Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Harm Reduct J ; 18(1): 119, 2021 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-34823538

RESUMO

BACKGROUND: The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. METHODS: We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. RESULTS: Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients' access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients' access to treatment via telehealth may hinge on clinician perceptions of patient "stability" rather than patient preferences. CONCLUSIONS: Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed "unstable" via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.


Assuntos
Buprenorfina , COVID-19 , Transtornos Relacionados ao Uso de Opioides , Telemedicina , Buprenorfina/uso terapêutico , Humanos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , SARS-CoV-2 , Estados Unidos
2.
JAMA Netw Open ; 4(7): e2118801, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34323984

RESUMO

Importance: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. Objective: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. Design, Setting, and Participants: This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. Interventions: The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. Main Outcomes and Measures: Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. Results: Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients' treatment preferences and risk of opioid misuse. Conclusions and Relevance: In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. Trial Registration: ClinicalTrials.gov Identifier: NCT03134092.

3.
Hum Vaccin Immunother ; 17(9): 2868-2872, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-33970786

RESUMO

Widespread SARS-CoV-2 vaccine uptake will be critical to resolution of the COVID-19 pandemic. Politicians have the potential to impact vaccine sentiment and uptake through vaccine-related communication with the public. We used tweets (n = 6,201), abstracted from Quorum, a public affairs software platform, to examine changes in the frequency of vaccine-related communication by legislators on the social media platform, Twitter. We found an increase in vaccine-related tweets by legislators following the arrival of SARS-CoV-2 in the United States. In the pre-COVID-19 era the majority of vaccine-related tweets were generated by Democrat and state senators. The increase in tweets following the arrival of COVID-19, however, was greater among Republican and federal legislators than Democrat or state legislators. This suggests that legislators who were previously less engaged in public discussion of vaccination, became engaged following the arrival of SARS-CoV-2, which may have implications for COVID-19 vaccine uptake among their followers.


Assuntos
COVID-19 , Mídias Sociais , Vacinas contra COVID-19 , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Estados Unidos
6.
Psychol Assess ; 29(6): 710-719, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28594214

RESUMO

This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and service connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD service connected status. The concordance rate between independent SCID current PTSD diagnosis and PTSD disability examination diagnosis was 70.4%, and between SCID lifetime PTSD diagnosis and PTSD disability examination diagnosis was 77.7%. Among veterans with current SCID diagnosed PTSD, Black veterans were significantly less likely than White veterans to receive a PTSD diagnosis from their C&P examiner (odds ratio [OR] = .39, p = .003, confidence interval [CI] = .20-.73). Among veterans without current SCID diagnosed PTSD, White veterans were significantly more likely than Black veterans to receive a PTSD diagnosis from their C&P examiner (OR = 4.07, p = .005, CI = 1.51-10.92). Splitting the sample by use of psychometric testing revealed that examinations that did not include psychometric testing demonstrated the same relation between veteran race and diagnostic concordance. However, for examinations in which psychometric testing was used, the racial disparity between SCID PTSD status and disability exam PTSD status was no longer significant. Results suggest that psychometric testing may reduce disparities in VA PTSD disability exam outcomes. (PsycINFO Database Record


Assuntos
Afro-Americanos/estatística & dados numéricos , Avaliação da Deficiência , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adulto , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
7.
J Trauma Dissociation ; 18(5): 679-692, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27918877

RESUMO

Research has revealed a significant association between several peritraumatic emotional responses and posttraumatic stress disorder (PTSD). Preliminary research has also linked peritraumatic emotional responses with a diagnosis of major depressive disorder (MDD). The majority of this research has been cross-sectional, thereby making it difficult to determine the extent to which the various peritraumatic emotional responses may increase risk for, or serve as a premorbid marker of, PTSD and MDD. This study examined the longitudinal role of peritraumatic emotional responses on the subsequent development of PTSD and MDD in a sample of US military veterans. Whereas a number of peritraumatic emotional responses were concurrently associated with PTSD, only peritraumatic numbness maintained the association with this diagnosis longitudinally. For MDD, peritraumatic numbness was the only emotional response related to the diagnosis both concurrently and longitudinally. Study findings are a preliminary proof of concept that peritraumatic numbness may serve as a premorbid marker for the development of PTSD and MDD following a traumatic event. Implications of these findings for the diagnosis, assessment, and treatment of both PTSD and MDD are discussed.


Assuntos
Transtorno Depressivo Maior/psicologia , Emoções , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Sistema de Registros , Fatores de Risco , Inquéritos e Questionários , Estados Unidos
8.
Front Psychol ; 7: 1096, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27486427

RESUMO

This paper presents a limited case study examining the causal inference of student mobility on standardized test performance, within one middle-class high school in suburban Connecticut. Administrative data were used from a district public high school enrolling 319 10th graders in 2010. Propensity score methods were used to estimate the causal effect of student mobility on Math, Science, Reading, and Writing portions of the Connecticut Academic Performance Test (CAPT), after matching mobile vs. stable students on gender, race/ethnicity, eligibility for free/reduced lunches, and special education status. Analyses showed that mobility was associated with lower performance in the CAPT Writing exam. Follow-up analyses revealed that this trend was only significant among those who were ineligible for free/reduced lunches, but not among eligible students. Additionally, mobile students who were ineligible for free/reduced lunches had lower performance in the CAPT Science exam according to some analyses. Large numbers of students transferring into a school district may adversely affect standardized test performance. This is especially relevant for policies that affect student mobility in schools, given the accountability measures in the No Child Left Behind that are currently being re-considered in the recent Every Student Succeeds Act.

9.
J Clin Psychiatry ; 77(4): 517-22, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-26797388

RESUMO

OBJECTIVE: This study examined the extent to which veterans' posttraumatic stress disorder (PTSD) service connection (SC) status corresponded to their PTSD diagnostic status, as determined by a semistructured diagnostic interview. METHOD: Participants were 834 veterans in the Veterans After-Discharge Longitudinal Registry (Project VALOR), an observational registry of veterans with and without PTSD who are enrolled in the Veterans Affairs (VA) health care system. PTSD diagnostic status was confirmed using the Structured Clinical Interview for DSM-IV (SCID). RESULTS: Concordance between PTSD SC status and current and lifetime PTSD diagnosis was 70.2% and 77.2%, respectively. Individuals with PTSD SC were twice as likely as those without PTSD SC to have a current SCID PTSD diagnosis (OR = 2.11 [95% CI, 1.47-3.04]; P < .001) and almost 3 times as likely to have a lifetime SCID PTSD diagnosis (OR = 2.72 [95% CI, 1.67-4.41]; P < .001). For current PTSD, results showed a slightly higher proportion of false positives-individuals who did not meet SCID criteria but who did have SC for PTSD-than false negatives-individuals who met SCID criteria but did not have SC for PTSD. For lifetime PTSD, the proportion of false negatives was approximately twice the proportion of false positives. CONCLUSIONS: PTSD diagnostic and SC status are discordant for a significant minority of veterans. Findings revealed that both the number of veterans who are service connected without meeting criteria for PTSD and the number of veterans who meet PTSD criteria but have not been granted SC status are concerning.


Assuntos
Campanha Afegã de 2001- , Registros Eletrônicos de Saúde/estatística & dados numéricos , Guerra do Iraque 2003-2011 , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Adulto , Idoso , Diagnóstico Diferencial , Avaliação da Deficiência , Feminino , Humanos , Entrevista Psicológica , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estatística como Assunto , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto Jovem
10.
Addict Behav ; 36(12): 1160-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21835550

RESUMO

This study examined prevalence of alcohol dependence symptoms and diagnosis among a nationally representative sample of recent onset adolescent drinkers aged 12-21 years (mean 17 years) across different levels of drinking drawn from National Survey of Drug Use and Health (N=9490). We assessed whether the relationship between level of alcohol use and alcohol dependence was similar for individuals from different socio-demographic groups (i.e., gender, age group, ethnic group, family income, and substance use in the past year). The most prevalent DSM-IV alcohol dependence criteria at low levels of alcohol use were "unsuccessful efforts to cut down", "tolerance", and "time spent" in activities necessary to obtain alcohol or recover from its effect. Logistic regression with polynomial contrasts indicated increasing rates of each criterion and an overall dependence diagnosis with increasing alcohol exposure that differed most between the lowest levels of recent drinking frequency. After controlling for drinking quantity, younger adolescents, females, Native American/Alaskans and Asian/Pacific Islanders were most likely to experience alcohol dependence symptoms and a diagnosis of dependence, suggesting that these demographic subgroups may experience dependence symptoms or develop dependence more quickly after beginning to drink. Recognizing early symptoms of alcohol dependence may assist in early identification and intervention of those at risk for heavier drinker in the future.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Adolescente , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/diagnóstico , Alcoolismo/etiologia , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...