Is that a treatment program? Examining the physical landscape of opioid treatment programs in Los Angeles.

INTRODUCTION: Little attention has been paid to the built environment of outpatient opioid treatment programs, despite the need to increase access to medications for opioid use disorder, particularly among people of color. The aims of this study were to rate the attractiveness of publicly-funded opioid treatment programs (OTPs) in Los Angeles County and explore whether less attractive OTPs are found in disadvantaged neighborhoods. METHODS: We conducted observations of the exteriors of all OTPs located in specialty substance use disorder treatment clinics in Los Angeles County in 2021 (N = 44). We created an attractiveness index based on attractiveness of the building exteriors and the surrounding grounds, the presence of disorder such as garbage and graffiti, and the presence of bars on the windows. We tested whether less attractive facilities were more likely to be situated in disadvantaged neighborhoods with high concentrations of racial/ethnic minorities. RESULTS: Most building exteriors were found to have an ordinary level of attractiveness or rated as unattractive. The grounds were largely unattractive. We found a significant negative association between attractiveness and neighborhood disadvantage. CONCLUSION: This project was a preliminary study of the physical conditions of OTPs in Los Angeles. We found was that the physical conditions of OTPs in LA County were generally poor. Research has identified many individual and structural barriers to treatment for people with opioid use disorders. Future research should empirically test the association between the built environment of treatment clinics and access to treatment, particularly in communities of color.

Utilization Efficiency of Human Milk Oligosaccharides by Human-Associated Akkermansia Is Strain Dependent.

Akkermansia muciniphila is a mucin-degrading bacterium found in the human gut and is often associated with positive human health. However, despite being detected by as early as 1 month of age, little is known about the role of Akkermansia in the infant gut. Human milk oligosaccharides (HMOs) are abundant components of human milk and are structurally similar to the oligosaccharides that comprise mucin, the preferred growth substrate of human-associated Akkermansia. A limited subset of intestinal bacteria has been shown to grow well on HMOs and mucin. We therefore examined the ability of genomically diverse strains of Akkermansia to grow on HMOs. First, we screened 85 genomes representing the four known Akkermansia phylogroups to examine their metabolic potential to degrade HMOs. Furthermore, we examined the ability of representative isolates to grow on individual HMOs in a mucin background and analyzed the resulting metabolites. All Akkermansia genomes were equipped with an array of glycoside hydrolases associated with HMO deconstruction. Representative strains were all able to grow on HMOs with various efficiencies and growth yields. Strain CSUN-19, belonging to the AmIV phylogroup, grew to the highest level in the presence of fucosylated and sialylated HMOs. This activity may be partially related to the increased copy numbers and/or the enzyme activities of the α-fucosidases, α-sialidases, and ß-galactosidases. This study examines the utilization of individual purified HMOs by Akkermansia strains representing all known phylogroups. Further studies are required to examine how HMO ingestion influences gut microbial ecology in infants harboring different Akkermansia phylogroups. IMPORTANCE Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk and provide several benefits to developing infants, including the recruitment of beneficial bacteria to the human gut. Akkermansia strains are largely considered beneficial bacteria and have been detected in colostrum, breast milk, and young infants. A. muciniphila MucT, belonging to the AmI phylogroup, contributes to the HMO deconstruction capacity of the infant. Here, using phylogenomics, we examined the genomic capacities of four Akkermansia phylogroups to deconstruct HMOs. Indeed, each phylogroup contained differences in their genomic capacities to deconstruct HMOs, and representative strains of each phylogroup were able to grow using HMOs. These Akkermansia-HMO interactions potentially influence gut microbial ecology in early life, a critical time for the development of the gut microbiome and infant health.

A farmacovigilância na reabilitação fonoaudiológica de pacientes com doenças neurológicas / Vigilancia farmacéutica en la rehabilitación fonoaudiológica de pacientes con enfermedades neurológicas / Pharmacosurveillance in phonoaudiological rehabilitation of patients with neurological illnesses

O paciente com doença neurológica pode apresentar alterações de fala, linguagem e de funções relacionadas à alimentação, além de limitação física e/ou psíquica, por conseqüência de um distúrbio do sistema nervoso central ou periférico. As medicações utilizadas no tratamento farmacológico destes pacientes podem potencializar as disfunções já existentes, devido aos efeitos adversos provocados, que podem piorar o quadro clínico do paciente e, por conseqüência, o processo de reabilitação fonoaudiológica. O objetivo deste trabalho foi identificar as reações adversas a medicamentos (RAM) dos principais fármacos administrados por pacientes com doenças neurológicas e o grau de interferência das RAM na terapia fonoaudiológica. Para o fonoaudiólogo, torna-se imprescindível o conhecimento dos efeitos das RAM, bem como o domínio de informações relativas ao grau de interferência desses fármacos sobre a comunicação e funções da alimentação. Sendo assim, a prática da farmacovigilância ajuda o fonoaudiólogo a prevenir os problemas relacionados a medicamentos, garantindo a evolução terapêutica, a reabilitação e a melhora da qualidade de vida do paciente.

Patients with neurological illness can present alterations of speech, language and functions related to feeding, besides physical and/or psychic limitations, due to disturbances of the central or peripheral nervous system. Medications used in the pharmacological treatment of these patients can potentiate dysfunctions already present due to their possible side-effects, which can worsen the clinical condition of patients and as a consequence, the process of phonoaudiological rehabilitation. The aim of this work is to identify medicine side-effects (MSE) of the main drugs given to patients with neurological illnesses and the degree of interference of these in phonoaudiological therapy. For the phonoaudiologist, the knowledge of the effect of MSE is essential, as well as having information about the degree of interference these drugs have on communication and feeding functions. Thus, the practice of pharmacosurveillance helps phonoaudiologists prevent problems related to drugs, guaranteeing therapeutic evolution, rehabilitation and the improvement of the patient’s quality of life.

Los pacientes con enfermedad neurológica pueden presentar alteraciones del habla, del lenguaje y de las funciones relacionadas con la alimentación, además de las limitaciones físicas y/o psíquicas, debido a los disturbios del sistema nervioso central o periférico. Las medicaciones usadas en el tratamiento farmacológico de estos pacientes pueden reforzar disfunciones existentes debido a sus efectos secundarios posibles, y esto puede empeorar la condición clínica de los pacientes y por consiguiente, el proceso de rehabilitación fonoaudiológica. El objetivo de este trabajo es identificar los efectos secundarios de medicaciones (ESM) de las drogas principales dadas a los pacientes con enfermedades neurológicas y el grado de interferencia de éstos en la terapia fonoaudiológica. Para el fonoaudiólogo, el conocimiento de los efectos de ESM es esencial, así como tener información sobre el grado de interferencia de estas drogas en las funciones de comunicación y de alimentación. Así, la práctica de de la vigilancia farmacéutica ayuda los fonoaudiólogos a prevenir los problemas relacionados con las drogas, garantizando la evolución terapéutica, la rehabilitación y la mejora de la calidad de vida del paciente.

Padrão de sucção e seu desempenho em recém-nascidos pré-termo e a termo no momento da alta hospitalar

Verifica o padrão de sucção e a sua eficiência através de uma avaliação de alimentação, comparando recém-nascidos a termo com recém-nascidos pré-termo, no momento da alta hospitalar. Analisa, paralelamente, o efeito da estimulação sensorial, comparando grupos de recém-nascidos pré-termo com e sem estimulação. Os Ss são 102 bebês, divididos entre vários grupos, em três instituições distintas sendo cada um deles avaliados sempre no período da manhã, no horário da mamada. A avaliação teve por base as variáveis alimentares consideradas para análise do desempenho/eficiência da avaliação: volume de leite, volume de leite ingerido por minuto, (ml/min) número de sucções entre pausas e dias de vida . Através da análise de variância (ANOVA), obtém efeitos globais significativos fazendo comparações dois-a-dois, através do teste de Bonferroni, ao nível de 0,05. As variáveis alimentares consideradas para análise do padrão de sucção são: estado de consciência no início e fim da mamada, grau de força de sucção, pausas, número de sucções nutritivas, variação na força de sucção, escape de leite, variação do tono global, sinal de estresse e tempo que permanece sugando. Como essas variáveis estão relacionadas a aspectos qualitativos cria categorias e atribui valores diferentes para cada variável. Utiliza na análise estatística o teste Qui-quadrado de Pearson. Os resultados obtidos evidenciam que os padrões de postura, sucção, deglutição, respiração e a sua coordenação nos recém-nascidos pré-termo não se equiparam aos da população nascida a termo, mesmo estando aqueles no momento da alta hospitalar. Isto ocorre independentemente de terem ou não recebido estimulação motora-oral, ficando evidente a diferença existente no que diz respeito ao desenvolvimento da alimentação. Verifica melhora no desenvolvimento do padrão motor-oral e desempenho/eficiência para sugar dos bebês pré-termo, em função das estimulações sensoriais a eles aplicadas (sucção não nutritiva e/ou tátil) (AU)