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Journal of General Internal Medicine Jul 2024Medications for opioid use disorder (MOUD) including buprenorphine are effective, but underutilized. Rural patients experience pronounced disparities in access. To reach...
BACKGROUND
Medications for opioid use disorder (MOUD) including buprenorphine are effective, but underutilized. Rural patients experience pronounced disparities in access. To reach rural patients, the US Department of Veterans Affairs (VA) has sought to expand buprenorphine prescribing beyond specialty settings and into primary care.
OBJECTIVE
Although challenges remain, some rural VA health care systems have begun offering opioid use disorder (OUD) treatment with buprenorphine in primary care. We conducted interviews with clinicians, leaders, and staff within these systems to understand how this outcome had been achieved.
DESIGN
Using administrative data from the VA Corporate Data Warehouse (CDW), we identified rural VA health care systems that had improved their rate of primary care-based buprenorphine prescribing over the period 2015-2020. We conducted qualitative interviews (n = 30) with staff involved in implementing or prescribing buprenorphine in these systems to understand the processes that had facilitated implementation.
PARTICIPANTS
Clinicians, staff, and leaders embedded within rural VA health care systems located in the Northwest, West, Midwest (2), South, and Northeast.
APPROACH
Qualitative interviews were analyzed using a mixed inductive/deductive approach.
KEY RESULTS
Interviews revealed the processes through which buprenorphine was integrated into primary care, as well as processes insufficient to enact change. Implementation was often initially catalyzed through a targeted hire. Champions then engaged clinicians and leaders one-on-one to "pitch" the case, describe concordance between buprenorphine prescribing and existing goals, and delineate the supportive role that they could provide. Sites were prepared for implementation by developing new clinical teams and redesigning clinical processes. Each of these processes was made possible with the active, instrumental support of leadership.
CONCLUSIONS
Results suggest that rural systems seeking to improve buprenorphine accessibility in primary care may need to alter primary care structures to accommodate buprenorphine prescribing, whether through new hires, team development, or clinical redesign.
PubMed: 38955895
DOI: 10.1007/s11606-024-08898-1 -
Predicting COVID-19 Cases in Nursing Homes of California and Ohio: Does the Work Environment Matter?Journal of Occupational and... Jul 2024The cross-sectional study evaluates if the pre-pandemic work environments in nursing homes predict COVID-19 cases among residents and staff, accounting for other factors.
OBJECTIVE
The cross-sectional study evaluates if the pre-pandemic work environments in nursing homes predict COVID-19 cases among residents and staff, accounting for other factors.
METHOD
Leveraging data from a survey of California and Ohio nursing homes (n = 340), we examined if Workplace Integrated Safety and Health domains - Leadership, Participation, and Comprehensive and Collaborative strategies predicted cumulative COVID-19 cases among nursing home residents and staff.
RESULTS
In Ohio, a 1-unit increase in Leadership score was associated with 2 fewer staff cases and 4 fewer resident cases. A 1-unit increase in Comprehensive and Collaborative Strategies score in California showed an average marginal effect of approximately 1 less staff case and 2 fewer resident cases.
CONCLUSION
These findings suggest that leadership commitment and inter-department collaboration to prioritize worker safety, may have protected against COVID-19 cases in nursing homes.
PubMed: 38955810
DOI: 10.1097/JOM.0000000000003181 -
World Journal of Surgery Jul 2024The superiority between remimazolam and propofol for anesthesia is controversial in elderly patients (≥60 years). This meta-analysis aimed to systematically compare...
BACKGROUND
The superiority between remimazolam and propofol for anesthesia is controversial in elderly patients (≥60 years). This meta-analysis aimed to systematically compare anesthetic effect and safety profile between remimazolam and propofol in elderly patients under any surgery.
METHODS
Cochrane Library, Web of Science, and PubMed were searched until December 25, 2023 for relevant randomized controlled trials.
RESULTS
Ten studies with 806 patients receiving remimazolam (experimental group) and 813 patients receiving propofol (control group) were included. Time to loss of consciousness [standard mean difference (SMD) (95% confidence interval (CI): 1.347 (-0.362, 3.055), p = 0.122] and recovery time [SMD (95% CI): -0.022 (-0.300, 0.257), p = 0.879] were similar between experimental and control groups. Mean arterial pressure at baseline minus 1 min after induction [SMD (95% CI): -1.800 (-3.250, -0.349), p = 0.015], heart rate at baseline minus 1 min after induction [SMD (95% CI): -1.041 (-1.537, -0.545), p < 0.001], incidences of hypoxemia [relative risk (RR) (95% CI): 0.247 (0.138, 0.444), p < 0.001], respiratory depression [RR (95% CI): 0.458 (0.300, 0.700), p < 0.001], bradycardia [RR (95% CI): 0.409 (0.176, 0.954), p = 0.043], hypotension [RR (95% CI): 0.415 (0.241, 0.714), p = 0.007], and injection pain [RR (95% CI): 0.172 (0.113, 0.263), p < 0.001] were lower in the experimental group compared to the control group. Postoperative nausea and vomiting was not different between groups [RR (95% CI): 1.194 (0.829, 1.718), p = 0.341]. Moreover, this meta-analysis displayed a low risk of bias, minimal publication bias, and good robustness.
CONCLUSION
Remimazolam shows comparative anesthetic effect and better safety profile than propofol in elderly patients under any surgery.
PubMed: 38955808
DOI: 10.1002/wjs.12273 -
Journal of Occupational and... Jul 2024Estimate in a sample of U.S. fire investigators the: (1) prevalence of generalized anxiety disorder (GAD), depression, post-traumatic stress disorder (PTSD) risk and...
OBJECTIVE
Estimate in a sample of U.S. fire investigators the: (1) prevalence of generalized anxiety disorder (GAD), depression, post-traumatic stress disorder (PTSD) risk and mental health services use; and (2) association between organizational stigma and mental health disorders.
METHODS
Cross-sectional study design used to administer between November 2023 and January 2024, a 35-item behavioral/mental health survey.
RESULTS
Approximately 18.0% of fire investigators had GAD, 22.8% depression, and 18.2% PTSD risk. Organizational stigma about mental health disorders was reported by 53.3% of fire investigators. The most frequently used behavioral/mental health services were cognitive behavioral therapy (40.1%) and medication management (36.1%). Organizational stigma around reporting mental health disorders was significantly associated with PTSD risk (aOR = 5.25;[2.41-11.43]).
CONCLUSION
Mental health disorders are present in the fire investigator workforce and organizational stigma is associated with limited report of PTSD risk.
PubMed: 38955804
DOI: 10.1097/JOM.0000000000003173 -
Journal of Occupational and... Jul 2024To determine the association between the occupational history as a wildland firefighter (WFF) and clinical indicators of cardiovascular health.
OBJECTIVE
To determine the association between the occupational history as a wildland firefighter (WFF) and clinical indicators of cardiovascular health.
METHODS
Among 2,862 WFFs we evaluated associations between the number of total days assigned on fire and high-risk categories of three clinically measured cardiovascular indicators.
RESULTS
Almost one-third (32%) of WFFs had one or more clinical measures that would place them in high-risk categories for BMI, blood pressure, and total cholesterol. WFF work history was associated with some of these measures: odds ratio (and 95% confidence interval) for highest versus lowest tertile of days on fire were 1.4 (1.2, 1.8) and 1.2 (1.0, 1.5) for high-risk categories of BMI and cholesterol, respectively.
CONCLUSION
More frequent screening and targeted health promotion programs for WFFs are warranted to increase awareness of cardiovascular risk and prevention strategies.
PubMed: 38955802
DOI: 10.1097/JOM.0000000000003172 -
Neuropsychopharmacology Reports Jul 2024Bipolar disorder often emerges from depressive episodes and is initially diagnosed as depression. This study aimed to explore the effects of a prior depression diagnosis...
BACKGROUND
Bipolar disorder often emerges from depressive episodes and is initially diagnosed as depression. This study aimed to explore the effects of a prior depression diagnosis on outcomes in patients diagnosed with bipolar disorder.
METHODS
This cohort study analyzed data of patients aged 18-64 years who received a new bipolar disorder diagnosis in Japan, using medical claims data from January 2005 to October 2020 provided by JMDC, Inc. The index month was defined as the time of the bipolar diagnosis. The study assessed the incidence of psychiatric hospitalization, all-cause hospitalization, and mortality, stratified by the presence of a preceding depression diagnosis and its duration (≥1 or <1 year). Hazard ratios (HRs) and p-values were estimated using Cox proportional hazards models, adjusted for potential confounders, and supported by log-rank tests.
RESULTS
Of the 5595 patients analyzed, 2460 had a history of depression, with 1049 experiencing it for over a year and 1411 for less than a year. HRs for psychiatric hospitalization, all hospitalizations, and death in patients with a history of depression versus those without were 0.92 (95% CI = 0.78-1.08, p = 0.30), 0.87 (95% CI = 0.78-0.98, p = 0.017), and 0.61 (95% CI = 0.33-1.12, p = 0.11), respectively. In patients with preceding depression ≥1 year versus <1 year, HRs were 0.89 (95% CI = 0.67-1.19, p = 0.43) for psychiatric hospitalization, 0.85 (95% CI = 0.71-1.00, p = 0.052) for all hospitalizations, and 0.25 (95% CI = 0.07-0.89, p = 0.03) for death.
CONCLUSION
A prior history and duration of depression may not elevate psychiatric hospitalization risk after bipolar disorder diagnosis and might even correlate with reduced hospitalization and mortality rates.
PubMed: 38955798
DOI: 10.1002/npr2.12457 -
Journal of Food Science Jul 2024Food fraud is a problematic yet common phenomenon in the food industry. It impacts numerous sectors, including the market of edible mushrooms. Morel mushrooms are prized...
Food fraud is a problematic yet common phenomenon in the food industry. It impacts numerous sectors, including the market of edible mushrooms. Morel mushrooms are prized worldwide for their culinary and medicinal use. They represent a taxonomically complex group in which food fraud has already been reported. Among the methods to evaluate food fraud, some rely on comparisons of genetic sequences obtained from a sample to existing databases. However, the quality and usefulness of the results are limited by the type of comparison tool and the quality of the database used. The Centroid-based approach is applied by SmartGene in a proprietary artificial intelligence-based method for the generation of automatically curated reference databases that can be further expert curated. In this study, using sequences of the ribosomal internal transcribed spacer (ITS) of the genus Morchella (true morels), we compared this approach to the traditional pairwise alignment tool using two other databases: UNITE and Mycobank (MLST). The Centroid-based approach using an expert-curated database was more performant for the identification of 53 representative ITS sequences corresponding to validated species (83% accuracy, compared to 36% and 47% accuracy for UNITE and MLST, respectively). The Centroid method also revealed an inaccurate taxonomic annotation for sequences of commercial cultivars submitted to public databases. Combined with the web-based commercial software IDNS® available at Smartgene, the Centroid-based approach constitutes a valuable tool to ensure the quality of morel products on the market for actors of the food industry. PRACTICAL APPLICATION: The Centroid-based approach can be used by agri-food actors who need to identify true morels down to the species level without any prior taxonomical knowledge. These include routine laboratories of the food industry, food distributors, and public surveillance agencies. This is a reliable method that requires minimal skills and resources, therefore being particularly adapted for nonspecialists.
PubMed: 38955792
DOI: 10.1111/1750-3841.17219 -
East Asian Archives of Psychiatry :... Jun 2024We conducted a systematic review evaluating the efficacy of rivastigmine augmentation for treatment-refractory posttraumatic stress disorder (PTSD). The Preferred... (Review)
Review
We conducted a systematic review evaluating the efficacy of rivastigmine augmentation for treatment-refractory posttraumatic stress disorder (PTSD). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The databases Ovid MEDLINE, PubMed, CINAHL, and EMBASE were searched using key words: 'rivastigmine' OR 'Exelon' OR 'rivastigmine augmentation' OR 'Exelon augmentation' AND 'posttraumatic stress disorder*' OR 'post-traumatic stress disorder*' OR 'PTSD' OR 'combat disorder*' OR 'post-traumatic symptoms'. The asterisk specified plural forms of the relevant word. Four papers were identified, comprising one double-blind randomised controlled trial, one non-controlled open trial, one case series (presenting three case studies), and one paper with two case studies. The randomised controlled trial found no statistically significant difference in efficacy, using the PTSD CheckList-Military Version as the relevant outcomes measure, between the active add-on rivastigmine interventions and placebo or treatment as usual. The open trial, although reporting relatively positive outcomes, had a weak study design and lacked reporting of key information, including participant sex and age and pre-rivastigmine PTSD measures. The assessment of efficacy was based on participants' reporting of subjective benefits, and clinician-rating using a Clinical Global Impression, rather than established PTSD assessments scales. Although the five case studies reported improvement in PTSD symptoms, there were confounding factors and limitations in clinical and demographic data, warranting caution regarding attributed benefits. There is a lack of methodologically robust evidence supporting the efficacy of add-on rivastigmine for the treatment of refractory PTSD. Additional research may help in further evaluating its possible clinical efficacy.
Topics: Rivastigmine; Humans; Stress Disorders, Post-Traumatic; Neuroprotective Agents; Cholinesterase Inhibitors
PubMed: 38955788
DOI: 10.12809/eaap2353 -
East Asian Archives of Psychiatry :... Dec 2023Suicidal behaviour can be influenced by attitudes towards suicide and psychological distress. This study aimed to investigate the associations between psychological...
BACKGROUND
Suicidal behaviour can be influenced by attitudes towards suicide and psychological distress. This study aimed to investigate the associations between psychological distress, attitudes towards suicide, and suicidal behaviour and to determine the prevalence of suicidal behaviour among students of a public university in East Malaysia.
METHODS
A total of 521 students from a public university in East Malaysia were asked to complete the Malay versions of the Suicidal Behaviour Questionnaire-Revised (SBQ-R), the Attitudes Towards Suicide Scale, and the Depression Anxiety Stress Scale.
RESULTS
197 women and 290 men (mean age, 19.13 years) completed the questionnaires, giving a response rate of 93.4%. The prevalence of high-risk suicidal behaviour (SBQ-R score ≥7) was 23.8%. Suicidal behaviour was positively associated with psychological distress and favourable attitudes towards suicide, and negatively associated with unfavourable attitudes towards suicide. Predictors for suicidal behaviour were psychological distress and favourable attitudes towards suicide ('the ability to understand and accept suicide').
CONCLUSION
The prevalence of suicidal behaviour is high among students in a public university in East Malaysia. Services and education for mental health awareness and screening for early detection and intervention of psychological distress should be provided to university students. Implementation of suicide awareness policies and suicide prevention training is crucial.
Topics: Humans; Malaysia; Female; Male; Students; Young Adult; Universities; Psychological Distress; Prevalence; Adult; Suicidal Ideation; Surveys and Questionnaires; Suicide; Adolescent; Suicide, Attempted
PubMed: 38955783
DOI: 10.12809/eaap2342 -
East Asian Archives of Psychiatry :... Mar 2024During the COVID-19 pandemic, social-distancing and confinement measures were implemented. These may affect the mental health of patients with mental disorders such as... (Observational Study)
Observational Study
BACKGROUND
During the COVID-19 pandemic, social-distancing and confinement measures were implemented. These may affect the mental health of patients with mental disorders such as schizophrenia. This study examined the clinical course of patients with schizophrenia at a public hospital in Morocco during the COVID-19 pandemic.
METHODS
This longitudinal observational study was conducted across three periods in 15 months: 1 April 2020 (start of strict home confinement) to 30 June 2020 (T1), 1 July 2020 to 31 January 2021 (corresponding to the Delta wave) [T2], and 1 February 2021 to 30 June 2021 (corresponding to the Omicron wave) [T3]. Patients aged 18 to 65 years with a diagnosis of schizophrenia or schizoaffective disorder (based on DSM 5) made before the pandemic who presented to the Faculty of Medicine and Pharmacy of Rabat were invited to participate. Psychotic symptomatology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Severity and improvement of mental disorder were evaluated using the Clinical Global Impression (CGI)-Severity and -Improvement subscales. Depressive symptoms were assessed using the Calgary Depression Scale (CDS). Adherence to treatments was assessed using the Medication Adherence Rating Scale (MARS). All assessments were made by psychiatrists or residents face-to-face (for T1) or via telephone (for T2 and T3).
RESULTS
Of 146 patients recruited, 83 men and 19 women (mean age, 39 years) completed all three assessments. The CGI-Severity score was higher at T2 than T1 and T3 (3.24 vs 3.04 vs 3.08, p = 0.041), and the MARS score was higher at T1 and T2 than T3 (6.80 vs 6.83 vs 6.35, p = 0.033). Patient age was negatively correlated with CDS scores for depressive symptoms at T1 (Spearman's = -0.239, p = 0.016) and at T2 (Spearman's = -0.231, p = 0.019). The MARS score for adherence was higher in female than male patients at T1 (p = 0.809), T2 (p = 0.353), and T3 (p = 0.004). Daily tobacco consumption was associated with the PANSS total score at T3 (p = 0.005), the CGI-Severity score at T3 (p = 0.021), and the MARS score at T3 (p = 0.002). Patients with a history of attempted suicide had higher CDS scores than those without such a history at T1 (p = 0.015) and T3 (p = 0.018) but not at T2 (p = 0.346).
CONCLUSION
Home confinement during the COVID-19 pandemic had limited negative impact on the mental health of patients with schizophrenia in Morocco.
Topics: Humans; COVID-19; Morocco; Male; Female; Adult; Longitudinal Studies; Middle Aged; Schizophrenia; Young Adult; Adolescent; Psychotic Disorders; Antipsychotic Agents; Aged; Medication Adherence; Psychiatric Status Rating Scales; Depression; SARS-CoV-2
PubMed: 38955777
DOI: 10.12809/eaap2255