...HHS Public Access Author manuscript Author Manuscript JAMA Intern Med. Author manuscript; available in PMC 2015 October 01. Published in final edited form as: JAMA Intern Med. 2014 October ; 174(10): 1668–1673. doi:10.1001/jamainternmed.2014.4005. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 Author Manuscript Marcus A. Bachhuber, MD, Brendan Saloner, PhD, Chinazo O. Cunningham, MD, MS, and Colleen L. Barry, PhD, MPP Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Bachhuber); Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia (Bachhuber); Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Bachhuber, Saloner, Barry); Robert Wood Johnson Health and Society Scholars Program, University of Pennsylvania, Philadelphia (Saloner); Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (Cunningham); Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Barry) Abstract Author Manuscript IMPORTANCE—Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose...
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...may delay seeking and obtaining treatment, underutilize preventive health care services, and may have a high prevalence of chronic disease risks. Access and Usage of Healthcare Services Disparities in access to health services affect individuals and society. Limited access to health care impacts people's ability to reach their full potential, negatively affecting their quality of life. Barriers to services include lack of availability, high cost and lack of insurance coverage. Health insurance coverage helps patients get into the health care system. Uninsured people are less likely to receive medical care, more likely to die early and to have poor health status. According to Kaiser Family Foundation analysis of the 2000-2012 National Health Interview Surveys, in 2014, 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for public coverage. In addition, undocumented immigrants are ineligible for Medicaid or Marketplace coverage. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured live with the knowledge that they may not be able to afford to pay for their family’s medical care, which can cause anxiety and potentially lead them to delay or forgo care. Lacking insurance coverage puts people at risk...
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...ETHICS, PUBLIC POLICY, AND MEDICAL ECONOMICS A Systematic Review of Satisfaction with Care at the End of Life Sydney Morss Dy, MD, MSc,Ã wz Lisa R. Shugarman, PhD,§ Karl A. Lorenz, MD, MSHS,§ k Richard A. Mularski, MD, MSHS,# and Joanne Lynn, MD, MA, MS,§ for the RANDFSouthern California Evidence-Based Practice Center (See editorial comments by Dr. Jean S. Kutner, pp 160–162) The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients’ decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A metaanalysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six...
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...The Need of Personalized Medicine for Social Anxiety Disorders Social anxiety disorder (SAD) is a distressing psychiatric disorder that is defined as having excessive, abnormal amounts of apprehension during social settings. SAD is one of the most common psychiatric disorders, having a lifetime prevalence of 12%, yet only a small portion respond favorably to the most common treatment options including selective serotonin reuptake inhibitors (SSRIs), and cognitive behavioral therapy. Stronger treatment options with higher efficacy such as benzodiazepines tend to be habit forming and have adverse side effects that are not tolerated well by many people. Considering that first-line treatment options for SAD have low response rates, coupled with the fact that there are many classes of treatment options, creates a strong demand to develop techniques that increases the likelihood of finding the optimal treatment option for each unique patient. Recent studies by Stein et al have found that four single-nucleotide polymorphisms (SNPs) of the RGS2 gene significantly predicts SAD remission rates of patients taking the SSRI sertraline. A randomized controlled trial was performed on 346 adults that have SAD, with the treatment group receiving sertraline, titrated up to 200 mg/d over 10 weeks, and the Liebowitz Social Anxiety Scale being used to assess remission of SAD symptoms. Adjusted regression models found significant correlations between four SNPs in the RGS2 gene and the efficacy of...
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...In this essay, I will do a journal article comparison. The articles selected have something in common – treatment of drug. The first article is “Do drug treatment variables predict cognitive performance in multidrug-treated opioid-dependent patients? A regression analysis study” by Pekka Rapeli, Carola Fabritius, Hely Kalska and Hannu Alho. This article was taken from an open access article under Substance Abuse Treatment, Prevention, and Policy 2012, at http://www.substanceabusepolicy.com/content/7/1/45. The second article entitled “Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety” by Redonna K. Chandler, Bennett W. Fletcher and Nora D. Volkow. It was taken from a public access journal under National Institute of Health: JAMA. 2009 January 14; 301(2): 183–190. doi:10.1001/jama.2008.976. The purpose of the first article was to examine the predictive power of drug treatment variables on specific cognitive performance measures in multidrug-treated opioid dependent patients. Also, the researchers interested in finding out which of the possible significant associations turn out as hypothesized. On the other hand, the purpose of the second article was to summarize relevant neuroscientific findings and evidence-based principles of addiction treatment that, if implemented in the criminal justice system, could help improve public health and reduce criminal behaviour. For methodologies, the first research involved 104 Opioid-Dependent...
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...resources to make people aware of the ill effects of polio thereby allowing immunization to take place all over the world so that this harmful disease can be combated. However one of the most challenging tasks that were faced during this initiative was to reach the far flung places which were poor in economy and had very little access to health facilities so that polio could be completely eradicated. The program used various strategies combined with research and innovation so that they could gain access to populations that had been unreached (Adedeji, Marquez, Moore & Gonzalez, 2007). Here in this analysis we shall be reviewing the challenges that came while conquering the polio battle in both India and Pakistan during the years of 2000 up to 2007. This case study will delve upon the following points: 1. The epidemiological aspect of polio 2. The data analysis 3. Strategies of communication used to make people more conscious It also deals about how findings are based on research projects and communication with the people via media formats such as the television, radio and newspapers and social mobilization. These forms of communication with the common people have helped to drastically cut down the occurrence of Polio in both the countries (Peek, 2000). Communication campaigns that include social networking, listening to what the people...
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...The Translating Research Into Action for Diabetes (TRIAD) study ANDREW J. KARTER, PHD1 MARK R. STEVENS, MSPH, MA2 WILLIAM H. HERMAN, MD, MPH3 SUSAN ETTNER, PHD4 DAVID G. MARRERO, PHD5 MONIKA M. SAFFORD, MD6 MICHAEL M. ENGELGAU, MD, MS2 J. DAVID CURB, MD, MPH7 ARLEEN F. BROWN, MD, PHD4 THE TRIAD STUDY GROUP* OBJECTIVE — Despite the increased shifting of health care costs to consumers, little is known about the impact of financial barriers on health care utilization. This study investigated the effect of out-of-pocket expenditures on the utilization of recommended diabetes preventive services. RESEARCH DESIGN AND METHODS — This was a survey-based observational study (2000 –2001) in 10 managed care health plans and 68 provider groups across the U.S. serving ϳ180,000 patients with diabetes. From 11,922 diabetic survey respondents, we studied the occurrence of self-reported annual dilated eye exams and diabetes health education and among insulin users, daily self-monitoring of blood glucose (SMBG). Conditional probabilities were estimated for outcomes at each level of self-reported out-of-pocket expenditure by using hierarchical logistic regression models with random intercepts. RESULTS — Conditional probabilities of utilization (95% CI) varied by expenditure for dilated eye exam [no cost 78% (75– 82), copay 79% (75– 82), and full price 70% (64 –75); P Ͻ 0.0001]; diabetes health education [no cost 29% (23–36), copay 29% (23–36), and full price 19% (14 –25);...
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...have the potential to improve the quality and cost-effectiveness of care, as demonstrated by the Federal Employees Health Benefits Program (FEHBP) and Medicare Part D. 3. Consumer-driven health plans are viable alternatives to traditional plans, and consumers should have the option of choosing such plans. 4. Proper risk adjustment mechanisms can prevent adverse selection. 5. Migrating toward value-based payment systems will result in greater quality of care at lower costs, in part by incentivizing the health care industry to make great strides in offering integrated care, innovative treatments, and personalized medicine. ABOUT THE AUTHOR Kevin D. Dayaratna, Ph.D.Senior Statistician and Research Programmer Center for Data Analysis Over the course of the past several decades, federal and state lawmakers have proposed a variety of initiatives to reform America’s health care system and reduce costs. One idea has been to instill competition in the health care markets to enable the industry to operate more like a traditional market. Regrettably, the Congressional Budget Office (CBO) has remained unable to score the financial gains resulting from competition in health care. In fact, after being presented with...
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...Financial Analysis Name: Medtronic, Inc. (NYSE- MDT) Principal Office: 710 Medtronic Pkwy., N.E. Minneapolis, MN 55432, (763) 514-4000 Website: www.medtronic.com NAICS: 325412: Pharmaceutical Preparation Manufacturing Primary SIC: 3845- Electromedical and Electrotherapeutic Apparatus Manufacturing Secondary SIC: 339112- Surgical and Medical Instrument Manufacturing. Auditor: PricewaterhouseCoopers LLP, New York, NY Primary Bank: Wells Fargo Bank, N.A., Minneapolis, MN Company started: 1949 Number of Employees: 45,499 Table of Contents: Sl. | Topics | Page | 1 | General Description of Medtronic Inc. | 1 | 2 | Challenges 2.a. Medical Device Industry2.b. Medtronic Inc. | 3 | 3 | Ethical issues | 5 | 4 | Financial Analysis4.a. Financial Analysis of 10K 4.b.Cost and expenses analysis 4.c. Financial Ratios | 689 | 5 | Industry/Competitor Analysis | 11 | 6 | Conclusion | 13 | 7 | Bibliography | 14 | By Geethapriya Setty (100918266) Address: 1300 Hennepin Ave, Apt M101, Minneapolis, Minnesota-55403 Section 1: General Description of Medtronic Inc. Medtronic Inc., a medical technology company, was founded in 1949 by Earl Bakken and Palmer Hermundslie. It was incorporated in 1957 in Minneapolis, Minnesota. They were the first to create a wearable cardiac pacemaker in 1957. They have been able to expand their business from a small repair company, which serviced medical equipment...
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...Nicolette, MD Peter Indelicato, MD Douglas B. McKeag, MD T HE MANAGEMENT OF MILD TRAU- matic brain injury (MTBI; eg, concussion, defined as a traumatically induced alteration in mental status not necessarily resulting in loss of consciousness) in athletics is currently one of the most compelling challenges in sports medicine. Despite the high prevalence1 and potentially serious outcomes2,3 associated with concussion, systematic research on this topic is lacking. Many sports medicine practitioners are not satisfied with current return-to-play and treatment options, which do not appear to be evidence based.4-6 There is also little research examining whether long-term cognitive See also pp 954, 958, 971, 974, and 989. 964 JAMA, September 8, 1999—Vol 282, No. 10 Context Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes. Objectives To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players. Design, Setting, and Participants A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions...
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...Levels of Neutrophil Gelatinase- Associated Lipocalin for Early Kidney Disease. Student’s Name University Table of Contents 1.0 Introduction/Background of the Study………………………………………………...3 2.0 Problem………………………………………………………………………………..3 3.0 Significance to Nursing……………………………………………………………….4 4.0 Purpose………………………………………………………………………………..4 5.0 Objectives……………………………………………………………………………..4 6.0 Research Questions……………………………………………………………………4 7.0 Methods of Study……………………………………………………………………...4 8.0 Quantitative or Qualitative…………………………………………………………….5 9.0 Research Design……………………………………………………………………….5 10.0 Sample………………………………………………………………………………..5 11.0 Procedures/results of Study…………………………………………………………..5 12.0 Findings………………………………………………………………………………6 13.0 Implications for Nursing……………………………………………………………....6 14.0 Contribution of Findings to Nursing Knowledge…………………………………….6 15.0 Ethical Considerations………………………………………………………………..6 16.0 Study Approval…………………………………………………………………….....7 17.0 Patient Privacy Protection………………………………………………………….....7 18.0 Conclusion…………………………………………………………………………….7 References……………………………………………………………………………….…8 1. Background of the Study Neutrophil Gelatinase also known as Oncogene 24p3 is associated with Lipocalin, Coresh et. al(2007). NGAL is a protein that is in humans and is always associated with the genes of LCN2.Lipocalin abbreviated...
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...1. Peoples’ susceptibility to alcohol, mood and how it affects the client. Effects of alcohol on mood In a study conducted by Nurnberger (2002), a direct relationship exists between consumption of alcohol and mood . Alcoholic intoxification commonly produces a “high” with attendant giddiness and lowering of inhibitions. Conversely, hangovers and acute withdrawal typically produce dysphoria with elements of anxiety and depression mixed with physical malaise. Furthermore, alcoholism and depression can coexist and their susceptibility can run in families (Merikangas and Gelernter 1990). In addition , other studies carried out by Merikangas et al 1994 patients often use alcohol as a form of self medication for an affective disorder. In other words, depression may develop as a result of alcoholism; in this case alcoholism is the primary disorder and depression is considered an organic mood disorder (ie mood disorder with a physiological cause). Conversely, is was argued in other studies that there was no unequivocal effect on mood. ( Tilburg and Vingerhoets 2001). While come studies found that drinking was associated with inducing positive feelings of pleasure or reduction in negative feelings like uncertainty and tension ( ref 3,4) others have reported reported an increase in negative emotions (ref 5,6) or no direct effects on the mood at all ( ref 7,8) . Perkins at al (7) observed that alcohol intake decreased self- report Heavy alcohol use or alcohol misuse and major...
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...The Prevalence of Bullying and Victimization among the School Youth Lisa Marie Giacinti MHA – Biostatistics Professor James Koziol August 19, 2013 ABSTRACT In our society today, many students experienced a lot of physical and social harm, threatened by others which results to much trembling and fear - fear of unknown. In that case, it presumes unhealthy to students to experience that kind of situation. In this paper, it presents the full context of school bullying, determine underlying factors and explore findings to what bullying is all about. It focuses mainly on reporting statistical analysis, like describing the population of interest, estimating mean and proportion and interpreting results due to hypothesis testing and interval estimation. The prevalence of bullying among US youth is substantial. Given the concurrent behavioral and emotional difficulties associated with bullying, as well as the potential long-term negative outcomes for these youth, the issue of bullying merits serious attention, both for future research and preventive intervention. In many cases, bullying may not only happen among children and youth. It also takes place in corporate world or public institution. However, it is beyond the scope of this paper since we limit the topic only to school bullying. INTRODUCTION Bullying is a pervasive type of aggression, which often occurs in schools. As with other types of aggression, the harm that is inflicted – whether physical, emotional or both...
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...Dietary Intake and Risk Factors for Poor Diet Quality Among Children in Nova Scotia Paul J. Veugelers, PhD1 Angela L. Fitzgerald, MSc, PDt2 Elizabeth Johnston, PhD, PDt, FDC3 ABSTRACT Objective: Public health policies promote healthy nutrition but evaluations of children’s adherence to dietary recommendations and studies of risk factors of poor nutrition are scarce, despite the importance of diet for the temporal increase in the prevalence of childhood obesity. Here we examine dietary intake and risk factors for poor diet quality among children in Nova Scotia to provide direction for health policies and prevention initiatives. Methods: In 2003, we surveyed 5,200 grade five students from 282 public schools in Nova Scotia, as well as their parents. We assessed students’ dietary intake (Harvard’s Youth Adolescent Food Frequency Questionnaire) and compared this with Canadian food group and nutrient recommendations. We summarized diet quality using the Diet Quality Index International, and used multilevel regression methods to evaluate potential child, parental and school risk factors for poor diet quality. Results: In Nova Scotia, 42.3% of children did not meet recommendations for milk products nor did they meet recommendations for the food groups ‘Vegetables and fruit’ (49.9%), ‘Grain products’ (54.4%) and ‘Meat and alternatives’ (73.7%). Children adequately met nutrient requirements with the exception of calcium and fibre, of which intakes were low, and dietary fat and sodium...
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...islamic leviathan religion and global politics John L. Esposito, Series Editor University Professor and Director Center for Muslim-Christian Understanding Georgetown University islamic leviathan Islam and the Making of State Power Seyyed Vali Reza Nasr Islamic Leviathan Islam and the Making of State Power Ú seyyed vali reza nasr 1 2001 3 Oxford Athens Chennai Kolkata Nairobi New York Auckland Bangkok Bogotá Buenos Aires Cape Town Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kuala Lumpur Madrid Melbourne Mexico City Mumbai Paris São Paul Shanghai Singapore Taipei Tokyo Toronto Warsaw and associated comapnies in Berlin Ibadan Copyright © 2001 by Seyyed Vali Reza Nasr Published by Oxford University Press, Inc., 198 Madison Avenue, New York, New York 10016 Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Nasr, Seyyed Vali Reza, 1960 – Islamic leviathan : Islam and the making of state power / Seyyed Vali Reza Nasr. p. cm.—(Religion and global politics) Includes bibliographical references and index. ISBN 0-19-514426-0 1. Malaysia—Politics and government. 2. Islam and politics—Malaysia. 3. Pakistan—Politics and government—1988...
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