The Associations Between Opioid Use Disorder and Healthcare-Related Outcomes in Vaso-occlusive Crisis.

BACKGROUND: In patients who experience frequent vaso-occlusive crises (VOC), opioid dependence may be due to a need for pain control as opposed to addiction; the implications of opioid use disorder (OUD) in this population are unclear. OBJECTIVE: To compare outcomes in hospitalizations for VOC in those with a history of OUD to those without a history of OUD. DESIGN: A retrospective assessment of hospitalizations for adults in the USA with a primary discharge diagnosis of VOC using the National Inpatient Sample database from 2016 to 2019. We also compared VOC hospitalizations to hospitalizations for all other reasons to assess differences in OUD-associated clinical factors. PARTICIPANTS: In total, 273,460 hospitalizations for VOC; 23,120 (8.5%) of these hospital stays involved a secondary diagnosis of OUD. MAIN MEASURES: Primary outcomes were length of hospital stay and cost. Mortality was a secondary outcome. KEY RESULTS: Hospital length of stay was increased (mean 6.2 vs 4.9 days) in patients with OUD (adjusted rate ratio = 1.24, 95% CI 1.20-1.29, p < 0.001). Mean cost was also higher in those with OUD ($9076) than those without OUD ($8020, p < 0.001). Mortality was decreased in VOC hospitalizations in those with OUD, but the difference was not statistically significant (adjusted OR = 0.64, 95% CI 0.028-1.48, p = 0.30). CONCLUSIONS: OUD is associated with increased length of stay and costs in patients with VOC. While there are many possible explanations, providers should consider undertreatment of pain due to addiction concerns as a potential factor; individualized pain plans to mitigate this challenge could be explored.

The impact of intuitive eating on the association between posttraumatic stress disorder (PTSD) symptoms and disordered eating among women who have experienced intimate partner violence (IPV).

OBJECTIVE: Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating. METHODS: Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors. RESULTS: Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors. DISCUSSION: Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.

'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women.

Transgender women are among the populations at highest risk for HIV in the USA and have elevated risk for intimate partner violence (IPV). There is an urgent need for integrated HIV-IPV prevention interventions for transgender women. Using qualitative methods, we explored transgender women's lived experiences of IPV and the relationship between IPV and HIV risk. Using thematic analysis, we identified four key concepts that warrant inclusion in the development of models for IPV and HIV interventions: (1) considering the boundaries of IPV; (2) normalising expectations of chronic violence; (3) relationship safety; (4) calls for trans-affirming and empowering services.

Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation.

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η2P = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η2P = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.

Comparing Prevalence and Correlates of Intimate Partner Sexual Victimization Relative to Other Victim-Offender Relationships in College Students.

Research on sexual victimization (SV) in college women often focuses on perpetration by nonpartners thus, little is known about SV by intimate partners on college campuses. To address this gap in the literature, the current study compared prevalence and revictimization rates and negative correlates of SV based on victim-offender relationship. Findings suggest higher prevalence rates of SV perpetrated by a nonpartner compared to an intimate partner although similar and alarming rates of revictimization. Regarding negative correlates of SV, no differences were identified based on victim-offender relationship; however, victims of SV by both an intimate partner and a nonpartner demonstrated the highest negative correlates. These findings demonstrate the importance of addressing SV by nonpartners and intimate partners and the necessity for tertiary prevention efforts to decrease revictimization.

Comparison of Adding Treatment of PTSD During and After Shelter Stay to Standard Care in Residents of Battered Women's Shelters: Results of a Randomized Clinical Trial.

This study explored the acceptability, feasibility, and initial efficacy of an expanded version of a PTSD treatment developed for residents of battered women's shelters, Helping to Overcome PTSD through Empowerment (HOPE) in women who received standard shelter services (SSSs). A Phase I randomized clinical trial comparing HOPE + SSSs (n = 30) to SSSs (n = 30) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (Blake et al., 1995) and the Revised Conflict Tactic Scales (Straus, Hamby, Boney-McCoy, & Sugarman, ). Participants were followed at 1-week, and 3- and 6-months posttreatment. Only 2 women dropped out of HOPE + SSS treatment. Latent growth curve analyses found significant treatment effects for PTSD from intimate partner violence (IPV) (ß = -.007, p = .021), but not for future IPV (ß = .002, p = .709) across follow-up points. Significant effects were also found for secondary outcomes of depression severity (ß = -.006, p = .052), empowerment (ß = .155, p = .022), and resource gain (ß = .158, p = .036). Additionally, more women in HOPE + SSSs were employed at 3- and 6-month follow-up compared to those in SSSs only. Results showed the acceptability and feasibility of adding IPV-related treatment to standard services. They also suggested that HOPE may be a promising treatment for residents of battered women's shelters. Further research with a larger sample, utilizing more diverse shelter settings and a more rigorous control condition, is needed to confirm these findings.

Patients and nursing staff views of using the education needs assessment tool in rheumatology clinics: a qualitative study.

AIMS AND OBJECTIVES: To evaluate the usability of the educational needs assessment tool in clinical practice, from a practitioner and patient perspective and to establish whether patients perceive that they are getting an equally good or equally inadequate education service for their needs. BACKGROUND: The educational needs assessment tool was developed to enable patients with Rheumatoid Arthritis to assess their education needs prior to a consultation with a health professional. The educational needs assessment tool has been translated into nine languages and measurement properties have been established, however, its usability in clinical practice has not been studied. DESIGN: A qualitative study embedded into a multicentre RCT in which patients had been randomised into either educational needs assessment tool-focused education (Experimental Group) or usual care (control group). METHODS: Both groups were seen by a clinical nurse specialist. Sixteen patients and four clinical nurse specialists were recruited from the Rheumatology Outpatient Departments of three Acute Hospitals within the U K. Data were collected by interviews with patients and clinical nurse specialist. Analysis followed the Framework approach. RESULTS: Patients and clinical nurse specialist found completion of the educational needs assessment tool straightforward, comprehensive and easy to use. Completing the educational needs assessment tool helped patients to focus on what they needed to know from the clinical nurse specialist. Patients in both the control group and the experimental group felt supported and reassured by their clinical nurse specialist and perceived that they received a good and adequate education provision. CONCLUSION: This study provides useful insights into the ability of the educational needs assessment tool to assess the educational needs of patients with rheumatoid arthritis in routine clinical practice. RELEVANCE TO CLINICAL PRACTICE: The educational needs assessment tool would be useful as a structured guide for nurses when assessing and meeting individual patient educational needs. This has the potential to improve patient-centred care, involve patients more actively in their care and enhance the long-term effects of patient education provision.

Rapid HIV testing and counseling for residents in domestic violence shelters.

Over one million Americans live with the human immunodeficiency virus (HIV), and roughly 20 percent of those living with HIV are unaware of their status. One way to decrease this epidemic is community-based rapid testing with high-risk populations. One high-risk population that has received limited attention is victims of intimate partner violence who seek shelter. In an effort to gain foundational information to implement rapid HIV testing and counseling services in domestic violence shelters, the current study conducted a series of focus groups with eighteen residents and ten staff of local shelters from October 15 to December 12, 2012. Participants provided valuable insight into how HIV rapid testing and counseling might be best implemented given the resources and constraints of shelter life. Despite identifying some potential barriers, most believed that the promise of quick results, the convenience and support afforded by the shelter venue, and the timing of the intervention at a point when women are making life changes would render the intervention acceptable to residents. Further insights are discussed in the article.

Relationships between socioeconomic status and cardiovascular outcomes in patients with complete heart block.

BACKGROUND: Literature illustrates an association between adverse outcomes and lower socioeconomic status (SES) in patients with critical cardiovascular presentations; however. limited data exist on complete heart block (CHB) outcomes in the context of SES. OBJECTIVES: The purpose of this study was to assess the association of SES (using zip code income quartiles) with the outcomes of CHB cases. METHODS: We queried the 2016-2019 Nationwide Inpatient Sample and identified CHB as the primary diagnosis. We compared in-hospital outcomes based on zip code mean income quartiles (≤2 [< $59,000] vs ≥3). The primary outcome was mortality. Secondary outcomes included total and early permanent pacemaker (PPM) and temporary pacemaker (TPM) use, cardiogenic shock, palliative care involvement, mechanical ventilation use, length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. RESULTS: Of 150,265 CHB hospitalizations, 76,635 (51%) involved patients with a lower income quartile. Lower quartiles were associated with lower odds of early PPM use (adjusted odds ratio [aOR] 0.86; 95% confidence interval [CI] 0.81-0.90) and higher odds of in-hospital mortality (aOR 1.23; 95% CI 1.05-1.46), total TPM use (aOR 1.08; 95% CI 1.02-1.14), palliative care (aOR 1.2; 95% CI 1.02-1.43), mechanical ventilation use (aOR 1.11; 95% CI 1.01-1.23), cardiogenic shock (aOR 1.15; 95% CI 1.01-1.31), and longer LOS (4 days vs 3.6 days; P <.001) compared to patients in higher quartiles. CONCLUSION: Patients with lower income admitted for CHB were less likely to receive an early PPM and had higher adverse outcomes compared to patients with higher income.

Survival sex among a diverse sample of women with histories of intimate partner violence: Results from a domestic violence shelter.

OBJECTIVE: The current study sought to investigate the prevalence and correlates of survival sex among a diverse sample of women residing in a domestic violence (DV) shelter. METHOD: Two hundred seven women (44% Black, 37.7% White, 10.6% Multiracial, 4.3% Latina, 1% Arab, 1% Asian/Pacific Islander, and 1.4% Indigenous or Aboriginal) residing in a Summit County, Ohio, DV shelter completed a survey assessing their involvement in survival sex, the associated contextual factors (e.g., age at first incidence of survival sex, the reason for engaging in survival sex), and self-report measures assessing substance use, post-traumatic stress disorder (PTSD) symptoms, intimate partner violence (IPV) victimization, adverse childhood experiences (ACEs), and empowerment. RESULTS: More than two-thirds of participants reported engaging in survival sex, and participants who did were more likely to have elevated rates of substance use, PTSD symptoms, ACEs, and IPV victimization, along with lower empowerment. Most commonly, women reported engaging in survival sex for fear that the other person would take away valuable support or things they needed. Participants also reported engaging in survival sex for securing shelter, for money, for food, and to obtain drugs or alcohol. Notably, a sizable minority of women first engaged in survival sex as minors, suggesting overlap with the phenomenon of domestic minor sex trafficking. CONCLUSIONS: Engaging in survival sex may be commonly experienced by women residing in DV shelters and is associated with trauma history and post-traumatic stress symptoms. Despite the small, non-representative sample, results indicate education for providers is necessary to interact effectively with this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pregnancy Weight Gain and Postpartum Weight Retention in Active Duty Military Women: Implications for Readiness.

INTRODUCTION: Weight gain in pregnancy is expected; however, excessive gestational weight gain and postpartum weight retention (PPWR) can cause long-term changes to a patient's body mass index (BMI) and increase the risk for adverse health outcomes. This phenomenon is understudied in active duty military women, for whom excess weight gain poses challenges to readiness and fitness to serve. This study examines over 30,000 active duty military women with and without preeclampsia to assess changes in BMI postpartum. MATERIALS AND METHODS: This is a retrospective analysis of claims data for active duty military women, aged 18-40 years, and experiencing pregnancy during fiscal years 2010-2014. Women with eating disorders, high-risk pregnancy conditions other than preeclampsia, scheduled high-risk medical interventions, or a second pregnancy within 18 months were excluded from the analysis. Height and weight were obtained from medical records and used to calculate BMI. Women with and without preeclampsia were categorized into BMI categories according to the Centers for Disease Control and Prevention classification of underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), or obese (>30.0). Linear regressions adjusted by age and race were performed to assess differences in prepregnancy weight and weight gain, retention, and change at 6 months postpartum. RESULTS: The greatest number of pregnant, active duty service women were found among ages 18-24 years, White race, Army service, junior enlisted rank, married status, and with no mental health diagnosis. Overall, over 50% of women in normal and preeclamptic pregnancies returned to their baseline BMI postpartum. Women in both populations more often gained than lost weight postpartum. Preeclampsia strongly affected weight retention, with 40.77% of overweight women and 5.33% of normal weight women progressing to postpartum obesity, versus 32.95% of overweight women and 2.61% of normal weight women in the main population. Mental health conditions were not associated with significant weight gain or PPWR. Women with cesarean deliveries gained more weight during pregnancy, had more PPWR, and lost more weight from third trimester to 6 months postpartum. CONCLUSIONS: Most women remain in their baseline BMI category postpartum, suggesting that prepregnancy weight management is an opportunity to reduce excess PPWR. Other opportunities lie in readiness-focused weight management during prenatal visits and postpartum, especially for patients with preeclampsia and cesarean sections. However, concerns about weight management for readiness must be carefully balanced against the health of the individual service members.

Computer-based intervention for residents of domestic violence shelters with substance use: A randomized pilot study.

BACKGROUND: Intimate Partner Violence (IPV) is a significant public health problem often associated with serious mental health and physical health implications. Substance use disorders (SUDs) are one of the most common comorbidities among women with IPV, increasing risk of subsequent IPV. METHODS: The current study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention to reduce alcohol and drug use among women with IPV. Fifty women with recent IPV and alcohol and drug use risk were recruited from domestic violence shelters and randomized to the experimental computerized intervention or to an attention and time control condition. The primary outcome was percent heavy drinking or drug using days in 3 month increments over the 6 months after leaving the shelter. Receipt of substance use services and IPV severity were evaluated as secondary outcomes. RESULTS: The computerized intervention was feasible and acceptable, with high (n = 20, 80%) completion rates, engagement with the intervention, and satisfaction scores. As expected in this pilot trial, there were no significant differences between conditions in percent heavy drinking/drug using days or receipt of substance use services and large individual differences in outcomes. For example, receipt of substance use services decreased by a mean of 0.05 times/day from the baseline to the 6-month time period in the control condition (range -1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range -0.13 to +0.89). There were large decreases in IPV severity over time in both conditions, but directions of differences favored the control condition for IPV severity. CONCLUSION: A computerized intervention to reduce the risk of alcohol/drug use and subsequent IPV is feasible and acceptable among residents of a domestic violence shelter. A fully powered trial is needed to conclusively evaluate outcomes.

The Role of Race, Social Support, Empowerment, and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder.

Black women experience more frequent and severe intimate partner violence (IPV), but there are mixed findings on their posttraumatic stress disorder (PTSD) symptom severity. This may be explained by cultural-salient factors which are associated with fewer posttraumatic cognitions. We hypothesized an indirect effect of race on PTSD symptoms via social support, empowerment, and posttraumatic cognitions, serially. Path analysis revealed Black women reported increased social support, which was associated with higher levels of empowerment, which was associated with lower levels of posttraumatic cognitions. Decreased posttraumatic cognitions were associated with less severe PTSD symptoms. Results increase understanding of culturally-salient factors that may impact PTSD symptoms in Black women.

Associations among Intimate Partner Violence, Posttraumatic Stress Disorder Symptoms, and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter.

Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.

Increased stability of glycol-terminated self-assembled monolayers for long-term patterned cell culture.

Self-assembled monolayers (SAMs) are widely used to confine proteins and cells to a pattern to study cellular processes and behavior. To fully explore some of these phenomena, it is necessary to control cell growth and confinement for several weeks. Here, we present a simple method by which protein and cellular confinement to a pattern can be maintained for more than 35 days. This represents a significant increase in pattern stability compared to previous monolayer systems and is achieved using an amide-linked glycol monomer on 50 Å titanium/100 Å gold-coated glass coverslips. In addition, this study provides insight into the method of SAM degradation and excludes interfacial mixing of the monomers and blooming of the adlayer as major mechanisms for SAM degradation.

Remission of PTSD after victims of intimate partner violence leave a shelter.

Intimate partner violence (IPV) is a significant public health problem associated with high rates of posttraumatic stress disorder (PTSD). Few longitudinal studies have investigated IPV-related PTSD and we know of only 1 longitudinal study to date that has explored IPV-related PTSD in residents of battered women's shelters. The current report describes a prospective study of IPV-related PTSD in an initial sample of 147 residents of battered women's shelters. Baseline correlates of remission of IPV-related PTSD (i.e., PTSD and IPV severity, loss of personal and social resources, cessation of abuse, reunion with abuser, and length of shelter stay) over a 6-month follow-up period were investigated. Although findings are consistent with prior research suggesting a natural recovery of PTSD in IPV-victims, they also show that a significant number (46.8%) of women exhibit chronic PTSD. Participants whose PTSD remitted over follow-up had at baseline less severe IPV-related PTSD (partial η(2) = .104) and fewer loss of personal and social resources (partial η(2) = .095), and were less likely to reunite with their abuser after leaving the shelter than participants with chronic PTSD (3.3% and 22.4%, respectively). Clinical implications and limitations of findings are discussed.

Encouraging legal help seeking for victims of intimate partner violence: the therapeutic effects of the civil protection order.

Civil protective orders (CPOs) are the most widely used justice system remedy for intimate partner violence (IPV), and were implemented to ensure safety and increase victim participation in the justice system. Limited data exists regarding the effectiveness of CPOs; however, theories of therapeutic jurisprudence argue that legal interventions in and of themselves can improve mental health outcomes. To test this hypothesis, we examined the effectiveness of having a CPO issued against one's abuser at improving the psychological sequelae of exposure to trauma. We used a longitudinal sample of female residents of battered women's shelters who had experienced IPV (N = 106; 55% African American). One-way analyses of variance using gain scores indicated that PTSD symptoms (effect size η(p)(2) = .16) and incidents of sexual revictimization (effect size η(p)(2) = .09) decreased from baseline to 6-months postshelter for women who had a CPO against their most recent abuser compared to women without a CPO. These results support theories of therapeutic jurisprudence, suggesting that having a CPO can improve mental health outcomes. Limitations and clinical implications of our findings are discussed, including arguing for a coordinated service system that incorporates both legal and psychological assistance to improve the mental health of victims of IPV.

Understanding the relationship between interpersonal trauma and disordered eating: An extension of the model of psychological adaptation.

OBJECTIVE: Interpersonal trauma is a nonspecific risk factor for disordered eating (DE). Studies have begun to examine mechanisms that explain the relationship; however, few have tested comprehensive theoretical models. The Model of Psychological Adaptation (McCann, Sakheim, & Abrahamson, 1988) posits that trauma exposure results in core schema disruptions that are associated with varying psychological response patterns, or psychological adaptations, that are also established predictors of DE, such as interpersonal and affective problems. The model has been successfully applied to symptoms of other psychological disorders, such as PTSD and depression, but has not previously been extended to predict DE. The current study addressed this gap in the literature by assessing an extension of the Model of Psychological Adaptation to DE. METHOD: A sample of 371 undergraduate women completed an online survey. RESULTS: Using structural equation modeling, the results of the current study demonstrated positive fit for a model that represents the extension of the Model of Psychological Adaptation to DE. CONCLUSION: These findings corroborate the link between interpersonal trauma and DE, thus demonstrating the potential importance of assessing for DE symptoms among clients who have survived interpersonal trauma and attending to trauma history among clients who have DE. In addition, it highlights mechanisms that may be relevant to the conceptualization and treatment of DE among survivors of interpersonal trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predicting emotional abuse among a sample of college students.

Objective This study aims to examine factors related to emotional abuse, an understudied type of intimate partner violence (IPV), among a sample of college students. Participants: 601 undergraduates from one large public university in the Midwestern United States (Spring 2017) and 756 undergraduates from one large public university in the Southern United States (Fall 2019) participated in the study. Methods: Participants completed an online survey measuring demographic information, behavioral variables (viewing porn, alcohol consumption, and hooking up), and history of violence (witnessing a father abuse his spouse, emotional abuse history). Descriptive statistics and binary logistic regression analyses predicting emotional abuse victimization were conducted. Results: Results indicate female, white, older students were more likely to report emotional abuse. Also, students witnessing their father abuse his spouse, frequent pornography use, increased alcohol use, and frequent hookups increased odds of emotional abuse. Conclusion: College campuses should consider emphasizing emotional abuse in IPV programing.