A Qualitative Exploration of Rural Older Adults' Experiences With Pain From Chronic Illnesses and Its Treatment.

Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.

Applications of Immersive Virtual Reality for Illicit Substance Use: A Systematic Review.

OBJECTIVE: This study aims to review applications of immersive, head-mounted display (HMD)-delivered virtual reality (VR) technology for the assessment and modification of clinically relevant factors (e.g., craving, electrophysiological reactions, brain activation) present in illicit substance use. METHOD: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review was conducted and retrieved articles from four databases. Articles included were peer-reviewed, empirical studies and were screened on criteria pertaining to sample using (or with a history of using) substances and measurement of substance-related factors. RESULTS: Eighteen articles met inclusion criteria. Applications of immersive, HMD-delivered VR in assessment and modification were most prevalent among individuals using (or with a history of using) methamphetamine and targeted subjective craving, electrophysiological biomarkers (e.g., heart rate variability, skin conductance), and brain activity. Environments presented through VR involved substance-relevant cues (e.g., paraphernalia) and neuropsychological assessments. The majority of assessment studies elicited clinically relevant factor(s) present in illicit substance use through VR and all reviewed modification studies effectively reduced clinically relevant factors in methamphetamine and opioid use (e.g., craving, subjective pain). CONCLUSIONS: There is evidence to support the use of immersive, HMD-delivered VR in the assessment and modification of clinically relevant factors in methamphetamine use, as well as preliminary evidence to support its effectiveness for clinically relevant factors in opioid use. Future research should further examine the effectiveness of HMD-delivered VR in modifying illicit substance use and triangulate biomarkers measured in individuals using illicit substances.

Survey of barriers and opportunities for prescribing buprenorphine for opioid use disorder in Alabama.

Opioid-related overdose deaths have significantly increased in the USA and in Alabama. Despite this, medications for opioid use disorder (MOUD) remains significantly underutilized. Thus, this study aims to gain a better understanding of clinicians' viewpoints on potential barriers and opportunities that are likely to impact and improve the access to MOUD, especially buprenorphine prescribing. A cross-sectional survey study was conducted with Alabama's clinicians (n = 492). The survey containing a QR code was mailed to clinicians throughout the state and was asked about their viewpoints and thoughts on prescribing buprenorphine. Multivariable linear regression was used to examine associations between OUD self-efficacy, beliefs about the effectiveness of MOUD, attitudes regarding whether or not MOUD is addictive, and positive affect surrounding the treatment of OUD patients. A minority of respondents (39.8%) reported that they have an active X-waiver for MOUD. Results showed that beliefs that MOUD is addictive were significantly inversely correlated with beliefs about MOUD being effective. Furthermore, both self-efficacy and positive affect were significantly and positively associated with beliefs that MOUD is effective. Furthermore, nurse practitioners were more likely than physicians to have higher scores on the "MAT is Addictive" construct. Self-efficacy with OUD patients was positively associated with the "MOUD is Effective" construct. Finally, results showed that X-waivered providers expressed greater positive affect toward OUD patients than providers who were not X-waivered (b = 2.9, p < 0.001). Belief that MOUD is effective was also positively associated with higher scores on the positive affect construct (b = 0.5, p < 0.001). Several barriers and opportunities were identified in our survey data which could be used to explore MOUD expansion, especially buprenorphine prescribing. Strategic plans in expanding MOUD access may include educational trainings on MOUD, motivating clinicians to utilize their capacity by implementing incentive plans, increasing provider self-efficacy, reducing stigma around MOUD, and providing more financial support to uninsured patients.

Opioid Literacy Among Individuals Living in Rural Alabama: The Role of Social Determinants of Health.

Using the social determinants of health (SDOH) framework, the current study aimed to examine opioid literacy and the role of SDOH on opioid literacy. This study used a cross-sectional survey design to collect self-reported data from people living in four rural Alabama counties affected by the opioid crisis. Participants reported moderate levels of opioid knowledge. There were no significant predictors of general knowledge. For opioid overdose knowledge, the strongest individual predictors were educational level (Bachelor's degree) and self-rated financial strain, which contributed to higher scale scores. For the models evaluating opioid overdose response knowledge, the strongest individual predictors were minority status (inverse), self-rated mental health, and interpersonal safety. Our findings indicate that SDOH, such as financial strain and interpersonal safety, are significantly linked to opioid literacy. Educational efforts to enhance opioid literacy, proper usage, and management in rural counties should consider SDOH factors. Findings further outline the team's integrative approach to developing intervention strategies for opioid treatment and recovery that can benefit the northwest Alabama community and beyond. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 52-59.].

Resilience as a Protective Factor in Older Adult Suicide: A Rapid Review.

Nearly 700,000 suicide deaths occur each year. One in every five suicide death occurs among adults over 60 years of age or older. As the aging population increases rapidly, there is a need to understand protective factors to prevent older adult suicide. This study used the rapid review methodology to search literature from 1997 to 2022, examining whether resilience was a protective factor. The literature search was conducted over the following six databases for peer-reviewed journals and gray literature including Abstracts in Social Gerontology, Academic Search Premier, APA PsycInfo, CINAHL Complete, MEDLINE, and SocINDEX with Full Text. A total of six peer-reviewed journal articles met the inclusion criteria. The conclusion of the articles suggested resilience may be a protective factor in older adult suicide. Despite its underpinning, resilience in suicide prevention literature is lacking. More studies should examine resilience and its constructs as part of the effort to prevent older adult suicide.

Racial and ethnic differences in retrospective end-of-Life outcomes: A systematic review.

The purpose of this systematic review was to provide a comprehensive account of racial and ethnic differences in retrospective end-of-life outcomes. Studies were searched from the following databases: Abstracts in Social Gerontology, Academic Search Premier, CINAHL Plus with Full Text, ERIC, MEDLINE, PsycINFO, PubMED, and SocIndex. Studies were included if they were published in English, included people from groups who have been minoritized, included adults aged 18 and older, used retrospective data, and examined end-of-life outcomes. Results from most of the 29 included studies showed that people from groups who have been minoritized had more aggressive/intensive care, had less hospice care, were more likely to die in a hospital, less likely to engage in advance care planning, less likely to have good quality of care, and experienced more financial burden at the end of life. Implications for practice (timely referrals), policy (health insurance access), and research (intervention studies) are provided.

The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups.

BACKGROUND: Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS: This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS: The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION: Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.

Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs.

BACKGROUND: Fatal drug overdoses in the USA hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. METHODS: Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. RESULTS: Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. CONCLUSIONS: Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.

Deficiency in RCAT-1 Function Causes Dopamine Metabolism Related Behavioral Disorders in Caenorhabditis elegans.

When animals are faced with food depletion, food search-associated locomotion is crucial for their survival. Although food search-associated locomotion is known to be regulated by dopamine, it has yet to investigate the potential molecular mechanisms governing the regulation of genes involved in dopamine metabolism (e.g., cat-1, cat-2) and related behavioral disorders. During the studies of the pheromone ascaroside, a signal of starvation stress in C. elegans, we identified R02D3.7, renamed rcat-1 (regulator of cat genes-1), which had previously been shown to bind to regulatory sequences of both cat-1 and cat-2 genes. It was found that RCAT-1 (R02D3.7) is expressed in dopaminergic neurons and functions as a novel negative transcriptional regulator for cat-1 and cat-2 genes. When a food source becomes depleted, the null mutant, rcat-1(ok1745), exhibited an increased frequency of high-angled turns and intensified area restricted search behavior compared to the wild-type animals. Moreover, rcat-1(ok1745) also showed defects in state-dependent olfactory adaptation and basal slowing response, suggesting that the mutants are deficient in either sensing food or locomotion toward food. However, rcat-1(ok1745) has normal cuticular structures and locomotion genes. The discovery of rcat-1 not only identifies a new subtype of dopamine-related behaviors but also provides a potential therapeutic target in Parkinson's disease.

Impact of COVID-19 Among People Who Use Drugs: A Qualitative Study With Harm Reduction Workers and People Who Use Drugs.

Background: Fatal drug overdoses in the United States hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This exploratory qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. Methods: Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. Results: Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. Conclusions: Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.

A conserved neuronal DAF-16/FoxO plays an important role in conveying pheromone signals to elicit repulsion behavior in Caenorhabditis elegans.

Animals use pheromones as a conspecific chemical language to respond appropriately to environmental changes. The soil nematode Caenorhabditis elegans secretes ascaroside pheromones throughout the lifecycle, which influences entry into dauer phase in early larvae, in addition to sexual attraction and aggregation. In adult hermaphrodites, pheromone sensory signals perceived by worms usually elicit repulsion as an initial behavioral signature. However, the molecular mechanisms underlying neuronal pheromone sensory process from perception to repulsion in adult hermaphrodites remain poorly understood. Here, we show that pheromone signals perceived by GPA-3 is conveyed through glutamatergic neurotransmission in which neuronal DAF-16/FoxO plays an important modulatory role by controlling glutaminase gene expression. We further provide evidence that this modulatory role for DAF-16/FoxO seems to be conserved evolutionarily by electro-physiological study in mouse primary hippocampal neurons that are responsible for glutamatergic neurotransmission. These findings provide the basis for understanding the nematode pheromone signaling, which seems crucial for adaptation of adult hermaphrodites to changes in environmental condition for survival.

MGL-1 on AIY neurons translates starvation to reproductive plasticity via neuropeptide signaling in Caenorhabditis elegans.

Reproductive plasticity is the ability of an animal to modulate its reproductive functions in response to environmental changes. For example, Caenorhabditis elegans, a free-living nematode, can adjust the onsets of oogenesis and embryogenesis under harsh environmental conditions, including starvation. However, the molecular mechanisms used to perceive and translate environmental signals into reproductive functional adjustments remain largely uncharacterized. We discovered that in C. elegans, the glutamate receptor homolog MGL-1 initiated reproductive plasticity in response to starvation. A genetic analysis of the mutant gene, mgl-1(tm1811), suggested that starvation delayed the onsets of oogenesis and embryogenesis via MGL-1. Cell-specific rescues of mgl-1 deletion mutants, which used transgenic lines designed to express MGL-1 in different neurons (e.g., RMD, AIA, AIY, and NSM), suggested that only AIY-rescued animals exhibited normal delays in oogenesis and embryogenesis equivalent to those of wild-type animals, suggesting recovery. Furthermore, in AIY neurons, MGL-1 appears to use neuropeptide signaling, rather than glutamate, to translate starvation stimuli into delayed oogenesis and embryogenesis. Our findings, which reveal molecular linkages between starvation signals and reproductive alterations, may provide a basis for understanding energy reallocation mechanisms, as the mgl-1 deletion mutant exhibited more severe reductions in lifespan and fat accumulation than did wild-type animals under starvation conditions. Taken together, MGL-1 is the molecular driver underlying the translation of starvation signals to reproduction plasticity in an AIY neuron-specific manner.