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There is limited research on outcomes for patients who start treatment for opioid use disorder (OUD) with only psychosocial treatment compared to those who initiate treatment with either medications for OUD (MOUD) or the combination of psychosocial treatment and MOUD. Cox proportional hazards regression was used on a database of individuals with commercial health insurance or Medicare Advantage to estimate the associations of treatment type with opioid overdose and self-harm (separately). Logistic regression was used to estimate the association of treatment type with prescription opioid fill following treatment initiation. Relative to patients who initiated treatment with only psychosocial treatment, patients who also initiated treatment with MOUD had lower risk of having an overdose inpatient or emergency department (ED) encounter, a self-harm inpatient or ED encounter, and a prescription opioid filled following treatment initiation. Starting treatment with MOUD was associated with better patient outcomes than initiating treatment with only psychosocial treatment. [ABSTRACT FROM AUTHOR]

A study examining the links between cultural orientation and substance use surveyed 2,449 American Indians from 9 South Dakota reservations. After controlling for age, gender, education, and employment, biculturalism and low orientation to American Indian culture were associated with higher levels of alcohol abuse but were not correlated with drug abuse. (Contains 47 references.) (TD)

Objective: Pharmacotherapy for opioid use disorder is effective but underused from a clinical perspective, and average treatment duration is shorter than current recommendations. In this analysis, the authors examined factors associated with initiation of, engagement in, and duration of treatment among patients with opioid use disorder.Methods: Using the OptumLabs Data Warehouse (a large, national, deidentified database of commercial or Medicare Advantage plan enrollees), the authors identified a sample of 204,225 patients with opioid use disorder between July 1, 2010, and April 1, 2019. Factors associated with initial treatment type were identified with multinomial logistic regression. The odds of treatment engagement, defined as two claims for treatment and a treatment episode of ≥30 days, were estimated with logistic regression. The hazard ratios for treatment discontinuation were estimated with a Cox proportional hazards model.Results: Treatment initiation with pharmacotherapy (alone or in combination with psychosocial therapy) was associated with higher odds of treatment engagement and a lower hazard of treatment discontinuation. Patients with certain behavioral health conditions (e.g., anxiety or mood disorders) had higher odds of initiating treatment with pharmacotherapy and engaging in treatment and a lower hazard of discontinuing treatment. Patients with certain painful general health conditions (e.g., fibromyalgia or musculoskeletal disorders) had lower odds of initiating and engaging in treatment.Conclusions: Treatment initiation with pharmacotherapy was associated with treatment engagement and duration. Previous contact with behavioral health treatment may support initiating, engaging in, and remaining in treatment. Patients with painful conditions may benefit from provider support in initiating treatment for opioid use disorder. [ABSTRACT FROM AUTHOR]

In recent years, accountable care organizations (ACOs) have become more prevalent in the United States. This study describes the origins, implementation, and early results of Minnesota's Medicaid ACO payment model, the Integrated Health Partnership (IHP) demonstration project. We describe the structure of the program and present preliminary evaluation results to document the state's important work and to provide lessons for other states interested in implementing Medicaid ACOs. The IHP program has expanded in size over time, the state has reported significant savings, and evidence exists of capacity building among participating providers. We identify factors that may have contributed to the program's early success, but more work is needed to investigate the specific drivers of quality improvement and savings within Minnesota's ACO program and to compare the design and effects of the IHP with other Medicaid and Medicare ACO programs. We conclude with comments about the future of the state's Medicaid ACO program and situate Minnesota's findings within the context of the broader ACO movement. [ABSTRACT FROM AUTHOR]

Pursuant to passage of the Patient Protection and Affordable Care Act, the National Center for Health Statistics has enhanced the content of the National Health Interview Survey (NHIS)--the primary source of information for monitoring health and health care use of the US population at the national level--in several key areas and has positioned the NHIS as a source of population health information at the national and state levels. We review recent changes to the NHIS that support enhanced health reform monitoring, including new questions and responsecategories, samplingdesign changes to improve state-level analysis, and enhanced dissemination activities. Wediscuss the importance of theNHIS, the continued need for state-level analysis, and suggestions for future consideration. [ABSTRACT FROM AUTHOR]

Objectives. We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Methods. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. Results. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota's insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Conclusions. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD). METHODS: This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psycho- tropic polypharmacy was defined as concurrent medication fills across ≥2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy. RESULTS: Among 33 565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy (≥2 classes), and 15% used medications from ≥3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of co- occurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy. CONCLUSIONS: Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its co- occurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD. [ABSTRACT FROM AUTHOR]

Phased retirement programs represent one important and attractive way to increase flexibility for older workers, while simultaneously benefiting organizations that are worried about the loss of staff and expertise that will occur as the Baby Boom generation moves into retirement. Yet phased retirement advocates have often been baffled by the various intersecting employment laws adopted to protect older workers and their pensions. We describe the legal and regulatory barriers related to supplementing part-time wages with defined benefit pension benefits, as well as other legal concerns. Recent regulatory developments have clarified when phased retirement (with pension supplements) is permissible and what would constitute a compliant phased retirement program for the Internal Revenue Service. However, there are still some regulatory and practical questions that make it difficult to predict whether phased retirement will be widely adopted in the near future. [ABSTRACT FROM AUTHOR]

Invasion of brain by tumor cells is an inherent feature of the malignant phenotype. Assays to quantitate invasiveness should provide a powerful tool to investigate this phenomenon. We have developed a modified in vitro assay to measure tumor cell invasion, attachment, and chemotaxis using a barrier of the complex basement membrane Matrigel on gelatin-coated filters. Within 5 hours, 7.8% of U251MGp and 2.6% of SF126 human malignant glioma cells invaded the Matrigel and filter, compared with 0.8% of normal human leptomeningeal cells. The extent of invasion was directly proportional to incubation time and filter pore size and inversely proportional to the Matrigel concentration. Cells from exponentially growing U251MG cultures invaded more readily (10.9%) than cells from plateau-phase cultures (2.3%); however, labeling studies with bromodeoxyuridine showed that quiescent cells and rapidly dividing cells were equally capable of invading. This suggests that the mechanisms underlying invasion by malignant glioma cells are distinct from those underlying proliferation and indicates the need for therapy aimed specifically at invasive behavior. In a practical application of this assay to test a potential anti-invasive strategy, monoclonal antibodies to the β subunit of an integrin receptor mediating attachment to the extracellular matrix inhibited invasion by U251MG cells in a dose-dependent manner. This assay should allow evaluation of the cellular and molecular basis of brain tumor progression and perhaps aid the development of rationally designed drugs that limit tumor invasion. It may also allow prediction of the clinical behavior of neoplasms in individual patients. [ABSTRACT FROM AUTHOR]

We tested an experimental strategy to decrease the dose-limiting hematotoxicity of carboplatin without compromising its activity against brain tumors. The effect of pretreatment with WR-1065, a chemomodifier that penetrates brain poorly, on carboplatin's cytotoxicity was evaluated in human hematopoietic granulocyte-monocyte progenitor cells and in three human glioblastoma cell lines. WR-1065 reduced bone marrow toxicity without decreasing carboplatin's activity against glioblastoma cells. These results suggest that the therapeutic index of carboplatin might be increased in the treatment of malignant brain tumors. [ABSTRACT FROM AUTHOR]