Alternative use of buprenorphine among people who use opioids in three U.S. Cities.

Background: Buprenorphine is an effective treatment for opioid use disorder, yet some persons are concerned with its "alternative use" (i.e., any use unintended by the prescriber). There is limited evidence on the factors associated with alternative use of buprenorphine (AUB); in this study, we examined correlates of recent (past 6 months) AUB. Methods: Multivariable logistic regression was used to analyze survey data from a multi-site, cross-sectional study of people who use drugs (PWUD) (N = 334) in Baltimore, Maryland; Boston, Massachusetts; and Providence, Rhode Island. Results: One-fifth (20%) of the sample reported recent AUB. In adjusted analyses, significant negative correlates of AUB were female gender (adjusted odds ratio [aOR] 0.48, 95% confidence intervals [CI] 0.24-0.95), recent emergency room visit (aOR 0.45, 95% CI 0.23-0.89), and recent injection drug use (aOR 0.41, 95% CI 0.19-0.88). Significant positive correlates were alternative use of other prescription opioids (aOR 8.32, 95% CI 4.22-16.38), three or more overdoses in the past year (aOR 3.74, 95% CI 1.53-9.17), recent buprenorphine use as prescribed (aOR 2.50, 95% CI 1.12-5.55), and recent residential rehabilitation treatment (aOR 3.71, 95% CI 1.50-9.16). Conclusions: Structural and behavioral correlates of AUB may help identify PWUD at high risk of overdose with unmet treatment needs.

Water quality and probabilistic non-carcinogenic health risk of groundwater: a half decadal scenario change in Vadodara.

Groundwater is essential to secure the safety of water supply in Vadodara, Gujarat. In this study, groundwater samples were collected from various part of the city which separated in 12 wards. The present study contains analyses of 720 groundwater samples gathered from various tube and open wells and analyzed for fluoride and other physicochemical parameters during 2014 and 2019. The results indicated that fluoride and TDS were high and the overall water quality was poor in the study area. Gastrointestinal and other health-related issues increased due to higher TDS in east, north and northeast regions. Likewise, hierarchical cluster analysis also indicated that TDS and chloride-rich water. Fluoride concentration was observed in the range of 0.66-1.61 mg/l (2014) and 0.86-1.77 mg/l (2019) which indicates that 62% samples are unfit for drinking purpose, which could cause dental and skeletal fluorosis. The water quality index (WQI) indicated lack of excellent water in the studied area in the last half-decade. As per WQI calculation suggest that 82.12% (2014) and 69.00% (2019) of groundwater samples represent poor, very poor and unsuitable categories, whereas remaining 17.85% (2014) and 31.00% (2019) of the samples represent good category for drinking purposes in entire Vadodara, Gujarat. Marginal improvement in the groundwater quality is reported due to good rainfall in 2019. Health risks associated with high fluoride drinking water were assessed for various age groups of inhabitants such as children, infants and adults. The non-carcinogenic hazard quotient estimated by oral intake was 1.38-3.36 (2014) and 1.79-3.70 (2019) for infants; 0.69-1.68 (2014) and 0.90-1.85 (2019) for children, whereas 0.07-0.18 (2014) and 0.10-0.20 (2019) for adults. Therefore, infant and children are relatively at higher health risk due to the intake of fluoride-rich drinking water than adult in the studied region. Both indices were indicated contaminated water or closer to contamination which induced non-carcinogenic health risk on citizens. Thus, the comprehensive results of present study can be used as a baseline data and valuable tool for government authorities for long-term monitoring, health monitoring and sustainable development of Vadodara, Gujarat.

Physical and Vestibular Physical Therapy Referrals in People With Alzheimer Disease.

People with Alzheimer disease (AD) are at increased risk of falls and disproportionately burdened with vestibular impairment compared with healthy older adults. Although physical therapy (PT) and vestibular physical therapy (VPT) are effective rehabilitation interventions in improving balance and fall risk, referral patterns for these services in the AD population are understudied. A retrospective chart review was conducted of patients seen for primary AD care at a tertiary AD referral center to investigate the frequency of rehabilitation referrals. Of the 801 people with AD seen for AD care in 1 year, 48 individuals (6.0%) were referred to PT and 5 individuals (0.6%) to VPT. People with AD appear to receive very infrequent PT and VPT referrals, despite the potentially large number of people with AD who could benefit from PT and VPT services to improve their balance and vestibular function.

Self-Reported Sense of Direction and Vestibular Function in the Baltimore Longitudinal Study of Aging (BLSA).

Sense of direction is an individual's ability to navigate within an environment and generate a mental map of novel environments. Although sense of direction is correlated with psychometric tests of spatial ability, it also reflects an individual's real-world spatial ability that is not fully captured by laboratory-based assessments. Sense of direction is known to vary widely in the population and has been shown to decline with age. However, other factors that contribute to an individual's sense of direction have not been well-characterized. Vestibular impairment has been linked to reduced spatial cognitive ability, which encompasses spatial memory and navigation skills. Several studies have shown that vestibular input is necessary for effective spatial cognition, notably accurate spatial navigation ability. These studies have typically considered laboratory-based spatial navigation assessments; however, the influence of vestibular function on variation in real-world sense of direction is unknown. In this study, we evaluated whether vestibular function is associated with self-reported sense of direction. Participants for this cross-sectional study were recruited from the Baltimore Longitudinal Study of Aging, a longstanding cohort study of healthy aging. In a modified version of the Santa Barbara Sense-of-Direction (SBSOD) Scale, participants rated statements about spatial and navigational abilities. A lower average score indicates poorer self-reported sense of direction. Vestibular function testing included cervical vestibular-evoked myogenic potential (VEMP) to assess saccular function, ocular VEMP to assess utricular function, and the video head-impulse test to assess semicircular canal function based on vestibular ocular reflex. The study sample included 82 participants with mean age of 71.0 (± 16.9) years and mean SBSOD score of 4.95(± 1.07). In a multivariate linear regression model, female sex and bilateral saccular loss were associated with a lower average SBSOD score. These data suggest that vestibular impairment contributes to the known variation in spatial navigation ability.

Health Care in the Age of Mass Incarceration: A Selective Course for Medical Students in Their Preclinical Years.

Introduction: While medical school curricula increasingly address health disparities, content regarding health care for persons impacted by incarceration is a persistent and notable gap. There is a high burden of disease among incarcerated populations, and health care challenges continue postincarceration. We developed a course to introduce medical students to the current landscape of mass incarceration in the US and implications for health and health care delivery to people impacted by this system. Methods: We developed a 3.5-hour elective course taken by 19 first-year medical students in its first year and 20 students in its second. The course utilized lecture, case-based discussion, and guest speaker modalities to introduce students to the history of mass incarceration, health care delivery within the carceral system, and challenges in accessing care during and following incarceration. Results: Students received two surveys after completing the course. In the first, 100% of respondents reported outstanding, excellent, or good levels of satisfaction with various elective components, including organization, learning activities, and student discussion. The second found significant increases in knowledge about mass incarceration and incarceration health issues, in addition to significant increases in interest in advocating or providing health care for incarcerated populations. Discussion: Given current mass incarceration practices, students will encounter patients impacted by this system. This elective course sought to better prepare students to effectively care for these patients. We were limited by time availability, and future directions include incorporating a standardized patient exercise, trauma-informed care principles, and providers working within the carceral system.

Mild Transaminase Elevation With Rapid Diagnostic Escalation: A Teachable Moment.

This Teachable Moment describes a 33-year-old woman with decreasing transaminase levels on repeated testing and ultrasonography showing fatty infiltration.