Prescription Painkiller Misuse in Hispanic and non-Hispanic Adults Ages 50 and Older: Trends and Correlates in a National Sample, 2015-2019.

Background: Older adults, an increasingly diverse segment of the United States population, are a priority population for prescription painkiller misuse. This study documents trends and correlates of prescription painkiller misuse among Hispanic and non-Hispanic adults ages 50 and older. Methods: A secondary analysis of adults 50 years and older across 5 cohorts using the 2015-2019 National Survey on Drug Use and Health (unweighted n = 16,181, 8.5% Hispanic, and 54% female). Logistic regression modeling with complex survey design was used to examine trends in prescription painkiller misuse. Results: Over time, the prevalence of past year painkiller misuse significantly decreased for Hispanic respondents (56.1% relative decrease, p = 0.02); elevated proportions were observed across strata of demographic characteristics. Conclusions: Variability in the prevalence of painkiller misuse may be explained by demographic characteristics. Further, these results emphasize the importance of addressing comorbid recreational marijuana use when designing interventions to address painkiller misuse for older adults.

Postmortem THC in decedents following legalization of recreational cannabis in Clark County, Nevada.

Marijuana is the most prevalent illicit substance used globally. With increasing US legalizing recreational marijuana, more evidence is vital to minimize potential health risks. This study was conducted to test several hypotheses regarding postmortem THC/COOH-THC in decedents before and after legalization of recreational marijuana in Nevada. We also compared presence of THC/COOH-THC in decedents with respect to manner of death as recorded by the Clark County Office of the Coroner/Medical Examiner. THC/COOH-THC concentrations for years 2015-2016 (pre-legalization) and 2017-2019 (post-legalization) were compared through an independent samples t-test and chi-square tests. A binary logistic regression was used to compare the presence of THC/COOH-THC with covariates: age, gender, race, and manner of death. The average concentration of THC/COOH-THC detected per decedent did not significantly differ before and after recreational legalization, whereas the proportion of decedents testing positive for THC showed a small but significant increase following legalization although no significant change in COOH-THC was detected. The likelihood of testing positive for THC/COOH-THC decreased as age increased. Sex, race, and manner of death were all associated with the relative risk of presence of THC/COOH-THC in toxicology reports. An increase in proportion of users but not in concentration of THC/COOH-THC was observed after legalization. The results are generally consistent with national reports and suggest toxicology data from decedents is a valuable method for surveying marijuana use by the general public. The early adoption of recreational marijuana by neighboring states may have precluded any major changes in use following legalization in Nevada.

Efficacy of EUS-guided needle-based confocal laser endomicroscopy in the diagnosis of pancreatic lesions: A systematic review and meta-analysis.

Background and Objectives: Needle-based confocal laser endomicroscopy (nCLE) is a procedure in which an AQ-Flex nCLE mini-probe is passed through an EUS-FNA needle into a pancreatic lesion to enable subsurface in vivo tissue analysis. In this study, we conducted a systematic review and meta-analysis of nCLE for the diagnosis of pancreatic lesions. Materials and Methods: We conducted a comprehensive search of several databases and conference proceedings, including PubMed, EMBASE, Google-Scholar, MEDLINE, SCOPUS, and Web of Science databases (earliest inception to March 2020). The primary outcomes assessed the pooled rate of diagnostic accuracy for nCLE and the secondary outcomes assessed the pooled rate of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and adverse events (AE) of nCLE to diagnose premalignant/malignant pancreatic lesions. Results: Eleven studies on 443 patients were included in our analysis. The pooled rate of diagnostic accuracy of EUS nCLE was 83% (95 confidence interval [CI] = 79-87; I 2 = 0). The pooled rate of sensitivity, specificity, PPV and NPV of EUS nCLE was 85.29% (95% CI = 76.9-93.68; I 2 = 85%), 90.49% (95% CI = 82.24-98.74; I 2 = 64%), 94.15% (95% CI = 88.55-99.76; I 2 = 68%), and 73.44% (95% CI = 60.16-86.72; I 2 = 93%), respectively. The total AE rate was 5.41% (±5.92) with postprocedure pancreatitis being the most common AE at 2.28% (±3.73). Conclusion: In summary, this study highlights the rate of diagnostic accuracy, sensitivity, specificity, and PPV for distinguishing premalignant/malignant lesions. Pancreatic lesions need to be further defined with more validation studies to characterize CLE diagnosis criteria and to evaluate its use as an adjunct to EUS-FNA.

Comparing the effect of distance to treatment facility on reconstruction and breast conservation therapy for early-stage invasive ductal carcinoma between the nation and the mountain region.

BACKGROUND: Our objective is to evaluate the effect of distance to facility on the use of breast conservation therapy and reconstruction for early stage breast cancer. METHODS: Utilizing the National Cancer Database, we identified females, age <65, with Stage I invasive ductal carcinoma from 2004 to 2015. Using logistic regression, we compared radiation, mastectomy, and reconstruction treatment patterns. A subgroup analysis was performed within the mountain region (MR). RESULTS: Nationwide, there are decreasing odds of radiation, increasing odds of mastectomy, and increasing odds of reconstruction. Patients living farther were less likely to receive radiation, more likely to undergo mastectomy, with no effect on reconstruction. Within the MR, patients living farther from their facility were less likely to receive radiation, more likely to undergo mastectomy, however, they were less likely to undergo reconstruction. CONCLUSIONS: Nationwide and within the MR, patients living farther from their facility are less likely to receive radiation and more likely to undergo mastectomy. There is a disparity between the MR and the nation in use of reconstruction for this population.

Cancer survivorship in hematologic malignancies: Lifestyle changes after diagnosis.

BACKGROUND: Studies show that patients make lifestyle changes soon after certain solid tumor diagnoses, suggesting that this may be a teachable moment to motivate and promote healthy behaviors. There is a paucity of data regarding changes made after a diagnosis of a hematologic malignancy. METHODS: A cross-sectional study of 116 patients at a community oncology center who completed anonymous questionnaires was performed. Questions addressed lifestyle choices made with respect to smoking, alcohol consumption, recreational drug use, diet, and exercise habits before and after diagnosis of a hematologic malignancy. Support systems utilized, including psychiatry services, were also assessed. RESULTS: Patients exhibited significant reduction in smoking behavior (Χ2  = 31.0, p < 0.001). 82.4% (n = 14) of one pack per day smokers quit between the time periods, with nearly all smokers showing a reduction after diagnosis. Alcohol use overall did not change significantly, however, 10.3% (n = 12) of patients reported quitting drinking completely between time periods. Changes in dietary intake and exercise were not statistically significant overall. Utilization of external support systems correlated with improved diet as well as decrease in total smoking years. CONCLUSIONS: This study demonstrates that patients exhibited significant lifestyle changes after being diagnosed with a hematologic malignancy. Clinicians should take advantage of this 'teachable moment' to educate patients about positive health behavior changes. Advances in cancer therapeutics have led to an increase in cancer survivors, this education is crucial in reducing the risk of developing chronic comorbidities as well as secondary malignancies.

Comparing treatment patterns of hepatocellular carcinoma at academic centers and non-academic centers within the Mountain Region.

BACKGROUND: Our objective is to explore differences in survival and treatment approaches for hepatocellular carcinoma (HCC) between academic centers (ACs) and non-academic centers (NACs), which may contribute to disparities in the Mountain Region (MR). METHODS: Using the National Cancer Database, HCC cases from 2004 to 2015 in the MR were divided into AC and NAC subgroups. Cox-proportional hazard regression and binary logistic regression were performed to analyze survival, compare treatment patterns, and examine the effect of facility type and surgical approach on margin status. RESULTS: Treatment at ACs, compared to NACs, is associated with improved survival. At ACs, the odds of surgical or systemic treatment were higher. The odds of receiving radiation and positive margins was lower. Overall, the odds of positive margins was higher with laparoscopic compared to open or an unspecified surgical approach; this relationship persisted on subgroup analysis of NACs, but not ACs. CONCLUSIONS: Treatment of HCC at an AC in the MR increases the odds of surgery and improves survival. A laparoscopic approach increases the odds of positive margins, irrespective of center type.

Low colorectal cancer survival in the Mountain West state of Nevada: A population-based analysis.

Colorectal cancer (CRC) is the third greatest cancer burden in the United States. The remarkably diverse Mountain West state of Nevada has uncharacteristically high CRC mortality compared to other Western states. We aimed to study the determinants of the CRC excess burden by using data from the Nevada Central Cancer Registry from 2003-2013. Five-year cause-specific age-adjusted survival from colorectal cancer was calculated and stratified by sex, race/ethnicity and region of Nevada. Cox Proportional Hazards regression modelling was used to study the impact of demographic, social, and clinical factors on CRC survival in Nevada, assessing follow-up as accurately as possible. The extent to which differences in survival can be explained by receipt of stage-appropriate treatment was also assessed. 12,413 CRC cases from 2003-2013 in Nevada were analyzed. Five-year CRC survival was low: 56.0% (95% CI: 54.6-57.5) among males and 59.5% (95% CI: 58.0-61.1) among females; significantly lower than national 5-year survival of 65.1% and 66.5%, respectively. Low survival was driven by populous Southern Nevada; after adjustment for all covariates, Southern Nevadans were at 17% higher risk of death than their counterparts in Northwestern Nevada (HR:1.17; 95% CI:1.08-1.27). Many patients did not receive stage-appropriate treatment, although this only partly explained the poor survival, uniformly low for every race/ethnicity in Nevada. The observed disparity for this one state within a single nation merits public health attention; regardless of the state or region of residence, all Americans deserve equal opportunity for optimum health outcomes in the face of a cancer diagnosis. The current study provides baseline information critical to clinicians, public health professionals, and all relevant stakeholders as they attempt to discern why Nevada's outcomes are vastly divergent from its neighboring Western states and make plans for remediation.

Health Disparities Among Sexual Gender Minority Women in the United States: A Population-Based Study.

There is a paucity of population-based research to identify health disparities experienced by sexual gender minority (SGM) women. The purpose of this study was to use a population-based data set to understand disparities in access to healthcare, preventive care, and health risk behaviors of lesbian and bisexual women compared to their straight counterparts and to each other. This was a cross-sectional study using the 2016 Behavioral Risk Factor Surveillance System data. SPSS with complex samples was used to calculate weighted descriptive statistics. Logistic regression was used to calculate odds and adjusted odds ratios. 9016 women were included in the analyses. Women who identified as lesbian were more likely to be from a minority group. Bisexual women were more likely to be in the younger age groups and were less likely to be college graduates or report a higher income. Lesbian and bisexual women were more likely to report depression, smoking, and heavy/binge drinking compared to straight women. They were also less likely to have received a pap test. Compare to lesbian women, bisexual women were more likely to report depression and poorer health. SGM women are at greater risk of depression and risky coping behaviors such as smoking and heavy/binge drinking. Within the SGM subgroup, bisexual women have a higher risk for depression and worse general health. Health promotion programs and interventions must be tailored to account for the unique stressors SGM women encounter and associated negative health outcomes.

Effects of Human Maternal Placentophagy on Maternal Postpartum Iron Status: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

INTRODUCTION: Advocates of human maternal placentophagy report that encapsulated placenta is an excellent source of dietary iron. Our study compared the effect of ingested encapsulated placenta on maternal postpartum iron status versus that of a beef placebo. METHODS: A randomized, double-blind, placebo-controlled pilot study (N = 23) was conducted among healthy human research participants experiencing a normal pregnancy. Maternal iron status was measured via hemoglobin, transferrin, and ferritin taken from blood samples drawn in the participants' homes at 4 time points: the 36th week of pregnancy, within 96 hours of parturition, between days 5 and 7 postpartum, and during week 3 postpartum. Iron concentrations in the encapsulated placenta and encapsulated beef placebo were compared using inductively coupled plasma mass spectrometry. RESULTS: Seventy-eight percent (18/23) of study participants' hemoglobin concentrations were above the World Health Organization cutoff for gestational iron deficiency (≥ 11.0 g/dL) during the 36th week of pregnancy. Results revealed no statistically significant differences (hemoglobin, P = .603; ferritin, P = .852; transferrin, P = .936) in maternal iron status (including postpartum iron rebound in the first week postpartum) between women in the placenta supplement (n = 10) and placebo (n = 13) groups. Average iron concentrations were considerably higher in encapsulated placenta (0.664 mg/g) compared to the encapsulated beef placebo (0.093 mg/g) but provided only 24% of the recommended daily allowance (RDA) for iron among lactating women based on the study's maximum daily intake. DISCUSSION: The current study suggests that encapsulated placenta supplementation neither significantly improves nor impairs postpartum maternal iron status for women consuming the RDA of dietary iron during pregnancy and lactation, compared to a beef placebo. This may be an especially important finding for women who are iron deficient postpartum and whose only source of supplemental dietary iron is encapsulated placenta, as this may provide an inadequate source of supplemental iron in cases of deficiency.

Association of Leisure-Time Physical Activity to Cardiovascular Disease Prevalence in Relation to Smoking among Adult Nevadans.

It is well known that cigarette smoking and physical activity have significant impacts on cardiovascular disease (CVD) mortality and morbidity. Meanwhile, it is of interest to understand whether physical activity protects against CVD for smokers in a similar manner as it does for non-smokers. The present study examined how leisure-time physical activity (LTPA) is associated with the prevalence of CVD in relation to smoking status among adult Nevadans, using data from the 2010 Nevada Behavioral Risk Factor Surveillance System. Of the 3,913 survey respondents, 8.5% self-reported that they had ever been diagnosed with CVD. People with a history of CVD were significantly less likely to engage in LTPA than those with no history of CVD (p < 0.05). After adjusting for common sociodemographic variables, it was revealed that people with CVD were twice more likely to not engage in LTPA than their counterparts independent of smoking status. Without taking LTPA into account, the odds of having CVD for current and former smokers was 1.87-2.25 times higher than the odds for non-smokers. Interestingly, however, if LTPA was accounted for, there was no significant difference in the odds of having CVD between current and non-smokers. These results indicate that LTPA is inversely associated with the prevalence of CVD independent of smoking status, and that regular physical activity may protect against CVD for smokers as well as for non-smokers. Physical activity, along with smoking cessation, should be promoted to better prevent and control CVD among smokers.