Platelet Releasate and Extracorporeal Shock Wave Therapy (ESWT) for Treatment of a Partial Supraspinatus Tear in an Adolescent Baseball Player.

Supraspinatus tears are a common injury, particularly among athletes who engage in sports that include repetitive overhead motions, such as baseball players. Standard conservative therapies include rest and activity modification, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), cold/heat therapy, and corticosteroid injections. Ongoing research and anecdotal evidence support using platelet-rich plasma (PRP) for supraspinatus/rotator cuff tears. Platelet releasate is obtained from PRP via the activation of platelets, subsequently releasing bioactive substances. Activation can be achieved through various methods, some of which include the addition of calcium chloride, thrombin, or exposure to low-level lasers. Platelet releasate has the potential to assist in the healing of tears by releasing growth factors that facilitate muscle and tendon repair. This case presentation discusses the outcomes of platelet releasate paired with extracorporeal shock wave therapy (ESWT) for the treatment of a partial-thickness supraspinatus tear in an 18-year-old male baseball athlete. After exploring conservative treatment options, the patient opted for a single platelet releasate injection along with a four-part series with ESWT. Four weeks post-procedure, the patient reported a 25% improvement. He was able to fully return to play for the entire baseball season. Although the effectiveness of platelet releasate is still a topic of debate and further investigation, this case demonstrates how platelet releasate shows promising results in accelerating the treatment recovery for a partial supraspinatus tear. Further investigation and research could support the benefit of this procedure for accelerated recovery of injuries compared to PRP.

Racial and ethnic disparities in receipt of specialty treatment across risk profiles of adults with heavy alcohol use.

BACKGROUND: Variation in specialty treatment utilization for alcohol use disorder (AUD) by patient subgroups is poorly understood. This study examined whether and how patient risk profiles predict receipt of specialty treatment and whether there are disparities by race and ethnicity. METHODS: This cohort study included 206,956 adults with heavy alcohol use (that which exceeded National Institute on Alcohol Abuse and Alcoholism guidelines) between June 1, 2013 and December 31, 2014, using electronic health record data from Kaiser Permanente Northern California. Five risk profiles (characterized by daily or weekly heavy drinking and level of health risks) were identified in latent class analysis. Logistic regression models were fit to examine associations between risk profiles, race, ethnicity, and receipt of specialty treatment (including addiction medicine, psychiatry, or integrated behavioral health visits, and AUD pharmacotherapy), adjusting for other patient characteristics. Variation in the association between risk profiles and receipt of specialty treatment by race/ethnicity was also examined. RESULTS: Overall, 4.0% of patients received specialty treatment. Latino/Hispanic and Asian/Pacific Islander patients had lower odds of receiving specialty treatment than White patients (adjusted odds ratio [aOR] [95% CI] = 0.80 [0.75, 0.85], and 0.64 [0.59, 0.70], respectively). The substance use disorder and mental health disorder (SUD/MH) risk profile had the highest odds of receiving specialty treatment (10.46 [9.65, 11.34]). Associations between risk profiles and receipt of specialty treatment significantly differed by race/ethnicity. Black patients in the SUD/MH risk profile, and Hispanic/Latino patients in the risk profile with heavy daily drinking and more health risks, had lower odds of receiving specialty treatment than their White counterparts (adjusted ratio of odds ratios [aROR] [95% CI] = 0.69 [0.50, 0.94], and 0.79 [0.67, 0.92], respectively). CONCLUSIONS: This study provides new insights into racial/ethnic disparities in specialty treatment utilization for alcohol problems. Findings may help inform strategies for tailoring interventions to address heavy alcohol use.

Nissl Granules, Axonal Regeneration, and Regenerative Therapeutics: A Comprehensive Review.

Nissl granules, traditionally recognized for their pivotal role in protein synthesis within neuronal cell bodies, are emerging as intriguing components with far-reaching implications in the realm of regenerative therapeutics. This abstract encapsulates the essence of a comprehensive review, exploring the nexus between Nissl granules, axonal regeneration, and their transformative applications in regenerative medicine. The molecular intricacies of Nissl granules form the foundation of this exploration, unraveling their dynamic role in orchestrating cellular responses, particularly in the context of axonal regeneration. As we delve into the interplay between Nissl granules and regenerative processes, this review highlights the diverse mechanisms through which these granules contribute to neuronal repair and recovery. Beyond their conventional association with neurobiology, recent advancements underscore the translational potential of Nissl granules as therapeutic agents. Insights into their involvement in enhancing axonal regeneration prompt a reconsideration of these granules as key players in the broader field of regenerative medicine. The abstract encapsulates evidence suggesting that modulating Nissl granule-related pathways holds promise for augmenting tissue regeneration, extending their applicability beyond the confines of the nervous system. This review aims to serve as a valuable resource for medical professionals, researchers, and clinicians seeking to comprehend the multifaceted role of Nissl granules in regenerative therapeutics. By illuminating the intricate connections between Nissl granules, axonal regeneration, and therapeutic applications, this work aspires to catalyze further research and innovation, ultimately contributing to the evolution of regenerative strategies that harness the innate reparative capacities within cellular constituents.

Nevada's Healthcare Crisis: A Severe Shortage of Physicians and Residency Positions.

The state of Nevada is home to millions of people and a prominent entertainment industry. However, the state ranks among the lowest in terms of available primary care doctors and general surgeons per capita, resulting in limited access to essential healthcare services and an increased reliance on emergency departments and hospitals. Nevada also faces the challenges posed by an aging physician workforce and a significant proportion of inactive providers. The scarcity of residency positions in Nevada's medical schools drives many graduates to seek residency training opportunities elsewhere, leading to a reduced likelihood of their return to practice within the state. We propose potential solutions, including increased funding for residency positions, prioritizing the retention of medical school graduates through local residency training, and the establishment of interdisciplinary comprehensive academic health centers. These measures are essential to meet the escalating healthcare demands of Nevada's rapidly growing population and to ultimately enhance patient outcomes.

Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale.

INTRODUCTION: The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment. METHODS: In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model. RESULTS: The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers. CONCLUSION: Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.

Noise levels encountered in university dental clinics during different specialty treatments.

BACKGROUND: Noise levels encountered during the dental treatments in different departments have deleterious effects on the ears of dental healthcare providers and there is scarcity of data in the literature in Saudi Arabia. Hence, the aim of the study was to determine the noise levels resulting from the usage of different specialty instruments and equipment. MATERIAL AND METHODS: A cross-sectional study was conducted to measure the level of noise produced by different specialty instruments and equipment within the dental clinics of the College of Dentistry, Riyadh Elm University (REU), Riyadh. The noise produced during the restorative treatments, endodontics and prosthodontics was recorded objectively using a decibel (dB) meter placed at a distance of 30 cm from the operator's ear. Mean noise levels were calculated and compared among the various specialty treatments using Analysis of Variance (ANOVA). Furthermore, Tukey's test was applied to perform a pairwise comparison between the groups. RESULTS: An overall noise of 73.83 ± 4.39 dB was found to be generated within the dental clinical setting. A highest sound level of 79.44 ± 2.10 dB was observed during restorative treatment followed by 74.14 ± 3.08, 73.22 ± 1.93, 71.39 ± 3.37 and 70.97 ± 4.70 dB for endodontic, periodontal, and prosthodontic treatments, respectively. A statistically significant difference was observed in the noise levels produced from the different specialty treatments (P = 0.000). CONCLUSION: The greatest noise level was recorded with the use of the amalgamator in restorative dental treatment. It was inferred that the noise emanating from all the specialty dental treatments was below the hazardous levels. Long-term exposure may, however, have adverse effects on auditory as well as general health.

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA.

Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.

A current re-examination of racial/ethnic disparities in the use of substance abuse treatment: Do disparities persist?

OBJECTIVE: Racial/ethnic disparities in the use of substance abuse treatment services have been documented. The objective of this study was to re-examine if racial/ethnic disparities in the use of treatment still exist using current data collected post-implementation of the Affordable Care Act. METHODS: Data were pooled from the National Survey on Drug Use and Health survey years 2015, 2016, and 2017. Analyses were limited to adult White, Black, and Latino participants who met DSM-IV criteria for a past-year substance use disorder (n = 12,070). Hierarchical multivariate logistic regression models examined the role of race/ethnicity on past-year use of (1) any substance abuse treatment services and (2) specialty treatment. Important covariates included socio-demographics, problem severity, and perceived treatment need. A sub-analysis was also conducted that was limited to participants who reported having health insurance to explore the role of insurance status on treatment utilization by race/ethnicity. RESULTS: Findings showed that Latinos and Blacks significantly underutilized specialty treatment relative to Whites. These relationships were statistically significant after controlling for socio-demographic characteristics, problem severity, and perceived treatment need. However, when analyses were limited to only those with health insurance, Black-White disparities became non-significant, while Latino-White disparities persisted. CONCLUSIONS: Findings highlight that Black-White and Latino-White disparities in the use of substance abuse treatment still persist. However, Black-White disparities may be limited to only those who are uninsured. Public health implications are discussed.

Understanding barriers to specialty substance abuse treatment among Latinos.

BACKGROUND: National studies have documented that Latinos are less likely to use specialty substance abuse treatment (e.g., rehabilitation programs, in/out-patient services) than other racial/ethnic groups. Disparities in treatment utilization are particularly pronounced between Latinos and Whites. Few national studies have explicitly examined barriers to treatment by race/ethnicity, and current results are inconclusive. The purpose of this study was to gain a better understanding of barriers to specialty substance abuse treatment among Latinos. METHODS: In 2017-2018, in-depth qualitative interviews were conducted with 54 White, Black, and Latino participants who met eligibility criteria for a recent substance use disorder. Participants were recruited via online ads and screened for eligibility through an online survey. Interview questions were grounded in the Theory of Planned Behavior (TBP): Participants were asked about treatment-related barriers in the domains of attitudes, subjective norms, and perceived control. Interviews were transcribed verbatim and coded by two independent coders. Barriers were compared across all interviews and by race/ethnicity. RESULTS: Latinos were significantly more likely to report attitudinal and subjective norm barriers than their White and Black counterparts. Within the attitudes domain, results suggested that Latinos largely avoided specialty treatment due to barriers stemming from cultural factors, perceived treatment efficacy, recovery goals, and perceived treatment need. In the area of subjective norms, stigma and perceived lack of social support from family were more pervasive among Latinos' narratives. Lastly, in terms of perceived control, a minority of Latinos reported logistical barriers to treatment. CONCLUSION: Specialty substance abuse treatment services have been found to be effective regardless of race/ethnicity. Understanding why Latinos use specialty treatment at low rates is key to reducing existing racial/ethnic disparities related to substance abuse. This study identified several malleable barriers that interventions can target to increase Latinos' utilization of treatment. These barriers may also be key to explaining Latino-White disparities in treatment utilization.

Specialty addiction and psychiatry treatment initiation and engagement: Results from an SBIRT randomized trial in pediatrics.

OBJECTIVE: Many adolescents needing specialty addiction or psychiatry treatment never access care. We examined initiation and engagement with addiction and/or psychiatry treatment among adolescents referred to treatment from a trial comparing two different modalities of delivering Screening, Brief Intervention and Referral to Treatment (SBIRT) to Usual Care in pediatric primary care. We hypothesized that both intervention arms would have higher initiation and engagement rates than usual care. METHODS: We randomized all pediatricians (n=52) in a pediatric primary care clinic to three arms: 1) pediatrician-only arm, in which pediatricians were trained to deliver SBIRT for substance use and/or mental health problems; 2) embedded-behavioral health clinician (embedded-BHC arm), in which pediatricians referred adolescents who endorsed substance use and/or mental health problems to a BHC; and 3) Usual Care (UC). We used electronic health record (EHR) data to examine specialty addiction and psychiatry treatment initiation and engagement rates after referral. RESULTS: Among patients who screened positive for substance use and/or mental health problems and were referred to specialty addiction and/or psychiatry (n=333), those in the embedded-BHC arm had almost four times higher odds of initiating treatment than those in the pediatrician-only arm, OR=3.99, 95% CI=[1.99-8.00]. Compared to UC, those in the pediatrician-only arm had lower odds of treatment initiation (OR=0.53, 95% CI=[0.28-0.99]), while patients in the embedded-BHC arm had marginally higher odds (OR=1.83, 95% CI=[0.99-3.38]). Black patients and those with other/unknown race/ethnicity had lower odds of treatment initiation compared with white adolescents; there were no gender or age differences. We found no differences in treatment engagement across the three arms. CONCLUSIONS: Embedded BHCs can have a significant positive impact on facilitating treatment initiation for pediatric primary care adolescents referred to addiction and/or psychiatry services. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov #NCT02408952.

Service delivery and pharmacotherapy for alcohol use disorder in the era of health reform: Data from a national sample of treatment organizations.

BACKGROUND: Although there is a growing literature examining organizational characteristics and medication adoption, little is known about service delivery differences between specialty treatment organizations that have and have not adopted pharmacotherapy for alcohol use disorder (AUD). This study compares adopters and nonadopters across a range of treatment services, including levels of care, availability of tailored services for specific populations, treatment philosophy and counseling orientations, and adoption of comprehensive wraparound services. METHODS: In-person interviews were conducted with program leaders from a national sample of 372 organizations that deliver AUD treatment services in the United States. RESULTS: About 23.6% of organizations had adopted at least 1 AUD medication. Organizations offering pharmacotherapy were similar to nonadopters across many measures of levels of care, tailored services, treatment philosophy, and social services. The primary area of difference between the 2 groups was for services related to health problems other than AUD. Pharmacotherapy adopters were more likely to offer primary medical care, medications for smoking cessation, and services to address co-occurring psychiatric conditions. CONCLUSIONS: Service delivery differences were modest between adopters and nonadopters of AUD pharmacotherapy, with the exception of health-related services. However, the greater adoption of health-related services by organizations offering AUD pharmacotherapy represents greater medicalization of treatment, which may mean these programs are more strongly positioned to respond to opportunities for integration under health reform.