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1.
Parasit Vectors ; 13(1): 372, 2020 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-32709250

RESUMEN

BACKGROUND: The pork tapeworm, Taenia solium, is a serious public health problem in rural low-resource areas of Latin America, Africa and Asia, where the associated conditions of nuerocysticercosis (NCC) and porcine cysticercosis cause substantial health and economic harms. An accurate and validated transmission model for T. solium would serve as an important new tool for control and elimination, as it would allow for comparison of available intervention strategies, and prioritization of the most effective strategies for control and elimination efforts. METHODS: We developed a spatially-explicit agent-based model (ABM) for T. solium ("CystiAgent") that differs from prior T. solium models by including a spatial framework and behavioral parameters such as pig roaming, open human defecation, and human travel. In this article, we introduce the structure and function of the model, describe the data sources used to parameterize the model, and apply sensitivity analyses (Latin hypercube sampling-partial rank correlation coefficient (LHS-PRCC)) to evaluate model parameters. RESULTS: LHS-PRCC analysis of CystiAgent found that the parameters with the greatest impact on model uncertainty were the roaming range of pigs, the infectious duration of human taeniasis, use of latrines, and the set of "tuning" parameters defining the probabilities of infection in humans and pigs given exposure to T. solium. CONCLUSIONS: CystiAgent is a novel ABM that has the ability to model spatial and behavioral features of T. solium transmission not available in other models. There is a small set of impactful model parameters that contribute uncertainty to the model and may impact the accuracy of model projections. Field and laboratory studies to better understand these key components of transmission may help reduce uncertainty, while current applications of CystiAgent may consider calibration of these parameters to improve model performance. These results will ultimately allow for improved interpretation of model validation results, and usage of the model to compare available control and elimination strategies for T. solium.

2.
Am J Drug Alcohol Abuse ; : 1-11, 2020 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-32515234

RESUMEN

BACKGROUND: The U.S. opioid epidemic has caused substantial harm for over 20 years. Policy interventions have had limited impact and sometimes backfired. Experts recommend a systems modeling approach to address the complexities of opioid policymaking. OBJECTIVES: Develop a system dynamics simulation model that reflects the complexities and can anticipate intended and unintended intervention effects. METHODS: The model was developed from literature review and data gathering. Its outputs, starting in 1990, were compared against 12 historical time series. Four illustrative interventions were simulated for 2020-2030: reducing prescription dosage by 20%, cutting diversion by 30%, increasing addiction treatment from 45% to 65%, and increasing lay naloxone use from 4% to 20%. Sensitivity testing was performed to determine effects of uncertainties. No human subjects were studied. RESULTS: The model fits historical data well with error percentage averaging 9% across 201 data points. Interventions to reduce dosage and diversion reduce the number of persons with opioid use disorder (PWOUD) by 11% and 16%, respectively, but each of these interventions reduces overdoses by only 1%. Boosting treatment reduces overdoses by 3% but increases PWOUD by 1%. Expanding naloxone reduces overdose deaths by 12% but increases PWOUD by 2% and overdoses by 3%. Combining all four interventions reduces PWOUD by 24%, overdoses by 4%, and deaths by 18%. Uncertainties may affect these numerical results, but policy findings are unchanged. CONCLUSION: No single intervention significantly reduces both PWOUD and overdose deaths, but a combination strategy can do so. Entering the 2020s, only protective measures like naloxone expansion could significantly reduce overdose deaths.

3.
Artículo en Inglés | MEDLINE | ID: mdl-32132906

RESUMEN

The specific role of the autonomic nervous system (ANS) in emotional and behavioral regulation-particularly in relation to automatic processes-has gained increased attention in the sensory modulation literature. This mini-review article summarizes current knowledge about the role of the ANS in sensory modulation, with a focus on the integrated functions of the ANS and the hypothalamic-pituitary-adrenal (HPA) axis and their measurement. Research from the past decade illustrates that sympathetic and parasympathetic interactions are more complex than previously assumed. Patterns of ANS activation vary across individuals, with distinct physiological response profiles influencing the reactivity underlying automatic behavioral responses. This review article advances a deeper understanding of stress and the complex stress patterns within the ANS and HPA axis that contribute to allostatic load (AL). We argue that using multiple physiological measurements to capture individual ANS response variation is critical for effectively treating children with sensory modulation disorder (SMD) and sensory differences. We consider the relative contributions of automatic vs. deliberately controlled processes across large-scale neural networks in the development of sensorimotor function and their associated links with arousal patterns and sensory over- and under-responsivity.

4.
Parasit Vectors ; 12(1): 352, 2019 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-31311596

RESUMEN

BACKGROUND: Taenia solium (cysticercosis) is a parasitic cestode that is endemic in rural populations where open defecation is common and free-roaming pigs have access to human feces. The purpose of this study was to examine the roaming patterns of free-range pigs, and identify areas where T. solium transmission could occur via contact with human feces. We did this by using GPS trackers to log the movement of 108 pigs in three villages of northern Peru. Pigs were tracked for approximately six days each and tracking was repeated in the rainy and dry seasons. Maps of pig ranges were analyzed for size, distance from home, land type and contact with human defecation sites, which were assessed in a community-wide defecation survey. RESULTS: Consistent with prior GPS studies and spatial analyses, we found that the majority of pigs remained close to home during the tracking period and had contact with human feces in their home areas: pigs spent a median of 79% (IQR: 61-90%) of their active roaming time within 50 m of their homes and a median of 60% of their contact with open defecation within 100 m of home. Extended away-from-home roaming was predominately observed during the rainy season; overall, home range areas were 61% larger during the rainy season compared to the dry season (95% CI: 41-73%). Both home range size and contact with open defecation sites showed substantial variation between villages, and contact with open defecation sites was more frequent among pigs with larger home ranges and pigs living in higher density areas of their village. CONCLUSIONS: Our study builds upon prior work showing that pigs predominately roam and have contact with human feces within 50-100 m of the home, and that T. solium transmission is most likely to occur in these concentrated areas of contact. This finding, therefore, supports control strategies that target treatment resources to these areas of increased transmission. Our finding of a seasonal trend in roaming ranges may be useful for control programs relying on pig interventions, and in the field of transmission modeling, which require precise estimates of pig behavior and risk.


Asunto(s)
Cisticercosis/veterinaria , Defecación , Heces/parasitología , Estaciones del Año , Enfermedades de los Porcinos/transmisión , Animales , Conducta Animal , Cisticercosis/epidemiología , Cisticercosis/transmisión , Femenino , Sistemas de Información Geográfica , Humanos , Masculino , Movimiento , Perú/epidemiología , Factores de Riesgo , Población Rural , Análisis Espacial , Porcinos/parasitología , Enfermedades de los Porcinos/epidemiología , Enfermedades de los Porcinos/parasitología , Taenia solium/aislamiento & purificación
5.
J Manipulative Physiol Ther ; 42(4): 237-246, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31221495

RESUMEN

OBJECTIVE: The purpose of this investigation was to create a system dynamics (SD) model, including published data and required assumptions, as a tool for future research identifying the role of chiropractic care in the management of chronic, nonmalignant pain in a Canadian population. METHODS: We present an illustrative case description of how we evaluated the feasibility of conducting a large-scale clinical trial to assess the impact of chiropractic care in mitigating excessive opioid use in Canada. We applied SD modeling using current evidence and key assumptions where such evidence was lacking. Modeling outcomes were highlighted to determine which potential factors were necessary to account for compelling study designs. RESULTS: Results suggest that a future clinical study diverting patients with nonmalignant musculoskeletal pain early to the chiropractic stream of care could be most effective. System dynamics modeling also highlighted design challenges resulting from unresearched assumptions that needed to be proxied for model completion. Assumptions included changing rates in opioid-associated deaths and rates of success in treatment management of addicted patients. CONCLUSION: In this case, SD modeling identified current research gaps and strong contenders for appropriate follow-up questions in a clinical research domain, namely the role of chiropractic care in the management of chronic, nonmalignant pain in a Canadian population.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor Crónico/terapia , Técnicas de Apoyo para la Decisión , Modelos Teóricos , Dolor Musculoesquelético/terapia , Canadá , Quiropráctica/métodos , Humanos , Manipulación Quiropráctica , Trastornos Relacionados con Opioides/prevención & control
6.
Inj Epidemiol ; 5(1): 34, 2018 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-30221317

RESUMEN

BACKGROUND: Motor vehicle crashes remain the leading cause of teen deaths in spite of preventive efforts. Prevention strategies could be advanced through new analytic approaches that allow us to better conceptualize the complex processes underlying teen crash risk. This may help policymakers design appropriate interventions and evaluate their impacts. METHODS: System Dynamics methodology was used as a new way of representing factors involved in the underlying process of teen crash risk. Systems dynamics modeling is relatively new to public health analytics and is a promising tool to examine relative influence of multiple interacting factors in predicting a health outcome. Dynamics models use explicit statements about the process being studied and depict how the elements within the system interact; this usually leads to discussion and improved insight. A Teen Driver System Model was developed by following an iterative process where causal hypotheses were translated into systems of differential equations. These equations were then simulated to test whether they can reproduce historical teen driving data. The Teen Driver System Model that we developed was calibrated on 47 newly-licensed teen drivers. These teens were recruited and followed over a period of 5-months. A video recording system was used to gather data on their driving events (elevated g-force, near-crash, and crash events) and miles traveled. RESULTS: The analysis suggests that natural risky driving improvement curve follows a course of a slow improvement, then a faster improvement, and finally a plateau: that is, an S-shaped decline in driving events. Individual risky driving behavior depends on initial risk and driving exposure. Our analysis also suggests that teen risky driving improvement curve is created endogenously by several feedback mechanisms. A feedback mechanism is a chain of variables interacting with each other in such a way they form a closed path of cause and effect relationships. CONCLUSIONS: Teen risky driving improvement process is created endogenously by several feedback mechanisms. The model proposed in the present article to reflect this improvement process can spark discussion, which may pinpoint to additional processes that can benefit from further empirical research and result in improved insight.

7.
Ann Fam Med ; 16(5): 440-442, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30201641

RESUMEN

We aimed to better understand the association between opioid-prescribing continuity, risky prescribing patterns, and overdose risk. For this retrospective cohort study, we included patients with long-term opioid use, pulling data from Oregon's Prescription Drug Monitoring Program (PDMP), vital records, and hospital discharge registry. A continuity of care index (COCI) score was calculated for each patient, and we defined metrics to describe risky prescribing and overdose. As prescribing continuity increased, likelihood of filling risky opioid prescriptions and overdose hospitalization decreased. Prescribing continuity is an important factor associated with opioid harms and can be calculated using administrative pharmacy data.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Continuidad de la Atención al Paciente/estadística & datos numéricos , Sobredosis de Droga/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Adolescente , Adulto , Anciano , Sobredosis de Droga/etiología , Femenino , Humanos , Prescripción Inadecuada/efectos adversos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/etiología , Oregon/epidemiología , Alta del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Programas de Monitoreo de Medicamentos Recetados , Sistema de Registros , Estudios Retrospectivos , Adulto Joven
8.
Front Neurol ; 9: 203, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29670568

RESUMEN

Despite increasing public awareness and a growing body of literature on the subject of concussion, or mild traumatic brain injury, an urgent need still exists for reliable diagnostic measures, clinical care guidelines, and effective treatments for the condition. Complexity and heterogeneity complicate research efforts and indicate the need for innovative approaches to synthesize current knowledge in order to improve clinical outcomes. Methods from the interdisciplinary field of systems science, including models of complex systems, have been increasingly applied to biomedical applications and show promise for generating insight for traumatic brain injury. The current study uses causal-loop diagramming to visualize relationships between factors influencing the pathophysiology and recovery trajectories of concussive injury, including persistence of symptoms and deficits. The primary output is a series of preliminary systems maps detailing feedback loops, intrinsic dynamics, exogenous drivers, and hubs across several scales, from micro-level cellular processes to social influences. Key system features, such as the role of specific restorative feedback processes and cross-scale connections, are examined and discussed in the context of recovery trajectories. This systems approach integrates research findings across disciplines and allows components to be considered in relation to larger system influences, which enables the identification of research gaps, supports classification efforts, and provides a framework for interdisciplinary collaboration and communication-all strides that would benefit diagnosis, prognosis, and treatment in the clinic.

9.
Pain ; 159(6): 1147-1154, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29521813

RESUMEN

Lumbar fusion surgery is usually prompted by chronic back pain, and many patients receive long-term preoperative opioid analgesics. Many expect surgery to eliminate the need for opioids. We sought to determine what fraction of long-term preoperative opioid users discontinue or reduce dosage postoperatively; what fraction of patients with little preoperative use initiate long-term use; and what predicts long-term postoperative use. This retrospective cohort study included 2491 adults undergoing lumbar fusion surgery for degenerative conditions, using Oregon's prescription drug monitoring program to quantify opioid use before and after hospitalization. We defined long-term postoperative use as ≥4 prescriptions filled in the 7 months after hospitalization, with at least 3 occurring >30 days after hospitalization. Overall, 1045 patients received long-term opioids preoperatively, and 1094 postoperatively. Among long-term preoperative users, 77.1% continued long-term postoperative use, and 13.8% had episodic use. Only 9.1% discontinued or had short-term postoperative use. Among preoperative users, 34.4% received a lower dose postoperatively, but 44.8% received a higher long-term dose. Among patients with no preoperative opioids, 12.8% became long-term users. In multivariable models, the strongest predictor of long-term postoperative use was cumulative preoperative opioid dose (odds ratio of 15.47 [95% confidence interval 8.53-28.06] in the highest quartile). Cumulative dose and number of opioid prescribers in the 30-day postoperative period were also associated with long-term use. Thus, lumbar fusion surgery infrequently eliminated long-term opioid use. Opioid-naive patients had a substantial risk of initiating long-term use. Patients should have realistic expectations regarding opioid use after lumbar fusion surgery.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Región Lumbosacra/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Medicamentos bajo Prescripción/uso terapéutico , Fusión Vertebral/efectos adversos , Adolescente , Adulto , Anciano , Área Bajo la Curva , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/cirugía , Estudios de Cohortes , Esquema de Medicación , Monitoreo de Drogas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prescripciones/estadística & datos numéricos , Adulto Joven
11.
J Pain ; 19(2): 166-177, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29054493

RESUMEN

Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their effects on prescribing and health outcomes remain unclear, with conflicting reports. We sought to determine if prescriber use of Oregon's PDMP led to fewer high-risk opioid prescriptions or overdose events. We conducted a retrospective cohort study from October 2011 through October 2014, using statewide PDMP data, hospitalization registry, and vital records. Early PDMP registrants (n = 927) were matched with clinicians who never registered during the study period, using baseline prescribing metrics in a propensity score. Generalized estimating equations were used to examine prescribing trends after PDMP registration, using 2-month intervals. We found a statewide decline in measures of per capita opioid prescribing. However, compared with nonregistrants, PDMP registrants did not subsequently have significantly fewer patients receiving high-dose prescriptions, overlapping opioid and benzodiazepine prescriptions, inappropriate prescriptions, prescriptions from multiple prescribers, or overdose events. At baseline, frequent PDMP users wrote fewer high-risk opioid prescriptions than infrequent users; this persisted during follow-up with few significant group differences in trend. Thus, although opioid prescribing declined statewide after implementing the PDMP, registrants did not show greater declines than nonregistrants. PERSPECTIVE: Factors other than PDMP use may have had greater influence on prescribing trends. Refinements in the PDMP program and related policies may be necessary to increase PDMP effects.


Asunto(s)
Analgésicos Opioides/efectos adversos , Prescripciones de Medicamentos/estadística & datos numéricos , Mal Uso de Medicamentos de Venta con Receta/efectos adversos , Programas de Monitoreo de Medicamentos Recetados , Benzodiazepinas/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Masculino , Oregon , Evaluación de Resultado en la Atención de Salud , Sistema de Registros , Trastornos Relacionados con Sustancias/epidemiología
12.
Pain ; 159(1): 150-156, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28976421

RESUMEN

To develop a simple, valid model to identify patients at high risk of opioid overdose-related hospitalization and mortality, Oregon prescription drug monitoring program, Vital Records, and Hospital Discharge data were linked to estimate 2 logistic models; a first model that included a broad range of risk factors from the literature and a second simplified model. Receiver operating characteristic curves, sensitivity, and specificity of the models were analyzed. Variables retained in the final model were categories such as older than 35 years, number of prescribers, number of pharmacies, and prescriptions for long-acting opioids, benzodiazepines or sedatives, or carisoprodol. The ability of the model to discriminate between patients who did and did not overdose was reasonably good (area under the receiver operating characteristic curve = 0.82, Nagelkerke R = 0.11). The positive predictive value of the model was low. Computationally simple models can identify high-risk patients based on prescription history alone, but improvement of the predictive value of models may require information from outside the prescription drug monitoring program. Patient or prescription features that predict opioid overdose may differ from those that predict diversion.


Asunto(s)
Analgésicos Opioides/envenenamiento , Dolor Crónico/tratamiento farmacológico , Sobredosis de Droga/prevención & control , Programas de Monitoreo de Medicamentos Recetados , Prescripciones de Medicamentos , Humanos , Modelos Teóricos , Factores de Riesgo
13.
Front Neurol ; 8: 513, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29033888

RESUMEN

Traumatic brain injury (TBI) has been called "the most complicated disease of the most complex organ of the body" and is an increasingly high-profile public health issue. Many patients report long-term impairments following even "mild" injuries, but reliable criteria for diagnosis and prognosis are lacking. Every clinical trial for TBI treatment to date has failed to demonstrate reliable and safe improvement in outcomes, and the existing body of literature is insufficient to support the creation of a new classification system. Concussion, or mild TBI, is a highly heterogeneous phenomenon, and numerous factors interact dynamically to influence an individual's recovery trajectory. Many of the obstacles faced in research and clinical practice related to TBI and concussion, including observed heterogeneity, arguably stem from the complexity of the condition itself. To improve understanding of this complexity, we review the current state of research through the lens provided by the interdisciplinary field of systems science, which has been increasingly applied to biomedical issues. The review was conducted iteratively, through multiple phases of literature review, expert interviews, and systems diagramming and represents the first phase in an effort to develop systems models of concussion. The primary focus of this work was to examine concepts and ways of thinking about concussion that currently impede research design and block advancements in care of TBI. Results are presented in the form of a multi-scale conceptual framework intended to synthesize knowledge across disciplines, improve research design, and provide a broader, multi-scale model for understanding concussion pathophysiology, classification, and treatment.

14.
Am J Drug Alcohol Abuse ; 41(6): 508-18, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25982491

RESUMEN

BACKGROUND: Nonmedical use of pharmaceutical opioid analgesics (POA) increased dramatically over the past two decades and remains a major health problem in the United States, contributing to over 16 000 accidental poisoning deaths in 2010. OBJECTIVES: To create a systems-oriented theory/model to explain the historical behaviors of interest, including the various populations of nonmedical opioid users and accidental overdose mortality within those populations. To use the model to explore policy interventions including tamper-resistant drug formulations and strategies for reducing diversion of opioid medicines. METHODS: A system dynamics model was constructed to represent the population of people who initiate nonmedical POA usage. The model incorporates use trajectories including development of use disorders, transitions from reliance on informal sharing to paying for drugs, transition from oral administration to tampering to facilitate non-oral routes of administration, and transition to heroin use by some users, as well as movement into and out of the population through quitting and mortality. Empirical support was drawn from national surveys (NSDUH, TEDS, MTF, and ARCOS) and published studies. RESULTS: The model was able to replicate the patterns seen in the historical data for each user population, and the associated overdose deaths. Policy analysis showed that both tamper-resistant formulations and interventions to reduce informal sharing could significantly reduce nonmedical user populations and overdose deaths in the long term, but the modeled effect sizes require additional empirical support. CONCLUSION: Creating a theory/model that can explain system behaviors at a systems level scale is feasible and facilitates thorough evaluation of policy interventions.


Asunto(s)
Analgésicos Opioides/efectos adversos , Política de Salud , Modelos Estadísticos , Trastornos Relacionados con Opioides/mortalidad , Trastornos Relacionados con Opioides/prevención & control , Progresión de la Enfermedad , Sobredosis de Droga , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos
15.
Behav Brain Res ; 282: 144-54, 2015 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-25549855

RESUMEN

The paper focuses on the biology of stress and resilience and their biomarkers in humans from the system science perspective. A stressor pushes the physiological system away from its baseline state toward a lower utility state. The physiological system may return toward the original state in one attractor basin but may be shifted to a state in another, lower utility attractor basin. While some physiological changes induced by stressors may benefit health, there is often a chronic wear and tear cost due to implementing changes to enable the return of the system to its baseline state and maintain itself in the high utility baseline attractor basin following repeated perturbations. This cost, also called allostatic load, is the utility reduction associated with both a change in state and with alterations in the attractor basin that affect system responses following future perturbations. This added cost can increase the time course of the return to baseline or the likelihood of moving into a different attractor basin following a perturbation. Opposite to this is the system's resilience which influences its ability to return to the high utility attractor basin following a perturbation by increasing the likelihood and/or speed of returning to the baseline state following a stressor. This review paper is a qualitative systematic review; it covers areas most relevant for moving the stress and resilience field forward from a more quantitative and neuroscientific perspective.


Asunto(s)
Adaptación Psicológica/fisiología , Alostasis/fisiología , Resiliencia Psicológica , Estrés Psicológico/psicología , Humanos , Biología de Sistemas/métodos
16.
J Behav Health Serv Res ; 42(4): 540-53, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24554390

RESUMEN

Most pharmaceutical opioids are used to treat pain, and they have been demonstrated to be effective medications for many. Their abuse and misuse pose significant public health concerns in the USA. Research has provided much insight into the prevalence, scope, and drivers of opioid abuse, but a holistic understanding is limited by a lack of available data regarding key aspects of this public health problem. Twelve data gaps were revealed during the creation of a systems-level computer model of medical use, diversion, nonmedical use, and the adverse outcomes associated with opioid analgesics in the USA. Data specific to these gaps would enhance the validity and real-world applications of systems-level models of this public health problem and would increase understanding of the complex system in which use and abuse occur. This paper provides an overview of these gaps, argues for the importance of closing them, and provides specific recommendations for future data collection efforts.


Asunto(s)
Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/etiología , Salud Pública , Humanos
17.
Rev Health Care ; 5(1): 33-50, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25525498

RESUMEN

OBJECTIVE: Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation. This work offers a systematic categorization of data sources regarding the nonmedical use of pharmaceutical opioids in the United States. METHODS: A list of keywords regarding the nonmedical use of pharmaceutical opioids was used to conduct systematic searches in PubMed®. Filtration of search results generated 92 peer-reviewed academic articles, published between January 1995 and April 2012, as well as a number of primary data sources. Lists of topics were developed independently by two researchers which were later compared and consolidated. All sources were then categorized according to their relevance to each of these topics and according to their capacity for geographical and longitudinal trend analysis. RESULTS: Tables cataloging data sources can be used to identify data relevant to specific topics in diversion, nonmedical use, and adverse outcomes associated with pharmaceutical opioids, and they illustrate global trends in data coverage, identifying several topics that have minimal data. A network diagram illustrates global trends in data coverage, showing variation among sources in the number of topics they cover, as well as variation among topics in the number of sources that cover them. CONCLUSIONS: The categorization of data sources is hoped to facilitate ongoing research, analysis, and evaluation of this public health problem by serving as a guide for researchers, policy makers, and others who seek data regarding the nonmedical use of pharmaceutical opioids in the United States.

18.
Health Educ Behav ; 40(1 Suppl): 74S-86S, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24084403

RESUMEN

Three educational interventions were simulated in a system dynamics model of the medical use, trafficking, and nonmedical use of pharmaceutical opioids. The study relied on secondary data obtained in the literature for the period of 1995 to 2008 as well as expert panel recommendations regarding model parameters and structure. The behavior of the resulting systems-level model was tested for fit against reference behavior data. After the base model was tested, logic to represent three educational interventions was added and the impact of each intervention on simulated overdose deaths was evaluated over a 7-year evaluation period, 2008 to 2015. Principal findings were that a prescriber education intervention not only reduced total overdose deaths in the model but also reduced the total number of persons who receive opioid analgesic therapy, medical user education not only reduced overdose deaths among medical users but also resulted in increased deaths from nonmedical use, and a "popularity" intervention sharply reduced overdose deaths among nonmedical users while having no effect on medical use. System dynamics modeling shows promise for evaluating potential interventions to ameliorate the adverse outcomes associated with the complex system surrounding the use of opioid analgesics to treat pain.


Asunto(s)
Analgésicos Opioides/efectos adversos , Sobredosis de Droga/prevención & control , Personal de Salud/educación , Trastornos Relacionados con Opioides/prevención & control , Educación del Paciente como Asunto , Desvío de Medicamentos bajo Prescripción/prevención & control , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Simulación por Computador , Sobredosis de Droga/etiología , Sobredosis de Droga/mortalidad , Humanos , Modelos Educacionales , Modelos Teóricos , Trastornos Relacionados con Opioides/mortalidad , Desvío de Medicamentos bajo Prescripción/estadística & datos numéricos , Medición de Riesgo , Análisis de Sistemas , Estados Unidos/epidemiología
19.
Sci Transl Med ; 4(129): 129fs6, 2012 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-22496544

RESUMEN

A simplified dynamic model generates patient-specific estimates of intracranial pressure and suggests a path forward for bringing simulated (SIM) physiologic models to the patient's bedside.


Asunto(s)
Presión Sanguínea/fisiología , Circulación Cerebrovascular/fisiología , Presión Intracraneal/fisiología , Humanos , Masculino
20.
Pain Med ; 12 Suppl 2: S26-35, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21668754

RESUMEN

OBJECTIVE: A panel of experts in pain medicine and public policy convened to examine root causes and risk factors for opioid-related poisoning deaths and to propose recommendations to reduce death rates. METHODS: Panelists reviewed results from a search of PubMed and state and federal government sources to assess frequency, demographics, and risk factors for opioid-related overdose deaths over the past decade. They also reviewed results from a Utah Department of Health study and a summary of malpractice lawsuits involving opioid-related deaths. RESULTS: National data demonstrate a pattern of increasing opioid-related overdose deaths beginning in the early 2000s. A high proportion of methadone-related deaths was noted. Although methadone represented less than 5% of opioid prescriptions dispensed, one third of opioid-related deaths nationwide implicated methadone. Root causes identified by the panel were physician error due to knowledge deficits, patient non-adherence to the prescribed medication regimen, unanticipated medical and mental health comorbidities, including substance use disorders, and payer policies that mandate methadone as first-line therapy. Other likely contributors to all opioid-related deaths were the presence of additional central nervous system-depressant drugs (e.g., alcohol, benzodiazepines, and antidepressants) and sleep-disordered breathing. CONCLUSIONS: Causes of opioid-related deaths are multifactorial, so solutions must address prescriber behaviors, patient contributory factors, nonmedical use patterns, and systemic failures. Clinical strategies to reduce opioid-related mortality should be empirically tested, should not reduce access to needed therapies, should address risk from methadone as well as other opioids, and should be incorporated into any risk evaluation and mitigation strategies enacted by regulators.


Asunto(s)
Analgésicos Opioides/envenenamiento , Sobredosis de Droga/mortalidad , Analgésicos Opioides/uso terapéutico , Comorbilidad , Bases de Datos Factuales , Sobredosis de Droga/etiología , Humanos , Errores de Medicación , Metadona/envenenamiento , Dolor/tratamiento farmacológico , Cooperación del Paciente , Síndromes de la Apnea del Sueño/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Estados Unidos
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