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IMPORTANCE Substantial increases in both neonatal abstinence syndrome (NAS) and maternal opioid use disorder have been observed through 2014. OBJECTIVE To examine national and state variation in NAS and maternal opioid-related diagnoses (MOD) rates in 2017 and to describe national and state changes since 2010 in the US, which included expanded MOD codes (opioid use disorder plus long-term and unspecified use) implemented in International Classification of Disease, 10th Revision, Clinical Modification. DESIGN, SETTING, AND PARTICIPANTS Repeated cross-sectional analysis of the 2010 to 2017 Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community nonrehabilitation hospitals in 47 states and the District of Columbia. EXPOSURES State and year.MAIN OUTCOMES AND MEASURES NAS rate per 1000 birth hospitalizations and MOD rate per 1000 delivery hospitalizations. RESULTSIn 2017, there were 751 037 birth hospitalizations and 748 239 delivery hospitalizations in the national sample; 5375 newborns had NAS and 6065 women had MOD documented in the discharge record. Mean gestational age was 38.4 weeks and mean maternal age was 28.8 years. From 2010 to 2017, the estimated NAS rate significantly increased by 3.3 per 1000 birth hospitalizations (95% CI, 2.5-4.1), from 4.0 (95% CI, 3.3-4.7) to 7.3 (95% CI, 6.8-7.7). The estimated MOD rate significantly increased by 4.6 per 1000 delivery hospitalizations (95% CI, 3.9-5.4), from 3.5 (95% CI, 3.0-4.1) to 8.2 (95% CI, 7.7-8.7). Larger increases for MOD vs NAS rates occurred with new International Classification of Disease, 10th Revision, Clinical Modification codes in 2016. From a census of 47 state databases in 2017, NAS rates ranged from 1.3 per 1000 birth hospitalizations in Nebraska to 53.5 per 1000 birth hospitalizations in West Virginia, with Maine (31.4), Vermont (29.4), Delaware (24.2), and Kentucky (23.9) also exceeding 20 per 1000 birth hospitalizations, while MOD rates ranged from 1.7 per 1000 delivery hospitalizations in Nebraska to 47.3 per 1000 delivery hospitalizations in Vermont, with West Virginia (40.1), Maine (37.8), Delaware (24.3), and Kentucky (23.4) also exceeding 20 per 1000 delivery hospitalizations. From 2010 to 2017, NAS and MOD rates increased significantly for all states except Nebraska and Vermont, which only had MOD increases. CONCLUSIONS AND RELEVANCEIn the US from 2010 to 2017, estimated rates of NAS and MOD significantly increased nationally and for the majority of states, with notable state-level variation.

BACKGROUND Brief interventions (BI) have been shown to reduce alcohol use and improve outcomes in Hazardous and Harmful (HH) drinkers but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of BI may contribute to uncertainty about their effectiveness. METHODS We randomized 889 adult ED patients with HH drinking. A total of 740 received 1) an emergency practitioner (EP)-performed Brief Negotiation Interview (BNI, n=297), 2) BNI with a 1-month follow-up telephone booster (BNI with Booster), (n=295), or 3) standard care (SC, n=148). We also included a standard care with no assessments (SC-NA, n=149) group to examine the impact of assessments on drinking outcomes. Primary outcomes analyzed using mixed models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months collected by Interactive Voice Response. Secondary outcomes included negative health behaviors and consequences collected by phone surveys. RESULTS The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in BNI with Booster: from 20.4 (95% confidence interval [CI], 18.8-22.0) to 11.6 (95% CI, 9.7-13.5) to 13.0 (95% CI, 10.5-15.5) and BNI: from 19.8 (95% CI, 18.3-21.4) to 12.7 (95% CI, 10.8-14.6), to 14.3 (95% CI, 11.9-16.8), than in SC: from 20.9 (95% CI, 18.7-23.2) to 14.2 (95% CI, 11.2-17.1), to 17.6 (95% CI, 14.1-21.2). The reduction in 28-day binge episodes was also greater in BNI with Booster: from 7.5 (95% CI, 6.8-8.2) to 4.4 (95% CI, 3.6-5.2) to 4.7 (95% CI, 3.9-5.6) and in BNI: from 7.2 (95% CI, 6.5-7.9) to 4.8 (95% CI, 4.0-5.6), to 5.1 (95% CI, 4.2-5.9), than in SC: from 7.2 (95% CI, 6.2-8.2) to 5.7 (95% CI, 4.5-6.9), to 5.8 (95% CI, 4.6-7.0). BNI with Booster offered no significant benefit over BNI. There were no differences in drinking outcomes between the SC and SC-NA groups. The reductions in rates of driving after drinking ≥ 3 drinks from baseline to 12 months were greater in the BNI (38% to 29%) and BNI with Booster (39% to 31%) groups than in the SC group (43% to 42%). CONCLUSIONS EP-performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in HH drinkers. These results support the use of brief interventions in ED settings.

IMPORTANCE Treatment of opioid use disorder (OUD) with buprenorphine decreases opioid use and prevents morbidity and mortality. Emergency departments (EDs) are an important setting for buprenorphine initiation for patients with untreated OUD; however, readiness varies among ED clinicians. OBJECTIVE To characterize barriers and facilitators of readiness to initiate buprenorphine for the treatment of OUD in the ED and identify opportunities to promote readiness across multiple clinician types.

A relationship between certain prior medical conditions and medication use and risk of NHL was observed in this study. Further studies are warranted to confirm our findings.

A population-based case-control study (601 cases and 717 controls) was conducted in 1995-2001 among Connecticut women to evaluate the relation between diet and nutrient intakes and the risk of non-Hodgkin's lymphoma (NHL). When the highest quartile of intake was compared with the lowest, the authors found an increased risk of NHL associated with animal protein (odds ratio = 1.7, 95% confidence interval: 1.2, 2.4) and saturated fat (odds ratio = 1.9, 95% confidence interval: 1.1, 2.3) but a reduced risk for polyunsaturated fat (odds ratio = 0.6, 95% confidence interval: 0.4, 0.9) and no relation for vegetable protein and monounsaturated fat. An increased risk was also observed for higher intakes of retinol, eggs, and dairy products. On the other hand, a reduced risk was found for higher intakes of dietary fiber and for several fruit and vegetable items. Risk of NHL associated with diet and nutrient intakes appeared to vary based on NHL subtype. An association between dietary intake and NHL risk is biologically plausible because diets high in protein and fat may lead to altered immunocompetence, resulting in an increased risk of NHL. The antioxidant or inhibiting nitrosation reaction properties of vegetables and fruits may result in a reduced risk. Further investigation of the role of dietary intakes on the risk of NHL is warranted.

Study Objective-To determine efficacy of emergency practitioner performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an Emergency Department (ED) setting.Methods-A randomized clinical trial (Project ED Health) was conducted in an urban ED from 5/2002 to 11/2003 for hazardous/harmful drinkers. Patients ≥ 18 who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for "low risk" drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge drinking episodes over the past 30 days were collected at 6 and 12-months; negative consequences and use of treatment services at 12-months. A Brief Negotiation Interview (BNI) performed by emergency practitioners was compared to scripted discharge instructions (DI).Results-A total of 494 hazardous/harmful drinkers were studied. The two groups were similar with respect to baseline characteristics. In the BNI group the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The DI group decreased 2.6 from 12.4 at baseline. Likewise, binge drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the BNI group and 1.5 from 5.4 in the DI group. For each outcome the time effect was significant and the treatment effect was not. Conclusion: Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed BNI and DI. Further studies to test the efficacy of brief intervention in the ED are needed.