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BACKGROUND AND OBJECTIVES: Criminal-legal (CL) referrals to addiction treatment have historically had low utilization of medications for opioid use disorder (MOUD). While state differences have been reported, an in-depth longitudinal analysis of state-by-state differences is lacking. METHODS: The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset-Admissions 2000-2020 provided data for individuals entering their initial treatment with an opioid as their primary substance. Outcome was planned use of MOUD, assessing odds ratio (OR) of CL referrals relative to non-CL referrals cumulatively over the 21-year period and as incremental change (change in relative disparity) using effect sizes, stratified by each state. RESULTS: 2,187,447 cases met the criteria. Planned MOUD occurred in 37.7% of non-CL clients versus 6.5% of CL clients (OR = 0.11, 95% confidence interval = 0.11-0.12). For all clients, planned MOUD increased from 2000 (33.9%) to 2020 (44.8%). This increase was blunted within CL clients, increasing from 2000 (6.4%) to 2020 (13.3%). Rhode Island saw the greatest improvements in equity. DISCUSSION AND CONCLUSIONS: While rates of planned MOUD increased over the 21 years, a significant disparity persisted among CL clients in most states. As opioid use disorders and opioid-related overdoses are more prevalent among those involved with the CL system, improving this has high impact. SCIENTIFIC SIGNIFICANCE: Provides the most comprehensive analysis of state-by-state inequities in MOUD access for CL relative to non-CL referrals over a 21-year period through use of a national data set. Positive outliers are used as case examples for others to follow in pursuit of more equitable care.
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BACKGROUND: The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups. METHODS: Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions. RESULTS: Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines. CONCLUSIONS: Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks.
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COVID-19 , Carrera , Humanos , Anciano , Conducta Sedentaria , Pandemias , COVID-19/epidemiología , Ejercicio Físico , Alemania/epidemiologíaRESUMEN
BACKGROUND: Classical anthropometric traits may fail to fully represent the relationship of weight, adiposity, and height with cancer risk. We investigated the associations of body shape phenotypes with the risk of overall and site-specific cancers. METHODS: We derived four distinct body shape phenotypes from principal component (PC) analysis on height, weight, body mass index (BMI), waist (WC) and hip circumferences (HC), and waist-to-hip ratio (WHR). The study included 340,152 men and women from 9 European countries, aged mostly 35-65 years at recruitment (1990-2000) in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: After a median follow-up of 15.3 years, 47,110 incident cancer cases were recorded. PC1 (overall adiposity) was positively associated with the risk of overall cancer, with a HR per 1 standard deviation (SD) increment equal to 1.07 (95% confidence interval 1.05 to 1.08). Positive associations were observed with 10 cancer types, with HRs (per 1 SD) ranging from 1.36 (1.30-1.42) for endometrial cancer to 1.08 (1.03-1.13) for rectal cancer. PC2 (tall stature with low WHR) was positively associated with the risk of overall cancer (1.03; 1.02-1.04) and five cancer types which were not associated with PC1. PC3 (tall stature with high WHR) was positively associated with the risk of overall cancer (1.04; 1.03-1.05) and 12 cancer types. PC4 (high BMI and weight with low WC and HC) was not associated with overall risk of cancer (1.00; 0.99-1.01). CONCLUSIONS: In this multi-national study, distinct body shape phenotypes were positively associated with the incidence of 17 different cancers and overall cancer.
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Neoplasias del Recto , Somatotipos , Humanos , Femenino , Estudios de Cohortes , Estudios Prospectivos , Factores de Riesgo , Circunferencia de la Cintura , Obesidad/epidemiología , Adiposidad , Índice de Masa Corporal , Relación Cintura-Cadera , Fenotipo , Modelos de Riesgos ProporcionalesRESUMEN
BACKGROUND: The benefit of physical activity (PA) for increasing longevity is well-established, however, the impact of diurnal timing of PA on mortality remains poorly understood. We aimed to derive circadian PA patterns and investigate their associations with all-cause mortality. METHODS: We used 24 h PA time series from 96,351 UK Biobank participants aged between 42 and 79 years at accelerometry in 2013-2015. Functional principal component analysis (fPCA) was applied to obtain circadian PA patterns. Using multivariable Cox proportional hazard models, we related the loading scores of these fPCs to estimate risk of mortality. RESULTS: During 6.9 years of follow-up, 2,850 deaths occurred. Four distinct fPCs accounted for 96% of the variation of the accelerometry data. Using a loading score of zero (i.e., average overall PA during the day) as the reference, a fPC1 score of + 2 (high overall PA) was inversely associated with mortality (Hazard ratio, HR = 0.91; 95% CI: 0.84-0.99), whereas a score of -2 (low overall PA) was associated with higher mortality (1.69; 95% CI: 1.57-1.81; p for non-linearity < 0.001). Significant inverse linear associations with mortality were observed for engaging in midday PA instead of early and late PA (fPC3) (HR for a 1-unit increase 0.88; 95% CI: 0.83-0.93). In contrast, midday and nocturnal PA instead of early and evening PA (fPC4) were positively associated with mortality (HR for a 1-unit increase 1.16; 95% CI: 1.08-1.25). CONCLUSION: Our results suggest that it is less important during which daytime hours one is active but rather, to engage in some level of elevated PA for longevity.
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Acelerometría , Bancos de Muestras Biológicas , Humanos , Adulto , Persona de Mediana Edad , Anciano , Ejercicio Físico , Reino UnidoRESUMEN
BACKGROUND AND OBJECTIVES: Comorbid substance use can negatively impact multiple aspects of treatment for patients with an opioid use disorder (OUD). We investigated if treatment for OUD led to improvements in patients' recovery capital (RC) overtime, and whether there were associated changes in co-occurring alcohol use. METHODS: Participants (n = 133) were patients with OUD seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) and reported drinking days per 30-day period thrice over the 6-month study. No specific treatments targeting alcohol were used. Two different models were employed to assess changes in total ARC score and adjusted odds ratio (aOR) for past 30-day abstinence. RESULTS: Baseline mean ARC scores were 36.6 and significantly increased to mean score of 41.2 at study end. Ninety-one participants (68.4%) reported no alcohol use at baseline, and 97 (78.9%) reported no use in the previous 30 days at study endpoint. For each increase in ARC, there was an aOR 1.07 (confidence interval [CI]: 1.02-1.13) for past 30-day abstinence. Considering ARC standard deviation of 10.33 over all measurements, this equates to an aOR of 2.10 (CI: 1.22-3.62) for past 30-day abstinence. DISCUSSION AND CONCLUSIONS: We saw significantly increased aOR for past 30-day abstinence as RC improved in an OUD treatment-seeking population. This difference was not caused by differences in ARC between study completers and noncompleters. SCIENTIFIC SIGNIFICANCE: Showcases how RC growth may be protective of past 30-day alcohol use in an OUD cohort and adds specific aOR for abstinence per ARC increase.
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Consumo de Bebidas Alcohólicas , Trastornos Relacionados con Opioides , Humanos , Trastornos Relacionados con Opioides/epidemiología , Comorbilidad , Analgésicos OpioidesRESUMEN
PURPOSE: Psychedelics are being explored for their potential therapeutic benefits across a wide range of psychiatric diagnoses and may usher in a new age in psychiatric treatment. There is stigma associated with these currently illegal substances, and use varies by race and age. We hypothesized that minoritized racial and ethnic populations, relative to White respondents, would perceive psychedelic use as riskier. METHODS: Using 2019 cross-sectional data from the National Survey of Drug Use and Health, we conducted a secondary analysis of 41,679 respondents. Perceived risk of heroin was used as a surrogate for overall risk of illegal substance use; heroin and lysergic acid diethylamide were the only substances queried this way in the sample. RESULTS: A majority regarded lysergic acid diethylamide (66.7%) and heroin (87.3%) as a great risk if used once or twice. There were clear differences by race, with White respondents and those indicating more than one race having significantly lower perceived risk of lysergic acid diethylamide than respondents from other groups. Perceived risk of use also significantly increased with age. CONCLUSION: Perceived risk of lysergic acid diethylamide is unevenly distributed across the population. Stigma and racial disparities in drug-related crimes likely contribute to this. As research into potential therapeutic indications for psychedelics continues, perceived risk of use may change.
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Alucinógenos , Trastornos Relacionados con Sustancias , Humanos , Estados Unidos/epidemiología , Alucinógenos/uso terapéutico , Dietilamida del Ácido Lisérgico/uso terapéutico , Estudios Transversales , Heroína , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
BACKGROUND: People with substance use disorders are highly prevalent in the carceral system. Recovery capital (RC) is the resources available to an individual to initiate or maintain substance use cessation. Sex differences have been identified in RC during both active substance use and recovery in the general population, however, less is known about these sex differences in the post-incarceration population. METHODS: Participants (n = 136) were those with an opioid or stimulant use disorder with past year involvement with the Iowa criminal justice system (USA), who completed the Assessment of Recovery Capital (ARC) twice over a six-month cohort study. Participants were involved in an addiction clinic that utilized active case management. Analysis of covariance evaluated changes in ARC during the study. Separate models compared total ARC and individual ARC domains, with sex as the independent variable of interest. Model means were generated for interpretation based on sex, comparing baseline and study endpoint ARC scores. RESULTS: There were no baseline sex differences in total ARC. ARC increased significantly for the group, however, males showed disproportionate growth. Females ended the study with a mean ARC of 37.8 (SD= 9.3) and males finished at 41.6 (SD= 9.3), which was a significant difference (p = 0.044); this significant difference was driven by ARC subdomains of 'Psychological Health' and 'Physical Health.' CONCLUSIONS: People post-incarceration are at high risk for return to substance use. Treatment that is informed by sex-based differences may have the potential to decrease the differing rates of growth in RC between sexes.
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Conducta Adictiva , Trastornos Relacionados con Sustancias , Humanos , Masculino , Femenino , Caracteres Sexuales , Estudios de Cohortes , Trastornos Relacionados con Sustancias/psicología , Analgésicos OpioidesRESUMEN
Background: Sedentary behavior is associated with an increased risk of chronic diseases, such as metabolic syndrome and type 2 diabetes and all-cause mortality. Occupational sitting time contributes to large amounts of daily sedentary behavior, especially in office workers. Objective: This study investigated the amount of time spent in sedentary behavior during different tasks at work and while commuting of administrative personnel of a university hospital in Germany. Material and methods: A cross-sectional questionnaire-based study of administrative employees at the University Hospital Regensburg, Germany was carried out to assess work-related sedentary behavior. Descriptive and exploratory statistical analyses were performed. Results: The study population consisted of 159 participants (54.1% women, 51.6% older than 40 years), which corresponds to a response rate of 26%. The median daily sitting time in the office was 7.0â¯h (interquartile range, IQR 6.0-7.5â¯h) and mostly occurred during computer work (57.3%), telephone calls (13.2%) and meetings (11.7%). Median standing time at work was 0.8â¯h (IQR 0.3-1.4â¯h). Administrative staff spent a median of 0.7â¯h (IQR 0.3-1.0â¯h) per day sedentary while commuting, with 67.3% of respondents commuting by car, motorbike or scooter. The participants were of the opinion that sitting for long uninterrupted periods had negative (69.6%) or relatively negative (29.7%) effects on health. Conclusion: Administrative staff in hospitals spend large amounts of the daily working time with sedentary behavior. Interventions that enable working both in sitting and standing positions can lead to reduced work-related sitting time and thereby could improve occupational and, in a broader sense, public health.
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OBJECTIVES: To see whether the percentage of older adults entering substance use treatment for their first time continued to increase and whether there were changes in the use patterns leading to the treatment episode, particularly an increase in illicit drugs. DESIGN: Public administrative health record study. SETTING: The Treatment Episode Data Sets publicly available from the Substance Abuse Mental Health Services Administration from 2008 to 2018. PARTICIPANTS: Young adults age 30-54 years (N = 3,327,903) and older adults age 55 years and older (N = 453,598) with a first-time admission for a publicly funded substance use treatment. MEASUREMENTS: Demographic and substance use history variables at admission. RESULTS: The proportion of older adults going for substance use treatment for the first time continued to increase between 2008 and 2018 relative to younger adults, continuing the trend of increasing first-time admission between 1998 and 2008. For the first time, the primary substance at admission for older adults was an illicit substance only, surpassing alcohol only and the combination of alcohol and illicit drug use. In this period, use of opioids, particularly heroin, and methamphetamine increased among older adults entering treatment. CONCLUSIONS: As our population ages and substance use trends change, healthcare providers that take care of older adults must have skills to prevent, screen for, diagnose, and treat substance use disorders. Given recent trends in substance use and treatment among older adults, substance use treatment programs must adapt to meet the needs of an older population.
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Servicios de Salud Mental , Trastornos Relacionados con Sustancias , Anciano , Hospitalización , Humanos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapiaRESUMEN
BACKGROUND: Physical activity has been positively related to malignant melanoma. However, that association may be confounded by ultraviolet radiation (UV), a variable closely related to both outdoor physical activity and malignant melanoma. We examined physical activity, grip strength and sedentary behaviour in relation to risk of malignant melanoma, accounting for relevant confounders using data from a prospective cohort study. METHODS: In 350,512 UK Biobank participants aged 38-73 years at baseline, physical activity was assessed with a modified version of the International Physical Activity Questionnaire Short Form, grip strength was measured with a hand dynamometer, and sedentary behaviour was recorded with three specific questions. Multivariable hazard ratios (HR) and corresponding 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. RESULTS: During 7 years of follow-up, 1239 incident malignant melanoma diagnoses were recorded. Physical activity and sedentary behaviour were unrelated to malignant melanoma (HRs 1.01 (95% CI 0.95-1.07) and 1.04 (95% CI 0.97-1.12), respectively), and the initially positive association with grip strength in the basic model (HR 1.23, 95% CI 1.08-1.40) was attenuated after full adjustment (HR 1.10, 95% CI 0.96-1.26). CONCLUSION: Physical activity, grip strength and sedentary behaviour are not associated with malignant melanoma risk.
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Ejercicio Físico/estadística & datos numéricos , Fuerza de la Mano/fisiología , Melanoma/epidemiología , Adulto , Anciano , Bancos de Muestras Biológicas , Femenino , Humanos , Incidencia , Masculino , Melanoma/etiología , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Conducta Sedentaria , Reino Unido/epidemiologíaRESUMEN
With the Covid-19 pandemic, face masks have become part of our daily lives. While face masks are effective in slowing down the spread of the virus, they also make face-to-face communication more challenging. The present study sought to examine the impact of face masks on listeners' intelligibility and recall of sentences produced by one German native adult and one child talker. In the intelligibility task, German native adult listeners watched video clips of either an adult or a child talker producing sentences with and without a face mask. In a cued-recall experiment, another group of German native listeners watched the same video clips and then completed a cued-recall task. The results showed that face masks significantly affected listeners' intelligibility and recall performance, and this effect was equally true for both talkers. The findings here contribute to the fast growing and urgent research regarding the impact of face masks on communication.
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COVID-19 , Percepción del Habla , Adulto , Niño , Humanos , Máscaras , Pandemias , SARS-CoV-2 , Inteligibilidad del HablaRESUMEN
The effect of face covering masks on listeners' recall of spoken sentences was investigated. Thirty-two German native listeners watched video recordings of a native speaker producing German sentences with and without a face mask, and then completed a cued-recall task. Listeners recalled significantly fewer words when the sentences had been spoken with a face mask. This might suggest that face masks increase processing demands, which in turn leaves fewer resources for encoding speech in memory. The result is also informative for policy-makers during the COVID-19 pandemic, regarding the impact of face masks on oral communication.
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COVID-19/prevención & control , Máscaras/tendencias , Recuerdo Mental/fisiología , Percepción del Habla/fisiología , Estimulación Acústica/métodos , Adulto , Femenino , Humanos , Masculino , Máscaras/efectos adversos , Estimulación Luminosa/métodos , Adulto JovenRESUMEN
In a self-paced reading study, we investigated how effects of biasing contexts in idiom processing interact with effects of idiom literality. Specifically, we tested if idioms with a high potential for literal interpretation (e.g., break the ice) are processed differently in figuratively and literally biasing contexts than idioms with a low potential (e.g., lose one's cool). Participants read sentences that biased towards a figurative or literal reading of idioms and continued with resolutions that were congruent or incongruent with these biases (e.g., [The new schoolboy/the chilly Eskimo] just wanted to break the ice [with his peers/on the lake] ). While interpretations of high-literality idioms were strengthened by supporting contexts and showed costs for incongruent resolutions, low-literality idioms did not show this effect. Rather, interpreting low-literality idioms in a literal manner showed a cost regardless of context. We conclude that biasing contexts are used in a flexible process of real-time idiom processing and meaning constitution, but this effect is mediated by idiom literality.
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Cognición , Comprensión/fisiología , Lectura , Semántica , Adulto , Femenino , Humanos , Masculino , Vocabulario , Adulto JovenRESUMEN
Growing evidence that certain poly- and perfluoroalkyl substances (PFASs) are associated with negative human health effects prompted the U.S. Environmental Protection Agency to issue lifetime drinking water health advisories for perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) in 2016. Given that groundwater is a major source of drinking water, the main objective of this work was to investigate geochemical and hydrological processes governing the subsurface transport of PFASs at a former fire training area (FTA) on Cape Cod, Massachusetts, where PFAS-containing aqueous film-forming foams were used historically. A total of 148 groundwater samples and 4 sediment cores were collected along a 1200-m-long downgradient transect originating near the FTA and analyzed for PFAS content. The results indicate that unsaturated zones at the FTA and at hydraulically downgradient former domestic wastewater effluent infiltration beds both act as continuous PFAS sources to the groundwater despite 18 and 20 years of inactivity, respectively. Historically different PFAS sources are evident from contrasting PFAS composition near the water table below the FTA and wastewater-infiltration beds. Results from total oxidizable precursor assays conducted using groundwater samples collected throughout the plume suggest that some perfluoroalkyl acid precursors at this site are transporting with perfluoroalkyl acids.
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Fluorocarburos , Contaminantes Químicos del Agua , Agua Potable , Agua Subterránea/química , HidrologíaRESUMEN
This study examined the use of fricative noise information and coarticulatory cues for categorization of word-final fricatives [s] and [f] by younger and older Dutch listeners alike. Particularly, the effect of information loss in the higher frequencies on the use of these two cues for fricative categorization was investigated. If information in the higher frequencies is less strongly available, fricative identification may be impaired or listeners may learn to focus more on coarticulatory information. The present study investigates this second possibility. Phonetic categorization results showed that both younger and older Dutch listeners use the primary cue fricative noise and the secondary cue coarticulatory information to distinguish word-final [f] from [s]. Individual hearing sensitivity in the older listeners modified the use of fricative noise information, but did not modify the use of coarticulatory information. When high-frequency information was filtered out from the speech signal, fricative noise could no longer be used by the younger and older adults. Crucially, they also did not learn to rely more on coarticulatory information as a compensatory cue for fricative categorization. This suggests that listeners do not readily show compensatory use of this secondary cue to fricative identity when fricative categorization becomes difficult.
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Señales (Psicología) , Pérdida Auditiva/fisiopatología , Fonética , Habla/fisiología , Estimulación Acústica , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Modelos Biológicos , Países Bajos , Espectrografía del Sonido , Adulto JovenRESUMEN
In three cross-modal priming experiments we asked whether adaptation to a foreign-accented speaker is automatic, and whether adaptation can be seen after a long delay between initial exposure and test. Dutch listeners were exposed to a Hebrew-accented Dutch speaker with two types of Dutch words: those that contained [I] (globally accented words), and those in which the Dutch [i] was shortened to [I] (specific accent marker words). Experiment 1, which served as a baseline, showed that native Dutch participants showed facilitatory priming for globally accented, but not specific accent, words. In experiment 2, participants performed a 3.5-minute phoneme monitoring task, and were tested on their comprehension of the accented speaker 24 hours later using the same cross-modal priming task as in experiment 1. During the phoneme monitoring task, listeners were asked to detect a consonant that was not strongly accented. In experiment 3, the delay between exposure and test was extended to 1 week. Listeners in experiments 2 and 3 showed facilitatory priming for both globally accented and specific accent marker words. Together, these results show that adaptation to a foreign-accented speaker can be rapid and automatic, and can be observed after a prolonged delay in testing.
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Automatismo , Comprensión , Lenguaje , Fonética , Acústica del Lenguaje , Percepción del Habla , Femenino , Humanos , Masculino , Memoria a Corto Plazo , Psicolingüística , Memoria Implícita , Retención en Psicología , Adulto JovenRESUMEN
Alcohol use disorders (AUD) and alcohol-associated liver disease (ALD) have growing impacts on public health, yet many do not receive evidence-based care. People with co-occurring AUD and ALD, especially those in rural communities with less access to specialty care, are most in need of novel integrated care models. The use of telehealth to facilitate co-location within an integrated care model may help to improve access to AUD and ALD care while reducing barriers and improving recovery outcomes for both the substance use disorder and liver disease.
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Alcoholismo , Prestación Integrada de Atención de Salud , Trastornos Relacionados con Sustancias , Telemedicina , Humanos , Alcoholismo/epidemiología , Alcoholismo/terapia , Población RuralRESUMEN
OBJECTIVES: Older adults (OAs; age 55+ years) are increasingly seeking specialty treatment of opioid use disorder. Previous analyses of the Treatment Episode Data Set-Discharges (TEDS-D) database have reported higher rates of in-treatment mortality for those receiving medications for opioid use disorder (MOUD). We evaluate current trends in mortality for treatment-seeking OAs. METHODS: Using the 2020 TEDS-D, logistic regression predicted in-treatment mortality for OAs from planned MOUD, service level, and interaction terms. RESULTS: Of the 26,993 OA treatment discharges, 679 people were discharged due to death (2.52%). OAs with MOUD (3.65%, 95% confidence interval [CI], 3.37%-3.95%) were significantly more likely to discharge due to death than those without MOUD (0.82%; 95% CI, 0.66%-1.01%). Most records were for nonintensive outpatient (83.7%; n = 22,588), which had the highest mortality (2.89%; 95% CI, 2.68%-3.11%); intensive services (n = 4405) had a mortality rate of 0.61% (95% CI, 0.42%-0.89%). Among OAs, planned MOUD with nonintensive outpatient services had a mortality rate of 4.17% (95% CI, 3.56%-4.9%). CONCLUSIONS: This TEDS-D analysis extends previous literature highlighting a significant interaction between planned MOUD and service intensity on in-treatment mortality for OAs. Additional research is needed to address the causal mechanisms behind these interactions and inform the delivery of safe effective care in the growing OA population.
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Buprenorfina , Trastornos Relacionados con Opioides , Humanos , Anciano , Persona de Mediana Edad , Atención Ambulatoria , Bases de Datos Factuales , Pacientes Ambulatorios , Alta del Paciente , Analgésicos Opioides , Tratamiento de Sustitución de OpiáceosRESUMEN
Illicitly manufactured fentanyl (IMF) is a significant contributor to the increasing rates of overdose-related deaths. Its high potency and lipophilicity can complicate opioid withdrawal syndromes (OWS) and the subsequent management of opioid use disorder (OUD). This scoping review aimed to collate the current OWS management of study populations seeking treatment for OWS and/or OUD directly from an unregulated opioid supply, such as IMF. Therefore, the focus was on therapeutic interventions published between January 2010 and November 2023, overlapping with the period of increasing IMF exposure. A health science librarian conducted a systematic search on November 13, 2023. A total of 426 studies were screened, and 173 studies were reviewed at the full-text level. Forty-nine studies met the inclusion criteria. Buprenorphine and naltrexone were included in most studies with the goal of transitioning to a long-acting injectable version. Various augmenting agents were tested (buspirone, memantine, suvorexant, gabapentin, and pregabalin); however, the liberal use of adjunctive medication and shortened timelines to initiation had the most consistently positive results. Outside of FDA-approved medications for OUD, lofexidine, gabapentin, and suvorexant have limited evidence for augmenting opioid agonist initiation. Trials often have low retention rates, particularly when opioid agonist washout is required. Neurostimulation strategies were promising; however, they were developed and studied early. Precipitated withdrawal is a concern; however, the rates were low and adequately mitigated or managed with low- or high-dose buprenorphine induction. Maintenance treatment continues to be superior to detoxification without continued management. Shorter induction protocols allow patients to initiate evidence-based treatment more quickly, reducing the use of illicit or non-prescribed substances.
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Body shape phenotypes combining multiple anthropometric traits have been linked to postmenopausal breast cancer (BC). However, underlying biological pathways remain poorly understood. This study investigated to what extent the associations of body shapes with postmenopausal BC risk is mediated by biochemical markers. The study included 176,686 postmenopausal women from UK Biobank. Four body shape phenotypes were derived from principal component (PC) analysis of height, weight, body mass index, waist and hip circumferences, and waist-to-hip ratio (WHR). The four-way decomposition of the total effect was used to estimate mediation and interaction effects simultaneously as well as the mediated proportions. After 10.9 years median follow-up, 6,396 incident postmenopausal BC were diagnosed. There was strong evidence of positive associations between PC1 (general obesity) and PC2 (tall, low WHR), and BC risk. The association of PC1 with BC risk was positively mediated by testosterone and negatively by insulin-like growth factor-1 (IGF-1), with the overall proportion mediated (sum of the mediated interaction and pure indirect effect (PIE)) accounting for 11.4% (95% confidence intervals: 5.1 to 17.8%) and -12.2% (-20.5% to -4.0%) of the total effect, respectively. Small proportions of the association between PC2 and BC were mediated by IGF-1 (PIE: 2.8% (0.6 to 4.9%)), and sex hormone-binding globulin (SHBG) (PIE: -6.1% (-10.9% to -1.3%)). Our findings are consistent with differential pathways linking different body shapes with BC risk, with a suggestive mediation through testosterone and IGF-1 in the relationship of a generally obese body shape and BC risk, while IGF-1 and SHBG may mediate a tall/lean body shape-BC risk association.