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1.
J Synchrotron Radiat ; 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39073992

RESUMO

A broadband online X-ray spectrometer has been designed and commissioned at the SUD beamline of the Shanghai Soft X-ray Free-Electron Laser Facility, which can deliver both SASE and seeded FEL pulses to user experiments, spanning the photon energy range of 50-620 eV. The resolving powers of the spectrometer calibrated via online measurement at 92 eV and 249 eV are ∼20000 and ∼15000, respectively, and the absolute photon energy is characterized by an electron time-of-flight spectrometer. The high energy resolution provided by the spectrometer can differentiate the fine structure in the FEL spectrum, to determine its pulse length.

2.
J Gen Intern Med ; 39(11): 2087-2096, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38698295

RESUMO

BACKGROUND: Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality. In particular, few studies have explored their positive care perceptions or recommendations for improvement. OBJECTIVE: To explore perspectives on positive aspects, negative aspects, and consequences of care, as well as recommendations for improvement among hospitalized patients with SUDs. DESIGN AND PARTICIPANTS: We conducted semi-structured, in-depth bedside interviews (n = 15) with patients who have been diagnosed with a SUD and were admitted to medical or surgical floors of an urban academic medical center. APPROACH: Interviews explored patients' hospital experiences and recommendations for improvement. The interviews were audio-recorded, transcribed verbatim, and imported into NVivo software. Two reviewers independently coded the transcripts using interpretative phenomenological analysis and inductive thematic analysis according to grounded theory, and recurring themes were identified from the data. Patients' demographic and clinical data were analyzed with descriptive statistics. KEY RESULTS: Perceived clinical and emotional proficiency were the most important components of positive experiences, whereas perceived bias and stigmatized attitudes, clinical improficiency, and inhumane treatment were characteristic of negative experiences. Such care components were most consequential for patients' emotional well-being, trust, and care quality. Recommendations for improving care included specific suggestions for initiating and promoting continued recovery, educating, and partnering in compassionate care. CONCLUSIONS: Hospitalized patients with SUDs often experience lower quality and less compassionate care linked to pervasive stigma and poor outcomes. Our study highlights under-recognized perspectives from this patient population, including socioemotional consequences of care and recommendations grounded in lived experiences. By striving to advance our care in accordance with patients' viewpoints, we can turn hospitalizations into opportunities for engagement and promoting recovery.


Assuntos
Hospitalização , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Pessoa de Meia-Idade , Adulto , Estigma Social , Idoso , Pacientes Internados/psicologia
3.
Addict Biol ; 29(5): e13400, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38706091

RESUMO

Substance use disorders are characterized by inhibition deficits related to disrupted connectivity in white matter pathways, leading via interaction to difficulties in resisting substance use. By combining neuroimaging with smartphone-based ecological momentary assessment (EMA), we questioned how biomarkers moderate inhibition deficits to predict use. Thus, we aimed to assess white matter integrity interaction with everyday inhibition deficits and related resting-state network connectivity to identify multi-dimensional predictors of substance use. Thirty-eight patients treated for alcohol, cannabis or tobacco use disorder completed 1 week of EMA to report substance use five times and complete Stroop inhibition testing twice daily. Before EMA tracking, participants underwent resting state functional MRI and diffusion tensor imaging (DTI) scanning. Regression analyses were conducted between mean Stroop performances and whole-brain fractional anisotropy (FA) in white matter. Moderation testing was conducted between mean FA within significant clusters as moderator and the link between momentary Stroop performance and use as outcome. Predictions between FA and resting-state connectivity strength in known inhibition-related networks were assessed using mixed modelling. Higher FA values in the anterior corpus callosum and bilateral anterior corona radiata predicted higher mean Stroop performance during the EMA week and stronger functional connectivity in occipital-frontal-cerebellar regions. Integrity in these regions moderated the link between inhibitory control and substance use, whereby stronger inhibition was predictive of the lowest probability of use for the highest FA values. In conclusion, compromised white matter structural integrity in anterior brain systems appears to underlie impairment in inhibitory control functional networks and compromised ability to refrain from substance use.


Assuntos
Imagem de Tensor de Difusão , Inibição Psicológica , Imageamento por Ressonância Magnética , Substância Branca , Humanos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Masculino , Feminino , Adulto , Avaliação Momentânea Ecológica , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico por imagem , Teste de Stroop , Alcoolismo/fisiopatologia , Alcoolismo/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Pessoa de Meia-Idade , Tabagismo/fisiopatologia , Tabagismo/diagnóstico por imagem , Abuso de Maconha/fisiopatologia , Abuso de Maconha/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Smartphone , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Anisotropia , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-38411725

RESUMO

PURPOSE: In China, individuals with substance use disorders (SUD) face severe stigma, but reliable stigma assessment tool is lacking. Therefore, this study aimed to validate the Chinese version of the Substance Use Stigma Mechanism Scale (SU-SMS-C) and set its cut-off point. METHODS: We recruited 1005 individuals with SUDs from Chinese rehabilitation centers. These participants completed a battery of questionnaires that included the SU-SMS-C, The Multidimensional Scale of Perceived Social Support (MSPSS), Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and Perceived Devaluation and Discrimination (PDD). Confirmatory factor analysis was used to assess the construct validity of the scale. Additionally, the Naive Bayes classifier was used to establish the cut-off point for the SU-SMS-C. We additionally explored the correlation between patient demographic characteristics and stigma. RESULTS: A confirmatory factor analysis was utilized, revealing a second-order five-factor model. Based on the Naive Bayes classifier, the area under the receiver operating characteristic (AUCROC) of 0.746, the cut-off point for the SU-SMS-C was established at 44.5. The prevalence of stigma observed in the study population was 49.05%. Significant disparities were observed in the distribution of stigma across genders, with males experiencing more pronounced stigma than females. Moreover, patients consuming different primary substances reported diverse levels of stigma. Notably, those primarily using heroin endured a higher degree of stigma than users of other substances. CONCLUSION: The study is the first to identify a cut-off point for the SU-SMS-C by Naive Bayes classifier, bridging a major gap in stigma measurement research. SU-SMS-C may help treat and manage SUDs by reducing stigma.

5.
Subst Use Misuse ; : 1-10, 2024 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-39086209

RESUMO

Objectives: Clinical heterogeneity among patients in addiction treatment settings represents a challenge as most of the treatment programs are designed to treat substance use disorders (SUD) generally rather than offering more tailored approaches addressing individual patient needs. Systematic characterization of clinical heterogeneity may permit more individualized care paths toward improving outcomes. Methods: Data were collected from a large inpatient SUD treatment program between April 2018 and March 2020 (n = 1519). Latent profile analysis (LPA) was applied to identify latent clusters based on differences in substance use and co-occurring depression, anxiety, and post-traumatic stress disorder. Results: Five distinct profiles emerged: Profile 1 (38%) exhibited the lowest substance use and lowest psychiatric severity (Overall Low); Profile 2 (39%) exhibited high alcohol and psychiatric severity; Profile 3 (13%) exhibited high opioid severity and low psychiatric severity. Profile 4 (8%) exhibited high cannabis use and high psychiatric severity, and profile 5 (3%) exhibited high polysubstance use other than alcohol and cannabis use. The latter two profiles were younger and exhibited higher self-regulatory deficits. The (High Alc/high psych) and the (High Cann/Psych) profiles exhibited differentially higher psychiatric severity. Profiles showing high polysubstance use, as well as high cannabis use and high psychiatric severity, showed significantly higher impulsive behavior than the others. Conclusions: LPA revealed five clusters of patients varying substantially in terms of SUD and psychiatric severity. Addressing common features of clinical heterogeneity for tailored care paths in a personalized treatment approach may improve treatment outcomes.

6.
J Dual Diagn ; 20(3): 201-209, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38728603

RESUMO

OBJECTIVE: To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. METHODS: Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). RESULTS: 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). CONCLUSIONS: Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694482.


Assuntos
COVID-19 , Comorbidade , Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , COVID-19/epidemiologia , COVID-19/psicologia , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Diagnóstico Duplo (Psiquiatria) , Adulto , Pessoa de Meia-Idade , Itália/epidemiologia , Transtornos Mentais/epidemiologia , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/diagnóstico , Fatores Sexuais
7.
BMC Cardiovasc Disord ; 23(1): 468, 2023 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-37726694

RESUMO

BACKGROUND: ST-elevation myocardial infarction (STEMI) is a major public health problem. This study aimed to determine the prevalence and identify the determinants of STEMI-related complications in the Cardiology Intensive Care Unit of the Sud Francilien Hospital Center (SFHC). METHODS: We retrospectively analyzed the data of 315 patients with STEMI aged ≥ 18 years. Logistic regression was used to identify factors independently associated with the occurrence of complications. RESULTS: Overall, 315 patients aged 61.7 ± 13.4 years, of whom 261 were men, had STEMI during the study period. The hospital frequency of STEMI was 12.7%. Arrhythmias and acute heart failure were the main complications. Age ≥ 75 years (adjusted odds ratio [aOR], 5.18; 95% confidence interval [CI], 3.92-8.75), hypertension (aOR, 3.38; 95% CI, 1.68-5.82), and cigarette smoking (aOR, 3.52; 95% CI, 1.69-7.33) were independent determinants of acute heart failure. Meanwhile, diabetes mellitus (aOR, 1.74; 95% CI, 1.09-3.37), history of atrial fibrillation (aOR, 2.79; 95% CI, 1.66-4.76), history of stroke or transient ischemic attack (aOR, 1.99; 95% CI, 1.31-2.89), and low high-density lipoprotein-cholesterol (HDL-C) levels (aOR, 3.70; 95% CI, 1.08-6.64) were independent determinants of arrhythmias. CONCLUSION: STEMI is a frequent condition at SFHC and is often complicated by acute heart failure and arrhythmias. Patients aged ≥ 75 years, those with hypertension or diabetes mellitus, smokers, those with a history of atrial fibrillation or stroke, and those with low HDL-C levels require careful monitoring for the early diagnosis and management of these complications.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Hipertensão , Infarto do Miocárdio com Supradesnível do Segmento ST , Masculino , Humanos , Feminino , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-37682331

RESUMO

Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation method that, through its manipulation of endogenous oscillations, can affect cognition in healthy adults. Given the fact that both endogenous oscillations and cognition are impaired in various psychiatric diagnoses, tACS might represent a suitable intervention. We conducted a search of Pubmed and Web of Science databases and reviewed 27 studies where tACS is used in psychiatric diagnoses and cognition change is evaluated. TACS is a safe and well-tolerated intervention method, suitable for multiple-sessions protocols. It can be administered at home, individualized according to the patient''s anatomical and functional characteristics, or used as a marker of disease progression. The results are varying across diagnoses and applied protocols, with some protocols showing a long-term effect. However, the overall number of studies is small with a great variety of diagnoses and tACS parameters, such as electrode montage or used frequency. Precise mechanisms of tACS interaction with pathophysiological processes are only partially described and need further research. Currently, tACS seems to be a feasible method to alleviate cognitive impairment in psychiatric patients; however, a more robust confirmation of efficacy of potential protocols is needed to introduce it into clinical practise.

9.
BMC Psychiatry ; 23(1): 407, 2023 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-37286936

RESUMO

BACKGROUND: Substance use disorders (SUDs) affect ~ 35 million people globally and are associated with strong cravings, stress, and brain alterations. Mindfulness-based interventions (MBIs) can mitigate the adverse psychosocial outcomes of SUDs, but the underlying neurobiology is unclear. Emerging findings were systematically synthesised from fMRI studies about MBI-associated changes in brain function in SUDs and their associations with mindfulness, drug quantity, and craving. METHODS: PsycINFO, Medline, CINAHL, PubMed, Scopus, and Web of Science were searched. Seven studies met inclusion criteria. RESULTS: Group by time effects indicated that MBIs in SUDs (6 tobacco and 1 opioid) were associated with changes in the function of brain pathways implicated in mindfulness and addiction (e.g., anterior cingulate cortex and striatum), which correlated with greater mindfulness, lower craving and drug quantity. CONCLUSIONS: The evidence for fMRI-related changes with MBI in SUD is currently limited. More fMRI studies are required to identify how MBIs mitigate and facilitate recovery from aberrant brain functioning in SUDs.


Assuntos
Comportamento Aditivo , Atenção Plena , Transtornos Relacionados ao Uso de Substâncias , Humanos , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Transtornos Relacionados ao Uso de Substâncias/diagnóstico por imagem , Transtornos Relacionados ao Uso de Substâncias/terapia
10.
Soc Psychiatry Psychiatr Epidemiol ; 58(10): 1509-1522, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37133523

RESUMO

PURPOSE: The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD. METHODS: We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms. RESULTS: Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD. CONCLUSIONS: Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Transtornos de Estresse Pós-Traumáticos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Feminino , Masculino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Alcoolismo/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia
11.
Matern Child Health J ; 27(Suppl 1): 94-103, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37256517

RESUMO

OBJECTIVE: Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE). METHOD: We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record. RESULTS: In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3. DISCUSSION: PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population.


Children with PSE face environmental risks in the early developmental period. Often in the United States, CPS is relied on to assess and mitigate these risks. Amid calls for a public health response to PSE, it is essential to understand how children with PSE interact with CPS. We describe the incidence and timing of custody interruptions in a large U.S. state, comparing infants with PSE to those investigated by CPS for other reasons. This study extends current understanding by demonstrating the independent risk of custody interruption conferred by PSE status.


Assuntos
Maus-Tratos Infantis , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Lactente , Gravidez , Declaração de Nascimento , California/epidemiologia , Serviços de Proteção Infantil , Pais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
12.
J Adolesc ; 95(2): 372-381, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36345114

RESUMO

BACKGROUND: A substantial volume of the literature suggests that religious factors buffer against alcohol/substance use among adults, but research among adolescents is sparse. Further, few studies in this area have been prospective, and therefore it is unclear how religion may impact less alcohol/substance use among adolescents. METHOD: We prospectively evaluated effects of religious affiliation on initiation of alcohol/substance use in a sample of 81 psychiatrically healthy 13-14-year-olds from New England, over a 3-year period (from November 2015 to January 2019). Known risk factors were also evaluated including anxiety, depression, and impulsivity; family history of mental illness and alcohol/substance misuse; and volume of brain regions implicated in adolescent alcohol/substance misuse (assessed by Magnetic Resonance Imaging). RESULTS: Religiously affiliated adolescents were significantly less likely to initiate use of alcohol/substances (hazard ratio [HR] = 0.38). The addition of family history of alcohol/substance misuse to the model increased the predictive value of religious affiliation (HR = 0.34). Other risk factors did not diminish nor increase observed effects. CONCLUSIONS: These findings support and extend the current research by suggesting that religious affiliation protects against initiation of alcohol/substance use during early adolescence, particularly in individuals with elevated risk.


Assuntos
Consumo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Adolescente , Estudos Prospectivos , Religião , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/etiologia
13.
J Dual Diagn ; 19(4): 189-198, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37796916

RESUMO

OBJECTIVE: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) commonly co-occur and represent a complex, challenging clinical comorbidity. Meta-analytic studies and systematic reviews suggest that trauma-focused treatments are more efficacious than non-trauma focused interventions for co-occurring PTSD/SUD. However, relatively little is known about mental health clinicians' practices or preferences for treating co-occurring PTSD/SUD. The present study aimed to describe the current clinical practices of mental health clinicians who treat PTSD and/or SUD-related conditions and to assess interest in novel integrative treatments for PTSD/SUD. METHODS: Licensed mental health clinicians (N = 76; Mage = 39.59, SD = 8.14) who treat PTSD and/or SUD completed an anonymous online survey from April 2021 to July 2021. RESULTS: The majority (61.8%) of clinicians reported using integrative treatments for PTSD/SUD. The most commonly used trauma-focused treatments were 1) Cognitive Processing Therapy (CPT: 71.1%) and 2) Prolonged Exposure Therapy (PE: 68.4%) for PTSD. Approximately half (51.3%) of clinicians endorsed using Relapse Prevention (RP) for SUD. The vast majority (97.4%) of clinicians were somewhat or very interested in a new integrative CPT-RP intervention, and 94.7% of clinicians believed patients would be interested in a CPT-RP intervention. In the absence of an available evidence-based integrative treatment using CPT, 84.0% of clinicians reported modifying extant treatment protocols on their own to address PTSD and SUD concurrently. CONCLUSIONS: The findings demonstrate mental health clinician support of integrative treatments for PTSD/SUD. The most commonly used trauma-focused intervention was CPT and clinicians expressed strong interest in an integrative intervention that combines CPT and RP. Implications for future treatment development are discussed.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos , Transtornos Relacionados ao Uso de Substâncias , Humanos , Adulto , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Saúde Mental , Terapia Cognitivo-Comportamental/métodos , Comorbidade , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
14.
Community Ment Health J ; 59(1): 77-84, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35751789

RESUMO

Improving interactions between first responders and individuals experiencing behavioral crisis is a critical public health challenge. To gain insight into these interactions, key informant qualitative interviews were conducted with 25 Chicago stakeholders. Stakeholders included directors and staff of community organizations and shelters that frequently engage first responders. Interviews included granular depictions related to the expectations and outcomes of 911 behavioral crisis calls, and noted areas requiring improved response. Stakeholders called 911 an average of 2 to 3 times per month, most often for assistance related to involuntary hospitalization. Engagements with first responders included unnecessary escalation or coercive tactics, or conversely, refusal of service. While stakeholders lauded the value of police trained through the city's Crisis Intervention Team program, they emphasized the need for additional response strategies that reduce the role of armed police, and underscored the need for broader social and behavioral health services for individuals at-risk of such crises.


Assuntos
Intervenção em Crise , Polícia , Humanos , Chicago , Comportamento Cooperativo
15.
Int J Mol Sci ; 24(9)2023 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-37175645

RESUMO

Antiviral protease inhibitors are peptidomimetic molecules that block the active catalytic center of viral proteases and, thereby, prevent the cleavage of viral polyprotein precursors into maturation. They continue to be a key class of antiviral drugs that can be used either as boosters for other classes of antivirals or as major components of current regimens in therapies for the treatment of infections with human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, sustained/lifelong treatment with the drugs or drugs combined with other substance(s) often leads to severe hepatic side effects such as lipid abnormalities, insulin resistance, and hepatotoxicity. The underlying pathogenic mechanisms are not fully known and are under continuous investigation. This review focuses on the general as well as specific molecular mechanisms of the protease inhibitor-induced hepatotoxicity involving transporter proteins, apolipoprotein B, cytochrome P450 isozymes, insulin-receptor substrate 1, Akt/PKB signaling, lipogenic factors, UDP-glucuronosyltransferase, pregnane X receptor, hepatocyte nuclear factor 4α, reactive oxygen species, inflammatory cytokines, off-target proteases, and small GTPase Rab proteins related to ER-Golgi trafficking, organelle stress, and liver injury. Potential pharmaceutical/therapeutic solutions to antiviral drug-induced hepatic side effects are also discussed.


Assuntos
COVID-19 , Doença Hepática Induzida por Substâncias e Drogas , Infecções por HIV , Inibidores da Protease de HIV , Humanos , SARS-CoV-2 , Inibidores da Protease de HIV/farmacologia , Inibidores de Proteases/farmacologia , Antivirais/efeitos adversos , Antivirais/química , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico
16.
Health Promot Pract ; 24(5): 1018-1028, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37439759

RESUMO

Introduction. National strategies to end the HIV epidemic and eliminate hepatitis c (HCV) through a syndemic approach require improvements in testing for HIV and HCV. Given the intersection of the opioid crisis with HIV and HCV acquisition, substance use disorder (SUD) treatment centers providing medications for opiate use disorder (MOUD) provide a critical opportunity to expand testing. Rates of testing in MOUD clinics have been suboptimal. Method. We employed the Nominal Group Technique (NGT), Ishikawa cause and effect diagrams, and individualized Quality Improvement (QI) efforts at two SUD clinics (SUD A and B) in Connecticut (CT) as part of an HRSA-funded grant focused on improving HCV cure in persons with HIV/HCV coinfection. Baseline and longitudinal data were collected on rates of HIV and HCV testing and positivity as well as linkage to treatment. Results. Between April 1, 2019, and May 31, 2021, for SUD A and B respectively, HIV testing increased from 13% to 90% and 33% to 83%; HCV testing increased from 4% to 90% and 30% to 82%, with few reported cases of HIV/HCV coinfection. HCV testing revealed new and prior diagnoses at both sites, with subsequent referrals for treatment. Qualitative assessments identified best practices which included the institution of formal policies and procedures, streamlining of testing logistics, designation of a site champion, and broadening relevant education to staff and clients. Conclusion. Strategic assessment of barriers and facilitators to HIV and HCV testing at MOUD clinics can lead to improved testing and referral rates that are key to improving the cascade of care for both diseases.


Assuntos
Coinfecção , Infecções por HIV , Hepatite C , Alcaloides Opiáceos , Transtornos Relacionados ao Uso de Substâncias , Humanos , Alcaloides Opiáceos/uso terapêutico , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Hepacivirus , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia
17.
Infant Ment Health J ; 44(1): 54-75, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36538474

RESUMO

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.


La intervención de Afectividad y Alcance del Bio-comportamiento (ABC) está dirigida a mejorar el funcionamiento socioemocional y regulatorio de los infantes bajo riesgo. Sin embargo, para usar el ABC para infantes y niños pequeñitos con discapacidades intelectuales / retrasos en el desarrollo (ID/DD) y dentro de nuevos contextos culturales, tal como en Sudáfrica, se requieren adaptaciones. Este estudio se propuso, por tanto, explorar las opiniones de expertos clínicos y las percepciones de quienes prestan el cuidado acerca del uso del ABC con niños con ID/DD en Sudáfrica. También buscaba incorporar las experiencias de familias de niños con ID/DD que recibían, así como de practicantes de la intervención que ofrecían el servicio de ABC durante su primera implementación en Sudáfrica. Se llevaron a cabo entrevistas semiestructuradas con 18 participantes. Análisis temáticos explicaron los 12 principales temas: Puntos Fuertes de la Intervención, Puntos que Preocupan y Recomendaciones (Expertos); Enfoque en la Relación Cuidador-Niño y Metas de Enfoque y Duración de la Intervención (Cuidadores); Beneficios del ABC y Consideraciones Culturales (Quienes recibían el ABC); Lo Enfocado y Diseñado como Meta, Valor de Ideas Recibidas, Supervisión con Apoyo, Alianza de Trabajo y Retos Experimentados (Practicantes de la Intervención ABC). Las recomendaciones de práctica y entrenamiento incluyen la psico-educación de padres, entrenamiento a quienes practican la intervención específicamente orientada a ID/DD, expandir la capacidad de supervisión, formar la sensibilidad y competencia cultural/lingüística de quienes practican la intervención, acceso a los sistemas de referencias, incluir Trabajadores de Salud Comunitarios como practicantes de la intervención y mayor flexibilidad en cómo organizar las sesiones.


L'attachement et le rattrapage bio-comportemental (en anglais Attachment and Biobehavioral Catch-up, soit ABC) est une intervention ciblée sur l'amélioration du fonctionnement socio-émotionnel et régulatoire de bébés à risques. Cependant, pour utiliser l'ABC pour des bébés/jeunes enfants avec des retards intellectuels et des retards du comportement (ID/DD) et dans des contextes culturels nouveaux, comme l'Afrique du Sud, des adaptations pourraient être nécessaires. Par conséquent cette étude s'est donné pour but d'explorer les opinions d'experts cliniques et les perceptions des personnes prenant soin d'un bébé quant à l'utilisation de l'ABC pour des enfants avec ID/DD en Afrique du Sud. On a aussi cherché à incorporer les expériences de familles d'enfants avec ID/DD qui ont reçu l'ABC, ainsi que des intervenants qui l'ont facilité, dans sa première mise en oeuvre en Afrique du Sud. Des entretiens semi-structurés ont été faits avec 18 participants. Une analyse thématique a explicité 12 thèmes principaux: Forces de l'Intervention, Points d'Inquiétude, et Recommandations (Experts); Accent sur la Relation Personne prenant soin de l'enfant-enfant et Cibles d'Intervention et Durée d'Intervention (Personnes prenant soin d'un bébé); Bénéfices de l'ABS, et Considérations Culturels (personnes ayant reçu l'ABC); Ciblé et Centré, Valeur du Retour, Supervision de Soutien, Alliance entre entités, et Défis Vécus (Intervenants ABC). Les recommandations de pratique et de formation incluent une psychoéducation pour les parents, une formation pour les intervenants qui est spécifique à l'ID/DD, l'élargissement de la capacité de supervision, le développement de la sensibilité et de la compétence culturelle/linguistique des intervenants, l'accès aux réseau d'orientation, y compris des Travailleurs de Santé Communautaires en tant qu'intervenants, et une plus grande flexibilité dans la manière dont les sessions sont organisées.


Assuntos
Deficiência Intelectual , Poder Familiar , Humanos , Lactente , Pré-Escolar , Poder Familiar/psicologia , Deficiência Intelectual/psicologia , África do Sul , Apego ao Objeto , Pais/psicologia
18.
J Child Sex Abus ; : 1-17, 2023 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-37357921

RESUMO

Women involved in the criminal legal system report high rates of interpersonal violence, particularly sexual violence, and mental health problems. Although existing research has linked experiences of interpersonal violence to multiple negative mental health outcomes, few researchers have examined concurrent psychopathology as an outcome of child and adult sexual violence in system-involved women. The purpose of this study was to examine child sexual abuse (CSA) and adult sexual violence, while controlling for other forms of interpersonal violence, as predictors of current symptoms of posttraumatic stress disorder (PSTD), substance use disorder (SUD), and dissociation in women in jail in the Mountain West. Randomly selected participants (N = 146) completed clinician-administered measures of trauma histories and mental health symptoms. The majority of the women (73%) reported experiences of CSA and about half reported experiences of adult sexual violence. Over half of the women reported symptoms consistent with current probable PTSD, about 20% reported dissociation symptoms in a clinical range, and over 70% met criteria for a SUD in the past year. The proposed model was tested with path analysis. CSA significantly predicted current symptoms of PTSD while adult sexual violence exposure predicted symptoms of SUD and dissociation. These results illustrate the high rates of sexual violence exposure as well as the complexity of mental health needs associated with these exposures in system-involved women. Findings highlight the need to comprehensively assess incarcerated women's trauma exposure and psychological distress to better meet the needs of this population.

19.
J Pak Med Assoc ; 73(4): 848-852, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37051998

RESUMO

OBJECTIVE: To review literature on the impact of stigmatisation and perceived social support on the treatment of substance use disorder patients. METHODS: The systematic review was conducted from March 2020 to June 2021, and comprised literature search through key words on PubMed, Scopus, PsycINFO, Science Direct, Full Free PDF, and Google Scholar databases of studies about stigma, social support and treatment of substance use disorders published in English language between 2010 and 2021. RESULTS: Of the 52 studies found, 8(15.3%) qualified for detailed review. The outcome suggested that the impact of stigma had negative consequences on the treatment of substance use disorders, and negative comments from close relatives was a major cause of relapse. In contrast, perceived social support had a constructive impact on the treatment of substance use disorders. CONCLUSIONS: Further research is required to understand the phenomenon of stigmatisation in the Pakistani population through validated tools.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Humanos , Transtornos Relacionados ao Uso de Substâncias/terapia , Estereotipagem , Estigma Social , Apoio Social
20.
Child Youth Serv Rev ; 1442023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38156094

RESUMO

Using national child welfare data, we created a longitudinal data set (N = 142,143) to examine a subset of foster children (7%) who entered care due to parental incarceration (PI). Spanning FY 2005-2017, the dataset allowed us to compare children who entered care due to PI to children entering for other reasons. We found children of incarcerated parents were younger (median age of 4 vs. 6), more often White (47% vs. 42%), and less often Black (15% vs. 20%) when compared to other foster children. Parental use of alcohol (12% v. 6%) and drugs (42% v. 26%) were both more common among children who entered due to PI compared to those who entered for other reasons. Our understanding of this population is limited by inadequate data collection procedures that fail to account for societal changes created by mass incarceration. Our data indicate that investments in substance use treatment could decrease the number of children entering care.

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