52426 research outputs found
Sort by
Disparities in Treatment and Referral After an Opioid Overdose Among Emergency Department Patients.
No full textIMPORTANCE: There is a disproportionately high rate of overdose deaths immediately following an emergency department (ED) visit for opioid overdose. Thus, an improved understanding of disparities in ED treatment and referral is vital. Racial and ethnic disparities in access to naloxone and buprenorphine have been described in the outpatient setting but prevalence in the ED setting remains understudied.
OBJECTIVE: To examine racial and ethnic disparities in treatment referral rates in ED patients with opioid overdose.
DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of a prospective consecutive cohort from the Toxicology Investigators Consortium (TOXIC) Fentalog Study from September 21, 2020, to November 11, 2023. Ten hospital sites were a part of the TOXIC network and participants included ED patients in aged 18 years or older with opioid overdose. Data were analyzed from December 2022 to March 2025.
EXPOSURES: Patient race, ethnicity, sex, and other demographic and clinical factors of interest.
MAIN OUTCOMES AND MEASURES: Study outcomes included the proportion of patients receiving a referral to outpatient addiction care and the proportion receiving a naloxone kit or prescription or buprenorphine prescription at discharge. Descriptive statistics were tabulated, and χ2 and multivariable logistic regression analyses were used to evaluate for differences by race, ethnicity, sex, and other demographic and clinical variables.
RESULTS: In this study, 1683 patients met all inclusion criteria (mean [SD] age, 42.5 [14.5] years; 1221 males [72.6%]; 461 females [27.4%]; 447 Black patients [26.6%]; 63 Hispanic patients [4.3%]; 867 White patients [51.5%]). Of the 1683 included patients, 299 (17.8%) received a referral for outpatient treatment, 713 (42.4%) received a naloxone kit or prescription, and 141 (8.4%) received a buprenorphine prescription. Compared with White patients, Black patients had a decreased adjusted odds ratio (aOR) of outpatient treatment referral (aOR, 0.67; 95% CI, 0.47-0.97). Hospital admission was also associated with increased adjusted odds of outpatient treatment referral (aOR, 3.13; 95% CI, 2.34-4.20). Geographic variation was associated with all primary and secondary outcomes.
CONCLUSIONS AND RELEVANCE: In this study, Black patients were less likely to receive outpatient referrals for OUD. These findings underscore the need for targeted interventions to address racial disparities in ED care for OUD, particularly in enhancing referral processes
Rare Large Intestinal Lesions: A Case Series of Colonic Leiomyomas.
No full textINTRODUCTION: Colonic leiomyomas are benign smooth muscle tumors of the large intestine. Although more commonly seen in the esophagus, leiomyomas of the colon are occasionally discovered during colonoscopies with the large intestine accounting for only 3% of gastrointestinal leiomyomas. Appropriate excision and staining can differentiate them from similar mesenchymal growths. Current guidelines do not offer recommendations on follow-up for this type of lesion, but recurrence rates are low based on reported cases. The purpose of this case series is to report 10 cases of this rare form of colonic lesion and investigate their recommended follow-up timelines and recurrence rates.
CASE SERIES: We report the cases of 10 histologically proven colonic leiomyomas identified between the years 2015 and 2025 within one hospital system. Eighty percent of these were discovered on screening colonoscopy in asymptomatic patients. Staining of these leiomyomas to confirm diagnosis included a positive actin and/or desmin stain and a negative CD34, CD117, DOG1 and/or S100-protein stain to rule out similar appearing gastrointestinal stromal tumors. The average follow-up recommendation made for these patients to repeat colonoscopy or imaging was 3.35 years. There are no documented recurrences of leiomyomas within these cases to date.
CONCLUSION: Although colonic leiomyomas are benign, these lesions should be excised and appropriately stained to differentiate them from similar appearing smooth muscle tumors. Although there are no current guidelines on the timeline to follow up, exploration of cases and investigation of recurrence rates can contribute to the development of specific follow-up recommendations when endoscopists encounter these rare lesions
Impact of natal and childhood metabolic markers on childhood asthma burden - a nationwide cohort study.
No full textBACKGROUND: Pediatric obesity, a risk factor for asthma, is increasing in prevalence. Obesity-mediated metabolic abnormalities are one of the mechanisms that link asthma and obesity. While maternal obesity contributes to obesity and respiratory morbidity in the child, the contribution of paternal obesity and parental metabolic abnormalities to the child\u27s asthma is not known.
METHODS: To quantify the impact of parental and child\u27s body weight and metabolic traits, including elevated HbA1c, and blood cholesterol levels based on national, age-specific cut-off values, on asthma exacerbations, control, and severity, in a Danish nationwide cohort of 29,851 children aged 2-17 years with inhaled corticosteroid-treated asthma during 2015-17.
RESULTS: Among the 29,851 children, 1,430 had severe asthma, 4,750 had poor asthma control, and 2,353 had exacerbating asthma. Elevated LDL in the child was associated with 2.2-fold higher odds of severe asthma and elevated triglycerides with 1.5-fold higher odds of exacerbating asthma, while reduced HDL was associated with 1.5-fold higher odds of poor control. Both triglycerides and HDL were associated with 1.5-fold higher odds of exacerbating asthma. Maternal parameters including elevated LDL cholesterol, triglycerides, and HbA1C were associated with 1.2 to 1.4-fold higher odds of uncontrolled asthma in the child. Elevated paternal HbA1C was associated with exacerbating asthma.
CONCLUSION: Dyslipidemia, including elevated LDL and decreased HDL, in the child and their parents was associated with high asthma burden in a Danish pediatric cohort with persistent asthma. These observations highlight the need to investigate the underlying mechanisms driven by fat metabolism that are transgenerational
