Routine biopsies of long-standing fistula tracts in patients with Crohn's disease should be strongly considered and may yield an earlier diagnosis of cancer in the fistula tracts.
Introduction: Television (TV) viewing may be associated with increased venous thromboembolism (VTE) risk independent of VTE risk factors including physical activity. This association was assessed in a large biracial US cohort of Black and White adults. Methods: Between 2003 and 2007 The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study recruited 30,239 participants aged ≥45 years, who were surveyed for baseline TV viewing and followed for VTE events. TV viewing was categorized as <2 hours (light), 2 to 4 hours (moderate), and ≥4 hours (heavy) per day. Physical activity was classified as poor, intermediate, or ideal based on reported weekly activity. Hazard ratios of TV viewing and physical activity were calculated adjusting for VTE risk factors. Multiple imputation for missingness was used as a sensitivity analysis. Results: Over 96,813 person-years (median: 5.06 years) of follow-up there were 214 VTE events. Heavy TV viewing was not associated with VTE risk in the unadjusted and fully adjusted model (adjusted hazard ratio [aHR]: 0.92 [95% confidence interval (CI): 0.62, 1.36]). Ideal physical activity trended toward a reduced VTE risk (HR: 0.71 [95%CI: 0.51, 1.01]). There was no evidence of an interaction between TV viewing, physical activity, and risk of VTE. Conclusions: In this contemporary racially and geographically diverse US cohort, there was no association between TV viewing and VTE risk, before and after accounting for physical activity. The high burden of traditional VTE risk factors in REGARDS may mask any association of TV viewing with VTE, or TV viewing may have only a modest association with VTE risk.
Objectives: Primary care providers (PCPs) prescribe medication for opioid use disorder (MOUD), but patients may receive MOUD from a provider who only prescribes MOUD, and who does not provide routine medical care that would be expected from a PCP. The importance of receiving MOUD from one's own PCP versus another provider on patient MOUD retention is not known. Methods: All patients receiving MOUD from December 2016 through November 2019 within a rural, Federally Qualified Health Center were included. Patient sociodemographic, PCP-MOUD concordance, and retention time in MOUD were extracted from the electronic health record. Travel-time from patients' home to the clinic where MOUD was provided was calculated. The risk of premature discontinuation was estimated with Kaplan-Meier curves and with hazard ratios (HR) with 95% confidence intervals (CI). All analyses were performed using R version 3.4.4. Results: Among (n = 353) patients receiving MOUD from 2016 to 2019, n = 77 (21.8%) patients receivedMOUD from their PCP (PCP-MOUD concordance). PCP-MOUD concordance was associated with reduced risk of premature discontinuation (HR = 0.41, 95% CI = 0.18-0.95), however, after multivariable adjustment, PCP-MOUD concordance was not significant (HR = 0.45, 95% CI = 0.19-1.05). Conclusions: In this rural Federally Qualified Health Center, MOUD provision by a patient's own PCP, as compared to a separate provider, did not reach statistical significance for an association with improved retention in treatment. These findings are likely due to a small sample size, and support expanding buprenorphine access as part of comprehensive primary care to combat the opioid crisis, especially in rural areas.
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