Modeling dynamics of fatal opioid overdose by state and across time.

Opioid overdose fatalities include deaths from natural opioids (morphine and codeine), semi-synthetic opioids (oxycodone, hydrocodone), synthetic opioids (prescription and illicit fentanyl, tramadol), methadone, and heroin. From 1999 to 2017, there were 702,568 drug overdose deaths in the U.S., with 399,230 attributed to opioids. This study aimed to assess the dynamics of opioid related fatalities throughout the U.S. from 2006-2016. This study is a secondary analysis of data obtained through the Kaiser Family Foundation's analysis of Centers for Disease Control and Prevention data, 1999-2016. The data obtained were from all 50 states and the District of Columbia. A total of 272,130 individuals were included in the analysis. This represents the number of opioid overdose deaths in the United States from 2006-2016. Descriptive analysis of overall rates was conducted and mapped for visualization. Novel predictive models of increase for each drug overdose category were developed and used to calculate rate changes. Finally, the elasticity of change in rate for each drug category was calculated annually for the past 11 years. The highest rate of opioid overdose-related death occurred in West Virginia (40.03 per 100,000). In our secondary analysis, we explored the change in the rate of opioid-related deaths from 2015 to 2016. The changing dynamics of fatal opioid overdose at the state level is critical to guiding policy makers in addressing this crisis. Rates of fatal opioid overdose vary across the states, but we identify some trends. Regional differences are identified in states with the highest overdose rates from all opioids combined.

Occupational Health and Sleep Issues in Underserved Populations.

Sleep disorders and occupational hazards, injuries, and illnesses impact an individual's overall health. In the United States, substantial racial, ethnic, and socioeconomic disparities exist in sleep and occupational health. Primary care physicians working in underserved communities should be aware of this disparity and target these higher-risk populations for focused evaluation and intervention.

Sports nutrition needs: before, during, and after exercise.

This article discusses how athletes should properly fuel their bodies before, during, and after exercise to maximize athletic performance. Emphasis is placed on hydration status and glycogen stores being maintained above deficits that negatively affect sport performance. Timing of nutrient intake is as important as composition.

Immune response due to silica exposure in Egyptian phosphate mines.

Silicosis is the most common occupational lung disease in Egypt where its prevalence rate ranges from 18.5 % to 45.8% among workers exposed to free crystalline silica dust. Despite its high prevalence, there is a lack of enforcement of exposure limits, availability and use of personal protective equipment, and occupational health education programs. These factors led the authors to study this unique working population; to the best of our knowledge, this is the first work that investigates the effect of exposure to crystalline silica on select immune response of exposed Egyptian phosphate miners. The main aims of this study were to investigate the effect of exposure to free crystalline silica on pulmonary function parameters and select immune response of exposed Egyptian phosphate miners. The study involved of three groups: 50 silica-exposed workers with radiological evidence of silicosis, 50 silica-exposed workers without evidence of silicosis, and 50 healthy unexposed subjects. There were significant differences between pulmonary function parameters in exposed groups with and without silicosis, and healthy unexposed control subjects (p<.001) and pulmonary function was significantly correlated with duration of silica exposure. Smoking had an additive effect on reduction of pulmonary function. Average values of C-reactive protein, rheumatoid factor, complement component C3, IgA, IgG, and IgM were significantly higher in the exposed group with silicosis than in the exposed group without silicosis and in healthy unexposed control subjects (p<.001).

Ion transport mechanisms linked to bicarbonate secretion in the esophageal submucosal glands.

The esophageal submucosal glands (SMG) secrete HCO(3)(-) and mucus into the esophageal lumen, where they contribute to acid clearance and epithelial protection. This study characterized the ion transport mechanisms linked to HCO(3)(-) secretion in SMG. We localized ion transporters using immunofluorescence, and we examined their expression by RT-PCR and in situ hybridization. We measured HCO(3)(-) secretion by using pH stat and the isolated perfused esophagus. Using double labeling with Na(+)-K(+)-ATPase as a marker, we localized Na(+)-coupled bicarbonate transporter (NBCe1) and Cl(-)-HCO(3)(-) exchanger (SLC4A2/AE2) to the basolateral membrane of duct cells. Expression of cystic fibrosis transmembrane regulator channel (CFTR) was confirmed by immunofluorescence, RT-PCR, and in situ hybridization. We identified anion exchanger SLC26A6 at the ducts' luminal membrane and Na(+)-K(+)-2Cl(-) (NKCC1) at the basolateral membrane of mucous and duct cells. pH stat experiments showed that elevations in cAMP induced by forskolin or IBMX increased HCO(3)(-) secretion. Genistein, an activator of CFTR, which does not increase intracellular cAMP, also stimulated HCO(3)(-) secretion, whereas glibenclamide, a Cl(-) channel blocker, and bumetanide, a Na(+)-K(+)-2Cl(-) blocker, decreased it. CFTR(inh)-172, a specific CFTR channel blocker, inhibited basal HCO(3)(-) secretion as well as stimulation of HCO(3)(-) secretion by IBMX. This is the first report on the presence of CFTR channels in the esophagus. The role of CFTR in manifestations of esophageal disease in cystic fibrosis patients remains to be determined.

A survey of size-fractionated dust levels in the U.S. wood processing industry.

A survey of size-fractionated dust exposure was carried out in 10 wood processing plants across the United States as part of a 5-year longitudinal respiratory health study. The facilities included a sawmill, plywood assembly plants, secondary wood milling operations, and factories producing finished wood products such as wood furniture and cabinets. Size-fractionated dust exposures were determined using the RespiCon Personal Particle Sampler. There were 2430 valid sets of respirable, thoracic, and inhalable dust samples collected. Overall, geometric mean (geometric standard deviation) exposure levels were found to be 1.44 (2.67), 0.35 (2.65), and 0.18 (2.54) mg/m, for the inhalable, thoracic, and respirable fractions, respectively. Averaged across all samples, the respirable fraction accounted for 16.7% of the inhalable dust mass, whereas the corresponding figure for thoracic fraction as a percentage of the inhalable fraction was 28.7%. Exposures in the furniture manufacturing plants were significantly higher than those in sawmill and plywood assembly plants, wood milling plants, and cabinet manufacturing plants, whereas the sawmill and plywood assembly plants exhibited significantly lower dust levels than the other industry segments. Among work activities, cleaning with compressed air and sanding processes produced the highest size-fractionated dust exposures, whereas forklift drivers demonstrated the lowest respirable and inhalable dust fractions and shipping processes produced the lowest thoracic dust fraction. Other common work activities such as sawing, milling, and clamping exhibited intermediate exposure levels, but there were significant differences in relative ranking of these across the various industry segments. Processing of hardwood and mixed woods generally were associated with higher exposures than were softwood and plywood, although these results were confounded with industry segment also.