Residing in a Food Desert and Adverse Cardiovascular Events in US Veterans With Established Cardiovascular Disease.

Residents living in a "food desert" are known to be at a higher risk for developing cardiovascular disease (CVD). However, national-level data regarding the influence of residing in a food desert in patients with established CVD is lacking. Data from veterans with established atherosclerotic CVD who received outpatient care in the Veterans Health Administration system between January 2016 and December 2021 were obtained, with follow-up information collected until May 2022 (median follow-up: 4.3 years). A food desert was defined using the United States Department of Agriculture criteria, and census tract data were used to identify Veterans in these areas. All-cause mortality and the occurrence of major adverse cardiovascular events (MACEs; a composite of myocardial infarction/stroke/heart failure/all-cause mortality) were evaluated as the co-primary end points. The relative risk for MACE in food desert areas was evaluated by fitting multivariable Cox models adjusted for age, gender, race, ethnicity, and median household income, with food desert status as the primary exposure. Of the 1,640,346 patients (mean age 72 years, women 2.7%, White 77.7%, Hispanic 3.4%), 25,7814 (15.7%) belonged to the food desert group. Patients residing in food deserts were younger; more likely to be Black (22% vs 13%)or Hispanic (4% vs 3.5%); and had a higher prevalence of diabetes mellitus (52.7% vs 49.8%), chronic kidney disease (31.8% vs 30.4%,) and heart failure (25.6% vs 23.8%). Adjusted for covariates, food desert patients had a higher risk of MACE (hazard ratio 1.040 [1.033 to 1.047]; p <0.001) and all-cause mortality (hazard ratio 1.032 [1.024 to 1.039]; p <0.001). In conclusion, we observed that a large proportion of US veterans with established atherosclerotic CVD reside in food desert census tracts. Adjusting for age, gender, race, and ethnicity, residing in food deserts was associated with a higher risk of adverse cardiac events and all-cause mortality.

Assessment of Impostor Phenomenon in Student Pharmacists and Faculty at Two Doctor of Pharmacy Programs.

Objective. To evaluate the prevalence of impostor phenomenon in student pharmacists and faculty members at two educational institutions in the United States.Methods. Participants anonymously completed an electronic self-report survey instrument that included the validated Clance Impostor Phenomenon Scale (CIPS) from April 2020 to May 2020. Demographic data including age range, gender, and other characteristics were collected. The Clance Impostor Phenomenon Scale scores were reported as means (SDs), and data were compared between institutions and demographic groups using t tests.Results. The overall mean CIPS survey score (N=209, 35.5% response rate) was 63.8 (SD=15.1). The mean student pharmacist CIPS score for Northeast Ohio Medical University (NEOMED) was 64.7 (SD=14.4) vs 63.8 (SD=16.1) for Sullivan University College of Pharmacy and Health Sciences (SUCOPHS), which was statistically similar. Mean faculty CIPS score for NEOMED was 59.2 (SD=14.0) vs 64.7 (SD=16.8) for SUCOPHS, which was statistically similar. Mean CIPS score for the combined student pharmacist group (NEOMED and SUCOPHS) was 64.3 (SD=15.1) vs 61.2 (SD=15.1) for the combined group of faculty members, which was statistically similar. Overall, most respondents fell in the "moderate" to "frequent" CIPS score classification range (36.4% and 44%, respectively).Conclusion. Impostor phenomenon feelings were common among responding student pharmacists and faculty members at the institutions surveyed; however, little is known about the implications of these findings. Future research should seek to elucidate factors predictive of or associated with impostor phenomenon as well as assess the impact of strategies to prevent or manage impostor phenomenon.

Prevalence, predictors and trends of opioid prescribing for lower back pain in United States emergency departments.

WHAT IS KNOWN AND OBJECTIVE: Current evidence-based guidelines for the treatment of acute low back pain (ALBP) recommend the use of opioid medications only after failure of nonpharmacological therapy, non-steroidal anti-inflammatory drugs and skeletal muscle relaxants and after thorough evaluation of risks and benefits. Despite this recommendation and the state of the opioid epidemic in the United States (US), opioids remain a common drug of choice for ALBP in the emergency department (ED). The purpose of this study was to quantify the prevalence and identify predictors of opioid prescribing for acute lower back pain (ALBP) in emergency departments (EDs) in the United States. METHODS: This was a national, cross-sectional study of the National Hospital Ambulatory Care Survey from 2013-2016. ED visits for patients aged ≥18 years treated for ALBP were included. Patients presenting with specified reasons that an opioid may be indicated were excluded. The primary endpoint was frequency of opioids prescribed. A multivariate logistic regression model identified patient- and provider-level predictors of opioid use. RESULTS AND DISCUSSION: This analysis included 2260 visits for ALBP. Opioids were prescribed in 32.3% of visits. Positive predictors of opioid prescribing were pain score of 7-10 (OR 1.85; 95% CI 1.26-2.70), and patients seen in the Southern (OR 2.53; 95% CI 1.47-4.36) or Western US (OR 2.10; 95% CI 1.19-3.70). Opioids were prescribed less often to patients who received a NSAID or acetaminophen (OR 0.38; 95% CI 0.28-0.52 and OR 0.03; 95% CI 0.01-0.10, respectively). WHAT IS NEW AND CONCLUSION: Opioid prescribing rates for ALBP remain high and the predictors identified demonstrate that this prescribing pattern is not uniformly distributed across the patient and provider characteristics studied.