A non-randomized pilot study to test the feasibility of treating chronic pain and opioid prescription use in rural areas with acceptance and commitment therapy (T-PACT).

Chronic non-cancer pain (CNCP) involves one-third of the US population, and prescription opioids contribute to the opioid epidemic. The Centers for Disease Control and Prevention emphasizes maximizing non-opioid treatment, but many rural populations cannot access alternative therapies. Clinical and Translational Science Award hubs across four rural states performed a multi-site, single-arm intervention feasibility study testing methods and procedures of implementing a behavioral intervention, acceptance and commitment therapy, in primary care CNCP patients on chronic opioids. Using the CONSORT extension for feasibility studies, we describe lessons learned in recruiting/retaining participants, intervention implementation, data measurement, and multi-site procedures. Results inform a future definitive trial and potentially others conducting rural trials.

Greater Odds for Angina in Uranium Miners Than Nonuranium Miners in New Mexico.

OBJECTIVE: The aim of this study was to test the hypothesis that uranium miners in New Mexico (NM) have a greater prevalence of cardiovascular disease than miners who extracted the nonuranium ore. METHODS: NM-based current and former uranium miners were compared with nonuranium miners by using cross-sectional standardized questionnaire data from the Mining Dust in the United States (MiDUS) study from 1989 to 2016. RESULTS: Of the 7215 eligible miners, most were men (96.3%). Uranium miners (n = 3151, 43.7%) were older and diabetic, but less likely to currently smoke or use snuff (P ≤ 0.001 for all). After adjustment for covariates, uranium miners were more likely to report angina (odds ratio 1.51, 95% confidence interval 1.23 to 1.85) than nonuranium miners. CONCLUSION: Our data suggest that along with screening for pulmonary diseases, uranium industry workers should be screened for cardiovascular diseases.

Uranium Workers Demonstrate Lower Lobe Predominant Irregular Pneumoconiotic Opacities on Chest Radiographs.

BACKGROUND: There is a paucity of literature on the chest radiographic findings in uranium workers. OBJECTIVE: To characterize the chest radiographic findings of pneumoconiosis in a New Mexican cohort of uranium workers. METHODS: The most recent results from chest radiographs were abstracted in this cross-sectional study. RESULTS: Radiographs showed small pneumoconiotic opacities of profusion score of ≥ 1/0 in 155/429 (36.1%) uranium workers. The most common shape/size of the primary and secondary opacities was s (90.3%) and t (83.7%) types, respectively. Lower lung zones were the most affected. American Indians were the population group at greatest odds for having profusion score ≥ 1/0 (O.R. 2.65, 95% C.I. 1.61, 4.36). CONCLUSIONS: Uranium workers' pneumoconiosis is associated with predominantly lower lobe, irregular, and small opacities. Clinical providers and policymakers must consider uranium workers' pneumoconiosis in the differential diagnosis for lower lobe-predominant interstitial lung disease, in the appropriate exposure setting.

Similar Risk Patterns After Cervical Screening in Two Large U.S. Populations: Implications for Clinical Guidelines.

OBJECTIVE: To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets. METHODS: The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21-64 years screened in 2007-2011 in the New Mexico HPV Pap Registry and 2003-2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion. RESULTS: There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P=.5), ASC-US (3.4% and 3.4%, respectively, P=.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P=.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P=.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P=.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable. CONCLUSION: Current U.S. cervical screening and management recommendations are based on comparative risks of histologic high-grade CIN after screening test results. The similar results from these two large cohorts from different real-life clinical practice settings support risk-based management thresholds across U.S. clinical populations and practice settings.

Black widow spider envenomation in pregnancy.

OBJECTIVE: Little data exist regarding the optimal treatment and outcomes of pregnancies complicated by black widow spider envenomation. Our objective is to evaluate the clinical effects, medical outcomes, and treatment differences between pregnant and nonpregnant women. METHODS: This observational study is based on a review of the database maintained by the American Association of Poison Control Centers from 2003 to 2007. RESULTS: Of the 12,640 human black widow spider envenomations reported at 61 poison centers in the United States, 3194 (25.3%) involved women of reproductive age, defined as age 15-45 years of age, with 97 (3.0% of reproductive-age women) being pregnant. Comparing pregnant and nonpregnant women, there were no significant differences in recommended or administered treatments. Pregnant women were more likely than nonpregnant women (OR: 1.84, 95% CI: 1.20-2.83) to have outcomes coded as minor, moderate, or major rather than no effect. Significantly higher percentages of pregnant patients were treated at a healthcare facility where they were either released (36.1% vs. 19.9%, p < 0.001) or admitted (13.4% vs. 4.0%, p < 0.001), than nonpregnant women. There were no documented pregnancy losses. CONCLUSIONS: Black widow spider envenomation is a rare occurrence in pregnant women and the short-term outcomes appear to be favorable.