Adoption of the 275-patient buprenorphine treatment waiver for treating opioid use disorder: A state-level longitudinal analysis

Abstract

Background: Increasing access to buprenorphine treatment is a critical tool for addressing the opioid epidemic in the United States. In 2016, a federal policy change allowed physicians who meet specific requirements to treat up to 275 concurrent buprenorphine patients. This study examines state-level measures of buprenorphine treatment supply over 21?months since this policy change and estimates associations between the supply of 275-patient waivers and state characteristics. Methods: Monthly state-level measures of the number of physicians holding the 275-patient waiver per 100,000 residents were constructed from September 2016 to May 2018 using the Drug Enforcement Agency’s Controlled Substance Act database. State characteristics were obtained from publicly available sources. Mixed-effects regression models were estimated to examine change over time. Results: During the 21-month period, the number of physicians waivered to treat 275 patients increased from 153 to 4009 physicians. The mean supply of 275-patient physicians per 100,000 state residents significantly increased from 0.07 (SD?=?0.21) in September 2016 to 1.43 (SD?=?1.08) in May 2018 (t?=??9.84, df?=?50, P?<?.001). The final mixed-effects regression model indicated that Census division and the preexisting supply of 100-patient waivered physicians were correlated with the rate of growth in 275-patient waivers over the study period. Conclusions: Although uptake of the 275-patient waiver has exceeded initial projections, growth is uneven across the United States. Unequal patterns of growth pose a challenge to efforts to increase treatment availability as a means of addressing the opioid epidemic.     

Intestinal schistosomiasis: a very long-lived tropical parasite

We report a case of intestinal schistosomiasis in a patient who had not travelled outside Europe after migrating 20 years ago. Images of the Schistosoma mansoni eggs are shown that confirm the active nature of the infection.     

Adult Dental Visits in California: Successes and Challenges

OBJECTIVES: This study sought to estimate and characterize the proportion of California adults who visited a dentist in the preceding year and to identify reasons for not going. METHODS: In 1995, 4,029 adults were interviewed by telephone as part of the California Behavioral Risk Factor Surveillance System. Items included recentness of a dental visit, dental insurance status, and number of teeth lost due to disease. Persons who had not seen a dentist within the preceding year were asked the main reason they had not gone. RESULTS: In 1995, 65.9% of adults reported visiting a dentist in the preceding twelve months. Use of dental services was greater among persons aged 35 years or older (70.4%) than among those aged 18-34 years (58.4%) and among those with dental insurance (74.9%) than those without (54.4%). Dental visits were less likely among adults living at or below 200 percent of the federal poverty level, those with less than a high school education, and the edentulous. Reasons most commonly cited for not seeing a dentist were no perceived reason to go (37.2%), cost (30.7%), and fear (9.2%). CONCLUSION: Substantial variation in use of dental services exists among California's adults. Achieving equity in access and opportunity for disease prevention in this state may require expanded dental insurance coverage and serious efforts in oral health promotion.     

Excel 2000软件在即刻法质控中的应用与改良

目的 在即刻法用于免疫学实验的质控中，探讨一种更简便、快速、准确且直观的操作方法。方法 应用Excel2000对质控数据的自动统计、分析及评价并绘制出即时累积的L—J质控图，将此改良的操作方法用于日常质控中进行评价。结果 改良后的即刻法能自动、快速地完成质控操作，结合即时的质控图能更准确的进行评价，效果明显优于单用即刻法。结论 Excel2000软件改良的即刻法质控图能更准确、高效地实现免疫实验的质控，并可以推广于现代检验医学各专业的质控，成为替代手工质控的一种必然趋势。     

VCE取材Bethesda 2001报告在宫颈癌筛查中的意义

目的：探讨VCE取材Bethesda 2001报告系统在宫颈癌筛查中的意义。方法：采用VCE取材Bethesda2001报告系统对3 056例健康体检女性进行阴道细胞学检查,并对不明确意义的不典型鳞状上皮细胞（ASC-US）以上病变者经阴道镜取材进行宫颈组织病理学诊断。结果：阴道细胞学检查(VCE取材Bethesda 2001报告系统)检出宫颈异常鳞状上皮细胞66例,阳性率2.15%。其中不明确意义的不典型鳞状上皮细胞（ASC-US）17例（25.76％）,不除外高度病变的不典型鳞状上皮细胞（ASC-H）4例,（6.06％）,低度鳞状上皮内病变（LSIL）28例（42.42％）,高度鳞状上皮内病变(HSIL)14例（21.21％）,宫颈鳞癌（SCC）3例（4.55％）。66例细胞学阳性诊断病例经宫颈活检组织病理学诊断CIN I级以上病变60例（90.91％）,其中CIN Ⅰ级35例（53.03％）,CIN Ⅱ级12例（18.18％）,CIN Ⅲ级7例（10.61％）,宫颈鳞癌6例（9.09％）。结论：VCE取材Bethesda2001报告系统取材方便、报告准确,阴道细胞学检查阳性诊断与病理诊断符合率高达90.91％,VCE取材Bethesda2001报告系统在宫颈癌筛查中具有重要意义。     

Cardioprotective effect of β-d-mannuronic acid (M2000) as a novel NSAID on gene expression of oxLDL scavenger receptors in the experimental diabetic model

Context: The investigations have shown that patients with diabetes have the elevated levels of glucose and oxLDL. These two play an important role in increased expression levels of oxLDL scavenger receptors on the surface of macrophages and endothelial cells that leads to deposition of oxLDL and macrophages in vascular walls.

Objective: The present study intends to show the effects of β-d-mannuronic acid (M2000) on the expression profile of ox-LDL scavenger receptors (including SR-A, LOX-1, CD36, and CD68) in an experimental model of diabetes.

Materials and methods: Eighteen Sprague-Dawley rats were randomly divided into three 6-member groups of the healthy control, diabetic control, and treated rats by M2000. Diabetes was induced in rats by intraperitoneal (IP) administration of 60?mg/kg streptozotocin. The treated rats were given daily intraperitoneal injections of M2000 with a dose of 25?mg/kg for 28 days and at the end of the 28th day, their aortas were removed. The qRT-PCR technique was then used to evaluate the expression levels of the proposed gene.

Results: The gene expression levels of the SR-A, LOX-1, CD36, and CD68 significantly declined in the diabetic group that received M2000 compared with untreated diabetic rats.

Conclusions: The M2000, as a novel NSAID is able to modify by lowering the gene expression levels of SR-A, LOX-1, CD36, and CD68 in treated rats compared to the untreated diabetic group, which may play an important role in preventing the complications that could lead to a cardioprotective efficacy.