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A novel rural hospital/clinic-system practice-based research network: the Rural Addiction Implementation Network (RAIN) initiative and its goals, implementation, and early results. 新颖的农村医院/诊所系统实践研究网络:农村戒毒实施网络 (RAIN) 计划及其目标、实施情况和早期成果。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-04 DOI: 10.1080/00952990.2024.2394487
Kody Hafen, Harlan Wallace, Kayla Fritz, Cole Fordham, Tyler Haskell, A Taylor Kelley, Audrey L Jones, Gerald Cochran, Adam J Gordon

Background: Rural and frontier communities face high rates of opioid use disorders (OUDs). In 2021, the Rural Addiction Implementation Network (RAIN) sought to establish a rural hospital/clinic-system practice-based research network (RH-PBRN) to facilitate implementation of evidence-based addiction-related prevention, treatment, and recovery (PTR) services to reduce the morbidity of OUD and substance use disorder (SUD) in rural communities.Objective: To describe the goals and implementation of PTR activities of RAIN, a novel RH-PBRN.Methods: RAIN identified teams of external/internal facilitators at four rural hospitals/clinic-networks to achieve at least 15 PTR activities involving OUD and other SUDs. RAIN utilized an implementation-facilitation approach: facilitators assessed the implementation environment and promoted interventions to overcome barriers to PTR implementation. Other interventions included site visits, community of learning calls, and e-communication. RAIN assessed and recorded facilitators and barriers to implementation, milestone attainment, and outcomes of PTR activities. At 18 months, we queried facilitators about the fidelity and implementation of RAIN activities.Results: RAIN established an HP-PBRN in four sites (Idaho, Montana, Utah, and Wyoming). Within the HP-PBRN, 20 PTR activities were established (p = 7, T = 10, R = 3; range 3-7 per site). Barriers to implementation of PTR activities included competing clinical demands, especially due to COVID-19, lack of dedicated effort for staff at sites, and stigma of addiction and its treatment. Facilitators of implementation included the use of trained expert facilitators and communication between the sites.Conclusions: RAIN implemented 20 addiction-related PTR activities in four rural hospitals/clinic-networks. RAIN's intervention model could be replicated to address addiction-related harms in other rural communities.

背景:农村和边疆社区的阿片类药物使用失调(OUDs)发病率很高。2021 年,农村成瘾实施网络(RAIN)试图建立一个农村医院/诊所系统实践研究网络(RH-PBRN),以促进实施以证据为基础的成瘾相关预防、治疗和康复(PTR)服务,从而降低农村社区 OUD 和药物使用障碍(SUD)的发病率:描述新型 RH-PBRN RAIN 的目标和 PTR 活动的实施情况:RAIN 在四家农村医院/诊所网络中确定了外部/内部促进者团队,以实现至少 15 项涉及 OUD 和其他 SUD 的 PTR 活动。RAIN 采用了一种实施促进方法:促进者对实施环境进行评估,并推动干预措施,以克服实施 PTR 的障碍。其他干预措施包括现场访问、社区学习电话和电子通信。RAIN 评估并记录了实施的促进因素和障碍、里程碑的实现情况以及 PTR 活动的成果。在 18 个月时,我们向促进者询问了 RAIN 活动的忠实度和实施情况:RAIN 在四个地点(爱达荷州、蒙大拿州、犹他州和怀俄明州)建立了 HP-PBRN。在 HP-PBRN 中,共开展了 20 项 PTR 活动(P = 7,T = 10,R = 3;每个地点的范围为 3-7 项)。实施 PTR 活动的障碍包括相互竞争的临床需求(尤其是 COVID-19)、医疗点员工缺乏专门的努力以及对成瘾及其治疗的偏见。实施的促进因素包括使用训练有素的专家促进者以及各医疗点之间的沟通:RAIN 在四家农村医院/诊所网络中开展了 20 项与成瘾相关的 PTR 活动。RAIN 的干预模式可在其他农村社区推广,以解决与成瘾相关的危害问题。
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引用次数: 0
High lifetime prevalence of regular nitrous oxide use in French medical students. 法国医学生一生中经常使用一氧化二氮的比例很高。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-09-30 DOI: 10.1080/00952990.2024.2392566
Mathilde Thevenin, Alexandre Malmartel, Laurent Karila, Mathilde Camus Jacqmin

Background: Although nitrous oxide (N₂O) is increasingly misused recreationally, its use and risks among medical students who have professional access to it are rarely explored.Objectives: To investigate the recreational use of N₂O among medical students in Paris Region (France).Methods: This cross-sectional study used an online questionnaire distributed in 2022 through social networks, to all medical students (undergraduate student from the 2nd year of medical studies to residents until the end of the residency) from the six medical universities in Paris Region. We collected demographic characteristics, patterns of N₂O consumption, co-consumptions, and N₂O training (academic course or self-training). Factors associated with N₂O consumption and complications were analyzed using multivariable logistic regressions.Results: The questionnaires of 444 students (mean age: 25.9 years (SD = 2.69), 75.5% female, and 63.74% residents) were analyzed. Recreational N₂O consumption was reported by 71.85% of students and 20.50% consumed at least monthly. N₂O consumption was associated with being a resident (versus undergraduate student) (adjusted OR (aOR) = 3.07[1.45-6.72]; p < .01), receiving training on N₂O (aOR) = 3.13[1.84-6.24]; p < .01), and consumption of cannabis (aOR = 18.21[3.47-104.26]; p < .01), ecstasy (aOR = NA, p = .048) and poppers (aOR = 13.9[2.64-77.94]; p < .01). Complications (mainly dizziness, paresthesia and burns) were reported in 8.15% of students consuming N₂O. They were associated with consuming more than 10 balloons per intake (aOR = 6.04[1.32-25.00); p < .01) and inversely associated with receiving training (aOR = 0.35[0.14-0.86]; p = .01).Conclusions: Almost three-quarters of medical students experienced recreational N₂O consumption, particularly with poly-drug use. Given that complications were associated with high consumption and lack of education, risk training and screening for N₂O consumption could be beneficial.

背景:尽管一氧化二氮(N₂O)被越来越多地滥用于娱乐,但却很少有人探讨专业医学生使用一氧化二氮的情况及其风险:调查法国巴黎大区医科学生娱乐性使用一氧化二氮的情况:这项横断面研究于 2022 年通过社交网络向巴黎大区六所医科大学的所有医学生(从医学专业二年级的本科生到住院医师,直至住院医师培训结束)发放了一份在线调查问卷。我们收集了人口特征、N₂O 消费模式、共同消费和 N₂O 培训(学术课程或自我培训)。使用多变量逻辑回归分析了与 N₂O 消费和并发症相关的因素:对 444 名学生(平均年龄:25.9 岁(SD = 2.69),75.5% 为女性,63.74% 为居民)的问卷进行了分析。71.85%的学生报告了娱乐性消费 N₂O,20.50%的学生至少每月消费一次。N₂O 消费与住院医师(相对于本科生)(调整 OR (aOR) = 3.07[1.45-6.72]; p p p = .048)和 poppers(aOR = 13.9[2.64-77.94]; p p p = .01)有关:结论:近四分之三的医科学生有娱乐性消费 N₂O的经历,尤其是使用多种药物。鉴于并发症与高消耗量和缺乏教育有关,风险培训和N₂O消耗筛查可能是有益的。
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引用次数: 0
Exploring the impact of inflammatory cytokines on alcoholic liver disease: a Mendelian randomization study with bioinformatics insights into potential biological mechanisms. 探索炎症细胞因子对酒精性肝病的影响:一项孟德尔随机化研究与潜在生物机制的生物信息学见解。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-09-25 DOI: 10.1080/00952990.2024.2402569
Zhitao Chen, Chenchen Ding, Kailei Chen, Chicheng Lu, Qiyong Li

Background: Alcoholic liver disease (ALD) significantly contributes to global morbidity and mortality. The role of inflammatory cytokines in alcohol-induced liver injury is pivotal yet not fully elucidated.Objectives: To establish a causal link between inflammatory cytokines and ALD using a Mendelian Randomization (MR) framework.Methods: This MR study utilized genome-wide significant variants as instrumental variables (IVs) for assessing the relationship between inflammatory cytokines and ALD risk, focusing on individuals of European descent. The approach was supported by comprehensive sensitivity analyses and augmented by bioinformatics tools including differential gene expression, protein-protein interactions (PPI), Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, and analysis of immune cell infiltration.Results: Our findings reveal that increased levels of stem cell growth factor beta (SCGF-β, beta = 0.141, p = .032) and interleukin-7 (IL-7, beta = 0.311, p = .002) are associated with heightened ALD risk, whereas higher levels of macrophage inflammatory protein-1α (MIP-1α, beta = -0.396, p = .004) and basic fibroblast growth factor (bFGF, beta = -0.628, p = .008) are linked to reduced risk. The sensitivity analyses support these robust causal relationships. Bioinformatics analyses around inflammatory cytokine-associated SNP loci suggest multiple pathways through which cytokines influence ALD.Conclusion: The genetic evidence from this study convincingly demonstrates that certain inflammatory cytokines play directional roles in ALD pathogenesis. These findings provide insights into the complex biological pathways involved and underscore the potential for developing targeted therapies that modulate these inflammatory responses, ultimately improving clinical outcomes for ALD patients.

背景:酒精性肝病(ALD)是导致全球发病率和死亡率的重要原因。炎性细胞因子在酒精诱导的肝损伤中的作用至关重要,但尚未完全阐明:利用孟德尔随机化(MR)框架建立炎性细胞因子与 ALD 之间的因果联系:这项MR研究利用全基因组重大变异作为工具变量(IV),评估炎性细胞因子与ALD风险之间的关系,重点关注欧洲后裔。该方法得到了综合敏感性分析的支持,并得到了生物信息学工具的辅助,包括差异基因表达、蛋白质-蛋白质相互作用(PPI)、基因本体(GO)、京都基因和基因组百科全书(KEGG)富集分析以及免疫细胞浸润分析:我们的研究结果表明,干细胞生长因子β(SCGF-β,β=0.141,p=0.032)和白细胞介素-7(IL-7,β=0.311,p=0.002)水平升高与ALD风险升高有关,而巨噬细胞炎症蛋白-1α(MIP-1α,β=-0.396,p=0.004)和碱性成纤维细胞生长因子(bFGF,β=-0.628,p=0.008)水平升高与风险降低有关。敏感性分析支持这些稳健的因果关系。围绕炎性细胞因子相关 SNP 位点的生物信息学分析表明,细胞因子通过多种途径影响 ALD:本研究的遗传学证据令人信服地表明,某些炎性细胞因子在 ALD 发病机制中起着定向作用。这些发现深入揭示了所涉及的复杂生物通路,并强调了开发调节这些炎症反应的靶向疗法的潜力,从而最终改善 ALD 患者的临床预后。
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引用次数: 0
Perceptions of disposal options for unused opioid analgesics among people who have been prescribed an opioid analgesic in North Carolina. 北卡罗来纳州开出阿片类镇痛药处方的人群对未使用阿片类镇痛药处置方案的看法。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-08-22 DOI: 10.1080/00952990.2024.2386536
Cassidy Joyce, Alice R Richman, Melissa J Cox, Donald W Helme, J Todd Jackson, Mahdi Sesay, Kathleen L Egan

Background: Medication disposal programs have been promoted as one solution to the opioid crisis, but uptake by community members has been minimal.Objectives: To clarify perceptions of medication disposal options among people who have been prescribed an opioid analgesic in North Carolina to inform interventions that can facilitate the disposal of unused opioids.Methods: In 2022, we conducted focus groups with participants who received an opioid medication in the past year to gain information to develop an intervention related to the disposal of unused opioid medication (12 focus group discussions (FGDs); total N = 37; 30 identified as female, 6 as male, and 1 as another gender). Participants were shown a slide with the Food and Drug Administration's recommended disposal options and asked about their perceptions of each option. Themes were derived using an inductive, thematic, qualitative approach.Results: Seven themes about perceptions of medication disposal programs emerged from the data. Four of the themes reflect potential barriers to medication disposal: failed disposal attempts, lack of sufficient education on proper disposal, unclear meaning of specific disposal language, and concerns about existing disposal options. Three of the themes provide insight on potential facilitators of medication disposal: preference of low-cost disposal options, ease and accessibility among disposal methods, and preferred disposal methods.Conclusion: Patients should be provided clear and consistent guidance from prescribers and dispensing pharmacists on when and how to dispose of unused medications and opportunities to dispose of medications at no cost to the patient.

背景:药物处置计划已被作为阿片类药物危机的一种解决方案加以推广,但社区成员对该计划的接受度却很低:目的:澄清北卡罗来纳州被处方阿片类镇痛药的人群对药物处置选择的看法,为促进未使用阿片类药物处置的干预措施提供信息:2022 年,我们与去年接受过阿片类药物治疗的参与者进行了焦点小组讨论,以获取信息,从而制定与未使用阿片类药物处置相关的干预措施(12 次焦点小组讨论;总人数 = 37;其中 30 人为女性,6 人为男性,1 人为其他性别)。向参与者展示了一张幻灯片,上面有食品与药物管理局推荐的处理方案,并询问他们对每种方案的看法。采用归纳、主题、定性的方法得出了主题:结果:从数据中得出了七个关于对药物处置方案看法的主题。其中四个主题反映了药物处置的潜在障碍:处置尝试失败、缺乏足够的正确处置教育、特定处置语言含义不清以及对现有处置方案的担忧。其中三个主题提供了药物处置的潜在促进因素:低成本处置方案的偏好、处置方法的简易性和可及性以及首选处置方法:结论:处方医生和配药药剂师应为患者提供清晰一致的指导,告知患者何时以及如何处置未使用的药物,并为患者提供免费处置药物的机会。
{"title":"Perceptions of disposal options for unused opioid analgesics among people who have been prescribed an opioid analgesic in North Carolina.","authors":"Cassidy Joyce, Alice R Richman, Melissa J Cox, Donald W Helme, J Todd Jackson, Mahdi Sesay, Kathleen L Egan","doi":"10.1080/00952990.2024.2386536","DOIUrl":"https://doi.org/10.1080/00952990.2024.2386536","url":null,"abstract":"<p><p><i>Background:</i> Medication disposal programs have been promoted as one solution to the opioid crisis, but uptake by community members has been minimal.<i>Objectives:</i> To clarify perceptions of medication disposal options among people who have been prescribed an opioid analgesic in North Carolina to inform interventions that can facilitate the disposal of unused opioids.<i>Methods:</i> In 2022, we conducted focus groups with participants who received an opioid medication in the past year to gain information to develop an intervention related to the disposal of unused opioid medication (12 focus group discussions (FGDs); total <i>N</i> = 37; 30 identified as female, 6 as male, and 1 as another gender). Participants were shown a slide with the Food and Drug Administration's recommended disposal options and asked about their perceptions of each option. Themes were derived using an inductive, thematic, qualitative approach.<i>Results:</i> Seven themes about perceptions of medication disposal programs emerged from the data. Four of the themes reflect potential barriers to medication disposal: failed disposal attempts, lack of sufficient education on proper disposal, unclear meaning of specific disposal language, and concerns about existing disposal options. Three of the themes provide insight on potential facilitators of medication disposal: preference of low-cost disposal options, ease and accessibility among disposal methods, and preferred disposal methods.<i>Conclusion:</i> Patients should be provided clear and consistent guidance from prescribers and dispensing pharmacists on when and how to dispose of unused medications and opportunities to dispose of medications at no cost to the patient.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Implementing contingency management into rural recovery housing: recommendations of a professional advisory expert panel. 在农村恢复性住房中实施应急管理:专业咨询专家小组的建议。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-08-22 DOI: 10.1080/00952990.2024.2387725
David M Ledgerwood, Milena C Stott, Stacey Quesada, Marci Sontag, Rachel M Beck, Michael G McDonell, David Johnson, Dominick DePhilippis, Sherrie Donnelly, Bryan Hartzler, Tammera Nauts, Matthew D Novak, James A Peck, Carla J Rash

Background: Rural areas in the United States have been severely impacted by recent rises in substance use related mortality and psychosocial consequences. There is a dearth of treatment resources to address substance use disorder (SUD). Rural recovery houses (RRH) are important services that provide individuals with SUD with an environment where they can engage in recovery-oriented activities, but dropout rates are unacceptably high, and evidence-based interventions such as contingency management (CM) may reduce dropout and improve outcomes for RRH residents. In this paper, we describe the results of a national convening of experts that addressed important issues concerning the implementation of CM within the context of RRHs.Methods: Twelve experts (five female) in the areas of CM, RRH and rural health participated in a one-day facilitated meeting that used nominal group technique to identify expert consensus in three areas as they pertain to RRH: (a) facilitators and barriers to CM implementation, (b) elements necessary for successful program building based on group feedback, and (c) recommendations for future implementation of CM.Results: Several RRH- and system-level barriers and facilitators to implementing CM were identified by the panel, and these were categorized based on the level of importance for and ease of implementation. CM funding, staff and resident buy-in, set policies, education on CM, and consistent fidelity to CM procedures and tracking were identified as important requirements for implementing CM in RRH.Conclusions: We provide recommendations for the implementation of CM in RRH that may be useful in this context, as well as more broadly.

背景:美国农村地区受到近期药物使用相关死亡率和社会心理后果上升的严重影响。解决药物使用障碍(SUD)的治疗资源十分匮乏。农村康复之家(RRH)是一项重要的服务,它为药物滥用障碍患者提供了一个可以参与以康复为导向的活动的环境,但辍学率却高得令人无法接受,而应急管理(CM)等循证干预措施可以减少辍学率并改善农村康复之家居民的治疗效果。在本文中,我们介绍了全国专家会议的成果,会议讨论了在 RRHs 环境下实施应急管理的重要问题:方法:社区医疗、 RRH 和农村健康领域的 12 名专家(5 名女性)参加了为期一天的促进会议,会议采用名义小组技术,在三个与 RRH 相关的领域达成了专家共识:(a)实施社区医疗的促进因素和障碍;(b)根据小组反馈成功建立项目的必要因素;以及(c)对未来实施社区医疗的建议:小组确定了在 RRH 和系统层面实施社区医疗的若干障碍和促进因素,并根据实施的重要程度和难易程度对这些因素进行了分类。在 RRH 中实施社区医疗的重要条件包括:社区医疗资金、员工和居民的认同、既定政策、社区医疗教育以及始终坚持社区医疗程序和跟踪:我们为在 RRH 中实施社区医疗提供了一些建议,这些建议可能在这种情况下以及更广泛的情况下有用。
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引用次数: 0
Psychometric properties and Longitudinal Measurement Invariance of the Spanish version of the Alcohol Expectancies Questionnaire Short Form among young adult binge drinkers. 西班牙文版酗酒者酒精期望问卷简表的心理测量特性和纵向测量不一致性。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-08-19 DOI: 10.1080/00952990.2024.2377256
Bella M González-Ponce, Angelina Pilatti, Gabriela Rivarola Montejano, Adrian J Bravo, Fermín Fernández Calderón

Background: Longitudinal Measurement Invariance (LMI) is critically important to evaluate changes in alcohol expectancies over time. However, past research has not explored the longitudinal properties of the Spanish Expectancy Questionnaire Short Form (EQ-SF).Objectives: To examine the reliability, sources of validity (structural, invariance across sex, and concurrent validity), and LMI of the Spanish EQ-SF among young adults who engage in binge drinking.Methods: Participants (n = 279; 48.4% female) completed the EQ-SF and, two months later, completed it again along with measures of alcohol use, drinking motives, and protective behavioral strategies (PBS). We performed confirmatory factor analysis for structural validity and measurement invariance analysis for longitudinal and sex stability.Results: The eight-factor intercorrelated model (i.e. social facilitation, fun, sexual disinhibition, tension reduction, antisocial effects, negative emotional states, negative physical effects, and cognitive impairments) provided the best fit (χ2(df) = 497.29(224), CFI = .962, RMSEA = .064, SRMR = .049). This model was invariant across sex and time. Reliability coefficients (Ordinal alpha) for each dimension were consistently strong at both time points (from .72 to .93 at T1 and .73 to .91 at T2). Positive alcohol expectancies at baseline were positively related to alcohol use and drinking motives and negatively related to PBS at follow-up, demonstrating predictive validity.Conclusion: Our results support the temporal invariance of the EQ-SF scores among Spanish young adults who engage in binge drinking. The evidence supports the suitability of this measure for accurately assessing changes in alcohol expectancies over time in interventions aimed at preventing binge drinking in young adults.

背景:纵向测量不变性(LMI)对于评估酒精预期随时间的变化至关重要。然而,过去的研究并未探讨西班牙期望问卷简表(EQ-SF)的纵向特性:目的:研究西班牙EQ-SF在暴饮青年中的可靠性、效度来源(结构效度、性别不变性和并发效度)和LMI:参与者(n = 279;48.4% 为女性)填写了 EQ-SF,两个月后,他们再次填写了 EQ-SF,同时还填写了酒精使用、饮酒动机和保护性行为策略(PBS)的测量结果。我们对EQ-SF的结构有效性进行了确认性因子分析,并对其纵向稳定性和性别稳定性进行了测量不变量分析:八因子相互关联模型(即社交促进、乐趣、性抑制、紧张缓解、反社会影响、负面情绪状态、负面身体影响和认知障碍)的拟合效果最佳(χ2(df) = 497.29(224),CFI = .962,RMSEA = .064,SRMR = .049)。该模型在不同性别和不同时间具有不变性。在两个时间点,每个维度的信度系数(Ordinal alpha)都很高(T1 为 0.72 至 0.93,T2 为 0.73 至 0.91)。基线时的积极酒精预期与酒精使用和饮酒动机呈正相关,而与随访时的 PBS 呈负相关,这证明了预测的有效性:我们的研究结果表明,在暴饮的西班牙年轻人中,EQ-SF 分数具有时间不变性。有证据表明,在旨在预防年轻人暴饮暴食的干预活动中,该方法适用于准确评估酒精预期随时间推移而发生的变化。
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引用次数: 0
Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022. 2018 年至 2022 年门诊药物使用治疗机构内综合服务的可用性趋势。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-07-30 DOI: 10.1080/00952990.2024.2370462
Zoe Lindenfeld, Jonathan H Cantor, Ji E Chang

Background: Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs.Objective: To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022.Methods: We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities (n = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics.Results: Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model.Conclusion: Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.

背景:人们对药物使用障碍(SUD)治疗机构在多大程度上采用综合服务来满足患者的医疗和社会需求知之甚少:研究 2018 年至 2022 年期间门诊 SUD 治疗机构提供综合服务的趋势:我们使用了精神健康和成瘾治疗追踪库(Mental Health and Addiction Treatment Tracking Repository)中的数据,这是一个关于 SUD 治疗机构的全国性数据库(n = 13793)。我们考察了从 2018 年到 2022 年四个领域的综合服务和四种类型的 SUD 治疗服务的可用性。我们进行了双变量和多变量逻辑回归,预测综合服务模式(定义为每个服务领域至少有一项服务)的可用性,同时控制组织和社区特征:从 2018 年到 2022 年,提供的综合服务越来越多。在未调整和调整后的模型中,获得外部认证(OR:1.50;95%CI:1.30-1.74)、接受医疗补助(OR:1.51;95%CI:1.30-1.74)、开展社区外展(OR:2.05;95%CI:1.80-2.33)、提供纳洛酮和用药过量教育(OR:3.50;95%CI:3.06-3.99)、拥有强大的 SUD 治疗基础设施(OR:2.33;95%CI;2.结论:研究结果凸显了反映 SUD 治疗基础设施的重要因素,这些基础设施包括:白人居民比例较低(OR:0.99;95%CI:0.99-0.99);贫困居民比例较高(OR:1.02;95%CI:1.00-1.03);东北部与南部相比(OR:1.21;95%CI:1.01-1.45):研究结果凸显了反映组织变革工作经验和增强外部支持等因素的重要性。致力于提高综合服务普及率的政策制定者应将重点放在获得发展这些模式所需的资金和技术支持上。
{"title":"Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022.","authors":"Zoe Lindenfeld, Jonathan H Cantor, Ji E Chang","doi":"10.1080/00952990.2024.2370462","DOIUrl":"https://doi.org/10.1080/00952990.2024.2370462","url":null,"abstract":"<p><p><i>Background:</i> Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs.<i>Objective:</i> To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022.<i>Methods:</i> We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities (<i>n</i> = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics.<i>Results:</i> Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model.<i>Conclusion:</i> Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Detecting univariate, bivariate, and overall effects of drug mixtures using Bayesian kernel machine regression. 利用贝叶斯核机器回归检测药物混合物的单变量、双变量和总体效应。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-07-23 DOI: 10.1080/00952990.2024.2380463
Jemar R Bather, Larry Han, Alex S Bennett, Luther Elliott, Melody S Goodman

Background: Innovative analytic approaches to drug studies are needed to understand better the co-use of opioids with non-opioids among people using illicit drugs. One approach is the Bayesian kernel machine regression (BKMR), widely applied in environmental epidemiology to study exposure mixtures but has received far less attention in substance use research.Objective: To describe the utility of the BKMR approach to study the effects of drug substance mixtures on health outcomes.Methods: We simulated data for 200 individuals. Using the Vale and Maurelli method, we simulated multivariate non-normal drug exposure data: xylazine (mean = 300 ng/mL, SD = 100 ng/mL), fentanyl (mean = 200 ng/mL, SD = 71 ng/mL), benzodiazepine (mean = 300 ng/mL, SD = 55 ng/mL), and nitazene (mean = 200 ng/mL, SD = 141 ng/mL) concentrations. We performed 10,000 MCMC sampling iterations with three Markov chains. Model diagnostics included trace plots, r-hat values, and effective sample sizes. We also provided visual relationships of the univariate and bivariate exposure-response and the overall mixture effect.Results: Higher levels of fentanyl and nitazene concentrations were associated with higher levels of the simulated health outcome, controlling for age. Trace plots, r-hat values, and effective sample size statistics demonstrated BKMR stability across multiple Markov chains.Conclusions: Our understanding of drug mixtures tends to be limited to studies of single-drug models. BKMR offers an innovative way to discern which substances pose a greater health risk than other substances and can be applied to assess univariate, bivariate, and cumulative drug effects on health outcomes.

背景:为了更好地了解非法药物使用者同时使用阿片类药物和非阿片类药物的情况,需要对药物研究采用创新的分析方法。其中一种方法是贝叶斯核机器回归(BKMR),它被广泛应用于环境流行病学研究暴露混合物,但在药物使用研究中却很少受到关注:描述 BKMR 方法在研究毒品物质混合物对健康结果的影响时的实用性:方法:我们模拟了 200 人的数据。使用 Vale 和 Maurelli 方法,我们模拟了多元非正态分布的药物暴露数据:恶嗪(平均值 = 300 毫微克/毫升,标差 = 100 毫微克/毫升)、芬太尼(平均值 = 200 毫微克/毫升,标差 = 71 毫微克/毫升)、苯二氮卓(平均值 = 300 毫微克/毫升,标差 = 55 毫微克/毫升)和硝氮(平均值 = 200 毫微克/毫升,标差 = 141 毫微克/毫升)的浓度。我们使用三个马尔可夫链进行了 10,000 次 MCMC 采样迭代。模型诊断包括轨迹图、r-hat 值和有效样本量。我们还提供了单变量和双变量暴露-反应及总体混合物效应的直观关系:结果:在控制年龄的情况下,芬太尼和硝基苯浓度越高,模拟健康结果越高。示踪图、r-hat 值和有效样本量统计表明,BKMR 在多个马尔可夫链中具有稳定性:我们对药物混合物的了解往往局限于单药模型的研究。BKMR 提供了一种创新的方法,可用于鉴别哪些物质比其他物质对健康构成更大的风险,并可用于评估单变量、双变量和累积药物对健康结果的影响。
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引用次数: 0
New therapeutics for the prevention or amelioration of fetal alcohol spectrum disorders: a narrative review of the preclinical literature. 预防或改善胎儿酒精谱系障碍的新疗法:临床前文献综述。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-07-18 DOI: 10.1080/00952990.2024.2361442
Montserrat Olivares-Costa, María Carolina Fabio, Erwin De la Fuente-Ortega, Paola A Haeger, Ricardo Pautassi

Background: Ethanol consumption during pregnancy induces enduring detrimental effects in the offspring, manifesting as a spectrum of symptoms collectively termed as Fetal Alcohol Spectrum Disorders (FASD). Presently, there is a scarcity of treatments for FASD.Objectives: To analyze current literature, emphasizing evidence derived from preclinical models, that could potentially inform therapeutic interventions for FASD.Methods: A narrative review was conducted focusing on four prospective treatments: nutritional supplements, antioxidants, anti-inflammatory compounds and environmental enrichment. The review also highlights innovative therapeutic strategies applied during early (e.g. folate administration, postnatal days 4-9) or late (e.g. NOX2 inhibitors given after weaning) postnatal stages that resulted in significant improvements in behavioral responses during adolescence (a critical period marked by the emergence of mental health issues in humans).Results: Our findings underscore the value of treatments centered around nutritional supplementation or environmental enrichment, aimed at mitigating oxidative stress and inflammation, implying shared mechanisms in FASD pathogenesis. Moreover, the review spotlights emerging evidence pertaining to the involvement of novel molecular components with potential pharmacological targets (such as NOX2, MCP1/CCR2, PPARJ, and PDE1).Conclusions: Preclinical studies have identified oxidative imbalance and neuroinflammation as relevant pathological mechanisms induced by prenatal ethanol exposure. The relevance of these mechanisms, which exhibit positive feedback loop mechanisms, appear to peak during early development and decreases in adulthood. These findings provide a framework for the future development of therapeutic avenues in the development of specific clinical treatments for FASD.

背景:孕期服用乙醇会对后代产生持久的有害影响,表现为一系列症状,统称为胎儿酒精紊乱症(FASD)。目前,治疗 FASD 的方法很少:分析目前的文献,强调从临床前模型中获得的证据,这些证据有可能为 FASD 的治疗干预提供依据:方法:对营养补充剂、抗氧化剂、抗炎化合物和丰富环境这四种前瞻性治疗方法进行了叙述性综述。综述还重点介绍了在产后早期(如在产后第 4-9 天服用叶酸)或晚期(如在断奶后服用 NOX2 抑制剂)采用的创新治疗策略,这些策略显著改善了青春期(人类出现心理健康问题的关键时期)的行为反应:我们的研究结果强调了以营养补充或丰富环境为中心的治疗方法的价值,其目的是减轻氧化应激和炎症,这意味着FASD的发病机制是共同的。此外,该综述还强调了与潜在药理靶点(如 NOX2、MCP1/CCR2、PPARJ 和 PDE1)的新型分子成分参与有关的新证据:临床前研究发现,氧化失衡和神经炎症是产前乙醇暴露诱发的相关病理机制。这些机制表现出正反馈循环机制,其相关性似乎在早期发育期间达到顶峰,并在成年后下降。这些发现为今后开发针对 FASD 的特定临床疗法提供了一个治疗途径框架。
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引用次数: 0
X-ray absorption spectroscopy combined with deep learning for auto and rapid illicit drug detection. X 射线吸收光谱与深度学习相结合,用于自动快速检测非法药物。
IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-07-03 Epub Date: 2024-08-19 DOI: 10.1080/00952990.2024.2377262
Zheng Fang, Xiefeng Zhan, Bichao Ye

Background: X-ray absorption spectroscopy (XAS) is a widely used substance analysis technique. It bases on the different absorption coefficients at different energy level to achieve material identification. Additionally, the combination of spectral technology and deep learning can achieve auto detection and high accuracy in material identification.Objectives: Current methods are difficult to identify drugs quickly and nondestructively. Therefore, we explore a novel approach utilizing XAS for the detection of prohibited drugs with common X-ray tube source and photon-counting (PC) detector.Method: To achieve automatic, rapid, and accurate detection of drugs. A CdTe detector and a common X-ray source were used to collect data, then dividing the data into training and testing sets. Finally, the improved transformer encoder model was used for classification. LSTM and ResU-net models are selected for comparation.Result: Fifty substances, which are isomers or compounds with similar molecular formulas of drugs, were selected for experiment substances. The results showed that the improved transformer model achieving 1.4 hours for training time and 96.73% for accuracy, which is better than the LSTM (2.6 hours and 65%) and ResU-net (1.5 hours and 92.7%).Conclusion: It can be concluded that the attention mechanism is more accurate for spectral material identification. XAS combined with deep learning can achieve efficient and accurate drug identification, offering promising application in clinical drug testing and drug enforcement.

背景:X 射线吸收光谱(XAS)是一种广泛应用的物质分析技术。它基于不同能级的不同吸收系数来实现物质识别。此外,光谱技术与深度学习相结合,可实现自动检测,实现物质识别的高准确性:目前的方法难以快速、无损地识别药物。因此,我们利用普通的 X 射线管源和光子计数(PC)探测器,探索一种利用 XAS 检测违禁药物的新方法:方法:实现自动、快速、准确地检测毒品。方法:为了实现自动、快速、准确地检测毒品,使用碲化镉探测器和普通 X 射线管源收集数据,然后将数据分为训练集和测试集。最后,使用改进的变压器编码器模型进行分类。结果:实验物质选取了 50 种物质,它们是药物的同分异构体或分子式相似的化合物。结果表明,改进后的变压器模型训练时间为 1.4 小时,准确率为 96.73%,优于 LSTM(2.6 小时和 65%)和 ResU-net(1.5 小时和 92.7%):可以得出结论,注意力机制在光谱材料识别方面的准确率更高。XAS与深度学习相结合,可以实现高效、准确的药物识别,在临床药物检测和禁毒执法中具有广阔的应用前景。
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引用次数: 0
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American Journal of Drug and Alcohol Abuse
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