Objective To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts. Design Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation. Setting 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. Participants OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users. Intervention OEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone. Main outcome measures Adjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals. Results Among these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100 000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100 000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant. Conclusions Opioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.

Executive functioning has been repeatedly linked to the integrity of instrumental activities of daily living (IADL). The present study examined the association of multiple executive functioning elements (i.e., working memory, generation, inhibition, planning, and sequencing) to IADLs among an older adult cohort at risk for future cognitive and functional decline. Seventy-two participants with prevalent but stable cardiovascular disease completed a neuropsychological protocol assessing multiple elements of executive functioning, including COWA, PASAT, DKEFS Color-Word Interference Test, DKEFS Trail-Making Test, DKEFS Tower Test, and Ruff Figural Fluency Test. Reliable informants completed a measure of IADLs. Stepwise logistic regression selected a model involving a single significant predictor, a measure of inhibition (i.e., DKEFS Color-Word Interference Test), which had a significant regression coefficient. Subsequent correlation analyses confirmed an association between the inhibition measure and multiple IADL items. Inter-item comparisons among the IADLs revealed significant differences, such that telephone use and laundry were significantly more intact than most other IADLs while shopping and housekeeping were most compromised. Our data suggest that inhibition, also known as susceptibility to interference, is most strongly related to IADL impairment among patients at risk for future cognitive and functional decline.

BACKGROUND: Lesbian, gay, and bisexual populations are not part of cancer surveillance, resulting in scarce information about the cancer survivorship of these populations. To address this information gap, the authors examined the prevalence of cancer survivorship by sexual orientation and cancer survivors' self-reported health by sexual orientation. METHODS: The authors explored these issues by analyzing pooled data from the California Health Interview survey from 2001, 2003, and 2005. By using descriptive statistics and logistic regressions, they examined the cancer prevalence in men and women by sexual orientation and subsequently compared the self-reported health of male and female cancer survivors by sexual orientation. RESULTS: Among women, the authors found no significant differences in cancer prevalence by sexual orientation, but lesbian and bisexual female cancer survivors had 2.0 and 2.3× the odds of reporting fair or poor health compared with heterosexual female cancer survivors. Among men, we found significant differences in cancer prevalence, with gay men having 1.9× the odds of reporting a cancer diagnosis compared with heterosexual men. There were no differences by sexual orientation in male cancer survivors' self-reported health. CONCLUSIONS: Our novel findings suggest sex differences in the impact of cancer on lesbian, gay, and bisexual cancer survivors. Lesbian and bisexual cancer survivors need to be targeted by programs and services to assist these cancer survivors in improving their health perceptions, whereas healthcare providers and public health agencies need to be made aware of the higher prevalence of cancer in gay men to prevent future cancers through increased screening and primary prevention. Cancer 2011;. © 2011 American Cancer Society.

Overall, 61 (16%) of 388 participants had an appropriate change in surgical management based on MR findings—more than the 41 (11%) participants with an appropriate change based on positron emission mammography (PEM) findings (P = .003) and fewer than the 71 (18%) participants with an appropriate change based on combined PEM and MR findings (P = .004 for comparison with MR imaging alone); 25 (6.4%) women had excessive excisions on the basis of MR findings compared with 19 (4.9%) women who had them on the basis of PEM findings (P = .26) and 32 (8.2%) women who had them after undergoing combined PEM and MR imaging (P = .023 for comparison with MR imaging alone). PurposeTo determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer.Materials and MethodsFour hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November 2008 to participate in a multicenter institutional review board–approved, HIPAA-compliant protocol. Participants underwent contrast material–enhanced MR imaging and fluorine 18 fluorodeoxyglucose PEM in randomized order; resultant images were interpreted independently. Added biopsies and changes in surgical procedure for the ipsilateral breast were correlated with histopathologic findings. Performance characteristics were compared by using the McNemar test and generalized estimating equations.ResultsThree hundred eighty-eight women (median age, 58 years; age range, 26–93 years; median estimated tumor size, 1.5 cm) completed the study....