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Journal articles on the topic 'Substance Use Prioritization Workgroup'
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1
Bukstein, Oscar. "Substance Use Disorders and ADHD." CNS Spectrums 14, S6 (July 2009): 10–12. http://dx.doi.org/10.1017/s1092852900024834.
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In examining the challenges in treating comorbid attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), there are a number of issues regarding misinformation and misconception that exist for clinicians. Like other ADHD comorbidities, there is a lack of screening, particularly among adult clinical populations who have the psychiatric comorbidity or, for patients with SUDs, there is the issue of prioritization, which condition to treat first, and determining the place of medication management—particularly stimulant medication—paramount in treatment planning.
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Chelgren-Koterba, Pamela, Larry Iwamoto, Charlene Hutton, and Carl Lautenberger. "ALASKA INCIDENT MANAGEMENT SYSTEM (AIMS) GUIDE FOR OIL AND HAZARDOUS SUBSTANCE RESPONSE." International Oil Spill Conference Proceedings 2001, no. 2 (March 1, 2001): 1059–66. http://dx.doi.org/10.7901/2169-3358-2001-2-1059.
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ABSTRACT In January 2000, the ad hoc Alaska Statewide Oil and Hazardous Substance Incident Management System workgroup submitted standardized spill response management guidelines (Alaska Incident Management System, AIMS #1) to the Alaska Regional Response Team (ARRT) for their review, use, and feedback. These guidelines are a landmark step in response management systems because they merge the concepts of the National Contingency Plan (NCP#2) with NIIMS #3, received acceptance by both government and industry users in Alaska, have been customized to meet Alaska's unique needs, are consistent with the latest update being prepared by the States/British Columbia Task Force FOG #4 update workgroup, and will yield substantial savings to all users by providing guidelines for adoption and maintenance of a single system for the Alaska spill response community.
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Hopkins, Richard S., Michael Landen, and Megan Toe. "Development of Indicators for Public Health Surveillance of Substance Use and Mental Health." Public Health Reports 133, no. 5 (August 3, 2018): 523–31. http://dx.doi.org/10.1177/0033354918784913.
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Substance use and mental health disorders can result in disability, death, and economic cost. In the United States, rates of death from suicide, drug overdose, and chronic liver disease (a marker for alcohol abuse) have been rising for the past 15 years. Good public health surveillance for these disorders, their consequences, and their risk factors is crucially important for their prevention and control, but surveillance has not been conducted consistently in the states. In 2015, the Council of State and Territorial Epidemiologists convened a workgroup to develop a set of uniformly defined surveillance indicators that could be used by state and local health departments to monitor these disorders and to compare their occurrence in various jurisdictions. This report briefly describes the indicators and outlines the process used to develop them.
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Nolan, Karen, Andrew R. Zullo, Elliott Bosco, Christine Marchese, and Christine Berard-Collins. "Controlled substance diversion in health systems: A failure modes and effects analysis for prevention." American Journal of Health-System Pharmacy 76, no. 15 (July 18, 2019): 1158–64. http://dx.doi.org/10.1093/ajhp/zxz116.
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Abstract Purpose The purpose of this study was to demonstrate the utility of failure modes and effects analysis (FMEA) for systematically identifying potential sources of controlled substance diversion and developing solutions in an academic health system. Methods The FMEA was conducted by an 18-member cross-functional team from the department of pharmacy. The team developed scoring criteria specifically for controlled substance diversion, outlined the controlled substance processes from procurement to administration or disposal, and identified ways in which each step of the medication supply process might fail (failure modes) and result in diversion of controlled substances. Failure modes with a vulnerability score of 48 or 64 were considered highest risk and were immediately intervened on by the FMEA team. Results The FMEA outlined a total of 10 major steps and 30 substeps in the controlled substance supply process. From this, 103 potential failure modes were identified, with 24 modes (23%) receiving a vulnerability score of 48 or 64. Development of specific reports addressed 15 failure modes, while 9 involved pharmacy workflow alterations. Notable reports included controlled substance activity under temporary patients and discrepancy trends by user, medication, and patient care area. Notable workflow alterations included expanded use of cameras in high-risk areas and additional verification checks. Conclusion FMEA allowed for systematic identification of controlled substance diversion opportunities, prioritization by level of vulnerability, and the development of targeted strategies to reduce risk of diversion.
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Harper, Gary W., Jessica Crawford, Katherine Lewis, Caroline Rucah Mwochi, Gabriel Johnson, Cecil Okoth, Laura Jadwin-Cakmak, Daniel Peter Onyango, Manasi Kumar, and Bianca D. M. Wilson. "Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya." International Journal of Environmental Research and Public Health 18, no. 3 (February 1, 2021): 1311. http://dx.doi.org/10.3390/ijerph18031311.
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Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18–34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.
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Sinclair, Ryan G., Joan B. Rose, Syed A. Hashsham, Charles P. Gerba, and Charles N. Haas. "Criteria for Selection of Surrogates Used To Study the Fate and Control of Pathogens in the Environment." Applied and Environmental Microbiology 78, no. 6 (January 13, 2012): 1969–77. http://dx.doi.org/10.1128/aem.06582-11.
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ABSTRACTThis article defines the term surrogate as an organism, particle, or substance used to study the fate of a pathogen in a specific environment. Pathogenic organisms, nonpathogenic organisms, and innocuous particles have been used as surrogates for a variety of purposes, including studies on survival and transport as well as for method development and as “indicators” of certain conditions. This article develops a qualitative surrogate attribute prioritization process and allows investigators to select a surrogate by systematically detailing the experimental process and prioritizing attributes. The results are described through the use of case studies of various laboratories that have used this process. This article also discusses the history of surrogate and microbial indicator use and outlines the method by which surrogates can be used when conducting a quantitative microbial risk assessment. The ultimate goal of selecting a sufficiently representative surrogate is to improve public health through a health-based risk assessment framework. Under- or overestimating the resistance, inactivation, or movement may negatively impact risk assessments that, in turn, will impact health assessments and estimated safety levels. Reducing uncertainty in a risk assessment is one of the objectives of using surrogates and the ultimate motive for any experiment investigating potential exposure of a pathogen.
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Kokane, Arun, Abhijit Pakhare, Gopalkrishna Gururaj, Mathew Varghese, Vivek Benegal, Girish Rao, Banavaram Arvind, et al. "Mental Health Issues in Madhya Pradesh: Insights from National Mental Health Survey of India 2016." Healthcare 7, no. 2 (March 31, 2019): 53. http://dx.doi.org/10.3390/healthcare7020053.
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Background: About 14% of the global mental health burden is contributed by India. However, there exists a disparity in mental health patterns, utilization, and prioritization among various Indian states. The state of Madhya Pradesh is a low performer among Indian states, ranking lower than the national average on the Human Development Index, Hunger Index, and Gross Domestic Product (GDP). The state also performes poorly on other health-related indicators. Objectives of Study: To estimate the prevalence and patterns of mental illnesses in the state of Madhya Pradesh, India. Material and Methods: This study used the multistage, stratified, random cluster sampling technique, with selection probability proportionate to size at each stage. A total of 3240 individuals 18 years and older were interviewed. The mixed-method study that was employed had both quantitative and qualitative components. The Mini International Neuropsychiatric Interview along with 10 other instruments were used. Results: The overall weighted prevalence for any mental illness was 13.9%, with 16.7% over the lifetime. The treatment gap for all of the mental health problems is very high (91%), along with high suicidal risk and substance use in the state. Conclusions: This study provides evidence of the huge burden of mental, behavioral, and substance use disorders as well as the treatment gap in Madhya Pradesh. This information is crucial for developing an effective prevention and control strategy. The high treatment gap in the state calls for coordinated efforts from all stakeholders, including policy makers, political leaders, health care professionals, and the society at large to give mental health care its due priority. These findings also highlight the need for multi-pronged interventions rooted in health policy directed at reducing the treatment gap in the short term and disease burden in the long run.
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Siva, Shivi, Chung Sang Tse, Nayantara Coelho-Prabhu, and Rajeev Jain. "AMERICAN GASTROENTEROLOGICAL ASSOCIATION’S QUALITY LEADERSHIP COUNCIL’S PRACTICE WORK GROUP: A NATIONWIDE INITIATIVE TO REDUCE THE USE OF PRESCRIPTION OPIOID AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT A LOCAL LEVEL." Inflammatory Bowel Diseases 27, Supplement_1 (January 1, 2021): S48. http://dx.doi.org/10.1093/ibd/izaa347.114.
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Abstract Background and aims The use of opioids among patients with inflammatory bowel disease (IBD) in the United States is increasing and it is associated with higher mortality, re-admissions, healthcare utilization, and disability. The American Gastroenterological Association’s (AGA) Quality Leadership Council’s practice workgroup developed educational materials to educate and modify narcotic prescribing habits of providers treating IBD and change the attitudes and expectations of patients who require analgesics. Methods Council members participated in two 1-hour virtual planning meetings to develop a key driver diagram to illustrate the aims, theories to achieve the aims, and specific action items to change ideas of opioid prescribing practices. Four working groups were created to perform a literature search and create educational resources for providers and patients regarding the risks of opioid use and non-opioid alternatives for pain management. The educational resources were reviewed by the Crohn’s and Colitis Foundation prior to online publication electronic and dissemination to the AGA membership. Results We developed a key driver diagram (Figure 1) to illustrate the components of promoting non-opioid pain management in patients with IBD. Educational materials were developed to 1) Delineate the risk factors for opioid abuse among patients with IBD to prescribers of a controlled substance including; Crohn’s disease, functional gastrointestinal disorders, anxiety, depression, female sex, a history of narcotic abuse, ≥2 previous surgeries, moderate to severe pain, clinical disease activity, sexual, emotional and physical abuse, 2) Recommend alternative therapies for opioids including medications and non-pharmacological treatment alternatives (Table 1), 3) Address salient key points that patients should discuss with their provider if an opioid is prescribed including complications associated with prolonged use of narcotic medications, and 4) Illustrate alternate medical therapy and other techniques for patients including yoga and mindfulness-based techniques, cognitive behavioral therapy, and medical hypnosis. Conclusions Using quality improvement methods, we developed educational materials for patients with IBD and providers treating IBD on opioid avoidance and non-opioid alternative therapy utilizing an evidence-based approach.
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Greg Miller, W., Gary L. Myers, Mary Lou Gantzer, Stephen E. Kahn, E. Ralf Schönbrunner, Linda M. Thienpont, David M. Bunk, et al. "Roadmap for Harmonization of Clinical Laboratory Measurement Procedures." Clinical Chemistry 57, no. 8 (August 1, 2011): 1108–17. http://dx.doi.org/10.1373/clinchem.2011.164012.
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Abstract Results between different clinical laboratory measurement procedures (CLMP) should be equivalent, within clinically meaningful limits, to enable optimal use of clinical guidelines for disease diagnosis and patient management. When laboratory test results are neither standardized nor harmonized, a different numeric result may be obtained for the same clinical sample. Unfortunately, some guidelines are based on test results from a specific laboratory measurement procedure without consideration of the possibility or likelihood of differences between various procedures. When this happens, aggregation of data from different clinical research investigations and development of appropriate clinical practice guidelines will be flawed. A lack of recognition that results are neither standardized nor harmonized may lead to erroneous clinical, financial, regulatory, or technical decisions. Standardization of CLMPs has been accomplished for several measurands for which primary (pure substance) reference materials exist and/or reference measurement procedures (RMPs) have been developed. However, the harmonization of clinical laboratory procedures for measurands that do not have RMPs has been problematic owing to inadequate definition of the measurand, inadequate analytical specificity for the measurand, inadequate attention to the commutability of reference materials, and lack of a systematic approach for harmonization. To address these problems, an infrastructure must be developed to enable a systematic approach for identification and prioritization of measurands to be harmonized on the basis of clinical importance and technical feasibility, and for management of the technical implementation of a harmonization process for a specific measurand.
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Giannitrapani, Karleen F., Soraya Fereydooni, Maria J. Silveira, Azin Azarfar, Peter A. Glassman, Amanda Midboe, Maria Zenoni, William C. Becker, and Karl A. Lorenz. "How Patients and Providers Weigh the Risks and Benefits of Long-Term Opioid Therapy for Cancer Pain." JCO Oncology Practice 17, no. 7 (July 2021): e1038-e1047. http://dx.doi.org/10.1200/op.20.00679.
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PURPOSE: To understand how patients and providers weigh the risks and benefits of long-term opioid therapy (LTOT) for cancer pain. METHODS: Researchers used VA approved audio-recording devices to record interviews. ATLAS t.i., a qualitative analysis software, was used for analysis of transcribed interview data. Participants included 20 Veteran patients and 20 interdisciplinary providers from primary care– and oncology-based practice settings. We conducted semistructured interviews and analyzed transcripts used thematic qualitative methods. Interviews explored factors that affect decision making about appropriateness of LTOT for cancer related pain. We saturated themes for providers and patients separately. RESULTS: Factors affecting patient decision-making included influence from various information sources, persuasion from trusted providers, and sometimes deferral of the decision to their provider. Relative prioritization of pain management as the focal patient concern varied with some patients describing comparatively more fear of chemotherapy than opioid analgesics, comparatively more knowledge of opioids in relation to other drugs;patients expressed a preference to spend the limited time they have with their oncologist discussing cancer treatment rather than opioid use. Factors affecting provider decision making included prognosis, patient goals, patient characteristics, and provider experience and biases. Providers differed in how they weigh the relative importance of alleviating pain or avoiding opioids in the face of treating patients with cancer and histories of substance abuse. CONCLUSION: Divergent perspectives on factors need to be considered when weighing risks and benefits. Policies and interventions should be designed to reduce variation in practice to promote equal access to adequate pain management. Improved shared decision-making initiatives will take advantage of patient decision-making factors and priorities.
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Romanova, Anna Anatoliivna, Viktoriya Viktorivna Zhydok, and Tetiana Volodymyrivna Zabashtanska. "MARKET RESEARCH OF INBOUND TOURISTS IN CHERNIGOV AS A FACTOR OF INCREASING TOURIST ATTRACTIVENESS." SCIENTIFIC BULLETIN OF POLISSIA 1, no. 2(10) (2017): 216–28. http://dx.doi.org/10.25140/2410-9576-2017-1-2(10)-216-228.
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Urgency of the research. Tourist sector in Ukraine is developing in close relationship with the historical, cultural and natural resources within a particular area (region, city), which should be considered as a specific tourist product with unique properties, different competitive advantages necessary for optimum tourist attraction. Target setting. Ukraine generally and for individual areas (regions and cities) has great potential for development of tourism industry. Its effective operation requires state support and systematic market research. Actual scientific researches and issues analysis. Research trends of the tourism market and the impact of tourism on the socio-economic development of certain areas (regions and cities) were committed by A. Romanova, T. Sergeeva, S. Shkarlet. Uninvestigated parts of general matters defining. Сonsidering the complexity of the political and economic situation in Ukraine, the lack of regulation of tourism experience, changes in the environment there is the necessity of regular monitoring of the tourism industry. The research objective. The purpose of the article is to study the market of entry tourists in Chernihiv, to identify problems and prospects of tourism development that will increase the tourist attractiveness of the city. The statement of basic materials. Through market research entry of tourists of Chernihiv there were identified such problems of development as poor infrastructure; the substance of a clear concept of tourism; deficit financing; lack of coordination of actions between the government, businesses and the public. The development prospects for increasing the tourist attractiveness of Chernihiv on the basis of accounting weaknesses, leveling threats of tourism in the city, efficient use of available resources and potential are proposed. Conclusions. On the way to increase tourist attractiveness of Chernihiv an important thing is an accurate and correct prioritization of tourism development that is subject to systematic market research.
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McManus, Shauna, Alexandra K. Zaleta, Melissa F. Miller, Joanne S. Buzaglo, Julie S. Olson, Sara Goldberger, and Kevin Stein. "HSR19-100: CancerSupportSource®-15: Development and Evaluation of a Short Form of a Distress Screening Program for Cancer Survivors." Journal of the National Comprehensive Cancer Network 17, no. 3.5 (March 8, 2019): HSR19–100. http://dx.doi.org/10.6004/jnccn.2018.7160.
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Background: CancerSupportSource (CSS) is a 25-item distress screening tool implemented at community-based cancer support organizations and hospitals nationwide. CSS assesses distress over 5 domains: (1) emotional concerns (including depression and anxiety risk screening subscales), (2) symptom burden, (3) body and healthy lifestyle, (4) healthcare team communication, and (5) relationships. This study developed a short form of CSS and examined its psychometric properties. Methods: 2,379 cancer survivors enrolled in the Cancer Support Community’s Cancer Experience Registry. Participants provided demographic and clinical background and completed CSS-25 and PROMIS-29, a measure of health-related quality of life. Item reduction was conducted with a subsample of 1,435 survivors and included external item quality (correlations between items and PROMIS-29 scales), internal item quality (inter-item and inter-factor correlations, factor loadings and structure, and item communalities from an exploratory factor analysis of CSS-25), and professional judgement (ranking/prioritization of items by CSS-25 developers, accounting for theoretical and practical implications). Pearson correlations and confirmatory factor analysis were conducted on a separate subsample of 944 survivors to corroborate psychometric properties and dimensionality of the shortened scale. Results: Scale refinement resulted in a 15-item short form of CSS (CSS-15). At least 1 item from each of the 5 CSS-25 domains was retained to preserve multidimensionality, including anxiety and depression risk screening subscale items. Additionally, 1 item about tobacco/substance use was kept due to clinical significance for risk assessment. In confirmatory factor analysis, the model explained 59% of the variance and demonstrated good fit (RMSEA=0.068, 90% CI=0.061–0.075; SRMR=0.033; CFI=0.959; χ2(68)=334.75, P<.001). Correlation between CSS-15 and CSS-25 was 0.986, P<.001. Total distress was associated with PROMIS subscales (rs=−.65–.75, ps<.001); internal consistency reliability was excellent (α=.92). Conclusions: CSS-15 is a brief, reliable, and valid multidimensional measure of distress. The reduced measure retained excellent internal consistency and a stable factor structure, while correlating well with CSS-25 and PROMIS-29. CSS-15 can serve as a practical tool to efficiently screen for distress among cancer patients and survivors.
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Amadi, Obumneke A. "4066 In Teenagers Who Smoke Cigarettes Are Nicotine Patches as Compared to Placebo Effective to Decrease the Number of Cigarettes Smoked? – A Systematic Review." Journal of Clinical and Translational Science 4, s1 (June 2020): 138. http://dx.doi.org/10.1017/cts.2020.408.
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OBJECTIVES/GOALS: The aim was to examine whether nicotine patch was more effective in encouraging abstinence from cigarettes smoking compared to placebo. METHODS/STUDY POPULATION: Randomized controlled trials involving the general teenage age group smokers who were current smokers-“smoked less than 100 cigarettes over their lifetime and smoked at the time of the interview. Databases were searched for relevant studies reported in English that employed a randomized design published since 2000. Two authors extracted data and assessed quality. The primary outcomes and prioritization were continuous abstinence at 3, 6 and 12-month follow-up or more for the number of patients who responded to treatment, defined as a reduction/abstinence. Heterogeneity between studies did not preclude combined analyses of the data. RESULTS/ANTICIPATED RESULTS: 4 of 266 publications were included. Four studies reported positive effects on smoking cessation at end of treatment: (1) nicotine patches improved continuous abstinence at 6 weeks – 9 weeks months; (2) nicotine patch improved continuous abstinence at 3 to 6 months; (3) nicotine patches improved continuous abstinence 6 and 12 months; (4) nicotine patches improved continuous abstinence at 6 months – 12 and 24 months (5). All studies showed, continuous abstinence at follow up differed in percentage between groups both at 6 weeks through 24 months, with NRT (Nicotine patch) intervention groups achieving higher rates in most of the studies compared to placebo intervention group. Conclusions: NRT intervention methods seem to increase smoking abstinence in those treated for smoking cessation. Further and larger sample size studies are required to make stronger the base of evidence. DISCUSSION/SIGNIFICANCE OF IMPACT: Four randomized controlled trials investigating the effectiveness of smoking cessation interventions, for teenagers who smoke cigarettes were identified for inclusion in this review. Four of the studies reported significant effects on smoking cessation, providing evidence of effectiveness of NRT (nicotine patch), behavioral support and combinations of the two, although not all trials intervention treatments found an effect. The four studies reported important intervention effects at both the short and long follow-ups required: 6 weeks up to the 24 months, thereby, providing stronger evidence to support the effectiveness of NRT intervention on smoking cessation. All studies showed some evidence of improved smoking abstinence outcomes. The four studies had in common that the smoking cessation interventions provided a combination of intent to treat prevention, and of all the clinical trials none of them suggested a negative effect of smoking cessation treatment on substance use outcomes using NRT. However, the studies used reliable methods and reported their cases properly, but the small number of studies reviewed for the systematic review makes the conclusion about the effectiveness of these interventions uncertain. The papers visibly stated how the trials protected against bias, as indicated by the Yes (low risk). No (high risk) and U as “unclear risk.” All four studies conducted a random sequence generation of participants enrolled into the study sample.
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Servis, Mark, Scott M. Fishman, Mark S. Wallace, Stephen G. Henry, Doug Ziedonis, Daniel Ciccarone, Kelly R. Knight, et al. "Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California." Pain Medicine, December 14, 2020. http://dx.doi.org/10.1093/pm/pnaa399.
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Abstract Objective The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). Methods The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. Results The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. Conclusions The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.
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"Round table: Substance use disorders (SUD)." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.468.
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Abstract Substance use disorders are among the priority conditions identified by the World Health Organization mental health gap action program. The health community has taken a range of (non-exclusive) positions on how to respond to them. These include a spectrum from prohibition, through regulation, to harm reduction and another from individually targeted measures to collective policies. Which measures are adopted depend on many factors outside the health system, including beliefs about the relationship between the individual and the state, the power of producer interests (tobacco/ alcohol industries), and the predominant public narrative. In contrast, a public health approach would focus on the risks of harm, to the individual and society, its distribution within the population, and the potential for unintended consequences. In this workshop, we will explore policy responses to four harmful substances, in four different European countries. These are electronic cigarettes (Martin McKee), cannabis (Jean-Pierre Couteron) illegal drugs (Henrique Barros) and alcohol (Jutta Lindert). First, the case of electronic cigarettes have divided the health community. While some groups, mainly in England, have embraced them, others have expressed concerns, with US authorities describing their increasing use by adolescents as a public health emergency. We will ask why these different views exist, exploring the use of different paradigms, the prioritization of different population groups and conditions, and the role of cognitive biases. This presentation will highlight some of the wider divisions in approaches to substance use disorders. Second, the use of cannabis in France will be presented. France ranks fourth in the European Union in terms of monthly consumption of cannabis and second only to Denmark in terms of persons who have ever used cannabis. As of November 2018 the penalty for possession of cannabis in France was reduced to a €200 fine. This presentation will discuss the rationale for and expectations of this policy. Third, we will focus on Portugal which, in 2001, became the first country to decriminalise the possession and consumption of all illicit substances. Rather than being arrested, those caught with a personal supply are given a small fine or told to appear before a local commission. Finally, the challenges for Public health of harmful alcohol use will be presented. The harmful use of alcohol creates a serious health burden in refugees. Germany has among the highest alcohol consumptions in Europe, after Luxembourg, is the European country with the lowest percentage of people who abstain from drinking. Alcohol is widely accepted. This creates challenges for refugees coming from countries with much more restrictive approaches to alcohol. This presentation will explore the challenges that arise when a population coming from a regulated environment move to one that is highly liberalised, including a discussion of the challenges in developing culturally appropriate public health responses. Key messages Substance use is a major public health challenges. Legal and policy responses differ widely in the European Union - evidence based policies are highly beeded.
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Shah, Sayed Shah Nur Hussein, Ahmed Laving, Violet Caroline Okech-Helu, and Manasi Kumar. "Depression and its associated factors: perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya." BMC Psychiatry 21, no. 1 (September 8, 2021). http://dx.doi.org/10.1186/s12888-021-03439-0.
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Abstract Background Little data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya’s largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment. Methods We sampled 338 residents belonging to 8 different specialties using self administered questionnaires in this cross-sectional survey between October 2019 and February 2020. Questionnaires included: sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure. Bivariate and multivariate linear regression were used to assess for risk factors for depression. Results Mean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported no to mild depressive symptoms, 12.7% had moderate, and 16.9% had severe depressive symptoms. Most residents had high social support (71.8%) and moderate stress (61.6%). The educational environment was rated as more positive than negative by 46.3% of residents. Bivariate analyses revealed significant correlations between depressive symptoms, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis showed that depression was strongly associated with: fewer hours of sleep (β = − 0.683, p = 0.002), high perceived stress (β = 0.709, p < 0.001) and low perceived social support (β = − 2.19, p < 0.001). Conclusions Only 30% of medical residents in our study had moderate and severe depressive symptoms. Most residents in our study reported high levels of social support, and moderate levels of stress. Though their overall appraisal of medical residency experience was positive, mental health support and self-care skills in the training of medical professionals needs prioritization.
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"Exercise addiction – cases, possible indicators and open questions." Sports & Exercise Medicine Switzerland, 2020. http://dx.doi.org/10.34045/sems/2020/39.
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While addictive disorders involving substances are well researched, the field of behavioral addictions, including exercise addiction, is in its infancy. Although exercise addiction is not yet recognized as a psychiatric disorder, evidence for the burden it imposes has gained attention in the last decade. Characterised by a rigid exercise schedule, the prioritization of exercise over one’s own health, family and professional life, and mental wellbeing, and extreme distress when exercise is halted, the phenomenon shares many feature with substance use disorders. While prevalence is thought to be low, affecting one in every 1000 exercisers, current research suggests that the symptoms are extremely burdensome, and may often be accompanied by other psychiatric disorders. It is no longer thought to be the case that only endurance athletes are at risk. While disease history and neural substrates are still to be clarified, there are a number of indicators which may help clinicians and sports physicians identify a possible case of exercise addiction.
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Hawkins, Eric J., Anissa N. Danner, Carol A. Malte, Brittany E. Blanchard, Emily C. Williams, Hildi J. Hagedorn, Adam J. Gordon, et al. "Clinical leaders and providers’ perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs’ facilities." Addiction Science & Clinical Practice 16, no. 1 (September 6, 2021). http://dx.doi.org/10.1186/s13722-021-00263-5.
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Abstract Background Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers’ perceptions about MOUD over the first year of implementation. Methods Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach. Results Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents’ ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time. Conclusions Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers’ and clinical leaders’ perceptions of MOUD over time. Strategies that improve leaders’ prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics.
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Hicks, Peter, Emilie Lamb, and David Trepanier. "Updates to the Implementation Guide for Syndromic Surveillance." Online Journal of Public Health Informatics 10, no. 1 (May 22, 2018). http://dx.doi.org/10.5210/ojphi.v10i1.8911.
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Objective: To describe the process to update the Implementation Guide (IG) for Syndromic Surveillance via community and stakeholder engagement and highlight significant modifications as the IG is vetted through the formal HL7 balloting process.Introduction: In 2011, the CDC released the PHIN Implementation Guide (IG) for Syndromic Surveillance v.1 under the Public Health Information Network. In the intervening years, new technological advancements, EHR capabilities as well as epidemiological and Meaningful Use requirements have led to the periodic update and revision of the IG through informal and semi-structured solicitation and collection of comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the IG v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the IG in a more systematic manner and released further updates via an Erratum and a technical document developed with NIST to clarify validation policies and testing parameters. These documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), Validation Test Cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT).As part of a Cooperative Agreement initiated in 2017, CDC and ISDS built upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the IG with the goal of having the final product to become an “HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance Standard for Trial Use” following a formal HL7 balloting process in 2018.Methods: ISDS coordinated a multi-stakeholder working group to revisit the consolidated IG, v.2.1 and began to collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and ultimately reconciliation and resolution when there were errors, conflicts or differing perspectives. 132 comments were received during the initial review period (April – July 2017) with 16 elements captured for each comment which included: Subject, Request Type, Clinical Venue, Name, IG Section, Priority, Working & Final Resolution (Fig. 1). The online portal also allowed for members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’, this has been an important feature in teasing out the underlying concerns and issues with a given comment across different local, state, and private sector partners which many have differing institutional perspectives and state or locally derived requirements (Fig. 2). Some comments were able to be fully described and resolved using this feature. Following the initial comment period, ISDS initiated a weekly webinar-based review process to delve into specific issues in an in-depth manner. In general, approximately 12 comments were addressed on a given call. Each week ISDS staff would lead the webinars structured around similar comment types (e.g. values sets, DG1 Segments, IN1 Segments, Conformance Statements, etc.). This efficiently leveraged the expertise of individuals and institutions with concerns revolving around a specific domain, messages segment, or specification described within the IG. Comments for which consensus and resolution was achieved would be “closed-out’ on the portal inventory and new assignments for review would be disseminated across the Message Guide Workgroup for consideration and discussion during the subsequent review calls.Results: To date this review process has identified and updated a wide-range of specification and requirements described within the IG v.2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messages, modification of values such as pregnancy status, travel history, and medication list from “O” to “RE”, and the update of PHIN VADS value sets.Conclusions: The results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the Message Guide (re-branded to the HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance) will be made available to the Public Health community by November 2017, when a second round of review and commentary will be initiated.This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As we continue to move through this review process we believe that the final HL7 balloted “Standard for Trial Use” IG 2.5 will be a stronger more extensible product in supporting syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and public health authorities.
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Lamb, Emilie, Dave Trepanier, and Shandy Dearth. "Updates to the HL7 2.5.1 Implementation Guide for Syndromic Surveillance." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9726.
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ObjectiveTo describe the latest revisions and modifications to the “HL7 2.5.1 Implementation Guide for Syndromic Surveillance” (formerly the PHIN Message Guide for Syndromic Surveillance) that were made based on community commentary and resolution of feedback from the HL7 balloting process. In addition, the next steps and future activities as the IG becomes an “HL7 Standard for Trial Use” will be highlighted.IntroductionIn 2011, the Centers for Disease Control and Prevention (CDC) released the PHIN Messaging Guide for Syndromic Surveillance v. 1. In the intervening years, new technological advancements including Electronic Health Record capabilities, as well as new epidemiological and Meaningful Use requirements have led to the periodic updating and revision of the Message Guide. These updates occurred through informal and semi-structured solicitation and in response to comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the Message Guide v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the Message Guide in a more systematic manner and released further updates via an Erratum and a technical document developed with the National Institute of Standards and Technology (NIST) to clarify validation policies and certification parameters. This trio of documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), validate test cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT).As part of a Cooperative Agreement (CoAg) initiated in 2017, CDC partnered with ISDS to build upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the Message Guide. The goal of this CoAg is have the final product become an “HL7 Standard for Trial Use” following the second phase of formal HL7 balloting p in Fall 2018.MethodsISDS coordinated a multi-stakeholder working group to revisit the consolidated Message Guide, v.2.1 and collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and reconciliation and resolution when there were errors, conflicts, or differing perspectives for select specifications. Over 220 comments were received during the most recent review period via the HL& balloting process (April – June 2018) with sixteen elements captured for each comment, which included: Subject, Request Type, Clinical Venue Application, Submitter Name, IG Section #, Priority, Working and Final Resolution (Figure 1). The online portal was used to communicate with members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’. This became an important feature in teasing out underlying concerns and issues with a given comment across different local, state, and private sector partners (Figure 2). Some comments were able to be fully described and resolved using this feature. Following the HL7 balloting period, ISDS continued the weekly webinar-based review process to delve into specific issues in detail. Each week ISDS staff would lead the webinars structured around similar comment types (e.g. values sets, DG1 Segments, IN1 Segments, Conformance Statements, etc.). This leveraged the expertise of individuals and institutions with concerns revolving around a specific domain, messages segment, or specification described within the Message Guide. Comments for which consensus and resolution was achieved were “closed-out’ on the portal inventory and new assignments for review would be disseminated across the Message Guide Workgroup for consideration and discussion during the subsequent webinar.ResultsTo date this review process has identified and updated a wide-range of specification and requirements described within the Message Guide v.2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messages, modification of values such as pregnancy status, travel history, and medication list from “O” to “RE”, and the update of value sets and PHIN VADS references for FIPS, SNOmed, ICD-10-CM, Acuity, Patient Class, and Discharge Disposition.ConclusionsThe results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the Message Guide (re-branded to the HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance) will go through a second round of review and commentary thru HL7 in Fall 2018.This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As this review process continues it is anticipated that the final HL7 balloted “Standard for Trial Use” IG 2.5 will represent a more refined and extensible product that can support syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and public health authorities.ISDS and CDC have recommended that future modifications to the Promoting Interoperability (PI) Programs (formerly Meaningful Use) reference and require the utilization of the revised Implication Guide for Certification. The HL7 2.5.1 Implementation Guide can be found: https://cdn.ymaws.com/www.healthsurveillance.org/resource/resmgr/docs/Group_Files/Message_Guide/IG_SyS_Release_1.pdf
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Smith, L., A. Sarki, F. Onukwugha, and M. Magadi. "Schools health promotion among adolescents in Northern Nigeria." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa165.1139.
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Abstract Background Jigawa and Kano States, Northern Nigeria have some of the worst human development outcomes globally for adolescents across a wide range of health indicators. Our aim was to understand health awareness, beliefs, and behaviours of adolescents in school in Jigawa and Kano States, to inform prioritization and development of health promotion interventions in the region. Methods We carried out a cross-sectional survey followed by focus group discussions (FGDs) with adolescents aged 15 to 20 years from four schools in Jigawa and Kano States (July-August 2019). Adolescents (274 per school) were randomly selected stratified by class-year (SS1 and SS2); 64 participated in FGDs (8 groups of 8). Trained researchers administered a questionnaire face-to-face via smart phones. Topics included: mental health; tobacco use; substance misuse; violence and unintentional injury; physical and dietary behaviours; and hygiene. FGDs investigated topics in greater depth. Here we report prevalence and predictors of mental health calculated from survey responses, and thematic analysis of interview findings. Results One thousand and seventy-nine students completed the survey (98%);∼50% girls. Preliminary analysis showed prevalence of moderate-severe anxiety was higher in girls than boys (6.8% girls, 0.8% boys, p < 0.001); and moderate-severe depression (10.3% girls, 0.5% boys, p < 0.001). Up to 50% boys and girls experienced violence or abuse in school, and 16% used a prescription drug without a prescription in past 30 days. Multivariable logistic regression showed female gender (aOR =4.0, 95% CI; 2.7,6.0); 30-day off-prescription drug use - aOR=2.3 (1.5,3.8); and being hit or slapped by a teacher - aOR=1.7, (1.1, 2.6) were predictors of moderate to severe anxiety. Results were similar for moderate to severe depression. Qualitative findings supported and contextualized these results. Conclusions Results will inform school-based interventions to improve health of adolescents in the region. Key messages Administering a health questionnaire to gather health information of adolescents in school in Kano and Jigawa states, Nigeria was feasible. Health questionnaire and focus group data will be shared with school and community leaders to shape school-based interventions to improve health outcomes amongst adolescents.