BACKGROUND: Obesity affects over 10% of the world population and has significant public health implications. With rising recognition of the long-term effects of Long COVID (LC) coupled with new agents to facilitate weight loss, it is critical to understand the influence of obesity on LC. This study assessed the association of obesity with rates of LC and degree of LC-related mental and physical health outcomes among participants up to three years after initial infection. METHODS: This was a cross-sectional, multisite study of participants with SARS-CoV-2 infection from 12/11/2020–8/29/2022, with data collected through 4/2/2024. Surveys included validated tools for physical and mental health. Data were analyzed by self-reported new obesity (follow-up only), persistent obesity (baseline and follow-up), or no obesity. RESULTS: Of 3,663 participants, 547 (14.9%) had new obesity and 805 (21.9%) had persistent obesity. Compared with persons without obesity, LC was significantly more common among those with new (39.7% vs 22.8%; aOR: 1.9, 95% CI 1.5–2.4) or persistent obesity (39.1% vs 22.8%; aOR: 1.7, 95% CI 1.4–2.1). Regardless of chronicity and current LC status, obesity was associated with lower (worse) scores for PROMIS Physical (mean differences: 2.7–4.0) and Mental Health (mean differences: 1.7–3.6) function, worse moderate-to-severe fatigue (aOR: 1.3–2.1), worse dyspnea (aOR: 1.9–3.7), worse loneliness (aOR: 1.3–1.6), and insufficient activity (aOR for SNAP ≤ 4: 1.6–2.8; aOR for EVS ≤ 150 min/week: 2.0–3.1). CONCLUSIONS: Participants with obesity had higher rates of LC and worse physical and mental health outcomes, regardless of LC status. These findings raise key questions about obesity interventions to treat LC and a possible role for obesity management before the next pandemic. TRIAL REGISTRATION: NCT04610515

Importance Although US opioid overdose deaths have recently declined, mortality remains higher than before the COVID-19 pandemic, and the role of naloxone in opioid-associated out-of-hospital cardiac arrest (OA-OHCA) remains uncertain. The American Heart Association has identified a critical evidence gap regarding the role of naloxone in resuscitation care. Objective To assess the association between naloxone administered by emergency medical services (EMS) clinicians and outcomes in patients with suspected OA-OHCA. Design, Setting, and Participants This retrospective cohort study of adults (aged ≥18 years) with EMS-treated OHCA used data from the California Resuscitation Outcomes Consortium from January 1, 2021, to December 31, 2022. The primary cohort was patients with OA-OHCA, identified using the Naloxone Cardiac Arrest Decision Instrument (NACARDI) as age younger than 50 years and unwitnessed cardiac arrest. Additional analyses were conducted in patients with EMS-presumed drug-related OHCA and all patients with OHCA. Data were analyzed between November 2024 and July 2025. Exposure Naloxone administration during EMS resuscitation. Main Outcomes and Measures The primary outcome was survival to hospital discharge. Secondary outcomes were favorable neurologic outcome and return of spontaneous circulation (ROSC). Inverse probability weighted regression was used to estimate naloxone treatment effects as absolute risk differences (ARDs). Results Among 3811 patients meeting NACARDI criteria (median patient age, 37 years [IQR, 30-43 years]; 2792 [73.3%] male), 1251 (32.8%) received naloxone and 2560 (67.2%) did not. Survival to hospital discharge occurred in 101 patients (8.1%) who received naloxone vs 112 (4.4%) who did not. Favorable neurologic outcome occurred in 92 (7.4%) vs 84 (3.3%) and sustained ROSC in 177 (14.1%) vs 245 (9.6%), respectively. After adjustment for patient, OHCA incident, and agency-level factors, naloxone was associated with improved survival to hospital discharge (ARD, 2.75 percentage points [pp]; 95% CI, 1.25 to 4.26 pp), favorable neurologic outcome (ARD, 3.18 pp; 95% CI, 1.79 to 4.57 pp), and sustained ROSC (ARD, 3.27 pp; 95% CI, 1.11 to 5.43 pp). In sensitivity analyses of patients who received epinephrine, naloxone was not associated with improved survival to hospital discharge (adjusted ARD, 0.31 pp; 95% CI, −0.09 to 1.58 pp) or the other clinical outcomes. Conclusions and Relevance In this cohort study, among patients with suspected OA-OHCA, EMS-administered naloxone was associated with improved survival and neurologic status and sustained ROSC. These findings support the need for a randomized trial to assess the effects of naloxone in opioid-associated cardiac arrest.

INTRODUCTION:The prevalence of opioid-associated out-of-hospital cardiac arrest (OA-OHCA) is increasing in the United States. Naloxone administration during OA-OHCA has been associated with improved clinical outcomes, but identifying OA-OHCA in the field remains challenging. Previous work demonstrated association between non-shockable cardiac rhythms and OA-OHCA, suggesting that cardiac rhythm may help identify patients likely to benefit from naloxone. In this work, we assessed the association of naloxone with clinical outcomes for patients with OHCA, stratifying by presenting cardiac rhythm. METHODS:We used 2019-2020 data from the ESO Data Collaborative in this retrospective cohort study. Cases were classified a priori according to presenting rhythm (shockable rhythm, pulseless electrical activity [PEA], asystole). The exposure was prehospital naloxone administration and outcomes of interest were prehospital ROSC and survival to hospital discharge. We utilized logistic regression and adjusted propensity-score matching to determine associations with outcomes. RESULTS:We analyzed 40,333 cases in which 7567 (18.8%) patients received naloxone. Before matching, the rate of prehospital ROSC was 21.5% and survival to hospital discharge was 9.0%. After propensity score matching, patients in PEA who received naloxone had similar rates of ROSC (OR 1.09, 95%CI 0.90-1.31) and higher survival (OR 1.46, 95%CI 1.11-1.92). Naloxone administration was not associated with differences in either outcome in patients presenting with shockable rhythms or asystole. Given the retrospective nature of this work, we were unable to fully address selection bias or resuscitation time bias and cannot comment on causality. CONCLUSION:In this national cohort, naloxone administration was associated with improved survival to hospital discharge for OHCA patients in PEA. No association was found between naloxone and clinical outcomes for OHCA patients with shockable rhythms or asystole. Prospective, randomized trials are needed to assess for true causality.

BACKGROUND AND AIMS:Psychedelic drug use is increasing due in part to local legislative reforms. Understanding the patterns of first-time psychedelic drug use is imperative for informing consumers, healthcare providers, and policy makers. DESIGN SETTING AND PARTICIPANTS:The National Survey on Drug Use and Health (NSDUH) is a repeated cross-sectional nationally representative survey of civilians aged 12 and older. Use estimates are presented for 2002-2019 and 2021-2023; regression analyses did not span 2020 due to data incompatibility. MEASUREMENTS:Primary analysis variables were binary indicators for a) lifetime use of hallucinogens (LSD, psilocybin, and MDMA) and b) first-time use of hallucinogens in the past year. FINDINGS:Among 1,005,421 respondents from 2002 to 2019 the prevalence of first-time use of any hallucinogen in the past year was 0.71 %; among 173,808 respondents from 2021 to 2023 0.79 % reported new hallucinogen use. From 2002-2019, an average of 0.39 % of participants used MDMA for the first time; 0.28 % used psilocybin for the first time; and 0.18 % used LSD for the first time each year. First-time use of any hallucinogen increased from 2002 to 2019 at an average odds ratio (OR) 1.009 (95 % confidence interval (CI) 1.001-1.016). New use varied by age group, with the age cohort x year interaction showing a decrease among the 12-17 age cohort (OR 0.96 (95 %CI 0.96-0.97)) and an increase among the 65 +  cohorts (OR 1.56 (95 %CI and 1.02 (95 %CI 1.01-1.03), respectively). New LSD use increased (OR per additional year 1.08, 95 % CI 1.07-1.09). Similar increases were not observed for psilocybin, MDMA, or hallucinogens overall. For 2021-2023, there was no change in new use of hallucinogens (OR 0.97 [95 %CI 0.86-1.08]). CONCLUSIONS:First-time psychedelic and hallucinogen increased only slightly over the period from 2002 to 2019 though there were notable age-group and substance-specific trends: new use generally decreased among adolescents and increased in among those aged 65 and older. Trends from 2021 to 2023 likewise did not suggest changes in overall new use, but continue to show changing patterns of use across substances and age groups.

BACKGROUND:The clinical consequences of repeated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not clear, especially as they relate to long-term symptoms after infection. We analyzed data collected for the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) to determine whether reinfection changes the likelihood of symptoms 3-6 months after reinfection compared with the likelihood in individuals experiencing a single infection. METHODS:Individuals reporting a single SARS-CoV-2 infection or a single reinfection were included in this analysis. A positive SARS-CoV-2 test occurring ≥90 days after a first infection was considered a reinfection. Outcomes included severe fatigue (fatigue severity score ≥25) and the presence of organ system symptoms 3-6 months after the last infection. RESULTS:The analysis included 886 individuals, 415 (46.8%) of whom experienced reinfection. For individuals who experienced their first infections in either the pre-Delta or Delta periods, the odds of having ≥3 symptoms 3-6 months after their most recent infection was lower in those reinfected than those with a single infection (weighted adjusted odds ratio, 0.45 [95% confidence interval, .21-.95] and 0.51 [.32-.79], respectively). However, in individuals reporting their first infection during the Omicron wave, the odds of reporting ≥3 symptoms after the most recent infection was higher in those reinfected than in those with a single infection (weighted adjusted odds ratio, 1.54 [95% confidence interval, 1.02-2.34]). CONCLUSIONS:The timing of initial infection, reinfection, and the variants involved may play important roles in longer-term clinical outcomes. Repeated infection with Omicron variants may increase the risk of long-term symptoms.

BACKGROUND:Up to fifteen percent of out-of-hospital cardiac arrests (OHCAs) are precipitated by occult drug overdose - cases without history or evidence of drug use that are often attributed to a non-overdose cause. The NAloxone Cardiac ARrest Decision Instrument (NACARDI) was derived to help emergency medical service (EMS) providers rapidly identify patients at higher risk of occult opioid-associated (OA)-OHCAs during resuscitation. In this analysis we externally validate NACARDI in an independent cohort of OHCA patients. METHODS:We conducted a retrospective validation using data from EMS-attended OHCA patients and coroner records in Ontario, Canada between 2020-2021. Inclusion criteria were age ≥18 years and OHCA death with a coroner record. Exclusion criteria were EMS-suspected drug overdose or known cause of the OHCA. NACARDI consists of two criteria: patient age and unwitnessed cardiac arrest. Two cut-offs for patient age were assessed for this validation: <50 years (NACARDI-50) and <60 years (NACARDI-60). The primary outcome was coroner adjudicated cause of death. We calculated screening characteristics and receiver operating characteristic (ROC) curves using standard formulae. RESULTS:Of 2904 OHCA cases without an obvious cause, 791 had coroner evaluations and 121 (15.3 %) were adjudicated as occult OA-OHCA. NACARDI-60 had: sensitivity 82.6 % (95 %CI 74.9-88.4 %), specificity 77.1 % (95 %CI 73.8-80.1 %), negative predictive value 96.1 % (95 %CI 94.1-97.4 %), and positive predictive value 39.4 % (95 %CI 33.6-45.5 %). NACARDI-50 had: sensitivity 63.6 % (95 %CI 54.4-72.2 %), specificity 89.3 % (95 %CI 86.7-91.5 %), negative predictive value 93.2 % (95 %CI 90.9-95.0 %), and positive predictive value 51.7 % (95 %CI 43.4-59.9 %). ROC curves for both NACARDI-50 and NACARDI-60 demonstrated excellent discrimination for occult OA-OHCA. CONCLUSION:In this external validation cohort, NACARDI had a sensitivity and specificity sufficiently high to aid in the real-time identification of occult OA-OHCA in the field. NACARDI has the potential to guide targeted interventions for OA-OHCA.

Aims Alcohol consumption along with negative sequelae from excess alcohol intake increased during the COVID-19 pandemic. We evaluated the association between binge alcohol use and long-term functional outcomes among COVID-19-positive individuals.Methods Using a prospective, longitudinal, multisite cohort study design, we evaluated the association between binge alcohol use and mental and physical functional outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS)-29 scores three and six months postinfection. Eligible patients were those who presented with COVID-19-like symptoms, tested positive for COVID-19, and completed a three-month survey. Binge drinking was identified at the time of infection using the Tobacco, Alcohol, Prescription medication and other Substance use screener. Generalized estimating equation models, adjusted for demographic characteristics, social determinants of health, substance use, comorbidities, and COVID-19 vaccine status, were used to assess the association between binge alcohol use and mental and physical functional outcomes.Results Of 3529 individuals, 23.7% screened positive for binge drinking. At three months, prior self-reported binge drinking was associated with differences in physical function [estimate: 1.08; 95% confidence interval (CI) 0.44, 1.71], pain interference (estimate: -0.86; 95% CI -1.57, -0.15), and physical health (estimate: 1.09; 95% CI 0.43, 1.75). At six months, no associations were found between binge drinking and outcomes.Conclusions Binge alcohol use before COVID-19 infection was associated with statistically significant but clinically irrelevant improvements in function at three months, which were not sustained at six months. Postinfectious and postpandemic stressors may have played a larger impact on functional outcomes than binge alcohol use. A higher frequency of binge drinking and its association with functional outcomes, particularly among individuals with COVID-19 warrants further study. Short Summary: Using a prospective, longitudinal cohort study design, we evaluated the association between binge alcohol use and long-term functional outcomes among COVID-19-positive individuals. Binge alcohol use before COVID-19 infection was associated with statistically significant but clinically irrelevant improvements in function at 3 months, which were not sustained at six months.

BACKGROUND:While most research on Long COVID (LC) has focused on symptoms and quality of life, there remains a critical need to better understand the effect of LC on resource utilization. This study sought to determine the type and amount of healthcare utilization among participants with versus without LC. METHODS:This was a secondary analysis of a prospective, longitudinal, multicenter U.S. study of adult participants with symptomatic COVID-19, confirmed with testing, who completed 3-month post-infection surveys and had electronic health record data for at least 180 days pre- and post-index testing. We excluded participants with any COVID-19 infections within the 6 months following enrollment. Consistent with prior work, LC was defined as ≥3 post-infectious symptoms at 3 months, while those with <3 symptoms were categorized as not having LC. Our primary outcome was to compare the change in visit types between pre- and post-index testing (hospitalization, emergency department visit, office visit, procedure, telehealth, and other). As secondary outcomes, we assessed differences in visit complexity using the summative length of each encounter for each category as a measure of total healthcare usage. RESULTS:A total of 847 participants met inclusion criteria (179 LC, 668 non-LC). When compared with the pre-index period, there was an overall increase in visit numbers of all six visit categories during the post-index period for all groups, most pronounced in office and telehealth visits. When compared with the non-LC group, the LC group was less likely to have ED visits (OR: 0.1; 95% CI 0.0-0.5). However, among those with LC who had at least one hospitalization, they were more likely to have additional hospitalizations (OR: 2.6; 95% CI 1.5-4.6). Visit length for office visits and hospitalization in the LC group was increased when compared with the non-LC group, though this diminished after adjustment for patient baseline characteristics. CONCLUSIONS:All participants who were infected with SARS-CoV-2 had a marked increase in healthcare utilization during the subsequent 180 days. The LC group had significantly higher rates of additional hospitalization compared with those without LC, which may help to inform healthcare resource planning.

Interest in and use of hallucinogens appears to be growing in the United States, yet less is known about the use of multiple hallucinogens. The aims of this study are to characterize subgroups of lifetime hallucinogen use and to identify sociodemographic correlates of these subgroups. Latent class models were fit using 2021-2022 National Survey on Drug Use and Health (NSDUH) data on a sub-sample of individuals who reported having ever used any hallucinogen (n = 17,977). A four-class model identified the following subgroup classes: Psilocybin (16%), LSD/Psilocybin (46%), Ecstasy (23%), and a fourth class (15%) labeled Multiple substances, with high probabilities of use of psilocybin, LCD, and ecstasy, in addition to moderate probabilities of use of other hallucinogens. In survey-weighted multinomial logistic regression analyses, compared to the Psilocybin class, the adjusted odds of being in the LSD/Psilocybin class increased with age-group level (AORs = 1.5-6.4, 95% CIs:1.3-8.7), and non-White participants had higher odds of being in the Ecstasy class (AORs = 1.7-3.2, 95% CIs:1.1-4.4). As policies regulating and clinical practice with hallucinogens continue to evolve, these patterns of lifetime hallucinogen use demonstrate the overlapping nature of hallucinogen experiences in the U.S. population, which has implications for expanding clinical trial inclusion criteria and establishing a baseline for future trends.

OBJECTIVE:To examine participants' motivations and their experiences throughout a decentralized, longitudinal COVID-19 study in the U.S. METHODS:We recruited 355 participants from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) between November 2022 - March 2023 to answer five qualitative survey questions anonymously. We used an inductive content analysis approach to analyze the data. RESULTS:We identified five key themes from the analysis, which reflected participants' a) motivations to join the study, b) study benefits, c) perceptions of survey questions, d) experiences with the research process, and e) preferences for disseminating research findings. Participants were motivated to learn with researchers about COVID-19. They expressed divided opinions about the relevance of INSPIRE research questions. They reported difficulties navigating the virtual research platform and the need for making survey participation less cognitively demanding. They sought more regular feedback on study findings. CONCLUSIONS:Our findings offered insights into incorporating decentralized participatory methods in longitudinal research, strengthening reciprocal research communications, making virtual research platforms user-friendly, and employing strategies to reduce participants' cognitive burden in research. POLICY IMPLICATIONS:Longitudinal studies should focus on optimizing these aspects of participant engagement to produce rigorous findings that inform policy and practice on lasting effects of COVID-19 including Long COVID.

Background Although short-term outcomes of Long COVID have been described, longer-term physical and mental health outcomes of Long COVID are less well-established. This study sought to assess differences in long-term physical and mental health outcomes extending up to three years among those with current, resolved, and no Long COVID, as well as duration of Long COVID and vaccination status. Methods This was a prospective, multisite, study of participants with SARS-CoV-2 infection from 12/7/2020-8/29/ 2022, with data collected through 4/2/2024. Surveys included validated tools for physical and mental health. Data were analyzed by Long COVID status (never-had, resolved, current), Long COVID duration and vaccination status. Findings Of 3663 participants, 2604 (71.1%) never had Long COVID, 994 (27.1%) reported current Long COVID, and 65 (1.8%) reported resolved Long COVID. Compared to never having Long COVID, current Long COVID had lower/ worse scores for Patient-Reported Outcomes Measurement Information System (PROMIS) version 29 Physical (7.8; 95% confidence interval [CI] 7.3-8.3) and Mental Health (9.4; 95% CI 8.8-10.1) and higher likelihood of moderate-to-high stress (adjusted odds ratio [aOR]: 2.0; 95% CI 1.6-2.4), moderate-to-high loneliness (aOR: 1.6; 95% CI 1.4-2.0), moderate-to-severe fatigue (aOR: 3.0; 95% CI 2.5-3.7), insufficient activity (aOR for Speedy Nutrition and Physical Activity Assessment <= 4: 0.6; 95% CI 0.5-0.7; aOR for Exercise Vital Sign <= 150 min/week: 0.7, 95% CI 0.6-1.0), and worse dyspnea (aOR: 5.0; 95% CI 4.3-5.8). Resolved Long COVID had lower scores for PROMIS Physical by 2.0 (95% CI 0.2-3.8) and Mental Health by 2.3 (95% CI 0.2-4.4) than the never-had-Long COVID cohort. Number of COVID-19 vaccinations was associated with better outcomes across all measures. Interpretation Among participants followed up to 3 years after initial infection, those with current Long COVID had worse physical and mental health outcomes. The majority of those with Long COVID did not resolve, with less than 2% having resolved Long COVID. The resolved Long COVID cohort had moderately worse physical and mental health compared with those never-having-Long COVID. COVID-19 vaccination was associated with better outcomes. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

OBJECTIVE:During the COVID-19 pandemic, the United States Centers for Disease Control and Prevention provided strategies, such as extended use and reuse, to preserve N95 filtering facepiece respirators (FFR). We aimed to assess the prevalence of N95 FFR contamination with SARS-CoV-2 among healthcare personnel (HCP) in the Emergency Department (ED). DESIGN:Real-world, prospective, multicenter cohort study. N95 FFR contamination (primary outcome) was measured by real-time quantitative polymerase chain reaction. Multiple logistic regression was used to assess factors associated with contamination. SETTING:Six academic medical centers. PARTICIPANTS:ED HCP who practiced N95 FFR reuse and extended use during the COVID-19 pandemic between April 2021 and July 2022. PRIMARY EXPOSURE:Total number of COVID-19-positive patients treated. RESULTS:Two-hundred forty-five N95 FFRs were tested. Forty-four N95 FFRs (18.0%, 95% CI 13.4, 23.3) were contaminated with SARS-CoV-2 RNA. The number of patients seen with COVID-19 was associated with N95 FFR contamination (adjusted odds ratio, 2.3 [95% CI 1.5, 3.6]). Wearing either surgical masks or face shields over FFRs was not associated with FFR contamination, and FFR contamination prevalence was high when using these adjuncts [face shields: 25% (16/64), surgical masks: 22% (23/107)]. CONCLUSIONS:Exposure to patients with known COVID-19 was independently associated with N95 FFR contamination. Face shields and overlying surgical masks were not associated with N95 FFR contamination. N95 FFR reuse and extended use should be avoided due to the increased risk of contact exposure from contaminated FFRs.

Importance:While much of the focus on long COVID (LC; defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) has been on health status and quality of life, the impact on individual work productivity and financial distress are less well established. Objectives:To assess differences in work and financial outcomes among individuals with current, resolved, and no LC up to 3 years after initial infection. Design, Setting, and Participants:This prospective, multisite, longitudinal cohort study enrolled adult participants (age ≥18 years) with at least 1 reported SARS-CoV-2 infection from December 7, 2020, to August 29, 2022. Follow-up electronic surveys were collected through April 2, 2024. Data were analyzed from January 20 to February 4, 2025. Exposure:Self-reported resolved or current LC and vaccination status. Main Outcomes and Measures:Financial toxicity was measured using Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (FACIT-COST), and work impact was measured using the Work Productivity & Activity Impairment questionnaire (version 2.0). Results:Of 3663 participants (mean [SD] age, 40.2 [14.2] years; 2429 [66.3%] female), 994 (27.1%) reported current LC, 2604 (71.1%) never had LC, and 65 (1.8%) had resolved LC. Participants with current LC reported more overall work impairment due to health (mean [SD], 17.7% [25.3%] of total hours worked per week) compared with those who never had LC (mean [SD], 3.2% [11.8%] of total hours) and resolved LC (mean [SD], 5.6% [12.2%] of total hours), with significantly increased odds of any work impairment compared with those who never had LC (adjusted odds ratio [aOR], 7.24; 95% CI, 5.68-9.21). The current LC group had increased odds of missing work due to their health (aOR, 2.62; 95% CI, 1.93-3.57) and of experiencing work impairment (aOR, 11.82; 95% CI, 8.90-15.70) compared with the group who never had LC. Individuals with current LC had increased odds of having moderate to high FACIT-COST scores compared with those who never had LC (aOR, 5.20; 95% CI, 3.92-6.89) and compared with those with resolved LC (aOR, 3.16; 95% CI, 1.19-8.41). Participants who were vaccinated had lower overall work impairment (aOR, 0.71; 95% CI, 0.55-0.92), impairment while working (aOR, 0.66; 95% CI, 0.50-0.87), impairment of nonwork activities (aOR, 0.74; 95% CI, 0.57-0.96), and financial toxicity (least-squares mean difference, 1.07; 95% CI, 0.19-1.95) compared with those who were not vaccinated. Conclusions and Relevance:In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported LC reported worse work impairment, missed work, and financial distress compared with those who never had LC, while vaccination was associated with improved work outcomes and less financial distress even among individuals with LC. These data underscore the need for postpandemic assistance programs, as well as vaccination to decrease societal harms.

Objectives:Given the increasing use of psilocybin-containing substances across a variety of use settings, understanding the potential risks is imperative for informing public health policy, health care providers, and consumers. Poison centers (PCs) receive calls following exposures to potential toxins to support the detection, prevention, and treatment of toxin-related health emergencies. This report assesses trends in PC encounters of psilocybin and a subset of other comparator substances. Methods:A retrospective study of PC encounters documenting exposure to psilocybin, other psychedelic substances (lysergic acid diethylamide, mescaline/peyote, and hallucinogenic plants), or toxic plants and mushrooms from 2013 to 2022 was performed. The primary outcome was the occurrence of psilocybin-related encounters, with and without other coingestants. Psilocybin-related encounters were presented overall and stratified by age groups, and the clinical outcomes were described. Results:There were 6933 PC encounters for psilocybin-containing substances between 2013 and 2022. PC encounters for psilocybin-containing substances (alone or with coingestants) increased over time-from 477 in 2013 to 1441 in 2022. Psilocybin-related encounters increased over the study period among all age groups (years) and were most common in the 18 to 24 and 25 to 44 year-old age groups. Across all years, the number of psilocybin-related encounters was similar to those for lysergic acid diethylamide and mescaline/peyote, and far lower than those for other mushrooms and toxic plants. Conclusion:From 2013 to 2022, there was a 3-fold increase in psilocybin-related PC encounters, nearly all of which occurred since 2019. A similar pattern was not observed with other substances. Although the number of encounters remains low, this trend could continue as psilocybin use increases.

Background The clinical consequences of repeated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not clear, especially as they relate to long-term symptoms after infection. We analyzed data collected for the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) to determine whether reinfection changes the likelihood of symptoms 3-6 months after reinfection compared with the likelihood in individuals experiencing a single infection.Methods Individuals reporting a single SARS-CoV-2 infection or a single reinfection were included in this analysis. A positive SARS-CoV-2 test occurring >= 90 days after a first infection was considered a reinfection. Outcomes included severe fatigue (fatigue severity score >= 25) and the presence of organ system symptoms 3-6 months after the last infection.Results The analysis included 886 individuals, 415 (46.8%) of whom experienced reinfection. For individuals who experienced their first infections in either the pre-Delta or Delta periods, the odds of having >= 3 symptoms 3-6 months after their most recent infection was lower in those reinfected than those with a single infection (weighted adjusted odds ratio, 0.45 [95% confidence interval, .21-.95] and 0.51 [.32-.79], respectively). However, in individuals reporting their first infection during the Omicron wave, the odds of reporting >= 3 symptoms after the most recent infection was higher in those reinfected than in those with a single infection (weighted adjusted odds ratio, 1.54 [95% confidence interval, 1.02-2.34]).Conclusions The timing of initial infection, reinfection, and the variants involved may play important roles in longer-term clinical outcomes. Repeated infection with Omicron variants may increase the risk of long-term symptoms. The clinical consequences of repeated severe acute respiratory syndrome coronavirus 2 infection are unclear, especially as they relate to long-term symptoms. The timing of initial infection, reinfection, and the variants involved may play important roles in longer-term clinical outcomes.

IMPORTANCE The COVID-19 pandemic resulted in a widespread acute shortage of N95 respirators, prompting the Centers for Disease Control and Prevention to develop guidelines for extended use and limited reuse of N95s for health care workers (HCWs). While HCWs followed these guidelines to conserve N95s, evidence from clinical settings regarding the safety of reuse and extended use is limited. OBJECTIVE To measure the incidence of fit test failure during N95 reuse and compare the incidence between N95 types. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted from April 2, 2021, to July 15, 2022, at 6 US emergency departments (EDs), included HCWs who practiced N95 reuse for more than half of their clinical shift. Those who were unwilling to wear an N95 for most of their shift, repeatedly failed baseline fit testing, were pregnant, or had facial hair or jewelry that interfered with the N95 face seal were excluded. EXPOSURES Wearing the same N95 for more than half of each clinical shift and for up to 5 consecutive shifts. Participants chose an N95 model available at their institution; models were categorized into 3 types: dome (3M 1860R, 1860S, and 8210), trifold (3M 1870+ and 9205+), and duckbill (Halyard 46727, 46767, and 46827). Participants underwent 2 rounds of testing using a different mask of the same type for each round. MAIN OUTCOMES AND MEASURES The primary outcome was Occupational Safety and Health Administration-approved qualitative fit test failure. Trained coordinators conducted fit tests after clinical shifts and recorded pass or fail based on participants tasting a bitter solution. RESULTS A total of 412 HCWs and 824 N95s were fit tested at baseline; 21 N95s (2.5%) were withdrawn. Participants' median age was 34.5 years (IQR, 29.5-41.8 years); 252 (61.2%) were female, and 205 (49.8%) were physicians. The overall cumulative incidence of fit failure after 1 shift was 38.7% (95% CI, 35.4%-42.1%), which differed by N95 type: dome, 25.8% (95% CI, 21.2%-30.6%); duckbill, 28.3% (95% CI, 22.2%-34.7%); and trifold, 61.3% (95% CI, 55.3%-67.3%). The risk of fit failure was significantly higher for trifold than dome N95s (adjusted hazard ratio, 1.75; 95% CI, 1.462.10). CONCLUSIONS AND RELEVANCE In this cohort study of ED HCWs practicing N95 reuse, fit failure occurred in 38.7% of masks after 1 shift. Trifold N95s had higher incidence of fit failure compared with dome N95s. These results may inform pandemic preparedness, specifically policies related to N95 selection and reuse practices.

Introduction: Estimates of the prevalence of drug-related out of hospital cardiac arrest (OHCA) vary, ranging from 1.8% to 10.0% of medical OHCA. However, studies conducted prior to the recent wave of fentanyl deaths likely underestimate the current prevalence of drug-related OHCA. We evaluated recent trends in drug-related OHCA, hypothesizing that the proportion of presumed drug-related OHCA treated by emergency medical Methods: We conducted a retrospective analysis of OHCA patients treated by EMS providers in San Francisco, California between 2015 and 2023. Participants included OHCA cases in which resuscitation was attempted by EMS. The study exposure was the year of arrest. Our primary outcome was the occurrence of drug-related OHCA, defined as the EMS impression of OHCA caused by a presumed or known overdose of medication(s) or Results: From 2015 to 2023, 5044 OHCA resuscitations attended by EMS (average 561 per year) met inclusion criteria. The median age was 65 (IQR 50-79); 3508 (69.6%) were male. The EMS impression of arrest etiology was drug-related in 446/5044 (8.8%) of OHCA. The prevalence of presumed drug-related OHCA increased significantly each year from 1% in 2015 to 17.6% in 2023 (p-value for trend = 0.0001). After adjustment, presumed drug-related OHCA increased by 30% each year from 2015-2023. Conclusion: Drug-related OHCA is an increasingly common etiology of OHCA. In 2023, one in six OHCA was presumed to be drug related. Among participants less than 60 years old, one in three OHCA was presumed to be drug related.

PURPOSE:This study reports on a prospective, multicenter, single-arm, clinical trial utilizing the SonoMotion (San Mateo, California) Break Wave lithotripsy (BWL) device to fragment urinary stones. MATERIALS AND METHODS:Patients with a urinary stone underwent a single treatment of 30 minutes and peak negative pressure of 4.5 to 8 MPa. Subjects were contacted and outcomes assessed at 7, 14, and 35 days after treatment, with clinical follow-up and CT imaging 70 ± 14 days postprocedure. The primary objectives were to assess the safety (hematomas, complications, etc) and effectiveness of BWL (any fragmentation, residual fragments ≤4 mm or ≤2 mm, and completely stone-free rate) as assessed via noncontrast CT-kidneys, ureters, and bladder. RESULTS:Forty-four patients with a ureteral (43%) or renal (57%) stone were treated across 5 centers. Stone fragmentation occurred in 88% of cases; 70% had fragments ≤ 4 and 51% ≤ 2 mm, while 49% were completely stone free on CT; no serious adverse events were reported. Eighty-six percent of patients received either no analgesic medication at all (50%) or minor analgesia (36%). After determining optimal therapy settings, 36 patients were treated and the effectiveness improved exhibiting fragmentation in 92% (33/36), residual fragments ≤ 4 mm in 75% and 58% with fragments ≤ 2 mm with 58% completely stone free. Effectiveness was less in subjects with lower pole stones with 81% fragmentation, 71% having fragments ≤ 4 mm, 29% with fragments ≤ 2 mm, and 29% completely stone free; of distal ureteral stone patients, 89% were completely stone free. CONCLUSIONS:BWL offered safe and effective noninvasive stone therapy requiring little to no anesthesia and was carried out successfully in nonoperative environments. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT03811171.

This cohort study examines the association of reuse of N95 filtering facepiece respirators and N95 filtration efficiency.

IntroductionData on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection.MethodsParticipants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point.ResultsFollowing SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36–2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06–2.02; much less, OR: 2.23; 95%CI: 1.38–3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25–2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21–2.46; much less, OR: 2.08; 95%CI: 1.18–3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13–3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60–5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10–3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02–2.51; much less, OR: 2.49; 95%CI: 1.40–4.44), and more missed work (OR: 2.25; 95%CI: 1.27–3.98).DiscussionAwareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.