. The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample provided supplemental nonfatal assault incidence data for comprehensive reporting by injury mechanism., Results: Of the $86B estimated annual economic burden of youth homicide, $78B was caused by firearms, $4B by cut/pierce injuries, and $1B by unspecified causes. Of the $36B billion estimated economic burden of nonfatal youth violence injuries, $19B was caused by struck by/against injuries, $3B by firearm injuries, and $365M by cut/pierce injuries., Conclusions: The lethality of assault injuries affecting youth when a weapon is explicitly or likely involved is high-firearms and cut/pierce injuries combined account for nearly all youth homicides compared to one-tenth of nonfatal assault injury ED visits. There are numerous evidence-based policies, programs, and practices to reduce the number of lives lost or negatively impacted by youth violence., (Published by Elsevier Inc.)

Study Objective: The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States., Methods: We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults., Results: There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups., Conclusion: Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk., (Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Introduction: On March 13, 2020, the U.S. declared COVID-19 to be a national emergency. As communities adopted mitigation strategies, there were potential changes in the trends of injuries treated in emergency department. This study provides national estimates of injury-related emergency department visits in the U.S. before and during the pandemic., Methods: A secondary retrospective cohort study was conducted using trained, on-site hospital coders collecting data for injury-related emergency department cases from medical records from a nationally representative sample of 66 U.S. hospital emergency departments. Injury emergency department visit estimates in the year before the pandemic (January 1, 2019-December 31, 2019) were compared with estimates of the year of pandemic declaration (January 1, 2020-December 31, 2020) for overall nonfatal injury-related emergency department visits, motor vehicle, falls-related, self-harm-, assault-related, and poisoning-related emergency department visits., Results: There was an estimated 1.7 million (25%) decrease in nonfatal injury-related emergency department visits during April through June 2020 compared with those of the same timeframe in 2019. Similar decreases were observed for emergency department visits because of motor vehicle‒related injuries (199,329; 23.3%) and falls-related injuries (497,971; 25.1%). Monthly 2020 estimates remained relatively in line with 2019 estimates for self-harm‒, assault-, and poisoning-related emergency department visits., Conclusions: These findings provide updates for clinical and public health practitioners on the changing profile of injury-related emergency department visits during the COVID-19 pandemic. Understanding the short- and long-term impacts of the pandemic is important to preventing future injuries., (Published by Elsevier Inc.)

Bicycling leads to the highest number of sport and recreation-related emergency department (ED) visits for traumatic brain injuries (TBIs) in the United States (1). Because bicycling continues to grow in popularity,* primarily among U.S. adults, examining the strategies that mitigate the risk for TBI is important. CDC analyzed data from the National Electronic Injury Sursveillance System-All Injury Program (NEISS-AIP) to determine the incidence of EDs for bicycle-related TBIs during 2009-2018. An estimated 596,972 ED visits for bicycle-related TBIs occurred in the United States during the study period. Rates of ED visits were highest among adult males (aged ≥18 years) and among children and adolescents aged 10-14 years during 2009-2018. Overall, the rate of ED visits for bicycle-related TBIs decreased by approximately one half (48.7%) among children and by 5.5% among adults. As the number of persons riding bicycles increases, expansion of comprehensive bicycling safety interventions for bicyclists and drivers by states and local communities, such as interventions to increase driver compliance with traffic laws and helmet use among riders, improvements in bicycling infrastructure, and customized interventions for males and other groups at high risk might help reduce bicycle-related injuries., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: National estimates for nonfatal self-directed violence (SDV) presenting at EDs are calculated from the National Electronic Injury Surveillance System - All Injury Program (NEISS-AIP). In 2005, the Centers for Disease Control and Prevention and Consumer Product Safety Commission added several questions on patient characteristics and event circumstances for all intentional, nonfatal SDV captured in NEISS-AIP. In this study, we evaluated these additional questions along with the parent NEISS-AIP, which together is referred to as NEISS-AIP SDV for study purposes., Methods: We used a mixed methods design to evaluate the NEISS-AIP SDV as a surveillance system through an assessment of key system attributes. We reviewed data entry forms, the coding manual, and training materials to understand how the system functions. To identify strengths and weaknesses, we interviewed multiple key informants. Finally, we analyzed the NEISS-AIP SDV data from 2018-the most recent data year available-to assess data quality by examining the completeness of variables., Results: National estimates of SDV are calculated from NEISS-AIP SDV. Quality control activities suggest more than 99% of the cause and intent variables were coded consistently with the open text field that captures the medical chart narrative. Many SDV variables have open-ended response options, making them difficult to efficiently analyze., Conclusions: NEISS-AIP SDV provides the opportunity to describe systematically collected risk factors and characteristics associated with nonfatal SDV that are not regularly available through other data sources. With some modifications to data fields and yearly analysis of the additional SDV questions, NEISS-AIP SDV can be a valuable tool for informing suicide prevention. Practical Applications: NEISS-AIP may consider updating the SDV questions and responses and analyzing SDV data on a regular basis. Findings from analyses of the SDV data may lead to improvements in ED care., (Published by Elsevier Ltd.)

Introduction: Despite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emotion., Methods: To describe changes over time in TBI incidence by mechanism of injury, injury intent, and age group among AI/ANs, the CDC analyzed hospitalization and death data from the 2008-2014 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the National Vital Statistics System (NVSS), respectively., Results: From 2008-2014, the incidence of TBI-related hospitalizations increased by 32% (1,477 in 2008 to 1,945 in 2014) and resulted in a 21% increase in age-adjusted rates of people hospitalized with TBI. TBI-related deaths increased in number (569 in 2008 to 644 in 2014) and age-adjusted rate (22.7 in 2008 to 25.4 in 2014) by approximately 13% and 12%, respectively. Motor-vehicle crashes were the leading cause of TBI-related deaths among AI/ANs aged 0-54 years. Practical application: Prevention efforts should focus on increasing motor-vehicle safety and advancing prevention strategies for other leading causes of TBI, including: falls, intentional self-harm, and assaults., (Copyright © 2019 National Safety Council and Elsevier Ltd. All rights reserved.)

Introduction: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0-4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group., Method: Data analyzed were from the 2001-2013 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted., Results: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001-2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products., Conclusions: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls., (Copyright © 2019. Published by Elsevier Ltd.)

Pool chemicals are added to water in treated recreational water venues (e.g., pools, hot tubs/spas, and water playgrounds) primarily to protect public health. Pool chemicals inactivate pathogens (e.g., chlorine or bromine), optimize pH (e.g., muriatic acid), and increase water clarity, which helps prevent drowning by enabling detection of distressed swimmers underwater. However, pool chemicals can cause injuries if mishandled. To estimate the annual number of U.S. emergency department (ED) visits for pool chemical injuries, CDC analyzed 2008-2017 data from the National Electronic Injury Surveillance System (NEISS), operated by the U.S. Consumer Product Safety Commission (CPSC). During 2015-2017, pool chemical injuries led to an estimated 13,508 (95% confidence interval [CI] = 9,087-17,929) U.S. ED visits; 36.4% (estimated 4,917 [95% CI = 3,022-6,811]) of patients were aged <18 years. At least 56.3% (estimated 7,601 [95% CI = 4,587-10,615]) of injuries occurred at a residence. Two thirds of the injuries occurred during the period from Memorial Day weekend through Labor Day. This report also describes a toxic chlorine gas incident that occurred at a public pool in New York in 2018. Pool chemical injuries are preventable. CDC's Model Aquatic Health Code (MAHC) is an important resource that operators of public treated recreational water venues (e.g., at hotels, apartment complexes, and waterparks) can use to prevent pool chemical injuries., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Since interpersonal violence was recognized as a public health problem in the 1970s, much attention has focused on preventing violence among young persons and intimate partners (1). Violence directed against older adults (≥60 years) has received less attention, despite the faster growth of this population than that of younger groups (2). Using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) and the National Vital Statistics System (NVSS), CDC analyzed rates of nonfatal assaults and homicides against older adults during 2002-2016. Across the 15-year period, the nonfatal assault rate increased 75.4% (from 77.7 to 136.3 per 100,000) among men, and from 2007 to 2016, increased 35.4% (from 43.8 to 59.3) among women. From 2010 to 2016, the homicide rate increased among men by 7.1%, and a 19.3% increase was observed from 2013 to 2016 among men aged 60-69 years. Growth in both the older adult population and the rates of violence against this group, especially among men, suggests an important need for violence prevention strategies (3). Focusing prevention efforts for this population will require improved understanding of magnitude and trends in violence against older adults., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Traumatic brain injuries (TBIs), including concussions, are at the forefront of public concern about athletic injuries sustained by children. Caused by an impact to the head or body, a TBI can lead to emotional, physiologic, and cognitive sequelae in children (1). Physiologic factors (such as a child's developing nervous system and thinner cranial bones) might place children at increased risk for TBI (2,3). A previous study demonstrated that 70% of emergency department (ED) visits for sports- and recreation-related TBIs (SRR-TBIs) were among children (4). Because surveillance data can help develop prevention efforts, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP)* by examining SRR-TBI ED visits during 2010-2016. An average of 283,000 children aged <18 years sought care in EDs each year for SRR-TBIs, with overall rates leveling off in recent years. The highest rates were among males and children aged 10-14 and 15-17 years. TBIs sustained in contact sports accounted for approximately 45% of all SRR-TBI ED visits. Activities associated with the highest number of ED visits were football, bicycling, basketball, playground activities, and soccer. Limiting player-to-player contact and rule changes that reduce risk for collisions are critical to preventing TBI in contact and limited-contact sports. If a TBI does occur, effective diagnosis and management can promote positive health outcomes among children., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Objective: To investigate whether the presence of fraternities and sororities was associated with a higher local injury rate among undergraduate-age youth., Methods: In 2016 we compared the rate of 2010-2013 youth (18-24 years) emergency department (ED) visits for injuries in Hospital Service Areas (HSA) with and without fraternities and sororities. ED visits were identified in the State Emergency Department Database (n=1,560 hospitals, 1,080 HSAs, 16 states). US Census Bureau and National Center for Education Statistics sources identified HSA population and campus (n=659) characteristics. A proprietary database identified campuses with fraternities and sororities (n=287). ED visits explicitly linked to fraternities and sororities in the National Electronic Injury Surveillance System-All Injury Program were used to identify injury causes for sub-group analysis., Results: HSAs serving campuses with fraternities and sororities had lower age 18-24 injury rates for all causes except firearm injuries (no difference)., Conclusions: Fraternities and sororities were not associated with a higher injury rate at the population level among undergraduate-age youth. A major limitation is not being able to observe campus health services utilization.

In 2015, persons aged 10-24 years who were treated for nonfatal assault injuries in emergency departments (EDs) in the United States accounted for 32% of the approximately 1.5 million patients of all ages that EDs treated for nonfatal assault injuries (1). CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) to examine 2001-2015 trends in nonfatal assault injuries among youths treated in EDs, by sex and age group, and to assess current rates by sex, age group, mechanism of injury, and disposition (1). Rates for 2001-2015 were significantly higher among males than among females and among young adults aged 20-24 years than among youths aged 10-14 and 15-19 years. During 2011-2015, rates declined for all groups. The 2015 rate among persons aged 10-24 years was 753.2 per 100,000 population, the lowest in the 15-year study period. Despite encouraging trends, the assault rate among young persons remains high. Rates in 2015 were higher among males, persons aged 20-24 years, and those who incurred intentional strike or hit injuries. Nearly one in 10 patients were admitted to the hospital, transferred to another hospital, or held for observation. Youth violence prevention strategies, including primary prevention approaches that build individual skills, strengthen family relationships, or connect young persons treated in EDs to immediate and ongoing support, can be implemented to decrease injuries and fatalities (2)., Competing Interests: No conflicts of interest were reported.

Problem/condition: Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts., Reporting Period: 2001-2015., Description of System: Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme., Results: Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties., Interpretation: Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death., Public Health Action: Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention.