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Evolution and Reproducibility of Simulation Modeling in Epidemiology and Health Policy Over Half a Century. 半个世纪以来流行病学和卫生政策模拟模型的演变和可重复性。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab006
Mohammad S Jalali, Catherine DiGennaro, Abby Guitar, Karen Lew, Hazhir Rahmandad

Simulation models are increasingly being used to inform epidemiologic studies and health policy, yet there is great variation in their transparency and reproducibility. In this review, we provide an overview of applications of simulation models in health policy and epidemiology, analyze the use of best reporting practices, and assess the reproducibility of the models using predefined, categorical criteria. We identified and analyzed 1,613 applicable articles and found exponential growth in the number of studies over the past half century, with the highest growth in dynamic modeling approaches. The largest subset of studies focused on disease policy models (70%), within which pathological conditions, viral diseases, neoplasms, and cardiovascular diseases account for one-third of the articles. Model details were not reported in almost half of the studies. We also provide in-depth analysis of modeling best practices, reporting quality and reproducibility of models for a subset of 100 articles (50 highly cited and 50 randomly selected from the remaining articles). Only 7 of 26 in-depth evaluation criteria were satisfied by more than 80% of samples. We identify areas for increased application of simulation modeling and opportunities to enhance the rigor and documentation in the conduct and reporting of simulation modeling in epidemiology and health policy.

模拟模型越来越多地被用于流行病学研究和卫生政策,但其透明度和可重复性差异很大。在这篇综述中,我们概述了模拟模型在卫生政策和流行病学中的应用,分析了最佳报告实践的使用,并使用预定义的分类标准评估了模型的可重复性。我们确定并分析了1,613篇适用的文章,发现在过去的半个世纪里,研究数量呈指数增长,其中动态建模方法的增长最快。最大的研究子集集中在疾病政策模型上(70%),其中病理状况、病毒性疾病、肿瘤和心血管疾病占文章的三分之一。几乎一半的研究没有报告模型细节。我们还为100篇文章的子集(50篇被高度引用的文章和50篇随机选择的文章)提供建模最佳实践、报告质量和模型可重复性的深入分析。在26项深度评价标准中,只有7项的样本满意率超过80%。我们确定了增加模拟建模应用的领域,以及在流行病学和卫生政策模拟建模的实施和报告中加强严谨性和文件记录的机会。
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引用次数: 11
Longitudinal Methods for Modeling Exposures in Pharmacoepidemiologic Studies in Pregnancy. 妊娠药物流行病学研究中暴露建模的纵向方法。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab002
Mollie E Wood, Angela Lupattelli, Kristin Palmsten, Gretchen Bandoli, Caroline Hurault-Delarue, Christine Damase-Michel, Christina D Chambers, Hedvig M E Nordeng, Marleen M H J van Gelder

In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as "ever exposed" versus "never exposed" within each trimester or even over the entire pregnancy. This approach is often far from real-world exposure patterns, may lead to exposure misclassification, and does not to incorporate important aspects such as dosage, timing of exposure, and treatment duration. Alternative exposure modeling methods can better summarize complex, individual-level medication use trajectories or time-varying exposures from information on medication dosage, gestational timing of use, and frequency of use. We provide an overview of commonly used methods for more refined definitions of real-world exposure to medication use during pregnancy, focusing on the major strengths and limitations of the techniques, including the potential for method-specific biases. Unsupervised clustering methods, including k-means clustering, group-based trajectory models, and hierarchical cluster analysis, are of interest because they enable visual examination of medication use trajectories over time in pregnancy and complex individual-level exposures, as well as providing insight into comedication and drug-switching patterns. Analytical techniques for time-varying exposure methods, such as extended Cox models and Robins' generalized methods, are useful tools when medication exposure is not static during pregnancy. We propose that where appropriate, combining unsupervised clustering techniques with causal modeling approaches may be a powerful approach to understanding medication safety in pregnancy, and this framework can also be applied in other areas of epidemiology.

在许多围产期药物流行病学研究中,在每个三个月甚至整个怀孕期间,药物暴露被分为“曾经暴露”和“从未暴露”。这种方法往往与现实世界的暴露模式相距甚远,可能导致暴露错误分类,并且没有纳入剂量、暴露时间和治疗持续时间等重要方面。替代暴露建模方法可以从药物剂量、妊娠期使用时间和使用频率等信息中更好地总结复杂的、个体水平的药物使用轨迹或时变暴露。我们概述了常用的方法,以更精确地定义怀孕期间药物使用的真实世界暴露,重点是这些技术的主要优势和局限性,包括方法特异性偏差的可能性。无监督聚类方法,包括k-means聚类、基于群体的轨迹模型和分层聚类分析,之所以引起人们的兴趣,是因为它们可以直观地检查怀孕期间药物使用轨迹和复杂的个人水平暴露,并提供对药物和药物转换模式的洞察。时变暴露方法的分析技术,如扩展Cox模型和罗宾斯的广义方法,在怀孕期间药物暴露不是静态的情况下是有用的工具。我们建议,在适当的情况下,将无监督聚类技术与因果建模方法相结合可能是了解妊娠用药安全的有力方法,并且该框架也可以应用于流行病学的其他领域。
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引用次数: 15
Burden of Antimicrobial Resistance: Compared to What? 抗菌素耐药性负担:与什么相比?
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab001
Marlieke E A de Kraker, Marc Lipsitch

The increased focus on the public health burden of antimicrobial resistance (AMR) raises conceptual challenges, such as determining how much harm multidrug-resistant organisms do compared to what, or how to establish the burden. Here, we present a counterfactual framework and provide guidance to harmonize methodologies and optimize study quality. In AMR-burden studies, 2 counterfactual approaches have been applied: the harm of drug-resistant infections relative to the harm of the same drug-susceptible infections (the susceptible-infection counterfactual); and the total harm of drug-resistant infections relative to a situation where such infections were prevented (the no-infection counterfactual). We propose to use an intervention-based causal approach to determine the most appropriate counterfactual. We show that intervention scenarios, species of interest, and types of infections influence the choice of counterfactual. We recommend using purpose-designed cohort studies to apply this counterfactual framework, whereby the selection of cohorts (patients with drug-resistant, drug-susceptible infections, and those with no infection) should be based on matching on time to infection through exposure density sampling to avoid biased estimates. Application of survival methods is preferred, considering competing events. We conclude by advocating estimation of the burden of AMR by using the no-infection and susceptible-infection counterfactuals. The resulting numbers will provide policy-relevant information about the upper and lower bound of future interventions designed to control AMR. The counterfactuals should be applied in cohort studies, whereby selection of the unexposed cohorts should be based on exposure density sampling, applying methods avoiding time-dependent bias and confounding.

对抗菌素耐药性(AMR)的公共卫生负担的日益关注提出了概念上的挑战,例如确定多药耐药生物体造成的危害程度,或如何确定这种负担。在此,我们提出了一个反事实框架,并为协调研究方法和优化研究质量提供了指导。在抗菌素耐药性负担研究中,采用了两种反事实方法:耐药感染的危害相对于相同药敏感染的危害(易感感染反事实);以及相对于这种感染被预防的情况(无感染反事实),耐药感染的总危害。我们建议使用基于干预的因果方法来确定最合适的反事实。我们表明干预方案,感兴趣的物种和感染类型影响反事实的选择。我们建议使用目的设计的队列研究来应用这种反事实框架,据此,队列(耐药患者、药敏感染患者和无感染患者)的选择应基于暴露密度抽样与感染的时间匹配,以避免有偏估计。考虑到竞争项目,优先考虑生存方法的应用。最后,我们主张使用无感染和易感感染反事实来估计抗菌素耐药性的负担。由此得出的数字将提供有关未来旨在控制抗生素耐药性的干预措施上限和下限的政策相关信息。反事实应应用于队列研究,即选择未暴露的队列应基于暴露密度抽样,采用避免时间相关偏差和混淆的方法。
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引用次数: 21
Availability, Accessibility, and Coverage of Needle and Syringe Programs in Prisons in the European Union. 欧盟监狱中针头和注射器项目的可得性、可及性和覆盖范围。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa003
Babak Moazen, Kate Dolan, Sahar Saeedi Moghaddam, Masoud Lotfizadeh, Karen Duke, Florian Neuhann, Heino Stöver, Albrecht Jahn

Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.

针头和注射器规划是控制监狱内注射吸毒者感染传播的最有效干预措施之一。我们评估了欧盟国家监狱中nsp的可得性、可及性和覆盖范围。根据系统评价和荟萃分析的首选报告项目(PRISMA)标准,我们系统地检索了4个同行评议出版物数据库(MEDLINE (PubMed), ISI Web of Science, EBSCO和ScienceDirect)和53个包含灰色文献的数据库,以收集2008年1月至2018年8月发表的数据。共发现文献23,969份(论文17,297份,灰色文献6,672份),其中26份纳入本研究。2018年,28个欧盟国家的监禁率在芬兰的每10万人中有51人,立陶宛的每10万人中有235人。只有4个国家的监狱中有国家安全服务提供者:德国(在1所监狱中)、卢森堡(没有发现覆盖数据)、罗马尼亚(在50%以上的监狱中)和西班牙(在所有监狱中)。葡萄牙在6个月的试点阶段后停止了NSP。尽管以监狱为基础的国家卫生服务方案对感染传播具有保护作用,但只有4个欧盟国家向在监狱注射毒品的人分发无菌注射器,而且这些国家内项目的覆盖率非常低。由于大多数囚犯最终将返回社区,欧盟监狱中缺乏国家卫生服务提供者不仅对囚犯的健康构成威胁,而且危害公共卫生。
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引用次数: 11
Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States. 在美国阿片类药物治疗项目中共同发生的物质使用评估。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa009
Mirinda Ann Gormley, Courtney T Blondino, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Elizabeth C Prom-Wormley, Juan Lu

The effectiveness of opiate treatment programs (OTPs) can be significantly influenced by co-occurring substance use, yet there are no standardized guidelines for assessing the influence of co-occurring substance use on treatment outcomes. In this review, we aim to provide an overview on the status of the assessment of co-occurring substance use during participation in OTPs in the United States. We searched 4 databases-MEDLINE/PubMed, EMBASE, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from database inception to November 2018 to select relevant publications on OTPs that assessed participants' co-occurring substance use. We used a standardized protocol to extract study, intervention, and co-occurring substance use characteristics. Methodological quality was assessed using the Quality in Prognosis Studies tool. Of the 3,219 titles screened, 614 abstracts and 191 full-text original publications were assessed, leaving 85 eligible articles. Co-occurring substance use was most often assessed during opioid treatments using combined (pharmacological and behavioral) (n = 57 studies) and pharmacological (n = 25 studies) interventions. Cocaine, alcohol, marijuana, and benzodiazepines were frequently measured, while amphetamines and tobacco were rarely assessed. Great variation existed between studies in the timing and measurement of co-occurring substance use, as well as definitions for substances and polysubstance/polydrug use. Inconsistencies in the investigation of co-occurring substance use make comparison of results across studies challenging. Standardized measures and consensus on research on co-occurring substance use is needed to produce the evidence required to develop personalized treatment programs for persons using multiple substances and to inform best-practice guidelines for addressing polydrug use during participation in OTPs.

阿片类药物治疗方案(OTPs)的有效性可能受到同时发生的物质使用的显著影响,但目前还没有标准化的指南来评估同时发生的物质使用对治疗结果的影响。在这篇综述中,我们的目的是概述美国参加OTPs期间共发生物质使用的评估状况。我们检索了4个数据库- medline /PubMed、EMBASE、PsychINFO和护理和相关健康文献累积索引(CINAHL)-从数据库建立到2018年11月,以选择评估参与者共同发生的药物使用的otp相关出版物。我们使用标准化的方案来提取研究、干预和共同发生的物质使用特征。采用预后研究质量工具评估方法学质量。在筛选的3,219个标题中,评估了614篇摘要和191篇全文原始出版物,留下85篇符合条件的文章。在阿片类药物治疗期间,使用联合(药理学和行为)(n = 57项研究)和药理学(n = 25项研究)干预措施最常评估共同发生的物质使用情况。经常测量可卡因、酒精、大麻和苯二氮卓类药物,而很少评估安非他明和烟草。在同时发生的物质使用的时间和测量以及物质和多物质/多药物使用的定义方面的研究存在很大差异。同时发生的物质使用调查的不一致性使得跨研究结果的比较具有挑战性。需要对同时发生的药物使用的研究采取标准化措施并达成共识,以便为使用多种药物的人制定个性化治疗方案提供所需的证据,并为参与otp期间处理多种药物使用的最佳实践指南提供信息。
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引用次数: 4
Policing Practices and Risk of HIV Infection Among People Who Inject Drugs. 警务实践与注射吸毒者感染艾滋病毒的风险。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa010
Pieter Baker, Leo Beletsky, Liliana Avalos, Christopher Venegas, Carlos Rivera, Steffanie A Strathdee, Javier Cepeda

Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.

禁毒执法是注射吸毒者(PWID)健康的结构性决定因素。警察与注射吸毒者之间的街头冲突(如没收注射器、人身攻击)与健康危害有关,但这些关系尚未得到系统评估。我们进行了一项系统性文献综述,以评估警务对吸毒者感染人体免疫缺陷病毒(HIV)风险的影响。我们筛选了 MEDLINE、社会学数据库和灰色文献,以查找 1981 年至 2018 年 11 月期间发表的、包含 HIV 感染/危险行为和街头治安遭遇估计值的研究。我们从所有符合条件的研究中提取并总结了定量研究结果。我们筛选了 8201 篇摘要,审阅了 175 篇全文,并纳入了来自 9 个国家(加拿大、中国、印度、马来西亚、墨西哥、俄罗斯、泰国、乌克兰和美国)的 27 项符合条件的分析。变量和终点选择的异质性排除了荟萃分析。在 5 项(19%)研究中,感染艾滋病病毒的吸毒者与注射器被没收、因害怕警察而不愿购买/携带注射器、因警察在场而匆忙注射、害怕被捕、因种植毒品而被捕以及身体虐待有显著关联。21项(78%)研究发现,治安管理措施与注射吸毒相关的艾滋病风险行为(如共用注射器、使用 "射击场")有关。在 9 项(33%)研究中,治安与注射吸毒者避免使用减少伤害服务有关,包括注射器交换、美沙酮维持治疗和安全消费设施。有证据表明,治安影响了注射吸毒者感染艾滋病毒的风险,但低收入环境中的代表性不足。要遏制与注射相关的艾滋病毒风险,就必须采取更多的结构性干预措施。方法上的统一可以促进关于警察作为人口健康决定因素的作用的知识生成。
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引用次数: 0
The Role of Evidence in the US Response to the Opioid Crisis. 证据在美国应对阿片类药物危机中的作用。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa004
Joshua M Sharfstein, Yngvild Olsen

The National Institutes of Health is investing hundreds of millions of dollars into new research on opioids. As these studies yield insights and results, their results will have to change policy and practice before they can bend the curve of the epidemic. However, the United States does not have a strong track record of translating evidence on drug policy into action. Three reasons for the translation gap are the historical legacy of drugs in the United States, vested interests, and politics. Researchers can become engaged in policy and political processes to strengthen the US response.

美国国立卫生研究院正在投资数亿美元用于阿片类药物的新研究。由于这些研究产生了见解和结果,它们的结果必须改变政策和做法,才能扭转这一流行病的曲线。然而,美国在将有关毒品政策的证据转化为行动方面并没有良好的记录。造成翻译差距的三个原因是美国药物的历史遗产、既得利益和政治。研究人员可以参与政策和政治进程,以加强美国的应对措施。
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引用次数: 2
The Influence of Co-Occurring Substance Use on the Effectiveness of Opiate Treatment Programs According to Intervention Type. 同时发生物质使用对阿片治疗方案干预类型有效性的影响。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa005
Courtney T Blondino, Mirinda Ann Gormley, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Juan Lu, Elizabeth C Prom-Wormley

This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.

本系统综述描述了共同发生的物质使用对阿片类药物治疗方案有效性的影响。从数据库建立到2018年11月28日,检索MEDLINE/PubMed、Embase、PsychINFO以及护理和联合健康文献累积索引,以确定美国符合条件的阿片类药物治疗研究,这些研究评估了共存物质使用与治疗结果(即阿片类药物戒断和治疗保留)之间的关系。共纳入34项符合条件的研究。总体而言,无论干预类型如何,共同发生的物质使用与负面治疗结果相关。然而,模式因物质和干预类型而异。特别是,可卡因或大麻与阿片类药物同时使用与治疗保留率降低和阿片类药物戒断有关,无论干预类型如何。与不使用或减少使用安非他明相比,同时使用安非他明降低了治疗效果。同时使用酒精与治疗结果呈正相关和负相关。一项研究报告了镇静剂使用与阿片类药物戒断之间的显著正相关。总的来说,研究结果表明,与单独的药物或行为干预研究相比,联合干预报告了更好的健康结果。本综述的结果强调需要全面研究和解决共同发生的物质使用,以改善阿片类药物治疗方案。
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引用次数: 7
The Evolving Overdose Epidemic: Synthetic Opioids and Rising Stimulant-Related Harms. 不断发展的过量流行病:合成阿片类药物和不断上升的兴奋剂相关危害。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa011
Christopher M Jones, Faraah Bekheet, Ju Nyeong Park, G Caleb Alexander

The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013), and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.

阿片类药物过量流行通常被描述为分三波发生,发病率和死亡率随着时间的推移而增加,主要来自处方阿片类药物(1999-2010年)、海洛因(2011-2013年)和非法芬太尼和其他合成阿片类药物(2014年至今)。然而,越来越多的合成类阿片混入非法药物供应,包括与可卡因和甲基苯丙胺等兴奋剂混合,以及与兴奋剂有关的死亡人数不断上升,反映了过量用药流行病的迅速演变性质,构成了紧迫和新的公共卫生挑战。我们综合了这些趋势背后的证据,考虑了诸如芬太尼和兴奋剂同时暴露的地点和方式等关键问题,并为关键利益相关者确定了如何最好地解决这些新出现的威胁以及过量流行的持续演变的行动。
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引用次数: 71
Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States. 美国处方药监测项目和处方阿片类药物相关结果。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa002
Victor Puac-Polanco, Stanford Chihuri, David S Fink, Magdalena Cerdá, Katherine M Keyes, Guohua Li

Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.

处方药监测项目(PDMPs)是联邦和州政府应对阿片类药物流行的重要组成部分。关于PDMPs在减少处方阿片类药物相关不良后果方面的有效性的证据参差不齐。我们进行了一项系统综述,以检查PDMP在美国的实施是否与4个处方阿片类药物相关结果领域的变化有关:阿片类药物处方行为、阿片类药物转移和供应、阿片类药物相关发病率和物质使用障碍以及阿片类药物相关死亡。我们在Embase、Google Scholar、MEDLINE和Web of Science中搜索了符合条件的出版物。2009年至2019年间发表的29项研究符合纳入标准。在16项检查PDMPs和处方行为的研究中,11项发现实施PDMPs减少了处方行为。关于阿片类药物转移和供应的所有3项研究都报告了所检查结果的减少。在阿片类药物相关发病率和物质使用障碍领域,8项研究中有7项发现了与处方阿片类药物相关结果的关联。在阿片类药物相关死亡领域的8项研究中,有4项报告死亡率降低。尽管结果喜忧参半,但新出现的证据支持,国家PDMPs的实施减少了阿片类药物处方、阿片类药物的转移和供应,以及阿片类药物相关的发病率和物质使用障碍的结果。当检查PDMP特征时,强制性获取规定与处方行为、转移结果、住院率、物质使用障碍和死亡率的减少有关。结果领域之间证据基础的不一致是由于不同研究的分析方法,以及在某种程度上,不同州和不同时期实施的PDMP政策的异质性。
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引用次数: 30
期刊
Epidemiologic Reviews
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