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INTRODUCTION: Exposure to xylazine has been associated with wounds distinct from typical injection-related skin and soft tissue infections. We sought to understand drug use and wound care practices, and treatment experiences of people who use drugs (PWUD) in a high-prevalence area of xylazine adulteration. METHODS: In August 2023, we surveyed adult PWUD reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs. Using a representative illustration, participants indicated if they had experienced a xylazine wound in the past 90 days. We compared demographic, drug use factors, wound care, and medical treatment experiences among those with and without xylazine wounds. We also conducted additional content analysis of open-ended responses. RESULTS: Of the 171 respondents, 87 % (n=148) had a xylazine wound in the past 90 days. There were no statistically significant demographic differences between those with and without xylazine wounds. Among those primarily injecting (n=155), subcutaneous injection was nearly ten times more likely among people with xylazine wounds. For those with xylazine wounds (n=148), many engaged in heterogeneous wound self-treatment practices, and when seeking medical care, 74 % experienced healthcare stigma and 58 % had inadequate pain and withdrawal management. CONCLUSION: People with self-identified xylazine wounds were more likely to engage in subcutaneous injection and faced several barriers seeking medical wound treatment. Programs serving people exposed to xylazine should work to support safer injection practices, including alternatives to injecting and improving access to high-quality, effective wound care. Further study is warranted to understand the causes, promoters, and prevention of xylazine-related wounds.
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Pain, substance use, and mental health conditions are common among people living with HIV (PLWH), and avoidance and rumination may influence the co-occurrence of these conditions. The present study examined longitudinal associations between avoidance/rumination and pain outcomes, anxiety, anger, and substance use among PLWH. Participants (Nâ¯=â¯187) with chronic pain and depressive symptoms completed self-report assessments over a 1-year period. Greater avoidance/rumination was positively associated with mental health outcomes (anxiety, anger), pain interference, and alcohol use across participants after controlling for depression severity. At time points with greater avoidance/rumination than average, participants also reported increased pain severity and interference, anxiety and anger symptoms, and alcohol use. No associations were found between avoidance/rumination and cannabis use. Results suggest a mechanistic effect of avoidance/rumination, such that increases in avoidance/rumination correspond with poorer health outcomes among PLWH over time. Targeting avoidance/rumination through intervention approaches may be beneficial for addressing comorbid health conditions among PLWH. Additional research is necessary to investigate this possibility and further characterize the effects of avoidance/rumination on health outcomes for PLWH.
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Ansiedade , Depressão , Infecções por HIV , Saúde Mental , Ruminação Cognitiva , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Infecções por HIV/psicologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Pessoa de Meia-Idade , Depressão/psicologia , Depressão/epidemiologia , Depressão/complicações , Adulto , Ansiedade/psicologia , Ansiedade/epidemiologia , Saúde Mental/estatística & dados numéricos , Dor Crônica/psicologia , Dor Crônica/epidemiologia , Ira , Aprendizagem da Esquiva , AutorrelatoRESUMO
This Viewpoint reviews the history of mandates governing access to medical diagnostic equipment in Section 504 of the Rehabilitation Act of 1973 and reviews the new rules.
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Direitos Civis , Pessoas com Deficiência , Equipamentos e Provisões , Acessibilidade aos Serviços de Saúde , Humanos , Direitos Civis/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Equipamentos e Provisões/provisão & distribuição , Estados Unidos , Acessibilidade aos Serviços de Saúde/legislação & jurisprudênciaRESUMO
This Viewpoint describes the need for more health care organizations to include disability accessibility information on their websites and to improve physical access for patients with disabilities.
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Acesso à Internet , Humanos , Acesso à Informação , Disparidades em Assistência à SaúdeRESUMO
BACKGROUND: Despite growing concern about opioid misuse and mental health of college students, little is known about this population who are at high risk of co-occurrence and unmet needs. This national study aims to estimate the prevalence of opioid misuse, examine correlates with anxiety and depression symptoms, and quantify help-seeking behaviors among U.S. college students. METHODS: Data come from students in the Healthy Minds Study between 2017 and 2020 (n = 176,191). Validated screening tools assessed mental health symptoms (PHQ-9, GAD-7). Marginal effects of logistic regression models estimate the effect of opioid misuse on mental health symptoms, help-seeking and academic performance. RESULTS: 782 students indicated past month opioid misuse. Student opioid misuse was associated with 24.1 percentage point increase in the probability of screening positive for anxiety/depression (p < 0.001) and 3.6 percentage point increase in the probability of informal help-seeking (p = 0.017). Less than half of students with opioid misuse and a positive depression/anxiety screen received any treatment in the past year. LIMITATIONS: Limitations to this study include: possible non-response bias, as it is unknown whether students with opioid misuse may be differentially-likely to respond to the survey; differing time frame for opioid misuse and mental health questions; and data was collected prior to the COVID-19 pandemic. CONCLUSIONS: This large, multi-campus study underlines the need for more partnership between substance use and mental health services on campus. It also highlights that college peers could receive training in ways to best help students who misuse opioids, directing them to on- or off-campus care.
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Ansiedade , Depressão , Transtornos Relacionados ao Uso de Opioides , Estudantes , Humanos , Masculino , Feminino , Estudantes/estatística & dados numéricos , Estudantes/psicologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Adulto Jovem , Universidades , Estados Unidos/epidemiologia , Depressão/epidemiologia , Adolescente , Ansiedade/epidemiologia , Adulto , Prevalência , Saúde Mental/estatística & dados numéricos , Comportamento de Busca de Ajuda , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Among people living with HIV (PLWH), unhealthy drinking presents an increased risk for negative outcomes. Physical inactivity and sedentariness raise additional health risks. Despite evidence that physical activity (PA) is associated with improved physical and mental functioning and reduced alcohol cravings, there have been no PA studies conducted with PLWH engaged in unhealthy drinking. We describe a study protocol of a remote lifestyle physical activity (LPA) intervention to increase PA and reduce alcohol consumption among PLWH. METHODS: Using online advertisements, 220 low-active PLWH engaged in unhealthy drinking will be recruited and randomized nationwide. After providing informed consent and completing a baseline interview, participants will receive a Fitbit. Participants will complete 15 days of ecologic momentary assessment through a phone application and up to 15 days of Fitbit wear time. Following this period, participants will be randomly assigned to a Fitbit-only control condition or a LPA and Fitbit intervention condition. Health counselors meet with control participants once (and have 6 subsequent brief check ins on Fibit use) and with intervention participants 7 times for PA counseling over a 12-week period. Follow-up assessments will be conducted at 3- and 6-months post-randomization. We hypothesize that individuals in the LPA and Fitbit condition will have lower rates of alcohol consumption and higher rates of PA at 6-month follow-up. CONCLUSION: The randomized controlled trial described in this paper investigates remote methods to influence multimorbidity among PLWH using a LPA approach for increasing PA and reducing alcohol consumption.
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Consumo de Bebidas Alcoólicas , Exercício Físico , Infecções por HIV , Adulto , Feminino , Humanos , Masculino , Consumo de Bebidas Alcoólicas/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Aconselhamento/métodos , Avaliação Momentânea Ecológica , Infecções por HIV/psicologia , Estilo de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Importance: Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap. Objectives: To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt. Design, Setting, and Participants: This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023. Exposure: Demographic and clinical factors potentially associated with posthospitalization MOUD receipt. Main Outcomes and Measures: The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually. Results: Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates. Conclusions and Relevance: This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.
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Transtornos Relacionados ao Uso de Opioides , Humanos , Massachusetts/epidemiologia , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Feminino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Metadona/uso terapêutico , Adolescente , Adulto Jovem , Readmissão do Paciente/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Naltrexona/uso terapêuticoRESUMO
BACKGROUND: Persons receiving prescription buprenorphine for opioid use disorder experience high rates of comorbid conditions such as chronic pain and depression, which present barriers to buprenorphine care retention. This paper describes the protocol of the TOPPS (Treating Opioid Patients' Pain and Sadness) study, which compares a values-based, behavioral activation intervention with a health education contact-control condition, with the aim of decreasing chronic pain and depression, and increasing buprenorphine care retention for persons with opioid use disorder. METHODS: This randomized controlled trial (RCT) enrolls and randomizes up to 250 participants currently being treated with buprenorphine to receive three months of either TOPPS, a six-session phone-based behavioral intervention, or a health education (HE) control condition. We compare the TOPPS intervention to HE on the following outcomes: 1) pain interference and pain severity over the 3-month treatment phrase; 2) depressive symptoms over the 3-month treatment phase; and 3) sustained improvements in pain interference, depressive symptoms, and buprenorphine treatment retention over the 12-month study period. We also examine mechanisms by which the intervention may reduce pain interference. DISCUSSION: This RCT explores a novel intervention to address chronic pain and depression for individuals receiving buprenorphine in office-based settings. TOPPS may lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this intervention and heightening its public health impact. CLINICAL TRIAL: #NCT03698669.
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Analgésicos Opioides , Buprenorfina , Dor Crônica , Depressão , Transtornos Relacionados ao Uso de Opioides , Humanos , Buprenorfina/uso terapêutico , Buprenorfina/administração & dosagem , Dor Crônica/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/terapia , Depressão/tratamento farmacológico , Depressão/terapia , Depressão/epidemiologia , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Masculino , Retenção nos Cuidados , Terapia Comportamental/métodos , Adulto , Feminino , Educação em Saúde/organização & administração , Educação em Saúde/métodos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Insufficient physical activity (PA) is a leading risk factor for non-communicable diseases posing a significant economic burden to healthcare systems and societies. The study aimed to examine the differences in healthcare and indirect costs between sufficient and insufficient PA and the cost differences between PA intensity groups. METHODS: The cross-sectional analysis was based on data from 157,648 participants in the baseline examination of the German National Cohort (NAKO) study. Healthcare and indirect costs were calculated based on self-reported information on health-related resource use and productivity losses. PA in the domains leisure, transport, and work was assessed by the Global Physical Activity Questionnaire and categorized into sufficient/insufficient and intensity levels (very low/low/medium/high) based on PA recommendations of the World Health Organization. Two-part models adjusted for relevant covariates were used to estimate mean costs for PA groups. RESULTS AND CONCLUSION: Insufficiently active people had higher average annual healthcare costs (Δ 188, 95% CI [64, 311]) and healthcare plus indirect costs (Δ 482, 95% CI [262, 702]) compared to sufficiently active people. The difference was especially evident in the population aged 60 + years and when considering only leisure PA. An inverse association was observed between leisure PA and costs, whereas a direct association was found between PA at work and costs. Adjusting for the number of comorbidities reduced the differences between activity groups, but the trend persisted. The association between PA and costs differed in direction between PA domains. Future research may provide further insight into the temporal relationship between PA and costs.
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INTRODUCTION: Compared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women. METHODS: Fifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes. RESULTS: Higher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC. CONCLUSIONS: The LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.
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Alcoolismo , Exercício Físico , Estilo de Vida , Humanos , Feminino , Pessoa de Meia-Idade , Projetos Piloto , Alcoolismo/terapia , Alcoolismo/psicologia , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Consumo de Bebidas Alcoólicas/prevenção & controleRESUMO
Cryolipolysis (CL) is a noninvasive technique that uses applicators to cool tissue to temperatures that selectively destroy adipocytes. Since its introduction to the market, it has rapidly become one of the leading non-surgical modalities to reduce fat in the aesthetic industry. Paradoxical Adipose Hyperplasia (PAH) is an adverse reaction to CL, whereby there is initial reduction in fat volume, followed by abnormal fat growth exceeding the original volume in the treated area. The incidence of PAH is thought to be underreported, and its pathophysiology and management remains unclear. The objective of this study was to present a series of PAH cases and review efficacy of management modalities.
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Globally, more than 1 billion people with disabilities are disproportionately and differentially at risk from the climate crisis. Yet there is a notable absence of climate policy, programming, and research at the intersection of disability and climate change. Advancing climate justice urgently requires accelerated disability-inclusive climate action. We present pivotal research recommendations and guidance to advance disability-inclusive climate research and responses identified by a global interdisciplinary group of experts in disability, climate change, sustainable development, public health, environmental justice, humanitarianism, gender, Indigeneity, mental health, law, and planetary health. Climate-resilient development is a framework for enabling universal sustainable development. Advancing inclusive climate-resilient development requires a disability human rights approach that deepens understanding of how societal choices and actions-characterised by meaningful participation, inclusion, knowledge diversity in decision making, and co-design by and with people with disabilities and their representative organisations-build collective climate resilience benefiting disability communities and society at large while advancing planetary health.
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Pessoas com Deficiência , Resiliência Psicológica , Humanos , Direitos Humanos , Saúde Mental , Mudança ClimáticaRESUMO
Large population-based cohort studies utilizing device-based measures of physical activity are crucial to close important research gaps regarding the potential protective effects of physical activity on chronic diseases. The present study details the quality control processes and the derivation of physical activity metrics from 100 Hz accelerometer data collected in the German National Cohort (NAKO). During the 2014 to 2019 baseline assessment, a subsample of NAKO participants wore a triaxial ActiGraph accelerometer on their right hip for seven consecutive days. Auto-calibration, signal feature calculations including Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD), identification of non-wear time, and imputation, were conducted using the R package GGIR version 2.10-3. A total of 73,334 participants contributed data for accelerometry analysis, of whom 63,236 provided valid data. The average ENMO was 11.7 ± 3.7 mg (milli gravitational acceleration) and the average MAD was 19.9 ± 6.1 mg. Notably, acceleration summary metrics were higher in men than women and diminished with increasing age. Work generated in the present study will facilitate harmonized analysis, reproducibility, and utilization of NAKO accelerometry data. The NAKO accelerometry dataset represents a valuable asset for physical activity research and will be accessible through a specified application process.
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Acelerometria , Exercício Físico , Masculino , Humanos , Feminino , Reprodutibilidade dos Testes , Calibragem , QuadrilRESUMO
OBJECTIVE: Strong positive links exist between mood, alcohol craving, and sweet taste preference. Research suggests a substitution effect of alcohol with sweets. During alcohol abstinence, individuals have increased craving for alcohol and sweets, in association with anxiety and depression symptoms. Thus, the present study examined the moderating role of sweet taste preference on links between anxiety and depression symptoms and alcohol craving. METHOD: Participants were individuals (N = 91) with alcohol use disorder (AUD) enrolled in a partial hospitalization program. Participants completed baseline assessments of anxiety and depression symptoms, alcohol use and craving, and sweet taste preference. RESULTS: We found significant correlations between symptoms of depression, anxiety, alcohol craving, and sweet taste preference. Sweet taste preference moderated links between both depression and anxiety symptoms with alcohol craving. CONCLUSIONS: For those low and moderate in sweet taste preference, internalizing symptoms appeared positively linked with alcohol craving. For those high in sweet taste preference, alcohol craving remained elevated regardless of anxiety symptoms, but appeared to decrease with heightened depressive symptoms. Should future research replicate this finding using controlled research designs that demonstrate temporality and causality, tailored early AUD interventions may be justified based on individuals' levels of sweet taste preference.
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Body shape phenotypes combining multiple anthropometric traits have been linked to postmenopausal breast cancer (BC). However, underlying biological pathways remain poorly understood. This study investigated to what extent the associations of body shapes with postmenopausal BC risk is mediated by biochemical markers. The study included 176,686 postmenopausal women from UK Biobank. Four body shape phenotypes were derived from principal component (PC) analysis of height, weight, body mass index, waist and hip circumferences, and waist-to-hip ratio (WHR). The four-way decomposition of the total effect was used to estimate mediation and interaction effects simultaneously as well as the mediated proportions. After 10.9 years median follow-up, 6,396 incident postmenopausal BC were diagnosed. There was strong evidence of positive associations between PC1 (general obesity) and PC2 (tall, low WHR), and BC risk. The association of PC1 with BC risk was positively mediated by testosterone and negatively by insulin-like growth factor-1 (IGF-1), with the overall proportion mediated (sum of the mediated interaction and pure indirect effect (PIE)) accounting for 11.4% (95% confidence intervals: 5.1 to 17.8%) and -12.2% (-20.5% to -4.0%) of the total effect, respectively. Small proportions of the association between PC2 and BC were mediated by IGF-1 (PIE: 2.8% (0.6 to 4.9%)), and sex hormone-binding globulin (SHBG) (PIE: -6.1% (-10.9% to -1.3%)). Our findings are consistent with differential pathways linking different body shapes with BC risk, with a suggestive mediation through testosterone and IGF-1 in the relationship of a generally obese body shape and BC risk, while IGF-1 and SHBG may mediate a tall/lean body shape-BC risk association.
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Bancos de Espécimes Biológicos , Neoplasias da Mama , Fenótipo , Pós-Menopausa , Humanos , Feminino , Neoplasias da Mama/epidemiologia , Reino Unido/epidemiologia , Pessoa de Meia-Idade , Idoso , Análise de Mediação , Fatores de Risco , Estudos de Coortes , Índice de Massa Corporal , Relação Cintura-Quadril , Somatotipos , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like I/análise , Biobanco do Reino UnidoRESUMO
It remains unknown whether adiposity subtypes are differentially associated with colorectal cancer (CRC). To move beyond single-trait anthropometric indicators, we derived four multi-trait body shape phenotypes reflecting adiposity subtypes from principal components analysis on body mass index, height, weight, waist-to-hip ratio, and waist and hip circumference. A generally obese (PC1) and a tall, centrally obese (PC3) body shape were both positively associated with CRC risk in observational analyses in 329,828 UK Biobank participants (3728 cases). In genome-wide association studies in 460,198 UK Biobank participants, we identified 3414 genetic variants across four body shapes and Mendelian randomization analyses confirmed positive associations of PC1 and PC3 with CRC risk (52,775 cases/45,940 controls from GECCO/CORECT/CCFR). Brain tissue-specific genetic instruments, mapped to PC1 through enrichment analysis, were responsible for the relationship between PC1 and CRC, while the relationship between PC3 and CRC was predominantly driven by adipose tissue-specific genetic instruments. This study suggests distinct putative causal pathways between adiposity subtypes and CRC.
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Neoplasias Colorretais , Somatotipos , Humanos , Estudo de Associação Genômica Ampla , Neoplasias Colorretais/genética , Obesidade/genética , Fenótipo , Variação Genética , Fatores de RiscoRESUMO
This cross-sectional study examines awareness of opioid overdose, the ability to administer naloxone, and the willingness to help during an overdose on college campuses across the US.
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Conhecimentos, Atitudes e Prática em Saúde , Overdose de Opiáceos , Humanos , Adolescente , Overdose de Opiáceos/epidemiologia , Overdose de Opiáceos/prevenção & controle , Adulto Jovem , Masculino , Feminino , Analgésicos Opioides/intoxicação , Analgésicos Opioides/efeitos adversosRESUMO
The manifestations of syphilis, a sexually transmitted infection caused by Treponema pallidum, can be divided into primary, secondary, or tertiary stages. In addition, syphilis can cause a latent infection with no clinical manifestations and be diagnosed solely by serologic testing. Secondary syphilis is especially known for causing a rash and diverse clinical manifestation which can make its diagnosis challenging-particularly in patients whose medical and sexual histories do not align with the classical epidemiologic and textbook description of secondary syphilis. We present a case of a 20-year-old immunocompetent heterosexual woman who presented with a rash atypical for secondary syphilis and accompanied by neurologic, ocular, and otic manifestations. This case highlights the importance of considering syphilis in the differential diagnosis of sexually active patients with a rash, even when their clinical presentations do not align with the textbook description of a syphilitic rash. Health care providers must remain vigilant for the diagnosis of syphilis in diverse clinical contexts, as early recognition and treatment are vital to prevent further syphilitic complications and transmission in military and civilian populations. Timely identification and intervention are crucial for both patient care and public health.
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Background: Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). Methods: We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). Findings: Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18). Interpretation: The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. Funding: US National Institute on Drug Abuse.
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BACKGROUND: The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups. METHODS: Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions. RESULTS: Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines. CONCLUSIONS: Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks.