Provider Perspectives of Battlefield Acupuncture: Advantages, Disadvantages and Its Potential Role in Reducing Opioid Use for Pain.

OBJECTIVES: Nonpharmacological options to treat pain are in demand, in part to address the opioid crisis. One such option is acupuncture. Battlefield acupuncture (BFA) is an auricular needling protocol currently used to treat pain in the Veterans Health Administration. We aimed to identify the advantages and disadvantages of BFA from providers' perspectives. METHODS: We rely on an inductive qualitative approach to explore provider perceptions through thematic analysis of semistructured interviews with 43 BFA providers across the nation. RESULTS: We identified the following themes. Disadvantages included: (1) clinical guidelines are insufficient; (2) patients often request multiple BFA visits from providers; (3) BFA can be uncomfortable; (4) BFA may not be an effective treatment option unless it can be provided "on demand"; and (5) BFA can promote euphoria, which can have deleterious consequences for patient self-care. Perceived advantages included: (1) BFA can simultaneously effectively control pain while reducing opioid use; (2) BFA may alleviate the pain that has been unsuccessfully treated by conventional methods; (3) BFA gives providers a treatment option to offer patients with substance use disorder; (4) BFA helps build a trusting patient-provider relationship; (5) BFA can create the opportunity for hope. CONCLUSIONS: Providers perceive BFA to have many benefits, both clinical and relational, including ways in which it may have utility in addressing the current opioid crisis. BFA is easy to deliver and has potential clinical and relational utility. Efforts to better understand effectiveness are warranted.

Addressing Tobacco Cessation at Federally Qualified Health Centers: Current Practices & Resources.

This study assesses the current practices of Federally Qualified Health Centers (FQHCs) to address tobacco cessation with patients. A national sample of 112 FQHC medical directors completed the web-based survey. Frequently endorsed barriers to providing tobacco cessation services were: patients lacking insurance coverage (35%), limited transportation (27%), and variance in coverage of cessation services by insurance type (26%). Nearly 50% indicated that two or more tobacco cessation resources met the needs of their patients; 25% had one resource, and the remaining 25% had no resources. There were no differences among resource groups in the use of electronic health record (EHR) best-practice-alerts for tobacco use or in the perceived barriers to providing tobacco cessation assistance. Systems changes to harmonize coverage of tobacco assistance, such as broader accessibility to evidence-based cessation services could have a positive impact on the efforts of FQHCs to provide tobacco cessation assistance to their patients.

The Prevalence of Tobacco Use at Federally Qualified Health Centers in the United States, 2013.

We explored tobacco use across federally qualified health centers (FQHCs) and compared data on state-level tobacco use between FQHC patients and the general population. We used data from the Uniform Data System (UDS) and the Behavioral Risk Factor Surveillance System (BRFSS) to generate estimates of 2013 prevalence of tobacco use among adults aged 18 years or older. According to UDS data, the overall prevalence of tobacco use was 25.8% in FQHCs compared with 20.6% in the general population represented by BRFSS data, an average of 5.2 percentage points (range, -4.9 to 20.9) higher among FQHCs. Among FQHCs, the burden of tobacco use and the opportunity for offering cessation assistance is substantial.

Residential segregation and lung cancer mortality in the United States.

OBJECTIVE: To examine the relationship between race and lung cancer mortality and the effect of residential segregation in the United States. DESIGN: A retrospective, population-based study using data obtained from the 2009 Area Resource File and Surveillance, Epidemiology and End Results program. SETTING: Each county in the United States. PATIENTS: Black and white populations per US county. MAIN OUTCOME MEASURES: A generalized linear model with a Poisson distribution and log link was used to examine the association between residential segregation and lung cancer mortality from 2003 to 2007 for black and white populations. Our primary independent variable was the racial index of dissimilarity. The index is a demographic measure that assesses the evenness with which whites and blacks are distributed across census tracts within each county. The score ranges from 0 to 100 in increasing degrees of residential segregation. RESULTS The overall lung cancer mortality rate was higher for blacks than whites (58.9% vs 52.4% per 100 000 population). Each additional level of segregation was associated with a 0.5% increase in lung cancer mortality for blacks (P < .001) and an associated decrease in mortality for whites (P = .002). Adjusted lung cancer mortality rates among blacks were 52.4% and 62.9% per 100 000 population in counties with the least (<40% segregation) and the highest levels of segregation (≥60% segregation), respectively. In contrast, the adjusted lung cancer mortality rates for whites decreased with increasing levels of segregation. CONCLUSION: Lung cancer mortality is higher in blacks and highest in blacks living in the most segregated counties, regardless of socioeconomic status.

Development and validation of the mindful eating questionnaire.

"Mindful eating" describes a nonjudgmental awareness of physical and emotional sensations associated with eating. This article reports the development of a mindful eating questionnaire (MEQ) to support rigorous scientific inquiry into this concept. An item pool was developed based on hypothesized domains of mindful eating. A cross-sectional survey examined associations of MEQ scores with demographic and health-related characteristics. The MEQ was distributed to seven convenience samples between January and May 2007, with an overall response rate of 62% (n=303). Participants were mostly women (81%) and white (90%), and had a mean age of 42+/-14.4 years (range 18 to 80 years). Exploratory factor analysis was used to identify factors, which were defined as the mean of items scored one to four, where four indicated higher mindfulness; the mean of all factors was the summary MEQ score. Multiple regression analysis was used to measure associations of demographic characteristics, obesity, yoga practice, and physical activity with MEQ scores. Domains of the final 28-item questionnaire were: disinhibition, awareness, external cues, emotional response, and distraction. The mean MEQ score was 2.92+/-0.37, with a reliability (Chronbach's alpha) of .64. The covariate-adjusted MEQ score was inversely associated with body mass index (3.02 for body mass index <25 vs 2.54 for body mass index >30, P<0.001). Yoga practice, but neither walking nor moderate/intense physical activity, was associated with higher MEQ score. In this study sample, the MEQ had good measurement characteristics. Its negative association with body mass index and positive association with yoga provide evidence of construct validity. Further evaluation in more diverse populations is warranted.

Effect of population trends in body mass index on prostate cancer incidence and mortality in the United States.

Concurrent with increasing prostate cancer incidence and declining prostate cancer mortality in the United States, the prevalence of obesity has been increasing steadily. Several studies have reported that obesity is associated with increased risk of high-grade prostate cancer and prostate cancer mortality, and it is thus likely that the increase in obesity has increased the burden of prostate cancer. In this study, we assess the potential effect of increasing obesity on prostate cancer incidence and mortality. We first estimate obesity-associated relative risks of low- and high-grade prostate cancer using data from the Prostate Cancer Prevention Trial. Then, using obesity prevalence data from the National Health and Nutrition Examination Survey and prostate cancer incidence data from the Surveillance, Epidemiology, and End Results program, we convert annual grade-specific prostate cancer incidence rates into incidence rates conditional on weight category. Next, we combine the conditional incidence rates with the 1980 prevalence rates for each weight category to project annual grade-specific incidence under 1980 obesity levels. We use a simulation model based on observed survival and mortality data to translate the effects of obesity trends on prostate cancer incidence into effects on disease-specific mortality. The predicted increase in obesity prevalence since 1980 increased high-grade prostate cancer incidence by 15.5% and prostate cancer mortality by between 7.0% (under identical survival for obese and nonobese cases) and 23.0% (under different survival for obese and nonobese cases) in 2002. We conclude that increasing obesity prevalence since 1980 has partially obscured declines in prostate cancer mortality.

Computer-assisted mammography feedback program (CAMFP) an electronic tool for continuing medical education.

RATIONALE AND OBJECTIVES: Our goal was to develop and evaluate software to support a computer assisted mammography feedback program (CAMFP) to be used for continuing medical education (CME). MATERIALS AND METHODS: Thirty-five radiologists from our region signed consent to participate in an institutional review board-approved film-reading study. The radiologists primarily assessed digitized mammograms and received feedback in five film interpretation sessions. A bivariate analysis was used to evaluate the joint effects of the training on sensitivity and specificity, and the effects of image quality on reading performance were explored. RESULTS: Interpretation was influenced by the CAMFP intervention: Sensitivity increased (Delta sensitivity = 0.086, P < .001) and specificity decreased (Delta specificity = -0.057, P = .04). Variability in interpretation among radiologists also decreased after the training sessions (P = .035). CONCLUSION: The CAMFP intervention improved sensitivity and decreased variability among radiologist's interpretations. Although this improvement was partially offset by decreased specificity, the program is potentially useful as a component of continuing medical education of radiologists. Dissemination via the web may be possible using digital mammography.