Outcomes of adding cognitive behavioral therapy to medication-assisted treatment for opioid use disorder.

BACKGROUND: With increasing rates of opioid overdose deaths throughout the United States, there is an urgent need to implement interventions to mitigate this trend. Psychosocial interventions are reported to improve retention rates in rehabilitation centers with medication-assisted treatment (MAT) programs for opioid use. LOCAL PROBLEM: In 2020, 14% (187 of 1,309) of opioid overdose deaths in Georgia were in Dougherty County where an intensive outpatient MAT program had historically used twice weekly group therapy plus individual cognitive behavioral therapy (CBT) with an inconsistent duration and frequency. METHOD: Using existing clinical data, a quality-improvement project was designed and implemented to determine whether 60 min of CBT every other week, in addition to weekly group therapy, and prescription medication would result in higher opioid use disorder treatment retention rates. INTERVENTION: A 6-month data analysis of monthly MAT reports compared program retention rates from the 3 months before to 3 months after the policy change. RESULTS: The retention rate significantly increased from 8% to 56% (χ 2 = 8.93, p = .01) following the policy change, adding consistent (98%) individual CBT every other week. CONCLUSIONS: Implementing a policy with a consistent 60 min of individual CBT every other week in addition to the group counseling twice a week and the prescribed medication was associated with an increased retention rate among patients engaged in MAT for opioid use.

Handgrip and sex-specific cardiometabolic risk factors in Hispanic/Latino migrant farmworkers.

Studies have suggested that handgrip strength might be a marker for cardiometabolic risk (CMR), but it has not been studied in Hispanic/Latino farmworker population. This study aimed to characterize absolute and relative handgrip strength in Hispanic/Latino farmworkers, and investigate the sex-specific association between handgrip strength and CMR factors. CMR factors and seated isometric absolute (the sum of both hands) and relative (absolute handgrip strength divided by body mass index) handgrip strengths were collected in 173 Hispanic/Latino farmworkers (mean age 35.1 ± 0.7 years; 49% female). The absolute and the relative handgrip strengths were 89.2 ± 1.8 kg, 3.3 ± 0.1 kg among males, and 56.5 ± 1.9 kg, 1.9 ± 0.1 kg among females, respectively. Age was correlated with absolute (r = - 0.17, p = 0.03) and relative handgrip strengths (r = - 0.28, p < 0.01). In males, absolute handgrip was related to triglycerides (r = - 0.25, p < 0.05), whereas relative handgrip was related to waist circumference (r = - 0.32, p < 0.01), waist/hip circumference ratio (r = - 0.36, p < 0.01), high-density lipoprotein (r = 0.24, p < 0.05), and triglycerides (r = - 0.35, p < 0.01). In females, absolute handgrip was related to fasting plasma glucose (r = - 0.28, p = 0.03), whereas relative handgrip was related to waist circumference (r = - 0.38, p < 0.01) and fasting plasma glucose (r = - 0.22, p < 0.05). Males had lower absolute handgrip strength when their triglycerides levels were at risk (p = 0.021), and lower relative handgrip strength when their plasma glucose (p = 0.034) and triglycerides (p = 0.002) levels were at risk. Females had lower relative handgrip strength when their plasma glucose (p = 0.001) and blood pressure (p = 0.004) were at risk. This study suggests that handgrip strength may be associated with sex-specific CMR factors in a Hispanic/Latino farmworker population.

The Association of Intraocular Pressure With Obesity and Cardiometabolic Risk in a Young Farmworker Population.

PRCIS: Intraocular pressure (IOP) was found to be significantly correlated with body mass index (BMI), waist circumference, and diastolic blood pressure (DBP) in a farmworker population located in the southeast Georgia, USA. BMI was correlated with IOP, independent of systemic blood pressures. PURPOSE: Elevated IOP is a known risk factor for glaucomatous optic neuropathy and is believed to be associated with obesity and cardiometabolic diseases. The high prevalence of these conditions in the United States necessitates an evaluation of the relationship among obesity, cardiometabolic risks, and IOP among understudied younger populations. MATERIALS AND METHODS: Farmworker data were collected from the annual Costa-Layman Health Fair between 2013 and 2017. Correlations of IOP with demographic factors, obesity, and cardiometabolic risks were analyzed using analysis of covariance, partial Pearson correlations, and linear regressions. RESULTS: In the farmworker population (n=346), the mean IOP was 15.5 mm Hg and the prevalence of ocular hypertension (IOP>21 mm Hg) was 5.5%. BMI, waist circumference, and DBP were significantly correlated (r=0.192, P=0.001; r=0.128, P=0.017; r=0.142, P=0.007, respectively) with IOP when adjusted for age, sex, and ethnicity. Each 10 mm Hg increase in DBP corresponded with a 0.51 mm Hg increase in IOP. With adjustment for age, sex, ethnicity, systolic blood pressure, and DBP, BMI remained significantly correlated with IOP (r=0.166, P=0.002). CONCLUSIONS: Higher IOP is associated with obesity measures including BMI and waist circumference and is correlated with DBP. These findings suggest that BMI is an independent risk factor for elevated IOP.

Evidence of African-American women's frustrations with chronic recurrent bacterial vaginosis.

PURPOSE: The purpose of this study was to explore the impact of recurrent bacterial vaginosis (BV) and its treatment on quality of life (QOL), acceptance of current treatment options, and psychosocial issues related to lifestyle practices associated with BV. DATA SOURCES: Qualitative and quantitative data were obtained from 23 African American women with recurrent BV. Participants completed a short survey, developed by the researchers based on a prior study which examined factors associated with recurrent BV, and a one-on-one interview assessing the impact of BV, current treatment modalities, and lifestyle practices related to recurrent BV. CONCLUSIONS: Emerging themes suggest that recurrent BV is associated with psychosocial issues that are currently not addressed in a typical office visit. Reported feelings of shame and embarrassment often cause women to engage in hypervigilant routines of hygiene that negatively impact their professional, personal, and intimate relationships, significantly affecting their QOL. IMPLICATIONS FOR PRACTICE: Without proper education, advice, and support, BV is perpetuated by lifestyle practices leading to recurrent infection and associated symptoms. With proper guidance, it is expected that women with recurrent BV will see an improvement in their QOL, with fewer complications from BV infection, and healthy relationships with intimate partners, family, and friends.