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Background Among former prisoners, a high rate of death has been documented in the early postrelease period, particularly from drug-related causes. Little is known about risk factors and trends in postrelease mortality in the past decade, especially given general population increases in overdose deaths from pharmaceutical opioids. Objective To determine postrelease mortality between 1999 and 2009; cause-specific mortality rates; and whether sex, calendar year, and custody factors were risk factors for all-cause, overdose, and opioid-related deaths. Design Cohort study. Setting Prison system of the Washington State Department of Corrections. Participants 76 208 persons released from prison. Measurements Identities were linked probabilistically to the National Death Index to identify deaths and causes of death, and mortality rates were calculated. Cox proportional hazards regression estimated the effect of age, sex, race or ethnicity, whether the incarceration resulted from a violation of terms of the person’s community supervision, length of incarceration, release type, and calendar year on the hazard ratio (HR) for death. Results The all-cause mortality rate was 737 per 100 000 person-years (95% CI, 708 to 766) (n = 2462 deaths). Opioids were involved in 14.8% of all deaths. Overdose was the leading cause of death (167 per 100 000 person-years [CI, 153 to 181]), and overdose deaths in former prisoners accounted for 8.3% of the overdose deaths among persons aged 15 to 84 years in Washington from 2000 to 2009. Women were at increased risk for overdose (HR, 1.38 [CI, 1.12 to 1.69]) and opioid-related deaths (HR, 1.39 [CI, 1.09 to 1.79]). Limitation The study was done in only 1 state. Conclusion Innovation is needed to reduce the risk for overdose among former prisoners. Primary Funding Source National Institute on Drug Abuse and the Robert Wood Johnson Foundation.

Objective Determine the efficacy and safety of high dose vitamin D supplementation for ARI prevention in older long-term care residents. Design, Setting, and Participants Randomized controlled trial investigating high dose vs standard dose vitamin D conducted from 2010–2014. Participants were older residents (≥60 years) of Colorado long-term care facilities. Interventions 1) The high dose group received monthly supplement of 100,000 IU vitamin D3; 2) The standard dose group received either a monthly placebo (for participants taking 400–1,000 IU/day as part of usual care) or a monthly supplement of 12,000 IU of vitamin D3 (for participants taking <400 IU/day as part of usual care). Main Outcomes Incidence of ARI during the 12-month intervention. Secondary outcomes included falls/fractures, 25-hydroxyvitamin D levels, hypercalcemia, and kidney stones. Results We randomized 107 participants (55 high dose, 52 standard dose) and included all in the final analysis. The high dose group had 0.67 ARIs per person-year compared to 1.11 in the standard dose group (incidence rate ratio [IRR] 0.60; 95%CI 0.38–0.94; p= 0.02). Falls were more common in the high dose group (1.47 per person-year) compared to 0.63 in the standard dose group (IRR 2.33; 95%CI 1.49–3.63; p<0.001). Fractures were uncommon and similar in both groups (high dose 0.10 vs standard dose 0.19 per person-year; p=0.31). The mean 25-hydroxyvitamin D level during the trial was 32.6 ng/mL in the high dose group and 25.1 ng/mL in the standard dose group. There was no hypercalcemia or kidney stones in either group. Conclusion Monthly high dose vitamin D3 supplementation reduced the incidence of ARI in older long-term care residents but was associated with a higher rate of falls without an increase in fractures.

There are no established chemopreventive agents for lung cancer, the leading cause of cancer death in the United States. Prostacyclin levels are low in lung cancer and supplementation prevents lung cancer in preclinical models. We carried out a multicenter double-blind, randomized, phase II placebo-controlled trial of oral iloprost in current or former smokers with sputum cytologic atypia or endobronchial dysplasia. Bronchoscopy was performed at study entry and after completion of six months of therapy. Within each subject, the results were calculated by using the average score of all biopsies (Avg), the worst biopsy score (Max), and the dysplasia index (DI). Change in Avg was the primary end point, evaluated in all subjects, as well as in current and former smokers. The accrual goal of 152 subjects was reached and 125 completed both bronchoscopies (60/75 iloprost, 65/77 placebo). Treatment groups were well matched for age, tobacco exposure, and baseline histology. Baseline histology was significantly worse for current smokers (Avg 3.0) than former smokers (Avg 2.1). When compared with placebo, former smokers receiving oral iloprost exhibited a significantly greater improvement in Avg (0.41 units better, P = 0.010), in Max (1.10 units better, P = 0.002), and in DI (12.45%, P = 0.006). No histologic improvement occurred in current smokers. Oral iloprost significantly improves endobronchial histology in former smokers and deserves further study to determine if it can prevent the development of lung cancer.