ABSTRACT
BACKGROUND AND OBJECTIVES: Opioid use and overdose remain a central and worsening public health emergency in the United States and abroad. Efforts to expand treatment have struggled to match the rising incidence of opioid use disorder (OUD), and treating patients in primary care settings represents one of the most promising opportunities to meet this need. Learning collaboratives (LCs) are one evidence-based strategy to improve implementation of medication treatment for opioid use disorder (MOUD) in primary care. METHODS: We developed and studied a multidisciplinary MOUD learning collaborative involving six underserved primary care clinics. We used a mixed-methods approach to assess needs, develop curriculum, and evaluate outcomes from these clinics. RESULTS: We recruited six clinics to participate in the collaborative. Half had an established MOUD program. Approximately 80% of participants achieved their organizational quality improvement goals for the collaborative. After the collaborative, participants also reported a significant increase in their perceived competence to implement/improve a MOUD program (pre-LC competence=2.80, post-LC competence=6.33/10, P=.02). The most consistent barrier we identified was stigma around OUD and its effects on patients' ability to access services and staff/provider ability to provide services. The most frequent enablers of program success were trainee interest, organizational leadership support, and a dedicated MOUD care team. CONCLUSIONS: Organizations used clinical and systems improvement knowledge to enhance their existing programs or to take steps to create new programs. All participants identified the need for additional staff/clinician training, especially to overcome stigma around OUD. The outcomes demonstrated the crucial importance of long-term organizational support for program success.
Subject(s)
Drug Overdose , Opioid-Related Disorders , Humans , Learning , Curriculum , Opioid-Related Disorders/therapy , Primary Health Care , Analgesics, OpioidABSTRACT
This study sought to evaluate the psychometric properties of a Spanish version of the PEG scale (PEG-S, whose items assess Pain intensity and pain interference with Enjoyment of life and General activity) in a sample of Spanish-speaking adults receiving care for pain at primary care clinics in the Northwestern United States. We evaluated the PEG-S's 1) internal consistency, 2) convergent validity, and 3) discriminant validity. All participants (n = 200, mean age = 52 years [SD = 15], 76% women, mean PEG-S score = 5.7 [SD = 2.5]) identified as having Hispanic or Latino ethnicity, and detailed ethnic origin was predominantly Mexican or Chicano (70%). The PEG-S's internal consistency (Cronbach's alpha, .82) was good. Correlations between the PEG-S scale scores and established measures of pain intensity and interference ranged from .68 to .79, supporting the measure's convergent validity. The correlation between the PEG-S scale score and the Patient Health Questionnaire-9 (r = .53) was weaker than those between the PEG-S scale and measures of pain intensity and interference, supporting the measure's discriminant validity. The findings support reliability and validity of the PEG-S for assessing a composite score of pain intensity and interference among Spanish-speaking adults. PERSPECTIVE: We present evidence supporting the reliability and validity of the PEG scale in Spanish (PEG-S) in a sample of adults receiving pain care at primary care clinics in the Northwestern United States. This 3-item composite measure of pain intensity and interference can help clinicians and researchers assess pain among Spanish-speaking adults.
Subject(s)
Hispanic or Latino , Pain Measurement , Pain , Adult , Female , Humans , Male , Middle Aged , Pain/diagnosis , Primary Health Care , Psychometrics , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
BACKGROUND: Policies to combat the COVID-19 pandemic have disrupted the screening, diagnosis, treatment, and monitoring of noncommunicable (NCD) patients while affecting NCD prevention and risk factor control. AIMS: To discuss how the first wave of the COVID-19 pandemic affected the health management of NCD patients, identify which aspects should be carried forward into future NCD management, and propose collaborative efforts among public-private institutions to effectively shape NCD care models. METHODS: The NCD Partnership, a collaboration between Upjohn and the European Innovation Partnership on Active and Healthy Ageing, held a virtual Advisory Board in July 2020 with multiple stakeholders; healthcare professionals (HCPs), policymakers, researchers, patient and informal carer advocacy groups, patient empowerment organizations, and industry experts. RESULTS: The Advisory Board identified barriers to NCD care during the COVID-19 pandemic in four areas: lack of NCD management guidelines; disruption to integrated care and shift from hospital-based NCD care to more community and primary level care; infodemics and a lack of reliable health information for patients and HCPs on how to manage NCDs; lack of availability, training, standardization, and regulation of digital health tools. CONCLUSIONS: Multistakeholder partnerships can promote swift changes to NCD prevention and patient care. Intra- and inter-communication between all stakeholders should be facilitated involving all players in the development of clinical guidelines and digital health tools, health and social care restructuring, and patient support in the short-, medium- and long-term future. A comprehensive response to NCDs should be delivered to improve patient outcomes by providing strategic, scientific, and economic support.
Subject(s)
COVID-19 , Noncommunicable Diseases , Caregivers , Humans , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/prevention & control , Pandemics/prevention & control , SARS-CoV-2ABSTRACT
The Association of American Medical Colleges projects an increasing shortage of physicians in rural areas. Medical schools have developed specialty track programs to improve the recruitment and retention of physicians who can serve rural populations. One such program in California includes a variety of unique elements including outreach, admissions, rural clinical experiences, focused mentorship, scholarly and leadership opportunities, and engagement with rural communities. Preliminary outcomes demonstrate that this rural track program has achieved some success in the recruitment, retention, and training of students interested in future rural practice and in the placement of students in primary care residencies. Long-term outcomes, such as graduates entering rural practice, are still unknown, but will be monitored to assess the impact and sustainability of the rural program. This article illustrates the opportunities and challenges of training medical students for rural practice and provides lessons learned to inform newly-established and long standing rural medical education programs.
Subject(s)
Medically Underserved Area , Professional Practice Location , Rural Health Services , Students, Medical , California , Career Choice , Education, Medical , Humans , Program Evaluation , Rural Population , Schools, MedicalABSTRACT
The nature of work and the way it is conceptualised has been evolving since the dawn of humankind.[...].
Subject(s)
Health Promotion/trends , Job Satisfaction , Occupational Health/trends , Personal Satisfaction , Age Factors , Efficiency , Humans , Unemployment/psychology , Workplace/psychologyABSTRACT
Anthropogenic land use may shape vegetation composition and affect trophic interactions by altering concentrations of host plant metabolites. Here, we investigated the hypotheses that: (1) plant N and defensive secondary metabolite contents of the herb Plantago lanceolata are affected by land use intensity (LUI) and the surrounding vegetation composition (=plant species richness and P. lanceolata density), and that (2) changes in plant chemistry affect abundances of the herbivorous weevils Mecinus pascuorum and Mecinus labilis, as well as their larval parasitoid Mesopolobus incultus, in the field. We determined plant species richness, P. lanceolata density, and abundances of the herbivores and the parasitoid in 77 grassland plots differing in LUI index in three regions across Germany. We also measured the N and secondary metabolite [the iridoid glycosides (IGs) aucubin and catalpol] contents of P. lanceolata leaves. Mixed-model analysis revealed that: (1) concentrations of leaf IGs were positively correlated with plant species richness; leaf N content was positively correlated with the LUI index. Furthermore: (2) herbivore abundance was not related to IG concentrations, but correlated negatively with leaf N content. Parasitoid abundance correlated positively only with host abundance over the three regions. Structural equation models revealed a positive impact of IG concentrations on parasitoid abundance in one region. We conclude that changes in plant chemistry due to land use and/or vegetation composition may affect higher trophic levels and that the manifestation of these effects may depend on local biotic or abiotic features of the landscape.
Subject(s)
Herbivory/physiology , Host-Parasite Interactions , Plantago/chemistry , Wasps/growth & development , Weevils/growth & development , Animals , Germany , Humans , Iridoid Glucosides/metabolism , Iridoid Glycosides/metabolism , Larva/growth & development , Larva/parasitology , Models, Biological , Plant Leaves/chemistry , Plant Leaves/growth & development , Plant Leaves/metabolism , Plant Leaves/parasitology , Plantago/growth & development , Plantago/metabolism , Plantago/parasitology , Weevils/parasitologyABSTRACT
Biodiversity, a multidimensional property of natural systems, is difficult to quantify partly because of the multitude of indices proposed for this purpose. Indices aim to describe general properties of communities that allow us to compare different regions, taxa, and trophic levels. Therefore, they are of fundamental importance for environmental monitoring and conservation, although there is no consensus about which indices are more appropriate and informative. We tested several common diversity indices in a range of simple to complex statistical analyses in order to determine whether some were better suited for certain analyses than others. We used data collected around the focal plant Plantago lanceolata on 60 temperate grassland plots embedded in an agricultural landscape to explore relationships between the common diversity indices of species richness (S), Shannon's diversity (H'), Simpson's diversity (D1), Simpson's dominance (D2), Simpson's evenness (E), and Berger-Parker dominance (BP). We calculated each of these indices for herbaceous plants, arbuscular mycorrhizal fungi, aboveground arthropods, belowground insect larvae, and P. lanceolata molecular and chemical diversity. Including these trait-based measures of diversity allowed us to test whether or not they behaved similarly to the better studied species diversity. We used path analysis to determine whether compound indices detected more relationships between diversities of different organisms and traits than more basic indices. In the path models, more paths were significant when using H', even though all models except that with E were equally reliable. This demonstrates that while common diversity indices may appear interchangeable in simple analyses, when considering complex interactions, the choice of index can profoundly alter the interpretation of results. Data mining in order to identify the index producing the most significant results should be avoided, but simultaneously considering analyses using multiple indices can provide greater insight into the interactions in a system.
ABSTRACT
Plant diversity is known to affect success of host location by pest insects, but its effect on olfactory orientation of non-pest insect species has hardly been addressed. First, we tested in laboratory experiments the hypothesis that non-host plants, which increase odour complexity in habitats, affect the host location ability of herbivores and parasitoids. Furthermore, we recorded field data of plant diversity in addition to herbivore and parasitoid abundance at 77 grassland sites in three different regions in Germany in order to elucidate whether our laboratory results reflect the field situation. As a model system we used the herb Plantago lanceolata, the herbivorous weevil Mecinus pascuorum, and its larval parasitoid Mesopolobus incultus. The laboratory bioassays revealed that both the herbivorous weevil and its larval parasitoid can locate their host plant and host via olfactory cues even in the presence of non-host odour. In a newly established two-circle olfactometer, the weevils capability to detect host plant odour was not affected by odours from non-host plants. However, addition of non-host plant odours to host plant odour enhanced the weevils foraging activity. The parasitoid was attracted by a combination of host plant and host volatiles in both the absence and presence of non-host plant volatiles in a Y-tube olfactometer. In dual choice tests the parasitoid preferred the blend of host plant and host volatiles over its combination with non-host plant volatiles. In the field, no indication was found that high plant diversity disturbs host (plant) location by the weevil and its parasitoid. In contrast, plant diversity was positively correlated with weevil abundance, whereas parasitoid abundance was independent of plant diversity. Therefore, we conclude that weevils and parasitoids showed the sensory capacity to successfully cope with complex vegetation odours when searching for hosts.
Subject(s)
Feeding Behavior/physiology , Herbivory/physiology , Larva/physiology , Odorants/analysis , Poaceae/parasitology , Weevils/physiology , Animals , Ecosystem , Germany , Host Specificity , Host-Parasite Interactions , Models, Biological , Olfactory Perception/physiology , Oviposition/physiologyABSTRACT
OBJECTIVE: To measure the performance characteristics of an immunochromatographic rapid antigen test for respiratory syncytial virus (RSV) and determine how its interpretation should be contextualised in patients presenting to the emergency department (ED) with bronchiolitis. DESIGN: Diagnostic accuracy study of a rapid RSV test. SETTING: County hospital ED. INTERVENTION: We took paired nasal samples from consecutively enrolled infants with bronchiolitis and tested them with a rapid immunochromatographic antigen test and reverse transcriptase PCR gold standard. OUTCOME MEASURES: Sensitivity, specificity, the effect of point prevalence, clinical findings and overall context on predictive values. We used these to construct a graphical contextual model to show how the results of RSV antigen tests from infants presenting within 24 h should influence interpretation of subsequent antigen tests. RESULTS: We analysed 607 patients. The sensitivity and specificity for immunochromatographic testing was 79.4% (95% CI 73.9% to 84.2%) and 67.1% (95% CI 61.9% to 72%) respectively. We found little evidence of spectrum bias. In our contextual model the best predictor of a positive RT-PCR test was a positive antigen test OR 5.47 (95% CI 3.65 to 8.18) and the number of other infants having positive tests within 24 h OR 1.48 (95% CI 1.26 to 1.72) per infant. Increasing numbers presenting to the ED with bronchiolitis in a given day increases the probability of RSV infection. CONCLUSIONS: The RSV antigen test we examined had modest performance characteristics. The results of the antigen test should be interpreted in the context of the results of previous tests.
Subject(s)
Antigens, Viral/blood , Bronchiolitis, Viral/diagnosis , Chromatography, Affinity/methods , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Viruses/immunology , Chromatography, Affinity/standards , Emergency Service, Hospital , Female , Humans , Infant , Male , Nasopharynx/virology , Reagent Kits, Diagnostic/standards , Reverse Transcriptase Polymerase Chain Reaction , Sensitivity and SpecificitySubject(s)
Cardiovascular Diseases/prevention & control , Diabetes Mellitus/prevention & control , Neoplasms/prevention & control , Prenatal Care , Prenatal Exposure Delayed Effects , Pulmonary Disease, Chronic Obstructive/prevention & control , Environmental Pollutants/adverse effects , Epigenesis, Genetic , Female , Humans , PregnancyABSTRACT
The RCN is on the cusp of a decision that could have profound effects on nursing worldwide. RCN council faces a momentous choice about whether and when to exercise its new power to withdraw the college from membership of the International Council of Nurses (ICN) (letters April 10, analysis and letters April 17, news and letters May 1).
ABSTRACT
Increasing numbers of people across the world are developing preventable non-communicable diseases (NCDs). This has massive social and economic implications for individuals, families, communities and countries, and impacts on the roles, responsibilities and future careers of nurses. The growing epidemic of NCDs is attracting increasing attention at every level and in almost every country. Many of the causes and solutions are beyond the remit of the health sector alone, calling instead for a system-wide approach. However, with the necessary knowledge and skills, the millions of nurses worldwide are well placed to make a significant contribution to the prevention and management of NCDs, focusing particularly on tobacco cessation, a healthy diet (including safe use of alcohol) and physical activity.
Subject(s)
Chronic Disease/nursing , Education, Nursing/organization & administration , Health Promotion/methods , Clinical Competence , Humans , Nursing Education Research , Nursing Evaluation ResearchABSTRACT
This article addresses an area that has been largely underserved by the development community, and one in which there is a particularly good opportunity for the private sector to take a lead in making a difference to employees, customers and local communities: chronic, non-communicable diseases (NCDs). It highlights the extent of the epidemic of NCDs in developing countries, sets out the 'business case' for the private sector to act on NCDs, and gives examples of initiatives by business to ensure that the healthy choice really is an easier choice for employees, consumers and local communities. It makes the case that, to be genuinely sustainable, businesses should be addressing health as a core part of what they do and, by working in partnership - as called for by the Millennium Development Goals - they can make a real difference and become part of the solution. Identifying ways in which this can be done should form a key part both of planning for, and action after, the UN High-level Meeting on NCDs, to be held in September 2011.
Subject(s)
Food Industry/organization & administration , Health Promotion/organization & administration , Food Safety , Government Regulation , Humans , Marketing/organization & administration , Nutrition Policy , Obesity/epidemiology , Obesity/etiology , Obesity/prevention & control , Social Responsibility , United Kingdom/epidemiologyABSTRACT
Non-communicable diseases should become the next focus of the United Nations' aims to reduce poverty in developing countries.
Subject(s)
Chronic Disease/prevention & control , Developing Countries , Global Health , Health Priorities/organization & administration , Chronic Disease/epidemiology , Humans , Lobbying , Nurse's Role , United NationsABSTRACT
The charity C3 Collaborating for health wants nurses' views on how health care and nursing roles might evolve.
Subject(s)
Attitude of Health Personnel , Delivery of Health Care/trends , Nurse's Role , Charities , Continuity of Patient Care/trends , Cost Control , Delivery of Health Care/economics , Diffusion of Innovation , Forecasting , Humans , Internet/trends , Primary Health Care/trendsABSTRACT
UK nurses joined international colleagues to discuss the profession's contribution to fighting chronic conditions.