The present study aims to compare Years of Life Lost for unintentional drug overdose and the leading underlying causes of death in the United States annually from 2017 to 2019. Years of Life Lost provide valuable context to incident deaths when comparing the relative mortality burden of underlying causes of death. Prior research has shown unintentional drug overdose was the third leading cause of Years of Life Lost in the state of Ohio in 2017. However, this finding has yet to be replicated at the national level in the US. Death statistics for 2017-2019 were accessed via CDC WONDER. Years of Life Lost were calculated for unintentional drug overdose and each of the top five causes of incident deaths in the US during the study period. Unintentional drug overdose caused nearly seven million Years of Life Lost in the US during the three-year period of study and was the fourth leading cause of Years of Life Lost after cancer, heart disease and other accidents. Incidence alone provides an incomplete picture of the effect of unintentional drug overdose on overall mortality burden in the US. Years of Life Lost give critical context to the overdose crisis, underscoring unintentional drug overdose as a leading cause of premature mortality.

Effective pain management is essential for optimal surgical outcomes; however, it can be challenging in patients with a history of opioid use disorder (OUD). Buprenorphine, a partial opioid agonist, is a valuable treatment option for patients with OUD. Initiating buprenorphine treatment in patients concurrently taking opioids can be complex due to potential adverse outcomes like precipitated withdrawal. Evolving guidelines suggest there are benefits to continuing buprenorphine for surgical patients throughout the perioperative period, however situations do arise when buprenorphine has been discontinued. Typically, in this scenario patients would be restarted on buprenorphine after they have fully recovered from post-surgical pain and no longer require opioids for pain control. Unfortunately, holding MOUD may expose the patient to risks such as opioid induced respiratory depression or addiction relapse. In this case series, we discuss a novel method to restart buprenorphine in small incremental doses, known as micro-dosing, while the patient is still taking opioids for pain. We will present two complex clinical cases when this method was used successfully at a tertiary care hospital system.

Abstract Background. Opioid use disorder (OUD) affects millions in the United States. Emerging technologies like home motion sensors offer the potential for relapse prediction. The study evaluates the feasibility and acceptability of such technology in OUD patients. Methods. Participants were recruited through local OUD treatment centers in Columbus, Ohio. The study involved installing passive monitoring sensors in participants' homes and required participants to wear a Fitbit and complete daily surveys. The target was to enroll 25 patients, with incentives provided for participation. Results. Out of 170 evaluated records, 50 met the inclusion criteria, and only 14 consented to participate, with four completing the study. Main recruitment challenges included housing instability, privacy concerns, and the COVID-19 pandemic's impact. Most participants were willing to use sensor devices, especially in less private home areas. Conclusions. The study faced significant barriers in recruiting and retaining participants, highlighting the complexities of OUD research. Despite methodological adaptations like virtual follow-ups, the retention rate remained low. This suggests the need for more flexible, patient-centric approaches in future research, particularly for populations experiencing instability or distrust. The study underscores the potential of technology in treatment but emphasizes the importance of building trust and understanding within target communities.

OBJECTIVE: To evaluate whether class of oral antihypertensive medication impacts response to acute antihypertensive agents in treatment of severe hypertensive episodes in pregnancy and postpartum.STUDY DESIGN: Retrospective analysis at a single academic tertiary care center (2015-2017) of patients who received acute treatment for severe hypertension during pregnancy or postpartum period with intravenous labetalol, intravenous hydralazine, or immediate release oral nifedipine.Data pertaining to oral antihypertensive medication regimen, acute IV antihypertensive therapy, duration of treatment and time to resolution of the severe hypertensive episode were abstracted from electronic health records and the response to treatment was compared among three groups: those who received the same class of medication as their prior home regimen, a different class, and those who were not on medication prior to the acute episode.A Cox proportional hazards model incorporated factors associated with time to resolution of severe hypertension.RESULTS: Of 776 patients with severe hypertension, 465 met inclusion criteria.96 (21%) were on an oral antihypertensive regimen prior to the acute event.Pretreatment mean arterial pressure (MAP), body mass index > 45 kg/m 2 , self-reported non-Hispanic black race, and treatment with the same class of medication were associated with longer duration of severe hypertension in the adjusted proportional hazards model evaluating factors associated with duration of severe hypertension up to 2 hours after treatment.Duration of severe hypertension varied significantly between the three oral antihypertensive regimen groups (P < .01).CONCLUSION: For those patients on an oral antihypertensive agent prior to their presentation with an acute hypertensive episode, delayed resolution of severe hypertension is associated with acute treatment using the same class of medication as the patient's prior oral antihypertensive regimen.

Abstract Background Recent studies in the United States have shown that between 56 to 74% are willing to receive the COVID-19 vaccine. A significant portion of the population should be vaccinated to avoid severe illness and prevent unnecessary deaths. We examined correlates of COVID-19 vaccine acceptance among a representative sample of adults residing in Ohio. Methods We conducted a cross-sectional study using an online platform (n = 2358). Descriptive statistics, chi-square test and multivariable regression analysis were performed. Results Overall, 59.1% of the participants indicated COVID-19 vaccine acceptance to be vaccinated. In the multivariable model, the likelihood of COVID-19 vaccine acceptance was lower for younger individuals compared to those 55 years and older. The odds of COVID-19 vaccine acceptance were lower for: females compared to males (OR 0.58, 95% CI: 0.47–0.71; P = 0.001), non-Hispanic blacks compared to non-Hispanic whites (OR: 0.49 95% CI: 0.35–0.70; P = 0.001), previously married (OR 0.64 95% CI: 0.49–0.84; P = 0.002) and never been married (OR 0.75 95% CI: 0.59–0.96; P = 0.023) compared to married people, individuals with less than high school (OR 0.21 95% CI: 0.08–0.60; P = 0.003) and high school education (OR: 0.45 95% CI: 0.36–0.55; P < 0.001) compared to those with education beyond high school, and for individuals who had no confidence in the abilities of the state government (OR 0.69 95% CI: 0.53–0.89; P = 0.005) and other world governments to combat COVID-19 (OR 0.67 95% CI: 0.50–0.91; P = 0.009). A one unit increase in knowledge about COVID-19 (OR 1.19, 95% CI: 1.13–1.26; P < 0.001), behavioral adherence (OR 1.25, 95% CI: 1.15–1.37; P < 0.001), perceived susceptibility (OR 1.10, 95% CI: 1.03–1.17; P = 0.004), perceived severity (OR 1.09, 95% CI: 1.03–1.16; P = 0.003), and trust in COVID-19 messages from the government scores (OR 1.08, 95% CI: 1.06–1.10; P < 0.001) were associated with an increase in the likelihood of COVID-19 vaccine acceptance. Conclusions COVID-19 vaccine acceptance differed by sociodemographic and other modifiable factors. Findings can inform local public health authorities in the development of effective, context-specific communication strategies to improve vaccination uptake.

BACKGROUND:Emerging evidence suggests the composition of local illicit drug markets varies over time and the availability and relative lethality of illicit drugs may contribute to temporal trends in overdose mortality. Law enforcement drug seizures represent a unique opportunity to sample the makeup of local drug markets. Prior research has associated shifts in the types of drugs seized and trends in unintentional drug overdose mortality. The present report builds on this work by demonstrating a novel methodology, the Street-Drug Lethality Index, which may serve as a low-lag predictor of unintentional overdose deaths.METHODS:Data included administrative records of law enforcement drug seizures and unintentional drug overdose deaths in Ohio from 2009 -to- 2018. Death records and lab results from drug seizures occurring during the calendar year 2017 were transformed via the described procedure to create lethality indices for individual drugs. These indices were then summed annually to create the independent variable for a linear regression model predicting unintentional overdose deaths for all years during the study period.RESULTS:The regression model explained 93 % of the year-to-year variance in unintentional overdose fatalities (slope = 0.009480; CI = 0.007369 to 0.011590; t10 = 10.355942; P = 0.000007; Y = 11.808982 + 0.009480X, r2 = 0.931).CONCLUSION:These findings contribute to a growing body of evidence that changes in the composition of the drug supply may predict trends in unintentional overdose mortality. The proposed methodology might inform future overdose prevention and response efforts as well as research.

Newborns with in-utero opioid exposure are most commonly evaluated for neonatal opioid withdrawal syndrome (NOWS) using the modified Finnegan neonatal abstinence scoring system (FNASS) to assess for withdrawal and guide pharmacologic intervention. While some studies suggest high variability related to the observer-rated scale, few studies have assessed the relationship between FNASS scores guiding pharmacologic treatment and infant race or ethnicity. We sought to investigate racial disparities in pharmacologic treatment for NOWS based on FNASS assessments. Retrospective cohort study of patients with opioid use disorder (OUD) who received co-located prenatal and addiction care from 2013 to 2020 at a large academic institution. Non-Hispanic Black (NHB) patients were matched to a group of non-Hispanic White (NHW) patients by gestational age and year of delivery. Race and ethnicity were based on mother reported data. The primary outcome was pharmacological treatment of newborns for NOWS. Secondary outcomes included differences in modified Finnegan neonatal abstinence scoring system (FNASS) composite scores. Multivariable analysis was conducted adjusting for >1 illicit substance on admission UDS. A total of 42 NHB mother-newborn dyads were compared to 42 matched NWH dyads. There were no significant differences in baseline demographics between the two groups, including SSRI use, gestational age at delivery, male infant or breastfeeding rates (Table 1). Infants born to NHB patients were less likely to receive pharmacological treatment for NOWS compared to those born to NHW patients (36% vs 57%, aOR 0.41, 95% CI 0.17-0.99) (Table 2). No significant differences in the occurrence or severity of NOWS based on incidence and frequency Finnegan scores ≥8 or length of stay >5 day. Despite no differences in severity of NOWS, infants born to NHB patients, and exposed to opioids in-utero, were less likely to receive pharmacologic treatment for withdrawal symptoms. Our findings provide initial evidence of racial disparities in the treatment of NHB newborns with NOWS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Neonates exposed in-utero to opioids are commonly evaluated for neonatal opioid withdrawal syndrome (NOWS) using modified Finnegan Neonatal Abstinence Scoring System (FNASS). FNASS includes 21 different components of central nervous system, metabolic, vasomotor, respiratory, and GI disturbances. Consecutive cumulative scores ≥8 are suggestive for starting pharmacologic treatment. Our objective was to identify significant differences in FNASS scoring in neonates stratified by race. Retrospective cohort study of patients with opioid use disorder (OUD) who received co-located prenatal and addiction care from 2013 to 2020 at a large academic institution. Non-Hispanic Black (NHB) patients were matched to non-Hispanic White (NHW) patients by year and gestational age at delivery. Race and ethnicity were self-reported by the mother. The primary outcome was differences in individual scoring components. 42 NHB mother-newborn dyads were compared to 42 matched NWH dyads. There were no significant differences in baseline demographics between the groups. NHB newborns were significantly less likely than NHW to be scored for observed red, blotchy skin changes consistent with skin mottling (79% vs 100%, P<0.01). All NHB and NHW newborns were scored for mild tremors when disturbed and increased muscle tone; there were no significant scoring differences in the remaining FNASS components. NHB newborns were less likely to receive a FNASS ≥8 (69% vs. 81%, RR 0.85, CI 0.66-1.09) compared to NHW infants, and to receive pharmacological treatment for NOWS (76% vs. 98%, RR 0.78, CI 0.66-0.93) compared with NHW newborns. However, within this cohort of NHB newborns, receiving a score for mottling would have resulted in earlier and/or increased rates of pharmacologic treatment for NOWS in 36% (n=15) of patients. Infants born to NHB patients were less likely to receive score for skin mottling on modified FNASS. Lack of recognition of mottling maybe due to skin pigmentation differences and could potentially result in underscoring and delay of pharmacological treatment for NOWS.

Accidental overdose is increasing among perinatal women in Ohio and now accounts for more than 40% of pregnancy-associated years of life lost in the state.

This cross-sectional study examines excess mortality, measured as years of life lost, associated with unintentional drug overdose in Ohio from 2009 to 2018.

Objectives: The aim of the study was to quantify the burden of premature mortality because of opioid overdose in Ohio, document the role of fentanyl poisoning in contribution to this evolving epidemic, examine geographic, demographic, and temporal patterns of mortality burden within Ohio, and measure the effect of opioid overdose on lifespan in the state. Methods: A serial cross-sectional analysis was performed for all fatal opioid poisonings (N = 12,782) in the state of Ohio between January 1, 2010 and December 31, 2016. The burden of fatal opioid overdose was calculated in Years of Life Lost (YLL). YLL were mapped with respect to geographic and cultural region. The geographic spread of fentanyl poisoning was also mapped, and the shifting contribution of fentanyl poisoning to overall opioid mortality burden was assessed over time. Finally, the negative effect of opioid overdose on average lifespan was calculated. Results: Opioid overdose resulted in 508,451 total YLL. In the year 2016 alone, there were 136,679 YLL attributable to opioid poisoning. Fentanyl-related YLL rose from 7.5% of all YLL because of opioid overdose in 2010 to 69.0% in 2016. In the same year, opioid overdose lowered the lifespan of an average Ohioan by 0.97 years. Conclusions: Fatal opioid overdose accounted for over half a million YLL in Ohio during the 7-year study period. Opioid overdose mortality rose annually. Fentanyl involved overdoses accounted for a growing proportion of excess mortality. Burden was not equally distributed within the state. Two distinct geographical clusters of excess mortality were identified in the northeast and south.

Despite evidence suggesting race and ethnicity are important factors in responses to environmental exposures, drug therapies, and disease risk, few studies focus on the health needs of racially- and ethnically-diverse aging adults.The objective of this study was to determine the burden of 10 health conditions across race and ethnicity for a nationally-representative sample of aging Americans.Data from the 1998 to 2014 waves of the Health and Retirement Study, an ongoing longitudinal-panel study, were analyzed.Those aged over 50 years who identified as Black, Hispanic, or White were included. There were 5510 Blacks, 3423 Hispanics, and 21,168 Whites in the study.At each wave, participants reported if they had cancer, chronic obstructive pulmonary disease, congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Disability-adjusted life years (DALYs) were calculated for each health condition by race and ethnicity. Ranked DALYs determined how race and ethnicity was differentially impacted by the burden of each health condition. Sample weights were utilized to make DALY estimates nationally-representative.Weighted DALY estimates (in thousands) ranged from 1405 to 55,631 for Blacks, 931 to 28,442 for Hispanics, and 15,313 to 295,623 for Whites. Although the health conditions affected each race and ethnicity differently, hypertension had the largest number of DALYs, and hip fractures had the fewest across race and ethnicity. In total, there were an estimated 198,621, 101,462, and 1,187,725 DALYs for older Black, Hispanic, and White aging adults.Our findings indicate that race and ethnicity may be influential on health and disease for aging adults in the United States. Monitoring DALYs may help guide the flow of health-related expenditures, improve the impact of health interventions, advance inclusive health care for diverse aging adult populations, and prepare healthcare providers for serving the health needs of aging adults.

Many adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.

Objective: To determine the association between spinal cord injury (SCI) etiology categories and mortality, and examine the association between etiology sub-categories and mortality. Design: Prospective cohort study. Setting: Model Systems and Shriners Hospital SCI units. Participants: Data were analyzed from 42,627 cases in the SCI Model System Collaborative Survival Study Database from 1973 to 2017. Those with SCI etiologies categorized as vehicular, violent, sports, falls, pedestrian, and medical were included. Interventions: Not applicable. Outcome Measure: Time to mortality after SCI. Results: Relative to the sports related etiology category, those with medical, pedestrian, violence, falls, and vehicular related SCIs had a 2.00 (95% confidence intervals (CIs): 1.79-2.24), 1.57 (CIs: 1.34-1.83), 1.54 (CIs: 1.41-1.68), 1.35 (CIs: 1.25-1.45), and 1.26 (CIs: 1.17-1.35) higher hazard for mortality, respectfully. Persons with SCIs from automobile crashes had a 1.38 (CIs: 1.23-1.56) higher hazard for mortality, whereas those with SCIs from motorcycle crashes had a 1.21 (CIs: 1.04-1.39) higher hazard for mortality, relative to other etiologies within the vehicular category. Those with SCIs from diving had a 1.37 (CIs: 1.18-1.59) higher hazard for mortality relative to other etiologies within the sports category. Conclusions: Injury etiology categories and certain sub-categories were associated with a higher risk for early mortality. Understanding how additional factors such as socioeconomic status, co-occurring injuries, medical co-morbidities, and environmental aspects interact with SCI etiologies may provide insights for how etiology of injury impacts survival. These findings may serve as a development for extending long-term life expectancy by informing SCI prevention programs and care post-injury.

Objectives: Impairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States. Design: Longitudinal panel. Setting: Detailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone. Participants: A nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years. Measures: Ability to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability. Results: The presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map. Conclusions/Implications: Our findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

McGrath, RP, Kraemer, WJ, Vincent, BM, Hall, OT, and Peterson, MD. Muscle strength is protective against osteoporosis in an ethnically diverse sample of adults. J Strength Cond Res 31(9): 2586-2589, 2017-The odds of developing osteoporosis may be affected by modifiable and nonmodifiable factors such as muscle strength and ethnicity. This study sought to (a) determine whether increased muscle strength was associated with decreased odds of osteoporosis and (b) identify whether the odds of osteoporosis differed by ethnicity. Data from the 2013 to 2014 National Health and Nutrition Examination Survey were analyzed. Muscle strength was measured with a hand-held dynamometer, and dual-energy x-ray absorptiometry was used to assess femoral neck bone mineral density. A T-score of ≤2.5 was used to define osteoporosis. Separate covariate-adjusted logistic regression models were performed on each sex to determine the association between muscle strength and osteoporosis. Odds ratios (ORs) were also generated to identify if the association between muscle strength and osteoporosis differed by ethnicity using non-Hispanic blacks as the reference group. There were 2,861 participants included. Muscle strength was shown to be protective against osteoporosis for men (OR: 0.94; 95% confidence interval [CI]: 0.94-0.94) and women (OR: 0.90; CI: 0.90-0.90). Although ORs varied across ethnicities, non-Hispanic Asian men (OR: 6.62; CI: 6.51-6.72) and women (OR: 6.42; CI: 6.37-6.48) were at highest odds of osteoporosis. Increased muscle strength reduced the odds of osteoporosis among both men and women in a nationally representative, ethnically diverse sample of adults. Non-Hispanic Asians had the highest odds of developing osteoporosis. Irrespective of sex or ethnicity, increased muscle strength may help protect against the odds of developing osteoporosis.