The Inflation Reduction Act: How Will Medicare Negotiating Drug Prices Impact Patients with Heart Disease?

PURPOSE OF REVIEW: Cardiovascular medications improve health and prevent early death. However, high drug prices reduce the use of these medications and strain the health system. The Inflation Reduction Act (IRA) of 2022 allows Medicare to negotiate drug prices with manufacturers and reduces out-of-pocket drug costs for Medicare beneficiaries. This article explores the potential impact that the IRA will have on the treatment of cardiovascular disease. RECENT FINDINGS: Cardiovascular disease medications are likely to be selected for price negotiations under the IRA, leading to savings for patients and for Medicare. Recent work suggests that the IRA's reforms to the Medicare Part D drug benefit will meaningfully reduce out-of-pocket costs for important cardiovascular medications. The IRA is expected to impact cardiovascular disease treatments via price negotiations and through the broader access to medications afforded by improvements to Part D coverage design.

Racial/Ethnic Differences in the Effects of Adverse Childhood Experiences on Substance Misuse among Justice-Involved Children.

Background: Adverse childhood experiences (ACEs) are linked to substance use (SU) and substance use disorders (SUD). However, this relationship has yet to be tested among justice-involved children (JIC), and it is unclear if racial/ethnic differences exist. This study aimed to determine: (1) whether ACEs are associated with increased risk of SU and SUD among JIC; and (2) if the effects of ACEs on SU and SUD are moderated by race/ethnicity. Methods: Bivariate and multivariate logistic regression analyses were employed to examine a statewide dataset of 79,960 JIC from the Florida Department of Juvenile Justice. Marginal odds were estimated to examine how race moderates the relationship between ACEs and SU and SUD. Results: Results showed higher ACEs scores were linked to SU and SUD. Black JIC were 2.46 times more likely, and Latinx JIC were 1.40 times more likely to report SU than white JIC. Specifically, Black and Latinx JIC with a higher average ACEs score were more likely to report SU but less likely to have ever been diagnosed with a SUD when compared to white JIC with equivalent ACEs. Conclusions: Study results highlight the need to develop trauma-informed and culturally appropriate interventions for SU and SUD among JIC.

Examining Gender Differences in the Relationship Between School Bonding and Opioid Misuse Among Justice-Involved Adolescents.

Justice-involved adolescents (JIAs) have an increased risk for opioid use disorder and overdose related to opioid misuse (OM). Consequences of untreated OM include recidivism and poor educational outcomes, which can be harsher for female JIA. Therefore, identifying relevant factors and settings that reduce the risk for OM is critical. Schools are a central institution in adolescent development. Drawing on social control theory, JIA with higher levels of school bonding was hypothesized to attenuate risk for OM. Cross-sectional data on 79,960 JIA from the Florida Department of Juvenile Justice were examined. Multivariate and stratified logistic regression analyses were employed. On average, for every one-unit increase in school bonding, JIA had 22%, female JIA had 23%, and male JIA had 22% lower odds of OM. Results suggest school bonding and the school context should be considered in treatment and how this setting may impact OM intervention outcomes among JIA.

Neural oscillations track recovery of consciousness in acute traumatic brain injury patients.

Electroencephalography (EEG), easily deployed at the bedside, is an attractive modality for deriving quantitative biomarkers of prognosis and differential diagnosis in severe brain injury and disorders of consciousness (DOC). Prior work by Schiff has identified four dynamic regimes of progressive recovery of consciousness defined by the presence or absence of thalamically-driven EEG oscillations. These four predefined categories (ABCD model) relate, on a theoretical level, to thalamocortical integrity and, on an empirical level, to behavioral outcome in patients with cardiac arrest coma etiologies. However, whether this theory-based stratification of patients might be useful as a diagnostic biomarker in DOC and measurably linked to thalamocortical dysfunction remains unknown. In this work, we relate the reemergence of thalamically-driven EEG oscillations to behavioral recovery from traumatic brain injury (TBI) in a cohort of N = 38 acute patients with moderate-to-severe TBI and an average of 1 week of EEG recorded per patient. We analyzed an average of 3.4 hr of EEG per patient, sampled to coincide with 30-min periods of maximal behavioral arousal. Our work tests and supports the ABCD model, showing that it outperforms a data-driven clustering approach and may perform equally well compared to a more parsimonious categorization. Additionally, in a subset of patients (N = 11), we correlated EEG findings with functional magnetic resonance imaging (fMRI) connectivity between nodes in the mesocircuit-which has been theoretically implicated by Schiff in DOC-and report a trend-level relationship that warrants further investigation in larger studies.

Primary Purpose for Committing a Crime and Past-30 Day Opioid Misuse: A Statewide Sample of Justice-Involved Children.

The prevalence of opioid misuse (OM) among justice-involved children (JIC) is significantly higher than children in the general population, yet little research has examined the predictors of OM among JIC. Goldstein's "economic compulsive model" hypothesizes that JIC who commit crimes for material gain will have a higher likelihood of meeting past-30 day (P30D) OM criteria. The data in this study were cross-sectional and represented 79,960 Florida JIC. To test the hypothesis, logistic regression analyses were utilized. Over 2000 JIC (2.67%) met P30D OM criteria and JIC who committed crimes for material gain were 2.55 times as likely to meet P30D OM criteria. Findings indicate that children may be incarcerated due to an inability to afford their addiction, contributing to the criminalization of mental health. JIC could benefit from the increased utilization of drug courts and the implementation of a cascade of care model.

The nexus between gender, parental supervision, and opioid misuse among justice-involved adolescents.

Justice-involved adolescents (JIA) are at higher risk for opioid misuse (OM) and opioid-related overdose than nonoffending adolescents. Untreated OM can lead to severe consequences (e.g., trauma), which may be harsher for female JIA. Therefore, examining risk and protective factors, such as parental supervision, is essential to identify factors that may impact OM. The current study used a statewide, cross-sectional dataset including 79,960 JIA from the Florida Department of Juvenile Justice. Stratified logistic regression analyses were conducted. Results indicated that JIA who experienced sporadic or inadequate supervision had 2.14 and 3.54 higher odds, respectively, of misusing opioids compared to JIA who experienced consistent supervision. Female JIA who experienced sporadic or inadequate supervision had 2.23 and 3.70 higher odds, respectively, of misusing opioids. Results suggest parental supervision is an important protective factor that should be considered in developing prevention and treatment efforts that serve JIA who misuse opioids, especially females.

Exploring perceptions of implementation practice capacity in community-based behavioral health organizations.

Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.

Longitudinal changes in blood-based biomarkers in chronic moderate to severe traumatic brain injury: preliminary findings.

Objectives: This longitudinal study aims at 1) providing preliminary evidence of changes in blood-based biomarkers across time in chronic TBI and 2) relating these changes to outcome measures and cerebral structure and activity.Methods: Eight patients with moderate-to-severe TBI (7 males, 35 ± 7.6 years old, 5 severe TBI, 17.52 ± 3.84 months post-injury) were evaluated at monthly intervals across 6 time-points using: a) Blood-based biomarkers (GFAP, NSE, S100A12, SDBP145, UCH-L1, T-tau, P-tau, P-tau/T-tau ratio); b) Magnetic Resonance Imaging to evaluate changes in brain structure; c) Resting-state electroencephalograms to evaluate changes in brain function; and d) Outcome measures to assess cognition, emotion, and functional recovery (MOCA, RBANS, BDI-II, and DRS).Results: Changes in P-tau levels were found across time [p = .007]. P-tau was positively related to functional [p < .001] and cognitive [p = .006] outcomes, and negatively related to the severity of depression, 6 months later [R = -0.901; p =.006]. P-tau and P-tau/T-tau ratio were also positively correlated to shape change in subcortical areas such as brainstem [T(7) = 4.71, p = .008] and putamen [T(7) = 3.25, p = .012].Conclusions: Our study provides preliminary findings that suggest a positive relationship between P-tau and the recovery of patients with chronic TBI.

Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children.

AIM: Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. METHODS: A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. RESULTS: Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. CONCLUSION: Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.

Runaway History and Past 30-Day Opioid Misuse in Justice-Involved Adolescents.

This study used a sample from the Florida Department of Juvenile Justice (n= 79,960) to analyze the association between runaway history and past 30-day opioid misuse (OM) among justice involved adolescents. Past 30-day OM was confirmed using a urine analysis. Adolescents who were runaways in their lifetime were twice as likely to misuse opioids, and those who were runaways at the time of arrest were three times as likely to be opioid misusers compared to adolescents who never ran away or been kicked out of a home. These findings emphasize a need for resources that focus on developing strong attachment bonds.

The association between somatic complaints and past-30 day opioid misuse among justice-involved children.

BACKGROUND: Individuals in the criminal justice system are especially vulnerable to the adverse effects of opioid misuse. Research on justice-involved children (JIC) is needed to uncover the variables that predict opioid misuse initiation to prevent misuse or reduce harm in this population. Somatic symptoms are symptoms experienced in the body, such as physical sensations, movements or experiences, which can cause severe distress and dysfunction. These include pain, nausea, dizziness, and fainting. In this study, we hypothesize that somatic complaints will be associated with a higher likelihood of opioid misuse among Florida JIC. METHODS: The study examined statewide data on 79,960 JIC in the Florida Department of Juvenile Justice database. Logistic regression was employed to investigate an ordinal measure of somatic complaints at first screen and a binary outcome measure of past-30 day illicit or nonmedical opioid use at final screen while controlling for sociodemographic and mental health factors. RESULTS: Nearly 28% of JIC had a history of one or more somatic complaints. Compared to those with no history of somatic complaints, JIC with a history of one or two somatic complaints were 1.23 times more likely to misuse opioids in the past 30 days and those with three or four somatic complaints were 1.5 times more likely to meet criteria for past-30 day opioid misuse. CONCLUSIONS: Individuals may consume illicit or non-medical prescription opioids to manage somatic symptoms - indicating that increased access to healthcare may reduce misuse. Risk of opioid overdose sharply increases as justice-involved individuals are released from correctional settings largely due to a reduced tolerance to opioids as a result of incarceration and diminished access to legal medicines that are provided in the justice system. Justice systems must ensure seamless access to quality healthcare services as individuals transition from correctional settings to their communities.

Parental perceptions linked to opioid misuse among justice-involved children.

Justice-involved children (JIC) are a subset of at-risk youth highly susceptible to the ill-consequences of opioid misuse (OM), especially for younger JIC. Parental practices and attitudes towards delinquency are known to influence a child's behavior, however the relationship between parental attitudes towards youth delinquent behavior and odds of OM has yet to be investigated. The current study used a sample from the Florida Department of Juvenile Justice (age 10-18; M=14; n=79,960) to investigate how parental attitudes towards youth delinquent behavior influence the likelihood JIC meet criteria for past-30 day (P30D) OM. P30D OM was verified utilizing urinalysis. Youth with parents expressing proud or accepting attitudes towards youth delinquent behavior were roughly twice as likely to meet criteria for P30D OM as those with parents expressing disapproving attitudes. This relationship varied by age, with younger ages experiencing the greatest risk. These findings support early intervention efforts to develop prosocial attitudes in youth and their parents.

Age-related differences in the neural bases of phonological and semantic processes in the context of task-irrelevant information.

As we age we have increasing difficulty with phonological aspects of language production. Yet semantic processes are largely stable across the life span. This suggests a fundamental difference in the cognitive and potentially neural architecture supporting these systems. Moreover, language processes such as these interact with other cognitive processes that also show age-related decline, such as executive function and inhibition. The present study examined phonological and semantic processes in the presence of task-irrelevant information to examine the influence of such material on language production. Older and younger adults made phonological and semantic decisions about pictures in the presence of either phonologically or semantically related words, which were unrelated to the task. FMRI activation during the semantic condition showed that all adults engaged typical left-hemisphere language regions, and that this activation was positively correlated with efficiency across all adults. In contrast, the phonological condition elicited activation in bilateral precuneus and cingulate, with no clear brain-behavior relationship. Similarly, older adults exhibited greater activation than younger adults in several regions that were unrelated to behavioral performance. Our results suggest that as we age, brain-behavior relations decline, and there is an increased reliance on both language-specific and domain-general brain regions that are seen most prominently during phonological processing. In contrast, the core semantic system continues to be engaged throughout the life span, even in the presence of task-irrelevant information.

Family structure and past-30 day opioid misuse among justice-involved children.

BACKGROUND: To prevent opioid-related overdose among high risk youth, research on the predictors of opioid misuse (OM) initiation among justice-involved children (JIC) is needed. Living in a single-parent household, an important adverse childhood experience, is prevalent among JIC and linked to substance abuse. It is hypothesized that JIC who live in single-parent households will have a higher likelihood of meeting criteria for past-30 day OM than those who live in two-parent households. METHODS: The data in this paper were obtained from the Florida Department of Juvenile Justice (FLDJJ). Cross-sectional data on 79,960 JIC from FLDJJ were examined. To test the hypothesis, multivariate logistic regression analyses were employed. RESULTS: Over 2,000 JIC in the sample met criteria for past-30 day (P30D) OM. Over 27.1% of those who met criteria for past-30 day OM lived in a two-parent household while 21.3% of those who were non-past-30 day users lived in two-parent households. Contrary to our hypothesis, JIC who lived in grandparent-only households were 28% as likely to report P30D OM as those who lived in single-parent households. Those who lived in two-parent households were 16% as likely to meet criteria for P30D OM as those in single-parent households. These relationships varied by age. CONCLUSION: Two-parent and grandparent-only households maybe associated with increased access to opioids compared to other family structures with fewer adults. The risk of increased access may be more harmful than the strain of a single-parent household. Disposal of prescription medication initiatives should target households with multiple adults and grandparents.

The Association Between Admiration of Antisocial Peers and Past 30-Day Opioid Misuse Among Justice-Involved children.

AIM: Prevention of illicit or nonmedical opioid use, called opioid misuse (OM) is a key public health concern that requires research on the factors that influence OM initiation among high-risk populations. Justice-involved children (JIC) have more risk factors and fewer resources. Antisocial peers have been linked to adolescent substance abuse and delinquency. However, the association between the admiration of antisocial peers and OM among JIC has not yet been studied. This study hypothesizes that admiration of antisocial peers will be associated with a higher likelihood of OM among Florida JIC. METHODS: Cross-sectional data on 79,960 JIC from the Florida Department of Juvenile Justice (FLDJJ) were examined. To test the hypothesis, bivariate and multivariate logistic regression analyses were employed. The multivariate models controlled for gender, race, age in 2007, family income, history of mental health, history of depression, and optimism. RESULTS: Nearly 2.7% of the sample met the criteria for past 30-day OM, and over 75% of those current users admired or somewhat admired their antisocial peers. Compare to JIC who did not admire their antisocial peers, those who had some admiration of antisocial peers were 2.39 times more likely to misuse opioids in the past 30-days and those who admired their antisocial peers were 4.40 times more likely to meet the criteria for past 30-day OM. CONCLUSIONS: Cultivating positive peer interactions and providing positive peer role models may help to reduce illicit opioid use among JIC.

Trauma, Race, and Risk for Violent Felony Arrests Among Florida Juvenile Offenders.

This study tests the assumptions of the The Childhood Trauma Model, which proposes that marginalized populations are both more likely to have traumatic childhoods and more criminalized than those in the upper echelons of society. It hypothesizes that traumatic childhood experiences increase risk of being sanctioned for violent behavior, and risks are amplified for minority and disadvantaged groups. The study finds that experiencing three or more traumas had a 200% to 370% increased chance of being arrested for a violent felony as youth who experienced a single traumatic event, and Blacks had up to 300% increased risk than Whites with equal trauma scores.

Frontoparietal activation during visual conjunction search: Effects of bottom-up guidance and adult age.

We conducted functional magnetic resonance imaging (fMRI) with a visual search paradigm to test the hypothesis that aging is associated with increased frontoparietal involvement in both target detection and bottom-up attentional guidance (featural salience). Participants were 68 healthy adults, distributed continuously across 19 to 78 years of age. Frontoparietal regions of interest (ROIs) were defined from resting-state scans obtained prior to task-related fMRI. The search target was defined by a conjunction of color and orientation. Each display contained one item that was larger than the others (i.e., a size singleton) but was not informative regarding target identity. Analyses of search reaction time (RT) indicated that bottom-up attentional guidance from the size singleton (when coincident with the target) was relatively constant as a function of age. Frontoparietal fMRI activation related to target detection was constant as a function of age, as was the reduction in activation associated with salient targets. However, for individuals 35 years of age and older, engagement of the left frontal eye field (FEF) in bottom-up guidance was more prominent than for younger individuals. Further, the age-related differences in left FEF activation were a consequence of decreasing resting-state functional connectivity in visual sensory regions. These findings indicate that age-related compensatory effects may be expressed in the relation between activation and behavior, rather than in the magnitude of activation, and that relevant changes in the activation-RT relation may begin at a relatively early point in adulthood. Hum Brain Mapp 38:2128-2149, 2017. © 2017 Wiley Periodicals, Inc.

Medicare 2.0-A Vision for the Future of America's Health Insurance Plan.

This Viewpoint offers recommendations to unify various Medicare reform proposals to optimize the health insurance plan.