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1.
J Am Pharm Assoc (2003) ; 63(3): 925-932, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36935292

RESUMEN

BACKGROUND: Opioid Use Disorder (OUD) is a major public health concern, with mortality rates in individuals who use opioid medications being up to 30 times greater than those of individuals who do not use such medications. Social risk factors influence one's ability to make healthy choices and pose challenges for individuals recovering from OUD. OBJECTIVE: This study aimed to explore the relationship between OUD and social risk factors for patients who have been prescribed opioid medications. METHODS: Data for this retrospective cohort study were obtained from a health care system's comprehensive data warehouses consisting of electronic health records (EHR) with Social Determinants of Health (SDoH) screening information, and medical and prescription claims data. The study compared patients 18 years of age or older with an opioid prescription who were considered users of opioids to patients who had a documented diagnosis of OUD in the EHR. All patients were screened for SDoH. The analyses were performed using Statistical Analysis System (SAS) (SAS Institute Inc, Cary, NC). RESULTS: The study included patients with an outpatient visit at one of the health care system's primary care or oncology facilities between January 1, 2017 and December 31, 2018. There were 5003 patients with an opioid prescription who were considered users of opioids, and 209 patients with an opioid prescription as well as a diagnosis of OUD. Compared to the opioid use group, patients with OUD were more likely to have a lower educational attainment, encounter financial hardship, or be food insecure. Being female, older than 40, and having a higher Charlson Comorbidity Index score were factors associated with lower rates of opioid misuse. CONCLUSION: Identifying social risk factors and providing appropriate services to individuals with OUD is essential in mitigating challenges to recovery and promoting overall health for these individuals.


Asunto(s)
Analgésicos Opioides , Trastornos Relacionados con Opioides , Humanos , Femenino , Adolescente , Adulto , Masculino , Analgésicos Opioides/efectos adversos , Estudios Retrospectivos , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/tratamiento farmacológico , Prescripciones de Medicamentos , Factores de Riesgo
2.
Front Immunol ; 12: 687627, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34220843

RESUMEN

Oral mucositis (OM) is a treatment-limiting adverse side effect of radiation and chemotherapy. Approximately 80% of patients undergoing radiotherapy (RT) for head and neck cancers (HNC) develop OM, representing a major unmet medical condition. Our understanding of the immunopathogenesis of OM is limited, due in part to the surprising paucity of information regarding healing mechanisms in the oral mucosa. RNAseq of oral tissue in a murine model that closely mimics human OM, showed elevated expression of IL-17 and related immune pathways in response to head and neck irradiation (HNI). Strikingly, mice lacking the IL-17 receptor (IL-17RA) exhibited markedly more severe OM. Restoration of the oral mucosa was compromised in Il17ra-/- mice and components associated with healing, including matrix metalloproteinase 3, 10 and IL-24 were diminished. IL-17 is typically associated with recruitment of neutrophils to mucosal sites following oral infections. Unexpectedly, in OM the absence of IL-17RA resulted in excessive neutrophil recruitment and immunopathology. Instead, neutrophil activation was IL-1R-driven in Il17ra-/- mice. Blockade of IL-1R and depletion of neutrophils lessened the severity of damage in these mice. Overall, we show IL-17 is protective in OM through multiple mechanisms including restoration of the damaged epithelia and control of the neutrophil response. We also present a clinically relevant murine model of human OM to improve mechanistic understanding and develop rational translational therapeutics.


Asunto(s)
Interleucina-17/metabolismo , Traumatismos por Radiación/metabolismo , Receptores de Interleucina-17/metabolismo , Estomatitis/metabolismo , Lengua/metabolismo , Cicatrización de Heridas , Animales , Proliferación Celular , Supervivencia Celular , Modelos Animales de Enfermedad , Interleucina-1/metabolismo , Interleucina-17/genética , Ratones Noqueados , Infiltración Neutrófila , Traumatismos por Radiación/genética , Traumatismos por Radiación/inmunología , Traumatismos por Radiación/patología , Receptores de Interleucina-1/metabolismo , Receptores de Interleucina-17/genética , Transducción de Señal , Estomatitis/genética , Estomatitis/inmunología , Estomatitis/patología , Lengua/inmunología , Lengua/patología , Transcriptoma
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