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All analyses were weighted by nonresponse adjusted, trimmed, and calibrated sampling weights and took into account the complex survey design. Among men, compared with Mexican background IR: Among women, compared with Mexican background IR: Abstract Background: While much of the chronic kidney disease CKD literature focuses on the role of blood pressure reduction in delaying CKD progression, little is known about the benefits of modest population-wide decrements in blood pressure on incident CKD.

The population comprised 15, participants of the Atherosclerosis Risk in Communities Study years of age at baseline, Incident CKD was ascertained from laboratory assays and abstraction of medical records. Results: Over a mean of 20 years of follow up, 3, incident CKD events were ascertained. After adjustment for antihypertensive use, gender, diabetes, and age a 1 mmHg decrement in SBP across the total population was associated with an estimated Interventions targeted to the population with blood pressure above JNC 7 goal produced greater reductions in incident CKD than interventions targeted at reductions in blood pressure above JNC 8 treatment goal.

Conclusions: Modest blood pressure interventions population-wide provide an opportunity to substantially reduce the burden of incident CKD. Abstract Introduction: The microvascular contribution to dementia may be under-recognized because of the inability to visualize the brain microvasculature in vivo.

Although the easily-imaged retinal vasculature may be a surrogate measure for that in the brain, large prospective studies of the relationship between retinal vascular signs and dementia are scarce. Methods: Retinal signs were measured using fundus photography Presence and etiology of dementia and mild cognitive impairment MCI were adjudicated using data collected in , including a complete neuropsychological battery and brain magnetic resonance imaging subset of participants. For participants not attending the visit, dementia cases were identified using the Telephone Interview for Cognitive Status—Modified or informant interview, or by hospitalization or death certificate code.

Multivariable-adjusted Cox proportional hazards models and logistic regression were used to quantify the relationship of retinal signs with dementia risk and with etiologic subtype, respectively. Moderate or severe vs. Retinopathy was associated with cerebrovascular-related dementia and MCI odds ratio, 2. Conclusions: Retinal photography captures small vascular signs in the eye that are related to increased dementia risk. Emerging techniques, such as optical coherence tomography angiography, may have the sensitivity to provide surrogate indices of microvascular lesions relevant to dementia in older adults.

Abstract Introduction: Improvements in the treatment of congenital heart disease CHD have resulted in the majority of infants born with CHD surviving into adulthood; completely modifying the epidemiologic profile of patients with CHD. The unique disjointed healthcare system in the U. Hypothesis: Use of capture-recapture methodology in a state-wide CHD surveillance system will result in a higher estimated prevalence of CHD in adolescents and adults by adjusting for incomplete case ascertainment.

Methods: Adolescents and adults age 11 to 64 years with a CHD lesion listed as a diagnostic code on an encounter occurring between January 1, to December 31, were captured by the Colorado CHD surveillance system. Five primary data sources, representing electronic medical records EMR from participating healthcare systems and claims data from the All Payer Claims database, were used for case ascertainment. These sources provide inpatient, outpatient and emergency care across the state of Colorado. Once CHD cases were identified in one of the above data sources, a probabilistic record linkage algorithm was used for de-duplication of cases within and across data sources.

Crude prevalence estimates were generated and then capture-recapture methods were employed to estimate the number of adolescents and adults with CHD in Colorado that were not captured in the surveillance system. Data were analyzed using a log-linear model incorporating severity of CHD as a variable of potential heterogeneous catchability.

Results: The five primary data sources identified 24, CHD cases that met our case definition corresponding to 19, unique individuals during our 3-year surveillance period. The observed overall crude prevalence rate of CHD in adolescents and adults was 5. Using capture-recapture methodology, the estimated prevalence of CHD in adolescents and adults corrected for incomplete case ascertainment was 5.

Conclusion: Our study provides novel insight into strategies for EMR-based surveillance at the population-level by demonstrating the utility of capture-recapture methodology to estimate, and then correct for, cases missed in standard surveillance techniques. Abstract Background: Oral anticoagulants OACs are recommended for AF patients for the prevention of thromboembolic events, including stroke.

Stroke risk stratification scores e. However, these were derived before the advent of direct OACs. Using bootstrapping methods and backward selection of 44 candidate variables, we developed a model which selected variables predicting stroke. The final model was validated in patients with non-valvular AF in the Optum Clinformatics database in the period The stepwise model identified 15 variables including type of OAC associated with ischemic stroke Table.

The discrimination c-statistic of the model was adequate [0. The model was then applied to the 84, AF patients in the Optum data set stroke events. The model showed similar discrimination c-statistic 0. Abstract Introduction: Uncertainty remains regarding the most efficient and cost-effective year atherosclerotic cardiovascular disease ASCVD risk prediction tool for identifying moderate to high-risk patients for primary prevention statin treatment.

However, more precise estimates of trajectories of CVH across the lifespan are needed to guide intervention. The aims of this analysis are to describe trajectories in CVH from childhood through middle age and examine whether there are critical inflection points in the decline in CVH. The association between clinical CVH score and age in years was modeled using a segmented linear mixed model, with a random participant intercept, fixed slopes, and fixed change points. All models were adjusted for race, gender and cohort.

CVH scores decline with age from 8 through 55 years. We found two ages at which the slope of the CVH trajectories change significantly. The second change point occurs at age 30 Conclusion: The clinical CVH score declines from favorable levels from childhood through adulthood, with a rapid decline starting at age 17 that becomes slightly steeper from age 30 to 55 years.

Abstract Background: While some studies report muscle strength is associated with mortality, independent of aerobic physical activity PA , in older people, there are less data in women and lack of studies adjusting the association for objective measures of PA and physical performance. We prospectively examined this association in 5, multiethnic White, Primary covariables included age, race-ethnicity, current smoking, BMI, and number of comorbidities.

Accelerometer measured moderate-to-vigorous PA MVPA and total sedentary time, and gait speed during a self-paced 8 meter walk test were further assessed as confounding factors. Results: There were 5. Further adjustment for MVPA attenuated these associations which remained statistically significant, 1. Similarly, adding sedentary time or gait speed to the primary covariables did not eliminate significance of the inverse mortality trends with either muscle strength measure. Adjusting for primary covariables, each 1-standard deviation 6. Adjusting for primary covariables and MVPA, each 1-standard deviation 6.

Controlling for gait speed opposed to MVPA resulted in consistent findings. Conclusions: Higher muscular strength is associated with lower mortality in older women, independent of device-measured MVPA and sedentary time, and measured gait speed, an indicator of aerobic fitness. If results are confirmed, in addition to guideline recommendations regarding aerobic PA, promoting skeletal muscle strength is an important component of aging well. Abstract Background and Purpose: Sedentary behavior SB and physical inactivity are distinct constructs for which separate research and intervention paradigms may be warranted.

To this end, we compared individual- and neighborhood-level risk factors of each among youth at risk of obesity. Activity level was measured using accelerometers at age y and again 2 years later at age y. Child-level factors included sex, sleep duration, and weekly frequency seeing friends; neighborhood-level factors included density of fast food outlets, convenience stores, and parks; school proximity, street connectivity, land use mix, disorder, social and material deprivation, and parental perceived safety. Separate logistic regression models were estimated for each of inactivity and excessive SB.

We tested models using the identical set of baseline risk factors at both time points. Analyses were restricted to children with complete data at age y, and to children with complete data at age y. Only area-level disorder was associated with being excessively sedentary, and only in y olds; in contrast, several factors increased the likelihood of being inactive, including area deprivation at age y OR: 1.

Although obesity status in children was strongly associated with outcomes in all models, other determinants were unaffected by its inclusion in the models. Conclusions: Our findings suggest that physical inactivity and sedentary behavior are driven by largely distinct paradigms. Each of these may be impacted through increases in light PA. Although interventions need to target all spheres of influence, reducing physical inactivity may be more effectively mediated by features of the built environment, while leveraging social and peer groups may be more effective to reduce sedentary behaviors.

Abstract Introduction: The Look AHEAD trial examined cardiovascular disease incidence in adults with type 2 diabetes randomly assigned to an intensive lifestyle intervention compared to those randomly assigned to diabetes support and education control. In a substudy, physical activity was assessed using accelerometry, which provides an opportunity to examine whether the incidence of cardiovascular disease varied by the measured change in physical activity.

Hypothesis: There is a beneficial association between the 1- and 4-year change in physical activity and the pre-specified primary and secondary outcomes in participants in the Look AHEAD trial. MET-minutes per week of moderate-to-vigorous physical activity MVPA performed in bouts of at least 10 minutes was identified from the accelerometry data.

The 1- and 4-year change in MVPA was computed as the difference from baseline. The primary outcome was pre-defined as non-fatal myocardial infarction, stroke, hospitalized angina, and cardiovascular disease death. The relationships between 1- and 4-year change in physical activity and the primary and secondary outcomes were examined using Cox proportional hazards models with data collapses across the two treatment groups.

Hazard ratios HR were adjusted for age, sex, history of cardiovascular disease, duration of diabetes, diabetes medication use, baseline weight, change in weight, and baseline physical activity. Conclusions: Change in physical activity at 4-years is associated with a reduction in incidence of cardiovascular disease in adults with type 2 diabetes. These findings suggest improvements in physical activity may need to be sustained for a relatively long period 4 years to elicit a beneficial effect on incidence of cardiovascular disease. Aim: To estimate the potential health gains and health-related cost savings for food industry employees from the FDA sodium targets.

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We defined the industry perspective as including all costs to the food industry and all health-related costs and health benefits to people working in the industry. Costs included industry reformulation costs, government costs, and health-related costs healthcare, productivity, informal care for individuals working in the industry. Conclusions: Sustained sodium reduction is estimated to benefit the overall food industry with a healthier workforce and partly offset the reformulation costs for the subset of the processed food industry.

Abstract Background: Traditional factors leave substantial risk for incident cardiovascular disease CVD unexplained. Recent literature addressing this limitation identifies non-traditional risk factors, such as depression and clinical biomarkers. This study explored retirement sequences as a new non-traditional risk factor for CVD among older Americans.

Methods: Heart disease and stroke incidence were measured for 7, Health and Retirement Study participants age 70 and over. Non-parametric survival curves and time-discrete survival models were used to compare the succeeding incidence of CVD across the retirement sequences that individuals followed between ages and We employed six holistic types of retirement sequences: i early for individuals who completely retired at or before age 62; ii complete for the conventional normative model of retirement by which people who are working in full-time jobs completely retire at the legally established age; iii ambiguous for people out of the labor force who shifted into retirement; iv partial for subjects with full-time jobs that claimed partial pension benefits in their early 60s; v compact for individuals moving from part-time positions into partial retirement; and vi late for individuals with full-time employments until their late 60s.

These sequences were measured as longitudinal pathways of labor-force statuses and transitions measured in two-year intervals between the ages to years. Models were fitted for the whole sample, as well as males and females separately, adjusting for the probability of dying before CVD onset, sociodemographics, traditional risk factors, and clinical characteristics. Results: Out of all participants, Individuals following retirement sequences characterized by a progression from full-time jobs to either early retirement heart disease, HR 3.

However, the effects are stronger for heart disease among women and stroke among men. Conclusions: Retirement sequences may indeed be regarded as a non-traditional risk factor for CVD in aging populations. Keywords: Retirement-Heart disease-Stroke-Work. We assessed the incidence of diabetes based on American Heart Association AHA ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA Impact Goals, based on baseline ICH components total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index BMI.

Incident rate ratios IRR were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status normal vs. This suggests the AHA guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

Abstract Introduction: The Farm Bill represents a major opportunity to reduce disparities in diet and health. Their comparative health impacts and cost-effectiveness are not established. Model inputs included national data from NHANES , policy effects from SNAP pilots and food pricing meta-analyses, diet-disease effects from meta-analyses, and policy, food subsidy, and healthcare costs.

Results: From a societal perspective, all 3 scenarios were cost-savings at 5, 10, 20 y and lifetime Table. Scenario 3 was generally most cost-effective or -saving, followed by scenario 2 and then scenario 1; all were cost-effective over a lifetime from a government affordability perspective. However, the factors underlying the transition from at-risk to clinical HF in AA is not well understood. We aimed to examine the independent and joint effects of subclinical myocardial injury, as measured by highly sensitive assays for cardiac troponin hs-TnI and left ventricular hypertrophy LVH , on risk of HF in AA.

Longitudinal increase in hs-TnI levels is also associated with significant risk of HF. Targeting these high-risk subsets may be an important strategy to mitigate HF risk in blacks. Abstract Background: Plasma free fatty acids FFAs are a byproduct of lipolysis largely derived from adipose tissue. High plasma FFA levels have toxic effects on a variety of organs central to cardiometabolic disease.

Whether FFAs associates with cognitive decline or dementia remains unknown. Objective: To assess the association of plasma FFAs with risk of cognitive decline and dementia. We observed no interactions with APOE genotype or race for cognitive outcomes. Conclusions: In non-demented older men and women, higher plasma FFA levels are associated with faster cognitive decline and higher risk of dementia over the subsequent years. Abstract Introduction: Chronic stress and related changes in serum cortisol have adverse effects on brain structure and cognition in animal models.

However, evidence from population-based studies is scant. We assessed the association of early morning serum cortisol with cognition and brain structural integrity in middle-aged adults without dementia. Hypotheses: High or low levels of serum cortisol are associated with lower cognitive performance and brain volumes. Methods: We evaluated dementia-free Framingham Study Generation 3 participants mean age We used linear or logistic cortisol categorized in tertiles, middle tertile as the reference regression to assess the relations of cortisol with cognition, MRI volumes and voxel-based microstructural white matter integrity and gray matter density, adjusting for age, sex, APOE and vascular risk factors.

Results: Higher cortisol highest tertile vs. Higher cortisol was associated with multiple areas of microstructural changes on voxel-based analyses gray matter density and FA. There was no effect modification by the apoE4 genotype of the relations of cortisol and cognition or imaging traits. Conclusions: Higher serum cortisol was associated with lower brain volumes and impaired memory in asymptomatic young adults in their forties; women may be particularly susceptible to this influence.

Abstract Introduction: In animal models of afterload stress, eicosapentaenoic acid EPA prevents interstitial myocardial fibrosis and preserves diastolic dysfunction. Hypothesis: We hypothesized that EPA is similarly protective in humans. Over a median follow-up of EPA was associated with lower incidence of HF, having a hazard ratio of 0. Adjusting for age, sex, race, BMI, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, and albuminuria did not change this relationship.

Sensitivity analysis showed no dependence on heart failure type. Adjusting for other fatty acids with clustering did not change hazards. Subjects with sufficient EPA levels were at 0. Conclusion: High abundance of EPA is robustly associated with reduced risk for heart failure, independent of established risk factors and regardless of ejection fraction status. We found high mobility, such that childhood CV risk burden tracks into adulthood, but not so strongly that a low CV-risk stratum in adulthood is unreachable.

Because geopolitical, ethnic, and healthcare differences may affect mobility in life course CV health, we sought to further test CRM using an international consortium. During childhood age yr , participants were percentile-ranked by their CV risk factor burden using an age- and sex-adjusted sum of z-scores from total cholesterol, systolic blood pressure, BMI, and triglycerides.

During adult follow-up age yr , participants were percentile-ranked using the Framingham score. Conclusions: Populations in the developed world track, yet exhibit large mobility in CV risk. Children are readily able to move from both high to low and low to high CV risk strata over the life course. Abstract Introduction: Growth in early infancy is hypothesized to affect chronic disease risk factors later in life. To date, most reports draw on European ancestry cohorts with few observations of early growth. We used a false discovery rate of 0.

LGMM models offered more nuanced findings. Summary: This study provides evidence of associations between infant growth from 0 and 5 months and blood lipid profiles during adolescence.


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Based on two different analytic approaches, characteristics of infant length trajectories were associated with HDL-C at mean age 17 years. These findings align with the well-established relationship between height and CVD in adulthood. Furthermore, groups with higher acceleration in all three trajectory types were more likely to have adverse lipid outcomes.

Future research can inform the role of infant body size change in the context of downstream effects and CVD risk. Abstract Introduction: Studies of isolated hunter-gatherers have found little evidence of the age-related rise in blood pressure BP that is common to Western societies, but none of these studies have included children or, for comparison, neighboring tribes exposed to Western culture. We tested the hypothesis that BP does not rise with age in isolated, hunter-gatherer Yanomami, and the age-BP slope is greater in neighboring Yekwana tribes that have some Western exposure.

Methods: In the Upper Caura basin, a remote area of the Venezuelan Amazon, we sampled participants from 5 isolated Yanomami-Sanema villages, accessible only by foot or canoe, and 3 Yekwana villages, 1 of which had a grass landing strip for small-engine planes, allowing for delivery of medicine and aspects of Western lifestyle, including salt. These results indicate that at age 10 y, mean sitting SBP was, on average, 5. Conclusion: In isolated Yanomami with hunter-gatherer-grower lifestyles, BP does not increase with age over ages 2 to 60 y.

Yet, among the Yekwana—the closest geographic neighbors of the Yanomami in whom Westernization is at the incipient stages—age is positively associated with BP, suggesting that the rise in BP with age may result in part from cumulative exposure to Western lifestyle. We investigated longitudinal changes in obesity sub-phenotypes, and their associations with health outcomes. Hypothesis: We hypothesized that metabolically heathy obesity MHO is associated with elevated risk of cardiovascular disease [CVD], metabolic disease and cancer, compared to healthy non-obesity.

Methods: We evaluated 4, Framingham Offspring Study participants attending at least two examinations between cycles 2 [] through 7 [] 26, participant-observations. We assessed changes in subphenotypes over time, and their relations to coronary artery calcification CAC , subclinical CVD presence of one or more of the following: left ventricular [LV] systolic dysfunction, LV hypertrophy, increased carotid intima-media thickness, reduced ankle-brachial index or microalbuminuria and incident diabetes, hypertension, chronic kidney disease, CVD and mortality.

Conclusion: Over two decades, most MHO participants developed metabolic abnormalities, subclinical and clinical disease, suggesting that this subphenotype is a harbinger of future disease risk. Abstract Introduction: A life course approach has been suggested as the most appropriated to establish the actual impact of socioeconomic status SES on health outcomes.

Hypothesis: We assessed the hypothesis that SES trajectories from childhood to adulthood are useful to better evaluate the role of SES towards mortality risk in a large general population-based cohort. Methods: Longitudinal analysis on 22, subjects recruited in the general population of the Moli-sani study, Italy Results: Over a median follow-up of 8.

Conclusions: In conclusion, for individuals with low SES in childhood, an upward of both educational attainment and material factors over the life course is associated with lower risk of total and CVD death. In advantaged groups in childhood, lack of a higher educational attainment, rather than material factors, over the life course appears to be unfavourably associated with survival. Abstract Background: Although the association between socioeconomic adversity and risk for cardiovascular disease CVD is established, little is known about the effect of socioeconomic disadvantages across the life-course on arterial stiffness, an important marker of subclinical cardiovascular disease CVD.

Objective: To investigate whether exposure to adverse socioeconomic position SEP throughout the life course and especially in early life, is associated with increased arterial stiffness in adults. In addition, we assessed whether increasing number of unfavorable SEP events during the life course is associated with higher arterial stiffness. Methods: A total of 14, adults from the ELSA-Brasil cohort study baseline , aged between 34 and 75 years ELSA-Brazil is a multicenter cohort of civil servants from universities and research institutions of six Brazilian cities that aims to investigate the determinants of cardiovascular disease.

Arterial stiffness was measured by cfPWV. The following variables were used for adjustments: age, sex, race, mean arterial pressure, heart rate, smoking, physical activity, diabetes, antihypertensive use. Multiple linear regression models were used. Individuals exposed to low SEP in childhood and adulthood presented an average increase of 0. Conclusion: Accumulation of exposures to socioeconomic disadvantages throughout life was associated with higher cfPWV in adults.

Thus, it may imply that longer exposure to social disadvantages throughout life accelerates arterial aging. Abstract Introduction: Laws banning smoking in indoor public places have been associated with reductions in second-hand smoke exposure and cardiovascular disease among non-smokers. Second-hand smoke exposure has been associated with hypertension in prior studies. However, it is unknown whether smoke-free policies are associated with changes in blood pressure.

Fixed-effects linear regression estimated associations of each type of smoke-free policy restaurant, bar, workplace with within-person changes in systolic and diastolic blood pressure SBP and DBP. Results: At baseline, mean SBP was Smoke-free policies were associated with within-person reductions in SBP and DBP in fully adjusted models expressed as average change between exams in mmHg. Mean reductions in SBP were Mean reductions in DBP were Conclusions: Smoke-free policies in restaurants and other workplace are associated with within-person reductions in systolic and diastolic blood pressure among non-smokers.

These results suggest an additional health benefit of these policies beyond those previously described in the literature. Abstract Introduction: While a range of population-level and clinical interventions have been implemented to improve cardiometabolic CM health in the US, little is known about their different effects at the state-level. Objective: To develop a novel index to evaluate the performance of the healthcare system and population-level interventions to improve CM health at the state-level from to Methods: To evaluate healthcare access and quality, we estimated risk-standardized age-standardized mortality rates for six CM diseases that are amenable to healthcare.

Risk-standardization removed geographic variation in all risk factors not directly amenable to medical intervention. To evaluate the effect of population-level interventions, we estimated the risk-weighted exposure to lifestyle risk factors including smoking, alcohol, diet, body mass index, and physical activity.

We averaged the healthcare index with the risk factor index to create a single composite index. Data sources included mortality and risk factor estimates from the Global Burden of Disease Study. Results: Between and , healthcare access and quality for CM diseases significantly improved in 38 states. These increases were mainly driven by significant improvements nationwide in healthcare for ischemic heart disease, ischemic stroke, and rheumatic heart disease. Notably, healthcare for diabetes significantly worsened in 16 states. There were no significant changes in the lifestyle risk factor index since Stability was driven by diverging trends, with smoking and diet quality significantly improving and BMI significantly worsening in all states.

Importantly, the gap between the best and worst performing states across all indices increased between and , indicating greater health disparities.

Conclusions: This study has quantified the separate and combined effects of healthcare access, quality, and risk factors on CM health, with implications on priority setting for both population-level and clinical interventions. Abstract Background: Familial hypercholesterolemia FH significantly increases the risk of atherosclerotic cardiovascular disease ASCVD ; however, recent data from ambulatory care centers suggests that prescription rates for statins remain low in patients with severe dyslipidemia or diagnosed FH.

National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown. Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. Results were extrapolated to the U. Less than half of those on statins were prescribed a high-intensity statin. Older age, insurance, having a usual source of care, diabetes, hypertension, and having a personal history of early ASCVD were associated with statin use.

The discrepancy between cholesterol screening and treatment rates was most pronounced in younger patients, uninsured patients, and patients without a usual source of care. Conclusions: Despite high rates of cholesterol screening and awareness, only about half of U. S adults with FH are on statin therapy and even fewer are prescribed a high-intensity statin; young and uninsured patients are at the highest risk for under treatment. This study highlights an opportunity and an imperative to improve statin treatment rates in this high-risk population.

Additional studies are needed to better understand how to close the gap between screening and treatment among adults with FH and improve treatment rates among those with limited access to care. Abstract Background: Identification of individuals at risk for heart failure HF is necessary for implementation of primary prevention strategies. Methods: Estimation of year risk equations for developing a HF event were derived from community-based cohorts representative of the U.

HF occurred in 1, participants. Independent predictors of HF included in the model were age, blood pressure treated or untreated , fasting glucose treated or untreated , body mass index, cholesterol, smoking status, and QRS duration. The data-derived model had excellent discrimination in the 11, distinct participants in the validation cohort C-statistics 0.

Abstract Background: While economic incentives through health insurance are being considered to promote healthy behaviors, little is known about health or financial impacts of incentivizing diet, a leading risk factor for CVD. We estimated health and economic impacts of programs to incentivize healthful foods through Medicare and Medicaid over a 5, 10, and 20 y horizon.

Productivity gains were conservatively excluded. Results: Both incentive programs were cost-effective from a healthcare government affordability perspective Table. Findings were robust to a range of sensitivity analyses; within Medicare, the incentive program was more cost-effective among individuals with lower income.

These incentive programs were also cost-effective at 5 and 10 y not shown. Conclusions: Economic incentives for healthier foods through either Medicare or Medicaid could generate substantial health gains and healthcare cost savings. Abstract Severe obesity in youth is associated with accentuated risks of chronic health problems. However, quantifying risk of cardiovascular disease CVD events later in life is challenged by long latent periods between risk factor development and overt disease outcomes. A year CVD event risk score has been developed in the Framingham Offspring cohort to address this problem.

The year CVD event risks were estimated for adolescents with severe obesity prior to and up to 5 years after undergoing bariatric surgery. We hypothesized that adolescents with severe obesity would be at high risk for full CVD events within years and that bariatric surgery would reduce that risk. Data collected preoperatively and annually to 5 years were analyzed. A year composite risk score CVD event risk was examined which included the following hard endpoints: coronary death, myocardial infarction, and stroke fatal and nonfatal , coronary insufficiency, angina pectoralis, transient ischemic attack, intermittent claudication, and congestive heart failure.

CVD event risk score requires the following risk factors for calculation: Sex, age, systolic blood pressure, antihypertensive treatment, smoking, diabetes mellitus, total cholesterol, high-density lipoprotein cholesterol, and BMI. Data are presented as mean SD with differences between time-points examined using linear mixed-models. Preoperatively, the likelihood of CVD events was 7. Preoperatively, At 1-year post-surgery a significant reduction in CVD events 7. These predicted benefits for full CVD events were sustained at 2 years 4. These data suggest that prior to bariatric surgery, the risk of CVD event within years is pronounced.

However, following bariatric surgery, risk of hard endpoints is substantially reduced for up to 5 years following surgery. Diet and lifestyle factors after diabetes diagnosis were repeatedly assessed every years. After multivariate adjustment including medication use, the individual low-risk lifestyle factors after diabetes diagnosis were each significantly associated with a lower risk of CVD incidence and mortality.

The population-attributable-risk for poor adherence to low-risk lifestyle was In addition, greater improvements in lifestyle factors from pre- to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and mortality. Conclusions: Greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and mortality among adults with type 2 diabetes. These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in diabetic patients.

Abstract Background: In observational studies, coffee consumption has been consistently associated with a lower risk of type 2 diabetes mellitus. Trials examining the effect of coffee consumption on glucose metabolism have been limited by the use of surrogate insulin sensitivity indices, small sample sizes, lack of blinding, and short follow-up duration. We aimed to overcome these limitations in a randomized placebo-controlled trial examining the effects of coffee consumption on insulin sensitivity. The primary outcome was bodyweight-standardized M-value M bw assessed with a hyperinsulinemic euglycemic clamp.

Secondary outcomes included other clamp-based insulin sensitivity measures, biological mediators of insulin sensitivity, and measures of fasting glucose metabolism, body weight and composition. Furthermore, no significant differences in fasting plasma glucose [3. Coffee consumption led to a loss of body weight as compared with placebo [ Conclusions: Consuming 4 cups per day of caffeinated coffee for 24 weeks had no significant effect on insulin sensitivity or biological mediators of insulin resistance.

Coffee consumption led to a modest decrease in body fat as compared with coffee abstinence. Trial Registration: ClinicalTrials. Registered on 28 November Trial Site: National University of Singapore. Abstract Background: The inter-relationships between smoking cessation, subsequent weight change, and type 2 diabetes T2D risk remain to be characterized.

Methods: We prospectively followed , U. Participants were followed biennially for smoking status, weight change, and diabetes risk. Self-reported T2D was confirmed using a validated supplementary questionnaire. Results: Compared with current smokers, T2D risk among quitters significantly increased and peaked after years of quitting, and gradually decreased along extended durations. With a mean quitting duration of 9. The T2D risk approached that of never smokers after 30 years of quitting among older nurses.

There was, on average, 5. We estimated that for quitters who did not gain weight within the first 6 years, their T2D risk approached that of never smokers after 5 years of quitting. Conclusions: Weight gain after quitting smoking may significantly attenuate the benefits of smoking cessation by increasing T2D risk.

Our findings underscore the importance of weight control after quitting in maximizing the benefits of smoking cessation. Because light physical activity LPA; 1. Fully adjusted models accounted for age, race-ethnicity, smoking, education, body mass index, systolic blood pressure, co-morbidity score, physical function, and self-rated health. Women with the highest vs. Women in the highest vs. Increasing levels of LPA is an achievable behavioral intervention for improving heart health in older women. Abstract Introduction: Several studies report late-life physical activity PA to be associated with less brain atrophy.

Associations of PA and subclinical brain markers evaluated at older ages may be subject to reverse causality due to comorbidity, age-related changes in lifestyle, or incipient cognitive impairment. Therefore, we aimed to compare late-life cross-sectional estimates of PA and ROI brain volumes to those using prospective PA measures from mid- to late-life.

Brain MRI using 3D Weighted linear regression adjusted for intracranial volume, demographics, select cardiovascular risk factors and ApoE4 estimated the standardized difference in ROI volumes. High mid-life PA was only modestly associated with larger frontal cortical and deep gray matter volumes in late-life Table. Habitually high PA in mid-life was not associated with less atrophy across brain regions in late-life. Conclusions: Our results do not support a causal interpretation of the cross-sectional associations between PA and brain volumes reported in late-life.

Drawing on long-term population-based data, this study provides novel information on the associations of PA across life epochs with brain health, which can inform translational and intervention efforts to reduce age-related cognitive impairment. Hypotheses: We hypothesized that: 1 baseline CRF is inversely associated with the risk of incident CKD after adjustment for covariates and 2 differences in baseline CRF account for a proportion of the disparity in incident CKD between blacks and whites.

Methods: A total of young adults without CKD age Models adjusted for baseline race, sex, age, field center, alcohol intake, smoking status, healthy eating index, eGFR, maximal educational attainment, and time-varying BMI, diabetes, and hypertension. The percent reduction in parameter estimates determined the excess risk explained according to CRF.

Results: During the 30 years of follow-up, 84 blacks and 43 whites developed CKD. Blacks were 1. This was reduced to 1. Conclusion: Both low fitness during young adulthood and black race are associated with higher incidence of CKD later in life. Fitness is a modifiable factor that could be targeted to address a portion of the disparity gap in CKD. CAC was assessed via cardiac computed tomography, while physical activity was assessed via questionnaire and categorized by quintiles of moderate and vigorous LTPA e. Abstract Introduction: Low levels of cardiorespiratory fitness, moderate-to-vigorous-intensity physical activity MVPA , and excess sedentary behaviors are associated with a greater risk of type 2 diabetes.

Less is known about the role of fitness, MVPA, and sedentary behaviors before pregnancy with subsequent development of gestational diabetes mellitus GDM , a strong risk factor for future diabetes and cardiovascular disease. Objective: To assess the associations of pre-pregnancy fitness, MVPA, and time spent watching television a surrogate for sedentary behavior with risk of GDM.

Baseline fitness was estimated using a graded symptom-limited maximal treadmill test and expressed in metabolic equivalent units METS. Results: Over 25 years of follow up, women developed GDM. Conclusions: This is one of the first studies to report an inverse association between objectively measured pre-pregnancy fitness and subsequent development of GDM. Improved pre-conception fitness may benefit women at risk for GDM. Abstract Background: Evidence on sedentary behavior and cardiovascular disease CVD is largely based on self-reported sedentary time. Furthermore, how sedentary time is accumulated in longer vs.

Separate models evaluated associations after adding moderate-to-vigorous physical activity MVPA and possible mediators: body mass index, diabetes, hypertension, systolic blood pressure, fasting glucose, HDL-cholesterol, and triglycerides. All CHD associations remained significant but attenuated after adjustment for possible mediators. After adjustment for MVPA, highest vs.

Among women with high sedentary time, the HRs CI comparing the 75 th vs. Conclusions: Both sedentary time and mean bout duration showed independent, dose-response associations with increased risk of CVD and CHD events in older women. Among women with high sedentary time, longer mean bout duration was associated with higher CHD risk. Taken together, this provides evidence that both total sedentary time and the way it is accumulated are predictive of incident CHD.

Abstract Introduction: Recent metabolomics studies have identified circulating levels of branched-chain amino acids BCAAs; isoleucine, leucine, valine as strong predictors of type 2 diabetes T2D. Hypothesis: We hypothesized that higher baseline levels of plasma BCAAs are associated with an elevated risk of incident CVD events, and evaluated whether this relationship was dependent on an intermediate diagnosis of T2D.

Results: 1, confirmed CVD events occurred over follow-up mean Further adjusting for biomarkers of potential intermediates, HbA1c, lipids, and a lipoprotein-based insulin resistance score entirely eliminated the associations of BCAAs with CVD. Abstract Background: Atrial fibrillation AF is the most common clinical arrhythmia. Molecular studies suggest that mitochondrial dysfunction is associated with increased risk of AF through reduced production of adenosine triphosphate and increased production of reactive oxidative species. AF were identified through electrocardiograms, review of hospital discharge codes, and death certificates.

DNA samples were isolated from buffy coat. Results: The mean SD age was During 21 years of median follow-up, 1, participants developed AF. Decline in mitochondrial function may be a novel mechanism underlying biological changes that increase the risk of AF in the general population. Thus, studying whether the IL6R variant is protective for a phenotype can inform which diseases may benefit from treatment with IL6R blockade.

We extracted all diagnoses codes and mapped them to phenotype groups using published PheWAS methods. Routine laboratory measurements, e. A PheWAS was performed by constructing logistic regression models testing associations between the IL6R variant AspAla, rs and 1, phenotype groups; linear regression models were constructed to screen for associations between IL6R and 26 routine laboratory measurements. All models were adjusted for age, gender, and race.

Results: We studied , participants; the minor allele frequency of the IL6R variant was IL6R was most strongly associated with a reduced risk of aortic aneurysm OR 0. We observed the expected association between IL6R and reduced C-reactive protein. We also observed known side effects of IL6R blockade, elevated transaminases, as well as elevated triglycerides, an initially unexpected result in the early clinical trials. Conclusion: In this proof of concept study, we demonstrate the utility of PheWAS to inform drug effects using the largest US-based biobank study.

The strong association with aortic aneurysm corresponded with the newest indication for IL6R blockade to prevent aortic aneurysms due to large vessel vasculitis. Abstract Introduction: Widely consumed beverages e. Taste perception and preferences are highly heritable and strong determinants of food and beverage choice. We aimed to identify novel loci underlying habitual bitter and sweet beverage intake. Bitter beverage intake was the sum of coffee, tea and grapefruit juice.

Sweet beverage intake was the sum of artificially and sugar sweetened beverages and other fruit juice. Multivariable linear regression under an additive genetic model was applied. The effect size per allele ranged from 0. Replication efforts are ongoing. So far, associations at all loci, except 1q Conclusions: Loci linked to caffeine metabolism and obesity predisposition rather than taste are major determinants of beverage intake.

These and other identified loci have been linked to chronic disease and risk factors, suggesting causal or pleiotropic effects. Our findings have potential public health and methodological implications. Abstract Platelets are critical in inflammation, wound healing, and thrombosis. Platelet count PLT and mean platelet volume MPV are heritable, frequently assessed measures for which hundreds of genetic associations have been identified, predominantly in European populations.

However, causal variants are unknown at most loci, and additional genetic determinants in diverse ancestral populations remain to be discovered. Inverse normalized residuals were adjusted for sex, age, study, and an empirical genetic relationship matrix, allowing for heterogeneous variance by study.

This variant and an LD proxy rs overlap a GATA1 binding site in erythroblasts, the sister lineage of platelet producing megakaryocytes. Aggregated sliding window tests did not identify any additional signals. These results show suggestive evidence for association with PLT for two novel variants common only in African ancestry populations, but larger sample sizes of diverse ancestry will be necessary for replication and further discovery of novel loci. Transcription elongation control has broad effects on gene expression, the misregulation of which is known to influence cardiac conduction system morphogenesis as well as activation or repression of key regulatory genes.

Inverse-variance weighted meta-analysis of genomically controlled ancestry- and study-specific summary effects estimated using multivariable adjusted linear models or generalized estimating equations that incorporated robust standard errors was performed using METAL. Conclusion: Extension of traditional main effects GWAS to interrogate gene-gene interactions for biologically motivated loci like TCEA3 may help inform the structure and function of genetic pathways underlying complex traits like QT.

Abstract Introduction: Diet beverages are calorie free beverages sweetened with non-nutritive sweeteners. People with diabetes are the highest per-capita consumers of diet beverages, tending to consume them as a replacement for dietary sources of sugar, especially in place of sugar sweetened beverages.

This behavior is endorsed by dietetic and scientific organizations and diet beverages are marketed synonymously with better health, weight loss, and thus, are considered advantageous for diabetes control. The underlying public health concern is the lack of data to support or refute this concept.

We carried out a 2-step meta-analysis using individual level, cohort-specific Cox regression analyses with identical adjustment for demographic, lifestyle, overall diet quality and clinical risk factors to generate effect estimates that were pooled together using fixed and random effects meta-analysis. Results: 1, participants developed adjudicated CHD during follow-up. There was a positive, graded association between diet beverage intake and risk of incident CHD Table.

Results were consistent by sex, race and age. These results suggest the need to further evaluate dietary recommendations related to diet beverages and consider their role in this high risk population. Although they typically remain asymptomatic, rupture of an AAA carries high mortality. Medical emergency; methadone. Any disclosure of records pursuant to this subsection must be documented as described in Title 22, section , subsection 7. Legislation passed [HB] which requires mandatory Prescription Drug Monitoring Program registration for Controlled Dangerous Substances prescribers and pharmacists by July 1, [mandated use by July 1, ].

Any other patient diagnosed with a terminal illness; iii A patient who resides in:.

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Program established. Provider group does not include a professional association supported by dues-paying members. In developing opioid disenrollment standards, the standards may be described in terms of the length of time in which prescribing practices fall outside community standards and the nature and amount of opioid prescribing that fall outside community standards; and. Any other prescriber who prescribes opioids may comply with the components of this program described in paragraph a on a voluntary basis.

The commissioner shall annually collect and report to opioid prescribers data showing the sentinel measures of their opioid prescribing patterns compared to their anonymized peers. A quality improvement plan must include:. Notwithstanding this data classification, the commissioner shall share with all of the provider groups with which an opioid prescriber is employed or affiliated, a report identifying an opioid prescriber who is subject to quality improvement activities under subdivision 5, paragraph b or c. Annual report to legislature. The report must include data on the utilization of opioids within the Minnesota health care programs.

For the purposes of this section, controlled substances includes butalbital and gabapentin. Dispensing does not include the direct administering of a controlled substance to a patient by a licensed health care professional. For the purposes of this section, a dispenser does not include a licensed hospital pharmacy that distributes controlled substances for inpatient hospital care or a veterinarian who is dispensing prescriptions under section Treatment of intractable pain.

No prescriber shall be subject to disciplinary action by a health-related licensing board for prescribing a controlled substance according to the provisions of section The committee must include at least one representative of:. Notwithstanding any other provisions of law to the contrary, the task force shall not expire. The board may allow dispensers to omit data listed in this subdivision or may require the submission of data not listed in this subdivision provided the omission or submission is necessary for the purpose of complying with the electronic reporting or data transmission standards of the American Society for Automation in Pharmacy, the National Council on Prescription Drug Programs, or other relevant national standard-setting body.

The board shall maintain data that could identify an individual prescriber or dispenser in encrypted form. Except as otherwise allowed under subdivision 6, the database may be used by permissible users identified under subdivision 6 for the identification of:. Effective January 1, , data older than 24 months must be destroyed. Data reported on or after January 1, , must be destroyed no later than 12 months from the date the data was received. The health professionals services program personnel shall not provide this data to a health-related licensing board or the Emergency Medical Services Regulatory Board, except as permitted under section For purposes of clause 4 , access by an individual includes persons in the definition of an individual under section Data submitted by a prescriber, pharmacist, or their delegate during the registration application process, other than their name, license number, and license type, is classified as private pursuant to section No other permissible users may directly access the data electronically.

The permissible user shall identify reasonably foreseeable internal and external risks to the security, confidentiality, and integrity of personal information that could result in the unauthorized disclosure, misuse, or other compromise of the information and assess the sufficiency of any safeguards in place to control the risks.

A vendor shall not use data collected under this section for any purpose not specified in this section. When the commissioner determines there have been multiple prescribers or multiple prescriptions of controlled substances, the commissioner shall:. If determined necessary, the commissioner of human services shall seek a federal waiver of, or exception to, any applicable provision of Code of Federal Regulations, title 42, section 2. Any funds received shall be appropriated to the board for this purpose. The board may not expend funds to enhance the program in a way that conflicts with this section without seeking approval from the legislature.

Each respective board may adjust the fees that the boards are required to collect to compensate for the amount apportioned to each board by the administrative services unit. Opioid stewardship fund [Effective July 1, ; Effective until June 30, ]. Opioid stewardship payment imposed on manufacturers and distributors. On an annual basis, the commissioner shall certify to the state comptroller the amount of all revenues collected from opioid stewardship payments and any penalties imposed.

The amount of revenues so certified shall be deposited quarterly into the opioid stewardship fund established pursuant to section ninety-seven-aaaaa of the state finance law. No licensee shall pass the cost of their ratable share amount to a purchaser, including the ultimate user of the opioid, or such licensee shall be subject to penalties pursuant to subdivision ten of this section. Determination of opioid stewardship payment. The total opioid stewardship payment amount shall be one hundred million dollars annually, subject to downward adjustments pursuant to subdivision nine of this section.

Reports and records. Each manufacturer and distributor licensed under this article that sells or distributes opioids in the state of New York shall provide to the commissioner a report detailing all opioids sold or distributed by such manufacturer or distributor in the state of New York.

Such report shall include:. Subsequent annual reports shall be submitted on April first of each year based on the actual opioid sales and distributions of the prior calendar year. Determination of ratable share. Each manufacturer and distributor licensed under this article that sells or distributes opioids in the state of New York shall pay a portion of the total opioid stewardship payment amount.

The ratable share shall be calculated as follows:. The licensee payment percentage shall be multiplied by the total opioid stewardship payment. Thereafter, the department shall notify the licensee in writing annually on or before October fifteenth of each year based on the opioids sold or distributed for the prior calendar year. Payment of ratable share. The licensee shall make payments quarterly to the department with the first payment of the ratable share, provided that the amount due on January first, two thousand nineteen shall be for the full amount of the first annual payment, with additional payments to be due and owing on the first day of every quarter thereafter.

Rebate of ratable share. In any year for which the commissioner determines that a licensee failed to report required information as required by this section, those licensees complying with this section shall receive a reduced assessment of their ratable share in the following year equal to the amount in excess of any overpayment in the prior payment period. Licensee opportunity to appeal. A licensee shall be afforded an opportunity to submit information to the department to justify why the ratable share provided to the licensee, pursuant to paragraph c of subdivision five of this section, or amounts paid thereunder are in error or otherwise not warranted.

If the department determines thereafter that all or a portion of such ratable share, as determined by the commissioner pursuant to subdivision five of this section, is not warranted, the department may:. Department annual review. The department shall annually review the amount of state operating funds spent in the office of alcoholism and substance abuse services OASAS budget for opioid prevention, treatment and recovery.

The commissioner of OASAS shall certify to the department the amount of annual spending for such services, utilizing available information on patient demographics and the actual cost of services delivered by the state and by state-funded providers. The certification of such spending shall begin in state fiscal year two thousand eighteen-nineteen, and continue annually thereafter. The total amount of such spending shall be provided to the department by the commissioner of OASAS no later than June thirtieth of each year.

There shall be no stewardship fund payments beginning on July first in the event state operating funds spent in the OASAS budget for opioid prevention, treatment and recovery in the most recently reported year is equal to or less than state operating funds spent for such purposes in state fiscal year two thousand nine-ten. Section aaaaa. Moneys in opioid stewardship fund shall be kept separate and shall not be commingled with any other moneys in the custody of the state comptroller and the commissioner of taxation and finance.

The opioid stewardship fund shall consist of moneys appropriated for the purpose of such account, moneys transferred to such account pursuant to law, contributions consisting of promises or grants of any money or property of any kind or value, or any other thing of value, including grants or other financial assistance from any agency of government and moneys required by the provisions of this section or any other law to be paid into or credited to this account. Moneys of the opioid stewardship fund, when allocated, shall be available, subject to the approval of the director of the budget, to support programs operated by the New York state office of alcoholism and substance abuse services or agencies certified, authorized, approved or otherwise funded by the New York state office of alcoholism and substance abuse services to provide opioid treatment, recovery and prevention and education services; and to provide support for the prescription monitoring program registry as established pursuant to section thirty-three hundred forty-three-a of the public health law.

At the request of the budget director, the state comptroller shall transfer moneys to support the costs of opioid treatment, recovery, prevention, education services, and other related programs, from the opioid stewardship fund to any other fund of the state to support this purpose. The moneys, when allocated, shall be paid out of the opioid stewardship fund, pursuant to subdivision four of this section, and subject to the approval of the director of the budget, on the audit and warrant of the comptroller on vouchers certified or approved by.

No Schedule II substance shall be dispensed pursuant to a written prescription more than six months after the date it was prescribed. This subsection does not apply to prescriptions for targeted controlled substances issued by any of the following:. A dispenser may continue to dispense targeted controlled substances from valid written, oral, or facsimile prescriptions that are otherwise consistent with applicable laws. A practitioner shall not prescribe more than a seven-day supply of any targeted controlled substance for post-operative acute pain relief immediately following a surgical procedure.

Upon any subsequent consultation for the same pain, the practitioner may issue any appropriate renewal, refill, or new prescription for a targeted controlled substance. This subsection does not apply to prescriptions for controlled substances issued by a practitioner who orders a controlled substance to be wholly administered in a hospital, nursing home licensed under Chapter E of the General Statutes, hospice facility, or residential care facility, as defined in G.

A practitioner who acts in accordance with the limitation on prescriptions as set forth in this subsection shall be immune from any civil liability or disciplinary action from the practitioner's occupational licensing agency for acting in accordance with this subsection. The term does not include chronic pain or pain being treated as part of cancer care, hospice care, palliative care, or medication-assisted treatment for substance use disorder.

This term includes the diagnostic or therapeutic treatment of conditions or disease processes by use of instruments such as lasers, ultrasound, ionizing, radiation, scalpels, probes, or needles that cause localized alteration or transportation of live human tissue by cutting, burning, vaporizing, freezing, suturing, probing, or manipulating by closed reduction for major dislocations and fractures, or otherwise altering by any mechanical, thermal, light-based, electromagnetic, or chemical means.

Prescriptions shall be retained in conformity with the requirements of G. No prescription for a Schedule II substance may be refilled. Such prescription may not be filled or refilled more than six months after the date thereof or be refilled more than five times after the date of the prescription. Such request must be made on each distribution and must contain the names and addresses of the supplier and the requester and the name and quantity of the specific controlled substance requested.

The manufacturer shall maintain a record of each such request for a period of two years. Requirements for controlled substances reporting system; civil penalties for failure to properly report. Each dispenser shall submit the information in accordance with transmission methods and frequency established by rule by the Commission. The Department may issue a waiver to a dispenser who is unable to submit prescription information by electronic means.

The waiver may permit the dispenser to submit prescription information by paper form or other means, provided all information required of electronically submitted data is submitted. The dispenser shall report the information required under this section no later than the close of the next business day after the prescription is delivered; however, dispensers are encouraged to report the information no later than 24 hours after the prescription was delivered.

The information shall be submitted in a format as determined annually by the Department based on the format used in the majority of the states operating a controlled substances reporting system. In the event the dispenser is unable to report the information within the time frame required by this section because the system is not operational or there is some other temporary electrical or technological failure, this inability shall be documented in the dispenser's records.

Once the electrical or technological failure has been resolved, the dispenser shall promptly report the information. The Commission may modify these requirements as necessary to carry out the purposes of this Article. The dispenser shall report:. Each day of a continuing violation shall constitute a separate violation.

A pharmacy acting in good faith that attempts to report the information required by this section shall not be assessed any civil penalty. The clear proceeds of penalties assessed under this section shall be deposited to the Civil Penalty and Forfeiture Fund in accordance with Article 31A of Chapter C of the General Statutes. The Commission shall adopt rules to implement this subsection that include factors to be considered in determining the amount of the penalty to be assessed. Except as otherwise provided by this section, prescription information shall not be disclosed or disseminated to any person or entity by any person or entity authorized to review prescription information.

The criteria for reporting established by rule shall not establish the standard of care for prescribing or dispensing, and it shall not be a basis for disciplinary action by an agency that the Department reported a practitioner to an agency based on the criteria. A person authorized to receive data pursuant to this paragraph may delegate the authority to receive the data to other persons working under his or her direction and supervision, provided the Department approves this delegation.

The administrator of a hospital emergency department or hospital acute care facility shall provide the Department with a list of prescribers who are authorized to prescribe controlled substances for the purpose of providing medical care for patients of the hospital emergency department or hospital acute care facility and a list of delegates who are authorized to receive data on behalf of the providers listed. The administrator acting under this paragraph shall submit the lists to the Department no later than December 1 of the calendar year preceding the year during which the delegates are to receive data and may provide updated lists at any time during the course of the year.

Within one week of receiving the initial or updated lists described in this paragraph, the Department shall establish all of the delegate accounts necessary to enable each delegate listed by the administrator of the hospital emergency department or hospital acute care facility to receive data on behalf of the listed prescribers. Delegations made pursuant to this paragraph are valid during the calendar year for which submitted by the administrator. The Office of the Attorney General shall review the Department's findings to determine if the findings should be reported to the SBI and the appropriate sheriff for investigation of possible violations of State or federal law relating to controlled substances.

The Department shall maintain in a separate database all information purged from the controlled substances reporting system database pursuant to this subsection and may release data from that separate database only as provided in subsection d of this section. Practitioner use of controlled substances reporting system; mandatory reporting of violations.

For every subsequent three-month period that the targeted controlled substance remains a part of the patient's medical care, the practitioner shall review the information in the controlled substances reporting system pertaining to the patient for the month period preceding the determination that the targeted controlled substance should remain a part of the patient's medical care. Each instance in which the practitioner reviews the information in the controlled substances reporting system pertaining to the patient shall be documented in the patient's medical record.

In the event the practitioner is unable to review the information in the controlled substances reporting system pertaining to the patient because the system is not operational or there is some other temporary electrical or technological failure, this inability shall be documented in the patient's medical record. Once the electrical or technological failure has been resolved, the practitioner shall review the information in the controlled substances reporting system pertaining to the patient and the review shall be documented in the patient's medical record.

The Department shall determine a system for selecting a subset of prescriptions to examine during each auditing period. The Department shall report to the appropriate licensing board any prescriber found to be in violation of this section. A violation of this section may constitute cause for the licensing board to suspend or revoke a prescriber's license.

The Department shall administer the Fund. The Department shall use the Fund only for operation of the controlled substances reporting system and to carry out the provisions of this Article. Any balance remaining in the Fund at the end of any fiscal year shall remain in the Fund and shall not revert to the General Fund. If the physician assistant practices primarily in a county of this state that adjoins another state, the physician assistant or delegate also shall request a report of any information available in the drug database that pertains to prescriptions issued or drugs furnished to the patient in the state adjoining that county.

The requests shall be made at intervals not exceeding ninety days, determined according to the date the initial request was made. The request shall be made in the same manner provided in division B 1 of this section for requesting the initial report of information from the drug database. D The state medical board may adopt rules that establish standards and procedures to be followed by a physician assistant licensed under this chapter who has been granted physician-delegated prescriptive authority regarding the review of patient information available through the drug database under division A 5 of section The rules shall be adopted in accordance with Chapter E This section and any rules adopted under it do not apply if the state board of pharmacy no longer maintains the drug database.

If the physician practices primarily in a county of this state that adjoins another state, the physician or delegate also shall request a report of any information available in the drug database that pertains to prescriptions issued or drugs furnished to the patient in the state adjoining that county. D The state medical board may adopt rules that establish standards and procedures to be followed by a physician regarding the review of patient information available through the drug database under division A 5 of section A As used in this section:.

If the advanced practice registered nurse practices primarily in a county of this state that adjoins another state, the advanced practice registered nurse or delegate also shall request a report of any information available in the drug database that pertains to prescriptions issued or drugs furnished to the patient in the state adjoining that county. D The board of nursing may adopt rules, in accordance with Chapter If the state board of pharmacy establishes and maintains a drug database pursuant to section A The board shall present a biennial report to the standing committees of the house of representatives and the senate that are primarily responsible for considering health and human services issues.

Each report shall include all of the following:.

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B The board shall submit a semiannual report to the governor, the president of the senate, the speaker of the house of representatives, the attorney general, the chairpersons of the standing committees of the house of representatives and the senate that are primarily responsible for considering health and human services issues, the department of public safety, the state dental board, the board of nursing, the state vision professionals board, the state medical board, and the state veterinary medical licensing board.

The state board of pharmacy shall make the report available to the public on its internet web site. Each report submitted shall include all of the following for the period covered by the report:. B Is confidential and not subject to disclosure under ORS To receive information under this subparagraph, or to authorize the receipt of information by a staff member under this subparagraph, a practitioner or pharmacist must certify that the requested information is for the purpose of evaluating the need for or providing medical or pharmaceutical treatment for a patient to whom the practitioner or pharmacist anticipates providing, is providing or has provided care.

To receive information under this subparagraph, or to authorize the receipt of information by a staff member under this subparagraph, a medical director must certify that the requested information is for the purposes of overseeing the operations of a hospital, health care clinic or system of hospitals or health care clinics and ensuring the delivery of quality health care within the hospital, clinic or system. To receive information under this subparagraph, or to authorize the receipt of information by a staff member under this subparagraph, a pharmacy director must certify that the requested information is for the purposes of overseeing the operations of a pharmacy or system of pharmacies and ensuring the delivery of quality pharmaceutical care within the pharmacy or system.

C In accordance with subparagraphs A and B of this paragraph, to an individual described in subparagraphs A and B of this paragraph through a health information technology system that is used by the individual to access information about patients if:. D To a practitioner in a form that catalogs all prescription drugs prescribed by the practitioner according to the number assigned to the practitioner by the Drug Enforcement Administration of the United States Department of Justice.

E To the State Medical Examiner or designee of the State Medical Examiner, for the purpose of conducting a medicolegal investigation or autopsy. F To designated representatives of the authority or any vendor or contractor with whom the authority has contracted to establish or maintain the electronic system established under ORS A.

G Pursuant to a valid court order based on probable cause and issued at the request of a federal, state or local law enforcement agency engaged in an authorized drug-related investigation involving a person to whom the requested information pertains. H To a health professional regulatory board that certifies in writing that the requested information is necessary for an investigation related to licensure, license renewal or disciplinary action involving the applicant, licensee or registrant to whom the requested information pertains. B For the purpose of educating practitioners about the prescribing of opioids and other controlled substances;.

E To officials of the authority who are conducting special epidemiologic morbidity and mortality studies in accordance with ORS A A patient may request the authority to correct any information related to the patient that is maintained in the electronic system established under ORS A. The authority shall grant or deny a request to correct information within 10 business days after the authority receives the request.

If a request to correct information cannot be granted because the error occurred at the pharmacy where the information was inputted, the authority shall inform the patient that the information cannot be corrected because the error occurred at the pharmacy. Upon receiving notice of an appeal under this subparagraph, the authority shall conduct a contested case hearing as provided in ORS chapter Notwithstanding ORS A The identity of each person who requests or receives information from the program and any organization the person represents;.

C The date and time the information was requested and the date and time the information was provided. A practitioner or pharmacist who prescribes or dispenses a prescription drug may not be held liable for damages in any civil action on the basis that the practitioner or pharmacist did or did not request or obtain information from the prescription monitoring program.

To determine whether a patient may be under treatment with an opioid drug product by another health care practitioner, the prescribing health care practitioner shall query the prescription drug monitoring program in accordance with section 8 of the act of October 27, P. This section shall not apply to any medication provided to a patient in the course of treatment while undergoing care in an emergency department.

Obtaining records to facilitate investigations regarding opiate drug abuse, overdoses, and deaths. Such facilities shall provide records in the most efficient and expedient means possible. To determine these means, the department shall:. Practice sites where a controlled substance dispensed required to provide for electronic access to the controlled substance database -- Exceptions -- Violations and penalties.

An authorized healthcare practitioner's delegate may check the controlled substance database on behalf of the healthcare practitioner. A new episode of treatment means a prescription for a controlled substance that has not been prescribed by that healthcare practitioner within the previous twelve 12 months. The dispenser shall check the controlled substance database again at least once every twelve 12 months for that human patient after the initial dispensing.

The initial dispensing check fulfills the first annual check. A The controlled substance is prescribed or dispensed for a patient who is currently receiving hospice care;. B The committee has determined that healthcare practitioners in a particular medical specialty shall not be required to check the database as a result of the low potential for abuse by patients receiving treatment in that medical specialty;. C The quantity of the controlled substance which is prescribed or dispensed does not exceed an amount which is adequate for a single, seven-day treatment period and does not allow a refill; or.

D The controlled substance is prescribed for administration directly to a patient during the course of inpatient or residential treatment in a hospital or nursing home licensed under title In determining the conduct that constitutes a potentially harmful prescribing or dispensing pattern or practice, the board, at a minimum, shall consider:. A is connected to the database through a connection that has been approved by the division; and. PDMP Programs. Return to main Opioids and the Courts page Alabama Sec. Alaska Sec. Arizona Sec. Arkansas Sec.

Prescriber requirements. California Sec.


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Colorado Sec. Connecticut Sec. Delaware Sec. District of Columbia Sec. Florida Sec. Before release, a request by the following entities shall be verified as authentic and authorized with the requesting organization by the program manager, the program manager's program and support staff, or as determined in rules by the department as being authentic and as having been authorized by the requesting entity: 1. The Attorney General for Medicaid fraud cases involving prescribed controlled substances.

Performance measures may include, but are not limited to, efforts to achieve the following outcomes: a Reduction of the rate of inappropriate use of prescription drugs through department education and safety efforts. The contract must, at a minimum, provide for: 1. Submission of an annual budget for the approval of the department. In addition, the direct-support organization may collect and provide funding to the department in furtherance of the prescription drug monitoring program by: a.

Providing funds for future enhancements of the program within the intent of this section. Providing funds for travel expenses.

Georgia Sec. Hawaii Sec. Any practitioner who fails to deliver a written prescription within the seven-day period shall be in violation of section a 1 ; 2 No schedule II narcotic controlled substance may be prescribed or dispensed for more than a thirty-day supply, except where such substances come in a single unit dose package that exceeds the thirty-day limit or where a terminally ill patient is certified by a physician to exceed the thirty-day limit; 3 When dispensed directly by a practitioner, other than a pharmacist, to the ultimate user.

No prescription for a controlled substance in schedule II may be refilled; or 4 In the case of an electronic prescription, a pharmacist may dispense a controlled substance listed in schedule II upon receiving an electronic prescription. The following requirements shall apply: 1 A pharmacy may electronically transmit, including by facsimile, prescriptions for controlled substances listed in schedule III, IV, or V to a central fill pharmacy. The pharmacist shall not make changes to the patient's name, the controlled substance being prescribed, the quantity of the prescription, the practitioner's Drug Enforcement Administration number, the practitioner's name, the practitioner's electronic signature, or the practitioner's signature; 2 An intern, resident, or foreign-trained physician, or a physician on the staff of a Department of Veterans Affairs facility or other facility serving veterans, exempted from registration under this chapter, shall include on all prescriptions issued by the physician: A The registration number of the hospital or other institution; and B The special internal code number assigned to the physician by the hospital or other institution in lieu of the registration number of the practitioner required by this section.

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Each written prescription shall have the name of the physician stamped, typed, or hand-printed on it, as well as the signature of the physician; 3 An official exempted from registration shall include on all prescriptions issued by the official: A The official's branch of service or agency e. Each prescription shall have the name of the officer stamped, typed, or handprinted on it, as well as the signature of the officer; and 4 A physician assistant registered to prescribe controlled substances under the authorization of a supervising physician shall include on all controlled substance prescriptions issued: A The Drug Enforcement Administration registration number of the supervising physician; and B The Drug Enforcement Administration registration number of the physician assistant.

No further quantity shall be supplied beyond seventy-two hours without a new prescription; 2 The partial filling of a prescription for a controlled substance listed in schedule III, IV, or V is permissible; provided that: A Each partial filling is recorded in the same manner as a refilling; B The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed; C No dispensing occurs more than three months after the date on which the prescription was issued; and D The prescription is refilled no more than two times after the initial date of the prescription, unless the prescription is renewed by the practitioner; and 3 A prescription for a schedule II controlled substance issued for a patient in a long-term care facility or for a patient with a medical diagnosis documenting a terminal illness may be filled in partial quantities to include individual dosage units.

A prescription for a schedule III, IV, or V controlled substance may be transmitted by the practitioner or the practitioner's agent to a pharmacy by facsimile; provided that: 1 The information shall be communicated only between the prescribing practitioner or the prescriber's authorized agent and the pharmacy of the patient's choice. The original prescription shall be maintained by the practitioner in accordance with section ; 2 The information shall be communicated in a retrievable, recognizable format acceptable to the intended recipient and shall include the physician's oral code designation and the name of the recipient pharmacy; 3 No electronic system, software, or other intervening mechanism or party shall alter the practitioner's prescription, order entry, selection, or intended selection without the practitioner's approval on a per prescription per order basis.

Facsimile prescription information shall not be altered by any system, software, or other intervening mechanism or party prior to receipt by the intended pharmacy; 4 The prescription information processing system shall provide for confidentiality safeguards required by federal or state law; and 5 Prescribing practitioners and pharmacists shall exercise prudent and professional judgment regarding the accuracy, validity, and authenticity of any facsimile prescription information. The electronic prescription shall be maintained by the practitioner in accordance with section ; 2 The information shall be communicated in a retrievable, recognizable format acceptable to the intended recipient; 3 No electronic system, software, or other intervening mechanism or party shall alter the practitioner's prescription, order entry, selection, or intended selection without the practitioner's approval on a per-prescription, per-order basis.

Transmitted prescription information shall not be altered by any electronic system, software, or other intervening mechanism or party prior to receipt by the intended pharmacy; 4 The prescription information processing system shall provide for confidentiality safeguards required by any applicable federal or state law; and 5 Prescribing practitioners and pharmacists shall exercise prudent and professional judgment regarding the accuracy, validity, and authenticity of any electronic prescription information.

Idaho Sec. Illinois Sec. This website shall include, at a minimum, the following information: 1 current clinical guidelines developed by health care professional organizations on the prescribing of opioids or other controlled substances as determined by the Advisory Committee; 2 accredited continuing education programs related to prescribing of controlled substances; 3 programs or information developed by health care professionals that may be used to assess patients or help ensure compliance with prescriptions; 4 updates from the Food and Drug Administration, the Centers for Disease Control and Prevention, and other public and private organizations which are relevant to prescribing; 5 relevant medical studies related to prescribing; 6 other information regarding the prescription of controlled substances; and 7 information regarding prescription drug disposal events, including take-back programs or other disposal options or events.

These updates shall include the following information: 1 opportunities for accredited continuing education programs related to prescribing of controlled substances; 2 current clinical guidelines developed by health care professional organizations on the prescribing of opioids or other drugs as determined by the Advisory Committee; 3 programs or information developed by health care professionals that may be used to assess patients or help ensure compliance with prescriptions; 4 updates from the Food and Drug Administration, the Centers for Disease Control and Prevention, and other public and private organizations which are relevant to prescribing; 5 relevant medical studies related to prescribing; 6 other information regarding prescribing of controlled substances; 7 information regarding prescription drug disposal events, including take-back programs or other disposal options or events; and 8 reminders that the Prescription Monitoring Program is a useful clinical tool.

Indiana Sec. Iowa Sec.

Kansas Sec. Kentucky Sec. Louisiana Sec. Maine Sec. Prescribers and dispensers required to check prescription monitoring information 1. A dispenser shall check prescription monitoring information prior to dispensing a benzodiazepine or an opioid medication to a person under any of the following circumstances: A. The person is not a resident of this State; B. The prescription is from a prescriber with an address outside of this State; C.

The person is paying cash when the person has prescription insurance on file; or D. The requirements to check prescription monitoring information established in this section do not apply: A. When a licensed or certified health care professional directly orders or administers a benzodiazepine or an opioid medication to a person in an emergency room setting, an inpatient hospital setting, a long-term care facility or a residential care facility or in connection with a surgical procedure; B.

When a licensed or certified health care professional directly orders, prescribes or administers a benzodiazepine or an opioid medication to a person suffering from pain associated with end-of-life or hospice care; or C. Records [Effective upon contingency being met] 1. Maryland Sec. Prescription monitoring by prescribers a In general. Any other patient diagnosed with a terminal illness; iii A patient who resides in: 1. An assisted living facility; 2. A long-term care facility; 3.

A comprehensive care facility; or 4. A developmental disabilities facility; or 4 To treat or prevent acute pain for a period of not more than 14 days following: i A surgical procedure in which general anesthesia was used; ii A fracture; iii Significant trauma; or iv Childbirth. Prescription monitoring data a Confidentiality. Violations a Penalty for failure to submit data. Massachusetts Sec. Michigan Sec. Minnesota Sec. Opioid prescribing work group. Program components. In developing opioid disenrollment standards, the standards may be described in terms of the length of time in which prescribing practices fall outside community standards and the nature and amount of opioid prescribing that fall outside community standards; and 5 addressing other program issues as determined by the commissioners.

Program implementation. A quality improvement plan must include: 1 components of the program described in subdivision 4, paragraph a ; 2 internal practice-based measures to review the prescribing practice of the opioid prescriber and, where appropriate, any other opioid prescribers employed by or affiliated with any of the provider groups with which the opioid prescriber is employed or affiliated; and 3 appropriate use of the prescription monitoring program under section Data practices. Prescription electronic reporting system. The committee must include at least one representative of: 1 the Department of Health; 2 the Department of Human Services; 3 each health-related licensing board that licenses prescribers; 4 a professional medical association, which may include an association of pain management and chemical dependency specialists; 5 a professional pharmacy association; 6 a professional nursing association; 7 a professional dental association; 8 a consumer privacy or security advocate; and 9 a consumer or patient rights organization.

Reporting requirements; notice. Use of data by board. Except as otherwise allowed under subdivision 6, the database may be used by permissible users identified under subdivision 6 for the identification of: 1 individuals receiving prescriptions for controlled substances from prescribers who subsequently obtain controlled substances from dispensers in quantities or with a frequency inconsistent with generally recognized standards of use for those controlled substances, including standards accepted by national and international pain management associations; and 2 individuals presenting forged or otherwise false or altered prescriptions for controlled substances to dispensers.

Access to reporting system data. When the commissioner determines there have been multiple prescribers or multiple prescriptions of controlled substances, the commissioner shall: 1 inform the medical director of the opioid treatment program only that the commissioner determined the existence of multiple prescribers or multiple prescriptions of controlled substances; and 2 direct the medical director of the opioid treatment program to access the data directly, review the effect of the multiple prescribers or multiple prescriptions, and document the review. Disciplinary action.

Immunity from liability; no requirement to obtain information. Mississippi Sec. Missouri Sec. Montana Sec. Nebraska Sec. Nevada Sec. New Hampshire Sec. New Jersey Sec. New Mexico Sec. Opioid stewardship fund [Effective July 1, ; Effective until June 30, ] 1. Initial and future reports. The ratable share shall be calculated as follows: a The total amount of MMEs sold or distributed in the state of New York by the licensee for the preceding calendar year, as reported by the licensee pursuant to subdivision four of this section, shall be divided by the total amount of MME sold in the state of New York by all licensees pursuant to this article to determine the licensee payment percentage.